Diffusion tensor imaging in children with periventricular leukomalacia: variability of injuries to white matter tracts

BACKGROUND AND PURPOSE

Conventional MR imaging shows evidence of brain injury and/or maldevelopment in 70%-90% of children with cerebral palsy (CP), though its capability to identify specific white matter tract injury is limited. The great variability of white matter lesions in CP already demonstrated by postmortem studies is thought to be one of the reasons why response to treatment is so variable. Our hypothesis is that diffusion tensor imaging (DTI) is a suitable technique to provide in vivo characterization of specific white matter tract lesions in children with CP associated with periventricular leukomalacia (PVL).

MATERIALS AND METHODS

In this study, 24 children with CP associated with PVL and 35 healthy controls were evaluated with DTI. Criteria for identification of 26 white matter tracts on the basis of 2D DTI color-coded maps were established, and a qualitative scoring system, based on visual inspection of the tracts in comparison with age-matched controls, was used to grade the severity of abnormalities. An ordinal grading system (0=normal, 1=abnormal, 2=severely abnormal or absent) was used to score each white matter tract.

RESULTS

There was marked variability in white matter injury pattern in patients with PVL, with the most frequent injury to the retrolenticular part of the internal capsule, posterior thalamic radiation, superior corona radiata, and commissural fibers.

CONCLUSION

DTI is a suitable technique for in vivo assessment of specific white matter lesions in patients with PVL and, thus, a potentially valuable diagnostic tool. The tract-specific evaluation revealed a family of tracts that are highly susceptible in PVL, important information that can potentially be used to tailor treatment options in the future.

Treatment of wastewater containing acid rose red dye by biologically aerated filter after chemical oxidation

Combined processes of pre-chemical oxidation and biological aerated filter (BAF) were used to treat wastewater containing non-biodegradable acid rose red dye. Advance oxidation processes (AOPs) of ozone and Fenton reagent were applied for pre-chemical oxidation, which reduced the degree of color and organic matter simultaneously increasing the biodegradability of the wastewater. The majority of the organic matter was removed by BAF. When using ozone as pre-chemical oxidation, the operation is simpler. The combined processes of AOPs, including ozone and Fenton reagent, followed by BAF reduced the color and chemical oxygen demand (COD) to less than 20 degrees and 40 mg l(-1), respectively from the influent concentration of about 4000 degree color and 300 mg l(-1) COD. The effluent water quality could meet the required standard for grey water reuses.

Cotrimoxazole for prophylaxis or treatment of opportunistic infections of HIV/AIDS in patients with previous history of hypersensitivity to cotrimoxazole

BACKGROUND

Opportunistic infections continue to cause a significant amount of morbidity and mortality worldwide in patients infected with HIV. Trimethoprim-sulfamethoxazole (cotrimoxazole) is used in the treatment and prophylaxis of several opportunistic infections. In patients with HIV/AIDS, cotrimoxazole use can cause a higher rate of adverse drug reactions than in the general population. Given the cost-effectiveness of cotrimoxazole, the management of these adverse reactions has included continuing the drug (treating-through) and reintroducing the drug at a later date, either using dose-escalation (desensitization), or rechallenge at full dose. This systematic review is the first to examine the differences in patient outcomes between these strategies.

OBJECTIVES

To compare the rate of discontinuation of cotrimoxazole and adverse reactions among the three strategies of treating-through, desensitization, and rechallenge in patients living with HIV who previously had an adverse reaction to cotrimoxazole.

SEARCH STRATEGY

We searched MEDLINE, EMBASE, LILACS, The Cochrane Library, Meeting Abstracts, AIDSTRIALS, ACTIS, Current Controlled Trials, The National Institutes of Health Clinical Trials Registry, and CenterWatch (search date May 2006).

SELECTION CRITERIA

Randomised trials comparing treating-through, rechallenge, or desensitization of cotrimoxazole treatment or prophylaxis in adults (age 18 years or over) and/or children (age 17 years or under).

DATA COLLECTION AND ANALYSIS

Two reviewers independently assessed trial eligibility and quality, and extracted data. Where data were incomplete or unclear, a third reviewer resolved conflicts and/or trial authors were contacted for further details.

MAIN RESULTS

Three trials that examined cotrimoxazole prophylaxis and involving 268 adults were included. Meta-analysis of these studies found a beneficial effect of using a desensitization protocol over a rechallenge protocol at six months of follow-up for preventing discontinuation of cotrimoxazole (number needed to treat (NNT) 7.14, 95% confidence interval (CI) 4.0-33.0), and for lower incidence of overall hypersensitivity (NNT 4.55, 95% CI 3.03-9.09). No severe hypersensitivity reactions occurred for either protocol in the three studies.

AUTHORS' CONCLUSIONS

In the small trials included in this review, when compared to cotrimoxazole rechallenge for prophylaxis of opportunistic infections, cotrimoxazole desensitization resulted in fewer treatment discontinuations and overall adverse reactions in HIV-infected patients with a previous history of mild or moderate hypersensitivity to cotrimoxazole. Paediatric data and trials in resource-poor settings are urgently required. Further randomised controlled trials are also needed for the treatment of opportunistic infections, treating-through, adjunctive medications, and different desensitization-dosing schedules.

Interventions for the treatment of decreased bone mineral density associated with HIV infection

BACKGROUND

Decreased bone mineral density (BMD) occurs more commonly in patients with HIV than in the general population, making this group more susceptible to fragility fractures. However, bone loss is under-treated in patients with HIV.

OBJECTIVES

To assess the effects of interventions aimed at increasing bone mineral density in HIV-infected adults.

SEARCH STRATEGY

We searched MEDLINE, EMBASE, LILACS, The Cochrane Library, Meeting Abstracts, AIDSTRIALS, ACTIS, Current Controlled Trials, National Institutes of Health Clinical Trials Registry, and CenterWatch (search date July 2006).

SELECTION CRITERIA

Randomised trials comparing any pharmacological or non-pharmacological therapy with placebo, no treatment, or an alternative therapy, with the goal of increasing bone mineral density in adult (age 18 years or over) patients with HIV.

