Development of a core descriptor set for Crohn's anal fistula

AIM

Crohn's anal fistula (CAF) is a complex condition, with no agreement on which patient characteristics should be routinely reported in studies. The aim of this study was to develop a core descriptor set of key patient characteristics for reporting in all CAF research.

METHOD

Candidate descriptors were generated from published literature and stakeholder suggestions. Colorectal surgeons, gastroenterologists and specialist nurses in inflammatory bowel disease took part in three rounds of an international modified Delphi process using nine-point Likert scales to rank the importance of descriptors. Feedback was provided between rounds to allow refinement of the next ratings. Patterns in descriptor voting were assessed using principal component analysis (PCA). Resulting PCA groups were used to organize items in rounds two and three. Consensus descriptors were submitted to a patient panel for feedback. Items meeting predetermined thresholds were included in the final set and ratified at the consensus meeting.

RESULTS

One hundred and thirty three respondents from 22 countries completed round one, of whom 67.0% completed round three. Ninety seven descriptors were rated across three rounds in 11 PCA-based groups. Forty descriptors were shortlisted. The consensus meeting ratified a core descriptor set of 37 descriptors within six domains: fistula anatomy, current disease activity and phenotype, risk factors, medical interventions for CAF, surgical interventions for CAF, and patient symptoms and impact on quality of life.

CONCLUSION

The core descriptor set proposed for all future CAF research reflects characteristics important to gastroenterologists and surgeons. This might aid transparent reporting in future studies.

When are anti-fat attitudes understood as prejudice versus truth? An experimental study of social influence effects

BACKGROUND/OBJECTIVES

If people who hold anti-fat attitudes believe these attitudes to be true, then anti-prejudice appeals are likely to be unsuccessful, if only because the targets will not see their attitudes as in need of change. The current study examined processes that may lead people to see their anti-fat attitudes as 'truth' or as 'prejudice'.

SUBJECTS/METHODS

Participants (N = 482) read anti-fat statements and were then presented with an interpretation of these statements as 'truth' or 'prejudice'. The source of this interpretation was either an (i) in-group or out-group member and (ii) expert or non-expert. Participants' judgements of the statements were expected to vary such that in-group others and experts would exert more influence than would out-group others and non-experts.

RESULTS

Participants aligned their own interpretations of an anti-fat statement with those of an expert, but not with those of a non-expert, F(1,466) = 8.97, p < 0.05, ηp 2 = 0.02. The group membership variable had no effect on judgements of 'truth' or 'prejudice' of the anti-fat statement.

CONCLUSION

The expressions that people believe constitute anti-fat prejudice versus truth about people described as overweight are influenced by exposure to expert opinion (in this case, by medical doctors). Implications for the success of weight-based anti-prejudice appeals and for healthcare provision are discussed.

Cell-culture-based immunochromatography for rapid detection of group A human rotaviruses in aquatic environments

In an effort to detect rapidly and conveniently the infectious waterborne group A human rotaviruses that cause diarrhea in infants and children, the authors developed the first-ever cell-culture-based immunochromatography method. An immunochromatography kit interacted only with the human rotaviruses VP6 antigen, and the cell-culture-based immunochromatography detected group A human rotaviruses with a sensitivity as low as 1.99 TCID50 ml(-1). This detection sensitivity was similar to that of the cytopathic effect-based method. There were no actual differences between the sensitivity of this method and that of the real-time reverse transcription polymerase chain reaction method, which is known as a method with a relatively high sensitivity. Furthermore, while cell culture detection methods, that is total culturable virus assay, can determine only the presence of infectious waterborne viruses, the cell-culture-based immunochromatography is advantageous for the accurate detection of group A human rotaviruses. Compared with the real-time reverse transcription polymerase chain reaction method, the cell-culture-based immunochromatography is advantageous because it requires a relatively simple process that enables easy quality controls and low test costs. Thus, this study proposed a new method for the identification of group A human rotaviruses, and it is suggested that this cell-culture-based immunochromatography may be applied to detect group A human rotaviruses in aquatic environments.

Multiple mutagenesis of the Candida rugosa LIP1 gene and optimum production of recombinant LIP1 expressed in Pichia pastoris

Candida rugosa lipase, a significant catalyst, had been widely employed to catalyze various chemical reactions such as non-specific, stereo-specific hydrolysis and esterification for industrial biocatalytic applications. Several isozymes encoded by the lip gene family, namely lip1 to lip7, possess distinct thermal stability and substrate specificity, among which the recombinant LIP1 showed a distinguished catalytic characterization. In this study, we utilized PCR to remove an unnecessary linker of pGAPZalphaC vector and used overlap extension PCR-based multiple site-directed mutagenesis to convert the 19 non-universal CTG-serine codons into universal TCT-serine codons and successfully express a highly active recombinant C. rugosa LIP1 in the Pichia expression system. Response surface methodology and 4-factor-5-level central composite rotatable design were adopted to evaluate the effects of growth parameters, such as temperature (21.6-38.4 degrees C), glucose concentration (0.3-3.7%), yeast extract (0.16-1.84%), and pH (5.3-8.7) on the lipolytic activity of LIP1 and biomass of P. pastoris. Based on ridge max analysis, the optimum LIP1 production conditions were temperature, 24.1 degrees C; glucose concentration, 2.6%; yeast extract, 1.4%; and pH 7.6. The predicted value of lipolytic activity was 246.9+/-39.7 U/ml, and the actual value was 253.3+/-18.8 U/ml. The lipolytic activity of the recombinant LIP1 resulting from the present work is twofold higher than that achieved by a methanol induction system.

Arteriovenous fistula using transposed basilic vein in chronic hypotensive hemodialysis patients

AIM

Chronic hypotension is not uncommon in uremic patients on regular hemodialysis. This subset of patients often requires multiple operations to maintain their vascular access due to frequent thrombosis and occlusion of the arteriovenous fistula. Our aims was to assess whether surgical intervention with the brachial artery-transposed basilic vein fistula is effective in chronic hypotensive hemodialysis patients.

MATERIALS AND METHODS

Fifty-four hemodialysis patients with chronic hypotension were enrolled in this study. Most ofthem were referred from local hospitals. They were 23 men and 31 women. The brachial artery-transposed basilic vein arteriovenous fistula was performed in a period of 46 months at the teaching hospital. Primary patency was defined as the length of time from the fistula creation until the development of thrombosis or a complication that required operative revision ofthe fistula. Secondary patency was defined by whether the fistula could be salvaged by revision such that blood flow was maintained.

