Glandular tularemia: Uncommon presentation of the cause of lymphadenopathy in two children

This report details the clinical and histopathological characteristics and course of glandular tularemia, an uncommon but significant cause of cervical lymphadenopathy in two children. Tularemia should be considered in the differential diagnosis of cases with non-tuberculosis, suppurative cervical lymphadenopathy, particularly in those not responding to penicillin treatment.

Arterial spin-labeling in routine clinical practice, part 1: technique and artifacts

The routine use of arterial spin-labeling (ASL) in a clinical population has led to the depiction of diverse brain pathologic features. Unique challenges in the acquisition, postprocessing, and analysis of cerebral blood flow (CBF) maps are encountered in such a population, and high-quality ASL CBF maps can be generated consistently with attention to quality control and with the use of a dedicated postprocessing pipeline. Familiarity with commonly encountered artifacts can help avoid pitfalls in the interpretation of CBF maps. The purpose of this review was to describe our experience with a heterogeneous collection of ASL perfusion cases with an emphasis on methodology and common artifacts encountered with the technique. In a period of 1 year, more than 3000 pulsed ASL cases were performed as a component of routine clinical brain MR evaluation at both 1.5 and 3T. These ASL studies were analyzed with respect to overall image quality and patterns of perfusion on final gray-scale DICOM images and color Joint Photographic Experts Group (JPEG) CBF maps, and common artifacts and their impact on final image quality were categorized.

Arterial spin-labeling in routine clinical practice, part 2: hypoperfusion patterns

Arterial spin-labeling (ASL) is a powerful perfusion imaging technique capable of quickly demonstrating both hypo- and hyperperfusion on a global or localized scale in a wide range of disease states. Knowledge of pathophysiologic changes in blood flow and common artifacts inherent to the sequence allows accurate interpretation of ASL when performed as part of a routine clinical imaging protocol. Patterns of hypoperfusion encountered during routine application of ASL perfusion imaging in a large clinical population have not been described. The objective of this review article is to illustrate our experience with a heterogeneous collection of ASL perfusion cases and describe patterns of hypoperfusion. During a period of 1 year, more than 3000 pulsed ASL procedures were performed as a component of routine clinical brain MR imaging evaluation at both 1.5 and 3T. These images were reviewed with respect to image quality and patterns of hypoperfusion in various normal and disease states.

[Efficacy evaluation of polysaccharide nucleic acid-fraction of BCG on vasomotor rhinitis]

OBJECTIVE

To investigate the efficacy and safety of polysaccharide nucleic acid-fraction (BCG-PSN) in the treatment of vasomotor rhinitis.

METHOD

Sixty patients were randomly divided into BCG-PSN group (n = 30) and control group (n = 30). The patients in BCG-PSN group were administered with BCG-PSN 1.0 mg twice a week for two months, and intranasal azelastine was used if needed. The patients in control group were administered with intranasal azelastine solely twice a day, which could be decreased with the symptom relief. Follow-up was 6 months. Symptom and medication scores were recorded. Side effects were registered.

RESULT

The symptom and medication scores of BCG-PSN group were significantly lower than that of control group (P < 0.01) after BCG-PSN treatment. There was no significant difference in symptom score between the two groups at 6 months after BCG-PSN treatment (P > 0.05), while the medication score of BCG-PSN group was still much lower than that of control group (P < 0.01). No serious adverse events were reported in BCG-PSN group except for local pain on the injection place in one patient.

CONCLUSION

BCG-PSN is effective and safe in the treatment of vasomotor rhinitis.

Association between heat-shock protein 70 gene polymorphisms and DNA damage in peripheral blood lymphocytes among coke-oven workers

Hsp70 has been shown to act as a chaperone and be associated with cytoprotection against DNA damage caused by environmental stresses. However, it is unknown whether genetic variation in HSP70 plays a role in stress tolerance and cytoprotection against DNA damage. We determined the frequencies of three polymorphisms, HSP70-1 G190C, HSP70-2 G1267A, and HSP70-hom T2437C from 251 steel-plant workers exposed to coke-oven emission and 130 controls. We estimated the association between the HSP70variants/haplotypes and the levels of DNA damage in their peripheral blood lymphocytes detected by single-cell gel electrophoresis assay. Our results showed that overall coke-oven workers had higher levels of the Olive tail moment (Olive TM) (1.27+/-1.12) than that of the controls (0.56+/-0.99, P<0.001). Coke-oven workers with the HSP70-1 C/C genotype had higher levels of Olive TM (2.19+/-0.65), compared with HSP70-1 G/C and G/G carriers (Olive TM=1.34+/-1.09 and 1.14+/-1.08, respectively, P=0.022 and 0.003, respectively). However, the HSP70-2 G1267A and HSP70-hom T2437C polymorphisms were not associated with the levels of Olive TM (P=0.929 and 0.795, respectively). Haplotype analysis showed that carriers of TCG/TCG haplotype pairs had the highest levels of Olive TM among both the exposed subjects (2.04+/-0.59) and the controls (0.81+/-0.59). Our results suggest that the individuals with the homozygous HSP70-1 C/C genotype among the coke-oven workers may be susceptible to DNA damage.

