Ventilator Weaning and Terminal Extubation: Withdrawal of Life-Sustaining Therapy in Children. Secondary Analysis of the Death One Hour After Terminal Extubation Study

OBJECTIVE

Terminal extubation (TE) and terminal weaning (TW) during withdrawal of life-sustaining therapies (WLSTs) have been described and defined in adults. The recent Death One Hour After Terminal Extubation study aimed to validate a model developed to predict whether a child would die within 1 hour after discontinuation of mechanical ventilation for WLST. Although TW has not been described in children, pre-extubation weaning has been known to occur before WLST, though to what extent is unknown. In this preplanned secondary analysis, we aim to describe/define TE and pre-extubation weaning (PW) in children and compare characteristics of patients who had ventilatory support decreased before WLST with those who did not.

DESIGN

Secondary analysis of multicenter retrospective cohort study.

SETTING

Ten PICUs in the United States between 2009 and 2021.

PATIENTS

Nine hundred thirteen patients 0-21 years old who died after WLST.

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

71.4% ( n = 652) had TE without decrease in ventilatory support in the 6 hours prior. TE without decrease in ventilatory support in the 6 hours prior = 71.4% ( n = 652) of our sample. Clinically relevant decrease in ventilatory support before WLST = 11% ( n = 100), and 17.6% ( n = 161) had likely incidental decrease in ventilatory support before WLST. Relevant ventilator parameters decreased were F io2 and/or ventilator set rates. There were no significant differences in any of the other evaluated patient characteristics between groups (weight, body mass index, unit type, primary diagnostic category, presence of coma, time to death after WLST, analgosedative requirements, postextubation respiratory support modality).

CONCLUSIONS

Decreasing ventilatory support before WLST with extubation in children does occur. This practice was not associated with significant differences in palliative analgosedation doses or time to death after extubation.

SERCA2a stimulation by istaroxime improves intracellular Ca2+ handling and diastolic dysfunction in a model of diabetic cardiomyopathy

Funding Acknowledgements

Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): This work was supported by CVie Therapeutics Limited (Taipei, Taiwan) and Windtree Therapeutics (Warrington, USA)

Diabetic cardiomyopathy is a multifactorial disease characterized by an early onset of diastolic dysfunction (DD) that precedes the development of systolic impairment. Mechanisms that can restore cardiac relaxation improving intracellular Ca2+ dynamics represent a promising therapeutic approach for cardiovascular diseases associated to DD. Istaroxime has the double property to accelerate Ca2+ uptake into sarcoplasmic reticulum (SR) through the SR Ca2+ pump (SERCA2a) stimulation and to inhibit Na+/K+ ATPase (NKA). The project aims to characterize istaroxime effects at a concentration (100 nM) marginally affecting NKA, in order to highlight its effects dependent on the stimulation of SERCA2a in a model of mild diabetes.

Streptozotocin (STZ) treated diabetic rats were studied at 9 weeks after STZ injection in comparison to controls (CTR). Istaroxime effects were evaluated in vivo and in left ventricular (LV) preparations. STZ animals showed 1) marked DD not associated to cardiac fibrosis, 2) LV mass reduction associated to reduced LV cell dimension and T-tubules loss, 3) reduced LV SERCA2 protein level and activity and 4) slower SR Ca2+ uptake rate, 5) LV action potential (AP) prolongation and increased short-term variability (STV) of AP duration, 6) increased diastolic Ca2+, 7) unaltered SR Ca2+ content and stability in intact cells. Acute istaroxime infusion (0.11 mg/kg/min for 15 min) reduced DD in STZ rats. Accordingly, in STZ myocytes istaroxime (100 nM) stimulated SERCA2a activity and blunted STZ-induced abnormalities in LV Ca2+ dynamics. In CTR myocytes, istaroxime increased diastolic Ca2+ level due to NKA blockade albeit minimal, while its effects on SERCA2a were almost absent.

SERCA2a stimulation by istaroxime improved STZ-induced DD and intracellular Ca2+ handling anomalies. Thus, SERCA2a stimulation can be considered a promising therapeutic approach for DD treatment. Abstract Figure.

Growth failure in focal dermal hypoplasia

Focal dermal hypoplasia (FDH) is a rare genetic disorder caused by mutations in the PORCN gene located on the X chromosome. Short stature was previously noted to be a common finding in FDH, however the etiology of this is unclear. The present study sought to elucidate specific causes for short stature by assessing growth charts, determining bone ages and auxologic measurements, examining laboratory data for the common causes of growth failure, assessing dietary intake, and performing a growth hormone stimulation test. Sixteen patients with FDH between the ages of 3 and 18 years of age consented to the study. While 11 out of 16 patients had short stature based on height less than 2 standard deviations below mid-parental target height percentile and bone age not suggestive of likely catch-up growth, only four had a BMI less than the 5th percentile for age. Laboratory studies did not support a gastrointestinal, allergy or autoimmune cause of growth failure. Three patients had results suggestive of possible growth hormone deficiency. Although short stature is a common feature in FDH, our data suggests that severe undernutrition is not common in this group and that there may be underlying treatable causes for this short stature in some patients.

Abstract P1-04-04: DNA methylation landscapes of breast cancer progression to brain metastasis: A pre-clinical study

Due to improvements in overall survival rates, breast cancer brain metastasis (BCBM) is a major life-limiting condition with rising incidence. The molecular mechanisms involved in breast cancer (BC) progression to brain metastasis are still poorly understood. We have demonstrated that DNA methylation, a key epigenetic regulatory mechanism, is involved in BC progression to metastatic disease. Here, we characterized the BCBM DNA methylation landscapes according to their molecular subtypes. Methods: This study included 22 BCBM specimens from 19 patients (ER+/PgR+/HER2-(n=6), HER2+(n=7), and ER-/PgR-/HER2-(TNBC; n=6)) and primary BC specimens with paired molecular subtypes. After microdissection, we generated genome-wide DNA methylomes using HM450K BeadChips. Results: Multidimensional scaling revealed that DNA methylation patterns specifically clustered BCBMs according to their respective molecular subtypes. Additionally, we observed that while ER+/PgR+/HER2- BCBM showed a significant global hypermethylation, HER2+ and TNBC BCBMs presented a significant global hypomethylation compared to the respective primary BC specimens. Hypermethylation on ER+/PgR+/HER2- BCBMs mainly affected CpG islands and was significantly enriched in regions overlapping tumor-related genes, such as APC2, CREB3L1, and GLI3; and a large number of developmental genes, including HOXA9, HOXA10, HOXB13, and PAX6 (Table1). On the other hand, hypomethylation on HER2+ and TNBC BCBMs significantly overlapped with conserved intergenic cis regulatory elements. Two significantly affected regions included enhancer elements associated with NEUROD1, a neurogenic differentiation factor, and MYT1L, a Pan-neural transcription factor associated with neuronal differentiation, suggesting an acquisition of brain-like properties (Table2). Conclusions: Our study suggests a significant role of DNA methylation reprogramming during BC progression to brain metastasis and describes the existence of molecular subtype-specific DNA methylomes. Altogether, this data offers new insight into the complexity of this clinical complication.

