The use of nasal splints in the primary management of unilateral cleft nasal deformity

Primary surgical correction of the cleft lip nasal deformity is routinely performed at the Craniofacial Center at Chang Gung Memorial Hospital. Over time, however, there is a tendency for the lower lateral cartilage to retain its memory and, subsequently, recreate the preoperative nasal deformity. Therefore, it is current practice to use a nostril retainer for a period of at least 6 months to maintain the corrected position of the nose. The aim of this study was to qualitatively assess the benefit of postoperative nasal splinting in the primary management of unilateral cleft nasal deformity. Data from two groups of 30 patients with complete unilateral cleft lips each were retrospectively collected and analyzed. The first group served as a control (no nasal splints), and the second group used the nasal retainer compliantly for at least 6 months postoperatively. All patients had their primary lip repair at 3 months of age. A photographic evaluation of the results when the patients were between 5 and 8 years of age was conducted. The parameters used to assess the nasal outcome were nostril symmetry, alar cartilage slump, alar base level, and columella tilt. The first scores were based on residual nasal deformity, and the second set were based on overall appearance. It was found that the mean scores of residual nasal deformity for all four parameters in patients who used the nasal stent were statistically better than the scores of patients who did not (p values ranged from 0.0001 to 0.005). The overall appearance scores for the four parameters in the patients who used the nasal stent after surgery were also statistically better than the scores for those who did not (p values ranged from 0.0001 to 0.01). The results show that postoperative nasal splinting in the primary management of the unilateral cleft nasal deformity serves to preserve and maintain the corrected position of the nose after primary lip and nasal correction, resulting in a significantly improved aesthetic result. Therefore, it is recommended that all patients undergoing primary correction of complete unilateral cleft deformity use the nasal retainer postoperatively for a period of at least 6 months.

Relationships of plasma tryptophan availability to course of illness and clinical features of alcoholism: a preliminary study

RATIONALE

Serotonergic (5-HT) mechanisms may be involved in impulse control (including antisocial behavior) across psychiatric syndromes. Age of onset may differentiate alcoholics on psychopathological characteristics associated with impulse control, especially mood disturbance, hostility, and a broad range of antisocial behaviors. Thus, there may be a predictable relationship between markers of 5-HT function and age of onset-related characteristics.

OBJECTIVE

We tested the hypothesis that there would be a predictable relationship between the ratio of plasma tryptophan to large neutral amino acids (i.e. TRYP/LNAA ratio), a marker of 5-HT function, age of onset and related psychopathological characteristics associated with impulse control.

METHODS

Fifty-eight male and female DSM-IV diagnosed alcoholics attending an outpatient treatment center completing a comprehensive psychopathological assessment, and from whom blood samples were obtained.

RESULTS

Plasma TRYP/LNAA ratio was positively correlated with symptoms of dysphoria, and negatively associated with harm avoidance on Cloninger's Temperament and Character Inventory. Low tryptophan availability was associated with antisocial-type personality characteristics. Interestingly, the few (nine) subjects who had both early onset alcoholism and antisocial personality disorder had a higher plasma tryptophan but similar TRYP/LNAA ratio to the others.

CONCLUSIONS

These data suggest that a low plasma TRYP/LNAA ratio is associated with susceptibility to anxiety, antisocial-type personality characteristics, and an early age of onset for alcoholism. In contrast, a high plasma TRYP/LNAA ratio is associated with a later onset of alcoholism and dysphoria.

Cleft lip scar camouflage using dermal micrografts

The use of dermal micrografts to camouflage cleft lip scars is a simple and effective method. We have used dermal micrografts, some hairbearing, to camouflage hypopigmented scars in 10 patients. This method improves the color of the scar, corrects wound distortion and direction to a certain degree, and enables the resultant scar to blend into the adjacent tissue more naturally. Unlike with other methods of scar revision, additional tissue is not sacrificed and new incision lines are not created.

