POS0279 THE ABCG2 rs2231142 POLYMORPHISM ARE ASSOCIATED WITH RISK OF NEPHROLITHIASIS IN A TAIWANESE POPULATION

Background

In genome-wide association studies (GWAS), the strong association of ABCG2 rs2231142 variant with hyperuricemia and gout was confirmed in Asian population. Additionally, the obesity, diet, lifestyle, genetics and underlying comorbidities are important risks factors predisposing to hyperuricemia and gout. The systematic reviews revealed a significant link between obesity, systemic comorbidities and hyperuricosuria for predisposition of kidney stones (nephrolithiasis). However, whether ABCG2 plays an important role in the phathogenesis of nephrolithiasis remain unclear. The interaction between genetic factors and other risk factors of nephrolithiasis is still elusive.

Objectives

In this study, we want to explore the association between ABCG2 rs2231142 variant and the risk of nephrolithiasis in modern Taiwanese population, and clarify the role of uric acid in nephrolithiasis formation.

Methods

This retrospective case-control study was conducted using the Taiwan Biobank database. A total of 120,267 individuals of Taiwanese Han Chinese aged 30-70 years were enrolled in the study. The primary outcome was the incidence of self-reported nephrolithiasis. Odds ratio (OR) of incident nephrolithiasis was analyzed by multiple logistic regression models and the interaction between ABCG2 rs2231142 variants, serum uric acid level, on the nephrolithiasis was explored. The multifactorial confounding factors for prediction of nephrolithiasis were also re-examined in our study.

Results

Finally, we identified 8,410 participants with nephrolithiasis and the prevalence was 11.52% and 4.37% in men and women, respectively. Older age (OR=1.08, 95% CI: 1.02-1.03, p<0.001) and male gender (OR=2.21, 95% CI: 2.08-2.36, p<0.001) showed an independent predictor for development of incident nephrolithiasis. The risk of nephrolithiasis markedly increased resulting from the interaction of ABCG2 rs2231142 and nephrolithiasis. In comparison with GG genotype, the risk of nephrolithiasis also demonstrated a significant association with TT and GT genotype (TT: OR=1.18, 95% CI: 1.09-1.28, p<0.001; GT: OR=1.12, 95% CI: 1.06-1.18, p<0.001). The variant comorbidities significantly associated with susceptibility to nephrolithiasis are hyperlipidemia (OR=1.40, 95% CI: 1.29-1.51, p<0.001), hypertension (OR=1.67, 95% CI: 1.57-1.78, p<0.001), diabetes mellitus (OR=1.16, 95% CI: 1.06-1.26, p=0.002), and hyperuricemia (OR=1.06, 95% CI: 1.04-1.08, p<0.001) with significant difference. The interaction of lifestyles and the risk of nephrolithiasis revealed significant differences in smoking (OR=1.15, 95% CI: 1.09-1.22, p<0.001) and overweight (OR=1.22, 95% CI: 1.15-1.28, p<0.001) rather than alcohol use(OR=0.92, 95% CI: 0.84-1.01, p=0.083). Participants with regular physical exercise is a protective factor from nephrolithiasis (OR=0.95, 95% CI:0.9-1.0, p=0.048).

Conclusion

Our study demonstrated the risk of nephrolithiasis is significant association with ABCG2 rs2231142 variants. This risk also increased with systemic comorbidities (hyperlipidemia, hypertension, diabetes mellitus, and hyperuricemia), and lifestyle (obesity, and smoking). Regular physical exercise is associated with protective factor for incident nephrolithiasis.

Table 1.

Adjusted Odds ratio of kidney stone.

VariableOR95% CIp-valueAge, years1.03(1.02-1.03)<0.001Gender female1.00—— male2.21(2.08-2.36)<0.001ABCG2 rs2231142 GG1.00—— GT1.12(1.06-1.18)<0.001 TT1.18(1.09-1.28)<0.001Hyperlipidemia No1.00—— Yes1.40(1.29-1.51)<0.001Hypertension No1.00—— Yes1.67(1.57-1.78)<0.001Diabetes No1.00—— Yes1.16(1.06-1.26)0.002Hyperuricemia >7.0 mg/dL No1.00—— Yes1.06(1.04-1.08)<0.001Smoking No1.00—— Yes1.15(1.09-1.22)<0.001Alcohol use No1.00—— Yes0.92(0.84-1.01)0.083Regular physical exercise No1.00—— Yes0.95(0.90-1.00)0.048Overweight, BMI ≥24 kg/m2 No1.00—— Yes1.22(1.15-1.28)<0.001

OR was adjusted for all variables in table.

Disclosure of Interests

None declared

Fluid Restriction for Treatment of “Fluid Creep” after Acute Burn Resuscitation

Objective

Fluid creep in patients recovering from acute burns still exists, despite the use of a more treatment conservative approach. Most of our severe burn patients develop fluid overload and body weight increase after acute fluid resuscitation. How to quickly return patients to their pre-injury body weight is an important issue.

Methods

Right after acute fluid resuscitation, we applied a “total fluid requirement” volume (usually 1/2 to 2/3 of initial 24 hour volume) and strictly monitored patients' hourly urine (between 0.5-1 ml/kg/hr). Patients' responses (body weight, enteric feeding amount, pulmonary condition, etc.) were also closely monitored and frequent adjustments of fluid volume administration were performed simultaneously.

Results

Most patients regained their pre-injury body weight within 2-3 weeks. Enteric feeding also improved markedly. No patients had severe oedema-related complications.

