Sphingolipid-to-glycerophospholipid conversion in SPL-null cells implies the existence of an alternative isozyme

Sphingosine-1-phosphate (S1P) lyase catalyzes the cleavage of the bioactive lipid molecule S1P to phosphoethanolamine and hexadecenal, both of which are utilized as glycerophospholipid precursors. Until now, only one gene, SPL, has been identified as encoding a S1P lyase. In the present study, SPL-null F9 cells were able to convert radiolabeled dihydrosphingosine to glycerophospholipids, albeit at much lower efficiency than parent cells. Lysates prepared from the SPL-null cells exhibited weak but significant dihydrosphingosine-1-phosphate lyase activity in vitro. These results provide evidence of the existence of an alternative S1P lyase.

The MELD score may help to determine optimum time for liver transplantation

BACKGROUND

The model for end-stage liver disease (MELD) score is a good predictor of mortality on the waiting list and short-term survival post liver transplantation.

AIM

Our aim was to determine if there is a pretransplant MELD score beyond which liver transplantation is prohibitive.

PATIENTS AND METHODS

Forty-six adult patients underwent primary liver transplantation from January 1996 to December 2002. Patients followed to the most recent visit or death underwent survival analysis using Cox regression and Kaplan Meier methods.

RESULTS

There was a significant correlation between the pretransplant MELD score and survival at 6 months posttransplant (P=.037 95% CI: 1.004-1.13). Patients with pretransplant MELD score greater than or equal to 32 showed significantly greater mortality compared with those less than 32 (HR 9.18, 95%CI=1.16-72.44).

CONCLUSION

Pretransplant MELD may help to determine the optimum time for liver transplantation.

Previous abdominal operations do not affect the outcomes of laparoscopic colorectal surgery

BACKGROUND

Previous abdominal surgery has been regarded as a relative contraindication for laparoscopic surgery. However, studies on laparoscopic cholecystectomy have showed that the presence of prior abdominal procedures does not affect the outcomes of surgery. This study aimed to investigate the impact of previous abdominal surgery on laparoscopic colorectal surgery.

METHODS

This study enrolled 295 consecutive patients who underwent laparoscopic colorectal surgery from May 2000 to May 2003. The patients were divided into two groups: those with previous abdominal surgery (n = 84) and those without a prior operation (n = 211). The outcomes of surgery for the two groups were compared with respect to the duration of surgery, blood loss, conversion rate, time to return of bowel function, resumption of diet, complications, and the hospital stay.

RESULTS

The study included 158 men and 137 women. The median age of the patients was 70 years (range, 33-91 years). Significantly more female patients and patients with benign diseases had prior abdominal surgery. Conversion was required for 17.8% of the patients with and 11.4% of the patients without previous surgery (p = 0.181). There were no differences in the operating time or blood loss between the two groups. The time to bowel movement and resumption of diet were similar in the two groups. The median hospital stay was 7 days for both groups. Of the 39 conversions, 28.2% were necessitated mainly by the presence of adhesions. In the patients who underwent conversion because of adhesions (n = 11), nine had prior surgery and two did not (p = 0.001).

CONCLUSIONS

The presence of prior surgery does not affect the operating time or blood loss of patients undergoing laparoscopic colorectal surgery. The conversion rate is not increased for patients with prior surgery. The postoperative outcomes in terms of ileus, complication rate, and hospital stay are not worse for patients with prior surgery. Previous abdominal surgery should not be considered as a contraindication for laparoscopic colorectal surgery.

Pulmonary preservation effect of nitroglycerine in isolated rat lung reperfusion model

PURPOSE

Though nitric oxide has many favorable protective effects on donor lungs, it may also have cytotoxic side effects. In this regard, we investigated whether administration of nitroglycerine, a nitric oxide donor, could minimize ischemia-reperfusion injury in an isolated rat lung reperfusion model.

MATERIALS AND METHODS

Thirty-five Sprague-Dawley rats were used for this experiment. The nitroglycerine (NTG) group (n = 18) received the drug intravenously and the 17 control group hosts were treated with the same amount of normal saline. The heart-lung block was retrieved, weighed, and maintained in University of Wisconsin solution for 24 hours at 10 degrees C. Reperfusion was performed using human blood diluted in Krebs-Hensleit solution for 60 minutes. Peak inspiratory pressure, pulmonary artery pressure, and blood gas analysis were performed. After 60 minutes of reperfusion, the amount of protein in bronchoalveolar lavage (BAL) fluid and the myeloperoxidase (MPO) activity in the lung were measured.

