[Study on particle contamination produced by syringe needles and rubber stoppers for pharmaceutical solutions]

The contamination of particles produced by syringe needles and rubber stoppers for pharmacal solution of venous transfusion was studied. The results showed that the contamination of particles was positive correlation with the usage frequency of syringe needles, so the syringe needles for single use were suggested. To compare two kinds of syringe needles with different structure (side hole and incline), the result was that the difference of particle contamination between them was similar and without statistic significance. The particles contamination produced by primary and used rubber stoppers which was protected by polyester film was studied. It was shown that the difference between them was no significant statistically. The results of this study supplyed a scientific evidence about repeated use of rubber stoppers.

Role of the Kv4.3 K+ channel in ventricular muscle. A molecular correlate for the transient outward current

The expression of 15 different K+ channels in canine heart was examined, and a new K+ channel gene (Kv4.3), which encodes a rapidly inactivating K+ current, is described. The Kv4.3 channel was found to have biophysical and pharmacological properties similar to the native canine transient outward current (I(to)). The Kv4.3 gene is also expressed in human and rat heart. It is concluded that the Kv4.3 channel underlies the bulk of the I(to) in canine ventricular myocytes, and probably in human myocytes. Both the Kv4.3 and Kv4.2 channels are likely to contribute to the I(to) in rat heart, and differential expression of these two channels can account for observed differences in the kinetic properties of the I(to) in different regions of rat ventricle. There are significant differences in the pattern of K+ channel expression in canine heart, compared with rat heart, and these differences may be an adaptation to the different requirements for cardiac function in mammals of markedly different sizes. It is possible that the much longer ventricular action potential duration observed in canine heart compared with rat heart is due, in part, to the lower levels of Kv1.2, Kv2.1, and Kv4.2 gene expression in canine heart.

Transvaginal progesterone supplementation increases serum insulin-like growth factor-binding protein-1 levels

The objective of this study was to assess the effect, which might be mediated by progesterone-dependent insulin-like growth factor-binding protein-1 (IGFBP-1), of micronized progesterone supplementation through different administration routes (oral or vaginal) on successful pregnancy. A total of 299 anovulatory women were treated with clomiphene citrate (100 mg/day on days 5-9 of the menstrual cycle) to stimulate follicular growth. Human chorionic gonadotropin (hCG, 10,000 IU) was injected intramuscularly when at least one follicle was > 20 mm in diameter as monitored by transvaginal ultrasonography. Micronized progesterone (300 mg/day, at bedtime) was used as supplementation of progesterone randomly by oral (n = 153) or vaginal (n = 146) administration from approximately 36-48 h after hCG administration until the following menstrual period or the 10th week of gestation from the last menstrual period. As a control, 18 apparently healthy females with at least three regular menstrual cycles immediately before the present study were also recruited but no interventions were made. Serum levels of progesterone, IGFBP-1, insulin-like growth factor-I (IGF-I) and insulin were determined on day 8 after hCG administration (day 0 indicates the day of hCG administration; progesterone supplementation group) or on day 21 of the menstrual cycle (controls). In the midluteal phase higher progesterone and lower IGFBP-1 levels were observed in the serum from patients supplemented with oral progesterone than in those using vaginal progesterone. Total and continuing pregnancy rates were also higher in the patients using oral than in those using vaginal progesterone (p < 0.04, by the zI-test). However, there was no difference in serum IGF-I or insulin level between the groups. It was concluded that oral administration of micronized progesterone at bedtime appears to be a convenient method of luteal supplement, whereas vaginal supplementation during the luteal phase might directly stimulate endometrial production of IGFBP-1, which possibly, in turn, deters embryo implantation and results in a decrease in the pregnancy rate.

