Sire pedigree error estimation and sire verification of the Taiwan dairy cattle population by using SNP markers

Information regarding the correct pedigree of and relationship between animals is useful for managing dairy breeding, reducing inbreeding, estimating breeding value, and establishing correct breeding programs. Additionally, the successful implementation of progeny testing is crucial for improving the genetics of dairy cattle, which depends on the availability of correct pedigree information. Incorrect pedigree information leads to bias in bull evaluation. In this study, Neogen GeneSeek Genomic Profiler (GGP) 50K SNP chips were used to identify and verify the sire of Taiwanese Holstein dairy cattle and analyze the reasons that lead to incorrect sire records. Samples were collected from 2,059 cows of 36 dairy farms, and the pedigree information was provided by breeders. The results of sire verification can be divided into three categories: submitted unconfirmed sire, submitted confirmed sire, and incorrectly submitted verified sire. Data on the sires of 1,323 (64.25%) and 572 (27.78%) dairy cows were verified and discovered, respectively. Sires of 1,895 (92.03%) dairy cattle were identified, which showed that the paternal pedigree of dairy cattle could be discovered and verified through genetic testing. An error-like analysis revealed that the data of 37 sires were incorrectly recorded because the bull's NAAB code number was incorrectly entered into the insemination records: for 19 sires, the wrong bull was recorded because the frozen semen of a bull placed in the wrong storage tank was used, 6 had no sire records, and for 12 sires, the NAAB code of the correct bull was recorded but with a wrong stud code, marketing code, or unique number for the stud or breed. To reduce recorded sire error rates by at least 27.78%, automated identification of the mated bull must be adopted to reduce human error and improve dairy breeding management on dairy farms.

P2556TXNDC5 is a novel therapeutic target of atrial fibrosis and fibrillation

Background

Atrial fibrillation (AF), one of the most common cardiac arrhythmias, increases the risk of stroke, systemic embolization and cardiovascular mortality. Atrial fibrosis, a hallmark of chronic AF, provides substrates to initiate/propagate fibrillation waves in the atria. There, however, lacks effective and specific therapeutics targeting atrial fibrosis. We have recently identified an endoplasmic reticulum (ER) protein thioredoxin domain containing 5 (TXNDC5) as a critical mediator of cardiac ventricular fibrosis. We hypothesized that TXNDC5 could also play an important role in the pathogenesis of atrial fibrosis and fibrillation.

Purpose

To determine the role of TXNDC5 in atrial fibrosis and fibrillation.

Methods and results

TXNDC5 transcript and protein levels were both significantly upregulated in the atrial tissue from patients with AF. In addition, TXNDC5 mRNA expression levels were positively correlated with those of transcripts encoding transforming growth factor β1 (TGFβ1) and extracellular matrix (ECM) proteins in human atrial tissue. Knockdown of TXNDC5 in human atrial fibroblasts (hAF) attenuated TGFβ1–induced hAF activation, proliferation and ECM protein upregulation, whereas overexpression of TXNDC5 was sufficient to trigger hAF activation, proliferation and ECM protein production. Further experiments revealed that the fibrogenic effects of TXNDC5 were dependent on c-Jun N-terminal kinase (JNK) signaling. Furthermore, using α-MHC-TGFβcys33ser mice, a transgenic mouse model with cardiac-specific overexpression of constitutively active TGFβ, which develop extensive atrial fibrosis and inducible AF, we showed that TXNDC5 was strongly upregulated in the fibrotic atria of α-MHC-TGFβcys33ser mice and specifically enriched in collagen-secreting atrial fibroblasts. Targeted deletion of TXNDC5 (Txndc5−/−) in α-MHC-TGFβcys33ser mice considerably mitigated the extent of atrial fibrosis. In addition, transesophageal atrial burst pacing induced AF in 75% (3 out of 4) α-MHC-TGFβcys33ser mice, whereas knockout of Txndc5 markedly reduced the inducibility of AF (25%, 3 out of 12) in α-MHC-TGFβcys33ser mice (Figure).

TXNDC5 KO Reduces AF Inducibility

Conclusion

The present study revealed that ER protein TXNDC5 augments atrial fibrosis by promoting cardiac fibroblast proliferation and ECM protein production via JNK signaling activation. Targeted deletion of Txndc5 protects against TGFβ induced atrial fibrosis and AF. Targeting TXNDC5, therefore, could be a promising new therapeutic approach to treat or prevent atrial fibrosis and AF.

