Epoetin alfa and darbepoetin alfa: effects on ventricular hypertrophy in patients with chronic kidney disease

BACKGROUND

Anemia is very common in chronic kidney disease (CKD) and is commonly treated with recombinant human erythropoietin. The aim of this study was to analyze the efficacy of epoetin alfa and darbepoetin alfa on left ventricular parameters in patients with CKD.

METHODS

Patients with CKD not yet dependent on dialysis were randomly assigned to treatment with epoetin alfa at weekly intervals (Epo group; baseline hemoglobin 8.5 +/- 0.8 mg/dL, creatinine clearance 10.0 +/- 2.0 ml/min per 1.73 m2) or darbepoetin alfa every 2 weeks (Dar group; baseline hemoglobin 8.2 +/- 0.8 mg/dL, creatinine clearance 10.8 +/- 2.4 ml/min per 1.73 m2). Patients not receiving erythropoietin served as a control group. Two-dimensional color Doppler echocardiography was performed at baseline and at 24 weeks to measure left ventricular mass index (LVMI) and ejection fraction.

RESULTS

Hemoglobin in the 2 treatment arms was corrected to 10.6 +/- 0.6 mg/dL and 10.7 +/- 0.5 mg/dL for Epo and Dar groups, respectively. The LVMI decreased significantly in both the Epo (-5.7 +/- 14.2 g/m2) and the Dar group (-5.6 +/- 15.8 g/m2) but increased in the control group (9.0 +/- 15.1 g/m2; p=0.02, between the Epo and control groups, and between the Dar and control groups). The ejection fraction was increased in both treatment groups (Epo group: 2.45% +/- 2.28%, Dar group: 1.64% +/- 2.95%) and decreased in controls (-1.15% +/- 3.69%) (p=0.004 among groups). The 2 treatment groups showed similar efficacy. The degree and the change of renal function did not differ among the 3 groups at end of study.

CONCLUSIONS

The 2 erythropoiesis-stimulating agents epoetin alfa and darbepoetin alfa, when given to patients with CKD in doses aimed at standard anemia correction are associated with a similar degree of LVMI reduction, in the absence of a concomitant enhancement of CKD progression.

Application of biofiltration system on AOC removal: column and field studies

The Cheng-Ching Lake Water Treatment Plant (CCLWTP) is the main supplier of domestic water for the Greater Kaohsiung area, the second largest metropolis in Taiwan. Biological activated carbon (BAC) filtration is one of the major treatment processes in CCLWTP. The objectives of this study were to evaluate the effectiveness of BAC filtration on water treatment in the studied advanced water treatment plant and its capability on pollutants [e.g., AOC (assimilable organic carbon), bromide, bromate, iron] removal. In this study, water samples from each treatment process of CCLWTP were collected and analyzed periodically to assess the variations in concentrations of AOC and other water quality indicators after each treatment unit. Moreover, the efficiency of biofiltration process using granular activated carbon (GAC) and anthracite as the fillers was also evaluated through a column experiment. Results show that the removal efficiencies for AOC, bromide, bromate, and iron are 86% 100%, 17%, and 30% after the BAC filter bed, respectively. This indicates that BAC filtration plays an important role in pollutant removal. Results also show that AOC concentrations in raw water and effluent of the CCLWTP are approximately 143 and 16 microg acetate-Cl(-1), respectively. This reveals that the treatment processes applied in CCLWTP is able to remove AOC effectively. Results of column study show that the AOC removal efficiencies in the GAC and anthracite columns are 60% and 17%, respectively. Microbial colonization on GAC and anthracite were detected via the observation of scanning electron microscopic images. The observed microorganisms included bacteria (rods, cocci, and filamentous bacteria), fungi, and protozoa. Results from this study provide us insight into the mechanisms of AOC removal by advanced water treatment processes. These findings would be helpful in designing a modified water treatment system for AOC removal and water quality improvement.

