Oral supplementation of Gordonibacter urolithinfaciens promotes ellagic acid metabolism and urolithin bioavailability in mice

Ellagic acid (EA) is an abundant dietary polyphenol with multifarious health benefits but low bioavailability. To increase its bio-efficacy, converting EA to urolithins by supplementing urolithin-producing bacteria, e.g., Gordonibacter urolithinfaciens (G.uro), could be a solution. This work first tested three methods for oral delivery of live G.uro. Intestinal colonization of G.uro and its impact on local gut microbiota, EA-to-urolithin conversion and bioavailability were then investigated in C57BL/6J mice administered to EA only or a synbiotic (G. uro + EA). In vitro results suggested that G.uro largely survived simulated gastrointestinal digestion and could be administered without protection. In vivo results showed that G.uro had little impact on local gut microbiota but could not colonize the gut. Moreover, synbiotic remarkably promoted Akkermansia, Lactobacillus and Bifidobacterium growth, and significantly enhanced the bioavailability of urolithins compared with the EA-only group. This study demonstrated the potential of oral supplementation of G.uro for enhancing EA-to-urolithin bioconversion and bioavailability.

Do variations in nasal irrigation recipes and storage effect the risk of bacterial contamination?

OBJECTIVE

Make-at-home nasal irrigation solutions are often recommended for treating chronic rhinosinusitis. Many patients will store pre-made solution for convenient use. This study investigated the microbiological properties of differing recipes and storage temperatures.

METHOD

Three irrigation recipes (containing sodium chloride, sodium bicarbonate and sucrose) were stored at 5oC and 22oC. Further samples were inoculated with Staphylococcus aureus and Pseudomonas aeruginosa. Sampling and culturing were conducted at intervals from day 0-12 to examine for bacterial presence or persistence.

RESULTS

No significant bacterial growth was detected in any control solution stored at 5oC. Saline solutions remained relatively bacterial free, with poor survival of inoculated bacteria, which may be related to either lower pH or lower osmolality. Storing at room temperature increased the risk of contamination in control samples, particularly from pseudomonas.

CONCLUSION

If refrigerated, pre-made nasal irrigation solutions can be stored safely for up to 12 days without risking cross-contamination to irrigation equipment or patients.

Mechanistic insights into zearalenone-accelerated colorectal cancer in mice using integrative multi-omics approaches

Zearalenone (ZEA), a secondary metabolite of Fusarium fungi found in cereal-based foods, promotes the growth of colon, breast, and prostate cancer cells in vitro. However, the lack of animal studies hinders a deeper mechanistic understanding of the cancer-promoting effects of ZEA. This study aimed to determine the effect of ZEA on colon cancer progression and its underlying mechanisms. Through integrative analyses of transcriptomics, metabolomics, metagenomics, and host phenotypes, we investigated the impact of a 4-week ZEA intervention on colorectal cancer in xenograft mice. Our results showed a twofold increase in tumor weight with the 4-week ZEA intervention. ZEA exposure significantly increased the mRNA and protein levels of BEST4, DGKB, and Ki67 and the phosphorylation levels of ERK1/2 and AKT. Serum metabolomic analysis revealed that the levels of amino acids, including histidine, arginine, citrulline, and glycine, decreased significantly in the ZEA group. Furthermore, ZEA lowered the alpha diversity of the gut microbiota and reduced the abundance of nine genera, including Tuzzerella and Rikenella. Further association analysis indicated that Tuzzerella was negatively associated with the expression of BEST4 and DGKB genes, serum uric acid levels, and tumor weight. Additionally, circulatory hippuric acid levels positively correlated with tumor weight and the expression of oncogenic genes, including ROBO3, JAK3, and BEST4. Altogether, our results indicated that ZEA promotes colon cancer progression by enhancing the BEST4/AKT/ERK1/2 pathway, lowering circulatory amino acid concentrations, altering gut microbiota composition, and suppressing short chain fatty acids production.

Effect of Oral Supplementation of Gordonibacter urolithinfaciens on Gut Microbiota and Bioavailability of Ellagic Acid and Urolithins in Mice

Objectives

Gordonibacter urolithinfaciens (GUro) is one of the three human bacteria that can convert ellagic acid (EA) to urolithins (Uros). Individuals deficient in Uro-producing bacteria may not benefit from EA-rich diets due to poor bioavailability of EA. Thus, GUro supplementation could be a solution. This work aims to examine 1) the viability of naked and protected GUro after gastrointestinal (GI) digestion; 2) colonization of GUro in vivo and the impact of GUro on gut microbiota; 3) the effect of GUro supplementation on the bioavailability of EA and Uros.

