Measurement of the 3He(e,e'p)pn reaction at high missing energies and momenta

Results of the Jefferson Lab Hall A quasielastic 3He(e,e'p)pn measurements are presented. These measurements were performed at fixed transferred momentum and energy, q=1502 MeV/c and omega=840 MeV, respectively, for missing momenta p(m) up to 1 GeV/c and missing energies in the continuum region, up to pion threshold; this kinematic coverage is much more extensive than that of any previous experiment. The cross section data are presented along with the effective momentum density distribution and compared to theoretical models.

Redox-mediated enrichment of self-renewing adult human pancreatic cells that possess endocrine differentiation potential

OBJECTIVES

The limited availability of transplantable human islets has stimulated the development of methods needed to isolate adult pancreatic stem/progenitor cells capable of self-renewal and endocrine differentiation. The objective of this study was to determine whether modulation of intracellular redox state with N-acetyl-L-cysteine (NAC) would allow for the propagation of pancreatic stem/progenitor cells from adult human pancreatic tissue.

METHODS

Cells were propagated from human pancreatic tissue using a serum-free, low-calcium medium supplemented with NAC and tested for their ability to differentiate when cultured under different growth conditions.

RESULTS

Human pancreatic cell (HPC) cultures coexpressed alpha-amylase, albumin, vimentin, and nestin. The HPC cultures, however, did not express other genes associated with differentiated pancreatic exocrine, duct, or endocrine cells. A number of transcription factors involved in endocrine cell development including Beta 2, Islet-1, Nkx6.1, Pax4, and Pax6 were expressed at variable levels in HPC cultures. In contrast, pancreatic duodenal homeobox factor 1 (Pdx-1) expression was extremely low and at times undetectable. Overexpression of Pdx-1 in HPC cultures stimulated somatostatin, glucagon, and carbonic anhydrase expression but had no effect on insulin gene expression. HPC cultures could form 3-dimensional islet-like cell aggregates, and this was associated with expression of somatostatin and glucagon but not insulin. Cultivation of HPCs in a differentiation medium supplemented with nicotinamide, exendin-4, and/or LY294002, an inhibitor of phosphatidylinositol-3 kinase, stimulated expression of insulin mRNA and protein.

CONCLUSION

These data support the use of intracellular redox modulation for the enrichment of pancreatic stem/progenitor cells capable of self-renewal and endocrine differentiation.

Polymorphism of HLA-B27 in Taiwanese Chinese

Heterogeneity of HLA-B27 is represented by a family of 24 closely related alleles/subtypes. Frequency and disease association of these alleles with spondyloarthropathies differ among ethnic groups. Accurate investigation of frequencies of alleles is often hindered by the size and demographic region of sample tested. With an ever-increasing number of B27 alleles being discovered, it is becoming imperative to establish disease association of each individual alleles and its biological importance. In a large number of normal healthy Taiwanese Chinese individuals (75,777) tested nationally, over a period of five years, in a single immunogenetics centre, we found additional B27 subtypes not revealed in a previous Taiwanese Chinese population study. The subtypes found in Taiwanese Chinese and the frequencies of each of the subtypes are reported.

Effect of dietary Echinacea purpurea on viremia and performance in porcine reproductive and respiratory syndrome virus-infected nursery pigs