Interpopulation and intrapopulation maternal lineage genetics of the Lanyu pig (Sus scrofa) by analysis of mitochondrial cytochrome b and control region sequences

The Lanyu pig is an indigenous breed from the Lanyu Islet, which is southeast of Taiwan. Two herds of Lanyu pigs were introduced from the Lanyu Islet into Taiwan in 1975 and 1980. The current population of conserved Lanyu pigs consists of only 44 animals with unknown genetic lineage. The Lanyu pig possesses a distinct maternal genetic lineage remote from Asian and European pigs. The present study aimed to understand the phylogenetic relationship among conserved Lanyu, Asian, and European type pigs based on the cytochrome b coding gene, to ascertain the maternal lineage and genetic diversity within the conserved Lanyu pigs, and to address whether genetic introgression from exotic or Formosan wild pigs had occurred in the conserved Lanyu pigs. Entire mitochondrial genomes of both types of Lanyu pig comprised 2 ribosomal RNA, 22 transfer RNA, and 13 protein-coding genes. Only 2 haplotypes of the mitochondrial DNA (mtDNA) control region and cytochrome b were identified in the conserved Lanyu pig herds. When maximum likelihood trees were constructed, the Type I Lanyu mitochondrial genes formed a unique clade with a large pairwise distance of both cytochrome b and the control region from Asian and European type breeds, Formosan wild pigs, and exotic breeds. Significant loss of genetic diversity of mtDNA within the conserved Lanyu pigs was demonstrated by low haplotype and nucleotide diversities, supported by Fu and Li's D* neutrality test (1.44055; P < 0.05). The mtDNA control region sequences of extant pigs in the Lanyu Islet, however, showed high haplotype and nucleotide diversity, and clustered with exotic pigs. These results indicate no maternal lineage mtD-NA gene introgression from Formosan wild pigs and introduced exotic pigs to conserved Type I Lanyu pigs, and a severe loss of heterozygosity of mtDNA in conserved Lanyu pigs. The remaining extant pigs on the Lanyu Islet have been introgressed with exotic breeds. Strategies for future conservation of native Lanyu pigs are now even more urgent and important.

The type I Lanyu pig has a maternal genetic lineage distinct from Asian and European pigs

The Lanyu pig is an indigenous breed from Lanyu Islet, located south-east of Taiwan, with phenotypic characteristics distinctive from other pig breeds in Asia and Europe. Based on geographic considerations, the Lanyu pig may have originated from mainland China, Austronesia or the Ryukyu Islands. In the present study, polymorphism of the mitochondrial DNA control region sequence was used to clarify phylogenetic relationships among two herds of Lanyu pigs imported before 1980 from Lanyu Islet into Taiwan and reared in isolation on two different farms. Two distinct mitochondrial control region haplotypes were found. The type I Lanyu sequence appeared independently as a unique clade different from Asian and European pig sequences, while the type II Lanyu sequence was clustered within the major Asian clade. The pairwise distances between the major Asian clade vs. the type I Lanyu and European clades were 0.01726 +/- 0.00275 and 0.01975 +/- 0.00212 changes per site respectively. Estimates of divergence time suggest that the type I Lanyu sequence split from the major Asian pig clade in prehistoric times. The type II Lanyu mtDNA shares a close genetic lineage with Japanese Satsuma and New Zealand Kune Kune mtDNA with pairwise distances of 0.00095 +/- 0.00000 and 0.00192 +/- 0.00000 respectively, indicating gene flow between Lanyu Islet, Japan and Oceania in recent times. Together these results indicate that the type I Lanyu pig has a genetic lineage separate from Asian-type pigs, while the type II Lanyu sequence may represent a more recent introgression of modern Asian pigs.

Observation of locomotor functional recovery in adult complete spinal rats with BWSTT using semiquantitative and qualitative methods

STUDY DESIGN

Experimental rat model of spinal cord transection .

SETTING

China rehabilitation research center.

OBJECTIVE

To investigate locomotor functional recovery in spinal rats with BWSTT using semiquantitative and qualitative methods.

METHODS

Five-day postoperative (dpo), adult female complete spinal rats (at T(8) level) received 40 days of body weight-supported treadmill training (BWSTT). Signs of functional recovery were examined with average combined scores (ACOS) and Basso Beattie and Bresnahan (BBB) scales at different time points.

