Epidemiology of age-related dementia in China

The results of these epidemiological studies suggest that the morbidity of age related moderate and severe dementia among the population of 65+ was 1.82%, when adjusted by 1984 US population ratio, it became 3.2%, as reported by US and European authors. Yet MID appears more common than PDD, which was more close to the data from Japan. The average annual incidence of moderate and severe dementia for persons aged 60+ was 0.3% (95% CI: 0.08%-0.52%). The incidence for those aged 70-79 (0.41%) was similar to that reported by US authors (Sluss), 0.58% among 70-74 years old, but lower than that observed by European authors (Hagnell, Magnusso) varied from 1.2% to 5.2% in the same age group. These great differences are likely to be partly due to differences in the age structure of samples, instruments for testing dementia, and diagnostic criteria. The course and outcome of dementia after 3-year follow-up indicated that the average survival time was 8 years, and the risk for death of dementia was 3 times higher than that of the whole cohort; the results were similar to those reported by westerners. The major risk factors for AD as identified in this study showed that family history both in first degree relatives of AD and psychosis were significantly associated with AD. The finding was consistent with the genetic hypothesis in western countries. In 7 risk factors that have been studied in US and European countries, 6 showed that the family history of dementia was significantly associated with AD.(ABSTRACT TRUNCATED AT 250 WORDS)

Amyloid plaques in cerebellar cortex and the integrity of Purkinje cell dendrites

We probed serial and near serial sections of cerebellum from 13 Alzheimer's disease (AD), 10 older Down's syndrome (DS) patients, and 9 age-matched, non-AD controls, using single and double labeling immunohistochemistry to investigate the pathologic consequences of beta-amyloid or A4 (A beta) deposits in cerebellum and their relationship to Purkinje cells (PCs). Our data showed that A beta deposits in cerebellum of AD and older DS adults only form diffuse or preamyloid plaques and the density of A beta lesions per unit area of molecular layer correlated with the number of PCs per unit length of the subjacent PC layer in double immunostained sections (r = 0.85; p < 0.001). About 65% of these cerebellar A beta deposits were in physical contact with PC dendrites. No A beta plaques were found in the cerebellum of controls. Despite the abundance of A beta deposits in the cerebellar cortex of AD and older DS patients, neither PC bodies nor PC dendrites in physical contact with A beta lesions showed evidence of structural abnormalities.

Mass spectrometric investigations of drug-receptor interactions

Mass spectrometric (MS) detection of biologically important noncovalent complexes is reviewed within the scope of on-going studies on this topic from this laboratory. The merits of ion spray MS and tandem MS are demonstrated in this area with examples that show systemic studies of several receptor-ligand, enzyme-substrate, and enzyme-product complexes associated with both an established well-characterized biological system (lysozyme hydrolysis of N-acetylglucosamine) and an important modern receptor-ligand complex (FKBP-FK-506 and FKBP-rapamycin). These examples and recent applications of negative ion MS and MS/MS with DNA adducts, heme-globin complexes, and antibiotic-binding proteins suggest an exciting new area of applications for MS that have not been previously available to investigators.

[A clinicopathologic study of 15 cases of collecting duct carcinoma of the kidney]

Fifteen cases of papillary adenocarcinoma of the kidney are presented. The lesions were polycystic in gross appearance. Histologically, they were subdivided into three types: papillary cystadenocarcinoma, papillary oncocytic cystadenocarcinoma and papillary mucinous cystadenocarcinoma. Immunohistochemically, the tumor cells demonstrated positive reactivity for high molecular weight keratin and glandular lumina membrane positivity for EMA, which support a collecting duct origin for the tumor. Most of the tumors were large (average diameter 9.6 cm) and invasion of perinephric tissues was observed in 80% of the cases, an indication of its aggressive behavior. As most of the tumors occurred in the medulla and invaded the collecting ducts, the clinical manifestations were different from those of renal cell carcinomas.

Novel lacto-ganglio type gangliosides with GM2-epitope in bovine brain which react with IgM from a patient of the amyotrophic lateral sclerosis-like disorder

A motor neuron disorder resembling that of amyotrophic lateral sclerosis was found in a patient who had received the intramuscular administration of a mixture of bovine brain gangliosides (Yuki, N., Sato, S., Miyatake, T., Sugiyama, K., Katagiri, T., and Sasaki, H. (1991) Lancet 337, 1109-1110). A very high titer of anti-GM2 IgM was detected in the patient's serum and the patient quickly recovered after plasmapheresis. The clinical course of the patient appeared to be different from amyotrophic lateral sclerosis and the anti-GM2 IgM was thought to be the culprit. The IgM reacted with GM2, GM1b-GalNAc, SPG(alpha 2-3)-GalNAc, and GD1a-GalNAc, but not with GA2 or GD2, meaning that the epitope recognized by the IgM was the GM2-like terminal structure, GalNAc beta 1-4(Neu-Ac alpha 2-3)Gal beta 1-. In this study, we found two novel GM2-epitope containing gangliosides, X1 and X2, in bovine brain gangliosides by TLC immunostaining using the patient's IgM. They were characterized as unique lacto-ganglio type gangliosides containing the following branching structures. [formula: see text] Their unusual structures may be immunogenic to humans to induce anti-GM2 antibody.