DATA COLLECTION AND ANALYSIS

Two reviewers independently assessed trial eligibility and quality, and extracted data. Where data were incomplete or unclear, conflicts were resolved with discussion and/or trial authors were contacted for further details.

MAIN RESULTS

Three completed randomised-controlled studies examined the role of alendronate in patients with HIV and osteopenia or osteoporosis. When all three studies were combined, much heterogeneity was seen (p<0.0001), most likely due to different populations and interventions. A sensitivity analysis showed that in two studies without heterogeneity (p=0.11), alendronate, calcium and vitamin D improved lumbar BMD after one year when compared with calcium and vitamin D (weighted mean difference +2.65 95% confidence interval (CI) 0.80, 4.51 percent). However the alendronate group did not have less fragility fractures, relative risk (RR) 1.28 (95% CI 0.20, 8.21), or osteoporosis, RR 0.50 (95% CI 0.24, 1.01). Adverse events were not significantly different between groups, RR 1.28 (95% 0.20, 8.21). One randomised-controlled study done in patients with AIDS wasting found that after three months, testosterone enanthane improved lumbar BMD compared to placebo by +3.70 (95% CI 0.48, 6.92) percent, but progressive resistance training did not improve lumbar BMD (+0.40 95% CI -2.81, 3.61 percent). No group in this study had any adverse effects.

AUTHORS' CONCLUSIONS

The very limited data reviewed showed that bisphosphonate therapy andin those with AIDS wasting syndrome, testosteronemay be safe and possibly effective methods to improve bone mineral density in HIV patients. The available studies are small, of short duration, and not powered to detect changes in WHO categories and fracture rates. Larger studies using bisphosphonates are currently underway. The role of colecalciferol, androgen replacement in women, and growth hormone are also under investigation.

HIV-related knowledge, stigma, and willingness to disclose: A mediation analysis

Increasing HIV knowledge is a focus of many HIV education and prevention efforts. While the bivariate relationship of HIV serostatus disclosure with HIV-related knowledge and stigma has been reported in the literature, little is known about the mediation effect of stigma on the relationship of HIV knowledge with HIV serostatus disclosure. Data from 4,208 rural-to-urban migrants in China were analyzed to explore this issue. Overall, 70% of respondents reported willingness to disclose their HIV status if they were HIV-positive. Willingness to disclose was negatively associated with misconceptions about HIV transmission and stigma. Stigma mediated the relationship between misconceptions and willingness to disclose among women but not men. The mediation effect of stigma suggests that stigmatization reduction would be an important component of HIV prevention approaches. Gender inequality needs to be addressed in stigmatization reduction efforts.

Diethylstilbestrol and docetaxel: A phase II study in patients with metastatic, androgen independent prostate cancer

4627

Background: The combination of diethylstilbestrol (DES) and docetaxel has additive to synergistic activity against prostate cancer in preclinical models and DES inhibits expression of taxane resistant tubulin isoforms. The objective of this study is to determine the effects of the combination of DES and docetaxel on PSA, overall response, and toxicity. Methods: Twenty nine patients with metastatic androgen independent prostate cancer progressing by rising PSA or scan were treated with DES 5 mg daily the day prior to docetaxel and 1 mg daily continuously in combination with Docetaxel 36mg/m2 IV weekly for 3 weeks of a 4 week cycle. Prophylactic anticoagulation was used in all patients. All patients were assessed by PSA monthly and CT or bone scans every 3 cycles. Dose modifications for hematologic, hepatic and renal toxicity were made. The RECIST criteria and PSA decline by >50% which was maintained for 4 weeks were used. Results: The median age is 69 years (56–84), SWOG PS 0 (0–1), alkaline phosphatase 120 U/L (45–523), Hgb 12.6 g/dL (9.2–16.3), PSA 67 ng/dL (6–1962). The median number of cycles is 5. The median follow up after completion of therapy is 6 mos (1–18). Soft tissue metastases were present in 46% of patients and bone metastases in 96%. Twenty four patients are evaluable for response and toxicity. Of these, 18 patients (75%) had PSA responses and the PSA declined by >90% in 9 patients (38%). The overall response for was 75%. 11 patients suffered grade 3/4 toxicity. Two patients died of causes unrelated to therapy and another died from a steroid induced ulcer. The median number of cycles for responding patients is 9. Two patients developed thrombosis and were positive for Factor V mutations. Conclusions: The combination of DES and docetaxel is well tolerated and toxicity is indistinguishable from docetaxel alone. The overall response rate was 75%, with approximately half of responding patients achieving a PSA < 4.0, suggesting that DES improves the therapeutic index of docetaxel substantially and is an effective regimen using easily administered drugs. (Supported by Sanofi Aventis).

[Table: see text]

Excellent survival of pediatric dermatofibrosarcoma protuberans in Taiwanese

19512

Background: Pedicatric dermatofibrosarcoma protuberans (PDFSP) was a rare disease. We reported our institutional experience with PDFSP treated from 1977–2002. Methods: Twelve patients with PDFSP diagnosed before age 18 years were treated in our institute from 1977–2002 according to institutional cancer registry. After approved by institutional research ethic committee (ClinicalTrials.gov Identifier: NCT00173355 ), active patient contact and linkage with National Residency Registry was done to survey the disease status. Results: There were 6 boys and 6 girls in this study. The median age at diagnosis were 16 years (range: 3 months ∼18 years). The disease sites were diverse, from scalp to knee. Nine of them underwent wide excision in our hospital for their primary disease; the other 3 patients underwent wide excision in our hospital for local recurrent disease. None of them underwent neoadjuvant or adjuvant therapy. All of them had low grade T1a (≤ 5cm in size, superficially located) disease except T staging was not available in two patients. Negative margin was obtained in all in the operation of our instituion except close margin in one patient, who had uncontrolled recurrence and died of progressive disease later. The clinical follow-up (FU) period range from 1 to 214 months (median: 30). Active patients contact via telephone followed by twice postcard invitation was done. No evidence of disease (NED) was revealed by medical FU for three patients and by telephone FU for three patients. For the remaining six patients who had no response after telephone and postcards contact, data from linkage with National Residency Registry was used. Death was noted in one patient and aliveness was noted in five patients (all of them were NED in their last FU in our hospital). The 10-year/15-year progression free and overall survival rates were 100%/75% and 100%/83% respectively without obvious complications. Conclusion: The prognosis of PDFSP in Taiwanese was excellent when adequate surgical margin was obtained.

