Measurement of Total Starch in Cereal Products by Amyloglucosidase-α-Amylase Method: Collaborative Study

American Association of Cereal Chem- ists/AOAC collaborative study was conducted to evaluate the accuracy and reliability of an enzyme assay kit procedure for measurement of total starch in a range of cereal grains and products. The flour sample is incubated at 95°C with thermostable α-amylase to catalyze the hydrolysis of starch to maltodextrins, the pH of the slurry is adjusted, and the slurry is treated with a highly purified amyloglucosidase to quantitatively hydrolyze the dextrins to glucose. Glucose is measured with glucose oxidase-peroxidase reagent. Thirty-two collaborators were sent 16 homogeneous test samples as 8 blind duplicates. These samples included chicken feed pellets, white bread, green peas, high- amylose maize starch, white wheat flour, wheat starch, oat bran, and spaghetti. All samples were analyzed by the standard procedure as detailed above; 4 samples (high-amylose maize starch and wheat starch) were also analyzed by a method that requires the samples to be cooked first in dimethyl sulfoxide (DMSO). Relative standard deviations for repeatability (RSDr) ranged from 2.1 to 3.9%, and relative standard deviations for reproducibility (RSDr) ranged from 2.9 to 5.7%. The RSDr value for high amylose maize starch analyzed by the standard (non-DMSO) procedure was 5.7%; the value

BIOIMPEDANCE SPECTROSCOPY IS NOT ASSOCIATED WITH A CLINICAL DIAGNOSIS OF BREAST CANCER-RELATED LYMPHEDEMA

The objective of this study was to evaluate the accuracy of bioimpedance spectroscopy measurements (L-Dex) in the diagnosis of breast cancer-related lymphedema. A retrospective review of a prospectively maintained database was performed of all patients that underwent surgical treatment for breast cancer at a tertiary medical center. Patients who had preoperative and postoperative evaluation for possible lymphedema by limb circumference measurements and bioimpedance were eligible for inclusion in the study. No significant demographic differences were found between the group of patients clinically diagnosed with lymphedema (N=134) and those without a clinical diagnosis of lymphedema (N=261). The ability of bioimpedance to diagnose lymphedema based on the manufacturer's criteria demonstrated low sensitivity, which was 7.5% when lymphedema was defined as an absolute L-Dex value greater than 10, and 24.6% when defined as a relative change of >10 between preoperative and postoperative measurements. This corresponded with a positive predictive value of 61-71% and a negative predictive value of 67-70%. We are unable to recommend the use of bioimpedance as a screening tool or for measurement of breast cancer-related lymphedema.

Bioimpedance spectroscopy is not associated with a clinical diagnosis of breast cancer-related lymphedema

The objective of this study was to evaluate the accuracy of bioimpedance spectroscopy measurements (L-Dex) in the diagnosis of breast cancer-related lymphedema. A retrospective review of a prospectively maintained database was performed of all patients that underwent surgical treatment for breast cancer at a tertiary medical center. Patients who had preoperative and postoperative evaluation for possible lymphedema by limb circumference measurements and bioimpedance were eligible for inclusion in the study. No significant demographic differences were found between the group of patients clinically diagnosed with lymphedema (N=134) and those without a clinical diagnosis of lymphedema (N=261). The ability of bioimpedance to diagnose lymphedema based on the manufacturer's criteria demonstrated low sensitivity, which was 7.5% when lymphedema was defined as an absolute L-Dex value greater than 10, and 24.6% when defined as a relative change of >10 between preoperative and postoperative measurements. This corresponded with a positive predictive value of 61-71% and a negative predictive value of 67-70%. We are unable to recommend the use of bioimpedance as a screening tool or for measurement of breast cancer-related lymphedema.

Vega is a rapidly rotating star

Vega, the second brightest star in the northern hemisphere, serves as a primary spectral type standard. Although its spectrum is dominated by broad hydrogen lines, the narrower lines of the heavy elements suggested slow to moderate rotation, giving confidence that the ground-based calibration of its visible spectrum could be safely extrapolated into the ultraviolet and near-infrared (through atmosphere models), where it also serves as the primary photometric calibrator. But there have been problems: the star is too bright compared to its peers and it has unusually shaped absorption line profiles, leading some to suggest that it is a distorted, rapidly rotating star seen pole-on. Here we report optical interferometric observations that show that Vega has the asymmetric brightness distribution of the bright, slightly offset polar axis of a star rotating at 93 per cent of its breakup speed. In addition to explaining the unusual brightness and line shape peculiarities, this result leads to the prediction of an excess of near-infrared emission compared to the visible, in agreement with observations. The large temperature differences predicted across its surface call into question composition determinations, adding uncertainty to Vega's age and opening the possibility that its debris disk could be substantially older than previously thought.

The combined effects of novel tocotrienols and lovastatin on lipid metabolism in chickens

Both lovastatin (a fungal product) and a tocotrienol rich fraction (TRF(25), a mixture of tocols isolated from stabilized and heated rice bran containing desmethyl [d-P(21)-T3] and didesmethyl [d-P(25)-T3] tocotrienols) are potent hypocholesterolemic agents, although they suppress cholesterol biosynthesis by different mechanisms. To determine additive and/or synergistic effects of both agents, chickens were fed diets supplemented with 50 ppm TRF(25) or d-P(25)-T3 in combination with 50 ppm lovastatin for 4 weeks. Combinations of d-P(25)-T3 with lovastatin were found most effective in reducing serum total cholesterol and low-density lipoprotein (LDL) cholesterol compared to the control diet or individual supplements. The mixture of TRF(25)+lovastatin inhibited the activity of beta-hydroxy-beta-methylglutaryl coenzymeA reductase (21%) compared to lovastatin alone, which did not change its activity. Cholesterol 7alpha-hydroxylase activity was increased by lovastatin (11%) and by lovastatin plus TRF(25) (19%). TRF(25)+lovastatin decreased levels of serum total cholesterol (22%), LDL cholesterol (42%), apolipoprotein B (13-38%), triglycerides (19%), thromboxane B(2) (34%) and platelet factor 4 (26%), although high-density lipoprotein (HDL) cholesterol, and apolipoprotein A1 levels were unaffected. The mixture of TRF(25)+lovastatin showed greater effects than did the individual treatments alone, reflecting possible additive pharmacological actions. The effects, however, of the d-P(25)-T3/lovastatin combination were no greater than that of d-P(25)-T3 alone, possibly indicating that d-P(25)-T3 produced a maximum cholesterol lowering effect at the concentration used.

