Single-institution experience using transarterial chemoembolization (TACE) with carboplatinum (carbo) and doxorubicin in patients (pts) with hepatocellular carcimona (HCC) awaiting liver transplantation (LTx)

336

Background: LTx is the best treatment option for multinodular HCC and those with advanced liver dysfunction. Tumor progression occurs in 20-50% of pts on liver transplant list. TACE is increasingly used as locoregional therapy and as a bridge to LTx. We report here our single institutional experience with TACE using carbo and doxorubicin in pts with HCC awaiting LTx.

Methods: Retrospective chart review was performed in all pts who had TACE between 2008 and June 2010. Our institutional protocol uses a fixed dose of carbo 300mg, doxorubicin 50mg, in 10ml of lipoidol solution. We analyzed pt demographics, etiologies of liver disease, Child-Pugh status, CLIP scores, size of tumor, alpha-fetoprotein (AFP), toxicity, length of stay, and transplantation statistics.

Results: 32 pts (28 men) were treated with 39 TACE procedures. The median age was 57 (32-83). 28 of 32 had cirrhosis with Child's A/B/C 36/51/18% respectively. The major etiologies of cirrhosis were hepatitis C (HCV) 8, alcohol and HCV 19, alcohol 7; portal vein thrombosis in 8 pts. The median tumor size was 6.2 cm (range 2-12 cm) and 81% were multifocal CLIP score 0,1/2,>3 were 5/62/38%. There were no mortality within 30 days of TACE procedure. The majority of the pts were discharged after 24 hr observation; 6 pts require readmissions within 30days. There was no systemic hematologic toxicity. 11 pts had elevated AFP at baseline and 6/11 (54%) had >50 % reduction in AFP value. 11pts (34%) received Ltx; 3 pts came off the LTx list due to disease progression, 2 pts are still on transplant list, and 16pts not able to be listed. 42% of pts received sorafenib in addition to TACE. The median time from last TACE to LTx was 55 days and 4 pts received transplantation within 30days. Very good pathological treatment effect was observed in 8/11 explanted liver.

Conclusions: Our regimen of TACE with carbo/doxorubicin appears to be a safe and tolerable approach for localized treatment as a bridge to liver transplantation. It has acceptable toxicity and is associated with good AFP and pathological responses. We plan to evaluate different baseline parameters for better pt selection.

No significant financial relationships to disclose.

Distribution of hydrogen-metabolizing bacteria in alfalfa field soil

H(2) evolved by alfalfa root nodules during the process of N(2) fixation may be an important factor influencing the distribution of soil bacteria. To test this hypothesis under field conditions, over 700 bacterial isolates were obtained from fallow soil or from the 3-mm layer of soil surrounding alfalfa (Medicago sativa L.) root nodules, alfalfa roots, or bindweed (Convolvulus arvensis L.) roots. Bacteria were isolated under either aerobic or microaerophilic conditions and were tested for their capacity to metabolize H(2). Isolates showing net H(2) uptake and H(2) incorporation activity under laboratory conditions were assigned a Hup phenotype, whereas organisms with significant H(2) output capacity were designated as a Hout phenotype. Under aerobic isolation conditions two Hup isolates were obtained, whereas under microaerophilic conditions five Hup and two Hout isolates were found. The nine isolates differed on the basis of 24 standard bacteriological characteristics or fatty acid composition. Five of the nine organisms were isolated from soil around root nodules, whereas the other four were found distributed among the other three soil environments. On the basis of the microaerophilic isolations, 4.8% of the total procaryotic isolates from soil around root nodules were capable of oxidizing H(2), and 1.2% could produce H(2). Two of the Hup isolates were identified as Rhizobium meliloti by root nodulation tests, but the fact that none of the isolates reduced C(2)H(2) under the assay conditions suggested that the H(2) metabolism traits were associated with various hydrogenase systems rather than with nitrogenase activity. Results from this study support the concept that H(2) evolution by alfalfa root nodules has a significant effect on the surrounding microenvironment and influences the number and diversity of bacteria occupying that region.

Isolation of Rhizobium meliloti nod Gene Inducers from Alfalfa Rhizosphere Soil

Methanolic extracts of alfalfa rhizosphere soil induce more nod gene transcription in Rhizobium meliloti than extracts of nonrhizosphere soil. Six peaks of nod-inducing activity were separated by high-performance liquid chromatography from rhizosphere soil extract, and one compound was identified by H nuclear magnetic resonance, mass spectrometry, and UV-visible spectra as a formononetin-7-O-glycoside that activates both NodD1 and NodD2 proteins. The unanticipated presence of a glycoside in rhizosphere soil suggests either that large amounts of the glycoside were exuded by roots or that some glycosides are unexpectedly stable in soil.

Uptake Hydrogenase Activity Determined by Plasmid pRL6JI in Rhizobium leguminosarum Does Not Increase Symbiotic Nitrogen Fixation

Six mutants of Rhizobium leguminosarum 3855 lacking uptake hydrogenase activity (Hup phenotype) as a result of Tn5-mob mutagenesis of the hup-containing plasmid pRL6JI were tested for symbiotic performance on Pisum sativum L. and Vicia benghalensis L. Three pea cultivars and one vetch line, which induce four different levels of Hup activity in strain 3855, were grown to flowering under microbiologically controlled conditions in the absence of combined N. Direct Kjeldahl N measurements showed that in every case at least one Hup mutant fixed as much N(2) as the isogenic Hup strain. Measures of C(2)H(2) reduction, H(2) evolution, H(2) incorporation, and plant dry weight were consistent with the interpretation that the oxidation of H(2) produced by the nitrogenase enzyme complex was not necessarily associated with increased N(2) fixation in these symbiotic associations. Tests with a smaller subset of the Hup strains under four different root environments ranging from pH 5.0 to 8.2 likewise showed no significant advantage for the isogenic Hup strain. It was concluded that the improvements in symbiotic N(2) fixation produced by pRL6JI are associated with some trait other than the Hup phenotype.

Occurrence of flavonoids and nucleosides in agricultural soils

AN ECOLOGICALLY RELEVANT SOIL EXTRACTION PROCEDURE SEPARATED TWO TYPES OF MOLECULES IMPORTANT FOR BACTERIA: flavonoids and small hydrophilic organic compounds. Two flavonoids, identified previously as inducers of nodulation genes in Rhizobium meliloti, were detected in rhizosphere soil from alfalfa (Medicago sativa L.). In addition, biologically significant quantities (micromoles per kilogram) of ribonucleosides and deoxyribonucleosides were found in all soils tested. Long-term wheat (Triticum aestivum L.) plots that had received manure contained elevated amounts of nucleosides, and in a separate experiment, the presence of legumes in a wheat-cropping sequence increased soil nucleosides. Intact bacterial cells accounted for less than 1% of the free nucleosides detected. These results suggest new testable hypotheses for molecular ecologists and differ from those obtained with older, harsher techniques.

