[Association between serum lysophosphatidylcholine level and elderly health index in older people from longevity areas of Guangxi Province]

Objective: To investigate the relationship between serum lysophosphatidylcholine (LPC) level and the health index of the elderly. Methods: A total of 251 subjects were selected from the 2016 baseline survey of the Yongfu Longevity Cohort in Guangxi Province among whom 66, 63 and 122 were in the young and middle-aged group (≤59 years old), the young group (60-89 years old) and the longevity group (≥90 years old), respectively. Demographic data were collected and related indicators of height, weight, blood pressure and lipid metabolism were measured. The cognitive and physical functions of the elderly were assessed by the results of the simple mental state scale and the daily living activity scale to construct the health index of the elderly. The serum levels of LPC16∶0, LPC18∶0, LPC18∶1 and LPC18∶2 were determined by liquid chromatography-tandem mass spectrometry, and the differences among different ages and health status groups were compared. The logistic regression model was used to analyze the relationship between the serum LPC level and the health index of the elderly. Results: With the increase in age, the proportion of female subjects increased, and the rate of smoking and drinking decreased. BMI, TC, TG, LDL-C, diastolic blood pressure, and the four LPCs levels decreased with the increase of age, and systolic blood pressure levels increased with the increase of age (all P values<0.05). There was no significant difference in HDL-C levels among age groups (P>0.05). With the decline of health status in the elderly, serum levels of LPC16∶0, LPC18∶0, LPC18∶1 and LPC18∶2 showed a downward trend (all P values<0.001). After adjusting for age and gender, only LPC18∶0 was associated with the health status in old age [OR (95%CI): 0.48 (0.25-0.92)]. For every 1 standard deviation (16.87 nmol/L) increase in serum LPC18∶0 concentration, the risk of poor health status in old age decreased by 52%. Conclusion: Serum LPC18∶0 was associated with the health status in old age independent of age and sex.

[Research progress on main disease-related factors of healthy life expectancy]

International research on healthy life expectancy (HALE) focuses on inequality of socioeconomic status and individual natural attributes. With the acceleration of population ageing and the increase in average life expectancy, the extension of unhealthy life expectancy and the increase of social and economic burden caused by diseases have gradually attracted the attention of countries around the world. Therefore, the evaluation of disease factors affecting HALE is a meaningful direction in the future. This study introduces the development process and commonly used measurement methods of HALE. According to the definition of health from the Global Burden of Disease Study and World Health Organization, physical and mental diseases such as cardiovascular and cerebrovascular diseases, chronic respiratory diseases, diabetes, malignant tumors and depression were selected to summarize the impact of these diseases and pre-disease states on HALE. It is expected to provide a theoretical basis for the formulation of relevant public health policies and the improvement of quality of life in China.

[Association between pulse pressure and new-onset diabetes in hypertensive patients]

Objective: To determine the association between pulse pressure and the risk of new-onset diabetes in hypertensive patients. Methods: In this prospective cohort study, hypertensive patients from the Kailuan Study, who were diagnosed in 2006-2007 check-up, were screened for enrollment. Participants who finished the biennial follow-up until December 31, 2017 were finally included in this analysis. The primary outcome was incident diabetes development. The pulse pressure variables were divided into quartiles (Q1-Q4), and the Kaplan-Meier curve was used to examine and estimate the cumulative incidence of new-onset diabetes among quartiles. Cox proportional hazards regression model was performed to explore the association between pulse pressure and the risk of new-onset diabetes in hypertensive patients. Results: During an average follow-up of 8.17 years, 6 617 new-onset diabetes were identified out of the 32 917 hypertensive patients with no history or evidence of diabetes in 2006-2007 check-up. Participants were classified into quartiles according to pulse pressure levels as follows: Q1 group(<41 mmHg (1mmHg=0.133kPa))(n=7 995); Q2 group(41-<51 mmHg) (n=8 196); Q3 group (51-<61 mmHg) (n= 8 270); Q4 group (≥61 mmHg) (n=8 456). The cumulative incidences of new-onset diabetes across the quartiles were 16.94%, 19.61%, 21.07%, and 22.33%, respectively, with the incidence density was 20.27, 23.20, 24.92, and 26.10 per 1 000 person-years, respectively. The cumulative incidence of new-onset diabetes increased in proportion with increasing pulse pressure levels (P<0.01 by the Log-rank test). After multivariate adjustment, compared with the first quartile, the hazard ratios for new-onset diabetes in the third and fourth quartiles were 1.13 (95%CI 1.04-1.22, P<0.01) and 1.14 (95%CI 1.05-1.24, P<0.01), respectively. The risk of new-onset diabetes increased 5%(HR=1.05, 95%CI 1.02-1.08, P<0.01) with the fractional pulse pressure increased per 1 SD (0.13). Findings from the three sensitivity analyses were consistent with the main results in this cohort. Conclusions: Pulse pressure at baseline is positively associated with the incidence of new-onset diabetes among hypertensive individuals, and pulse pressure is an independent risk factor for the development of diabetes in hypertensive patients.

Machine Learning-Based Prediction of Small Intracranial Aneurysm Rupture Status Using CTA-Derived Hemodynamics: A Multicenter Study

BACKGROUND AND PURPOSE

Small intracranial aneurysms are being increasingly detected while the rupture risk is not well-understood. We aimed to develop rupture-risk models of small aneurysms by combining clinical, morphologic, and hemodynamic information based on machine learning techniques and to test the models in external validation datasets.

MATERIALS AND METHODS

From January 2010 to December 2016, five hundred four consecutive patients with only small aneurysms (<5 mm) detected by CTA and invasive cerebral angiography (or surgery) were retrospectively enrolled and randomly split into training (81%) and internal validation (19%) sets to derive and validate the proposed machine learning models (support vector machine, random forest, logistic regression, and multilayer perceptron). Hemodynamic parameters were obtained using computational fluid dynamics simulation. External validation was performed in other hospitals to test the models.

RESULTS

The support vector machine performed the best with areas under the curve of 0.88 (95% CI, 0.85-0.92) and 0.91 (95% CI, 0.74-0.98) in the training and internal validation datasets, respectively. Feature ranks suggested hemodynamic parameters, including stable flow pattern, concentrated inflow streams, and a small (<50%) flow-impingement zone, and the oscillatory shear index coefficient of variation, were the best predictors of aneurysm rupture. The support vector machine showed an area under the curve of 0.82 (95% CI, 0.69-0.94) in the external validation dataset, and no significant difference was found for the areas under the curve between internal and external validation datasets (P = .21).