Conclusions

Stricter fluid administration after acute burn fluid resuscitation is advised for allowing patients to reduce body weight to their pre-injury weight or at least close to it. We use pre-injury body weight, enteric feeding and urine output as our guides. (Hong Kong j.emerg.med. 2014;21:222-229)

Genetic variation in the developmental regulation of cortical avpr1a among prairie voles

Early experiences can have enduring impacts on brain and behavior, but the strength of these effects can be influenced by genetic variation. In principle, polymorphic CpGs (polyCpGs) may contribute to gene-by-environment interactions (G × E) by altering DNA methylation. In this study, we investigate the influence of polyCpGs on the development of vasopressin receptor 1a abundance in the retrosplenial cortex (RSC-V1aR) of prairie voles (Microtus ochrogaster). Two alternative alleles ('HI'/'LO') predict RSC avpr1a expression, V1aR abundance and sexual fidelity in adulthood; these alleles differ in the frequency of CpG sites and in methylation at a putative intron enhancer. We hypothesized that the elevated CpG abundance in the LO allele would make homozygous LO/LO voles more sensitive to developmental perturbations. We found that genotype differences in RSC-V1aR abundance emerged early in ontogeny and were accompanied by differences in methylation of the putative enhancer. As predicted, postnatal treatment with an oxytocin receptor antagonist (OTA) reduced RSC-V1aR abundance in LO/LO adults but not their HI/HI siblings. Similarly, methylation inhibition by zebularine increased RSC-V1aR in LO/LO adults, but not in HI/HI siblings. These data show a gene-by-environment interaction in RSC-V1aR. Surprisingly, however, neither OTA nor zebularine altered adult methylation of the intronic enhancer, suggesting that differences in sensitivity could not be explained by CpG density at the enhancer alone. Methylated DNA immunoprecipiation-sequencing showed additional differentially methylated regions between HI/HI and LO/LO voles. Future research should examine the role of these regions and other regulatory elements in the ontogeny of RSC-V1aR and its developmentally induced changes.

Cardiac transplantation and concomitant coronary artery bypass grafting: our experiences in 11 cases

INTRODUCTION

The shortage of donor hearts for transplantation could be alleviated by including the hearts of older donors. Previous literature revealed similar early and medium-term survival outcomes compared with those of younger donors. This study presents our experience with patients who underwent orthotopic heart transplantation and concomitant coronary artery bypass grafting at our institution.

METHODS

We present our experience with 11 patients with end-stage cardiomyopathy (8 men and 3 women) undergoing orthotopic heart transplantation and concomitant coronary artery bypass grafting from September 2002 to November 2011 at our institute.

RESULTS

All 11 donor organs would otherwise have been rejected, depriving potential recipients of organ transplantation. Two patients received concurrent 2-coronary-artery bypass, and the other 9 patients received concurrent single-coronary-artery bypass during orthotopic heart transplantation. All patients had an uneventful postoperative course, with follow-up completed 3 to 128 months after cardiac transplantation and concomitant coronary artery bypass grafting surgery.

CONCLUSIONS

Our experiences suggest that donor hearts requiring coronary artery bypass grafting, which form a small but significant donor subgroup, can be used effectively and safely when matched to the recipients' age and medical condition.

Predictors of bloodstream infection associated with permanently implantable venous port in solid cancer patients

BACKGROUND

The purpose of this study is to characterize the risk factors of bloodstream infection (BSI) associated with the use of permanent implantable venous ports (Port-A) in solid cancer patients.

METHODS

Solid cancer patients implanted with a Port-A were prospectively observed for the occurrence of Port-A-associated BSI (PABSI), defined as BSI without other identifiable infection foci. A PABSI risk score was developed using the Cox proportional hazards model.

RESULTS

A total of 415 patients were registered; 88 PABSI episodes occurred in 58 patients (incidence1.05 per 1000 catheter-days). All but one patient had stage IV cancer. Independent predictors of PABSI occurrence included neutropenia, total parenteral nutrition (TPN), chronic steroid use, invasive procedures, postoperative antibiotics, and preoperative antibiotics. A PABSI risk score with a cut-off value of 0 (sensitivity 88.5%, specificity 64.3%) was defined for stage IV cancer patients as follows: neutropenia, +1.350; TPN, +1.256; chronic steroid use, +1.947; preoperative antibiotics, -0.970; postoperative antibiotics, +0.959; and invasive procedures, +1.098. The median PABSI-free survival was 4.47 months for patients with scores ≥ 0 but not reached for patients with scores <0 (P < 0.0001).

CONCLUSION

The PABSI risk score can assist in identifying high-risk solid cancer patients and may assist in designing future preventive strategies.

Risk Factors of Acute ST Segment Elevation Myocardial Infarction Patients without Chest Pain

Introduction

To identify factors associated with ST-segment myocardial infarction (STEMI) patients who had no chest pain, and to improve recognition of STEMI patients without presentation of chest pain in the emergency department (ED).

Method

Clinical characteristics and presentations were recorded in patients diagnosed with STEMI in the ED in a retrospective study of patients treated from 2006 to 2009. Patients with and without chest pain were compared according to clinical features.

Results

Among 260 STEMI patients, 12.7% of patients had no chest pain presentation in the ED. Syncope, epigastric pain, and dyspnea accounted for more than 60% of symptoms in STEMI patients without chest pain. Diabetes mellitus (DM), cerebrovascular accident (CVA), and old age were risk factors for STEMI patients without chest pain.

Conclusions

DM, CVA, and elderly patients are more likely to be without chest pain when STEMI occurred.

Lack of efficacy to systemic chemotherapy for treatment of metaplastic carcinoma of the breast in the modern era

Metaplastic carcinoma of the breast (MCB) is a rare subtype of breast cancer. Anecdotal reports are available regarding its response to systemic chemotherapy. We reviewed the records of patients diagnosed with MCB at National Taiwan University Hospital between 1988 and 2009. A total of 46 MCB cases were identified from 8,695 breast tumor patients who underwent biopsy or resection. About 11 of 25 patients with initial bulky disease (T3-4) received neoadjuvant chemotherapy before surgery, and 2 (18.2%) exhibited a partial response. About 12 of 18 patients who developed distant metastasis received palliative systemic chemotherapy. Of them, only 1 (8.3%), 1 (10%), and none (0%) responded to first-, second-, or third- and beyond line chemotherapy, respectively. None of the patients who received anthracyline- (n = 13), vinorelbine- (n = 7), or cyclophosphamide-based (n = 18) chemotherapy responded, whereas 3 (17.6%) of 17 patients who received taxane-based chemotherapy exhibited a partial response. Tumor response to systemic chemotherapy remains generally poor for MCB patients. Taxanes may have modest activity, but need to be validated in further studies.