RESULTS

There was no technical failure and none of these patients died due to the surgical operation. The primary patency rate was 89.80% at 1 year, 73.08% at 2 years, and 64.710% at 3 years. The secondary patency rate was 95.92% at 1 year, 84.62% at 2 years, and 76.47% at 3 years.

CONCLUSIONS

Brachial artery-transposed basilic vein arteriovenous fistula may present good primary alternative vascular access in chronic hypotensive hemodialysis patients.

Increase in the expression of human leukocyte antigen class I in human fibroblasts by soluble factors secreted from human cytomegalovirus-infected cells

The human cytomegalovirus (HCMV) is known to downregulate the expression of the human leukocyte antigen (HLA) class I for escape from immune surveillance. In order to understand the HCMV immune evasion mechanism, expression of HLA class I on the surface of HCMV-infected cells was investigated. A decrease in the HLA class I expression was observed at higher MOI; whereas at a lower MOI a slight increase in the HLA class I expression was observed. When HCMV-infected and uninfected cells were separately prepared on coverslips and co-cultured, the increased HLA class I expression was observed in uninfected cells. Treatment of the uninfected cells with the culture supernatant from HCMV-infected cells resulted in an increase in the HLA class I expression. A biochemical analysis of the HCMV-infected cell culture supernatant revealed the presence of interferon (IFN) beta interleukin (IL)-1beta, and IL-6. The HLA class I-enhancing activity of the culture supernatant was mimicked by IFN beta, but not by IL1-beta or IL-6, and was partially reversed by pretreatment with an antibody to IFN beta. Therefore, it appears that the HCMV infection of human foreskin fibroblast cells induces interferon beta and other soluble factor(s) that are responsible for the up-regulation of the HLA class I expression.

Recombinant expression and characterization of the Candida rugosa lip4 lipase in Pichia pastoris: comparison of glycosylation, activity, and stability

Although Candida rugosa utilizes a nonuniversal serine codon (CUG) for leucine, it is possible to express lipase genes (LIP) in heterologous systems. After replacing the 19 CUG codons in LIP4 with serine codons by site-directed mutagenesis, a recombinant LIP4 was functionally overexpressed in Pichia pastoris in this study. This recombinant glycosylated lipase was secreted into the culture medium with a high purity of 100 mg/liter in a culture broth. Purified recombinant LIP4 had a molecular mass of 60 kDa, showing a range similar to that of lipase in a commercial preparation. Since LIP4 has only a glycosylation site at position Asn-351, this position may also be the major glycosylation site in C. rugosa lipases. Although the thermal stability of recombinant LIP4 significantly increased from 52 to 58 degrees C after glycosylation, there were no significant differences in the catalytic properties of recombinant glycosylated lipase from P. pastoris and the unglycosylated one from Escherichia coil. These two recombinant LIP4s showed higher esterase activities toward long-chain ester (C16 and C18) and exhibited higher lipase activities toward unsaturated and long-chain lipids. In addition, LIP4 does not show interfacial activation as compared with LIP1 toward lipid substrates of tributyrin and triolein. These observations demonstrated that LIP4 shows distinguished catalytic activities with LIP1 in spite of their high sequence homology.

Recombinant expression of the Candida rugosa lip4 lipase in Escherichia coli

It is difficult to express recombinant Candida rugosa lipases (CRLs) in heterologous systems, since C. rugosa utilizes a nonuniversal serine codon CUG for leucine. In this study, recombinant LIP4 in which all 19 CUG codons had been converted to a universal serine codon was overexpressed in Escherichia coli BL21(DE3). The recombinant LIP4 was found mainly in the inclusion bodies and showed a low catalytic activity. To increase the amount of soluble form and activity of recombinant LIP4, the DNA was fused to the gene for thioredoxin (TrxFus-LIP4) and then expressed in E. coli strain AD494(DE3). This strategy promotes the formation of disulfide bonds in the cytosol and yields enzymatically active forms of LIP4. The purified recombinant TrxFus-LIP4 and LIP4 expressed in AD494(DE3) had the same catalytic profiles. In addition, recombinant LIP4 had higher esterase activities toward long-chain ester and lower lipase activities toward tributyrin, triolein, and olive oil. This system for the expression of fungal lipase in E. coli strain AD494(DE3) is reliable and may produce enzymatically active forms of recombinant lipase without an in vitro refolding procedure.

Expression of transforming growth factor-alpha mRNA in livers of patients with chronic viral hepatitis and hepatocellular carcinoma

BACKGROUND

Transforming growth factor-alpha (TGFalpha) is an important autocrine growth factor of hepatocytes. The authors evaluated the roles of TGFalpha in chronic viral hepatitis (CVH) and hepatocellular carcinoma (HCC).

METHODS

The authors measured the amounts of TGFalpha mRNA in liver tissues from 18 patients with HCC, 31 patients with CVH, and 7 normal controls. " Hot-start" reverse transcription-polymerase chain reaction (RT-PCR) using oligo-dT and specific primers detected TGFalpha mRNA in total cellular RNA extracted from liver tissues. The levels of TGFalpha mRNA were determined by the end point titers of serial, two-fold dilutions of cDNA. The amounts of hepatitis B virus RNA (HBV-RNA) in livers of patients with chronic hepatitis B also were measured by Northern blot hybridization.

RESULTS

TGFalpha mRNA levels were extremely higher in patients with HCC compared with patients with CVH and normal controls, and the levels in patients with CVH also were elevated compared with normal controls. The levels of TGFalpha mRNA were overexpressed in the underlying livers of patients with HCC compared with patients with CVH, although they were lower than those found in HCC tissues. The levels of TGFalpha mRNA were higher in samples from patients with chronic hepatitis B than in samples from patients with chronic hepatitis C. The levels of TGFalpha mRNA were not correlated with serum alanine aminotransferase or HBV-RNA levels in liver tissues in patients with chronic hepatitis B. However, the expression of TGFalpha mRNA tended to be higher in the livers of patients with raised serum alpha-fetoprotein levels.

CONCLUSIONS

The overexpression of TGFalpha mRNA in the liver seems to be associated with the regeneration of hepatocytes rather than hepatic necrosis or viral replication. Also, it may be related closely to the development or progression of HCC, especially in the livers of patients with chronic hepatitis B.