Methods

In vitro studies: Simulated GI digestion was conducted with GUro in naked (NG), alginate-chitosan encapsulated (ACG) or hydrogel protected (HGG) forms. Bacteria enumeration was performed by plate count. In vivo studies: Male C57BL/6J mice deficient in GUro were divided into 2 groups: Control (Ctrl, vehicle) and Experiment (Exp, GUro at 107 CFU/mouse). Mice received vehicle or GUro on days 1, 2, 3 and 7 by oral gavage, and then 20 mg/kg EA 12 h after the final dose of GUro or vehicle on D8. Feces were collected for gut microbiota analysis. Blood and tissues were collected at 0.5, 12, 24 and 36 h after EA intake. 36 h excretion of urine and feces were collected. The change in the main genera of gut microbiota was measured by qPCR. Colon tissue histology was examined by H&E staining. EA and Uros were extracted from biosamples and analyzed by UHPLC with triple quadrupole mass spectrometry.

Results

NG showed comparable viability as ACG and HGG after in vitro GI digestion indicating GUro's suitability to be ingested without protection. For in vivo study, the level of GUro increased 8 folds 12 h after the last dose of GUro but returned to baseline in 24–36 h. For Ctrl group, Akkermansia (Akk) increased substantially at all time points. Similarly, Akk bloomed post-gavage of EA but most strikingly at 0.5 h in Exp group. GUro administration significantly enhanced the bioavailability of EA and Uros. Substantial amounts of Uro C, dimethyl Uro C, Uro A and methyl Uro A were excreted in the urine of Exp group, but barely detected in the Ctrl.

Conclusions

Supplementation of GUro improved the bioavailability of EA and bioactive metabolites. Moreover, the high survival rate of naked GUro after GI digestion indicated its potential to serve as a probiotic.

Funding Sources

National Natural Science Foundation of China; PolyU Research Institute for Future Food.

Luminescent cyclometallated iridium(III) bis(quinolylbenzaldehyde) diimine complexes--synthesis, photophysics, electrochemistry, protein cross-linking properties, cytotoxicity and cellular uptake

Four new luminescent cyclometallated iridium(III) bis(quinolylbenzaldehyde) diimine complexes [Ir(qba)(2)(N⁁N)](PF(6)) (Hqba = 4-(2-quinolyl)benzaldehyde, N⁁N = 2,2'-bipyridine, bpy (1); 1,10-phenanthroline, phen (2); 3,4,7,8-tetramethyl-1,10-phenanthroline, Me(4)-phen (3); 4,7-diphenyl-1,10-phenanthroline, Ph(2)-phen (4)) have been synthesised and characterised, and their electronic absorption, emission and electrochemical properties investigated. The X-ray crystal structures of complexes 1 and 2 have been determined. Upon irradiation, complexes 1-4 exhibited intense and long-lived orange-yellow emission in fluid solutions at 298 K and in alcohol glass at 77 K. The emission has been assigned to a triplet intra-ligand ((3)IL) excited state associated with the qba ligand, probably with mixing of some triplet metal-to-ligand charge-transfer ((3)MLCT) (dπ(Ir) →π*(qba)) character. Reductive amination reactions of complexes 1-4 with the protein bovine serum albumin (BSA) afforded the bioconjugates 1-BSA-4-BSA, respectively. Upon photoexcitation, these bioconjugates displayed intense and long-lived (3)MLCT (dπ(Ir) →π*(N⁁C)) emission in aqueous buffer at 298 K. The cross-linked nature of the Ir-BSA bioconjugates has been verified by SDS-PAGE. Additionally, the cytotoxicity of the complexes towards human cervix epithelioid carcinoma (HeLa) cells has been examined by 3-(4,5-dimethyl-2-thiazolyl)-2,5-diphenyltetrazolium bromide (MTT) assays, and the cellular uptake of complex 4 has been investigated by laser-scanning confocal microscopy and flow cytometry.

Unicystic ameloblastoma--use of Carnoy's solution after enucleation

A retrospective analysis of 29 patients with a histologically confirmed diagnosis of unicystic ameloblastoma is reported with special emphasis on a treatment regime employing enucleation and application of Carnoy's solution. Despite the finding that 93% of lesions exhibited mural invasion, a recurrence rate of 10% after treatment is reported, suggesting a possible benefit of Carnoy's solution against recurrence.

Role of PTCH and p53 genes in early-onset basal cell carcinoma

Basal cell carcinoma (BCC) is the most common skin cancer in the Western world. Ultraviolet (UV) exposure, race, age, gender, and decreased DNA repair capacity are known risk factors for the development of BCC. Of these, UVB irradiation from sunlight is the most significant risk factor. The incidence of sporadic BCC increases in individuals older than age 55, with the greatest incidence reported in individuals who are older than 70, and is rare in individuals who are younger than 30. In this study, we analyzed 24 BCC samples from individuals who had BCC diagnosed by the age of 30. Fifteen single-stranded conformation polymorphism variants in the PTCH gene were identified in 13 BCC samples. Sequence analysis of these single-stranded conformation polymorphism variants revealed 13 single nucleotide changes, one AT insertion, and one 15-bp deletion. Most of these nucleotide changes (nine of 15) were predicted to result in truncated PTCH proteins. Fifteen p53 mutations were also found in 11 of the 24 BCC samples. Thirty-three percent (five of 15) and 60% (nine of 15) of the nucleotide changes in the PTCH and p53 genes, respectively, were UV-specific C-->T and CC-->TT nucleotide changes. Our data demonstrate that the p53 and PTCH genes are both implicated in the development of early-onset BCC. The identification of UV-specific nucleotide changes in both tumor suppressor genes suggests that UV exposure is an important risk factor in early onset of BCC.