The effect of dietary Echinacea purpurea on performance, viremia, and ontogeny of the humoral antibody response against porcine reproductive and respiratory syndrome virus (PRRSV) infection was evaluated in weaned pigs. In three replicates, 120 weaned pigs (25 +/- 1 d of age; 8.46 +/- 0.48 kg of BW) from a PRRSV-naive herd were allotted randomly to one of eight pens (diets) in two separate rooms (four pens/room), with each pen containing five pigs. Pigs began one of four dietary treatments (as-fed basis) 1 wk before inoculation with PRRSV: 1) basal diet composed of corn, soybean meal, whey, and essential vitamins and minerals; 2) basal diet plus carbadox (0.055 g/kg of diet; as-fed basis); 3) basal diet plus Echinacea 2% (2% of the total diet); 4) basal diet plus Echinacea 4% (4% of the total diet). The diets were formulated to be isocaloric and isolysinic. Echinacea purpurea was purchased in powder form and determined by chemical analysis to contain 1.35% cichoric acid (as-fed basis). Seven days after starting the diets, all pigs in one room were intranasally inoculated with PRRSV isolate ATCC VR-2332 at a concentration of 10(4) tissue culture infectious dose50/mL. To monitor the effects of Echinacea and PRRSV challenge, BW and blood samples were obtained from all pigs at 7-d intervals. Serum samples were analyzed for the presence of PRRSV and PRRSV-specific antibodies. All challenged pigs became infected with PRRSV, and all unchallenged pigs remained free of infection. No differences (P > 0.10) in ADG, ADFI, or gain:feed (G:F) were observed in PRRSV-challenged compared with unchallenged animals. For PRRSV-challenged animals receiving diets supplemented with Echinacea at 2 or 4%, no differences (P > 0.10) were observed in ADG, ADFI, or G:F ratio. Among PRRSV-challenged pigs, dietary Echinacea did not affect (P > 0.10) the rate or level of the ELISA-detectable antibody response from d 7 to 42 or the level and duration of PRRSV in serum. For PRRSV-unchallenged animals receiving diets supplemented with Echinacea at 2 or 4%, no differences (P > 0.10) were observed in ADG, ADFI, and G:F ratio. Under the conditions of this study, dietary Echinacea did not enhance growth, exhibit antiviral effects to PRRSV, or show any evidence of immune enhancing properties.

Detection of HPV infection by analyzing the changes in structure of peripheral blood lymphocytes specifically induced by HPV E7 antigen

PURPOSE

Detection of human papilloma virus (HPV) infection in clinical practice was examined based on the observation that peripheral blood lymphocytes exposed in vitro to antigenic or mitogenic stimulation change their intracellular structures as measured by polarization of fluorescent light emitted by labeled cells.

MATERIALS AND METHODS

A total of 47 women were enrolled in this study. They were classified into four groups based on the results of HPV-DNA detection in cervical tissues by the Hybrid Capture II kit (Digene, Gaithersburg, MD, USA) and pathological examination. Ten women with no HPV-DNA detection were used as a normal control group. Fifteen women without pathological diagnosis in the cervical tissues had HPV-DNA detection. Ten women with CIN lesions had 80% HPV-DNA detection. Twelve women with invasive squamous cell carcinoma had 100% HPV detection. Peripheral blood lymphocytes derived from all women were collected and then exposed to HPV-E7 antigen and PHA mitogen.

RESULTS

The positive response rate of HPV-E7 antigen was ten percent (1/10) in the normal control group, 73.3% (11/15) in the HPV infectious women, 50% (5/10) in the CIN women, and 91.7% (11/12) in the cervical cancer patients. The overall sensitivity rate of blood tests was 77.1% and the specificity rate was 57.8% when the Hybrid Capture II HPV Test kit was used as the standard detection method for cervical tissue.

CONCLUSIONS

The results showed that peripheral blood lymphocytes derived from patients with cervical lesions might be another choice to be used as a screening method to detect HPV infection compared with conventional methods.

The differential effects of tamoxifen and ICI 182,780 on the reduction of Na+/K+ ATPase activity and spontaneous oscillations by 17beta-estradiol

