A phase I study of IMC-001, a PD-L1 blocker, in patients with metastatic or locally advanced solid tumors

Introduction IMC-001 is a fully human IgG1 monoclonal antibody that binds to human PD-L1 (programmed death-ligand 1). This study evaluated the safety, pharmacokinetics, and pharmacodynamics of IMC-001 in patients with advanced solid tumors. Materials and Methods This open-labeled phase I study used a standard 3 + 3 dose-escalation design, with doses ranging from 2 to 20 mg/kg. IMC-001 was administered intravenously every 2 weeks until disease progression or unacceptable toxicity. The dose-limiting toxicity window was defined as 21 days from the first dose. Results Fifteen subjects were included in 5 dose-escalation cohorts. No dose-limiting toxicity was observed, and the maximum tolerated dose was not reached. The most common adverse events (AEs) were general weakness, decreased appetite, fever, and cough. No grade 4 or 5 treatment emergent AEs were reported during the study. One subject in the 2 mg/kg cohort showed grade 2 immune-induced thyroiditis and diabetes mellitus suspected to be related to IMC-001. Over the dose range of 2-20 mg/kg IMC-001, the AUC0-14d, AUC0-∞, and Cmax generally increased in a dose-proportional manner for each step of dose escalation. Of the 15 enrolled patients, 1 subject with rectal cancer showed a partial response, and the disease control rate was 33.3%. Conclusions IMC-001 demonstrated a favorable safety profile up to 20 mg/kg administered intravenously every 2 weeks and showed preliminary efficacy in patients with advanced solid tumors. Based on pharmacokinetic and pharmacodynamic data, 20 mg/kg was selected as the recommended phase II dose. Clinical trial identification NCT03644056 (date of registration: August 23, 2018).

Functionally distinct disease-associated fibroblast subsets in rheumatoid arthritis

Fibroblasts regulate tissue homeostasis, coordinate inflammatory responses, and mediate tissue damage. In rheumatoid arthritis (RA), synovial fibroblasts maintain chronic inflammation which leads to joint destruction. Little is known about fibroblast heterogeneity or if aberrations in fibroblast subsets relate to pathology. Here, we show functional and transcriptional differences between fibroblast subsets from human synovial tissues using bulk transcriptomics of targeted subpopulations and single-cell transcriptomics. We identify seven fibroblast subsets with distinct surface protein phenotypes, and collapse them into three subsets by integrating transcriptomic data. One fibroblast subset, characterized by the expression of proteins podoplanin, THY1 membrane glycoprotein and cadherin-11, but lacking CD34, is threefold expanded in patients with RA relative to patients with osteoarthritis. These fibroblasts localize to the perivascular zone in inflamed synovium, secrete proinflammatory cytokines, are proliferative, and have an in vitro phenotype characteristic of invasive cells. Our strategy may be used as a template to identify pathogenic stromal cellular subsets in other complex diseases.

Synovial fibroblasts are thought to be central mediators of joint destruction in rheumatoid arthritis (RA). Here the authors use single-cell transcriptomics and flow cytometry to identify synovial fibroblast subsets that are expanded and display distinct tissue distribution and function in patients with RA.

Stromal cell cadherin-11 regulates adipose tissue inflammation and diabetes

M2 macrophages, innate lymphoid type 2 cells (ILC2s), eosinophils, Tregs, and invariant NK T cells (iNKT cells) all help to control adipose tissue inflammation, while M1 macrophages, TNF, and other inflammatory cytokines drive inflammation and insulin resistance in obesity. Stromal cells regulate leukocyte responses in lymph nodes, but the role of stromal cells in adipose tissue inflammation is unknown. PDGFRα+ stromal cells are major producers of IL-33 in adipose tissue. Here, we show that mesenchymal cadherin-11 modulates stromal fibroblast function. Cadherin-11-deficient mice displayed increased stromal production of IL-33, with concomitant enhancements in ILC2s and M2 macrophages that helped control adipose tissue inflammation. Higher expression levels of IL-33 in cadherin-11-deficient mice mediated ILC2 activation, resulting in higher IL-13 expression levels and M2 macrophage expansion in adipose tissue. Consistent with reduced adipose tissue inflammation, cadherin-11-deficient mice were protected from obesity-induced glucose intolerance and adipose tissue fibrosis. Importantly, anti-cadherin-11 mAb blockade similarly improved inflammation and glycemic control in obese WT mice. These results suggest that stromal fibroblasts expressing cadherin-11 regulate adipose tissue inflammation and thus highlight cadherin-11 as a potential therapeutic target for the management of obesity.

Transcriptional profiling of stroma from inflamed and resting lymph nodes defines immunological hallmarks

Lymph node stromal cells (LNSCs) closely regulate immunity and self-tolerance, yet key aspects of their biology remain poorly elucidated. Here, comparative transcriptomic analyses of mouse LNSC subsets demonstrated the expression of important immune mediators, growth factors and previously unknown structural components. Pairwise analyses of ligands and cognate receptors across hematopoietic and stromal subsets suggested a complex web of crosstalk. Fibroblastic reticular cells (FRCs) showed enrichment for higher expression of genes relevant to cytokine signaling, relative to their expression in skin and thymic fibroblasts. LNSCs from inflamed lymph nodes upregulated expression of genes encoding chemokines and molecules involved in the acute-phase response and the antigen-processing and antigen-presentation machinery. Poorly studied podoplanin (gp38)-negative CD31(-) LNSCs showed similarities to FRCs but lacked expression of interleukin 7 (IL-7) and were identified as myofibroblastic pericytes that expressed integrin α(7). Together our data comprehensively describe the transcriptional characteristics of LNSC subsets.

Self-assembled growth of GaAs anti quantum dots in InAs matrix by migration enhanced molecular beam epitaxy

Self-assembled GaAs anti quantum dots (AQDs) were grown in an InAs matrix via migration enhanced molecular beam epitaxy. The transmission electron microscopy image showed that the 2D to 3D transition thickness is below 1.5 monolayers (MLs) of GaAs coverage. The average diameter and height of the GaAs AQDs for 1.5 ML GaAs coverage taken from the atomic force microscopy image were approximately 29.0 nm and 1.4 nm, respectively. The density was approximately 6.0 x 10(10) cm(-2). The size of the AQDs was enlarged in the InAs matrix compared with that on the surface. These results indicate that the GaAs AQDs in the InAs matrix under tensile strain can be effectively formed with the assistance of the migration enhanced epitaxy method.

Modulation of matrix metalloproteinase production by rheumatoid arthritis synovial fibroblasts after cadherin 11 engagement

OBJECTIVE

Cadherin 11 is a homophilic cell-to-cell adhesion molecule expressed on joint synovial fibroblasts. Absence of cadherin 11 in a mouse rheumatoid arthritis (RA) model led to striking reductions in cartilage erosion. Matrix metalloproteinases (MMPs) are enzymes expressed by synovial fibroblasts important for cartilage erosion. The objective of this study was to determine if synovial fibroblast MMP production is regulated by cadherin 11.

