Selective activation of IFNγ-ipilimumab enhances the therapeutic effect and safety of ipilimumab

INTRODUCTION

Immune checkpoint inhibitor therapy is a highly promising strategy for clinical treatment of cancer. Among these inhibitors, ipilimumab stands out for its ability to induce cytotoxic T cell proliferation and activation by binding to CTLA-4. However, ipilimumab also gives rise to systemic immune-related adverse effects and tumor immune evasion, limiting its effectiveness.

OBJECTIVES

We developed IFNγ-ipilimumab and confirmed that the addition of INF-γ does not alter the fundamental properties of ipilimumab.

RESULTS

IFNγ-ipilimumab can be activated by matrix metalloproteinases, thereby promoting the IFNγ signaling pathway and enhancing the cytotoxicity of T cells. In vivo studies demonstrated that IFNγ-ipilimumab enhances the therapeutic effect of ipilimumab against colorectal cancer by increasing CD8+ and CD4+ lymphocyte infiltration into the tumor area and inducing MHC-I expression in tumor cells. Mice treated with IFNγ-ipilimumab showed higher survival rates and body weight, as well as lower CD4+ and CD8+ lymphocyte activation rates in the blood and reduced organ damage.

CONCLUSION

IFNγ-ipilimumab improved the effectiveness of ipilimumab while reducing its side effects. It is likely that future immunotherapies would rely on such antibodies to activate local cancer cells or immune cells, thereby increasing the therapeutic effectiveness of cancer treatments and ensuring their safety.

High-peak-power optically pumped passively mode-locked semiconductor laser with minimal components

A high-peak-power sub-500-fs mode-locked optically pumped semiconductor laser is innovatively developed with only three components of a semiconductor gain chip, a semiconductor saturable absorber, and a focusing lens. The developed laser near the threshold pump power of 3.9 W can be operated with stable fundamental mode locking. The laser output can be naturally turned into the stable harmonic mode locking (HML) with the order gradually changing from 2nd to 8th by increasing the pump power from 4.0 W to 5.0 W. Due to the onset of the high-order transverse modes, the order of HML is fixed at 8th for a pump power greater than 5.0 W. For the HML with order less than 8th, the overall peak power and pulse width in the HML are approximately 0.36 kW and 550 fs, respectively. In the operation of 8th-order HML, the minimum pulse width and maximum peak power can reach 480 fs and 0.95 kW, respectively.

Urban-rural disparity of preventive healthcare utilisation among children under the universal health insurance coverage in Taiwan: a national birth cohort analysis

OBJECTIVE

In the context of universal health insurance coverage, this study aimed to determine whether urban-rural inequality still exists in preventive health care (PHC) amongst children in Taiwan.

STUDY DESIGN

Prospective cohort study.

METHODS

A total of 184,117 mothers and their children born in 2009 were identified as the study cohort. The number of children born in urban, satellite and rural areas was 40,176, 57,565 and 86,805, respectively. All children were followed for 7 years, before which a total of seven times PHC were provided by Taiwan's National Health Insurance (NHI) programme. Ordinal logistic regression models were used to associate urbanisation level with the frequency of PHC utilisation. Stratified analyses were further performed in accordance with the children's birth weight and the mothers' birthplace.

RESULTS

Children from satellite areas had higher utilisation for the first four scheduled PHC visits. Children living in urban areas received more PHC for the fifth and sixth scheduled visits. Compared with those from rural areas, children in satellite areas exhibited a small but significant increase in odds in PHC utilisation, with a covariate-adjusted odds ratio (aOR) of 1.04 and 95% confidence interval (CI) of 1.02-1.06. By contrast, no significant difference was observed between rural and urban areas (aOR = 1.01). Further stratified analyses suggest more evident urban-rural difference in PHC utilisation amongst children with low birth weight and foreign-born mothers.

CONCLUSIONS

Given a universal health insurance coverage and embedded mechanisms in increasing the availability of healthcare resources in Taiwan, a slight urban-rural difference is observed in PHC utilisation amongst children. Hence, sociodemographic inequality in utilisation of PHC still exists. This issue should be addressed through policy intervention.

Lack of evidence for a harmful effect of sodium-glucose co-transporter 2 (SGLT2) inhibitors on fracture risk among type 2 diabetes patients: a network and cumulative meta-analysis of randomized controlled trials

AIM

To evaluate the comparative effects of sodium-glucose co-transporter 2 (SGLT2) inhibitors on risk of bone fracture in patients with type 2 diabetes mellitus (T2DM).

METHODS

PubMed, EMBASE, CENTRAL and ClinicalTrials.gov were systematically searched from inception to 27 January 2016 to identify randomized controlled trials (RCTs) reporting the outcome of fracture in patients with T2DM treated with SGLT2 inhibitors. Pairwise and network meta-analyses, as well as a cumulative meta-analysis, were performed to calculate odds ratios (ORs) and 95% confidence intervals (CIs).

RESULTS

A total of 38 eligible RCTs (10 canagliflozin, 15 dapagliflozin and 13 empagliflozin) involving 30 384 patients, with follow-ups ranging from 24 to 160 weeks, were included. The fracture event rates were 1.59% in the SGLT2 inhibitor groups and 1.56% in the control groups. The incidence of fracture events was similar among these three SGLT2 inhibitor groups. Compared with placebo, canagliflozin (OR 1.15; 95% CI 0.71-1.88), dapagliflozin (OR 0.68; 95% CI 0.37-1.25) and empagliflozin (OR 0.93; 95% CI 0.74-1.18) were not significantly associated with an increased risk of fracture. Our cumulative meta-analysis indicated the robustness of the null findings with regard to SGLT2 inhibitors.

CONCLUSIONS

Our meta-analysis based on available RCT data does not support the harmful effect of SGLT2 inhibitors on fractures, although future safety monitoring from RCTs and real-world data with detailed information on bone health is warranted.

Association between serum ferritin and microalbuminuria in Type 2 diabetes in Taiwan

AIMS

Serum ferritin has been found closely related with diabetes and glucose metabolism, but its impact on diabetic nephropathy remains unknown. This study aimed to explore the association between serum ferritin and microalbuminuria in Type 2 diabetes.

METHODS

Eight hundred and fifty-one subjects with Type 2 diabetes were selected from a cohort participating in a glycaemic control study in Taiwan in 2008. We used urine albumin:creatinine ratio to define microalbuminuria; serum ferritin was divided into quartiles for analysis. Logistic regression and trend tests were used to delineate the association between serum ferritin and microalbuminuria.