CONCLUSIONS

This study revealed that machine learning had a good performance in predicting the rupture status of small aneurysms in both internal and external datasets. Aneurysm hemodynamic parameters were regarded as the most important predictors.

Veno-venous extracorporeal membrane oxygenation successfully treated a case of severe pulmonary hemorrhage caused by leptospirosis

BACKGROUND

Pulmonary hemorrhage is an important complication of leptospirosis. Once acute respiratory distress syndrome (ARDS) occurs as a secondary condition, treatment is extremely difficult and the mortality rate is very high.

CASE PRESENTATION

The patient was a 49-year-old. He was admitted to the hospital because he had experienced a fever and cough for 4 days. Hemorrhage, respiratory failure, ARDS and other symptoms appeared soon after admission. Due to severe pulmonary hemorrhage secondary to ARDS, mechanical ventilation was performed through tracheal intubation. During intubation, the patient suffered cardiac arrest, and the patient's condition worsened. He was confirmed to have leptospirosis through second-generation sequencing of the alveolar lavage fluid. Finally, we successfully treated the patient with penicillin as an anti-infective medication and venous-venous extracorporeal membrane oxygenation (v-vECMO). To the best of our knowledge, this report is the first to describe the successful application of ECMO in mainland China.

CONCLUSIONS

Leptospirosis can induce serious but transient ARDS with a better prognosis than other causes of ARDS. Our patient was successfully treated with V-vECMO.

[A cohort study on body mass index and risk of all-cause mortality among hypertensive population]

Objective: To investigate the relationship between body mass index (BMI) and all-cause mortality in hypertensive population. Methods: All participants were selected from a prospective cohort study based on a rural population from Henan province, China. Cox proportional hazards regression models were used to estimate the associations of different levels of BMI stratification with all-cause mortality. Restricted cubic spline models were used to detect the dose-response relation. Results: Among the 5 461 hypertensive patients, a total of 31 048.38 person-years follow-up was conducted. The median of follow-up time was 6 years, and 589 deaths occurred during the follow-up period. Compared to normal weight group (18.5 kg/m(2)<BMI<24.0 kg/m(2)) the multivariate-adjusted hazard ratios for all-cause mortality associated with BMI levels (<18.5 kg/m(2), 24-28 kg/m(2), and ≥28 kg/m(2)) were 0.83 (95%CI: 0.37-1.87), 0.81 (95%CI: 0.67-0.97), and 0.72 (95%CI: 0.56-0.91), respectively. The dose-response analysis showed a nonlinear, reverse "S" shaped relationship (non-linearity P<0.001). Conclusion: Overweight or obese might have a protective effect on all-cause mortality in hypertensive population, which supports the "obesity paradox" phenomenon.

[Epidemiology related to soil-borne nematode disease in Danzhou city, Hainan province]

Objective: To understand the prevalence, trend and related factors on soil-borne nematode in Danzhou city to provide information for prevention and control of the disease. Methods: According to the guidelines set by the National National soil-borne nematode technical solutions, one village was randomly chosen from every township as the monitoring location, in the east, west, south and north parts of Danzhou city. A total of 200 residents aged 3 years and over were randomly selected in each monitoring site, with modified Kato thick smear and Cellophane tape anal swab used for microscopy. Results: In this survey, we retrospectively analyzed the rates on soil borne nematode infection in five monitoring locations of Danzhou city and the results showed that the overall positive rates of infection was 19.5% (195/1 000). Comparing with the previous surveys, rates on soil-borne parasites infection were decreasing. The main types of soil-borne nematode infection appeared as roundworm, whipworm, hookworm and pinworm in Danzhou city, with rate of hookworm-egg infection ranking the highest (42.5%, 85/200) in Dacheng. The infection rate was seen significantly higher in females than males. People aged over 60 and between 3-10, had a higher rates of infection. Rate on multiple infections reached 16.9%, including 5 triple infection cases. Conclusion: Rates of infection on soil-borne nematodes in Danzhou city showed a decreasing trend from 2013 to 2016 with hookworm and whipworm as the major ones.

Cerebral CTA with Low Tube Voltage and Low Contrast Material Volume for Detection of Intracranial Aneurysms

BACKGROUND AND PURPOSE

Multidetector row CTA has become the primary imaging technique for detecting intracranial aneurysms. Technical progress enables the use of cerebral CTA with lower radiation doses and contrast media. We evaluated the diagnostic accuracy of 80-kV(peak) cerebral CTA with 30 mL of contrast agent for detecting intracranial aneurysms.

MATERIALS AND METHODS

Two hundred four patients were randomly divided into 2 groups. Patients in group A (n = 102) underwent 80-kVp CTA with 30 mL of contrast agent, while patients in group B (n = 102) underwent conventional CTA (120 kVp, 60 mL of contrast agent). All patients underwent DSA. Image quality, diagnostic accuracy, and radiation dose between the 2 groups were compared.

RESULTS

Diagnostic image quality was obtained in 100 and 99 patients in groups A and B, respectively (P = .65). With DSA as reference standard, diagnostic accuracy on a per-aneurysm basis was 89.9% for group A and 93.9% for group B. For evaluating smaller aneurysms (<3 mm), the diagnostic accuracy of groups A and B was 86.3% and 90.8%, respectively. There was no difference in diagnostic accuracy between each CTA group and DSA (all, P > .05) or between the 2 CTA groups (all, P > .05). The effective dose in group A was reduced by 72.7% compared with group B.

CONCLUSIONS

In detecting intracranial aneurysms with substantial radiation dose and contrast agent reduction, 80-kVp/30-mL contrast CTA provides the same diagnostic accuracy as conventional CTA.

Enhanced immunity and antiviral effects of an HBV DNA vaccine delivered by a DC-targeting protein

DNA vaccine targeting delivery to DC represents one effective strategy to improve the immunogenicity of the vaccine. In a previous study, we developed a novel DC-targeting recombinant protein that can deliver plasmid DNA to DCs by an electrostatic coupling effect and can thus improve the uptake efficiency of DCs, improving the expression of plasmid DNA in DCs. In this study, we coupled the protein with the HBV DNA vaccine pSVK-HBVA and investigated whether the immunogenicity and antiviral ability of the vaccine can be improved in HBV transgenic mice. The results show that a stronger specific immune response can be induced in mice after immunization with the coupling vaccine. The HBV DNA copy number and circulating antigen HBsAg in the serum of HBV transgenic mice were significantly decreased. Therefore, this study has demonstrated that the DC-targeting protein has the ability to improve the immunogenicity and the antiviral activity of the HBV DNA vaccine pSVK-HBVA. These findings indicate that this DC-targeting protein can be a potential method for the delivery of DNA vaccines directly to DCs.