A prolonged treatment with 17beta-estradiol reduces the frequency of spontaneous oscillations and the Na+/K+ ATPase activity in rat uteri. Acute inhibition of Na+/K+ ATPase activity by a Na+/K+ ATPase inhibitor, ouabain, decreases the frequency of oxytocin-induced oscillations in uteri. Therefore, the purpose of this study was to examine whether the prolonged inhibition of Na+/K+ ATPase activity by 17beta-estradiol was estrogen receptor (ER)-dependent. The uterine explants from ovariectomized rats were cultured in vitro as our experimental model to compare the effect of two antiestrogenic compounds (ICI 182,780 and tamoxifen) on the Na+/K+ ATPase activity and the frequency of spontaneous oscillations. ATPase assay and a standard muscle bath apparatus were to measure the activity and the contraction. When compared with the control, a 2-day treatment with 17beta-estradiol in vivo or in vitro decreased the activity and the frequency. ICI 182,780 lowered the activity but tamoxifen did not. ICI 182,780 did not decrease the frequency but tamoxifen did. Even the reversal effects of these antiestrogenic compounds on the reduced activity and the frequency by 17beta-estradiol were different. Tamoxifen elicited a greater reversal effect on the reduced activity but ICI 182,780 did not. In contrast, ICI 182,780 elicited a greater reversal effect on the reduced frequency but tamoxifen did not. Prolonged inhibition of Na+/K+ ATPase activity by K+-free solution suppressed the frequency with the elevation of basal tension. Addition of KCl at lower concentrations (0.3-1.2 mM) induced oscillatory contraction after reducing the basal tension. As our data suggest, the prolonged effect of 17beta-estradiol may decrease uterine the activity through ER dependent and independent pathways. The reduction of uterine Na+/K+ ATPase activity by estrogens may increase the basal tension after each oscillatory cycle, which, in part, contributes to the reduced frequency of spontaneous oscillations.

Spatial analysis of Yersinia pestis and Bartonella vinsonii subsp. berkhoffii seroprevalence in California coyotes (Canis latrans)

Zoonotic transmission of sylvatic plague caused by Yersinia pestis occurs in California, USA. Human infections with various Bartonella species have been reported recently. Coyotes (Canis latrans) are ubiquitous throughout California and can become infected with both bacterial agents, making the species useful for surveillance purposes. This study examined the geographic distribution of 863 coyotes tested for Y. pestis and Bartonella vinsonii subsp. berkhoffii serologic status to gain insight into the natural history of B. vinsonii subsp. berkhoffii and to characterize the spatial distribution of the two agents. We found 11.7% of specimens positive to Y. pestis and 35.5% positive to B. vinsonii subsp. berkhoffii. The two pathogens had distinct spatial clusters: Y. pestis was more prevalent in eastern portions of the state and B. vinsonii subsp. berkhoffii in coastal regions. Prevalence of Y. pestis increased with increasing elevation, whereas prevalence of B. vinsonii subsp. berkhoffii decreased with increasing elevation. There were differences in the proportions of positive animals on a yearly basis to both pathogens.

Validation for use with coyotes (Canis latrans) of a commercially available enzyme-linked immunosorbent assay for Dirofilaria immitis

Serological tests offer a potentially powerful tool for monitoring parasites in wildlife populations. However, such tests must be validated before using them with target wildlife populations. We evaluated in coyotes (Canis latrans) the performance of a commercially available serological test used to detect canine heartworm (Dirofilaria immitis) in domestic dogs. We obtained 265 coyote carcasses and serological specimens from 54 additional coyotes from several regions of California, USA. We necropsied coyotes to determine the adult heartworm infection status. Blood was collected at necropsy on filter paper strips and allowed to dry; it was later eluted in a buffer solution, and the supernatant was tested for heartworm. Receiver operating characteristic (ROC) analysis was used to assess discriminatory power of the test and indicated a 93% probability that a randomly selected infected coyote would exhibit a higher enzyme-linked immunosorbent assay (ELISA) value than a randomly selected uninfected coyote. We estimated specificity at 96% (95% CI: 92-98%) for 165 uninfected coyotes and sensitivity at 85% (77-91%) for 100 infected coyotes, results similar to published values for the commercial serological test used with dog serum or plasma. Test performance was similar for filter paper specimens and supernatant of frozen whole blood collected in EDTA tubes (i.e. hemolyzed plasma). We found no difference in test performance among geographic or demographic coyote groups. Our findings support application of the test to filter paper or standard serological specimens for detection of heartworm in coyote populations.