Vaccination of malignant glioma patients with peptide-pulsed dendritic cells elicits systemic cytotoxicity and intracranial T-cell infiltration

In this Phase I trial, patients' peripheral blood dendritic cells were pulsed with peptides eluted from the surface of autologous glioma cells. Three biweekly intradermal vaccinations of peptide-pulsed dendritic cells were administered to seven patients with glioblastoma multiforme and two patients with anaplastic astrocytoma. Dendritic cell vaccination elicited systemic cytotoxicity in four of seven tested patients. Robust intratumoral cytotoxic and memory T-cell infiltration was detected in two of four patients who underwent reoperation after vaccination. This Phase I study demonstrated the feasibility, safety, and bioactivity of an autologous peptide-pulsed dendritic cell vaccine for patients with malignant glioma.

Interleukin-10-induced T cell unresponsiveness can be reversed by dendritic cell stimulation

The secretion of immunosuppressive factors like interleukin-10 (IL-10), either by tumor cells or by tumor-infiltrating leukocytes, has been recognized as one of the mechanisms involved in tumor immunological escape and a serious obstacle for successful immunotherapy. Therefore, any therapeutic attempts aimed at inducing antitumor immunity in tumor-bearing hosts must overcome this immunosuppressive state. This study aimed to determine whether dendritic cell (DC) immunization, a promising approach to induce antitumor immunity, could break IL-10-induced anergic state in CD4+ T cells, essential cells in generating tumor-specific immunity. We found that the ability of DC to reverse IL-10-induced anergic state in human CD4+ T cells is dependent on the IL-10 concentration that T cells have been exposed to and the degree of DC maturation. The efficacy of mature DC in reversing T cell anergy can be mimicked by higher cell numbers of immature DC. In addition, activated T cells induced by DC stimulation are sensitive to IL-10 treatment. Collectively, our results suggest the use of mature DC and the necessity of antagonizing the action of tumor-derived IL-10 in immunotherapy of cancer with DC immunization.

Field kit to characterize physical, chemical and spatial aspects of potential primate foods

An outline is given for a field kit aiming to substantially increase the in situ knowledge gleaned from feeding studies of primates. Measurements are made of colouration (spectrum of non-specular reflection) and many mechanical, chemical and spatial properties of primate foods.

Lumbar epidural blocks: a case report of a life-threatening complication

A case of life-threatening complication resulting from a lumbar epidural block is presented. A 70-year-old woman with spinal stenosis developed cardiac and respiratory arrest 5 minutes after receiving a lumbar epidural block containing 80 mg of triamcinolone acetonide and 6mL of 1.5% lidocaine. The patient received cardiopulmonary resuscitation and recovered without any sequelae. It is suggested that this complication was caused by subdural or intravascular injection of local anesthetics. It might be preventable by injecting a test dose of local anesthetics before injecting a full dose of local anesthetics and by using fluoroscopy.

Electrosurgical facial resurfacing: a prospective multicenter study of efficacy and safety

BACKGROUND

A novel electrosurgical technology that uses a bipolar electrode-tipped stylet to deliver relatively low-radiofrequency energy through an electrically conductive medium has been developed.

OBJECTIVE

To evaluate the efficacy and safety of the radiofrequency resurfacing system for the treatment of facial wrinkles.

DESIGN

Multicenter, prospective, noncomparative study with longitudinal follow-up.

SETTING

Four US academic dermatologic surgery clinics.

PATIENTS

Ninety-five patients with mild to severe photodamage (Fitzpatrick classes I-III) involving periorbital (75 treatment sites) and perioral (50 sites) facial skin.

INTERVENTION

Radiofrequency resurfacing with the use of 2 to 3 passes at 125 or 139 V.

MAIN OUTCOME MEASURES

Wrinkle and cosmetic improvements evaluated by patients, investigators, and, by means of photographs, an independent panel of 5 evaluators.

RESULTS

All evaluators determined a positive mean improvement in wrinkles for both periorbital and perioral anatomic sites, with greater improvement for patients with more severe wrinkles at baseline. An increased number of passes and higher voltage settings had a positive impact on wrinkle improvement. Transient postinflammatory hyperpigmentation occurred in 26% of periorbital and 4% of perioral sites. Hypertrophic scars occurred in 3.8% of treatment sites, with all but 1 scar resolving by 6 months. For the most part, healing was rapid, pain was minimal, and erythema largely resolved within 2 months. Other untoward effects were relatively few and short-lived.

CONCLUSIONS

At the study settings used, radiofrequency resurfacing is an effective modality in the treatment of periorbital and perioral wrinkles in patients with Fitzpatrick class I, II, and III photodamage. There is less severe postoperative morbidity than seen with carbon dioxide or coagulating erbium:YAG lasers. The potential risks are similar to those seen with other resurfacing modalities.

