Choline plus cytidine stimulate phospholipid production, and the expression and secretion of amyloid precursor protein in rat PC12 cells

The amyloid precursor protein (APP) is a transmembrane protein anchored in the membrane lipid bilayer. Choline and cytidine are major precursors of cell membranes, and are regulatory elements in membrane biosynthesis. We examined the levels of cellular APP holoprotein and secreted APPs when rat PC12 cells are stimulated to undergo increase in membrane phospholipids by choline+cytidine (2+2, 5+5, 10+10 or 50+50 microM) treatment. We now show that as phospholipids levels are increased by supplemental choline and cytidine treatment, the levels of cell-associated APP also rise stoichiometrically; these treatments also caused major (up to 6. 8-fold) increases in the amounts of secreted APP released into the cell medium, and also stimulated increased process formation. These results show that choline plus cytidine increase both phospholipid levels, and the expression and secretion in PC12 cells. It appears that agents that stimulate cellular membrane biosynthesis may be used to stimulate the secretion of neurotrophic APPs and neurite formation in neurodegenerative disorders such as Alzheimer's disease.

Establishment of cell culture systems from penaeid shrimp and their susceptibility to white spot disease and yellow head viruses

Monolayer cultures were established from ovary, heart, lymphoid tissue and peripheral hemocytes of penaeid shrimps including Penaeus monodon, P. japonicus and P. penicillatus. The most favorable conditions for the culture of penaeid shrimp cells in vitro was in CMRL and L-15 tissue culture media when used within an osmolarity range of 620--760 mmol/kg. The optimal maintenance temperature was 25 degrees C for tissues of P. japonicus and 28 degrees C for tissues of P. monodon and P. penicillatus. Among the four tissues tested, lymphoid tissue, or 'Oka organ', was superior to the other tissues for the formation of confluent cell monolayers. Cell cultures from lymphoid tissue and ovary have been subcultured up to three times. When peripheral hemocytes and heart were cultured, a maximum survival of 4 days was obtained. In contrast, cell cultures derived from ovary and lymphoid tissue were maintained alive for at least 20 days in appropriate culture systems. Neither confluent cell sheet nor adherence of cells was obtained in cultivation of hepatopancreas using the present culture systems. The results obtained from the present study also revealed that ovary extract, muscle extract and lobster hemolymph enhanced the survival of the cultured cells of penaeid shrimp in vitro. When the 'Oka organ' cell monolayer was incubated with either white spot disease virus (WSDV) or yellow head virus (YHV), no cytopathic effect (CPE) was obtained. However, at 5--7 days after establishment, significant CPE (a few foci) was observed in cell monolayers derived from WSDV- and YHV-infected Oka tissue. By electron microscopy, virions of WSDV and YHV were observed in the nuclei and cytoplasm of cultured cells. The CPE foci developed further with increased incubation time.

Establishment of cell lines derived from oyster, Crassostrea gigas Thunberg and hard clam, Meretrix lusoria Röding

The present study attempts to establish cell culture systems for the oyster, Crassostrea gigas Röding and the hard clam, Meretrix lusoria Thunberg. Treatment with collagenase was better than trypsin at dissociating mollusc tissue fragments for in vitro culture. Heart tissue of oyster and hard clam proved to be the most promising target tissue for the establishment of cell lines in vitro. Primary cultures of clam heart were established and successfully maintained for more than 5 months. Collagenase at a concentration of 100 microg/ml may enhance the growth of oyster and hard clam heart cell cultures in vitro.

Gastroduodenal perforation in cancer patients

BACKGROUND/AIMS

Patients with advanced or metastatic cancer have compromised nutritional, metabolic, and immune conditions. Little is known about gastroduodenal perforation in cancer patients.

METHODOLOGY

Data of 11 cancer patients with gastroduodenal perforation were retrospectively reviewed.

