Hepatitis G virus infection in hemodialysis and continuous ambulatory peritoneal dialysis patients

To determine the prevalence and clinical relevance of HGV infection in dialysis patients, we performed a cross-sectional study of 61 HD patients and 79 Continuous Ambulatory Peritoneal Dialysis (CAPD) patients. HGV-RNA was identified by reverse-transcription (RT) polymerase chain reaction (PCR) assay with primers from the 5'-untranslated region of the viral genome. The prevalence of HGV infection was similar in HD and CAPD patients (9.8% vs. 12.7%), while that of HCV infection was significantly higher in HD patients compared to CAPD patients (16.4% vs. 1.3%, p < 0.05). The mean age (49.2 +/- 13.4 vs. 46.7 +/- 13.0 years), male to female ratio (2.4:1 vs. 1.3:1), history of transfusion (62.3% vs. 49.4%), history of hepatitis (27.9% vs. 26.6%), mean ALT level during the previous 6 months (22.4 +/- 37.9 vs. 14.0 +/- 7.4 IU/L), and the prevalence of HBsAg (8.2% vs. 6.3%) showed no difference between HD and CAPD patients. In both HD and CAPD patients, the presence of HGV RNA was not related to age, sex, duration of dialysis, history of transfusion, history of hepatitis, or to the presence of HBV or HCV markers. There was no significant difference in the clinical and biochemical data between patients with isolated HGV infection (n = 12) and patients without viremia (n = 106). The clinical feature of patients coinfected with HGV and HBV (n = 2), or HGV and HCV (n = 2) seemed to be similar to those of patients with isolated HBV (n = 8) or HCV (n = 9) infection. In conclusion, the prevalence of HGV infection was not different between HD and CAPD patients, and HGV infections did not seem to be associated with clinically significant hepatitis. The routes of HGV transmission, other than transfusion or contamination during HD procedure, were suspected.

Characterization of a mammalian peroxiredoxin that contains one conserved cysteine

A new type of peroxidase enzyme, named thioredoxin peroxidase (TPx), that reduces H2O2 with the use of electrons from thioredoxin and contains two essential cysteines was recently identified. TPx homologs, termed peroxiredoxin (Prx), have also been identified and include several proteins, designated 1-Cys Prx, that contain only one conserved cysteine. Recombinant human 1-Cys Prx expressed in and purified from Escherichia coli has now been shown to reduce H2O2 with electrons provided by dithiothreitol. Furthermore, human 1-Cys Prx transiently expressed in NIH 3T3 cells was able to remove intracellular H2O2 generated in response either to the addition of exogenous H2O2 or to treatment with platelet-derived growth factor. The conserved Cys47-SH group was shown to be the site of oxidation by H2O2. Thus, mutation of Cys47 to serine abolished peroxidase activity. Moreover, the oxidized intermediate appears to be Cys-SOH. In contrast to TPx, in which one of the two conserved cysteines is oxidized to Cys-SOH and then immediately reacts with the second conserved cysteine of the second subunit of the enzyme homodimer to form an intermolecular disulfide, the Cys-SOH of 1-Cys Prx does not form a disulfide. Neither thioredoxin, which reduces the disulfide of TPx, nor glutathione, which reduces the Cys-SeOH of oxidized glutathione peroxidase, was able to reduce the Cys-SOH of 1-Cys Prx and consequently could not support peroxidase activity. Human 1-Cys Prx was previously shown to exhibit a low level of phospholipase A2 activity at an acidic pH; the enzyme was thus proposed to be lysosomal, and Ser32 was proposed to be critical for lipase function. However, the mutation of Ser32 or Cys47 has now been shown to have no effect on the lipase activity of 1-Cys Prx, which was also shown to be a cytosolic protein. Thus, the primary cellular function of 1-Cys Prx appears to be to reduce peroxides with the use of electrons provided by an as yet unidentified source; the enzyme therefore represents a new type of peroxidase.