Genetic association of blaSHV-5 with transposable elements IS26 and IS5 in Klebsiella pneumoniae from Taiwan

A cloned 5,248-bp EcoRI fragment from the Klebsiella pneumoniae transferable plasmid pKP53 (> 70 kb) containing bla(SHV-5) was sequenced. Insertion sequences IS26 and IS5 were found downstream from bla(SHV-5). The DNA sequences of the genetic environment surrounding bla(SHV-5) were homologous to plasmid p1658/97 from Escherichia coli, containing a truncated recF gene and a truncated deoR gene upstream and downstream from bla(SHV-5), respectively. RecF may be involved in bla(SHV-5) translocation to the plasmid by RecF-dependent recombination. This novel genetic environment may be associated with the successful proliferation and/or expression of SHV-5 in K. pneumoniae strains from Taiwan.

Electrochemical Modification of Vertically Aligned Carbon Nanotube Arrays

Electrochemical oxidation and reduction were utilized to modify vertically aligned carbon nanotube (CNT) arrays grown on a porous network of conductive carbon microfibers. Ultrafast and complete CNT opening and purification were achieved through electrochemical oxidation. Highly dispersed platinum nanoparticles were then uniformly and densely deposited as electrocatalysts onto the surface of these CNTs through electrochemical reduction. Using supercritical drying techniques, we demonstrate that the unidirectionally aligned and laterally spaced geometry of the CNT arrays can be fully retained after being subjected to each step of electrochemical modification. The open-tipped CNTs can also be electrochemically detached in full lengths from the supporting substrates and harvested if needed.

α-Synuclein promoter RsaI T-to-C polymorphism and the risk of Parkinson’s disease

Increased alpha-synuclein expression may be involved in the pathogenesis of Parkinson's disease (PD). We investigated the association of Rep1 microsatellite and RsaI T-to-C substitution in the alpha-synuclein promoter region with the risk of PD by a case-control study. The RsaI C/C genotype and C allele were found less frequently in PD patients than in controls. A reduced risk of the Rep1-RsaI 0-C haplotype (OR = 0.57, 95% CI = 0.36-0.90) with PD was evident. The quantitative real-time PCR study showed that the alpha-synuclein mRNA expression was increased (although not significantly) in PD patients with RsaI T/T genotype or Rep1-RsaI 0-T haplotype as compared to T/C genotype or 0-C haplotype. Reporter constructs containing the RsaI C allele drove significantly lower transcriptional activity compared with the RsaI T allele in both IMR32 and 293 cells. The findings suggest that the RsaI T-to-C substitution may have a functional relevance to the susceptibility to PD.

Non-adiabatic intramolecular and photodissociation dynamics studied by femtosecond time-resolved photoelectron and coincidence imaging spectroscopy

Time-resolved photoelectron spectroscopy (TRPES) is emerging as a useful tool for the study of non-adiabatic dynamics in isolated polyatomic molecules and clusters due to its sensitivity to both electronic and vibrational dynamics. A powerful extension of TRPES, coincidence imaging spectroscopy (CIS), based upon femtosecond time-resolved 3D momentum vector imaging of both photoions and photoelectrons in coincidence, is a new technique for the study of complex dissociative processes. Here we show how these spectroscopies can be used to study both non-adiabatic intramolecular and photodissociation dynamics in polyatomic molecules. Intramolecular dynamics in the alpha, beta-enones acrolein, crotonaldehyde and methyl vinyl ketone are studied using both TRPES and laser-induced fluorescence of HCO(X) product yields. The location of the methyl group is seen to have very dramatic effects on the relative electronic relaxation rates and the HCO(X) yield. Applying both TRPES and CIS to the 200 nm and 209 nm photodissociation of the nitric oxide dimer, (NO)2, we observe the fs time-scale evolution of the excited parent neutral via its photoelectron spectrum and the emergence of the NO(A) photofragment including its energy and angular distributions.

Self-sensitized photooxygenation of 3,4-dialkoxyfurans to vitamin C or its derivatives

Self-sensitized photooxygenation of 3,4-dialkoxyfurans 3a-d with molecular oxygen and UV- or sunlight at room temperature gave vitamin C derivatives 2a-d in good to excellent yields. Furan 3c, having photodegradable protecting groups, was also photooxygenated to give L-ascorbic acid (1) in a "one-pot" reaction. Furthermore, a novel photolytic transformation was developed for deuteration of furan 3b at the C-2 position with D(2)O to give furan 3d in 95% yield. Toxicity of furans 3a-c and butenolides 2a-c against human embryonic cell, murine embryo fibroblasts, normal fibroblasts, HeLa, and Vero cell lines in the presence of oxygen and indirect solar light was found to be much less than those of the antipsoriasis drugs anthralin and 8-methoxypsoralen.

Expression and characterization of monocot rice cytosolic CuZnSOD protein in dicot Arabidopsis

Cytosolic CuZnSOD removes deleterious superoxides from plant cells. In order to understand its function better, we sought to express a monocot CuZnSOD gene in transgenic Arabidopsis. We constructed a transgene using the CaMV 35S promoter to express a rice cytosolic CuZnSOD gene in Arabidopsis and generated over 200 transformants. A 16 kD polypeptide, the same size as the native rice CuZnSOD polypeptide, was detected in the transgenic Arabidopsis. Interestingly, two forms of rice CuZnSOD, rSODI and rSODII, having the same dimeric size, were detected in the transgenic plants. rSODII protein was relatively abundant but had low specific activity. In contrast, rSODI protein was relatively rare and had high specific activity. Inter-conversion of rSODI and rSODII could be achieved by the addition and removal of copper ions into the purified recombinant SOD and to the leaf extract of transgenic plants. Our analysis indicates that rSODI most likely corresponds to native rice CuZnSOD that has incorporated the Cu and Zn ions required for full activity, whereas the less active rSODII form may not have properly incorporated the necessary copper ions.