Novel tocotrienols of rice bran suppress cholesterogenesis in hereditary hypercholesterolemic swine

A tocotrienol-rich fraction (TRF(25)) and novel tocotrienols (d-P(21)-T3 and d-P(25)-T3) of rice bran significantly lowered serum and low density lipoprotein cholesterol levels in chickens. The present study evaluated the effects of novel tocotrienols on lipid metabolism in swine expressing hereditary hypercholesterolemia. Fifteen 4-mo-old genetically hypercholesterolemic swine were divided into five groups (n = 3). Four groups were fed a corn-soybean control diet, supplemented with 50 microg of either TRF(25), gamma-tocotrienol, d-P(21)-T3 or d-P(25)-T3 per g for 6 wk. Group 5 was fed the control diet for 6 wk and served as a control. After 6 wk, serum total cholesterol was reduced 32-38%, low density lipoprotein cholesterol was reduced 35-43%, apolipoprotein B was reduced 20-28%, platelet factor 4 was reduced 12-24%, thromboxane B(2) was reduced 11-18%, glucose was reduced 22-25% (P<0.01), triglycerides were reduced 15-19% and glucagon was reduced 11-17% (P<0.05) in the treatment groups relative to the control. Insulin was 100% greater (P<0.01) in the treatment groups than in the control group. Preliminary data (n = 1) indicated that hepatic activity of the 3-hydroxy-3-methylglutaryl-coenzyme A reductase was lower in the treatment groups, and cholesterol 7alpha-hydroxylase activity was unaffected. Cholesterol and fatty acid levels in various tissues were lower in the treatment groups than in control. After being fed the tocotrienol-supplemented diets, two swine in each group were transferred to the control diet for 10 wk. The lower concentrations of serum lipids in these four treatment groups persisted for 10 wk. This persistent effect may have resulted from the high tocotrienol levels in blood of the treatment groups, suggesting that the conversion of tocotrienols to tocopherols may not be as rapid as was reported in chickens and humans.

Isolation and identification of novel tocotrienols from rice bran with hypocholesterolemic, antioxidant, and antitumor properties

Two novel tocotrienols were isolated from stabilized and heated rice bran, apart from the known alpha-, beta-, gamma-, and delta-tocopherols and tocotrienols. These new tocotrienols were separated by HPLC, using a normal phase silica column. Their structures were determined by ultraviolet, infrared, nuclear magnetic resonance, circular dichroism, and high-resolution mass spectroscopies and established as desmethyl tocotrienol [3, 4-dihydro-2-methyl-2-(4,8,12-trimethyltrideca-3'(E),7'(E), 11'-trienyl)-2H-1-benzopyran-6-ol] and didesmethy tocotrienol [3, 4-dihydro-2-(4,8,12-trimethyltrideca-3'(E),7'(E), 11'-trienyl)-2H-1-benzopyran-6-ol]. These tocotrienols significantly lowered serum total and LDL cholesterol levels and inhibited HMG-CoA reductase activity in chickens. They had much greater in vitro antioxidant activities and greater suppression of B16 melanoma cell proliferation than alpha-tocopherol and known tocotrienols. Results indicated that the number and position of methyl substituents in tocotrienols affect their hypocholesterolemic, antioxidant, and antitumor properties.

Antioxidant capacity of oat (Avena sativa L.) extracts. 2. In vitro antioxidant activity and contents of phenolic and tocol antioxidants

Oat milling fractions were examined for concentrations of total phenolics, tocols, and phenolic acids and in vitro antioxidant activity to determine their potential as dietary antioxidants. Methanolic extracts of pearling fractions, flour and aspirations from flaking, and trichomes had high, intermediate, and low antioxidant activities, respectively, evaluated by the beta-carotene bleaching method. Pearling fractions were also highest in total phenolics and tocols. p-Hydroxybenzoic acid, vanillic acid, caffeic acid, vanillin, p-coumaric acid, and ferulic acid were identified and quantified by HPLC. Three avenanthramides and an unidentified ferulate derivative were also detected. Total phenolic content was significantly correlated with antioxidant activity, and regression equations that predicted antioxidant activity from phenolic and tocol concentrations were calculated. Antioxidant activity, evaluated by beta-carotene bleaching, was correlated with measures of oxygen radical absorbance capacity and low-density lipoprotein oxidation. These data indicate a potential for oat products, especially those enriched in outer layers of the groat, to contribute to dietary intakes of antioxidant phytonutrients.