Mammalian peroxiredoxin isoforms can reduce hydrogen peroxide generated in response to growth factors and tumor necrosis factor-alpha

Mammalian tissues express three immunologically distinct peroxiredoxin (Prx) proteins (Prx I, II, and III), which are the products of distinct genes. With the use of recombinant proteins Prx I, II, and III, all have now been shown to possess peroxidase activity and to rely on Trx as a source of reducing equivalents for the reduction of H2O2. Prx I and II are cytosolic proteins, whereas Prx III is localized in mitochondria. Transient overexpression of Prx I or II in cultured cells showed that they were able to eliminate the intracellular H2O2 generated in response to growth factors. Moreover, the activation of nuclear factor kappaB (NFkappaB) induced by extracellularly added H2O2 or tumor necrosis factor-alpha was blocked by overproduction of Prx II. These results suggest that, together with glutathione peroxidase and catalase, Prx enzymes likely play an important role in eliminating peroxides generated during metabolism. In addition, Prx I and II might participate in the signaling cascades of growth factors and tumor necrosis factor-alpha by regulating the intracellular concentration of H2O2.

Abnormal distribution of Fc gamma receptor type IIa polymorphisms in Korean patients with systemic lupus erythematosus

OBJECTIVE

Abnormal immune complex clearance is a feature of systemic lupus erythematosus (SLE). Polymorphisms of the Fc gamma receptor type IIa (Fc gammaRIIa) genes (the receptor binds IgG2 and IgG3) are important disease susceptibility factors in some populations. This study sought to determine the effects of these polymorphisms among Korean patients with SLE.

METHODS

Polymerase chain reaction of genomic DNA and allele-specific oligonucleotide hybridization were used to determine Fc gammaRIIa genotypes in Korean patients with SLE and healthy control subjects. Clinical manifestations were analyzed in each patient and correlated with the genotypes.

RESULTS

Among the 73 SLE patients, there was an abnormal distribution of Fc gammaRIIa alleles when compared with 64 controls: 11.0% of the SLE patients were homozygous for Fc gammaRIIa-H131 compared with 34.4% of the controls (odds ratio [OR] 0.20, 95% confidence interval [95% CI] 0.04-0.95, chi2 = 5.7, P = 0.01699). The allelic frequency of Fc gammaRIIa-H131 was significantly lower in the SLE patients than in the controls (49.3% versus 63.3%; P = 0.02019), and it was also significantly lower in lupus patients with nephritis compared with the normal population (OR 0.53, 95% CI 0.29-0.95, chi2 = 5.15, P = 0.02330), but was not significantly lower in lupus patients without nephritis (P = 0.13663 versus controls). Clinically, the level of proteinuria was significantly higher in the lupus nephritis patients who had R/R131 than in those who had H/H131 or R/H131.

CONCLUSION

An abnormal distribution of Fc gammaRIIa polymorphisms was associated with SLE in Korean patients. There was a significant decrease in the Fc gammaRIIa-H/H131 genotype and H131 allelic frequency in SLE patients, particularly in those with nephritis. This suggests that the H131 allele confers some protection from SLE in this population.

Characterization of a human alpha1-antitrypsin variant that is as stable as ovalbumin

The metastability of inhibitory serpins (serine proteinase inhibitors) is thought to play a key role in the facile conformational switch and the insertion of the reactive center loop into the central beta-sheet, A-sheet, during the formation of a stable complex between a serpin and its target proteinase. We have examined the folding and inhibitory activity of a very stable variant of human alpha1-antitrypsin, a prototype inhibitory serpin. A combination of seven stabilizing single amino acid substitutions of alpha1-antitrypsin, designated Multi-7, increased the midpoint of the unfolding transition to almost that of ovalbumin, a non-inhibitory but more stable serpin. Compared with the wild-type alpha1-antitrypsin, Multi-7 retarded the opening of A-sheet significantly, as revealed by the retarded unfolding and latency conversion of the native state. Surprisingly, Multi-7 alpha1-antitrypsin could form a stable complex with a target elastase with the same kinetic parameters and the stoichiometry of inhibition as the wild type, indicating that enhanced A-sheet closure conferred by Multi-7 does not affect the complex formation. It may be that the stability increase of Multi-7 alpha1-antitrypsin is not sufficient to influence the rate of loop insertion during the complex formation.

Thioredoxin peroxidase is a novel inhibitor of apoptosis with a mechanism distinct from that of Bcl-2

Thioredoxin peroxidase (TPx) is a member of a newly discovered family of proteins that are conserved from yeast to mammals and to which natural killer enhancing factor belongs. These proteins are antioxidants that function as peroxidases only when coupled to a sulfhydryl reducing system. The physiological function of TPx in cells is not yet known. Here we demonstrate that when the human TPx II, a member of this family, is stably overexpressed in Molt-4 leukemia cells, it protects from apoptosis induced by serum deprivation, ceramide, or etoposide. TPx II, like Bcl-2, is able to inhibit release of cytochrome c from mitochondria to cytosol, and it inhibits lipid peroxidation in cells. TPx II, unlike Bcl-2, could prevent hydrogen peroxide accumulation in cells, suggesting that it functions upstream of Bcl-2 in the protection from apoptosis and may be implicated as an endogenous regulator of apoptosis.

