Free flaps as flow-through vascular conduits for simultaneous coverage and revascularization of the hand or digit

In complex extremity injuries, which include volar skin loss and ischemic digits, simultaneous coverage and revascularization are required. In this series of 12 patients, free-tissue transfers were utilized to provide both soft tissue coverage and a flow-through arterial conduit for revascularization. Eleven cases involved the hand or digits, and one case involved the great toe. Six cases were performed for acute ischemia associated with traumatic soft-tissue loss. The remaining six flaps were utilized to lengthen contracted vascular pedicles and provide vascularized soft-tissue coverage during reconstruction of severe hand and foot contractures. Nine temporoparietal fascia free flaps were used for hand or digit revascularization. Two fillet flaps were created, one from a nonreplantable foot and another from an isolated index amputation. The distal end of the axial artery of the flap was anastomosed to a digital artery to restore circulation. Fascial flaps were covered with full-thickness skin grafts. Primary wound healing was achieved in all patients. There were no flap losses or other complications. All the distal parts were revascularized adequately by the axial arteries of the flaps, and functional recovery was good. In this technique, the flap satisfied the need for both coverage and revascularization. Vein grafts were not needed. This series further describes the utility of flow-through flaps in the revascularization of digits.

[Leukoencephalomalacia in two horses--moldy corn poisoning in Germany?]

Moldy corn poisoning is a mycotoxicosis of Fusarium sp. causing a disease termed equine leukoencephalomalacia (ELEM). This article reviews the literature on ELEM and describes two cases with clinical signs and morphological findings comparable with fusariotoxicosis. Since in both cases neither a fungus nor a toxin proof were performed, the different causes of leukoencephalomalacia in horses are discussed.

Evaluation of Sanofi Diagnostics Pasteur Chlamydia Microplate EIA shortened assay and comparison with cell culture and Syva Chlamydia MicroTrak II EIA in high- and low-risk populations

Seven hundred thirty-two female urogenital samples were collected for Chlamydia trachomatis testing by both the Sanofi Diagnostics Pasteur (Chaska, Minn.) Chlamydia Microplate EIA by the shortened protocol and the Syva (San Jose, Calif.) MicroTrak II EIA, and the results were compared with those obtained by cell culture. For the analysis of samples from female patients, the patients were divided into high- and low-risk categories. An additional 121 male urethral samples were collected and tested by the Sanofi Microplate EIA and cell culture; for the analysis of samples from male patients, the patients were divided into asymptomatic and symptomatic categories. All specimens positive by enzyme immunoassay (EIA) were confirmed by a blocking assay following the respective manufacturer's instructions. Specimens negative by EIA that fell within a gray zone 30% below the cutoff and negative cultures with one or more corresponding positive EIA results were tested further by cytocentrifugation and direct immunofluorescent assay. The overall sensitivity, specificity, positive predictive value, and negative predictive value for Syva versus culture were 94, 98.8, 85.5 and 99.6%, respectively. After resolution, the results were 94.5, 99.6, 94.5, and 99.6%, respectively. The parallel results for the Sanofi Microplate EIA versus culture were 94.0, 98.7, and 83.9, and 99.6%, respectively, and after being resolved, the results were 94.9, 100, 100, and 99.6%, respectively. In the small male population tested, the resolved results of the Sanofi Microplate EIA versus culture demonstrated sensitivity, specificity, positive predictive value, and negative predictive value of 100, 100, 100, and 100%, respectively. The present study demonstrated that the Sanofi Microplate EIA shortened protocol is highly sensitive and specific in comparison with cell culture and the Syva MicroTrak II EIA.

