Recognition of patient referral desires in an academic managed care plan frequency, determinants, and outcomes

OBJECTIVE

To determine the frequency and determinants of provider nonrecognition of patients' desires for specialist referral.

DESIGN

Prospective study.

SETTING

Internal medicine clinic in an academic medical center providing primary care to patients enrolled in a managed care plan.

PARTICIPANTS

Twelve faculty internists serving as primary care providers (PCPs) for 856 patient visits.

MEASUREMENTS AND MAIN RESULTS

Patients were given previsit and postvisit questionnaires asking about referral desire and visit satisfaction. Providers, blinded to patients' referral desire, were asked after the visit whether a referral was discussed, who initiated the referral discussion, and whether the referral was indicated. Providers failed to discuss referral with 27% of patients who indicated a definite desire for referral and with 56% of patients, who indicated a possible desire for referral. There was significant variability in provider recognition of patient referral desire. Recognition is defined as the provider indicating that a referral was discussed when the patient marked a definite or possible desire for referral. Provider recognition improved significantly (P <.05), when the patient had more than one referral desire, if the patient or a family member was a health care worker and when the patient noted a definite desire versus a possible desire for referral. Patients were more likely (P <.05) to initiate a referral discussion when they had seen the PCP previously and had more than one referral desire. Of patient-initiated referral requests, 14% were considered "not indicated" by PCPs. Satisfaction with care did not differ in patients with a referral desire that were referred and those that were nor referred.

CONCLUSIONS

These PCPs frequently failed to explicitly recognize patients' referral desires. Patients were more likely to initiate discussions of a referral desire when they saw their usual PCP and had more than a single referral desire.

Synthesis of biotinylated glyfoline for immunoelectron microscopic localization

Antineoplastic glyfoline (1) has potent antitumor efficacy against various murine and human solid tumors. To elucidate the actual mechanism of action, we synthesized biotinylated glyfoline (B-Gly) and used it for the visualization of glyfoline-binding sites in nasopharyngeal carcinoma (NPC) cells. Under the electron microscope (EM), after cells were incubated for 6-36 h, the reaction products of anti-B-Gly were seen on some areas of the external cell surface and on the outer and inner membranes of the mitochondria. Pure EM morphology of NPC cells after glyfoline treatment revealed the similar morphological change of mitochondria. These findings indicate that the binding site of glyfoline in NPC is the inner membrane of the mitochondria, suggesting that B-Gly can be used as a marker for glyfoline localization.

Degradation of repaired denture base materials in simulated oral fluid

This in vitro study evaluates the degradation of repaired denture bases upon immersion in a simulated oral fluid. Denture base materials (Luciton 199), after being repaired by Repair Material and Triad, using three different joint surface designs (butt, round and 45 degrees bevel), were immersed onto 99.5 vol.% ethanol/water solution (with similar solubility parameter) for various amounts of time (0-72 h). The flexural loads of the six combination of groups were measured by the three-point bending tests using a universal testing machine. Acoustic emission (AE) during sample fracturing were processed using the MISTRA 2001 system. The fracture pattern and surface details of the interface were examined with a scanning electronic microscope (SEM). Data were analysed using three-way ANOVA and Tukey LSD tests. SEM micrographs of the fracture interface were used to differentiate the fracture mode. The flexural loads (2.72 +/- 0.51 Kgf) of the round joint specimens were significantly higher (P< 0.05) than those (butt: 1.66 +/- 0.38 Kgf, 45 degrees bevel: 1.93 +/- 0.41 Kgf) of the other two designs. This corresponds to the microscopic examination in which more cohesive failure mode was found for the round joint group after storage. The flexural loads (2.54 +/- 0.39 Kgf) of the specimens repaired with Triad were significantly higher (P < 0.05) than those (1.59 +/- 0.40 Kgf) of specimens repaired with Repair Material. Significant progressive reduction of the flexural load and/or AE signals of the specimens was noted in proportion to the length of time of the immersion in the simulated oral fluid. Mechanical strength of a denture base repaired with a round joint design and light-cured material is significantly higher after immersion in simulated oral fluid.