Impact of metabolic acidosis on serum albumin and other nutritional parameters in long-term CAPD patients

To evaluate the effects of metabolic acidosis on serum albumin and other nutritional parameters in long-term continuous ambulatory peritoneal dialysis (CAPD) patients, we undertook a retrospective study involving 106 CAPD patients who had monthly biochemical measurements and urea kinetic studies every 6 months for more than 2 years. The patients were divided into three groups according to their mean total CO2 (tCO2) level of the 2-year follow-up (Group I: mean tCO2 < 22 mmol/L; Group II: 22 mmol/L < or = tCO2 < 26 mmol/L; Group III: mean tCO2 > or = 26 mmol/L), and the clinical, biochemical, and urea kinetic data were compared between the three groups. The mean tCO2 in Groups I, II, and III were 20.62 +/- 1.2 mmol/L, 23.91 +/- 1.1 mmol/L, and 27.3 +/- 0.8 mmol/L, respectively. The percentage of body weight (Bwt) to ideal body weight (IBW) was significantly higher in Group I (113.1 +/- 15.3%) compared to Group II (103.5 +/- 11.5%) and Group III (98.7 +/- 8.0%) (p < 0.05), but the percentage of lean body mass (LBM) to Bwt was not different between the three groups. Compared to Group III, Group I had significantly higher blood urea nitrogen (BUN) (61.1 +/- 14.3 vs 46.1 +/- 7.2 mg/dL, p < 0.05), serum albumin (4.04 +/- 0.31 vs 3.75 +/- 0.39 g/dL, p < 0.05), and normalized protein equivalent to nitrogen appearance (NPNA) (1.02 +/- 0.21 vs 0.88 +/- 0.14 g/kg/day, p < 0.05), and more ultrafiltration volume (1.4 +/- 0.4 vs 1.0 +/- 0.3 L/day, p < 0.05), in spite of comparable dialysis dose and albumin loss into the dialysate. No differences were observed in the three groups in the changes of tCO2, Bwt/IBW, LBM/Bwt, BUN, and albumin from the baseline values after the 2-year follow-up. Using stepwise multiple regression analysis, NPNA, Bwt/IBW, and ultrafiltration volume were independent factors affecting mean tCO2 level. In conclusion, low tCO2 levels in long-term CAPD patients may reflect increased protein intake, and the mild to moderate degrees of metabolic acidosis may not affect the nutritional status of well-dialyzed CAPD patients.

Cloning and sequencing of the secY gene homolog from Mycobacterium bovis BCG

The complete nucleotide sequence of a 1,513 bp fragment of Mycobacterium bovis BCG containing the secY gene homolog and partial adk gene that encodes an adenylate kinase has been determined. The secY gene of BCG has an open reading frame of 441 amino acids with homology to the SecY protein family. Comparative analyses of the deduced amino acid sequence of additional partial ORF revealed strong similarity to the known adenylate kinases.

The effect of anti-hypertensive drugs on DNA synthesis and proliferation of cultured rat aortic smooth muscle cells

The aim of this study was to elucidate the effects of anti-hypertensive drugs, nifedipine, furosemide, hydrochlorothiazide, captopril, and atenolol on DNA synthesis and proliferation of cultured rat aortic smooth muscle cells induced by fetal calf serum. Aortic smooth muscle cells from Sprague-Dawley rats were isolated, cultured, and seeded in multi-well plates. When confluent, cells were cultured in a conditioned medium without fetal calf serum. After 72 hours, cells were cultured in the medium retaining 10% fetal calf serum with or without anti-hypertensive drugs by increasing the concentration between 10(-8) and 10(-4) M. DNA synthesis was assessed by [3H]-thymidine uptake and proliferation by cell numbers using a hemocytometer. Nifedipine at a concentration of 10(-5) M and 5 x 10(-5) M inhibited serum-induced DNA synthesis significantly by 50.8% and 86.6%, respectively (p < 0.05). The results of cell numbers paralleled those of 3H-thymidine incorporation. Serum-induced DNA synthesis was also reduced by 32.6% at the highest dose of furosemide (10(-4) M), but there was no statistical significance. Hydrochlorothiazide, captopril, and atenolol did not show anti-proliferative effect throughout any of the doses. In conclusion, among the various anti-hypertensive drugs, nifedipine seems to be most beneficial in view of its direct inhibitory effect on DNA synthesis and proliferation of smooth muscle cells, as well as for its anti-hypertensive effect.

