Epinephrine increases facility of outflow and cyclic AMP content in the human eye in vitro.

The physiologic mechanism that underlies the epinephrine-induced increase in facility of outflow (C) in glaucomatous human eyes and normal primate eyes is not completely understood. In this study, a recently developed in vitro human eye perfusion model was used to simultaneously monitor facility and cyclic adenosine monophosphate (AMP) changes in response to epinephrine (EPI). In this system, EPI (2.5 x 10(-5) mol/l) resulted in a maximal 44% increase in C, with an ED50 occurring at approximately 8 x 10(-6) mol/l. The C-increasing effect of 10(-5) mol/l EPI was unaffected by 10(-6) mol/l phentolamine. However, it was completely blocked in the presence of 10(-6) mol/l timolol or 2 x 10(-7) mol/l ICI118,551, suggesting the involvement of beta-2 adrenergic receptors. In biochemical studies, 10(-5) mol/l EPI induced a 12- to 14-fold increase in cyclic AMP in the perfusate of treated eyes. This increase was blocked by ICI118,551. In isolated intact human trabecular tissue, a 10 min incubation with 10(-5) EPI stimulated cyclic AMP by a factor of 2.7 over control levels. After 90 min, cyclic AMP levels were increased 4.2 fold over control levels. Collectively, these results show that the intraocular pressure lowering effect of EPI in the human eye is mediated, at least in part, by an increase in facility of outflow. Furthermore, the facility increase appears to be mediated by beta-2 adrenergic receptors and is correlated in time with increased cyclic AMP production.


Association between IgE response against Bet v I, the major allergen of birch pollen, and HLA-DRB alleles.

The association of the human IgE response against Bet v I, the major allergen of birch pollen, and the HLA-DR and DQ phenotype was studied. Birch pollen allergic patients showed a typical case history, positive skin-prick test, and positive RAST with birch pollen extracts. They were divided into two groups. Group I (n = 37) consisted of individuals generating IgE antibodies that selectively reacted with Bet v I. Their serum IgE did not react with minor allergens from birch pollen as tested by immunoblot analysis, nor did they show a response against allergens from a panel of grass and other tree pollen or perennial allergens from animals and fungi as determined by skin-prick test. Patients belonging to group II (n = 34) possessed IgE reacting with Bet v I plus one or more additional allergens. The control group consisted of 637 healthy blood donors. Comparison of the frequencies of RFLP-defined HLA-DR and DQ alleles in patients and the control group revealed that the distribution of DRB3 alleles in group I patients differed significantly from that in the control group: A higher frequency of the DRw52a/c alleles in comparison to the control group (pcorr less than 0.02) was observed. In addition, alleles defined by nucleotide sequences coding for the amino acid sequence tyrosine-phenylalanine-histidine at positions 30-32 of the beta chain of DR molecules were found with a higher frequency in patient group I (pcorr less than 0.02), too. These alleles comprise DRw52a/c and some DRB1 alleles.(ABSTRACT TRUNCATED AT 250 WORDS)


Molecular characterization of a recombinant HLA-DR1/DR2 haplotype.

Serologic analysis of two families identified an HLA-DR haplotype in which DR1 and DR2 cosegregated. DNA-RFLP analysis of these families with an HLA-DRB probe revealed a pattern of hybridization suggestive of a recombination between DR1 and DR15. Following amplification, cloning, and nucleotide sequencing of HLA-DRB-gene second-exon DNA sequences, three DRB amplification products associated with the novel haplotype were identified: these corresponded to DRB1*0101, DR2 pseudogene, and DRB5*0101. Clones representing the DRB1*1501 and DR1 pseudogenes were not identified: oligonucleotide typing with DRB1*1501-specific probes confirmed the absence of this gene within the DR1/DR2 haplotype. We postulate that the DR1/DR2 haplotype represents a recombinant between those of DR1-Dw1 and DR15-Dw2, and that the crossing-over may have been between the DRB1*0101 gene and the DR2 pseudogene. This is further supported by DNA-RFLP analysis with HLA-DQB and DQA CDNA probes, which revealed conserved linkage genes between the DQB1*0501, DQA1*0101, and DRB1*0101 genes.


Therapy of small breast cancer: a prospective study on 1036 patients with special emphasis on prognostic factors.

In 1983, The German Breast Cancer Study Group, sponsored by the Federal Ministry of Research and Technology, started a prospective multicenter trial on the treatment of early breast cancer pT1 pN0 M0. Treatment consisted of initial tumorectomy with microscopically free margins and lower axillary dissection. After conformation of a pT1 pN0-stage, additional treatment was either mastectomy or adjuvant radiotherapy (50 Gy in 25 fractions to the entire breast plus 12 Gy electron boost). In medially located tumors, the parasternal and supraclavicular area was also irradiated with 50 Gy. A randomization between both treatment modalities was initially planned but was not feasible and abandoned. Nearly all patients were treated according to their own choice. From November 1983 through December 1989, 1119 patients were recruited. Eighty-three were excluded from the protocol. Out of the remaining 1036 patients, 733 (71%) underwent breast preservation and 303 (29%) mastectomy. A detailed pathohistological examination of all tumorectomy specimens was performed in a pathologic reference center. Oncogen overexpression was evaluated by immunohistological detection of the transmembrane protein p-185 (corresponding to c-erb-B2) in 425 cases. After a median follow-up of 48 months, the frequency of local recurrences (4.7%), regional recurrences (1%), and distant metastases (5.4%) was the same in the breast preservation group and the mastectomy group. The 3-year disease-free survival was 90% after breast preservation and 88% after mastectomy (p = 0.21). In the breast preserving group, 24 patients with microscopically involved margins had a poorer disease-free survival than the study group (75% vs 90% after 3 years). The width of the margins had no impact on prognosis. Other prognostic factors in an univariate and multivariate analysis were tumor size and tumor grade. Age, menopausal status, hormone receptor status, histological tumor type, and treatment (mastectomy vs breast preservation) were not significant. P-185-expression was dependent on tumor grade and was the strongest prognostic factor in an univariate and multivariate analysis (p less than 0.001). The results emphasize the central role of tumor grade for prognosis and suggest the independent prognostic significance of the c-erb-B2 oncogen (corresponding to p-185) in pN0-patients.