Ultrasonographic measurement of tongue movement during swallowing

Previous ultrasonographic studies on tongue functions were limited by the possibility of artifacts caused by movement of the submental area during function. Consequently, tongue movements were misinterpreted. A dynamic tongue imaging technique, the cushion-scanning technique, was used to overcome this problem. Later, swallowing was investigated and divided into five phases using cushion-scanning technique-aided M-mode ultrasonograms. In this study, cushion-scanning technique in combination with the B-mode and M-mode ultrasonography was applied to investigate and measure the tongue movement during swallowing in 55 normal persons. The average duration, range of motion and speed of swallowing were found to be 2.43 s, 24.06 mm, and 10.34 mm/s, respectively. The computer-aided B-mode plus M-mode ultrasonography in combination with the cushion-scanning technique is a valuable tool for study of tongue functions.

Radical resection and intraoperative radiotherapy for a recurrent endometrial cancer after prolonged remission following aggressive salvage therapy: case report

The prognosis of recurrent endometrial carcinomas is generally poor, except for isolated vaginal relapse. We report a case of recurrent endometrial cancer in a 58-year-old woman who initially received a type I extended hysterectomy with bilateral salpin-go-oophorectomy and bilateral para-aortic and pelvic lymph node dissection. The first recurrence occurred in the left parametrium 7 months after the primary surgery. The salvage therapy consisted of radiotherapy combined with hormonal therapy (tamoxifen and Megace). Complete remission was achieved initially. Subsequently, the patient accepted six courses of chemotherapy (cisplatin and Adriamycin) for progressive elevation of cancer antigen 125 (CA-125). The CA-125 levels remained elevated with titers fluctuating around 100 U/ml until a second recurrence at the left iliac 75 months following salvage therapy. The second salvage treatment consisted of maximal debulking of the pelvic mass and intraoperative radiotherapy (IORT) followed by four courses of chemotherapy with paclitaxel and carboplatin. Complete remission was again accomplished, with clinical investigations and molecular markers returning to normal. The patient has been clinically free of disease for more than 2 years since the second relapse of cancer. In this particular case, we found that repeated recurrence could occur after a long complete remission following salvage therapy; however, the disease could be recontrolled with further aggressive salvage efforts. A multimodality approach with combinations of radical resection, IORT, and paclitaxel-based chemotherapy can be offered to patients with localized recurrent or repeatedly recurrent endometrial carcinoma after previous cisplatin-based chemotherapy and pelvic radiation.

E-, P-, and N-cadherin are co-expressed in the nasopharyngeal carcinoma cell line TW-039

The cadherin/catenin complex plays a key role in the initiation of cell-cell recognition, and adhesion, and the elaboration of structural and functional organization in multicellular tissues and organs. It is associated with tumor metastasis and also acts as an "invasion suppressor" of cancer cells. Nasopharyngeal carcinoma (NPC) is notorious for its highly metastatic nature. The expression of the E-cadherin/catenin complex is down-regulated in NPC tumor specimens. To obtain better insight into the intercellular adhesive property of NPC cells, we used immunofluorescence microscopy, immunoprecipitation, and immunoblot analysis to examine the expression of the classical cadherins and beta-catenin in a NPC cell line, TW-039. The results demonstrate a change in the distribution of E-cadherin from cytosolic flakes to cell-cell contacts with increasing time in culture. Between days 1 and 5 after plating, the detergent-insoluble fraction of E-cadherin increased from 20% to 37% of total E-cadherin, and that for P-cadherin increased from 33% to 40%. By contrast, the values for beta-catenin remained unchanged (26% and 25%). Both immunofluorescence and immunoblot studies suggested that P-cadherin may be involved in pioneer contact adhesion of TW-039 cells. Interestingly, E-, P-, and N-cadherin are co-expressed in this cell line. Immunoprecipitation studies also showed that other members of the cadherin family may be involved in the contact adhesion of TW-039 cells.

High-risk human papillomavirus deoxyribonucleic acid as an adjunct marker in cervical cytology

BACKGROUND

This study was designed to determine whether screening for high-risk human papillomaviruses testing could improve the detection of cervical dysplasia and cancer in assistance with conventional Papanicoloau (Pap) smears.

METHODS

The study was based on 114 patients with abnormal Pap smears referred for colposcopy from Feb. 1997 to Dec. 1997. The presence of high-risk human papillomavirus (HPV) DNA was determined with the Hybrid Capture method (including HPV types 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, and 68). Cytologic examination by Papanicolaou smear was based on the Bethesda system and cervical biopsy was done via colposcopy.