RESULTS

There were no major statistical differences between the two groups in peak inspiratory pressure and pulmonary artery pressure, but the NTG group maintained lower pulmonary artery pressure during the whole period of reperfusion. Oxygen tension in the NTG group was significantly higher, whereas there were no differences in carbon dioxide tension, BAL fluid, protein, or MPO activity.

CONCLUSION

Administration of NTG before donor lung preservation resulted in better lung protection, a possible strategy for clinical application.

Routine vascular control using the Hem-o-lok clip in laparoscopic nephrectomy: animal study and clinical application

BACKGROUND AND PURPOSE

During laparoscopic nephrectomy (LPN), a stapling device is often used for vascular control, especially of the renal vein. Herein, we report our experience using a polymer clip (Hem-o-lok) for routine control of the vessels during LPN in the animal and clinical setting.

PATIENTS AND METHODS

Fifty ablative and fifteen live-donor nephrectomies were performed in domestic pigs. Hem-o-lok clips (10 mm; Weck Closure System, Research Triangle Park, NC) were routinely used for vascular control. In addition, from January 2001 to July 2002, 46 patients underwent hand-assisted laparoscopic (HAL) (N=40) or laparoscopic (N=6) nephrectomy for renal disease or donor nephrectomy. Venous control was achieved solely by the Hem-o-lok clips where at least two clips were applied on the patient side. Arterial control was obtained by the Hem-o-lok clips either alone or in combination with the metal clips. The technical difficulty in obtaining vascular control, transfusion requirement, and clinical outcome were evaluated.

RESULTS

In the animal study (total 65 nephrectomies), individual vascular control was obtained by the Hem-o-lok clip in all cases except two, where vascular injury during dissection necessitated endoscopic stapling of renal hilum or open conversion. The warm ischemic time for animal donor kidney harvest was uniformly <2 minutes. In the clinical study, arterial control was obtained mostly by a combination of Hem-o-lok and metal clips. Venous control using the Hem-o-lok was successful in all 46 cases without any slipping of clips or uncontrolled bleeding. The mean operating time was 148 minutes. No open conversion was required. The transfusion rate was 6.5% (N=3), with none of the transfusions being related to inadequacy of vascular control using the Hem-o-lok. Major complications included deep vein thrombosis and postoperative retroperitoneal hemorrhage (same patient) and acute respiratory distress syndrome (N = 1). The mean postoperative stay was 5.2 days (range 1-20 days).

CONCLUSION

The Hem-o-lok is a reliable and economical device for vascular control in laparoscopic renal surgery.

Endocrine disrupting compounds (EDC) in municipal wastewater treatment: a need for mass balance

Increasing attention has been focused on endocrine disrupting compounds (EDCs) as pollutants in municipal wastewater. Recent studies have shown that these compounds can have a negative impact on the environment, and that in many cases they are not efficiently removed in wastewater treatment plants (WWTPs). Studies have also revealed that their destruction and transport out into the environment depend on the design and operational characteristics of these treatment systems and on the properties of the chemicals themselves. This paper reviews the current knowledge on EDCs, natural and synthetic hormones including estrone (E1), 17beta-estradiol (E2), and 17alpha-ethinylestradiol (EE2) in WWTP. Several key data gaps are addressed when assessing the removal of EDCs in WWTPs. First, analytical methods used by most researchers do not account for the inactive or conjugated form of the compounds, yet they can become deconjugated to active forms during treatment, leading to an additional source of contaminant load. Next, insufficient measurements are made at various stages within the WWTP preventing adequate analyses on how each u nit process contributes to degradation. Currently, there is no standardized procedure for assessing degradation of EDCs in WWTPs, and it is often difficult to compare published data generated by individual test protocols. This paper identifies streams that should be sampled in WWTPs and suggests a mass balance approach that takes into account all forms of the compound in both liquid and solid phases. Issues of potential concern in performing mass balances are discussed leading to a proposal of variables that should be analyzed and included in published articles. The adoption of similar methods by researchers in future work will produce a better picture of the presence and fate of these compounds in the environment.