Colour cues for leaf food selection by long-tailed macaques (Macaca fascicularis) with a new suggestion for the evolution of trichromatic colour vision

Leaf colour, size and toughness were investigated in five plant species important in the diet of Macaca fascicularis in Singapore. Leaf colour and size were examined as potential visual cues for food selection, whereas toughness mirrored fibre content, the inverse of food quality. As leaves matured, they changed colour and toughened. Leaf lightness and yellowness were strongly negatively correlated with toughness, but variation in both the red-green axis of the CIE Lab colour space and leaf size were not. Leaves selected as food by the macaques were distinguished by being very light, yellow to slightly green. Some leaves were dappled with red. The literature suggests that these leaves are relatively rich in protein without being tough and therefore would be sought after by primates. We argue that leaf colour is an important indicator of the nutritive value of leaves. Trichromatic vision is an important advantage in finding those palatable leaves that are dappled red. These would appear dark to dichromatic primates and be deceptive by making leaves look older (lower in quality) than they actually are. This would decrease the perceived window of feeding opportunity for such primates who would be at a disadvantage in trying to find these leaves. It is possible that trichromatic vision in catarrhine primates may have originally evolved for the detection of red coloration in the leaves of shade-tolerant tropical plants, enabling the better exploitation of a food resource.

Porphyria cutanea tarda occurring in a patient with renal failure, systemic lupus erythematosus and chronic hepatitis C infection treated with hemodialysis

The diagnosis and management of porphyria cutanea tarda (PCT) is complicated when it occurs in the context of renal failure, chronic hemodialysis, and anemia. We report a case of a woman who presented with painful acral blisters and hyperpigmentation. Her medical history included systemic lupus erythematosus, chronic hepatitis C infection, and renal failure necessitating chronic hemodialysis with a baseline anemia. A highly elevated serum porphyrin level led to the diagnosis of PCT. Treatment with small repeated phlebotomies and concomitant administration of erythropoietin was effective in managing her PCT.

PTEN/MMAC1 mutations in hepatocellular carcinomas

Mutations in the PTEN/MMAC1 gene have been identified in several types of human cancers and cancer cell lines, including brain, endometrial, prostate, breast, thyroid, and melanoma. In this study, we screened a total of 96 hepatocellular carcinoma (HCC) samples from Taiwan, where HCC is the leading cancer in males and third leading cancer in females, for mutations in the PTEN/MMAC1 gene. Complete sequence analysis of these samples demonstrated a missense mutation in exon 5 (K144I) and exon 7 (V255A) from HCC samples B6-21 and B6-2, respectively. A putative splice site mutation was also detected in intron 3 from sample B6-2. Both B6-21 and B6-2 were previously shown to contain missense mutations in the coding sequences of the p53 gene. Functional studies with the two missense mutations demonstrated that while mutation V255A in exon 7 resulted in a loss of phosphatase activity, mutation K144I in exon 5 retained its phosphatase activity. Additionally, we identified a silent mutation (P96P) in exon 5 of the PTEN/MMAC1 gene from HCC sample B6-22. These data provide the first evidence that the PTEN/MMAC1 gene is mutated in a subset of HCC samples.

Replantation of fingertip amputation by using the pocket principle in adults

There are several treatment modalities for zone 1 or zone 2 fingertip amputations that cannot be replanted by using microsurgical techniques, such as delayed secondary healing, stump revision, skin graft, local flaps, distant flaps, and composite graft. Among these, composite graft of the amputated digit tip is the only possible means of achieving a full-length digit with a normal nail complex. The pocket principle can provide an extra blood supply for survival of the composite graft of the amputated finger by enlarging the area of vascular contact. The surgery was performed in two stages. The amputated digit was debrided, deepithelialized, and reattached to the proximal stump. The reattached finger was inserted into the abdominal pocket. About 3 weeks later, the finger was removed from the pocket and covered with a skin graft. We have consecutively replanted 29 fingers in 25 adult patients with fingertip amputations by using the pocket principle. All were complete amputations with crushing or avulsion injuries. Average age was 33.64 years, and men were predominant. The right hand, the dominant one, was more frequently injured, with the middle finger being the most commonly injured. Of the 29 fingers, 16 (55.2 percent) survived completely and 10 (34.5 percent) had partial necrosis less than one-quarter of the length of the amputated part. The results of the above 26 fingers were satisfactory from both functional and cosmetic aspects. Twenty of the 29 fingers, which had been followed up for more than 6 months (an average of 16 months), were included in a sensory evaluation. Fifteen of these 20 fingers (75 percent) were classified as "good" (static two-point discrimination of less than 8 mm and normal use). From the overall results and our experience, we suggest that the pocket principle is a safe and valuable method in replantation of zone 1 or zone 2 fingertip amputation, an alternative to microvascular replantation, even in adults.