Development of an imaging-planning program for screen/film and computed radiography mammography for breasts with short chest wall to nipple distance

OBJECTIVE

Imaging breasts with a short chest wall to nipple distance (CWND) using a traditional mammographic X-ray unit is a technical challenge for mammographers. The purpose of this study is the development of an imaging-planning program to assist in determination of imaging parameters of screen/film (SF) and computed radiography (CR) mammography for short CWND breasts.

METHODS

A traditional mammographic X-ray unit (Mammomat 3000, Siemens, Munich, Germany) was employed. The imaging-planning program was developed by combining the compressed breast thickness correction, the equivalent polymethylmethacrylate thickness assessment for breasts and the tube loading (mAs) measurement. Both phantom exposures and a total of 597 exposures were used for examining the imaging-planning program.

RESULTS

Results of the phantom study show that the tube loading rapidly decreased with the CWND when the automatic exposure control (AEC) detector was not fully covered by the phantom. For patient exposures with the AEC fully covered by breast tissue, the average fractional tube loadings, defined as the ratio of the predicted mAs using the imaging-planning program and mAs of the mammogram, were 1.10 and 1.07 for SF and CR mammograms, respectively. The predicted mAs values were comparable to the mAs values, as determined by the AEC.

CONCLUSION

By applying the imaging-planning program in clinical practice, the experiential dependence of the mammographer for determination of the imaging parameters for short CWND breasts is minimised.

Activity and function of rabbit muscle-specific creatine kinase at low temperature by mutation at gly268 to asn268

Carp muscle-specific creatine kinase M1 isoenzyme (M1-CK) seems to have evolved to adapt to synchronized changes in body temperature and intracellular pH. When gly(268) in rabbit muscle-specific creatine kinase was substituted with asn(268) as found in carp M1-CK, the rabbit muscle-specific CK G286N mutant specific activity at pH 8.0 and 10°C was more than 2-fold higher than that in the wild-type rabbit enzyme. Kinetic studies showed that K(m) values of the rabbit CK G268N mutant were similar to those of the wild-type rabbit enzyme, yet circular dichroism spectra showed that the overall secondary structures of the mutant enzyme, at pH 8.0 and 5°C, were almost identical to the carp M1-CK enzyme. The X-ray diffraction pattern of the mutant enzyme crystal revealed that amino acid residues involved in substrate binding are closer to one another than in the rabbit enzyme, and the cysteine283 active site of the mutant enzyme points away from the ADP binding site. At pH 7.4-8.0 and 35-10°C, with a smaller substrate, dADP, specific activities of the mutant enzyme were consistently higher than the wild-type rabbit enzyme and more similar to the carp M1-CK enzyme. Thus, the smaller active site of the RM-CK G268N mutant may be one of the reasons for its improved activity at low temperature.

Emergency management and infection control in a radiology department during an outbreak of severe acute respiratory syndrome

The World Health Organization classified Taiwan as a serious epidemic-stricken area when the extent of severe acute respiratory syndrome (SARS) in Taiwan became clear. As of 11 July 2003, 671 probable SARS cases had been identified in Taiwan and 7 healthcare workers had died from the disease. Radiographers were easily infected by SARS because they had close contact with suspected or probable cases while conducting chest X-ray examinations. Three radiographers had been infected by the end of May 2003. Because of the impact of SARS on the Radiology Department, the department established a SARS emergency infection control team and re-designed the department's infection-control and emergency-management procedures based on the concept of risk-grade protection. This effort included installing a radiographic room at the fever-screening station, re-allocating human resources in the Radiology Department, training the department staff in infection control, and drafting new operational procedures for radiographers conducting X-ray examinations on SARS patients. The goal of this program was to reduce the infection rate and distribute materials efficiently in the department. This article introduces the emergency-management procedure of the Radiology Department during the SARS outbreak and the infection-protection experience of the department staff.