Expression of transforming growth factor-alpha mRNA in livers of patients with chronic viral hepatitis and hepatocellular carcinoma

BACKGROUND

Transforming growth factor-alpha (TGFalpha) is an important autocrine growth factor of hepatocytes. The authors evaluated the roles of TGFalpha in chronic viral hepatitis (CVH) and hepatocellular carcinoma (HCC).

METHODS

The authors measured the amounts of TGFalpha mRNA in liver tissues from 18 patients with HCC, 31 patients with CVH, and 7 normal controls. " Hot-start" reverse transcription-polymerase chain reaction (RT-PCR) using oligo-dT and specific primers detected TGFalpha mRNA in total cellular RNA extracted from liver tissues. The levels of TGFalpha mRNA were determined by the end point titers of serial, two-fold dilutions of cDNA. The amounts of hepatitis B virus RNA (HBV-RNA) in livers of patients with chronic hepatitis B also were measured by Northern blot hybridization.

RESULTS

TGFalpha mRNA levels were extremely higher in patients with HCC compared with patients with CVH and normal controls, and the levels in patients with CVH also were elevated compared with normal controls. The levels of TGFalpha mRNA were overexpressed in the underlying livers of patients with HCC compared with patients with CVH, although they were lower than those found in HCC tissues. The levels of TGFalpha mRNA were higher in samples from patients with chronic hepatitis B than in samples from patients with chronic hepatitis C. The levels of TGFalpha mRNA were not correlated with serum alanine aminotransferase or HBV-RNA levels in liver tissues in patients with chronic hepatitis B. However, the expression of TGFalpha mRNA tended to be higher in the livers of patients with raised serum alpha-fetoprotein levels.

CONCLUSIONS

The overexpression of TGFalpha mRNA in the liver seems to be associated with the regeneration of hepatocytes rather than hepatic necrosis or viral replication. Also, it may be related closely to the development or progression of HCC, especially in the livers of patients with chronic hepatitis B.

Combined therapy consisting of intraarterial cisplatin infusion and systemic interferon-alpha for hepatocellular carcinoma patients with major portal vein thrombosis or distant metastasis

BACKGROUND

Hepatocellular carcinoma (HCC) patients with major vascular involvement or extrahepatic metastasis are not good candidates for surgery or transarterial chemoembolization (TACE). In this study, the authors evaluated the efficacy of combined therapy with intraarterial cisplatin infusion and systemic administration of interferon-alpha (IFN-alpha) as a palliative treatment for these patients.

METHODS

Sixty-eight HCC patients with major portal vein thrombosis (n = 47) or distant metastasis (n = 27) were randomly allocated to 1 of 3 groups. Group I (n = 19) received combined therapy consisting of intraarterial cisplatin infusion and systemic IFN-alpha, Group II (n = 23) received intraarterial cisplatin infusion, and Group III (n = 26) was managed with only supportive care. Cisplatin 2 mg/kg was infused through the proper hepatic artery every 8 weeks, and IFN-alpha 3 million IU/m2 was administered subcutaneously 3 times a week.

RESULTS

The partial response (defined as a 50% or greater reduction in the product of the 2 longest perpendicular tumor measurements) rate of Group I was significantly higher than that of Group II (33% vs. 14%; P < 0.05). Also, the 1-year survival rate of Group I (27%) was higher than that of Group II (9%) or Group III (0%) (P < 0.05 and P < 0.01, respectively). The median survival period of Group I was 19 weeks, which was significantly longer than that of Group II (11 weeks) or Group III (5 weeks) (P < 0.05 and P < 0.01, respectively).

CONCLUSIONS

These results suggest that combined therapy consisting of intraarterial cisplatin infusion and systemic IFN-alpha may be useful as a palliative treatment for HCC patients with major vascular involvement or extrahepatic metastasis.

Persistent endemicity of Gymnophalloides seoi infection in a southwestern coastal village of Korea with special reference to its egg laying capacity in the human host

Follow-up studies have been conducted every three years on the endemicity of Gymnophalloides seoi infection in a small coastal village of Chollanam-do (Province), Korea, since it was first known as an endemic area in 1994. Special attention was given to its egg laying capacity in the human host. In fecal examinations, the overall helminth egg and/or cyst positive rate was 78.7% (74/94) in 1997 and 76.6% (82/107) in 2000. Among them G. seoi eggs showed the highest rate; 71.3% (67/94) in 1997 and 72.0% (77/107) in 2000. The average number of eggs per gram of feces (EPG) was 1,015 in 1997, while a reduced rate of 353 was observed in 2000. In 1997, total of 320,677 adult flukes of G. seoi (av. 10,344/person, 94-69,125 in range) were collected from the diarrheic stools of 31 treated patients. The EPG/worm obtained from 21 cases ranged from 0.04 to 0.77 (av. 0.23), suggesting density-dependent constraints on the worm fecundity. The relationship between the worm burden (X) and EPG/worm (Y) can be expressed as Y = 0.42.e-1.2 chi (r = 0.49). The results showed that G. seoi infection is persistently endemic in this village.

Analysis of the gene family encoding lipases in Candida rugosa by competitive reverse transcription-PCR

Synthesis of multiple extracellular lipases in Candida rugosa has been demonstrated. However, it is difficult to characterize the expression spectrum of lip genes, since the sequences of the lip multigene family are very closely related. A competitive reverse transcription-PCR assay was developed to quantify the expression of lip genes. In agreement with the protein profile, the abundance of lip mRNAs was found to be (in decreasing order) lip1, lip3, lip2, lip5, and lip4. To analyze the effects of different culture conditions, the transcript concentrations for these mRNA species were normalized relative to the values for gpd, encoding glyceraldehyde-3-phosphate dehydrogenase. In relative terms, lip1 and lip3 were highly and constitutively expressed (about 10(5) molecules per microg of total RNA) whereas the other inducible lip genes, especially lip4, showed significant changes in mRNA expression under different culture conditions. These results indicate that differential transcriptional control of lip genes results in multiple forms of lipase proteins.