Failure of Q-switched ruby laser to eradicate atypical-appearing solar lentigo: report of two cases

Cutaneous lasers, including argon, Q-switched Nd:YAG, Q-switched ruby, Q-switched alexandrite, and short pulsed dye lasers, have been used to treat solar lentigines and other benign melanocytic lesions. However, the effects of these lasers at standard fluences on atypical melanocytic lesions have not been examined. We describe two patients in whom the Q-switched ruby laser failed to successfully treat clinically atypical-appearing solar lentigines. In both, clinically atypical-appearing melanocytic lesions were treated with excellent initial cosmetic results. In the first patient, the pigmentation returned several months after treatment and continued to increase in size and color. A biopsy specimen 30 months after Q-switched ruby laser therapy revealed a lentigo maligna melanoma. In the second patient, the lesion recurred 6 months after Q-switched ruby laser therapy, and a biopsy specimen 1 year after treatment showed an early lentigo maligna. Thus Q-switched ruby lasers and other cutaneous lasers capable of targeting melanin may be inadequate to eliminate lentigo maligna and other atypical melanocytic lesions completely. These cases emphasize the importance of careful clinical assessment before any laser surgery and the need to advise patients to return for evaluation should pigmentation return.

A prescription survey in a hospital hypertension outpatient clinic

AIMS

The objective of this study was to investigate drug utilization in the management of hypertension in Hong Kong.

METHODS

We conducted a prescription survey to examine the use of antihypertensive drugs in a hypertension clinic in a regional hospital and the resulting expenditure incurred. The use of concurrent medications such as antidiabetic drugs and lipid-lowering agents was also examined.

RESULTS

During a 7-week study period, 530 prescriptions were collected. All except 14 patients received antihypertensive drugs with 262 (50.8%) on monotherapy and 254 (49.2%) on combination therapy. Calcium channel blocking agents and beta-adrenoceptor blocking agents were the two most popular antihypertensive drugs used in both monotherapy (38% and 31%, respectively) and combination therapy (27% and 33%, respectively). Forty-nine patients (19%) received three antihypertensive drugs or more. The number of antihypertensive drugs showed a significant positive correlation with the duration of attendance at the clinic (r=0.88, P < 0.001). Of the total 530 prescriptions, 5.6% and 10% contained antidiabetic drugs and lipid-lowering agents, respectively. Calcium channel blocking agents, angiotensin converting enzyme (ACE) inhibitors and lipid lowering agents, accounted for 82% (HK$211,654; pounds sterling 1 approximately HK$12) of the total drug expenditure (HK$258,115). Seventy-nine percent of the lipid lowering agents prescribed were hydroxymethylglutaryl coenzyme A (HMG CoA) reductase inhibitors. Amlodipine accounted for 26% of usage but contributed to 41% of the overall costs of calcium channel blocking agents. Alpha1-adrenoceptor blocking agents were only used infrequently and were the most expensive class of drugs, due to the preferred use of doxazosin rather than prazosin which is far cheaper than the former.

CONCLUSIONS

In view of the use of these often costly drugs for long-term therapy, monitoring of their use and its correlation with clinical outcomes and quality of life is essential to ensure the optimal use of health care resources.

Heavy metal contamination of settling particles in a retention pond along the A-71 motorway in Sologne, France

A retention pond is a part of a drainage system designed to control water flow during rainstorms and to trap contaminated solid particles washed off by runoff water from a motorway. A series of studies have been carried out concerning the physico-chemical characteristics of the particles which settle down in such a pond in order to evaluate the effectiveness of the pond as a trap for heavy metals such as Pb, Zn and Cd. The highly contaminated roadside soil and the uncontaminated background soil were also studied for comparison. The settling particles had heavy metal concentrations 2-8 times higher than the background Sologne soil, depending on the metals. Heavy metal concentrations in the roadside soil were 7-26 times higher than those in the former. Sequential extractions, using the procedure of Tessier et al. (1979) illustrate that the highly contaminated roadside soil consisted mainly of the readily soluble fractions for all three heavy metals, with a limited proportion of residual metals. In the settling particles, the proportion of the latter is significantly increased, up to one-third of the total. The high concentration differences between the roadside soil and the settling particles indicates that most of the heavy metals are lost to the surroundings even before reaching the retention pond. Cadmium exhibited a specific behavior in that the most soluble fraction (exchangeable), which is negligible for Pb and Zn, occupied as much as one-fourth of the total in the roadside soil. Based on the 'enrichment factor' normalized to Fe introduced by Helz in 1976, the degree of contamination by heavy metals for the roadside soil and the settling particles was evaluated. The level of contamination was very severe in the roadside soil, while it was not so great in the settling particles. Suggestions are made to improve their removal efficiency.