Intralesional photocoagulation of vascular anomalies of the tongue

Vascular anomalies remain a challenge for patients and reconstructive surgeons. Recently, promising results have been reported using intralesional photocoagulation (ILP) to treat large, deep vascular lesions. We report our experience in treating 12 patients with vascular anomalies of the tongue (10 venous malformations and two haemangiomas) using intralesional photocoagulation. All patients were treated with a Nd:YAG (neodymium:yttrium-aluminium-garnet) (1064 nm) laser (Sharplan, Inc., NJ, USA) delivered with a 600 microns optical fibre. Laser power was set at 7 or 10 W, delivered with a pulse duration of 10 s. Laser energy was delivered to all areas of the vascular lesion. Heat, visible shrinkage and firmness of the lesion signalled the end-point of treatment. The mean follow-up period was 9.5 months (range 3-20 months). All patients demonstrated improvement as judged by a clinical assessment of the reduction in lesion size (mean reduction = 87%, range 60-100%). Three patients (25%) had complications attributed to photocoagulation. Energy delivered too superficially resulted in ulceration or scarring. These complications should be avoidable if this potential for harm is kept in mind.

Lack of correlation in JNK activation and p53-dependent Fas expression induced by apoptotic stimuli

Induction of Fas expression by DNA-damaging agents is dependent on the expression of functional p53, and has been suggested to play an important role in apoptosis induction. JNK (c-Jun N-terminal kinase), which is capable of phosphorylating p53, is also involved in apoptotic signaling induced by various apoptotic stimuli. Here, we report that although Fas induction is closely linked to the expression of wild type p53, it is not correlated with JNK activation induced by apoptotic stimuli. JNK activation does not necessarily lead to Fas expression, even in cells containing wild type p53. In addition, Fas expression can be induced without significant JNK activation. Furthermore, induction of Fas expression is not sufficient for apoptosis induction; however, it may sensitize cells to Fas-ligation induced apoptosis.

Bilateral coronoid process hyperplasia with limitation on mouth opening: case report

Coronoid process hyperplasia with limitation of mouth opening is rare. The pathology is often ignored, but it can be easily detected using dental panoramic view of x-ray films. Definition of the coronoid process hyperplasia can be made by measuring the height of coronoid process and the ratio of coronoid/condyle height on lateral cephalometric x-ray film. Etiology of the coronoid process hyperplasia can be congenital or acquired. Differentiation of the diagnosis may be difficult. The congenital type occurs at early age with clinical manifestations. Proposed hypotheses for the formation of coronoid process hyperplasia include increased activity within the temporalis muscle from conditions such as functional stress, compression, and tension. For patients with coronoid process hyperplasia and restriction on mouth opening, conservative treatment should first be attempted. Surgical treatment is considered if conservative treatment fails. Coronoidectomy with early mobilization and aggressive physiotherapy corrects the problem. We present a patient with coronoid process hyperplasia with limitation of mouth opening who was successfully treated.

Basic fibroblast growth factor enhanced LAK cell cytotoxicities against human bladder neoplasm cells

AIM

To study the effects of basic fibroblast growth factor (bFGF) on the proliferation of lymphokine-activated killer (LAK) cells from patients with bladder cancer and LAK cells cytolysis against bladder tumor cells.

METHODS

LAK cell proliferation was assayed in the presence of various concentrations of bFGF combined with interleukin-2 (IL-2) by cell count. Cytotoxicity of LAK cells against bladder cancer cell line EJ cells and bladder tumor cells (BTC) from patients was determined by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assays.

RESULTS

The proliferation of peripheral blood monocytes (PBMC) was inhibited by bFGF 5 micrograms.L-1. bFGF did not affect the stimulation of LAK cells induced by IL-2. The LAK cell numbers in the combination of IL-2 with bFGF were not significantly different compared with that treated with IL-2 alone. bFGF enhanced cytotoxicity of LAK cells against bladder cancer cell line EJ cells or BTC, respectively.

CONCLUSION

Although the proliferation of PBMC was inhibited by bFGF, bFGF increased LAK cell cytotoxicity against bladder neoplasm cells.

