Congenital prepubic sinus: a variant of dorsal urethral duplication suggested by immunohistochemical analysis

PURPOSE

Congenital prepubic sinus is a rare disorder of uncertain etiology. Immunohistochemical staining is used to elucidate the etiology of the sinus.

MATERIALS AND METHODS

We treated 5 patients with congenital prepubic sinus. A sinogram delineated the tract, which was then excised. In addition to routine hematoxylin and eosin stain of the 5 specimens, immunohistochemical analysis was also performed with smooth muscle and sarcomeric actin, high (34betaE12) and low molecular weight cytokeratin (35betaH11), and cytokeratin 7 antibodies.

RESULTS

The 2 females and 3 males were 1 month to 14 years old. All patients had presented with purulent discharge from the sinus opening. Hematoxylin and eosin stain demonstrated transitional and squamous epithelium lining the sinus. Immunohistochemical study showed that the stain with 3 cytokeratin antibodies was moderately to strongly positive in all patients at the proximal end, low molecular weight cytokeratin weakly to moderately positive and cytokeratin 7 weakly positive to negative in 4 at the distal end. The results suggested that the lining epithelium was transitional proximally and squamous distally. An exception was a female patient who had the shortest tract lined with squamous epithelium only. Furthermore, smooth muscle but not sarcomeric actin demonstrated smooth muscle bundles around the sinus tract in 4 patients.

CONCLUSIONS

The existence of transitional epithelium in the proximal part of the sinus and presence of smooth muscle bundles around it reinforce the theory that congenital prepubic sinus is a variant form of dorsal urethral duplication.

Effects of inverse ratio ventilation versus positive end-expiratory pressure on gas exchange and gastric intramucosal PCO(2) and pH under constant mean airway pressure in acute respiratory distress syndrome

BACKGROUND

In patients with acute respiratory distress syndrome, whether inverse ratio ventilation differs from high positive end-expiratory pressure (PEEP) for gas exchange under a similar mean airway pressure has not been adequately examined. The authors used arterial oxygenation, gastric intramucosal partial pressure of carbon dioxide (PiCO(2)), and pH (pHi) to assess whether pressure-controlled inverse ratio ventilation (PC-IRV) offers more benefits than pressure-controlled ventilation (PCV) with PEEP.

METHODS

Seventeen acute respiratory distress syndrome patients were enrolled and underwent mechanical ventilation with a PCV inspiratory-to-expiratory ratio of 1:2, followed by PC-IRV 1:1 initially. Then, they were randomly assigned to receive PC-IRV 2:1, then 4:1 or 4:1, and then 2:1, alternately. The baseline setting of PCV 1:2 was repeated between the settings of PC-IRV 2:1 and 4:1. Mean airway pressure and tidal volume were kept constant by adjusting the levels of peak inspiratory pressure and applied PEEP. In each ventilatory mode, hemodynamics, pulmonary mechanics, arterial and mixed venous blood gas analysis, PiCO(2), and pHi were measured after a 1-h period of stabilization.

RESULTS

With a constant mean airway pressure, PC-IRV 2:1 and 4:1 decreased arterial and mixed venous oxygenation as compared with baseline PCV 1:2. Neither the global oxygenation indices with oxygen delivery and uptake nor PiCO(2) and pHi were improved by PC-IRV. During PC-IRV, applied PEEP was lower, and auto-PEEP was higher.

CONCLUSION

When substituting inverse ratio ventilation for applied PEEP to keep mean airway pressure constant, PC-IRV does not contribute more to better gas exchange and gastric intramucosal PiCO(2) and pHi than does PCV 1:2 for acute respiratory distress syndrome patients, regardless of the inspiratory-to-expiratory ratios.

Ascending cholangitis provokes IL-8 and MCP-1 expression and promotes inflammatory cell infiltration in the cholestatic rat liver

BACKGROUND/PURPOSE

Postoperative cholangitis is one of the most common complications after bile duct reconstruction. The pathogenesis and early consequences of ascending cholangitis still are unidentified.

METHODS

Male Sprague-Dawley rats were divided into 5 treatment groups: control (n = 4), blood sampling and liver biopsy only; group I, [BDL/Eschericha coli; n = 6], ligation of common bile duct (BDL) for a week, followed by Roux-en-Y choledochojejunostomy (RYCJ) and injection of E coli (ATCC 25922) into Roux limb after 24 hours; group II, [BDL/NS; n = 5], same procedures as in group I, with injection of normal saline (NS) into Roux limb; group III, [SBDL/E coli; n = 6], primary RYCJ was constructed 1 week after sham ligation of common bile duct (SBDL) followed by the same treatment as group I; Group IV, [SBDL/N.S; n = 6], same procedures as in group III, but injecting NS into Roux limb. All animals were killed after 24 hours of treatment. Blood was sampled for culture and serum cytokine levels. The liver was harvested for quantitative bacterial culture, as well as for MCP-1, interleukin (IL)-8 (CINC in the rat) and transforming growth factor beta1 mRNA expression by reverse transcriptase polymerase chain reaction (RT-PCR) and for immunohistochemistry. The choledochojejunostomy was resected for culture. Serum cytokine levels were detected by ELISA kits.

RESULTS

A significant increase of E coli ATCC 25922, occurred in the livers of group I rats, compared with group IV (P =.037). MCP-1 expression increased in all groups, compared with control (P =.000). The IL-8 mRNA expression was significantly higher in group I than in control (P =.021). The expression of TGF-beta1 mRNA was similar among the groups (P =.361), consistent with the immunohistochemistry results. The serum MCP-1 and IL-8 levels were higher in the 4 groups than in the control (P =.000) and were significantly higher in group I than in group IV (P =.001).

CONCLUSIONS

This study found that a significant colonization of E coli of the same strain was present in the cholestatic rat liver injected into the Roux limb, which was associated with a higher expression of liver MCP-1 and IL-8 mRNA, a significant increase of serum MCP-1 and IL-8, and a more evident inflammatory cell infiltration into the porta hepatis.

Treatment outcomes and costs of dental sealants among children enrolled in Medicaid

OBJECTIVES

This retrospective cohort analysis of children enrolled in the North Carolina Medicaid program compared the likelihood of restorative treatments and associated cumulative Medicaid expenditures for teeth with or without dental sealants.

METHODS

We assessed the dental experience of the cohort of 15 438 children from 1985 to 1992 on the basis of enrollment and claims files. We conducted regression analyses for outcomes (caries-related services involving the occlusal surface [CRSOs] of permanent first molars) and cumulative expenditures, controlling for characteristics of the child, the treating dentist, and the child's county of residence.

RESULTS

Overall, 23% of children received at least 1 sealant and 33% at least 1 CRSO. Sealants were effective in preventing CRSOs, although the degree of effectiveness was highest for children with the greater levels of CRSOs before sealant placement. Estimated cumulative Medicaid expenditures indicated expenditure savings from sealants within 2 years of application for children with 2 or more prior CRSOs.

CONCLUSIONS

Sealant placement was associated with expenditure savings to Medicaid for certain high-risk children, so Medicaid and, more broadly, society will benefit by providing for sealant placement in these children.

Detailed optical studies of several banana-shaped compounds in liquid crystal B2 phase

Null-transmission ellipsometry has been performed on free-standing films of one compound in the liquid crystal B2 phase. We have studied films of thickness from 1 to 121 layers. One of the compounds used has an unusually wide 59 K window for the B2 phase. The tilt angle was investigated as a function of temperature and found to be constant over this temperature range to within our resolution of 1 degrees. The one-layer films studied exhibit the same structure as the thicker films, and have helped us to refine the optical model for the B2 phase. For thin films we find that modeling a single smectic layer as two uniaxial layers is a better description of the data than a single biaxial layer, but that for thick films the model used does not effect the simulated result appreciably. Preliminary results also find that the surface layers are less tilted than the interior layers, in contrast to rodlike liquid crystals, which show an enhanced surface tilt.