Invasive pulmonary fungal infections in patients with connective tissue disease: a retrospective study from northern China

Invasive pulmonary fungal infection (IPFI) is a potentially fatal complication in patients with connective tissue disease (CTD). The current study aimed to uncover the clinical characteristics and risk factors of patients with IPFI-CTD. The files of 2186 CTD patients admitted to a single center in northern China between January 2011 and December 2013 were retrospectively reviewed. A total of 47 CTD patients with IPFI were enrolled into this study and assigned to the CTD-IPFI group, while 47 uninfected CTD patients were assigned to the control group. Clinical manifestations were recorded, and risk factors of IPFI were calculated by stepwise logistical regression analysis. Forty-seven (2.15%) CTD patients developed IPFI. Systemic lupus erythematosus patients were responsible for the highest proportion (36.17%) of cases with IPFI. Candida albicans (72.3%) accounted for the most common fungal species. CTD-IPFI patients had significantly elevated white blood cell count, erythrocyte sedimentation rate, C-reactive protein and fasting glucose values compared to controls (P<0.05). Cough, sputum and blood in phlegm were the most common symptoms. Risk factors of IPFI in CTD included maximum prednisone dose ≥30 mg/day within 3 months prior to infection, anti-microbial drug therapy, and interstitial pneumonia. CTD patients who have underlying interstitial pneumonia, prior prednisone or multiple antibiotics, were more likely to develop IPFI.

Designing a broad-spectrum integrative approach for cancer prevention and treatment

Targeted therapies and the consequent adoption of "personalized" oncology have achieved notable successes in some cancers; however, significant problems remain with this approach. Many targeted therapies are highly toxic, costs are extremely high, and most patients experience relapse after a few disease-free months. Relapses arise from genetic heterogeneity in tumors, which harbor therapy-resistant immortalized cells that have adopted alternate and compensatory pathways (i.e., pathways that are not reliant upon the same mechanisms as those which have been targeted). To address these limitations, an international task force of 180 scientists was assembled to explore the concept of a low-toxicity "broad-spectrum" therapeutic approach that could simultaneously target many key pathways and mechanisms. Using cancer hallmark phenotypes and the tumor microenvironment to account for the various aspects of relevant cancer biology, interdisciplinary teams reviewed each hallmark area and nominated a wide range of high-priority targets (74 in total) that could be modified to improve patient outcomes. For these targets, corresponding low-toxicity therapeutic approaches were then suggested, many of which were phytochemicals. Proposed actions on each target and all of the approaches were further reviewed for known effects on other hallmark areas and the tumor microenvironment. Potential contrary or procarcinogenic effects were found for 3.9% of the relationships between targets and hallmarks, and mixed evidence of complementary and contrary relationships was found for 7.1%. Approximately 67% of the relationships revealed potentially complementary effects, and the remainder had no known relationship. Among the approaches, 1.1% had contrary, 2.8% had mixed and 62.1% had complementary relationships. These results suggest that a broad-spectrum approach should be feasible from a safety standpoint. This novel approach has potential to be relatively inexpensive, it should help us address stages and types of cancer that lack conventional treatment, and it may reduce relapse risks. A proposed agenda for future research is offered.

6-Phosphogluconate dehydrogenase links oxidative PPP, lipogenesis and tumour growth by inhibiting LKB1-AMPK signalling

The oxidative pentose phosphate pathway (PPP) contributes to tumor growth, but the precise contribution of 6-phosphogluconate dehydrogenase (6PGD), the third enzyme in this pathway, to tumorigenesis remains unclear. We found that suppression of 6PGD decreased lipogenesis and RNA biosynthesis and elevated ROS levels in cancer cells, attenuating cell proliferation and tumor growth. 6PGD-mediated production of ribulose-5-phosphate (Ru-5-P) inhibits AMPK activation by disrupting the active LKB1 complex, thereby activating acetyl-CoA carboxylase 1 and lipogenesis. Ru-5-P and NADPH are thought to be precursors in RNA biosynthesis and lipogenesis, respectively; thus, our findings provide an additional link between oxidative PPP and lipogenesis through Ru-5-P-dependent inhibition of LKB1-AMPK signaling. Moreover, we identified and developed 6PGD inhibitors, Physcion and its derivative S3, that effectively inhibited 6PGD, cancer cell proliferation and tumor growth in nude mice xenografts without obvious toxicity, suggesting that 6PGD could be an anticancer target.

Targeting HER (ERBB) signaling in head and neck cancer: An essential update

HNC (head and neck cancer) remains the 6th most common carcinoma worldwide. The suboptimal survival and toxicities observed with conventional approaches warrant exploration of novel therapeutic strategies such as targeted therapies. Although targeting EGFR (epidermal growth factor receptor) with cetuximab demonstrated clinical promise, HER (human epidermal growth factor receptor) or ERBB (erythroblastic leukemia viral oncogene homolog) targeted therapy in HNC has overall been suboptimal to date in clinical settings. Overcoming the resistance as well as identifying new strategies therefore remains a significant challenge. In this review, we will discuss the emerging roles of HER members besides EGFR. A comprehensive "three-dimensional" view of HER signaling pathway from the importance of EGFR nuclear translocation to our maturing concept of receptors' "spatial regulation", as well as the interdependence and interaction among different HER members will also be addressed to complete an essential update of HER signaling in HNC.

Lysine acetylation activates 6-phosphogluconate dehydrogenase to promote tumor growth

Although the oxidative pentose phosphate pathway is important for tumor growth, how 6-phosphogluconate dehydrogenase (6PGD) in this pathway is upregulated in human cancers is unknown. We found that 6PGD is commonly activated in EGF-stimulated cells and human cancer cells by lysine acetylation. Acetylation at K76 and K294 of 6PGD promotes NADP(+) binding to 6PGD and formation of active 6PGD dimers, respectively. Moreover, we identified DLAT and ACAT2 as upstream acetyltransferases of K76 and K294, respectively, and HDAC4 as the deacetylase of both sites. Expressing acetyl-deficient mutants of 6PGD in cancer cells significantly attenuated cell proliferation and tumor growth. This is due in part to reduced levels of 6PGD products ribulose-5-phosphate and NADPH, which led to reduced RNA and lipid biosynthesis as well as elevated ROS. Furthermore, 6PGD activity is upregulated with increased lysine acetylation in primary leukemia cells from human patients, providing mechanistic insights into 6PGD upregulation in cancer cells.