In vitro study of ultrasound based real-time tracking for renal stones in shock wave lithotripsy: Part II--a simulated animal experiment

PURPOSE

We have previously developed and reported an ultrasound based real-time tracking system for renal stones. In the current study we continued to verify the reliability of this tracking system by a simulated animal test.

MATERIALS AND METHODS

We used 13 prerecorded ultrasound stone trajectories to test the system. The real-time tracking system was implemented on the Litemed 9200 electrohydraulic lithotriptor (LiteMed Co., Taipei, Taiwan). An artificial stone and tap water were sealed in a balloon. The balloon was inserted into the pelvis of a pig kidney. While the kidney was affixed to and moved by a simulator, it was immersed in a specifically designed simulated animal model tank containing tap water. The stone was localized by ultrasound. The kidney was moved by the simulator according to a prerecorded stone trajectory. A total of 3,000 shock waves were delivered to the stone. For each recorded stone trajectory experiments were done under nontracking and tracking conditions. We performed tests of the fragment-to-weight ratio, which denotes the performance of a shock wave lithotriptor when fragmenting a stone.

RESULTS

The mean fragment-to-weight ratio was 55.3% +/- 25.9% in the nontracking and 100% +/- 0% in the tracking group. The difference in these 2 groups was statistically significant (paired t test p <0.01).

CONCLUSIONS

The ultrasound based real-time tracking system proved to improve the performance of a shock wave lithotriptor significantly when fragmenting stones in a simulated animal test. We believe that the tracking system would greatly reduce the number of shocks and time needed for treating renal stones.

Tolerization of dendritic cells by T(S) cells: the crucial role of inhibitory receptors ILT3 and ILT4

Immunoglobulin-like transcript 3 (ILT3) and ILT4 belong to a family of inhibitory receptors expressed by human monocytes and dendritic cells. We show here that CD8+CD28(-) alloantigen-specific T suppressor (TS) cells induce the up-regulation of ILT3 and ILT4 on monocytes and dendritic cells, rendering these antigen-presenting cells (APCs) tolerogenic. Tolerogenic APCs show reduced expression of costimulatory molecules and induce antigen-specific unresponsiveness in CD4+ T helper cells. Studies of human heart transplant recipients showed that rejection-free patients have circulating TS cells, which induce the up-regulation of ILT3 and ILT4 in donor APCs. These findings demonstrate an important mechanism of immune regulation.

Reduction in erythropoietin doses by the use of chronic intravenous iron supplementation in iron-replete hemodialysis patients

BACKGROUND

Iron deficiency is the most common cause of suboptimal response to recombinant human erythropoietin (rHuEPO) in chronic hemodialysis (HD) patients. Iron supply can correct this situation, however, optimal dosage, route of administration, and monitoring of iron status during rHuEPO therapy in maintenance HD patients remains controversial.

METHODS

We conducted a 12-month intravenous iron substitution trial in 149 iron-replete chronic HD patients receiving subcutaneous rHuEPO therapy. The available iron pool was maintained with 100 mg iron every 2 weeks or 1 month depending on serum ferritin and transferrin saturation levels, the rHuEPO dosage titrated depending on hematocrit (Hct) levels.

RESULTS

After 12-month protocol, the Hct increased (28.7 +/- 4.1 vs 27.7 +/- 2.6, p = 0.003), rHuEPO requirement reduced 25% (46.1 +/- 28.9 vs 61.5 +/- 67.8 U/kg/week, p = 0.006), serum ferritin increased (1,383 +/- 727 vs 930 +/- 857 ng/ml, p < 0.001), so did the transferrin saturation (36.1 +/- 12.7 vs 27.5 +/- 12.8%, p < 0.001). The serum albumin decreased slightly but reached statistical significance (4.1 +/- 0.48 vs 4.2 +/- 0.36 g/dl, p = 0.006), so did the cholesterol levels (166 +/- 41 vs 173 +/- 38 mg/dl, p = 0.044) and pre-dialysis creatinine (11.3 +/- 2.3 vs 11.5 +/- 2.4 mg/dl, p = 0.015). Besides, the iPTH levels did not interfere with the rHuEPO dosage reduction and Hct increment in our patients.