Interaction of sulfhydryl reactive reagents with components involved in (1,3)-beta-glucan synthesis from Candida albicans

Glucan synthesis was sensitive to several sulfhydryl reacting compounds: mercurials, reversible disulfides, and an alkylating sulfhydryl reagent (IC50 3-45 microM). Thiol groups associated with glucan synthesis were hydrophilic in nature, since both hydrophilic and hydrophobic reagents were active. Glucan synthase complex consists of at least two components: a peripheral GTP-binding protein that can be solubilized with detergents (supernatant) and the catalytic membrane-bound component (pellet). A rapid separation technique was developed to study sulfhydryl interactions with the complex. The GTP-binding protein was solubilized with 0.6% 3-((3-cholamidopropyl)dimethylammonio)-1-propane sulfonate from isolated microsomes of Candida albicans cells grown at either 10 or 30 degrees C. The residual membranous fraction contained the core catalytic moiety of glucan synthase. Both fractions were devoid of glucan synthase activity until they were reconstituted by mixing the two fractions together. In reconstitution experiments, the pellet lost almost 50% activity when preincubated with 2.5 microM N-ethylmaleimide and combined with an untreated supernatant whereas only 10% activity was lost when the supernatant was treated with N-ethylmaleimide. The catalytic active site of glucan synthase was not protected with UDP-Glc when preincubated with 10 microM N-ethylmaleimide but the GTP-binding fraction was partially protected with GTP gamma S.

Fusacandins A and B; novel antifungal antibiotics of the papulacandin class from Fusarium sambucinum. I. Identity of the producing organism, fermentation and biological activity

The fuscandins, antifungal agents of the papulacandin class, are produced by a strain of Fusarium sambucinum. Fermentation yielded 60 mg/liter of fusacandin A and minor amounts of fusacandin B. As expected, the fusacandins inhibit (1,3)-beta-glucan synthesis. Fusacandin A is slightly less active than papulacandin B against Candida albicans and, like papulacandin, loses activity in the presence of serum.

Supplemental phytic acid and microbial phytase change zinc bioavailability and cadmium accumulation in growing rats

Three groups of individually housed albino rats (n = 6 each, initial average weight = 47 g) were fed diets based on egg white and corn starch over a 4-week period. All diets were supplemented with 15 mg/kg of Zn and 5 mg/kg of Cd. Group I (Control) was fed the basal diet free of phytic acid (PA) and phytase. By replacing corn starch by 0.5% PA (as NaPA) in groups II and III, a molar PA/Zn ratio of 33 was obtained. In group III, 2000 U of microbial phytase per kg diet were added. Addition of PA to diet (group II) resulted in a significant decrease in growth and zinc status. The negative effect of dietary PA on growth and zinc status was considerably counteracted by the supplementation of 2000 U microbial phytase (group III). In group I the highest apparent zinc absorption (58.2%) was measured. The addition of 0.5% PA (group II) significantly decreased apparent zinc absorption to 23.4%. In rats receiving the phytase-enriched diet (group III) 46.5% of ingested zinc was apparently absorbed. Liver cadmium concentration in rats fed the diet containing PA was significantly higher than that in the control group, whereas phytase supplementation lowered liver cadmium accumulation. In tendency similar effects were obtained for kidney cadmium accumulation.

Effect of phytic acid and microbial phytase on Cd accumulation, Zn status, and apparent absorption of Ca, P, Mg, Fe, Zn, Cu, and Mn in growing rats

Three groups of individually housed albino rats (n = 6, initial average weight = 47 g) were fed diets based on egg white and cornstarch (basal diet 8 g Ca, 5.2 g P, 0.76 g Mg, 100 mg Zn, 100 mg Fe, 50 mg Mn, 7 mg Cu, and 5 mg Cd per kilogram diet) over a 4-week period. Group I (controls) was fed the basal diet free of phytic acid (PA) and microbial phytase. In groups II and III cornstarch was replaced by 0.5% PA from NaPA (molar PA/Zn ratio approximately 5). In group III, 2,000 U of microbial phytase from Aspergillus niger per kilogram diet was added. Live weight gain, zinc status (zinc in plasma, femur, liver, and testes; activity of the plasma alkaline phosphatase), and apparent absorption of zinc, iron, copper, and manganese remained unchanged by the different dietary treatments. The apparent phosphorus absorption was highest in the phytase group. PA decreased and microbial phytase improved the apparent absorption of calcium and magnesium. Liver cadmium concentration, total liver and kidney cadmium content, as well as fractional liver and kidney cadmium accumulation in rats fed the diet containing PA were significantly higher than those in the controls. Phytase supplementation lowered liver and kidney cadmium accumulation. Differences in calcium and magnesium bioavailability due to PA and microbial phytase may be one factor in the alteration of tissue cadmium accumulation.