Evaluation of bacteria isolated from rice for plant growth promotion and biological control of seedling disease of rice

Of 102 rhizoplane and endophytic bacteria isolated from rice roots and stems in California, 37% significantly (P < or = 0.05) inhibited the growth in vitro of two pathogens, Achlya klebsiana and Pythium spinosum, causing seedling disease of rice. Four endophytic strains were highly effective against seedling disease in growth pouch assays, and these were identified as Pseudomonas fluorescens (S3), Pseudomonas tolaasii (S20), Pseudomonas veronii (S21), and Sphingomonas trueperi (S12) by sequencing of amplified 16S rRNA genes. Strains S12, S20, and S21 contained the nitrogen fixation gene, nifD, but only S12 was able to reduce acetylene in pure culture. The four strains significantly enhanced plant growth in the absence of pathogens, as evidenced by increases in plant height and dry weight of inoculated rice seedlings relative to noninoculated rice. Three bacterial strains (S3, S20, and S21) were evaluated in pot bioassays and reduced disease incidence by 50%-73%. Strain S3 was as effective at suppressing disease at the lowest inoculum density (106 CFU/mL) as at higher density (10(8) CFU/mL or undiluted suspension). This study indicates that selected endophytic bacterial strains have potential for control of seedling disease of rice and for plant growth promotion.

Race and ethnicity as variables in Nursing Research, 1952-2000

BACKGROUND

Although the use of race and ethnicity as variables in research has increased over the past five decades, there is confusion regarding the meaning of the terms, as well as how the words are defined and determined in scientific inquiry.

OBJECTIVE

To review the use of race and ethnicity as variables in nursing research literature.

METHODS

Original research articles published in Nursing Research in the years, 1952, 1955, and every 5 years thereafter through 2000 were reviewed. Those articles describing human characteristics (N = 337) were analyzed for content concerning: (a) frequency of racial and ethnic terms, (b) words used for racial and ethnic categories, (c) detinitions of racial and ethnic terms, and (d) how a study participant's race or ethnicity was determined.

RESULTS

Racial and ethnic variables were mentioned in 167 of the 337 reviewed articles. Eighty-one terms and word phrases were used for these variables. In only five articles were the variables defined. Race and ethnic labels were often intermixed and the majority of studies provided no information about how categorization of the participant's race or ethnicity was made. In addition, there was relatively little growth in the number of studies that had racial/ethnic groups, other than Whites, as the majority of the sample.

CONCLUSION

Racial and ethnic variables provide nurse researchers with many challenges. Although race and ethnicity were widely used in Nursing Research articles, the categories were not defined in the majority of papers, and methods used to determine a participant's race or ethnicity were unclear. In order to construct a common and consistent understanding of racial and ethnic categories, nurse researchers should be explicit regarding the rationale related to their use of the categories and the assumptions underlying particular racial and ethnic categorizations.

Entomological investigations of an outbreak of Japanese encephalitis virus in the Torres Strait, Australia, in 1998

Japanese encephalitis (JE) virus first appeared in Australia in 1995, when three clinical cases (two fatal) were diagnosed in residents on Badu Island in the Torres Strait, northern Queensland. More recently, two confirmed human JE cases were reported in the Torres Strait Islands and Cape York Peninsula, in northern Queensland in 1998. Shortly after JE virus activity was detected in humans and sentinel pigs on Badu Island in 1998, adult mosquitoes were collected using CO2 and octenol-baited CDC light traps; 43 isolates of JE virus were recovered. Although Culex sitiens group mosquitoes yielded the majority of JE isolates (42), one isolate was also obtained from Ochlerotatus vigilax (Skuse). Four isolates of Ross River virus and nine isolates of Sindbis (SIN) virus were also recovered from members of the Culex sitiens group collected on Badu Island in 1998. In addition, 3,240 mosquitoes were speciated and pooled after being anesthetized with triethylamine (TEA). There was no significant difference in the minimum infection rate of mosquitoes anesthetized with TEA compared with those sorted on refrigerated tables (2.8 and 1.6 per 1,000 mosquitoes, respectively). Nucleotide analysis of the premembrane region and an overlapping region of the fifth nonstructural protein and 3' untranslated regions of representative 1998 Badu Island isolates of JE virus reveled they were identical to each other. Between 99.1% and 100% identity was observed between 1995 and 1998 isolates of JE from Badu Island, as well as isolates of JE from mosquitoes collected in Papua New Guinea (PNG) in 1997 and 1998. This suggests that the New Guinea mainland is the likely source of incursions of JE virus in Australia.

Methodology for social accountability: multiple methods and feminist, poststructural, psychoanalytic discourse analysis

Bridging the gap between the individual and social context, methodology that aims to surface and explore the regulatory function of discourse on subjectivity production moves nursing research beyond the individual level in order to theorize social context and its influence on health and well-being. This article describes the feminist, poststructural, psychoanalytic discourse analysis and multiple methods used in a recent study exploring links between cultural discourses of masculinity, performativity of masculinity, and practices of male violence.

A chemometric approach to understanding the bioelimination of anionic, water-soluble dyes by a biomass using empirical and semi-empirical molecular descriptors

Single correlation and multiple linear regression analyses have been applied to understand the bioelimination of 103 anionic, water-soluble dyes by a biomass at a wastewater treatment works. The chemometric approach highlighted that anionic, water-soluble dyes with larger molecular size/ionic charge ratios and containing more primary aromatic amines and unsulphonated naphthalene nuclei and fewer aliphatic alcohol groups had superior levels of bioelimination.

Flaviviruses isolated from mosquitoes collected during the first recorded outbreak of Japanese encephalitis virus on Cape York Peninsula, Australia

In response to an outbreak of Japanese encephalitis (JE) virus on Cape York Peninsula, Australia, in 1998, mosquitoes were collected using CO2 and octenol-baited Centers for Disease Control and Prevention light traps. A total of 35,235 adult mosquitoes, comprising 31 species, were processed for virus isolation. No isolates of JE virus were recovered from these mosquitoes. However, 18 isolates of Kokobera virus, another flavivirus were obtained from Culex annulirostris. Twelve isolates were from western Cape York (minimum infection rate (MIR) of 0.61: 1,000 mosquitoes) and 6 were from the Northern Peninsula Area (MIR of 1.0:1,000). Potential explanations for the failure to detect JE virus in mosquitoes collected from Cape York Peninsula include the timing of collections, the presence of alternative bloodmeal hosts, differences in pig husbandry, asynchronous porcine seroconversion, and the presence of other flaviviruses.