Cleft of the lip and palate in twins

BACKGROUND

Cleft lip and palate is one of the most common congenital anomalies in Taiwan. Its etiology remains unknown for the majority of the patients. The study of twins is a classic method for evaluating the relative roles of genetic and environmental factors in the formation of the anomaly.

METHODS

In this study, 37 pairs of twins and one set of triplets with cleft lip and palate were evaluated. Clinical data were collected for zygosity determination and analysis of etiologic factors. The concordance rate and heritability index were assessed.

RESULTS

The results showed that the concordance rate was 26% for all twins and 57% among the monozygotic pairs, which is higher than those rates for the Caucasian population. The heritability index was 53%, higher than the other reports as well. The influence of the environment could not be ruled out.

CONCLUSION

The results confirm a strong genetic role in the etiology of clefts in our patients. Environmental factors were acting as well. The findings in this study support the multifactorial threshold model in the development of cleft lip and palate.

Phenomenology of mania: evidence for distinct depressed, dysphoric, and euphoric presentations

OBJECTIVE

A substantial number of manic episodes include conspicuous depressive symptoms. Manic episodes have been clinically classified a posteriori using preset criteria. The aim of this study was to investigate the possibility that there might be a natural division of manic episodes into clinical types.

METHOD

One hundred and five inpatients met Research Diagnostic Criteria and DSM-III-R criteria for manic episodes and were rated before institution of pharmacological treatment. The authors conducted a factor analysis of 37 behavior rating items from the Schedule for Affective Disorders and Schizophrenia. The resulting factors were used as independent variables in a cluster analysis of the patients.

RESULTS

This analysis revealed four factors corresponding to manic activation, depressed state, sleep disturbance, and irritability/paranoia. Cluster analysis separated the patients into two groups. One included patients with major depressive disorder and mania. Blind, a priori clinical classification into classic and mixed mania (mania plus depression) showed that all of the patients in the depressed cluster, and about 40% of those in the nondepressed cluster, were in a mixed state according to clinical criteria. Comparison of the clinically mixed and nonmixed patients in the nondepressed cluster revealed that the mixed patients in that cluster had higher scores for items related to anger, worry, dysphoria, and irritability.

CONCLUSIONS

These data suggest that manic episodes can be naturalistically classified as classic (predominately euphoric), dysphoric, or depressed.

Orthognathic surgery in craniomaxillofacial fibrous dysplasia

In craniomaxillofacial fibrous dysplasia, jaw involvement often causes facial asymmetry, an occlusal cant, and loss of teeth. Although conservative management of fibrous dysplasia affecting the jaws is widely practiced, orthognathic surgery is indicated in such cases to restore occlusion and correct dentofacial deformity brought on by the disease process. Since 1981, the Craniofacial Center at Chang Gung Memorial Hospital in Taiwan has treated a total of 84 patients with craniomaxillofacial fibrous dysplasia. Of these, 55 (65%) had fibrous dysplasia affecting the jaws (Zone 4). Between 1988 and 1997, orthognathic surgery was performed on 1 male and 4 female patients with fibrous dysplasia involving the teeth-bearing jaws. One patient had localized fibrous dysplasia that involved the mandible. The other 4 patients had polyostotic craniofacial involvement of Zones 1, 2, or 3 and 4A. The patient with isolated mandibular involvement and 2 patients with maxillary fibrous dysplasia had single-jaw surgery. The other 2 patients with maxillary involvement required simultaneous two-jaw surgery to correct the dentofacial deformities resulting from the disease process. Follow-up ranged from 12 months to 9 years. All the patients had stable occlusion, good facial aesthetics, and no further recurrence after surgery. The long-term stability of the achieved occlusion and facial appearance confirms that adequate healing in fibrodysplastic bone is to be expected using the standard fixation.