Factors affecting human cytomegalovirus gene expression in human monocyte cell lines

To understand the mechanisms for establishing and reactivating monocytes and macrophages from latency by human cytomegalovirus (HCMV), human monocyte cell lines were infected and HCMV gene expression was investigated. Indirect immunofluorescence assay (IFA) with monoclonal antibody to HCMV major immediate early (MIE) IE1 or IE2 proteins revealed that HCMV MIE genes were expressed at low levels in relatively more differentiated THP-1 cells with TPA treatment after virus infection (posttreatment). Less differentiated cells such as U937 or HL60 did not support MIE gene expression even after TPA treatment. If THP-1 cells were pretreated before virus infection with TPA and became differentiated at the time of HCMV infection, MIE gene expression increased by 5-6 fold. Therefore, the relative degree of monocyte cell differentiation appears to be an important factor for regulating HCMV gene expression. Further IFA studies using monoclonal antibodies specific for IE1 or IE2 proteins indicate that the sequence and general pattern of IE1 and IE2 gene expression in THP-1 cells treated with TPA were similar to those in permissive human fibroblast cells with some delay in time. Formation of the replication compartment detected with monoclonal antibody to HCMV polymerase accessory protein UL44 in THP-1 cells suggests a fully productive replication process of HCMV in these cells. Monocytes are known to be induced to differentiate by hydrocortisone (HC), tumor necrosis factor (TNF)-alpha or interferon (IFN)-gamma. HC, which is known to stimulate HCMV replication in permissive human fibroblast (HF) cells, enhanced HCMV gene expression by 2-3 fold in TPA-pre or posttreated THP-1 cells, but TNF-alpha or IFN-gamma had little effect. Nitric oxide (NO) is released by immune cells in the defense against foreign stimuli and was shown to inhibit HCMV gene expression in HF cells. Increasing NO by nitroprusside significantly reduced HCMV gene expression in THP-1 cells. Therefore, it appears that the expression of HCMV immediate early genes in THP-1 cells treated with TPA closely resembles those in permissive HF cells.

Myelin degeneration in multiple system atrophy detected by unique antibodies

A rabbit antiserum (anti-EP), induced against a synthetic peptide corresponding to residues 68 to 86 of guinea pig myelin basic protein, powerfully immunostained abnormal-appearing oligodendrocytic processes and cell bodies in demyelinating areas associated with multiple system atrophy (MSA). However, as we reported previously, the antiserum, which is highly specific for the sequence QDENPVV corresponding to human myelin basic protein residues 82 to 88, failed to recognize any structures in normal human brain. QD-9, a mouse monoclonal antibody raised against human myelin basic protein residues 69 to 88, which also recognizes specifically the epitope QDENPVV, gave the same results as did anti-EP. The unusual epitope recognized by anti-EP/QD-9 antibodies appears to be accessible in areas of myelin degeneration, and the antibodies have been shown to detect such areas in multiple sclerosis and infarcted brains. These antibodies detect myelin degeneration more widely than previous conventional methods. The present study emphasizes the importance of myelin degeneration in the pathogenesis of multiple system atrophy.

Timing of dexamethasone treatment in experimental Staphylococcus aureus endophthalmitis

PURPOSE

This study sought to determine whether intravitreal dexamethasone with vancomycin preserves retinal function in eyes with experimental Staphylococcus aureus endophthalmitis better than intravitreal vancomycin alone.

METHODS

Twenty-four rabbits received intravitreal injections in both eyes with S. aureus. Right eyes were treated with intravitreal dexamethasone plus vancomycin and left eyes were treated with vancomycin alone at 24, 36, 48, or 72 hours after inoculation. Evaluation was performed by slit-lamp biomicroscopy, indirect ophthalmoscopy, and electroretinogram. Vitreous humor cultures and histopathologic examinations were performed on the eyes after the rabbits were killed.

RESULTS

The combination of intravitreal dexamethasone and vancomycin resulted in significantly less inflammation than vancomycin alone at 24 and 36 hours after inoculation, but electroretinograms showed significantly better preservation only at 36 hours after bacterial inoculation. Viable bacteria were cultured from eyes treated 48 and 72 hours after inoculation.

CONCLUSION

Intravitreal dexamethasone was found to be beneficial by electroretinography when administered 36 hours after infection. In the authors' model, a single intravitreal injection of vancomycin with or without the addition of dexamethasone was insufficient to sterilize eyes 48 and 72 hours after bacterial inoculation.

Unmasking of an unusual myelin basic protein epitope during the process of myelin degeneration in humans: a potential mechanism for the generation of autoantigens

A rabbit antiserum (anti-EP), induced against a synthetic peptide corresponding to residues 68 to 86 of guinea pig myelin basic protein, powerfully immunostained abnormal-appearing oligodendrocytic processes and cell bodies in demyelinating areas associated with multiple sclerosis plaques. However, it failed to recognize any structures in normal human, rat, or guinea pig brain. The antiserum recognized the synthetic peptide QDENPVV, which corresponds to human myelin basic protein residues 82 to 88. Immunoabsorption with this peptide eliminated immunohistochemical staining. By contrast, several commercial antibodies recognizing nearby sequences of human myelin basic protein intensely stained all myelinated structures in both normal and multiple sclerosis tissue. The unusual epitope recognized by anti-EP appears to be accessible only in areas of myelin degeneration. If insults occur that repeatedly expose a region of MBP normally sheltered from immunosurveillance, a self-sustaining immune reaction might result.

Improving the design of muscle relaxant studies. Stabilization period and tetanic recruitment

BACKGROUND

The results from studies of muscle relaxants show wide variations among institutions. The authors hypothesized that some of this variability could be explained by differences in duration of nerve stimulation before drug administration (stabilization period).

METHODS

Train-of-four stimulation was applied every 12 s to both ulnar nerves and adductor pollicis twitch tension was measured in anesthetized participants given 30 micrograms/kg vecuronium. In phase 1, the stabilization period was > 30 min for both extremities. In phase 2-4, stabilization period was 20 min for one extremity and 2 min for the other. In addition, in phase 3, a 2-s 50-Hz tetanus initiated the 2-min stimulation period; in phase 4, duration of tetanus was 5 s. Twitch recovery was recorded until stable for more than 15 min. Time to 25% recovery (clinical duration) was calculated based on two indices: predrug and final (recovery) twitch tension. Values for onset and clinical duration were compared by paired parametric and nonparametric tests.