No significant financial relationships to disclose.

Genetic heterogeneity in acrokeratosis verruciformis of Hopf

BACKGROUND

Acrokeratosis verruciformis of Hopf (AKV) is a rare genodermatosis characterized by multiple flat-topped, flesh-coloured papules on the dorsa of hands and feet, and punctuate keratoses on the palms and soles. A mutation in the ATP2A2 gene has been shown to be associated with AKV and with Darier's disease (DD).

OBJECTIVES

To explore the molecular aetiology of AKV and DD.

METHODS

We investigated the clinical and histological information in two families and a sporadic case with AKV and one family and a sporadic case with DD in China. Mutation analysis of ATP2A2 was performed by PCR and direct sequencing, and genotyping and linkage analysis performed using six polymorphic microsatellite markers spanning the locus at 12q23-12q24 containing ATP2A2.

RESULTS

Mutational analysis showed no mutation in ATP2A2 among the AKV patients, but we found two novel mutations (p.C318F and p.M719fs) in the DD patients. The genotyping and linkage analysis results revealed no linkage evidence of the locus at 12q23-12q24 in a large AKV family.

CONCLUSIONS

Our findings provide evidence for the genetic heterogeneity of AKV and demonstrate that mutations in genes other than ATP2A2 are responsible for AKV in a proportion of the Chinese population.

Functional polymorphisms in cell death pathway genes FAS and FASL contribute to risk of lung cancer

BACKGROUND

The FAS and FASL system plays a key role in regulating apoptotic cell death and corruption of this signalling pathway has been shown to participate in immune escape and tumorigenesis. There is reduced expression of FAS but elevated expression of FASL in many types of human cancers including lung cancer. We recently reported an association between functional polymorphisms in FAS (-1377G-->A) and FASL (-844T-->C) and risk of oesophageal cancer.

OBJECTIVE

To examine the contribution of these polymorphisms to risk of developing lung cancer.

METHODS

Genotypes of 1000 lung cancer patients and 1270 controls were analysed by PCR based restriction fragment length polymorphism. Associations with risk of lung cancer were estimated by logistic regression.

RESULTS

Compared with non-carriers, there was a 1.6 fold excess risk of developing lung cancer for carriers of the FAS -1377AA genotype (odds ratio (OR) 1.59, 95% confidence interval (CI) 1.21 to 2.10; p = 0.001), and 1.8 fold excess risk (OR 1.79, 95% CI 1.26 to 2.52; p = 0.001) for carriers of FASL -844CC. Gene-gene interaction of FAS and FASL polymorphisms increased risk of lung cancer in a multiplicative manner (OR for the carriers of both FAS -1377AA and FASL -844CC genotypes 4.18, 95% CI 2.83 to 6.18). Gene-environment interaction of FAS or FASL polymorphism and smoking associated with increased risk of lung cancer was also found.

CONCLUSION

These results are consistent with our initial findings in oesophageal cancer and further support the hypothesis that the FAS and FASL triggered apoptosis pathway plays an important role in human carcinogenesis.

A novel T-77C polymorphism in DNA repair gene XRCC1 contributes to diminished promoter activity and increased risk of non-small cell lung cancer

X-ray repair cross-complementing 1 (XRCC1) plays a key role in DNA base excision repair and cells lacking its activity are hypersensitive to DNA damage. Recently, we reported a SNP (rs3213245, -77T>C) in the XRCC1 gene 5' untranslated region (UTR) was significantly associated with the risk of developing esophageal squamous-cell carcinoma. Computer analysis predicted that this SNP was in the core of Sp1-binding motif, which suggested its functional significance. Gel shift and super shift assays confirmed that -77T>C polymorphic site in the XRCC1 promoter was within the Sp1-binding motif and the T>C substitution greatly enhanced the binding affinity of Sp1 to this region. Luciferase assays indicated that the Sp1-high-affinity C-allelic XRCC1 promoter was associated with a reduced transcriptional activity. The association between -77T>C and three other amino-acid substitution-causing polymorphisms in XRCC1 and risk of lung cancer was examined in 1024 patients and 1118 controls and the results showed that only the -77T>C polymorphism was significantly associated with an increased risk of developing lung cancer. Multivariate logistic regression analysis found that an increased risk of lung cancer was associated with the variant XRCC1 -77 genotypes (TC and CC) compared with the TT genotype (OR=1.46, 95% CI=1.18-1.82; P=0.001) and the increased risk was more pronounced in smokers (OR=1.63, 95% CI=1.20-2.21) than in non-smokers (OR=1.28, 95% CI=0.94-1.76). Taken together, these results showed that the functional SNP -77T>C in XRCC1 5'UTR was associated with cancer development owing to the decreased transcriptional activity of C-allele-containing promoter with higher affinity to Sp1 binding.

Risk factors for colonization with third-generation cephalosporin-resistant enterobacteriaceae

BACKGROUND AND METHOD

Colonization and infections caused by Enterobacteriaceae resistant to third-generation cephalosporins (CRE) have been observed with increasing frequency in intensive care unit (ICU) patients. In contrast to outbreak investigations, information about risk factors for colonization in an endemic situation are rare. We studied risk factors for colonization with CRE in a case control study including 1,706 patients, admitted to any of the 15 ICUs of Heidelberg University Hospitals.

RESULTS

163 patients carried CRE with Enterobacter spp. representing the predominant species. Independent risk factors for CRE carriage in the multivariate logistic regression analysis were an age of under 2.5 years (OR 4.034), an indwelling central venous catheter (CVC) for more than 3 days (OR 2.640), treatment with second- or third generation cephalosporin for longer than 3 days (OR 2.260) and any antibiotic therapy before admission to the ICU.

CONCLUSION

Apart from the well-recognized risk factor previous antibiotic treatment, the risk factors age and presence of a CVC might suggest that bacterial overgrowth of the gut either due to an increased susceptibility in younger age or as a consequence of parenteral nutrition is a relevant mechanism for acquiring carriage of CRE in a non-outbreak situation.