METHODS

To mimic cadherin 11 engagement, human RA synovial fibroblasts were stimulated with a chimeric construct consisting of the cadherin 11 extracellular domain linked to the human IgG1 Fc domain (Cad-11-Fc). Effects on MMP production were measured by enzyme-linked immunosorbent assay, quantitative reverse transcription-polymerase chain reaction analysis, and immunoblotting.

RESULTS

Human Cad-11-Fc up-regulated MMP-1 and MMP-3 protein production by RA synovial fibroblasts, both alone and in synergy with tumor necrosis factor α. This up-regulation required cell cadherin 11 engagement, since a mutant Cad-11-Fc with reduced binding affinity stimulated significantly less MMP production. Also, short hairpin RNA (shRNA) cadherin 11 silencing almost completely inhibited Cad-11-Fc-induced MMP expression. Cad-11-Fc stimulation increased RA synovial fibroblast MMP messenger RNA levels. It also increased the phosphorylation of the MAPKs JNK, ERK, and p38 kinase, the phosphorylation of NF-κB p65, and the nuclear translocation of activator protein 1 transcription factor. MAPK and NF-κB inhibitors partially blocked RA synovial fibroblast MMP expression.

CONCLUSION

Cadherin 11 engagement stimulates increased synthesis of several MMPs by RA synovial fibroblasts in a MAPK- and NF-κB-dependent manner. These results underscore the existence of a pathway by which cadherin 11 regulates MMP production and has important implications for joint destruction in RA.

Value of alpha-foetoprotein for screening of recurrence in hepatocellular carcinoma post resection

INTRODUCTION

The aim of this study was to establish the value of alpha-foetoprotein (AFP) for the screening of recurrences in hepatocellular carcinoma (HCC) in patients who have undergone curative hepatic resection.

METHODS

72 HCC patients who had curative resection/liver transplant in 2000-2006 were monitored for recurrence by evaluating the three- or six-monthly AFP and computed tomography images. Patients without recurrence were followed up for a mean duration of 7.27 years.

RESULTS

Out of the 72 patients, 34 (47.2%) suffered from HCC recurrence. 65.4% of recurrent cases had AFP values showing an upward trend. Patients with recurrence had higher AFP values than those without at last follow-up (119.45 μg/L vs. 3.1 μg/L, p < 0.001). AFP at recurrence was independent of gender, race, history of alcohol consumption and hepatitis C or cirrhosis status. Patient with hepatitis B or those with tumours larger than 5 cm had higher AFP values. The best cut-off AFP indicative of HCC recurrence was 5.45 μg/L (sensitivity 84.4%; specificity 77.1%). High preoperative AFP was associated with high AFP at recurrence (correlation coefficient 0.553, p = 0.01).

CONCLUSION

AFP alone is an inadequate screening test for HCC recurrence since only about two-thirds of patients showed upward AFP trend on recurrence. Our study found a relatively low cut-off point for detection of recurrence (5.54 μg/L). Patients with high preoperative AFP tended to have high AFP on recurrence. Imaging is recommended for patients with AFP levels > 5.45 μg/L, especially when AFP shows a rising trend.

Genetic polymorphism in milk fat globule-EGF factor 8 (MFG-E8) is associated with systemic lupus erythematosus in human

Milk fat globule-EGF factor 8 (MFG-E8) is a molecule implicated in phagocytic clearance of apoptotic cells by bridging between macrophages and apoptotic cells. Defects in MFG-E8 cause lupus-like disease in murine models. The aim of our study is to determine whether genetic variation in MFG-E8 predisposes human to systemic lupus erythematosus (SLE). A case-control study of MFG-E8 genetic polymorphism was performed on 147 SLE patients and 146 non-lupus control subjects. Single nucleotide polymorphisms (SNPs) in the coding sequence of human MFG-E8 gene were investigated. SNPs on MFG-E8 residues 3 (3(Arg or Ser)) and 76 (76(Leu or Met)) did not show genetic linkage. Genetic polymorphism on MFG-E8 residue 76 correlated significantly to SLE. The MFG-E8-76(Met) allele predisposed subjects to SLE in a recessive mode (odds ratio: 2.1, P = 0.020), while carriage of MFG-E8-76(Leu) were negatively associated with SLE. The MFG-E8 genotypic combinations with 3(Ser) and 76(Leu) showed the most pronounced protective effect on SLE when compared to the most predisposing genotype 3(Arg/Arg)-76(Met/Met) (OR: 0.29, P = 0.007). According to our result, MFG-E8 is associated with SLE predisposition in Taiwanese. Our study implicates that the impairment of phagocytic clearance of apoptotic cells through phosphotidylserine-dependent MFG-E8 system may lead to the development of human SLE.

Multidetector row CT angiography in spontaneous lobar intracerebral hemorrhage: a prospective comparison with conventional angiography

BACKGROUND AND PURPOSE

The aim of our study was to assess the accuracy of multidetector row CT angiography (MDCTA) in the detection of the underlying vascular abnormalities causing spontaneous lobar intracerebral hemorrhage (ICH) compared with conventional digital subtraction angiography (DSA).

MATERIALS AND METHODS

Seventy-eight patients who underwent MDCTA with use of a 16-detector row scanner and DSA were prospectively included in this study. Each study was assessed by 2 independent blinded neuroradiologists; decisions were made in consensus. Findings on CT angiograms, including the original axial data, multiplanar reformations, and volume-rendered images with and without automated bone segmentation, were used to identify the underlying causes of ICH.

RESULTS

Twenty-two of the 78 patients (28.2%) exhibited angiographic abnormalities, including aneurysms of the proximal arteries (n = 9), arteriovenous malformations (n = 7), Moyamoya disease (n = 4), and aneurysms of the distal arteries (n = 2). MDCTA detected the underlying vascular abnormalities in 21 patients except 1 case of small arteriovenous malformation. Overall sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of MDCTA for detection of underlying vascular abnormalities were 95.5%, 100%, 100%, 98.2%, and 98.7%, respectively.

CONCLUSIONS

MDCTA is a highly accurate imaging technique in the diagnosis of underlying vascular abnormalities in patients with spontaneous lobar ICH.

B lymphocyte stimulator regulates adaptive immune responses by directly promoting dendritic cell maturation

B lymphocyte stimulator (BLyS) is a well-known direct costimulator of adaptive immune cells, particularly B lineage cells. However, we have reported recently that BLyS is also able to activate monocytes. Other innate immune cells, such as dendritic cells (DCs), play a key role in the initiation of adaptive immune responses and the purpose of the current study was to assess whether there is a direct role for BLyS in modulating human DC functions. In this study, we show that BLyS induces DC activation and maturation. Thus, BLyS strongly induced up-regulation of surface costimulatory molecule expression and secretion of specific cytokines and chemokines in DCs. BLyS-stimulated DCs (BLyS-DCs) were also able to augment allogeneic CD4 T cell proliferation to a greater extent than control DCs. BLyS-DCs secreted elevated levels of the major Th1-polarizing cytokine, IL-12p70, and they promoted naive CD4 T cell differentiation into Th1 T cells. Regarding BLyS receptor expression, DCs primarily express cytoplasmic transmembrane activator and CAML interactor; however, low levels of cell surface transmembrane activator and CAML interactor are expressed as well. Collectively, our data suggest that BLyS may modulate adaptive immune cells indirectly by inducing DC maturation.