RESULTS

In phase 1, predrug and recovery twitch tension were similar in each extremity, and onset and clinical duration did not differ between extremities, permitting paired comparisons in remaining studies. In phase 2, onset was more rapid with 20-min of prestimulation. With 20-min prestimulation, predrug and recovery twitch tension were similar; with 2-min prestimulation, recovery twitch tension exceeded predrug values. When referenced to predrug twitch tension, clinical duration was shorter with 2-min, that with 20-min prestimulation. Initiating stimulation with 2-s or 5-s 50-Hz tetani (phases 3, 4) abolished differences between extremities in onset and recovery.

CONCLUSIONS

With only train-of-four stimulation (no tetani), onset and clinical duration vary with duration of prestimulation, suggesting that a brief period of predrug stimulation is inadequate. However, lengthy prestimulation may be impractical in clinical studies. Tetanic stimulation for 2 or 5 s obviates the need for prolonged stabilization during studies of muscle relaxants.

The human cytomegalovirus UL94 open reading frame encodes a conserved herpesvirus capsid/tegument-associated virion protein that is expressed with true late kinetics

In this report, we provide a detailed characterization of the human cytomegalovirus (HCMV) UL94 gene product. Northern (RNA) blot analysis of infected cell RNA demonstrated that UL94 message was found only at late times of infection and was not synthesized in the presence of the viral DNA replication inhibitor ganciclovir. Expression of the UL94 open reading frame in vitro and in vivo yielded a protein with the predicted molecular mass of 36 kDa. A monoclonal antibody raised to a UL94-specific peptide reacted specifically with a 36-kDa protein in HCMV-infected fibroblasts. This protein was found only at late times of infection and was also present in purified HCMV virions. Fractionation of purified virions and HCMV-infected cells revealed an association of UL94 immunoreactivity with the capsid/tegument and nuclear fractions, respectively. The evolutionary conservation of UL94 protein sequence and an analysis of potential functional regions of the protein are discussed.

Identification of glucocorticoid response element of the rat TRH gene

OBJECTIVES

It was suggested that glucocorticoid exerts cell-specific effects on thyrotropin-releasing hormone (TRH) gene expression at the transcriptional level. Although there is no typical palindromic glucocorticoid response element (GRE) on the rat TRH gene promoter, a perfect GRE half-site is found between -205 bp and -211 bp. We investigated whether the segment between -242 bp and -200 bp of the rat TRH gene promoter is responsible for glucocorticoid response.

METHODS

For the 5' deletion study of the TRH gene, four different plasmid constructs, pTRH(- 554/84), pTRH(-242/84), pTRH(-200/6), pTRH(-113/84) were used for transient transfection study. The plasmid pMAMneo-LUC was used as a positive control and pRSV-GR expression vector, as a co-transfection study. Transfection was performed by the modified calcium precipitation method with 2 micrograms of each lasmid on the HeLa cells.

RESULTS

Dexamethasone (DEX) stimulated the transcriptional activity of pTRH(-554/84)-LUC and pTRH(-242/84)-LUC by approximately 3.2 fold at 10(-8) M and 5.4 fold at 10(-8) M. On the contrary, deletion of the region between -242 to -200 bp reduced the basal transcriptional activity by 90% and also completely abolished the DEX-induced transcriptional activation of the luciferase gene. The DEX-induced transcriptional activation of pTRH(-242/84)-LUC was in dose-dependent manner. While the co-transfection of glucocorticoid receptor expression vector (pRSV-GR) did not increase the basal transcriptional activity of pMAMneo-LUC, it increased the basal transcription of pTRH(-242/84)-LUC by 1.8 fold. The pRSV-GR co-transfection and DEX treatment further increased the transcription of pTRH(-242/84)-LUC by 2-4 fold at the concentration of 10(-8) M.

CONCLUSION

These findings suggest that a cis-acting element(s) which is important for the basal transcriptional activation and glucocorticoid response of the rat TRH gene is located between -242 bp and -200 bp. The gene has a weak GRE glucocorticoid response and seems to be mediated by an interaction between glucocorticoid receptor and other transcriptional factor (s).

Elevated numbers of proliferating mononuclear cells in the peripheral blood of psoriatic patients correlate with disease severity

Although psoriasis is characterized by the accumulation of activated proliferating lymphoid cells in the psoriatic skin lesion, it is not known whether these cells are activated and proliferating before entry into the psoriatic plaque. The current study evaluates the number and phenotype of proliferating lymphoid cells in the blood of psoriatic patients. Proliferation of peripheral blood mononuclear cells was evaluated on cytospun preparations of these cells using autoradiographic techniques after pulsing the mononuclear cells with 3H-methyl thymidine for 2 h. The phenotypes of the labeled peripheral blood mononuclear cells were determined combining autoradiography and immunohistochemistry with monoclonal antibodies directed at CD3, CD4, CD8, CD11c, CD22, and human leukocyte antigen-DR. The data demonstrated elevated numbers of proliferating lymphoid cells in the blood of psoriatic patients compared with normal nonpsoriatic volunteers (p < 0.01). Furthermore, the number of circulating proliferating mononuclear cells increased significantly with increasing psoriasis skin disease severity (correlation coefficient 0.95; p < 0.0001). When the phenotype of the proliferating cells in the blood was examined, the numbers of T cells (CD3+, CD4+, CD8+ cells), B cells (CD22+ cells), monocytes (CD11c+ cells), and human leukocyte antigen-DR+ cells were significantly elevated compared with nonpsoriatic skin (p < 0.01) and increased with increasing disease activity (correlation coefficient range 0.48-0.74; p < 0.05). The data suggest a generalized systemic activation of T, B, and monocytic cells that results in labeling of up to 0.16% of the circulating mononuclear cells with 3H-methyl thymidine (i.e., proliferating and presumably activated) when assayed in vitro.

Detection of amplified Y chromosome-specific sequence by capillary electrophoresis with laser-induced fluorescence

OBJECTIVE

To develop a sensitive method for genetic diagnosis using capillary electrophoresis with laser-induced fluorescence.

DESIGN

Using male DNA diluted with female DNA as an example, ZFY gene from Y chromosome was amplified specifically by polymerase chain reaction (PCR) with fluorescence-labeled primers and detected by capillary electrophoresis with laser-induced fluorescence.

SETTING

Laser operating laboratory.

PARTICIPANTS

Human male and female DNA were extracted from healthy human male and female subjects.

INTERVENTIONS

None.

MAIN OUTCOME MEASURES

The concentration of human DNA was determined by using a spectrophotometer at an absorbance of 260 nm.