RESULTS

There were 2 females and 9 males with a mean (+/- s.e.) age of 56.7+/-4.7 years and a median of 55. The primary malignancies included lung cancers (3 cases), hepatocellular carcinomas (2 cases), squamous cell carcinomas of the tongue (2 cases), malignant lymphoma of the small bowel (1 case), adenocarcinoma of the pancreas (1 case), adenocarcinoma of the stomach (1 case), and acute lymphoblastic leukemia (1 case). The average duration of symptoms was 36.5+/-10.1 hours (median: 24 hours). Methods of surgical treatment included simple closure of the perforation (6 cases), truncal vagotomy and pyloroplasty (3 cases), pyloroplasty (1 case), and subtotal gastrectomy (1 case). Four patients (36.4%) had post-operative complications. The post-operative hospital mortality rate was 18.2%. One patient died of sepsis with gastrointestinal hemorrhage and 1 died of hepatic failure and respiratory failure. Pre-operative shock is the only significant factor in predicting operative mortality.

CONCLUSIONS

Gastroduodenal perforation occurring in cancer patients without chemotherapy had favorable short-term operative results.

Metaplastic carcinomas of the breast

BACKGROUND AND OBJECTIVES

Metaplastic carcinomas of the breast are rare neoplasms. The purpose of the present study is to better characterize the clinical course, treatment, and prognostic factors of metaplastic breast carcinomas.

METHODS

Data of 14 patients with metaplastic breast carcinoma were retrospectively reviewed. The follow-up period ranged from 2 months to 10 years, 10 months (median 4.3 years).

RESULTS

The patients' ages ranged from 38 to 66 years (median 50.5 years). The tumors were 2.5 to 18 cm (median 4.8 cm) in size. Seven patients had axillary nodal metastases at the time of diagnosis. Estrogen and progesterone receptors were positive in only one tumor. Twelve patients underwent modified radical mastectomy and two patients underwent incisional biopsy. Adjuvant chemotherapy was administered to six patients, and radiotherapy to two patients after mastectomy. Two patients received preoperative chemotherapy. Seven patients were living without evidence of disease at a median of 7.3 years after surgery. A patient died of ovarian carcinoma without recurrence or metastasis of breast cancer. Metastases occurred in five patients at 4 to 16 months (median 8 months) after initial treatment. Duration of symptoms, TNM stage, tumor size, and axillary nodal status were significant prognostic factors of survival.

CONCLUSIONS

The patients with metaplastic breast carcinomas may have a favorable prognosis.

Metaplastic carcinomas of the breast

BACKGROUND AND OBJECTIVES

Metaplastic carcinomas of the breast are rare neoplasms. The purpose of the present study is to better characterize the clinical course, treatment, and prognostic factors of metaplastic breast carcinomas.

METHODS

Data of 14 patients with metaplastic breast carcinoma were retrospectively reviewed. The follow-up period ranged from 2 months to 10 years, 10 months (median 4.3 years).

RESULTS

The patients' ages ranged from 38 to 66 years (median 50.5 years). The tumors were 2.5 to 18 cm (median 4.8 cm) in size. Seven patients had axillary nodal metastases at the time of diagnosis. Estrogen and progesterone receptors were positive in only one tumor. Twelve patients underwent modified radical mastectomy and two patients underwent incisional biopsy. Adjuvant chemotherapy was administered to six patients, and radiotherapy to two patients after mastectomy. Two patients received preoperative chemotherapy. Seven patients were living without evidence of disease at a median of 7.3 years after surgery. A patient died of ovarian carcinoma without recurrence or metastasis of breast cancer. Metastases occurred in five patients at 4 to 16 months (median 8 months) after initial treatment. Duration of symptoms, TNM stage, tumor size, and axillary nodal status were significant prognostic factors of survival.

CONCLUSIONS

The patients with metaplastic breast carcinomas may have a favorable prognosis.