Table1: Hypermethylated CpG sites in ER+/PgR+/HER2- BCBMChrStartGeneCpG ContextDiff. MethFDR P-val1746802888HOXB13Island0.824.6E-061656666575MT1MIsland0.813.7E-101685160569IntergenicShelf0.773.7E-17742277807GLI3Island0.738.7E-0567728888BMP6Island0.713.1E-051811149470FAM38BIsland0.703.4E-081146317577CREB3L1Shore0.705.3E-17191467979APC2Island0.693.0E-05727213984HOXA10Island0.697.5E-061131826421PAX6Island0.677.4E-06727205381HOXA9Island0.651.7E-061396204854CLDN10Island0.642.1E-042176956678HOXD13Island0.632.3E-04

Table2: Hypomethylated CpG sites in HER2+ and TNBC BCBMsChrStartGeneCpG ContextDiff. Meth.FDR P-val1746619555IntergenicShore-0.583.2E-042182543233NEUROD1OpenSea-0.566.9E-0312132900938GALNT9Island-0.562.1E-051391827042IntergenicShore-0.558.7E-051746618614IntergenicShore-0.551.4E-0522119853MYT1LOpenSea-0.532.5E-041156623074BCANOpenSea-0.532.1E-0310128275008IntergenicOpenSea-0.521.6E-04480885981ANTXR2Island-0.515.2E-037157280331IntergenicShelf-0.516.9E-032059832924CDH4Shelf-0.512.7E-0241407858IntergenicIsland-0.513.7E-03592925721NR2F1Shore-0.513.1E-08

Citation Format: Orozco JIJ, Bustos MA, Nelson N, Hsu SC, Cheung G, Bostick PJ, Lucci A, DiNome M, Kelly DF, Hoon DSB, Marzese DM. DNA methylation landscapes of breast cancer progression to brain metastasis: A pre-clinical study [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P1-04-04.

Experimental characterization of the stagnation layer between two obliquely merging supersonic plasma jets

We present spatially resolved measurements characterizing the stagnation layer between two obliquely merging supersonic plasma jets. Intrajet collisionality is very high, but the interjet ion-ion mean free path is of the order of the stagnation layer thickness of a few centimeters. Fast-framing camera images show a double-peaked emission profile transverse to the stagnation layer, with the central emission dip consistent with a density dip in the interferometer data. We demonstrate that our observations are consistent with collisional oblique shocks.

Microstructural remodeling of articular cartilage following defect repair by osteochondral autograft transfer

OBJECTIVE

To assess collagen network alterations occurring with flow and other abnormalities of articular cartilage at medial femoral condyle (MFC) sites repaired with osteochondral autograft (OATS) after 6 and 12 months, using quantitative polarized light microscopy (qPLM) and other histopathological methods.

DESIGN

The collagen network structure of articular cartilage of OATS-repaired defects and non-operated contralateral control sites were compared by qPLM analysis of parallelism index (PI), orientation angle (α) relative to the local tissue axes, and retardance (Γ) as a function of depth. qPLM parameter maps were also compared to ICRS and Modified O'Driscoll grades, and cell and matrix sub-scores, for sections stained with H&E and Safranin-O, and for Collagen-I and II.

RESULTS

Relative to non-operated normal cartilage, OATS-repaired regions exhibited structural deterioration, with low PI and more horizontal α, and unique structural alteration in adjacent host cartilage: more aligned superficial zone, and reoriented deep zone lateral to the graft, and matrix disorganization in cartilage overhanging the graft. Shifts in α and PI from normal site-specific values were correlated with histochemical abnormalities and co-localized with changes in cell organization/orientation, cloning, or loss, indicative of cartilage flow, remodeling, and deterioration, respectively.

CONCLUSIONS

qPLM reveals a number of unique localized alterations of the collagen network in both adjacent host and implanted cartilage in OATS-repaired defects, associated with abnormal chondrocyte organization. These alterations are consistent with mechanobiological processes and the direction and magnitude of cartilage strain.

Simulations of magnetic field generation in unmagnetized plasmas via beat-wave current drive

This work describes the scientific basis and associated simulation results for the magnetization of an unmagnetized plasma via beat-wave current drive. Two-dimensional electromagnetic particle-in-cell simulations have been performed for a variety of angles between the injected waves to demonstrate beat-wave generation in agreement with theoretical predictions of the beat-wave wave vector and saturation time, revealing new 2D effects. The simulations clearly demonstrate electron acceleration by the beat waves and resultant current drive and magnetic field generation. The basic process depends entirely on the angle between the parent waves and the ratio of the beat-wave phase velocity to the electron thermal velocity. The wave to magnetic energy conversion efficiency of the cases examined is as high as 0.2%. The technique could enable novel plasma experiments in which the use of magnetic coils is infeasible.

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.

Diagnostics for the plasma liner experiment

The goal of the Plasma Liner Experiment (PLX) is to explore and demonstrate the feasibility of forming imploding spherical "plasma liners" via merging high Mach number plasma jets to reach peak liner pressures of ∼0.1 Mbar using ∼1.5 MJ of initial stored energy. Such a system would provide HED plasmas for a variety of fundamental HEDLP, laboratory astrophysics, and materials science studies, as well as a platform for experimental validation of rad-hydro and rad-MHD simulations. It could also prove attractive as a potential standoff driver for magnetoinertial fusion. Predicted parameters from jet formation to liner stagnation cover a large range of plasma density and temperature, varying from n(i)∼10(16) cm(-3), T(e)≈T(i)∼1 eV at the plasma gun mouth to n(i)>10(19) cm(-3), T(e)≈T(i)∼0.5 keV at stagnation. This presents a challenging problem for the plasma diagnostics suite which will be discussed.

Patients with mutations in Gsalpha have reduced activation of a downstream target in epithelial tissues due to haploinsufficiency

CONTEXT

Patients with Albright hereditary osteodystrophy (AHO) have defects in stimulatory G protein signaling due to loss of function mutations in GNAS. The mechanism by which these mutations lead to the AHO phenotype has been difficult to establish due to the inaccessibility of the affected tissues.

OBJECTIVE

The objective of the study was to gain insight into the downstream consequences of abnormal stimulatory G protein signaling in human epithelial tissues.

PATIENTS AND DESIGN

We assessed transcription of GNAS and Gsalpha-stimulated activation of the cystic fibrosis transmembrane conductance regulator (CFTR) in AHO patients, compared with normal controls and patients with cystic fibrosis.

MAIN OUTCOME MEASURES

Relative expression of Gsalpha transcripts from each parental GNAS allele and cAMP measurements from nasal epithelial cells were compared among normal controls and AHO patients. In vivo measurements of CFTR function, pulmonary function, and pancreatic function were assessed in AHO patients.

RESULTS

GNAS was expressed equally from each allele in normals and two of five AHO patients. cAMP generation was significantly reduced in nasal respiratory epithelial cells from AHO patients, compared with normal controls (0.4 vs. 0.6, P = 0.0008). Activation of CFTR in vivo in nasal (P = 0.0065) and sweat gland epithelia (P = 0.01) of AHO patients was significantly reduced from normal. In three patients, the reduction in activity was comparable with patients with cystic fibrosis due to mutations in CFTR. Yet no AHO patients had pulmonary or pancreatic disease consistent with cystic fibrosis.