Should chronic treatment-refractory akathisia be an indication for the use of clozapine in schizophrenic patients?

Clozapine, an atypical neuroleptic, is an effective medication in a subgroup of schizophrenic patients who have either failed to respond to the typical neuroleptics or experienced intolerable side effects such as neuroleptic malignant syndrome and disabling tardive dyskinesia. Its efficacy for persistent and disabling akathisia is less clear. Akathisia, especially the chronic and disabling form, can be a treatment dilemma for the clinician and the patient. We describe three representative case illustrations of schizophrenic patients who had severe, persistent treatment-resistant akathisia. Two of them had refractory psychoses and the third had multiple disabling side effects during treatment with typical neuroleptics. Two had tardive dyskinesia. These patients were treated with clozapine while other neuroleptics were discontinued. During a 2-year follow-up, these patients made impressive social and vocational strides coinciding with a fairly rapid remission of akathisia (under 3 months) and a lesser though notable improvement in the psychoses. Tardive dyskinesia also remitted, though over a period of 6 to 12 months. Our experience leads us to suggest a trial of clozapine in a subgroup of schizophrenic patients, who in addition to refractory psychoses have persistent disabling akathisia. However, given the risk of agranulocytosis with clozapine, we suggest that the usual treatment strategies for akathisia be tried before clozapine is initiated in the approved manner. Future controlled trials of clozapine that specifically investigate persistent akathisia may answer this question more conclusively.


Glutamate transport into synaptic vesicles. Roles of membrane potential, pH gradient, and intravesicular pH.

Glutamate, the major excitatory neurotransmitter in the mammalian central nervous system, is transported into bovine synaptic vesicles in a manner that is ATP dependent and requires a vesicular electrochemical proton gradient. We studied the electrical and chemical elements of this driving force and evaluated the effects of chloride on transport. Increasing concentrations of Cl- were found to increase the steady-state ATP-dependent vesicular pH gradient (delta pH) and were found to concomitantly decrease the vesicular membrane potential (delta psi). Low millimolar chloride concentrations, which cause 3-6-fold stimulation of vesicular glutamate uptake, caused small but measurable increases in delta pH and decreases in delta psi, when compared to control vesicles in the absence of chloride. Nigericin in potassium buffers was used to alter the relative proportions of delta pH and delta psi. Compared to controls, at all chloride concentrations tested, nigericin virtually abolished delta pH and increased the vesicle interior positive delta psi. Concomitantly, nigericin increased ATP-dependent glutamate uptake in 0-1 mM chloride but decreased glutamate uptake in 4 mM (45%), 20 mM (80%), and 140 mM (75%) Cl- (where delta pH in the absence of nigericin was large). These findings suggest that either delta psi, delta pH, or a combination can drive glutamate uptake, but to different degrees. In the presence of 4 mM Cl-, where uptake is optimal, both delta psi and delta pH contribute to the driving force for uptake. When the extravesicular pH was increased from 7.4 to 8.0, more Cl- was required to stimulate vesicular glutamate uptake. In the absence of Cl-, as extravesicular pH was lowered to 6.8, uptake was over 3-fold greater than it was at pH 7.4. As extravesicular pH was reduced from 8.0 toward 6.8, less Cl- was required for maximal stimulation. Decreasing the extravesicular pH from 8.0 to 6.8 in the absence of Cl- significantly increased glutamate uptake activity, even though proton-pumping ATPase activity actually decreased about 45% under identical conditions. In the absence of chloride, nigericin increased glutamate uptake at all the pH values tested except pH 8.0. Glutamate uptake at pH 6.8 in the presence of nigericin was over 6-fold greater than uptake at pH 7.4 in the absence of nigericin. We conclude from these experiments that optimal ATP-dependent glutamate uptake requires a large delta psi and a small delta pH.(ABSTRACT TRUNCATED AT 400 WORDS)


Inhibition by glucagon of the cGMP-inhibited low-Km cAMP phosphodiesterase in heart is mediated by a pertussis toxin-sensitive G-protein.

We have recently reported that glucagon activated the L-type Ca2+ channel current in frog ventricular myocytes and showed that this was linked to the inhibition of a membrane-bound low-Km cAMP phosphodiesterase (PDE) (Méry, P. F., Brechler, V., Pavoine, C., Pecker, F., and Fischmeister, R. (1990) Nature 345, 158-161). We show here that the inhibition of membrane-bound PDE activity by glucagon depends on guanine nucleotides, a reproducible inhibition of 40% being obtained with 0.1 microM glucagon in the presence of 10 microM GTP, with GTP greater than GTP gamma S, while GDP and ATP gamma S were without effect. Glucagon had no effect on the cytosolic low-Km cAMP PDE, assayed with or without 10 microM GTP. Glucagon inhibition of membrane-bound PDE activity was not affected by pretreatment of the ventricle particulate fraction with cholera toxin. However, it was abolished after pertussis toxin pretreatment. Mastoparan, a wasp venom peptide known to activate G(i)/G(o) proteins directly, mimicked the effect of glucagon. PDE inhibition by glucagon was additive with the inhibition induced by Ro 20-1724, but was prevented by milrinone. This was correlated with an increase by glucagon of cAMP levels in frog ventricular cells which was not additive with the increase in cAMP due to milrinone. We conclude that glucagon specifically inhibits the cGMP-inhibited, milrinone-sensitive PDE (CGI-PDE). Insensitivity of adenylylcyclase to glucagon and inhibition by the peptide of a low-Km cAMP PDE were not restricted to frog heart, but also occurred in mouse and guinea pig heart. These results confirm that two mechanisms mediate the action of glucagon in heart: one is the activation of adenylylcyclase through Gs, and the other relies on the inhibition of the membrane-bound low-Km CGI-PDE, via a pertussis toxin-sensitive G-protein.


