Aberrantly downregulated FENDRR by arecoline elevates ROS and myofibroblast activation via mitigating the miR-214/MFN2 axis

Long non-coding RNA FENDRR possesses both anti-fibrotic and anti-cancer properties, but its significance in the development of premalignant oral submucous fibrosis (OSF) remains unclear. Here, we showed that FENDRR was downregulated in OSF specimens and fibrotic buccal mucosal fibroblasts (fBMFs), and overexpression of FENDRR mitigated various myofibroblasts hallmarks, and vice versa. In the course of investigating the mechanism underlying the implication of FENDRR in myofibroblast transdifferentiation, we found that FENDRR can directly bind to miR-214 and exhibit its suppressive effect on myofibroblast activation via titrating miR-214. Moreover, we showed that mitofusin 2 (MFN2), a protein that is crucial to the fusion of mitochondria, was a direct target of miR-214. Our data suggested that FENDRR was positively correlated with MFN2 and MFN2 was required for the inhibitory property of FENDRR pertaining to myofibroblast phenotypes. Additionally, our results showed that the FENDRR/miR-214 axis participated in the arecoline-induced reactive oxygen species (ROS) accumulation and myofibroblast transdifferentiation. Building on these results, we concluded that the aberrant downregulation of FENDRR in OSF may be associated with chronic exposure to arecoline, leading to upregulation of ROS and myofibroblast activation via the miR-214-mediated suppression of MFN2.

XIST/let-7i/HMGA1 axis maintains myofibroblasts activities in oral submucous fibrosis

Long non-coding RNA XIST promotes the development of various types of head and neck cancers, but its role in the progression of precancerous oral submucous fibrosis (OSF) has not been determined yet. As such, we aimed to examine whether XIST implicates in the regulation of myofibroblast activation. Our results showed that the expression of XIST was upregulated in OSF tissues and fibrotic buccal mucosal fibroblasts (fBMFs), and the silencing of XIST downregulated several myofibroblasts features. We demonstrated that elevation of let-7i after inhibition of XIST may lead to reduced myofibroblast activation. On the contrary, overexpression of high mobility group AT-Hook 1 (HMGA1) following the suppression of let-7i may result in enhanced myofibroblast activities. Moreover, we showed that the suppressive effect of silencing of XIST on myofibroblasts hallmarks was reversed by let-7i inhibition or HMGA1 overexpression, suggesting the pro-fibrotic property of XIST was mediated by downregulation of let-7i and upregulation of HMGA1. These findings revealed that myofibroblast activation of fBMFs may attribute to the alteration of the XIST/let-7i/HMGA1 axis. Therapeutic approaches to target this axis may serve as a promising direction to ameliorate the malignant progression of OSF.

MiR-424/TGIF2-Mediated Pro-Fibrogenic Responses in Oral Submucous Fibrosis

Oral submucous fibrosis (OSF) has been recognized as a potentially malignant disorder and is characterized by inflammation and the deposition of collagen. Among various regulators of fibrogenesis, microRNAs (miR) have received great attention but the detailed mechanisms underlying the miR-mediated modulations remain largely unknown. Here, we showed that miR-424 was aberrantly overexpressed in OSF tissues, and then we assessed its functional role in the maintenance of myofibroblast characteristics. Our results demonstrated that the suppression of miR-424 markedly reduced various myofibroblast activities (such as collagen contractility and migration ability) and downregulated the expression of fibrosis markers. Moreover, we showed that miR-424 exerted this pro-fibrosis property via direct binding to TGIF2, an endogenous repressor of the TGF-β signaling. In addition, our findings indicated that overexpression of miR-424 activated the TGF-β/Smad pathway, leading to enhanced myofibroblast activities. Altogether, our data revealed how miR-424 contributed to myofibroblast transdifferentiation, and targeting the miR-424/TGIF2 axis may be a viable direction for achieving satisfactory results from OSF treatment.

α-Mangostin Inhibits the Activation of Myofibroblasts via Downregulation of Linc-ROR-Mediated TGFB1/Smad Signaling

Oral submucous fibrosis (OSF) is a premalignant disorder and persistent activation of myofibroblasts is implicated in this pathological progression. Increasing attention has been addressed towards non-coding RNA-regulated myofibroblasts activities and the effects of phytochemicals on non-coding RNA modulation are of great importance. In the present study, we examined the anti-fibrosis property of α-mangostin, a xanthone isolated from the pericarp of mangosteen. We found that α-mangostin exhibited inhibitory potency in myofibroblast activities and expression of fibrosis markers at the concentrations that caused neglectable damage to normal cells. Apart from the downregulation of TGF-β1/Smad2 signaling, we found that α-mangostin attenuated the expression of long non-coding RNA LincROR as well. Our results demonstrated that the effects of α-mangostin on myofibroblast activation were reverted when LincROR was overexpressed. Additionally, we showed the expression of LincROR in OSF specimens was elevated and silencing of LincROR successfully attenuated myofibroblast characteristics and TGF-β1/Smad2 activation. Taken together, these findings indicated that the anti-fibrosis effects of α-mangostin merit consideration and may be due to the attenuation of LincROR.

LINC01296 promotes cancer stemness traits in oral carcinomas by sponging miR-143

Background/purpose

Emerging evidence has shown that various failures in cancer therapy, such as drug resistance, metastasis, and cancer relapse are attributed to cancer stem cells (CSCs). Also, growing attention has been paid to the regulation of non-coding RNAs in cancer stemness. Here, we aimed to investigate the contribution of LINC01296 in the modulation of oral CSCs.

Materials and methods

The phenotypic assays including migration, invasion, and colony-forming abilities were carried out in CSCs of two types of oral cancer cells (SAS and GNM) following the knockdown of LINC01296. In addition, the percentage of cells expressing stemness marker, ALDH1, and drug resistance marker, ABCG2, was examined as well as the self-renewal capacity after silencing of LINC01296. Moreover, a luciferase reporter was used to validate the direct interaction between LINC01296 and miR-143.

Results

Our results showed that LINC01296 was significantly overexpressed in oral cancer tissues and positively correlated with stemness markers. The phenotypic and flow cytometry assays demonstrated that suppression of LINC01296 reduced the aggressiveness, cancer stemness features, and colony-forming and self-renewal abilities in oral CSCs. Furthermore, we demonstrated that LINC01296 may enhance cancer stemness features through suppression of the effect of miR-143.

Conclusion

Silencing of LINC01296 may be a promising direction for oral cancer therapy by reducing cancer stemness via regulation of miR-143.