Potential of autologous immunologic effector cells for bone marrow purging in patients with chronic myeloid leukemia

Relapse is a major concern in autologous bone marrow transplantation (BMT). Therefore, purging of bone marrow to reduce the amount of tumor cells reinfused into the patient is widely used. Immunologic effector cells such as lymphokine activated killer (LAK) cells are attractive for purging of bone marrow since these cells might have an additional in vivo effect on tumor cells in contrast to other purging protocols. In patients with chronic myelogenous leukemia (CML), LAK cells can only be used in some patients for purging bone marrow since LAK cells possess no or only limited cytolytic activity against autologous CML tumor cells in most cases. In this study, we investigated the effect of autologous and allogeneic cytokine-induced killer (CIK) cells on tumor cells from patients with CML. CIK cells have been generated from peripheral blood lymphocytes by incubation with interferon-gamma on day 0, interleukin-1, interleukin-2 and a monoclonal antibody against CD3 on day 1. In contrast to LAK cells, CIK cells were able to lyse both autologous and allogeneic cells from patients with CML as determined by a 51Cr release and a tumor colony assay. The cytotoxicity of CIK cells against CML cells was confined to the CD56+ population. CIK cells showed no major toxic effect on hematopoietic progenitor cells when tested in CFU-GM assays. CIK cells eliminated three orders of magnitude of K562 cells and less than one order of magnitude of progenitor cells (25% reduction). This represents a differential effect of CIK cells on tumor and progenitor cells.(ABSTRACT TRUNCATED AT 250 WORDS)

The use of a confirmatory assay to increase the sensitivity and specificity of the Chlamydiazyme test

The blocking assay was used to reexamine 15,662 patient specimens (2,565 male specimens, 13,097 female specimens) that were submitted for Chlamydia detection using the Chlamydiazyme EIA assay (Abbott Laboratories, North Chicago, IL). Specimens that gave optical density (OD) readings between 1.99 to cutoff and between cutoff to 3 times the negative control in the Chlamydiazyme EIA assay were analyzed further by the blocking assay during the phase 1 study. In the phase 2 study, another 1,120 specimens (473 male specimens and 647 female specimens) that had the above mentioned OD range in the Chlamydiazyme assay were tested with the blocking assay and the direct fluorescent antibody test using the cytospin method. Significant finding from phase 1 study demonstrated that 42.3% of the male specimens with optical density between cutoff to three times the negative control can be blocked by blocking assay (confirmed positive), whereas only 50% of the female specimens with OD range between cutoff to .5 were blocked by the blocking assay. In the phase 2 study, similar results were obtained with the blocking assay. The direct fluorescent antibody test showed excellent correlation with the blocking assay. These data showed that both blocking or direct fluorescent antibody tests can be used for confirmation purposes to increase the sensitivity and specificity of the assay. However, for specimens with OD values below the cutoff to 3 times the negative control, it was necessary to reassess the specimens by either of the methods. This was true especially with the male specimens.

Characterization of (1,3)-beta-glucan synthase in Candida albicans: microsomal assay from the yeast or mycelial morphological forms and a permeabilized whole-cell assay