Correlation of quantitative bone marrow and blood cultures in AIDS patients with disseminated Mycobacterium avium complex infection

The relationship between Mycobacterium avium complex (MAC) infection of blood and bone marrow was studied in human immunodeficiency virus-infected patients before and during treatment. Quantitative cultures were obtained at baseline from 17 persons with newly detected MAC bacteremia. Serial blood cultures were obtained, and a second bone marrow sample was obtained at 4 or 8 weeks. At baseline, the median MAC load in bone marrow core samples was 3 log10 higher than in blood. Bone marrow MAC loads ranged widely (866-847,315 cfu/g), and no significant correlation was found between MAC load in blood and that in bone marrow core samples. MAC loads in bilateral bone marrow biopsy samples from 7 subjects were highly correlated. MAC loads declined in blood and bone marrow at similar rates during therapy, but blood was sterilized before bone marrow. Length of survival was inversely associated with initial bone marrow core MAC load but not with blood MAC load. Initiation of treatment when tissue MAC load is low may increase the likelihood of favorable clinical outcome.

Application of a birdcage coil at 3 Tesla to imaging of the human knee using MRI

A transceive RF birdcage coil designed for very high field with a novel matching scheme was implemented with the specific geometry chosen for the human knee. This coil design incorporates a hinge for greater patient accessibility. Volunteer human subjects were studied using spin-echo and 3D gradient echo sequences for image acquisition. The higher signal-to-noise and improved tissue contrast obtained from this high-field system, coupled with the optimized coil design, improves visualization of the structural detail in articular cartilage, which is not seen well at conventional field strengths. This has important clinical implications, as newer medical and surgical treatments become available for the treatment of early cartilage degeneration. Magn Reson Med 42:215-221, 1999.

HIV-1-specific CD4+ T cells are detectable in most individuals with active HIV-1 infection, but decline with prolonged viral suppression

The role of HIV-1-specific CD4+ T-cell responses in controlling HIV-1 infection remains unclear. Previous work has suggested that such cells are eliminated in the early stages of infection in most subjects, and thus cannot substantially contribute to host defense against HIV-1. Here, using flow cytometric detection of antigen-induced intracellular cytokines, we show that significant frequencies of gag specific, T-helper-1 CD4+ memory T cells are detectable in most subjects with active/progressive HIV-1 infection (median frequency, 0.12% of memory subset; range, 0-0.66%). Median frequencies of these cells were considerably higher in nonprogressive HIV-1 disease (0.40%), but there was substantial overlap between the two groups (range of nonprogressors, 0.10-1.7%). Continuous HIV-1 suppression with anti-retroviral therapy was associated with a time-dependent reduction in median frequencies of gag-specific CD4+ memory T cells: 0.08% in subjects treated for 4-24 weeks, and 0.03% in subjects treated for 47-112 weeks. Thus, functional HIV-1-specific CD4+ T cells are commonly available for support of anti-HIV-1 effector responses in active disease, but their decline with anti-retroviral therapy indicates that immunologic participation in long-term HIV-1 control will probably require effective vaccination strategies.

Integrated RF coil with stabilization for fMRI human cortex

Functional brain imaging of the human cortex is limited by poor contrast to noise ratio (CNR) and image degradation due to subject motion during the acquisition period. The work described here combines the use of closely coupled phased array receiver coils with a stabilization system to address these needs. Several phased array designs are evaluated and compared with the conventional "birdcage" design. Coil performance is reported in terms of relative SNR and fMRI results. Relative improvements of up to 360% are obtained for the occipital region and 180% in the temporal region. More modest gains of 10-30% were obtained for a "dome"-shaped birdcage volume coil covering the entire cortex.

Determination of antigen-specific memory/effector CD4+ T cell frequencies by flow cytometry: evidence for a novel, antigen-specific homeostatic mechanism in HIV-associated immunodeficiency

The highly regulated secretion of effector cytokines by CD4+ T cells plays a critical role in immune protection against pathogens such as cytomegalovirus. Here, we directly compare the frequency and functional characteristics of cytomegalovirus-specific CD4+ memory/effector T cells in normal and HIV+ subjects using a novel, highly efficient multiparameter flow cytometric assay that detects the rapid intracellular accumulation of cytokine(s) after short-term (6 h) in vitro antigen stimulation. Responses in this assay correlate precisely with independent measures of sensitization history (e.g., seroreactivity), and allow the simultaneous assessment of multiple cytokines in single effector T cells. Healthy HIV- individuals manifested an average of 0.71, 0.72, 0.38, and 0.06% CD4+ T cells responding to cytomegalovirus with gamma-IFN, TNF-alpha, IL-2, and IL-4 production, respectively, with the simultaneous production of gamma-IFN, TNF-alpha, and IL-2 being the most common effector phenotype. Significantly, overall cytomegalovirus-specific CD4+ effector frequencies were markedly higher among 40% of HIV+ subjects (2.7-8.0%), and demonstrated a predominately polarized gamma-IFN+/TNF-alpha+/IL-2-/IL-4- phenotype. In contrast, CD4+ effector frequencies for heterologous, nonubiquitous viruses such as the mumps virus were low or absent in the HIV+ group. These data suggest the existence of homeostatic mechanisms in HIV disease that selectively preserve memory T cell populations reactive with ubiquitous pathogens such as cytomegalovirus-likely at the expense of T cell memory to more sporadically encountered infectious agents.

Amaranth and its oil inhibit cholesterol biosynthesis in 6-week-old female chickens

All amaranth varieties contain tocotrienols and squalene compounds which are known to affect cholesterol biosynthesis. Therefore, in the present study, the influence of dietary supplementation of whole seed, popped, and milled amaranth and amaranth oil on cholesterogenesis was studied in 6-wk-old female chickens. Serum total cholesterol and LDL-cholesterol were lowered 10-30% and 7-70% (P < 0.01), respectively, in birds fed amaranth-containing diets. HDL-cholesterol was not affected by amaranth supplementation. Activities of liver cholesterol 7alpha-hydroxylase (the enzyme responsible for cholesterol breakdown into bile acids) were 10-18% higher (P < 0.01) than those of controls for birds fed most forms of amaranth and its oil, whereas activities of liver 3-hydroxy-3-methylglutaryl coenzyme A reductase (the rate-limiting enzyme for cholesterol biosynthesis) were lowered by about only 9% (P < 0.01) by popped, milled amaranth and its oil. This lack of marked inhibition of this enzyme suggests the presence of some other potent cholesterol inhibitor(s) apart from tocotrienols and squalene in amaranth.