Assembly of plant ferredoxin-NADP+ oxidoreductase in Escherichia coli requires GroE molecular chaperones.

We have recently reported the expression in Escherichia coli of an enzymatically competent ferredoxin-NADP+ oxidoreductase from cloned pea genes encoding either the mature enzyme or its precursor protein (Ceccarelli, E. A., Viale, A. M., Krapp, A. R., and Carrillo, N. (1991) J. Biol. Chem. 266, 14283-14287). Processing to the mature form by bacterial protease(s) and FAD assembly occurred in the bacterial cytosol. Expression of ferredoxin-NADP+ reductase in chaperonin-deficient (groE-) mutants of E. coli resulted in partial reductase assembly at permissive growth temperatures (i.e. 30 degrees C), and in total breakdown of holoenzyme assembly, and accumulation as aggregated inclusion bodies at non-permissive temperatures (i.e. 42 degrees C). Coexpression in these mutants of a cloned groESL operon from the phototrophic bacterium Chromatium vinosum resulted in partial or total recoveries of ferredoxin-NADP+ reductase assembly. The overall results indicate that bacterial chaperonins are required for the productive folding/assembly of eucaryotic ferredoxin-NADP+ reductase expressed in E. coli.


Purification of a pituitary receptor for somatostatin. The utility of biotinylated somatostatin analogs.

A somatostatin (SRIF) receptor and its associated Gi regulatory proteins was purified from GH4C1 rat pituitary cells by: 1) saturation of the membrane-bound receptor with biotinyl-NH-[Leu8,D-Trp22,Tyr25] SRIF28 (bio-S28); 2) solubilization of receptor-ligand (R.L) complex with deoxycholate-lysophosphatidylcholine (D.L); 3) adsorption of solubilized receptor-ligand complex to immobilized streptavidin; and 4) elution of receptor and G-protein by GTP. The receptor, a glycoprotein with an average M(r) of 85,000, was then purified to substantial homogeneity on immobilized wheat germ agglutinin. The 85-kDa glycoprotein was identified as a SRIF receptor by several criteria. (a) It had the same size as the chemically cross-linked R.[125I]L complex. (b) Yield of the purified protein increased and plateaued in the same range of bio-S28 concentrations where specific high affinity binding reached saturation. (c) It was copurified with appropriate G-protein subunits. The 85-kDa receptor and two other proteins with M(r) values of 35,000 and 40,000, the sizes of G beta and G alpha, did not appear in eluates from control streptavidin columns done with SRIF receptors loaded with nonbiotinylated S14. The 40-kDa protein was identified as a Gi alpha by ADP-ribosylation from [32P]NAD catalyzed by pertussis toxin. (d) Both the chemically cross-linked R.[125I]L complex and SRIF receptor purified from [35S]methionine-labeled GH4C1 cells were reduced in size to about 38 kDa by endoglycosidase F. (e) Amino acid sequence from the purified receptor was nearly identical with that of a recently cloned SRIF receptor subtype.


Solubilization and partial purification of somatostatin-28 preferring receptors from hamster pancreatic beta cells.

Somatostatin-28 (SRIF-28) preferring receptors were solubilized from hamster beta cell insulinoma using the zwitterionic detergent 3-[(3-cholamidopropyl) dimethylammonio]-1-propanesulfonate. The binding of the iodinated [Leu8-D-TRP22-Tyr25]SRIF-28 analog (referred to as 125I[LWY] SRIF-28) to the solubilized fraction was time-dependent, saturable, and reversible. Scatchard analysis of equilibrium binding data indicated that the solubilized extract contained two classes of SRIF-28-binding sites: a high affinity site (Kd = 0.3 nM and Bmax = 1 pmol/mg protein) and a low affinity site (Kd = 13 nM and Bmax = 4.7 pmol/mg protein). The binding of 125I[LWY]SRIF-28 to solubilized SRIF-28 receptors was sensitive to the GTP analog guanosine-5'-O-thiotriphosphate, suggesting that receptors are functionally linked to a G-protein. By anion-exchange chromatography of the solubilized extract followed by chromatography on wheat germ agglutinin, a 46-fold purification of SRIF-28 receptors was obtained. At this stage of purification, only high affinity sites were found (Kd = 1 nM) and the GTP effect was not maintained. A specific protein of 37 kDa was identified by sodium dodecyl sulfate-polyacrylamide gel electrophoresis after photoaffinity labeling. We suggest that this protein is the putative SRIF-28 receptor or a subunit thereof.


Bethanechol inhibition of chicken intestinal brush border Na/H exchange: role of protein kinase C and other calcium-dependent processes.