Effects of maternal Campylobacter rectus infection on murine placenta, fetal and neonatal survival, and brain development

BACKGROUND

Maternal periodontal infection has been associated with increased risk of prematurity and low birthweight. Infection and inflammatory pathways that mediate prematurity have also been implicated in neonatal developmental impairments. The objective of this study was to determine whether maternal Campylobacter rectus infection that induces fetal growth restriction in a mouse model also compromises neonatal pup survival, growth, and neurodevelopment.

METHODS

Timed pregnant mice were challenged with C. rectus on gestation day 7.5. One group of animals was sacrificed on embryonic day 16.5 for placental histology and measurement of fetal brain mRNA expression of tumor necrosis factor (TNF)-alpha and interferon (IFN)-gamma. Another group of animals was allowed to deliver to follow pup survival, growth, and brain structure at day 9.

RESULTS

C. rectus challenge resulted in abnormal placental architecture with inflammation and a 2.8-fold increase in fetal brain expression of IFN-gamma (P = 0.04). Pup birthweight was unaffected by C. rectus exposure, but lethality was 3.9-fold higher after 1 week. Ultrastructurally, the 9-day neonatal brain tissue displayed cellular and myelin alterations consistent with white matter damage.

CONCLUSIONS

Maternal C. rectus infection induces placental inflammation and decidual hyperplasia as well as concomitant increase in fetal brain IFN-gamma. Maternal infection increased pup mortality, and preliminary findings demonstrate ultrastructural changes in the hippocampal region of the neonatal brain, in a manner analogous to the effects of maternal infection on white matter damage seen in humans. Thus, the threat of maternal oral infectious exposure during pregnancy may not be limited to the duration of gestation, but may also potentially affect perinatal neurological growth and development.

Gain of 1q25–32, 12q23–24.3, and 17q12–22 facilitates tumorigenesis and progression of human squamous cell lung cancer

To explore the genetic changes involved in the stepwise development of lung cancer, we have determined the genetic events associated with the histological progression from normal bronchial epithelium to squamous cell carcinoma. Comparative genomic hybridization was used to identify chromosomal imbalances in 54 microdissected samples, including squamous metaplasia, dysplasia, carcinoma in situ, and invasive tumour derived from 23 patients with squamous cell carcinoma of the lung. Histopathological progression was accompanied by an increased number of chromosomal abnormalities. Gains of 1q25-32, 12q23-24.3, and 17q12-22, in particular, were detected at high frequencies in both carcinoma in situ and invasive tumours and were found more often in the cases with lymph node metastases than in those without. Our previous expression profiling of squamous cell carcinomas had identified overexpression of laminin5 gamma2, a gene located at 1q25-31. Therefore, this was investigated at the protein level by immunohistochemical analysis in 336 samples of squamous cell carcinoma of the lung. Consistent with the genomic data for this region, the expression level of laminin5 gamma2 was higher in the primary tumours with lymph node metastases than in tumours without metastases (p = 0.012). These data suggest that gains of genes from 1q25-32, 12q23-24.3, and 17q12-22 facilitate tumorigenesis and progression of squamous cell carcinoma of the lung, and may serve as potential predictors for this disease.

Workplace and HIV-related sexual behaviours and perceptions among female migrant workers

Data from 1,543 female migrants working in eight occupational clusters in Beijing and Nanjing, China were analysed to examine the association of workplace with HIV-related behaviours and perceptions. For sexually experienced women (n = 666, 43.2%), those working in entertainment establishments or personal service (e.g., nightclubs, dancing halls, barbershops, beauty salons, massage parlours, etc.) engaged in risky sexual practices twice as frequently as those working in non-entertainment establishments (e.g. restaurants, stalls, domestic service, factories, etc.). About 10% of women in the entertainment establishments reported having sold sex, 30% having multiple sexual partners and 40% having sex with men with multiple sexual partners. The rate of consistent condom use was less than 15%. They also tended to have a higher level of perceptions of both peer risk involvement and positive expectancy of risk behaviours, and lower perceptions of severity of STDs and HIV. For women who were not sexually experienced, those working in 'stalls' or 'domestic service' tended to perceive higher peer risk involvement, less severity of HIV infection, and less effectiveness of protective behaviour. The occupational pattern of sexual risk behaviours and perceptions observed in the current study indicates employment conditions are associated with HIV risk. Intervention strategies should be tailored to address occupational-related factors.

A common polymorphism in the 3'UTR of cyclooxygenase 2/prostaglandin synthase 2 gene and risk of lung cancer in a Chinese population

Cyclooxygenases (COXs) are key enzymes that convert arachidonic acid to prostaglandins. Overexpression of COX-2, one of the COX isozymes, has been shown to be an early event in lung carcinogenesis and may play an important role in lung cancer development. A common single nucleotide polymorphism, T8473C, located within a potential functional region in the 3'UTR of COX-2 gene was identified and we hypothesized that this COX-2 variant is associated with lung cancer risk. To test this hypothesis, we genotyped this variant in a case-control study of 322 histologically-confirmed lung cancer patients and 323 age and sex frequency-matched cancer-free controls in a Chinese population. The results showed that the frequencies of variant genotypes 8473CT/CC were significantly less common in the cases (27.3%) than in the controls (35.3%) (P=0.034), suggesting that the 8473C allele was protective against lung cancer. Multivariate logistic regression analyses revealed that the COX-2 variant genotypes (8473CT/CC) were associated with a significantly decreased risk of lung cancer compared with the 8473TT wild-type homozygotes (OR=0.64, 95% CI=0.45-0.92). When we defined the reference group as non-smokers having the 8473CT/CC variant genotypes, the smokers with the 8473TT wild-type genotype had the greatest risk (adjusted OR=5.28, 95% CI=3.10-9.00). These findings indicate that the COX-2 T8473C polymorphism may contribute to lung cancer susceptibility in the Chinese population. Further larger molecular epidemiological studies are warranted to confirm these findings.