High-Resolution Spectroscopy of Jet-Cooled (32)SO(2) and (34)SO(2): The ã(3)B(1)-;X(1)A(1), 2(1)(0) and 1(1)(0) Bands

Laser-induced excitation spectra of the two bands ã(3)B(1)-;X(1)A(1), 2(1)(0) and 1(1)(0) of (32)SO(2) and (34)SO(2) have been recorded in a supersonic jet at a resolution of 0.015 cm(-1). The rotational and electron-spin fine structure has been analyzed for both isotopic species. Analysis of the rotational and electron-spin fine structure yields precise values of the rotational constants A, B, and C and the spin constants alpha and beta for both (32)SO(2) and (34)SO(2) in the states ã(3)B(1) (010) and (100). No interaction between these two vibrational states with any nearby triplet state is observed for rotational levels with J </= 8 and K </= 2. Copyright 2000 Academic Press.

Single pedicle vascularized double joint transfer: anatomic study of two models

This study examined the anatomic structures that communicate between the tibial and fibular digital arteries of the second toe at the distal phalanx to identify a channel for retrograde blood flow from the dominant pedicle to the distal joint flap. We also assessed the feasibility of two models designed to mobilize toe joints to perform single pedicle vascularized double-joint transfer. The continuity of the vascular pathway in both models was demonstrated by microfil injection and angiographic study. The average mobile distance between the PIP joint and the MTP joint was 5.6 +/- 0.6 cm in model I and 5.1 +/- 0.4 cm in model II. The dissection and mobilizing procedures of the neurovascular pedicle are more complicated and extensive in model II than in model I, and the risk of jeopardizing vascularity of the distal joint flap is higher. Both models may be suitable to replace two adjacent metacarpophalangeal (MCP) joints in the hand or two nonadjacent MCP joints (excluding the thumb) separated by no more than one normal metacarpal.

Unexpected recurrent seizures following repeated spinal injections of tetracaine--a case report

A 36-year-old male patient was scheduled to undergo ureteroscopic lithotomy because of left ureteral stone under spinal anesthesia. After receiving a renewed spinal anesthesia with 8 mg tetracaine to compensate for the first attempt (with 10 mg tetracaine), which proved to be a failure, he was soon seized with episodic seizure attacks. Central nervous system toxicity of the local anesthetic might be the cause of the seizure. We brought forward this case for discussion for warning that the possibility of systemic toxicity of local anesthetic might exist despite a seemingly undisputable spinal anesthesia.

Balance evaluation in hemiplegic stroke patients

BACKGROUND

Decreased equilibrium in standing and walking is a common problem associated with hemiplegic stroke patients. Stroke patients with balance problems are prone to falls. In addition to spatial recognition, the appropriate pattern of muscle activity to preserve balance depends on sensory and motor processes. Previous reports have mentioned that the right posterior parietal cortex seems to be predominantly involved in spatial integration. We therefore wanted to conduct a study to quantify and compare the balance control between right hemispheric stroke and left hemispheric stroke patients.

METHODS

Thirty hemiplegic stroke patients (14 right, 16 left) and 15 age-matched healthy subjects were included in this study. The objective measurement of the basic components of balance control was performed using the SMART Balance Master. The motor status of the hemiplegic limbs was evaluated by Brunnstrom staging. The functional outcome of the stroke patients was evaluated by the functional independence measure (FIM).

RESULTS

The balance function of stroke patients was significantly worse as compared to that of the healthy subjects especially in dynamic stability. However, different from the other reports, our right hemispheric stroke patients had better balance function than our left hemispheric patients. The locomotion and mobility scores of the FIM were also better in the right hemispheric stroke patients.

CONCLUSION

This result suggested that the motor function of the healthy limbs of stroke patients may play an important role in their balance function. The results of this study may provide a guide for prescribing a more efficient rehabilitation program for stroke patients.

Multiple Entrapment Neuropathy in the Upper Extremity

Multiple entrapment neuropathy is compression of more than two nerves in the same extremity. In this case series, 169 patients (208 upper extremities) with this condition were identified, and 124 patients (138 upper extremities) had surgical decompression after an ineffective course of conservative treatment. There were 31 men and 93 women. Average age was 41 years (range 20-87 years). Follow-up averaged 23 months (range 12 to 60 months). Our rating system included patients' self-assessment of overall symptom improvement and return to activity and a physician assessment of strength (grip and pinch) and sensibility (recovery of two-point discrimination). A total of 92 patients (67%) achieved good to excellent results. The clinical features of multiple entrapment neuropathy in our series were presented with a variety of nerve compression syndromes and with a high incidence of regional musculotendinous syndromes. In our surgical treatment, we emphasise simultaneous release of all possible compression sites with a minimally invasive endoscopic approach to achieve better results.

Cubital tunnel release with endoscopic assistance: results of a new technique

We evaluated the results of cubital tunnel release with endoscopic assistance. The study included 76 patients (85 elbows); 47 women and 29 men. Nine patients had bilateral procedures. Patients were excluded if they had less than 1 year of follow-up, associated pathology at the elbow to account for the nerve compression, or recurrent cubital tunnel syndrome. Before surgery, cases were categorized by stage of cubital tunnel syndrome according to Dellon's classification: 33 (39%) elbows were classified as mild, 35 (41%) moderate, and 17 (20%) severe. Surgical results were assessed according to a modified Bishop rating system. The mean follow-up period was 32 months (range, 12-52 months). Results were excellent in 42% of the elbows, good in 45%, fair in 11%, and poor in 2%. Recurrence occurred in 3 elbows. There were no serious complications. The results of this study support our recommendation of cubital tunnel release with endoscopic assistance as a safe and reliable technique for the treatment of cubital tunnel syndrome, especially in patients with mild to moderate symptoms.