Bethanechol, a muscarinic agonist, inhibits the initial rate of amiloride-sensitive Na uptake by intact mucosa of avian small intestine as well as by isolated chicken villus enterocytes, an effect that is maximal at 90 seconds and reverses by 6 minutes. Bethanechol similarly decreases intracellular pH in isolated cells suspended in bicarbonate-free buffer in a time course similar to inhibition of enterocyte Na uptake, suggesting inhibition of Na/H exchange. In brush border membrane vesicles rapidly prepared from cells stimulated with bethanechol, proton-dependent 22Na uptake is transiently inhibited in a time course similar to inhibition of cell Na uptake. Bethanechol also stimulates transient translocation of protein kinase C from the cytosol to the particulate fraction, a portion of this activity translocating to the brush border membrane. To determine the calcium dependence of bethanechol's action, enterocytes were loaded with varying concentrations of the calcium buffering agent quin-2. Inhibition of cell Na uptake by the calcium ionophore ionomycin could be completely reversed by quin-2 buffering in a concentration-dependent manner. In contrast, quin-2 buffering had little or no effect on the inhibition of Na uptake caused by the protein kinase C activators phorbol esters and oleoylacetylglycerol. Bethanechol's inhibitory effects were partially, but not completely reversed by quin-2 buffering. These data suggest that the effects of bethanechol on chicken villus enterocyte brush border Na/H exchange are mediated by calcium-dependent process(es) as well as by protein kinase C.


Metabolic effects of beta 2-agonists.

Catecholamines produce a number of biochemical changes most of which result from stimulation of beta 2-receptors. Interest in these metabolic effects has increased recently as a consequence of the concern over the relatively high mortality from acute asthma attacks. In this review the data on the impact of beta 2-agonists on glucose production, insulin release and lipolysis are presented. Thereafter the subject of hypokalaemia, the mechanism for its production by beta 2-agonists and its relevance to cardiac arrhythmias are considered in detail. Finally the fall in plasma magnesium and the possible role of beta 2-agonists in the production of lactic acidosis are discussed.


Transient aggregation of nascent thyroglobulin in the endoplasmic reticulum: relationship to the molecular chaperone, BiP.

Because of its unusual length, nascent thyroglobulin (Tg) requires a long time after translocation into the endoplasmic reticulum (ER) to assume its mature tertiary structure. Thus, Tg is an ideal molecule for the study of protein folding and export from the ER, and is an excellent potential substrate for molecular chaperones. During the first 15 min after biosynthesis, Tg is found in transient aggregates with and without interchain disulfide bonds, which precede the formation of free monomers (and ultimately dimers) within the ER. By immunoprecipitation, newly synthesized Tg was associated with the binding protein (BiP); association was maximal at the earliest chase times. Much of the Tg released from BiP by the addition of Mg-ATP was found in aggregates containing interchain disulfide bonds; other BiP-associated Tg represented non-covalent aggregates and unfolded free monomers. Importantly, the immediate precursor to Tg dimer was a compact monomer which did not associate with BiP. The average stoichiometry of BiP/Tg interaction involved nearly 10 BiP molecules per Tg molecule. Cycloheximide was used to reduced the ER concentration of Tg relative to chaperones, with subsequent removal of the drug in order to rapidly restore Tg synthesis. After this treatment, nascent Tg aggregates were no longer detectable. The data suggest a model of folding of exportable proteins in which nascent polypeptides immediately upon translocation into the ER interact with BiP. Early interaction with BiP may help in presenting nascent polypeptides to other helper molecules that catalyze folding, thereby preventing aggregation or driving aggregate dissolution in the ER.


The effect of changing somatostatin tone on the pituitary growth hormone and thyroid-stimulating hormone responses to their respective releasing factor stimuli.

Somatostatin (SS) inhibits GH and TSH secretion, but its role in modulating their pulsatility is unclear. We studied GH and TSH responses to GH-releasing hormone (GHRH) and TRH stimulation upon a variable background infusion of saline, SS-(1-14) at 20 and 100 micrograms/m2.h, and oral pyridostigmine (30 and 60 mg) in six adult males. Basal GH levels were unaffected by SS-(1-14). Deconvolution analysis of serum GH values demonstrated that the pituitary responded to two GHRH stimuli 90 min apart without attenuation of the second response. The higher dose of SS-(1-14) significantly blunted the first GH response; second GH responses were further attenuated by both SS-(1-14) doses. Maximum GH release and "switch-off" rates for both stimuli were reduced without changes in the 50% secretion time. Pyridostigmine enhanced the first GH response to GHRH with an increase in the GH release rate; second GH responses were not augmented. GH secretion was prolonged by pyridostigmine, although the 50% secretion time remained unchanged. Peak stimulated serum TSH was attenuated by both SS-(1-14) doses, but pyridostigmine had no effect. All other TSH parameters examined were unaffected. We conclude that the GH response to GHRH is dependent on SS tone, but that the thyrotroph is not tonically inhibited by SS. SS attenuates the rate of GH release without changing the duration of secretion and appears important in terminating GH secretion.


Somatostatin receptors on thyrotropin-secreting pituitary adenomas: comparison with the inhibitory effects of octreotide upon in vivo and in vitro hormonal secretions.

The in vivo and in vitro inhibitory effects of a somatostatin (SRIH) analog, octreotide, upon TSH, alpha-subunit, GH, and PRL have been studied, as well as SRIH receptors and their coupling to adenylate cyclase, in nine TSH-secreting pituitary adenomas. From in vivo and cell culture studies, the TSH- and alpha-subunit-secreting adenomas appeared heterogeneous, with four out of the nine tumors cosecreting GH and/or PRL. A single sc injection of octreotide (100 micrograms) lowered plasma concentration of TSH by 40 +/- 5% (mean +/- SE of 5), of alpha-subunit by 27 +/- 9% (n = 5), of GH by 60 +/- 5% (n = 4), and of PRL by 27 +/- 9% (n = 4). In cells cultures, octreotide (10(-8) mol/L) inhibited equally TSH, alpha-subunit, and GH release. 125I-Tyr0-DTrp8-SRIH binding sites were measurable in the nine TSH-secreting adenomas either on membrane preparations (n = 6; Bmax: 152 +/- 73 fmol/mg protein) or on frozen sections by radioautography (n = 3). Their density was variable among TSH adenomas and was lower than that measured in GH-secreting adenomas but higher than in nonfunctioning tumors. Two out of three TSH-secreting adenoma displayed an heterogeneous distribution of 125I-Tyr0-DTrp8-SRIH binding sites. 125I-Tyr0-DTrp8-SRIH specific binding was inhibited by guanosine triphosphate (GTP: 10(-4) mol/L). SRIH inhibited adenylate cyclase in 5/5 TSH-secreting adenomas and a good correlation (r = 0.92, P less than 0.02) was found between 125I-Tyr0-DTrp8-SRIH binding capacity (Bmax) and maximal adenylate cyclase inhibition by SRIH. These results demonstrate in vivo and in vitro inhibition of TSH, alpha-subunit, PRL, and GH secretion by octreotide in TSH-secreting pituitary adenomas. Functional SRIH receptors are present on these tumors and the effect of SRIH on hormonal secretion could be mediated, at least in part, by inhibition of adenylate cyclase. These findings support the medical treatment of this rare type of tumors by SRIH analogs.