Marker-based cloning of the region containing the UhAvr1 avirulence gene from the basidiomycete barley pathogen Ustilago hordei

Race-cultivar specialization during the interaction of the basidiomycete smut pathogen Ustilago hordei with its barley host was described in the 1940s. Subsequent genetic analyses revealed the presence of dominant avirulence genes in the pathogen that conform to the gene-for-gene theory. This pathosystem therefore presents an opportunity for the molecular genetic characterization of fungal genes controlling avirulence. We performed a cross between U. hordei strains to obtain 54 progeny segregating for three dominant avirulence genes on three differential barley cultivars. Bulked segregant analysis was used to identify RAPD and AFLP markers tightly linked to the avirulence gene UhAvr1. The UhAvr1 gene is located in an area containing repetitive DNA and this region is undetectable in cosmid libraries prepared from the avirulent parental strain. PCR and hybridization probes developed from the linked markers were therefore used to identify cosmid clones from the virulent (Uhavr1) parent. By walking on Uhavr1-linked cosmid clones, a nonrepetitive, nearby probe was found that recognized five overlapping BAC clones spanning 170 kb from the UhAvr1 parent. A contig of the clones in the UhAvr1 region was constructed and selected probes were used for RFLP analysis of the segregating population. This approach genetically defined an approximately 80-kb region that carries the UhAvr1 gene and provided cloned sequences for subsequent genetic analysis. UhAvr1 represents the first avirulence gene cloned from a basidiomycete plant pathogen.

The genetic epidemiology of alopecia areata in China

BACKGROUND

Alopecia areata (AA) is hypothesized to be an organ-specific autoimmune disease with genetic predisposition and an environmental trigger. There are few clinical data in Asians.

OBJECTIVES

To describe the genetic epidemiological features of AA patients in China and to determine the possible genetic model for AA.

METHODS

Data for 1032 patients with AA were obtained by questionnaire in the Institute of Dermatology of Anhui Medical University in China from 2001 to 2003. Complex segregation analysis and heritability analysis were performed using Falconer's method, EPI INFO 6.0 and SAGE-REGTL programs.

RESULTS

In total, 1032 AA patients (male/female ratio 1.1 : 1) were enrolled, representing 0.94% of the total number of cases seen in our outpatient clinic during that time. The mean +/- SD age of onset was 28.98 +/- 13.43 years. The difference between the mean age of onset in males and females was not significant. Most patients (82.6%) experienced their first episode of AA within the first four decades of life. A positive family history of AA was obtained in 87 patients (8.4%). The prevalence of AA in first-, second- and third-degree relatives of the proband with AA was 1.6%, 0.19% and 0.03%, respectively. These figures were higher than those in controls. A greater severity and longer duration of AA were seen in the early onset group than in the late-onset group. The early onset group also had more affected first- and second-degree relatives. The heritability of AA in first-, second- and third-degree relatives was 47.16%, 42.53% and 22.29%, respectively. Based on the REGTL results, the best model was a polygenic additive model for AA.

CONCLUSIONS

The effect of genetic factors is strong in AA, but environmental factors such as infection and psychological stress may still play an important role. Our findings on the genetics of AA are consistent with a polygenic additive mode of inheritance.

Prevalence of colonisation with third-generation cephalosporin-resistant Enterobacteriaceae in ICU patients of Heidelberg University Hospitals

The aim of this study was to assess colonisation and transmission of third-generation cephalosporin-resistant Enterobacteriaceae (CRE) from patients in 16 intensive care units. A prospective, repetitive point prevalence survey was performed over 6 months, involving samples from 1851 patients. CRE were isolated from 186 (10%) patients, with Enterobacter spp. being the most common. Mean point prevalence rates were significantly higher for paediatric wards (22.5%) compared to surgical (8.1%) and medical (5.5%) units. All CRE isolates were typed by pulsed-field gel electrophoresis. Non-outbreak nosocomial transmission rates of these pathogens were calculated as 12.8% for paediatric patients, compared to 6.8% for adult patients, which may reflect differences in sensitivity to overgrowth with resistant bacteria and contact with health care workers.

Ablation of atrial fibrillation: localizing triggers, mapping systems and ablation techniques

Ablation to eliminate atrial fibrillation (AF) is a therapy in evolution. Approaches to the ablation appear to be currently divided into 2 major strategies anatomic versus electrically guided. In addition in using an electrically guided techniques debate remains whether a targeted approach should be used, whether exit block should be documented, and whether all non pulmonary vein triggers should be targeted. This review highlights the different ablation strategies and identifies a systematic approach to ablation of pulmonary and non pulmonary vein triggers that we have adapted at our institution. The role of intracardiac echo, trigger provocation and localization and the use of 3-D mapping systems in AF ablation are defined.

[Study on family aggregation of cases of advanced schistosomiasis japonica]

AIM

To explore the family aggregation of advanced schistosomiasis japonica.

METHODS

Eighty-one cases of advanced schistosomiasis(AS) and 67 cases of non-advanced schistosomiasis with history of infections in Yushan County, Jiangxi Province were chosen as proband groups and control groups respectively, then grades 1 and 2 relatives of them were investigated on AS. Family aggregation of AS was analyzed through comparing the prevalence rate between the close and distant relatives of probands and controls and fitting the observed distribution of AS cases among the population by zero-truncated Poisson distribution and zero-truncated negative binomial distribution.

RESULTS

The prevalence rate was higher in the close relatives (Group I relatives) of the probands than in the distant relatives(Group II relatives) of the probands and in the controls' relatives. The observed distribution of AS was beyond the probability of the zero-truncated Poisson distribution, but consistent with the zero-truncated negative binomial distribution.

CONCLUSION

Family aggregation of advanced schistosomiasis does exist.