CONCLUSIONS

In humans, haploinsufficiency of GNAS causes a significant reduction in the activation of the downstream target, CFTR, in vivo.

The molecular mechanisms of the mammalian exocyst complex in exocytosis

Exocytosis is a highly ordered vesicle trafficking pathway that targets proteins to the plasma membrane for membrane addition or secretion. Research over the years has discovered many proteins that participate at various stages in the mammalian exocytotic pathway. At the early stage of exocytosis, co-atomer proteins and their respective adaptors and GTPases have been shown to play a role in the sorting and incorporation of proteins into secretory vesicles. At the final stage of exocytosis, SNAREs (soluble N-ethylmaleimide-sensitive fusion protein attachment protein receptor) and SNARE-associated proteins are believed to mediate the fusion of secretory vesicles at the plasma membrane. There are multiple events that may occur between the budding of secretory vesicles from the Golgi and the fusion of these vesicles at the plasma membrane. The most obvious and best-known event is the transport of secretory vesicles from Golgi to the vicinity of the plasma membrane via microtubules and their associated motors. At the vicinity of the plasma membrane, however, it is not clear how vesicles finally dock and fuse with the plasma membrane. Identification of proteins involved in these events should provide important insights into the mechanisms of this little known stage of the exocytotic pathway. Currently, a protein complex, known as the sec6/8 or the exocyst complex, has been implicated to play a role at this late stage of exocytosis.

Perinatal calcium metabolism: physiology and pathophysiology

Disturbances in mineral homeostasis are common in the neonatal period, especially in premature infants and infants who are hospitalised in an intensive care unit. In many cases these disturbances are thought to be exaggerated responses to the normal physiological transition from the intrauterine environment to neonatal independence. By contrast, some disturbances in calcium homeostasis are the result of genetic defects, which in many instances can now be identified at the molecular level. In other cases hypocalcaemia or hypercalcaemia may result from pathological intrauterine conditions, birth trauma or stress, or fetal immaturity. Diagnosis and management of hypocalcaemia and hypercalcaemia in the neonate and infant requires specific knowledge of perinatal mineral physiology and the unique clinical and biochemical features of newborn mineral metabolism. In this chapter we will provide a brief overview of calcium metabolism with an emphasis on the neonatal transition, followed by discussion of the common causes of hypercalcaemia and hypocalcaemia.

Experimental identification of the kink instability as a poloidal flux amplification mechanism for coaxial gun spheromak formation

The magnetohydrodynamic kink instability is observed and identified experimentally as a poloidal flux amplification mechanism for coaxial gun spheromak formation. Plasmas in this experiment fall into three distinct regimes which depend on the peak gun current to magnetic flux ratio, with (I) low values resulting in a straight plasma column with helical magnetic field, (II) intermediate values leading to kinking of the column axis, and (III) high values leading immediately to a detached plasma. Onset of column kinking agrees quantitatively with the Kruskal-Shafranov limit, and the kink acts as a dynamo which converts toroidal to poloidal flux. Regime II clearly leads to both poloidal flux amplification and the development of a spheromak configuration.

Systemic lupus erythematosus presented as non-inflammatory necrotizing vasculopathy-induced ischemic glomerulopathy and small vessels-related ischemic cardiomyopathy

The clinical significance of lupus non-inflammatory necrotizing vasculopathy (NINV) is not well established. For example, since lupus renal NINV is usually reported to coexist with proliferative and active glomerulonephritis, it is difficult to demonstrate the role of NINV on renal pathophysiology. Here we report a 16-year-old SLE boy with renal NINV presenting as ischemic glomerulopathy and small vessels-related ischemic heart failure. The renal biopsy demonstrated mild proliferative glomerulonephritis and NINV initially, and one month later repeated renal biopsy showed NINV with ischemic glomerulopathy. These findings established that NINV, but not proliferative glomerulonephritis, was responsive for his acute renal failure (ARF). Another interesting question is about the pathophysiology of his myocardial dysfunction. This patient presented typical angina and congestive heart failure (CHF). Echocardiograms and ventriculography revealed dilatation of four chambers and low ejection fraction. Serial electrocardiograms demonstrated evolutionary ischemic changes. Coronary angiography revealed no abnormality of large vessels. These findings suggested small vascular lesions-induced myocardial ischemia was the underlying mechanism of dilated cardiomyopathy. As myocardial biopsy was not done in our case, we could only speculate, but not prove, that the NINV observed in renal biopsy may also involve in cardiac microvascular beds. Nevertheless, this interesting case emphasized the role of obliterative small vascular lesions in the pathophysiology of ARF and myocardial dysfunction. The patient was treated with high-dose corticosteroid, plasma infusion and hemodialysis. His cardiac function improved gradually, however the renal function did not recover.

Primary hyperparathyroidism in children and adolescents: the Johns Hopkins Children's Center experience 1984-2001

Primary hyperparathyroidism (PHPT) generally affects older adults, yet it also occurs in a small number of children, adolescents, and young adults. The early presentation of PHPT in children and adolescents suggests that these parathyroid tumors may differ in pathobiology from more typical tumors that occur in older adults. We performed a retrospective analysis of cases of PHPT treated surgically at the Johns Hopkins Children's Center between 1984 and 2001. Patients were ascertained by review of surgical pathology records, which confirmed the diagnosis of PHPT, and clinical and biochemical characteristics were extracted from medical records. We retrieved data on 16 of 17 patients; these patients (9 male, 7 female) were aged 10.5-20 years (16.3 +/- 2.9 years, median 16.8 years) at the time of diagnosis. Five patients had known metabolic risk factors for development of hyperparathyroidism, whereas 11 patients had spontaneous PHPT. The preoperative serum calcium level was markedly elevated (2.98 +/- 0.25 mM) in all 13 patients with normal renal function. Nearly all (77%) of these patients were found to have at least one symptom or sign of PHPT, most commonly hypercalciuria (83%) or nephrolithiasis (54%). Of these patients, 11 (85%) had single adenomas (mean weight, 597 mg; median, 600 mg; range, 170-1550 mg) while 2 had multiple gland disease, including 1 patient with multiple endocrine neoplasia type 2 (MEN2). In all cases, surgery was curative. These data suggest that PHPT in children is a more severe disease than in older adults, which may reflect a bias of ascertainment or a difference in fundamental parathyroid pathobiology.

Effect of hormone replacement therapy on uterine fibroids in postmenopausal women—a 3-year study

OBJECTIVE

The aim of this prospective 3-year clinical study was to examine the effect of hormone replacement therapy (HRT) on uterine fibroid growth among postmenopausal women.

METHODS

Thirty-seven postmenopausal women with uterine solitary fibroids were recruited randomly for HRT in a 3-year program. All participants received 0.625 mg conjugated equine estrogen (CEE) and 5 mg medroxyprogesterone (MPA) daily. Fibroid volume was measured by transvaginal ultrasonography at baseline and then at 12-month intervals for 3 times. Clinically, significant fibroid growth was defined as an increase in volume of more than 25% compared with baseline. Also, 35 postmenopausal women with uterine fibroid were studied as control who did not receive HRT during the study period.