RESULTS

Cytologic examination demonstrated high-grade squamous intraepithelial lesions (HSIL) in 24 patients with HPV positive (75%), low-grade squamous intraepithelial lesions (LSIL) in 38 with 61% HPV positive, and atypical squamous cells of undetermined significance (ASCUS) in 52 with 37% HPV positive. Among patients with a cytologic diagnosis of borderline abnormalities (ASCUS or LSIL), those with who were HPV positive were significantly more likely to have cervical dysplasia (both p < 0.05). The sensitivity of combined HPV assay and/or cytology for detection of noninvasive precursor (91%) was significantly greater than those of cytology (68%) or HPV assay (81%) alone.

CONCLUSION

The addition of the hybrid capture high-risk HPV DNA assay to cytologic examination of cervical smears appears to increase the sensitivity of cervical screening. Our findings suggest that HPV DNA may be a useful adjunct marker for early detection of cervical dysplasia in women with minimally abnormal Pap smears (ASCUS/low-grade SIL).

A space-time delay neural network for motion recognition and its application to lipreading

Motion recognition has received increasing attention in recent years owing to heightened demand for computer vision in many domains, including the surveillance system, multimodal human computer interface, and traffic control system. Most conventional approaches classify the motion recognition task into partial feature extraction and time-domain recognition subtasks. However, the information of motion resides in the space-time domain instead of the time domain or space domain independently, implying that fusing the feature extraction and classification in the space and time domains into a single framework is preferred. Based on this notion, this work presents a novel Space-Time Delay Neural Network (STDNN) capable of handling the space-time dynamic information for motion recognition. The STDNN is unified structure, in which the low-level spatiotemporal feature extraction and high-level space-time-domain recognition are fused. The proposed network possesses the spatiotemporal shift-invariant recognition ability that is inherited from the time delay neural network (TDNN) and space displacement neural network (SDNN), where TDNN and SDNN are good at temporal and spatial shift-invariant recognition, respectively. In contrast to multilayer perceptron (MLP), TDNN, and SDNN, STDNN is constructed by vector-type nodes and matrix-type links such that the spatiotemporal information can be accurately represented in a neural network. Also evaluated herein is the performance of the proposed STDNN via two experiments. The moving Arabic numerals (MAN) experiment simulates the object's free movement in the space-time domain on image sequences. According to these results, STDNN possesses a good generalization ability with respect to the spatiotemporal shift-invariant recognition. In the lipreading experiment, STDNN recognizes the lip motions based on the inputs of real image sequences. This observation confirms that STDNN yields a better performance than the existing TDNN-based system, particularly in terms of the generalization ability. In addition to the lipreading application, the STDNN can be applied to other problems since no domain-dependent knowledge is used in the experiment.

Plasmid linking number change induced by topoisomerase I-mediated DNA damage

The state of cellular chromatin in response to DNA damage has been examined by monitoring the change in the linking number of circular episomes. COS cells transfected with an SV40-based vector were treated with camptothecin (CPT), a eukaryotic DNA topoisomerase I (TOP1) poison which induces TOP1-mediated DNA damage. Within minutes, a large increase in the linking number (over 10 linking number) of a small fraction (5-15%) of the episomal DNA was observed. A similar CPT-induced increase in plasmid DNA linking number was observed in Saccharomyces cerevisae expressing human DNA TOP1. In this case, the majority of the plasmid DNA can undergo rapid relaxation. The large increase in the plasmid linking number suggests major chromatin structural reorganization in response to TOP I-mediated DNA damage.

Superior vena cava syndrome as a complication of transvenous permanent pacemaker implantation

Venous thrombosis induced by a transvenous permanent pacemaker is a common complication. However, superior vena cava (SVC) syndrome caused by pacemaker leads is only occasionally seen and its prevalence has been estimated to be less than 1 in 1000 pacemaker patients. Herein, we report a Taiwanese patient of high grade AV block, who presented with SVC syndrome 2 years after transvenous permanent pacemaker implantation. This case features fibrotic stenosis of the junction of right brachiocephalic trunk and SVC, and an extensive thrombus formation resulting in complete obliteration of the left brachiocephalic vein. The collateral circulation was so delicate that he still could lead a rather normal life, even if anticoagulant therapy proved to be ineffective from an angiographic point of view.