RESULTS

Subjects with diabetes with higher ferritin tended to have more metabolic disorders, higher high-sensitivity C-reactive protein and higher prevalence of microalbuminuria. Compared with those in the lowest quartile, subjects with diabetes in the highest ferritin quartile were 55% (P = 0.029) more likely to have microalbuminuria. After controlling for demographics, metabolic profiles and other inflammatory markers, the association between serum ferritin levels and microalbuminuria remained significant (P for trend < 0.001). This independent relationship was not changed either for those who had better glycaemic control or those who had not used an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker.

CONCLUSIONS

The current study shows hyperferritinemia may be an independent risk factor of nephropathy in patients with Type 2 diabetes.

Mechanical properties of three different compositions of calcium phosphate bioceramic following immersion in Ringer's solution and distilled water

Dissolution tests were carried out to compare the mechanical properties of calcium phosphate based bioceramics with different compositions, before and after ageing for various time periods in Ringer's solution (pH 7.2) or distilled water (pH 7.2 and 4.0) at 37 degrees C. The results indicate that the sample composition seems to have more of an effect on the mechanical properties than does the storage environment. No obvious decrease in mechanical properties was found after samples had been aged in the various solutions during the different time periods. This indicates that these samples could be of significant clinical interest as their good structural properties were retained.

Mechanical characterization of dense calcium phosphate bioceramics with interconnected porosity

Porous hydroxyapatite/tricalcium phosphate (HA/TCP) bioceramics were fabricated by a novel technique of vacuum impregnation of reticulated polymeric foams with ceramic slip. The samples had approximately 5-10% interconnected porosity and controlled pore sizes appropriate to allow bone ingrowth, combined with good mechanical properties. A range of polyurethane foams with 20, 30 and 45 pores per inch (ppi) were used as templates to produce samples for testing. The foams were inpregnated with solid loadings in the range of 60-140 wt%. The results indicated that the average apparent density of the HA/TCP samples was 2.48 g/cm(3), the four-point bending strength averaged 16.98 MPa, the work of fracture averaged 15.46 J/m(2) and the average compressive strength was 105.56 MPa. A range of mechanical properties resulted from the various combinations of different grades of PU foam and the solid loading of slips. The results indicated that it is possible to manufacture open pore HA/TCP bioceramics, with compressive strengths comparable to human bone, which could be of significant clinical interest.

Fabrication of porous bioceramics with porosity gradients similar to the bimodal structure of cortical and cancellous bone

The aim of this study was to fabricate porous implant materials with graded pore structures similar to the bimodal structure of cortical and cancellous bone. Porous hydroxyapatite/tricalcium phosphate (HA/TCP) bioceramics with interconnected porosity and controlled pore sizes required to simulate natural bone tissue morphology were fabricated by a novel technique of vacuum impregnation of reticulated polymeric foams with ceramic slip. Functionally gradient materials (FGMs) with porosity gradients were made by joining different pore per inch (ppi) foams together by either stitching or pressfitting to form templates. Post production, no defects could be seen at the interface between the two different porosity sections. The macropore sizes of the HA/TCP bioceramics were larger than 100 mum which is appropriate for bone ingrowth. A sample with a graded porous structure which is close to the human bone morphology was also developed. The two component structures were conspicuously different but joined together firmly. Four point bend testing of FGM samples showed them to have similar mechanical properties to homogeneous ceramics based on foam templates with uniform pore sizes, with no evidence of interfacial weakness. Many potential biomedical applications could be developed utilising graded porous structures. The ease of processing will make it possible to fabricate a range of complex shapes for different applications.

Fabrication and mechanical testing of porous calcium phosphate bioceramic granules

Porous hydroxyapatite/tricalcium phosphate (HA/TCP) granules were fabricated by a novel technique of vacuum impregnation of reticulated polyurethane (PU) foams with ceramic slip. The resultant granules had 5-10% interconnected porosity with controlled pore sizes necessary to allow bone ingrowth combined with good mechanical properties. Using PU foams with a different number of pores per inch (ppi), porous HA/TCP granules in the size range of 2-8 mm were successfully manufactured. Dieplunger tests were used to compare the compression and relaxation properties of the granules with those of a commercially available bone graft product, BoneSave. The results of the die-plunger testing showed that the experimental granules were stiffer than the BoneSave materials and had less of a tendency to crumble to powder after testing. This therefore suggests that these experimental granules would be useful for impaction grafting and space filling applications.

Association of tri-nucleotide (CAG and GGC) repeat polymorphism of androgen receptor gene in Taiwanese women with refractory or remission rheumatoid arthritis

We investigated the relationship between CAG and GGC repeat polymorphism of the androgen receptor (AR) gene and rheumatoid arthritis (RA) in female patients with different disease subtypes. This case-control study enrolled 215 women in three groups: RA patients refractory to standardized therapy (n = 51); RA patients at complete remission phase (n = 60); and healthy controls (n = 104). CAG and GGC repeat lengths were determined by automated fluorescence-based DNA fragment-sizing method. Demographic data, allele lengths, allele distribution, and zygosity status of CAG/GGC repeats were assessed for the three groups. Refractory RA patients tend to have a significantly younger onset age of RA and more elevated erythrocyte sedimentation rates than do remission RA patients. Mean and median values of CAG and GGC repeat lengths are similar in both RA and control patients. However, RA patients harboring any long CAG alleles with more than 23 repeats had an increased risk of a refractory course, whereas differences in risk were not observed between these patients and RA subtypes harboring any long GGC alleles with more than 16 repeats. In addition, the homozygous frequency of CAG but not GGC alleles was lower in refractory RA than in remission RA patients or in controls (p = 0.042). Neither CAG nor GGC repeat lengths had a significant relationship with rheumatoid factor reactivity. Our observations indicate that short CAG repeats of the AR gene with higher transactivation activity may have protective effects against refractory course of RA development and that homozygous frequency of CAG alleles may be involved in the disease remission subtype. In contrast, lack of association of GGC polymorphism and RA was also observed. Together, these data imply that CAG but not GGC alleles in the AR polymorphism may play an important role in modulating the disease pattern of RA among Taiwanese women.

The effect of hyperbaric oxygen on human oral cancer cells

Discoveries of the beneficial cellular and biochemical effects have strengthened the rationale for the administration of hyperbaric oxygen therapy (HBO2) as an adjunctive therapy for the treatment of osteoradionecrosis (ORN). Malignancies, however, are considered a contraindication for HBO2 because of the possible tumor-promoting effects. The aim of this study was to examine the effects of HBO2 therapy on tumor weight, and to measure the progression of apoptosis and tumor cell proliferating activity in a cultured human oral cancer cell line. Twenty 5-week-old male NODscid mice underwent daily HBO2 of 2.5 atm abs, 90 minutes for 20 treatments. The control group, n = 20, did not undergo HBO2 and tumor weight, apoptosis index, and proliferating activity parameters were compared between the two groups. The results showed no significant differences (p < 0.05) in the whole-body weights, tumor weights, apoptotic index or proliferating activity index between the two groups. By using the apoptosis and proliferating activity assays which were better indicators of tumor cell growth than tumor weight alone, our results suggest that the clinical application of HBO2 does not promote the growth or proliferation of human oral cancer cells.