Leukoregulin induction of prostaglandin-endoperoxide H synthase-2 in human orbital fibroblasts. An in vitro model for connective tissue inflammation

Several proinflammatory cytokines can increase prostaglandin E2 (PGE2) synthesis in a variety of cell types, constituting an important component of the inflammatory response. We demonstrate here that leukoregulin, a 50-kDa product of activated T lymphocytes, dramatically increases PGE2 synthesis in cultured human orbital fibroblasts. This up-regulation is mediated through an induction of prostaglandin-endoperoxide H synthase-2 (PGHS-2), the inflammatory cyclooxygenase. Steady-state levels of PGHS-2 mRNA are increased within 1.5 h of leukoregulin addition and are near maximal by 6 h, when they are 50-fold or higher above basal levels. The increase in PGHS-2 mRNA levels is partially blocked by cycloheximide, suggesting de novo synthesis of an intermediate protein may be required for a maximal leukoregulin response. Nuclear run-on studies indicate PGHS-2 gene transcription is up-regulated by leukoregulin 2-fold after 2 and 6 h. PGHS-2 protein, as assessed by Western blotting and two-dimensional protein gel analysis, is increased dramatically in orbital fibroblasts. This lymphokine-dependent expression of PGHS-2 is blocked by dexamethasone, and the increase in PGE2 and cAMP levels following leukoregulin treatment is also blocked by indomethacin and by SC 58125, a newly developed PGHS-2-selective cyclooxygenase inhibitor. The dramatic increase in cAMP levels causes marked alteration in orbital fibroblast morphology. PGHS-2 expression in dermal fibroblasts is also increased by leukoregulin; however, the response is considerably less robust, and these cells do not undergo a change in morphology. Both orbital and dermal fibroblasts express high levels of PGHS-1 mRNA and protein, the other abundant form of cyclooxygenase. In contrast to its effects on PGHS-2 expression, leukoregulin fails to alter PGHS-1 levels in either orbital or dermal fibroblasts, suggesting that PGHS-1 is not involved in cytokine-dependent prostanoid production in human fibroblasts. The increased PGHS-2 expression elicited by leukoregulin in orbital fibroblasts may be a consequence of both transcriptional and post-transcriptional effects. These observations help clarify the pathogenic mechanism relevant to the intense inflammation associated with Graves' ophthalmopathy. Lymphocytes trafficked to orbital tissues have a putative role, through the cytokines they release, in the activation of fibroblasts in this autoimmune disease.

Acrodermatitis enteropathica-like eruption during treatment of maple syrup urine disease: report of one case

We describe a Chinese infant with maple syrup urine disease (MSUD) who had acrodermatitis enteropathica-like skin manifestations, edema, anemia, and diarrhea due to inadequate intake of branched-chain amino acids (BCAAs). A BCAA supplementation resulted in resolution of the eruption. This observation suggested the importance of monitoring plasma amino acids' levels for infants with metabolic disease on special formula.

Laparoscopic Removal of a Large Leiomyoma Using Airlift Gasless Laparoscopy

Some discrepancies still exist with regard to the efficacy of laparoscopic removal of large symptomatic leiomyomas. In our experience, when performing myomectomy, airlift gasless laparoscopy has several advantages. First, a small incision can be made, through which conventional surgical instruments (endoscopic equipment is not required) are inserted and the myomectomy is efficiently performed. Second, the large excised leiomyoma can be cut into strips easily with a conventional long knife and removed through a small abdominal incision. Third, sutures can be placed easily, and the surgeon can place fingers through a small surgical wound to palpate the organ and tie the knot directly. Fourth, high-pressure irrigation and large-volume suction devices can be used without fear of decompressing the pneumoperitoneum. Finally, the potential risks of metabolic and hemodynamic instability due to carbon dioxide insufflation to establish pneumoperitoneum are avoided.

Role of SOD-1 and nitric oxide/cyclic GMP cascade on neurofilament aggregation in ALS/MND