Nucleotide sequences and biologic properties of toxic shock syndrome toxin 1 from ovine- and bovine-associated Staphylococcus aureus

Toxic shock syndrome toxin (TSST) 1 was purified from ovine (TSST-ovine) and bovine (TSST-bovine) mastitis-associated Staphylococcus aureus. These toxins were previously reported to have molecular weights identical to that of human TSST-1. However, TSST-ovine was reported as having an isoelectric point (pI) of 8.5, whereas TSST-bovine has the same pI (7.2) as TSST-1. Nucleotide sequence analysis revealed that TSST-bovine was identical to TSST-1 and that TSST-ovine had 14 nucleotide differences that changed 9 amino acid residues. Only 1 nucleotide difference, at position 514, was predicted to cause an amino acid charge difference, as glutamic acid at position 132 of TSST-1 was changed to lysine in TSST-ovine. Like TSST-1, TSST-ovine was mitogenic, but unlike TSST-1, it was not pyrogenic, was unable to enhance endotoxic shock, and was unable to induce TSS in a rabbit model. Also, TSST-ovine was less reactive to certain monoclonal antibodies raised against TSST-1.

Effects of staphylococcal toxic shock syndrome toxin 1 on aortic endothelial cells

In staphylococcal toxic shock syndrome, hypotension and shock due to capillary leak may rapidly lead to death of the host. To investigate its pathogenesis, the cytotoxic effects of toxic shock syndrome toxin 1 (TSST-1) on porcine aortic endothelial cells (PAEC) were examined in vitro. TSST-1 killed PAEC (as measured by 51Cr release) in a dose- and time-dependent fashion and was blocked by anti-TSST-1 antibodies. Receptor-mediated endocytosis may be critical for the cytotoxic effects of TSST-1, as killing was inhibited by cold (4 degrees C) and by addition of chloroquine and methylamine. Furthermore, calcium and oxygen appeared necessary for TSST-1 effects on PAEC. Membrane receptor binding studies indicated PAEC bind TSST-1 with high affinity (Kd = 5.7 x 10(-7) M) and had 2.2 x 10(4) receptors/cell. Last, as measured by 125I-labeled albumin flux in a transendothelial permeability model, TSST-1 enhanced the permeability of PAEC monolayers in a dose- and time-dependent manner.

Intravenous leiomyomatosis with intracardiac extension: an unusual cause of cardiac syncope

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Atypical hepatic vein leiomyoma extending into the right atrium: an unusual cause of the Budd-Chiari syndrome

A 14-year-old male presented with a one week history of weakness, lightheadedness and vomiting. Bilateral pleural effusions were evident on chest radiography; electrocardiogram revealed decreased voltages. Echocardiogram, abdominal ultrasound and magnetic resonance imaging revealed a mass in an hepatic vein and the inferior vena cava extending up to and filling the right atrium. Under deep hypothermia and extracorporeal circulation the mass was removed en bloc. It originated from the hepatic vein. Pathology revealed a smooth muscle tumour intermediate between benign and malignant (atypical leiomyoma). This is the first reported pediatric primary leiomyoma of the hepatic vein. It caused the Budd-Chiari syndrome, a rare pediatric entity.

Two-dimensional and pulsed Doppler echocardiographic diagnosis of an acquired aortic right ventricular fistula

A patient with an asymptomatic aortic right ventricular fistula acquired after aortic valve and mitral valve replacement is presented. This was diagnosed by two-dimensional and pulsed Doppler echocardiography, and confirmed at cardiac catheterization.

Quantification and toxicity of group A streptococcal pyrogenic exotoxins in an animal model of toxic shock syndrome-like illness

Toxic shock-like syndrome isolates of group A streptococci were evaluated for production of pyrogenic exotoxins (also called SPEs, scarlet fever toxins, and erythrogenic toxins). The isolates were consecutively obtained during 1987 and 1988. Of these isolates, 23 of 26 made SPE type A, 10 of 26 made SPE B, and 8 of 26 made SPE C. SPE A was produced in significantly greater amounts than SPEs B and C (3.2 micrograms/ml of culture fluid compared with 0.7 and 0.6 microgram/ml, respectively). SPE A, administered in miniosmotic pumps implanted subcutaneously in rabbits, was significantly more toxic than SPE C; seven of eight rabbits succumbed after challenge with 150 or 300 micrograms of SPE A, compared with one of six after challenge with SPE C.

Studies on the submicrosomal fractions of bovine oligodendroglia: lipid composition and glycolipid biosynthesis

Oligodendroglia were isolated from bovine brain, and a "crude" microsomal fraction obtained from cell homogenates was subfractionated into myelin (MP), plasma membranes (PM), Golgi (GF), smooth (SER) and rough (RER) endoplasmic membranes using discontinuous-sucrose gradient centrifugation. The submicrosomal fractions were characterized by ultrastructural examination and analysis of the specific organelle markers. The myelin and plasma membrane rich fractions contained characteristically the highest amounts of the lipid with lower mole percentages of total phospholipids and phosphatidylcholine, and higher concentrations of phosphatidylethanolamine (+ plasmalogens), cholesterol and galactolipids. Considerable amounts of the typical myelin galactolipids (galacto-cerebrosides, sulfatides and monogalactosyl diglycerides) were also found in the Golgi fraction (GF). The GF fraction had the greatest enrichment of glycolipid-forming galactosyltransferases, and the distribution of these enzymes correlated well with that of the Golgi marker enzymes. The results give evidence that intracellular Golgi apparatus of oligodendroglia is rich in the myelin-specific lipids, and suggest its involvement in the synthesis and processing of myelin lipids.