CONCLUSION

We conclude that maintaining high levels of serum ferritin and transferrin saturation could further reduce the requirement of rHuEPO in chronic HD patients, but the long-term effect of iron overloading to patients' nutritional status must be further evaluated in contrast to the economic saving.

Beam coupling in nanotube-doped liquid-crystal films

Diffraction gratings written in films of nematic liquid crystals doped with multiwall carbon nanotubes were investigated by measurements of exponential beam-coupling coefficients. These phase gratings were induced by the interference modulation of two coherent optical beams, in conjunction with an externally applied dc field. Systematic and consistent results of the gain properties indicate that the bserved coherent-beam amplification depends strongly on the pump-to-probe intensity ratio.

Shedding of porcine reproductive and respiratory syndrome virus in mammary gland secretions of sows

OBJECTIVE

To document shedding of porcine reproductive and respiratory syndrome (PRRS) virus in mammary gland secretions of experimentally inoculated sows, to evaluate effects of vaccination during gestation on virus shedding during the subsequent lactation, and to evaluate shedding of PRRS virus in milk of sows in commercial herds.

ANIMALS

6 sows seronegative for PRRS virus were used for experiment 1, and 2 sows were retained for experiment 2. For experiment 3, 202 sows in commercial herds were used.

PROCEDURE

In experiment 1, 2 sows were inoculated with PRRS virus, 2 sows were vaccinated with modified-live PRRS virus vaccine, and 2 sows served as control pigs. Mammary gland secretions were assayed for PRRS virus. In experiment 2, pregnant vaccinated sows from experiment 1 were vaccinated with another modified-live PRRS virus vaccine. Mammary gland secretions were assayed in the same manner as for experiment 1. For experiment 3, milk collected from 202 sows in commercial herds was assayed for PRRS virus.

RESULTS

In experiment 1, PRRS virus was detected in mammary gland secretions of both vaccinated and 1 of 2 virus-inoculated sows. In experiment 2, virus was not detected in samples from either vaccinated sow. In experiment 3, all samples yielded negative results.

CONCLUSIONS AND CLINICAL RELEVANCE

Naïve sows inoculated late in gestation shed PRRS virus in mammary secretions. Previous vaccination appeared to prevent shedding during the subsequent lactation. Results for samples obtained from sows in commercial herds suggested that virus shedding in mammary gland secretions of such sows is uncommon.

Prevalence of Bartonella species and 16s rRNA gene types of Bartonella henselae from domestic cats in Thailand

Prevalence of Bartonella infection among 275 cats in 9 sites from 4 geographical regions (northern area: Chiang Mai; central area: Kanchanaburi, Ratchaburi, and Bangkok; northeastern area: Khon Kaen, Roi Et, Ubon Ratcharthani, and Nakhonratchasima; southern area: Songkhla) of Thailand was investigated. Overall, Bartonella species were isolated from 27.6% (76 of 275) of the cats. The isolation rate varied from 12.8% (5 of 39) in Songkhla (southern area) to 50.0% (26 of 52) in Khon Kaen (northeastern area). Bartonella henselae and B. clarridgeiae were isolated from 82.9% (63 of 76) and 11.8% (9 of 76) of the Bartonella-positive cats, respectively. Coinfection with both species was found in 5.3% (4 of 76) of the bacteremic cats. Of the 67 bacteremic cats from which B. henselae was isolated, 48 (71.6%) and 13 (19.4%) were infected with only Type I and Type II, respectively. Coinfection with both types was observed in 9.0% (6 of 67) of the B. henselae-positive cats. To our knowledge, this is the first report on the presence of Bartonella infection in domestic cats from Thailand, which constitute a large reservoir of Bartonella infection in this country.