Dietary alpha-tocopherol attenuates the impact of gamma-tocotrienol on hepatic 3-hydroxy-3-methylglutaryl coenzyme A reductase activity in chickens

The concentration-dependent impact of gamma-tocotrienol on serum cholesterol can be traced to the posttranscriptional down-regulation of 3-hydroxy-3-methylglutaryl coenzyme A reductase activity. gamma-Tocotrienol also suppresses tumor growth. Palmvitee, the tocopherol and tocotrienol-rich fraction of palm oil, is the sole commercial source of gamma-tocotrienol. Contrary to the universal findings of the efficacy of gamma-tocotrienol there are conflicting reports of the impact of Palmvitee on 3-hydroxy-3-methylglutaryl coenzyme A reductase activity, serum cholesterol concentrations and tumor development. These conflicting reports led us to examine the impact of alpha-tocopherol on the cholesterol-suppressive action of gamma-tocotrienol. Control and experimental diets were fed to groups of White Leghorn chickens (n = 10) for 26 d. The control diet was supplemented with 21 nmol alpha-tocopherol/g. All experimental diets provided 141 nmol of blended tocols/g diet. The alpha-tocopherol and gamma-tocotrienol concentrations of the experimental diets ranged from 21 to 141 and 0 to 120 nmol/g, respectively. We now report that including alpha-tocopherol in tocol blends containing adequate gamma-tocotrienol to suppress 3-hydroxy-3-methylglutaryl coenzyme A reductase activity results in an attenuation of the tocotrienol action (P < 0.001). A summary of results from studies utilizing different Palmvitee preparations shows that effective preparations consist of 15-20% alpha-tocopherol and approximately 60% gamma- (and delta-) tocotrienol, whereas less effective preparations consist of > or = 30% alpha-tocopherol and 45% gamma- (and delta-) tocotrienol.

Response of hypercholesterolemic subjects to administration of tocotrienols

The cholesterol-suppressive actions of Palmvitee and gamma-tocotrienol were assessed in hypercholesterolemic subjects after acclimation to the American Heart Association Step 1 dietary regimen for four and eight weeks, respectively. The four-week dietary regimen alone elicited a 5% decrease (P < 0.05) in the cholesterol level of the 36 subjects. Subjects continuing on the dietary regimen for a second four-week period experienced an additional 2% decrease in their cholesterol levels. Dietary assessments based on unanticipated recalls of 24-h food intake records suggest that significant reductions in energy and fat, predominantly in saturated fat, intakes are responsible. The subjects experienced significant Palmvitee- and gamma-tocotrienol-mediated decreases in cholesterol. The group of subjects acclimated to the dietary regimen for four weeks responded to Palmvitee (a blend of tocols providing 40 mg alpha-tocopherol, 48 mg alpha-tocotrienol, 112 mg gamma-tocotrienol, and 60 mg delta-to-cotrienol/day for four weeks) with a 10% decrease in cholesterol (P < 0.05). Dietary assessments showed no further change in energy and fat intakes. alpha-Tocopherol attenuated the cholesterol-suppressive action of the tocotrienols. The second group of subjects, acclimated to the dietary regimen for eight weeks, received 200 mg gamma-tocotrienol/d for four weeks. The cholesterol-suppressive potency of this alpha-tocopherol-free preparation was calculated to be equivalent to that of the mixture of tocotrienols (220 mg) used in the prior study. Cholesterol levels of the 16 subjects in the second group decreased 13% (P < 0.05) during the four-week trial. Plasma apolipoprotein B and ex vivo generation of thromboxane B2 were similarly responsive to the tocotrienol preparations, whereas neither preparation had an impact on high density lipoprotein cholesterol and apolipoprotein A-1 levels.

Noncovalent binding of a mitomycin C metabolite, 2,7-diaminomitosene, to duplex DNA

The major metabolite of mitomycin C, 2,7-diaminomitosene (DAM), interacts noncovalently with DNA. This was supported by ultraviolet-visible spectrum changes upon mixing with DNA and ethidium bromide displacement from DNA, measured as fluorescence changes. Moreover, DAM bound to DNA sufficiently strongly to hold DNA in a double stranded conformation under denaturing gel electrophoresis conditions commonly used to measure mitomycin C cross-links. These data show that generation of DAM and interaction with DNA represent a potential additional mechanism of DNA damage induced by mitomycin C.

Dose-related activity of stavudine in patients infected with human immunodeficiency virus

In a multicenter, randomized, open-label, dose-ranging study to determine the relative effects of three dose levels of stavudine on CD4 lymphocyte count, weight gain, and hematologic variables in patients infected with human immunodeficiency virus (HIV), 152 patients with CD4 lymphocyte counts < or = 600/mm3 received stavudine at 0.1 mg/kg/day (n = 51), 0.5 mg/kg/day (n = 53), or 2.0 mg/kg/day (n = 48). The study was designed to evaluate the activity of stavudine after 10 weeks of therapy and permitted extended dosing and follow-up for long-term safety. A significant dose effect on increases in CD4 lymphocyte counts and declines in HIV titer in peripheral blood mononuclear cells was observed. Stavudine was well-tolerated; the only dose-related, dose-limiting adverse event was peripheral neuropathy, which usually was reversible. In this trial, the most favorable therapeutic index was seen at 0.5 mg/kg/day.