Intrahepatic cholangiocarcinoma in Taiwan

We report our experience of the surgical treatment of intrahepatic cholangiocarcinoma (ICC) in Taiwanese patients. A total of 162 patients with histologically proven ICC were treated of whom 106 (65. 4%) had associated hepatolithiasis. Patients with hepatolithiasis were in earlier stages than those without hepatolithiasis. Two-thirds of the patients with hepatolithiasis presented with acute cholangitis, and two-thirds of those without hepatolithiasis presented with hepatomegaly. The rate of hepatic resection was 29.6% (48 of 162), and these rates were 31.1% and 26.8% for the patients with and without hepatolithiasis, respectively. Ninety-three percent of the patients with hepatolithiasis underwent common bile duct exploration, compared with 18% of those without hepatolithiasis. The surgical mortality rates were 3.7% (6/162), for all patients, and 3. 8% and 3.6% for patients with and without hepatolithiasis, respectively. The morbidity rate was much higher in the patients with hepatolithiasis (37.7% vs 16.1%). The 1-, 3-, and 5-year survival rates were 35.5%, 20.5%, and 16.5% in the patients with hepatolithiasis and 27.2%, 8.8%, and 7.8% in those without hepatolithiasis. Concomitant hepatolithiasis prevented precise diagnosis preoperatively and precipitated biliary sepsis, which affected resectability and increased postoperative morbidity. Hepatolithiasis per se did not influence long-term survival.

Risk factors for adolescent primigravida in Kaohsiung county, Taiwan

OBJECTIVES

To study the risk factors for adolescent primigravida in Kaohsiung county, Taiwan.

METHODS

This is a population survey on primigravida based on household registry to study risk factors affecting pregnancy of 215 women aged < 18; 341 women aged 18-19; and 590 women aged 20-34.

RESULTS

The mean age of menarche, first intercourse, and first pregnancy, as well as the duration of menarche to the first intercourse increased significantly with the increased age of primigravida (P < 0.001). Adolescent primigravida, when compared to adult primigravida, were less likely to communicate well with their parents or be in a dual parent family (P < 0.05). They were also more likely to have alcoholic fathers, have drinking alcohol and smoking health behavior problems, exhibit poor school performance, have relatives or friends who became pregnant as adolescents, have been raped, and exhibit poorer knowledge of contraception before pregnancy (P < 0.05). Dose-response relationship in the odds ratio was found. Non-dual family, adolescent pregnancy in relatives or friends, smoking before pregnancy, and age of menarche were independent factors in multiple logistic regression on adolescent primigravida.

CONCLUSIONS

The main risk factors for adolescent primigravida in Kaohsiung county. Taiwan, were family influence, health behavior problems, adolescent pregnancy in relatives or friends, and earlier onset of menarche. The age at which intercourse and smoking start appear to be two crucial factors that can be addressed through education as a means of intervention before pregnancy occurs.

Fibrogenesis imperfecta ossium: imaging correlation in three new patients

OBJECTIVE

Fibrogenesis imperfecta ossium is an extremely rare disorder that can easily be misdiagnosed. We retrospectively reviewed the clinical and imaging data of three confirmed cases of fibrogenesis imperfecta.

DESIGN AND PATIENTS

The patients consisted of two men and one woman, ranging in age from 40 to 53 years. Radiography was performed in all the patients. One patient had a 3-year follow-up of the thoracolumbar spine with conventional radiography and thoracolumbar magnetic resonance (MR) imaging. Open biopsy was performed in all cases, confirming the diagnosis of fibrogenesis imperfecta ossium.

RESULTS

All our cases demonstrated "fishnet" trabecular pattern by conventional radiographs, and a pelvis radiograph of one patient showed an equivocal sclerosis pattern. Multiple fractures were noted in two patients. A pseudoexostosis was present in the ilium in one patient. Thoracolumbar MR imaging demonstrated diffuse low signal intensity within the medullary space on both T1-weighed and T2-weighted images, except for a region of increased signal intensity in the L1 and L2 vertebral bodies on T2-weighed images due to edema from acute collapse.

CONCLUSIONS

Although uncommon, fibrogenesis imperfecta ossium should be considered in a previously healthy patient with a combination of progressive bone pain, unexplained fractures, a radiologic pattern of fishnet osteopenia and MR imaging of low signal intensity bone marrow on both T1-weighted and T2-weighted images.