Characterization of the dimer-monomer equilibrium of the papaya Copper/Zinc superoxide dismutase and its equilibrium shift by a single amino acid mutation

The coding region of the copper/zinc superoxide dismutase (Cu/Zn SOD) cDNA from papaya fruit, Carica papaya L. cv. Tainong 2, was cloned into an expression vector, pET-20b(+). The Cu/Zn SOD was expressed in Escherichia coli and purified by His-tag technique. Two active forms of the enzyme (30% dimer and 70% monomer) in equilibrium were observed. The activity of the dimeric enzyme was higher than that of the monomeric form. The thermal inactivation rate constant K(d) values calculated for the dimer and monomer at 90 degrees C were -0.0203 and -0.0216 min(-1), and the half-lives for inactivation were 41.9 and 31.8 min, respectively. This indicated that the dimeric enzyme was more stable than its monomeric form. The dimerization of the enzyme was inhibited under acidic pH (below 3.0) or imidazole buffer (above 0.5 M), whereas it was not affected under alkaline pH (above 9.0). Both activity and forms of the enzyme were not affected by 1-4% SDS. Furthermore, the dimeric enzyme was much more resistant to proteolytic attack after 3 h of incubation at 37 degrees C with trypsin or chymotrypsin. In addition, mutation of the papaya Cu/Zn SOD at position 48 from Leu to Phe (L48F) affected the association of monomer, whereas a mutant with Lys substitution (L48K) at the same position tended to dissociate into monomeric form.

Suspected nasopharyngeal carcinoma in three workers with long-term exposure to sulphuric acid vapour

Sulphuric acid vapour has been suspected of being an industrial carcinogen. In this study, a cluster is presented of three patients with nasopharyngeal carcinoma (NPC) who worked in the same building of a telecommunications conveyance station in southern Taiwan with long term exposure to sulphuric acid vapour concentrations as high as 0.18 mg/m3. All three workers were diagnosed with NPC within a 5 month period between September 1992, and March 1993. Compared with 19 other healthy workers from the same building, these three workers with NPC had worked significantly longer in this building than had the others (mean (SD) (years): 12.7 (0.6) v 7.4 (4.4); p = 0.01). With an in situ nucleic acid hybridisation and immunostaining method for colocalised Epstein-Barr virus (EBV) and secretory component (SC) protein among biopsy specimens of these three patients with NPCs, it was found that some tumour cells did not contain EBV and SC protein staining signals. These results indicate that EBV infection is not the only risk factor for NPC and long term exposure to relatively low concentrations of sulphuric acid vapour may be associated with the development of NPC.

Extrasplenic pseudoaneurysm. The role of color flow Doppler ultrasound in diagnosis

Pseudoaneurysm of the splenic artery has been rarely reported and the Doppler echocardiographic finding seldom described. Herein we report a rare case of huge extrasplenic pseudoaneurysm, which was detected by color flow Doppler ultrasonography and successfully treated by ligation of the splenic artery and resection of the pseudoaneurysm.

A study of diagnostic failure of loop conization in microinvasive carcinoma of the cervix

OBJECTIVE

The aim of this study was to evaluate the specimen adequacy and the histological interpretation of loop conization for microinvasive cervical carcinoma.

METHODS

We retrospectively reviewed the histopathological findings of the original cone specimens together with the final hysterectomy specimens in patients with microinvasive carcinoma of the cervix. From 1990 to 1995, 63 consecutive patients with microinvasive carcinoma of the cervix were included in the study, of which 35 patients underwent loop conization and 28 underwent cold-knife conization. All patients had a hysterectomy.

RESULTS

The mean width, depth, and cone volume of the conization specimens were 2.44 cm, 2.15 cm, and 3.96 cm3, respectively, in the loop group versus 2.3 cm, 2.35 cm, and 4.38 cm3 in the cold-knife group. No significant differences were seen between the two groups. The application of loop conization was completed in a single slice in 27 patients (77.1%) and multiple slices by the loop in 8 (22.9%), in spite of the attempt to perform conization in a one-pass application when possible. In assessing these cone specimens microscopically, the rate of transection of tissue was significantly higher in the loop cone than in the cold-knife cone (17.1% versus 0%, P = 0.02). Because of transection of tissue and misorientation, pathologic determination of the depth and width of stromal invasion was undetermined in two loop cone specimens compared with none in the cold-knife cones.