Exposure to chronic mild stress alters thresholds for lateral hypothalamic stimulation reward and subsequent responsiveness to amphetamine

Chronic mild stress in rodents has been proposed to model some of the environmental factors that contribute to the induction of depressive disorders in humans. This model is based on the hypothesis that chronic mild stress induces a change in brain reward function that resembles the symptomatology of major depression, namely, a decrease in responsiveness to rewarding stimuli. The purpose of the first experiment was to investigate whether chronic mild stress affects brain reward function as measured by alterations in lateral hypothalamic self-stimulation behavior in rats. Exposure to chronic mild stress induces a reduction in body weight which might affect brain reward function on its own. Therefore, the potential contribution of a reduction in body weight to the chronic mild stress-induced alterations in brain reward function was examined in a separate group of food-restricted rats. Thresholds for lateral hypothalamic self-stimulation were slightly but significantly lowered in animals exposed to chronic mild stress, indicating an enhancement of stimulation reward efficacy. Food restriction had no effect on brain reward function. The second experiment examined the interaction between prior exposure to chronic mild stress or food restriction and responsiveness to a pharmacological challenge, amphetamine, that enhances brain reward function. Acute administration of amphetamine produced a greater enhancement of lateral hypothalamic self-stimulation reward in animals exposed to chronic stress relative to non-stressed and food-restricted animals. Taken together, the present findings indicate that chronic mild stress sensitizes the neural substrates that mediate both lateral hypothalamic stimulation and psychostimulant drug reward. These findings support the hypothesis that prior exposure to stress affects the vulnerability for drug-taking behavior by increasing the positive reinforcing properties of drug of abuse.

A study on the discontinuation and failure of contraception among newly married couples in Shanghai

The authors investigate contraceptive failure and discontinuation among newly married couples in Shanghai, China, with a focus on the questions, "What percentage of births is due to contraceptive failure? What socio-psychological and demographic characteristics of a couple are related to the discontinuation or failure of contraception? How do the continuation rate and failure rate of contraception among newly married couples reflect the acceptance and effectiveness of various forms of contraception?"

Assessment of denaturing high-performance liquid chromatography (DHPLC) in screening for mutations in connexin 26 (GJB2)

Mutations in the gene GJB2 encoding connexin 26 (Cx26), a gap junction protein, have been shown to be responsible for a majority of recessive nonsyndromic hereditary hearing impairment in children. Over 60 different mutations in Cx26 have been reported. To obviate the need for direct sequencing of each specimen, a variety of screening techniques have been used to detect mutations in Cx26. However, each of these methods has significant shortcomings including expense, time consumption, and limited sensitivity. Denaturing high-performance liquid chromatography (DHPLC) has been recently introduced as a rapid and highly sensitive method of detecting sequence alterations. We have assessed the efficacy of DHPLC as a screening assay for detecting mutation in Cx26 coding region in 154 patients with hereditary hearing impairment. The GJB2 coding exon was amplified in one or two fragments, analyzed by DHPLC, and sequenced. Sequence analysis identified sequence variations in 34 patients concordant with abnormal DHPLC results. Three novel Cx26 mutations were identified: a single base pair substitution 511G>A, a 4 bp insertion 504insAACG, and a 3 bp deletion 358delAGG in three unrelated patients. In 120 patients with normal Cx26 sequence, DHPLC was normal. These results yield sensitivity and specificity of 100% for DHPLC-based detection of Cx26 mutations, and demonstrate that DHPLC is a highly sensitive and specific method of screening for sequence variations in Cx26 that is time and labor efficient. Further, our experience suggests that DHPLC screening alone followed by DNA sequencing only when DHPLC is abnormal may be adequate for identification of all sequence alterations in Cx26.

[A comparison of the kinetic characters of NT-3, NT-4 and BDNF retrogradely transported in facial nerve]

OBJECTIVE

To compare the kinetic characters of retrograde transport of neurotrophin-3 (NT-3), neurotrophin-4 (NT-4) and brain-derived neurotrophin factor (BDNF) in facial nerve.

METHODS

Radioactive tracer technique was used. After one lateral facial nerve trunk of adult rabbit was transected, a silicone chamber was inserted between the stumps, and 3.7 MBq of 125I-NT-3 or 125I-NT-4 or 125I-BDNF or 125I-HSA was administered into the chamber. At different time-points after injection, the facial nerve trunk and facial nerve motor neurone of brain-stem were collected and the uptake rates were measured. The kinetic parameters of each labeled compound were calculated using 3P87 program of kinetics.

RESULTS

The transport amount of neurotrophin retrogradely transported by facial nerve is NT-3 > BDNF > NT-4 (P < 0.05), the transport rate is NT-4 > NT-3 > BDNF (P < 0.05).

CONCLUSION

The findings could serve as the kinetic characters of retrograde transport of neurotrophins.

A 3.1-kb genomic fragment of Bacillus subtilis encodes the protein inhibiting growth of Xanthomonas oryzae pv. oryzae

AIMS

To clone genes of Bacillus subtilis encoding peptides that inhibit the growth of Xanthomonas orzae pv. oryzae (Xoo).

METHODS AND RESULTS

A 3.1-kb DNA fragment from B. subtilis SO113 encoding peptides that inhibit the growth of Xoo (anti-Xoo, showing an inhibition zone) was isolated from a plasmid library of B. subtilis 6 GM15. Sequence analysis revealed that it contained three complete open reading frames (ORFs): ybcO, ybcS and a novel ORF designated ybcPQ. Deleting the last 96 bp of ybcS from the plasmid eliminated the anti-Xoo activity, suggesting that ybcS is required for producing the anti-Xoo activity. However, no anti-Xoo activity could be detected for the plasmid with ybcS alone. Further analysis showed that ybcO, at least, was also required to obtain the anti-Xoo activity.

CONCLUSIONS

A fragment of B. subtilis has been cloned that expresses an anti-Xoo activity that requires ybcS and ybcO.

SIGNIFICANCE AND IMPACT OF THE STUDY

These genes could be useful for the genetic engineering of resistance to rice bacterial diseases and for the design of new anti-Xoo biocontrol agents.

The three-dimensional structure of the C-terminal DNA-binding domain of human Ku70

The proteins Ku70 (69.8 kDa) and Ku80 (82.7 kDa) form a heterodimeric complex that is an essential component of the nonhomologous end joining DNA double-strand break repair pathway in mammalian cells. Interaction of Ku with DNA is central for the functions of Ku. Ku70, which is mainly responsible for the DNA binding activity of the Ku heterodimer, contains two DNA-binding domains. We have solved the solution structure of the Ku80-independent DNA-binding domain of Ku70 encompassing residues 536-609 using nuclear magnetic resonance spectroscopy. Residues 536-560 are highly flexible and have a random structure but form specific interactions with DNA. Residues 561-609 of Ku70 form a well defined structure with 3 alpha-helices and also interact with DNA. The three-dimensional structure indicates that all conserved hydrophobic residues are in the hydrophobic core and therefore may be important for structural integrity. Most of the conserved positively charged residues are likely to be critical for DNA recognition. The C-terminal DNA-binding domain of Ku70 contains a helix-extended strand-helix motif, which occurs in other nucleic acid-binding proteins and may represent a common nucleic acid binding motif.