An epidemic of dengue 3 in far north Queensland, 1997-1999

OBJECTIVES

To describe an epidemic of dengue type 3 that occurred in far north Queensland in 1997-1999 and its influence on the further development of dengue prevention and control strategies.

DESIGN

Epidemiological and laboratory investigation of cases, entomological surveys and phylogenetic analysis of dengue virus isolates.

MAIN OUTCOME MEASURES

Numbers and characteristics of confirmed cases; Breteau Index (BI; number of containers breeding Aedes aegypti per 100 premises); effect of control measures on mosquito populations; genetic homology of epidemic virus with other dengue virus isolates.

RESULTS

The epidemic lasted 70 weeks and comprised 498 confirmed cases in three towns (Cairns, Port Douglas and Mossman); 101 patients (20%) were admitted to hospital. Median interval between symptom onset and notification was seven days (range, 0-53 days), and cumulative duration of viraemia of public health significance was 2,072 days. BIs in affected areas were high, particularly in Mossman (45) and Port Douglas (31). Control measures significantly reduced mosquito populations (assessed as number of ovitraps containing Ae. aegypti eggs and mean number of eggs per trap [P< 0.05 for both]). However, transmission persisted in several foci, in part due to undetected waterfilled containers breeding Ae. aegypti. The epidemic virus belonged to serotype 3; phylogenetic analysis suggested it was imported from Thailand.

CONCLUSIONS

The epidemic had greater morbidity than other recent Queensland epidemics of dengue and was harder to control, necessitating substantial revision of the Dengue Fever Management Plan for North Queensland. The epidemic's severity supports the hypothesis that dengue viruses from South East Asia are more virulent than others.

Language as Constitutive: Critical Thinking for Multicultural Education and Practice in the 21st Century

Postmodern understandings of language can function as revolutionary critical thinking tools and enable multicultural education in a way yet to be resolutely embraced by the discipline. This thesis is illustrated with critical thinking examples relevant to topics in nursing education, such as maternal infant attachment, HIV prevention education, standardized instruments measuring quality of life and self-esteem, domain of person, and adolescent male identity formation. Working through postmodern positions on language produces important questions. It offers nursing provocative ways of thinking about education and provides radically different approaches to critical thinking and cultural competence. Capitalizing on postmodern sensibilities about language to create multicultural education and practice will take persistent self-reflective educational practices that question the ground that nursing stands on, as well as good intentions regarding a deep and broad embrace of complexly understood cultural competence.

Identification of lumichrome as a sinorhizobium enhancer of alfalfa root respiration and shoot growth

Sinorhizobium meliloti bacteria produce a signal molecule that enhances root respiration in alfalfa (Medicago sativa L.) and also triggers a compensatory increase in whole-plant net carbon assimilation. Nuclear magnetic resonance, mass spectrometry, and ultraviolet-visible absorption identify the enhancer as lumichrome, a common breakdown product of riboflavin. Treating alfalfa roots with 3 nM lumichrome increased root respiration 21% (P < 0.05) within 48 h. A closely linked increase in net carbon assimilation by the shoot compensated for the enhanced root respiration. For example, applying 5 nM lumichrome to young alfalfa roots increased plant growth by 8% (P < 0.05) after 12 days. Soaking alfalfa seeds in 5 nM lumichrome before germination increased growth by 18% (P < 0.01) over the same period. In both cases, significant growth enhancement (P < 0.05) was evident only in the shoot. S. meliloti requires exogenous CO2 for growth and may benefit directly from the enhanced root respiration that is triggered by lumichrome. Thus Sinorhizobium-alfalfa associations, which ultimately form symbiotic N2-reducing root nodules, may be favored at an early developmental stage by lumichrome, a previously unrecognized mutualistic signal. The rapid degradation of riboflavin to lumichrome under many physiological conditions and the prevalence of riboflavin release by rhizosphere bacteria suggest that events demonstrated here in the S. meliloti-alfalfa association may be widely important across many plant-microbe interactions.

A Nod factor-binding lectin is a member of a distinct class of apyrases that may be unique to the legumes

Recent studies from our laboratory have found that a root lectin from the legume Dolichos hifloris is present on the root surface, binds rhizobial Nod factor and has apyrase activity. To assess the broader significance of this lectin/nucleotide phosphohydrolase (Db-LNP), we have cloned a second related cDNA (Db-apyrase-2) from D. hiflorus, as well as related cDNAs from the legumes Lotus japonicus and Medicago sativa, and from Arabidopsis thaliana, a non-legume. The deduced amino acid sequences of these apyrases were aligned with one another and with the sequences of other apyrases from plants, animals, yeast and protozoa. Phylogenetic analysis shows that Db-LNP has closely related orthologs only in other legumes, while Db-apyrase-2 is more closely related to apyrase sequences from non-leguminous plants. We also show that the orthologs of Db-LNP from M. sativa and Pisum sativum have carbohydrate binding activity. The results suggest that legume LNPs may represent a special class of apyrases that arose by gene duplication and subsequent specialization.

BioS, a biotin-induced, stationary-phase, and possible LysR-type regulator in Sinorhizobium meliloti

Sinorhizobium meliloti 1021 produces biotin required for growth, but it also responds to external biotin signals from alfalfa plants through the bioS regulatory locus. Mutation of bioS increases biotin uptake, extends stationary phase in the presence of biotin, and impairs competitive growth in the presence of biotin. New data supporting the relevance of this gene to plant-microbe interactions show that a bioS-gusA reporter fusion is expressed by bacteria on plant roots, by bacteria in alfalfa root nodules, and more generally by any stationary-phase bacterial cells in the presence of biotin. Significant transcription of bioS-gusA was detected at 50 pM biotin, and a 16-fold induction was measured in stationary-phase cells with 1 nM biotin. A positive autoregulation of bioS is suggested by the fact that, in the presence of 10 nM biotin, a bioS-gusA fusion in wild-type cells was transcribed at more than twice the rate of the same reporter fusion in a bioS mutant background. Analyses of primer extension products and expression studies with three different bioS-gusA promoter fusions defined major characteristics of the bioS promoter. Expression of bioS in Escherichia coli resulted in the production of a 35-kDa BioS protein with characteristics of an LysR-type regulator. Those traits included a deduced amino acid sequence containing possible helix-turn-helix DNA-binding structures and three T-N(11)-A motifs upstream from the bioS gene. A regulatory role for BioS protein was supported by tests showing that a 321-bp DNA fragment containing the bioS promoter altered the electrophoretic mobility of recombinant BioS and of a corresponding band in protein extracts from S. meliloti 1021. The absence in BioS of any significant homology to known amino acid sequences was consistent with the fact that DNA hybridization tests with seven genera of bacteria detected bioS only in Sinorhizobium.