[Pulmonary edema in transcervical endometrial ablation: a case report]

The use of the transcervical resectoscope for endometrial ablation and/or resection of myomas is a relatively new technique in gynecologic surgery. Although complications are uncommon with this procedure, they can occasionally appear and lead to potential hazard. Here a patient presenting for endometrial ablation is described; 1.5% glycine was used as the irrigation solution to enhance visibility and to wash away blood and tissue particles. Unfortunately, a large amount of glycine was absorbed by the open vessels in the myometrium during operation, leading to pulmonary edema and dilutional hyponatremia. After administration of diuretics, sodium supplement and 100% oxygen, complications improved progressively. The patient was discharged on postoperative day 5 without any sequelae.

Studies on heme binding in myoglobin, hemoglobin, and cytochrome c by ion spray mass spectrometry

The ion spray mass spectra of three representative heme-containing proteins were studied, with an emphasis on results obtained under neutral (pH 7) aqueous conditions. The noncovalently bound heme in myoglobin and hemoglobin may be readily distinguished from the covalently bound heme prosthetic group attached to cytochrome c by using collisioninduced dissociation in the free-jet expansion region of the mass spectrometer as well as in the collision quadrupole with premass selection. The charge state of iron in the expelled heme from myoglobin and hemoglobin appears to be 3+ but 2f for heme expelled from cytochrome c.

[Combined pregnancy: a case report and literature review]

Combined or heterotopic pregnancy has been regarded as extremely rare in the past three decades. If it continues without diagnosis, a life-threatening situation may occur. A case of eight-week gestation is presented in which there was threatened abortion. The patient underwent exploratory laparotomy for internal bleeding. Upon operation, combined pregnancy, with a ruptured ectopic pregnancy, was diagnosed. Left salpingectomy was performed uneventfully. Neither chronic salpingitis nor administration of ovulation-induction agents was part of past history. A viable ongoing intrauterine pregnancy continued after operation, and a normal male was delivered by cesarean section after a 39-week gestation where labor progressed too slowly for normal delivery.

[Twin pregnancy complicated by single intrauterine death. Report of six cases and literature review]

From 1982 to 1991, six twin pregnancies, in which one of the fetuses died in utero, have been encountered. The causes of antepartum death in twin gestation could be identified in four cases; one with abruptio placenta, one with twin-to-twin transfusion syndrome, one with twisting of cord and one with velamentous insertion of cord. All six surviving infants had no abnormality in the follow-up of two to seven years. Although a conclusion about the prognosis could not be drawn from such a small series, these good results may have resulted from 1) 2 cases having been dichorionic twins, and 2) the other 4 monochorionic twins of 31-36 gestation weeks were delivered 1 to 5 days after the diagnosis. Conservative treatment was usually suggested until the fetal lung was mature enough for induction of labor. One case was treated after the death of its counterpart with tocolytic agent for a further 15 days because of prematurity. Cesarean section was performed finally for fetal distress resulting from chronic abruption placenta. The other five cases were delivered through vaginal route. According to experience as well as literature review, to improve the prognosis, obstetricians should be familiar with the management of one fetal death in twin pregnancy, especially in those with monchorionic twins.

[Transcervical resection of endometrium and submucous myomas]

Transcervical resection of the endometrium and submucous myomas using an unmodified urologic resectoscope has recently been developed as a treatment for menorrhagia and/or infertility when conservative management proves unsatisfactory but the patient desires to preserve the fertility or wishes to avoid hysterectomy. Through June 1990, 7 patients were treated with this procedure including one for endometrial ablation and six for transcervical myomectomy alone. No significant complication was seen and the results were relatively satisfactory in an average 7 1/2 months follow up. This approach seems a safe, effective surgical procedure and represents an attractive alternative to hysterectomy or abdominal myomectomy.