Catalysis of ACAT may be completed within the plane of the membrane: a working hypothesis

Two ACAT sharing protein sequence homology near their C termini have been identified. Both proteins may span the endoplasmic reticulum (ER) membrane several times. There is good evidence implicating the role of ACAT1 in macrophage foam cell formation, and ACAT2 in intestinal cholesterol absorption. On the other hand, the functional roles of ACAT1 and ACAT2 in the VLDL or chylomicron assembly process are less clear. It is possible that both enzymes are able to form lipid droplets (which are present in the cytoplasm), and participate in lipoprotein assembly (which occurs in the ER lumen). To link the site of ACAT catalysis with its function, we propose that part of the ACAT catalytic site may reside within the lipid bilayer, allowing catalysis to be completed within the plane of the membrane. Cholesteryl esters (CE) produced in situ may burst into cytoplasmic lipid droplets, carrying phospholipid monolayers as their outer coats. In cells engaged in lipoprotein assembly and secretion, CE in the bilayer may be recognized by the specific protein microsomal triacylglycerol transfer protein (MTP), reaching out from the lumenal side of the membrane. MTP then lipidates the growing apolipoprotein B (apoB) chain with CE and TG during the early stages of apoB lipoprotein assembly.

Endoscopic mucosal resection with a cap-fitted endoscope for early gastric carcinoma with focal submucosal invasion in a patient with decompensated liver cirrhosis

Prognosis for patients with early gastric cancer who undergo gastric resection is far better than that for patients with advanced disease. However, patients with advanced liver cirrhosis may not be suitable for general anesthesia and major surgery. We used a less invasive endoscopic mucosal resection (EMR) with a cap-fitted endoscope to resect an early gastric cancer in a 58-year-old male with decompensated liver cirrhosis. Although postoperative pathology revealed that the tumor had focal invasion to the submucosa, the patient had an uneventful course and was well during 4 years' follow-up. This method may be effective for the treatment of early gastric cancer with focal submucosal invasion when patients are not suitable for major surgery.

Transvenous permanent pacemaker implantation in children and adolescent

In pediatric patients cardiac pacing has been traditionally carried out by the epicardial approach in Taiwan. This study was to define the long-term results of transvenous endocardial pacemaker therapy in growing children. From 1994 to 1997, patients with sympatomatic bradycardia referred for permanent pacemaker were enrolled. Permanent pacemaker was implanted under propofol anesthesia and direct puncture of subclavian vein and creation of prepectoral pocket. A total of 10 patients ( 5 male, 5 female) aged from 5 to 17 years (13 +/- 4 yrs), constituted the study population. Follow-up period ranged from 14 to 48 months (29 +/- 14 months) . Underlying rhythm disturbances and pacemaker type implanted were: complete atrioventricular (AV) block 5 (VDD pacemaker in 3 and VVIR in 2), sick sinus syndrome 2 (DDDR pacemaker in both), sick sinus syndrome with abnormal AV conduction 1 (WIR), long QT syndrome 1 (VVIR) and hypertrophic cardiomyopathy 1 (DDDR). Pacemaker dysfunction occurred in only one patient in whom the endocardial lead was fixed by absorbable thread with an aim to have more flexibility of the lead. The endocardial lead was dislodged but properly reimplanted about 3 months after the initial implantation. All patients had satisfactory lead sensing and pacing threshold during the long-term follow-up. The pacing threshold was much better than that usually neededfor epicardial leads. With growing, none have the problems of lead length. Quality of life was reported to be improved in all. Tranvenous permanent pacemaker implantation is feasible in children aged 5 or older The long-term efficacy is satisfactory. Physiological pacing using a single lead (VDD) is recommended for younger patients with impaired AV conduction.

Methimazole-induced pulmonary hemorrhage associated with antimyeloperoxidase-antineutrophil cytoplasmic antibody: a case report

Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis has been recently recognized in Graves' disease patients treated with antithyroid drugs. We describe the case of an 18-year-old girl who developed antimyeloperoxidase ANCA (MPO-ANCA)-positive vasculitis manifesting as a skin lesion and hemoptysis with hypoxic respiratory failure after taking methimazole. An open lung biopsy was consistent with acute capillaritis. Both skin and sural nerve biopsy showed lymphocytic vasculitis. Administration of steroid and plasmapheresis produced a good clinical response.