A number of free radicals such as superoxide and nitric oxide may cause damage to motor neurons but the exact mechanism remains to be elucidated. A potent free radical, peroxynitrite, is readily formed from superoxide and nitric oxide, which captures superoxide three times faster than SOD-1. Peroxynitrite may nitrate tyrosine residues of light neurofilaments (NF-I), thereby altering NF assembly and causing NF accumulation in motor neurons. To test this hypothesis we have probed the massive NF aggregates which are histopathological hallmarks of ALS/MND with immunohistochemistry. We investigated localization of reaction products related to SOD-1, nitric oxide synthase (NOS) and cyclic GMP activities. Our studies show colocalization of NF aggregates with SOD-1/b-NOS/calmodulin /citrulline/cGMP and nitrotyrosine in upper motor neuron conglomerates (Cgl) and lower motor neutron axonal spheroids (Axs). This strongly supports the notion that peroxynitrite deranges NF phosphorylation and assembly, by nitrating tyrosine residues in NF-L. Impaired phosphorylation of NF subunits, either at NF-I or at NF-H, may affect the slow axonal transport culminating in proximo-distal accumulation of NF and slowly progressive motoneuron death.

p53, apoptosis and human cancers

More than half of human cancers contain p53 mutations. Structural analyses of p53-DNA interactions indicate that hot spots of p53 mutation are often either involved in direct contact with target DNA or those that maintain specific conformation of p53. One significant consequence of the loss of wild type p53 function is inhibition of apoptosis, which may be through the inability of mutant p53 to transcriptionally activate bax gene expression. Quantitative correlation among ultraviolet-induced p53 mutations of keratocytes, inhibition of apoptosis and the development of squamous cell cancer of the skin further suggest a central role of inhibited apoptosis between p53 mutations and tumorigenesis. Hypoxia-mediated selection for p53 mutant cells with diminished apoptotic potential in solid tumors may account for the high prevalence of p53 mutations in human cancers. Our increasing understanding of the role of p53 mutations and apoptosis in human cancers has also provided some insights into strategies for anticancer therapy. Studies reconstituting the wild-type p53 through gene therapy have been encouraging. More importantly, further elucidation of the mechanisms of therapy-induced p53-independent apoptosis in cancer cells will facilitate the development of more efficient, less toxic anticancer therapy.

Laparoscopic myomectomy of large symptomatic leiomyoma using airlift gasless laparoscopy: a preliminary report

Despite the expanding role of laparoscopic surgery in many gynaecological fields, some discrepancies still exist regarding the efficacy of laparoscopic myomectomy in treating patients with large symptomatic leiomyoma. In this report, a better operative procedure and the results of treatment are evaluated. Patients (n = 14) presenting with infertility, menorrhagia, pressure symptoms or pelvic mass associated with a large leiomyoma were managed with laparoscopic myomectomy using airlift gasless laparoscopy. Uterine size ranged from 14 to 24 weeks gestational age and the weight of the myoma ranged from 246 to 669 g (mean 454); operative time ranged from 78 to 165 min (mean 104) and blood loss from 90 to 580 ml (mean 201). No major complication occurred during the operation or follow-up. All except one patient were discharged within 72 h of the operation and resumed normal activity within 1 week. When myomectomy is indicated, the airlift gasless laparoscopic approach appears to offer a better alternative to abdominal or pneumoperitoneum laparoscopic surgery in selected cases. Airlift gasless laparoscopy has several advantages: (i) small abdominal incisions and minimal endoscopic equipment are required; (ii) the excised leiomyomata mass can be easily cut into strips and removed through the small abdominal incision; (iii) the uterine defect can be more efficiently repaired using easily performed suture techniques; (iv) high-pressure irrigation and large-volume suction devices can be used without fear of decompressing the pneumoperitoneum; and (v) the potential risk of metabolic and haemodynamic derangements during pneumoperitoneum laparoscopy are obviated. Gasless laparoscopy also has some disadvantages. The exposure obtained with gasless laparoscopy is not as good, under some circumstances, as that achieved by pneumoperitoneum. For patients who are thin, and even those with moderate obesity, the exposure obtained with airlift mechanical suspension is adequate; however, morbidly obese patients with previous abdominal surgery with suspected pelvic adhesions can incur some problems during the operation because of a poor operative field.

Insulin-like growth factor-binding protein 1 and insulin-like growth factor-binding protein 3 in pre-eclampsia

OBJECTIVE

To investigate circulating levels of insulin-like growth factor-binding protein 1 (IGFBP-1) and IGFBP-3 in the mother and the fetus in pregnancies complicated by pre-eclampsia, and the relationship between serum levels of IGFBPs and fetal birthweight.