Klebsiella pneumoniae bacteremia: community-acquired vs. nosocomial infections

BACKGROUND

This study attempted to determine the clinical manifestations and influential factors affecting the prognosis of patients with community-acquired and nosocomial bacteremia of Klebsiella pneumoniae (K. pneumoniae).

METHODS

We retrospectively reviewed the medical records of 211 patients who had a clinically significant episode of K. pneumoniae bacteremia from January 1997 until December 1999.

RESULTS

Most reports describe K. pneumoniae bacteremia as typically nosocomial, but in our study approximately 3 of 4 episodes were community-acquired. Without including "unknown origin", the most common infectious site for both community-acquired and nosocomial bacteremia was the hepatobiliary tract. The overall mortality for all 211 patients with K. pneumoniae bacteremia was 25.1%. Significantly higher mortality rates occurred in patients who were elderly (> 65 years), had a nosocomial infection, for whom the respiratory tract was the portal of entry, and ultimately fatal conditions or acute complications were due to shock or renal insufficiency.

CONCLUSIONS

Patients with community-acquired and nosocomial bacteremia had different types of underlying diseases. Isolates from nosocomial infections were significantly more frequently resistant to aminoglycosides, antipseudomonal penicillin, and all three generations of cephalosporins. In this regard, an aggressive empirical therapeutic approach to infections of K. pneumoniae is suggested.

Systemic p53 gene therapy of cancer with immunolipoplexes targeted by anti-transferrin receptor scFv

BACKGROUND

A long-standing goal in genetic therapy for cancer is a systemic gene delivery system that selectively targets tumor cells, including metastases. Here we describe a novel cationic immunolipoplex system that shows high in vivo gene transfer efficiency and anti- tumor efficacy when used for systemic p53 gene therapy of cancer.

MATERIALS AND METHODS

A cationic immunolipoplex incorporating a biosynthetically lipid-tagged, anti-transferrin receptor single-chain antibody (TfRscFv), was designed to target tumor cells both in vitro and in vivo. A human breast cancer metastasis model was employed to evaluate the in vivo efficacy of systemically administered, TfRscFv-immunolipoplex-mediated, p53 gene therapy in combination with docetaxel.

RESULTS

The TfRscFv-targeting cationic immunolipoplex had a size of 60-100 nm, showed enhanced tumor cell binding, and improved targeted gene delivery and transfection efficiencies, both in vitro and in vivo. The p53 tumor suppressor gene was not only systemically delivered by the immunolipoplex to human tumor xenografts in nude mice but also functionally expressed. In the nude mouse breast cancer metastasis model, the combination of the p53 gene delivered by the systemic administration of the TfRscFv-immunolipoplex and docetaxel resulted in significantly improved efficacy with prolonged survival.

CONCLUSIONS

This is the first report using scFv-targeting immunolipoplexes for systemic gene therapy. The TfRscFv has a number of advantages over the transferrin (Tf) molecule itself: (1) scFv has a much smaller size than Tf producing a smaller immunolipoplex giving better penetration into solid tumors; (2) unlike Tf, the scFv is a recombinant protein, not a blood product; (3) large scale production and strict quality control of the recombinant scFv, as well as scFv-immunolipoplex, are feasible. The sensitization of tumors to chemotherapy by this tumor-targeted and efficient p53 gene delivery method could lower the effective dose of the drug, correspondingly lessening the severe side effects, while decreasing the possibility of recurrence. Moreover, this approach is applicable to both primary and recurrent tumors, and more significantly, metastatic disease. The TfRscFv-targeting of cationic immunolipoplexes is a promising method of tumor targeted gene delivery that can be used for systemic gene therapy of cancer with the potential to critically impact the clinical management of cancer.

An enormous abdominal mass associated with acute renal failure

We report a 67-year-old man with acute uric acid nephropathy, secondary to spontaneous tumor lysis syndrome, that presented itself as a huge intra-abdominal tumor that led to acute renal failure, hyperuricemia, and azotemia. Initial finding of hydronephrosis detected by ultrasonography led us to believe that the azotemia and decreasing amount of urine resulted from obstructive uropathy, a common complication of malignancy, caused by either a direct renal invasion or a urinary outflow tract compression because of a tumor mass effect. However, clinical observations and the response to therapeutic intervention confirmed the diagnosis of spontaneous tumor lysis syndrome, which is a rare cause of acute uric acid nephropathy.

Analysis of large-volume DNA markers and polymerase chain reaction products by capillary electrophoresis in the presence of electroosmotic flow

We have demonstrated on-line concentration and separation of DNA in the presence of electroosmotic flow (EOF) using poly(ethylene oxide) (PEO) solutions. After injecting large-volumes DNA samples, PEO solutions entered a capillary filled with 400 mM Tris-borate (TB) buffers by EOF and acted as sieving matrices. DNA fragments stacked between the sample zone and PEO solutions. Because sample matrixes affected PEO adsorption on the capillary wall, leading to changes in EOF, migration time, concentration, and resolving power varied with the injection length. When injecting phiX174 RF DNA-HaeIII digest prepared in 5 mM Tris-HCl buffer, pH 7.0, at 250 V/cm, peak height increased linearly as a function of injection volume up to 0.9 microl (injection time 150 s). The sensitivity improvement was 100-fold compare to that injected at 25 V/cm for 10 s (0.006 microl). When injecting 1.54 microl of GeneScan 1000 ROX, the sensitivity improvement was 265-fold. The sensitivity improvement was 40-fold when injecting 0.17 microl DNA sample containing pBR 322/HaeIII, pBR 328/BglI, and pBR 328/HinfI digests prepared in phosphate-buffered saline. This method allows the analysis of polymerase chain reaction (PCR) products amplified after 17 cycles when injecting 0.32 microl (at 30 cm height for 300 s). The total analysis time was shorter (91.6 min) than that (119.6 min) obtained from injecting PCR products after 32 cycles for 10 s.

Molecular characterization of foot-and-mouth disease virus isolated from ruminants in Taiwan in 1999-2000

In 1999, 10 sporadic outbreaks of cattle foot-and-mouth disease (FMD) occurred in Taiwan. By the time, infection was limited to the Chinese yellow cattle (a native species of beef cattle in Mainland China), which did not develop vesicular lesions under field conditions. Five viruses isolates obtained from individual farms were confirmed to be the serotype O FMD virus (O/Taiwan/1999). During January-February 2000, however, this virus has spread to dairy cattle and goat herds, causing severe mortality in goat kids and vesicular lesions in dairy cattle. Partial nucleotide sequence of the capsid coding gene 1D (VP1) was determined for the virus isolates obtained in this study. Phylogenetic analysis of the VP1 sequences indicated that the O/Taiwan/1999 viruses shared 95-97% similarities to the virus strains isolated from the Middle East and India. The species susceptibility of the O/Taiwan/1999 virus was experimentally studied in several species of susceptible animals, showing that the virus did cause generalized lesions in dairy cattle and pigs, however, it would not cause vesicular lesions on the Chinese yellow cattle and the adult goats. These studies suggested that the O/Taiwan/1999 virus was a novel FMD virus of Taiwan and it presented various levels of susceptibility in cattle species.

