External Validation of the Graded Prognostic Assessment for Patients with Non-Small Cell Lung Cancer and Brain Metastases Using Molecular Markers (Lung-molGPA)

PURPOSE/OBJECTIVE(S)

Patients with non-small cell lung cancer (NSCLC) and brain metastases represent a markedly heterogeneous population. The original diagnosis-specific graded prognostic assessment is a prognostic index based on data from patients diagnosed between 1985 and 2005 and includes patients age, performance status, extracranial disease, and number of brain metastases. An updated prognostic index (Lung-molGPA) that incorporates molecular features (EGFR and ALK alterations) was created in 2016 based on the North American retrospective database analysis of 2186 patients with NSCLC and newly diagnosed brain metastases between 2006 and 2014. The aim of this study is to validate the Lung-molGPA model in an independent Asian patient population.

MATERIALS/METHODS

Four hundred thirty-three patients (368 adenocarcinoma and 65 nonadenocarcinoma) with NSCLC with newly diagnosed brain metastasis between 2005 and 2017 were reviewed retrospectively and scored using the Lung-molGPA model.

RESULTS

The overall median survival for the cohort in the present study was 14 months (16.5 months in the adenocarcinoma and 8.0 months in the nonadenocarcinoma, respectively; p = 0.003). For patients with adenocarcinoma, the median survival for patients with a Lung-molGPA score of 3.5 to 4.0 was 44.7 months, while the median survival was only 8.9 months in patients scoring 0-1.0, 17.0 months in patients scoring 1.5-2.0, and 30.2 months for scores of 2.5-3.0 (p <0.0001). For patients with nonadenocarcinoma, the median survival for scores 0-1.0, 1.5-2.0, and 2.5-3.0 were 6.7, 10.3, and 13.2 months, respectively (p = 0.038).

CONCLUSION

Survival for patients with NSCLC and brain metastases varies widely. This study provides an independent validation of the 2016 Lung-molGPA in Asian patients.

Safe administration of sotrovimab to a COVID-19 patient with acute phase type 1 diabetes mellitus

Type 1 diabetes mellitus (T1DM) and poor glycemic control are risk factors for severe coronavirus disease 2019 (COVID-19). Sotrovimab can treat mild-to-moderate COVID-19 in patients at a high risk of progression to severe COVID-19. However, its safety and efficacy in T1DM patients remain to be elucidated. We report the case of a 12-yr-old patient who was treated with sotrovimab for COVID-19 immediately after treatment for diabetic ketoacidosis (DKA) due to new-onset T1DM. He presented with nausea and sore throat and was diagnosed with severe DKA and COVID-19. A productive cough and sputum developed after admission. On the 3rd day of admission, the DKA resolved, and sotrovimab was administered to prevent exacerbation of COVID-19. Although the blood glucose levels increased after the administration of sotrobimab, there was no recurrence of DKA. Hyperglycemia may be a sotrovimab-related adverse event in T1DM patients. Nevertheless, the benefits of sotrovimab treatment may far outweigh the potential risks. Thus, sotrovimab was considered safe for patients with T1DM immediately after treatment of severe DKA.

Genome-wide screening antifungal genes in Streptomyces griseus S4-7, a Fusarium wilt disease suppressive microbial agent

Streptomyces is a widely studied bacterial genus, particularly with regard to secondary metabolites and antibiotics production. Streptomyces griseus S4-7 was isolated from a strawberry Fusarium wilt disease suppressive soil, and its biological control ability has been well established. However, the antifungal mechanism of strain S4-7 is not yet fully understood at the molecular and biochemical level. Therefore, in this study we created a random mutant library for strain S4-7 with the Tn5 transposon element to investigate antifungal traits on a genome-wide scale. In total 4646 individual mutant strains were created and 13 mutants were selected based on loss of antifungal activity. The knockout genes were identified as electron transfer oxidoreductase (eto),sigma factor-70(sig70) and nrps by Inverse PCR (I-PCR). eto regulates the geranylgeranyl reductase gene, which is involved in terpenoid-quinone biosynthesis, an important factor in cell fitness. In the △eto strain, expression of wbl, a master regulator of the production of secondary metabolites, was significantly reduced. sig70 is responsible for the cell differentiation sensing mechanism in genus Streptomyces. △nrps showed decreased production of hybrid peptide-polyketide siderophores. These results suggest that S. griseus S4-7 may have various antifungal mechanisms, and each mechanism is essential to maximal antifungal activity.

Development qRT-PCR Protocol to Predict Strawberry Fusarium Wilt Occurrence

Strawberry Fusarium wilt disease, caused by Fusarium oxysporum f. sp. fragariae, is the most devastating disease in strawberry production. The pathogen produces chlamydospores which tolerate against harsh environment, fungicide and survive for decades in soil. Development of detection and quantification techniques are regarded significantly in many soilborne pathogens to prevent damage from diseases. In this study, we improved specific-quantitative primers for F. oxysporum f. sp. fragariae to reveal correlation between the pathogen density and the disease severity. Standard curve r2 value of the specific-quantitative primers for qRT-PCR and meting curve were over 0.99 and 80.5°C, respectively. Over pathogen 105 cfu/g of soil was required to cause the disease in both lab and field conditions. With the minimum density to develop the wilt disease, the pathogen affected near 60% in nursery plantation. A biological control microbe agent and soil solarization reduced the pathogen population 2-fold and 1.5-fold in soil, respectively. The developed F. oxysporum f. sp. fragariae specific qRT-PCR protocol may contribute to evaluating soil healthiness and appropriate decision making to control the disease.

Inverse relationship between vitamin D levels and platelet indices in Korean adults

BACKGROUND AND AIMS

Vitamin D deficiency and increased platelet indices are associated with increased rate or risk of several diseases such as cardiovascular disease and metabolic syndrome, respectively. We investigated whether vitamin D deficiency is associated with increased platelet count (PC) and mean platelet volume (MPV).

METHODS AND RESULTS

The study included 3190 subjects older than 20 years. Subjects were divided into three groups based on their vitamin D levels: vitamin D deficiency (<10.0 ng/ml); insufficiency (10-20 ng/ml); and sufficiency (>20.0 ng/ml). The associations between platelet indices and various parameters were analyzed by Pearson's correlation analysis and t-tests. Then, multivariate linear regression analyses were done correcting for associated parameters. PC and MPV showed a negative correlation with vitamin D groups by ANOVA and multiple linear regression. PC was inversely related with vitamin D group after adjusting for sex, age, regular exercise, white blood cell count, total cholesterol, hemoglobin, and creatinine levels (β ± SE = -3.461 ± 1.512, P = 0.022). MPV was also inversely related with vitamin D group after adjusting for regular exercise, hemoglobin level, and total cholesterol level (β ± SE = -0.080 ± 0.026, P = 0.002), and this relationship remained statistically significant after adjusting for regular exercise, hemoglobin level, total cholesterol level, diabetes, hypertension, and body mass index (β ± SE=-0.082 ± 0.026, P = 0.002).

CONCLUSION

PC and MPV are inversely associated with vitamin D levels in adults.

The Survivorship and Clinical Results of Minimally Invasive Unicompartmental Knee Arthroplasty at 10-Year Follow-up

Background

In this study, we investigated the long-term clinical results and survival rate of minimally invasive unicompartmental knee arthroplasty (UKA) by collecting cases that had been implanted more than 10 years ago.