Successful treatment of Xylohypha bantiana brain abscess mimicking invasive cerebral aspergillosis in a liver transplant recipient

Invasive aspergillosis is a highly lethal disease in immunocompromised hosts especially with central nervous system involvement. In a review of 2380 liver transplants performed over 14 years, 13 out of 15 fungal brain abscesses were due to Aspergillus species and only one patient survived [Arch Surg, 132 (1997) 304]. Dematiaceous fungi while less readily recognised, often have a more favorable outcome [Transplantation, 63 (1997) 160]. We report a Xylophypha bantiana cerebral abscess in a liver transplant recipient initially identified as a branching mould on histology that had a successful outcome due to aggressive appropriate treatment.

A novel angiogenic factor derived from Aloe vera gel: beta-sitosterol, a plant sterol

Aloe vera gel has a beneficial effect on wound healing. Because angiogenesis is an essential process in wound healing, we hypothesized that Aloe vera gel might contain potent angiogenic compounds. Here we demonstrate that Aloe vera gel and its extracts are angiogenic on the chorioallantoic membrane (CAM) of chick embryo. Out of the three compounds purified from the final fraction of Aloe vera gel, beta-sitosterol showed a potent angiogenic activity in the CAM assay. In the presence of heparin, beta-sitosterol stimulated neovascularization in the mouse Matrigel plug assay and the motility of human umbilical vein endothelial cells in an in vitro wound migration assay. Thus beta-sitosterol is a novel plant-derived angiogenic factor which may have potential pharmaceutical applications for the management of chronic wounds.

A novel angiogenic factor derived from Aloe vera gel: beta-sitosterol, a plant sterol

Aloe vera gel has a beneficial effect on wound healing. Because angiogenesis is an essential process in wound healing, we hypothesized that Aloe vera gel might contain potent angiogenic compounds. Here we demonstrate that Aloe vera gel and its extracts are angiogenic on the chorioallantoic membrane (CAM) of chick embryo. Out of the three compounds purified from the final fraction of Aloe vera gel, beta-sitosterol showed a potent angiogenic activity in the CAM assay. In the presence of heparin, beta-sitosterol stimulated neovascularization in the mouse Matrigel plug assay and the motility of human umbilical vein endothelial cells in an in vitro wound migration assay. Thus beta-sitosterol is a novel plant-derived angiogenic factor which may have potential pharmaceutical applications for the management of chronic wounds.

Effect of 5-methoxypsoralen (5-MOP) on cell apoptosis and cell cycle in human hepatocellular carcinoma cell line

The chemopreventive role of 5-methoxypsoralen (5-MOP) in the human hepatocellular carcinoma (HCC) cell line was investigated by studying the regulation of proliferation and apoptosis in HCC (J5) cells. Morphological analysis, cell viability assay, DNA analysis and cell-cycle analysis suggest that there are at least three modes of the suppressive effects shown by 5-MOP: (a) kills J5 cells directly; (b) induces apoptosis by arresting J5 cells at the G2/M phase in the cell cycle; (c) induces apoptosis through an independent pathway with cell-cycle arrest at 24-72 h of exposure. Further immunoblot analysis demonstrated that inhibition of cyclin B1 by 5-MOP may play an important role in G2/M arrest of J5 cells and provides an additional way to prevent cells from entering the M phase and undergoing apoptosis. 5-MOP therefore appears to exert its anticarcinogenic properties by cytotoxic effect, inducing apoptosis and inhibiting proliferation in the human hepatocellular carcinoma cell line.

Sphingosine-1-phosphate lyase is involved in the differentiation of F9 embryonal carcinoma cells to primitive endoderm

Sphingosine 1-phosphate (S1P) is a bioactive lipid molecule that acts both extracellularly and intracellularly. The SPL gene encodes a mammalian S1P lyase that degrades S1P. Here, we have disrupted the SPL gene in mouse F9 embryonal carcinoma cells by gene targeting. This is the first report of gene disruption of mammalian S1P lyase. The SPL-null cells exhibited no S1P lyase activity, and intracellular S1P was increased approximately 2-fold, compared with wild-type cells. Treatment of F9 embryonal carcinoma cells with retinoic acid induces differentiation to primitive endoderm (PrE). An acceleration in this PrE differentiation was observed in the SPL-null cells. This effect was apparently caused by the accumulated S1P, since N,N-dimethylsphingosine, a S1P synthesis inhibitor, had an inhibitory effect on the PrE differentiation. Moreover, F9 cells stably expressing sphingosine kinase also exhibited an acceleration in the differentiation. Exogenous S1P had no effect on differentiation, indicating that intracellular but not extracellular S1P is involved. Moreover, we determined that expression of the SPL protein is up-regulated during the progression to PrE. We also showed that sphingosine kinase activity is increased in PrE-differentiated cells. These results suggest that intracellular S1P has a role in the PrE differentiation and that SPL may be involved in the regulation of intracellular S1P levels during this differentiation.