A review of 'The Health Security Act of 1993'

The Health Security Act of 1993, which is now before Congress, holds the potential to effect major changes in the way health care is delivered in this country and in how that delivery is financed. This article reviews the principal provisions proposed to be contained in the act (as presented in the preliminary summary released in September 1993) and offers suggestions regarding the issues that hospital financial managers should begin addressing now.

Logarithmic relationship of the CD4 count to survival in patients with human immunodeficiency virus infection

BACKGROUND

Survival, and the incidence of events that define the acquired immunodeficiency syndrome (AIDS), are known to be inversely related to the CD4 count in patients with human immunodeficiency virus infection. We wished to quantify this relationship more precisely, particularly for patients with CD4 counts of less than 50/mm3.

METHODS

Prospective surveillance for survival and for all AIDS-defining events was performed on all 2682 patients with human immunodeficiency virus infection who had at least one CD4 count performed at a large urban public hospital during a 3-year period. Product-limit survival and incidence of AIDS-defining events were calculated as a function of baseline CD4 count.

RESULTS

The 1-year product-limit survival was 17% +/- 6% for patients after a baseline CD4 count of 1 to 4/mm3; 44% +/- 6% after a count of 5 to 9/mm3; 48% +/- 5% after a count of 10 to 19/mm3; 51% +/- 4% after a count of 20 to 39/mm3; 62% +/- 5% after a count of 40 to 59/mm3; 71% +/- 4% after a count of 60 to 99/mm3; 79% +/- 3% after a count of 100 to 199/mm3; and 92% +/- 2% after a count of 200 to 499/mm3. One-year survival and baseline CD4 count were related by the following formula: percent 1-year survival = 10 + 32(log10 CD4 count) (R2 = .97; P < .001). The 1-year incidence of a first AIDS-defining event and baseline CD4 count were related by the following formula: percent developing AIDS in 1 year = 104-36(log10 CD4 count) (R2 = .89; P < .001). Similar relationships were calculated between the logarithm of the baseline CD4 count and the 1-year incidence of most AIDS-defining events. These relationships were linear over the CD4 range of 1 to 499/mm3 and over follow-up periods of 6 months to 2 years.

CONCLUSIONS

The relationship of the CD4 count to survival, and to the incidence of AIDS-defining events, is logarithmic. This relationship helps explain the substantial differences in 1-year survival associated with baseline CD4 counts in the range below 50/mm3.

Primary prophylaxis with fluconazole against systemic fungal infections in HIV-positive patients

OBJECTIVE

To investigate the efficacy of fluconazole prophylaxis against systemic fungal infections in HIV-positive patients.

DESIGN

Open label treatment compared with historical controls.

SETTING

Patients were seen at the Parkland Memorial Hospital HIV Clinic, Dallas, Texas, USA between 1 March 1990 and 28 February 1991.

PATIENTS, PARTICIPANTS

Three hundred and thirty-seven historical controls were followed for 157 patient-years, and 329 fluconazole-treated patients for 145 patient-years.

INTERVENTIONS

Fluconazole (100 mg daily) was administered to all patients with CD4 lymphocyte counts less than 68 x 10(6)/l seen at our HIV clinic after 1 March 1990.

MAIN OUTCOME MEASURES

Lysis-centrifugation blood cultures were recorded monthly for all patients during both study periods.

RESULTS

Twenty infections (16 cryptococcosis, four histoplasmosis) occurred in 337 historical reference control patients (product-limit 1-year incidence, 7.5 +/- 2.0/year). Four infections (one cryptococcosis, three histoplasmosis) occurred in the treated patient group (product-limit 1-year incidence, 1.8 +/- 0.9/year).

CONCLUSIONS

Fluconazole warrants further evaluation for prophylaxis against systemic fungal infections in HIV-positive patients.

Lowering of serum cholesterol in hypercholesterolemic humans by tocotrienols (palmvitee)

A double-blind, crossover, 8-wk study was conducted to compare effects of the tocotrienol-enriched fraction of palm oil (200 mg palmvitee capsules/day) with those of 300 mg corn oil/d on serum lipids of hypercholesterolemic human subjects (serum cholesterol 6.21-8.02 mmol/L). Concentrations of serum total cholesterol (-15%), LDL cholesterol (-8%), Apo B (-10%), thromboxane (-25%), platelet factor 4 (-16%), and glucose (-12%) decreased significantly only in the 15 subjects given palmvitee during the initial 4 wk. The crossover confirmed these actions of palmvitee. There was a carry over effect of palmvitee. Serum cholesterol concentrations of seven hypercholesterolemic subjects (greater than 7.84 mmol/L) decreased 31% during a 4-wk period in which they were given 200 mg gamma-tocotrienol/d. This indicates that gamma-tocotrienol may be the most potent cholesterol inhibitor in palmvitee capsules. The results of this pilot study are very encouraging.

Legal issues critical in software license agreements

The complex legal aspects of software license agreements are addressed in this final part of a three-part series. A healthcare organization that has selected a software vendor and has reviewed the central provisions of a licensing agreement must then take a close look at the other provisions of the agreement. These include numerous legal provisions, regulatory requirements, and ancillary agreements related to maintenance and access to the software.

Careful planning of software license agreements deters disputes

This article, part two of a three-part series on software license agreements, addresses the need to become familiar with the central provisions of such agreements. Healthcare institutions must carefully review proposed agreements to ensure the vendor meets all requirements. The best way to avoid legal disputes over breach of a contract is to carefully investigate vendors and to use an extremely detailed request for proposal. The agreement itself should specify the legal remedy to be used if a term of the contract is breached.