Trace metals in different species of mollusca, water and sediments from Taiwan coastal area

Since October 1994, a long-term program of Asia/Pacific Mussel Watch: Taiwan Regional Studies has been carried out. The results indicate that trace metal contents in mollusca varied among 30 different species and the environments (water and sediments) along the Taiwan coast. The orders of bioaccumulation of trace metals in mollusca were: Cu (over 200 microg/g), Thais clavigera > Isognomon legumen > Clibanarius rivescens > Crassostrea gigas; Zn (over 700 microg/g), Moruta granulata > C. gigas > Asiatica cypraea arabica > T. clavigera; Cd (over 5 microg/g), Trochus hanleyanus > Acanthopleura japonica > Nerita albicilla > Patella flexuosa; Pb (over 2 microg/g), P. flexuosa > C. gigas > T. hanleyanus > T. clavigera > C. gigas > Capiyulum mitella; Ni (over 10 microg/g), Meretrix lusoria > Philine sp. > Littoraria scabra > Tridacna squamosa > T. hanleyanus; Cr (over 30 microg/g), Littoraria undulata > T. hanleyanus > N. albicilla > Nerita chamaelor > M. granulata; As (over 20 microg/g), Perna viridis > L. scabra; and Sn (over 5 microg/g), P. viridis > L. undulata> C. mitella> C. gigas. Their seasonal and regional variations as well as their correlation are evaluated and discussed.

Resonant x-ray scattering study of the antiferroelectric and ferrielectric phases in liquid crystal devices

Resonant x-ray scattering has been used to investigate the interlayer ordering of the antiferroelectric and ferrielectric smectic C* subphases in a device geometry. The liquid crystalline materials studied contain a selenium atom and the experiments were carried out at the selenium K edge allowing x-ray transmission through glass. The resonant scattering peaks associated with the antiferroelectric phase were observed in two devices containing different materials. It was observed that the electric-field-induced antiferroelectric to ferroelectric transition coincides with the chevron to bookshelf transition in one of the devices. Observation of the splitting of the antiferroelectric resonant peaks as a function of applied field also confirmed that no helical unwinding occurs at fields lower than the chevron to bookshelf threshold. Resonant features associated with the four-layer ferrielectric liquid crystal phase were observed in a device geometry. Monitoring the electric field dependence of these ferrielectric resonant peaks showed that the chevron to bookshelf transition occurs at a lower applied field than the ferrielectric to ferroelectric switching transition.

High-resolution cranial ultrasound in the shaken-baby syndrome

With limited near-field resolution and accessible acoustic windows, sonography has not been advocated for assessing central nervous system injuries in the shaken-baby syndrome. Our purpose was to correlate high-resolution ultrasonographic characteristics of central nervous system injuries in whiplash injuries and the shaken-baby-syndrome with MRI and CT. Ultrasonographic images of 13 infants, aged 2-12 months, with whiplash or shaking cranial trauma were reviewed and compared with MRI in 10 and CT in 10. Five patients had serial ultrasonography and MRI or CT follow-up from 1 to 4 months after the initial injury. With ultrasonography we identified 20 subdural haematomas. MRI and CT in 15 of these showed that four were hyperechoic in the acute stage, three were mildly echogenic in the subacute stage, and that one subacute and seven chronic lesions were echo-free. Five patients had acute focal or diffuse echogenic cortical oedema which evolved into subacute subcortical hyperechoic haemorrhage in four, and well-defined chronic sonolucent cystic or noncystic encephalomalacia was seen at follow-up in two. Using ultrasonography we were unable to detect two posterior cranial fossa subdural haematomas or subarachnoid haemorrhage in the basal cisterns in three cases, but did show blood in the interhemispheric cistern and convexity sulci in two. U1-trasonography has limitations in demonstrating abnormalities remote from the high cerebral convexities but may be a useful adjunct to CT and MRI in monitoring the progression of central nervous system injuries in infants receiving intensive care.

Working memory of school-aged children with a history of febrile convulsions: a population study

OBJECTIVE

A prospective, population-based, case-control study was performed to ascertain whether febrile convulsion (FC) in early childhood is associated with specific working memory characteristics in school age.

METHODS

From a population survey of 4,340 live-birth newborns in Tainan City, Taiwan, 103 children with confirmed FC by age 3 years were followed-up until they were at least 6 years old. Three analogous searching tasks dissociating the mnemonic and executive aspects of performances were administered to 87 of these school-aged children and to 87 randomly selected age-matched control subjects to assess the learning, spatial, and sequential working memory.

RESULTS

The FC group performed significantly and consistently better than control subjects on all but one working memory measure, jumping errors. Multivariate analysis using linear regression revealed that the onset of FC before age 1 year was the only significant risk factor for deficits in mnemonic function. Prior neurodevelopmental delay was the only significant risk factor for deficits in executive function. Factors such as socioeconomic status, family predisposition for seizures, complex FC, recurrent FC, and subsequent unprovoked seizures were not risk factors for working memory deficits.

CONCLUSION

The authors found that school-aged children with a history of FC demonstrated significantly better mnemonic capacity, more flexible mental processing, and higher impulsivity than their age-matched control subjects. The underlying mechanism for the facilitated working memory function in children with a history of FC needs further delineation.

Carbon disulfide vasculopathy: a small vessel disease

We present the clinical manifestations of 4 male patients with acute stroke-like symptoms and polyneuropathy after long-term exposure to carbon disulfide (CS2) in a viscose rayon plant. The ages of onset of polyneuropathy ranged from 42 to 45 years with a duration of CS2 exposure between 6 and 21 years. The ages of onset of stroke were from 42 to 48 years. The risk factors for stroke including heart disease and diabetes were denied, except for smoking in 4, hyperlipidemia in 2 and hypertension in 1. At the initial visit in 1992, only 2 patients developed sudden onset of hemiparesis suggesting a lacunar stroke before the diagnosis of CS2 intoxication. Brain computed tomography (CT) scans showed low-density lesions in the basal ganglia in 2 patients, cortical atrophy in 1 and normal in 1. Brain magnetic resonance image (MRI) study disclosed multiple lesions in the corona radiata and basal ganglia on T(2)-weighted images in 3 patients and cortical atrophy in 1. After the diagnosis, they left their jobs for a CS2-free environment, and improvement of the working conditions was noted. During 5 years follow-up period, another 2 patients also developed an acute episode of stroke with hemiparesis. Brain CT and/or MRI follow-up studies in these 2 patients revealed new lesions in the basal ganglia and corona radiata. Intriguingly, a patient with previous stroke also developed new lesions in the bilateral thalami and brainstem. Carotid Doppler scan, transcranial Doppler scan and/or cerebral angiography did not show any prominent stenosis or occlusion in the major intracranial large arteries. We conclude that encephalopathy may occur in patients after long-term CS2 exposure, probably due to impaired cerebral perfusion. The lesions tend to occur in the basal ganglia, corona radiata and even brainstem, particularly involving the small-sized vessels. In addition, the cerebral lesions may progress even after cessation of CS2 exposure. Therefore, we suggest that CS2 exposure may be a risk factor for stroke.

Mycophenolate mofetil reduces renal cortical inducible nitric oxide synthase mRNA expression and diminishes glomerulosclerosis in MRL/lpr mice

Overexpression of inducible nitric oxide synthase (iNOS) has been implicated in the pathogenesis of lupus glomerulonephritis. Mycophenolate mofetil (MMF), a novel immunosuppressive agent, is currently used in organ transplantation and under evaluation for treatment of autoimmune disorders. Mycophenolic acid, the active metabolite of MMF, has been shown to suppress cytokine-induced nitric oxide production in vitro. The aim of this study was to evaluate the effect of MMF on the expression of renal cortical iNOS mRNA and protection against glomerulonephritis in MRL/lpr mice. Three-month-old MRL/lpr mice (n = 6) displaying clinical symptoms of glomerulonephritis were treated for 3 months with MMF (90 mg/kg/day) dissolved in a vehicle. Controls were age- and sex-matched mice (n = 6) that received the vehicle alone. By reverse-transcription competitive polymerase chain reaction, we found that the renal cortical iNOS/beta-actin mRNA ratio was reduced by 30.8% (P <.05) in MMF-treated mice. Furthermore, MMF significantly reduced urinary nitrite production and degree of glomerulosclerosis. The glomerular volume was reduced by 17.5% (P <.001). Proteinuria was also significantly reduced in the MMF-treated group. However, by electrophoretic mobility shift assay, the nuclear binding of nuclear factor-kappaB (NF-kappaB) was not affected by MMF treatment. We conclude that in addition to its immunosuppressive action, MMF may reduce renal cortical iNOS mRNA expression and diminish glomerulosclerosis in MRL/lpr mice independent of modulation of the NF-kappaB pathway.