Comparison between lidocaine and bupivacaine as local anesthetics with diflunisal for postoperative pain control after lower third molar surgery

The effect of lidocaine and bupivacaine on postoperative pain were compared in a double blind crossover study. Diflunisal (500 mg) was used as an analgesic and given before commencement of the surgical procedure.Bilateral impactions of lower third molars were removed on two occasions, four weeks apart, in a sample of 26 Chinese patients. One local anesthetic was used on one occasion and the alternate on the second. Pain intensity was indicated on a visual analogue scale hourly for eight hours, beginning one hour after the start of surgery.Pain at each postoperative hour was lower after bupivacaine and more patients indicated little or no pain after bupivacaine than after lidocaine. This was not reflected in patients' preference: 12 preferring lidocaine, 11 bupivacaine, and 3 indicating no preference, an important reason being a shorter period of numbness with lidocaine.Although diflunisal was given preoperatively, the postoperative course was not complicated by alveolitis in any case.While bupivacaine plus diflunisal resulted in less postoperative pain than lidocaine plus diflunisal, some patients were willing to sustain some pain after oral surgery if sensation was regained sooner.

A comparison of the incidence and nature of cardiac dysrhythmias occurring during enflurane and isoflurane anaesthesia for dental surgery

The incidence and nature of dysrhythmias with equipotent concentrations of enflurane and isoflurane during dental surgery were compared. Seventy-six Chinese patients between 17-30 years, of ASA Grade I, randomly received either enflurane or isoflurane with N2O and O2 for spontaneous ventilation during third molar extractions. The cardiac rhythm and the blood pressure were continuously monitored during the procedure. The incidence of dysrhythmias with both enflurane and isoflurane was low and the difference not statistically significant. During surgery one patient exhibited unifocal ventricular ectopics with isoflurane. Sinus tachycardia was common with both agents. No life-threatening dysrhythmias were seen with either agent and no clinically significant lowering of blood pressure occurred in association with the exhibited dysrhythmias. In this Chinese population, as in other studies, the incidence of dysrhythmias with both agents was low thus showing no difference between the races.

Radiological diagnosis of leiomyosarcoma of the inferior vena cava

A 46-year-old lady with leiomyosarcoma of the inferior vena cava extending into the hepatic veins and right atrium is described. The diagnosis was made preoperatively by a combination of radiological techniques including computed tomography, inferior vena cavography, arteriography, and two-dimensional echocardiography. The clinical presentation, radiological features and management of this condition are reviewed.

Combined use of warfarin and adjusted subcutaneous heparin during pregnancy in patients with an artificial heart valve

Adjusted subcutaneous heparin was used for thromboembolism prophylaxis during 18 pregnancies in 16 women with an artificial heart valve. Oral warfarin was replaced by subcutaneous heparin as soon as pregnancy was confirmed. The dosage of heparin was adjusted to maintain a partial thromboplastin time at 1.5 times the control value and treatment was administered during the first trimester and the last 3 weeks of gestation. Warfarin was used between the 13th and 37th week. There were no maternal thromboembolic complications and none of the live-born infants showed congenital malformations, indicating that this regimen is effective. However, there were nine spontaneous abortions, including five that occurred in the first 12 weeks. The early abortions were probably related to warfarin exposure at the beginning of pregnancy. The preconception replacement of warfarin by heparin in these patients may be indicated.

An unusual cause of central cyanosis in a patient with rheumatic heart disease

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Comparison of the incidence and nature of cardiac arrhythmias occurring during isoflurane or halothane anaesthesia. Studies during dental surgery

Seventy-six Chinese patients aged between 15 and 30 yr, undergoing 3rd molar extraction, were randomly allocated to two groups. One group received halothane and the other isoflurane. The incidence of arrhythmia during surgery under anaesthesia with isoflurane was significantly less than with halothane. Sinus tachycardia was a significant feature under anaesthesia with isoflurane. Under anaesthesia with halothane, the arrhythmias occurring most frequently during surgery were ventricular ectopics, the commonest being ventricular bigeminy. The frequency and nature of arrhythmias during surgery on right and left sides were similar. In three patients a slight decrease in arterial pressure was recorded in association with the arrhythmia, but on stopping the stimulus, both rhythm and arterial pressure returned to normal. The incidence of arrhythmia with halothane in the Chinese population in this study was significantly higher than that reported previously in non-Chinese patients.