A systematic evaluation of the in vitro (1,3)-beta-glucan synthase assay parameters was performed using microsomes prepared from Candida albicans from either yeast or mycelial phase cells. Enzyme activities of both yeast and mycelial phase microsomes depended on the presence of guanosine-5'-O-(3-thiophosphate) and either bovine serum albumin or a detergent [W-1 (polyoxyethylene ether detergent) or Brij-35 (polyoxyethylene ether, 23 lauryl ether)]. Brij-35 was included in standard assays as it was compatible with the permeabilized whole-cell assay. Microsomes derived from both the yeast and mycelial phases generally yielded similar glucan synthase activities under a range of different assay conditions. Brij-35 significantly stabilized the enzyme, yielding a half-life of 5.6 d at 4 degrees C, compared with 0.9 d without detergent. The addition of detergent during mechanical breakage of yeast cells dramatically improved glucan synthase stability and activity. Enzyme catalysis was linear for at least 75 min with 100 micrograms protein from microsomes of yeast cells grown to mid-exponential phase, with an apparent Km for UDP-glucose of 1.1 mM. The pH and temperature optima were 7.75 and 30 degrees C, respectively. Glucan synthase activity was highest in cells derived from early mid-exponential phase and declined to a basal level by stationary phase. A permeabilization-based in situ assay for glucan synthase was developed. Cells were permeabilized with 2% (v/v) solution of toluene/methanol (1:1) and assayed for glucan synthase activity using standard reaction mixtures. Reactions were linear for 30 min and were inhibited by known inhibitors of glucan synthesis.(ABSTRACT TRUNCATED AT 250 WORDS)

A 1-year evaluation of Syva MicroTrak Chlamydia enzyme immunoassay with selective confirmation by direct fluorescent-antibody assay in a high-volume laboratory

TThe Syva MicroTrak Chlamydia enzyme immunoassay (EIA; Syva Company, San Jose, Calif.) with cytospin and direct fluorescent-antibody assay (DFA) confirmation was evaluated on 43,630 urogenital specimens over a 1-year period in the Provincial Laboratory in Regina, Saskatchewan, Canada. This was a two-phase study intended to define a testing algorithm for Chlamydia trachomatis that would be both highly accurate and cost-effective in our high-volume (> 3,000 tests per month) laboratory. The prevalence of C. trachomatis infection in our population is moderate (8 to 9%). In phase 1, we tested 6,022 male and female urogenital specimens by EIA. All specimens with optical densities above the cutoff value and those within 30% below the cutoff value were retested by DFA. This was 648 specimens (10.8% of the total). A total of 100% (211 of 211) of the specimens with optical densities equal to or greater than 1.00 absorbance unit (AU) above the cutoff value, 98.2% (175 of 178) of the specimens with optical densities of between 0.500 and 0.999 AU above the cutoff value, and 83% (167 of 201) of the specimens with optical densities within 0.499 AU above the cutoff value were confirmed to be positive. A total of 12% (7 of 58) of the specimens with optical densities within 30% below the cutoff value were positive by DFA. In phase 2, we tested 37,608 specimens (32,495 from females; 5,113 from males) by EIA. Only those specimens with optical densities of between 0.499 AU above and 30% below the cutoff value required confirmation on the basis of data from phase 1 of the study. This was 4.5% of all specimens tested. This decrease in the proportion of specimens requiring confirmation provides a significant cost savings to the laboratory. The testing algorithm gives us a 1-day turnaround time to the final confirmed test results. The MicroTrak EIA performed very well in both phases of the study, with a sensitivity, specificity, positive predictive value, and negative predictive value of 96.1, 99.1, 90.3, and 99.7%, respectively, in phase 2. We suggest that for laboratories that use EIA for Chlamydia testing, a study such as this one will identify an appropriate optical density range for confirmatory testing for samples from that particular population.

Guidelines for testing slow acting drugs in osteoarthritis

New compounds appear to improve symptoms of osteoarthritis (OA), and others are putative chondroprotective agents. We suggest experimental designs for studying the effects of these agents in subjects with hip and knee OA. The course of the articular cartilage lesion is the primary outcome measure to be assessed in putative chondroprotective agent trials. Serial radiographic studies suggest that the annual rate of joint space narrowing in patients with hip or knee OA is about 0.25 mm. Other approaches to quantitation of cartilage loss, e.g., radiographic measurement of the area of joint space, ultrasonography, magnetic resonance imaging and fiberoptic arthroscopy (for knee OA) are under investigation.