DNA recognition by the herpes simplex virus transactivator VP16: a novel DNA-binding structure

Upon infection, the herpes simplex virus (HSV) transcriptional activator VP16 directs the formation of a multiprotein-DNA complex-the VP16-induced complex-with two cellular proteins, the host cell factor HCF-1 and the POU domain transcription factor Oct-1, on TAATGARAT-containing sequences found in the promoters of HSV immediate-early genes. HSV VP16 contains carboxy-terminal sequences important for transcriptional activation and a central conserved core that is important for VP16-induced complex assembly. On its own, VP16 displays little, if any, sequence-specific DNA-binding activity. We show here that, within the VP16-induced complex, however, the VP16 core has an important role in DNA binding. Mutation of basic residues on the surface of the VP16 core reveals a novel DNA-binding surface with essential residues which are conserved among VP16 orthologs. These results illuminate how, through association with DNA, VP16 is able to interpret cis-regulatory signals in the DNA to direct the assembly of a multiprotein-DNA transcriptional regulatory complex.

Cystic malignant fibrous histiocytoma of the gastrocolic ligament

A case of malignant fibrous histiocytoma (MFH) of the gastrocolic ligament is presented. It appeared as a huge, thin walled cystic tumour in the upper abdominal cavity on CT. Barium studies showed splaying of the stomach and transverse colon by the mass. 1 year after resection of the cystic tumour, recurrence occurred at the greater curvature of the stomach and in the liver, with a cystic appearance similar to the primary tumour. To our knowledge, the CT appearance of primary cystic MFH of the gastrocolic ligament has not been previously documented.

ViewFeature: integrated feature analysis and visualization

Visualization interfaces for high performance computing systems pose special problems due to the complexity and volume of data these systems manipulate. In the post-genomic era, scientists must be able to quickly gain insight into structure-function problems, and require flexible computing environments to quickly create interfaces that link the relevant tools. Feature, a program for analyzing protein sites, takes a set of 3-dimensional structures and creates statistical models of sites of structural or functional significance. Until now, Feature has provided no support for visualization, which can make understanding its results difficult. We have developed an extension to the molecular visualization program Chimera that integrates Feature's statistical models and site predictions with 3-dimensional structures viewed in Chimera. We call this extension ViewFeature, and it is designed to help users understand the structural Features that define a site of interest. We applied ViewFeature in an analysis of the enolase superfamily; a functionally distinct class of proteins that share a common fold, the alpha/beta barrel, in order to gain a more complete understanding of the conserved physical properties of this superfamily. In particular, we wanted to define the structural determinants that distinguish the enolase superfamily active site scaffold from other alpha/beta barrel superfamilies and particularly from other metal-binding alpha/beta barrel proteins. Through the use of ViewFeature, we have found that the C-terminal domain of the enolase superfamily does not differ at the scaffold level from metal-binding alpha/beta barrels. We are, however, able to differentiate between the metal-binding sites of alpha/beta barrels and those of other metal-binding proteins. We describe the overall architectural Features of enolases in a radius of 10 Angstroms around the active site.

[Efficacy of prostaglandin E1 in the treatment of chronic pulmonary heart disease in the elderly people at the acute stage]

OBJECTIVE

To investigate the effects of prostaglandin E1 (PGE1) in the treatment of chronic pulmonary heart disease in the elderlys at the acute stage.

METHODS

Forty cases of chronic pulmonary heart disease at the acute stage were treated with PGE1 at the dosage of 100 micrograms.d-1 for 7 days by intravenous drop, other 40 patients with the same disease were treated without PGE1, and 20 healthy subjects were selected as controls. The level of plasma D-dimer and serum fibrin degradation products (FDP), and blood PaO2 and PaCO2 were determined. The patients' symptoms and signs were observed before and after the treatment.

RESULTS

The levels of plasma D-dimer and serum FDP were significantly increased (P < 0.01) in both the PGE1 group and the control group (no PGE1) compared to the healthy subjects. In PGE1 and no PGE1 groups the levels of plasma D-dimer and serum FDP were significantly decreased (P < 0.01) after the treatment. The level of PaO2 was increased and there was no significant difference (P > 0.05) between the two groups, but the level of PaCO2 was significantly decreased (P < 0.01) in both PGE1 and no PGE1 groups, but the decreasing in the PGE1 group was lower than that in the no PGE1 group. The symptoms and signs in PGE1 group were more markedly improved than those in the no PGE1 group.

CONCLUSIONS

PGE1 is effective in the treatment of chronic pulmonary heart disease in old people at the acute stage.

Long-term on-line hemodiafiltration reduces predialysis beta-2-microglobulin levels in chronic hemodialysis patients

BACKGROUND

Hemodiafiltration (HDF) is effective in delaying the surgical need for carpal tunnel syndrome in chronic hemodialysis patients, however, predialysis beta(2)-microglobulin levels were not reduced in most short-term studies. The aim of this study was to assess the effect of long-term and differing frequencies of on-line HDF on serum beta(2)-microglobulin levels in comparison to high-flux hemodialysis (HD).

METHODS

One hundred and twelve patients in the Chang Gung Memorial Hospital Dialysis Unit were divided into three groups to receive different frequencies of on-line HDF alternating with high-flux HD. Group 1 was treated once with HDF and twice with high-flux HD per week (n = 21). Group 2 was treated twice with HDF and once with high-flux HD per week (n = 33). Group 3 was treated with HDF three times per week (n = 58). Analysis was performed to compare the serum beta(2)-microglobulin levels in these groups and to high-flux HD.

RESULTS

After receiving HDF for a mean of 7.9 months, group 3 patients had a reduced predialysis beta(2)-microglobulin level (22.2 +/-5.3 vs. 34.8 +/-6.3 mg/l, p < 0.001), postdialysis beta(2)-microglobulin level (6.3 +/- 2.0 vs. 13.8 +/- 6.8 mg/l, p < 0.001) and an increased beta(2)-microglobulin reduction rate (76.1 +/- 5.6 vs. 61.1 +/- 13.3%, p = 0.03) when compared to high-flux HD. A significant improvement in URR (p = 0.0004), Kt/V (p = 0.0002) and TAC urea levels (p = 0.006) but not nPCR (p = 0.122) was found after patients had been treated with on-line HDF. The beta(2)-microglobulin reduction rate was positively correlated with the overall volume of the replacement solution per session (p < 0.0001). Patients in group 3 had lower predialysis beta(2)-microglobulin levels than those in group 1 and group 2 (22.2 +/- 5.3 vs. 25.2 +/- 7.2 vs. 26.0 +/- 4.2 mg/l, p = 0.02). Furthermore, an inverse correlation was found between the predialysis beta(2)-microglobulin level and the duration of HDF, if patients were treated for more than 12 months (p = 0.031).