Positional cloning of heart and soul reveals multiple roles for PKC lambda in zebrafish organogenesis

BACKGROUND

The Par-3/Par-6/aPKC complex is a key regulator of cell polarity in a number of systems. In Drosophila, this complex acts at the zonula adherens (adherens junctions) to establish epithelial polarity and helps to orient the mitotic spindle during asymmetric neuroblast divisions. In MDCKII cells, this complex localizes to the zonula occludens (tight junctions) and appears to regulate epithelial polarity. However, the in vivo role of this complex during vertebrate embryogenesis is not known, due to the lack of relevant mutations.

RESULTS

We have positionally cloned the zebrafish heart and soul (has) mutation, which affects the morphogenesis of several embryonic tissues, and show that it encodes atypical protein kinase C lambda (aPKC lambda). We find that loss of aPKC lambda affects the formation and maintenance of the zonula adherens in the polarized epithelia of the retina, neural tube, and digestive tract, leading to novel phenotypes, such as the formation of multiple lumens in the developing intestine. In addition, has mutants display defects in gut looping and endodermal organ morphogenesis that appear to be independent of the defects in epithelial polarity. Finally, we show that loss of aPKC lambda leads to defects in spindle orientation during progenitor cell divisions in the neural retina.

CONCLUSIONS

Our results show that aPKC lambda is required for the formation and maintenance of the zonula adherens during early epithelial development in vertebrates and demonstrate a previously undescribed yet critical role for this protein in organ morphogenesis. Furthermore, our studies identify the first genetic locus regulating the orientation of cell division in vertebrates.

[Study on effect of Astragalus injection in treating congestive heart failure]

OBJECTIVE

To observe the clinical efficacy and side-effects of Astragalus Injection (AI) in treating congestive heart failure (CHF).

METHODS

Eighty-three patients of CHF with heart function of II-IV grade assessed by NYHA (New York Heart Association) classification were randomly divided into 2 groups. The 42 patients in the treated group were treated with AI 40 ml (equivalent to 80 g crude drug) by adding in 5% glucose solution 500 ml for intravenous dripping, once a day and the 41 patients in the control group were treated by nitrolingual injection 15 mg by adding in 5% glucose solution 500 ml for intravenous dripping once a day. The therapeutic course in both groups was 2 weeks and the patients were followed-up for 1-6 months.

RESULTS

The clinical heart function improvement rate and the total effective rate in the treated group after 1 month treatment were 26.2% and 78.6%, and after 6 months were 34.2% and 81.6% respectively, which were superior to those in the control group significantly (P < 0.05 or P < 0.01). The levels of left ventricular ejection fraction (LVEF), fractional shortening of left ventricular short axis (FS), the ratio of maximum blood flow between the advanced and early atrial systole (E/A), stroke volume (SV), cardiac output (CO) and the cardiac index (CI) were all improved in both groups (P < 0.01 or P < 0.05), but better improvement was shown in the treated group. Follow-up study showed that the incidence of cardiac event was lower in the treated group than that in the control group (P < 0.05).

CONCLUSION

AI can be took as one of the important auxiliary drugs for treatment of CHF especially in severe cases.

The de-ubiquitinating enzyme Unp interacts with the retinoblastoma protein

The ubiquitin pathway is involved in the proteolytic turnover of many short-lived cellular regulatory proteins. Since selective degradation of substrates of this system requires the covalent attachment of a polyubiquitin chain to the substrates, degradation could be counteracted by de-ubiquitinating enzymes (or isopeptidases) which selectively remove the polyubiquitin chain. Unp is a human isopeptidase with still poorly understood biological functions. Here, we show that cellular Unp specifically interacts with the retinoblastoma gene product (pRb).

[A study of on the transport of neurotrophin-4 in facial nerve]

OBJECTIVE

This is a study on the transport information of neurotrophin-4 (NT-4) in facial nerve using radioactive tracer technique.

METHODS

After one lateral facial nerve trunk of adult rabbit was transected, a silicone chamber was inserted between the stumps, and 7.4 MBq of 131I-NT-4 was administered into the chamber. At the distinct moment of post-injection, the head of one rabbit was imaged at coronary position, the bilateral facial nerve trunk and brain-stem of the others were collected and counted respectively. After 1 mg of brain-derived neurotrophic factor (BDNF) and 7.4 MBq of 131I-NT-4 were administered into the chamber of one rabbit, the rabbit was imaged at coronary position of head at distinct moment.

RESULTS

5.08% of 131I-NT-4 was transported into facial nerve trunk at 4 h of post-injection. 131I-NT-4 presented high peak in facial nerve trunk during the period of 8, 12 h, the peak values were 20.58% and 22.74% respectively. 34.75% and 45.57% of 131I-NT-4 were transported into the brain-stem of experimental side at 8 h and 12 h respectively. The transport of 131I-NT-4 was markedly restrained by BDNF in facial nerve.

CONCLUSION

NT-4 displays a receptor-mediated retrograde transport in facial nerve.