Methods

One hundred and twenty-eight patients (166 cases) who underwent Oxford phase 3 medial UKA using the minimally invasive surgery from January 2002 to December 2002 were selected. The mean age of the patients at the time of surgery was 61 years, and the duration of the follow-up was minimum 10 years. Clinical and radiographic assessments were performed using the Knee Society clinical rating system, and the survival analysis was done by the Kaplan-Meier method with 95% confidence interval (CI).

Results

The mean Knee Society knee and function scores improved significantly from 53.8 points (range, 25 to 70 points) and 56.1 points (range, 35 to 80 points) preoperatively to 85.4 points (range, 58 to 100 points) and 80.5 points (range, 50 to 100 points) at 10-year follow-up, respectively (p < 0.001). Failures following the UKA occurred in 16 cases (9.6%), and the mean time of the occurrence of the failure was 6.2 years after the surgery. The 10-year survival rate was 90.5% (95% CI, 85.9 to 95.0) when failure was defined as all the reoperations, whereas the 10-year survival rate was 93.4% (95% CI, 89.6 to 97.1) when the cases in which only revision total knee arthroplasty was defined as failure.

Conclusions

The results of this study show outstanding functions of the knee joint and satisfactory 10-year survival rate after minimally invasive UKA. Therefore, minimally invasive UKA could be a useful method in the treatment of osteoarthritis in one compartment of knee joint.

An insight into the heat and mass transfer mechanisms of eggshells hatching broiler chicks and its effects to the hatcher environment

Thermodynamic study of incubated eggs is an important component in the optimisation of incubation processes. However, research on the interaction of heat and moisture transfer mechanisms in eggs is rather limited and does not focus on the hatching stage of incubation. During hatch, both the recently hatched chick and the broken eggshell add extra heat and moisture contents to the hatcher environment. In this study, we have proposed a novel way to estimate thermodynamically the amount of water evaporated from a broken eggshell during hatch. The hypothesis of this study considers that previously reported drops in eggshell temperature during hatching of chicks is the result remaining water content evaporating from the eggshell, released on the inner membrane by the recently hatched wet chick, just before hatch. To reproduce this process, water was sprayed on eggshells to mimic the water-fluid from the wet body of a chick. For each sample of eggshell, the shell geometry and weight, surface area and eggshell temperature were measured. Water evaporation losses and convection coefficient were calculated using a novel model approach considering the simultaneous heat and mass transfer profiles in an eggshell. The calculated average convective coefficient was 23.9 ± 7.5 W/m(2) °C, similar to previously reported coefficients in literature as a function of 0.5-1m/s air speed range. Comparison between measured and calculated values for the water evaporation showed 68% probability accuracy, associated to the use of an experimentally derived single heat transfer coefficient. The results support our proposed modelling approach of heat and mass transfer mechanisms. Furthermore, by estimating the amount of evaporated water in an eggshell post-hatch, air humidity levels inside the hatcher can be optimised to ensure wet chicks dry properly while not dehydrating early hatching chicks.

Differential profiles of salivary proteins with affinity to Streptococcus mutans lipoteichoic acid in caries-free and caries-positive human subjects

Streptococcus mutans is a representative oral pathogen that causes dental caries and pulpal inflammation. Its lipoteichoic acid (Sm.LTA) is known to be an important cell-wall virulence factor involved in bacterial adhesion and induction of inflammation. Since Sm.LTA-binding proteins (Sm.LTA-BPs) might play an important role in pathogenesis and host immunity, we identified the Sm.LTA-BPs in the saliva of caries-free and caries-positive human subjects using Sm.LTA-conjugated beads and LTQ-Orbitrap hybrid Fourier transform mass spectrometry. Sm.LTA was conjugated to N-hydroxysuccinimidyl-Sepharose(®) 4 Fast Flow beads (Sm.LTA-beads). Sm.LTA retained its biological properties during conjugation, as determined by the expression of nitric oxide and interferon-γ-inducible protein 10 in a murine macrophage cell line and activation of Toll-like receptor 2 (TLR2) in CHO/CD14/TLR2 cells. Sm.LTA-BPs were isolated from pooled saliva prepared from 10 caries-free or caries-positive human subjects each, electrophoresed to see their differential expression in each group, and further identified by high-resolution mass spectrometry. A total of 8 and 12 Sm.LTA-BPs were identified with statistical significance in the pooled saliva from the caries-free and caries-positive human subjects, respectively. Unique Sm.LTA-BPs found in caries-free saliva included histone H4, profilin-1 and neutrophil defensin-1, and those in caries-positive saliva included cystatin-C, cystatin-SN, cystatin-S, cystatin-D, lysozyme C, calmodulin-like protein 3 and β-actin. The Sm.LTA-BPs found in both groups were hemoglobin subunits α and β, prolactin-inducible protein, protein S100-A9, and SPLUNC2. Collectively, we identified Sm.LTA-BPs in the saliva of caries-free and caries-positive subjects, which exhibit differential protein profiles.

INCB018424 induces apoptotic cell death through the suppression of pJAK1 in human colon cancer cells

Janus kinase (JAK) is one of the main upstream activators of signal transducers and activators of transcription (STAT) that are constitutively activated in various malignancies and are associated with cell growth, survival, and carcinogenesis. Here, we investigated the role of JAKs in colorectal cancer in order to develop effective therapeutic targets for INCB018424, which is the first JAK1/2 inhibitor to be approved by FDA. After examining the basal expression levels of phospho-JAK1 and phospho-JAK2, we measured the effects of INCB018424 on the phosphorylation of JAK1/2 using western blot analysis. Cell viability was determined using the trypan blue exclusion assay. The cell death mechanism was identified by the activation of caspase 3 using western blot and annexin V staining. The basal levels of phospho-JAK1 and phospho-JAK2 were cancer cell type dependent. Colorectal cancer cell lines that phosphorylate both JAK1 and JAK2 include DLD-1 and RKO. INCB018424 inactivates both JAK1 and JAK2 in DLD-1 cells but inactivates only JAK1 in RKO cells. Cell death was proportional to the inactivation of JAK1 but not JAK2. INCB018424 causes caspase-dependent cell death, which is prevented by treatment with z-VAD. The inhibition of JAK1 phosphorylation seemed sufficient to allow INCB018424-mediated apoptosis. JAK1 is a key molecule that is involved in colon cancer cell survival and the inhibition of JAK1 by INCB01424 results in caspase-dependent apoptosis in colorectal cancer cells. The use of selective JAK1 inhibitors could be an attractive therapy against colorectal cancer, but further clinical investigations are needed to test this possibility.