RESULTS

At 1-dpo, none of the spinal rats exhibited hindlimb movements. The spinal rats displayed functional progress with time, but the rare could recover to full weight-bearing hindlimb at 45-dpo. BBB and ACOS scores in the BWSTT group obtained better scores than those in the spinal cord injury (SCI) group at 30- and 45-dpo. Furthermore, all BBB and ACOS scores of spinal rats reached statistical significance between 7- and 30-dpo, and between 15- and 30-dpo. However, only ACOS but not BBB scores in the SCI and BWSTT groups showed statistics differences between 15- and 45-dpo, and between 30- and 45-dpo. The Spearman correlation coefficients of BBB and ACOS scores were 0.913 and 0.972 for the SCI and BWSTT groups, respectively.

CONCLUSIONS

The results confirmed the existence of partial spontaneous hindlimb functional recovery in adult chronically spinal cord-transected rats, and that BWSTT can improve motor performance. In addition, our study suggests that qualitative and semiquantiative methods are strongly correlated with locomotor recovery in spinal rats, and the latter may be more sensitive in reflecting minor variance at different time points.

Expression of 2',3'-cyclic nucleotide 3'-phosphodiesterase in the amoeboid microglial cells in the developing rat brain

Expression of 2',3'-cyclic nucleotide 3'-phosphodiesterase (CNPase) in amoeboid microglial cells (AMC) in developing rat brain from prenatal day 18 (E18) to postnatal day 10 (P10) was demonstrated by immunohistochemistry/immunofluorescence and immunoelectron microscopy both in vivo and in vitro, respectively. Furthermore, real time-polymerase chain reaction (PCR) was performed to determine the expression of CNPase at mRNA level in cultured microglial cells in control conditions and following lipopolysaccharide stimulation. CNPase immunoreactive amoeboid microglia occurred in large numbers in the corpus callosum, subventricular zone and cavum septum pellucidum at P0 but were progressively reduced with age and were undetectable at P14. By immunoelectron microscopy, immunoreaction product was associated primarily with the plasma membrane, filopodial projections and mitochondria in AMC. Real time-PCR analysis revealed that CNPase mRNA was expressed by cultured amoeboid microglia and was significantly up-regulated in microglial activation induced in vitro by lipopolysaccharide. The functional role of CNPase in AMC remains speculative. Given its expression in AMC transiently occurring in the perinatal brain and that it is markedly elevated in activated microglia, it is suggested that the enzyme may be linked to the major functions of the cell type such as release of chemokines and cytokines. In relation to this, CNPase may play a key role associated with transportation of cytoplasmic materials.

Orbital susceptibilities of PbSe quantum dots

Different sizes of three-dimensional PbSe quantum dots have been synthesized for the study of orbital magnetic susceptibilities. Two types of orbital susceptibilities have been found, including the Curie susceptibility and finite-size corrections to the Landau susceptibility. The Curie term of a quantum dot manifests itself in the temperature dependence of magnetic susceptibility at low temperatures, while the field dependence of differential susceptibility at high temperatures shows finite-size corrections to the Landau susceptibility. Both of the two kinds of orbital susceptibility, estimated per quantum dot, show linear dependence on the size.

Breakdown of K selection in 178Hf

Coulomb activation of the four quasiparticle Kpi=16+ 178Hf isomer (t1/2=31 y) has led to the measurement of a set of Elamda matrix elements coupling the isomer band to the ground band. The present data combined with earlier 178 Hf Coulomb excitation data have probed the components in the wave functions and revealed the onset and saturation of K mixing in low-K bands, whereas the mixing is negligible in the high-K bands. The implications can be applied to other quadrupole-deformed nuclei.

Boosting nitrification by membrane-attached biofilm

Nitrification is a key step for reliable biological nitrogen removal. In order to enhance nitrification in the activated sludge (AS) process, membrane-attached biofilm (MAB) was incorporated in a conventional activated sludge tank. Simultaneous organic carbon removal and nitrification of the MAB incorporated activated sludge (AS + MAB) process was investigated with continuous wastewater treatment. The effluent TOC concentration of AS and the AS + MAB processes were about 6.3 mg/L and 7.9 mg/L, respectively. The TOC removal efficiency of both AS and AS + MAB were above 95% during the wastewater treatment, indicating excellent organic carbon removal performance in both processes. Little nitrification occurred in the AS process. On the contrary, successful nitrification was obtained with the AS + MAB process with nitrification efficiency of about 90%. The volumetric and surface nitrification rates were about 0.14 g/Ld and 6.5 g/m2d, respectively. The results clearly demonstrated that nitrification in the conventional AS process was boosted by MAB. Furthermore, the microfaunal population in the AS + MAB process was different from that in the AS process. The high concentration of rotifers in the AS + MAB process was expected to decrease the generation of excess sludge in the process.