Purification and characterization of a strictly specific beta-D-fucosidase from Aspergillus phoenicis

Although beta-D-fucosidase (beta-D-fucohydrolase, EC 3.2.1.38) has been isolated from various sources, all those enzymes were associated with a high activity of beta-D-galactosidase and/or beta-D-glucosidase. We have purified a specific beta-D-fucosidase in electrophoretically homogeneous form from crude extracts of Aspergillus phoenicis by polyethyleneglycol 8000-phosphate buffer aqueous two-phase separation, and successive chromatography on DEAE-Sephadex A-50, hydroxyapatite, and Sephadex G-100 columns. The molecular weight of the enzyme was estimated to be 57,000 by sodium dodecyl sulfate-polyacrylamide gel electrophoresis and 50,000 to 60,000 by gel filtration on Sephadex G-100. The enzyme showed optimum activity at pH 6.0 and 40 degrees C; it was stable in the pH range 5.5-6.5 and below 35 degrees C. The Km and the Vmax values for pNP-beta -D-fucoside were 2.4 mM, and 12.8 mumol.min-1.mg-1, respectively. The enzyme was strongly inhibited by sulfhydryl group reagents, p-chloromercuribenzoate, n-ethylmaleimide, and iodoacetate. It was also inhibited by 1-ethyl-3-(3-dimethylaminopropyl) carbodiimide, diethyl pyrocarbonate, and N-bromosuccinimide. Thus, -SH and -COOH groups and histidyl and tryptophyl residues were essential for enzyme activity. The purified beta-D-fucosidase showed high specificity toward p-nitrophenyl-beta-D-fucoside. The enzyme was inhibited by D-fucose and D-fucono-gamma-lactone, but not by D-galactose, D-galactono-gamma-lactone, D-glucose, or D-glucono-gamma-lactone; the latter compounds are specific inhibitors of beta-D-galactosidase and beta-D-glucosidase, respectively. Thus, this enzyme is the most strictly specific beta-D-fucosidase when compared with those previously reported.

A case-control study of Alzheimer's disease in China

We conducted a case-control study to assess possible factors associated with Alzheimer's disease (AD) with 70 clinically diagnosed AD patients and 140 age- and sex-matched nondemented neighborhood controls in China. Factors significantly associated with AD cases were family history of dementia in first-degree relatives, family history of psychotic disorders in first-degree relatives, and left-handedness/ambidexterity. A history of arthritis showed a significantly negative association with AD. Neither a family history for Down's syndrome, history of head trauma, nor other conditions that might support immune or viral hypotheses in AD were significantly associated with AD cases. These data support the role of familial/genetic factors in AD.

Ceramide glycanase from the earthworm, Lumbricus terrestris

Ceramide glycanase (CGase) is an enzyme that cleaves the linkage between the sugar chain and the ceramide. To make this enzyme readily available, we have developed a simple method for preparing it from the earthworm, Lumbricus terrestris. The method involves Bio-Gel A-0.5m, octyl-Sepharose and p-aminophenylthiogalactoside-agarose column chromatography. By gel filtration, the molecular mass of earthworm CGase was found to be 43.7 kDa. With ganglioside GM1 as substrate, the optimal pH of this enzyme was found to be between pH 3.5 and 4.0. Earthworm CGase hydrolyses glycolipids only in the presence of a detergent. Among various bile salts tested, sodium cholate was found to be the most effective in stimulating the hydrolysis of GM1 by this enzyme. Earthworm CGase released intact glycan chains from various glycosphingolipids in which the glycan chain is linked to the ceramide through a beta-glucosyl linkage. It also detached glycan chains from lactosyldialkylglycerol and alkyl-beta-lactosides.

Thermostable, salt tolerant, wide pH range novel chitobiase from Vibrio parahemolyticus: isolation, characterization, molecular cloning, and expression

A chitobiase gene from Vibrio parahemolyticus was cloned into plasmid pUC18 in Escherichia coli strain DH5 alpha. The plasmid construct, pC120, contained a 6.4 kb Vibrio DNA insert. The recombinant gene expressed chitobiase [EC 3.2.1.30] activity similar to that found in the native Vibrio. The enzyme was purified by ion exchange, hydroxylapatite and gel permeation chromatographies, and exhibited an apparent molecular weight of 80 kDa on SDS-polyacrylamide gel electrophoresis. Chitobiose and 6 more substrates, including beta-N-acetyl galactosamine glycosides, were hydrolyzed by the recombinant chitobiase, indicating its putative classification as an hexosaminidase [EC 3.2.1.52]. The enzyme was resistant to denaturation by 2 M NaCl, thermostable at 45 degrees C and active over a very unusual (for glycosyl hydrolases) pH range, from 4 to 10. The purified cloned chitobiase gave 4 closely focussed bands on an isoelectric focusing gel, at pH 4 to 6.5. The N-terminal 43 amino acid sequence shows no homology with other proteins in commercial databanks or in the literature, and from its N-terminal sequence, appears to be a novel protein, unrelated in sequence to chitobiases from other Vibrios reported and unrelated to hexosaminidases from other organisms.