Feasibility and safety of day surgery laparoscopic cholecystectomy in a university hospital using a standard clinical pathway

INTRODUCTION

Laparoscopic cholecystectomy is currently the treatment of choice for symptomatic gallstone disease. In recent years, there has been a trend towards outpatient cholecystectomy. The aim of our study was to report on our experience with day surgery laparoscopic cholecystectomy and to assess its feasibility and safety.

METHODS

Data on all the patients who underwent day surgery laparoscopic cholecystectomy between February 2006 and December 2006 were collected. They all had symptomatic cholelithiasis proven on imaging or had previous history of biliary pancreatitis or cholangitis with normalisation of liver function test and imagery clearance of the common duct. The patients' biographical data (age, gender, American Society of Anaesthesiology [ASA] status, medical comorbidities) and surgical outcomes were then obtained. The success rate of day surgery laparoscopic cholecystectomy, reasons for overnight admission and re-admission rate were evaluated.

RESULTS

A total of 50 patients were included in our study. The success rate for day surgery laparoscopic cholecystectomy was 92 percent. The patients who failed day surgery procedure are mostly of an older age group with high ASA grading. Reasons for admission for these patients included persistent abdominal pain and postoperative emesis. Our re-admission rate was four percent.

CONCLUSION

Day surgery laparoscopic cholecystectomy is both safe and feasible in local settings. Careful patient selection is essential in ensuring a high success rate.

Divergent effects of BAFF on human memory B cell differentiation into Ig-secreting cells

B cell-activating factor belonging to the TNF family (BAFF) plays a critical role in B cell maturation, yet its precise role in B cell differentiation into Ig-secreting cells (ISCs) remains unclear. In this study, we find that upon isolation human naive and memory B (MB) cells have prebound BAFF on their surface, whereas germinal center (GC) B cells lack detectable levels of prebound BAFF. We attribute their lack of prebound BAFF to cell activation, because we demonstrate that stimulation of naive and MB cells results in the loss of prebound BAFF. Furthermore, the absence of prebound BAFF on GC B cells is not related to a lack of BAFF-binding receptors or an inability to bind exogenous BAFF. Instead, our data suggest that accessibility to soluble BAFF is limited within GCs, perhaps to prevent skewing of the conventional B cell differentiation program. In support of this concept, whereas BAFF significantly enhances ISC differentiation in response to T cell-dependent activation, we report for the first time the ability of BAFF to considerably attenuate ISC differentiation of MB cells in response to CpG stimulation, a form of T cell-independent activation. Our data suggest that BAFF may be providing regulatory signals during specific T cell-independent events, which protect the balance between MB cells and ISCs outside GCs. Taken together, these data define a complex role for BAFF in humoral immune responses and show for the first time that BAFF can also play an inhibitory role in B cell differentiation.

Detection and characterization of intracranial aneurysms with 16-channel multidetector row CT angiography: a prospective comparison of volume-rendered images and digital subtraction angiography

BACKGROUND AND PURPOSE

The aim of our study was to compare multidetector row CT angiography (MDCTA) with digital subtraction angiography (DSA) in the detection and characterization of intracranial aneurysms.

MATERIALS AND METHODS

In our blinded prospective study, 85 patients with suspected intracranial aneurysm (47 women, 38 men; age range, 19-83 years) underwent both 16-channel MDCTA and DSA. The MDCT angiograms were interpreted for the presence, location, size, ratio of the neck to the dome (N/D ratio), and lobularity of the aneurysms and relationship of the aneurysm with the adjacent arterial branches, by using volume-rendering techniques. MDCTA and DSA images (reference standard) were interpreted by 2 independent readers, and the results were compared.

RESULTS

A total of 93 aneurysms were detected at DSA in 71 patients, whereas no aneurysms were detected in 14 patients. Compared with DSA, the overall sensitivity, specificity, and accuracy of MDCTA on a per-aneurysm basis were 92.5%, 93.3%, and 92.6%, respectively, for both independent readers. For aneurysms of <3 mm, however, MDCTA had a sensitivity of 74.1% for reader 1 and 77.8% for reader 2. There was excellent agreement between readers in the detection of aneurysms (kappa = 0.822). In addition, MDCTA was also accurate in determining N/D ratio of aneurysms, aneurysm lobularity, and adjacent arterial branches.

CONCLUSION

MDCTA is accurate in the detection and characterization of intracranial aneurysms and can be used as a reliable alternative imaging technique to DSA in selected cases.

Characterization of Bacterial Susceptibility Isolates in Sixteen Dairy Farms in Taiwan

Bacteria were isolated from dairy cows, dairy farm environments, and dairy workers in 2 geographically different areas of eastern and northern Taiwan. Isolates were evaluated for antimicrobial susceptibility and the phylogenetics of isolated Escherichia coli O157:H7 were characterized. A total of 1,346 bacteria were identified, including 226 E. coli, 30 Pseudomonas spp. (7 Pseudomonas aeruginosa), 259 other gram-negative bacteria, 271 Enterococcus spp., 314 Staphylococcus spp., 195 Streptococcus spp., and 51 other gram-positive bacteria. Among them, 88% (1,184/1,346) of the isolates were resistant to sulfadimethoxine. The percentages of gram-negative bacteria resistant to oxy-tetracycline and streptomycin were 48% (249/515) and 78% (404/515), respectively. Gram-positive bacteria isolated from eastern Taiwan, the least polluted region of Taiwan, were found to have greater antimicrobial resistance than those isolated from northern Taiwan. Two E. coli O157:H7 from 2 different geographical areas were isolated. Both were vt2-positive but vt1-negative and had phylogenetic similarities of 82 and 67%, respectively, compared with previous isolates. Information on antimicrobial susceptibility revealed from this dairy farm survey may serve as a baseline for future studies and may also highlight the need to formulate better regulation strategies for the safe use of antimicrobials on food-producing farms.

A role for BLyS in the activation of innate immune cells

B-lymphocyte stimulator (BLyS) is a member of the tumor necrosis factor (TNF) ligand superfamily. Although BLyS costimulates adaptive immune cells, the ability of BLyS to stimulate innate immune cells has not been described. Here, we show that BLyS strongly induces human monocyte survival, and activation as measured by proinflammatory cytokine secretion and up-regulation of costimulatory molecule expression. In addition, monocytes cultured with BLyS differentiated into macrophage-like cells. Regarding BLyS receptor(s) expression, freshly isolated monocytes bound low levels of exogenous BLyS and expressed primarily intracellular TACI, and cell surface TACI levels increased following monocyte activation. Of interest, bone marrow monocytes from some multiple myeloma patients expressed significant levels of cell surface TACI at isolation. Our findings indicate that BLyS plays a role in activating innate immune cells. Moreover, this study may explain more clearly why high BLyS production is often correlated with certain inflammatory autoimmune diseases and B-lymphocyte malignancies.