Software: a team approach to investigating the options

Acquiring a new software package for a healthcare institution is a complicated process. This article, part one of a three-part series, addresses how to investigate the software options. Because the entire structure of contract negotiations may be irrevocably established during this early phase of the process, the institution must assemble a planning team of experts, including knowledgeable legal counsel, to investigate options. Parts two and three of the series will focus on the actual negotiating of license agreements.

Bowel obstruction secondary to mesenteric cyst formation

A rare cause of intra-abdominal obstruction, mesenteric cysts derive from lymphatic tissue. The differential diagnosis should include mesenteric cyst when the patient presents with a history of multiple episodes of partial small-bowel obstruction or with an asymptomatic abdominal mass. A year-old girl was brought to the Family Practice Center with episodic, sharp, nonradiating, left-sided, mid-upper-abdominal pain. Examination indicated a possible diagnosis of mesenteric adenitis. Due to variation in the signs and symptoms of the condition, it appears that the use of ultrasonography is the most effective, nonoperative method of evaluation. Ultrasonography appears to be the most effective, nonoperative method of evaluation. Surgery is the only definitive diagnostic and therapeutic modality.

Hordein gene expression in a low protein barley cultivar

The low protein barley (Hordeum vulgare L.) cultivar ;Karl' is deficient in hordeins, the major storage protein fraction, but has normal levels of other endosperm protein fractions. We compared hordein gene expression in Karl with that in ;Traill,' a related cultivar that contains normal amounts of hordein. In plants grown in controlled environmental conditions, hordein accumulation in Karl was 55% of that in Traill. The amount of hordein synthesized at all developmental stages tested was lower in Karl, as shown by pulse labeling of excised spikes with [(3)H]leucine. To determine whether levels of hordein mRNAs were related to amounts of hordein synthesis, total RNA preparations from endosperms at three or four developmental stages were hybridized to cDNA probes corresponding to B and C hordein genes. Both B and C hordein mRNA levels were significantly lower in Karl than in Traill at intermediate developmental stages. It was concluded that the low-hordein character of Karl was regulated by the size of the hordein mRNA pool. Transcriptional and/or post-transcriptional controls may be involved in the regulation of hordein mRNA levels.

Formation of the chlorophyll precursor delta-aminolevulinic acid in cyanobacteria requires aminoacylation of a tRNAGlu species

In the chloroplasts of higher plants and algae, the biosynthesis of the chlorophyll precursor delta-aminolevulinic acid (ALA) involves at least three enzymes and a tRNA species. Here we demonstrate that in cell extracts of the unicellular cyanobacterium Synechocystis sp. strain PCC 6803 ALA was formed from glutamate in a series of reactions in which activation of glutamate by glutamyl-tRNAGlu formation was the first step. The activated glutamate was reduced by a dehydrogenase which displayed tRNA sequence specificity. Fractionation of strain 6803 tRNA by reverse-phase chromatography and polyacrylamide gel electrophoresis yielded two pure tRNAGlu species which stimulated ALA synthesis in vitro. These tRNAs had identical primary sequences but differed in the nucleotide modification of their anticodon. The 6803 tRNAGlu was similar to the sequences of tRNAGlu species or tRNAGlu genes from Escherichia coli and from chloroplasts of Euglena gracilis and higher plants. Southern blot analysis revealed at least two tRNAGlu gene copies in the 6803 chromosome. A glutamate-1-semialdehyde aminotransferase, the terminal enzyme in the conversion of glutamate to ALA in chloroplasts, was detected in 6803 cell extracts by the conversion of glutamate-1-semialdehyde to ALA and by the inhibition of this reaction by gabaculin.

Synthesis of regiospecifically labeled [18O]glycolic acid and [18O]acyldihydroxyacetone phosphate

Methods are detailed for the preparation of [2-18O]glycolate from chloroacetic acid and for the direct conversion of these intermediates to regiospecifically labeled [2-18O]-2-O-acylglycolic acids containing approximately 90% 18O at the C-O-acyl bond. Methods are also detailed for optimization of reaction conditions and yields for each synthetic step in previously published methods for the preparation of 1-O-acyldihydroxyacetone-3-O-phosphate (DHAP) from acyloxyacetic acid (i.e., 2-O-acylglycolic acid), where acyl is tetradecanoyl, hexadecanoyl, or heptadecanoyl. The optimized reaction conditions generate 1-O-acyl DHAP in its acid form, both in high overall yield and in high purity, without requiring a final chromatographic purification of the product, 1-O-acyl DHAP. Combining these new methods, efficient and facile preparations of regiospecifically labeled [1-18O]-1-O-hexadecanoyl DHAP and [1-18O]-1-O-heptadecanoyl DHAP have now been demonstrated, in which approximately 90% 18O is specifically located only at the C-O-acyl position. Some mechanistic postulates are offered to account for the optimized yields, regioselectivities, and high 18O incorporation which are observed in the reactions we have employed to generate 1-O-acyl DHAP from glycolate intermediates.

Is the indirect antiglobulin crossmatch justified?

Pretransfusion testing has undergone a rationalization, resulting in a more efficient transfusion service but with no compromise to patient safety. Current debate centres on the necessity of performing an antiglobulin crossmatch if a suitable screening test for detecting red cell antibodies is negative. A retrospective study of all pretransfusion testing was undertaken to determine the specificities and possible clinical significance of antibodies detected by the crossmatch alone. The results indicate that omission of the crossmatch will not compromise patient safety. This will have benefits to both the patient and the laboratory. The patient will benefit because of less time needed to provide homologous donor blood. The laboratory will benefit from cost savings as a result of less antiglobulin reagent being used, less time taken for providing blood (and hence further cost savings) and less blood needing to be held in stock. The cost savings generated could be channelled into areas that will result in greater patient safety at a lower cost than crossmatching. Two of these areas are prevention of patient and specimen identification errors by the use of a unique transfusion number system and the full utilization of an autologous blood service.