CONCLUSION

On-line HDF has an increased dialysis efficiency compared to high-flux dialysis. Long-term HDF further reduced predialysis beta(2)-microglobulin levels, thus, it may provide an improved modality for renal replacement therapy.

Progress in understanding the factors regulating reversibility of long-term potentiation

Over the past two decades there has been a progressive understanding of the properties and mechanisms underlying long-term potentiation (LTP) of synaptic efficacy, a putative mechanism for learning and memory storage in the brain. Although LTP is remarkable for its stability, recent work has provided evidence that various manipulations can disrupt LTP if applied shortly after its induction. This kind of reversal of synaptic strength from the potentiated state to pre-LTP levels is termed depotentiation. Depotentiation of LTP is effectively induced by low-frequency afferent stimulation (1-5 Hz), brief periods of hypoxia, application of adenosine receptor agonists and brief cooling shocks. The examples of depotentiation described to date are input specific, and not differently expressed during development. The mechanisms responsible for this phenomenon remain to be fully characterized, although some possibilities are dependent on NMDA receptor activation, the increases in intracellular Ca2+, and altered states of protein kinases or phosphatases. In this review, we summarize the recent data concerning putative depotentiation mechanisms and the implications of this phenomenon in the mechanisms of "forgetting", and discuss the prevention of saturation of the storage capacity of a neuronal network.

The influence of long-term different diabetic therapies on plasma leptin in type 2 diabetic subjects

The aim of this study was to assess the effect of the long-term different diabetic therapies on the plasma leptin level in type 2 diabetic subjects. We measured plasma leptin, body fat and fasting plasma insulin in 96 type 2 diabetic male subjects. They had received the same treatment regimen for more than one year (3.5 +/- 2.3 years, mean +/- SD) and were weight-stable over the previous three months. The distribution was as follows: diet control group: 32, oral hypoglycemic agent (OHA) group: 32, and insulin group: 32. The results showed that the plasma leptin level of the different therapy groups was all positively correlated with body fat. The fasting insulin levels were significantly higher (p < 0.0001) in the insulin group than those in the other two groups. The fasting insulin of the OHA group was also greater than that of the diet group but was not statistically significant. The leptin concentrations were significantly higher in the insulin group (p < 0.001) and OHA group (p = 0.0082) than that in the diet group. The leptin concentrations of insulin group were also significantly higher (p = 0.0021) than that of the OHA group. Stepwise multiple regression analysis revealed that the significant differences in the leptin level of whole group was mainly affected by fasting insulin (p < 0.0001), followed by fat percentage (p = 0.001), fat distribution (p = 0.009) and fasting sugar (p = 0.02), whereas there was no association of leptin with age, height, glycosylated hemoglobin A1c, lipid, or blood pressure. We concluded that long-term different diabetic therapies may affect the plasma leptin level, which is mediated mainly by insulin changes. This insulin effect is independent of body fat and may be superior to the fat effect on plasma leptin in the type 2 diabetic patients.

Epitope mapping of factor VIII inhibitor antibodies of Chinese origin

Epitopes recognized by factor VIII (FVIII) inhibitors of Chinese origin were analysed by immunoblotting with full-length recombinant FVIII (rFVIII), thrombin-activated FVIII (FVIIIa) and 16 FVIII fusion proteins synthesized by bacteria. Twenty-eight patients, 12 with haemophilia A and 16 with autoimmune diseases, were recruited. Antibodies from 22 patients showed reactivity with rFVIII, 20 with FVIIIa, and one reacted only with FVIII fusion proteins. Of these 22 cases, most were reactive with A2-a2 and A3-C1-C2 of FVIII(a). Of the nine cases that depicted binding to the fusion proteins, three were reactive with the A domains, three with only the B domain, and the other three with both the A and B (or C) domains. An epitope for a neutralizing antibody of a haemophilia A patient, designated TWN-112, was localized to residues 323-390, specified by FVIII fusion proteins. The same epitope also appeared on an FVIII-expression phage library screening. Immunoabsorption of antibodies from TWN-112 with the epitope reduced the neutralizing activity of the inhibitor by 33%. The incidence of a1 of FVIII is higher, and that of a3 is lower, than previously reported. Two novel epitopes, reported for the first time in this paper, were localized on the 8B2 (amino acid residues 1022-1204) and 8A2(V) (residues 673-740) fusion proteins. These two epitopes were able to reduce inhibitory antibody activity by 24% and 25% respectively. Changes of FVIII fragment specificity were also observed in one of six patients for whom multiple samples, collected at different times, were available. Our initial finding showed that the FVIII inhibitors in these Chinese patients shared epitopes with those of patients from very different genetic backgrounds, suggesting a common mechanism for the development of FVIII inhibitors.

Time-dependent reversal of long-term potentiation by low-frequency stimulation at the hippocampal mossy fiber-CA3 synapses

Using mouse hippocampal slices, we studied the induction of depotentiation of long-term potentiation (LTP) at the mossy fiber synapses onto CA3 pyramidal neurons. A long train of low-frequency (1 Hz/900 pulses) stimulation (LFS) induced a long-term depression of baseline synaptic transmission or depotentiation of previously established LTP, which was reversible and was independent of NMDA receptor activation. This LFS-induced depotentiation was observed when the stimulus was delivered 1 or 10 min after LTP induction. However, when LFS was applied at 30 min after induction, significantly less depotentiation was found. The induction of depotentiation on one input was associated with a heterosynaptic reverse of the LTP induced previously on a separate pathway. In addition, this LFS-induced depotentiation appeared to be mediated by the activation of group 2 metabotropic glutamate receptors (mGluRs), because it was mimicked by the bath-applied group 2 agonist (2S,2'R,3'R)-2-(2', 3'-dicarboxycyclopropyl) glycine and was specifically inhibited by the group 2 antagonists (S)-alpha-methyl-4-carboxyphenylglycine and (alphaS)-alpha-amino-alpha-(1S,2S)-2-carboxycyclopropyl-9H-xanthine-9-propanic acid. Moreover, the induction of depotentiation was entirely normal when synaptic transmission is blocked by glutamate receptor antagonist kynurenic acid and was associated with a reversal of paired-pulse facilitation attenuation during LTP expression. Pretreatment of the hippocampal slices with G(i/o)-protein inhibitor pertussis toxin (PTX) prevented the LFS-induced depotentiation. These results suggest that the activation of presynaptic group 2 mGluRs and in turn triggering a PTX-sensitive G(i/o)-protein-coupled signaling cascade may contribute to the LFS-induced depotentiation at the mossy fiber-CA3 synapses.

Optical studies of the smectic-C(*)(alpha) phase layer structure in free-standing films

The layer structure of the smectic-C(*)(alpha) phase of one liquid-crystal compound has been acquired from both differential optical reflectivity and ellipsometry measurements in the free-standing film geometry. The data from both techniques display characteristic oscillations as a function of temperature, which can be described by a model for the film consisting of surface anticlinic layers and an interior short-pitched azimuthal helix. These results are consistent with those found previously for another compound. Depolarized reflected light microscopy is used to study the films when the unique features of the aforementioned oscillations occur.

Ginseng flowers stimulate progesterone production from bovine luteal cells

Our previous report first showed evidence that polysaccharides isolated from ginseng leaves obtained from Jilin, China possess luteotropic activities. In this study, we made further investigations on the root and flowers of Korean ginseng by means of the same bioassay system described briefly as follows. Frozen-thawed bovine luteal cells (1 x 10(5) cells/ml/well) in M199 were incubated in 24-well culture plates at 37 degrees C in a 5 % CO2 incubator. Ten microl of tested drugs with 1, 10 and 100 microg/ml were added into each well. After 4- and 24-hr incubation, the media were harvested and assayed for progesterone by an enzyme immunoassay. The production of progesterone from cells is the indicator for evaluating the action of tested drugs. Results showed that hot water extracts ofginseng flowers (GF-1) with 10 to 100 microg/ml significantly increased progesterone production, whereas those from ginseng root (GR-1) could not. Crude polysaccharides (GF-2) isolated from GF-1 is the active component and the small molecules (mw < 10,000 dalton) are excluded, indicating that the ginseng root has no luteotropic activities, but the polysaccharides of ginseng flowers have.