Characterization of two subclasses of PR-10 transcripts in lily anthers and induction of their genes through separate signal transduction pathways

The lily PR-10 belongs to a family of intracellular pathogenesis-related (IPR) proteins. Genomic Southern analysis indicates that the PR-10 is encoded by a family of multiple genes. Seven heterogeneous cDNA clones encoding lily PR-10 from Lilium longiflorum are divided into two subclasses based on sequence comparison and Southern hybridization. A 82% overall sequence similarity was found between the two subclasses (represented by PR-10c and d). The two cDNAs include an open reading frame of 474 bp encoding 157 amino acids. 5'- and 3'-untranslated regions exhibit low similarity, but similarity is high in the coding region. The lily PR-10 genes are induced by abscisic acid (ABA) and methyl jasmonate (MeJA) in the anther and various other organs of lily plants. The induction of PR-10 genes by ABA and MeJA in lily anthers occurs by two separate signal transduction pathways. The protein phosphatase inhibitor okadaic acid inhibits the MeJA-induced expression of PR-10 genes downstream of MeJA. In addition, the protein kinase inhibitor staurosporine inhibits the MeJA-induced expression of PR-10 genes, implying that an activity of staurosporine-sensitive protein kinases exists downstream of MeJA in the anther. However, okadaic acid does not inhibit the ABA-induced expression of PR-10 genes whereas staurosporine does. These observations suggest that, in addition to the known pathway that ABA induces gene expression by activating JA or MeJA, a MeJA-independent pathway of ABA induction exists in the anther. The alternative pathway of ABA induction involves a staurosporine-sensitive protein kinase activity downstream of ABA.

Characteristics and outcomes of adolescent pregnancies in Kaohsiung County, Taiwan

Adolescent pregnancy is a burgeoning problem in Taiwan. This descriptive epidemiologic study was designed to compare the prenatal characteristics and birth outcomes of adolescent and adult primigravidas. The adolescent primigravidas included 215 mothers (younger adolescents) younger than 18 years of age and 341 mothers aged 18 or 19 years, who registered a live birth in Kaohsiung County from June 1994 to May 1995. The control group consisted of 590 adult primigravidas including 290 mothers aged 20 to 24 years and 300 mothers aged 25 years or older, who registered a live birth in January or February 1995. Prenatally, adolescent primigravidas tended to have later awareness of their pregnancy, later first prenatal visits, fewer total prenatal visits, and less parental support than adults. In addition, adolescents had higher rates of unintended pregnancy, prenatal morbidity, and smoking, and were more often the victims of physical abuse by male partners. The cesarean section rate increased with maternal age, from 21% in younger adolescents to 39.7% in women aged 25 years or above. Potentially inadequate (< 12 kg) weight gain and short duration of breast feeding (< 1 month) were significantly more common in adolescents than in adults. There were no significant differences in birth weight, infant mortality, or postpartum maternal or neonatal morbidity before hospital discharge between the two groups. This study shows that adolescent primigravidas had more adverse prenatal characteristics and less maternal weight gain during gestation. Most of the adverse characteristics and outcomes of adolescent pregnancy found in this study are similar to those reported in Western countries.

Virus antigen expression and alterations in peripheral blood mononuclear cell subpopulations after classical swine fever virus infection

Depletion in the number of lymphocytes and viral persistence are thought to be the most important outcomes of classical swine fever virus (CSFV) infection. To define the change in peripheral blood mononuclear cells (PBMC) and virus replication in leukocytes after CSFV infection, 8-week old pigs were infected with the LPC vaccine strain or virulent CSFV (HCV-YL strain). Changes in the relative number of PBMCs were analyzed by flow cytometry. The results showed a significant increase in the relative percentage of monocytes in PBMCs during acute CSFV infection of naive pigs (p < 0.05). Monocyte frequencies were not changed in LPC-vaccinated pigs and control pigs. There was also a significant decrease in the number of IgM+ cells (p < 0.05) and a slight decrease in the number of CD4+ lymphocytes after 5 days of infection. There was no change in the frequency of CD8+ lymphocytes in PBMCs after infection. To define which subpopulation of PBMCs was the target for CSFV infection, PBMC populations from CSFV infected pigs were separated and stained for virus antigen expression. Alveolar macrophages (AM) were also studied. The results showed that CSFV replicated in all PBMC subpopulations: CD4+, CD8+, and IgM+ lymphocytes, and monocytes as well as AMs. However, virus antigen expression was more intense in monocytes and AMs. The infection of lymphocytes may, therefore, contribute to the depletion in their numbers after infection and lead to defective antibody production during virulent CSFV infection.