Combined chemotherapy and radiation versus radiation alone in the management of localized angiocentric lymphoma of the head and neck

BACKGROUND AND PURPOSE

To clarify the clinical benefit derived from the combined modality therapy (CMT) comprised of chemotherapy and involved-field radiotherapy (XRT) for stage I and II angiocentric lymphomas of the head and neck.

MATERIAL AND METHODS

Of 143 patients with angiocentric lymphoma of the head and neck treated at the Yonsei Cancer Center between 1976 and 1995, 104 patients (XRT group) received involved-field XRT alone with a median dose of 50.4 Gy (range: 20-70 Gy), while 39 patients (CMT group) received a median three cycles (range: 1-6 cycles) of chemotherapy before starting involved-field XRT. The response rate, patterns of failure, complications, and survival data of the XRT group were compared with those of the CMT group.

RESULTS

Despite a higher response rate, local failure was the most common pattern of failure in patients of the both groups. The patterns of failure, including the systemic relapse rate were not influenced by the addition of combination chemotherapy. Although both modalities were well tolerated by the majority of patients, aberrant immunologic disorders or medical illnesses, such as a hemophagocytic syndrome, sepsis, intractable hemorrhage, or the evolution of second primary malignancies were more frequently observed in patients of the CMT group. The prognosis of patients in the XRT group was relatively poor, with a 5-year overall actuarial survival rate of 38% and disease-free survival rate of 32%, respectively. However, their clinical outcome was not altered by the addition of systemic chemotherapy. Achieving complete remission was the most important prognostic factor on univariate and multivariate analyses, but treatment modality was not found to be a prognostic variable influencing survival.

CONCLUSIONS

Involved-field XRT alone for angiocentric lymphoma of the head and neck was insufficient to achieve an improved survival rate, but the combination of chemotherapy and involved-field XRT failed to demonstrate any therapeutic advantage over involved-field XRT alone.

A new Hg(2+)-selective chromoionophore based on calix[4]arenediazacrown ether

A new azophenol type chromogenic ionophore based on the p-tert-butylcalix[4]arenediazacrown ether was prepared: the ionophore exhibited a pronouncedly selective chromogenic behaviour toward Hg2+ ions among the surveyed guests of alkali, alkaline earth, transition and heavy metal ions in liquid-liquid extraction experiments.

Self-assembled monolayer of a redox-active calix[4]arene: voltammetric recognition of the Ba2+ ion in aqueous media

The Redox-active monolayer of a novel calix[4]arene recognizing redox-inactive ionic species by voltammetry is reported. Calix[4]arene-disulfide-diquinone, which is not only redox-active but is also a highly selective ionophore for the Ba2+ ion, spontaneously forms a stable and dense monolayer film on gold. The redox-active calixarene monolayer selectively recognizes Ba2+ ion in aqueous media, and the voltammetric signals are proportional to the ionic concentration. A new voltammetric peak can be detected by square-wave voltammetry upon adding a dilute solution containing Ba2+ ion having a concentration as low as 1.0 x 10(-6) M. The Langmuir plot (1/ip vs 1/[Ba2+]) shows a linear slope in the range from 1.0 x 10(-6) M to 1.0 x 10(-4) M. This modified electrode does not show any significant interference from alkali and alkaline earth metal ions except for Sr2+ and Ca2+. Only 100- and 500-fold concentrations of Sr2+ and Ca2+ ions, respectively, can lead to voltammetric responses comparable to that of Ba2+.

Synthesis of a chiral aziridine derivative as a versatile intermediate for HIV protease inhibitors

[reaction: see text] Chiral aziridine derivative 1 was prepared from D-tartaric acid. This compound could be utilized as a common intermediate for the synthesis of hydroxyethylamine class HIV protease inhibitors such as saquinavir, amprenavir, or nelfinavir.

Biotechnology--updates and new developments

Areas of priority for intensive discovery would be the agbiotechnology and biomedical sectors using gene technology as a platform. The use of genetic manipulation in farming and the use of plants as 'pharma' factories to manufacture therapeutics would be on the rise. The human genome will continue to have a powerful impact on research and development of human diseases and healthcare. Discovery of genetics and pharmacogenomics will have great impact on drug development and will allow the prediction of the patient' s response to various drugs as well as the onset of individualised or 'designer drugs'. Human stem cells could have their cellular clocks reset by the cloning process, enhancing opportunities to grow young cells, tissues and organs for an aging population. The cellular clock could also be reset by therapeutic cloning. Bioinformatics would be a technology which would be synonymous with biotechnology. The analyses of biotechnology research would be conducted in silico and would involve the exchange of information among sophisticated computer databases. Applications of biotechnology would be even more evident in environmental technology, food development and food processing. In electronics, the use of the specificity of proteins in biochips is underway. In tandem with the explosions in research, regulatory issues, legislation and intellectual property rights will evolve to enhance the climate of discovery and innovation. Public education will have to be continually enhanced as awareness could negate any fear resulting from novel and innovative improvements from biotechnology.

Depletion of plasma factor XIII prevents disseminated intravascular coagulation-induced organ damage

The impact of clot stability affecting the vasculopathy and tissue necrosis in Shwartzman reaction was investigated using plasma Factor XIII A2-depleted rabbit (FXIII-DR). Plasma Factor XIIIA2 (FXIIIA2) was depleted by infusion of the mono-specific goat anti-rabbit FXIIIA2 IgG. Generalized Shwartzman reaction (GSR) was induced by priming and challenged by i.v. injection of LPS and local Shwartzman reaction (LSR) was primed by intradermal injection of LPS and challenged by i.v. injection of LPS. Histological examination of the GSR animals showed, extensive thrombi accumulation in renal tubules and bilateral cortical necrosis of kidney in 8 out of 10 rabbits but none in the FXIII-DR. Fibrinogen levels were elevated to 3 approximately 4 fold at 24 h and lowered at 48 h whereas a steady rise was seen in the FXIII-DR. FDP levels in GSR animals were significantly elevated at 24 h and further increased at 48 h but only slightly elevated in the FXIII-DR. Examination of the LSR tissues after 48 h showed an acute onset of progressive cutaneous vascular thrombosis, purpura, and secondary hemorrhagic necrosis whereas neither fibrin deposit nor necrosis of tissue were detected in FXIII-DR despite of an early edema formation. Fibrinogen levels were also increased two fold at 24 h but returned to basal levels at 48 h in control LSR animals but not affected at all in FXIII-DR. These results suggest that during the severe inflammatory conditions such as sepsis, the fibrinolytic system is functionally sufficient to dissipate the pathogenic accumulation of disseminated intravascular clots and exudated fibrin clots if those clots were prevented from getting crosslinked in plasma.