Estimation of mean-glandular dose from monitoring breast entrance skin air kerma using a high sensitivity metal oxide semiconductor field effect transistor (MOSFET) dosimeter system in mammography

Estimation of mean-glandular dose (MGD) has been investigated in recent years due to the potential risks of radiation-induced carcinogenesis associated with the mammographic examination for diagnostic radiology. In this study, a new technique for immediate readout of breast entrance skin air kerma (BESAK) using high sensitivity MOSFET dosimeter after mammographic projection was introduced and a formula for the prediction of tube output with exposure records was developed. A series of appropriate conversion factors was applied to the MGD determination from the BESAK. The study results showed that signal response of the high sensitivity MOSFET exhibited excellent linearity within mammographic dose ranges, and that the energy dependence was less than 3% for each anode/filter combination at the tube potentials 25-30 kV. Good agreement was observed between the BESAK and the tube exposure output measurement for breasts thicker than 30 mm. In addition, the air kerma estimated from our prediction formula provided sufficient accuracy for thinner breasts. The average MGD from 120 Asian females was 1.5 mGy, comparable to other studies. Our results suggest that the high sensitivity MOSFET dosimeter system is a good candidate for immediately readout of BESAK after mammographic procedures.

The accuracy of endoscopic ultrasound, endoscopic retrograde cholangiopancreatography, computed tomography, and transabdominal ultrasound in the detection and staging of primary ampullary tumors

BACKGROUND/AIMS

To compare the accuracy between EUS (endoscopic ultrasound), ERCP (endoscopic retrograde cholangiopancreatography), CT (computed tomography), and transabdominal US (ultrasound) in the detection and staging of primary ampullary tumors. We will also try to discuss the influence of endobiliary stent on EUS in staging ampullary tumors.

METHODOLOGY

Twenty-one patients with ampullary tumors were evaluated by EUS, ERCP, CT, and US before operation. The accuracy was assessed with TNM staging and compared with the surgical-pathological findings.

RESULTS

EUS was superior to CT and US in detecting ampullary tumors, but EUS and ERCP are of similar sensitivity (EUS 95%, ERCP 95%, CT 19%, US 5%). EUS was superior to CT and US in T staging (EUS 75%, CT 5%, US 0%) and detecting lymph node metastasis (EUS 50%, CT 33%, US 0%) of ampullary tumors. The accuracy of EUS in T and N staging of ampullary tumors tended to be decreased in the presence of endobiliary stent (stenting: T 71%, N 75%; nonstenting T 83%, N 100%), but there was no statistical significance.

CONCLUSIONS

EUS was superior to CT and US in assessing primary ampullary tumors, but it was not significantly superior to ERCP in detecting ampullary tumors. The presence of endobiliary stent may decrease the accuracy of EUS in staging ampullary tumors.

The features of perforated peptic ulcers in conventional computed tomography

BACKGROUND/AIMS

CT is not usually of priority to evaluate the pathology of the gastrointestinal tract, especially perforated peptic ulcer. However CT might be employed when the presentation is atypical. The study was to summarize the imaging features of perforated peptic ulcer in conventional CT and assess its ability of detecting perforated peptic ulcer.

METHODOLOGY

The CTs of 14 consecutive patients with perforated peptic ulcer confirmed by operation were retrospectively reviewed. The CTs were obtained after intravenous contrast medium, but oral contrast medium was administered only in 5 patients. The CT findings were correlated with surgical findings.

RESULTS

Among these 14 patients, all the 14 patients (100%) had extraluminal air accumulation, 10 patients (71%) had abnormal fluid accumulation, and 5 (36%) patients had inflammatory changes in surrounding soft tissues. In addition, conventional CT could only demonstrate the site of perforation in 5 patients (36%) of them.

CONCLUSIONS

Conventional CT was valuable in the diagnosis of perforated peptic ulcer, and pneumoperitoneum was the most common feature. However the ability of conventional CT in localizing the site of perforation was poor.

Preoperative evaluation of periampullary tumors by endoscopic sonography, transabdominal sonography, and computed tomography

PURPOSE

The purpose of this retrospective study was to compare the sensitivity of endoscopic sonography (EUS), transabdominal sonography (US), and CT in the detection of, local staging of, and prediction of vascular involvement by or distant metastasis from periampullary tumors.

METHODS

Seventy-four consecutive patients with presumed periampullary tumors were evaluated by EUS, US, and CT during a 3.25-year period. The local staging accuracy of the modalities was assessed in the 36 patients with solid tumors who underwent surgery. The sensitivity of the modalities in predicting vascular involvement and distant metastasis was assessed in the 56 patients with carcinomas.