[Cloning and sequencing of p33 in a Korean isolate of Theileria sergenti]

The gene encoding the 33 kDa piroplasm surface protein of Theileria sergenti isolated in Korea was cloned and the nucleotide sequence was determined by dideoxy chain termination method. The cloned gene corresponds to 869 bp encoding an open reading frame 283 amino acids. Comparison of the sequence between Korean and Japanese isolates showed 99.4% homology rate in the nucleotide sequence and 98.9% homology rate in the amino acid sequence.

[Rapid detection of Theileria sergenti by polymerase chain reaction]

Four separate pairs of oligonucleotide primers within the coding region in a T. sergenti 33-kDa surface protein gene were selected to detect T. sergenti by PCR. The specificity of PCR-amplified DNA was examined by digestion with restriction enzyme and Southern blot hybridization using T. sergenti p33 DNA probe. PCR appears to be specific for T. sergenti, without detectable signals from uninfected erythrocytes, uninfected bovine leukocytes and other hemoparasites, including A. marginale and B. ovata. Although 46 of 71 specimens (64.8%) from grazing cattle were microscopically positive, PCR in this study showed that 64 specimens (88.7%) were positive. Therefore, PCR proves a useful diagnostic tool for detecting T. sergenti-infected cattle. In addition, it is also revealed that PCR was significantly more sensitive than traditional microscopic examination using Giemsa's stain.

Management of chronic hypotony following trabeculectomy with mitomycin C

Chronic hypotony is marked by decreased vision and late-onset leaking bleb after filtration surgery using topical mitomycin C; to manage this condition we followed a three-step approach: first, intrableb autologous blood injection; second, surgical exploration and additional suturing of the scleral flap; third, excision of the cystic bleb and advancement of a fornical conjunctival flap. For the avascular flap cystic blebs of five patients. In three of the six eyes, there was no increase of intraocular pressure (IOP); two eyes showed massive hyphema and were mildly resistant to the injection of autologous blood, and in one, a leaking hole was seen in the bleb wall two days after the injection of blood. Two eyes of three in which blood injection had failed, and another, in which the bleb had spread over more than half the eyeball, and which was the patient's only sighted eye, underwent the second step of the procedure. The remaining leaking eye, in which blood injection had been complicated, and another, in which spontaneous leakage from a thin avascular bleb had occurred, were subjected to the third step. After each of the three approaches, IOP increased on average from 1.67 to 5.67 mmHg, from 2.33 to 11.33 mmHg, and from 1.5 to 7 mmHg, respectively; each approach successfully improved vision. Intrableb autologous blood injection is a simple procedure for the management of chronic overfiltration and a way of determining whether excessive filtration is occurring through the scleral flap, in which case additional suturing is required, or in another way. Depending on the status of the bleb, additional suturing or excision of the cystic bleb and advancement of the fornical conjunctival flap are useful modalities for the treatment of late-onset leaking filtration bleb.

Interlimb interaction and stabilization of contralateral leg in isokinetic knee evaluation

OBJECTIVE

To determine if peak torque (PT) production during isokinetic knee testing is affected by the stabilization and movement patterns of the contralateral leg.

DESIGN

Repeated measure design.

INTERVENTION AND MAIN OUTCOME MEASURE

Thirty subjects participated in comparing the force outputs in relation to the movement pattern of both legs. Another group of 45 subjects volunteered to perform five maximal isokinetic extension-flexion contractions in each of three different knee testing conditions: (1) without stabilization of the contralateral leg; (2) with a bar in front of the ankle joint of the contralateral leg; (3) with the contralateral leg strapped just above the level of the malleoli and the muscles of that leg induced reciprocally to perform isometric contractions with respect to the testing leg. PT was used to compare the strength of three different conditions.

RESULTS

Significantly greater PT was measured when the contralateral leg of the subject was fixed and induced to contract reciprocally.