RESULT

Deoxyribonucleic acid fragments amplified from a single copy of ZFY gene were detected by capillary electrophoresis with laser-induced fluorescence after 35 cycles of PCR amplification.

CONCLUSION

This method is potentially applicable for rapid and sensitive detection of fetal Y chromosome DNA sequence in maternal circulation and of single-cell DNA diagnosis.

Antimicrobial resistance of bacterial pathogens at two tertiary-care centers, in Riyadh and Texas

Antimicrobial resistance of bacterial pathogens usually varies from one geographic location to another. During the last 20 years, outbreaks of disease caused by multiresistant bacteria have occurred with higher frequency in developing countries. We investigated the antimicrobial resistance patterns of bacteria isolated in 1992 from two tertiary-care centers, in Riyadh and Texas. Of the 8841 strains used, 5318 were isolated from clinical specimens of patients at King Faisal Specialist Hospital and Research Centre, Riyadh, and 3523 were from Olin E. Teague Veterans Medical Center, Temple, Tex. Members of Enterobacteriaceae at the King Faisal hospital were significantly more resistant to frequently prescribed antimicrobials than were those at the Olin Teague center. Susceptibility to less frequently used agents like ciprofloxacin and ceftazidime was similar at both hospitals. Resistance patterns of Pseudomonas aeruginosa, Haemophilus influenzae, and coagulase-negative staphylococci were similar at both medical centers. The Olin Teague center encountered significantly more methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococci.

A case of echinostomiasis with ulcerative lesions in the duodenum

Echinostomiasis is an endemic intestinal trematodiasis of humans in Korea. We observed a human case of Echinostoma hortense infection who had ulcerations on the duodenal mucosa. A 55-year old man living in Hamyang-gun, Kyongnam, complained of epigastric pain with hematemesis in April 1994. Endoscopy revealed lesions of early gastric cancer and duodenal ulcerations. A penetrating parasite into the duodenal mucosa was picked out, and identified as E. hortense. As the patient was treated with praziquantel 10 mg/kg single dose, 3 more E. hortense and 7 Metagonimus worms were recovered. This case demonstrates that echinostomiasis causes gross ulcerations in the duodenum.

A case of coincident multiple myeloma and non-Hodgkin's lymphoma

A rare case of coexisting multiple myeloma and non-Hodgkin's lymphoma at the time of diagnosis is presented. The patient presented with petechiae, melena and weight loss. IgA lambda monoclonal gammopathy in the serum and free lambda chain in urine were documented. Bone marrow biopsy demonstrated an interstitial infiltration of neoplastic plasma cells coexisting with localized collection of neoplastic lymphoid cells composed of monotonous small lymphocytes with occasional cleaved nuclei. Immunophenotype of plasma cell was IgA lambda. The patient also had a jejunal mass, with biopsy proven malignant lymphoma, diffuse small cleaved cell type. The tumor was diffusely positive for pan-B marker. After chemotherapy, the IgA lambda monoclonal protein decreased and the patient improved. This case suggest, that the seound B-cell neoplasm may have evolved by transformation of an original neoplastic clone, or that malignant tumors may be polyclonal at onset. Definitive diagnosis and staging of each disorder is important for proper management.

Synthesis and carbonic anhydrase inhibitory activity of 4-substituted 2-thiophenesulfonamides

A series of 4-substituted 2-thiophenesulfonamides was prepared from 3-thiophenecarboxaldehyde using metalation chemistry developed for 3-furaldehyde. Several of these compounds inhibit carbonic anhydrase II in vitro at concentrations of less than 10 nM. In addition, none of these compounds exhibit sensitization potential as determined from in vitro measurement of cysteine reactivity.

A case of giant hemangioma of the liver presenting with fever of unknown origin

A 37 year-old-woman was admitted to the hospital because of 15 days' duration of continuous fever. Routine studies for detection of fever foci were negative. Imaging studies revealed giant hemangioma of the liver with central thrombosis. The fever persisted for a period of 4 weeks, and subsided after conservative management. We report a case of hepatic hemangioma presenting with fever of unknown origin. The condition is very rare, but should be regarded as one of the causes of fever of unknown origin.

Comparative antibacterial activity of the aminothiazolyl cephalosporin RU 29,246

A total of 1,007 clinical isolates from a tertiary care center were tested against RU 29,246, ampicillin, cephalothin, cefoxitin, ceftazidime, Augmentin, oxacillin, piperacillin, gentamicin, amikacin and vancomycin. Bacteria tested consisted of 479 strains of Enterobacteriaceae, 64 pseudomonads, 18 Xanthomonas, 42 other gram-negative bacilli, 56 enterococci and 348 isolates of staphylococci. RU 29,246 showed excellent in vitro activity inhibiting > 90% of Escherichia coli, Klebsiella pneumoniae, K. oxytoca, Enterobacter, Proteus mirabilis, Providencia, Morganella, Salmonella, Shigella, Aeromonas hydrophila, and methicillin-susceptible Staphylococcus aureus at an MIC of 0.5-1.0 mg/l. Seventy-seven percent coagulase-negative staphylococci had an MIC of 1.0-4.0 mg/l. All strains of Pseudomonas aeruginosa and X. maltophilia were resistant to RU 29,246. Fifty-six percent of the enterococcal isolates were inhibited by 1.0-16.0 mg/l of RU 29,246.

Incidence of bacterial respiratory pathogens and their susceptibility to common antibacterial agents

Although most respiratory tract infections are caused by viruses, bacterial pathogens are responsible for higher morbidity and mortality. Because virtually nothing is known about the etiology of bacterial respiratory pathogens in Saudi Arabia, this study examined the incidence of these organisms in 5426 patients over a 1-year period. Of the bacterial pathogens isolated from 904 patients, the most common organism was Hemophilus influenzae (31%), followed by pneumococci (22%), Pseudomonas aeruginosa (16%), and others (31%). Because the first two organisms accounted for more than 50% of isolates, their susceptibility to commonly used antibiotics was also reviewed. The results are presented here.