An electron spin resonance spin-trapping investigation of the free radicals formed by the reaction of mitochondrial cytochrome c oxidase with H2O2

The reaction of purified bovine mitochondrial cytochrome c oxidase (CcO) and hydrogen peroxide was studied using the ESR spin-trapping technique. A protein-centered radical adduct was trapped by 5, 5-dimethyl-1-pyrroline N-oxide and was assigned to a thiyl radical adduct based on its hyperfine coupling constants of aN = 14.7 G and abetaH = 15.7 G. The ESR spectra obtained using the nitroso spin traps 3,5-dibromo-4-nitrosobenzenesulfonic acid (DBNBS) and 2-methyl-2-nitrosopropane (MNP) indicated that both DBNBS/.CcO and MNP/.CcO radical adducts are immobilized nitroxides formed by the trapping of protein-derived radicals. Alkylation of the free thiols on the enzyme with N-ethylmaleimide (NEM) prevented 5, 5-dimethyl-1-pyrroline N-oxide adduct formation and changed the spectra of the MNP and DBNBS radical adducts. Nonspecific protease treatment of MNP-d9/.NEM-CcO converted its spectrum from that of an immobilized nitroxide to an isotropic three-line spectrum characteristic of rapid molecular motion. Super-hyperfine couplings were detected in this spectrum and assigned to the MNP/.tyrosyl adduct(s). The inhibition of either CcO or NEM-CcO with potassium cyanide prevented detectable MNP adduct formation, indicating heme involvement in the reaction. The results indicate that one or more cysteine residues are the preferred reductant of the presumed ferryl porphyrin cation radical residue intermediate. When the cysteine residues are blocked with NEM, one or more tyrosine residues become the preferred reductant, forming the tyrosyl radical.

Augmentation of the nasal floor with Surgicel in primary lip repair: a prospective study showing no efficacy

The symmetry of the alar base and the nasal floor is very important in achieving a satisfactory result in primary lip and nasal reconstruction during cleft lip repair. The skeletal base of the nasal pyramid is usually hypoplastic even in incomplete clefts. A periosteal pocket filled with Surgicel can facilitate blood clot formation and can theoretically stimulate bone formation, thereby improving the asymmetry of the bone base. To test this hypothesis, a prospective study was performed in 64 primary lip repairs by comparing the effect of subperiosteal nasal floor augmentation with Surgicel. From February 1989 to June 1993, 64 patients with incomplete cleft lips (excluding occult cleft lip and complete clefts with Simonart's band) were operated by the same surgeon. The patients were divided randomly into two groups. One group had subperiosteal nasal floor augmentation with Surgicel and the other group did not. The lip repair was a rotation-advancement cheiloplasty with primary closed rhinoplasty of the tip and ala. In the first group, a subperiosteal pocket was created under the cleft alar base and the nasal floor. The pocket was filled with Surgicel up the point where the level of the alar base and the nasal floor was symmetrical with the noncleft side. The control group underwent a similar procedure, less the creation of the subperiosteal pocket and the use of Surgicel. All patients were followed for at least 3 years and their photographs were used to compare and analyze the results of their nasal correction. Critical attention was paid to the symmetry of their nasal floor and alar base. The results were evaluated by at least two plastic surgeons for consistency. The data indicate that the control group showed a higher number of subjects with asymmetry (10 of 32) compared with the study group (8 of 32). However, there was no statistical significance to the findings. Two patients in the study group who received Surgicel developed hypertrophic lip scars. This study, although unable to determine statistically the contributory affect of Surgicel in primary nasal reconstruction, does show a possible benefit from the use of osteogenic materials in the primary management of the deficient nasal floor. Hypertrophic scars developed by 2 patients in the study group may point to a possible soft-tissue reaction to the use of Surgicel in primary lip and nasal repair.