RESULTS

Fibroid volume had increased significantly after 1 year both in HRT users and non-users. These increases continued to the second year significantly in HRT users but not in non-users. However, the volumes declined significantly at the third year to similar levels as those measured at baseline in control. In HRT users, fibroid volume though significantly increased at the third year (vs. baseline) but declined insignificantly in comparison with the second year. Clinically, at end of the third year study, one of 34 and three of 34 women increased fibroid volume over 25% compared with baseline in HRT non-users and users, respectively.

CONCLUSIONS

HRT does increase uterine fibroid volume statistically. However, its effect appears in the first 2 years of use. The increased fibroid volume begins to decline at the third year both in HRT users and non-users. Clinically, the increased effect of HRT on uterine fibroid of postmenopausal women should be not over-emphasized at least for 3 years of usage.

Changes in vesicourethral function following laparoscopic hysterectomy versus abdominal hysterectomy

OBJECTIVE

To assess whether total hysterectomy is associated with increased postoperative vesicourethral abnormalities.

SAMPLE

Forty-five patients had a laparoscopic hysterectomy and 36 patients had a total abdominal hysterectomy.

DESIGN

Before and after hysterectomy, patients underwent a urinalysis, a personal interview, and an urodynamic study.

RESULTS

Of the laparoscopic hysterectomy group, 27 patients (60%) exhibited urinary symptoms preoperatively, and 22 patients (48.9%) remained symptomatic following surgery. There was no significant change in the number of women with one or more urinary symptoms, but the incidence of urinary frequency and stress incontinence decreased significantly following hysterectomy (p < 0.05). Of the total abdominal hysterectomy group, preoperative voiding symptoms were present in 22 patients (61.1%). After surgery, urinary symptoms were present in 19 patients (52.8%). Some patients did not complain of any urinary frequency or stress incontinence following hysterectomy, but this figure did not differ significantly (p > 0.05). Maximal urethral closure pressure and maximal cystometric capacity demonstrated significant increases for both groups following surgery.

CONCLUSIONS

The results indicated that total hysterectomy, either laparoscopic or total abdominal hysterectomy, did not significantly increase the subjective and objective incidence of vesicourethral dysfunction. On the contrary, some patients experience a substantial improvement of pre-existing urinary frequency or stress incontinence, partly as a result of an increase in the maximal urethral closure pressure and total bladder capacity following hysterectomy.

The effects on vesicourethral function following laparoscopic hysterectomy

The aim of our study is to determine whether laparoscopic hysterectomy is associated with increased postoperative urinary symptoms and to assess the change in urodynamic parameters after operation. Forty-five women were arranged for laparoscopic hysterectomy (LH). Each patient received urinalysis, interview, and urodynamic study including uroflowmetry, filling and voiding cystometry and urethral pressure profilometry before and after hysterectomy. A total of 27 patients (60%) had urinary symptoms preoperatively. After operation, only 22 patients (48.9%) remained symptomatic. There was no significant change in the number of women with one or more voiding symptoms before and after surgery, but the incidence of urinary frequency and stress incontinence decreased significantly after laparoscopic hysterectomy (P < 0.05). In addition, maximal urethral closure pressure and maximal cystometric capacity showed significant increases after operation. They were 73.1 cm H2O (range: 49-114) vs 104.4 cm H2O (range: 60-147) (P < 0.001), and 363.3 ml (range: 287-423) vs 396.1 ml (range: 265-515) (P < 0.001), respectively. The result indicated that laparoscopic hysterectomy did not significantly increase the subjective or objective incidence of vesicourethral dysfunction. On the contrary, some patients might be cured of urinary frequency or stress incontinence postoperatively.

Pseudo-Meigs syndrome and elevated levels of tumor markers associated with benign ovarian tumors--two case reports

Elevated tumor markers for a post-menopausal woman presenting with a multilocular adnexal mass, ascites, and pleural effusion were interpreted as being highly suspicious of malignancy. This paper describes two cases of ovarian tumors presenting with all signs of malignancy. Following surgical excision of the masses, and histopathological assay, a benign pure struma ovarii and a mucinous cystadenoma were diagnosed by pathologists. The immediate and complete resolution of symptoms were achieved post-operatively, and the previously-evident abnormal tumor markers rapidly declined to the normal range, the two tumors were subsequently classified as pseudo-Meigs' syndromes.

Observation of B --> J/psi K(1)(1270)

We report the first observation of the exclusive decay process B-->J/psi K(1)(1270) using a sample of 11.2M BB macro meson pairs collected in the Belle detector at the KEKB asymmetric energy e(+)e(-) collider. We measure branching fractions of B[B(0)-->J/psi K(0)(1)(1270)] = (1.30+/-0.34+/-0.32) x 10(-3) and B[B(+)-->J/psi K(+)(1)(1270)] = (1.80+/-0.34+/-0.39) x 10(-3), where the first error is statistical and the second is systematic. These modes constitute approximately 15% of the total number of B-->J/psi X decays. No evidence is seen for B-->J/psi K(1)(1400) and we set an upper limit for this branching fraction.

Seroprevalence and demographic characteristics of HTLV-I among blood donors in Taiwan: 1996-1999

Screening for the human T-cell lymphotropic virus type I (HTLV-I) and-II in blood donors was implemented in Taiwan beginning in February 1996. The purpose of the present study was to investigate the changes in HTLV-I seroprevalence in all unpaid blood donors in Taiwan during the period from February 1996 to December 1999 and to determine the influence of age and sex on the HTLV-I seropositivity of donors. HTLV-I and HTLV-II screening was performed using combined HTLV-I/II immunoassay. Repeated reactive samples were confirmed by Western blot analysis. Of a total of 3,701,087 donors in all 6 blood centers in Taiwan, 2,311 (0.058%) were seropositive for HTLV-I. The HTLV-I seropositivity was 0.130%, 0.063%, 0.044%, and 0.032% in the years 1996, 1997,1998, and 1999, respectively. There was a linear increase of HTLV-I seropositivity with advancing age. The HTLV-I carrier rate for female donors was twice that for the male donors. Ninty-seven percent of HTLV-I seropositive results came from first-time donors. Our findings suggest that Taiwan is a low-prevalence nonendemic area for HTLV-I infection. The large-scale HTLV-I screening program has decreased HTLV-I seropositivity among blood donors and is useful for preventing HTLV-I transmission via blood transfusion.

Observation of Cabibbo suppressed B --> D(*)K- decays at Belle

We report observations of the Cabibbo suppressed decays B-->D((*))K- using a 10.4 fb(-1) data sample accumulated at the Upsilon(4S) resonance with the Belle detector at the KEKB e(+)e(-) storage ring. We find that the ratios of Cabibbo suppressed to Cabibbo favored branching fractions are B(B--->D0K-)/B(B--->D0pi(-)) = 0.079+/-0.009+/-0.006, B(B(0)-->D+K-)/B(B(0)-->D+pi(-)) = 0.068+/-0.015+/-0.007, B(B--->D(*0)K-)/B(B--->D(*0)pi(-)) = 0.078+/-0.019+/-0.009, and B(B(0)-->D(*+)K-)/B(B(0)-->D(*+)pi(-)) = 0.074+/-0.015+/-0.006. These are the first observations of the B-->D+K-, D(*0)K-, and D(*+)K- decay processes.