Treatment of axillary bromhidrosis with superficial liposuction

Axillary bromhidrosis or osmidrosis is a distressing problem that causes a serious personal and social handicap, especially in an Asian society. Surgical excision of the subcutaneous tissue, with or without skin excision in the axillary hair-bearing area, has been the treatment of choice for several decades. However, the complications of partial necrosis of wound edges or hematoma, and the possibility of the obvious unsightly scars, are always problems. We report our method of treatment of modified superficial liposuction with subdermal scraping under local anesthesia with tumescent infiltration. By using two tiny stab wounds, these two steps of liposuction can be done in the two-directional crisscross pattern. From August of 1995 to May of 1997, 20 patients (16 women and 4 men) received this surgery for bilateral axillas on an outpatient basis. The follow-up period ranged from 6 months to 27 months, and the mean follow-up period was 14 months. Eighteen patients (90 percent) had excellent to good results. Complication included only one minor wound infection that was cured easily. Two patients experienced transient subdermal fibrotic bands in one side of the axilla, and one patient experienced axillary skin with marked induration and retraction. All of these symptoms disappeared after 1 month or so. This minimal incision operation has the advantages of a high success rate, low complication rate, tiny to invisible scars, no change of hair distribution pattern, minimal postoperative care with a short term of compressive dressing (less than 2 days), and rapid recovery for daily activity and exercise.

The influence of intra-graft heparin injection on the survival of composite grafts

BACKGROUND

Intra-replant subcutaneous heparin injection has been reported to be an alternative to venous anastomoses in finger replantations. It has also been recommended for composite graft type replants. In this study, we investigated three different regimens of intra-graft heparin injection in a rabbit ear model. Our aim was to determine whether or not continuous oozing from an incision wound on a composite graft made by an intra-graft heparin injection would increase the survival of a larger composite graft.

METHODS

A 25-mm-diameter circular composite graft (including dorsal skin and auricular cartilage) was harvested from the mid-portion of a rabbit ear. This size of graft was selected as the study model due to a significantly lower percent graft survival when compared to smaller-sized grafts (17.0 +/- 5.6%, p < 0.05). Three different regimens of intra-graft heparin injection were performed in the study group and the results of percent graft survival were compared.

RESULTS

Intra-graft injection of heparin calcium 250 IU/0.1 ml qd for seven days resulted in a significantly higher percent graft survival than the other two regimens and a control group (64.0 +/- 9.7%, p < 0.05). The "flow-through" phenomenon was observed in this study.

CONCLUSIONS

Intra-graft heparin injection resulted in a higher percent graft survival than the control group for the 25-mm-diameter circular composite graft. However, the mechanism of graft survival enhancement could not be clearly explained by this study. It is recommended that the clinical application of intra-graft heparin injection should only be used when subgraft hematoma can be avoided and systemic bleeding tendency is being closely monitored.

Estrogenic activity of a dieldrin/toxaphene mixture in the mouse uterus, MCF-7 human breast cancer cells, and yeast-based estrogen receptor assays: no apparent synergism

The estrogenic activity of dieldrin, toxaphene, and an equimolar mixture of both compounds (dieldrin/toxaphene) was investigated in the 21-day-old B6C3F1 mouse uterus, MCF-7 human breast cancer cells, and in yeast-based reporter gene assays. Treatment of the animals with 17beta-estradiol (E2) (0.0053 kg/day x3) resulted in a 3.1-, 4.8-, and 7.8-fold increase in uterine wet weight, peroxidase activity, and progesterone receptor binding, respectively. In contrast, treatment with 2.5, 15 and 60 micromol/kg (x3) doses of toxaphene, dieldrin, or dieldrin/toxaphene (equimolar) did not significantly induce a dose-dependent increase in any of the E2-induced responses. The organochlorine pesticides alone and the binary mixture did not bind to the mouse uterine estrogen receptor (ER) in a competitive binding assay using [3H]E2 as the radioligand. In parallel studies, estrogenic activities were determined in MCF-7 cells by using a cell proliferation assay and by determining induction of chloramphenicol acetyl transferase (CAT) activity in MCF-7 cells transiently transfected with plasmids containing estrogen-responsive 5'-promoter regions from the rat creatine kinase B and human cathepsin D genes. E2 caused a 24-fold increase in CAT activity in MCF-7 cells transiently transfected with creatine kinase B and a 3.8-fold increase in cells transiently transfected with the human cathepsin D construct. Treatment of MCF-7 cells with dieldrin, toxaphene, or an equimolar mixture of dieldrin plus toxaphene (10(-8)-10(-5) M) did not significantly induce cell proliferation or CAT activity in the transient transfection experiment with both plasmids. The relative competitive binding of the organochlorine pesticides was determined by incubating MCF-7 cells with 10(-9) M [3H]E2 in the presence or absence of 2 x 10(-7) M unlabeled E2 (to determine nonspecific binding), toxaphene (10(-5) M), dieldrin (10(-5) M), and equimolar concentrations of the dieldrin plus toxaphene mixture (10(-5) M). The binding observed for [3H]E2 in the whole cell extracts was displaced by unlabeled E2, whereas the organochlorine pesticides and binary mixture exhibited minimal to nondetectable competitive binding activity. E2 caused a 5000-fold induction of beta-galactosidase (beta-gal) activity in yeast transformed with the human ER and a double estrogen responsive element upstream of the beta-gal reporter gene. Treatment with 10(-6)-10(-4) M chlordane, dieldrin, toxaphene, or an equimolar mixture of dieldrin/toxaphene did not induce activity, whereas 10(-4) M endosulfan caused a 2000-fold increase in beta-gal activity. Diethylstilbestrol caused a 20-fold increase in activity in yeast transformed with the mouse ER and a single estrogen responsive element upstream of the beta-gal reporter gene. Dieldrin, chlordane, toxaphene, and endosulfan induced a 1.5- to 4-fold increase in activity at a concentration of 2.5 x 10(-5) M. Synergistic transactivation was not observed for any equimolar binary mixture of the pesticides at concentrations of either 2.5 x 10(-5) M or 2.5 x 10(-4) M. The results of this study demonstrate that for several estrogen-responsive assays in the mouse uterus, MCF-7 human breast cancer cells, and yeast-based reporter gene assays, the activities of both dieldrin and toxaphene were minimal, and no synergistic interactions were observed with a binary mixture of the two compounds.