The timeliness of notification of clinically suspected cases of dengue imported into north Queensland

OBJECTIVE

Evaluate the timeliness of notifications by medical practitioners of clinically suspected dengue importations into north Queensland (NQ). Describe the features the disease and determine the likely duration of viraemia prior to implementating public health measures.

METHOD

Since December 1994, the Tropical Public Health Unit (TPHU) has maintained a register of all imported cases of dengue into NQ. Only confirmed viraemic cases were included in the study. Timeliness of notifications was defined as the interval between the first medical consultation in NQ and notification to TPHU. An Epi info database was developed and used to analyse data.

RESULTS

There were 31 confirmed dengue importations into NQ during the study period, including all four dengue serotypes. The largest source (39%) was Papua New Guinea. The median time for notifications was 5.5 days. Doctor notifications ranged from 0 to 21 days (median 2 days), remaining notifications range from 1 to 42 days (median 10 days) (p < 0.05). The mean duration of viraemia of public health importance was 7 days (2-12 days).

CONCLUSIONS

Of concern, doctors failed to notify > 50% of suspected cases and only 26% of notifications were received within 48 hours. Notification delays led to prolonged viraemia of public health importance increasing the potential risk of secondary infections.

IMPLICATIONS

General practitioners need to promptly notify all clinically suspected cases of dengue in travellers recently arrived in NQ. The TPHU intends to reemphasise to general practitioner the importance of timely notifications and develop an orientation package for new doctors.

Japanese encephalitis in north Queensland, Australia, 1998

OBJECTIVE

To describe the circumstances of two cases of Japanese encephalitis (JE) in north Queensland in 1998, including one acquired on the Australian mainland.

DESIGN

Serological surveillance of sentinel pigs for JE virus activity; serological surveys of humans and pigs and viral cultures of mosquito collections.

SETTING

Islands in the Torres Strait and communities in the Northern Peninsula Area (NPA) and near the mouth of the Mitchell River in Cape York, Queensland, in the 1998 wet season (December 1997-May 1998).

RESULTS

Sentinel pigs in the Torres Strait began to seroconvert to JE virus in February 1998, just before onset of JE in an unvaccinated 12-year-old boy on Badu island. By mid-April, most sentinel pigs had seroconverted. Numerous JE viruses were isolated from Culex annulirostris mosquitoes collected on Badu. In early March, a person working at the mouth of the Mitchell River developed JE. Serological surveys showed recent JE virus infection in 13 young pigs on a nearby farm, but not in 488 nearby residents. In NPA communities, sentinel pigs seroconverted slowly and JE viruses were isolated from three, but none of 604 residents showed evidence of recent infection. Nucleotide sequencing showed that 1998 JE virus isolates from the Torres Strait were virtually identical not only to the 1998 isolate from an NPA pig, but also to previous (1995) Badu isolates.

CONCLUSIONS

JE virus activity was more widespread in north Queensland in the 1998 wet season than in the three previous wet seasons, but ecological circumstances (e.g., less intensive pig husbandry, fewer mosquitoes) appear to have limited transmission on the mainland. Nucleotide sequencing indicated a common source for the 1995 and 1998 JE viruses. Circumstantial evidence suggests that cyclonic winds carried infected mosquitoes from Papua New Guinea.

Genetic analysis of the bone morphogenetic protein-related gene, gbb, identifies multiple requirements during Drosophila development

We have isolated mutations in the Drosophila melanogaster gene glass bottom boat (gbb), which encodes a TGF-beta signaling molecule (formerly referred to as 60A) with highest sequence similarity to members of the bone morphogenetic protein (BMP) subgroup including vertebrate BMPs 5-8. Genetic analysis of both null and hypomorphic gbb alleles indicates that the gene is required in many developmental processes, including embryonic midgut morphogenesis, patterning of the larval cuticle, fat body morphology, and development and patterning of the imaginal discs. In the embryonic midgut, we show that gbb is required for the formation of the anterior constriction and for maintenance of the homeotic gene Antennapedia in the visceral mesoderm. In addition, we show a requirement for gbb in the anterior and posterior cells of the underlying endoderm and in the formation and extension of the gastric caecae. gbb is required in all the imaginal discs for proper disc growth and for specification of veins in the wing and of macrochaete in the notum. Significantly, some of these tissues have been shown to also require the Drosophila BMP2/4 homolog decapentaplegic (dpp), while others do not. These results indicate that signaling by both gbb and dpp may contribute to the development of some tissues, while in others, gbb may signal independently of dpp.

Arboviruses in the Australian region, 1990 to 1998

Arboviruses continue to be major human pathogens in the Australian region. This report provides a summary of the activities of these viruses over the past eight years, and comments on new findings relevant to their respective ecologies. Of particular interest and concern is the propensity of these viruses to spread. The examples discussed include the initiation of dengue epidemics in north Queensland by virus imported in viraemic travellers; the spread of Japanese encephalitis virus to the Australasian region and its probable enzootic establishment in the south-west of Papua New Guinea; the potential spread of Ross River virus to other countries, as demonstrated by the 1979-80 outbreak in the South Pacific, and the recent occurrence in military personnel from the United States of America after an exercise; and the recent spread of Barmah Forest virus into Western Australia.

A presumptive case of fatal Murray Valley encephalitis acquired in Alice Springs

A presumptive case of Murray Valley Encephalitis (MVE) acquired in Alice Springs in March 1997 is reported. The patient subsequently died in Mackay. The diagnosis of Murray Valley Encephalitis was supported by the detection of flavivirus IgM in cerebrospinal fluid. Low titres of IgM specific to Murray Valley Encephalitis and Alfuy were detected in a single serum sample. The patient's travel movements indicate that his infection was acquired in the Alice Springs vicinity. This conclusion was further supported by the detection of Murray Valley Encephalitis activity in sentinel animals in the area and by the presence of large numbers of the principal mosquito vector of Murray Valley Encephalitis in the Northern Territory.

An isoflavonoid-inducible efflux pump in Agrobacterium tumefaciens is involved in competitive colonization of roots

Agrobacterium tumefaciens 1D1609, which was originally isolated from alfalfa (Medicago sativa L.), contains genes that increase competitive root colonization on that plant by reducing the accumulation of alfalfa isoflavonoids in the bacterial cells. Mutant strain I-1 was isolated by its isoflavonoid-inducible neomycin resistance following mutagenesis with the transposable promoter probe Tn5-B30. Nucleotide sequence analysis showed the transposon had inserted in the first open reading frame, ifeA, of a three-gene locus (ifeA, ifeB, and ifeR), which shows high homology to bacterial efflux pump operons. Assays on alfalfa showed that mutant strain I-1 colonized roots normally in single-strain tests but was impaired significantly (P < or = 0.01) in competition against wild-type strain 1D1609. Site-directed mutagenesis experiments, which produced strains I-4 (ifeA::gusA) and I-6 (ifeA::omega-Tc), confirmed the importance of ifeA for competitive root colonization. Exposure to the isoflavonoid coumestrol increased beta-glucuronidase activity in strain I-4 21-fold during the period when coumestrol accumulation in wild-type cells declined. In the same test, coumestrol accumulation in mutant strain I-6 did not decline. Expression of the ifeA-gusA reporter was also induced by the alfalfa root isoflavonoids formononetin and medicarpin but not by two triterpenoids present in alfalfa. These results show that an efflux pump can confer measurable ecological benefits on A. tumefaciens in an environment where the inducing molecules are known to be present.