Prolonged fever and pyuria: a urinary tract infection presentation of incomplete Kawasaki disease

We report two patients with incomplete Kawasaki disease that presented as apparent urinary tract infection. Persistent fever and pyuria were the initial presentation without concomitant signs suggestive of Kawasaki disease; thus the patients were treated as urinary tract infection. Fever persisted despite antibiotic treatment. Diagnostic criteria of Kawasaki disease were not fulfilled for these two patients, yet aneurysmal dilatation of the coronary artery was noted 10 and 18 d, respectively, after the onset of fever. The diagnosis of incomplete Kawasaki disease was assigned when the coronary artery abnormality was detected. Fever subsided within 24 h of administration of intravenous immunoglobulin.

CONCLUSION

This report highlights the potentially misleading presentation of fever and pyuria as the sole initial manifestation of incomplete Kawasaki disease. Echocardiography is indicated to detect coronary artery abnormality when fever persists in such patients after adequate antibiotic treatment and thorough urological evaluation.

Unmasking the dynamic interplay between efflux transporters and metabolic enzymes

Drug efflux by intestinal P-glycoprotein (P-gp) is known to decrease the bioavailability of many CYP3A4 substrates. We have demonstrated that the interplay between P-gp and CYP3A4 at the apical intestinal membrane can increase the opportunity for drug metabolism by determining bidirectional extraction ratios across CYP3A4-transfected Caco-2 cells for two dual P-gp/CYP3A4 substrates, K77 (an experimental cysteine protease inhibitor) and sirolimus, as well as two negative control, CYP3A4 only substrates, midazolam and felodipine. Studies were carried out under control conditions, with a P-gp inhibitor (GG918) and with a dual inhibitor (cyclosporine). Measurement of intracellular concentration changes is an important component in calculating the extraction ratios. We hypothesize that the inverse orientation of P-gp and CYP3A4 in the liver will result in an opposite interactive effect in that organ. In vivo rat intestinal perfusion studies with K77 and rat liver perfusion studies with tacrolimus under control conditions and with inhibitors of CYP3A4 (troleandomycin), P-gp (GG918) and both CYP3A4/P-gp (cyclosporine) lend support to our hypotheses. These results serve as a template for predicting enzyme-transporter (both absorptive and efflux) interactions in the intestine and the liver.

Transporter-Enzyme Interactions: Implications for Predicting Drug-Drug Interactions from In Vitro Data

As discussed in earlier articles, predictions of in vivo drug-drug interactions from in vitro studies is a subject of high interest with obvious therapeutic as well as economic benefits. Up until now little attention has been given to the potential interplay between metabolic enzymes and transporters that could confound the in vivo-in vitro relationships. Drug efflux by intestinal P-glycoprotein (P-gp) is known to decrease the bioavailability of many CYP3A4 substrates. We have demonstrated that the interplay between P-gp and CYP3A4 at the apical intestinal membrane can increase the opportunity for drug metabolism by determining bidirectional extraction ratios across CYP3A4 transfected Caco-2 cells for two dual P-gp/CYP3A4 substrates, K77 (an experimental cysteine protease inhibitor) and sirolimus, as well as two negative control, CYP3A4 only substrates, midazolam and felodipine. Studies were carried out under control conditions, with a P-gp inhibitor (GG918) and with a dual inhibitor (cyclosporine). Measurement of intracellular concentration changes is an important component in calculating the extraction ratios. We hypothesize that the inverse orientation of P-gp and CYP3A4 in the liver will result in an opposite interactive effect in that organ. In vivo rat intestinal perfusion studies with K77 and rat liver perfusion studies with tacrolimus under control conditions and with inhibitors of CYP3A4 (troleandomycin), P-gp (GG918) and both CYP3A4/P-gp (cyclosporine) lend support to our hypotheses. These results serve as a template for predicting enzyme- transporter (both absorptive and efflux) interactions in the intestine and the liver.

Different enzyme activities of sialyltransferases in gynecological cancer cell lines

PURPOSE

Due to rarity of a relationship between sialyltransferase enzyme activities and gynecological cancers, we arranged the study to evaluate sialyltransferase enzyme activity in the various kinds of gynecological cancer cell lines.