The Fluorescence Excitation Spectrum of HCO &Btilde;2A'-&Xtilde;2A', 000 Band

The rotationally resolved laser-induced fluorescence spectrum of the HCO &Btilde;2A'-&Xtilde;2A' transition in the 000 band is observed under thermalized conditions. The formyl radical is produced from acetaldehyde photolyzed at wavelengths 310 or 308 nm. Some spin-splittings of the spectra are resolved. About 988 transitions to Ka' </= 3 and N' </= 24, approximately 94% of the observed lines, are assigned in this work including weak DeltaKa = &plusmn;2 transitions that become allowed because of the effects of axis-switching. Copyright 1997Academic Press

Torsade de pointes due to consumption of Sauropus androgynus as a weight-reducing vegetable

Sauropus Androgynus, known as cekur manis or sweet shoot, is a popular vegetable in Southeast Asia and is used as a weight-reducing vegetable in Taiwan. Three women who developed torsade de pointes after consuming large amounts of sauropus androgynus are described in this report.

Microsurgical replantation of avulsed scalps

Four cases of extensive scalp avulsion were successfully replanted in this reported series. All patients were female, with the youngest 3 years of age. All replanted scalps survived, with some marginal necrosis due to tissue destruction. Postoperative venous congestion of the involved ear in one patient was managed with anticoagulant therapy. Another patient underwent severe congestion of the whole replanted scalp and was treated with thin skin-graft shaving in the parietal area. In the follow-up period, all patients obtained hair growth in the scalp with light touch sensation.

Progression to complete atrioventricular block in a patient with bundle branch re-entry tachycardia

A 38-year-old man with no significant structural heart disease suffered from one episode of wide QRS tachycardia. The electrocardiogram showed a PR interval of 0.20 second and a QRS duration of 0.10 second. His bundle recording revealed an HV interval of 90-100 ms. The tachycardia was inducible with programmed stimulation and displayed a QRS morphology of complete left bundle branch block. It was characterized by an atrioventricular dissociation, a cycle length of 280 ms, and an H deflection preceding each QRS complex. Pacing from the right ventricular apex at a cycle length of 270 ms entrained the tachycardia, while at a cycle length of 260 ms, the tachycardia was terminated. Four years later, the patient presented with complete atrioventricular block with a wide QRS escape rhythm. An electrophysiologic study conducted while he was in 1:1 atrioventricular conduction showed an HV interval of 100 ms. Second-degree infrahisian block developed at an atrial paced cycle length of 700 ms. There was no induction of tachycardia with programmed stimulation before or after isoproterenol. The patient was treated with an implantation of a permanent pacemaker.

Radiofrequency ablation therapy in concealed left free wall accessory pathway with decremental conduction

An electrophysiologic study followed by transcatheter radiofrequency ablation therapy was performed in two adult patients with a permanent form of junctional tachycardia. Both patients had no structural heart disease and exhibited a normal resting ECG. The P wave during tachycardia was negative in leads 1, 3, and aVF, biphasic over V6, and positive in V1 and aVL in both patients, while the P-R/R-P interval ratio during tachycardia was 0.82 and 0.36, respectively, in both patients. Both patients displayed an eccentric atrial activation sequence with the earliest atrial activation occurring at the distal coronary sinus and a decremental retrograde conduction property during incremental ventricular pacing, suggesting the presence of a concealed slowly conducting left free wall accessory pathway. The tachycardia used the normal atrioventricular pathway for anterograde conduction and the concealed show left accessory pathway for retrograde conduction. It was terminated following adenosine administration in both patients; termination of tachycardia was due to a block in the retrograde accessory pathway in one patient and due to a block in the atrioventricular node in the other patient. Radiofrequency ablation was performed by the retrograde transaortic approach. The radiofrequency f4p4ent was delivered to the site of the earliest atrial activation during tachycardia at the ventricular aspect of the mitral annulus. The successful ablation site had a ventriculoatrial (VA) interval of 120 and 130 ms, respectively, and was located at the posterolateral and lateral aspects of the mitral annulus. Following ablation, there was no VA conduction; however, conduction through the normal atrioventricular pathway was noted during isoproterenol infusion in both patients. There was no induction of tachycardia. This study demonstrates that the permanent form of junctional tachycardia in adults can incorporate a concealed left free wall accessory pathway with a decremental property. Radiofrequency ablation therapy is effective and safe in this form of arrhythmia.

Radiofrequency ablation therapy in atypical or multiple atrioventricular node reentry tachycardias

Electrophysiologic study and radiofrequency ablation therapy were performed in 23 patients with atypical (8 patients) or multiple (15) atrioventricular node reentry tachycardias. Dual pathways with anterograde fast and slow pathway conductions were demonstrated in 16 patients. Studies on retrograde conduction revealed the presence of three different pathways, including fast (15 patients), intermediate (17), and slow (16). The radiofrequency current was applied to the inferior aspect, one-third anterior two-thirds posterior between the His bundle and the ostium of the coronary sinus, of Koch's triangle along the tricuspid annulus in all patients. Application of the current resulted in selective ablation or modification of both retrograde intermediate and slow pathway conductions in 20 patients. In two patients retrograde fast pathway conduction was also modified. Complete atrioventricular block occurred in the remaining patient. Sixteen patients had no induction of tachycardia or echo, 4 had induction of a single echo, and 2 had induction of the slow-fast form tachycardia; one of those 2 patients underwent a second trial and was successful. A median application of 2 was delivered at a power of 25 +/- 5 W and a duration of 18 +/- 4 sec. The total fluoroscopic time was 25 +/- 21 minutes. The anterograde fast pathway conduction was unaffected; the shortest atrial paced cycle length that sustained 1:1 fast pathway conduction was 329 +/- 65 msec and 330 +/- 68 msec before and after ablation, respectively. A follow-up electrophysiologic study was performed in 16 patients 60 +/- 15 days after ablation. Eleven had no induction of tachycardia or echo, and five had induction of < 3 echoes. This study demonstrated that radiofrequency ablation with the inferior approach is effective and safe in atypical or multiple atrioventricular node reentry tachycardias. It resulted in ablation of the slow pathway and retrograde intermediate pathway conduction with preserved atrioventricular conduction.