Cathepsin D expression by cancer and stromal cells in breast cancer: an immunohistochemical study of 1348 cases

This study was aimed at investigating the influence of cathepsin D (CD) expression by cancer cells and stromal cells on breast cancer prognosis. This is a study of 1348 node-positive (NPBC) and node-negative (NNBC) breast cancers diagnosed between 1980 and 1986 and with a minimum follow-up of 5.2 years. CD expression was assessed by immunohistochemistry on archival material using a polyclonal antibody. The expression by cancer and stromal cells was assessed separately and correlated with distant metastasis free (DMFS) and overall survival (OS). Cancer cells expressed CD (more than 10% cells expressing CD) in 38.9% of cases and reactive stromal cells in 43.6%. CD expression by reactive stromal cells, and not cancer cells, correlated with several factors of poor prognosis by cancer cells. A strong association was also found with expression of other proteases (stromelysin-3, gelatinase A, and urokinase Plasminogen Activator) by these same reactive stromal cells. CD expression by cancer cells did not predict DMFS or OS but, by univariate analysis, CD expression by reactive stromal cells was associated with earlier recurrence and shorter survival in NNBC (p = 0.0425) and NPBC patients submitted to adjuvant chemotherapy (p = 0.0234). However, CD expression by reactive stromal cells remained a significant predictor of recurrence by multivariate analyses only in a subgroup of NPBC submitted to adjuvant chemotherapy. Overall, those data support the concept that proteases produced by reactive stromal cells are under cancer cell stimulation and that CD by stromal cells, and not cancer cells, influences the prognosis, but only in a subgroup of patients with breast cancer.

A multicenter study on eradication of Helicobacter pylori infection in patients with duodenal ulcer by lansoprazole-antibiotics combined therapy

The aim of this prospective randomized multicenter study was to find out if there is one or several promising regimens containing lansoprazole with various combinations of antibiotics which have a high eradication rate of Helicobacter pylori, few side-effects, good patient compliance, and relative low cost if possible. Two hundred and ninety-seven patients with H. pylori positive duodenal ulcer were enrolled and randomly allocated into one of the five treatment groups: 1) group A: received lansoprazole 30 mg once daily for 2 weeks plus amoxicillin (AM) 500 mg and metronidazole (MZ) 500 mg twice daily for one week in the first week; 2) group B: the AM in group A was replaced by clarithromycin (CM) 250 mg; 3) group C: the MZ in group A was replaced by CM 250 mg; 4) group D: the AM and CM in group C was used for 2 wk; 5) group E: the CM in group D was doubled to 500 mg twice daily. All patients received endoscopies pre- and 4-6 weeks post termination of treatment. H. pylori was detected by culture, histology and rapid urease test (CLO test). 13C-urea breath test was performed if the patients refused the second endoscopy. The E-test was adopted to evaluate the MZ and CM resistance of H. pylori. Totally, 253 patients completed the study. The eradication rate of groups A, B, C, D and E were 75%, 80%, 78%, 92%, and 96%, respectively. The eradication rate of group E was significantly higher than that of groups A, B, or C. There were no significant differences of eradication rates between the groups D and E. Sixty-seven cases (28.8%) were MZ-resistant. The difference of eradication rates between MZ-S and MZ-R patients was significant in group A (85.3% vs. 42.9%) and in the combination of groups A and B (83.8% vs. 59.4%). Good compliance (defined as taking > 90% of medications) was seen in more than 90% of cases in each group. Triple therapy containing lansoprazole 30 mg once daily, AM 500 mg and CM 250 mg twice daily for two weeks is a promising regimen which reaches a high eradication rate, avoids MZ resistance, and has very good patient compliance at an acceptable cost.