New polymorphic microsatellite loci of threadsail filefish, Stephanolepis cirrhifer (Teleostei, Monacanthidae), from Korean waters

The threadsail filefish, Stephanolepis cirrhifer (Monacanthidae), is found mainly in the western Pacific. It is intensively caught in Korea and is a highly appreciated seafood delicacy. Consequently, the natural population of this species has drastically decreased, despite introductions from hatcheries. To provide information necessary for its conservation and management, we developed 24 polymorphic microsatellite markers using a combination of a total enriched genomic library and a small-scale 454 pyrosequencing. A total of 90,847 raw reads were obtained, and 75,128 unique sequences were generated, with an average length of 477 bp; 5350 (7.12%) sequences contained a minimum of 5 di- to tetranucleotide repeat motifs. Seventy-four sequences were used for microsatellite primer design. They all amplified successfully; 24 were polymorphic, with 8 containing trinucleotide repeats and 3 containing tetranucleotide repeats. The genetic variations based on 15 primer sets were investigated using 45 wild individuals from the coastal waters of Geomun Island. The number of alleles per locus varied from 4 to 15, with an average of 7.47. The observed and expected heterozygosities ranged from 0.333 to 0.956 and from 0.316 to 0.870, with averages of 0.692 and 0.701, respectively. No linkage disequilibrium was found between any pair of loci, indicating their independence. One locus significantly deviated from Hardy-Weinberg equilibrium after Bonferroni's correction; this may be due to the existence of a null allele. Cross-amplification was also tested for all 24 polymorphic loci in another monacanthid species, Thamnaconus modestus; 7 loci were effectively amplified. The high degree of polymorphism that was exhibited by the 15 newly developed microsatellites will be useful for assessing genetic variation and for conservation genetic studies of these 2 monacanthid species.

Development of adsorbent for the simultaneous removal of organic and inorganic contaminants from aqueous solution

In this study, a modified adsorbent, alginate complex beads, was prepared and applied to the removal of mixed contaminants from wastewater. The alginate complex beads were generated by the immobilization of powdered activated carbon and synthetic zeolites onto alginate gel beads, which were then dried at 110 °C for 20 h until the diameter had been reduced to 1 mm. This dry technique increased the hardness of the adsorbent to assure its durability and application. The adsorption onto the alginate complex beads of organic and inorganic compounds, as target contaminants, was investigated by performing both equilibrium and kinetic batch experiments. From the adsorption isotherms, according to the Langmuir equation, the alginate complex bead was capable of effectively removing benzene, toluene, zinc and cadmium. From kinetic batch experiments, the removal efficiencies of benzene, toluene, zinc and cadmium were found to be 66.5, 92.4, 74.1 and 76.7%, respectively, for initial solution concentrations of 100 mg L(-1). The results indicated that the adsorbent developed in this study has the potential to be a promising material for the removal of mixed pollutants from industrial wastewater or contaminated groundwater.

Comparing the effects of 5% albumin and 6% hydroxyethyl starch 130/0.4 on coagulation and inflammatory response when used as priming solutions for cardiopulmonary bypass

AIM

This prospective, randomized and controlled trial compares the use of human albumin (HA) and hydroxyethyl starch (HES) 130/0.4 in the priming solution for a non-biocompatible cardiopulmonary bypass (CPB) circuit. The effects of each substance on coagulation, postoperative blood loss and pro-inflammatory activities were examined.

METHODS

Thirty-six adult patients undergoing mitral valvular heart surgery were randomly assigned to either the HA or HES group; 500 mL of 5% HA or 6% HES 130/0.4 were added to the priming solution of the CPB circuit for each group, respectively. Coagulation variables were measured perioperatively; these variables included thromboelastographic (TEG) parameters and pro-inflammatory markers such as interleukin (IL)-6, IL-8 and tumor necrotic factor (TNF)-a. Postoperative blood loss and transfusion requirements were also assessed.

RESULTS

There were no significant intergroup differences in the coagulation variables (including TEG parameters), serum concentrations of IL-6, IL-8 and TNF-a, and blood loss or transfusion requirements. TEG parameters, which indicate the speed of solid clot formation and the strength of the fibrin clot, decreased up to 4 hours after CPB in both groups. Serum concentrations of IL-6, IL-8 and TNF-a were higher up to 12 hours after surgery compared to baseline values in both groups. Hemoglobin levels and platelet counts were lower up to 12 hours after surgery compared to baseline values in both groups.

CONCLUSION

HES 130/0.4 was comparable to albumin as a component of the priming solution for a non-biocompatible CPB circuit. The two substances showed similar effects on coagulation variables, blood loss and pro-inflammatory activities in adult patients undergoing mitral valvular heart surgery.

Value of specimen radiographs in diagnosing multifocality of thyroid cancer

BACKGROUND

Specimen radiography has been used widely to evaluate the complete excision of calcified breast lesions but has not been evaluated for thyroid cancer.

METHODS

Specimen radiographs were evaluated retrospectively to identify additional cancers that were demonstrated only as calcifications. Receiver operating characteristic curve analysis was performed to compare the combination of specimen radiography and ultrasonography versus ultrasonography alone for detecting multifocality.

RESULTS

Some 122 thyroid cancer specimens were obtained from 122 patients between January and April 2008. Specimen radiography detected 27 cancers (18.5 per cent) not detected by ultrasonography. Diagnoses were changed after evaluation of specimen radiographs in three of these patients. The area under the curve of the combination of specimen radiography and ultrasonography was significantly higher than that of ultrasonography alone (P = 0.005).

CONCLUSION

Specimen radiography is a potentially useful tool for diagnosing cancer type and predicting the extent of thyroid cancer.

Feasibility of electroflotation to separate solids and liquid in an activated sludge process

In this study, electroflotation (EF) has been applied as a secondary clarification in the activated sludge process to improve the efficiency of the solids-liquid separation, which is essential in maintaining effluent quality. The effects of sludge settleability were examined through a series of batch and semi-continuous experiments. The results of the batch experiments revealed that thickening efficiencies using EF were 2.6 to 9.2 times higher than those with gravity settling (GS). In addition, clarification efficiencies were not significantly influenced by sludge settling properties, as compared with GS as a control. In the semi-continuous EF experiments, the concentrations of solids in the float layer were maintained above 10 g L(-1) during flotation, regardless of variations in sludge settleability. Furthermore, the volumetric gas proportion in the float layer increased as the gas to solids (G/S) ratio rose. This allowed the float layer to be more stably suspended against gravity at the top of the reactor. Based on the results obtained from these batch and semi-continuous experiments, an anoxic/oxic (AO) reactor combined with EF clarifier remained in successful continuous operation for four months. In comparison with conventional AO processes using a GS clarifier, enhanced clarification and thickening efficiencies were achieved through the EF-AO system. In addition, higher mixed liquor suspended solids concentrations (averaging 5300 mg L(-1)) in the bioreactor (EF-AO) were maintained via the return of highly concentrated sludge (averaging 16,400 mg L(-1)) from the EF clarifier. These findings suggest that EF could be a promising and effective alternative for the solids-liquid separation of poorly settling sludge.

Remifentanil protects myocardium through activation of anti-apoptotic pathways of survival in ischemia-reperfused rat heart

Remifentanil is a commonly used opioid in anesthesia with cardioprotective effect in ischemia-reperfused (I/R) heart. We evaluated the influence of remifentanil on myocardial infarct size and expressions of proteins involved in apoptosis in I/R rat heart following various time protocols of remifentanil administration. Artificially ventilated anesthetized Sprague-Dawley rats were subjected to a 30 min of left anterior descending coronary artery occlusion followed by 2 h of reperfusion. Rats were randomly assigned to one of five groups; Sham, I/R only, remifentanil preconditioning, postconditioning and continuous infusion group. Myocardial infarct size, the phosphorylation of ERK1/2, Bcl2, Bax and cytochrome c and the expression of genes influencing Ca2+ homeostasis were assessed. In remifentanil-administered rat hearts, regardless of the timing and duration of administration, infarct size was consistently reduced compared to I/R only rats. Remifentanil improved expression of ERK1/2 and anti-apoptotic protein Bcl2, and expression of sarcoplasmic reticulum genes which were significantly reduced in the I/R rats only. Remifentanil reduced expression of pro-apoptotic protein, Bax and cytochrome c. These suggested that remifentanil produced cardioprotective effect by preserving the expression of proteins involved in anti-apoptotic pathways, and the expression of sarcoplasmic reticulum genes in I/R rat heart, regardless of the timing of administration.