DESIGN

A prospective study over an 18 month period.

SETTING

A tertiary care academic medical centre.

PARTICIPANTS

Sixty-six pregnant women with pre-eclampsia (35 cases of mild/moderate pre-eclampsia and 31 cases of severe pre-eclampsia) and 78 nonpre-eclamptic pregnant women of matched gestational weeks and maternal ages.

MAIN OUTCOME MEASURES

Serum concentrations of IGFBP-1 and IGFBP-3 at the time of delivery.

RESULTS

In pre-eclampsia associated with intrauterine growth retardation (IUGR), maternal and cord serum IGFBP-1 levels at the time of delivery were elevated. By contrast, circulating IGFBP-3 levels in both the mother and the fetus were lower in pre-eclampsia with IUGR than in nonpre-eclamptic pregnancy. However, there was no difference in serum IGFBP-1 and IGFBP-3 levels between pre-eclampsia without IUGR and nonpre-eclamptic pregnancy in both the mother and the fetus.

CONCLUSIONS

In pre-eclampsia, elevated concentrations of circulating IGFBP-1 and decreased serum IGFBP-3 levels were observed in both the mother and the fetus. However, these changes may simply reflect low birthweight in pre-eclampsia.

Effects of NGF overexpression on anatomical and physiological properties of sympathetic postganglionic neurons

To examine the effects of increased target derived nerve growth factor (NGF) on the sympathetic nervous system, the superior cervical ganglion was characterized in transgenic mice overexpressing NGF in keratinized epithelium (e.g. skin, tongue and oral cavity). In these mice NGF overexpression was achieved via expression of an NGF transgene driven by the K14 keratin promoter. This promoter is expressed at approximately embryonic day 11 and thereafter expressed constitutively in the adult. This expression results in supranormal levels of NGF in targets of sympathetic postganglionic neurons prior to the period of programmed cell death. Examination of postnatal day 6 (PN6) and adult transgenic mice shows ca. 2.5-fold increase in neuron number in the superior cervical ganglion (SCG). Analysis of SCG neuronal size revealed a dramatic hypertrophy in the transgenic mice that is present by PN6 and is maintained in the adult. Intracellular physiological measurements of control superior cervical ganglia identified two distinct types of neurons identified on the basis of their response to depolarizing current; 'phasic' neurons fire a single action potential while 'tonic' neurons fire continuously. In adult transgenic mice the phasic neurons were 102% larger than control phasic neurons while the tonic neurons only increased 44% relative to controls. The hypertrophy of sympathetic ganglia in the transgenic mice was correlated with an increased innervation of skin and dorsal root ganglia, structures that either express the transgene or concentrate NGF produced by the skin.

Insulin-like growth factor-binding proteins produced by Vero cells, human oviductal cells and human endometrial cells, and the role of insulin-like growth factor-binding protein-3 in mouse embryo co-culture systems