Comparative study of naphthalene-2,3-dicarboxaldehyde and o-phthalaldehyde fluorogenic reagents for chromatographic detection of sphingoid bases

Naphthalene-2,3-dialdehyde (NDA) was developed as a precolumn labeling reagent for the fluorescent determination in a HPLC system of bioactive sphingoid bases, including sphingosine, sphinganine, and C20-sphinganine. Cellular sphingoid bases generally exist in the range of 10 to approximately 100 pmol/10(6) cells in a wide variety of cell types and tissues. This study aimed to obtain stable fluorescent derivatives of sphingoid bases and to increase their detectability at low concentrations. Sphingoid bases were reacted with NDA in the presence of cyanide ion to readily make an intensely fluorescent structure, 1-cyano-2-alkyl-benz[f]isoindole (CBI) and were then eluted separately on a reversed-phase C18 column with a simple mobile phase of 90% acetonitrile. For evaluating the NDA method, we compared the fluorescent intensity, elution profile, stability, and detectability of NDA derivatives with those of corresponding o-phthalaldehyde (OPA) derivatives. By monitoring the fluorescent intensity at the excitation wavelength of 252 nm and emission wavelength of 483 nm, NDA derivatives were sensitively determined at concentrations below 1.0 pmol of sphingoid bases in 1 x 10(5) U937 cells and were more stable than OPA derivatives. Linear calibration plots were obtained in the range studied (0.5 to approximately 500 nM). The limit of detection for NDA derivatives of sphingoid bases was approximately 0.1 pmol (S/N=3). The method successfully measured the accumulation of sphingosine in U937 cells following N,N-dimethylsphingosine treatment, and of sphinganine following fumonisin B1 treatment.

Prophylactic lamivudine prevents hepatitis B reactivation in chemotherapy patients

BACKGROUND

Chronic hepatitis B virus carriers receiving chemotherapy develop a high hepatitis B virus reactivation rate (38-53%) with a high mortality (37-60%). Few studies have characterized the efficacy of lamivudine in the treatment of chemotherapy-induced hepatitis B virus reactivation.

AIM

To determine whether lamivudine prophylaxis reduces chemotherapy-induced hepatitis B virus reactivation and mortality.

METHODS

The medical records of all hepatitis B surface antigen-positive patients with malignancy treated with chemotherapy since 1995 at the National University Hospital of Singapore were identified, and divided into those who received lamivudine prophylaxis before chemotherapy (P) and those who did not (NP). The parameters examined included gender, age, malignancy type, steroid usage, number of chemotherapy courses and regimens, follow-up duration and hepatitis B virus status. The outcome measures were hepatitis B virus reactivation (abrupt rise of serum alanine aminotransferase to > 200 IU/L) and reactivation death. Patients with primary hepatoma or liver metastasis were excluded.

RESULTS

Thirty-five patients were identified: 16 in the P group and 19 in the NP group. The baseline characteristics of the two groups were similar. Seven of the 19 patients in the NP group and none of the 16 patients in the P group developed reactivation (36.8% vs. 0%, P=0.009). Six of the seven patients in the NP group who developed reactivation received lamivudine at that time, but five died (mortality, 71.4%), whilst no patient in the P group died from reactivation (P=0.064).

CONCLUSIONS

Prophylactic lamivudine appears to prevent hepatitis B virus reactivation and its associated mortality in patients treated with chemotherapy. This should be confirmed with prospective studies.

Reverse-phase HPLC separation of D-amygdalin and neoamygdalin and optimum conditions for inhibition of racemization of amygdalin

In boiling aqueous solution, D-amygdalin usually begins to convert into neoamygdalin in 3 min and more than 30% of the initial D-amygdalin is found as neoamygdalin after 30 min. In this report, we establish methods for simple HPLC analysis and the inhibition of D-amygdalin conversion. D-Amygdalin and its conversion product, neoamygdalin, were clearly separated on reverse-phase column chromatography by an optimized eluent of 10 mM sodium phosphate buffer (pH 3.8) containing 6% acetonitrile. Linearity for analyzing D-amygdalin and neoamygdalin was observed in the range from 0.05 to 0.5 mM. The detection limits for D-amygdalin and neoamygdalin were ca. 5 microM per injected amount. We found that D-amygdalin conversion was completely inhibited by adding 0.05% citric acid to the aqueous solution before boiling. To prevent the loss of pharmaceutical potency of Tonin, we applied this method to measure the conversion rate of D-amygdalin. We confirmed that D-amygdalin conversion in Tonin is effectively inhibited by acidic boiling solution with 0.1% citric acid.