METHODS

Ten cell lines from various kinds of gynecological cancers and two cell lines from normal tissue were enrolled in this study. The activities of each subtype of sialyltransferases were detected using Gal beta1,3GalNAc-acetyl-lactosamine)-Obz1 (acceptor for ST2,3Gal I), Gal beta1,3GlcNAc beta1,3Gal beta1,4GlcNAc (acceptor for ST2,3Gal III), Gal beta1,4GlcNAc (acceptor for ST2,3Gal IV), asialo-bovine submaxillary mucin (acceptor for ST2,6GalNAc I), asialo-fetuin (acceptor for STalpha2,6GalNAc II), and fetuin (acceptor for ST2,6GalNAc III), respectively. The amounts of sialic acids were measured using fluorescein-conjugated Sambucus nigra agglutinin (SNA) specific for alpha2,6-sialic acids and fluorescein-conjugated Maackia Amurensis agglutinin (MAA) specific for alpha2,3-sialic acids.

RESULTS

The activities of two sialyltransferase subtypes, ST3Gal I & ST6GalNAc II, were significantly higher in nearly all cell lines. More specifically, cervical cancer cell line-ME 180, ovarian cancer cell line-ES-2, and choriocarcinoma cell line-BeWo showed high levels of ST3Gal I enzyme activity; all gynecological cancer cell lines except endometrial cancer cell line-RL95-2 had high levels of ST6GalNAc II enzyme activity when compared with a normal control cell line--fibroblast cell line (CCD-966Sk). Cell lines tested in this study have diverse levels of surface alpha2,6-sialic acid sugar chains (enhanced SNA binding) when compared with alpha2,3-sialic acid sugar chains (enhanced MAA binding) but we found that some cell lines such as Ca Ski (cervical cancer cell line), CC7T (cervical cancer cell line), PA-I (ovarian cancer cell line), and BeWo showed significantly altered cell surface alpha2,6-sialic acid sugar chains.

CONCLUSION

Increasing enzyme activity of ST3Gal I and ST6GalNAc II might be important in various kinds of gynecological cancers. More specifically, enhanced activity of sialyltransferases involving alpha2,6-sialic acid sugar chains might be more important in cancer development. Future studies will investigate whether the enzyme activity of these sialyltransferases can be helpful for clinical practice.

Coulomb excitation paths of high-K isomer bands in 178Hf

Three distinctly different mechanisms are shown to populate the K(pi)=6(+) (t(1/2)=77 ns), 16(+) (31 yr), and 8(-) (4 s) isomer bands of 178Hf by Coulomb excitation. High spin states of the three isomer bands were populated by Coulomb excitation of a hafnium target with a 650 MeV 136Xe beam. Although direct population of high-K bands is highly K-forbidden, isomer bands in 178Hf were populated up to spins 13(+)(K=6), 20(+)(K=16), and 14(-)(K=8) with in-band gamma yields of approximately 10(-4) of the ground state band. The data are consistent with a rapid increase in K mixing with increasing spin in the isomer bands.

Severe pulmonary hemorrhage as the initial manifestation in systemic lupus erythematosus with active nephritis

Pulmonary hemorrhage (PH) is an uncommon clinical manifestation of patients with systemic lupus erythematosus (SLE). In this report, we describe a 14-year-old male with PH as the sole clinical manifestation of his SLE. Kidney biopsy was performed and the report revealed lupus nephritis class IVb. He demonstrated a rapid clinical response to the therapy of intravenous pulse methylprednisolone. Awareness of the possibility of PH as a sole clinical presentation of SLE may aid in the diagnosis and early aggressive management of this condition.

Effect of electrical stimulation on acupuncture points in diabetic patients with gastric dysrhythmia: a pilot study

BACKGROUND/AIMS

Abnormal gastric slow-wave frequencies have been observed in diabetic gastroparesis and are associated with impaired antral motor activity. In this study, we aimed at evaluating the effect of acupuncture on gastric slow waves in diabetic patients with symptoms suggesting gastric motor dysfunction.