Parental concerns for the child with febrile convulsion: long-term effects of educational interventions

OBJECTIVE

To evaluate long-term effects of educational interventions on parental concerns for children with febrile convulsions (FC).

SUBJECTS AND METHODS

209 FC parents were recruited from southern Taiwan, and assigned into program or pamphlet groups by their choices. A questionnaire was used to examine the parental concerns at 4 time points: prior to the interventions, 3 months, 1 year, and 2 years after the interventions.

RESULTS

The concern scores were high before the interventions. Parents concerned that their child is apt to get a fever, has further seizures in the night, that FC results in potential brain damage and is life threatening. After interventions the concern scores were significantly lower for the program group than for the pamphlet group. The educational program was the most significant factor that influenced the change in parental concerns. The recurrence of FC did not significantly influence the change in the concern trajectory in the program group but showed a significant difference in the pamphlet group.

CONCLUSION

FC parental concerns decreased as time passed particularly in the program group. The educational program was the significant factor that influenced the change of concern trajectories, and the recurrent/non-recurrent factor influenced the change of concern only in pamphlet group. FC parental concerns should be assessed, and information given combined with emotional support.

Presynaptic mechanisms underlying cannabinoid inhibition of excitatory synaptic transmission in rat striatal neurons

The striatum is a crucial site of action for the motor effects of cannabinoids (CBs). However, the electrophysiological consequences of activation of CB receptors on the striatal neurons have not been established. Here we report for the first time that the cannabimimetic aminoalkylindole WIN 55,212-2 and the endogenous cannabinoid anandamide substantially depress corticostriatal glutamatergic synaptic transmission onto striatal neurons in the brain slice preparation. The selective CB1 receptor antagonist SR 141716 effectively reversed this inhibition. WIN 55,212-2 significantly increased the paired-pulse facilitation of synaptically evoked EPSCs, while having no effect on the sensitivity of postsynaptic neurons to [alpha]-amino-3-hydroxy-5-methylisoxazole-4-propionic acid. WIN 55,212-2 also reduced the frequency of spontaneous, action potential-dependent EPSCs (sEPSCs) without altering their amplitude distribution. Superfusion of WIN 55,212-2 elicited a membrane hyperpolarization accompanied by a decrease in input resistance. Both effects were blocked by intracellular caesium. In contrast, intracellular caesium failed to affect WIN 55,212-2-mediated synaptic inhibition. The WIN 55,212-2-mediated synaptic inhibition was blocked by the Gi/o protein inhibitor pertussis toxin (PTX), but not by the GABA(A) receptor antagonist bicuculline or GABA(B) receptor antagonist SCH 50911. Pretreatment with the N-type Ca2+ channel antagonist [omega]-conotoxin GVIA selectively abolished the WIN-55,212-2-mediated synaptic inhibition. These results suggest that cannabinoids depress the corticostriatal glutamatergic synaptic transmission through the activation of presynaptic CB1 receptors to inhibit N-type Ca2+ channel activity, which in turn reduces glutamate release. The presynaptic action of cannabinoids is mediated by a PTX-sensitive Gi/o protein-coupled signalling pathway.

Unusual thickness-dependent thermal behavior and anticlinic coupling in chiral smectic free-standing liquid-crystal films

We observe, in free-standing films of a chiral smectic liquid crystal, a series of discrete transitions in the relative orientation of the tilt of the interior and surface layers. These transitions include a remarkable reentrant synclinic-anticlinic-synclinic ordering sequence of the film surfaces in the presence of an electric field upon cooling. The profiles of the associated heat-capacity anomalies are found to be strongly thickness dependent and exhibit a novel crossover behavior in reduced dimensions. We measure the anticlinic coupling between tilted surface layers in the smectic- A phase.

Optical studies of the liquid crystal B2 phase formed by banana-shaped molecules

Null-transmission ellipsometry and depolarized light microscopy have been performed on free-standing films of three achiral banana-shaped compounds in the B2 phase. Our results support a two-layer unit cell previously proposed to explain the observed antiferroelectricity in thin films and bulk samples. We have studied thicker films than previously reported and have found no deviations in the film structure from the earlier findings. Moreover, we can determine the layer spacing, the molecular tilt from the layer normal, and the three principal indices of refraction in the molecular reference frame.

Unusual presentation of mesangial proliferative glomerulonephritis in HELLP syndrome associated with acute renal failure

Acute renal failure in pregnancy is not common in industrialized countries. HELLP syndrome (hemolysis, elevated liver enzyme, and low platelets) was one of the causes of acute renal failure in pregnancy, but renal pathological findings in case of acute renal failure had rarely been reported. We reported an unusual case of HELLP syndrome with acute renal failure requiring renal replacement therapy and which histopathologic findings of kidney biopsy showed mesangial proliferative glomerulonephritis and her renal function completely recovered after immediate artificial abortion, supportive management, transfusion of blood products, and hemodialysis.

Organ system failures prediction model in intensive care patients with acute renal failure treated with dialysis

OBJECTIVE

To evaluate the organ system failures hospital mortality predictions in critically ill patients with acute renal failure requiring dialysis.

DESIGN

Prospective, cohort study.

SETTING

Intensive care units in a tertiary care university hospital in Taiwan.

PATIENTS

A total of 112 patients admitted to the intensive care units with acute renal failure who required dialysis from January 1999 through December 1999.

INTERVENTIONS

Collection of information necessary to compute the number of failed organs.

MEASUREMENTS AND RESULTS

Of the 112 patients studied, 75 were men and 37 were women. The mean age of survivors and non-survivors was 58.59 +/- 19.91 years and 58.76 +/- 19.62 years. The overall mortality rate was 67%. There were no significant differences between survivors and non-survivors in terms of age, gender, or indication for dialysis. The cause of death in the majority of patients was related to organ system failure during the 24 hours immediately preceding the initiation of acute hemodialysis, and carry mortality rates exceeding 83% with the coexistence of four or more failed organs. The area under the organ system failures prediction model receiver operating characteristic curve equaled 0.772 +/- 0.046.

CONCLUSION

We conclude that mortality rate for acute renal failure in intensive care unit patients continues to be high. Organ system failures prediction model performed well and simple in its ability to identify patients who die in hospital. Mortality rate increases as number of failed organ increases.

Domain specific monoclonal anti-factor VIII antibodies generated by inclusion body-renatured factor VIII peptides

Production of monoclonal anti-factor VIII (FVIII) antibodies was hampered by the availability of FVIII proteins devoid of albumin and the von Willebrand factor (vWF). We showed a successful way to generate domain specific anti-FVIII antibodies by using a series of Escherichia coli expressed FVIII fusion peptides. A total of eight fusion peptides were synthesized to cover almost the entire coding region of FVIII. All except one of the fusion peptides were insoluble and became aggregated as inclusion bodies. Purification and refolding of the peptides were accomplished by solublizing them with denaturants and dialyzing them in appropriate buffers, this being followed by chromatography of the refolded fractions on a metal-ion chelating column. These purified FVIII fusion peptides were used individually or as a pool to immunize mice and generate antibodies. Three monoclonal antibodies, D2, E6 and B12, were obtained. D2 recognizes a region (residues 1680-1703) of the light chain of FVIII, E6 recognizes a fragment (residues 744-1021) in the heavy chain, and B12, the A1 domain (residues 89-326). Both D2 and B12 inhibited >80% FVIII function. The affinities (k(A)) of the antibodies for FVIII were 1.62x10(7) M(-1) for D2 and 2.2x10(8) M(-1) for E6. Although B12 is inhibitory, it did not show a strong binding affinity with FVIII. The specificity of D2 and E6 for FVIII was demonstrated by immunoprecipitation of the FVIII protein in full-length recombinant FVIII (rFVIII) supplemented FVIII-deficient plasma, but not in FVIII-deficient plasma alone. An enzyme-linked immunosorbant assay (ELISA) using D2 or E6 was designed to detect plasma FVIII. The system may be useful in monitoring FVIII in cultured supernatants and in mouse models for gene therapy experiments.