Characterization of a new Agrobacterium tumefaciens strain from alfalfa

Agrobacterium tumefaciens strain 1D1609 is reported here as the first field isolate from alfalfa (Medicago sativa L.). Unlike well-characterized A. tumefaciens strains such as C58 and Ach5, strain 1D1609 is highly virulent on alfalfa and has a distinctive host range. Interestingly, strain 1D1609 is naturally resistant to kanamycin and spectinomycin. The Ti plasmid in strain 1D1609 is an octopine-type; thus, tumors formed by strain 1D1609 synthesize octopine, which is utilized by the bacterium as a sole carbon source. Reciprocal exchange of Ti plasmids between strains 1D1609 and C58 showed that both chromosomal and Ti plasmid genes in strain 1D1609 contribute specifically to tumor formation on alfalfa. In addition, the nondormant CUF101 alfalfa cultivar from which strain 1D1609 was isolated was significantly more susceptible to all Agrobacterium strains tested than was the dormant Agate cultivar.

Two contiguous outbreaks of dengue type 2 in north Queensland

OBJECTIVES

To investigate two outbreaks of dengue type 2 in north Queensland, one in the Torres Strait beginning in late 1996, the other in a Cairns suburb in early 1997.

DESIGN

Epidemiological investigation of all laboratory-confirmed cases of dengue, entomological investigation of the local environment, and laboratory analysis of the isolated dengue viruses.

MAIN OUTCOME MEASURES

Numbers of confirmed and of locally acquired cases; virus serotype; comparison of nucleotide sequences between viruses isolated from the two outbreaks; and Breteau Index (BI = number of containers with larvae of the mosquito vector Aedes aegypti found per 100 houses investigated) on the affected islands and in the Cairns suburb.

RESULTS

There were 201 confirmed cases of dengue in the Torres Strait outbreak, which lasted nearly seven months, and seven confirmed cases in the Cairns outbreak, which lasted about nearly 11 weeks. Most (190) were confirmed as dengue type 2. Nucleotide sequencing of viruses isolated from the two outbreaks showed they were identical. Ae. aegypti breeding sites were very common on the five Torres Strait islands surveyed (BIs, 73-219--high risk), but less so in the Cairns suburb (BI, 23). The most common breeding sites were water storage reservoirs, particularly rainwater tanks, on the outer Torres Strait islands, discarded containers (such as plastic containers, buckets and tyres) on Thursday Island, and garden items (such as flowerpot bases and jars) in Cairns.

CONCLUSIONS

The virus responsible for the Cairns outbreak was most probably introduced from the Torres Strait, whereas the virus responsible for the Torres Strait outbreak was imported from Papua New Guinea. Preventive strategies tailored to specific locations are needed to reduce breeding of Ae. aegypti in north Queensland, and the consequent risk of future outbreaks of dengue.

Distress and the micturating cystourethrogram: does preparation help?

This study evaluates the impact of therapeutic preparation methods on children undergoing MCUG. Parents of 35 children who had undergone MCUG were surveyed by questionnaire. The child's reaction to investigation was assessed using the Groningen Distress Rating Scale (rating 1 = calm > 5 = panic) and parental coping styles using the Utrecht Coping List. Families received one of two types of therapeutic preparation: storybooklet or storybooklet and play preparation. Reported distress levels were significantly lower with therapeutic preparation (mean score 2.5 +/- 1.02 SD) than without (mean score 3.3 +/- 1.22 SD). Previously, controls reported 46% of anxiety-linked behaviour changes post-MCUG, falling to 13% after therapeutic preparation. Parents who gave a candid explanation reported significantly lower child distress levels (mean 2.0 +/- 0.91 SD) than those parents who avoided upsetting details (mean 3.1 +/- 0.47 SD). We conclude that distress associated with the MCUG can be reduced by therapeutic preparation of the child and family prior to investigation.

A biotin-regulated locus, bioS, in a possible survival operon of Rhizobium meliloti

A novel biotin-inducible DNA locus, bioS, was found in Rhizobium meliloti 1021 by mutation with a transposable promoter probe. The promoterless nptII reporter responded to 40 nM biotin with a sixfold increase in NPTII protein. Stationary-phase mutant cells accumulated 50% more 14C-biotin than corresponding wild-type cells. The prototrophic mutant competed equally with the wild type in biotin-free medium but poorly when 40 nM biotin was present. The 588-bp bioS is located among three genes showing homology to survival operons of other bacteria, and it may be part of a system that R. meliloti uses to respond to plant biotin signals.

Ross River virus in mosquitoes (Diptera:Culicidae) during the 1994 epidemic around Brisbane, Australia

During the summer 1994 outbreak of epidemic polyarthritis in suburban Brisbane, 29,931 adult female mosquitoes were collected by octenol-CO2 light traps and tested for virus by species in pools of approximately 20 using an in situ enzyme-linked immunoassay. Overall, 63 isolations of Ross River (RR) virus were made from 7 different mosquito species, including 23 from freshwater-breeding Culex annulirostris Skuse, 13 from peridomestic Aedes notoscriptus (Skuse), 4 from Aedes procax (Skuse), 12 from the brackish water-breeding Aedes funereus (Theobald), 9 from saltmarsh Aedes vigilax (Skuse), and 1 each from Culex sitiens Wiedemann and Aedes alternans (Westwood). The RR virus minimum infection rate in mosquitoes ranged from 1.6 to 2.5/1,000 from March to June 1994. This study implicates freshwater and brackish water mosquitoes as important suburban vectors of RR virus and indicates the need for refocusing mosquito control priorities.

Occult choroidal neovascularization in age-related macular degeneration. A natural history study

OBJECTIVE

To explore morphological and vision changes in untreated eyes with subfoveal choroidal neovascularization (CNV) that have poorly demarcated boundaries.

DESIGN

Analysis of photographs of untreated patients with poorly demarcated occult CNV participating in a prospective clinical trial evaluating laser treatment compared with observation.

SETTING

Two tertiary retinal referral centers.

PATIENTS

Symptomatic individuals with poorly demarcated subfoveal occult CNV associated with age-related macular degeneration.

MAIN OUTCOME MEASURES

Change in size of lesion, development of classic CNV, change in vision, and development of subretinal fibrosis.