CONCLUSION

Our study suggests that cold-knife conization is a preferred method in assessing microinvasive carcinoma of the cervix if multiple applications of loop conization are inevitable.

Inhibition of hTAFII32-binding implicated in the transcriptional repression by central regions of mutant p53 proteins

We previously identified a movable and regulable inactivation function within the central region (CRts247) of a temperature-sensitive p53 (p53(ts)) mutant, p53(N247I). Here we showed that central regions from several p53(ts) mutants behaved similarly, i.e. they repressed a neighboring activation domain only when existing in the mutant status. Using chimeric protein GAL4VP16-CRts247 as an example, we demonstrated that de novo protein synthesis was not required for the reactivation of the chimeric protein, indicating that a post-translational mechanism was involved in the control of CRts247 activity. The CRts247-conferred thermo-regulability did not work via a mechanism demanding either an alteration of the subcellular compartmentalization of or the inactivation of DNA-binding activity of the GAL4 chimera. Further, CRts247 did not function in trans, eliminating the possibility that the observed repression was because of the competition for a putative factor(s) by the mutant p53 domain. Rather, CRts247 bestowed temperature-dependent interaction with hTAFII32 to the VP16 activation domain. In a parallel experiment, CRts247 also caused a large reduction in the affinity of hTAFII32 to the p53 activation domain at the nonpermissive temperature. These results strongly suggested that inhibition of hTAFII32 binding could be one of the mechanisms responsible for the transcriptional repression by mutant p53 central regions.

A method for custom-contoured cushion design using interface pressure measurements

The interface pressure distributions between flat foam cushions and the buttocks of seated test subjects were compared to custom-contoured cushion surface shapes generated with a seated-buttock contour gauge. Our hypothesis was that pressure measurements could be used to generate a contour equivalent to that obtained with a force-deflection contour gauge. The study was performed in a university medical center using spinal cord injured (SCI) (12) and elderly (30) test subjects. Interface pressure was measured using a pressure mapping pad. Contour shape was measured using an electronic force-deflection contour gauge. Pressure and contour information were reduced prior to analysis using singular value decomposition. Polynomial regressions were performed on the values in the first singular vectors of the corresponding pressure and contour decompositions. Relationships best described by cubic polynomials were detected between pressure and contour shape suggesting that interface pressure predicts optimal contour shape.

Inversion/dimerization of plasmids mediated by inverted repeats

In contrast with earlier studies on the lambda and Escherichia coli genomes, recombination between inverted repeats on plasmids is highly efficient and shown to be recA-independent. In addition, the recombination product is exclusively a head-to-head inverted dimer. Here, we show that this recombination/rearrangement event can occur on different plasmid replicons and is not specific to the particular sequence within the inverted repeats. Transcription readthrough into the inverted repeats has little effect on this event. Genetic analysis has also indicated that most known recombination enzymes are not involved in this process. Specifically, single or double mutants defective in Holliday junction resolution systems (RuvABC and/or RecG/RusA) do not abolish this recombination/rearrangement event. This result does not support the previous models (i.e. the reciprocal-strand-switching and the cruciform-dumbbell models) in which intermediates containing Holliday junctions are proposed. Further analysis has demonstrated that the recombination/rearrangement frequency is dramatically (over 1000-fold) reduced if mismatches (2.8 %) are present within the inverted repeats. Mutations in dam, mutH and mutL genes partially or completely restored the recombination/rearrangement frequency to the level exhibited by the perfect inverted repeats, suggesting the formation of heteroduplexes during recombination/rearrangement. Sequencing analysis of the recombination/rearrangement products have indicated that the majority of the products do not involve crossing-over. We discuss a possible mechanism in which blockage of the lagging strand polymerase by a hairpin triggers recombination/rearrangement mediated by inverted repeats.