The influence of different beta-blocking drugs on the peripheral circulation in Raynaud's phenomenon and in hypertension.

In a double-blind, randomized, placebo-controlled study, the authors investigated the effects of different beta-adrenoceptor blocking drugs on the peripheral circulation. A single intravenous injection of the nonselective beta-blocker propranolol (0.20 mg/kg), the beta 1-selective adrenoceptor blocker metoprolol (0.25 mg/kg), and the nonselective beta-blocker with partial agonistic activity (PAA) pindolol (0.04 mg/kg) and of placebo (saline) was given to eight patients with a primary Raynaud's phenomenon and to nine untreated patients with primary hypertension. The authors measured finger skin temperature (FST), and laser Doppler estimated finger skin blood flux (LDF) before, during, and after a standardized finger cooling test, performed 25 minutes after the administration of the drugs. In both patients groups propranolol, metoprolol, and pindolol had no significant effect on FST and LDF in the first 25 minutes after administration both in comparison to baseline value and to placebo. Also, no significant differences were found in the recoveries of FST and LDF after cold challenge between all drugs and placebo in both groups. The authors conclude that no adverse effect of any type of beta-adrenoceptor blocker in comparison to placebo could be detected after a single administration on both the baseline finger skin perfusion and the recovery after cold-induced vasoconstriction. In addition, the authors could not demonstrate a favorable effect of beta 1-selectivity or PAA in comparison to a nonselective beta-adrenoceptor blocker without PAA, in any group.


Comparative effects of a new cardioselective beta-blocker nebivolol and nifedipine sustained-release on 24-hour ambulatory blood pressure and plasma lipoproteins.

This double-blind, parallel-group study compared the effects of nebivolol, a novel cardioselective beta-blocker, with those of nifedipine sustained-release on 24-hour ambulatory blood pressure and plasma lipoprotein levels. After a washout period of 8 weeks, 51 patients with mild to moderate essential hypertension were randomized to double-blind treatment with either nebivolol 5 mg once a day (n = 26) or nifedipine sustained-release 20 mg bid (n = 25) over a period of 12 weeks. Both treatments produced similar and significant (P = .0001) reduction in office blood pressure as well as in 24-hour, work, awake, and sleep ambulatory blood pressure. The clinical response (diastolic blood pressure less than 90 mmHg or decreased by greater than or equal to 10 mmHg) rate was 69% for nebivolol and 59% for nifedipine, respectively. Moreover, the nebivolol and nifedipine treatment-induced decreases in mean 24-hour ambulatory blood pressure were similar to the decreases in clinic blood pressure. Furthermore, the percentages of "blood pressure loads" (awake greater than 140/90 mmHg and asleep greater than 120/80 mmHg) were lowered significantly (P = .0001), from 60% to 29% with nebivolol and from 60% to 39% with nifedipine. Mean ambulatory heart rate was reduced (P = .0001) from 79 +/- 7 to 68 +/- 7 beats/minute during nebivolol therapy and from 80 +/- 9 to 79 +/- 7 (not significant) with nifedipine. Total plasma cholesterol and low-density lipoprotein levels decreased significantly (P less than .05) by 5 and 8%, respectively, after nebivolol treatment, and each decreased by 3% after nifedipine treatment.(ABSTRACT TRUNCATED AT 250 WORDS)


Conventional screening for enteropathogenic Escherichia coli in the UK. Is it appropriate or necessary?

Enteropathogenic Escherichia coli (EPEC) is a well-recognized cause of infantile diarrhoea in the developing countries. In the developed countries, however, the incidence of EPEC associated outbreaks has dramatically declined. The last major outbreak in the UK was reported in 1980. This paper reviews the recent advances in the field of pathogenesis of diarrhoea caused by EPEC and questions the need to screen routinely for EPEC by conventional serological methods used in clinical microbiology laboratories in the UK.


The role of hospital infection control in the quality system of hospitals.

Like other highly specialized fields, quality systems have their own vocabulary which we must be familiar with; it has been internationally standardized. This standard should be adhered to in order to avoid unnecessary ambiguities and confusion, and to facilitate exchange of information between disciplines. We, in the infection control field, are quality pioneers in hospitals. We have, within our discipline, created quality systems and practised quality surveillance for decades. This must be recognized. Medical quality audits intended for comparisons between hospitals, services and wards require measurable quality criteria and comparable measures for the presence of all relevant patient-related risk factors. To specify quality within our field we need much more detailed information on the effect and cost of infection control practices, as well as the costs of the infections we intend to control. To progress one step further, patients or their representatives, politicians, need to express what monetary value should be put on health, namely freedom from infection and its consequences.