New Efficient Method for Hysteroscopic Isthmoplasty: Four Simple Steps Lead to a Significant Improvement in Bleeding Status

We demonstrate an effective reduction in postmenstrual spotting after our novel hysteroscopic isthmoplasty. This study included 66 patients with isthmocele-related postmenstrual spotting confirmed by sonography and diagnostic hysteroscopy between 2000 and 2017. Our new interventions included the following four steps: (1) make a resection gradient of the distal edge of the isthmocele from the ape of the isthmocele down to the cervical outer orifice; (2) resect the distal and proximal niches of the isthmocele; (3) electrocauterize the distal and proximal sides (not only the niche bottom) of the small cave on the scar side of the isthmocele; (4) manage the isthmocele until it is largely connected to the cavity. In our results, all patients underwent extensive hysteroscopic repair of newly hysteroscopic isthmoplasty without any intra- or postoperative complications. After final hysteroscopic repair modification, prolonged menstrual spotting was significantly decreased in 98.2% (53/54) of the patients, and the total number of bleeding days per menstrual cycle significantly decreased from a mean of 15.38 ± 3.3 days to 6.4 ± 1.9 days postoperatively (p < 0.001). Our four-step hysteroscopic technique successfully resolved prolonged menstrual spotting in over 90% of the patients, exceeding the resolution rates of 60−85% achieved with other hysteroscopic techniques used to treat symptomatic isthmocele. No patients experience recurrence after long-term follow up. Four simple steps led to a significant improvement in bleeding status.

miR-146a participates in the regulation of cancer stemness of oral carcinoma cells

Background/purpose

Increasing evidence regarded the existence of cancer stem cells (CSCs) as a leading cause of therapy failure and tumor relapse due to their self-renewal and differentiation abilities. Although ectopic overexpression of micro-RNAs (miRNAs) can modulate the cancer stemness and tumor development in oral cancer, their molecular mechanism is still unclear. Therefore, in the present study, we attempt to uncover the role of miR-146a in the maintenance of oral CSCs.

Materials and methods

The expression of miR-146a was determined using qRT-PCR analysis. Aldehyde dehydrogenase (ALDH) enzymic activity and sphere formation assays were used to evaluate the cancer stemness and self-renewal, respectively. Functional assays, including migration/invasion Transwell and colony formation assay, were used to evaluate the aggressive abilities. Luciferase reporter assay was performed to validate the relationship between miR-146a and Numb.

Results

In the present study, we reported an increased expression of miR-146a in the oral squamous cell carcinoma (OSCC) specimen, primary OSCC cells sphere, and high ALDH1 activity population within OSCC cells. Inhibition of miR-146a significantly suppressed the ALDH1 activity, self-renewal capacity, and aggressive abilities, including migration, invasion, and colony formation. Moreover, we demonstrated that Numb is a functional target of miR-146a in OSCC-CSCs. Notably, silencing of Numb could retrieve the self-renewal and migration impaired by knockdown of miR-146a.

Conclusion

Our results indicate that miR-146a can regulate the cancer stemness in OSCC by modulating Numb, and hence miR-146a/Numb axis can serve as a potential target for oral cancer therapy.

Potential Therapeutic Applications of Natural Compounds in Diabetes-Associated Periodontitis

Diabetes mellitus (DM) is a major worldwide health burden. DM is a metabolic disease characterized by chronic hyperglycemia, and if left untreated, can lead to various complications. Individuals with uncontrolled DM are more susceptible to periodontitis due to both a hyper-inflammatory host response and an impaired immune response. Periodontitis, on the other hand, may exacerbate DM by increasing both local and systemic inflammatory components of DM-related complications. The current standard for periodontal treatment in diabetes-associated periodontitis (DP) focuses mostly on reducing bacterial load and less on controlling the excessive host response, and hence, may not be able to resolve DP completely. Over the past decade, natural compounds have emerged as an adjunct approach for modulating the host immune response with the hope of curing DP. The anti-oxidant, anti-inflammatory, and anti-diabetic characteristics of natural substances are well-known, and they can be found in regularly consumed foods and drinks, as well as plants. The pathophysiology of DP and the treatment benefits of various bioactive extracts for DP will be covered in this review.

Regulation of Ferroptosis by Non-Coding RNAs in Head and Neck Cancers

Ferroptosis is a newly identified mode of programmed cell death characterized by iron-associated accumulation of lipid peroxides. Emerging research on ferroptosis has suggested its implication in tumorigenesis and stemness of cancer. On the other hand, non-coding RNAs have been shown to play a pivotal role in the modulation of various genes that affect the progression of cancer cells and ferroptosis. In this review, we summarize recent advances in the theoretical modeling of ferroptosis and its relationship between non-coding RNAs and head and neck cancers. Aside from the significance of ferroptosis-related non-coding RNAs in prognostic relevance, we also review how these non-coding RNAs participate in the regulation of iron, lipid metabolism, and reactive oxygen species accumulation. We aim to provide a thorough grounding in the function of ferroptosis-related non-coding RNAs based on current knowledge in an effort to develop effective therapeutic strategies for head and neck cancers.

Characterization of intracellular buffering power in human induced pluripotent stem cells and the loss of pluripotency is delayed by acidic stimulation and increase of NHE1 activity

The homeostasis of intracellular pH (pH_i ) affects many cellular functions. Our previous study has established a functional and molecular model of the active pH_i regulators in human induced pluripotent stem cells (hiPSCs). The aims of the present study were to further quantify passive pH_i buffering power (β) and to investigate the effects of extracellular pH and Na⁺ -H⁺ exchanger 1 (NHE1) activity on pluripotency in hiPSCs. pH_i was detected by microspectrofluorimetry with pH-sensitive dye-BCECF. Western blot, immunofluorescence staining, and flow cytometry were used to detect protein expression and pluripotency. Our study in hiPSCs showed that (a) the value of total (β_tot ), intrinsic (β_i ), and CO₂ -dependent ( β C O 2 ) buffering power all increased while pH_i increased; (b) during the spontaneous differentiation for 4 days, the β values of β_tot and β C O 2 changed in a tendency of decrease, despite the absence of statistical significance; (c) an acidic cultured environment retained pluripotency and further upregulated expression and activity of NHE1 during spontaneous differentiation; (d) inhibition on NHE1 activity promoted the loss of pluripotency. In conclusion, we, for the first time, established a quantitative model of passive β during differentiation and demonstrated that maintenance of NHE1 at a higher level was of critical importance for pluripotency retention in hiPSCs.

Functional effects of urotensin-II on intracellular pH regulators in human radial artery smooth muscle cells

The regulation of intracellular pH (pH_i) plays a vital role in various cellular functions. We previously demonstrated that three different acid extruders, the Na⁺-H⁺ exchanger (NHE), Na⁺-HCO₃^- co-transporter (NBC) and H⁺-linked monocarboxylate transporter (MCT), functioned together in cultured human radial artery smooth muscle cells (HRASMCs). However, the functions of acid-loading transporters in HRASMCs remain poorly understood. Urotensin II (U-II), one of the most potent vasoconstrictors, is highly expressed in many cardiovascular diseases. The aim of this present study was to determine the concentration effect of U-II (3 pM∼100 nM) on the functional activity of pH_i regulators in HRASMCs. Cultured HRASMCs were derived from segments of human radial arteries obtained from patients undergoing bypass grafting. Changes in pH_i recovery due to intracellular acidification and alkalization induced by NH₄Cl prepulse and Na-acetate prepulse, respectively, were detected by microspectrofluorimetry with the pH-sensitive fluorescent dye BCECF. Our present study showed that (a) U-II increased the activity of NHE in a concentration-dependent manner but did not change that of NBC or MCT or resting pH_i, (b) the Cl^--OH^- exchanger (CHE) facilitated base extrusion, and (c) U-II induced a concentration-dependent increase in the activity of CHE. In conclusion, for the first time, our results highlight a concentration-dependent increase in the activity of NHE and CHE, but not NBC and MCT, induced by U-II in HRASMCs.