Large-volume liposuction: a review of 631 consecutive cases over 12 years

Since the advent of epinephrine-containing wetting solutions and sophisticated fluid management techniques, increasingly larger and larger volumes of liposuction aspirations have been reported. Unfortunately, with these larger volumes of liposuction being routinely performed, greater rates of complications have also been reported, with the worst of these resulting in deaths. In a response to the increasing concerns over the safety of large-volume liposuction, a critical review of the senior author's own series has been performed to evaluate risks and benefits and to recommend guidelines for safe and effective large-volume liposuction. A retrospective chart review was performed on 631 consecutive patients who underwent liposuction procedures of at least 3000 cc total aspirate. All procedures were performed by the same senior surgeon between January of 1986 and March of 1998. Before September of 1996, traditional liposuction techniques were used. After September of 1996, ultrasound-assisted liposuction was performed. The superwet technique of fluid management was employed for all procedures performed after 1991. The particulars of the surgical and anesthetic techniques used are reviewed in the article. Data collection included preoperative patient demographics, preoperative and postoperative weights and measurements, and preoperative and postoperative photographs. Total aspirate volumes, fluid intakes, and fluid outputs were measured, and all complications were tallied. Average follow-up was 1 year. Results showed the majority of patients to be women, aged 17 to 74 years old. Of the preoperative weights, 98.7 percent were within 50 pounds of ideal chart weight. Total aspirate volumes ranged from 3 to 17 liters, with 94.5 percent of these under 10 liters. Fluid balance measurements showed an average of 120 cc/kg positive fluid balance at the end of the procedure, with none of these patients experiencing any significant fluid balance abnormalities. Cosmetic results were good, with a 2- to 6-inch drop from preoperative measurements, depending on the area treated. Ten percent of patients experienced minor skin contour irregularities, with most of these patients not requiring any additional surgical procedures. One year after surgery, 80 percent of patients maintained stable postoperative weights. No serious complications were experienced in this series. The majority of the complications consisted of minor skin injuries and burns, allergic reactions to garments, and postoperative seromas. The more serious complications included four patients who developed mild pulmonary edema and one patient who developed pneumonia postoperatively. These patients were treated appropriately and went on to have uneventful recoveries. The results show that large-volume liposuction can be a safe and effective procedure when patients are carefully selected and when anesthetic and surgical techniques are properly performed. Meticulous fluid balance calculations are necessary to avoid volume abnormalities, and experience is mandatory when performing the largest aspirations. Cosmetic benefits are excellent, and overall complication rates are low.

The significance of human papillomavirus viral load in prediction of histologic severity and size of squamous intraepithelial lesions of uterine cervix

OBJECTIVES

Persistence of high-risk types of human papillomavirus (HPV) in cervical scrapes is responsible for the development, maintenance, and progression of squamous intraepithelial lesions (SILs). Previous studies of viral load and histologic severity have ended with controversial results. This study evaluated the relationships of HPV viral load with size and histologic severity of cervical lesions, which has not been reported previously.

METHODS

By using Hybrid Capture II, DNA level of high-risk HPVs was determined in cervical scrapes and correlated with lesion size and histologic confirmation for 73 women referred for colposcopy. The lesion size was classified as nonvisible (n = 12), small (< or =2/5 of the 12x colposcopic visual filed, n = 36), and large (>2/5 of the 12x field, n = 25) lesions. The final disease status was categorized as high-grade SIL (HSIL)/squamous cell carcinoma (SCC) (designated HSIL+) (n = 32), low-grade SIL (LSIL) (n = 19), and no detectable SIL (n = 22).

RESULTS

A distinct upward trend of high-risk HPV DNA levels paralleled increasing size and histologic severity of cervical lesions (P = 0.003 and 0.001, respectively). With respect to relative risk, women who had high viral load of HPV were at significantly greater risk for large lesion size (odds ratio [OR] = 5.3, 95% confidence interval [CI] = 1.1-24.9) and HSIL+ (OR = 35.0, 95% CI = 4.2-294.5). Of particular note, the risk of developing large lesion size and HSIL+ significantly increased with increasing viral load of HPV (P values for trend test were 0.008 and 0.0004, respectively). In contrast, there were no significant associations of trend in viral load with risk in small lesion size and LSIL.