Hepatocellular carcinoma presenting with acquired porphyria: a case report and review of the literature

Hepatocellular carcinoma (HCC) with acquired porphyria is a very rare condition. It is characterized variably by hyperpigmentation, skin fragility and photodistributed subepidermal vesicles. The serum, urine and/or stool porphyrin levels, usually markedly elevated, can change according to the clinical course. We report here a case of hepatocellular carcinoma presenting with a paraneoplastic syndrome of acquired porphyria. A 73-year-old Chinese woman had the characteristic facial pigmentation of cutaneous porphyria and histologically proven hepatocellular carcinoma. Her serum zinc protoporphyrin was elevated and her urine tested positive for coproporphyrin. Her protoporphyrin and alpha-fetoprotein levels dropped after transarterial chemoembolization treatment. Acquired porphyria in hepatocellular carcinoma occurs exclusively in older persons with huge hepatocellular carcinoma and/or cirrhosis. Before diagnosis, it must be carefully differentiated from inherent porphyrias with HCC, and porphyrias induced by drugs or heavy metal intoxication must be ruled out.

Prognostic factors in node-negative breast cancer patients: the experience in Taiwan

BACKGROUND

Adjuvant chemotherapy has improved the length of disease-free survival and overall survival in node-negative breast cancer patients. It has been a common practice to select only the patients with higher rates of recurrence for adjuvant therapy. Therefore, it is essential to define the risk factors in node-negative breast cancer patients.

MATERIALS AND METHODS

Two hundred fifty-five patients with axillary node-negative breast cancers without adjuvant chemotherapy or hormonal therapy at Chang Gung Memorial Hospital between 1981 and 1986 were included in this study. Tissue blocks for DNA flow cytometry study was available in the tumors of 145 patients.

RESULTS

The median follow-up period was 121 months and the percentages of patients with 10 years of disease-free survival (DFS) and overall survival (OS) were 75.1% and 82.2%, respectively. The significant poor prognostic factors for 10 years of OS were a tumor size larger than 3 cm, negative estrogen and progesterone receptor status, and having a non-diploid tumor (p value = 0.0176, 0.048 and 0.016, respectively). The patients with frozen section, high mitotic rate, and Scarff-Blood-Richardson (SBR) grade II and III tumors had a worse prognosis than the others, but this trend did not reach statistical significance. The patients with positive estrogen receptor status had a 10-year disease-free rate (DFR) of 94%, and these with tumors less than 2 cm plus SBR grade I had a 10-year DFR of 92%.

CONCLUSION

The node-negative breast cancer patients with a low risk of recurrence were those who had estrogen receptor positive, tumor less than 2 cm with SBR grade I, and intraductal carcinomas. Adjuvant chemotherapy would be no benefit for these patients.

Characterization of a desiccation-related protein in lily pollen during development and stress

This work characterizes a lily (Lilium longiflorum Thunb. cv. Snow Queen) anther (LLA) protein associated with desiccation. Peptide mapping analysis revealed that the abundant LLA-23 doublet contained similar polypeptides, having an isoelectric point of 6.1. Immunoblots of pollen protein from developing anther/pollen confirmed that the LLA-23 protein accumulated only at the later stage of pollen maturation and that the levels remained steady in mature and vital pollen. The accumulation of LLA-23 proteins was correlated with desiccation that naturally occurred in pollen. Subcellular fractionation of pollen proteins revealed that the protein was located in the cytoplasmic fraction. Premature drying of developing pollen confirmed that the concomitant accumulation of LLA-23 was associated with desiccation. Peptide sequence analysis demonstrates similarities between the lily LLA-23 and a family of water-deficit/ripening-induced proteins including LP3 of pine, DS2 of potato, and Asr of tomato and pummelo. In addition, the concomitant accumulation of LLA-23 can be experimentally manipulated by methyl jasmonate (Me-JA) and salicylic acid (SA) as well as by mannitol and methyl viologen. The LLA-23 represents a novel member of the water-deficit/ripening-induced proteins.