Effects of Andrographolide on Intracellular pH Regulation, Cellular Migration, and Apoptosis in Human Cervical Cancer Cells †

Cancer cells have been characterized with alkaline intracellular pH (pH_i) values (≥7.2) to enable cancer proliferation, migration, and progression. The aim of the present study was to explore the concentration-dependent effects of Andrographolide, an active diterpenoid compound of herb Andrographis paniculata, on Na⁺/H⁺ exchanger isoform 1 (NHE1), cellular migration and apoptosis in human cervical cancer cells (HeLa). The pH_i was detected by microspectrofluorometry method, and intracellular acidification was induced by NH₄Cl prepulse technique. Viability and protein expression were determined by MTT (3-(4,5-Dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide) assay and Western blot, respectively. Human normal endocervical cells (End1), ectocervical cells (Ect1), and HeLa were bought commercially. The resting pH_i value of HeLa (≈7.47) was significantly higher than that of End1 and Ect1 (≈7.30), and shifted from alkaline to acidic following acid/base impacts. In HEPES (4-(2-Hydroxyethyl)piperazine-1-ethanesulfonic acid | N-(2-Hydroxyethyl)piperazine-N′-(2-ethanesulfonic acid) -buffered superfusate, NHE1 and V-ATPase co-existed functionally for acid extrusion in HeLa, while only NHE1 existed functionally in End/Ect1. Andrographolide (3–1000 μM) concentration-dependently inhibited NHE1 activity. Cell-migration and expressions of NHE1, V-ATPase, PARP (poly-ADP-ribose-polymerase), pro-Caspase-3, and Bcl-2 were significantly reduced by pretreating with Andrographolide (≥100 μM) for 24–48 h in HeLa. Andrographolide inhibited cell viability of End1-cells/Ect1 and HeLa (≥100 and ≥30 μM, respectively). The present findings implicate the promising clinical applications of Andrographolide on cervical cancer treatment.

Isoorientin Decreases Cell Migration via Decreasing Functional Activity and Molecular Expression of Proton-Linked Monocarboxylate Transporters in Human Lung Cancer Cells

Aggressive tumor cells mainly rely on glycolysis, and further release vast amounts of lactate and protons by monocarboxylate transporter (MCT), which causes a higher intracellular pH (pH_i) and acidic extracellular pH. Isoorientin, a principle flavonoid compound extracted from several plant species, shows various pharmacological activities. However, effects of isoorientin on anticancer and MCT await to explore in human lung cancer cells. Human lung cancer tissues were obtained from cancer patients undergoing surgery, while the human lung adenocarcinoma cells (A549) were bought commercially. Change of pH_i was detected by microspectrofluorometry method with a pH-sensitive fluorescent dye, BCECF. MTT and wound-healing assay were used to detect the cell viability and migration, respectively. Western blot techniques and immunocytochemistry staining were used to detect the protein expression. Our results indicated that the expression of MCTs1/4 and CD147 were upregulated significantly in human lung tissues. In experiments of A549 cells, under HEPES-buffer, the resting pH_i was 7.47, and isoorientin (1-300μM) inhibited functional activity of MCT concentration-dependently (up to -42%). Pretreatment with isoorientin (3-100μM) for 24h, MCT activity and cell migration were significantly inhibited (-25% and -40%, respectively), while the cell viability was not affected. Moreover, the expression of MCTs1/4, CD147, and matrix metalloproteinase (MMP) 2/9 were significantly down regulated. In summary, MCTs1/4 and CD147 are significantly upregulated in human lung adenocarcinoma tissues, and isoorientin inhibits cells-migration by inhibiting activity/expression of MCTs1/4 and MMPs2/9 in human lung cancer cells. These novel findings suggest that isoorientin could be a promising pharmacological agent for lung cancer.

Functional and molecular mechanism of intracellular pH regulation in human inducible pluripotent stem cells

AIM

To establish a functional and molecular model of the intracellular pH (pH_i) regulatory mechanism in human induced pluripotent stem cells (hiPSCs).

METHODS

hiPSCs (HPS0077) were kindly provided by Dr. Dai from the Tri-Service General Hospital (IRB No. B-106-09). Changes in the pH_i were detected either by microspectrofluorimetry or by a multimode reader with a pH-sensitive fluorescent probe, BCECF, and the fluorescent ratio was calibrated by the high K⁺/nigericin method. NH₄Cl and Na-acetate prepulse techniques were used to induce rapid intracellular acidosis and alkalization, respectively. The buffering power (β) was calculated from the ΔpH_i induced by perfusing different concentrations of (NH₄)₂SO₄. Western blot techniques and immunocytochemistry staining were used to detect the protein expression of pH_i regulators and pluripotency markers.

RESULTS

In this study, our results indicated that (1) the steady-state pH_i value was found to be 7.5 ± 0.01 (n = 20) and 7.68 ± 0.01 (n =20) in HEPES and 5% CO₂/HCO₃^--buffered systems, respectively, which were much greater than that in normal adult cells (7.2); (2) in a CO₂/HCO₃^--buffered system, the values of total intracellular buffering power (β) can be described by the following equation: β_tot = 107.79 (pH_i)² - 1522.2 (pH_i) + 5396.9 (correlation coefficient R² = 0.85), in the estimated pH_i range of 7.1-8.0; (3) the Na⁺/H⁺ exchanger (NHE) and the Na⁺/HCO₃^- cotransporter (NBC) were found to be functionally activated for acid extrusion for pH_i values less than 7.5 and 7.68, respectively; (4) V-ATPase and some other unknown Na⁺-independent acid extruder(s) could only be functionally detected for pH_i values less than 7.1; (5) the Cl^-/ OH^- exchanger (CHE) and the Cl^-/HCO₃^- anion exchanger (AE) were found to be responsible for the weakening of intracellular proton loading; (6) besides the CHE and the AE, a Cl^--independent acid loading mechanism was functionally identified; and (7) in hiPSCs, a strong positive correlation was observed between the loss of pluripotency and the weakening of the intracellular acid extrusion mechanism, which included a decrease in the steady-state pH_i value and diminished the functional activity and protein expression of the NHE and the NBC.

CONCLUSION

For the first time, we established a functional and molecular model of a pH_i regulatory mechanism and demonstrated its strong positive correlation with hiPSC pluripotency.

Expressional and Functional Characterization of Intracellular pH Regulators and Effects of Ethanol in Human Oral Epidermoid Carcinoma Cells

BACKGROUND/AIMS

To functionally characterize intracellular pH (pHi) regulating mechanisms, such as Na+-H+ exchanger (NHE) and Na+-HCO3- co-transporter (NBC), and further examine effects of ethanol on the pHi regulating mechanism in human oral epidermoid carcinoma (OEC-M1) cells.

METHODS

OEC-M1 cells were a gift from Tri-Service General Hospital. Changes of pHi were detected by microspectrofluroimetry with a pH-sensitive fluorescent dye, BCECF. Isoforms of transporters were examined by Western blot technique.