Influence of minor plant constituents on porcine hepatic lipid metabolism. Impact on serum lipids

The effects of plant constituents on lipid metabolism were examined in swine that had been fed for 4 weeks a standard diet containing, in addition, (per kg diet) 3.15 g of the methanol serial solvent fraction garlic bulbs or 3.5 g of the petroleum ether solubles high-protein barley flour or 5 mg of the plant growth regulator, AMO 1618. All treatments suppressed 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase and cholesterol 7 alpha-hydroxylase activities. Modest increases in serum triglycerides were associated with significantly increased hepatic lipogenic activities in response to all treatments except that of the barley extract. The methanol solubles of a second lot of garlic were fractionated by HPLC and tested in an avian hepatocyte system. One component, an isoprenoid metabolite, MW 358, suppressed HMG-CoA reductase.

Shear-induced platelet aggregation requires von Willebrand factor and platelet membrane glycoproteins Ib and IIb-IIIa

Different types of platelets in various types of plasma were subjected to levels of shear stress that produce irreversible platelet aggregation in normal platelet-rich plasma (PRP). At shear stresses of 90 or 180 dyne/cm2 applied for 30 seconds or five minutes, aggregation was either absent or only transient and reversible using severe von Willebrand's disease (vWD) PRP (less than 1% von Willebrand factor, vWF); Bernard-Soulier syndrome (BSS) PRP (platelets deficient in the membrane glycoprotein Ib, GPIb); normal PRP plus monoclonal antibody (MoAb) to GPIb; thrombasthenic PRP (platelets deficient in membrane glycoprotein IIb-IIIa complex, GPIIb-IIIa); and normal PRP plus MoAb to GPIIb-IIIa. Shear-induced aggregation was inhibited under the above conditions, even though the platelets were activated to release their granular contents. Sheared normal platelets in vWD plasma aggregated in response to added vWF. These studies demonstrate that the formation of stable platelet aggregates under conditions of high shear requires vWF and the availability of both GPIb and GPIIb-IIIa on platelet membranes. The experiments demonstrate that vWF-platelet interactions can occur in the absence of artificial agonists or chemical modification of vWF. They suggest a possible mechanism for platelet aggregation in stenosed or partially obstructed arterial vessels in which the platelets are subjected to relatively high levels of shear stress.

Synthesis of 3-(3-pyridyl)- and 3-(3-benzo[b]thienyl)-D-alanine

The DL-arylamino acid ethyl ester derivatives of beta-(3-pyridyl)-DL-alanine, and beta-(3-benzo[b]thienyl)-DL-alanine were synthesized by diethyl acetamidomalonate condensation with the respective arylmethyl halides followed by partial hydrolysis to the monoethyl ester and decarboxylation. Each derivative was enzymatically resolved to a separable mixture of the corresponding N-acetyl-L-amino acid and the unchanged D amino acid derivative. Acidic hydrolysis of the latter gave the corresponding D-amino acid, the optical purity of which was established by HPLC analysis of the 2,3,4,6-tetra-O-acetyl-beta-D-glucopyranosyl isothiocyanate (GITC) derivative. The free D amino acids were converted to D-BOC derivatives by reaction with di-tert-butyldicarbonate in tert-butyl alcohol, water and sodium hydroxide.

The structure of an inhibitor of cholesterol biosynthesis isolated from barley

Purification of the oily, nonpolar fraction of high protein barley (Hordeum vulgare L.) flour by high pressure liquid chromatography yielded 10 major components, two (I, II) of which were potent inhibitors of cholesterogenesis in vivo and in vitro. The addition of purified inhibitor I (2.5-20 ppm) to chick diets significantly decreased hepatic cholesterogenesis and serum total and low density lipoprotein cholesterol and concomitantly increased lipogenic activity. The high resolution mass spectrometric analysis and measurement of different peaks of inhibitor I gave a molecular ion at m/e 424 (C29H44O2) and main peaks at m/e 205, 203, and 165 corresponding to C13H17O2, C13H15O2, and C10H13O2 moieties, respectively. which are characteristic of d-alpha-tocotrienol. This identification was confirmed against synthetic samples. The tocotrienols are widely distributed in the plant kingdom and differ from tocopherols (vitamin E) only in three double bonds in the isoprenoid chain which appear to be essential for the inhibition of cholesterogenesis.

Autocatalytic quinone methide formation from mitomycin c

Mitomycin c in the presence of NADPH and brewers' yeast NADPH: (acceptor) oxidoreductase (Old Yellow enzyme, EC 1.6.99.1) is transformed, at pH 8.0 and with anaerobicity, to two major mitosene products (the cis- and trans-1-hydroxy-2,7-diaminomitosenes; respective yields of 45 and 30%). These arise by covalent trapping by solvent of a quinone methide intermediate, obtained by rearrangement of the mitomycin c hydroquinone. At lower pH (6.5), the major product of this reaction is 2,7-diaminomitosene, which arises by covalent trapping of the quinone methide by H+. In the former instance the quinone methide acts as an electrophile and in the latter as a nucleophile. A detailed kinetic analysis indicates that the role of the NADPH and Old Yellow enzyme is to initiate an autocatalytic reaction, propagated by mitomycin c reduction by the mitosene hydroquinones (arising by the electrophilic pathway). The evidence supporting this conclusion is the formation of oxidized mitosene products, under the rigorously anaerobic reaction circumstance, the nonstoichiometric participation of NADPH, a dependence of the velocity on the total mitomycin c concentration, the pH dependence of the reaction, and the accurate simulation of the overall kinetic course with a mathematical model of the autocatalytic pathway. These observations indicate that the autocatalytic pathway may be dominant during in vitro mitomycin c anaerobic reductive activation by other reducing agents and that (as with anthracycline reductive activation) oxidation of the mitosene hydroquinone obtained from nucleophile addition to the quinone methide may be a necessary event for the formation of stable covalent adducts in vivo.