The use of contrast-enhanced color Doppler ultrasound in the differentiation of retinal detachment from vitreous membrane

OBJECTIVE

To compare the clinical utility of contrast-enhanced color Doppler US in the differentiation of retinal detachment (RD) from vitreous membrane (VM) with that of various conventional US modalities, and to analyze the enhancement patterns in cases showing an enhancement effect.

MATERIALS AND METHODS

In 32 eyes examined over a recent two-year period, RD (n=14) and VM (n=18) were confirmed by surgery (n=28) or clinical follow-up (n=4). In all cases, gray-scale, color Doppler, and power Doppler US were performed prior to contrast injection, and after the intravenous injection of Levovist (Schering, Berlin) by hand for 30 seconds at a dose of 2.5 g and a concentration of 300 mg/mL via an antecubital vein, contrast-enhanced color Doppler US was performed. At Doppler US, the diagnostic criterion for RD and VM was whether or not color signals were visualized in membranous structures.

RESULTS

Diagnostic accuracy was 78% at gray-scale US, 81% at color Doppler US, 59% at power Doppler US, and 97% at contrast-enhanced color Doppler US. The sensitivity of color Doppler US to color signals in RD increased from 57% to 93% after contrast enhancement. The enhancement patterns observed were signal accentuation (n=3), signal extension (n=2), signal addition (n=3), and new signal visualization (n=5).

CONCLUSION

Contrast-enhanced color Doppler US was the most accurate US modality for differentiating RD from VM, showing a significantly increased signal detection rate in RD.

Toxic amebic colitis coexisting with intestinal tuberculosis

A patient with a fulminant amebic colitis coexisting with intestinal tuberculosis had a sudden onset of crampy abdominal pain, mucoid diarrhea, anorexia, fever and vomiting with signs of positive peritoneal irritation. Fulminant amebic colitis occurring together with intestinal tuberculosis is an uncommon event and may present an interesting patho-etiological relationship. The diagnosis was proven by histopathologic examination of resected specimen. Subtotal colectomy including segmental resection of ileum, about 80 cm in length, followed by exteriorization of both ends, was performed in an emergency basis. Despite all measures, the patient died on the sixth postoperative day. The exact relationship of fulminant amebic colitis and intestinal tuberculosis is speculative but the possibility of a cause and effect relationship exists. Fulminant amebic colitis may readily be confused with other types of inflammatory bowel disease, such as idiopathic ulcerative colitis, Crohn's disease, perforated diverticulitis and appendicitis with perforation. This report draws attention to the resurgence of tuberculosis and amebiasis in Korea, and the need for the high degree of caution required to detect it.

Plasma homocysteine, vitamin B6, vitamin B12 and folic acid in end-stage renal disease during low-dose supplementation with folic acid

In order to see whether conventional low-dose folic acid supplement along with vitamin B6 and B12 reduces hyperhomocysteinemia in patients with ESRD, we compared the levels of homocysteine, vitamin B6, B12 and folic acid among 3 groups of patients: 44 ESRD patients on hemodialysis with replacement of folic acid, vitamin B6, and B12 (dialysis group); 27 chronic renal failure patients without vitamin replacement (predialysis group); and 17 hypertensive patients without vitamin replacement (control group). Mean plasma total homocysteine concentration was higher in the dialysis (15.5 +/- 6.6 micromol/l) and the predialysis groups (15.7 +/- 4.2 micromol/l) than in the control group (6.2 +/- 1.5 micromol/l) (p < 0.001). However, there was no difference in homocysteine concentrations between the dialysis and predialysis groups. In the control and predialysis groups, the homocysteine concentration showed a reverse correlation with the concentrations of folic acid (r = 0.584, p = 0. 014 for the control group; r = 0.431, p = 0.247 for the predialysis group) and vitamin B12 (r = 0.485, p = 0.049 for the control group; r = -0.562, p = 0.023 for the predialysis group) but not with vitamin B6. In conclusion, plasma folic acid concentrations were 3-4 times higher in the dialysis than in the predialysis group. But these levels of folic acid are not enough to reduce hyperhomocysteinemia in ESRD.

Spatial frequency tuned covariance channels for red-green and luminance-modulated gratings: psychophysical data from human infants

This study concerns the spatial-frequency-tuned channels underlying infants' contrast sensitivity functions (CSFs) for red-green chromatic stimuli, and their relationship to the channels underlying infants' CSFs for luminance-modulated stimuli. Behavioral (forced-choice preferential-looking) techniques and stationary stimuli were used. In experiment 1. contrast thresholds were measured in 4- and 6-month-olds, using isoluminant red-green gratings with spatial frequencies ranging from 0.27 to 1.53 c deg. In experiment 2. contrast thresholds were measured in 4-month-olds. using both red-green and luminance-modulated gratings in the same low spatial frequency range. Covariance analyses of individual differences were performed. Experiment 1 revealed one dominant covariance channel for the detection of red-green gratings, with a second channel contributing to detection of the highest spatial frequencies used. Experiment 2 revealed two to three channels serving color and luminance: but surprisingly these channels were not statistically separable for luminance versus chromatic stimuli. Thus, covariance channels for color and luminance that are independent for adults [Peterzell & Teller (2000). Spatial frequency tuned covariance channels for red-green and luminance-modulated gratings: psychophysical data from human adults. Vision Research, 40, 417-430] are apparently interdependent in infants. These data suggest that for infants, detection thresholds for chromatic and luminance-modulated stimuli may be limited by common mechanisms.

Neoadjuvant chemotherapy and radiation for inoperable carcinoma of the maxillary antrum: a matched-control study

A matched-control study comparing standard radiotherapy versus neoadjuvant chemotherapy and radiation was undertaken to clarify the effects of neoadjuvant systemic chemotherapy for locally advanced squamous cell carcinoma of the maxillary antrum. Thirty-four patients with inoperable maxillary cancer were treated with neoadjuvant chemotherapy and radiotherapy (Group II). Before starting radiotherapy, all patients in Group II received two or three cycles of neoadjuvant chemotherapy consisting of cisplatin and a 5-day continuous infusion of 5-fluorouracil with or without intravenous injection of vinblastine. Radiation doses ranged from 66 Gy to 75 Gy (median, 70 Gy). The response rate, patterns of failure, toxicity, and survival for Group II were compared with those for 34 stage-matched patients treated with radiation alone (Group I). Despite a higher response rate to neoadjuvant chemotherapy, the recurrence rate and patterns of treatment failure were not influenced by the addition of neoadjuvant chemotherapy. In most cases, neoadjuvant chemotherapy did not interfere with subsequent radiotherapy, and radiation-induced late complications occurred equally in both treatment groups. After a median follow-up of 48 months, there was no significant difference in 5-year actuarial survival or disease-free survival between the two treatment groups. Radiation alone for inoperable maxillary cancer was clearly suboptimal for improving local control and survival rate, but neoadjuvant chemotherapy in addition to standard radiotherapy failed to demonstrate any therapeutic advantage over radiation alone.