Evaluation of alveolar permeability and lung ventilation in patients with chronic renal failure using Tc-99m DTPA radioaerosol inhalation lung scintigraphy

Lung ventilation (LV) and alveolar permeability (AP) were measured in 24 male chronic renal failure (CRF) patients on regular hemodialysis (HD). LV and AP were determined by Tc-99m DTPA aerosol inhalation lung scintigraphy using commercial lung radioaerosol delivery units. The equilibrium LV images were visually interpreted by two independent and experienced nuclear medicine physicians. The degree of AP damage to the total right lung was presented as the clearance rate (k value; %/min) of the time-activity curve from dynamic total right lung images. The results showed 10/24 (42%) cases with inhomogeneous distribution and 8/24 (33%) cases with hypoventilation on equilibrium LV images. In comparison with 10 male normal controls, the k value of the CRF patient group was larger (1.14 +/- 0.36%/min vs 0.75 +/- 0.14%/min, p value < 0.05). In addition, there was no significant correlation for k value and albumin level (r2 = 0.008) or for k value and HD duration (r2 = 0.228). In conclusion, CRF can predispose patients to LV change and AP damage. However, the degree of AP damage is not related to serum albumin level or HD duration.

Do the CK18 related proteins change in general in epithelial cancers?

The modulation of cytokeratin 18 during tumor transformation in hepatoma had been previously recognized through a series of biochemical and immunological approaches. Expression of cytokeratin 18 in transitional cell carcinoma comparing with hepatoma was investigated using the hepatoma transformation model. CK18 related molecules were found. In the present study, we design various epithelial cancers with the same model. CK18 related molecules were all evident. Therefore, we suggest that CK18 related proteins would play an important role in tumorigenesis of epithelial cancers.

The helicase-like domain of plant potexvirus replicase participates in formation of RNA 5' cap structure by exhibiting RNA 5'-triphosphatase activity

Open reading frame 1 (ORF1) of potexviruses encodes a viral replicase comprising three functional domains: a capping enzyme at the N terminus, a putative helicase in the middle, and a polymerase at the C terminus. To verify the enzymatic activities associated with the putative helicase domain, the corresponding cDNA fragment from bamboo mosaic virus (BaMV) was cloned into vector pET32 and the protein was expressed in Escherichia coli and purified by metal affinity chromatography. An activity assay confirmed that the putative helicase domain has nucleoside triphosphatase activity. We found that it also possesses an RNA 5'-triphosphatase activity that specifically removes the gamma phosphate from the 5' end of RNA. Both enzymatic activities were abolished by the mutation of the nucleoside triphosphate-binding motif (GKS), suggesting that they have a common catalytic site. A typical m(7)GpppG cap structure was formed at the 5' end of the RNA substrate when the substrate was treated sequentially with the putative helicase domain and the N-terminal capping enzyme, indicating that the putative helicase domain is truly involved in the process of cap formation by exhibiting its RNA 5'-triphosphatase activity.

Isolated craniosynostosis: prenatal ultrasound of scaphocephaly with polyhydramnios

Craniosynostosis is an abnormal shape or dimension of the skull caused by premature closure of one or more skull sutures. It includes scaphocephaly, brachycephaly, oxycephaly, plagiocephaly, trigonocephaly, turricephaly, and a cloverleaf-shaped head. The only cases of craniosynostosis that have been reported concern fetuses with complex and marked craniosynostosis syndromes such as acrocraniofacial dysostosis, Apert's syndrome, Beare-Stevenson cutis gyratum syndrome, Calabro's syndrome, etc. Isolated or simple craniosynostosis, however, is a developmental anomaly rarely found on routine ultrasound examination. We present a case that was diagnosed as scaphocephaly with moderate polyhydramnios by prenatal ultrasound. No other structural anomaly was detected, and the karyotyping was normal. So isolated sagittal craniosynostosis was diagnosed prenatally and was confirmed by postnatal skull radiography as well as 3-dimensional computed tomography. The infant underwent bilateral parietal craniectomy at the age of 3 months. He obtained a good result with no mental problems 4 years after the operation. To our knowledge, this is the second report on the prenatal detection of an isolated form of craniosynostosis.

The partial purified RNA-dependent RNA polymerases from bamboo mosaic potexvirus and potato virus X infected plants containing the template-dependent activities

RNA-dependent RNA polymerases (RdRp) isolated from bamboo mosaic potexvirus (BaMV) and potato virus X infected Nicotiana benthamiana plants and solubilized with the detergent NP-40, generated a full-length genomic and two subgenomic double-stranded RNAs of respective viruses in an in vitro RdRp assay containing endogenous RNA templates. Template-dependent and species-specific RdRp activity could be detected after the removal of endogenous RNA templates. The 3' untranslated regions (UTR) containing a stretch of 40 adenylate residues were shown to be an efficient exogenous RNA template for in vitro RdRp reactions. Solution hybridization and nuclease digestion studies revealed that the products transcribed in vitro were minus-sense. Besides using the 3' UTR for minus-sense RNA synthesis, the BaMV RdRp can also recognize 3' terminal 77 nucleotides of the minus-strand for plus-sense RNA synthesis. Promoter studies with BaMV RdRp showed that domain D containing the potexviral hexamer motif of the 3' UTR would be the major contributor of minus-sense RNA synthesis in vitro. On the other hand, the pseudoknot domain containing the poly(A) sequences would be sufficient for minus-sense RNA synthesis.

Hyperbaric oxygen treatment decreases post-ischemic neurotrophin-3 mRNA down-regulation in the rat hippocampus

The therapeutic effect of hyperbaric oxygen (HBO) on ischemic injury was investigated using in situ hybridization to detect the mRNA expression of neurotrophin-3 (NT-3), which is thought to play a crucial role in protecting against neuronal death induced by brain ischemia. The rats under investigation were subjected to 10 min transient forebrain ischemia, and subsequently exposed to HBO (100% oxygen, 2.5 atm absolute) for 2 h. Levels of NT-3 mRNA in the CA1, CA2 and CA3 regions, and the dentate gyrus of the hippocampus were measured after various reperfusion periods. Neuronal death in the hippocampal CA1 region was also measured by Nissl staining, seven days post ischemia. The results demonstrated that HBO treatment significantly reduced the ischemia-induced down-regulation of the NT-3 mRNA level at 4 h post ischemia, and significantly increased cell survival 7 days after reperfusion. The findings suggest that an HBO treatment maintaining the NT-3 mRNA level in the hippocampus can be beneficial to the ischemic brain within a certain time frame.