Nerve crush injuries--a model for axonotmesis

Nerve crush is a commonly used experimental model in the rat; however, a standard method of inducing this injury has not been defined. This study examined six crush techniques that are frequently used and characterized the subsequent nerve injury. Five types of nerve crush using a No. 5 jeweler's forceps and a sixth using a 30-s single crush with a serrated hemostat were studied in the posterior tibial nerve of the Lewis rat. Regeneration was evaluated using serial walking track assessments at 1, 2, 4, 6, and 8 weeks postoperatively. Nerve conduction studies and histological examination were performed at 2 days, 2 weeks, and 8 weeks. Blood-nerve barrier breakdown was observed at 2 days and recovered by 2 weeks. By 4 weeks normal walking track patterns were obtained in all groups. A pattern of Wallerian degeneration and axonal regeneration was noted at 2 weeks, with histological recovery in all groups by 8 weeks. Nerve crush, induced by any of the six methods tested, was similar and provides a reliable model of axonotmesis.

Structural investigation of the new potent DNA alkylator spiro(2H-1,3,2-benzodiazaphosphole-2,2',lambda 5 [1,3,5,2,4,6] triazatriphosphorine),4',4',6',6'-tetrakis(1-aziridinyl)-1,3,4',4',6', 6',-hexahydro

The molecular structure of spiro(2H-1,3,2-benzodiazaphosphole-2,2',lambda 5 [1,3,5,2,4,6] triazatriphosphorine), 4',4',6',6'-tetrakis(1-aziridinyl)-1,3,4',4',6',6'-hexahydro (CAS 133586-94-4), a recently synthesized potent cytostatic, was determined using X-ray diffraction method. The substance crystallizes in P2(1)2(1)2(1) orthorhombic space group. The unit cell contains 8 formal molecules coupled into 4 pseudo-centrosymmetric dimers by double intermolecular hydrogen bonds. The compound revealed, besides previously determined long-term chemical stability and good water solubility, also radiation stability. In spite of having less aziridinyl groups than 1,3,5,2,4,6-triazatriphosphorine,2,2,4,4,6,6-hexakis (1-aziridinyl)-2,2,4,4,6,6-hexahydro (N3P3Az3, Az = aziridinyl, CAS 52-46-0; Myko 63) the compound is twice more cytostatically active. Hypotheses attributing high cytostatic activity to the existence of conjugated pi-electron systems in the molecule and dimeric structures are discussed.

Distribution and predictors of depressive symptoms in osteoarthritis

OBJECTIVE

To determine the prevalence and correlates of depressive symptoms in a sample of elderly persons with osteoarthritis (OA).

METHODS

Secondary analysis of cross sectional interview data from 108 community living persons age 50 or over who met American College of Rheumatology clinical criteria for OA of the hip and/or knee.

RESULTS

The prevalence of substantial depressive symptomatology appeared to be no greater than would be expected in the general population for this age group. However, persons currently under a physician's care for OA were significantly more depressed than those not under care, and, with the exception of those who had post-high school education, depression was a better predictor of being under care than OA symptoms. The direct and interactive effects of 3 variables--education, age and self-perceived impact of the OA problem--were found to explain 40% of variance in depression scores in the total sample and 50% among those currently receiving care. Younger and less educated subjects had relatively more depressive symptoms and, furthermore, in this subgroup the correlation between OA impact and depression was high.

CONCLUSIONS

The importance of assessing depression in persons who seek care for OA is supported. Furthermore, our results suggest that the observed relationship between education and arthritis outcomes could be mediated, at least in part, by depression.

Thermal stability of low molecular weight urokinase during heat treatment. I. Effects of protein concentration, pH and ionic strength

Exposure of low molecular weight urokinase (LMW-UK) to prolonged heating (60 degrees C, 10 hours) is used to inactivate possible viral contaminants. This process leads to a significant loss of active enzyme. Amidolytic activity was monitored following heat treatment in order to establish the conditions for maintaining the optimal stability of LMW-UK. The effects of pH, ionic strength, protein concentration, and various ionic additives were examined. While LMW-UK is stable across a wide pH range (pH 2-11), heating LMW-UK in aqueous solution leads to complete loss of activity except between pH 4 and 7.5. The mechanism of inactivation was delineated using activity assays as well as turbimetric and spectroscopic methods. Thermal inactivation occurs via aggregation of unfolded LMW-UK, followed by subsequent precipitation. Threshold effects upon the thermally-induced aggregation of LMW-UK were observed.