Dermatoxicokinetic modeling of p-nitrophenol and its conjugation metabolite in swine following topical and intravenous administration

The development of a dermatotoxicokinetic (dTK) model for p-nitrophenol (PNP), a common metabolite from a variety of compounds and a biomarker of organophosphate (OP) insecticide exposure, may facilitate the kinetic modeling and risk assessment strategy for its parent compounds. In order to quantify and then clarify in vivo-in vitro correlation of PNP disposition, multicompartment kinetic models were formulated. Female weanling pigs were dosed with [14C]PNP intravenously (150 microg in ethanol, n = 4) or topically onto non-occluded abdominal skin (300 microg/7.5cm2 in ethanol, n = 4). PNP and p-nitrophenyl-beta-D-glucuronide (PNP-G) profiles were determined in plasma and urine in addition to total 14C quantitation in many other samples. Disposition parameters (rate constants, Ftop, T12, T1/2Ka, AUC, Vss, Clp, MAT, and MRT) and the simulated chemical mass-time profiles on the dosed skin surface and in the local, systemic, and excretory compartments were also determined. Total recoveries of 97.17 +/- 4.18% and 99.80 +/- 2.41% were obtained from topical and intravenous experiments, respectively. Ninety-six hours after topical and intravenous application, 70.92 +/- 9.72% and 98.65 +/- 2.43% of the dose were excreted via urine, and 0.55 +/- 0.16% and 0.51 +/- 0.10% via the fecal route, respectively. Peak excretion rate and time were also determined. It was suggested by experimental observation and modeling that urinary 14C excretion correlates with the systemic tissue depletion profile well and may be used as a biomarker of PNP exposure. This study also supports the strategy of using urinary PNP as a biomonitoring tool for OP pesticide exposure, although some precautions have to be taken. The strategy used in this study will be useful in comprehensive dTK modeling in dermal risk assessment and transdermal drug delivery.

Benefit of heat acclimation is limited by the evaporative potential when wearing chemical protective clothing

Heat acclimation-induced sweating responses have the potential of reducing heat strain for chemical protective garment wearers. However, this potential benefit is strongly affected by the properties of the garment. If the clothing ensemble permits sufficient evaporative heat dissipation, then heat acclimation becomes helpful in reducing heat strain. On the other hand, if the garment creates an impenetrable barrier to moisture, no benefit can be gained from heat acclimation as the additional sweating cannot be evaporated. Ten subjects were studied exercising on a treadmill while wearing two different chemical protective ensembles. Skin heat flux, skin temperature, core temperature, metabolic heat production and heart rate were measured. It was found that the benefit of heat acclimation is strongly dependent on the ability of the body to dissipate an adequate amount of heat evaporatively. The evaporative potential (EP), a measure of thermal insulation modified by moisture permeability, of the clothing ensemble offers a quantitative index useful to determine, a priori, whether heat acclimation would be helpful when wearing protective clothing system. The data show that when EP is < 15%, heat acclimation affords no benefit. An evaporative potential graph is created to aid in this determination.

Influence of 5,10-methylenetetrahydrofolate reductase gene polymorphism on plasma homocysteine concentration in patients with end-stage renal disease

The purpose of this study is to observe the influence of the methylenetetrahydrofolate reductase (MTHFR) gene (677C-->T substitution) on plasma homocysteine levels in end-stage renal disease (ESRD) patients who received a relatively large amount of folate (2 mg/d) and are undergoing hemodialysis. A cross-sectional study of plasma homocysteine, vitamin B(12), and folate was performed in patients with ESRD. The study population for the MTHFR gene study included 312 healthy subjects and 106 patients with ESRD undergoing hemodialysis. The C677T transition in the MTHFR gene was detected by HinF 1 restriction enzyme analysis and subsequent electrophoresis in a 3% agarose gel. The genotype of the MTHFR gene in 106 patients with ESRD was homozygous C677T mutation (VV) in 17 patients (16.1%) and heterozygous (AV) in 63 patients (58.4%); 26 patients (24.5%) did not carry this mutation (AA). The mean levels of homocysteine, vitamin B(12), and folate in the patients with ESRD were 23.3 +/- 14.0 mmol/L, 620.2 +/- 98.5 pmol/L, and 138.6 +/- 55.6 nmol/L, respectively. There was no significant difference in homocysteine levels among the three genotypes: 28.2 +/- 19.4 mmol/L for VV, 22.7 +/- 14.9 mmol/L for AV, and 23.4 +/- 11.1 mmol/L for AA genotype (P > 0.05). There was no difference in genotype distribution between the patient groups of less than 25th and greater than 75th percentiles, classified according to plasma homocysteine levels (P = 0.47). In conclusion, with high-dose folate supplementation, the hyperhomocysteinemia in patients with ESRD does not seem to be caused by the 677C-->T mutation in the MTHFR gene.

Molecular cloning of multiple splicing variants of JIP-1 preferentially expressed in brain

Stress-activated protein kinase/c-Jun N-terminal kinase (SAPK/JNK) is activated by a variety of cellular or environmental stresses. Proper regulation of the SAPK/JNK pathway may be critical for cell survival or death under various conditions. In this study, we report the molecular cloning of novel isoforms of JIP-1, which harbor a putative phosphotyrosine interaction domain and a helix-loop-helix domain, as well as an SH3 homologous region in the C terminus. Northern analysis indicates that transcription variant jip-1 is expressed in brain and kidney and transcription variants jip-2 and jip-3 are specifically expressed in brain. In situ hybridization data showed that the hybridized jip messages were heavily concentrated in adult brain, and were particularly enriched in the cerebral cortex and hippocampus, the brain regions vulnerable to pathological states such as hypoxia-ischemia, epilepsy, and Alzheimer's disease. All the deduced protein products of the jip transcription variants appear to have a similar property in that they inhibit the SAPK/JNK stimulation when overexpressed. Inhibition of SAPK activation by overexpression of the novel isoform JIP-2a resulted in suppression of etoposide-induced cell death in a neuroglioma cell line, N18TG. These findings suggest that JIP may play an important role in regulation of the SAPK pathway that is involved in stress-induced cellular responses.

p53 mutation in patients with ulcerative colitis in rectal biopsy

OBJECTIVES

Long standing ulcerative colitis (UC) has been known to be one of the precancerous diseases of colorectal cancer. Although the frequent loss of p53 allele (LOH) and aneuploidy were reported as the molecular events in carcinoma and dysplasia known as the precursor of UC, p53 genetic alteration was not reported in indefinite dysplasia and UC involved mucosa in long standing UC. Therefore, we investigated the mutational inactivation of the p53 gene in UC patients who showed dysplastic mucosa, as well as non-dysplastic mucosa on H & E stain and, secondly, if there is p53 mutation, we examined the relationship between p53 alteration and clinical data.

METHOD

Sixteen patients with UC who had different duration of colitis were studied by endoscopic examination with rectal mucosal biopsies, p53 gene alterations were detected by PCR-SSCP for exon 4-8 and immunohistochemical staining with p53 monoclonal antibody.