RESULTS

During follow-up (9-12 months), 32% of the occult choroidal neovascular lesions more than doubled their original size. Classic CNV developed in 52% of eyes that started without it. The median loss in visual acuity was 2.5 lines. Eyes with classic CNV or subretinal blood or both at baseline developed subretinal fibrosis more frequently and lost more visual acuity, but not to a statistically significant degree.

CONCLUSIONS

The morphological changes of eyes with subfoveal occult CNV in which the boundaries are poorly demarcated in variable; the presence of subretinal blood or a component of classic CNV may influence the prognosis for further loss of vision.

An outbreak of Japanese encephalitis in the Torres Strait, Australia, 1995

OBJECTIVES

To determine the distribution of virus infection during an outbreak of Japanese encephalitis (JE) in the Torres Strait, and to describe the environmental factors facilitating the outbreak.

DESIGN

Human and porcine serological surveys for JE virus activity throughout the Torres Strait, and mosquito and household surveys on the island of Badu.

SETTING

The island of Badu (where the clinical cases occurred) and the other islands of the Torres Strait, Australia, during April-May 1995.

RESULTS

The serological surveys identified recent JE virus infection among residents or domestic pigs on at least nine outer Torres Strait islands. A JE virus, confirmed by nucleotide sequencing, was isolated from two asymptomatic Badu residents. Virus isolations and mosquito surveys implicated Culex annulirostris as the major vector involved in the outbreak. There was prolific Cx. annulirostris breeding in a variety of water bodies close to and within the Badu community. Over half (53%) of the households kept pigs in pens, and many (63%) of the pigpens were situated near standing water; in 56% of these "wet" pigpens Cx. annulirostris was breeding.

CONCLUSIONS

There was evidence of widespread JE virus activity throughout the outer islands of the Torres Strait. We suggest that migratory birds and/or wind-blown mosquitoes could have imported the virus into the Torres Strait from a focus of viral activity, possibly in Papua New Guinea, thereby initiating the outbreak. A combination of environmental factors, with large numbers of domestic pigs in close proximity to human dwellings and mosquito breeding sites, undoubtedly facilitated the outbreak on Badu.

Recombinant Rhizobium meliloti strains with extra biotin synthesis capability

The growth of Rhizobium meliloti 1021 in an experimental alfalfa (Medicago sativa L.) rhizosphere was stimulated by adding nanomolar amounts of biotin. To overcome this biotin limitation, R. meliloti strains were constructed by conjugating the Escherichia coli biotin synthesis operon into biotin auxotroph R. meliloti 1021-B3. Transconjugant strains Rm1021-WS10 and Rm1021-WS11 grew faster in vitro and achieved a higher cell density than did R. meliloti 1021 and overproduced biotin on a defined medium. The increase in cell yield was associated with as much as a 99% loss in viability for Rm1021-WS11, but data suggested that a separate stabilizing factor in the E. coli DNA reduced cell death in Rm1021-WS10. In rhizosphere tests, the recombinant strains showed delayed growth and competed poorly against Rm1021.

Biotin and other water-soluble vitamins are key growth factors for alfalfa root colonization by Rhizobium meliloti 1021

Rhizosphere growth limitations imposed on Rhizobium meliloti by availability of biotin, thiamine, and riboflavin were overcome by adding nanomolar amounts of these vitamins. Studies done with R. meliloti 1021 showed that both synthesis and uptake of biotin promote colonization of alfalfa roots. Two lines of evidence indicated that plant-derived biotin normally promotes root colonization: (i) adding avidin significantly (P < or = 0.01) reduced rhizosphere growth of R meliloti 1021, and (ii) growth of Tn5-induced biotin auxotrophs still increased 10-fold in the rhizosphere. Synthesis, however, is the more important source of biotin for R. meliloti 1021 because in root colonization tests biotin auxotrophs competed very poorly with the parent strain. Mutations conferring biotin auxotrophy were closely linked on a single restriction fragment, and one was complemented with the Escherichia coli bio operon. Initial nucleotide sequencing and DNA-DNA hybridization tests showed the biotin synthesis genes in R. meliloti are quite different from those in E. coli.

Midfacial degloving for the management of nasal, sinus, and skull-base neoplasms

The midfacial degloving approach to the midfacial orbital and anterior skull base structures is very versatile. It provides excellent access to a wide range of resections, such as medial maxillectomy, radical maxillectomy with and without orbital exenteration, anterior skull base cranifacial resection, and partial rhinectomy. This technique is useful for removal of benign and malignant lesions. The postoperative complications are rare. Because of absence of external skin incisions the cosmetic results are excellent.

Suppression of an Isoflavonoid Phytoalexin Defense Response in Mycorrhizal Alfalfa Roots

Isoflavonoids and steady-state mRNA levels of phenylalanine ammonia-lyase, chalcone isomerase, and isoflavone reductase were followed during a rapid, nearly synchronous infection of alfalfa (Medicago sativa L.) roots by the vesicular arbuscular fungus Glomus intraradices (Schenck & Smith) to test whether previously indicated suppression of the host defense response is regulated by changes in the steady-state mRNA level. Relative amounts of steady-state phenylalanine ammonia-lyase mRNA in the mycorrhizal roots doubled between d 14 and 18 and then immediately declined by 75% to reach and maintain a value lower than the control roots through d 21. Relative levels of chalcone isomerase mRNA in the inoculated roots increased 6-fold between d 14 and 17 and then decreased rapidly to the control level. Isoflavone reductase mRNA was not induced by mycorrhizal colonization. High-performance liquid chromatography, proton-nuclear magnetic resonance, and fast atom bombardment-mass spectrometry analyses showed consistent increases in formononetin levels and transient increases in medicarpin-3-O-glycoside and formononetin conjugates in the inoculated roots when colonization began. As colonization increased, levels of formononetin conjugates declined in mycorrhizal roots below those in uncolonized controls. Medicarpin aglycone, an alfalfa phytoalexin normally associated with pathogenic infections, was not detected at any stage. These findings supply detailed evidence that, during early colonization of plant roots by symbiotic Glomus, defense transcripts are induced and then subsequently suppressed.

Plant isoflavonoids, pathogens and symbionts

It has recently been discovered that when symbiotic Rhizobium and Bradyrhizobium cells are outside the plant they are also exposed to the isoflavonoid phytoalexins that are normally associated with pathogenic infections. How the symbionts elicit and respond to isoflavonoids may help to define the mechanisms that are used by other beneficial soil microorganisms to colonize plant roots.

Child care for children in poverty: opportunity or inequity?