253. Toxic effects of hyperglycaemia arise from induced O-linked glycosylation in early mouse embryos

Glucose flux through the hexosamine biosynthetic pathway (HBP) which is essential for preimplantation development (1) produces uridine 5′-diphospho-N-acetylglucosamine, a donor substrate for multiple glycosylation reactions including O-linked glycosylation. This novel signalling arm of the HBP, known as the hexosamine signalling pathway (HSP) operates via reversible addition of an O-linked β-N-acetylglucosamine (O-GlcNAc) unit to serine and threonine residues of proteins including transcription factors, cytoskeletal components, metabolic enzymes and cellular signalling components. O-linked glycosylation is functionally reciprocal to phosphorylation at the same residues, altering the activity and/or stability of targeted proteins, thus providing a mechanism for modulating cellular physiology in response to glucose availability. The enzymes regulating this O-GlcNAcylation are the β-linked-O-GlcNAc transferase (OGT) and an O-GlcNAc-selective β-N-acetylglucosaminidase (O-GlcNAcase). We hypothesised that the toxicity of hyperglycemia on early embryos arises from increased flux through HBP and increased O-GlcNAcylation of key proteins. Mouse zygotes (18 h post hCG) were cultured under conditions of modified flux through the HSP including hypoglycemia, hyperglycemia or supplemented with glucosamine which feeds exclusively into the HBP to increase downstream O-GlcNAcylation. BADGP was used to inhibit OGT and O-GlcNAcylation. Blastocyst formation, cell proliferation and apoptosis were assessed. Treatments that perturb levels of intracellular protein O-GlcNAcylation inhibited embryo development. Whilst some flux through HBP is required to activate embryonic differentiation (1), excess flux arising from a hyperglycemic environment or glucosamine supplementation reduced cell proliferation and blastocyst formation, confirming the criticality of this novel post-translational signalling pathway. Inhibition of OGT using 2 mM BADGP blocked the negative impact of hyperglycemia on blastocyst formation, cell number and apoptosis supporting our hypothesis that O-GlcNAcylation is a key mechanism used by the embryo to sense and respond to perturbations of glucose in its environment. (1) Pantaleon M, Scott J and Kaye PL (2008) Biol Reprod, 78(4):595–600

Mutation analysis in a family with oculocutaneous albinism manifesting in the same generation of three branches

PURPOSE

To elucidate the molecular basis of oculocutaneous albinism with variable expressivity in a family from The Netherlands in which no consanguinity was reported.

METHODS

Three affected family members were screened for mutations in tyrosinase (TYR) and the pink-eye-dilution gene (P) by using SSCP. The melanocortin receptor gene (MC1R) and amplimers of P showing an aberrant banding pattern in SSCP were analyzed by direct sequencing. All participants underwent ophthalmologic examination including funduscopy, and visually evoked potentials were recorded in two cases.

RESULTS

The pedigree had three branches A, B, and C. We identified three mutations in P (V443I, N476S, C793F) that cause a compound heterozygous situation in cases from branch A (N476S/C793F) and B (V443I/C793F), who showed oculocutaneous albinism. Hair and skin color followed the light Nordic complexion that was also present in other affected and unaffected members of this family. Descendants of branches A and B showed light complexion with iris translucency and peripheral fundus hypopigmentation independent from the genotype identified. A single descendant had red hair, carrying a well known compound MC1R mutation combination for red hair color and a single heterozygous P mutation.

CONCLUSIONS

P mutations underlie oculocutaneous albinism in this family. Two known mutations in MC1R caused red hair color in one family member. No modifier effect of MC1R on P mutations could be deduced from the results of this study.

Evaluation of formocresol versus ferric sulphate primary molar pulpotomy: a systematic review and meta-analysis

AIM

To present a systematic review of the effects of formocresol and ferric sulphate when used as medicaments in pulpotomized primary molar teeth.

METHODOLOGY

The study list was obtained by using MEDLINE, the Cochrane Library, EMBASE and SCI search. Only those papers which met the inclusion criteria were accepted. The quality of studies used for meta-analysis was assessed by a series of validity criteria according to Jadad's scale. A systematic review and meta-analysis were performed.