RESULTS

Among 16 patients, 2 patients (12%) showed dysplasia on H-E stain. The p53 point mutations were detected in 4 (two dysplasia and 2 normal looking mucosa) on PCR-SSCP. 4 patients who had p53 gene mutation were positive in immunohistochemical staining. With regard to clinical characteristics, these patients with p53 point mutation showed poor response to medical treatment.

CONCLUSION

These results suggest that the p53 mutation may be an early molecular event of cancerous change in UC.

Cardiac manifestations in tuberous sclerosis: a 10-year review

OBJECTIVE

Tuberous sclerosis is a genetic disorder with multisystem involvement. The aim of this study was to focus primarily on the cardiac aspects of this condition.

METHOD

This review included 10 children with tuberous sclerosis presenting to our department during a 10-year period.

RESULTS

From our data, 80% were found to have cardiac involvement. There was an equal prevalence of neurologic complications.

CONCLUSIONS

Cardiac tumours and seizures were the most common problems encountered. Whereas most patients had no symptoms referable to the cardiovascular system and required no active intervention, many of those with neurologic involvement needed appropriate treatment.

The relationship between plasma homocysteine and amino acid concentrations in patients with end-stage renal disease

OBJECTIVE

Observe the relationship between homocysteine and other amino acids in patients with end-stage renal disease (ESRD).

DESIGN

A cross-sectional study of amino acids and homocysteine and comparison of the correlations between ESRD and control group.

SETTING

Nephrology unit of Soonchunhyang University hospital in Chunan, Korea.

PARTICIPANTS

Forty-five ESRD patients and 30 control volunteers.

MAIN OUTCOME MEASURES

Plasma amino acids and homocysteine.

RESULTS

Concentrations of asparate, proline and cysteine were higher and serine, tyrosine, valine, isoleuline, leucine, and lysine levels were lower in the ESRD group than in control group. The branched chain amino acids (BCAAs) and essential amino acid were lower in the ESRD group than in the control group, but there was no difference in non-essential amino acid and total amino acid between the two groups. The mean plasma total homocysteine concentrations were 6 +/- 1 mmol/L in the control group and 14 +/- 4 mmol/L in the ESRD group (P < .001). In the ESRD group, homocysteine concentrations showed a direct correlation with the concentration of histidine (R2: .403, P < .001), valine (R2: .324, P < .01), leucine (R2: .400, P < .01), isoleucine (R2: .351, P < .005), cysteine (R2: .287, P < .001), methionine (R2: .256, P < .01), BCAA (R2: .50, P < .01), and essential amino acid (R2: .416, P < .01). In the control group, no correlation between the homocysteine and amino acid concentrations was found.

CONCLUSIONS

Contrary to the control group, the homocysteine concentrations showed a direct correlation with the concentration of valine, leucine, isoleucine, methionine, and histidine levels in the ESRD group. Altered essential amino acid metabolism, specifically BCAAs and histidine, influence hyperhomocysteinemia in ESRD. Further study is needed to confirm this theory.

An E. coli B mutation, rpoB5081, that prevents growth of phage T4 strains defective in host DNA degradation

An E. coli B Tab strain, EM121, was isolated that restricts T4 denA (DNA endonuclease II) mutants at 37 degrees C and above, but is permissive for wild-type T4 at all temperatures examined. At 42 degrees C, other mutants affected in nucleic acid metabolism (T4 dexA, regA and uvsW strains) are also restricted. Genetic analysis revealed that one mutation (rpoB5081) in the RNA polymerase beta subunit gene is sufficient for restricting all denA mutants. rpoB5081, together with a second linked mutation, is also required for restricting the other T4 mutants, rpoB5081 (P806S), previously shown to increase transcription termination in E. coli K-12, causes delayed synthesis of T4 late proteins and reduced DNA synthesis in denA infections. Thus, T4 DNA synthesis and gene expression are impaired by the rpoB5081 beta subunit when degradation of host DNA is reduced. Because the restricted T4 mutants are not readily distinguished from wild-type phage under typical plating conditions, EM121 is an important host for screening and mapping T4 denA mutations.

Clinics in diagnostic imaging (30). Vein of Galen and straight sinus thrombosis

A 40-year-old lady presented with acute onset of confusion and disorientation. CT and MRI scans showed vein of Galen and straight sinus thrombosis. The clinical and imaging features of venous sinus thrombosis are described.

Heat strain models applicable for protective clothing systems: comparison of core temperature response

Core temperature (Tc) output comparisons were analyzed from thermal models applicable to persons wearing protective clothing. The two models evaluated were the United States (US) Army Research Institute of Environmental Medicine (USARIEM) heat strain experimental model and the United Kingdom (UK) Loughborough (LUT25) model. Data were derived from collaborative heat-acclimation studies conducted by three organizations and included an intermittent-work protocol (Canada) and a continuous-exercise/heat stress protocol (UK and US). Volunteers from the US and the UK were exposed to a standard exercise/heat stress protocol (ambient temperature 35 degrees C/50% relative humidity, wind speed 1 m/s, level treadmill speed 1.34 m/s). Canadian Forces volunteers did an intermittent-work protocol (15 min moderate work/15 min rest at ambient temperature of 40 degrees C/30% relative humidity, wind speed approximately 0.4 m/s). Each model reliably predicted Tc responses (within the margin of error determined by 1 root mean square deviation) during work in the heat with protective clothing. Models that are analytically similar to the classic Stolwijk-Hardy model serve as robust operational tools for prediction of physiological heat strain when modified to incorporate clothing heat-exchange factors.

Characterization of superoxide dismutase in Streptococcus thermophilus

Streptococcus thermophilus AO54 possesses a single manganese-containing superoxide dismutase (MnSOD). The enzyme was found to be insensitive to cyanide or to a modified H2O2 treatment. The enzyme is expressed in a growth-phase-dependent fashion, increasing three- to fourfold upon entry into stationary phase. The specific activity for MnSOD was the same under anaerobic or aerobic conditions and was not induced by the presence of paraquat under aerobic conditions.

Utilization of Chinese medicine in Taiwan

This article examines the use of Chinese medicine in Taiwan. Based on a national sample survey, the authors investigated how Chinese medicine is being used and factors that are associated with its use among the Taiwanese. Results of the study suggest that Chinese medicine use among this population depends on health conditions, and that having a regular source of care for Chinese medicine as well as a preference for Chinese medicine are two predictors for its use. Policies on the integration of Chinese medicine or other traditional medicine into the modern healthcare system are recommended.

The practice of Chinese medicine in Taiwan

This paper examines the practice of Chinese medicine in Taiwan. Using a national sample survey of Chinese medicine physicians, supplemented by another national survey of Chinese medicine hospitals and government records, the authors study the education and training background of Chinese medicine physicians, their mode of practice, their productivity measured by patient visits, and the practice characteristics of Chinese medicine hospitals. Moreover, the authors investigate the relationship between the resource input, the public health insurance contract, and the number of patient visits Chinese medicine physicians provided. Results of this study are used to make several recommendations on the appropriate way of integrating the practice of Chinese medicine into the modern health care system. Many of these recommendations may also be applicable to other countries that are contemplating integrating traditional or alternative medicine into their health care systems.