Body mass index and the risk of recurrent coronary events following acute myocardial infarction

Although excess adiposity appears to increase the risk of coronary heart disease in the general population, its importance in patients with established coronary disease is less defined. We evaluated a population-based inception cohort of survivors to hospital discharge following first acute myocardial infarction (AMI) (n = 2,541) to assess the association between body mass index (BMI) and the risk of recurrent coronary events and to explore the mechanisms for this relation. Using Cox proportional-hazards regression, we assessed the risk of recurrent coronary events associated with levels of adiposity as defined by BMI and then investigated potential mechanisms through which adiposity conferred risk by examining how adjustment for diabetes mellitus, systemic hypertension, and dyslipidemia affected the association. Forty-one percent of the cohort were overweight (BMI 25 to 29.9), and 27.8% were obese (BMI > or =30). After adjustment for other risk factors, the risk of recurrent coronary events (n = 418) increased as BMI increased, especially among those who were obese. Using a BMI of 16 to 24.9 as the reference group, for mildly overweight patients (BMI 25 to 27.4), the relative risk (RR) was 0.93 (95% confidence interval [CI] 0.70 to 1.24); it was 1.16 for more severe overweight patients (BMI 27.5 to 29.9; 95% CI 0.87 to 1.55). For patients with class I obesity (BMI 30 to 34.9), the RR was 1.49 (95% CI 1.12 to 1.98), and for class II to III obesity (BMI > or =35), the RR was 1.80 (95% CI 1.30 to 2.48). We estimated that clinical measurements of diabetes, hypertension, and dyslipidemia explained approximately 43% of this risk. Thus, excess adiposity as measured by BMI was associated with an increased risk of recurrent coronary events following AMI, particularly among those who were obese.

[Pilot study on mutations of p53 gene in laryngeal carcinoma]

OBJECTIVE

To determine the characteristic and frequency of the point mutation of p53 gene.

METHODS

22 cases of laryngeal squamous cell carcinoma (LSCC) with positive expression of mutant p53 protein and 2 cases of normal laryngeal epithelium as control were examined by means of polymerase chain reaction restriction fragment length polymorphism (PCR-RFLP), single strand conformation polymorphism (SSCP) and DNA sequencing analyses.

RESULTS

3 cases of LSCC had the point mutation on codons 248, 250 and 254 of exon 7 in p53 gene. None of the cases had the point mutation on codon 249.

CONCLUSION

These findings suggest that the point mutation on codon 249 of exon 7 in p53 gene may be uncommon in LSCC. SSCP and DNA sequencing analyses are sensitive and rapid methods for detecting p53 gene mutation.

[Classification study on the marshland in endemic areas of Schistosoma japonicum using satellite TM image data]

OBJECTIVE

To create a land cover map of the marshland region of Schistosoma Japonicum using satellite TM data from Chayegang, Jiangxi Province.

METHODS

Satellite data of three TM bands, namely TM3, TM4 and TM5, were selected to be used in classification study with Principal Components Analysis. Then TM satellite images were applied to false color composite and unsupervised classification with computer software to manage the TM data. Finally the resulting clusters were identified by undertaking site visits and a systematic sampling snail survey was also carried out in the study area in April, 2000.

RESULTS

Three land cover classes were generated, including class 1, the carex zone that is both the dominant vegetation and main snail habitats of the study area. Based on the snail survey in the spring of 2000, the live snail density and infectious snail density of the carex zone were 2.51/0.11 m2 and 0.006 9/0.11 m2, respectively. The infection rate of the snail was 0.28%. No snail was found in land cover class 3, the mixed vegetation, because the altitude of this area is either above 17 m or under 14 m and therefore the vegetation in this area is unsuitable for snails to survive.

CONCLUSION

Remote sensing can contribute the study on the distribution of snail habitats and become a promising epidemiological study method for schistosomiasis and other ecological diseases.

Dynamics of the Mrf-2 DNA-binding domain free and in complex with DNA

Mrf-2 is a member of a new class of DNA-binding proteins known as the AT-rich interaction domain family or ARID. Chemical shift indices and characteristic NOE values indicate that the three-dimensional structure of the Mrf-2 ARID in complex with DNA is nearly identical to that of the free protein. The backbone dynamics of the Mrf-2 domain free and in complex with DNA have been characterized by (15)N NMR relaxation measurements and model-free analysis. Chemical shift perturbations and dynamic studies suggest that two flexible interhelical loops, the flexible C-terminal tail, and one alpha-helix are involved in DNA recognition, indicating the importance of protein dynamics in DNA binding. Some well-structured regions, in particular the putative DNA-contacting helix, in Mrf-2 show a decrease in the order parameters (S(2)) upon complex formation. The less well-structured loops and the unstructured C-terminus show reduced flexibility upon DNA binding. In addition, the model-free analysis indicates motions on the picosecond to nanosecond and micro- to millisecond time scales at the DNA-binding surface of the bound Mrf-2 ARID, suggesting a model where interactions between the protein and DNA are highly dynamic.

Effect of dietary K intake on apical small-conductance K channel in CCD: role of protein tyrosine kinase

We have used Western blot to examine the expression of cSrc protein tyrosine kinase (PTK) and protein tyrosine phosphatase (PTP)-1D in the renal cortex, and the patch-clamp technique to determine the role of PTK in mediating the effect of dietary K intake on the small-conductance K (SK) channel in the cortical collecting duct (CCD). When rats were on a K-deficient (KD) diet for 1, 3, 5, and 7 days, the expression of cSrc increased by 40, 90, 140, and 135%, respectively. In contrast, the expression of cSrc in the renal cortex from rats on a high-K (HK) diet for 1, 2, and 3 days decreased by 40, 60, and 75%, respectively. However, the protein level of PTP-1D was not significantly changed by dietary K intake. The addition of 1 microM herbimycin A increased NP(o), a product of channel number (N) and open probability (P(o)) in the CCD from rats on a normal diet or on a KD diet. The increase in NP(o) was 0.30 (normal), 0.45 (1-day KD), 0.65 (3-day KD), 1.55 (5-day KD), and 1.85 (7-day KD), respectively. Treatment of the CCD with herbimycin A from rats on a KD diet increased NP(o) per patch from the control value (0.7) to 1.4 (1-day KD), 1.6 (3-day KD), 2.6 (5-day KD), and 3.5 (7-day KD), respectively. In contrast, HK intake for as short as 1 day abolished the effect of herbimycin A. Furthermore, the expression of ROMK channels in the renal cortex was the same between rats on a KD diet or on a HK diet. Moreover, treatment with herbimycin A did not further increase NP(o) in the CCDs from rats on a HK diet. We conclude that dietary K intake plays a key role in regulating the activity of the SK channels and that PTK is involved in mediating the effect of the K intake on channel activity in the CCD.