CONCLUSION

More rigorous standardization of isokinetic strength testing procedures is needed due to differences in PT production of knee muscles according to the stabilization and movement pattern of the contralateral leg.

Complete sequence of the UPP gene encoding uracil phosphoribosyltransferase from Mycobacterium bovis BCG

The nucleotide sequence of a 799 bp fragment of Mycobacterium bovis BCG containing the putative upp gene that encodes a uracil phosphoribosyltransferase (UPRTase [EC 2.4.2.9]) has been determined. The upp gene of BCG has an open reading frame (ORF) of 621 bp (207 amino acids) starting with GTG (position 112) and ending with TGA (position 733), and its molecular mass was calculated to be 21,864 Da. Comparative analyses of the deduced amino acid sequence of BCG UPRTase with the UPRTase of six bacterial genera revealed that 24% (50/211) of the residues are perfectly conserved and 32% (67/211) of the residues are well conserved.

Xanthogranulomatous cholecystitis: CT features with emphasis on differentiation from gallbladder carcinoma

PURPOSE

To evaluate the computed tomographic (CT) features of xanthogranulomatous cholecystitis (XGC) and to distinguish it from gallbladder carcinoma.

MATERIALS AND METHODS

Retrospective analysis was performed in 11 patients with XGC and 17 patients with gallbladder carcinoma in which the wall was thickened. The following CT features were analyzed: maximum wall thickness, intramural hypoattenuated nodules, mucosal line, patterns of wall thickening and enhancement, and the presence of stones. The changes outside the gallbladder were also compared.

RESULTS

The mean thickness of the gallbladder wall was 1.8 cm in patients with XGC and 2.1 cm in patients with gallbladder carcinoma. Intramural hypoattenuated nodules were seen in all patients with XGC but in only seven patients with gallbladder carcinoma (P = .008). The mucosal line was observed in nine patients with XGC and in six with gallbladder carcinoma (P = .02). The gallbladder wall was more diffusely thickened in patients with XGC (10 of 11 patients) than in patients with gallbladder carcinoma (seven of 17 patients) (P = .01). The occurrence of changes outside the gallbladder did not differ statistically significantly.

CONCLUSION

Because of a statistically significant overlap of CT features, only when intramural hypoattenuated nodules occupy a large area of the thickened gallbladder wall can the diagnosis of XGC be highly suggestive. The diagnosis of XGC at CT may indicate a less aggressive surgical approach.

Epidermal growth factor (EGF)-induced generation of hydrogen peroxide. Role in EGF receptor-mediated tyrosine phosphorylation

Recent evidence indicates that reactive oxygen species (ROS) may function as intracellular messengers in receptor signaling pathways. The possible role of ROS in epidermal growth factor (EGF) signaling was therefore investigated. Stimulation of A431 human epidermoid carcinoma cells with EGF resulted in a transient increase in the intracellular concentration of ROS, measured with the oxidation-sensitive fluorescent probe 2',7'-dichlorofluorescin diacetate and laser-scanning confocal microscopy. The predominant ROS produced appeared to be H2O2, because the EGF-induced increase in fluorescence was completely abolished by incorporation of catalase into the cells by electroporation. The elimination of H2O2 by catalase also inhibited the EGF-induced tyrosine phosphorylation of various cellular proteins including the EGF receptor and phospholipase C-gamma1. The dependence of H2O2 production on the intrinsic tyrosine kinase activity of the EGF receptor and the autophosphorylation sites located in its COOH-terminal tail was investigated. EGF failed to induce H2O2 generation in cells expressing a kinase-inactive EGF receptor. However, normal H2O2 generation was observed in cells expressing a mutant receptor from which the 126 COOH-terminal amino acids had been deleted to remove four (out of the total of five) autophosphorylation sites. These results suggest that EGF-induced H2O2 formation requires the kinase activity but probably not the autophosphorylation sites of the EGF receptor and that inhibition of protein tyrosine phosphatase activity by H2O2 may be required for EGF-induced protein tyrosine phosphorylation to be manifested.