RESULTS

EUS was the most sensitive modality in the detection (EUS, 97%; US, 24%; and CT, 39%; p < 0.001 for EUS versus US or CT) and T classification (EUS, 72%; US, 11%; CT, 22%; p < 0.001 for EUS versus US or CT) of periampullary tumors. EUS also had better sensitivity than US in detecting lymph node metastasis from periampullary cancers (EUS, 47%; US, 7%; and CT, 33%; p = 0.02 for EUS versus US; p = 0.7 for EUS versus CT). The accuracy of EUS in determining the T classification (without stent, 81%; with stent, 65%) and N classification (without stent, 80%; with stent, 70%) tended to decrease in the presence of an endobiliary stent, but the differences were not significant. EUS was the most sensitive modality in demonstrating vascular involvement (EUS, 100%; US, 0%; and CT, 33%; p = 0.002 for EUS versus US; p = 0.03 for EUS versus CT) but was not significantly different in detecting distant metastasis (EUS, 11%; US, 44%; and CT, 44%).

CONCLUSIONS

EUS is superior to US and CT in the local assessment of periampullary tumors. The staging accuracy of EUS is minimally but not significantly affected by the presence of an endobiliary stent.

Role of upright chest radiography and ultrasonography in demonstrating free air of perforated peptic ulcers

BACKGROUND/AIMS

The purpose of this study was to determine the value of upright chest radiography and ultrasonography in demonstrating free air of perforated peptic ulcers. METHOLOGY: Eighty-four patients with perforated peptic ulcers receiving both upright chest radiography and ultrasonography before laparotomy. The sensitivity of each modality in demonstrating free air was correlated.

RESULTS

Among the 84 patients receiving both examinations, free air was demonstrated in only 39 (46%) upright chest radiographs and 46 (55%) ultrasonographs, the direct sign could be demonstrated in 57 (68%) patients by combined radiography and ultrasonography. Besides, the indirect sign of ascites could be demonstrated in 26 (31%) ultrasonographs.

CONCLUSIONS

Ultrasonography is more sensitive than upright chest radiography to demonstrate free air of perforated peptic ulcers, and it should be considered in those patients of suspected perforated peptic ulcers with negative upright chest radiography. Combined methods of upright chest radiography and ultrasonography can increase the overall sensitivity in demonstrating free air.

High-performance liquid chromatographic determination for bile components in fish, chicken and duck

A HPLC procedure for the determination of 13 bile acids and cyprinol sulfate in animals was developed. The mobile system 0.3% ammonium carbonate solution-acetonitrile (73:27, v/v) 10 min-->(68:32) 10 min-->(50:50) 10 min was available for separating all 14 bile components, except for deoxycholic and glycodeoxycholic acids, which could be further separated with 0.3% ammonium carbonate solution-acetonitrile (73:27). After applying this method, grass carp and common carp bile was found to contain mainly cyprinol sulfate, while the other 12 fish species bile contained mainly taurocholic, taurochenodeoxycholic and cholic acids. Chicken bile was mainly composed of glycolithocholic and taurocholic acids, but duck bile was mainly composed of taurochenodeoxycholic, cholic and ursodeoxycholic acids.

Identification of cyprinol and cyprinol sulfate from grass carp bile and their toxic effects in rats

To elucidate the responsible toxic components of grass carp bile, the bile salt 5 alpha-cyprinol sulfate and its desalted form 5 alpha-cyprinol from grass carp bile were purified and identified by analyses of infrared spectrum, (1)H-, (13)C-nuclear magnetic resonance spectra and mass spectrum. The toxicity of grass carp bile powder, butanol extract of grass carp bile powder, 5 alpha-cyprinol and 5 alpha-cyprinol sulfate in rats were further determined. The kidney and liver functions were significantly affected by grass carp bile powder, butanol extract and 5 alpha-cyprinol sulfate. However, 5 alpha-cyprinol also significantly affected the kidney function, but the toxic effect was less.