Endoscopically assisted reconstruction of orbital medial wall fractures

Traditional surgical approaches to orbital medial wall fractures are either direct extraocular skin incisions or indirect bicoronal flap. However, these methods can leave remarkable orbital scars or scalp alopecia with the possible associated complications. A minimally invasive endoscopic technique with the assistance of a 2.7-mm, 30-degree telescope through a medial transconjunctival incision has been successfully used to reconstruct the orbital medial wall fractures. This technique was applied to four patients who had orbital medial wall fractures. Three patients also had concomitant orbital floor fractures. The other had associated superior orbital fissure syndrome. All patients were presented with limited eye movement, positive forced duction test, horizontal diplopia, and enophthalmos (3 mm to 6 mm) preoperatively. The entrapped periorbital tissues in the ethmoid sinus were completely reduced endoscopically. The bone defect of orbital medial wall was reconstructed with autogenous rib bone grafts under endoscopic control. The patients were followed up for 8 to 16 months with an average of 11 months. Three patients recovered completely without any residual eye symptoms after intervention. Clinically significant residual enophthalmos of 3 mm occurred in the patient with the superior orbital fissure syndrome. His eye movement limitation caused by entrapment of medial rectus muscle was relieved postoperatively. There was no donor-site morbidity or any complications related to the endoscopically assisted procedure. Endoscopically assisted medial transconjunctival approach to the orbital medial wall fractures is an excellent adjunct for the exposure and complete reduction of herniated periorbital tissue and bony reconstruction of the medial orbital wall.

Identification of a catalytic aspartyl residue of D-ribulose 5-phosphate 3-epimerase by site-directed mutagenesis

Guided by comparative sequence considerations, we have examined the possibility of a catalytic role of Asp186 of D-ribulose 5-phosphate epimerase by site-directed mutagenesis of the recombinant spinach enzyme. Accordingly, D186A, D186N, and D186E mutants of the epimerase were constructed, purified, and characterized; as judged by their electrophoretic mobilities the mutants are properly assembled into octamers like the wild-type enzyme. Based on the extent of internal quenching of Trp fluorescence, the conformational integrity of the wild-type enzyme is preserved in the mutants. The wild-type kcat of 7.1 x 10(3) s-1 is lowered to 3.3 x 10(-4) s-1 in D186A, 0.13 s-1 in D186N, and 1.1 s-1 in D186E; as gauged by D186A, altogether lacking a functional side chain at position 186, the beta-carboxyl of Asp186 facilitates catalysis by >10(7)-fold. Relative to the wild-type enzyme, the Km for D-ribulose 5-phosphate is essentially unaltered with D186N and D186E but increased 10-fold with D186A. Apart from their impairments in epimerase activity, the mutants are unable to catalyze exchange between solvent protons and the C3 proton of substrates. This deficiency and the differential alterations of kinetic parameters among the mutants are consistent with Asp186 serving as an electrophile to facilitate alpha-proton abstraction. This study is the first to identify a catalytic group of the epimerase.

Endoscopically assisted mandibular subcondylar fracture repair

The endoscope has been widely used in aesthetic surgery in recent years, but rarely has it been used in cases of facial trauma. From July of 1996 to December of 1996, the endoscope was used successfully to assist in the repair of mandibular subcondylar fractures in eight patients (five men and three women). Their ages ranged from 15 to 60 years with an average age of 31 years. Six of the patients had other associated mandibular fractures including angular, parasymphyseal, and contralateral subcondylar fractures. A 4.0-mm, 30-degree telescope was introduced to visualize the fracture site by means of an intraoral incision over the ascending ramus. A miniplate was used to stabilize the fracture site with the help of a percutaneous trocar. Intermaxillary fixation was applied for 3 to 6 days. Functionally, all patients returned to normal range of motion within 8 weeks. A slight deviation to the trauma site was noted on maximal opening in three patients, but this condition returned to normal 3 months after surgery. There was no facial palsy or lip numbness. The benefits of the endoscopic approach include not only the provision of better visualization and precise anatomic alignment of bony segments but also the avoidance of large facial scars and facial nerve injuries.

Suicidal thinking among adolescents with a history of attempted suicide

OBJECTIVE

To examine the risk of suicidal plans and ideation, depression, and other factors (low self-esteem, loneliness, fatalism, pessimism) among adolescents with a lifetime history of attempted suicide.

METHOD

A self-administered questionnaire was used in a school-based survey of five middle schools (grades 6 through 8) enrolling 6,400 students. Usable questionnaires were obtained from 5,423 (85.3%). Data were obtained on a wide range of constructs including recent and lifetime suicide attempts, recent and lifetime suicide plans, recent ideation, symptoms of DSM-IV major depression, self-esteem, pessimism, loneliness, and fatalism.