RESULTS

Eleven clinical studies comprising four randomized-clinical trials (RCTs), four controlled clinical trials (CCTs) and three retrospective studies were included. The results of the meta-analysis of six prospective clinical trials suggested that the two popular pulpotomy medicaments were not significantly different in terms of clinical outcomes, radiographic findings, prevalence of apical and furcal destruction, internal root resorption or pulp canal obliteration. The relative risk (RR) value and 95% CI for those parameters were 0.72 (0.43-1.23), 0.87 (0.59-1.30), 0.67 (0.27-1.66), 1.77 (0.56-5.58) and 1.41 (0.63-3.15), respectively. The overall clinical and radiographic success rates based on the data of treatments with ferric sulphate from the 11 studies included ranged from 78% to 100% (mean 91.6 +/- 8.15%) and from 42% to 97% (mean 73.5 +/- 18.40%), respectively.

CONCLUSIONS

In primary molar teeth with exposure of vital pulps by caries or trauma, pulpotomies performed with either formocresol or ferric sulphate have similar clinical and radiographic success. Ferric sulphate may be recommended as a suitable replacement for formocresol.

[The expression of serum IL-10,12,13,16 in patients with allergic rhinitis and vasomotor rhinitis]

OBJECTIVE

To study the role of serum IL-10, 12, 13, 16 in patients with allergic rhinitis and vasomotor rhinitis.

METHOD

The serum levels of IL-10, 12, 13, 16 were measured by ELISA in 30 cases of allergic rhinitis, 25 cases of vasomotor rhinitis and 20 healthy people.

RESULT

The level of IL-12 in allergic rhinitis was (170.33 +/- 90.58) ng/L, which was significantly lower than that of normal controls [(376.69 +/- 140.70) ng/L, P < 0.01]. The levels of IL-13 and IL-16 in allergic rhinitis were (408.51 +/- 189.68) ng/L and (151.53 +/- 63.56) ng/L, which were significantly higher than those of normal controls [(151.92 +/- 85.08) ng/L, (60.65 +/- 32.45) ng/L, P < 0.01]. There were no significant difference of levels of IL-10, 13, 16 between vasomotor rhinitis and normal controls, while the level of IL-12 in vasomotor rhinitis was lower than that of normal controls [(196.03 +/- 96.31) ng/L vs. (376.69 +/- 140.70) ng/L, P < 0.01]. It was suggested that IL-10 had positive correlation with IL-12 (r = 0.73, P < 0.01), and IL-13 had positive correlation with IL-16 (r = 0.94, P < 0.01).

CONCLUSION

The imbalance of IL-12, IL-13 and IL-16 play crucial roles of regulation in the onset and developing of allergic rhinitis. Further research is needed on the role of IL-12 in vasomotor rhinitis.

Comparison of the Levitan FPS Scope and the single-use bougie for simulated difficult intubation in anaesthetised patients

A randomised cross-over study was performed in 34 patients with no evidence of airway difficulties, following induction of general anaesthesia, to compare the efficacy of the Levitan FPS scope (LFPS) and the single-use bougie for tracheal intubation during simulated grade IIIa laryngoscopy. Success rates for intratracheal placement of the device, and the time required for insertion and tracheal intubation were recorded. Both devices were equally successful (31/34 for the LFPS vs 29/34 for the bougie) for insertion into the glottis. The mean insertion time for the LFPS was statistically longer than that for the bougie (4.4-12.5 s) but this difference was not clinically relevant. Intubation times were similar between the two devices. Major problems hindering successful intubation using the LFPS were the presence of a narrow epiglottic-pharyngeal wall space and copious secretions. An inability to maintain the desired shape was the principal cause of failure with the bougie.

Antisense integrin alphaV and beta3 gene therapy suppresses subcutaneously implanted hepatocellular carcinomas

BACKGROUND

Integrin alphaVbeta3 plays a critical role in tumour angiogenesis and metastasis formation, and is recognized as a key therapeutic target in the treatment of cancer.

AIM

To investigate whether antisense alphaV and beta3 gene therapy has utility in the treatment of hepatocellular carcinomas.

METHODS

Antisense expression plasmids targeting integrin alphaV or beta3 were constructed, and examined by immunohistochemistry and Western blot analyses for their ability to inhibit alphaV and beta3 expression. The antisense alphaV and beta3 expression vectors, either alone or in combination, were injected into HepG2 hepatomas established subcutaneously in nude mice and tumour growth, angiogenesis and apoptosis were monitored.

RESULTS

Antisense alphaV and beta3 downregulated the alphaV and beta3 subunits expressed by human umbilical vein endothelial cells, and the alphaV subunit expressed by HepG2 cells. Gene transfer of antisense alphaV and beta3 expression vectors downregulated alphaV and beta3 in HepG2 tumours established in nude mice, inhibited tumour vascularization and growth, and enhanced tumour cell apoptosis. Antisense alphaV suppressed tumour growth more strongly than antisense beta3; however antisense therapy that simultaneously targeted both integrin subunits was more effective than the respective monotherapies. Antisense alphaV and beta3 inhibited tumour angiogenesis to similar extents, by a process that is independent of vascular endothelial growth factor.