Extreme hypergastrinemia caused by atrophic gastritis and Helicobacter pylori infection--a case report

We present a case with extremely high serum gastrin induced by atrophic gastritis and Helicobacter pylori infection. The patient, a 95-year-old male, was diagnosed with idiopathic chronic diarrhea. During diagnostic work-up, his fasting serum gastrin was up to 2078 pg/mL. The secretin test was negative for gastrinoma. Octreotide scan showed no suspicious lesion except for diffuse faint uptake over the gastric antrum on the 48-hour-delay film. Gastric acidity test revealed achlorhydria. On histology examination, atrophic gastritis with Helicobacter pylori infection was found in the gastric body, but the antral mucus was normal with a slight increase in gastrin-secreting cells. To our knowledge, such extremely high serum gastrin induced by atrophic gastritis and Helicobacter pylori infection has never been reported before.

Clinicopathologic study of Kaposi's sarcoma and strain analysis of human herpesvirus 8 (HHV-8) DNA in the Hua-Lien area of eastern Taiwan

BACKGROUND AND PURPOSE

Kaposi's sarcoma (KS) is a spindle cell malignancy of endothelial cell origin. The tumor has been demonstrated to be associated with human herpesvirus 8 (HHV-8) or Kaposi's sarcoma-associated herpesvirus-like virus (KSHV). Previous studies have revealed the distribution of unique viral strains in different ethnic populations. Eastern Taiwan has an ethnically mixed population with a relatively high incidence of KS. This study was designed to characterize the clinicopathologic features of KS and to evaluate the HHV-8 strain distribution in the Hua-Lien area of Eastern Taiwan.

METHODS

Clinical records and laboratory data were collected from 15 cases of KS diagnosed and treated between 1993 and 1999 in Tzu-Chi General Hospital. For nine cases, paraffin blocks were available for the molecular study of HHV-8. HHV-8 genomic variation was analyzed using polymerase chain reaction nucleotide sequencing of ORF26 and ORF75 of HHV-8 genomes derived from different subgroups of KS.

RESULTS

Among the 15 patients with KS, two had AIDS-associated disease, four had gouty arthritis and psoriasis and were receiving corticosteroid therapy (iatrogenic type), and nine had classical KS. Nine of the 15 cases occurred in aborigines, including one with AIDS-associated disease, four with iatrogenic disease, and four with classical disease. Among the nine cases for which tissue was available for DNA analysis, eight were positive for HHV-8 DNA. Sequence analysis revealed that the C strain occurred in three Han Chinese KS patients, whereas a hitherto rarely described strain (strain D) occurred in all four aborigines tested (including one with AIDS-associated KS) and one Han Chinese with AIDS from Burma.

CONCLUSION

This study found a high proportion of iatrogenic KS and the finding of a rarely described strain D virus in Eastern Taiwan aborigines. Our studies further confirm the distribution of different types of KS and virus strains in different ethnic populations.

Immunohistochemical localization of deleted-in-colon-cancer (DCC) protein in human epithelial, neural, and neuro-endocrine tissues in paraffin sections with antigen retrieval

A gene called deleted in colon cancer (DCC) has been identified on a region of chromosome 18, which is deleted in 70% of colorectal cancers. The DCC gene encodes a protein belonging to the immunoglobulin superfamily with similarity to the N-CAM transmembrane proteins, and it is a putative tumor-suppressor gene. Alternative splicing of transcripts of transmembrane proteins, including N-CAM, is know to occur, resulting in different isoforms of the protein. Using a polyclonal antibody against the DCC gene product, we have demonstrated, by antigen retrieval immunostaining, the presence of a DCC protein isoform on the cell surface of goblet cells in the G-I tract, cytoplasm of squamous epithelium in the skin & esophagus and transitional epithelium in the urinary bladder, ductal glandular epithelium of endometrium, endocervix, prostate, gall bladder and breast, cytoplasm of neuron in the cerebral cortex and Purkinje cells in the cerebellum. In addition, we also demonstrated DCC protein expression in neuroendocrine cells including argentaffin cells of the stomach, small intestine, appendix and colon, C cells of thyroid gland, chromaffin cells of the adrenal gland, islets of Langerhans in the pancreas and neurons of the sympathetic ganglion. This restrictive distribution suggests the DCC gene products may be abundant expression in neuroendocrine cells of human tissue.

Incidence of transitional cell carcinoma and arsenic in drinking water: a follow-up study of 8,102 residents in an arseniasis-endemic area in northeastern Taiwan

A significant association between ingested arsenic and bladder cancer has been reported in an arseniasis-endemic area in southwestern Taiwan, where many households share only a few wells in their villages. In another arseniasis-endemic area in northeastern Taiwan, each household has its own well for obtaining drinking water. In 1991-1994, the authors examined risk of transitional cell carcinoma (TCC) in relation to ingested arsenic in a cohort of 8,102 residents in northeastern Taiwan. Estimation of each study subject's individual exposure to inorganic arsenic was based on the arsenic concentration in his or her own well water, which was determined by hydride generation combined with atomic absorption spectrometry. Information on duration of consumption of the well water was obtained through standardized questionnaire interviews. The occurrence of urinary tract cancers was ascertained by follow-up interview and by data linkage with community hospital records, the national death certification profile, and the cancer registry profile. Cox proportional hazards regression analysis was used to estimate multivariate-adjusted relative risks and 95% confidence intervals. There was a significantly increased incidence of urinary cancers for the study cohort compared with the general population in Taiwan (standardized incidence ratio = 2.05; 95% confidence interval (CI): 1.22, 3.24). A significant dose-response relation between risk of cancers of the urinary organs, especially TCC, and indices of arsenic exposure was observed after adjustment for age, sex, and cigarette smoking. The multivariate-adjusted relative risks of developing TCC were 1.9, 8.2, and 15.3 for arsenic concentrations of 10.1-50.0, 50.1-100, and >100 microg/liter, respectively, compared with the referent level of < or =10.0 microg/liter.

Sequences at the 3' untranslated region of bamboo mosaic potexvirus RNA interact with the viral RNA-dependent RNA polymerase

The 3' untranslated region (UTR) of bamboo mosaic potexvirus (BaMV) genomic RNA was found to fold into a series of stem-loop structures including a pseudoknot structure. These structures were demonstrated to be important for viral RNA replication and were believed to be recognized by the replicase (C.-P. Cheng and C.-H. Tsai, J. Mol. Biol. 288:555-565, 1999). Electrophoretic mobility shift and competition assays have now been used to demonstrate that the Escherichia coli-expressed RNA-dependent RNA polymerase domain (Delta 893) derived from BaMV open reading frame 1 could specifically bind to the 3' UTR of BaMV RNA. No competition was observed when bovine liver tRNAs or poly(I)(C) double-stranded homopolymers were used as competitors, and the cucumber mosaic virus 3' UTR was a less efficient competitor. Competition analysis with different regions of the BaMV 3' UTR showed that Delta 893 binds to at least two independent RNA binding sites, stem-loop D and the poly(A) tail. Footprinting analysis revealed that Delta 893 could protect the sequences at loop D containing the potexviral conserved hexamer motif and part of the stem of domain D from chemical cleavage.