RESULTS

Data on crude prevalence showed thoughts about death, wishing to be dead, thoughts of suicide, and suicide plans were all significantly higher among youths with a history of attempts. Suicidal thinking was related to being more lonely, more fatalistic, and more pessimistic, and to less self-esteem, in addition to depression and a history of attempts. Multivariate analyses revealed the strongest factors associated with current suicidal thinking were history of attempts (odds ratio [OR] = 3.50), depression (OR = 5.34), and recent life stress (OR = 2.64). Compared with youths with none of the factors examined, those with six or more were at extreme risk (OR = 67.87).

CONCLUSIONS

The strong association between history of suicide attempts, current ideation, and depression indicates that past suicide attempts occur in the context of other signs of psychosocial dysfunction. Given the paucity of epidemiological data on the natural history of suicidal behaviors among youths, more epidemiological studies of the antecedents and consequences of the range of suicidal behaviors among children and adolescents are needed. Given the high risk of subsequent suicidal behaviors by youths who have attempted but not completed suicide, this constitutes a high-risk population on which future research should focus.

The Le Fort I-palatal split approach for skull base tumors: efficacy, complications, and outcome

The Le Fort I, split-palate approach provides intraoral surgical access to a region of the midline skull base ranging from the upper clivus to the second cervical vertebra. Although this approach provides perhaps the largest exposure of all the intraoral techniques, there is little concerning it in the literature. Furthermore, there are no detailed descriptions of case histories, complications, and outcome. The purpose of this study was to evaluate this procedure's effectiveness and identify associated complications as well as outcome. Seven cases of patients who underwent eight skull base surgeries using the Le Fort I, split-palate approach were evaluated retrospectively. Particular attention was paid to postoperative occlusion, speech, mouth opening, infection, tumor recurrence, postoperative recovery period, and viability of maxillary bone and teeth. Follow-up ranged from 4 months to 7 years with a mean of 3.9 years. Pathologic diagnoses included three chordomas (two recurrent), one recurrent meningioma, one liposarcoma, one chondrosarcoma, and one inflammatory mass. One patient with chordoma underwent a second operation using the same approach. No deaths or major neurologic problems related to the procedure occurred. One patient who had known local metastases at the time of operation died several months after surgery. All other patients are still living. Duration of hospital stay ranged from 5 to 53 days with a mean of 25.4 days. Postoperative complications included one case of meningitis with an associated cerebrospinal fluid leak, three cases of malocclusion, one case of velopharyngeal insufficiency, and one extracranial soft-tissue infection. The case of meningitis was successfully treated by antibiotics. The malocclusions were corrected by conservative treatment. No problems with mouth opening or bone or tooth viability occurred. Tumor recurred in both cases in which malignancy was involved, whereas only one recurrence was noted among the benign cases. It is concluded that the Le Fort I-palatal split technique is a relatively safe and effective means for approaching midline skull base tumors. Several modifications to the surgical protocol and surgical technique are detailed herein.

Silicone molar block used as a fulcrum in condylar surgery

The narrowness of the temporomandibular joint (TMJ) can cause difficulty in open reduction and fixation of condylar fracture. The authors designed a silicone block that acts as a fulcrum to create more space around the TMJ. The block is made of high-quality silicone that is firm, elastic, nontoxic, autoclave tolerant, and harmless to dental tissue. This block has been used successfully in facilitating reduction and fixation of condylar fractures in 27 patients, and for releasing spastic muscles during closed reduction in 2 patients with prolonged TMJ dislocation. In edentulous patients, the silicone molar block can be used as a mouth opener to facilitate most intraoral procedures without injury to the gum.