Evidence for two cDNA clones encoding human GM2-activator protein

Two cDNAs encoding GM2 activator, pGM2A (648 bp) and GAP (1093 bp), were isolated from human placenta lambda gt11 libraries. The DNA sequence of pGM2A from 1 to 302 was almost identical with GAP, but diverged from 303-648. PCR was used to demonstrate the presence of both species of GM2 activator in placental RNA. Both cDNAs hybridized to mRNAs of approximately 2.3 kb and to identical single bands on genomic Southern blots.

[Uterine lipoleiomyoma with calcification: report of a case]

Uterine lipoleiomyoma is uncommon and has received little attention from gynecologists. We report a case of uterine lipoleiomyoma with subsequent pelvic abscess after rupture of the appendix. Its clinical picture mimicked uterine malignancy. The patient was a 60-year-old woman, who presented with a 2-week period of lower abdominal pain which was exacerbated 10 days later. After admission, gynecologic examination revealed a large pelvic mass of firm consistency. On a plain film of the abdomen, there was a large calcified mass in the pelvis. Pelvic ultrasound demonstrated a 15 yen 12 yen 12 cm mass with strong echogenicity in the margin, but the central component of the mass was attenuating and revealed a poorly defined echogenic mass. A computed tomography scan of the pelvis demonstrated a well-encapsulated mass that was predominantly the density of fat (-65 Hounsfield unit) in the central part, with calcification present in the peripheral layer of the mass. There was also a cystic lesion measuring 3 yen 2.5 yen 1.5 cm in the right adnexal area. A preoperative diagnosis of uterine lipoleiomyoma with necrosis, liposarcoma of the uterus or teratocarcinoma of the ovary was made by the CT scan. A diagnostic dilatation and curettage (D&C) revealed a uterine cavity length of 12 cm by sounding, and the specimen showed no malignant tissue. Therefore, the preoperative suspicion of ovarian teratocarcinoma could be excluded. The patient underwent an exploratory laparotomy, multiple pockets of pelvic abscess, enlargement of the uterus and induration of omentum surrounding the appendix were found.(ABSTRACT TRUNCATED AT 250 WORDS)

Scrub typhus and pregnancy: a case report and literature review

Scrub typhus is still prevalent on Penghu Islands. We herein report a case in a pregnant woman who had been to Yi-Lan County in Taiwan. The patient responded well to Minocycline (Minocin) therapy without complication. Her newborn baby was found not complicated with the disease. The relative literature is reviewed.

[Control of cisplatin-induced delayed emesis]

Despite excellent control of acute-stage emesis, some patients are still bothered by delayed emesis occurring more than 24 hours after cisplatin administration. We report 19 patients with 61 courses of cisplatin-based chemotherapy. They all received high-dose metoclopramide, dexamethasone and lorazepam on the day of cisplatin treatment. After 24 hours, they were treated with intravenous dexamethasone 8 mg once and metoclopramide 50 mg twice on day 2, and oral metoclopramide 10 mg qid on days 3-5. Delayed vomiting and nausea were noted in 27.9% and 39.4% respectively, as compared with 69.8% of delayed emesis and 79.4% of delayed nausea in 63 courses of 15 patients without receiving any antiemetics on days 2-5. The statistics showed significant difference (both P less than 0.001). Side effects were mild and acceptable. Therefore, this regimen is highly effective in preventing delayed vomiting and nausea.

Comparative evaluation of nine different methods for detecting enterotoxin of Escherichia coli

Nine different methods for detecting enterotoxin of Escherichia coli were studied and compared. We found rabbit ileal-loop test and suckling mouse assay were both quite accurate and reliable for detecting heat labile toxin (LT) and heat stable toxin (ST) of enterotoxigenic Escherichia coli (ETEC). Mouse ileal-loop test was simple, but its sensitivity and specificity were comparatively low. CHO cell-culture assay might be more sensitive and specific. LT-DNA probe was the most sensitive and specific method. In practical application, PIHT (plate immunohemolytic test), Biken's, SPA-CoA and ELISA methods are recognized as simple, rapid, sensitive and specific methods for detecting ETEC-LT. These methods can be selected for use in clinical laboratory.