CI-990 (PD 131112): A new quinolone prodrug

In vitro susceptibility of 1021 strains of recent clinical isolates was determined against the new fluoroquinolone CI-990 (PD 131112) and compared with CI-960, ciprofloxacin, fleroxacin, lomefloxacin, norfloxacin, perfloxacin, sparfloxacin, and temafloxacin. The minimum inhibitory concentrations (MIC) of CI-990 in mg/L required for >90% isolates were 0.03-0.5 for members of Enterobacteriaceae, 0.12-2.0 for Pseudomonas aeruginosa, 0.03-1.0 for Aeromonas hydrophilia, 1.0-2.0 for Acinetobacter calcoaceticus, 0.5-2.0 for Brucella melitensis, 0.06-1.0 for staphylococci, and 1.0-2.0 for enterococci. Its antibacterial activity was comparable or superior to other fluroquinolones tested against most gram-negative and gram-positive bacteria, including enterococci.

Seroepidemiology and evaluation of passive surveillance during 1988-1989 measles outbreak in Taiwan

A seroepidemiological study was carried out to explore the risk factors of a measles outbreak that occurred among school children at a rural village (Li-Tse) in Taiwan. Among the 1166 participants, the percentage susceptible before the outbreak was 10.5% (122/1158) which was estimated as the sum of measles IgG-negative (29/1158) and IgM-positive (93/1166) individuals. Among 340 vaccinated children, 16 (4.7%) were measles IgM-positive and 10 (2.9%) were measles IgG-negative; therefore the vaccine failure rate was estimated to be 7.6% (26/340) and vaccine efficacy was 79.7% (95% confidence interval [CI] : 65.0-88.5). The most important risk factors for acquiring measles infection were the presence of other measles cases in the family (Odds Ratio [OR] = 32.5, P = 0.002) and the presence of more than two cases in a class (OR = 29.1, P = 0.003). The physician reporting rate was 6.1% (4/66), and the sensitivity of passive measles surveillance was only 4.3% (4/93) by active serosurvey. A concomitant rubella epidemic also amplified the inaccuracy of a passive reporting system based only on clinical diagnosis. Five children developed measles IgM but did not experience any symptoms, indicating that asymptomatic measles infection can occur. Our experience has highlighted three important areas for future measles elimination: (1) the need for serological evaluation of vaccinees, particularly those who were born during the introduction of mass immunization; (2) improvement in measles vaccine efficacy; and (3) further investigations on the role of asymptomatic transmission and susceptibles who remain after mass immunization.

Numerical simulation for the propagation of nonlinear pulsatile waves in arteries

The behavior of nonlinear pulsatile flow of incompressible blood contained in an elastic tube is examined. The theory takes into account the nonlinear convective terms of the Navier-Stokes equations. The motion of the arterial wall is characterized by a set of linearized differential equations. The region bounded by the flexible arterial wall is mapped into a fixed area in which numerical discretization takes place. The finite element method (Galerkin weighted residual approach) is used for the solution of this nonlinear system. The results obtained are pressure distribution, velocity profile, flow rate and wall displacements along the elastic tube (20 cm long).

Can isolation of Aeromonas hydrophila from human feces have any clinical significance?

A total of 27,480 stool specimens from 15,548 patients with gastroenteritis were analyzed for bacterial enteropathogens during a 4-year period between 1986-89 at a major referral center in Saudi Arabia. Bacterial pathogens were isolated from 1,152 patients, Salmonella being the most frequent, followed by Campylobacter, Shigella, and Aeromonas hydrophila. The latter bacterium was found in 58 patients; seven of them were associated with other enteric pathogens, but A. hydrophila was the only organism in 51 patients. All had gastrointestinal symptoms, the most common being diarrhea (92%), followed by abdominal pain (68%), fever (37%), and vomiting (27%). Stool specimens from 1,368 control patients were negative for A. hydrophila.

In vitro activity of lomefloxacin, a difluorinated quinolone, compared with other antimicrobials

A total of 3,144 clinical isolates from 3,011 consecutive patients were tested against lomefloxacin by the agar dilution method. They consisted of 1,380 isolates of Enterobacteriaceae, 527 pseudomonads, 47 Haemophilus influenzae, 53 Acinetobacter, 42 Brucella melitensis, 903 staphylococci and 192 strains of enterococci. In vitro activity of lomefloxacin was compared with ciprofloxacin, norfloxacin, beta-lactams and aminoglycosides. Over 98% of Enterobacteriaceae were susceptible to lomefloxacin with an MIC of 0.06-4.0 micrograms/ml. It also inhibited 93 and 85% clinical isolates of Pseudomonas aeruginosa and Xanthomonas maltophilia, respectively. All isolates of Haemophilus, Brucella and Staphylococcus aureus were susceptible to this fluoroquinolone. However, only 43% of the 192 strains of enterococci exhibited in vitro susceptibility. Lomefloxacin was found to be comparable to ciprofloxacin and norfloxacin in its in vitro activity, and superior to most penicillins, cephalosporins and aminoglycosides against both gram-negative and gram-positive bacteria except enterococci.

Theoretical and computational investigations of nonlinear wave propagations in arteries. (I)--A theoretical model of nonlinear pulse wave propagations

In this paper, a new theoretical model of nonlinear wave propagations in arteries with surrounding tissues was put forward. The equations of motion for the blood vessels and their peripheral tissues as a system have been derived. These equations were expressed in terms of the stresses of the vessel wall and fluid, and the geometry of the blood vessel. They can be used to solve numerically the problems for the propagations of nonlinear pulse waves in arteries together with the momentum and continuity equations of incompressible-viscous flow, as well as the constitutive equations of fluid and vessel wall. The numerical solutions can involve pressure, velocities and flowrate of the blood flow, as well as displacements, velocities and stresses of the vessel wall. These physical variables of propagations of pulse waves in arteries are all of significance physiologically and clinically.

Osteomyelitis associated with pressure ulcers

Bone biopsies were performed in spinal cord injured patients with pressure ulcers in whom osteomyelitis was suspected. Roentogenograms and bone and gallium scans were also evaluated to determine their usefulness in diagnosing osteomyelitis. Infected bone underlying pressure ulcers revealed only mild focal inflammatory changes which did not correlate well with x-ray and nuclear scan abnormalities. Negative scans, however, essentially ruled out osteomyelitis. There was no clear association of delayed healing or recurrence of pressure sore with osteomyelitis. Antibiotic therapy of greater than three weeks' duration did not significantly affect the outcome of the disease.