Polymorphisms of twelve short tandem repeat loci in a Taiwanese population and their application in parentage testing

With the advancement of techniques in molecular biology, rapid, sensitive, and reliable methods of DNA typing for parentage testing have become available. In this study, we evaluated the usefulness of multiplex polymerase chain reaction (PCR) with 12 unlinked short tandem repeat (STR) loci for paternity testing in Taiwan. The genetic informativeness of this test was then compared with that of conventional human leukocyte antigen (HLA) analysis in 167 parentage studies. The 12 STR loci alone provided a cumulative power of exclusion of up to 0.9998. Paternity was excluded in 59 (35.3%) cases, including 40 of 112 paternity trios and 19 of 55 paternity duos. In the 40 trios in which paternity was excluded, a mean of 6 (range, 3-9) incompatible STR markers were in the 19 duos in which paternity was excluded, a mean of 4 (range, 1-8) incompatible STR markers were noted. In the 72 trios in which the alleged paternity could not be excluded, the mean probabilities of paternity (PP) were 90.6863% with HLA testing alone, 99.9847% with STR analysis alone, and 99.9972% with combined HLA and STR analysis. In the 36 duos in which the alleged paternity could not be excluded, the mean PPs were 81.4768% with HLA testing alone, 99.6124% with STR analysis alone, and 99.9145% with combined HLA and STR analysis. These results suggest that STR analysis is very powerful when used alone for paternity trio testing and when combined with conventional serologic HLA typing for duo parentage testing in the Taiwan population.

Transzygomatic coronoidectomy through an extended coronal incision for treatment of trismus due to an osteochondroma of the coronoid process of the mandible

Osteochondroma is the most common benign tumor of the skeletal system. In the craniofacial skeleton, however, osteochondroma is uncommon. Even more rare is osteochondroma of the coronoid process. A review of the literature reveals only 31 reported cases of osteochondroma of the coronoid process of the mandible. The preponderance of patients were young men (67.7%) and most presented with a facial deformity. As a benign tumor, the problems with surgical treatment have dealt with the inaccessibility of the lesion and hence the surgical approach of choice. The previous surgical approaches have either been intraoral, external, or a combination of both. We present a transzygomatic approach via a coronal incision that gives excellent access and a good cosmetic result, and protects the facial nerve from damage.

D-Ribulose-5-phosphate 3-epimerase: cloning and heterologous expression of the spinach gene, and purification and characterization of the recombinant enzyme

We have achieved, to our knowledge, the first high-level heterologous expression of the gene encoding D-ribulose-5-phosphate 3-epimerase from any source, thereby permitting isolation and characterization of the epimerase as found in photosynthetic organisms. The extremely labile recombinant spinach (Spinacia oleracea L.) enzyme was stabilized by DL-alpha-glycerophosphate or ethanol and destabilized by D-ribulose-5-phosphate or 2-mercaptoethanol. Despite this lability, the unprecedentedly high specific activity of the purified material indicates that the structural integrity of the enzyme is maintained throughout isolation. Ethylenediaminetetraacetate and divalent metal cations did not affect epimerase activity, thereby excluding a requirement for the latter in catalysis. As deduced from the sequence of the cloned spinach gene and the electrophoretic mobility under denaturing conditions of the purified recombinant enzyme, its 25-kD subunit size was about the same as that of the corresponding epimerases of yeast and mammals. However, in contrast to these other species, the recombinant spinach enzyme was octameric rather than dimeric, as assessed by gel filtration and polyacrylamide gel electrophoresis under nondenaturing conditions. Western-blot analyses with antibodies to the purified recombinant enzyme confirmed that the epimerase extracted from spinach leaves is also octameric.