CONCLUSIONS

The present study revealed that the effect of HPV infection on SIL development is highly influenced by high viral load and highlighted a potential application of viral load testing in predicting the size and severity of lesions of the uterine cervix.

Cerebrovascular reactivity to acetazolamide in alert patients with cerebral infarction: usefulness of first-pass radionuclide angiography using 99m Tc-HMPAO in monitoring cerebral haemodynamics

Cerebral blood flow (CBF) and cerebrovascular reactivity (CVR) were studied in 75 patients with cerebral infarction. All patients were alert with the symptoms of hemiparesis and/or aphasia, and were divided into two groups: 42 patients had occlusion or stenosis of >75% at the internal carotid artery or main trunk of middle cerebral artery; and 33 patients did not. Hemispheric mean CBF was measured by performing first-pass radionuclide angiography using 99mTc-hexamethylpropylene amine oxime. CVR was measured as the percentage change from the baseline mean CBF value after the administration of 500 mg acetazolamide. The CVR in both groups was significantly impaired (5.2+/-6.3%, P<0.001 and 7.7+/-6.1%, P<0.01, respectively) compared with normal controls (14.7+/-3.3%), although the mean CBF was not significantly reduced compared with age-matched controls. In the 12 patients with unilateral carotid occlusion, five patients with good collateral flow via the anterior communicating artery showed preserved CVR (11.0+/-7.8%), but those without did not (1.6+/-7.0%). CVR is impaired in alert patients with cerebral infarction, although the mean CBF is not reduced, and good collateral flow via the anterior communicating artery in patients with carotid occlusion may be a sign of well-preserved haemodynamic status.

A novel multiparametric approach for analysis of cytoplasmic immunoglobulin light chains by flow cytometry

We describe a novel flow cytometric approach using a two-step acquisition technique to determine the cytoplasmic immunoglobulin light chains (LC) expression. Samples were prepared by a lysed-whole-blood technique and incubated with CD38-PE (phycoerythrin) and CD45-FITC (fluorescein isothiocyanate). The cells were fixed and acquired on an FACSCalibur flow cytometer (first acquisition). The cells were then permeabilized, incubated with either kappa-FITC or lambda-FITC and reacquired (second acquisition). Analysis of the data was performed by gating on the differing intensities of CD38 and evaluating them for the presence of a shifting FITC-positive population from the first acquisition to the second acquisition. The FITC fluorescence intensity of the second acquisition was equal to the sum of surface CD45 expression obtained during the first acquisition and the cytoplasmic LC expression obtained during the second acquisition. Thus, the shifting (increase) of FITC fluorescence intensity during the second acquisition is specifically due to the cytoplasmic expression of either the kappa or lambda LC. We studied 15 multiple myeloma (MM) patients and 10 controls (samples from patients without plasma cell dyscrasias). None of the controls showed evidence of any clonal populations. Thirteen of 15 MM patients exhibited clonal plasma cells (CD38 bright), ranging from 0.01% to 34% of total events collected. In addition, we identified another minute clonal population of lymphocytes (CD38 dim, CD45 bright, low forward and side scatter) in 12 of 13 MM patients with clonal plasma cells. This population, ranging from 0.01% to 0.6% of total events collected, had the same LC restriction as the clonal plasma cells. Patients with a ratio of minor clonal population to clonal plasma cells less than 0.07 tended to remain in partial or complete remission than those with a ratio > or =0.07 (4/5 versus 1/4, P <.1, chi(2)). We conclude that this method is highly sensitive and permits us to identify the minute clonal population of lymphocytes in MM patients. Our preliminary observations with a small cohort of patients imply that this minute clonal population may have important prognostic significance. The prognostic significance should be confirmed by further studies.