RESULTS

i) the steady-state pHi value shifted from alkaline (7.35∼7.49) to acidic (7.0∼7.03) following acid/base impacts; ii) in HEPES-buffer system, pHi recovery following induced-acidification was totally blocked by either removing [Na]o+ or adding HOE 694 (a NHE1 specific inhibitor), which demonstrates existence of NHE1; iii) in HCO3-/CO2-buffer system, the pHi recovery following induced-acidification was entirely blocked by either removing [Na]o+ or adding HOE 694 plus DIDS (a NBC specific inhibitor), which suggests existence of Na+- and HCO3-dependent acid-extruder, i.e. NBC; iv) the isoforms of the two acid extruders were NHE1, NBCn1, NBCe1 and NDCBE; v) ethanol (10-1000 mM) showed a biphasic and concentration-dependent effect on resting pHi (i.e. increase then decrease) by changing the activity of NHE1 and NBC accordingly; vi) treatment with ethanol for 24 hr (<unterline>></unterline> 300 mM) significantly inhibited the expression of NHE1, NBCn1 and NDCBE, while up-regulated NBCe1.

CONCLUSIONS

Ethanol affects pHi in a concentration-dependent manner by changing function and expression of NHE1 and NBC isoforms in OEC-M1 cells.

Functional and molecular characterization of transmembrane intracellular pH regulators in human dental pulp stem cells

OBJECTIVE

Homeostasis of intracellular pH (pH_i) plays vital roles in many cell functions, such as proliferation, apoptosis, differentiation and metastasis. Thus far, Na⁺-H⁺ exchanger (NHE), Na⁺-HCO₃^- co-transporter (NBC), Cl^-/HCO₃^- exchanger (AE) and Cl^-/OH^- exchanger (CHE) have been identified to co-regulate pH_i homeostasis. However, functional and biological pH_i-regulators in human dental pulp stem cells (hDPSCs) have yet to be identified.

DESIGN

Microspectrofluorimetry technique with pH-sensitive fluorescent dye, BCECF, was used to detect pH_i changes. NH₄Cl and Na⁺-acetate pre-pulse were used to induce intracellular acidosis and alkalosis, respectively. Isoforms of pH_i-regulators were detected by Western blot technique.

RESULTS

The resting pH_i was no significant difference between that in HEPES-buffered (nominal HCO₃^--free) solution or CO₂/HCO₃-buffered system (7.42 and 7.46, respectively). The pH_i recovery following the induced-intracellular acidosis was blocked completely by removing [Na⁺]_o, while only slowed (-63%) by adding HOE694 (a NHE1 specific inhibitor) in HEPES-buffered solution. The pH_i recovery was inhibited entirely by removing [Na⁺]_o, while adding HOE 694 pulse DIDS (an anion-transporter inhibitor) only slowed (-55%) the acid extrusion. Both in HEPES-buffered and CO₂/HCO₃-buffered system solution, the pH_i recovery after induced-intracellular alkalosis was entirely blocked by removing [Cl^-]_o. Western blot analysis showed the isoforms of pH_i regulators, including NHE1/2, NBCe1/n1, AE1/2/3/4 and CHE in the hDPSCs.

CONCLUSIONS

We demonstrate for the first time that resting pH_i is significantly higher than 7.2 and meditates functionally by two Na⁺-dependent acid extruders (NHE and NBC), two Cl^--dependent acid loaders (CHE and AE) and one Na⁺-independent acid extruder(s) in hDPSCs. These findings provide novel insight for basic and clinical treatment of dentistry.

Collodion baby and loricrin keratoderma: a case report and mutation analysis

Hereditary palmoplantar keratodermas (PPK) comprise a clinically and genetically heterogeneous group of genodermatoses, which share the characteristic of impaired epidermal differentiation, resulting in prominent palmoplantar hyperkeratosis. Molecular genetic analyses have helped characterize the underlying genetic defects in an increasing number of hereditary PPKs over the past two decades, and thus a pathophysiological classificaiton seems more reasonable. Today PPK can be classified based on defects in keratins, loricrin, desmosomes, connexins and cathepsins. In this report, we describe a 22-year-old man who had been born a collodion baby, and later developed diffuse PPK with pseudoainhum and generalized ichthyosis. His mother and grandmother had similar characteristics. Direct sequencing of genomic DNA identified a frameshift insertion mutation (730insG) in the loricrin gene. This family had the typical presentation of loricrin keratoderma. It also indicates that collodion baby may be the first presentation in patients with loricrin keratoderma.

A retrospective study of pulmonary infarction in patients with systemic lupus erythematosus from southern Taiwan

Since large-scale reports of pulmonary infarction in systemic lupus erythematosus (SLE) are limited, a retrospective study was performed for this manifestation in 773 hospitalized patients in southern Taiwan from 1999 to 2009. Pulmonary infarction was defined as the presence of pulmonary embolism, persistent pulmonary infiltrates, and characteristic clinical symptoms. Demographic, clinical, laboratory, and radiological images data were analyzed. There were 12 patients with pulmonary embolism and 9 of them had antiphospholipid syndrome (APS). Six patients (19 to 53 years, average 38.2 ± 12.6) with 9 episodes of lung infarction were identified. All cases were APS and four episodes had coincidental venous thromboembolism. There were four episodes of bilateral infarction and seven episodes of larger central pulmonary artery embolism. Heparin therapy was routinely prescribed and thrombolytic agents were added in two episodes. Successful recovery was noted in all patients. In conclusion, there was a 0.8% incidence of pulmonary infarction in patients with SLE, all with the risk factor of APS. Differentiation between pulmonary infarction and pneumonia in lupus patients should be made; they have similar chest radiography with lung consolidation but require a different clinical approach in management. Although this report is a retrospective study with relatively small numbers of lupus patients with lung infarcts, our observation might provide beneficial information on the clinical features and radiological presentations during the disease evolution of pulmonary infarction in SLE with APS.

Expression of CD40 and CD40 ligand among cell populations within rheumatoid synovial compartment

Augmented and prolonged expression of CD40 ligand (CD40L) was recently reported in lymphoid cells from human lupus patients, suggesting that CD40/CD40L pathway was involved in the pathogenesis of systemic autoimmune diseases. This study was thus designed to study the expression of CD40 and CD40L among cell populations within inflammatory joints of patients with rheumatoid arthritis (RA). The result showed that most B cells and monocytes in synovial fluids (SF) expressed CD40. Cultured synovial fibroblasts also stained positive for CD40. Regarding CD40L, we found that T cells as well as B cells could express CD40L. Compared with normal controls, RA patients had higher levels of CD40L+ T cells (8.71 +/- 17.69% vs 1.74 +/- 2.30%, P > 0.05) and CD40L+ B cells (7.71 +/- 7.64% vs 1.12 +/- 1.59% P < 0.05). After in vitro stimulation, T cells from RA patients had higher and longer CD40L expression than T cells from normal peripheral blood. For investigating the effect of CD40 expressed on synovial fibroblasts on TNF-alpha production in joint compartment, we used anti-CD40 antibody to bind CD40 on fibroblasts for one hour and then co-cultured with synovial fluid mononuclear cells. We found that the levels of TNF-alpha decreased in the presence of anti-CD40 antibody. We concluded that there was an intrinsic hyperexpression of CD40L on lymphoid cells within rheumatoid joints, and synovial fibroblasts could contribute to articular inflammation through surface CD40 molecule.