Characterization of the AdoMet-dependent guanylyltransferase activity that is associated with the N terminus of bamboo mosaic virus replicase

Bamboo mosaic virus (BaMV), a member of the potexvirus group, infects primarily members of the Bambusoideae. Open reading frame 1 (ORF1) of BaMV encodes a 155-kDa polypeptide that has long been postulated to be a replicase involved in the replication and formation of the cap structure at the 5' end of the viral genome. To identify and characterize the enzymatic activities associated with the N-terminal domain of the BaMV ORF1 protein, the intact replicase and two C-terminally truncated proteins were expressed in Saccharomyces cerevisiae. All three versions of BaMV ORF1 proteins could be radiolabeled by [alpha-(32)P]GTP, which is a characteristic of guanylyltransferase activity. The presence of S-adenosylmethionine (AdoMet) was essential for this enzymatic activity. Thin-layer chromatography analysis suggests that the radiolabeled moiety linked to the N-terminal domain of the BaMV ORF1 protein is m(7)GMP. The N-terminal domain also exhibited methyltransferase activity that catalyzes the transfer of the [(3)H]methyl group from AdoMet to GTP or guanylylimidodiphosphate. Therefore, during cap structure formation in BaMV, methylation of GTP may occur prior to transguanylation as for alphaviruses and brome mosaic virus. This study establishes the association of RNA capping activity with the N-terminal domain of the replicase of potexviruses and further supports the idea that the reaction sequence of RNA capping is conserved throughout the alphavirus-like superfamily of RNA viruses.

Prenatal diagnosis of persistent fetal bradycardia: report of four cases

Persistent fetal bradycardia is infrequent in prenatal life and difficult to manage optimally. It is generally attributable to sinus bradycardia due to fetal distress, blocked atrial extrasystoles, and congenital complete heart block. We reported four cases of persistent fetal bradycardia from 1995 to 1999 in our hospital. The first, second, and third cases of sustained fetal bradycardia had congenital complete heart block with positive titers for anti-Ro/SSA antibodies in both mothers and fetuses. Because of progressive fetal hydrops in the second case, the pregnancy was terminated. The first and third cases were isolated congenital complete heart block without structural anomaly. After prenatal examination the babies were followed up closely until term and both had a good prognosis without any implantation of pacemaker. In the fourth case there was no clinically known etiology associated with sustained fetal bradycardia. The fetal heart rate returned to normal after 6 weeks of follow-up and the baby was delivered without any cardiac problems. Congenital complete heart block is the most common cause of persistent fetal bradycardia. Prenatal detailed monitoring until delivery is necessary before heart failure develops. Treatment strategies (corticosteroids, ritodrine, and plasmapheresis) are debatable and may include prophylactic therapy for high-risk pregnant women.

Functional analyses and identification of two arginine residues essential to the ATP-utilizing activity of the triple gene block protein 1 of bamboo mosaic potexvirus

The TGBp1 of bamboo mosaic potexvirus (BaMV) is encoded by the first overlapping gene of the triple-gene-block (TGB), whose products are thought to play roles in virus movement between plant cells. This protein forms cytoplasmic inclusions associated with virus particles in the BaMV-infected tissues. It has been proposed that the inclusion is one of the active forms of TGBp1. To prove this idea, we purified the TGBp1 inclusions from both the BaMV-infected Chenopodium quinoa and Escherichia coli cells overexpressing this protein to test some of their biochemical activities. We found that the TGBp1 inclusions isolated from the infected plant leaves, but not from E. coli, possess the NTP-binding and NTPase activities. However, they lack the RNA-binding activity possessed by the soluble TGBp1. These results indicate that the TGBp1 proteins in the BaMV-infected tissues assume two different functional forms. Mutational analyses and competition experiments show that the two arginine residues, Arg-16 and Arg-21, essential to RNA binding, are also required for the ATP-utilizing activity of the soluble TGBp1. This indicates that a same-structure motif is required for the two functions of the soluble TGBp1. The location of the two arginine residues outside the seven conserved motifs of the NTP-utilizing superfamily I RNA helicases, to which TGBp1 belongs, suggests that an extra-structure motif, besides the seven conserved ones, is required for the NTP-utilizing activity of the TGBp1 protein of BaMV.

Generation of subgenomic RNA directed by a satellite RNA associated with bamboo mosaic potexvirus: analyses of potexvirus subgenomic RNA promoter

Satellite RNA of bamboo mosaic potexvirus (satBaMV), a single-stranded positive-sense RNA encoding a nonstructural protein of 20 kDa (P20), depends on bamboo mosaic potexvirus (BaMV) for replication and encapsidation. A full-length cDNA clone of satBaMV was used to examine the sequences required for the synthesis of potexvirus subgenomic RNAs (sgRNAs). Subgenomic promoter-like sequences (SGPs), 107 nucleotides (nt) upstream from the capsid protein (CP) gene of BaMV-V, were inserted upstream of the start codon of the P20 gene of satBaMV. Insertion of SGPs gave rise to the synthesis of sgRNA of satBaMV in protoplasts of Nicotiana benthamiana and leaves of Chenopodium quinoa when coinoculated with BaMV-V genomic RNA. Moreover, both the satBaMV cassette and its sgRNA were encapsidated. From analysis of the SGPs by deletion mutation, we concluded that an SGP contains one core promoterlike sequence (nt -30 through +16), two upstream enhancers (nt -59 through -31 and -91 through -60), and one downstream enhancer (nt +17 through +52), when the transcription initiation site is taken as +1. Site-directed mutagenesis and compensatory mutation to disrupt and restore potential base pairing in the core promoter-like sequence suggest that the stem-loop structure is important for the function of SGP in vivo. Likewise, the insertion of a putative SGP of the BaMV open reading frame 2 gene or a heterologous SGP of potato virus X resulted in generation of an sgRNA. The satBaMV cassette should be a useful tool to gain insight into sequences required for the synthesis of potexvirus sgRNAs.