New techniques on deformed image motion estimation and compensation

In this paper, new techniques for deformed image motion estimation and compensation using variable-size block-matching are proposed, which can be applied to an image sequence compression system or a moving object recognition system. The motion estimation and compensation techniques have been successfully applied in the area of image sequence coding. Many research papers on improving the performance of these techniques have been published; many directions are proposed, which can all lead to better performance than the conventional techniques. Among them, both generalized block-matching and variable-size block-matching are successfully applied in reducing the data rate of compensation error and motion information, respectively. These two algorithms have their merits, but suffer from their drawbacks. Moreover, reducing the data rate in compensation error is sometimes increasing the data rate in motion information, or vice versa. Based on these two algorithms, we propose and examine several algorithms which are effective in reducing the data rate. We then incorporate these algorithms into a system, in which they work together to overcome the disadvantages to individual and keep their merits at the same time. The proposed system can optimally balance the amount of data rate in two aspects (i.e., compensation error and motion information). Experimental results show that the proposed system outweighs the conventional techniques. Since we propose a recovery operation which tries to recover the incorrect motion vectors from the global motion, this proposed system can also be applied to the moving object recognition in image sequences.

Isolation and investigation of canine phosducin as a candidate for canine generalized progressive retinal atrophies

A subtractive cDNA cloning strategy was used to isolate canine retina-specific genes. Canine phosducin cDNA was cloned from a canine subtracted retinal cDNA library and was analysed as a candidate for canine generalized progressive retinal atrophies (gPRA). Canine phosducin cDNA is 1230 bp in length encoding 245 amino acids. The nucleotide and amino acid sequences of canine phosducin are highly conserved when compared with those of five other mammalian species, namely human, cat, cow, rat, and mouse. Northern blot analysis demonstrated that the mRNA transcript for phosducin was approximately 1.3 kb in size and was present in canine retina, but showed no visible signals in 13 other canine tissues. The phosducin gene was examined for polymorphisms in a total of 101 pedigree dogs of eight breeds, including normal, obligate gPRA carriers, and gPRA-affected dogs, by single-stranded conformation polymorphisms (SSCP) analysis. Polymorphisms in the phosducin gene were detected only in the 3' untranslated region of the gene in two breeds of dogs: allelic heterozygous polymorphisms in miniature poodles suffering from one form of gPRA (progressive rod-cone degeneration, prcd), and a different polymorphism in a single normal Irish wolfhound. The polymorphisms of phosducin in prcd-affected miniature poodles did not segregate with the autosomal recessive form of gPRA. Heterozygous inheritance of the polymorphisms suggests that phosducin is very unlikely to carry the mutation causing prcd, so phosducin was probably excluded as a candidate for prcd-affected miniature poodles in this study.

G protein beta subunit is closely associated with microtubules

Previously, we have identified the association of G protein beta subunit (Gbeta) with mitotic spindles in various mammalian cells. Since microtubules are the main component of mitotic spindles, here we have isolated bovine brain microtubules and purified Gbeta subunit to identify the close association of Gbeta subunit with purified brain microtubules and have shown the direct incorporation of Gbeta subunit into the microtubules both in vitro and in vivo. It was found that: (1) microtubular fraction isolated from bovine brain contained Gbeta subunit, (2) coimmunoprecipitation demonstrated that Gbeta subunit could be coprecipitated with tubulin, (3) addition of purified Gbeta subunit into cytosolic extract for microtubule assembly caused direct incorporation of Gbeta subunit into assembled microtubules and increased the association of microtubule-associated proteins with microtubules, and (4) incubation of exogenous Gbeta subunit with detergent-permeabilized cells resulted in direct incorporation of Gbeta subunit into microtubule fibers and depolymerized tubulin molecules. We conclude that G protein beta subunit is closely associated with microtubules and may play an important role in the regulation of microtubule formation in addition to its regulatory role in cellular signal transduction.

Topics in microbial risk assessment: dynamic flow tree process

Microbial risk assessment is emerging as a new discipline in risk assessment. A systematic approach to microbial risk assessment is presented that employs data analysis for developing parsimonious models and accounts formally for the variability and uncertainty of model inputs using analysis of variance and Monte Carlo simulation. The purpose of the paper is to raise and examine issues in conducting microbial risk assessments. The enteric pathogen Escherichia coli O157:H7 was selected as an example for this study due to its significance to public health. The framework for our work is consistent with the risk assessment components described by the National Research Council in 1983 (hazard identification; exposure assessment; dose-response assessment; and risk characterization). Exposure assessment focuses on hamburgers, cooked a range of temperatures from rare to well done, the latter typical for fast food restaurants. Features of the model include predictive microbiology components that account for random stochastic growth and death of organisms in hamburger. For dose-response modeling, Shigella data from human feeding studies were used as a surrogate for E. coli O157:H7. Risks were calculated using a threshold model and an alternative nonthreshold model. The 95% probability intervals for risk of illness for product cooked to a given internal temperature spanned five orders of magnitude for these models. The existence of even a small threshold has a dramatic impact on the estimated risk.