METHODS

Fifteen patients with type II diabetes who had had dyspeptic symptoms for more than 3 months were enrolled. Two acupuncture needles were inserted into the subjects' legs at the Zusanli points, and electrical stimulation (2-Hz pulses) was delivered for 30 min. Cutaneous electrogastrography was performed for 30 min at baseline, for 30 min during acupuncture, and for an additional 30 min after acupuncture. Serum gastrin, motilin, and human pancreatic polypeptide levels were also measured.

RESULTS

There was a significant increase in the percentages of normal frequency during and after acupuncture (baseline vs. acupuncture and after acupuncture 21.99 +/- 19.38% vs. 45.93 +/- 19.72 and 48.92 +/- 19.56%; p < 0.01). In addition, the percentage of tachygastric frequency was decreased significantly during and after acupuncture. The dominant frequency was also changed significantly. There was an increase of serum human pancreatic polypeptide during acupuncture (baseline vs. acupuncture 56.96 +/- 27.64 vs. 73.11 +/- 22.37 pmol/l; p < 0.05).

CONCLUSIONS

The results of this study revealed that electrical stimulation at the Zusanli points could increase the percentage of normal electrogastrography frequency and decrease the percentage of tachygastric frequency in diabetic patients. The data indicate that acupuncture may enhance the regularity of gastric myoelectrical activity in diabetic patients.

Fish allergy in atopic children

The prevalence of fish allergy among 11 atopic children with elevated levels of specific immunoglobulin (Ig) E for cod was determined. None of the children had a history of fish allergy. All of the children had asthma and allergic rhinitis and 5 of them had also atopic dermatitis. The children underwent allergy skin tests (codfish, tuna, catfish, salmon, flounder, and bass), specific IgE tests (salmon, trout, tuna, eel, and mackerel), and food challenge tests. Skin tests in cod-specific IgE-positive children were positive for codfish in 4 children, tuna in 2, catfish in 2, salmon in 6, flounder in one, and bass in 2. Three children had elevated specific IgE for salmon, 5 for trout, 8 for tuna, 4 for eel, and 4 for mackerel. Oral fish challenge with 10 g of fish did not result in positive reaction in any of the children. In conclusion, a positive food challenge test provided the only definitive confirmation of fish allergy, whereas positive allergy skin tests or positive specific IgE tests were less reliable. Skin tests and in vitro specific IgE assays were not correlated with clinical symptoms of fish allergy, and the results of these 2 tests did not correlate with each other in this study.

Anesthetic management of a patient with relapsing polychondritis--a case report

Relapsing polychondritis is a rare multisystem disorder of uncertain etiology. It is characterized by recurrent and progressive destruction of both elastic and hyaline cartilages as well as connective tissue. Respiratory tract involvement is associated with high mortality and morbidity. General anesthesia may be required in these patients for tracheostomy, bronchoscopy, nasal reconstruction, aortic valve replacement, and recent tracheobronchial stenting which they usually sustain. Tracheostomy was once the most likely surgical procedure in relapsing polychondritis. However, this procedure is only effective in patients with upper subglottic involvement. In cases of extensive tracheobronchial involvement, tracheostomy is ineffective because the distant tracheal collapse below the tracheostomy is still unresolved. We would like to report a case of relapsing polychondritis with tracheobronchial involvement, who underwent an emergent tracheostomy. Tracheostomy with continuous positive airway pressure (CPAP) effectively improved her airway collapse. Herein, we also discuss the anesthetic management after review of the current literature.

Desorption of dye from activated carbon beds: effects of temperature, pH, and alcohol

The adsorption isotherms of yellow and red dye solutions onto granular activated carbon at varying solution pHs (2-8). temperatures (15-50 degrees C), and alcohol concentrations (0-20%) were experimentally determined by batch tests and the Tóth model was found to best fit the adsorption isotherm data for varying solution pHs. temperatures, and alcohol concentrations. The maximum adsorption capacity was found to decrease with increasing solution pH and alcohol concentration and could be predicted by the correlation equations obtained in this study. A correlation equation was also obtained to account for the effects of solution temperature on the adsorption equilibrium constant. The 25 degrees C water was found to be a very poor regenerant for the carbon bed presaturated with the yellow dye compared with 20% alcohol solution. A simple equation was derived, based on non-linear wave propagation theory, to predict the desorption curves of activated carbon bed. Given presaturation concentration, bed density and void fraction, and adsorption isotherm, the wave propagation theory predicted the desorption curves quite satisfactorily.