Clinical characteristics of tricho-rhino-phalangeal syndrome type I in Taiwanese

Tricho-rhino-phalangeal syndrome type I (TRPS-I) is a malformation syndrome characterized by distinctive craniofacial and skeletal abnormalities. Only one case of TRPS-I has been previously reported in Taiwan. This retrospective study analyzed the clinical, roentgenographic, and histopathologic findings in seven patients with a diagnosis of TRPS-I who were treated at a hospital in Tainan during a 6-year period from 1994 to 1999. Physical examination revealed fine, sparse, and short scalp hair, a pear-shaped nose, long philtrum, thinning of the lateral portion of the eyebrows, and brachydactyly of the thumbs and big toes. The stature and intelligence of these patients were normal. Histopathologic examination of the scalp in two patients showed hypotrichosis without inflammation or scarring. Roentgenographic evaluation of both hands and feet showed cone-shaped proximal epiphyses of the middle phalanges in all patients. The findings of this report suggest that TRPS-I is not rare among Taiwanese, although the island-wide incidence is not known. The diagnosis of this syndrome in our department was greatly facilitated by our prior experience with treatment of the first patient in this series because TRPS-I is readily recognizable by its characteristic clinical and roentgenographic features. The identification of these features is important to the facilitation of genetic and cosmetic counseling. In addition to the typical craniofacial manifestations, all patients in this study showed brachydactyly of the big toes. This additional feature appears to offer an easy way to recognize the syndrome clinically.

The effect of an infertility diagnosis on the distress, marital and sexual satisfaction between husbands and wives in Taiwan

BACKGROUND

Few studies have explored the effect of a gender-specific infertility diagnosis on the responses of couples in Taiwan. The purpose of this research was to compare the differences in distress, marital and sexual satisfaction in husbands and wives based on an infertility diagnosis.

METHODS

Three structured questionnaires were used.

RESULTS

Female members of couples in which both partners were infertile expressed less marital and sexual satisfaction than their husbands. No differences in marital and sexual satisfaction were found between wives and husbands with unexplained infertility. Only wives with a diagnosed female infertility expressed higher distress to infertility than their husbands. Although no differences in psychosocial responses were found among husbands, regardless of the diagnosis, wives with a diagnosed female infertility experienced higher distress in self-esteem and less satisfaction in acceptance by in-laws than wives experiencing a diagnosed male infertility.

CONCLUSIONS

These findings suggest that the diagnosis of infertility is an important factor in assessing the differences in infertility distress and marital and sexual satisfaction between husbands and wives. Health professionals can explain the gender differences when counselling infertile couples and encourage them to share each other's feelings, which may help couples to cope with the communication problems they may experience.

Mutation analysis in the family of a Taiwanese boy with with epidermolysis bullosa simplex dowling-meara

Epidermolysis bullosa simplex (EBS) is a group of hereditary bullous diseases characterized by intraepidermal blistering due to mechanical stress-induced degeneration of basal keratinocytes. The major subtypes of EBS, including EBS Dowling-Meara (EBS-DM), are caused by mutations of the basal keratin genes, keratin 5 (KRT5) or keratin 14 (KRT14). Here, we describe the first reported pedigree of EBS-DM in Taiwan. The proband was a 5-day-old newborn, who presented with numerous blisters of various sizes, some of which were hemorrhagic, as well as erosions on the extremities and hard palate since birth. Biopsy of a new vesicle showed subepidermal and basal cleavage with infiltration of eosinophils and neutrophils. Electron microscopy revealed cytolysis of basal cells and clumping of tonofilaments forming thick bundles and peculiar electron-dense round or oval basket-weave bodies. These features are characteristic of EBS-DM. The proband's mother had also suffered from a similar blistering disorder since birth, with gradual appearance of mottled pigmentation on the trunk, diffuse irregular or linear palmoplantar hyperkeratosis, and nail dystrophy. Mutation analysis revealed a heterozygous point mutation (R125C) in helix 1A of keratin 14 in the proband and his mother. The detection of this pathogenic point mutation enables future prenatal diagnosis in this family.

Erythema induratum: a clinicopathologic and polymerase chain reaction study

BACKGROUND

In Taiwan, cutaneous lesions with granulomatous lobular panniculitis, with or without vasculitis, are usually diagnosed as erythema induratum (EI), a common form of tuberculid associated with tuberculosis. However, there has been no study to elucidate the extent of this association in Taiwan. The aim of this study was to document the spectrum of the pathologic findings in EI and its association with Mycobacterium tuberculosis.

METHODS

The diagnostic/inclusion criteria for EI were recurrent tender subcutaneous nodules on the legs, histopathologic findings of granulomatous lobular or septolobular panniculitis plus necrosis or vasculitis, and positive response to antituberculosis therapy. The clinicopathologic findings in the 12 cases that fulfilled these criteria were analyzed, and nested polymerase chain reaction (PCR) was used to identify M. tuberculosis complex DNA from formalin-fixed, paraffin-embedded sections.

RESULTS

Eleven women and one man were included in the study, ranging from 18 to 70 years old (mean, 40.6 yr). The duration of the disease ranged from 10 days to 10 years (mean, 2.1 yr). Histopathology revealed granulomatous panniculitis; a diffuse lobular pattern was observed in nine cases and a focal lobular/septolobular pattern in three. Vasculitis was found in nine cases, four affecting an artery or vein, with three occurring in the patients with focal panniculitis. Ten cases showed various degrees of caseous necrosis. Eosinophils or focal eosinophilia were fairly common (10 patients). From PCR, nine patients were positive for M. tuberculosis complex DNA.

CONCLUSIONS

Type III and IV hypersensitivity reactions to M. tuberculosis complex were involved in the pathogenesis of EI. Our results suggest that approximately half of the cases with pathologic findings consistent with EI or nodular vasculitis in Taiwan are associated with M. tuberculosis.

Distribution of double-negative (CD4- CD8-, DN) T subsets in blood and synovial fluid from patients with rheumatoid arthritis

Double-negative (CD4- CD8-) T (DNT) cells have been postulated to be potentially autoreactive. However, the role of DNT cells in rheumatoid arthritis (RA) has received limited attention. We investigated the distribution of DNT subsets in peripheral blood (PB) and synovial fluid (SF) from patients with active RA to determine whether these cells have relevance to RA. Two-colour flow cytometric analysis was performed to detect DNT cells in PB from 35 RA patients, 26 healthy controls and in SF aspirated from 19 inflamed rheumatoid joints. The subsets of DNT cells, i.e those expressing T cell receptor alphabeta (alphabeta DNT) or gammadelta (gammadelta DNT) were simultaneously examined. Our results showed that DNT cells constituted a very minor subset of PB lymphocytes. When expressed as a percentage of total lymphocytes, alphabeta DNT levels in normal individuals ranged from 0.27 to 2.08% (average 0.76%), while those of gammadelta DNT ranged from 1.02 to 11.42% (average 3.23%). Compared with normal individuals, RA patients had a similar distribution of alphabeta DNT cells in both PB and SF. However, RA patients had significantly lower levels of gammadelta DNT cells in PB than control subjects (1.38 +/- 1.08% vs 3.23 +/- 2.12%, p<0.05), while the levels of gammadelta DNT cells in SF of RA patients were higher than those in PB from RA patients and normal controls. The difference between PB and SF in RA was statistically significant (3.90 +/- 1.88% vs 1.38 +/- 1.08%, p<0.05). A higher level of gammadelta DNT in SF than their paired PB was consistently noted from nine available paired samples. Our findings suggest that gammadelta NT cells, but not alphabeta DNT cells, are probably relevant to RA. The lower percentage of circulating gammadelta DNT cells might have resulted from migration from the circulation into the synovium, suggesting a role for gammadelta DNT cells in the pathogenesis of rheumatoid synovitis.