Evaluation of problem-based learning: a lecturer's perspective

INTRODUCTION

The exponential growth in medical/dental knowledge and the ever-expanding influence and sophistication of information technologies have placed a burden of responsibilities on dental educators to fashion out a curriculum that can prepare students to face the coming challenges in the new millennium. Consequently, a curriculum reform took place in the Faculty of Dentistry, National University of Singapore in 1997. Problem-based learning (PBL) was first introduced to the Faculty in 1996 as a pilot project to the 4th year. The purpose of this project was to evaluate the 4-year experience in PBL teaching and learning from the lecturers' point of view.

MATERIALS AND METHODS

All 12 lecturers, who had been involved in the PBL teaching, participated in this questionnaire survey, which was composed of 17 questions with a 5-digit Likert scale. Data analysis was carried out using the Spearman's correlation, t-test, and the Mann-Whitney U test.

RESULTS

Six female, 5 male and 1 unidentified lecturers were recruited into this survey with a 100% response rate. In general, lecturers learned more in teaching PBL and significantly took pleasure in the interactive learning and self-directed learning modes inherent to PBL (P = 0.004). Compared to the male lecturers, female lecturers had a greater propensity to feel that PBL teaching might not be cost-effective (P = 0.03). Senior lecturers felt more fulfilled compared with the younger ones (P = 0.026). Those lecturers who enjoyed the interactive learning experience in PBL seemed to like the self-directed learning and felt more fulfilled through teaching PBL compared to the traditional teaching (TT) (P < 0.01). They also felt that PBL may be cost-effective (P < 0.01). Lecturers did not have difficulties in being a facilitator (P = 0.04). Interestingly, lecturers who found difficulties in being a facilitator for the PBL class seemed to learn more in teaching PBL classes than in TT (P < 0.05). Overall, lecturers would like to suggest more PBL to be incorporated into the curriculum (P = 0.02). Nevertheless, lecturers were concerned about the knowledge gaps in students learning with PBL (P = 0.01) and the time constraint of students (P = 0.002).

CONCLUSION

The results of this study reveal the pros and cons of the current PBL teaching method and may thus provide proper guidelines to shape the further development of PBL in our faculty.

Observation of large CP violation in the neutral B meson system

We present a measurement of the standard model CP violation parameter sin2 phi(1) based on a 29.1 fb(-1) data sample collected at the Upsilon(4S) resonance with the Belle detector at the KEKB asymmetric-energy e(+)e(-) collider. One neutral B meson is fully reconstructed as a J/psi K(S), psi(2S)K(S), chi(c1)K(S), eta(c)K(S), J/psi K(L), or J/psi K(*0) decay and the flavor of the accompanying B meson is identified from its decay products. From the asymmetry in the distribution of the time intervals between the two B meson decay points, we determine sin2 phi(1) = 0.99+/-0.14(stat)+/-0.06(syst). We conclude that we have observed CP violation in the neutral B meson system.

Glycogen synthase kinase-3beta regulates presenilin 1 C-terminal fragment levels

The majority of familial Alzheimer's disease cases have been attributed to mutations in the presenilin 1 (PS1) gene. PS1 is synthesized as an inactive holoprotein that undergoes endoproteolytic processing to generate a functional N- and C-terminal heterodimer (NTF and CTF, respectively). We identified a single residue in PS1, Ser(397), which regulates the CTF levels in a population of dimer that has a rapid turnover. This residue is part of a highly conserved glycogen synthase kinase-3beta (GSK-3beta) consensus phosphorylation site within the loop domain of PS1. Site-directed mutagenesis at the Ser(397) position increased levels of PS1 CTF but not NTF or holoprotein. Similar increases in only CTF levels were seen when cells expressing wild type PS1 were treated with lithium chloride, an inhibitor of GSK-3beta. Both wild type and PS1 S397A CTF displayed a biphasic turnover, reflecting rapidly degraded and stable populations. Rapid turnover was delayed for mutant PS1 S397A, causing increased CTF. These data demonstrate that PS1 NTF.CTF endoproteolytic fragments are generated in excess, that phosphorylation at Ser(397) by GSK-3beta regulates the discard of excess CTF, and that the disposal of surplus NTF is mediated by an independent mechanism. Overall, the results indicate that production of active NTF.CTF dimer is more complex than limited endoproteolysis of PS1 holoprotein and instead involves additional regulatory events.

Rescue of a Wnt mutation by an activated form of LEF-1: regulation of maintenance but not initiation of Brachyury expression

Members of the LEF-1/TCF family of transcription factors have been implicated in mediating a nuclear response to Wnt signals by association with beta-catenin. Consistent with this view, mice carrying mutations in either the Wnt3a gene or in both transcription factor genes Lef1 and Tcf1 were previously found to show a similar defect in the formation of paraxial mesoderm in the gastrulating mouse embryo. In addition, mutations in the Brachyury gene, a direct transcriptional target of LEF-1, were shown to result in mesodermal defects. However, direct evidence for the role of LEF-1 and Brachyury in Wnt3a signaling has been limiting. In this study, we genetically examine the function of LEF-1 in the regulation of Brachyury expression and in signaling by Wnt3a. Analysis of the expression of Brachyury in Lef1(-/-)Tcf1(-/-) mice and studies of Brachyury:lacZ transgenes containing wild type or mutated LEF-1 binding sites indicate that Lef1 is dispensable for the initiation, but is required for the maintenance of Brachyury expression. We also show that the expression of an activated form of LEF-1, containing the beta-catenin activation domain fused to the amino terminus of LEF-1, can rescue a Wnt3a mutation. Together, these data provide genetic evidence that Lef1 mediates the Wnt3a signal and regulates the stable maintenance of Brachyury expression during gastrulation.

Weekly and monthly regimens of paclitaxel and carboplatin in the management of advanced ovarian cancer. A preliminary report on side effects

This preliminary study was carried out over 18 months to evaluate whether the side effects in patients with advanced ovarian cancer receiving chemotherapy using paclitaxel-carboplatin differed between weekly (98 cycles in 14 patients) and monthly (102 cycles in 15 patients) administrations. We used paclitaxel (60 mg/m2) and carboplatin (AUC of 2) in the weekly regimen and 175 mg/m2 of paclitaxel and carboplatin (AUC of 6) in the monthly regimen. All eligible patients received at least four cycles of treatment in both regimens. The results revealed significantly decreased hematological toxicity in weekly regimens relative to monthly ones, ie, 7.1% vs. 18.6% of anemia (> or = grade 2), 7.1% vs. 32.3% of grade 3/4 granulocytopenia, and 0% vs. 15.7% of >grade 2 thrombocytopenia. There was no significant difference in nonhematological toxicities between the two regimens. The incidence of unscheduled events was much less in the weekly regimen than in the monthly one; ie, delayed treatment (3 vs. 18 events), unanticipated hospitalizations (3 vs. 15 times), and supplemental support with G-CSF (7 vs. 33 times). Complete responses were observed in 6 of 14 patients in the weekly regimen and in five of 15 patients in the monthly regimen, while partial responses were seen in four and five patients in the weekly and monthly regimens, respectively. The present results demonstrate that the weekly regimen can achieve the benefits of tolerable toxicity with significantly reduced myelosuppression and improved cost-effectiveness in terms of unscheduled events.