Antithrombotic effect of PMC, a potent alpha-tocopherol analogue on platelet plug formation in vivo

Platelet thrombi formation was induced by irradiation of mesenteric venules with filtered light in mice pretreated intravenously with fluorescein sodium. PMC (2, 2, 5, 7, 8-pentamethyl-6-hydroxychromane; 20 microg/g, i.v.) significantly prolonged the latent period of inducing platelet plug formation in mesenteric venules. When fluorescein sodium was given at 10 microg/kg, PMC (20 microg/g) delayed occlusion time by about 1.7-fold. Furthermore, aspirin (250 microg/g) also showed similar activity in delaying the occlusion time. On a molar basis, PMC was about 14-fold more potent than aspirin at delaying the occlusion time. PMC was also effective in reducing the mortality of ADP-induced acute pulmonary thromboembolism in mice when administered intravenously at doses of 5 and 10 microg/g. In addition, intravenous injection of PMC (5 microg/g) significantly prolonged bleeding time by about 1.6-fold compared with normal saline in severed mesenteric arteries of rats. Continuous infusion of PMC (1 microg/g/min) significantly increased the bleeding time by about 1.6-fold and the bleeding time was also significantly prolonged for up to 90 min after cessation of PMC infusion. These results suggest that PMC has an effective antiplatelet effect in vivo and may be a potential therapeutic agent for arterial thrombosis, but must be assessed further for toxicity.

Simultaneous quantitative analysis of sphingoid base 1-phosphates in biological samples by o-phthalaldehyde precolumn derivatization after dephosphorylation with alkaline phosphatase

This paper describes a simultaneous analytical method for the measurement of sphingoid base 1-phosphates and sphingoid bases from a variety of biological samples. This method consists of two steps of sample pretreatment: the enzymatic dephosphorylation of sphingoid base 1-phosphates by alkaline phosphatase (APase) and the subsequent analysis of o-phthalaldehyde (OPA) derivatives of the liberated sphingoid bases by HPLC. By introducing C17-sphingosine 1-phosphate and C17-sphingosine as internal standards, not only phytosphingosine 1-phosphate, sphingosine 1-phosphate, and sphinganine 1-phosphate but also phytosphingosine, sphingosine, and sphinganine present in a sample could be quantified in 12 min on a C18 reversed-phase column with a simple mobile phase of acetonitrile:deionized distilled water (90:10, v/v). With this HPLC method, we could reproducibly analyze the levels of sphingoid base 1-phosphates over a broad range of concentrations from 0.5 to 100.0 pmol from various biological samples including serum, cultured cells, and rat tissue homogenates. The conversion of sphingoid base 1-phosphates into sphingoid bases increased the stability of the OPA adducts. Thus, this indirect measurement of sphingoid base 1-phosphates increased the sensitivity and reproducibility of the method. This HPLC method was also used to measure the changes in the levels of sphingoid base 1-phosphates in cultured cells after treatment with 1,25-(OH)2D3, a sphingosine kinase activator, or with fumonisin B1, a sphinganine N-acyltransferase inhibitor.

Diagnosing deep vein thrombosis in the lower extremity: correlation of clinical and duplex scan findings

OBJECTIVE

To identify factors that predict a positive duplex scan examination result in patients with suspected deep vein thrombosis of the lower extremity.

DESIGN

Retrospective study.

SETTING

Vascular laboratory in a university teaching hospital.

PATIENTS AND METHODS

The results of 345 lower extremity duplex venous scans performed between August 1994 and November 1998 were reviewed. All patients were in-patients referred from different specialties due to clinical suspicion of lower extremity deep vein thrombosis. Positive duplex scans were correlated with patients' demographic data (sex, age), medical history (history of malignancy, deep vein thrombosis, and pulmonary embolism) and clinical features (leg swelling, venous insufficiency, calf pain, and leg ulcer). Univariate analysis was performed using the Chi squared test.