Effects of induction anesthetic agents on outcome of assisted reproductive technology: a comparison of propofol and thiopental sodium

BACKGROUND

The use of propofol, as compared to barbiturates (e.g. thiopental), for short surgical procedures has been associated with more rapid recovery from the procedure. Propofol, an intravenous anesthetic drug, is frequently used as an adjunct to transvaginal oocyte retrieval but little is known about its effects upon fertilization, embryo development, and pregnancy rate when used drug the for induction of general anesthesia. This study was conducted to compare the outcome of assisted reproductive technology (ART) with the use of propofol versus thiopental sodium for the induction of general anesthesia during oocyte retrieval.

METHODS

In this retrospective study, 92 cases of infertile patients who underwent oocyte retrieval under the induction of general anesthesia with, respectively, either propofol (Group I, 72 cases) or thiopental sodium (Group II, 20 cases) were compared for fertilization rate, cleavage rate, and pregnancy rate.

RESULTS

The fertilization rate was 68.9% for Group I and 66.7% for group II (p = 0.614). The cleavage rate was 96.5% for Group I and 94.8% for Group II (p = 0.294). The rate of good embryo grading and poor embryo grading was, respectively, 85.1% and 14.9% for Group I, versus 85.7% and 14.3% for Group II (p = 0.887). The pregnancy rate was 30.5% for Group I and 20.0% for Group II (p = 0.354). The implantation rate and abortion rate was, respectively, 9.1% and 18.2% for Group I versus 7.2% and 25.0% for Group II (implantation rate, p = 0.590; abortion rate, p = 0.600).

CONCLUSION

There were no significant differences between these two groups for fertilization rate, cleavage rate, pregnancy rate, implantation rate and abortion rate. We suggest cautious use of propofol for the procedure of oocyte retrieval despite its associated more rapid post-operative recovery including less nausea/vomiting.

The expression of cytokeratin 18 in transitional cell carcinoma comparing with hepatoma

The epithelium in kidneys and urinary bladders contain CK18 as in liver cells. The modulation of cytokeratin 18 during tumor transformation in hepatoma had been previously recognized through a series of biochemical and immunological approaches. A 14 KD hepatoma related molecules was found in the previous studies. We would like to utilize the hepatoma transformation model to study the changes in CK18 in transitional cell carcinoma, using immunoblotting and western blotting techniques. The result is that transitional cell carcinoma retain their CK18 molecule. Furthermore, CK18 related molecules similar to those seen in hepatoma also present in transitional cell carcinoma. The conclusions are transitional cell carcinoma contains CK18 related proteins similar to those seen in hepatoma tissues. We suggest that this element would be responsible for the change during the malignant transformation processes.

Stabilizing of cytokeratin in PLC/PRF/5 cells

There are two sorted groups of cytokeratin 18 (CK18) in forms of assembly and disassembly in PLC/PRF/5 cells. A subcellular shifting is found in association with conditions of microtubule networks. The finding shows that CK18 mostly in forms of assembly, when microtubule networks are in status. The result also reveals that CK18 is relatively in forms of disassembly, while microtubule networks are disrupted in steps. It indicates that intact microtubule networks are probably a stabilizing factor of assembled CK18. It implies that CK18 is not a stable molecule when the cell is under environmental stress.

Identification and Subgrouping of Cucumber mosaic virus with Mouse Monoclonal Antibodies

ABSTRACT Using a mixture of isolates of Cucumber mosaic virus (CMV) from subgroups I and II as immunogens, 20 mouse hybridoma cell lines secreting monoclonal antibodies were produced. A reliable method for efficient detection and accurate subgrouping of CMV isolates has been developed. Tests with 12 well-characterized strains of CMV and other cucumoviruses demonstrated the presence of epitopes that were virus and subgroup specific. Analyses of 109 accessions of CMV isolates collected from various parts of the world revealed 70% were subgroup I, with 20% identified as subgroup II. Seven isolates (6%) did not react with group-specific antibodies but did react with antibodies that recognized all CMV isolates. Differential reactions among isolates suggested a total of 10 epi-topes were recognized. The antigenic diversity among subgroup II CMVs was greater than for the subgroup I isolates, even though fewer subgroup II isolates were tested.

The DCC protein expression in breast carcinoma

Inactivation of the gene "deleted in colon cancer" (DCC) on chromosome 18 is known to be associated with the tumorigenesis and metastasis of colorectal cancer. In the present study, we investigated the expression of DCC, P53 and HER-2/neu product in surgical specimens from 79 patients with invasive breast cancer by immunohistochemistry staining and found the expression of DCC to be decreased in 42 tumors (52%). Overexpression of HER-2/neu and P53 was detected in 29 (36.8%) and 26 (32.9%) of this 79 breast cancer specimens, respectively. To evaluate the outcomes of the 79 breast cancer patients, we followed up the patients during the period from May 1990 to August 1998. The average length of follow-up was 52 months (ranging from 4 to 94 months). Patients with tumors having a combination of DCC-negative and HER-2/neu overexpression showed a marginal influence on survival time of breast cancer (P = 0.06). However, patients with tumors having a combination of DCC-negative and P53 overexpression showed no influence of these on survival time of breast cancer (P = 0.36). These findings suggest that a decreased DCC expression and HER-2/neu overexpression may influence the prognosis of breast cancer.

TT virus infection among hemodialysis patients at a medical center in Taiwan

Although the association between TT virus (TTV) infection and hepatitis is controversial, the high prevalence of TTV infection in healthy blood donors and even higher rate among frequently transfused patients poses a potential threat to public health and clinical care. In addition, there is a lack of data concerning the prevalence and mode of transmission of TTV infection in different subpopulations in Taiwan. In the present study, we investigated the prevalence of TTV infection in 111 uremic patients receiving regular hemodialysis in a single hospital in Taiwan. Blood samples were collected and analyzed using a seminested polymerase chain reaction (PCR) designed to amplify a 271 base-pair DNA fragment. The results show that the overall TTV positive rate in uremic patients in our hospital was 61% (68/111), which was much higher than the reported TTV prevalence rate among the normal population (ranging from 1%-12%). The results of analysis of the demographic and clinical characteristics of the patients indicate that blood transfusion may play an important role in TTV transmission (p < 0.05). In addition, the hepatitis B positive rate was significantly lower in TTV positive patients. However, liver function tests were not significantly different between TTV positive and TTV negative patients. The results of the present study suggest that blood transfusion plays an important role in TTV transmission in uremic patients.