Data from a nationally representative survey of child care centers and a 5-site, observational study of centers were used to examine the quality of care provided to children from low-income families. Comparisons were made to a national sample of centers; among Head Start, public school-sponsored, and other community-based subsidized centers; and among centers that served families from differing socioeconomic groups. The quality of care in centers that served predominantly low-income children was adequate, but highly variable, with structural indices exhibiting higher quality than observations of global quality and of staff-child interactions. When compared to Head Start and public school-sponsored centers, the community-based centers had smaller groups and fewer children per teacher for preschoolers, but also had less well educated and compensated staff. Centers that predominantly served children from upper-income families provided the highest quality of care across multiple indices, and those that predominantly served children from middle-income families almost uniformly provided the poorest quality of care. The centers that served children from low-income families did not differ significantly in quality from the upper-income centers on most indices. However, the teachers in these programs were observed to be less sensitive and more harsh than teachers in the centers that served more advantaged families. The implications of the findings for research and policy are discussed.

Alfalfa (Medicago sativa L.) Root Exudates Contain Isoflavonoids in the Presence of Rhizobium meliloti

Root exudates of alfalfa (Medicago sativa L.) inoculated with symbiotic Rhizobium meliloti bacteria contained three isoflavonoids that were not found in exudates of uninoculated plants. Data from proton nuclear magnetic resonance, mass spectrometry, and ultraviolet-visible absorbance analyses indicated that root exudates of inoculated plants contained aglycone and glycoside forms of the phytoalexin medicarpin and a formononetin-7-O-(6"-O-malonylglycoside), a conjugated form of the medicarpin precursor formononetin. The medicarpin molecules did not induce nod gene transcription in R. meliloti, but the formononetin-7-O-(6"-O-malonylglycoside) induced nod genes regulated by both NodD1 and NodD2 proteins in R. meliloti. Hydrolysis of either the malonyl or the glycosyl linkage from the formononetin conjugate eliminated nod gene-inducing activity. The nod gene-inducing activity of crude root exudates was increased 200 and 65% upon inoculation with R. meliloti or R. leguminosarum bv phaseoli, respectively. When root exudate from uninoculated alfalfa was incubated with R. meliloti, high performance liquid chromatography analyses showed no evidence that bacterial metabolism produced medicarpin. These results indicate that alfalfa responds to symbiotic R. meliloti by exuding a phytoalexin normally elicited by pathogens and that the microsymbiont can use a precursor of the phytoalexin as a signal for inducing symbiotic nod genes.

Combined effects of urokinase and heparin on PTT values during thrombolytic therapy

The local infusion of urokinase may be complicated by hemorrhage. Except for maintaining fibrinogen levels above 100 mg/dL, no other criteria exist for titrating the dose of urokinase to avoid hemorrhagic complications. A retrospective examination of the fibrinolytic and coagulation states was performed on 11 patients receiving local high-dose urokinase (240,000 U/hr) and heparin for thrombolysis of acute occlusions to identify parameters other than fibrinogen levels that may correlate with bleeding complications. Five patients experienced bleeding complications, 3 of whom had partial thromboplastin time (PTT) values greater than 150 seconds. None of the five patients having hemorrhagic complications had fibrinogen levels below 100 mg/dL at any time. Urokinase began to enhance the effect of heparin on PTT values as a result of reducing fibrinogen levels. In 10 of 11 patients this effect caused PTT values to at least double when compared with heparin alone. This substantial rise in PTT occurred only after fibrinogen levels approached 200 mg/dL in 8 of 11 patients. Although the number of patients is small, these data suggest that when heparin is used during thrombolysis, closer PTT monitoring should be carried out as fibrinogen levels begin to decline, especially when they approach 200 mg/dL, to avoid excessive PTT elevations and subsequent bleeding.

Beyond beliefs: parent and child behaviors and children's perceived academic competence

Examined the relations of parent and child behaviors with children's perceptions of their academic competence. 74 high-achieving third-grade children, with varying levels of perceived academic competence, were observed working with mothers and fathers both on solvable tasks (Period 1) and during a period that included some unsolvable tasks (Period 2). Results indicated that children's perceived academic competence was positively related to father warmth, both at Period 1 and at Period 2. Children's perceived academic competence was also positively related to their own behavior when working with fathers at Period 2. Specifically, children with higher perceived academic competence showed more emotional restraint and were more self-reliant when working on tasks at Period 2 than were children with lower perceived academic competence. The results indicate that there are systematic, observable correlates of children's self-reports of their perceived academic competence.

Isolation of Kunjin virus from a patient with a naturally acquired infection

OBJECTIVE

To describe the first isolation of Kunjin virus from a patient with a natural infection.

CLINICAL FEATURES

A 48-year-old female egg collector presented with muscle weakness, fatigue and extreme lethargy three weeks after developing rigors, headache, photophobia and nausea. Kunjin virus was isolated from an acute phase serum sample.

INTERVENTION AND OUTCOME

The patient made a partial recovery after treatment for 10 days with Catovit (Boehringer Ingelheim), one tablet twice a day, and then declined further medical contact.

CONCLUSION

The isolation of Kunjin virus from this patient confirms previous serological observations which suggested that this mosquito-borne virus caused febrile episodes in humans accompanied, on occasion, by polyarthralgia or mild central nervous system signs and symptoms.

Trigonelline and Stachydrine Released from Alfalfa Seeds Activate NodD2 Protein in Rhizobium meliloti

Spectroscopic data (nuclear magnetic resonance, mass spectrometry, ultraviolet-visible) in this study identify trigonelline and stachydrine as major components of alfalfa (Medicago sativa L.) seed rinse. Moreover, biological assays show that these natural products induce nodulation (nod) gene transcription in Rhizobium meliloti by activating the regulatory protein NodD2, but not the homologous NodD1 protein. These findings contrast with the fact that the only previously identified NodD2 activator, 4,4' -dihydroxy-2' -methoxychalcone (MCh), also activates NodD1 protein. Trigonelline and stachydrine induce nod genes only at much higher concentrations than MCh, but they are released from seeds in correspondingly greater amounts. The existence of these amphoteric, nonflavonoid nod gene inducers broadens our understanding of the biochemical processes and ecological mechanisms that a legume host uses to regulate its microbial symbiont.

Thresholds of quality: implications for the social development of children in center-based child care

We assessed the quality of center child care relationships with adults and peers for 414 children (ages 14 to 54 months). Classrooms were classified by ratio and group size provisions of the Federal Interagency Day Care Requirements (FIDCR) and by the Early Childhood and Infant and Toddler Environmental Rating Scales. Children cared for in classrooms meeting FIDCR ratios were more likely to be in classrooms rated as good or very good in caregiving and activities. Children in classrooms rated as good or very good in caregiving were more likely to be securely attached to teachers. Securely attached children were more competent with peers. Children cared for in classrooms meeting FIDCR group size were more likely to be in classrooms rated higher in activities. Children in classrooms rated high in activities were likely to orient to both adults and peers. Children with social orientations to adults and peers were more competent with peers.