RESULTS

A total of 345 scans were performed for 313 patients. The mean age was 55 years (range, 19-92 years). Sixty-three patients (49 male, 14 female) had a positive scan, giving a yield of 18.3%. Four factors had a significant association with a positive scan: male sex (P=0.0102), history of malignancy (P=0.0040), history of deep vein thrombosis (P=0.0001), and history of pulmonary embolism (P=0.0265).

CONCLUSIONS

Common presenting clinical features do not predict the result of ultrasonographic investigation for deep vein thrombosis. The chance of having a positive scan is significantly higher in male patients and those with a history of malignancy, deep vein thrombosis, or pulmonary embolism.

Human kinesin superfamily member 4 is dominantly localized in the nuclear matrix and is associated with chromosomes during mitosis

In a previous study, we identified the human counterpart of murine kinesin superfamily member 4 (KIF4), a microtubule-based motor protein [Oh, Hahn, Torrey, Shin, Choi, Lee, Morse and Kim (2000) Biochim. Biophys. Acta 1493, 219-224]. As an initial step to understand the function(s) of human KIF4, its subcellular localization in HeLa cells was examined by using immunocytochemical and subcellular fractionation methods, and it was found that most KIF4 is localized in the nucleus. Since murine KIF4 is known to transport cytoplasmic vesicles, dominant nuclear localization of the human counterpart was somewhat surprising. Subsequent subnuclear fractionation revealed predominant association of KIF4 with the nuclear matrix. These results clearly indicate that human KIF4 is, at least, a nuclear protein. In further confirmation of this conclusion, the hexapeptide PKLRRR (amino acids 773-778) in the molecule was found to function as a nuclear localization signal. During the mitotic phase of the cell cycle, human KIF4 was associated with the chromosomes, suggesting that human KIF4 might be a microtubule-based mitotic motor, with DNA as its cargo.

Polymorphism of the angiotensin-converting enzyme gene in patients with cerebral infarction in Koreans

The relationship between cerebrovascular disease and an insertion/deletion (I/D) polymorphism in the angiotensin-converting enzyme (ACE) gene is still being debated. The frequency of the DD genotype of the ACE gene was significantly higher in subjects with than those without cerebral infarction in Japan. The aim of the present study was to assess the relationship between ACE gene polymorphism and the development of cerebral infarction in a population from Korea. We examined its possible role as a risk factor in patients with cerebral infarction. The association between ACE gene polymorphism and cerebral infarction was examined in 106 patients with cerebral infarction and 498 controls without cerebral infarction. Frequencies of the genotypes and alleles of the ACE gene were investigated. The ACE genotype was analyzed by the polymerase chain reaction (PCR). The frequency of D allele was 37.7% in patients and 39.1% in controls (chi2 = 0.128, p = 0.720). The frequencies of the genotypes of the ACE gene were II: 39.6%, ID: 45.3%, and DD: 15.1% in patients, and II: 37.1%, ID: 47.6%, and DD: 15.3% in controls (chi2 = 0.127, p = 0.721). There was no significant difference in the frequency of the DD genotype of the ACE gene, and we did not find any association between ACE polymorphism and cerebral infarction. These results indicate that ACE polymorphism is not a risk factor for the development of cerebral infarction in a Korean population.

Autoimmune hepatitis in Singapore: a rare syndrome affecting middle-aged women

BACKGROUND AND AIM

The prevalence of autoimmune hepatitis in Singapore is unknown. Over a period of 7 years, 24 cases were diagnosed in a district general hospital in Singapore (Toa Payoh Hospital) by using the scoring system proposed by the International Autoimmune Hepatitis Group in 1993. The aims of our study were to determine the prevalence of autoimmune hepatitis in Singapore, and to investigate the characteristics and prognosis in the mainly Chinese population.

METHODS

The case records of all 24 patients were reviewed, and the following parameters were recorded: age at presentation, sex, symptoms and signs at presentation, past exposure to hepatotoxic drugs, alcohol intake, blood transfusion laboratory and histological tests used to determine autoimmune hepatitis, response to treatment, complications, and survival.

RESULTS

The mean age of patients was 57 years old. There was a female-male ratio of 11:1. Forty-two percent of the patients were cirrhotic at presentation. The prevalence of autoimmune hepatitis was four per 100 000, with no significant difference between Chinese, Malay and Indian patients (Odds ratio of 0.38 by the chi-squared test). Eighty-nine percent of the patients responded to treatment with the induction of prednisolone, but the relapse rate was 61%. Treatment failure occurred in one patient. The mortality rate during the 7 years of follow up was 21%, and all were caused by complications of cirrhosis. The survival at 5 years was 71%, with a standard error of 0.13.