Spontaneous gastroduodenal perforation in cancer patients receiving chemotherapy

BACKGROUND/AIMS

Spontaneous gastroduodenal perforation is a rare and lethal complication in cancer patients receiving chemotherapy.

METHODOLOGY

Data of 9 patients with spontaneous gastroduodenal perforation occurring during chemotherapy were reviewed.

RESULTS

All 9 patients were male with an average age of 54.4+/-2.5 years. The primary malignancies included 5 head and neck cancers, 2 esophageal cancers, 1 malignant lymphoma, and 1 hepatocellular carcinoma. Abdominal pain was the most common symptom. The average interval between the onset of symptoms and surgery was 2.9+/-0.7 days (range: 16 hours to 7 days). Perforation was located on the duodenum (6 patients) and on the lower part of the body of the stomach (3 patients). Simple closure of the perforation was performed on 8 patients, and subtotal gastrectomy on 1 patient. Culture of the ascitic fluid of 8 patients revealed E. coli, Klebsiella pneumoniae, streptococcus viridans, and enterococcus. Four patients (44.4%) had post-operative complications. The 30-day post-operative mortality was 44.4% (4/9). Three patients died of sepsis with multiple organ failure, and 1 died of hepatic failure. Age, anaemia, leukopenia, serum albumin levels, impaired renal or liver functions are not significant operative risk factors. Pre-operative shock is a significant factor in predicting operative mortality and complications.

CONCLUSIONS

High index with suspicion of the disease with early treatment may improve survival of cancer patients with spontaneous gastroduodenal perforation.

An intelligent control system for ventilators

This study reports on a ventilator system that consists of several intelligent modules for controlling ventilator operation. These modules are software programs in two controllers. One controller is a personal computer used for diagnoses, determining settings and checking the effects of settings. The other controller is a single-chip microprocessor in a ventilator that controls the ventilator's settings in accordance with the computer settings. After setting up the system, an artificial lung model simulating a patient's lung is used to test the system. The result of test run indicated that it always responds to a patient's lung condition in a stable manner. Thus, the proposed system with its intelligent modules may assist clinicians in caring for patients and managing ventilator operation.

Differences in risk factors for being either a hepatitis B carrier or anti-hepatitis C+ in a hepatoma-hyperendemic area in rural Taiwan

This is a study of the differences in the risk factors for being either hepatitis B surface antigen positive [HBsAg(+)] or antibody to hepatitis C virus positive [Anti-HCV(+)] in A-Lein, a rural area in southern Taiwan, an area which also has a high hepatoma mortality rate. Three hundred eighty-five patients age > or =40 years participated in hepatoma screening at the A-Lein Community Health Center during 1995. Those who were HBsAg(-) and anti-HCV(-) or had coinfection of HBsAg(+) and anti-HCV(+) were excluded, leaving 293 patients: 109 HBsAg(+) and 184 anti-HCV(+). The anti-HCV(+) patients had a lower socioeconomic status (as defined by level of education and type of occupation) and were older than HBsAg(+) patients (P < 0.05). Those with higher alanine aminotransferase levels (ALT) also had a higher anti-HCV(+) to HBsAg(+) odds ratio (OR), and a dose response relationship was found, P < 0.0001. Anti-HCV(+) patients were more likely than HBsAg(+) patients to have a spouse who shared the infection, OR = 5.11; 95% CI, 2.30-11.28. Anti-HCV(+) patients were more likely than HBsAg(+) patients to have had blood transfusions (OR = 2.66; 95% CI, 1.20-5.89), frequent medical injections (OR = 2.64; 95% CI, 1.62-4.31), or injections by non-licensed medical providers (OR = 1.91; 95% CI, 1.18-3.09). Multiple logistic regression analysis showed that the significant factors for anti-HCV(+) patients vs. HBsAg(+) patients are drinking habit (OR = 3.45; 95% CI, 1.02-11.60), age (OR = 6.33; 95% CI, 2.93-13.68), and frequent medical injections (OR = 2.88; 95% CI, 1.65-5.03). The transmission of hepatitis C in A-Lein is closely related to low socioeconomic status, age, alcohol abuse, spouses being anti-HCV(+), and frequent medical injections, especially from non-licensed medical providers, including both pharmacists and those with no medical licensing whatsoever. These nonlicensed medical providers sometimes reuse needles to save money, which is a likely route of infection.