Relationship between echocardiographic index of ventricular filling pressure and intraoperative haemodynamic changes during off-pump coronary bypass surgery

BACKGROUND

The ratio of mitral velocity to early-diastolic velocity of the mitral annulus (E/e') is an indicator of diastolic function representing acute loading conditions of the left ventricle. We tested the efficacy of E/e' as a predictor of haemodynamic derangement during off-pump coronary artery bypass surgery (OPCAB), when heart displacement causes loading changes.

METHODS AND RESULTS

Fifty patients with left ventricular (LV) ejection fraction >or= 50% were divided into two groups; E/e'<8 (normal LV filling pressure, n=25) and >15 (increased LV filling pressure, n=25). Haemodynamic measurements were recorded after induction of anaesthesia, during grafting, and after sternum closure. Patients' characteristics and operative data were similar between the groups. Cardiac index and mixed venous oxygen saturation were significantly lower during grafting and after sternum closure in the E/e'>15 group, compared with E/e'<8 group and with the baseline values. The E/e'>15 group required significantly longer ventilation time and length of stay in the intensive care unit.

CONCLUSIONS

Even in patients with preserved systolic LV function, patients with E/e'>15 were more prone to undergo a significant decrease in cardiac output during OPCAB, which did not return to baseline level after completion of grafting. Whether this finding is associated with increased morbidity and mortality should be validated.

Effect of low-dose ketamine on inflammatory response in off-pump coronary artery bypass graft surgery

BACKGROUND

Off-pump coronary artery bypass graft surgery (OPCAB) is still associated with a marked systemic inflammatory response. The aim of this study was to investigate whether pre-emptive, low dose of ketamine, which has been reported to have anti-inflammatory activity in on-pump coronary artery bypass surgery, could reduce inflammatory response in low-risk patients undergoing OPCAB.

METHODS

In this prospective randomized-controlled trial, 50 patients with stable angina and preserved myocardial function undergoing OPCAB were randomly assigned to receive either 0.5 mg kg(-1) of ketamine (Ketamine group, n=25) or normal saline (Control group, n=25) during induction of anaesthesia. Inflammatory markers including C-reactive protein (CRP), interleukin (IL)-6, tumour necrosis factor-alpha (TNF-alpha), and cardiac enzymes were measured previous to induction (T1), 4 h after surgery (T2), and the first and second days after the surgery (T3 and T4).

RESULTS

There were no significant intergroup differences in the serum concentrations of the CRP, IL-6, and TNF-alpha and cardiac enzymes. Pro-inflammatory markers and cardiac enzymes, except TNF-alpha, were all increased after the surgery compared with baseline values in both groups.

CONCLUSIONS

Low-dose ketamine administered during anaesthesia induction did not exert any evident anti-inflammatory effect in terms of reducing the serum concentrations of pro-inflammatory markers in low-risk patients undergoing OPCAB.

Development of distant stereoacuity in visually normal children as measured by the Frisby-Davis distance stereotest

AIMS

To establish the range of normal distance stereoacuity and evaluate its development in visually normal children by using the Frisby-Davis distance stereotest (FD2).

METHODS

The distance stereoacuity of visually normal children aged less than 11 years and of adults was measured with FD2 using a standard testing protocol.

RESULT

This study involved 94 visually normal children aged 36-131 months and 46 visually normal adults aged 20-49 years. The distance stereoacuity of the children aged 36-59 months was 40.61 (SD 9.823) seconds of arc; that of the children aged 60-119 months, 14.18 (8.152) seconds of arc; and that of the adults, 12.50 (4.802) seconds of arc. The FD2 distance stereoacuity of the children aged 36-59 months differed significantly from that of the older subjects (p = 0.000), and the FD2 distance stereoacuity of the children aged more than 59 months did not differ significantly from that of the adults (p = 0.813).

CONCLUSION

Distance stereoacuity reaches adult levels at approximately 5 years of age. These data of the age-related normal values could represent a reference frame for the comparison of data obtained for clinical populations.

Diffuse sclerosing variant of papillary carcinoma of the thyroid: ultrasound features with histopathological correlation

AIM

To evaluate the ultrasound (US) features of the diffuse sclerosing variant of papillary carcinoma (DSVPC) of the thyroid, with histopathological correlations.

MATERIALS AND METHODS

The US and histopathological findings of six patients with surgically proven DSVPC of the thyroid were retrospectively assessed.

RESULTS

Most of cases showed diffuse, scattered microcalcifications with or without associated masses and underlying heterogeneous hypoechogenicity at the site of the DSVPC in the thyroid. At ultrasound, scattered microcalcifications and heterogeneous hypoechogenicity seen in the DSVPC correlated to psammoma bodies and lymphocytic infiltration at histopathological review.

CONCLUSION

DSVPC of the thyroid usually manifested as diffuse scattered microcalcifications and associated suspicious mass on ultrasound. These findings are not specific for the DSVPC of the thyroid. However, in relatively young patients with suspicious masses associated with underlying diffuse scattered microcalcifications on US, the possibility of DSVPC should be included in differential diagnosis.

Intraoperative examination of sentinel lymph nodes by immunohistochemical staining in patients with breast cancer

AIM

To performed a prospective investigation of the relative merits of rapid cytokeratin immunohistochemical (CK-IHC) staining of the SLN removed during the operation of breast cancer patients.

STUDY DESIGN

Between December 2002 and March 2004, 62 patients with T1 and T2 breast cancer were enrolled after undergoing successful sentinel lymph node biopsy. Eighty-nine sentinel lymph nodes (mean number, 1.44) were biopsied and first examined by hematoxylin-eosin (H&E) stained frozen section. All the tumour free sentinel lymph nodes by H&E stained frozen section were immunostained for cytokeratin using a rapid immunohistochemical assay (Cytokeratin (PAN), 1:50, Novocastra Lab., Newcastle, UK) during the operations.

RESULTS

Rapid IHC staining revealed seven positive sentinel lymph nodes that were negative for metastasis by H&E staining. This study showed a sensitivity of 92.86%, a specificity of 100%, an accuracy of 98.9%, and a negative predictive value of 98.7%.

CONCLUSIONS

The intraoperative examination of sentinel lymph nodes is an accurate and effective way of predicting the axillary lymph node status of patients with breast cancers.

Hypothalamic AMP-activated protein kinase mediates counter-regulatory responses to hypoglycaemia in rats

AIMS/HYPOTHESIS

Appropriate counter-regulatory hormonal responses are essential for recovery from hypoglycaemia. Although the hypothalamus is known to be involved in these responses, the molecular mechanisms have not been fully elucidated. AMP-activated protein kinase (AMPK) functions as a cellular energy sensor, being activated during energy depletion. As AMPK is expressed in the hypothalamus, an important site of neuroendocrine regulation, the present study was undertaken to determine whether hypothalamic AMPK mediates counter-regulatory responses to hypoglycaemia.