Development and use of a radioimmunoassay for D-(-)-norgestrel 17 beta-cyclopentanecarboxylate

The synthesis of the 6 alpha-carboxymethylmercapto BSA and homologous histamine conjugate of D-(-)-norgestrel 17 beta-cyclopentanecarboxylate is reported. Using the BSA conjugate as an immunogen for the development of antibody in the rabbit and the 125I-histamine conjugate as the radioligand, a radioimmunoassay (RIA) for the ester was developed. Serum profiles of the free alcohol and ester were determined following IV or IM injection in macaques. Peak values for the ester (about 12 ng/mL) were observed 2 min following an IV bolus of 0.5 mg in one rhesus monkey. Blood levels dropped rapidly within the first 30 min and were barely detectable at 24 h. Serum levels of the free alcohol rose to a peak at 30 min and then declined slowly to very low values by 24 h. Following IM injection of 20 mg in cynomolgus monkeys, peak levels of the ester were observed within a few days while the free alcohol reached a maximum about day 30. Serum concentrations of D-(-)-norgestrel had fallen to about 0.4 ng/mL 160 days post-injection when levels of the ester fell below 0.2 ng/mL.

Suppression of cholesterogenesis by plant constituents: review of Wisconsin contributions to NC-167

In animals, non-sterol metabolites of the mevalonate pathway act independently from receptor-mediated cholesterol uptake in the multivalent feedback regulation of mevalonate biosynthesis. Studies leading to the isolation and characterization of plant-borne suppressors of mevalonate biosynthesis are reviewed. We propose that one cardio-protective component of the vegetarian diet consists of a variety of non-sterol, post-mevalonate metabolites. These products of plant branches of the mevalonate pathway, discarded as animals evolved, continue to influence animal sterol metabolism. It is through this action, we propose, that the cholesterol-suppressive action of plant materials is expressed.

Role of the membrane concanavalin A binding site in platelet-fibrin interactions

Concanavalin A was employed to study the role of platelet membrane glycoproteins in platelet-fibrin interactions during clot formation. A rheological technique was used to study the interactions, measuring the clot rigidity and platelet contractile force simultaneously during the formation of network structure. Concanavalin A lowered the clot rigidity and contractile force of a platelet-rich plasma clot by a small extent. Plasma glycoproteins probably compete with platelet membranes for concanavalin A binding in platelet-rich plasma. Both native concanavalin A (tetrameric) and succinyl concanavalin A (dimeric) lowered the clot rigidity and contractile force of a washed platelet-fibrin clot dramatically, almost down to those values found for fibrin clots. Inhibition studies with alpha-methyl-D-mannoside indicated that the concanavalin A effects were specific for the concanavalin A binding capacity to platelets. The effects of native concanavalin A on platelet-fibrin clots were only partially reversible, while the succinyl concanavalin A effects were completely reversible. The observed concanavalin A effects are probably mainly due to concanavalin A binding to platelet membrane glycoproteins. The concanavalin A binding site appears to play an important role in the fibrin binding to platelets.

Development of tannin vacuoles in chalaza and seed coat of barley in relation to early chalazal necrosis in the seg1 mutant

Structural development of grain tissues of maternal origin in normal and seg1 barley (Hordeum vulgare L. cv. Betzes) was examined using light and electron microscopy. Chalaza and seedcoat cells of normal grains developed prominent tannin vacuoles which persisted throughout the grain-filling period. Tannins were present in the same tissues of seg1, but no large central vacuoles developed. Instead, the chalaza and nucellar projection degenerated and were crushed, presumably terminating sugar flow and causing formation of shrunken grains (35-55% normal dry weight). Tannins were localized using various histochemical stains. Extracts of chalaza and adjacent tissues contained proanthocyanidins which yielded delphinidin and cyanidin upon hydrolysis in boiling HCl. We suggest that the basis of the seg1 phenotype may be abnormal compartmentation of tannins causing precipitation of cytoplasmic proteins and early death of chalazal cells.

Developmentally regulated plant genes: the nucleotide sequence of a wheat gliadin genomic clone

Gliadins, the major wheat seed storage proteins, are encoded by a multigene family. Northern blot analysis shows that gliadin genes are transcribed in endosperm tissue into two classes of poly(A)+ mRNA, 1400 bases (class I) and 1600 bases (class II) in length. Using poly(A)+ RNA from developing wheat endosperm we constructed a cDNA library from which a number of clones coding for alpha/beta and gamma gliadins were identified by hybrid-selected mRNA translation and DNA sequencing. These cDNA clones were used as probes for the isolation of genomic gliadin clones from a wheat genomic library. One such genomic clone was characterized in detail and its DNA sequence determined. It contains a gene for a 33-kd alpha/beta gliadin protein (a 20 amino acid signal peptide and a 266 amino acid mature protein) which is very rich in glutamine (33.8%) and proline (15.4%). The gene sequence does not contain introns. A typical eukaryotic promoter sequence is present at -104 (relative to the translation initiation codon) and there are two normal polyadenylation signals 77 and 134 bases downstream from the translation termination codon. The coding sequence contains some internal sequence repetition, and is highly homologous to several alpha/beta gliadin cDNA clones. Homology to a gamma-gliadin cDNA clone is low, and there is no homology with known glutenin or zein cDNA sequences.