The effects of high glucose concentration on angiotensin II- or transforming growth factor-beta-induced DNA synthesis, hypertrophy and collagen synthesis in cultured rat mesangial cells

Hyperglycemia is a principal characteristic of diabetes, and has an influence on many cellular functions. In order to investigate whether the intracellular signaling pathways inducing proliferation, hypertrophy and matrix synthesis of mesangial cells are altered in a diabetic environment, we evaluated the effects of a high concentration of extracellular glucose(25 mM; 450 mg/dl) on [3H]thymidine uptake, hypertrophy, and [3H]proline incorporation into a collagenase-sensitive protein, induced by angiotensin II(Ang II) or transforming growth factor(TGF)-beta, in cultured rat mesangial cells. The exposure to a high glucose concentration for 7 days significantly inhibited Ang II(10(-6) M)-induced [3H]thymidine uptake, compared to normal glucose concentration (5 mM)(M +/- SD., 1050 +/- 100 cpm/well vs 550 +/- 97, p < 0.05), and markedly prevented the inhibition of [3H]thymidine uptake by TGF-beta(1 ng/ml)(132 +/- 10 vs 340 +/- 67, p < 0.05). The administration of H-7(50 microM), a protein kinase C(PKC) inhibitor, did not reverse these effects of high glucose on [3H]thymidine uptake. On flow cytometric analysis of cell size, the mean cell size was significantly greater for the cells exposed to high glucose or treated with Ang II or TGF-beta, compared to that for the untreated cells. But the addition of Ang II or TGF-beta to the cells exposed to high glucose did not show further enlargement in size. The exposure to high glucose and the treatment with Ang II or TGF-beta significantly increased collagen synthesis, measured by [3H]proline incorporation. The Ang II -or TGF-beta-induced increase of [3H]proline incorporation did not show changes under high glucose culture condition, compared to normal glucose concentration(Ang II, 27880 +/- 3560 cpm vs 26978 +/- 2284, TGF-beta, 26559 +/- 3700 vs 25800 +/- 1660, p > 0.05). In conclusion, although the signaling pathway for DNA synthesis by Ang II or TGF-beta are influenced, possibly mediated by PKC-independent mechanism(s), the pathway inducing hypertrophy or collagen synthesis by both agents appears to be unchanged under the high extracellular glucose concentration in cultured rat mesangial cells.

Studies on bone markers and bone mineral density in patients with chronic renal failure

Renal osteodystrophy has become a frequent complication in patients with chronic renal failure (CRF), and various histologic forms such as high turnover, low turnover and mixed bone disease have been demonstrated. The only reliable method for distinguishing patients with high turnover from those with low turnover bone disease is bone histomorphometric study, but its clinical utility is restricted. Because of its invasive nature, efforts have been made to predict indirectly the type and severity of this metabolic bone disease by serum assays. In this cross-sectional study, we measured total and regional (head, arms, trunk, ribs, legs, spine and pelvis) bone mineral densities (BMD) by dual X-ray absorptiometry (DXA) in patients with variable degrees of CRF and correlated them with various bone markers. Decreased BMDs were detected in various skeletal sites (trunk and pelvis) in the patients' group. Total BMD Z score was lower in predialysis CRF patients than in the control subjects. Decreased BMD Z scores on weight-bearing bone were pronounced at L1 lumbar vertebra, femur trochanter, femur neck and Ward's triangle. Positive linear correlations were found between creatinine clearance and trunk, ribs, pelvis, and spine BMDs. There were inverse linear correlations between total BMD and total BMD Z score and alkaline phosphatase (AP), urine deoxypyridinoline (U-DPD) in the patients' group. There were no correlations between regional and total BMD, total BMD Z score and serum calcium, ionized calcium, and serum phosphate. There were inverse linear correlations between BUN, creatinine and bone-specific alkaline phosphatase in the predialysis CRF group. We evaluated the correlations between intact parathyroid hormone (i-PTH) and biochemical and other bone markers. There was statistically significant linear correlation between i-PTH and AP. Other bone markers have no significant correlations with i-PTH. Our results demonstrated that there is significant bone loss in patients with CRF before the start of dialysis and also regional variations of BMDs in predialysis CRF patients. DXA is a useful method for evaluating regional and total BMDs and provides information about diverse regional skeletal changes. AP, i-PTH and U-DPD can predict BMD of predialysis CRF patients.