Incidence of acute mountain sickness in young adults at 3200 meters: comparison of the Lake Louise Scoring and Chinese Scoring Systems

The purpose of this study was to compare two scoring systems used for the diagnosis of acute mountain sickness (AMS): the Lake Louise Scoring (AMS-LLS) and the Chinese Scoring Systems (AMS-CSS). In total, 339 healthy young adult volunteers residing at sea level ascended to 3200 m by train and bus over a total journey time of 48 h. All subjects ascended in the same manner and were divided into three groups that were assessed after one (N = 88), two (N = 91), and three (N = 160) nights, respectively, at altitude. The overall incidence of AMS was 17.11% (N = 58) and 29.79% (N = 101) according to the AMS-LLS and AMS-CSS, respectively. Two participants (0.59%) experienced high-altitude pulmonary edema. Both scoring systems showed the highest incidence of AMS after the second night at high altitude. The AMS-CSS and AMS-LLS scores were significantly correlated (Pearson's r = 0.820, P < 0.001). The AMS-CSS identified all AMS subjects diagnosed by the AMS-LLS, and an additional 43 subjects. The dominant symptoms were reduced exercise tolerance (61.7%), fatigue (49.0%), dizziness (28.9%), chest distress (28.3%), and headache (27.4%). Compared with the AMS-LLS, the sensitivity, specificity, and positive and negative predictive values of the AMS-CSS were 100, 84.7, 57.43, and 100%, respectively. There was no relationship between oxygen saturation levels and AMS scores at 3200 m. In summary, the AMS-CSS was similar to AMS-LLS, except that it resulted in more positive diagnoses, and headache did not play a large diagnostic role.

The effects of media properties on the horseradish peroxidase-catalyzed fluorogenic reaction

The effects of media properties including buffers, acidity, solvents and surfactant on horseradish peroxidase-catalyzed fluorogenic reaction were investigated. The results showed that the so-called non-fluorescent hydrogen donors were in fact fluorescent. There existed an acid-base equilibrium in the fluorescent dimer product. For p -hydroxyphenylpropionic acid, a pK(a) value of 8.0 for the product was obtained from its titration curve. The product fluorescence increased with higher pH, however, a longer time was needed to reach the reaction equilibrium due to the pH mismatch problem. Cationic micelles cetyltrimethylammonium bromide and cetyltrimethylammonium chloride could reduce the pH mismatch and offered a way to further increase the determination sensitivity. Finally, a micelle-enhanced flow-injection analysis of horseradish peroxidase is suggested.

Therapeutic Nanoparticles as Controlled Anti-Cancer Medications

The development of therapeutic nanoparticles (TNPs) for cancer treatment is one of the fastest growing research areas in oncology. Accumulating evidence has shown many advantages of TNPs over freely delivered chemotherapeutic drugs, such as enhanced water solubility, tumor-specific accumulation, and antitumor efficacy, while at the same time reducing non-specific tumor toxicity. However, the mechanisms behind these observations and outcomes have not been fully elucidated. Major challenges for applying TNPs in the clinic are to understand precisely how chemotherapeutic agents are released from TNPs and delivered to the targeted tumor tissues/cells, and how the TNPs' biodistribution affects toxicity in major organs. This review focuses on recent exploration of these unresolved issues with comparisons between free drugs and TNPs and between targeted and non-targeted TNPs. Several well-developed TNPs with unique characteristics will be discussed. Their specific applications for the treatment of certain cancer types have shed light on the clinical use of TNPs in cancer therapy.

The role of radial oxygen loss and root anatomy on zinc uptake and tolerance in mangrove seedlings

Root anatomy, radial oxygen loss (ROL) and zinc (Zn) uptake and tolerance in mangrove plants were investigated using seedlings of Aegiceras corniculatum, Bruguiera gymnorrhiza and Rhizophora stylosa. The results revealed that B. gymnorrhiza, which possessed the 'tightest barrier' in ROL spatial patterns among the three species studied, took up the least Zn and showed the highest Zn tolerance. Furthermore, zinc significantly decreased the ROL of all three plants by inhibition of root permeability, which included an obvious thickening of outer cortex and significant increases of lignification in cell walls. The results of SEM X-ray microanalysis further confirmed that such an inducible, low permeability of roots was likely an adaptive strategy to metal stress by direct prevention of excessive Zn entering into the root. The present study proposes new evidence of structural adaptive strategy on metal tolerance by mangrove seedlings.

Uptake and accumulation of arsenic by 11 Pteris taxa from southern China

A field survey was conducted at a deserted arsenic (As) mine in Guangxi Province, China to explore new potential As hyperaccumulators. In addition, young plants of 11 Pteris taxa were grown in glasshouse conditions for 12 weeks on As-amended soils with 0, 50 and 200 mg As kg(-1). Results of the field survey showed that the fern Pteris fauriei accumulated over 1000 mg As kg(-1) in its fronds. Of the 11 Pteris taxa, Pteris aspericaulis, Pteris cretica var. nervosa, P. fauriei, Pteris multifida, P. multifida f. serrulata, and Pteris oshimensis were all found to hyperaccumulate As in addition to P. cretica 'Albo-Lineata' and Pteris vittata (already reported as As hyperaccumulators). However, Pteris ensiformis, Pteris semipinnata and Pteris setuloso-costulata showed no evidence of As hyperaccumulation. Results also revealed a constitutive property of As hyperaccumulation in different populations of P. cretica var. nervosa, P. multifida, P. oshimensis and P. vittata.

Combined neuroform intracranial stent and bioactive matrix detachable coil for embolization of a broad-necked persistent primitive trigeminal artery aneurysm. A case report

SUMMARY

We report a patient with a wide-necked aneurysm arising at the bifurcation of the right internal carotid artery and the persistent primitive trigeminal artery (PPTA) treated successfully by Matrix detachable coil occlusion and assisted by a Neuroform intracranial stent. First, a Neuroform self-expanding intracranial stent was delivered via a 5-F Guider Softtip XP and placed as desired, then the aneurysm dome was embolized with two Matrix detachable coils through the interstices of the stent. The aneurysm was 80% occluded angiographically and the parent artery was patent. DSA imaging six months after the procedure showed the aneurysm to be obliterated at angiography and the neck tissue thickness of the aneurysm to be increased, but the parent artery diameter was not impacted. We describe the case in detail and discuss our preliminary experience of using the Neuroform stent and Matrix detachable coils for the treatment of a PPTA wide-necked aneurysm.