Computed free energy differences between point mutations in a collagen-like peptide

We studied the results of mutating alanine --> glycine at three positions of a collagen-like peptide in an effort to develop a computational method for predicting the energetic and structural effects of a single point genetic mutation in collagen, which is associated with the clinical diagnosis of Osteogenesis Imperfecta (OI). The differences in free energy of denaturation were calculated between the collagen-like peptides [(POG)(4)(POA)(POG)(4)](3) and [(POG)(10)](3) (POG: proline-hydroxyproline-glycine).* Our computational results, which suggest significant destabilization of the collagen-like triple-helix upon the glycine --> alanine mutations, correlate very well with the experimental free energies of denaturation. The robustness of our collagen-like peptide model is shown by its reproduction of experimental results with both different simulation paths and different lengths of the model peptide. The individual free energy for each alanine --> glycine mutation (and the reverse free energy, glycine --> alanine mutation) in the collagen-like peptide has been calculated. We find that the first alanine introduced into the triple helix causes a very large destabilization of the helix, but the last alanine introduced into the same position of an adjacent chain causes a very small change in the peptide stability. Thus, our results demonstrate that each mutation does not contribute equally to the free energy. We find that the sum of the calculated individual residues' free energy can accurately model the experimental free energy for the whole peptide.

Human progesterone receptor shows differential sensitivity to carboxyl group modifying agents when bound to agonist and antagonist ligands

BACKGROUND

Modulation of human uterine progesterone receptor (PR) in relation to its binding to synthetic steroids with known agonist (R5020) and antagonist (triamcinolone acetonide, T.A.) properties was studied in the presence of the specific carboxyl group modifiers, N,N'-dicyclohexylcarbodiimide (DCCD) and 1-ethyl-3-carbodiimide hydrochloride (EDC).

METHODS

Uterine cytosol was treated with DCCD or EDC. The amounts of total bound were detected using the steroid binding measurements. The formation and transformation of progesterone-receptor complexes (PRc) were analyzed using sedimentation rate analysis.

RESULTS

Our studies show that the modification of the COOH group differentially influences the properties of mammalian PR binding with either R5020 or T.A. DCCD and EDC affect the steroid binding of PR by decreasing the binding sites, not by the changing the affinity.

CONCLUSION

Our studies indicate the importance of the carboxyl group in steroid binding by PR. This implies that both aspartic acid and glutamic acid residues, which have the carboxyl group, may play an important role when PR binds with steroid ligands.

Clinical improvement by increased frequency of on-line hemodialfiltration

BACKGROUND/AIMS

In spite of the better efficiency of on-line hemodiafiltration (HDF) compared with conventional hemodialysis (HD), it is relatively expensive. The aim of this study was to assess the advantages in the biochemical, hemodynamic and clinical effects in uremic patients treated with on-line HDF and with different frequencies of combination high-flux HD.

METHODS

One hundred eleven patients were divided into four groups receiving different frequencies of on-line HDF (thrice, twice, once per week) and high-flux HD.

RESULTS

Hemodynamic parameters including maximum drop of systolic blood pressure, episodes of symptomatic hypotension and mean saline infusion volumes during dialysis were reduced when frequencies of on-line HDF were increased. Significant improvements in urea kinetic were observed when frequencies of on-line HDF were increased. On-line HDF significantly reduced the amount of erythropoietin needed and improved intra- and inter-dialysis symptoms, physical well-being, menstruation and skin pigmentation when frequency of HDF is increased to three time per week.

CONCLUSION

On-line HDF offers a better cardiovascular stability and clinical improvement. Thrice weekly on-line HDF offers a significant benefit when compared with lower frequencies of HDF per week and high-flux HD.

Total creatinine appearance as indicator of risk of infectious complication in peritoneal dialysis

Peritonitis and exit-site infections are the main causes of complications in peritoneal dialysis. Death due to infectious complication is also one of the major causes of drop-out. The underlying cause of infection may include malnutrition. Total creatinine appearance (TCA) may reflect overall nutritional status. We determined TCA from the daily dialysate, urine, and estimated gut creatinine of patients and normalized it to actual body weight (nTCA). We examined the relationship between nTCA and the incidence of infection, and between nTCA and infection-related survival. The study included 323 adult patients in a single dialysis center. The mean nTCA of all patients was 19.73 +/- 4.75 mg/kg/day. The patients with an nTCA below 1 standard deviation from the mean (nTCA < 14.98 mg/kg/day) had a significantly higher peritonitis and exit-site infection rate (p < 0.01) and a higher chance of drop-out owing to infection-related complications (p < 0.0001). Our study concluded that the adult patient with malnutrition (nTCA < 14.98 mg/kg/day) has higher risk of infection.

Hypokalemic muscular paralysis causing acute respiratory failure due to rhabdomyolysis with renal tubular acidosis in a chronic glue sniffer

CASE REPORT

A 34-year-old male was admitted to the emergency department with the development of quadriparesis and respiratory failure due to hypokalemia after prolonged glue sniffing. The patient was subsequently given mechanical ventilatory support for respiratory failure. He was weaned from the ventilator 4 days later after potassium replacement. Toluene is an aromatic hydrocarbon found in glues, cements, and solvents. It is known to be toxic to the nervous system, hematopoietic system, and causes acid-base and electrolyte disorders. Acute respiratory failure with hypokalemia and rhabdomyolysis with acute renal failure should be considered as potential events in a protracted glue sniffing.

Outcome after treatment for papillary thyroid cancer

BACKGROUND

To evaluate the results of treatment and the prognostic variables of papillary thyroid carcinoma patients after long-term follow-up.

PATIENTS AND METHODS

Retrospective review of 1,373 thyroid cancer patients. Of the 1,016 papillary thyroid cancer patients, 394 patients received follow-up for more than 5 years, including 305 women (mean age, 38.4 +/- 13.7 years) and 89 men (mean age, 44.0 +/- 13.4 years). Of these papillary thyroid carcinoma patients, 227, 76, 68, and 23 patients were categorized in clinical stages I, II, III, and IV, respectively, at the time of diagnosis.

RESULTS

After treatment, 36 (9.1%) patients died. Only 23 (5.8%) of them died of papillary thyroid carcinoma. The 1-, 5-, 10-, and 20-year survival rates were 0.980, 0.951, 0.901, and 0.731. Mortality factors of the papillary thyroid carcinoma patients related to age, gender, tumor size, and postoperative serum thyroglobulin (Tg) levels. Twenty-four patients progressed from clinical stages I, II, and III to stage IV during the follow-up period. Of these 24 patients, 12 died during the follow-up period. In this study, age, gender, 131I accumulated dose, postoperative serum Tg levels, and the survival rate were demonstrated to be statistically significant between the patients in early stage and advanced stage groups after treatment.