The effect of an infertility diagnosis on treatment-related stresses

The purpose of this study was to determine the effect of an infertility diagnosis on treatment-related stresses. One hundred infertile Chinese couples participated in this study. Three structured questionnaires were used to analyze the differences between husbands and wives. As a group wives appear to experience significantly more stress from infertility tests and treatment than their husbands, regardless of whether female infertility was present. Husbands with mixed or idiopathic infertility experienced less stress to infertility than husbands with only male infertility or female infertility. Wives with mixed or idiopathic infertility experienced less stress to infertility than wives with only a female infertility. Marital duration, time in treatment, and the number of AIH or IVF procedures were positively related to the wives' stress level, whereas only number of IVF procedures was positively related to the husbands' stress level. Interventions to enhance the infertility treatment experience are suggested.

Treatment of classical type Kaposi's sarcoma with paclitaxel

Paclitaxel has recently been shown to be effective in treating acquired immunodeficiency syndrome-associated Kaposi's sarcoma. We report good therapeutic effects of paclitaxel in two patients with classical form Kaposi's sarcoma (KS) which had poor or partial response to chemotherapy (vincristine, vinblastine, oncovin, bleomycin, epirubicin, dactinomycin, decarbazine) and interferon alpha-2b. Paclitaxel appears to be active against Kaposi's sarcoma as a single agent. The experience suggests that paclitaxel is an effective alternative in the treatment of classical form Kaposi's sarcoma.

Development of the coping scale for infertile couples

Infertility treatment involves more complicated, uncomfortable, and humbling medical procedures for women, so the coping strategies used by wives may differ from those used by husbands. The purpose of this study was to develop and test a Coping Scale for Infertile Couples that would be sensitive to the differences in gender. What couples actually do to cope with infertility and whether these strategies are different between couples were also addressed. A total of 138 infertile couples participated in this study. The Coping Scale for Infertile Couples was administered with the Infertility Questionnaire, the Perceived Stress Scale, and the Jalowiec Coping Scale as measures of concurrent validity. Factor analysis extracted 4 subscales from the Coping Scale for Infertile Couples. Test-retest and internal consistency reliability were high. Paired t tests revealed that wives used the "Increasing space and Sharing the burden" strategies to a greater degree than their husbands. Husbands used the "Being the best" strategy to a greater degree than the wives. A significant correlation with distress, stress, and coping measures provided evidence of concurrent validity. Preliminary results suggest that this measure has good reliability and validity, which can contribute toward the elucidation of coping strategies used by infertile couples and assist in planning effective interventions.

Stabilization and sustained-release effect of misoprostol with methacrylate copolymer

The use of ammonio methacrylate copolymer (Eudrgit RS, RL) to form a sustained-release solid dispersion of Misoprostol can improve and enhance two important physical and chemical properties of Misoprostol. First, the solid dispersion matrix formed by the copolymer can protect Misoprostol from being degraded by water so that its stability is improved. Second, Misoprostol can be slowly released by diffusion from the copolymer matrix. Accelerated stability studies of Misoprostol-Eudragit solid dispersion after storing at various temperatures for different time periods were carried out. According to high performance liquid chromatography (HPLC) analyses, the stability of Misoprostol in a series of Eudragit appeared significantly improved at different ratios. The Misoprostol-Eudragit dispersion can be used in a powder form, filled in capsules, or compressed into tablets. The dissolution profiles of Misoprostol-Eudragit solid dispersion and its tablets in water, pH 1. 2, 4.5 and 6.8, dissolution media show that this stable solid dispersion is a sustained-release type.

Mutation report: complete paternal uniparental isodisomy of chromosome 1: a novel mechanism for Herlitz junctional epidermolysis bullosa

Uniparental disomy denotes a situation when an individual has inherited two copies of a specific chromosome from a single parent. Uniparental disomy has been demonstrated to be involved in the pathogenesis of recessively inherited diseases in rare cases. Here we report a patient of Japanese origin with Herlitz junctional epidermolysis bullosa (OMIM no. 226700), who died at the age of 8 mo from complications of the disease. The mutation analysis revealed that the proband was homozygous for a nonsense mutation C553X in the LAMC2 gene encoding the gamma2 chain of laminin 5. The father was a heterozygous carrier of this mutation whereas the mother had two normal alleles of this gene. The patient showed homozygosity for 15 known intragenic polymorphisms in the LAMC2 gene. Furthermore, genotype analysis, performed from the parents and the proband, using 16 microsatellite markers spanning the entire chromosome 1, revealed that the patient was homozygous for all markers tested, and that these alleles originated from the father. Among the 16 markers, eight were fully informative for the absence of the maternal chromosome 1 in the proband, suggesting that the patient had complete paternal isodisomy of this chromosome. Thus, the Herlitz junctional epidermolysis bullosa phenotype in this patient is caused by homozygous LAMC2 mutation C553X that is of paternal origin and results from nondisjunction and uniparental disomy involving monosomy rescue. This is a novel mechanism resulting in Herlitz junctional epidermolysis bullosa and has implications for assessment of the risk in subsequent pregnancies.

Cutaneous sarcoidosis among Taiwanese

BACKGROUND AND PURPOSE

Sarcoidosis is a multisystem disorder characterized by noncaseating, naked, epithelioid granulomas, and commonly involving the hilar lymph nodes, lungs, skin, and eyes. Once thought to be rare in Chinese, it is being encountered with increasing frequency in Taiwan. In this study, we examined the clinicopathologic findings of sarcoidosis in Chinese patients in Taiwan and investigated the role of Mycobacterium tuberculosis in the disease.

METHODS

The clinicopathologic features of all patients treated for sarcoidosis at a tertiary care hospital in Taiwan during a 10-year period were retrospectively examined. Nested polymerase chain reaction (PCR), using the IS6110 sequence as the amplification target, was used to detect M. tuberculosis complex DNA in formalin-fixed, paraffin-embedded skin specimens.

RESULTS

Sarcoidosis was diagnosed in a total of 12 patients (7 men, 5 women; mean age, 53 yr) during the study period. All patients presented with skin lesions varying from erythematous papules or nodules mainly located on the face (8 patients), to widespread papules, large plaques, and tumors on the extremities, trunk, or scalp (4 patients). Seven of the 12 patients had extracutaneous involvement. One developed cutaneous T cell lymphoma after 14 years of severe disease. Histopathologic examination of skin lesions revealed sarcoid or mixed sarcoid/tuberculoid granulomatous infiltration without evidence of mycobacterial, deep fungal infection, or foreign body material. Nested PCR failed to detect M. tuberculosis complex DNA in skin specimens.