Biological responses of dog prostate and adjacent structures after meso-tetra-(m-hydroxyphenyl) chlorin and aluminum disulfonated phthalocyanine based photodynamic therapy

Further to our work on the feasibility of application of photodynamic therapy (PDT) to the canine prostate, this study evaluates the biological responses of the prostate and adjacent vital structures with meso-tetra-(m-hydroxylphenyl) chlorin (mTHPC) or aluminum disulfonated phthalocyanine (AlS2Pc) based PDT as a preparatory step for clinical trials. Skin photosensitivity was not particularly problematic if light protection could be implemented properly for 2 weeks following sensitization. Prostate PDT was well tolerated by the experimental animals with only minor physical distress. mTHPC was more powerful than AlS2Pc in terms of prostate lesions induced. A large portion of prostate tissue could be destroyed by PDT with 4 punctures. Physical distress was probably caused by severe urethral irritation and aching from acute swelling of the prostate. Although the voiding condition normalized within 10 days, regeneration of urethral epithelium was not complete until 3-4 weeks after PDT. Improper placement of laser fiber caused extensive ecchymosis of the retroperitoneal organs. The biological significance of PDT induced hyperemia in the periprostatic structures remains poorly defined. Neither periprostatic nerve damage nor rectal lesions were seen in dogs receiving either mTHPC or AlS2Pc. Glandular atrophy with papillary cystic regeneration of the prostate was the most prominent finding 90 days after PDT. The glandular architecture was well preserved because the interlobular collagens were less affected than the cellular components of the glands. Our study suggests that PDT with mTHPC and AlS2Pc is safe and promising for necrosing a substantial amount of prostate tissue. The completeness of treatment and long-term therapeutic effectiveness for prostate cancer, however, remains to be determined through further investigation.

Identification of the RNA-binding sites of the triple gene block protein 1 of bamboo mosaic potexvirus

The triple gene block protein 1 (TGBp1) encoded by open reading frame 2 of bamboo mosaic potexvirus (BaMV) was overexpressed in Escherichia coli and purified in order to test its RNA-binding activity. UV crosslinking assays revealed that the RNA-binding activity was present mainly in the soluble fraction of the refolded TGBp1. The binding activity was nonspecific and salt concentration-dependent: activity was present at 0-50 mM NaCl but was almost abolished at 200 mM. The RNA-binding domain was located by deletion mutagenesis to the N-terminal 3-24 amino acids of TGBp1. Sequence alignment analysis of the N-terminal 25 amino acids of the TGBp1 homologues of potexviruses identified three arginine residues. Arg-to-Ala substitution at any one of the three arginines eliminated most of the RNA-binding activity, indicating that they were all critical to the RNA-binding activity of the TGBp1 of BaMV.

Bamboo mosaic potexvirus satellite RNA (satBaMV RNA)-encoded P20 protein preferentially binds to satBaMV RNA

A satellite RNA of 836 nucleotides [excluding the poly(A) tail] depends on the bamboo mosaic potexvirus (BaMV) for its replication and encapsidation. The BaMV satellite RNA (satBaMV) contains a single open reading frame encoding a 20-kDa nonstructural protein (P20). The P20 protein with eight histidine residues at the C terminus was overexpressed in Escherichia coli. Experiments of gel retardation, UV cross-linking, and Northwestern hybridization demonstrated that purified P20 was a nucleic-acid-binding protein. The binding of P20 to nucleic acids was strong and highly cooperative. P20 preferred binding to satBaMV- or BaMV-related sequences rather than to nonrelated sequences. By deletion analysis, the P20 binding sites were mainly located at the 5' and 3' untranslated regions of satBaMV RNA, and the RNA-protein interactions could compete with the poly(G) and, less efficiently, with the poly(U) homopolymers. The N-terminal arginine-rich motif of P20 was the RNA binding domain, as shown by in-frame deletion analysis. This is the first report that a plant virus satellite RNA-encoded nonstructural protein preferentially binds with nucleic acids.

Sufficient length of a poly(A) tail for the formation of a potential pseudoknot is required for efficient replication of bamboo mosaic potexvirus RNA

RNAs transcribed from a full-length infectious cDNA clone of the bamboo mosaic potexvirus (strain O) genome, pBaMV-O, were infectious to Nicotiana benthamiana plants. Mutant genomes in which the poly(A) tail is absent or replaced by a 3' tRNA-like structure from turnip yellow mosaic virus RNA failed to amplify detectably in N. benthamiana protoplasts. No amplification was detected in protoplasts inoculated with transcripts containing 4, 7, or 10 adenylate residues at the 3' end, whereas transcript inocula with 15 adenylate residues resulted in coat protein accumulation to a level 26% of that resulting from inoculation with transcripts with 25 adenylate residues (designated as wild type). Coat protein accumulation levels of 69 and 98% relative to wild type were observed after inoculation of protoplasts with transcripts bearing poly(A) tails 18 and 22 nucleotides long, respectively. The presence of a putative 3' pseudoknot structure including at least 13 adenylate residues of the 3'-terminal poly(A) tail was supported by enzymatic and chemical structural analysis. The functional relevance of this putative pseudoknot was tested by mutations that affected basepairing within the pseudoknot. These results support the existence of functional 3' pseudoknot that includes part of the 3' poly(A) tail.

Clinical experience with endoscopic stents for treatment of common bile duct stones

Endoscopic removal of common bile duct (CBD) stones after endoscopic sphincterotomy (EST) is now a widely accepted procedure. Surgery is usually recommended when extraction of stones after EST fails. For patients with major medical problems or who are at high surgical risk, however, endoscopic stent placement may help to prevent stone impaction and cholangitis. In this report, we describe the long-term effects and complications of biliary stent use in elderly patients with CBD stones. From August 1995 to June 1998, 19 patients with CBD stones underwent stent placement by duodenoscopy. Three of these patients underwent this procedure for temporary treatment while awaiting surgery or EST. In the remaining 16 patients (6 men and 10 women, mean age 76 +/- 10 years), invasive management carried a high risk of complications. We used a 7F straight stent for the first patient, while the remaining 15 received 7F pigtail stents. During a mean follow-up period of 34 months, two patients were lost to follow-up and two patients had migration of the stents. Three patients had acute cholangitis with stents in situ. Of these, one underwent stent exchange 8 months later, while the CBD stones were cleared either by endoscopy or surgery in the other two patients. Five patients died of nonbiliary diseases during the follow-up period. Our results show that long-term biliary stent placement is an advisable alternative therapeutic modality for high-risk and debilitated patients with CBD stones.