CONCLUSIONS

Antisense gene therapy targeting alphaV integrins warrants consideration as an approach to treat hepatocellular carcinomas.

Electrical properties of neurons in the intact rat major pelvic ganglion

The aim of this investigation was to characterize the electrical properties of neurons in the rat major pelvic ganglia (MPG) using intracellular recording techniques. MPG were dissected from male rats euthanized by isoflurane and thoracotomy. Neurons were classified as "phasic" or "tonic" according to their rate of accommodation during a 500-ms depolarizing current pulse. Phasic cells were further subdivided into rapidly or slowly adapting. The firing pattern of tonic cells was divided into regular high frequency, low frequency or irregular firing. In tonic cells, onset spikes showed TTX-resistant discharges; whereas sustained spikes were TTX sensitive. Changing the current pulse amplitude or the stimulation interval could alter the firing pattern in both types of neurons. Subthreshold membrane potential oscillations (SMPOs) were primarily observed when neurons were depolarized. SMPOs were Na(+) dependent and TTX sensitive. The majority of tonic and phasic neurons generated rebound spikes, most of which were partially Na(+) dependent. A small percentage (<6%) of neurons exhibited spontaneous activity. Taken together these findings are consistent with the concept that neurons in the MPG exhibit heterogeneous electrical properties.

Taurine transporter is expressed in vascular smooth muscle cells

The regulation of vascular smooth muscle cells (VSMCs) function by taurine has been a subject of increasing interest and investigation, and taurine is taken up into cells through a specific transporter system, the taurine transporter (TAUT). In the present study, we examined the expression of TAUT in VSMCs and the kinetic parameters of the uptake process of TAUT in VSMCs. RT-PCR and western blot demonstrated that the mRNA and protein of TAUT was expressed in VSMCs in vitro. Immunohistochemistry using antibody for TAUT revealed the expression of this protein in rat thoracic aorta. The maximal [(3)H]taurine uptake rate in VSMCs was 37.75 +/- 3.13 pmol/min per mg of protein, with a K ( m ) value of 5.42 +/- 0.81 microM. Thus, VSMCs are able to express a functional taurine transporter. The regulation and detailed function of taurine and TAUT in VSMCs remain unclear, but our findings suggest a functional role for them in VSMCs metabolism.

Cardiovascular risk factors and anthropometric measurements of adolescent body composition: a cross-sectional analysis of the Third National Health and Nutrition Examination Survey

OBJECTIVE

To assess the association between certain cardiovascular risk factors that are commonly clustered among individuals with insulin resistance syndrome (IRS) and adolescents' body composition measurements.

METHODS

We examined a total of 1068 adolescents aged 12-16 years from the Third National Health and Nutrition Examination Survey. The sex-specific third tertiles of glucose, triglycerides, systolic blood pressure and first tertile of high-density-lipoprotein (HDL) cholesterol were used to classify the presence of each IRS component. We compared adolescents with none, one, two and three/four IRS components across a series of body composition measurements and lipid profile.

RESULTS

About 18% of the adolescents had three or four IRS components. Overall, IRS among adolescents is more likely to be associated with body weight and measurements related to body girths and less likely to be associated with the measurements related to body lengths. Multivariate analysis results showed that the odds of being at increased risk of obesity (body mass index z-score> 0.85) were significantly greater among those with two (odds ratio (OR)=4.5; 95% CI 2.5-8.2) and three/four (OR=8.9, 95% CI 4.5-17.5) IRS components compared to those without any IRS components. Across sex, the level of non-HDL cholesterol was significantly higher among adolescents with more IRS components (P for trends <0.05).

CONCLUSIONS

The clustered cardiovascular risk factors are strongly associated with an increased risk of obesity and higher levels of non-HDL cholesterol among adolescents.

Debriefing after critical incidents for anaesthetic trainees

This survey investigated the need, and the availability, of debriefing after critical incidents for training anaesthetists. A cross-sectional postal survey of all Australian anaesthetic trainees was conducted in May 2002. Four hundred and nineteen responses were analysed (response rate 64%). Debriefing after a critical incident was perceived by most trainees to be useful, however 36% (n = 149) had never been debriefed. Trainees ranked their preferred content for a debriefing as 'anaesthetic issues' followed by the 'psychological impact of the incident' 'patient issues' and 'surgical issues'. Almost half of respondents reported that they did not feel supported by their anaesthetic department after a negative outcome incident. Trainees who had debriefings were more likely to feel supported by senior colleagues. Debriefing after critical incidents should be an integral part of the supervision of anaesthetic trainees.