Near-infrared reflectance analysis for predicting beef longissimus tenderness

Near-infrared reflectance spectra (1,100 to 2,498 nm) were collected on beef longissimus thoracis steaks for the purpose of establishing the feasibility of predicting meat tenderness by spectroscopy. Partial least squares (PLS) analysis (up to 20 factors) and multiple linear regression (MLR) were used to predict cooked longissimus Warner-Bratzler shear (WBS) force values from spectra of steaks from 119 beef carcasses. Modeling used the combination of log(1/R) and its second derivative. Overall, absorption was higher for extremely tough steaks than for tender steaks. This was particularly true at wavelengths between 1,100 and 1,350 nm. For PLS regression, optimal model conditions (R2 = .67; SEC = 1.2 kg) occurred with six PLS factors. When the PLS model was tested against the validation subset, similar performance was obtained (R2 = .63; SEP = 1.3 kg) and bias was small (<.3 kg). Among the 39 samples in the validation data set, 48.7, 87.7, and 97.4% of the samples were predicted within 1.0, 2.0, and 3.0 kg, respectively, of the observed Warner-Bratzler shear force value. The optimal PLS model was able to predict whether a steak would have a Warner-Bratzler shear force value < 6 kg with 75% accuracy. The R2 of MLR model was .67, and 89% of samples were correctly classified (< 6 vs > 6 kg) for Warner-Bratzler shear force. These data indicate that NIR is capable of predicting Warner-Bratzler shear force values of longissimus steaks. Refinement of this technique may allow nondestructive measurement of beef longissimus at the processing plant level.

Inhibition of the c-Jun N-terminal kinase (JNK) signaling pathway by curcumin

Curcumin, a dietary pigment in curry, suppresses tumor initiation and tumor promotion. Curcumin is also a potent inhibitor for AP-1 and NF-kappaB activation. In this report, we show that curcumin inhibits JNK activation by various agonists including PMA plus ionomycin, anisomycin, UV-C, gamma radiation, TNF-alpha, and sodium orthovanadate. Although both JNK and ERK activation by phorbol 12-myristate 13-acetate (PMA) plus ionomycin were suppressed by curcumin, the JNK pathway was more sensitive. The IC50 (50% inhibition concentration) of curcumin was between 5-10 microM for JNK activation and was 20 microM for ERK activation. In transfection assays, curcumin moderately suppressed MEKK1-induced JNK activation; however, it effectively blocked JNK activation caused by co-transfection of TAK1, GCK, or HPK1. Curcumin did not directly inhibit JNK, SEK1, MEKK1 or HPK1 activity. Although curcumin suppressed TAK1 and GCK activities at high concentrations, this inhibition cannot fully account for the JNK inhibition by curcumin in vivo. Our data suggest that curcumin may affect the JNK pathway by interfering with the signaling molecule(s) at the same level or proximally upstream of the MAPKKK level. Taken together, the inhibition of the MEKK1-JNK pathway reveals a possible mechanism of suppression of AP-1 and NF-kappaB signaling by curcumin, and may explain the potent anti-inflammatory and anti-carcinogenic effects of this chemical.

Modulating effect of mitomycin or cisplatin on lymphokine-activated killer cell proliferation and antitumor activity to bladder cancer cell lines in vitro

AIM

To study the effect of mitomycin (Mit) or cisplatin (Cis) on the proliferation of lymphokine-activated killer (LAK) cells in patients with transitional cell cancer of bladder and their cytolysis to bladder tumor cells.

METHODS

LAK cell proliferation was assayed in the presence of Mit or Cis by cell counting. Bladder cancer cell lines BIU-87 and EJ were cultured as target cells and cytotoxicity of LAK cells was determined by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay.

RESULTS

The proliferation of LAK cells induced by recombinant interleukin-2 (IL-2) was inhibited by Cis in a concentration-dependent manner and was decreased to 55.3% at 100 mg.L-1 compared with control at 96 h. The enhanced growth of the LAK cells was observed with Mit 5-10 mg.L-1 from 48 to 96 h. Cis 10 mg.L-1 increased the cytotoxicity against BIU-87 and EJ cells.

CONCLUSION

Immunomodulatory effect of chemotherapeutic agents on LAK cell proliferation induced by IL-2 in patients with bladder cancer mainly depends on the drug itself.

The "Taiwanese giant": hormonal and genetic influences in fibrous dysplasia

A 14-year-old boy has been followed for 4 years with a rapidly growing, recurrent area of fibrous dysplasia of the left maxilla and zygoma following resection and bone grafting. Standing 190 cm tall, he was found to have elevated serum growth hormone levels and a pituitary adenoma. His case appears to represent a postzygotic gene mutation of McCune-Albright syndrome. It is possible that the elevated growth hormone levels are in part responsible for the rapid progression of the tumor.