Clothing insulation in a hypobaric environment

HYPOTHESIS

Clothing insulation is the result of complex interactions between heat transfer mechanisms and clothing material thermal resistances. Hypobaria changes the heat transfer processes therefore should have observable effects on the clothing insulation.

METHODS

The effect of hypobaria on the thermal insulative properties of U.S. Army fatigue uniform (BDU) and U.S. Army chemical protective overgarment (BDO) were examined Barometric pressure of 429 mmHg, comparable to the condition at terrestrial elevation of 4570 m (15,000 ft) above sea level was created in a hypobaric chamber. The sea level environment was used as a baseline condition.

RESULTS

Our data support a diminished convective heat transfer and an enhanced evaporative heat transfer at higher altitude. We also found that hypobaria had only a small effect on the intrinsic clothing insulation values. For the less insulative BDU, hypobaria did not appreciably affect clothing insulation values. For the more insulative BDO, a maximum difference of 0.2 clo (clo = 0.155 m2.K.W-1) was found between hypobaric and normobaric environments.

CONCLUSION

Heavy clothing insulation forced the heat transfer processes at the skin surface to operate almost independently from those at the clothing surface. At the skin surface, evaporation was the dominant process, while at the outer clothing surface, convection dominated. At higher altitude, enhanced evaporative heat transfer resulted in a lower skin temperature, while reduced convective heat transfer hampered heat dissipation from clothing surface to the ambient environment, hence elevating the clothing temperature. Therefore, in hypobaric environment, the skin temperature was found to be lower, but the clothing temperature higher than at sea level.

Active index for content-based medical image retrieval

This paper introduces the active index for content-based medical image retrieval. The dynamic nature of the active index is its most important characteristic. With an active index, we can effectively and efficiently handle smart images that respond to accessing, probing and other actions. The main applications of the active index are to prefetch image and multimedia data, and to facilitate similarity retrieval. The experimental active index system is described.

Extraskeletal Ewing's sarcoma presenting with pulmonary embolism

Small round cell tumours with the morphologic characteristics of Ewing's sarcoma arise rarely in soft tissues of the extremities, retroperitoneum, chest and orbit. Patients usually present with symptoms arising from the swelling at the primary site. We report on a patient with a retroperitoneal extraskeletal Ewing's sarcoma who presented with massive tumour embolism to the pulmonary vasculature. To our knowledge, this is the first report of extraskeletal Ewing's sarcoma presenting with pulmonary tumour embolism.

Comparison of inversion recovery fast spin-echo (FSE) with T2-weighted fat-saturated FSE and T1-weighted MR imaging in bone marrow lesion detection

OBJECTIVE

To prospectively compare inversion recovery (IR) fast spin-echo (FSE) with T1-weighted spin-echo (SE) and T2-weighted chemical-shift fat-saturated (FS) FSE magnetic resonance sequences in the detection of bone marrow abnormality.

DESIGN

Twenty-nine sets of T1-weighted SE [400-640/10-20 (TR/TE)], T2-weighted FS-FSE [2400-3800/91-112/8 (TR/TE/ETL), and IR-FSE [3700-6000/12-14/170/8 (TR/TE/T1/ETL)] images were acquired with a 1.5-T magnet in 27 patients with bone marrow lesions. The visibility, margination, and extent of 41 lesions, image quality, contrast, and artifacts were qualitatively and quantitatively compared.

RESULTS

The lesions were more conspicuous on the IR-FSE than on the T1-weighted SE and T2-weighed FS-FSE images. The extent of lesions was similar for all three sequences. Image quality was better and there were fewer motion artifacts on the T1-weighted images. The mean lesion contrasted-to-noise ratio was significantly higher on the T1-weighted images (p < 0.05).

CONCLUSION

The IR-FSE sequence is highly sensitive for detecting bone marrow pathology, with scan time comparable to the T1-weighted SE and T2-weighted FS-FSE sequences.

Helicobacter pylori infection and serum pepsinogen I concentration in peptic ulcer patients: effect of bacterial eradication

OBJECTIVES

In order to test the hypothesis that H. pylori infections in the gastric antrum increase pepsinogen I release, fasting serum pepsinogen I concentrations were compared in peptic ulcer patients with and without H. pylori infection. A randomized prospective study was performed to determine whether the increased serum pepsinogen I concentrations associated with H. pylori infection respond to treatment that eradicates H. pylori.

METHODS

Fasting serum pepsinogen I concentrations were measured by RIA in 736 patients with endoscopically and histologically confirmed benign peptic ulcer with and without H. pylori infection. Out of 511 patients with H. pylori infection, 110 patients (group 1) were randomly selected and were treated with metronidazole and tripotassium dicitrato bismuthate combined with ranitidine and antacid, and 97 patients (group 2) were treated only with ranitidine and antacid. The third group, 54 patients free of H. pylori infection, was designed to evaluate the influence of H2-receptor antagonist and antacid on the change of pepsinogen I. Fasting pepsinogen I concentration and H. pylori status were compared before and after the treatment.

RESULTS

Patients infected by H. pylori (gastric ulcer 208, duodenal ulcer 303; total 511) had significantly higher fasting serum pepsinogen I concentrations than H. pylori negative patients (gastric ulcer 110, duodenal ulcer 115; total 225). Mean pepsinogen I level of the former was 124.3 +/- 46.9 and that of the latter was 77.9 +/- 25.8 ng/ml. (p < 0.0001). The difference in serum pepsinogen I concentrations according to the location of ulcer crater was significant only in non-infected subjects e.g., mean pepsinogen I level H. pylori-negative gastric ulcer was significantly lower than that of H. pylori-negative duodenal ulcer patients. H. pylori was eradicated in all the patients who had received antibacterial therapy for 4 weeks and serum pepsinogen I concentrations were significantly decreased from 129.8 +/- 43.0 to 82.4 +/- 24.0 ng/ml after eradication of the organism. (p < 0.0001) In contrast, H. pylori-positive patients who had not received antibacterial therapy were still infected at the completion of the study and there was no significant change in the serum pepsinogen I concentrations after the treatment (120.8 +/- 40.9 vs 126.3 +/- 40.4 ng/ml). (p > 0.57) None of the patients who were initially H. pylori-negative has been reinfected during the period of the study and their serum pepsinogen I concentrations were not changed. (pre-treatment value 75.1 +/- 8.0; post-treatment value 77.3 +/- 24.5 mg/ml) (p < 0.75) Four-to six-week therapy of H2-receptor antagonist and antacid did not exert any influence on serum pepsinogen I concentrations.

CONCLUSIONS

On the basis of our results, we have confirmed that the chronic infection of H. pylori of gastric antrum in peptic ulcer patients causes increased pepsinogen I release into the circulation, and eradication of the organism results in significant fall in serum pepsinogen I concentrations.