CONCLUSION

Autoimmune hepatitis in Singapore is mainly a disease in older women. The response to steroid treatment is good, with a 5-year survival rate of 71%.

Lymphoedema care of breast cancer patients in a breast care clinic: a survey of knowledge and health practice

Lymphoedema, an accumulation of protein-rich fluid in interstitial tissue, is a well-recognised life-altering result of breast cancer treatment. With the goal of studying the prevalence and management of lymphoedema after breast cancer therapy, 171 patients were invited to complete a self-administered questionnaire following completion of treatment for breast cancer. The survey revealed that 82.5% of patients knew they were at-risk of developing lymphoedema. However, the level of knowledge about preventive care in lymphoedema was inadequate, with a mean score of 4.07 out of a full mark of 10 (SD=2.35, mode=2). A substantial proportion (45.6%; n=78) of respondents reported that they had experienced lymphoedema and subsequently developed multiple sites of lymphoedema, but only 34.7% (n=26) had been referred for physiotherapy. The study also revealed that patients who had received the combined regimen of mastectomy, lymph node dissection, radiotherapy and chemotherapy were at a higher risk of developing lymphoedema (chi2=6.305, P=0.043). Interestingly, it was found that nurses were the most frequently cited resource for information, but the least consulted professionals for discussion on treatment. It is apparent from our patient survey that there is a lack of knowledge on lymphoedema care amongst breast cancer patients. In order to improve patients' level of knowledge and their awareness of lymphoedema care, the provision for systematic and comprehensive patient education, including management protocols for lymphoedema, needs to be addressed. Education and training, will be essential components of efforts to ensure appropriate care for lymphoedema patients.

Genotyping CagA, VacA subtype, IceA1, and BabA of Helicobacter pylori isolates from Korean patients, and their association with gastroduodenal diseases

The genetic status of cagA, vacA subtype, iceA1, and babA, and the relationship to gastroduodenal diseases were assessed in Helicobacter pylori isolates in Korea. Seventy-six strains of H. pylori were isolated from the antrum and the corpus of 41 adult patients (22 with peptic ulcer and 19 with gastritis). The cagA, iceA1, and babA genes were assessed by polymerase chain reaction and the vacA subtypes were determined by reverse hybridization-line probe assay. The positive rates of 349-bp cagA, 208-bp cagA, iceA1, and babA genes were 97.4%, 96.1%, 84.2%, and 36.1%, respectively. The vacA s1a, s1b, s1c, and s2 variants were detected in 11.8%, 3.9%, 80.4%, and 1.3%, respectively. m1 (78.9%) is more prevalent than m2 (5.3%). The most common vacA genotype was s1c/m1 (61.9%), and 14 isolates (18.4%) contained mixed vacA genotypes from a single biopsy specimen. Twenty-one (60%) of 35 patients were infected with more than two strains of different cagA, iceA1, babA, and vacA genotypes. None of cagA, iceA1, babA, and vacA s1/m1 were associated with peptic ulcer. In conclusion, most H. pylori isolates in Korea carry cagA, iceA1, and vacA s1c/m1 genes, and reside with multiple strains. These genes do not correlate with the peptic ulcer in the Korean patients.

Study on gelatin-containing artificial skin IV: A comparative study on the effect of antibiotic and EGF on cell proliferation during epidermal healing

Gelatin-hyaluronate sponge with and without antibiotic and epidermal growth factor (EGF) were prepared and compared. Four types of sponges were applied on the full-thickness dorsal skin defect of Wistar rat. The effects of antibiotic and EGF in gelatin-hyaluronate sponge on wound healing were investigated by light microscopy and image analyzer at postoperative days of 5, 12 and 21. An immunohistochemical technique, employing PC10, a monoclonal antibody against proliferating cell nuclear antigen (PCNA) was applied to wounded tissue sections. The number of PC10-positive cells was very high for the sponge with EGF at postoperative day 5, then gradually decreased with time. Also we found that antibiotics restrained the cell proliferation during the migratory phase. The sponge with both antibiotic and EGF showed good wound healing performances on the whole for a healing period. The epithelium was regenerated fast with EGF-impregnated sponges at day 5, but each sample had nearly the same length of regenerated epithelium at day 12.