The metalloprotease inhibitor 1,10-phenanthroline affects Schistosoma mansoni motor activity, egg laying and viability

The Zn(2+)-chelating metalloprotease inhibitor 1,10-phenanthroline (phenanthroline, 5-150 microM) elicited dose-dependent contraction of the longitudinal and circular (transverse) musculature of adult male schistosomes. At the same concentrations, phenanthroline did not cause contraction of dispersed individual muscle fibres. The phenanthroline-induced contractions were reduced by the inclusion of 100 or 300 microM Zn2+ in the extracellular medium. Phenanthroline (0.5-150 microM) also inhibited the egg production of adult worm pairs in vitro, with a 98% reduction at 50 microM. When worm pairs were exposed to phenanthroline, the males detached from the dish and released the females, resulting in unpaired worms. At the higher concentrations (50 and 150 microM), the worms were killed in vitro. Worm burdens were reduced by over 50% in infected mice injected with phenanthroline (20 mg/kg/day for 4 days), but twice the dose resulted in only a 25% reduction. Phenanthroline injections also induced an hepatic shift and an unpairing of adult worms in infected mice, and the female worms appeared degenerate and lacked gut pigmentation. Mice fed a diet containing 0.3% phenanthroline received significant protection from infection when challenged with schistosome cercaria, where phenanthroline-fed mice had 94% fewer adult worms than control mice. The broad range of phenanthroline effects on schistosomes suggests broad and important functions for metalloproteases in these worms.

Cholinergic inhibition of muscle fibres isolated from Schistosoma mansoni (Trematoda:Digenea)

Cholinergic compounds inhibit FMRFamide-induced contractions in dispersed muscle fibres isolated from adult Schistosoma mansoni. Acetylcholine (ACh) was the most effective cholinergic agonist tested with an EC50 < 100 nM. Less effective were propionylcholine and arecoline with EC50 < 1 microM and butyrylcholine and carbachol with EC50 < 10 microM. Choline, muscarine, pilocarpine, nicotine, DMPP (1,1-dimethylphenylpiperazine) and levamisole were all ineffective. Amongst tested antagonists, d-tubocurarine (100 microM), mecamylamine (1 mM), scopolamine (1 mM) and quinuclidinyl benzilate (10 microM) were all ineffective. Bicuculline, picrotoxin and strychnine were also ineffective. However alpha-bungarotoxin, at 100 nM, was able to block the inhibitory ACh effect. From these data it appears that the cholinergic receptor on the schistosome muscle fibres may be of the nicotinic type, but that its pharmacology is different from that of nicotinic receptors of vertebrates as well as of nematodes or a variety of other invertebrates.

[Effect of jiawei sijunzi decoction on migrating myoelectric complex in 8 Gy irradiated rats]

The normal intestinal migrating myoelectric complex (MMC) of rats recorded by implanted electrode consists of four phases (phase I, II, III and IV). After 8 Gy of gamma-radiation for 1 hour to 7 days, the MMC cycle in most of the rats were disappeared only phase I or II existed with minute's rhythm. 1 hour or 3 days after radiation, the MMC cycle appeared in a few rats with the phase II shortened significantly (P < 0.05). Results of observation on effect of Jiawei Sijunzi Decoction on MMC after radiation showed the changed phase and cycle of MMC were normalized basically by the medication. These results suggested that the Jiawei Sijunzi decoction could improve the intestinal disturbances caused by radiation, it might be one of the reason of its alleviating effect on the radiation diarrhea.

Immunohistochemical localization of a Shaker-related voltage-gated potassium channel protein in Schistosoma mansoni (Trematoda: Digenea)

We have recently isolated a cDNA (SKv1.1) encoding a Shaker-related K+ channel from the human parasitic trematode Schistosoma mansoni. In order to better understand the functions of SKv1.1 protein, the distribution of SKv1.1 protein in adult S. mansoni was analyzed by immunohistochemistry using a region-specific antibody. SKv1.1 proteins were widely expressed in the nervous and muscular systems. The strongest immunoreactivity (IR) was observed in the nervous system of both male and female. In the nervous system, IR for SKv1.1 proteins was localized in cell bodies and nerve fibers of the anterior ganglia, the central commissure, and the main nerve cords. IR was also observed in the dorsal and the ventral peripheral nerve nets, fine nerve fibers entering into a variety of structures such as the dorsal tubercles, longitudinal and ventral muscle fibers, and oral and ventral suckers. In the muscular system, SKv1.1 proteins were localized to the longitudinal, circular, and ventral muscle fibers of male as well as in isolated muscle fibers where native A-type K+ currents were measured. Moderate IR was also seen in a large number of cell bodies in the parenchyma. These results indicate that SKv1.1 protein may play an important role in the regulation of the excitability of neurons and muscle cells of S. mansoni.

Restriction fragment length polymorphism of the apolipoprotein B gene and response to dietary fat and cholesterol

OBJECTIVE

The relationship between response to dietary fat and cholesterol, and the EcoRI restriction fragment length polymorphism (RFLP) of the apolipoprotein B(apoB) gene was examined.

DESIGN

Forty-nine free-living subjects took part in a prospective double-blind crossover dietary intervention study. The apoB EcoRI cutting site was present in five women and 18 men (E+) and absent in 15 women and 11 men (E-).

INTERVENTION

Subjects consumed a low fat (25% energy), low cholesterol (less than 200 mg/day) diet. After two weeks on this background diet (baseline) subjects were randomly assigned to consume a liquid supplement for three weeks which was either fat and cholesterol free or which contained fat (30 to 36 g) and cholesterol (650 to 780 mg). After the first three-week period subjects switched to the other supplement. Blood samples were collected for plasma lipid analysis after an overnight fast on two consecutive days at the end of baseline and on three consecutive days after each three-week supplement period.

RESULTS

There was no significant difference in response to diet between the RFLP groups. Changes in plasma total, low density lipoprotein (LDL), high density lipoprotein(HDL), HDL2 and HDL3 cholesterol or plasma triglyceride were not different between the two RFLP groups. There was a significant difference between RFLP groups for baseline HDL2-cholesterol (0.31 +/- 0.04 and 0.16 +/- 0.02 mmol/L for E- and E+ subjects, respectively) which was independent of sex and apoE genotype (P = 0.032).

CONCLUSIONS

These results indicate that the EcoRI RFLP of the apoB gene is not associated with response to dietary fat and cholesterol.