Warfarin versus dipyridamole-aspirin and pentoxifylline-aspirin for the prevention of prosthetic heart valve thromboembolism: a prospective randomized clinical trial

In a prospective, randomized, parallel study, two regimens of platelet-suppressant therapy (PST)--dipyridamole-aspirin and pentoxifylline-aspirin--were compared with standard oral anticoagulation with warfarin in the prevention of prosthetic heart valve thromboembolism. In the entire group of 254 patients followed for 395.6 patient-years, the thromboembolic rate was significantly less in the warfarin group (warfarin vs dipyridamole-aspirin, p less than .005; warfarin vs pentoxifylline-aspirin, p less than .05). Subgroup analysis disclosed that, in patients with isolated mitral valve replacement, warfarin was superior to both of the PSTs with respect to the prevention of thromboembolism (warfarin vs dipyridamole-aspirin, p = .005; warfarin vs pentoxifylline-aspirin, p less than .05). Furthermore, a significant number of our patients could not tolerate the antiplatelet agents. However, in the rare situation in which repeated significant bleeding occurs despite careful adjustment of the dosage of warfarin, PST may be an acceptable alternate method of thromboembolism prophylaxis.

Percutaneous transfemoral catheterization in aortic stenosis with a USCI Sones catheter curve A type 1 (7540)

We report our experience with the use of a USCI Sones catheter curve A type 1 (7540) to cross the aortic valves of 45 patients with clinically significant aortic stenosis. The technique was successful in all our patients with a fluoroscopic time of less than 3 min. A gradient of up to 200 mmHg across the aortic valve area was recorded, and the smallest valve area calculated was less than 0.2 cm2. The method obviated the need for a guidewire and satisfactory left ventriculograms were obtained. No major complication was observed. We conclude that the technique is a simple, rapid, and safe means of obtaining left ventricular hemodynamic and angiographic information in patients with aortic stenosis of various degrees of severity.

Efficacy of low-dose, subcutaneously administered heparin in treatment of pregnant women with artificial heart valves

Between 1979 and 1982, the efficacy of fixed low-dose heparin, administered subcutaneously as thromboembolic prophylaxis, was studied during 14 pregnancies in 10 patients with mechanical heart valves. Calcium heparin (5000 units every 12 hours) was substituted for warfarin during the first trimester and the last month of pregnancy. Although the regimen was well tolerated and was associated with only 14% of first-trimester abortions, five episodes of thromboembolism occurred in four patients. Thus, this fixed, low-dose heparin regimen did not provide adequate thromboembolic prophylaxis in patients with prosthetic heart valves during pregnancy.

Myocardial metabolic effects of intravenous terbutaline in patients with severe heart failure due to coronary artery disease

Intravenous terbutaline, 0.3 mg/kg/min for 30 minutes followed by 0.15 mg/min for 60 minutes, was studied in nine patients with severe heart failure due to documented coronary artery disease. Hemodynamic and myocardial metabolic effects were measured during terbutaline infusion. Cardiac index and stroke index increased, whereas mean pulmonary artery wedge pressure and pulmonary vascular resistance decreased significantly. No significant alterations in aortic oxygen content, coronary sinus oxygen content, myocardial oxygen extraction, and myocardial lactate extraction were observed during terbutaline infusion. No patient developed angina or electrocardiographic changes suggestive of ischemia. These results indicate that intravenous terbutaline infusion, at the dosage employed, produces beneficial hemodynamic effects without a deterioration of myocardial metabolism in patients with heart failure due to coronary artery disease.

Terbutaline infusion in cardiogenic shock: acute hemodynamic effects and clinical response

The effect of terbutaline infusion was studied in six patients with cardiogenic shock due to acute myocardial infarction. Terbutaline was initiated at 3 micrograms/kg/min, and the subsequent infusion rate was adjusted according to heart rate and blood pressure. At 3 hours after infusion arterial pressure increased from 62 +/- 13 mm Hg (mean +/- S.D.) to 89 +/- 13 mm Hg (P less than 0.001), cardiac index increased from 1.38 +/- 0.29 liter/min/m2 to 2.68 +/- 0.47 liter/min/m2 (P less than 0.001), and heart rate increased from 92 +/- 32 beats/min to 112 +/- 29 beats/min (P less than 0.005). Pulmonary artery wedge pressure fell from 24 +/- 7 mm Hg to 17 +/- 3 mm Hg (P less than 0.01), right atrial pressure fell from 12 +/- 4 mm Hg to 6 +/- 3 mm Hg (P less than 0.005), and systemic vascular resistance fell from 1880 +/- 641 dyn-sec/cm5 to 1515 +/- 418 dyn-sec/cm5 (P less than 0.05). In addition, urine flow increased from 4 +/- 6 ml/hr to 314 +/- 237 ml/hr (P less than 0.05), and subjective improvement was noted in all subjects. Undesirable effects observed were hypokalemia (all subjects), supraventricular tachycardia (one subject), and ventricular ectopic beats (three subjects), which responded to potassium replacement and other treatments. All patients required prolonged maintenance infusion to maintain adequate hemodynamic and clinical response. Four patients were weaned off from maintenance therapy after a mean duration of 4.8 days and eventually were discharged from the hospital.(ABSTRACT TRUNCATED AT 250 WORDS)