Co-culturing embryos on helper cells can mimic the in-vivo environment, thereby enhancing embryo development in vitro. Insulin-like growth factors (IGF) and their binding proteins (IGFBP) also enhance embryo development. To investigate the kinds of IGFBP produced by various cell monolayers and the effects of IGFBP-3 on mouse embryo co-culture systems, 2-cell ICR mouse embryos were cultured in either human tubal fluid medium alone or in the presence of Vero cells, human oviductal cells or endometrial cells. The helper cells were analysed immunohistochemically to investigate the types of IGFBP produced by various cell monolayers. The concentrations of IGF-I and IGFBP-3 in media obtained from the culture of embryos alone, cells alone or cells plus embryos were determined by radioimmunoassays. On day 7, more blastocysts hatched in the co-culture groups (73% in the Vero cell group, 76% in the endometrial cell group and 74% in the oviductal cell group) than in the control group (43%) (P < 0.0001). The results of immunohistochemistry revealed that (i) all three cell groups produced a lot of IGFBP-1, -2 and -3, but only a little of IGFBP-4 and -5; and (ii) IGFBP-1, -2, and -3 were present in blastocysts in either the presence or absence of helper cells. The IGF-I secreted by cell monolayers or embryos was undetectable (detection limit 0.83 microg/l). The IGFBP-3 concentrations in media obtained from co-cultured embryos and cells were significantly higher than in media without embryos (median values in oviductal cell culture medium, 165 versus 127 microg/l, P = 0.04; median values in endometrial cell culture medium, 277.5 versus 183.5 microg/1, P = 0. 0002; median values in Vero cell culture medium, 219 versus 120 microg/l, P = 0.011). Although IGFBP-3 concentration in the medium that contained embryos alone was undetectable by radioimmunoassay (detection limit 1.1 microg/l), immunohistochemistry demonstrated the presence of IGFBP-3 in the embryos. Co-culture in systems in which there was an increased production of IGFBP-3 led to an improved development of mouse embryos. IGFBP can improve the binding of IGF to cell surface receptors of target tissue, and thus enhance the effect of limited IGF concentrations in promoting embryo development in a co-culture system. We conclude that Vero cells, human endometrial cells and oviductal cells produce IGFBP-1, -2, -3, -4 and -5. IGFBP-3 may play a role in embryotrophic potential by either regulating the action of IGF or directly enhancing embryo development.

Colocalization of NOS and SOD1 in neurofilament accumulation within motor neurons of amyotrophic lateral sclerosis: an immunohistochemical study

Peroxynitrite, formed from nitric oxide and superoxide, may affect neurofilament assembly and cause neurofilament accumulation in motoneurons. This hypothesis may reconcile the mutations of two genes: superoxide dismutase-1 in some patients with familial amyotrophic lateral sclerosis, and the gene for the heavy neurofilament in some patients with sporadic amyotrophic lateral sclerosis previously reported. We found colocalization of superoxide dismutase-1 and nitric oxide synthase in the foci of neurofilament accumulation as 'conglomerates' in upper motor neurons and 'axonal spheroids' in lower motor neurons. In addition, all the specific molecules related to the reactions, including calmodulin, 3', 5'-cyclic guanosine-monophosphate, citrulline, and nitrotyrosine were found strongly immunopositive in the site of neurofilament accumulation. Our data support the view that the neurofilament aggregates are tightly linked with superoxide dismutase-1 and nitric oxide synthase activities. Both enzymes may focally contribute to peroxynitrite formation at light neurofilament, which is rich in both tyrosine and arginine residues and hence considered as the vulnerable site for nitrotyrosine formation. Nitrotyrosine is known to inhibit phosphorylation and if it impairs phosphorylation of neurofilament subunits, either light or heavy, may alter the slow axonal transport culminating in proximo-distal accumulation of NF and slowly progressive motoneuron death.

Modulation of inwardly rectifying currents in rat sympathetic neurones by muscarinic receptors

1. Intracellular recordings were made from rat sympathetic neurones in isolated superior cervical ganglia (SCG), coeliac ganglia (CG), and superior mesenteric ganglia (SMG). 2. Following classification of the firing properties of these neurones as either 'phasic' or 'tonic', single-electrode voltage-clamp recordings of the inwardly rectifying current were performed. The inward rectifier conductance was 6.4 times larger in tonic neurones than in phasic neurones. 3. The basic features of the inward rectifier in sympathetic neurones were similar to those of the classic inward rectifier described in several neuronal and non-neuronal preparations. The properties of the native channel were also similar to a subset of recently cloned inwardly rectifying channels. The reversal potential and the slope conductance were both dependent on external potassium ion concentration. The conductance was blocked by low concentrations of external Ba(2+) and Cs(+) ions. 4. A striking feature of the inward rectifier in sympathetic neurones was its modulation by muscarine. Application of 20 microM muscarine produced a mean 78 +/- 1.4% inhibition of the current. From dose-response curves for muscarine a mean dissociation constant of K(D) = 1.95 +/- 0.2 microM was determined. Schild plot analysis using the competitive antagonists pirenzepine and himbacine indicated that the effect of muscarine was mediated by the M(1) class of muscarinic receptors. 5. The inward rectifier was also inhibited by repetitive nerve stimulation which produced a block of the conductance similar to that seen in response to bath-applied muscarine. The onset of inhibition was relatively slow, 20-30 s, suggesting that it is mediated by a soluble second messenger pathway.