MATERIALS AND METHODS

Hypoglycaemia was induced by i.p. injection of regular insulin (6 U/kg) in Sprague-Dawley rats. Hypothalamic AMPK phosphorylation and activities were determined 1 h after i.p. insulin injection. To investigate the role of hypothalamic AMPK activation in mediating counter-regulatory responses, an AMPK inhibitor, compound C, was pre-administered intracerebroventricularly (i.c.v.) or dominant-negative (DN)-AMPK was overexpressed in the hypothalamus before induction of hypoglycaemia.

RESULTS

Insulin-induced hypoglycaemia increased hypothalamic AMPK phosphorylation and alpha2-AMPK activities in rats. The change was significant in the arcuate nucleus/ventromedial hypothalamus (ARC/VMH) and paraventricular nuclei (PVN). Prior i.c.v. administration of compound C attenuated hypoglycaemia-induced increases in plasma concentrations of corticosterone, glucagon and catecholamines, resulting in severe and prolonged hypoglycaemia. ARC/VMH DN-AMPK overexpression impaired early counter-regulation, as evidenced by reduced glucagon and catecholamine responses. In contrast, PVN DN-AMPK overexpression attenuated late counter-regulation and corticosterone responses.

CONCLUSIONS/INTERPRETATION

Systemic hypoglycaemia causes hypothalamic AMPK activation, which is important for counter-regulatory hormonal responses. Our data indicate that hypothalamic AMPK acts as a fuel gauge, sensing the whole-body energy state and regulating not only energy homeostasis but also neuroendocrine functions.

Performance evaluation of physicochemical processes for biologically pre-treated livestock wastewater

The use of a combination of biological and physicochemical methods is a promising technique to reduce highly concentrated pollutants in livestock wastewater: firstly, biodegradable organic matters, nitrogen and a part of phosphorus should be removed in a biological treatment process and then residual non-biodegradable organic matters, color and phosphorus be eliminated by physicochemical methods. In this study, therefore, the integrations of chemical coagulation, activated carbon adsorption, Fenton oxidation and ozonation were evaluated to provide an appropriate post-treatment process for biologically pre-treated livestock wastewater. With applying a single method such as coagulation and Fenton oxidation, a yellowish brown color and COD still remained. According to the experimental result, the quality of treated wastewater including color was enough to be discharged after chemical coagulation followed by ozonation or Fenton oxidation process. Among these, ozonation was the most effective technology for decolorization. Neither simple biological nor physicochemical process provides an adequate treatability for the sufficient depletion of organics and decolorization when treating livestock wastewater. Considering only the removal efficiency, the integration of Fenton oxidation and ozonation would be an efficient alternative as a post-treatment.

Pilot-testing an alternative on-site wastewater treatment system for small communities and its automatic control

The pilot test of a new alternative for small wastewater treatment system has been conducted for two years. It consists of a hybrid bioreactor and the expert system including the programmable logic controller and human-machine interface. In order to monitor its status, the real-time data was transferred from the remote station to the central station via a wireless local area network. More efficient and stable performances were observed at automatic operating mode compared with the manual. On an average, COD, SS, T-N and T-P concentrations in the effluent from the hybrid bioreactor were less than 14, 7, 12 and 0.9 mg/L, respectively. According to the result from laboratory experiments, the quality of treated wastewater with chemical coagulation process followed by sand filtration was enough to be utilized again if a final disinfection step is included.

Development of a biological process for livestock wastewater treatment using a technique for predominant outgrowth of Bacillus species

The investigation has been carried out by treating 1 m3/day of livestock wastewater for 9 months. The biological process is composed of two reactors connected in series. Each reactor has been designed to stimulate the growth of Bacillus sp., spore-forming aerobic or facultatively anaerobic bacteria. As a consequence, the population of Bacillus sp. is aptly increased via the cycle of sporulation, germination and proliferation. With a predominant growth of Bacillus sp., the microbial activity has been increased comparing to activated sludge based on the result of measuring specific oxygen uptake rate (SOUR). This process was able to remove nitrogen and phosphorus as well as organic matter efficiently. More than 98% of biochemical oxygen demand (BOD) and chemical oxygen demand (COD) were removed. In term of removing the total nitrogen (T-N), about 98% of this was reduced. On average, the T-N concentration in the feed was 3,270 mg/l but 74 mg/l in the effluent including 30 mg/l of nitrite and nitrate nitrogen. The total phosphorus (T-P) reduction averaged 87.5%. As a result, it would be advantageous to load this process in order to deal with high-strength wastewater.

Structure-reactivity relationships in the pyridinolysis of N-methyl-N-arylcarbamoyl chlorides in dimethyl sulfoxide

Nucleophilic substitution reactions of N-methyl-N-arylcarbamoyl chlorides (YC(6)H(4)N(CH(3))COCl) with pyridines (XC(5)H(4)N) have been investigated in dimethyl sulfoxide at 45.0 degrees C. A striking trend in the selectivity parameters is that they are constant within experimental errors, rho(X) = -2.25 +/- 0.03, beta(X) = 0.42 +/- 0.01, and rho(Y) = 1.10 +/- 0.06, with changing reactivities of the electrophiles (deltasigma(Y)) and nucleophiles (deltasigma(X)), respectively, and this leads to a vanishingly small cross-interaction constant, rho(XY) approximately equals beta(XY) approximately equals 0. The rate data can be expressed in the Ritchie N(+) type equation. Based on this and other results, the mechanism of nucleophile (pyridine) addition to the resonance- stabilized carbocation is proposed. It has been shown from the definition of beta(XY) (and rho(XY)) together with the Marcus equation that the high intrinsic barrier, DeltaG(0), in the intrinsic-barrier controlled reaction series is a prerequisite for such reactions in which the cross-interaction vanishes and the N(+) relationship holds.

Reduction mammaplasty in the surgical management of a giant breast hamartoma: case report

INTRODUCTION

Hamartomas of the breast can achieve unusually large proportions, causing gross distortion of the breast. Conclusive preoperative diagnosis can be difficult. We present such a case and describe the application of reduction mammaplasty techniques in the removal of such a tumour.

CLINICAL PICTURE

A 39-year-old woman presented with gross enlargement of the right breast, which had developed over the course of many years. Clinically, there was no discrete mass within the breast and no palpable lymphadenopathy.

TREATMENT

She underwent unilateral reduction mammaplasty. Intraoperative findings were that of a giant hamartoma. The tumour was removed and the breast reconstructed using an inferior pedicled reduction mammaplasty.

OUTCOME

The resultant right breast was of a good match to the contralateral normal breast, both in size and shape.

CONCLUSION

Reduction mammaplasty is a useful technique for the surgical management of giant breast hamartomas, as it not only addresses the issue of tumour removal but also the aesthetic reconstruction of the breast.

Acinic cell carcinoma of the lacrimal gland with intracranial extension: a case report

PURPOSE

To describe a patient with acinic cell carcinoma of the lacrimal gland presenting with atypical manifestations including erosion of the orbital roof and intracranial extension. We compare his clinical manifestations with two previously reported cases.

METHODS

Case report.