Radiofrequency ablation therapy in idiopathic left ventricular tachycardia with no obvious structural heart disease

BACKGROUND

The feasibility and efficacy of radiofrequency ablation therapy in idiopathic left ventricular tachycardia has not been assessed in a large group of patients.

METHODS AND RESULTS

Twenty consecutive patients with idiopathic left ventricular tachycardia and without structural heart disease underwent electrophysiological study, pharmacological interventions with administration of verapamil and adenosine, and radiofrequency ablation therapy. There were 17 men and 3 women with a mean age of 28 +/- 8 years. The QRS configuration during tachycardia was of right bundle branch block and superior axis in 13 patients, indeterminate axis in 6 patients, and right axis in 1 patient. The tachycardia was electrically inducible and responsive to verapamil but not to adenosine. Thirteen patients demonstrated entrainment. Activation and pace-mapping studies disclosed that the tachycardia originated from the inferior apical septum in 15 patients, the midseptum in 4 patients, and the anterior lateral wall of the left ventricle in 1 patient. Radiofrequency ablation was successful in 17 of the 20 patients (85%). The successful ablation sites were characterized by an endocardial activation time 30 milliseconds earlier than the onset of QRS during tachycardia and by a pace-mapping QRS similar to or closely resembling the tachycardia. All patients displayed sharp spikes preceding the local ventricular electrogram at the ablation site. However, these sharp spikes also were noted in 15 control patients and were not specific for this tachycardia; they persisted after ablation. There were no complications. A follow-up of 7 +/- 8 months in the 17 successfully ablated patients showed no symptomatic tachyarrhythmias without medications. Six patients underwent repeat electrophysiological study, and no induction of tachycardia was revealed.

CONCLUSIONS

Radiofrequency ablation therapy is effective and safe in patients with idiopathic left ventricular tachycardia. It should be considered as the primary therapeutic modality in these patients.

Effect of "mood that day" on pharmacists' job and career satisfaction

We speculated that mood would affect responses to global measures of job and career satisfaction. We randomly selected 692 pharmacists from the Iowa Board of Pharmacy Examiners' mailing list. After two follow-up mailings, 389 questionnaires were received for a usable rate of 56.9%. "Good day" pharmacists were more satisfied with their jobs and careers than "typical day" pharmacists, supporting the contention that global satisfaction indicators reflect affective satisfaction.

Virus-like particles with reverse transcriptase activity associated with Kawasaki disease

To investigate the etiologic agent associated with Kawasaki disease (KD), we initially established a cocultivation system using concanavalin A (Con A)-stimulated lymphoblastoid cells obtained from each retrovirus-seronegative individual's peripheral blood mononuclear cells (MNCs) cocultivated with each of 1) 40 patients with KD, 2) 10 patients with other viral infection and skin rash, and 3) 10 age- and sex-matched normal controls. Five major findings suggested that virus-like particles with reverse transcriptase (RT) activity are associated with KD. First, RT activity appeared significantly higher on day 12 after the onset of fever in the KD patients than in those with other viral infections and normal controls (dTMP incorporation: 3,645 +/- 248 vs. 434 +/- 50 vs. 412 +/- 46 cpm, P < 0.0001). Second, the RT activity was not endogenous, because the Con A-stimulated lymphoblastoid cells were obtained from the individuals who were negative for retrovirus. Third, virus-like particles (80-100 nm in diameter) by electron microscopy were found in the concentrated pool supernatants of particulate fraction containing RT activity subjected to sucrose density gradient, obtained from KD patients. Fourth, the viral product, a 31.4 kilodalton molecule, was detected by SDS-PAGE after internal labelling (methionine-S35) and density gradient centrifugation. Fifth, using a "retrovirus universal pol gene region" as a primer and the RT-PCR method, a retrovirus-specific band was detected in the cocultivated supernatants obtained from four KD and one AIDS patients but not in patients with rubella or in healthy controls.(ABSTRACT TRUNCATED AT 250 WORDS)

Anterior pretectal nucleus-induced modulatory effects on trigeminal brainstem somatosensory neurons

This study examined the effects of anterior pretectal nucleus (APT) conditioning stimulation on the activity of 92 functionally identified somatosensory brainstem neurons in the trigeminal (V) subnuclei oralis, interpolaris and caudalis of anesthetized rats. Conditioning stimulation inhibited most of the nociceptive neurons and some of the non-nociceptive neurons; facilitation was observed only in some non-nociceptive neurons. These data indicate that the ATP has modulatory effects on both nociceptive and non-nociceptive V somatosensory neurons.

[Versatility of rectus abdominis muscle or myocutaneous flap--report of seven cases]

The rectus abdominis muscle, due to its strategic location in the abdomen with its dual blood supply and wide arc of transposition, is ideally suited to repair defects over the chest, abdomen, groin and perineum. The muscle is generally based on the superior epigastric artery, deep inferior epigastric artery and their associated capillary communications. From September 1989 to September 1990, at Taichung Veterans General Hospital, seven cases were presented utilizing unilateral rectus abdominis muscle or myocutaneous flap for local or free tissue transfer. The recipient areas included abdomen, groin, perineum, lower leg and a penis reconstruction. Of all flaps that survived, one developed minor skin necrosis causing urethral orifice stricture and urethrocutaneous fistula that later required repair. All cases achieved the surgical goals. There was no donor site infection, nor abdominal wall herniation but persisted wound pain in 2 cases was noted during the follow-up period. All patients resumed daily activity without limitation about six weeks postoperatively. The large skin territory with abundant soft tissue offers versatile flap design. The dissection is simple, speedy and straight foreward. The deep inferior epigastric vessels are long and their calibers are suitable for vascular anastomosis. Usually, the donor sites are primary closed. We recommend this flap as one to be considered in reconstruction planning and as a donor material for free tissue transfer.