n-Butyrate induces plasminogen activator inhibitor type 1 messenger RNA in cultured Hep G2 cells

n-Butyrate, a short-chain aliphatic carboxylic acid with pleiotropic actions, is present at high concentrations in the portal circulation and thus may play an important role in the regulation of specific gene expression in the mammalian liver. We report here that n-butyrate can increase substantially the level of plasminogen activator inhibitor type 1 (PAI-1) messenger RNA (mRNA) in Hep G2 cells, up to eightfold above control cultures. Maximal effects occurred at a concentration of 3 mmol/L n-butyrate and with a treatment period of 8 to 12 hours. Increases in PAI-1 mRNA were accompanied by modest increases (twofold) in the encoded protein as assessed by specific enzyme-linked immunosorbent assay and by [35S]methionine incorporation into immunoprecipitable PAI-1 in the culture medium. Nuclear run-on studies showed that the rate of transcription of the PAI-1 gene did not appear altered by treatment with 3 mmol/L n-butyrate for 6 hours. The increases in steady-state PAI-1 mRNA caused by exposure to n-butyrate can be blocked by cycloheximide. Enhanced stability of mature PAI-1 transcript could not be demonstrated in Hep G2 cells treated with the carboxylic acid. We have reported previously that n-butyrate can reduce the level of beta-galactoside alpha 2,6-sialyltransferase expression in Hep G2 cells. That effect was attenuated with inhibitors of protein and RNA synthesis and was mediated at the post-transcriptional level. Thus, n-butyrate can influence the expression of multiple genes in this hepatoblastoma cell through its actions on events that appear to be posttranscriptional. These observations may be relevant to the normal physiology of the mammalian liver because of the high concentrations of n-butyrate and related compounds to which the organ is ordinarily exposed.

Leiomyosarcoma of the rectum: a series of twelve cases

BACKGROUND

Leiomyosarcoma of the rectum is a rare disease without well-documented report on its management and prognosis in Taiwan. To evaluate the effectiveness and prognosis of different treatments for rectal leiomyosarcoma, we reviewed a series of 12 patients with rectal leiomyosarcoma treated at our hospital.

METHODS

This study is a retrospective review of 12 rectal leiomyosarcomas treated at VGH-Taipei from 1976 to 1995, with emphasis on symptoms, therapeutic procedures and prognosis.

RESULTS

The majority of tumors occurred in men (n = 10) and the average age at presentation was 54.4 years. Bloody stool and perianal pain were the two most common symptoms. Nine tumors were found in the lower rectum, within 4 cm above the dentate line. Five patients received abdominoperineal resection, four received wide local excision, and three had diversion colostomy. The effect of adjuvant therapy, either chemo- or radiotherapy, was poor. The overall one-year and five-year survival rates were 83% and 46%, respectively. Liver was the principal metastatic site. The local recurrence rate was much higher in patients receiving wide local excision than in those receiving abdominoperineal resection (100% vs. 20%).

CONCLUSIONS

Abdominoperineal resection is an appropriate choice of treatment for patients with operable rectal leiomyosarcoma due to its lower local recurrence rate. Wide local excision could be considered when the lesion is less than 2 cm in diameter or when patients are not suitable for radical surgery. The effect of adjuvant therapy, either radiotherapy or chemotherapy, is poor for rectal leiomyosarcoma.

Coexistence of schizencephaly and intracranial arteriovenous malformation in an infant

A 9-month-old infant had unilateral closed-lip schizencephaly in the right parietal lobe, which coexisted with an arteriovenous malformation in the nearby temporal area. Cranial MR showed a right parietal cleft lined with gray matter between the right lateral ventricle and the subarachnoid space, and cluster hypointensities throughout the right temporal lobe. Cerebral angiography revealed a right temporal arteriovenous malformation with feeding arteries arising from the right middle and posterior cerebral arteries and draining into the right sigmoid sinus via the engorged vein of Labbé.