Preparing a human membrane and secreted protein-enriched cDNA library using PCR primers derived from a genomic database

We describe here a strategy for preparing a human membrane and secreted protein (MSP)-enriched cDNA library based on human MSP- and non-MSP-encoding cDNA sequences in the databases. The signal peptide parts of the MSP-encoding cDNA sequences, which currently comprise about half of the estimated total number in humans, were analyzed for common patterns. These patterns form a 'minimal' set of polymerase chain reaction primer candidates of length varying from 9 to 21 nt. The products stemming from each primer candidate were determined and the results allowed us to obtain an 'optimal' mixed-length primer set. Ninety-six percent of the primers in this set were predicted to yield </=10% undesired products, and the desired MSP-cDNA products could be easily separated by gel electrophoresis. The present analysis establishes a methodology for preparing a cDNA library that enables the analysis of individual MSPs. This methodology may also help identify new MSPs. As many cell regulatory processes are mediated by secreted proteins and their membrane-bound receptors, the preparation of a MSP-enriched cDNA library should benefit research on MSPs.

Inadvertent hypothermia causes pulseless electrical activity in a patient during cervical spine surgery--a case report

Recent studies have shown that hypothermia triples the incidence of major cardiac events. We present a happening in which a 71-year-old patient developed pulseless electrical activity (PEA) while he was undergoing cervical laminectomy for spinal stenosis in the sitting position. Thromboembolism or venous air embolism and acute myocardial infarction were respectively excluded by transesophageal echocardiography and cardiac enzymes analysis to be the causes of the cardiac event. The abnormal finding that stood out was low nasopharyngeal temperature (31 degrees C) during the procedure, which was thought to contribute to the development of the PEA episode.

Non-Hodgkin's orbital lymphoma

BACKGROUND

The non-Hodgkin's lymphomas (NHL) are a group of neoplasms characterized by proliferation of malignant lymphocytes. Patients with NHL have a wide variety of presenting signs and symptoms, depending largely on the site of involvement and aggressiveness of the disease. Many organs in the body may be affected, including the eye and orbit.

CASE REPORT

A 47-year-old male with a 3-year history of stage IV non-Hodgkin's lymphoma who had undergone recent monoclonal antibody therapy presented with a complaint of blur in the left eye with occasional diplopia. Significant ocular findings of the left eye included ptosis, mild proptosis, increased intraocular pressure, and choroidal folds. Magnetic resonance imaging of the orbit revealed an orbital lymphoma that completely resolved after 2400 rads of external beam irradiation therapy. Eight months later, the patient developed a secondary radiation retinopathy.

CONCLUSION

The prevalence of NHL is on the rise, and orbital involvement may occur at any time during the course of the disease. The standard treatment for non-Hodgkin's orbital lymphoma is external beam irradiation therapy, although the optimal dose for obtaining local tumor control without complications remains to be determined. Non-Hodgkin's lymphoma, orbital lymphoma, and various treatment options are discussed.

Childhood serum sickness: a case report

Childhood serum sickness is a rare allergic disease that follows the administration of a foreign antigenic material, most commonly caused by injecting a protein or haptenic drug. The disease is a type III hypersensitivity reaction mediated by deposits of circulating immune complexes in small vessels, which leads to complement activation and subsequent inflammation. The clinical features are fever, cutaneous eruptions, lymphadenopathy, arthralgias, albuminuria, and nephritis. Serum sickness is an acute self-limited disease. We report a 3-year-old child who presented with fever and a rash; an invasive bacterial infection was strongly suspected. He was therefore given penicillin and gentamicin and responded well. At day 4 after admission, he developed a serum sickness reaction and showed symptoms of arthralgias, generalized edema, purpura, and gross hematuria. The white blood cell count was 12 190/mm3 with 7% eosinophils. Urinalysis revealed red blood cell above 100 per high power field, white blood cell 10 to 15 per high power field, and proteinuria. The antibiotics were discontinued and hydrocortisone (20 mg/kg/d), diphenhydramine HCl (4 mg/kg/d), aspirin (66 mg/kg/d) was administered, plus 1 dose of epinephrine (0.01 mL/kg) administered intramuscularly. On day 7, the 3rd day after withholding antibiotics, his condition dramatically improved. The clinical symptoms resolved progressively and his urinalysis returned to normal.