Traumatic aortic tear: screening with chest CT

Dynamic chest computed tomography (CT) was performed in 326 patients who had undergone abdominal CT for blunt trauma to evaluate the role of chest CT in screening for thoracic aortic injury. Evidence of mediastinal bleeding constituted an abnormal CT examination. The results were correlated with those from aortography in 131 patients. The chest radiographs were abnormal in 127 patients (39%). Of those 127 patients, chest CT scans were abnormal in 39 patients; an aortic tear was present in eight of those patients (21%). The remaining 88 patients had normal CT scans and no aortic injury. Of the 199 patients with normal radiographs, 15 had abnormal CT scans and 184 had normal CT scans and no aortic injury. There were no false-negative CT scans; 79% of patients with normal CT scans had false-positive chest radiographs. With CT there was a significant improvement over plain radiography in specificity, accuracy, and predictive value of positive results. If chest CT were used as an adjunct to chest radiography in the screening for traumatic aortic tear, the need for aortography would decrease by 56%. Chest CT can safely help discriminate candidates for aortography, is cost-effective, and, in hemodynamically stable patients, should be incorporated in the screening for traumatic aortic tear.

Rhizobium nod Gene Inducers Exuded Naturally from Roots of Common Bean (Phaseolus vulgaris L.)

Four compounds exuded from young roots of a black-seeded bean (Phaseolus vulgaris L., cv PI165426CS) induce transcription of nod genes in Rhizobium leguminosarum biovar phaseoli. The three most active nod gene inducers were identified by spectroscopic methods (ultraviolet/visible absorbance, proton nuclear magnetic resonance, and mass spectrometry) as being eriodictyol (5,7,3',4' -tetrahydroxyflavanone), naringenin (5,7,4' -trihydroxyflavanone), and a 7-O-glycoside of genistein (5,7,4' -trihydroxyisoflavone). Comparisons with authentic standards verified the chemical structures of the aglycones and their capacity to induce beta-galactosidase activity in R. leguminosarum strains containing nodA-lacZ or nodC-lacZ fusions controlled by R. leguminosarum biovar phaseoli nodD genes. Roots of 9-day-old seedlings released 42, 281, and 337 nanomoles per plant per day of genistein, eriodictyol, and naringenin, respectively. Genistein and naringenin induced higher maximum beta-galactosidase activities and required lower concentrations for half-maximum induction than eriodictyol. Comparing the nod gene-inducing activity of seed rinses with root exudate from PI165426CS bean showed that root flavonoids were released at about 6% the rate of those from seeds on a molar basis, but on average the individual compounds from roots were approximately three times more active than nod gene inducers from seeds.

Anthocyanidins and Flavonols, Major nod Gene Inducers from Seeds of a Black-Seeded Common Bean (Phaseolus vulgaris L.)

Eleven compounds released from germinating seeds of a black-seeded bean (Phaseolus vulgaris L., cv PI165426CS) induce transcription of nod genes in Rhizobium leguminosarum biovar phaseoli. Aglycones from 10 of those compounds were identified by spectroscopic methods (ultraviolet/visible, proton nuclear magnetic resonance, and mass spectroscopy), and their biological activities were demonstrated by induction of beta-galactosidase activity in R. leguminosarum strains containing nodA-lacZ or nodC-lacZ fusions controlled by R. leguminosarum biovar phaseoli nodD genes. By making comparisons with authentic standards, the chemical structures for aglycones from the 10 molecules were confirmed as being anthocyanidins (delphinidin, petunidin, and malvidin) and flavonols (myricetin, quercetin, and kaempferol). All anthocyanidins and flavonols had 3-O-glycosylation and free hydroxyl groups at the 4', 5, and 7 positions. Hydrolysis experiments showed that the mean concentration required for half-maximum nod gene induction (I(50)) by the 10 glycosides was about half that of the corresponding aglycones. The mean I(50) value for the three anthocyanidins (360 nanomolar) was less (P </= 0.05) than that of the three flavonol aglycones (980 nanomolar). Each seed released approximately 2500 nanomoles of anthocyanidin and 450 nanomoles of flavonol nod gene inducers in conjugated forms during the first 6 hours of imbibition. Based on amounts and activities of the compounds released, anthocyanins contributed approximately 10-fold more total nod-inducing activity than flavonol glycosides. These anthocyanidins from bean seeds represent the first nod-inducing compounds identified from that group of flavonoids.

Gastric tonometry and venous oximetry in cardiac surgery patients

OBJECTIVE

To determine the relationship between gastric intramucosal pH and several other indices of splanchnic perfusion in patients undergoing cardiopulmonary bypass.

DESIGN

Prospective, single-arm study.

SETTING

University Hospital.

METHODS

Elective cardiac surgery patients (n = 8), free of hepatic disease, were studied. Before anesthetic induction, a triple-lumen, heparin-bonded fiberoptic catheter was inserted into the hepatic vein under fluoroscopic guidance. An identical catheter was inserted into the pulmonary artery. After endotracheal intubation, a nasogastric tube modified to permit measurement of gastric intramucosal pH was inserted into the stomach. Systemic oxygen delivery (DO2), and arterial, mixed venous, hepatic venous, and femoral venous blood gases and lactate concentrations were recorded at the following times: immediately before induction of anesthesia (time 1); during atrial cannulation (time 2); after 30 mins of hypothermic cardiopulmonary bypass (time 3); 15 mins after termination of cardiopulmonary bypass (time 4); and 1 hr after arrival in the ICU (time 5). Hepatic venous hemoglobin saturation (SO2) and mixed venous hemoglobin saturation (SvO2) were monitored continuously from times 1 to 5. Gastric intramucosal pH was recorded at times 2, 3, 4, and 5. The hepatic catheter was removed as soon as the last samples were collected in the ICU.

RESULTS

The square of the weighted mean correlation coefficients (rw)2 for gastric intramucosal pH vs. hepatic venous lactate concentrations, gastric intramucosal pH vs. hepatic venous PO2, and gastric intramucosal pH vs. hepatic venous pH were (rw)2 = .50, (rw)2 = .58, and (rw)2 = .32, respectively. Systemic DO2, hepatic venous lactate concentrations, hepatic venous PO2, and hepatic venous pH were significant determinants in the multiple regression model for gastric intramucosal pH (r2 = .89). There were significant differences between SvO2 and hepatic venous SO2 at times 4 and 5.

CONCLUSION

Gastric intramucosal pH may provide a minimally invasive way to monitor the adequacy of splanchnic DO2 in patients undergoing cardiopulmonary bypass. Additional data are necessary to determine whether low gastric intramucosal pH is truly a marker of supply-dependent oxygen uptake across the hepatosplanchnic vascular bed under these conditions.