Cost-effectiveness analysis of the use of chlorhexidine detergent in preoperative whole-body disinfection in wound infection prophylaxis.

A total of 3482 general surgical patients entered a trial in which they had a chlorhexidine or placebo detergent shower three times before elective clean wound or potentially contaminated surgery. Patients who showered with a chlorhexidine detergent (N = 1744) had a significant reduction in skin flora compared with those who showered with a placebo detergent (N = 1738). The majority of wound infections occurred outside hospital (312 outpatient infections vs. 201 inpatient infections). Wound infection rates were similar in the chlorhexidine and placebo groups (5.79% vs. 5.75% for inpatient infections and 8.54% vs. 9.38% for outpatient infections). The average hospital cost of both non-infected and infected patients was higher in the chlorhexidine group. The average cost of a non-infected chlorhexidine patient was 847.95 pounds as opposed to 804.60 pounds for a non-infected placebo patient, whilst the average cost of an infected patient was 1459.70 pounds (chlorhexidine) and 1414.22 pounds (placebo). A cross-match comparison of patients undergoing vascular surgery revealed no statistical significance in the difference between the two experimental groups. Patients were matched for age, sex, type of operation and surgeon. We conclude that preoperative whole-body disinfection with a chlorhexidine detergent is not a cost-effective treatment for reducing wound infection.


Microbial growth and blockage of sub-floor drains in a renal dialysis centre: a problem highlighted.

The accumulation of microorganisms embedded in biofilm within the drainage pipework leading from individual dialysis monitors in a renal dialysis centre, represents a significant threat to the safe operation of the whole centre due to blockage of the pipes and overflow of waste water. Attempts to disperse the growth with chemicals and disinfectants have been unsuccessful. Only mechanical rodding has removed the deposit, and regrowth has occurred. Those planning new dialysis centres should ensure that effluent pipework is readily accessible with multiple rodding eyes and is made of material able to withstand rodding and chemicals.


Staphylococcus aureus colonization of the newborn in a Darlington hospital.

Evidence from research studies suggests a relationship between neonatal infection with Staphylococcus aureus and the level of umbilical colonization. During a 3-month prospective study (September-December 1990) the incidence and levels of S. aureus colonization were determined for all 370 live births in the Darlington Unit by taking swabs at 48 h and 8/9 days from the base of the umbilical cord. Infants were situated in one of four locations (The Special Care Unit, one of two wards or home) and the location at the time of swabbing was recorded. The overall percentages colonized at 48 h and 8/9 d were 68% and 65% respectively. Forty-eight hours after delivery, 49% showed a high level of S. aureus colonization. Although the percentage of infants colonized with S. aureus was almost identical at each sampling, only 62% were culture-positive on both occasions. Between 48 h and 8/9 days, 12% (44) of infants developed S. aureus infections of whom 35 showed heavy growth. Statistical analysis showed a significant relationship between levels of colonization at the two sampling times but no relationship between location and levels of colonization over the time period.


Outbreak of Mycoplasma pneumoniae infection among hospital personnel studied by a nucleic acid hybridization test.

An outbreak of Mycoplasma pneumoniae (MP) infection occurred during the period March-May 1989 among the personnel of the Accident and Emergency Department of the Kuopio University Hospital, Kuopio, Finland. The index patient was a young male orderly, who fell ill with severe pneumonia. His tracheal mucus sample proved to be strongly positive for MP when tested by a commercial DNA-RNA hybridization test (Gen-Probe). After the index patient two additional staff members (an orderly and a nurse) fell ill with pneumonia and 66 others showed symptoms of upper respiratory infection or fever. The most frequent symptoms were a sore throat, a cough, rhinitis and headaches. All 97 employees of the department were tested for the presence of MP in April-May 1989 using throat swabs as test material. Forty-three (44%) were found to be positive for MP by the 'Gen-Probe' test. Eight (19%) of the MP positive staff were completely asymptomatic. The MP positive staff were retested about 3 weeks later, whereupon 40 (93%) had become negative. Most of the persons involved in this outbreak suffered only from mild respiratory symptoms, suggesting that MP outbreaks like the present one may easily pass unnoticed.


A randomized study on the effect of bladder irrigation with povidone-iodine before removal of an indwelling catheter.

We have evaluated the effect of povidone-iodine (PVP-I) bladder irrigation prior to catheter removal on subsequent bacteriuria. Of 264 patients, 138 received PVP-I irrigation and 126 were controls. Both groups were similar with respect to duration of catheterization and bacteriuria before removal of the catheter. Of 497 cultures taken after catheter removal 99 (20%) were positive. This included 52 of 233 in the control group (22%) and 47 of 264 in the study group (18%). Patients with positive cultures had a significantly longer period of catheterization. Our trial did not demonstrate that PVP-I bladder irrigation before catheter removal reduces subsequent bacteriuria.


A study of 245 infected surgical wounds in Singapore.

The aims of the study were to correlate the laboratory detection rate of wound infections with the actual wound infection rate, and to analyse the bacteriology of these wounds to provide a rationale for antibiotic usage in prophylaxis and treatment of surgical wound infections. The wound infection rate in a general surgical unit was determined using the most comprehensive surveillance available to us and was correlated with the laboratory detection rate. A correlation coefficient of 0.8 was obtained, allowing a reasonable estimation of the actual wound infection rate from laboratory data. Review of the bacteriology of consecutive infected surgical wounds over a 4 year period in a university hospital, revealed that the commonest organisms cultured were Staphylococcus aureus, Escherichia coli, Klebsiella spp., Pseudomonas aeruginosa, enterococci and beta-haemolytic streptococci. Methicillin-resistant S. aureus (MRSA) caused 50% of all staphylococcal wound infections. All MRSA isolates were sensitive to fusidic acid and vancomycin. All the non-MRSA isolates of S. aureus were sensitive to cephalexin. Some 89% of E. coli were sensitive to gentamicin, with 93% and 100% sensitive to cefuroxime and ceftriaxone respectively. Klebsiella isolates have shown an increased resistance to aminoglycosides, with a new strain from one patient, isolated in 1990, resistant to penicillins, aminoglycosides and third generation cephalosporins. Pseudomonas spp., enterococci and beta-haemolytic streptococci did not show a change in resistance patterns over the same time period.