CONCLUSIONS

Our data suggest that sarcoidosis manifests with a wide range of cutaneous lesions in Taiwanese patients and that extracutaneous involvement is not rare. Dermatologists and general practitioners should be made aware that sarcoidosis may first manifest with skin lesions, so that the correct diagnosis can be made promptly. M. tuberculosis did not appear to be associated with sarcoidosis in this study group.

A de novo glycine substitution mutation in the collagenous domain of COL7A1 in dominant dystrophic epidermolysis bullosa

Dystrophic epidermolysis bullosa (DEB) is a hereditary mechanobullous disorder characterized by fragility of the skin and mucous membrane due to abnormalities of anchoring fibrils. Both dominant and recessive DEB have been shown to be caused by mutations in COL7A1, the gene encoding type VII collagen which is the major component of anchoring fibrils. De novo mutation in dominant DEB is rare. In this study, we report a novel de novo glycine substitution mutation in COL7A1 in a Chinese female patient presenting with mild DEB. In search of the mutation, we scanned the entire COL7A1 using polymerase chain reaction (PCR) amplification of all exons of COL7A1, followed by heteroduplex analysis and direct sequencing of the PCR products that exhibited heteroduplex pattern. A G-to-A transition at nucleotide position 6082 within exon 73 of COL7Al was detected. The mutation converted a glycine to an arginine (G2028R) within the triple-helical domain of type VII collagen. It was confirmed that the mutation was present only in the proband. Haplotype analyses suggested that the case arose as a de novo occurrence of autosomal dominant DEB.

Increased expression of down-regulatory CTLA-4 molecule on T lymphocytes from rheumatoid synovial compartment

Since the CTLA-4 molecule expressed on activated T lymphocytes has recently been suggested to be an important negative regulator in autoimmune diseases, this study was undertaken to investigate the expression and function of CTLA-4 on synovial T cells from patients with rheumatoid arthritis. CTLA-4-expressing T cells were detected using a dual fluorescence flow cytometric method. Only a small percentage of peripheral blood T cells from patients with rheumatoid arthritis had detectable surface CTLA-4 expression (mean +/- SD, 1. 89 +/- 1.92%). However, the levels of CTLA-4-positive T cells was increased significantly in rheumatoid synovial fluids (5.44 +/- 4. 96%) and synovial membranes (28.76 +/- 14.30%). To explore the role of CTLA-4 molecule in the inflammation of rheumatoid joints, CTLA-4 was blocked with anti-CTLA-4 antibody to assess its effects on the production of tumour necrosis factor alpha and interleukin 1beta in synovial fluid mononuclear cell culture. The addition of anti-CTLA-4 antibody enhanced the production of tumour necrosis factor alpha and interleukin 1beta in a dose-dependent manner. The data suggest that the expression of CTLA-4 plays a down-regulatory role in rheumatoid articular inflammation. We thus concluded that CTLA-4 was up-regulated on synovial T cells from patients with RA, and the increased CTLA-4 expression might exert a down-regulation effect on tumour necrosis factor alpha and interleukin 1beta production.

Leukemia cutis in acute lymphocytic leukemia masquerading as viral exanthem

Leukemia cutis is a specific skin lesion caused by infiltration of leukemic cells into the skin. It is uncommon in acute lymphocytic leukemia (ALL). It typically manifests as red or violaceous papules, nodules, or plaques, mainly on the face. Leukemia cutis presenting with a generalized viral exanthem-like maculopapular eruption appears to be rare in the English literature. We report such a case. A 19 year-old man presented with a generalized purpuric maculopapular eruption of eight day's duration. Hematologic studies showed changes of acute lymphocytic leukemia, T-cell type. A skin biopsy specimen revealed a cuff-like, dense, perivascular infiltration of atypical lymphocytes in the upper and mid-dermis, consistent with leukemia cutis. The rash resolved in two weeks after chemotherapy. Our case illustrates that leukemia cutis should be considered in the differential diagnosis of a generalized morbilliform viral exanthem-like eruptions. Skin biopsy is important in establishing the diagnosis.

Human skin surface lipid film: an ultrastructural study and interaction with corneocytes and intercellular lipid lamellae of the stratum corneum

Sebum is a complex mixture of lipids, which is secreted by mammalian sebaceous glands, and forms a fluid film over the skin surface. After sebum is secreted, it becomes mixed with lipid from the keratinizing epithelium and forms the skin surface lipid film (SSLF). Until now, direct fine structural observation of the SSLF has been lacking. In the present work, we viewed the detailed structures of the human SSLF by ruthenium tetroxide staining. The results showed that the SSLF formed an amorphous sheet of variable thickness on the skin surface instead of forming lipid droplets, as had been the usual assumption. In general, its thickness was < 0.5 microm or even negligible in sebum-poor extremities. However, in the sebum-rich face, its thickness was > 4 microm in focal areas. Consistent with the thickness of SSLF, the sebum quantity showed great regional variation. It varied from 1 microg/cm2 (leg) to 189 +/- 42.7 microg/cm2 (mean +/- SD: face). The SSLF was composed of numerous fine granules of about 4-5 nm in a random orientation. Within the SSLF, variable amounts of deranged lipid lamellae derived from corneocytes were mixed with sebum. As well as on the skin surface, a similar amount of sebum was also found between the desquamating corneocytes in the uppermost several layers of the stratum corneum (SC). We also observed the presence of intercellular lipid lamellae in the outer layers of the SC: their lipid envelope remained intact even in desquamated corneocytes. Our results provide some new insights concerning the structure of the SSLF and its relationship with the SC.

Use of tissue meshing technique to facilitate side to side closure of large defects

BACKGROUND

Primary closure of a large wound usually needs flaps of sophisticated design or skin grafts, both require more skill and wound care. Motley and Holt first reported the use of meshed advancement flap, a relative simple technique to close large defects of the lower leg in five patients.

OBJECTIVE

To report the use of tissue meshing technique to close large wounds with significant tension on various sites of the body.

METHODS

Six patients with large benign or malignant neoplasms at various sites of the body were included. Tissue meshing technique was used to facilitate wound closure after elliptical excision of the tumors at office visits.

RESULTS

The wound defects, ranging from 3.0-3.5 cm in width, were closed with satisfactory cosmetic results, except for the occurrence of transient small hypertrophic scars in one patient. There was no complication of wound dehiscence, ischemia, infection or hematoma.

CONCLUSION

Tissue meshing technique is a simple procedure and appears to be a satisfactory alternative to facilitate the closure of large wounds under tension. This technique is suitable for most body sites excluding central face and neck because there may be a stippled appearance in the area of meshing.