RESULTS

A 51-year-old man presented with a firm, tender, palpable mass in the superior temporal portion of his right orbit. CT scan demonstrated a large homogeneously enhancing mass displacing the globe inferiorly and eroding the roof of the orbit. MRI of the orbit showed intracranial extension of tumor. Biopsy revealed an acinic cell carcinoma of the lacrimal gland.

CONCLUSIONS

Acinic cell carcinoma is a rare neoplasm occurring primarily in the major and minor salivary glands.

Resurfacing of the nasopharynx after nasopharyngectomy using a free radial forearm flap

BACKGROUND

Nasopharyngectomy is emerging as an important treatment option for salvaging locally recurrent nasopharyngeal carcinoma (NPC). After nasopharyngectomy, resurfacing the nasopharynx and covering the internal carotid artery is important to minimize the risk of infection, osteoradionecrosis, and carotid rupture. Previous authors have advocated the use of free grafts of skin and mucosa for this purpose but have also described significant rates of partial and total graft failure.

METHODS

We believe that the best and most reliable way to resurface the nasopharynx is with vascularized tissue, and our preference is for the use of a free radial forearm flap. To illustrate our approach, we present two patients who underwent nasopharyngectomy by means of a maxillary swing approach and who had resurfacing of the surgical defect with a free radial forearm flap.

RESULTS

Both patients had complete en bloc resection of tumor followed by the insetting of a free radial forearm flap to reline the surgical defect. Both flaps remained completely viable, and both patients achieved successful resurfacing of the entire nasopharynx. The morbidity of surgery was minimal, and there were no perioperative complications. On assessment 1 year later, the free radial forearm flap continues to reline the entire neonasopharynx, and the long-term functional recovery after surgery is excellent.

CONCLUSION

Resurfacing the nasopharynx after nasopharyngectomy with a free radial forearm flap aids healing and minimizes the risk of complications. The morbidity of surgery is minimal and the functional recovery is excellent.

Hsp101 is necessary for heat tolerance but dispensable for development and germination in the absence of stress

Hsp101 is a molecular chaperone that is required for the development of thermotolerance in plants and other organisms. We report that Arabidopsis thaliana Hsp101 is also regulated during seed development in the absence of stress, in a pattern similar to that seen for LEA proteins and small Hsps; protein accumulates during mid-maturation and is stored in the dry seed. Two new alleles of the locus encoding Hsp101 (HOT1) were isolated from Arabidopsis T-DNA mutant populations. One allele, hot1-3, contains an insertion within the second exon and is null for Hsp101 protein expression. Despite the complete absence of Hsp101 protein, plant growth and development, as well as seed germination, are normal, demonstrating that Hsp101 chaperone activity is not essential in the absence of stress. In thermotolerance assays hot1-3 shows a similar, though somewhat more severe, phenotype to the previously described missense allele hot1-1, revealing that the hot1-1 mutation is also close to null for protein activity. The second new mutant allele, hot1-2, has an insertion in the promoter 101 bp 5' to the putative TATA element. During heat stress the hot1-2 mutant produces normal levels of protein in hypocotyls and 10-day-old seedlings, and it is wild type for thermotolerance at these stages. Thus this mutation has not disrupted the minimal promoter sequence required for heat regulation of Hsp101. The hot1-2 mutant also expresses Hsp101 in seeds, but at a tenfold reduced level, resulting in reduced thermotolerance of germinating seeds and underscoring the importance of Hsp101 to seed stress tolerance.

Immobilization of arsenic in tailing by using iron and hydrogen peroxide

Under environmental conditions, arsenic (As) reveals anionic behavior and is converted into various forms in accordance with the Eh/pH condition. This causes the difficulty of treating As with other heavy metals in tailing. This study was carried out to develop the immobilization method of arsenic in tailing as ferric arsenate (FeAsO4) using hydrogen peroxide. According to experimental results, the extracted concentrations of arsenic and iron (Fe) from tailing were reduced up to 84% and 93%, respectively. In the experiment using pure Pyrite (FeS2) and As solution, As concentration decreased with an increase of hydrogen peroxide dosage. The experimental results of re-extraction showed that only 10% of As and 20% of Fe were extracted in the case of using hydrogen peroxide. As a result, the long-term stability of this method was clarified.

Granzyme B and TIA-1 expression in chronic and acute on chronic renal allograft rejection

Although active inflammation may be deleterious and indicate immunologic activation in chronically rejected grafts, the underlying mechanism of tissue destruction has been little studied. Twenty-four cases of chronic rejection (CR) with or without acute rejection (AR) were stained with antibodies against CD3, CD8, CD68, granzyme B and TIA-1, and the number of positive cells were counted. Eleven cases of AR served as controls. The number of CD3 and CD8 positive cells increased in the acute on CR group compared to the CR group. About a half of CD3 positive T cells were CD8 positive in both groups, however, the proportion of TIA-1 or granzyme B positive cells was higher in the acute on CR group. The numbers of CD3, CD68, granzyme B and TIA-1 positive cells were higher in the AR group than the acute on CR group, however, no significant difference was found between the two groups. Serum creatinine level and proteinuria at the time of biopsy and the percentages of late onset AR and graft failure rate were higher in the acute on CR group than the CR group. Summarizing, these results suggest that infiltration of activated T cells containing cytotoxic granules plays a role in graft destruction in acute on CR.

The key role of the transforming growth factor-beta system in the pathogenesis of diabetic nephropathy

Progressive renal injury in diabetes mellitus leads to major morbidity and mortality. The manifestations of diabetic nephropathy may be a consequence of the actions of certain cytokines and growth factors. Prominent among these is transforming growth factor-beta (TGF-beta) because it promotes renal cell hypertrophy and stimulates extracellular matrix accumulation, the two hallmarks of diabetic renal disease. In cell culture, high ambient glucose increases TGF-beta mRNA and protein in proximal tubular, glomerular epithelial, and mesangial cells. Neutralizing anti-TGF-beta antibodies prevent the hypertrophic and matrix stimulatory effects of high glucose in these cells. In experimental and human diabetes mellitus, several reports describe overexpression of TGF-beta in the glomeruli and tubulointerstitium. We demonstrate that short-term treatment of diabetic mice with neutralizing monoclonal antibodies against TGF-beta significantly reduces kidney weight and glomerular hypertrophy and attenuates the increase in extracellular matrix mRNAs. Long-term treatment of diabetic mice further improves the renal pathology and also ameliorates the functional abnormalities of diabetic nephropathy. Finally, we provide evidence that the renal TGF-beta system is significantly up-regulated in human diabetes. The kidney of a diabetic patient actually elaborates TGF-beta1 protein into the circulation whereas the kidney of a non-diabetic subject extracts TGF-beta1 from the circulation. The data we review here strongly support the hypothesis that elevated production or activity of the TGF-beta system mediates diabetic renal hypertrophy and extracellular matrix expansion.