The changes in muscle strength and relaxation time after a comprehensive rehabilitation program for patients with myotonic dystrophy

Myotonic dystrophy is a muscular disorder characterized by muscle weakness and myotonia. Myotonia manifests with abnormally slow relaxation after strong voluntary contraction of the muscles. In our previous study we reported that quinine sulfate provided therapeutic benefit to myotonia and a home exercise program based on muscle strengthening exercises improved muscle strength. The purpose of this study was to determine the effect of a multi-therapeutic program in patients with myotonic dystrophy. For six months, seven patients with myotonic dystrophy received heat therapy, were given psychologic intervention using relaxation techniques, were trained at home, and were given quinine sulfate. The changes in muscle strength and relaxation time between the post-six-months home exercise program combined with quinine sulfate therapy, and the post-six months multi-therapeutic program, were assessed from the first dorsal interossei, the elbow flexors, and the knee extensors. The results were as follows: 1) The mean muscle strength of the each of the three muscles after the six months multi-therapeutic program was improved but was not significant compared with the post-six-months home exercise program combined with quinine sulfate therapy. 2) The mean relaxation time of each of the three muscles after the six months multi-therapeutic program was significantly reduced compared with the home exercise program combined with quinine sulfate therapy. In conclusion, the multi-therapeutic program undertaken in this study was the better program for the patients with myotonic dystrophy.

Removal of hydrogen peroxide by thiol-specific antioxidant enzyme (TSA) is involved with its antioxidant properties. TSA possesses thiol peroxidase activity

The thiol-specific antioxidant protein (TSA) protects glutamine synthetase from inactivation by a metal-catalyzed oxidation (MCO) system comprised of dithiothreitol (DTT)/Fe3+/O2 but not by the ascorbate/Fe3+/O2 MCO system. The removal of sulfur-centered radicals or H2O2 has been proposed as the protective mechanism of TSA. Like catalase, TSA prevents the initiation of the rapid O2 uptake phase during MCO of DTT but causes only partial inhibition when added after the reaction is well into the propagation phase. Stoichiometric studies showed that the antioxidant property of TSA is, at least in part, due to its ability to catalyze the destruction of H2O2 by the overall reaction 2 RSH + H2O2 --> RSSR + H2O. Results of kinetic studies demonstrate that the removal of H2O2 by TSA correlates with its ability to protect glutamine synthetase from inactivation. In the presence of thioredoxin, TSA is more active, whereas C170S (an active mutant of TSA in which cysteine 170 was replaced by a serine) and open reading frame 6 (a human antioxidant protein homologous to TSA with only one conserved cysteine residue) are only slightly affected. The thiol specificity of the protective activity of TSA derives from the fact that the oxidized form of TSA can be converted back to its sulfhydryl form by treatment with thiols but not by ascorbate.

Factors affecting low values of serum albumin in CAPD patients

To investigate the factors affecting low values of serum albumin (SA) in continuous ambulatory peritoneal dialysis (CAPD) patients, we undertook a cross-sectional study of 106 CAPD patients, with a mean age of 49.0 years and dialysis duration of 43.4 months, with respect to demographic, clinical, and biochemical parameters. In group I (n = 28, SA < or = 3.5 g/dL), diabetics were more common, patients were significantly older, and more patients were malnourished, according to the subjective global assessment (SGA), compared to group II (n = 78, SA > 3.5 g/dL). Serum C-reactive protein (CRP), lipoprotein (a), and 24-hour dialysate-to-plasma creatinine concentration ratio (D/P) were significantly higher, and 24-hour dialysate albumin was greater in group I. Compared to group II, group I had significantly lower serum creatinine and urea nitrogen appearance (UNA). Blood urea nitrogen (BUN), lean body mass (LBM), % of body weight (%BW), and normalized protein equivalent of nitrogen appearance (nPNA) tended to be lower in the low SA group, without statistical significance. There were no differences in the duration of CAPD, peritonitis rate, serum insulin-like growth factor-I (IGF-I), anthropometric data, dietary assessment, dialysis adequacy, and residual renal function (RRF) between the two groups. SA was positively correlated with serum creatinine, IGF-I, LBM, UNA, BUN, nPNA, and CAPD duration, and was negatively correlated with 24-hour D/P, 24-hour dialysate albumin, age, CRP, and bicarbonate (HCO3-). By stepwise multiple logistic regression analysis, 24-hour D/P, age, CRP, and SGA were independent risk factors for low SA level. In conclusion, SA seems to be influenced not only by nutritional factors but also by nonnutritional factors such as peritoneal membrane transport characteristics, age, and presence of acute phase protein response manifested by CRP elevation.