The exocyst complex associates with microtubules to mediate vesicle targeting and neurite outgrowth

During neuronal development, vesicles are targeted to the growth cone to promote neurite outgrowth and synaptogenesis. The Exocyst complex is an essential macromolecule in the secretory pathway that may play a role in vesicle targeting. Although it has been shown that this complex is enriched in rat brain, the molecular mechanism underlying its function is largely unknown. Here, we report that the Exocyst complex coimmunoprecipitates with microtubules from total rat brain lysate. Additionally, the Exocyst complex subcellular localization changes on neuronal differentiation. In undifferentiated pheochromocytoma (PC12) cells, this complex is associated with microtubules at the microtubule organizing center. However, in differentiated PC12 cells and cultured hippocampal neurons, the Exocyst complex and microtubules extend to the growing neurite and colocalize at the growth cone with synaptotagmin. Inhibition of the NGF-activated MAP kinase pathway blocks the Exocyst complex and microtubule redistribution, abolishing neurite outgrowth and promoting cytosolic accumulation of secretory vesicles. Consistently, the overexpression of Exocyst sec10 subunit mutant blocks neurite outgrowth. These results indicate that the Exocyst complex targets secretory vesicles to specific domains of the plasma membrane through its association with the microtubules, promoting neurite outgrowth.

Measurement of B(0)(d)-B_(0)(d) mixing rate from the time evolution of dilepton events at the upsilon(4S)

We report a determination of the B(0)(d)-&B_(0)(d) mixing parameter Deltam(d) based on the time evolution of dilepton yields in Upsilon(4S) decays. The measurement is based on a 5.9 fb(-1) data sample collected by the Belle detector at KEKB. The proper-time difference distributions for same-sign and opposite-sign dilepton events are simultaneously fitted to an expression containing Deltam(d) as a free parameter. Using both muons and electrons, we obtain Deltam(d) = 0.463+/-0.008 (stat)+/-0.016 (syst) ps(-1). This is the first determination of Deltam(d) from time evolution measurements at the Upsilon(4S). We also place limits on possible CPT violations.

Extreme metabolic alkalosis treated with normal bicarbonate hemodialysis

Metabolic alkalosis (MA), defined as a primary increment in plasma bicarbonate concentration, is a common complication in hospitalized patients and is associated with high morbidity and mortality in severe cases. One of the major routes of compensation for MA (ie, the secretion of an alkaline urine) is lost in renal failure patients. We report three cases involving four episodes of extreme MA with an arterial pH value greater than 7.60, serum bicarbonate concentration greater than 55 mmol/L, and stupor or seizure. Profound vomiting or massive gastric drainage combined with concurrent oliguric renal failure was the underlying mechanism for severe MA. Hydration and normal central venous pressure failed to improve the MA. The extreme MA was reversed quickly and safely by conventional hemodialysis with normal bicarbonate dialysate of 25 to 28 mmol/L. To our knowledge, this is the first reported successful use of normal bicarbonate dialysate in the treatment of severe MA. We also found that either H(2) blockers or proton-pump inhibitors have a prophylactic effect on the formation of MA.

Measurement of the CP violation parameter sin2 phi(1) in B(0)(d) meson decays

We present a measurement of the standard model CP violation parameter sin2 phi(1) (also known as sin2beta) based on a 10.5 fb(-1) data sample collected at the Upsilon(4S) resonance with the Belle detector at the KEKB asymmetric e(+)e(-) collider. One neutral B meson is reconstructed in the J/psiK(S), psi(2S)K(S), chi(c1)K(S), eta(c)K(S), J/psiK(L), or J/psipi(0) CP-eigenstate decay channel and the flavor of the accompanying B meson is identified from its charged particle decay products. From the asymmetry in the distribution of the time interval between the two B-meson decay points, we determine sin2 phi(1) = 0.58(+0.32)(-0.34)(stat)+0.09-0.10(syst).

Substitution of a glycogen synthase kinase-3beta phosphorylation site in presenilin 1 separates presenilin function from beta-catenin signaling

The majority of cases with early onset familial Alzheimer's disease have been attributed to mutations in the presenilin 1 (PS1) gene. PS1 protein is a component of a high molecular weight membrane-bound complex that also contains beta-catenin. The physiological relevance of the association between PS1 and beta-catenin remains controversial. In this study, we report the identification and functional characterization of a highly conserved glycogen synthase kinase-3beta consensus phosphorylation site within the hydrophilic loop domain of PS1. Site-directed mutagenesis, together with in vitro and in vivo phosphorylation assays, indicates that PS1 residues Ser(353) and Ser(357) are glycogen synthase kinase-3beta targets. Substitution of one or both of these residues greatly reduces the ability of PS1 to associate with beta-catenin. By disrupting this interaction, we demonstrate that the association between PS1 and beta-catenin has no effect on Abeta peptide production, beta-catenin stability, or cellular susceptibility to apoptosis. Significantly, in the absence of PS1/beta-catenin association, we found no alteration in beta-catenin signaling using induction of this pathway by exogenous expression of Wnt-1 or beta-catenin and a Tcf/Lef transcriptional assay. These results argue against a pathologically relevant role for the association between PS1 and beta-catenin in familial Alzheimer's disease.

Transport properties of ionic drugs in the ammonio methacrylate copolymer membranes

PURPOSE

Ammonio methacrylate copolymer is a pharmaceutical excipient widely used as a coating material for encapsulation of pellet and tablet dosage forms. Because of the charged ammonio function groups within the polymer, ionic drugs may interact with the coating film while transporting through it. The kinetic swelling and drug permeation properties of the ammonio methacrylate copolymer membranes were studied to delineate the effect of ionic interaction between the ionic drugs and the membranes.

METHODS

The pH and ionic strength of the solutions and the charged properties of drugs were varied to study the effects on the transport properties through the membranes. Ambroxol was chosen as a model cationic drug and aspirin as a model anionic drug.

RESULTS

The degree of membrane swelling in the drug-free solution decreases as the ionic strength increases but it is irrelevant to the pH. With the presence of ionic drugs, the degree of membrane swelling is affected by the drug species as well as the pH of the solutions in addition to the effect of ionic strength. The degree of swelling for a membrane in a solution containing aspirin is higher at a lower pH and ambroxol is lower at a lower pH. Aspirin experiences a three-stage permeation and ambroxol a two-stage one. The ion-exchange reaction between the anionic carboxylic groups in aspirin and the cationic ammonio groups in the membranes results in a slow permeation stage during the transient state. The pseudo steady-state permeability for each drug follows the trend as the degree of membrane swelling in the drug media at various pH and ionic strengths. However, it is much higher for aspirin than ambroxol although the degree of membrane swelling is higher in an ambroxol solution than that in an aspirin solution. The permeability of ambroxol through the membrane is largely reduced because of the Donnan exclusion effect.