A defective RNA associated with bamboo mosaic virus and the possible common mechanisms for RNA recombination in potexviruses

A naturally occurring 1.1 kb RNA was isolated from purified virions of bamboo mosaic potexvirus isolate S (BaMV-S). This RNA is a defective RNA (D RNA) derived from a single internal deletion of the BaMV genome. A cDNA clone representing the complete nucleotide sequence of the BaMV-S D RNA was generated and its nucleotide sequence was determined. The BaMV D cDNA is 1015 nts in length [excluding the poly(A) tail] and consists of two regions corresponding to 867 nts of the 5' terminus and 148 nts of the 3' terminus of the BaMV genomic RNA. BaMV D cDNA contains a single open reading frame (ORF) encoding a putative 29.7 kDa protein comprised of a fusion of the first 258 amino acids of BaMV ORF 1 and the last 2 amino acids of coat protein. The coding capacity of D RNA was verified by in vitro translation of native BaMV-S D RNA and of 1.1 kb RNA transcribed in vitro from the full-length D cDNA. BaMV D RNA can be reproducibly generated by serial passages of BaMV-S in Nicotiana benthamiana and is the first D RNA in the potexvirus group shown to be generated de novo. Alignments of sequences surrounding the 5' and 3' junction borders of reported potexvirus D RNAs reveal a 65.2-84.6% sequence identity, suggesting that common mechanisms for viral RNA recombination are involved in the generation of potexvirus D RNAs.

Identification and characterization of the Escherichia coli-expressed RNA-dependent RNA polymerase of bamboo mosaic virus

Bamboo mosaic virus (BaMV), a member of the potexvirus group, infects primarily members of the Bambusoideae. The open reading frame 1 (ORF1) of BaMV encodes a 155-kDa polypeptide that was postulated to be involved in the replication and the formation of cap structure at the 5' end of the viral genome. To characterize the activities associated with the 155-kDa viral protein, it was expressed in Escherichia coli BL21(DE3) cells with thioredoxin, hexahistidine, and S. Tag fused consecutively at its amino terminus, and the fusion protein was purified by metal affinity chromatography. Several RNA fragments, prepared by in vitro transcription, were tested as substrates for the RNA-dependent RNA polymerase (RdRp) activity. Among them, the expressed fusion enzyme was able to generate a 32P-labeled RNA product when 3'-end RNA fragments of the positive strand or negative strand of BaMV were included in the assay mixture. Dot hybridization assay revealed that the reaction products are complementary to their RNA substrates. Taken together, the evidence suggests that the 155-kDa protein encoded by ORF1 of BaMV has an RdRp activity and should be involved in the replication of BaMV. Mutational analyses demonstrate the importance of the GDD motif in the polymerase activity, and deletion studies suggest that the polymerase activity resides in the carboxyl terminus of the 155-kDa viral protein.

Subgenomic RNAs of bamboo mosaic potexvirus-V isolate are packaged into virions

Purified virions of bamboo mosaic potexvirus-V isolate (BaMV-V) were found to contain three major RNA species, the 6.4 kb genomic RNA and two RNAs of 2.0 and 1.0 kb, in addition to associated satellite RNA (0.85 kb). Results of Northern blot hybridization, primer extension analysis and cDNA sequencing showed that the packaged 2.0 and 1.0 kb RNAs of BaMV-V were subgenomic RNAs. In contrast, in the BaMV-O isolate, only genomic RNA was packaged and encapsidated subgenomic RNAs were not detectable. The transcription initiation sites for the 2.0 and 1.0 kb subgenomic RNAs of BaMV-V were located 1 1 and 16 nt upstream of the initiation codon of open reading frames (ORFs) 2 and 5, respectively. The 2.0 and 1.0 kb subgenomic RNAs functioned as messengers for the ORF2 protein and capsid protein, respectively. Packaging of the 1.0 kb subgenomic RNAs resulted in the formation of rod-shaped particles about 70 nm in length. Our results indicate that BaMV isolates have evolved distinctly for packaging of subgenomic RNAs.

Focal segmental glomerulosclerosis after poststreptococcal glomerulonephritis in the elderly: a case report

Acute poststreptococcal glomerulonephritis (PSGN) is quite rare in the elderly population. It is very difficult to recognize because the initial symptoms are similar to those of more common diseases of this age group. Compared with younger patients, elderly patients with PSGN tend to have a high incidence of renal function impairment and anuria or prolonged oliguria. Recovery from acute PSGN in the elderly is less predictable than in children and younger adults, especially when associated with severe impairment of renal function. We present the case of an elderly patient with PSGN, who had a skin infection of the face and anuria on admission. Percutaneous left renal biopsy was performed in the initial hospitalization period and in the recovery phase of the disease. Renal function recovered within two months. However, increased urinary white blood cell sediments with normal serum creatinine concentrations persisted in the successive three years of follow-up. Renal biopsy was repeated and showed evidence of focal segmental glomerulosclerosis.

Intracranial meningeal melanocytoma: CT and MRI

We report the MRI and CT findings of an intracranial meningeal melanocytoma (IMM) arising from Meckel's cave and review the imaging characteristics of IMM. On CT, IMM constantly appear as well-circumscribed, isodense to slightly dense, extra-axial tumours with homogeneous contrast enhancement. This appearance is non-specific and similar to that of meningiomas or small neuromas. On MRI, the signal of IMM is strongly related to the amount of melanin pigment: the more melanin, the more shortening of T1 and T2 relaxation times. Only when it shows as a homogeneous mass, bright on T1 and dark on T2 weighting, can a specific diagnosis of a melanin-containing tumour be made. However, this still cannot provide a distinction between IMM and malignant meningeal melanoma.

Dose-response relationship between prevalence of cerebrovascular disease and ingested inorganic arsenic

BACKGROUND AND PURPOSE

Circulatory diseases such as ischemic heart disease and peripheral vascular disease induced by long-term arsenic exposure have been well documented in previous studies, but the dose-response relationship between cerebrovascular disease and ingested inorganic arsenic remains to be elucidated. The prevalence of cerebrovascular disease among residents of the Lanyang Basin on the northeast coast of Taiwan was surveyed to examine its association with exposure to arsenic in well water.

METHODS

A total of 8102 men and women from 3901 households were recruited in this study. The status of cerebrovascular disease of study subjects was identified through home-visit personal interviews and ascertained by review of hospital medical records according to the World Health Organization criteria. Information on consumption of well water, sociodemographic characteristics, cigarette smoking, and alcohol consumption habits, as well as personal and family history of diseases, was also obtained. Arsenic concentration in the well water of each household was determined by hydride generation and atomic absorption spectrometry. Logistic regression analysis was used to estimate multivariate-adjusted odds ratios and 95% confidence intervals for various risk factors of cerebrovascular disease.

RESULTS

A significant dose-response relationship was observed between arsenic concentration in well water and prevalence of cerebrovascular disease after adjustment for age, sex, hypertension, diabetes mellitus, cigarette smoking, and alcohol consumption. The biological gradient was even more prominent for cerebral infarction, showing multivariate-adjusted odds ratios of 1.0, 3.4, 4.5, and 6.9, respectively, for those who consumed well water with an arsenic content of 0, 0.1 to 50.0, 50.1 to 299.9, and > 300 micrograms/L.

CONCLUSIONS

Long-term exposure to inorganic arsenic from well water was associated with an increased prevalence of cerebrovascular disease, especially cerebral infarction.