Structure and biosynthesis of anthocyanins in flowers of Campanula

Blue-flowering genotypes of Campanula were classified into four phenotypes on the basis of the anthocyanin composition of their flowers. The flowers contained one, two, three or four of the following anthocyanins: bisdeacylplatyconin (7-O-(beta-D-glucopyranosyl)-3-O-(6-O-alpha-L-rhamnopyranosyl-beta-D- glucopyranosyl)delphinidin), violdelphin (7-O-(6-O-(4-O-(6-O-(4-hydroxybenzoyl)-beta-D-glucopyranosyl)-oxybenz oyl)-beta- D-glucopyranosyl)-3-O-(6-O-alpha-L-rhamnopyranosyl-beta-D-glucopyranosyl ) delphinidin), an unknown anthocyanin and campanin (7-O-(6-O-(4-O-(6-O-(4-O-(6-O-p-hydroxybenzoyl-beta-D-glucopyranosyl) oxybenzoyl)-beta-D-glucopyranosyl)oxybenzoyl)-beta-D-glucopy ranosyl)-3-O-(6-O- (alpha-L-rhamnopyranosyl)-beta-D-glucopyranosyl)delphinidin). The structure of the unknown anthocyanin has been determined as 7-O-(6-O-(4-O-(6-O-(4-O-(beta-D-glucopyranosyl)oxybenzoyl)-beta-D- glucopyranosyl)oxybenzoyl)-beta-D-glucopyranosyl)-3-O-(6-O-(alpha- L- rhamnopyranosyl)-beta-D-glucopyranosyl)-delphinidin, i.e. monodeacylcampanin. The genetic evidence is consistent with a biosynthetic pathway in which bisdeacylplatyconin, violdelphin and monodeacylcampanin are intermediates in the biosynthesis of campanin.

Relationships between social background and medical care in osteoarthritis

Arthritis is relatively more prevalent among those of low socioeconomic status and it is important that this group have access to good arthritis care. In our study looking at relationships between socioeconomic status and medical care, histories were obtained from a convenience sample of 110 community living elderly persons of varying social backgrounds who had symptomatic osteoarthritis (OA) of the hip and/or knee. Almost all subjects had seen a physician at some time for their OA, and low income and black subjects were twice as likely to be currently receiving OA care as others. However, in looking at instruction and monitoring in relation to therapeutic joint exercises as a qualitative aspect of medical care, subjects who had both above mean OA impairment and more than a high school education were found to have received much more comprehensive care than any other subgroup.

A technique for nerve reconstruction following resection of soft-tissue sarcoma

Primary nerve grafting should be considered whenever tumor extirpation necessitates resection of an adjacent critical nerve. A technique of nerve grafting is presented which distinguishes motor from sensory fascicles, using intraoperative electrical stimulation. Stimulation of individual motor fascicles is performed proximal and distal to the lesion, and fascicles which produce the same muscle contraction are identified. Motor and silent sensory fascicles are tagged prior to tumor resection. This facilitates subsequent specific motor/sensory reconstruction of the defect, using intrafascicular grafting techniques.

Influence of a single parenteral application of a 10% fish oil emulsion on plasma fatty acid pattern and the function of thrombocytes in young adult men

50 ml of a 10% fish oil emulsion (41% omega-3 fatty acids of total fatty acids) were infused for 1 h into the arm vein of young, healthy, male volunteers. The fatty acid composition of the plasma, aggregation of the blood platelets as well as the thromboxane synthesis, were measured before the beginning of infusion, 20, 60, 120, 360 and 1,440 min after the start of the fat infusion. In the first 60 min, the fatty acid composition of the plasma changed in correspondence with the supplied fatty acid pattern. At the end of the investigation it was again within the normal range. As a result of fat application thromboxane synthesis was reduced and the aggregation of the platelets was inhibited but it was normalized by the 1,440-min value. Fish oil emulsions might be beneficial for parenterally fed patients with a high risk of thrombosis. Therefore the performance of further investigations using a varying dosage and multiple application can be recommended.