Synthesis of neoglycoconjugates using oligosaccharide transferring activity of ceramide glycanase

Ceramide glycanase (CGase) isolated from the leech Macrobdella decora was found to transfer the oligosaccharide en bloc from various glycosphingolipids to suitable acceptors. For example, CGase transferred the intact II3NeuAcGgOse4 from GM1 to 4-phenyl-1-butanol, 1,8-octanediol and various 1-alkanols having a chain length of six or more carbons. Among various 1-alkanols, 1-octanol was found to be the best acceptor. In an incubation mixture of 50 microliters containing 30 nmol of GM1, 50 micrograms of sodium cholate, 20 microliters of 1-octanol, and 0.1 unit of CGase, the ratio between hydrolysis and transglycosylation was approximately 3:1. Negative fast atom bombardment-mass spectral analysis of the enzymatically synthesized octyl-II3NeuAcGgOse4 showed a mass ion at m/z 1109.7 for the parent ion, consistent with its expected mass. NMR analysis of the enzymatically synthesized octyl-II3NeuAcGgOse4 showed that the Glc residue is linked to the octanol through a beta-linkage. Vicinal coupling constants of the ring protons of the sugar residues indicate that their pyranose ring geometries are not affected by the transferase activity. CGase also transferred the oligosaccharide from GM1 to CF3CO-NH(CH2)5CH2OH, (CH3)3CO-CO-NH(CH2)5CH2OH, (HOCH2)3C-NHCO-(CH2)4-COOMe, CH2 = CH-(CH2)7CH2OH and 1,2:3,4-di-O-isopropylidene-D-galactopyranose. The oligosaccharide transferring reaction carried out by CGase should become useful for the synthesis of neoglycoconjugates to study the biological functions expressed by glycan chains in glycosphingolipids.

[Improved control of cisplatin-induced emesis with high-dose metoclopramide, dexamethasone and lorazepam]

Despite treatment, emesis remains a major problem with cisplatin chemotherapy. Three potent antiemetics, metoclopramide, dexamethasone and lorazepam, were combined in prophylaxis of 18 patients receiving cisplatin based combination chemotherapy. In 75 courses of chemotherapy, 57% experienced complete protection from vomiting and 89% of treatment courses had two or fewer vomiting episodes. Complete protection and mild episodes from nausea was 47% and 53% respectively. Toxicities were mild and infrequent. It was concluded that combination of high-dose metoclopramide, dexamethasone and lorazepam was highly efficacious in preventing nausea and vomiting in moderate or high-dose cisplatin chemotherapy with little side effects.

Study of the identification of enterotoxigenic Escherichia coli by LT-DNA gene hybridization

Reference strains of enterotoxigenic Escherichia coli (ETEC), non-ETEC, and other enteropathogenic bacteria were used to prove the reliability of LT-DNA gene hybridization. In the test, LT-DNA gene hybridization was compared with plate immunohemolytic test (PIHT) in identifying LT-ETEC. The results obtained by both methods showed no significant differences. 791 strains of E. coli isolated from 1,875 children with acute diarrhea in Taiyuan Children's Hospital were examined for LT-ETEC by LT-DNA gene hybridization and PIHT. 289 strains examined by LT-DNA gene hybridization were LT positive, while 205 strains examined by PIHT were LT positive. Three different assays were done: colony hybridization, PIHT and fecal direct blot hybridization on each of 74 fecal specimens from children with acute diarrhea. It was found that identification of LT-ETEC using fecal direct blot hybridization is a simple, sensitive and more practical method.

A novel sialidase which releases 2,7-anhydro-alpha-N-acetylneuraminic acid from sialoglycoconjugates

The leech (Macrobdella decora) was found to contain two sialic acid-cleaving enzymes: an ordinary sialidase and a novel sialic acid-cleaving enzyme. This novel enzyme released 2,7-anhydro-alpha-N-acetylneuraminic acid (Neu2,7-anhydro5Ac) instead of alpha-N-acetylneuraminic acid (Neu5Ac) from 4-methylumbelliferyl-Neu5Ac, glycoproteins, and gangliosides. We have partially purified this novel sialidase from M. decora. We have also isolated Neu2,7-anhydro5Ac released from 4-methylumelliferyl-Neu5Ac and whale nasal keratan sulfate in pure form. The novel sialidase produced Neu2,7-anhydro5Ac only from sialoglycoconjugates, but not from free Neu5Ac. The structure of Neu2,7-anhydro5Ac produced by the novel sialidase was established by chemical analysis, mass spectrometry, and NMR spectroscopy. NMR analysis showed that instead of the original 2C5 conformation, the pyranose ring of Neu2,7-anhydro5Ac was in the 5C2 conformation, which makes the formation of the 2,7-anhydro bridge possible.