Teeth in the fracture line.

The department of maxillo-facial surgery in Cologne University has, for some 15 years, routinely treated patients with mandibular fractures, in which a tooth lies in the fracture line, by means of Champy miniplates. A review of such cases was conducted to determine the viability of such teeth not electively extracted at the time of fracture reduction. It was found that only rarely did the "salvaged" tooth subsequently require extraction and we believe our results should encourage the clinician to attempt to retain "fracture line" teeth unless there is an absolute contraindication.


Taxol, a microtubule-stabilizing antineoplastic agent, induces expression of tumor necrosis factor alpha and interleukin-1 in macrophages.

Taxol, a naturally occurring diterpene with antitumor activity, induces tubulin polymerization to generate abnormally stable and nonfunctional microtubules. Previously, we showed that taxol has lipopolysaccharide (LPS)-like effects on macrophages. As LPS is a potent inducer of macrophage cytokine production, we investigated whether a similar effect is exerted by taxol. In a dose-dependent manner, LPS-free taxol induced release of biologically active tumor necrosis factor alpha (TNF) by inflammatory murine macrophages. Taxol-induced production of TNF was inhibitable by interleukin-10. By Northern blot, taxol (10 and 1 microM) induced TNF mRNA expression to an extent similar to LPS. Induction of TNF mRNA by 10 microM taxol was detectable at 45 min of stimulation, maximal at 90 min, and evident for at least 8 h. The same low concentration of taxol also induced interleukin 1 (IL-1) alpha and beta mRNA expression. We conclude that taxol triggers macrophages for TNF and IL-1 production. These LPS-like effects of taxol might contribute to its antitumor activity.


Expression and distribution of CD11a/CD18 and CD54 during human T cell-B cell interactions.

Interactions between intercellular adhesion molecule 1 (ICAM-1, CD54) and leukocyte function-associated antigen 1 (LFA-1, CD11a/CD18) play a critical role in T cell-B cell collaboration. The current experiments were carried out to determine the expression and distribution of these adhesion molecules on human peripheral T cells and B cells during T cell-B cell collaboration. Resting CD4+ T cells were largely ICAM-1 negative, whereas immobilized anti-CD3 monoclonal antibody (mAb) rapidly induced ICAM-1 expression. By contrast, most B cells expressed ICAM-1 before activation, and further increases in density were noted with stimulation. Both B cells and CD4+ T cells expressed LFA-1 before activation, although the density on CD4+ T cells was considerably greater. A double staining method for electron microscopic analysis was developed that permitted analysis of the expression and distribution of ICAM-1 to be assessed during T cell-B cell collaboration. Under the experimental conditions examined, B cells showed a uniform distribution of ICAM-1. In contrast, ICAM-1 was highly mobile on the surface of CD4+ T cells. If the T cells were not fixed, staining, even at 4 degrees C, caused rapid redistribution of ICAM-1 into aggregates. However, by fixing cells before the staining procedures, the distribution of ICAM-1 on CD4+ T cells could be accurately assessed. Most (85%) of the fixed activated CD4+ T cells showed a uniform distribution of ICAM-1. However, when activated CD4+ T cells were cocultured with B cells, redistribution of ICAM-1 on CD4+ T cells but not B cells occurred, such that the majority (85%) was found at or immediately adjacent to the point of attachment to the B cells. No redistribution of LFA-1 on either T cells or B cells was found. These findings suggest that rapid changes in density of ICAM-1 expression and the mobility of ICAM-1 on activated T cells may play a role in providing activation signals to B cells during T cell-B cell collaboration.


Complications of nephropathia epidemica: three cases.

Haemorrhagic fever with renal syndrome (HFRS) in Scandinavia is called nephropathia epidemica (NE), and is caused by the Puumala-virus, which belongs to the Hanta-virus genus. The clinical course of NE is mostly benign, complications are uncommon, and deaths are rarely observed. We report the cases of three patients who developed serious complications in the course of NE caused by the Puumala-virus. One patient died within 24 h after admission, another developed progressive neuromuscular dysfunction (Guillain-Barré syndrome) which required auxiliary ventilation for several weeks before a slow recovery, and a third patient developed empty sella syndrome with pituitary gland insufficiency. In the first two cases the diagnosis of NE was confirmed by a rapid avidity assay for IgG antibody against Puumala-virus. In the third case the clinical course, and demonstration of NE immunity 16 years later, suggested that NE might have caused the hypopituitarism. Some patients with NE caused by the Puumala-virus may require intensive-care treatment, and the development of late complications such as empty sella syndrome and hypopituitarism should be taken into consideration.


Detection of serum IgM antibodies to glomerular basement membrane in two cases of nephropathia epidemica.

We report two serologically verified cases of nephropathia epidemica (NE) who developed high serum levels of non-Goodpasture IgM antibodies against glomerular basement membrane (anti GBM) in the acute phase of the disease. Moreover, in one of the patients a renal biopsy showed granular deposits of complement factor 3 along the glomerular capillary walls. The possible pathogenic significance of these findings is discussed.


Dysfunction of natural killer cells in human immunodeficiency virus-infected children with or without Pneumocystis carinii pneumonia.