Tyr115, gln165 and trp209 contribute to the 1, 2-epoxy-3-(p-nitrophenoxy)propane-conjugating activity of glutathione S-transferase cGSTM1-1

We investigated the epoxidase activity of a class mu glutathione S-transferase (cGSTM1-1), using 1,2-epoxy-3-(p-nitrophenoxy)propane (EPNP) as substrate. Trp209 on the C-terminal tail, Arg107 on the alpha4 helix, Asp161 and Gln165 on the alpha6 helix of cGSTM1-1 were selected for mutagenesis and kinetic studies. A hydrophobic side-chain at residue 209 is needed for the epoxidase activity of cGSTM1-1. Replacing Trp209 with histidine, isoleucine or proline resulted in a fivefold to 28-fold decrease in the k(cat)(app) of the enzyme, while a modest 25 % decrease in the k(cat)(app) was observed for the W209F mutant. The rGSTM1-1 enzyme has serine at the correponding position. The k(cat)(app) of the S209W mutant is 2. 5-fold higher than that of the wild-type rGSTM1-1. A charged residue is needed at position 107 of cGSTM1-1. The K(m)(app)(GSH) of the R107L mutant is 38-fold lower than that of the wild-type enzyme. On the contrary, the R107E mutant has a K(m)(app)(GSH) and a k(cat)(app) that are 11-fold and 35 % lower than those of the wild-type cGSTM1-1. The substitutions of Gln165 with Glu or Leu have minimal effect on the affinity of the mutants towards GSH or EPNP. However, a discernible reduction in k(cat)(app) was observed. Asp161 is involved in maintaining the structural integrity of the enzyme. The K(m)(app)(GSH) of the D161L mutant is 616-fold higher than that of the wild-type enzyme. In the hydrogen/deuterium exchange experiments, this mutant has the highest level of deuteration among all the proteins tested. We also elucidated the structure of cGSTM1-1 co-crystallized with the glutathionyl-conjugated 1, 2-epoxy-3-(p-nitrophenoxy)propane (EPNP) at 2.8 A resolution. The product found in the active site was 1-hydroxy-2-(S-glutathionyl)-3-(p-nitrophenoxy)propane, instead of the conventional 2-hydroxy isomer. The EPNP moiety orients towards Arg107 and Gln165 in dimer AB, and protrudes into a hydrophobic region formed by the loop connecting beta1 and alpha1 and part of the C-terminal tail in dimer CD. The phenoxyl ring forms strong ring stacking with the Trp209 side-chain in dimer CD. We hypothesize that these two conformations represent the EPNP moiety close to the initial and final stages of the reaction mechanism, respectively.

Lack of association between deletion polymorphism of the ACE gene and ischemic vascular diseases in a Chinese population in Taiwan

BACKGROUND

The association between deletion/insertion polymorphism of the angiotensin I-converting enzyme (ACE) gene and ischemic vascular diseases (IVDs) is still unclear. This study was designed to evaluate the role of ACE gene polymorphism in the pathogenesis of IVDs in a Chinese population living in Taiwan.

METHODS

A case-control study was carried out to examine the association of the ACE gene genotype and the allele frequency in 400 IVD patients, including 214 patients with ischemic cerebrovascular disease (ICVD) and 186 patients with ischemic heart disease (IHD), compared with 200 control individuals.

RESULTS

Although the patients with ICVD and IHD were found to have higher frequencies of the D/D genotype (22% and 43%) and the D allele (20% and 42%) than the controls (16% and 39%), the statistical differences were not significant, as shown by chi 2 analysis (p > 0.05). Upon further comparison of the frequencies of the D allele among the two sexes and different age subgroups, there was still no significant association.

CONCLUSIONS

Deletion polymorphism of the ACE gene was not associated with IVD in a Chinese population in Taiwan. The unique or synergistic effect of other genes that might contribute to the pathogenesis of IVDs needs further investigation.

Pancreatic tuberculosis with obstructive jaundice--a case report

Isolated pancreatic tuberculosis (TB) is very rare and its treatment somewhat controversial. We report a case of pancreatic TB diagnosed as pancreatic carcinoma. An 82-yr-old man presented with right upper abdominal pain and obstructive jaundice, without fever or weight loss. Ultrasonography, computed tomography, and endoscopic retrograde cholangiopancreatography showed a mass lesion in the pancreatic head, which caused stricturing of the distal common bile duct and pancreatic duct in the head of the gland. As malignancy was suspected, he underwent a Whipple procedure (pancreaticoduodenectomy). Histological examination of the resection specimen disclosed typical features of tuberculosis in the pancreatic head, lymph nodes, and at the ampulla of Vater. The rest of the abdominal cavity was unremarkable. After receiving antimicrobial therapy for tuberculosis for 6 months, he remains well, without jaundice or a recurrent mass visible by ultrasound.