Familial macrothrombocytopenia with granulocyte inclusion: a clinical and laboratory problem

The differential diagnosis of familial macrothrombocytopenia and idiopathic thrombocytopenic purpura (ITP) may be difficult owing to the similarities in their clinical and laboratory presentations, but it is important because of dissimilarities in their management and prognosis. We investigated two families with familial macrothrombocytopenia and granulocyte inclusion. The probands of both families presented with mild bleeding tendency, macrothrombocytopenia, normal bone marrow, and increased percentages of platelet-associated immunoglobulin G (IgG) and reticulated platelets. ITP had been misdiagnosed in both patients initially. Both probands failed to respond to steroid therapy. Family study revealed an autosomal dominant pattern of heredity in both families, with absence of Alport's syndrome-like features (hearing impairment, congenital cataract, and interstitial nephritis). All thrombocytopenic family members showed blue cytoplasmic inclusions in neutrophils on peripheral blood smears. Ultrastructurally, distinct granulocyte inclusions comprising clusters of rough endoplasmic reticulum, smooth endoplasmic reticulum, and polysomes were detected, without the presence of parallel filaments. The clinical, laboratory, and hereditary findings were consistent with a diagnosis of Sebastian platelet syndrome in both families. In conclusion, caution should be exercised when interpreting the percentages of platelet-associated IgG in thrombocytopenic patients, as overinterpretation may lead to misdiagnosis of macrothrombocytopenia as ITP. Family history is important, as familial ITP is rare, and careful examination of blood smears is essential.

Molecular Cloning of a cDNA Encoding Copper/Zinc Superoxide Dismutase from Papaya Fruit and Overexpression in Escherichia coli

A full-length complementary DNA (cDNA) clone encoding a putative copper/zinc superoxide dismutase (Cu/Zn SOD) of papaya fruit, Carica papaya L. cv. Tainong 2, was amplified according to the polymerase chain reaction technique from cDNA synthesized from fruit messenger RNA. Nucleotide sequence analysis of this cDNA clone revealed that it comprised a complete open reading frame coding for 152 amino acid residues. The deduced amino acid sequence showed higher identity (81.6-84.9%) with the sequences of the cytosolic Cu/Zn SODs than those of the chloroplast from other plant species, and no recognizable plastid targeting peptide was found. These suggest that the papaya fruit cDNA clone encodes a cytosolic Cu/Zn SOD. The residues required for coordinating copper (His-45, -47, -62, and -119) and zinc (His-62, -70, and -79 and Asp-82), as well as the two cysteines (56 and 145) that form a single disulfide bond, are conserved as they are among all reported Cu/Zn SOD sequences. In addition, the coding region of Cu/Zn SOD cDNA from papaya was introduced into an expression vetor, pET-20b(+), and transformed into Escherichia coli AD494(DE3)pLysS. A predominant protein band was detected by Coomassie blue staining of native PAGE, and activity staining confirmed the result of Coomassie blue staining. These indicate that this Cu/Zn SOD cDNA clone can overexpress active Cu/Zn SOD enzyme in E. coli.

BCECF in single cultured cells: inhomogeneous distribution but homogeneous response

Using confocal laser scanning microscopy with a dual-wavelength laser system, the behaviour of BCECF [(2',7'-bis-2-carboxyethyl)-5-(and-6)carboxyfluorescein] was investigated in a variety of cell lines. Selection of a small area for monitoring allowed discrimination between various intracellular organelles, whose identity was established by vital staining. It was found that, after loading the cells with BCECF, both the nucleus and the mitochondria showed a higher level of fluorescence than the cytoplasm. Calibration of the pH-sensitivity of these fluorescence signals using the nigericin method yielded identical curves, as did exposure of the cells to NH4Cl. These studies suggest that BCECF, despite its inhomogeneous intracellular distribution, reports the pH of only one cellular compartment, the cytosol.