Electrochemistry of purine derivatives. 1: Direct determination for the antiviral drug 9-[(1,3-dihydroxy-2-propoxy)methyl]guanine by anodic differential pulse voltammetry

Differential pulse voltammetry at a stationary glassy carbon electrode was used for the sensitive and selective analysis of a potent new antiviral analogue of 2-deoxyguanosine in a pharmaceutical formulation. In the electrochemical method for analysis of 9-[1,(3-dihydroxy-2-propoxy)methyl] guanine (1), an electroactive internal standard (uric acid) was used. Linear peak current-concentration relationships were obtained at 1 concentrations of 0.4-2.0 mM, with a quantitation limit of 0.1 mM. Degraded solutions of 1 were assayed directly by differential pulse voltammetry and also by two chromatographic methods to demonstrate the specificity of the electrochemical method. The voltammetric method reliably provides accurate and reproducible results in considerably less time than conventional chromatographic analysis.

Nonlinear elastic analysis of blood vessels

Based on the theory of Green and Adkins [9], a strain energy function is proposed to describe the nonlinear mechanical behavior of arteries. The arterial tissue is assumed to be a nonlinear elastic, incompressible material with local triclinicity and transverse isotropy. Although the arterial tissue shows viscous phenomena, experimental results have indicated that viscosity is only a second-order effect as compared to the nonlinear elasticity of the tissue. The advantage of the formulation presented herein is that it is relatively simple and results in an accurate stress-strain relation that can be used readily for the study of wave propagations in the blood vessels. For nonlinear finite strain elasticity of the order two, ten elastic constants are needed to describe the material nonlinearity of the arterial tissue. Based on the orthogonal, transverse isotropies and the incompressibility conditions, ten constraint equations may be established and the elastic constants can be uniquely determined by correlating with the experimental results. An example of calculating these elastic constants is made by using the experimental data of Patel, et al. [14-17] for the intercoastal arteries in living dogs. The predicted mechanical behavior of canine arteries is quite satisfactory as compared to the experimental data except when the longitudinal and the circumferential stretches exceed 1.60. However, such a strain magnitude may not be expected in in-vivo arteries because of the constraints of peripheral connecting tissues. Otherwise, the strain energy function including higher order strain terms should be used.(ABSTRACT TRUNCATED AT 250 WORDS)

On nonlinear viscoelastic properties of arterial tissue

Nonlinear viscoelasticity is important in a variety of studies in biomechanics. One of the subject areas is the necessity to characterize the dynamic properties of blood vessels. This study concerns a theoretical formulation to examine the higher order nonlinear viscoelastic relaxation functions for arterial tissue based on the assumption of transversely isotropic material properties. Simple numerical results for the first-order theory are compared with those available in the literature.

4-Chloro-6-methoxyindole is the precursor of a potent mutagen (4-chloro-6-methoxy-2-hydroxy-1-nitroso-ndolin-3-one oxime) that forms during nitrosation of the fava bean (Vicia faba)

Fava beans (Vicia faba) upon treatment with nitrite under simulated gastric conditions, form a direct-acting bacterial mutagen, comparable in specific activity to the most potent known mutagens for several strains of Salmonella typhimurium. The precursor of the mutagen was isolated and identified as 4-chloro-6-methoxyindole by u.v., i.r., m.s. and n.m.r. The precursor was dechlorinated with NaBH4 and PdCl2 as the catalyst and the product obtained from this reaction was identified as 6-methoxyindole. Since synthetic 4-chloro-6-methoxyindole was not available, structure activity studies were conducted on substituted indoles. Nitrosation of 4-chloroindole closely follows the results for nitrosation of 4-chloro-6-methoxyindole. The major product of nitrosation of 4-chloroindole is 4-chloro-2-hydroxy-N1-nitroso-indolin-3-one oxime. Thus, it appears that the major nitrosation product of 4-chloroindole and of 4-chloro-6-methoxyindole is a stable alpha-hydroxy N-nitroso compound. This is the first reported case of stable alpha-hydroxy N-nitroso compounds. In the presence of N-(1-naphthyl)ethylenediamine dihydrochloride (NEDD), the alpha-hydroxy N-nitroso compound rearranges to an aromatic diazonium ion which couples with the diamine to form an azo dye. Studies on nitrosation kinetics indicate that the nitrosation of indoles are relatively fast reactions. Both the structural and rate studies give strong support to the hypothesis that intragastric nitrosation of fava beans yield the putative gastric carcinogen in the high-risk area in Colombia.

Prevention of perinatally transmitted hepatitis B virus infections with hepatitis B immune globulin and hepatitis B vaccine

A randomised blind controlled trial of hepatitis B immune globulin (HBIG) plus hepatitis B vaccine for the prevention of the perinatally transmitted HBsAg carrier state was conducted in Taipei. Infants of e-antigen-positive HBsAg carrier mothers were given HBIG immediately after birth, and then one of three schedules of vaccination. There was no difference in efficacy between the three schedules; the combined efficacy was 94%, compared with that of HBIG alone (71%) or of vaccination alone (75%). Persistent HBs antigenaemia developed in only 9 (6%) of the 159 infants receiving prophylaxis, but in 88% of the controls. Antibodies developed in all those who did not become antigenaemic and presumably will provide long-term protection from hepatitis B virus infection. HBIG should be given as soon as possible after birth and need not be given again if the infant is subsequently vaccinated. With HBIG coverage from birth, the timing of the start of vaccination does not seem to be of importance within the first month of life, but to maximise compliance and minimise costs hepatitis B vaccination should be initiated during the confinement.

Immunogenicity of hepatitis B virus vaccine in healthy Chinese neonates

The immunogenicity of hepatitis B virus vaccine was studied in 38 Chinese neonates, 23 of whom were healthy and susceptible and 15 of whom had passive serum antibody to hepatitis B surface antigen (anti-HBs). Initially, each infant received two 20-micrograms doses of vaccine by the intramuscular route, with a one-month interval between doses. No adverse reactions occurred, and all susceptible neonates had a brisk antibody response that was comparable to that in older infants and children and superior to that in adults. The first dose of vaccine stimulated the production of anti-HBs within one month in 48% of the neonates. Anti-HBs was detectable in the serum of 91% of the vaccinees at the age of three months--that is, two months after the second dose. By the age of six months, 96% of vaccinees had detectable anti-HBs in their serum. All vaccinees developed anti-HBs after a third dose was administered at the age of seven months. High levels of anti-HBs were sustained after vaccination in infants who initially had passive antibodies.