Human high molecular weight-melanoma associated antigen mimicry by mouse anti-idiotypic monoclonal antibody MK2-23: modulation of the immunogenicity in patients with malignant melanoma

The mouse anti-idiotypic (anti-id) mAb MK2-23 bears the mirror image of the antigenic determinant defined by antihuman high molecular weight-melanoma associated antigen (HMW-MAA) mAb 763.74. The purpose of this study was to evaluate the effect of conjugation to a carrier and administration with an adjuvant and cyclophosphamide (CTX) on the immunogenicity of anti-id mAb MK2-23 in patients with malignant melanoma and to analyze the relationship between development of humoral immunity and survival time of patients. Fifty-eight patients were sequentially entered into four immunization protocols which included administration of mAb MK2-23, mAb MK2-23 conjugated to keyhole limpet hemocyanin (KLH) and mixed with Bacillus Calmette-Guérin (BCG), mAb MK2-23 and CTX, and mAb MK2-23 conjugated to KLH and mixed with BCG and CTX. Six patients could not be evaluated since they withdrew from the clinical trial after the first immunization. Sera were tested for the development of anti-anti-id antibodies, including those reacting with HMW-MAA. Testing of sera for development of antimouse Ig antibodies was used to monitor the immune competence of patients. Conjugation to KLH and administration with BCG markedly enhanced the ability of mAb MK2-23 to induce anti-anti-id antibodies, including those reacting with HMW-MAA. In contrast, pretreatment with CTX had no detectable effect on the ability of mAb MK2-23 to elicit a humoral anti-anti-id response. Kaplan-Meier survival analysis showed that the performance status of patients, anti-anti-id antibody level, and development of anti-HMW-MAA antibodies had an effect on survival time. This effect was found when the survival time was calculated both from the day of the first immunization and from 4 weeks after the first immunization to the end of the study. A multivariate analysis by Cox regression showed that the development of anti-HMW-MAA antibodies was the most important variable for predicting survival, and that performance status was the only variable that significantly added to the prediction of survival. These data have to be interpreted with caution because of the retrospective nature of the analysis. Nevertheless, the present study suggests that mAb MK2-23 represents a useful immunogen to implement active, specific immunotherapy in patients with malignant melanoma.

Isoprenylation of proteins in the protozoan Giardia lamblia

We report the ability of Giardia lamblia to modify several of its cellular proteins by isoprenylation. Trophozoites cultured in the presence of [3H]mevalonate synthesized radiolabeled proteins of approx. 50 and 21-26 kDa. Chemical analysis indicated that farnesyl and geranylgeranyl isoprenoids comprised the majority of the radiolabel covalently associated with trophozoite proteins. In addition, antibodies to human p21ras immunoprecipitated mevalonate-labelled species of approx. 21 kDa. Inhibitors of several enzymatic steps of the mevalonate pathway dramatically affected Giardia metabolism. Protein isoprenylation and cell growth were blocked by compactin and mevinolin, competitive inhibitors of HMG-CoA reductase, the rate-limiting enzyme in isoprenoid biosynthesis. In the presence of these inhibitors, Giardia growth was restored by the addition of mevalonate to the culture medium. In contrast, cell growth was blocked irreversibly by inhibitors of subsequent steps in the protein isoprenylation pathway. Trophozoite growth inhibition by limonene, perillic acid, perillyl alcohol and N-acetyl-S-farnesyl-L-cysteine was not reversed after the addition of mevalonate, dolichol, ubiquinone or cholesterol to the medium. These observations constitute the first description of protein isoprenylation in any protozoan and indicate that this post-translational modification is an important step in the regulation of the growth of this primitive eukaryote.

Characterization of mevalonate-labeled lipids isolated from parasite proteins in Schistosoma mansoni

Adult paired schistosomes incubated for 3 days in radiolabeled mevalonate can effectively label at least 2 major proteins with apparent sizes of 25 and 43 kDa. The 25-kDa mevalonate-labeled proteins comigrated with proteins that could be labeled with GTP. The lipids attached to these proteins were removed and resolved by HPLC and found to comigrate with known samples of farnesol and geranylgeraniol. Homogenates of the schistosome when incubated with labeled farnesol pyrophosphate effectively labeled a protein(s) with an apparent molecular weight of 43 kDa while homogenates incubated in the presence of labeled geranylgeranyl pyrophosphate-labeled schistosome proteins with an apparent molecular weight of 25 kDa. Our results demonstrate that Schistosoma mansoni has the ability to covalently attach farnesol and geranylgeranyl to low-molecular weight proteins.

Effect of Cordyceps sinensis on erythropoiesis in mouse bone marrow

The effect of Cordyceps sinensis crystal (CS-Cr) on stimulating proliferation of erythroid progenitor cells (CFU-E and BFU-E) in LACA mouse marrow in vivo and in vitro by methyl cellulose gel culture system is reported. The numbers of CFU-E and BFU-E were increased after 5 consecutive daily treatment with 100, 150 and 200 mg/kg of CS-Cr with a peak at 150 mg/kg. Higher doses (> 150 mg/kg) of CS-Cr resulted in a reduction of the peak of CFU-E and BFU-E and then, the numbers returned to the control level with increased doses. The cytosine arabinoside (Ara-C) suicide test showed significant increases in the percentage of CFU-E and BFU-E in S-phase after CS-Cr treatment. Pretreatment of mice with CS-Cr could protect CFU-E and BFU-E against the cytotoxic agent--harringtonine. Addition of CS-Cr to culture system also promoted the generation of CFU-E and BFU-E at concentrations of 150-200 micrograms/ml in vitro. With a liquid culture technique, a stimulatory action of CS-Cr on fibroblast colony-forming units (CFU-F) proliferation was seen in vivo and in vitro.

Effects of cordyceps sinensis on natural killer activity and colony formation of B16 melanoma

This paper reports the study on the effects of the ethanol extract of Cordyceps sinensis (CS-II), a potent herbal tonic, on murine and human in vitro natural killer cell (NK) activities and on murine in vivo NK activity (by 125I clearance assay), and on colony formation of B16 melanoma in mouse lungs. The results revealed that: 1. the in vivo and in vitro NK activities of mouse were both significantly augmented by intraperitoneal (ip) injection of CS-II. Besides, the inhibition of mouse NK activity by cyclophosphamide (Cy) was prevented following the administration of CS-II; 2. the in vitro NK activity of human peripheral blood mononuclear cells (PBMs) was elevated by preincubation of PBMs with CS-II; and 3. the colony formation of B16 melanoma in mouse lungs was reduced significantly by ip pretreatment of the mice with CS-II. This study indicates that CS-II may be used as an immunopotentiating agent in treating cancer and immunodeficient patients.