The impact of the total motile sperm count on the success of intrauterine insemination with husband's spermatozoa

PURPOSE

The purpose of this study was to evaluate the relationship between the total motile sperm count and the success of IUI treatment cycles with postwashed husband spermatozoa in couples with infertility in a large patient population.

PATIENTS

When 939 couples underwent 1375 cycles of IUI with varying etiologies of infertility which included male factor, endometriosis, tubal factor, ovulatory dysfunction, uterine factor, cervical factor, and unexplained infertility, the results were 207 pregnancies.

RESULTS

The overall pregnancy rate per cycle was 15.1% (207/1375). The total motile sperm count were significantly increased in the pregnant group than the nonpregnant group (38.7 x 10(6) versus 28.6 x 10(6); P < 0.001). There was a trend toward an increased success rate with increased total motile sperm count. Significance was reached when the total motile sperm count exceeded 5 x 10(6). Life table analysis was performed and the curve representing a cumulative chance of pregnancy calculated from our data reached 72%.

CONCLUSIONS

Our findings suggest that a final postwashed total motile sperm count used for IUI may be considered predictive of the success for pregnancy and allow couples to be informed of the chances of success.

Prostaglandin E2 alters human orbital fibroblast shape through a mechanism involving the generation of cyclic adenosine monophosphate

Orbital fibroblasts from patients with Graves' ophthalmopathy, when treated with prostaglandin E2 (PGE2), become stellate and develop prominent cellular processes. In this paper, we describe results of studies designed to characterize the action of PGE2 on orbital fibroblast shape changes in vitro. Orbital and dermal fibroblasts were incubated with PGE2, one of several prostanoid analogues, 8-br-cAMP or forskolin and were then visualized by phase-contrast microscopy. Other studies involved seeding cells in special chambers equipped with electrodes for cell sensing using electric cell-substrate impedance sensing (ECIS) to detect changes in shape. PGE2 (10(-7) mol/L) elicited a rapid and dramatic alteration in the shape of orbital fibroblasts but not those derived from the skin. Cells became stellate and developed prominent cytoplasmic processes that extended out from the central area containing the cell nucleus. The effects were stereoselective in that a number of structurally related compounds, including Sulprostone, PGI2, PGF2 alpha, thromboxane A2, thromboxane B2, and 11 deoxy,16,16 dimethyl PGE2 failed to elicit a similar shape change. Butaprost (10(-5) mol/L), a specific EP2 agonist, elicited a similar shape-change as that observed with PGE2. 16,16-dimethyl PGE2, a nonselective agonist, could mimic the action of PGE2. The effect of PGE2 was apparent at 10(-8) mol/L, maximal at a concentration of 10(-7) mol/L and took 4-8 hr to evolve completely. Cycloheximide (10 micrograms/mL) and actinomycin D (1 micrograms/mL) failed to block the shape change. The morphologic change could be reproduced by addition of 8-br-cAMP (3 mmol/L) and by forskolin (5 mumol/L). Moreover, PGE2 and Butaprost treatment elicited in orbital cultures a massive increase in endogenous cAMP production while analogues not affecting cell shape failed to influence cyclic nucleotide generation. Three strains of orbital fibroblasts from patients with Graves' ophthalmopathy and three from normal orbits were tested and all responded to PGE2 (10(-7) mol/L). Four strains of dermal fibroblasts failed to respond to PGE2. The changes in orbital fibroblast morphology were accompanied by a marked decrease in monolayer impedance as assessed by electric cell-substrate impedance sensing. The earliest effects were apparent within 30 min using this sensitive technique. The widely recognized roles of PGE2 and related compounds in the mediation of the inflammatory response make our current findings in orbital fibroblasts of potential importance to the pathogenesis of Graves' ophthalmopathy.

Late-onset pyridoxine-dependent seizures: report of two cases

We report two cases of late-onset pyridoxine-dependent seizures with age onset at 14 and 9 months, respectively. Their intractable seizures were refractory to diazepam, phenobarbital, phenytoin, carbamazepine, valproic acid, and adrenocorticotropic hormone, but stopped soon after intravenous administration of pyridoxine. The psychomotor development was retarded in both cases. Pyridoxine dependency is one of the few treatable intractable seizures in infancy. It should always be kept in mind, even in patients with intractable seizures beyond the neonatal period, regardless of previous patterns of electroencephalography and seizure types and responsiveness to the conventional anticonvulsants.