CONCLUSION

Twenty-four of the 47 papillary thyroid cancer patients with distant metastases were diagnosed during the follow-up period. This study suggests that distant metastasis may occur at a serum Tg level of 2.3 ng/mL with thyroxine replacement. Postoperative long-term close follow-up of these patients is recommended.

Differences in 99mTc-HMPAO brain SPET perfusion imaging between Tourette's syndrome and chronic tic disorder in children

Early differential diagnosis between Tourette's syndrome and chronic tic disorder is difficult but important because both the outcome and the treatment of these two childhood-onset diseases are distinct. We assessed the sensitivity and specificity of brain single-photon emission tomography (SPET) perfusion imaging in distinguishing the two diseases, and characterized their different cerebral perfusion patterns. Twenty-seven children with Tourette's syndrome and 11 with chronic tic disorder (mean age 9.5 and 8.6 years, respectively) underwent brain SPET with technetium-99m hexamethylpropylene amine oxime (HMPAO). Visual interpretation and semiquantitative analysis of SPET images were performed. On visual interpretation, 22 of 27 (82%) of the Tourette's syndrome group had lesions characterized by decreased perfusion. The left hemisphere was more frequently involved. None of the children with chronic tic disorder had a visible abnormality. Semi-quantitative analysis showed that, compared with children with chronic tic disorder, children with Tourette's syndrome had significantly lower perfusion in the left lateral temporal area and asymmetric perfusion in the dorsolateral frontal, lateral and medial temporal areas. In conclusion, using the visual approach, brain SPET perfusion imaging is sensitive and specific in differentiating Tourette's syndrome and chronic tic disorder. The perfusion difference between the two groups, demonstrated by semi-quantitative analysis, may be related more to the co-morbidity in Tourette's syndrome than to tics per se.

Pyeloureteritis cystica: case report

Pyeloureteritis cystica, characterized by multiple bubbly filling defects on urography and caused by inflammatory stimuli, is a rare disorder of the ureter. It commonly affects older people. Diagnosis is established by radiological studies. Antibiotics should be given if urinary tract infection is present. Up to now, no other specific treatment can be used to cure this disorder. We report a case of pyeloureteritis cystica associated with urinary tract infection and a ureteral stone in a young woman who presented with hematuria and bilateral flank pain. The pyeloureteritis cystica had a bead-like appearance on intravenous pyelogram and retrograde pyelogram as well as in magnetic resonance urography. The diagnosis and treatment of this disorder are discussed. Magnetic resonance urography can provide high-resolution of coronal images of the entire urinary tract without the use of contrast agents or ionizing radiation. However, the cost of the procedure is a major concern.

Outcomes and APACHE II predictions for critically ill patients with acute renal failure requiring dialysis

BACKGROUND

Despite the widespread availability of dialytic and intensive care unit technology, the probability of early mortality in critically ill patients with acute renal failure (ARF) is still high, and the evaluation of the patients' prognosis has been difficult. The Acute Physiology and Chronic Health Evaluation II (APACHE II) score is a reliable indicator of severity of illness and likelihood of survival in critically ill patients with ARF. We have attempted to determine whether the APACHE II scoring system can be used to predict prognosis.

METHODS

A retrospective cohort study evaluated the medical records of 100 consecutive patients in intensive care units with acute renal failure who required dialysis from January 1997 through December 1998.

RESULTS

Of the 100 patients studied, 65 were men and 35 were women. The mean age of survivors and nonsurvivors was 59.4 +/- 20.3 years and 58.3 +/- 20.0 years. The overall mortality rate was 71%. There were no significant differences between survivors and nonsurvivors in age, gender, or indication for dialysis. The cause of death in the majority of patients was related to higher APACHE II score during the 24 hours immediately preceding the initiation of acute hemodialysis, and carry mortality rates exceeding 85% with an APACHE II score of 24 or higher.

CONCLUSION

We conclude that mortality rate for acute renal failure in intensive care unit patients continues to be high. The use of the APACHE II score determined at the time of initiation of dialysis for patients with ARF is a statistically significant predictor of patient survival. There is a significant trend with APACHE II score for outcome.

Kimura's disease in a chronic hemodialysis patient

Eosinophilia is not an uncommon finding in chronic dialysis patients. It is usually benign in nature although definite pathogenesis is unknown. We have encountered a young uremic Chinese adult who developed Kimura's disease after being on maintenance hemodialysis for about 3 years. Asymptomatic eosinophilia had been noted for 1 year and 8 months prior to the development of progressively enlarged neck masses, which leads to the diagnosis of Kimura's disease. In contrast to most cases, eosinophilia was first noticed before the neck masses appeared. There is often a close correlation between Kimura's disease and glomerular disease, where renal involvement is considered as a systemic manifestation. However, we do not have strong evidence to support this relationship between terminal renal failure and Kimura's disease in this patient. To our knowledge, our patient is the first reported case of Kimura's disease occurring in chronic hemodialysis patients. Eosinophilia persisted for nearly 2 years before the neck mass developed and recurred after the excision. Besides, our patient also demonstrated a chronic and recurrent course typical of Kimura's disease.

Gastric intramucosal PCO2 and pH variability in ventilated critically ill patients

OBJECTIVE

Gastric intramucosal PCO2 (PiCO2) and pH (pHi) are currently used as indices of the adequacy of splanchnic perfusion and as end points to guide therapeutic intervention. However, little is known about their spontaneous variability over time. The present study was designed to define the magnitude of spontaneous variability of PiCO2 and pHi in sedated medical intensive care unit (ICU) patients using an automated recirculating air tonometer and to test whether high-level positive end-expiratory pressure (PEEP) or inverse inspiratory/expiratory (I:E) ratio ventilation resulted in a greater variability than low PEEP with conventional I:E ratio ventilation.

DESIGN

Prospective study.

SETTING

Medical ICU in a tertiary medical center.

PATIENTS

Twenty-three acute respiratory failure patients.

INTERVENTIONS

After being sedated, patients were randomized to undergo pressure control ventilation at the following three settings: A, high PEEP (15 cm H2O) with conventional I:E ratio (1:2), and B, low PEEP (5 cm H2O) with inverse I:E ratio (2:1) alternately, and then C, low PEEP (5 cm H2O) with conventional I:E ratio (1:2). Each ventilation setting period lasted 1 hr.

MEASUREMENTS AND MAIN RESULTS

The PiCO2 and pHi were measured at baseline (time 0), and at 15, 30, 45, and 60 mins thereafter. The corresponding coefficients of variation (CVs) of PiCO2 for overall pooled group and settings A, B, and C were 4.0%, 4.4%, 3.4%, and 4.2%, respectively. The corresponding CVs of pHi for overall pooled group and settings A, B, and C were 0.36%, 0.37%, 0.33%, and 0.4%, respectively. Analysis of variance showed no significant difference in the CVs of PiCO2 or pHi between the three settings. The 95% confidence interval is approximately +/-8% variability for PiCO2 and +/-0.7% variability for pHi.

CONCLUSIONS

In critically ill medical ICU patients with stable hemodynamics, the spontaneous variability of PiCO2 or pHi are not substantial. High PEEP (15 cm H2O) and inverse ratio ventilation (2:1), which does not change the cardiac output or hemodynamics, does not contribute to increased spontaneous variability in PiCO2 or pHi.

Intraspinal osteolipoma. Case report

Lipomatous tumors can contain uncommon or rare components (such as fibrolipoma or angiolipoma) that may result in the development of symptoms. To the best of the authors' knowledge, lipoma associated with an osseous component has not been previously reported. A case of intraspinal extradural tumor composed of both adipose and bone tissue is presented. Current theories on the cause of lipoma with an osseous component are discussed. The tumor was histologically confirmed to be an osteolipoma, and the patient recovered well after resection.