Self-expandable metallic stents in the management of malignant biliary obstruction

To overcome problems with conventional plastic endoprostheses, a study was conducted to determine the clinical efficacy of self-expandable metallic stents in the palliative treatment of malignant biliary obstruction. From May 1994 to March 1995, 19 self-expandable metallic stents were implanted in 13 consecutive patients with malignant obstructive jaundice due to cholangiocarcinoma (four patients), ampullary carcinoma (six), pancreatic carcinoma (one), and hepatic hilar lymph node metastasis (two). All patients underwent percutaneous transhepatic biliary drainage followed by stent insertion, except for two patients where the T-tube tract was used as access and another with previous placement of a polyethylene internal-external drainage catheter for more than 6 months. When both lobes of the biliary system were to be drained, stents were placed either side by side through punctured, separate hepatic ducts or, using a T configuration, through a single transhepatic tract. Percutaneous transhepatic stent placement was technically successful in all patients. After a mean follow-up of 5.9 months (range, 1-10 mo), 10 of 13 patients were still alive while three had died of nonprocedure-related causes. In 10 patients, total serum bilirubin levels decreased significantly (from 136.8 +/- 157 mumol/L to 34.2 +/- 22.2 mumol/L), while it increased in three patients. Two patients had stent occlusions at 2 and 3 months after stent placement, which required intervention. The overall patency period ranged from 1 to 9 months (mean, 5.1 mo). Our results confirm that the use of metallic stents is effective in the palliative treatment of malignant jaundice.

Percutaneous trans-hepatic cholangioscopy and lithotripsy in the treatment of intrahepatic stones: a study with 5 year follow-up

BACKGROUND

Intrahepatic stones are characterized by high treatment failure and recurrence rates. In the past, surgery played a major role in the management of this disease, but surgical intervention may not be feasible in previously operated patients or those classified as poor surgical risks. The development of percutaneous trans-hepatic cholangioscopy and lithotripsy has played an important role in the treatment of these patients.

METHODS

We reviewed our results in 165 patients with intrahepatic stones treated by percutaneous trans-hepatic cholangioscopy and lithotripsy in the past 12 years.

RESULTS

The rate of complete stone removal was 80% (132 cases) and the rate of recurrent biliary stones after a mean 58 month follow-up interval was 32.6% (43 of 132 cases). There were 2 deaths during the treatment period and 10 deaths during follow-up.

CONCLUSIONS

Percutaneous trans-hepatic cholangioscopy and lithotripsy are good alternatives in treating primary intrahepatic stones, especially for those patients unsuitable for surgery.

1H NMR investigation of the paramagnetic cluster environment in Pyrococcus furiosus three-iron ferredoxin: sequence-specific assignment of ligated cysteines independent of tertiary structure

One- and two-dimensional 1H NMR data tailored to detect paramagnetically relaxed protons near the S = 1/2, three-iron-sulfur cluster of the ferredoxin from the hyperthermophile Pyrococcus furiosus are analyzed to sequence specifically assign the hyperfine shifted ligated cysteine signals, to determine the nature of the secondary structural elements on which these cysteines reside, and to define the tertiary contacts of the cluster with the remainder of the previously characterized secondary structure remote from the cluster [Teng, Q., Zhou, Z.-H., Busse, S.C., Howard, J.B., Adams, M. W. W., & La Mar, G. N. (1994) Biochemistry 33, 6316-6326]. Inspection of the geometry of the cluster ligating cysteines in the six structurally characterized cubane ferredoxin (Fd) clusters reveals a pattern of distances from the cluster iron(s) that indicate that each Cys will exhibit one backbone proton that will allow the detection of dipolar connectivities to the backbone of adjacent residues. It is expected that the first and last of the Cys in the cluster consensus binding sequence will exhibit weakly relaxed peptide NH and strongly relaxed C alpha H signals, while the two central Cys in that sequence will exhibit strongly relaxed peptide NH but weakly relaxed C alpha H peaks. These dipolar contacts are clearly observed for the three ligated Cys in 3Fe P. furiosus Fd, providing the first sequence specific assignment of ligated cysteines which do not explicitly require knowledge of the tertiary structure of the protein. This approach is proposed to have very general application to cubane ferredoxins. A combination of steady-state NOEs and short mixing time NOESY experiments demonstrate that Cys17 is on a short helix through Leu20 and that Cys56 likely initiates a type I turn, as observed in the crystal structure of the 3Fe Fd for Desulfovibrio gigas [Kissinger, C. R., Sieker, L. C., Adman, E. T., & Jensen, L. H. (1991) J. Mol. Biol. 219, 693-715]. The observed relaxation rates of resolved or partially resolved signals are shown to correlate with their proximity to the various iron in the cluster, as determined for the homologous residues in D. gigas Fd, providing additional qualitative information on tertiary contacts of the cluster.