Increased glomerular and tubular expression of transforming growth factor-beta1, its type II receptor, and activation of the Smad signaling pathway in the db/db mouse

Activation of the renal transforming growth factor-beta (TGF-beta) system likely mediates the excess production of extracellular matrix in the diabetic kidney. To establish the role of the TGF-beta system in type 2 diabetic nephropathy, we examined the intrarenal localization and expression of the TGF-beta1 isoform, the TGF-beta type II receptor, and the Smad signaling pathway in the 16-week-old db/db mouse, a genetic model of type 2 diabetes that exhibits mesangial matrix expansion, glomerular basement membrane thickening, and renal insufficiency that closely resemble the human disease. Compared with its nondiabetic db/m littermate, the db/db mouse showed significantly increased TGF-beta1 mRNA expression by in situ hybridization in both glomerular and tubular compartments. Likewise, TGF-beta1 protein, by immunohistochemical staining, was increased in both renal compartments, but the fractional expression of TGF-beta1 protein was less than that of the mRNA in the glomerulus. In situ hybridization and immunohistochemical staining for the TGF-beta type II receptor revealed concordant and significant increases of both mRNA and protein in the glomerular and tubular compartments of diabetic animals. Finally, immunohistochemistry showed preferential accumulation of Smad3 in the nuclei of glomerular and tubular cells in diabetes. The complementary technique of Southwestern histochemistry using a labeled Smad-binding element demonstrated increased binding of nuclear proteins to Smad-binding element, indicating active signaling downstream of the TGF-beta stimulus. We therefore propose that the TGF-beta system is up-regulated at the ligand, receptor, and signaling levels throughout the renal cortex in this animal model of type 2 diabetes. Our findings suggest that the profibrotic effects of TGF-beta may underlie the progression to glomerulosclerosis and tubulointerstitial fibrosis that characterize diabetic nephropathy.

Purification and characterization of acharan sulfate lyases, two novel heparinases, from Bacteroides stercoris HJ-15

Two novel acharan sulfate lyases (ASL1 and ASL2: no EC number) have been purified from Bacteroides stercoris HJ-15 which was isolated from human intestinal bacteria with glycosaminoglycan (GAG) degrading enzymes. These enzymes were purified to apparent homogeneity by a combination of QAE-cellulose, DEAE-cellulose, carboxymethyl-Sephadex C-50, hydroxyapatite and HiTrap SP Sephadex C-25 column chromatography with the final specific activity of 50.5 and 76.7 micromol.min-1.mg-1, respectively. Both acharan sulfate lyases are single subunits of 83 kDa by SDS/PAGE and gel filtration. ASL1 showed optimal activity at pH 7.2 and 45 degrees C. ASL1 activity was inhibited by Cu2+, Ni2+ and Co2+, but ASL2 activity was inhibited by Cu2+, Ni2+and Pb2. Both enzymes were slightly inhibited by some agents that modify histidine and cysteine residues, but activated by reducing agents such as DL-dithiothreitol and 2-mercaptoethanol. Both purified bacteroidal acharan sulfate lyases acted to the greatest extent on acharan sulfate, and to a lesser extents on heparan sulfate and heparin. They did not act on de-O-sulfated acharan sulfate. These findings suggest that the biochemical properties of these purified acharan sulfate lyases are different from those of the previously purified heparin lyases, but these enzymes belong to heparinase II.

Tic convulsif caused by cerebellopontine angle schwannoma

A case is presented of painful tic convulsif caused by schwannoma in the cerebellopontine angle (CPA), with right trigeminal neuralgia and ipsilateral hemifacial spasm. Magnetic resonance images showed a 4 cm round mass displacing the 4th ventricle and distorting the brain stem in the right CPA. The schwannoma, which compressed the fifth and seventh cranial nerves directly, was subtotally removed by a suboccipital craniectomy. Postoperatively, the patient had a complete relief from the hemifacial spasm and marked improvement from trigeminal neuralgia. The painful tic convulsif in this case was probably produced by the tumor compressing and displacing the anterior cerebellar artery directly.

Leptin stimulates type I collagen production in db/db mesangial cells: glucose uptake and TGF-beta type II receptor expression

BACKGROUND

Serum leptin levels correlate with fat cell mass and are elevated in patients with massive obesity and type 2 diabetes mellitus, which are strong risk factors for the development of glomerulosclerosis. We have previously shown in cultured glomerular endothelial cells that leptin stimulates cellular proliferation and expression of the prosclerotic cytokine transforming growth factor-beta1 (TGF-beta1). Although the effect of leptin on the hypothalamus to regulate energy homeostasis is well known, the effect of leptin on the kidney, and specifically on the glomerular mesangial cell, is unclear.

METHODS

The obese, diabetic db/db mouse, which lacks the functional full-length Ob-Rb leptin receptor, is a suitable model to assess the effects of hyperleptinemia on peripheral tissues that express other receptor isoforms. The effects of leptin on glucose uptake, the TGF-beta system, and type I collagen production were evaluated in db/db mouse mesangial cells in culture. A phosphatidylinositol-3 kinase (PI-3K) inhibitor was used to assess the role of PI-3K in mediating the effects of leptin.

RESULTS

A short form of the leptin receptor (Ob-Ra), but not Ob-Rb, was present by reverse transcription-polymerase chain reaction in the kidney and mesangial cells of both nondiabetic db/m and diabetic db/db mice. In db/db mesangial cells, leptin increased 2-deoxy-D-glucose (2DOG) uptake dose dependently and stimulated gene expression of TGF-beta type II receptor (TbetaRII) and alpha1(I) collagen, but not TGF-beta1. Protein production of type I collagen (enzyme-linked immunosorbent assay) was also increased by leptin. Both leptin-stimulated 2DOG uptake and type I collagen production were suppressed by a PI-3K inhibitor, LY294002. Mesangial cells pretreated with leptin exhibited increased responsiveness to exogenous TGF-beta1, as evidenced by a greater production of type I collagen protein in leptin-pretreated cells exposed to low-dose TGF-beta1 (0.5 ng/mL). The addition of both TGF-beta1 (2 ng/mL) and leptin (100 ng/mL) increased type I collagen production more than addition of either TGF-beta1 or leptin alone.

CONCLUSIONS

Leptin increases glucose uptake and type I collagen in db/db mesangial cells through a PI-3K-dependent pathway. We postulate that increased leptin levels may transmit a signal through the short-form leptin receptor to up-regulate TbetaRII and activate the intraglomerular TGF-beta system, which may contribute to the glomerulosclerosis of obesity or type 2 diabetes.

The effects of particle size distribution on the settleability of CSOs pollutants

Over the past decades, flocculation and/or sedimentation processes have been adopted to remove pollutants from CSOs. It has been learned that major factors affecting settlement of pollutants are the particle size distribution, their settling velocities and their specific gravity. It is, therefore, a good idea to analyze the particle size distribution and settleability of CSOs pollutants in order to develop details in designing a process. Discussed in this study are pollutant characteristics of CSOs such as particle size distribution and settleability of pollutants. The power law function is applied and is found to be an effective and reliable index for expressing the particle size distribution of pollutants in CSOs. Based on the particle size spectrum analysis, the tendency toward settling and simultaneous flocculation-settling phenomenon of CSOs pollutants is described. Based on the regression analysis it is observed that the derived constants of curves representing settling velocity profile are proportional to the initial concentration of particles and to the beta-values of power law distributions. It is also revealed that the simultaneous flocculation-settling processes are effectively described by the changes of the average particle diameter and of the beta-values of power law distributions.