AmbiPack: a systematic algorithm for packing of macromolecular structures with ambiguous distance constraints

The determination of structures of multimers presents interesting new challenges. The structure(s) of the individual monomers must be found and the transformations to produce the packing interfaces must be described. A substantial difficulty results from ambiguities in assigning intermolecular distance measurements (from nuclear magnetic resonance, for example) to particular intermolecular interfaces in the structure. Here we present a rapid and efficient method to solve the packing and the assignment problems simultaneously given rigid monomer structures and (potentially ambiguous) intermolecular distance measurements. A promising application of this algorithm is to couple it with a monomer searching protocol such that each monomer structure consistent with intramolecular constraints can be subsequently input to the current algorithm to check whether it is consistent with (potentially ambiguous) intermolecular constraints. The algorithm AmbiPack uses a hierarchical division of the search space and the branch-and-bound algorithm to eliminate infeasible regions of the space. Local search methods are then focused on the remaining space. The algorithm generally runs faster as more constraints are included because more regions of the search space can be eliminated. This is not the case for other methods, for which additional constraints increase the complexity of the search space. The algorithm presented is guaranteed to find all solutions to a predetermined resolution. This resolution can be chosen arbitrarily to produce outputs at various level of detail. Illustrative applications are presented for the P22 tailspike protein (a trimer) and portions of beta-amyloid (an ordered aggregate).

Concurrent primary carcinoma of the gallbladder and acute cholecystitis

BACKGROUND/AIMS

Primary carcinoma of the gallbladder is rare and associated with a late diagnosis and poor prognosis. Concurrent acute cholecystitis frequently obscures the presence of carcinoma. The information regarding gallbladder carcinoma with acute cholecystitis is limited. In order to better understand the presentation of gallbladder carcinoma with acute cholecystitis, we retrospectively reviewed the data of patients with primary carcinoma of the gallbladder.

METHODOLOGY

The data of 86 patients with primary carcinoma of the gallbladder treated between 1979 and 1994 were compiled and reviewed. The patients were divided into 2 groups: Group 1 (with acute cholecystitis, 21 patients) and Group 2 (without cholecystitis, 65 patients). Clinicopathological comparisons were made and evaluated between these two groups

RESULTS

The average age of Group 1 patients was older than that of Group 2 patients (75+/-2 years vs. 63+/-2 years; p<0.05). Three Group 1 patients presented with sepsis. The interval between the onset of symptoms and hospital admission in Group 2 patients was significantly (p<0.05) longer than that in Group 1 patients (243+/-95 days vs. 20+/-11 days). Leukocytosis (>11,000/mm3) was more common in Group 1 patients than in Group 2 patients (47.6% vs. 15.4%). Jaundice was more common in Group 2, and fever was common in Group 1. The majority of Group 2 gallbladder cancers were stage V (75.4%). In contrast, 52.4% of Group 1 gallbladder cancers were stage III and 38.1% were stage V. The 30-day postoperative mortality rate in Group 1 and Group 2 patients was 9.5% and 7.7%, respectively. The cumulative survival of Group 1 patients was not different from that of Group 2 patients (log-rank test, p>0.05).

CONCLUSIONS

Age, the interval of symptoms prior to admission, the location of abdominal pain, fever, leukocytosis, and the absence of jaundice suggested the presence of acute cholecystitis in gallbladder carcinoma. A high index of suspicion of the disease, intraoperative examination of gallbladder specimens, and more aggressive surgical treatment may improve patient survival.