CONCLUSIONS

The interaction between ionic drugs with the cationic groups in the membranes affects the ionic strength of the solutions and results in a pH-dependent degree of swelling. The ionic interaction also determines the drug permeation rates as well as the transient permeation behaviors.

Construction of a tagging system for subcellular localization of proteins encoded by open reading frames

We have previously characterized a monoclonal antibody (SC1D7) that is directed to maltose-binding protein (MBP) of Escherichia coli and other closely related enteric bacteria. SC1D7 does not cross-react with proteins in eucaryotes and appears to be a highly specific tool in immunochemical analyses. To better map the epitope, we took advantage of an available plasmid, pMAL-c2, that encodes the E. coli MBP-coding sequence and constructed plasmids to express MBP fragments. A construct containing the N-terminal portion of MBP does not react with SC1D7, whereas a second construct expressing glutathione S-transferase fused with the C-terminal half of MBP does react with SC1D7. To precisely define the epitope, random peptides displayed on M13 were used to react with SC1D7. Sequences of reactive peptides were aligned, and a consensus sequence of XDXRIPX was deduced. This sequence matches MBP with an amino acid stretch of KDPRIAA. To consolidate the mapping result, a sequence encoding this epitope was inserted into an expression vector and the resulting recombinant protein did react with SC1D7. Thereafter, this epitope was incorporated into a eucaryotic expression plasmid containing a previously defined hepatitis delta virus epitope for protein tagging. This two-epitope-tagging vector is useful in various molecular analyses. We demonstrate its usage for localization of a bacterial virulence factor in host cells. This vector should be applicable for high-throughput characterization of new open reading frames found in genome sequencing.

PCR primers designed from malic acid dehydrogenase gene and their use for detection of Escherichia coli in water and milk samples

Escherichia coli has been the appropriate focus for monitoring of potential enteric pathogens in water and foods. Although several methods have been used for the detection or enumeration of E. coli cells in water and foods, the time and accuracy limitations of these methods suggest the need of a rapid and specific method. By comparison of the gene sequences coding for malic acid dehydrogenase (mdh) of E. coli and non-E. coli strains, two oligonucleotides were designed and their possible use as E. coli-specific PCR primers was tested. All of the 110 E. coli strains tested, including non-pathogenic and various pathogenic strains, generated the expected PCR products with Mw equal to 392 bp. On the other hand, only 97 of these 110 E. coli strains were detectable using the BAM gas production method. With the exception of Shigella strains, non-E. coli strains, including strains of the family of Enterobacteriaceae, did not generate any false positive PCR results. When this PCR system was used for the monitoring of E. coli cells inoculated into water and milk samples, as low as 10(0) cfu per 100 ml of water or per ml of milk sample could be detected if an 8 h preculture step was performed prior to the PCR. Including the preculture step, the whole PCR detection process may be completed within 12 h.

Adult-onset minimal change disease among Taiwanese: clinical features, therapeutic response, and prognosis

There are some racial differences in the prevalence and prognosis of idiopathic nephrotic syndrome; however, reports about minimal change disease (MCD) in Chinese were rare. We retrospectively analyzed 123 Chinese adults with idiopathic nephrotic syndrome, who received percutaneous renal biopsy in our institution within the last 10 years. In total, 46 patients (37.4%) were compatible with the pathological diagnosis of MCD. The male to female ratio was 1.2:1. The mean age of onset was 30.9 years, and 80% of the patients with MCD were less than 40 years. The mean daily proteinuria was 10.2 g, and serum albumin was 1.8 mg/dl. Azotemia occurred in 16 (35%) of 46 cases; hypertension, 13%; and microscopic hematuria, 13%. High selectivity index for proteinuria (SI <0.1) was noted in 12 (39%) of 31 cases; and high IgE level was found in 83.7% of the study subjects, although only one case had allergic history. Complete remission in 36 MCD patients treated with corticosteroid was achieved by 42% (15/36), 80% (29/36), and 94% (34/36) within 4, 8, and 12 weeks, respectively. The time interval to remission was similar between the younger group (<40 years old, 1.7 months) and older group (>40 years old, 1.6 months). Nineteen (56%) of 34 cases with steroid response did not relapse, and the other cases (44%) had a mean relapse rate of 1.5 times per patient within a period of 45 months. The age of onset in MCD cases was not significantly correlated with steroid-responsive rate, and the time interval to remission. However, a tendency existed between the onset in the young age and the sequentially relapsing rate (p = 0.06). Two cases with primary steroid resistance and 5 cases with frequent relapse or steroid dependence responded well to intravenous pulse therapy of cyclophosphamide, except one refractory case. No thrombotic episode was ever noted in our group. Regarding infectious complications, primary peritonitis occurred in one, pneumonia in one, and cellulitis in 6 cases during active nephrotic stage. Two mortality cases, one with E. coli-related necrotizing fasciitis and one from pneumonia, were noted. In brief, compared with children, adult patients with MCD had lesser high selectivity index for proteinuria, the same steroid-responsive rate (94%), but slower response, and significantly lesser relapsing rate. The intravenous pulse therapy of cyclophosphamide may be an alternative regimen for adult patients with steroid resistance or dependency. In addition, the Asian adult-onset MCD had younger age, male predominance, and lesser relapsing rate in comparison to those of the Western population.

Immunohistochemical differentiation of hepatitis D virus genotypes

Determination of hepatitis D virus (HDV) genotypes is epidemiologically and clinically important. Phylogenic analysis based on sequencing analysis of multiple HDV strains isolated from sera of patients is not convenient for mass screening in routine laboratories. This study was designed to develop genotype-specific antibodies against hepatitis delta antigen (HDAg) and to apply these antibodies for immunohistochemical differentiation of HDV genotypes in formalin-fixed, paraffin-embedded liver biopsies of patients. Divergence in the carboxyl-terminal 19 amino acids of the large HDAg between genotypes I and II is more than 70%. Peptides covering these residues were conjugated to keyhole limpet hemocyanin and were used for immunization. The generated antibodies were confirmed for their specificity by binding to type-specific HDAgs expressed in DNA-transfected Huh-7 hepatoma cells. Liver biopsies from 6 patients who had dominant genotype I HDV and 33 patients who had dominant genotype II HDV in sera were stained with these antibodies. The accuracy for these antibodies was 94.9%, and the agreement between dominant HDV genotypes in serum and dominant hepatic HDV genotypes based on HDAg staining was nearly perfect (kappa = 0.83). In summary, the carboxyl-terminal 19 amino acids of the large HDAg can be used as immunogens to generate genotype-specific antibodies. These antibodies were proven to be useful in immunohistochemical differentiation of HDV genotypes in liver biopsies.