Preventing nosocomial Mycobacterium tuberculosis transmission in international settings

Tuberculosis (TB) is a worldwide disease, and nosocomial transmission is known to occur. Authoritative preventive guidelines such as the one developed by the Centers for Disease Control have been published, but the expenses for implementing them can be prohibitive. Each country needs to develop its own protocol to prevent nosocomial transmission of TB. This article describes the key elements of a protocol undertaken for all public hospitals in Hong Kong, where TB is endemic.

Long-term prevention of renal insufficiency, excess matrix gene expression, and glomerular mesangial matrix expansion by treatment with monoclonal antitransforming growth factor-beta antibody in db/db diabetic mice

Emerging evidence suggests that transforming growth factor-beta (TGF-beta) is an important mediator of diabetic nephropathy. We showed previously that short-term treatment with a neutralizing monoclonal anti-TGF-beta antibody (alphaT) in streptozotocin-diabetic mice prevents early changes of renal hypertrophy and increased matrix mRNA. To establish that overactivity of the renal TGF-beta system mediates the functional and structural changes of the more advanced stages of nephropathy, we tested whether chronic administration of alphaT prevents renal insufficiency and glomerulosclerosis in the db/db mouse, a model of type 2 diabetes that develops overt nephropathy. Diabetic db/db mice and nondiabetic db/m littermates were treated intraperitoneally with alphaT or control IgG, 300 microgram three times per week for 8 wk. Treatment with alphaT, but not with IgG, significantly decreased the plasma TGF-beta1 concentration without decreasing the plasma glucose concentration. The IgG-treated db/db mice developed albuminuria, renal insufficiency, and glomerular mesangial matrix expansion associated with increased renal mRNAs encoding alpha1(IV) collagen and fibronectin. On the other hand, treatment with alphaT completely prevented the increase in plasma creatinine concentration, the decrease in urinary creatinine clearance, and the expansion of mesangial matrix in db/db mice. The increase in renal matrix mRNAs was substantially attenuated, but the excretion of urinary albumin factored for creatinine clearance was not significantly affected by alphaT treatment. We conclude that chronic inhibition of the biologic actions of TGF-beta with a neutralizing monoclonal antibody in db/db mice prevents the glomerulosclerosis and renal insufficiency resulting from type 2 diabetes.

Alterations in extracellular matrix components in transplant glomerulopathy

The distribution pattern of extracellular matrix (ECM) components in transplant glomerulopathy was studied in relation to light microscopic features, actin expression of mesangial cells, and intraglomerular inflammatory cells. Nine cases of mild (group I) and nine cases of severe (group II) transplant glomerulopathy were stained with antisera against fibronectin (FN), tenascin (TN), collagen types III and IV, smooth muscle actin, CD45RO, CD68, and Ki-67 antigen. The composition of ECM was similar in the two groups. The expanded mesangium was diffusely stained by type-IV collagen, FN and TN, and focally and weakly stained by type-III collagen and smooth muscle actin. Type-IV collagen was linearly stained along the capillary walls, imparting a double-contour feature, whereas FN and TN showed granular staining along the capillary walls. CD68 positive cells were increased in severe transplant glomerulopathy, but this increase was not related to ECM deposition. These findings suggest that increased glomerular deposition of normal and abnormal ECM components participate in the evolution of transplant glomerulopathy.

A case of membranoproliferative glomerulonephritis associated with a hydatidiform mole

We treated a 54-year-old woman who was suffering from membranoproliferative glomerulonephritis associated with a complete type of hydatidiform mole. The renal manifestations were proteinuria and hematuria. A renal biopsy, performed before gynecologic management, disclosed focal and segmental subendothelial deposits with a proliferation of the mesangial cell and showed irregularly thickened capillary loops by light and electronmicroscoy. Genralized edema, proteinuria and hematuria were completely recovered by suction and curettage of the hydatidiform mole with prophylactic chemotherapy. The clinical manifestation of earlier presented 3 cases have been the nephrotic syndrome. The common feature of them was a complete remission of the nephropathy after the removal of the hydatidiform mole. The relationship between the hydatidiform mole and glomerulonephritis remains unresolved at present. But we concluded that the hydatidiform mole might be a cause of glomerulonephritis in this case.

Antimicrobial activity of 9-O-acyl- and 9-O-benzoyl-substituted berberrubines

In the course of a structure-activity relationship study on berberrubine derivatives, a series of compounds bearing 9-O-acyl-(4-6) and 9-O-benzoyl- (7) substituents was synthesized with the expectation of increasing the antimicrobial activity. One of the berberrubine derivatives, 9-lauroylberberrubine chloride was the most active against Gram-positive bacteria Enterococcus faecalis, Staphylococcus aureus, Staphylococcus epidermidis, Micrococcus luteus, Bacillus subtilis as well as the Gram-negative bacterium Klebsiella pneumoniae in comparison to berberine, the currently used antibiotic in clinic. This result suggested that the presence of lipophilic substituents of certain structures and sizes might be crucial for the optimal antimicrobial activity.

Mutants of Arabidopsis thaliana defective in the acquisition of tolerance to high temperature stress

The ability of organisms to acquire thermotolerance to normally lethal high temperatures is an ancient and conserved adaptive response. However, knowledge of cellular factors essential to this response is limited. Acquisition of thermotolerance is likely to be of particular importance to plants that experience daily temperature fluctuations and are unable to escape to more favorable environments. We developed a screen, based on hypocotyl elongation, for mutants of Arabidopsis thaliana that are unable to acquire thermotolerance to high-temperature stress and have defined four separate genetic loci, hot1-4, required for this process. hot1 was found to have a mutation in the heat shock protein 101 (Hsp101) gene, converting a conserved Glu residue in the second ATP-binding domain to a Lys residue, a mutation that is predicted to compromise Hsp101 ATPase activity. In addition to exhibiting a thermotolerance defect as assayed by hypocotyl elongation, 10-day-old hot1 seedlings were also unable to acquire thermotolerance, and hot1 seeds had greatly reduced basal thermotolerance. Complementation of hot1 plants by transformation with wild-type Hsp101 genomic DNA restored hot1 plants to the wild-type phenotype. The hot mutants are the first mutants defective in thermotolerance that have been isolated in a higher eukaryote, and hot1 represents the first mutation in an Hsp in any higher plant. The phenotype of hot1 also provides direct evidence that Hsp101, which is required for thermotolerance in bacteria and yeast, is also essential for thermotolerance in a complex eukaryote.

Heat shock protein 101 plays a crucial role in thermotolerance in Arabidopsis

Plants are sessile organisms, and their ability to adapt to stress is crucial for survival in natural environments. Many observations suggest a relationship between stress tolerance and heat shock proteins (HSPs) in plants, but the roles of individual HSPs are poorly characterized. We report that transgenic Arabidopsis plants expressing less than usual amounts of HSP101, a result of either antisense inhibition or cosuppression, grew at normal rates but had a severely diminished capacity to acquire heat tolerance after mild conditioning pretreatments. The naturally high tolerance of germinating seeds, which express HSP101 as a result of developmental regulation, was also profoundly decreased. Conversely, plants constitutively expressing HSP101 tolerated sudden shifts to extreme temperatures better than did vector controls. We conclude that HSP101 plays a pivotal role in heat tolerance in Arabidopsis. Given the high evolutionary conservation of this protein and the fact that altering HSP101 expression had no detrimental effects on normal growth or development, one should be able to manipulate the stress tolerance of other plants by altering the expression of this protein.