Insulin-like growth factor-I and insulin-like growth factor-binding protein-1 in Taiwanese women during normal pregnancy

Circulating levels of insulin-like growth factor-I (IGF-I) and insulin-like growth factor-binding protein-1 (IGFBP-1) in Taiwanese women during normal pregnancy were investigated. Three hundred and eighty-five pregnant women at various gestational ages and 30 nonpregnant females were recruited into the study. Serum concentrations of IGF-I and IGFBP-1 were determined by immunoradiometric assay (IRMA) and radioimmunoassay (RIA). Maternal serum levels of IGF-I increased as pregnancy progressed. Circulating IGF-I levels in women during the first trimester of pregnancy were higher than those in nonpregnant females. Serum levels of IGFBP-1 rose rapidly before 12 weeks of gestation and remained high until term. Serum IGFBP-1 levels in pregnant women during the first trimester were significantly higher than those in nonpregnant females. However, there was no difference in maternal serum IGFBP-1 levels between the second and the third trimester of pregnancy. It is concluded that serum IGF-I levels during pregnancy may be regulated by various classes of IGF-binding proteins other than IGFBP-1.

Evidence for cellular heterogeneity in primary cultures of human orbital fibroblasts

Orbital fibroblasts in culture display phenotypic attributes that distinguish them from fibroblasts derived from other anatomical regions. The current studies were conducted to define potential cellular heterogeneity among orbital fibroblasts with regard to 1) differential expression of Thy-1, a 25-kilodalton glycoprotein associated with cell signaling; 2) cells undergoing a change in shape in response to prostaglandin E2 (PGE2); and 3) differences in morphology and Thy-1 expression between single cell-derived clonal fibroblast strains. On the basis of flow cytometric analysis using an anti-Thy-1 monoclonal antibody, 65% of intact orbital fibroblasts expressed surface Thy-1 (n = 5; range, 54-71%). In contrast, greater than 95% of the fibroblasts present in the five dermal strains tested were Thy-1 positive. A total of six strains of orbital fibroblasts were assessed for their shape change response to a 4-h treatment with PGE2 (100 nmol/L). A mean of 37% of the fibroblasts present in each culture responded to PGE2 (range, 22-50%). In contrast, only 1% of dermal fibroblasts exhibited any change in morphology. Three separate clones were generated from a single parent strain of Graves' orbital fibroblasts. These clones consisted of homogeneous appearing cells; however, substantial clone to clone differences in morphology were stably expressed for several population doublings. Thy-1 was expressed uniformly in cells of two clones, whereas the third was Thy-1 negative. Factor VIII and smooth muscle-specific alpha-actin were undetectable in any of the orbital or dermal cultures examined. Thus, Thy-1 expression is uniform in fibroblasts from certain anatomical regions such as the skin and heterogeneous in cells derived from human lung and orbit. These findings suggest that human orbital connective tissue may have a complexity not previously appreciated.

Transcranial color-coded sonography in normal Chinese adults and its clinical applications

We have performed transcranial color-coded sonography to 150 normal adults. Through the temporal, orbital and foraminal windows, by using a 2 MHz pulsed-wave transducer, we were able to directly insonate the brain parenchyma, and to obtain color-coded Doppler vascular imagings and flow velocities of the intracranial basal cerebral arteries. There was no significant difference of blood flow velocities and resistance index between the right and left hemispheres. The mean velocities was highest in the middle cerebral artery and lowest in the ophthalmic artery while which had the highest resistance index. Female had higher mean velocity in basilar artery. The mean velocity, peak systolic velocity, as well as end diastolic velocity decreased significantly with age in middle cerebral artery, anterior cerebral artery and basilar artery. Four illustrative cases with abnormal findings were presented to compare with normal control. Some pitfalls in ultrasonography were also described.