Characterization of phospholipase A2 (PLA2) from Taiwan Cobra: isoenzymes and their site-directed mutants

Extracellular and secretory phospholipase A2 (PLA2), a class of phospholipid digesting enzyme, is widely distributed in animal venoms of reptiles and insects. Two cDNAs encoding PLA2 isoenzymes from Taiwan Cobra (Naja naja atra) were cloned into pQE-30 plasmid vector and expressed in Escherichia coli. The recombinant products were subjected to refolding using sulfonation under reduction/oxidation conditions with glutathione and enterokinase removal of His-tag, resulting in the active recombinant PLA2 with the same molecular masses of native enzymes as determined by mass spectrometry. The recombinant PLA2 was also shown by circular dichroism to possess a secondary structure similar to native PLA2. The enzymatic activity of the major isoenzyme (PLA2-1) is higher than the other minor isoenzyme (PLA2-2), which shows two amino acid difference from PLA2-1. Site-directed mutagenesis was used to probe the structure/function relationship of two highly conserved residues among all reported PLA2, i.e., His-47 and Asp-93. Replacement of His-47 residue by either Ala or Arg resulted in the complete loss of activity. Similarly, the mutant Asp-93 --> Asn (D93N) also retained little activity. These results suggest that both His-47 and Asp-93 are essential for the catalytic activity of PLA2. Computer graphic study, based on homology modelling, highlights the differences between native PLA2 isoenzymes and their site-directed mutants, which may account for the differences in the observed biological activity.

Clear cell papulosis of the skin

Clear cell papulosis is a new entity first described in 1987. To date, six patients have been reported: all were young Taiwanese children. The disease is characterized clinically by multiple small, whitish maculopapules distributed along the milk line and by the presence of large, benign pagetoid cells in the epidermis resembling the clear cell of the nipple. The significance of this entity lies in its potential histogenetic link with Paget's disease of the skin. We report four new Taiwanese patients, three girls and one boy, aged between 21 months and 4 years. Two were sisters. Small hypopigmented macules first appeared on the pubis. They were eventually distributed bilaterally along the milk line but were most numerous in the public area. The disease may easily be overlooked when the macules are tiny or few in number and thus display no clear milk-line distribution, or when they occur in white-skinned individuals. Histologically, solitary large clear cells with large, round pale nuclei were detected in the basal layer of the hypomelaninized epidermis. The numbers of clear cells varied on haematoxylin and eosin staining and were only small in two patients. The cytoplasm of the clear cells was decorated by antikeratin AE1 and anticarcinoembryonic antigen antibodies. AE1 was the best marker of the clear cell. Some of the AE1-positive cells were tadpole-like in shape and were situated well above the basal layer. Ultrastructurally, large clumps of disintegrated or vacuolated mucin granules were present in the cytoplasm of the clear cells. The melanocytes appeared normal; the suprabasal keratinocytes were essentially devoid of melanosomes. The pathological findings in the present study support the hypothesis that these clear cells are an aberrant derivative of sweat gland cells in the epidermis and are potentially the precursor cells giving rise to mammary and extramammary Paget's disease. The differential diagnosis includes chicken pox scars, idiopathic guttate hypomelanosis, hypomelanotic tinea versicolor, anetoderma and early, hypopigmented lesions of Paget's disease.

Sweet's syndrome in a severely neutropenic patient during therapy with recombinant human granulocyte colony-stimulating factor

We report a new case of Sweet's syndrome (SS) associated with recombinant human granulocyte colony-stimulating factor (rHuG-CSF) therapy in a patient with acute myelogenous leukemia (AML). The patient developed a fever in association with multiple tender, purpuric and pustular skin lesions and swelling of both calves after receiving rHuG-CSF 3 micrograms/kg/d for 4 days. The absolute neutrophil count was 0.55 x 10(9)/L at onset. A skin biopsy revealed a dense neutrophilic infiltration in the dermis without evidence of vasculitis or infection. All skin and calf lesions regressed within 1 week after prednisolone therapy. Physicians should be aware of potential neutrophil-mediated dermatoses in patients with severe neutropenia on rHuG-CSF treatment.

Ileal perforation in Henoch-Schönlein purpura: report of one case

Henoch-Schönlein purpura (HSP) is a systemic vasculitis of unknown cause and abdominal pain is usually complained. Although intussusception and intestinal bleeding may occur, ileal perforation is rare. We present a case of ileal perforation following HSP in which our patient received corticosteroid on the 8th day of clinical course. Attention is focused on assessing the effect of corticosteroid and the relationships among ischemic enteritis, ileal perforation and the usage of steroid.

Diabetes intervention in the information age

Sustained improvement in blood glucose control is the only treatment outcome which will reduce or eliminate the long term complications of diabetes mellitus. We have designed and evaluated an electronic information system which facilitates this task. The system is voice-interactive, physician directed and affords, to remote patients, 24 h access via touch-tone telephone. Accordingly, patients access the system each day to report self-measured blood glucose levels or hypoglycaemic symptoms together with dietary changes, planned exercise, stress, illness or other lifestyle events. In turn they receive immediate advice with respect to medication dosing changes, and other pertinent feedback. Preliminary system beta-testing for safety and efficacy was performed for one year in an open study of 204 patients derived from two independent, health-care environments. Among the two testing centres, over 60,000 telephone cells were received by the computer systems during the start-up year. Safety and efficacy expectations were met. In addition, prevalence of diabetes related crises (hyperglycaemia or hypoglycaemia) fell approximately 3-fold. Glycated haemoglobin fell significantly (1.0-1.3%) in patients actively using the system. In control groups of patients not actively using the system, there were no improvements in metabolic control while body weights were stable in all groups. The new system was safe and effective in our hands and empowered our health professionals to provide improved diabetes care.

Widespread cutaneous necrosis associated with antiphospholipid syndrome

Widespread cutaneous necrosis as the catastrophic manifestation in antiphospholipid syndrome (APLS) is rather uncommon. Even in the few documented cases, the extensive skin necrosis lesions have been stabilized and regressed with eventual healing utilizing pulse steroid therapy alone or in conjunction with further treatment with plasmapheresis. We describe one case of APLS associated with lupus-like disease. The young female suffered from widespread cutaneous necrosis of the lower legs and gangrene change in the digital end of hands and feet. This condition necessitated amputation of major lower extremities and digital amputation of both hands.

Trichophyton tonsurans infection in Tainan area

We report a clinicomycologic study of eight culture-proven cases (diagnosed from May 1991 to June 1992) of Trichophyton tonsurans (T. tonsurans) infection in Tainan. T. tonsurans is the most common cause of tinea capitis in the United States and Mexico; Trichophyton violaceum (T. violaceum) is the most common cause in South Africa, India, Jordan and the Far East. To date, there has been no written report of infection caused by T. tonsurans in Taiwan. We report six cases of tinea capitis and two cases of tinea corporis which were proven to be T. tonsurans infection. In this small series, as in our previous series on T. violaceum infection, a predominance of adults of the female gender was noted. The median age of the adults was 58 years. The only child patient was an eight-year-old girl with tinea capitis whose mother was also infected. We have observed T. tonsurans infection with an increasing frequency over the last two years in Tainan. In the future, one would expect an increased incidence of T. tonsurans infections in other parts of the country, especially in adjoining cities. Dermatologists should be increasingly alerted to the possibilities of T. tonsurans as an etiologic agent in fungal infection.