Peripheral neovascularization of muscle and musculocutaneous flaps in the pig

Late loss of free muscle flaps following surgical or accidental trauma to the dominant vascular pedicle has been reported. In this study, time-dependent ligation of the dominant vascular pedicle was undertaken in denervated latissimus dorsi musculocutaneous or muscle-only island flaps in the pig. Muscle flaps were covered with a skin graft, and silicon rubber sheets were inserted between the flaps and their bases to simulate a poorly vascularized bed. Hemodynamic and viability studies were then performed using intravenous fluorescein (skin viability), tetrazolium blue (muscle viability), and radiolabeled 15-micron microspheres (capillary blood flow). Blood flow did not change in acutely raised musculocutaneous flaps (n = 10) but was significantly elevated in acutely raised muscle-only flaps (n = 10), suggesting that the skin paddle may steal blood flow from the underlying muscle in musculocutaneous flaps. Peripheral neovascularization at 1 day to 8 weeks was assessed (n = 30). Viability increased during the first week of revascularization and was not different in musculocutaneous and muscle-only flaps. Revascularization of muscle-only flaps was enhanced compared with musculocutaneous flaps in the 2- to 8-week period.

[Effect of xiao banxia-fuling decoction on the amplitude of gastric electrical spike wave in rats after irradiation of the gastric region]

The effect of xiao banxia-fuling decoction on the amplitude of gastric electrical spike wave in rats after irradiation of the gastric region was investigated in this study. The result proved: by using the medicine every day, the amplitude of spike wave, which was reduced by irradiation, was significantly raised at the 10th, 14th day in the corpus and 7th, 10th, 14th, 21st day in the antrum after 15Gy irradiation (P less than 0.01). Since the altitude of spike wave correlated with the intensity of the gastric motility. The authors believe that this compound Chinese herbs may have some beneficial effects on preventing the inhibition of gastric motility and reducing the radiation reaction of digestive system.

Purification and characterization of 3-hydroxymethylglutaryl-coenzyme A reductase of Schistosoma mansoni: regulation of parasite enzyme activity differs from mammalian host

The enzyme 3-hydroxymethylglutaryl-CoA (HMG-CoA) reductase plays a critical role in regulating the production of cholesterol, dolichols, and ubiquinones in mammals. The inhibition of this enzyme in Schistosoma mansoni is accompanied by a cessation of egg production by the female parasite and a reduced ability of the parasite to properly glycoslyate their proteins. Furthermore, we recently demonstrated that mevinolin, if given continuously over a period of 10-14 days, is a potent antischistosomal drug. In this paper, we describe the properties of purified HMG-CoA reductase from S. mansoni. Using affinity chromatography, we were able to obtain a 417-fold purification of the enzyme which had Km values similar to the rat enzyme for HMG-CoA and NADPH. The Ki value for mevinolin, a potent and selective inhibitor of the rat reductase (Ki = 0.6 nM), was significantly higher (Ki = 46 nM) for the schistosome enzyme. SDS-PAGE and HPLC of the purified enzyme resulted in the appearance of a single protein, which had a molecular weight (66,000) in the range reported for the rat enzyme. Parasite reductase activity, unlike that of its host, did not display a circadian rhythm. Furthermore, agents which elevate (cholestyramine) or decrease (cholesterol) mammalian reductase activity had no effect on the parasite enzyme. Our results suggest that the mechanism which regulates production of the parasite's enzyme may differ from its mammalian host.

Effects of Cordyceps sinensis on murine T lymphocyte subsets

It was shown by flow cytometry analysis that crystalized preparation of Cordyceps sinensis (Cs-Cr) caused significant elevation of the number of T helper cells and Lyt-1/Lyt-2 (T helper to T suppressor cell) ratio both in peripheral blood and the treated mice spleen. The spleen weight, phagocyte counts and phagocytic activity were also elevated in the treated group. In addition, Cs-Cr could protect T helper cells from the immunosuppressive effects of prednisolone acetate and cyclophosphamide. These results further substantiate the fact that Cs-Cr is an immunoregulator/biological response modifier of cellular immunity and may be potentially useful in handling immunodeficient or immunosuppressed patients.

Antischistosomal action of mevinolin: evidence that 3-hydroxy-methylglutaryl-coenzyme a reductase activity in Schistosoma mansoni is vital for parasite survival

The enzyme 3-hydroxy-3-methylglutaryl-coenzyme A (HMG-CoA reductase) plays an important role in regulating egg production in the human parasitic trematode Schistosoma mansoni. Infected mice treated with a low dose of mevinolin, an inhibitor of this enzyme, stopped egg production by the parasite and blocked the pathology associated with the infection. As an extension of this work, we exposed adult and developing schistosomes to higher doses of mevinolin for an extended period of time and observed the following: administration of 0.2% mevinolin in the diet of infected mice for 14 days resulted in 96-100% elimination of adult parasites. Administration of the same dose for 2 days before, and for 15 days after infection, resulted in 93-96% reduction of adult parasites. Co-administration of mevinolin with 0.5% mevalonate, but not 0.5% cholesterol, blocked the antischistosomal activity of mevinolin. We monitored schistosomal and mouse liver HMG-CoA reductase activity during the course of treatment and observed that HMG-CoA reductase activity was elevated in the liver but significantly reduced in the parasite. In vitro incubation of paired schistosomes with mevinolin, for up to 11 days, resulted in a dose- and time-dependent reduction of parasite motility and lactate production with eventual death. These in vitro effects were no evident when mevalonate was added to the culture system in place of, or in addition to, mevinolin. Collectively, the evidence suggests that mevalonate and/or metabolite not only plays a vital role in schistosome egg production, but is vital for survival of the parasite.