DNA-Based immunization produces Th1 immune responses to hepatitis delta virus in a mouse model

Hepatitis delta virus (HDV) superinfection is one of the major causes of fulminant hepatitis in endemic areas of hepatitis B virus (HBV) infection. Currently, there is no effective treatment or vaccine against HDV superinfection. DNA-based immunization is a promising antiviral strategy to prevent or treat persistent viral infections. In this study, we investigated the immunological effects of DNA vaccines against HDV in BALB/c mice. Plasmid (pD) encoding large hepatitis D antigen (L-HDAg), or plasmid (pS/pD) coexpressing hepatitis B surface antigen (HBsAg) and L-HDAg, were injected into mice intramuscularly. The seroconversion rate, anti-HBs levels, anti-HDV titers, T-cell proliferation responses, and T-helper (Th)-release cytokine profiles were analyzed. Mice immunized with plasmids, pS/pD or pD, produced low, but significant, titers of anti-HDV antibodies. In contrast, pS/pD induced much stronger anti-HBs titers in the immunized animals. Interestingly, splenic lymphocytes derived from pS/pD-inoculated mice demonstrated significant proliferation responses to recombinant HBsAg and HDAg, and resulted in a Th1-like immune response as suggested by the production of interferon gamma (INF-gamma) and interleukin-2 (IL-2), but not IL-4. The splenic lymphocyte derived from the pD-inoculated mice showed a similar Th1 response to the stimulation of HDAg, but not to HBsAg. In conclusion, our results suggest that DNA vaccines against HDV can induce significant cellular immune responses with a Th1 preference. HBV and HDV coimmunization can be performed by DNA vaccines. These results are promising for the future development of prophylactic and therapeutic HDV vaccines.

Characterization of a strain-specific monoclonal antibody to hepatitis delta virus antigen

Sequences of the hepatitis delta virus (HDV) vary to different degrees among isolates. A monoclonal antibody, designated as HP6A1, against the antigen of HDV (HDAg) has been characterized for its specificity. HP6A1 bound to HDAg of isolate 25 (genotype I) that was used for immunization, but not to others of both genotypes I and II. The epitope recognized by HP6A1 was then determined by a phage library displaying various heptapeptides. A consensus peptide deduced has the best match with that of residues 4-10 of HDAg (isolate 25). To confirm the phage mapping result, Escherichia coli recombinant proteins containing different lengths and various segments of HDAg (isolate 25) were constructed. The shortest HDAg segment contained in the fusion protein that reacted with HP6A1 was residues 1-10. When this peptide was added to the N-terminus of a heterologous protein engineered for eucaryotic expression, the fusion protein was detected by HP6A1. It is concluded that HP6A1 recognizes an epitope located at the N-terminus of HDAg (isolate 25). Since viruses of quasi-species exist in natural infections, a question of how different viral strains interact in vivo remains to be explored. The highly specific MAb opens a possibility to examine the fate of one strain in the presence of other related species in a cell transfection system.

Lead in the southern East China Sea

At present, in most oceans the lead (Pb) biogeochemical cycling has been disturbed by anthropogenic Pb through atmospheric input. The Pb concentrations in the upper water positively correlate with atmospheric input fluxes of Pb. The North Pacific is affected greatly by atmospheric substances via long-range transport from eastern Asia, especially from Mainland China. Mainland China may export considerable amounts of pollutants into the seas via rivers and the atmosphere owing to its recent fast growth in industry and economy. The East China Sea lies in an important geographical position--a transit between Mainland China and the western North Pacific. However, no data are available for seawater concentrations of Pb, a representative element with anthropogenic origin. In this work seawater samples from both 5 and 30-50 m water layers of 15 stations occupied over a cyclonic eddy in the southern East China Sea were analyzed for particulate Pb (PPb) and dissolved Pb (DPb). The Mean concentration of DPb (approximately 128 ng/l) in the southern East China Sea upper waters (< or = 50 m) is approximately several times higher than those in the Pacific; the high DPb concentrations in the southern East China Sea waters correspond to much higher atmospheric supplies of Pb to the East China Sea. Thus, this study partly fills the 'data gap' of the marginal seas. Also, it indicates that the East China Sea may be considerably contaminated by deposited polluted aerosols. Spatial distributions of DPb in the surface water show a tendency of increasing concentrations with distance offshore, that depends on the magnitudes of atmospheric Pb inputs and on particle scavenging processes. In contrast to DPb, spatial distributions of PPb basically display an 'omega'-like picture and a tendency of decreasing concentrations with distance offshore. These are related to riverine and scavenging sources and to the drive by the eddy. Additionally, the residence times of DPb in the surface water were estimated to be about 2 years, agreeing well with the reported data.

Local measurement of nonclassical ion heating during magnetic reconnection

Local ion temperature and flows are measured directly in the well-characterized reconnection layer of a laboratory plasma. The measurements indicate strongly that ions are heated due to reconnection and that more than half of the reconnected field energy is converted to ion thermal energy. Neither classical viscous damping of the observed sub-Alfvenic ion flows nor classical energy exchange with electrons is sufficient to account for the ion heating, suggesting the importance of nonclassical dissipation mechanisms in the reconnection layer.

Difference of plasma leptin levels in venous and arterial cord blood: relation to neonatal and placental weight

To investigate the physiological significance of umbilical plasma leptin in the fetal growth and its possible origin of production during pregnancy, plasma leptin concentrations in venous and arterial cord bloods were measured in 42 neonates (male = 23, female = 19, gestational age 36-41 weeks, birth weight 2600-4000 g). Leptin concentrations in umbilical veins (5.65 +/- 0.53 ng/mL, n = 42) and umbilical arteries (0.56 +/- 0.07 ng/mL, n = 42) were significantly (P < 0.001) lower than those in maternal peripheral veins (22.36 +/- 1.06 ng/mL, n = 42). Mean plasma leptin concentration (+/- SEM) in venous cord blood was significantly (P < 0.001) higher than that of arterial cord blood. There was significantly positive correlation (r = 0.447, P < 0.01) between umbilical venous leptin levels and neonatal body mass index (BMI). A positive correlation (r = 0.435, P < 0.01) was also found between umbilical arterial leptin and neonate BMI. There was no positive correlation between umbilical leptin levels in venous cord blood and placental weight. We thus conclude that umbilical plasma leptin may play an essential role in the fetal growth and metabolism during pregnancy and placenta is one of the major sources of leptin production, but the level of leptin in umbilico-placental circulation is independent of the weight of placenta.

p38 mitogen-activated protein kinase is involved in Fas ligand expression

p38 mitogen-activated protein kinase (MAPK) is activated by T cell receptor engagement. Here we showed that T cell receptor activated p38alpha but not p38delta. Inhibition of p38alpha by the specific inhibitor SB 203580 prevented activation-induced cell death in T cells. SB 203580 had no effect on Fas-initiated apoptosis. Instead, SB 203580 preferentially inhibited activation-induced Fas ligand (FasL) expression. The inhibition on FasL expression by SB 203580 was correlated with the suppression on the FasL promoter activation. Overexpression of active MAPK kinase 3b, the activator of p38 MAPK, led to activation of FasL promoter and induction of FasL transcripts in T cells. Stress stimulation of T cells by anisomycin also induced FasL expression in a p38 MAPK-dependent manner. The induction of FasL expression in nonlymphoid cells such as 293T also required activation of p38 MAPK. Our results suggest that p38 MAPK is essential for FasL expression.