Inhibitory effect of stimulation of the anterior pretectal nucleus on the jaw-opening reflex

The anterior pretectal nucleus (APT) has been recently implicated in sensorimotor integration and has been shown to have suppressive influences on tail flick behaviour and on nociceptive responses of spinal dorsal horn neurones in rats. The present study tested the effect of stimulation of the APT on the rat's digastric jaw-opening reflex elicited by orofacial stimuli. Either ipsilateral or contralateral electrical stimulation at histologically confirmed sites within and immediately subjacent to the APT produced a suppression of the reflex that had an onset of 20-30 ms, peaked around 50 ms and lasted for 200-300 ms; in some cases, a brief period of reflex facilitation preceded the onset of inhibition and the inhibition was sometimes followed by a facilitatory period. No prolonged period of suppression induced by electrical stimulation was noted in these anaesthetized rats. The injection of monosodium glutamate at comparable sites within and subjacent to APT induced reflex suppression that lasted several minutes. These findings represent the first documentation of APT-induced modulation in the trigeminal sensorimotor system, but support recent evidence suggesting the involvement of APT in sensorimotor integration and modulation.

Oral and facial representation in the trigeminal principal and rostral spinal nuclei of the cat

Transganglionic transport of horseradish peroxidase (HRP) was used to study the patterns of termination of somatic afferent fibers innervating oral and facial structures within the principal nucleus (Vp), nucleus oralis (Vo), and nucleus interpolaris (Vi). The primary trigeminal afferent fibers that innervate the oral cavity supplied by the pterygopalatine, superior alveolar, lingual, buccal, and inferior alveolar branches, as well as the facial skin supplied by the frontal, corneal, zygomatic, infraorbital, auriculotemporal, mylohyoid, and mental branches, were traced in this experiment. The results show that trigeminal afferent nerves that innervate the oral cavity project mainly to the principal nucleus, the rostrodorsomedial part (Vo.r) and dorsomedial division (Vo.dm) of pars oralis, and the dorsomedial region of pars interpolaris, while an extensive overlap of projections is found in the Vo.r, Vo.dm, and rostral Vi. The central processes of fibers innervating the anterior face (i.e., mental, infraorbital, and frontal nerves) terminate in the ventral division of principalis (Vpv), caudal region pars oralis (Vo.c), and ventrolateral Vi, with the largest numbers of terminals being found in the Vpv and Vi. In contrast, the central projection patterns of the corneal, zygomatic, mylohyoid, and auriculotemporal afferents are different from those of other afferent nerves examined, and present a discrete projection to the trigeminal sensory nuclear complex (TSNC). The corneal, mylohyoid, and auriculotemporal afferents mainly project to the restricted regions of principalis and caudal Vi, while zygomatic afferent nerve fibers project to the caudal third of pars interpolaris. The typical somatotopic organization with the face of the mouth open inverted is represented in the rostrocaudal midlevels of the Vpv and caudal pars interpolaris. The Vpd receives topographical projection from primary afferent nerves that innervate the oral structure only, while this projection was organized in a complicated manner. The relationship between the functional segregation and the cytoarchitectonic differentiation of the TSNC is discussed, particularly with respect to this somatotopic organization, combined with the characteristics of projecting cells in the TSNC.

Oral and facial representation within the medullary and upper cervical dorsal horns in the cat

Transganglionic transport of HRP was used to study the patterns of termination of somatic afferent fibers innervating oral and facial structures within the trigeminal nucleus caudalis and upper cervical dorsal horn of the cat. In separate animals, the superior alveolar, pterygopalatine, buccal, inferior alveolar, lingual, frontal, corneal, zygomatic, infraorbital, mental, mylohyoid, and auriculotemporal branches of the trigeminal nerve were traced in this experiment. The organization of the primary afferents innervating the oral structures is not uniform across laminae and at different rostrocaudal levels of the nucleus caudalis. The superior alveolar and pterygopalatine nerves mainly terminate in laminae I, II, and V at the level of the rostral one-third of the caudalis. By contrast, the lingual, inferior alveolar, and buccal nerve terminate in laminae I-V of, respectively, the rostral third, the entire length, and caudal two-thirds of the caudalis. In addition, the lingual, buccal, and pterygopalatine nerves terminate in the dorsal and middle parts of the interstitial islands or pockets of lamina I neuropil extending to the rostral levels parallel to the nucleus interpolaris. Mediolaterally, in laminae I, II, and V of the rostral third an extensive overlap of projections was found between the branches from each trigeminal division, and some overlap was observed between projections from the mandibular and maxillary divisions. On the other hand, the projections of primary afferents innervating the facial structures are arranged in a somatotopic fashion in rostrocaudal and mediolateral axes over the laminae (I-IV) through the nucleus caudalis and upper cervical dorsal horn. Fibers from the perioral and perinasal regions terminate most rostrally in caudalis, and fibers from progressively more posterior facial regions terminate at successively lower levels. A mediolateral somatotopic arrangement was observed, with fibers from the ventral parts of face ending in the medial regions and fibers from the progressively more dorsal parts of the face ending in successively more lateral regions of the medullary and upper cervical dorsal horns. Corneal afferent terminals are concentrated in the outer parts of lamina II at the levels of the rostral parts of the caudal two-thirds of the caudalis and the interstitial islands of lamina I. The maxillary division terminates first at the most caudal level of the caudalis, followed by the ophthalmic division descending as far as the C2 segment and the mandibular division reaching the most caudal level of the C2 segment.(ABSTRACT TRUNCATED AT 400 WORDS)