Bilateral hepatic duct decompression via a single percutaneous tract using a 'mother-baby' drainage catheter

Decompression of the right and left hepatic ducts using a 'mother-baby' self-made drainage system via a single percutaneous tract was performed successfully in 15 of 21 patients with benign (n = 4) and malignant (= 17) hilar obstruction. The 'mother-baby' drainage system was composed of an 18 F catheter placed through the right hepatic duct into the distal common bile duct which was designated as the 'mother' catheter, while a second 10 F baby catheter was placed through the first catheter into the left hepatic ducts. This was achieved by a three-stage procedure: (1) percutaneous transhepatic biliary drainage; (2) balloon dilatation of the tract; and (3) intubation of the contralateral hepatic duct and placement of the 'mother-baby' drainage catheters. The mean interval of stent clogging was 5 months, with a range of 2-9 months. In 12 malignant cases, average survival time was 9.8 months. The technique avoided a second percutaneous hepatic puncture in centrally obstructing lesions and afforded bilateral biliary decompression.

Percutaneous choledochoscopic biliary tract stone removal: experience in 645 consecutive patients

Our experience in non-operative retrieval of biliary tract stones through PTCS (percutaneous transhepatic cholangioscopy, n = 103) and POC (post-operative choledochoscopy, n = 542) plus the use of Dormia basket and EHL (electrohydraulic lithotripsy) is presented. The results of transhepatic and T-tube routes are compared, with emphasis on the technical difficulties encountered. The success rates were 96% and 97% in POC and PTCS, respectively. No mortality was related to these procedures. Intrahepatic duct angulation and stricture were the factors most often responsible for failure. Postoperative choledochoscopic stone removal is safe and the method of choice for retained biliary tract calculi, while PTCS is highly indicated for those high-risk patients with or without previous biliary surgery. POC and PTCS have, therefore, their own indications and differ in their clinical applications.

Percutaneous transcystic cholangioscopy for combined treatment of gallbladder and bile duct stones

A procedure for percutaneous transcystic cholangioscopy requiring only one percutaneous transhepatic fistulous tract to remove stones located in both the gallbladder and bile ducts is described. The procedure begins with percutaneous transhepatic drainage of the gallbladder or bile duct. Stones in the gallbladder and bile duct can be removed under direct vision on transhepatic cholangioscopy. Larger stones can be fragmented by electrohydraulic lithotripsy before removal. In a preliminary trial the procedure proved to be a feasible method for treatment of 13 patients with both gallbladder and bile duct stones as well as septic cholangitis who either refused operation or were considered poor candidates for surgery. On long-term follow-up (mean period 28 months) stone recurrence was observed in three patients.

Endoscopic sphincterotomy in the treatment of biliary tract diseases

Endoscopic sphincterotomy (EST) was performed in 53 patients with biliary disease. Indications for sphincterotomy were: 48 patients with choledocholithiasis, 3 patients with malignant biliary obstruction, and 2 patients with papillary stenosis. The procedure was successful in 52 patients (98.1%). In patients with choledocholithiasis, the stones were successfully removed or passed out spontaneously in 42 patients (87.5%). Endoscopic retrograde biliary drainage (ERBD) was successfully carried out in 2 cases of malignant biliary obstruction after EST. The clinical and biochemical evidence of cholestasis resolved in both patients with papillary stenosis. Complications consisted of hemorrhage (2 patients) and cholangitis (1 patient), resulting in one death. The overall complication and mortality rates were 5.7% and 1.9% respectively. Thirty-two patients received regular ultrasound examination follow-up with a mean of 13.4 months. Two patients had recurrent common bile duct stones and one had restenosis of papilla. The conditions were managed by endoscopic therapy. Endoscopic sphincterotomy is a relatively safe and effective means of relieving extrahepatic cholestasis; however, its comparison with surgical techniques needs long-term, randomized studies.