Physiological role of HMG-CoA reductase in regulating egg production by Schistosoma mansoni

Pathological lesions observed in humans infected with Schistosoma mansoni are due to the eggs produced by the female parasite. Mevinolin, a potent inhibitor of the enzyme hydroxymethylglutaryl-CoA (HMG-CoA) reductase, blocks egg production by this parasite. In this report, we demonstrate that cholesterol precursors, mevalonate and farnesol, stimulate egg production by the female parasite and that these precursors can reverse the mevinolin-induced inhibition of egg production. Because the parasite cannot synthesize cholesterol, we incubated parasites in a culture media containing radiolabeled acetate with and without mevinolin. We isolated nonsterol lipids from the parasite and observed that mevinolin dramatically reduced the conversion of acetate into the polyisoprenoid (dolichols) lipids of the parasite. Dolichols and other nonsterol lipids did not stimulate egg production. HMG-CoA reductase activity was observed in homogenates of the parasite and was inhibited by mevinolin (Ki = 52 nM), but its activity was tripled when the parasite was chronically exposed to low doses of the drug. Parasites with increased reductase activity produced five to six times more eggs. Lastly, chronic administration of large doses of mevinolin to infected mice resulted in a marked reduction of the pathology associated with the infection. These results suggest that egg production in S. mansoni is associated with the parasite's HMG-CoA reductase activity and that a nonsterol lipid produced in the biochemical pathway regulated by this enzyme stimulates egg production.

Capillary cloning of primary human tumor cells: assay miniaturization for drug efficacy testing

The conventional double-layer agar method of cloning human tumor cells requires a substantial number of viable tumor cells and 14-21 days of culture. These prerequisites frequently limit its utility as an assay. In an attempt to circumvent these limitations and to reduce the amount of drug that is needed in the assay, we have further developed and miniaturized the assay in which human tumor cells are cloned in glass microcapillary tubes. Cultures consisted of 50 microliters containing 15,000 nucleated cells in 975 mm capillary tubes which were incubated for seven days. The results from 50 consecutive tumor biopsies resulted in cloning efficiencies, ranging from 0.007% to 1.0% with an overall successful cloning of 88% of all tumors tested and a good linear growth relationship and chemotherapy sensitivity. This miniaturized assay offers distinct advantages for drug efficacy testing including high cloning efficiencies, small tumor sample and drug requirements, quicker assay turnaround time and a general conservancy of reagents and incubator space.

Glutamine- vs glucose-supported motor activity in Schistosoma mansoni: physiological relevance of aerobic metabolism

The ability of Schistosoma mansoni to generate energy through aerobic metabolic processes was examined in adult parasites in vitro. Parasite catabolism of radiolabeled glucose, glutamine, and other amino acids to CO2 and Krebs cycle intermediates was measured under a variety of incubation conditions. L-Glutamine was metabolized to CO2 via the intermediates glutamate, alpha-ketoglutaramate, and alpha-ketoglutarate in worms incubated in a balanced salts solution containing this amino acid as the only organic constituent. Of the other amino acids tested, CO2 production was detected from L-glutamate and L-asparagine. The catabolism of L-glutamine to CO2 was reduced by the respiratory inhibitor antimycin A. The motility of schistosomes in culture was maintained for at least 24 hr when L-glutamine was the only carbon source available to the worms. Under these conditions, motility was reduced when parasites were exposed to a respiratory inhibitor such as KCN, antimycin A, rotenone, or oligomycin, but it was completely restored by the addition of glucose to the medium. These results suggest that while the schistosome is capable of limited aerobic energy-generating processes under certain conditions, survival is not contingent upon these processes in the presence of glucose.

Schistosoma mansoni: measurement of Na+ ion activity in the tegument and the extracellular spaces using ion-selective microelectrodes

Ion-selective microelectrodes were used to measure sodium ion activity (aNa) in the tegument and interstitial spaces in adult male Schistosoma mansoni. In RPMI 1640, aNa averaged 31 +/- 13 mM in the tegument, a value significantly less than that in the bathing medium. In the interstitial spaces, it averaged 72 +/- 17 mM, a value nearly the same as that in the bathing medium. In hypo- or hyperosmotic media, aNa in the interstitial spaces varied by a value commensurate with change in aNa in the medium, but aNa in the tegument was changed by only a small amount. Monensin (10 microM), low temperature (20 C), and ouabain (0.3 to 10 microM) all caused significant increases in aNa in the tegument. Hypo- and hyperosmotic media produced initial weight changes followed by gradual recovery back toward original weights. It is concluded that the schistosome is a volume regulating osmoconformer with osmolality of the extracellular fluid approximating that of the bathing medium, but that within the tegument of the parasite, Na+ concentration is controlled by active transport processes.

Calmodulin: biochemical, physiological, and morphological effects on Schistosoma mansoni

Results of radioimmunoassays for the Ca2+-binding protein, calmodulin, revealed that this receptor constitutes 0.53 +/- 0.12% of the total protein in adult male Schistosoma mansoni. Schistosome calmodulin purified by Ca2+-dependent hydrophobic interaction chromatography showed an apparent molecular weight of 19 kDa, and its mobility on sodium dodecyl sulfate polyacrylamide gels was influenced by the presence of Ca2+ but not the antischistosomal drug praziquantel. Calmodulin from the parasite effected a four-fold stimulation of bovine heart adenosine 3',5'-cyclic monophosphate phosphodiesterase; this process was inhibited by removal of Ca2+ with ethyleneglycol-bis(B-aminoethylether)-N,N'-tetraacetic acid but not by praziquantel. Inhibition of calmodulin-activated processes with antipsychotic compounds in vitro resulted in a number of time- and concentration-dependent changes, including inhibition of schistosome calmodulin stimulation of bovine heart phosphodiesterase, disruption and depolarization of the parasite's tegument, and positive inotropic effects on longitudinal musculature. Results of this study indicate that calmodulin is a functional component of schistosomes and suggest that the role it serves is analogous to that obtained in other eukaryotes; i.e., it is an important component of numerous processes regulated, in part, by Ca2+.

Total reconstruction of the ear with auditory function: a two stage procedure

The rational treatment of severe microtia or anotia should be to restore not only the form but also the auditory function of the ear. To achieve this aim it is obvious that plastic surgeons must co-operate closely with an otologist: yet this degree of co-operation is seldom seen. This paper describes a two-stage procedure for total ear reconstruction with auditory function. In stage I, a tympanoplasty is performed before transplantation of the carved cartilage framework. Stage II consists of elevation of the reconstructed auricle and transplantation of a full-thickness skin graft to the post-auricular defect. Certain modifications of the operative techniques that we have found useful are discussed in detail.

The free thigh flap: a new free flap concept based on the septocutaneous artery

Based on the septocutaneous artery flap concept, the thigh, which is the commonest conventional donor site for split-skin grafts, can also become a donor area for skin flaps. The thigh flap, with its large and long neuro-vascular pedicle, can be used either as a free flap or as an island flap as an alternative to the lower abdominal flap, groin flap, tensor fasciae latae myocutaneous flap, sartorius myocutaneous flap or the gracilis myocutaneous flap. The anatomical basis, operative technique and characteristics of the thigh flap are discussed.