The development of Pneumocystis carinii pneumonia (PCP) in human immunodeficiency virus (HIV)-infected children with normal T-cell numbers is contrary to previous experience with HIV-infected adults, in whom low CD4+ T-cell numbers predict susceptibility to PCP. To determine whether PCP in HIV-infected children reflects a qualitative T-cell or other immune defect, we studied four HIV-infected children who also had PCP and 10 others without PCP for T-cell and natural killer (NK) cell function. Most of the HIV-infected children had normal T-cell numbers for age, and all had CD4+ T-cell numbers greater than those predictive of PCP in HIV-infected adults. All HIV-infected children had normal T-cell function in vitro. The HIV-infected children as a whole had deficient NK cell cytolysis. We obtained a significant interactive effect of age by health status for NK cell function between patients and age-matched control subjects. All HIV-infected children with defective NK cell function failed to enhance their NK cell cytolysis when their mononuclear cells were stimulated with recombinant interferon alfa (r-IFN-alpha). This NK cell defect in HIV-infected children may facilitate the development of secondary infection.


Management of renal hypertension in children with Takayasu's arteritis using renal autografting or allograft transplantation in selected circumstances and total lymphoid irradiation.

In a decade from 1980, 11 children aged 3 to 11 years presented with Takayasu's arteritis (TA). All were severely hypertensive. Operative correction was offered to 10 of 11 children presenting with renovascular hypertension (RVH) including cardiac failure alone in 1 and both renal and cardiac failure in 8, a result of TA involving renal arteries by stenosis or occlusion. Nine patients had renal autotransplantation to an heterotopic site in the pelvis. Seven of 12 kidneys were salvaged by autotransplant with relief of RVH. Renal artery stenosis was successfully corrected by this procedure in 5 patients. Autotransplantation failed in 4 patients, 1 of whom subsequently had a successful allograft transplant. One patient was treated primarily by cadaver allograft transplantation. One patient whose autotransplant failed had a functioning contralateral kidney and is well with controlled RVH. One patient died prior to any treatment. Patient survival improved with the use of total lymphoid irradiation in the most recent 7 patients.


The natural course of cryptorchidism in rats and the efficacy of orchidopexy or orchidectomy in its treatment before and after puberty.

Both clinical and experimental evidence suggest that fertility is impaired in unilateral cryptorchidism. To investigate the effect of the undescended testis on the contralateral descended gonad, a new experimental model based on natural cryptorchidism in rats was designed. Seventy male Buffalo rats with an undescended right testis noted at the age of 30 days were used. Fifty healthy animals served as a controls. The natural course of cryptorchidism was investigated at the ages of 30, 90, and 180 days. The effects of orchiopexy and orchiectomy performed in cryptorchid animals before and after puberty were evaluated at the age of 180 days. Both nonoperated and operated animals were mated at the age of 150 days in order to estimate their fertility. The animals were killed at 30, 90, and 180 days of life and the testes were removed. In each excised testis testicular weight and seminiferous tubular diameters were measured and the maturity of the germinal epithelium was determined using the Johnsen testicular biopsy score. The experiment demonstrated reduced testicular weight and seminiferous tubular diameters in undescended testis already at 30 days and arrest of spermatogenesis at the spermatocytes stage at 90 and 180 days. There was no significant difference between contralateral descended testes and controls at the age of 30 and 90 days, but at 180 days the degenerative changes were identical with those in the cryptorchid testes. Cryptorchid rats were completely infertile. Both orchiopexy and orchiectomy prevented the damage to the contralateral testis. A significant improvement in size and spermatogenesis was recorded in most cases of the surgically descended testes.(ABSTRACT TRUNCATED AT 250 WORDS)


Intrascrotal CGRP 8-37 causes a delay in testicular descent in mice.

The genitofemoral nerve is a key factor in the inguinoscrotal descent of the testis. The effect of androgens may be mediated via the central nervous system, which in turn secretes the neurotransmitter calcitonin gene-related peptide (CGRP) at the genitofemoral nerve endings, to cause testicular descent. The effect of endogenous CGRP was examined by weekly injections of a vehicle with or without synthetic antagonist (CGRP 8-37) into the developing scrotum of neonatal mice. The descent of the testis was delayed in the experimental group compared with the control group. At 2 weeks of age 43% of controls had descended testes compared with 0% of experimental animals. At 3 weeks of age 17% of experimentals still had undescended testes, whereas all testes were descended in controls. At 4 weeks 3 testes remained undescended in the experimental group. It is concluded that the CGRP antagonist can retard testicular descent. This result is consistent with the hypothesis that CGRP is an important intermediary in testicular descent.


Pheochromocytoma in children: 15 cases.

Pheochromocytoma is an uncommon tumor in childhood; nevertheless, 20% of all pheochromocytomas are found in the pediatric population. Fifteen children have been treated in our institution from 1962 to 1990. One percent of patients referred over the same period for investigation of high blood pressure were found to have a pheochromocytoma. The majority of patients have hypertension. It varies in intensity and is paroxysmal in about half the patients. Many pediatric cases of unilateral, bilateral, extra-adrenal, familial, and recurrent pheochromocytomas have been reported. We reviewed our 28 years experience with this tumor and concentrated on the diagnosis, the preoperative and operative management, and the occurrence of the multiple endocrine neoplasia syndromes.


Neutrophil modulation by Actinobacillus actinomycetemcomitans. I. Chemotaxis, surface receptor expression and F-actin polymerization.

Localized juvenile periodontitis is an early onset periodontitis, usually localized to molars and incisors. Patients usually present with decreased chemotaxis of systemic neutrophils (PMNs) and infection with Actinobacillus actinomycetemcomitans. The pathogenic mechanisms involved have not been clarified. The purpose of this study was to determine if an extract of A. actinomycetemcomitans could induce changes in PMN chemotaxis similar to those reported in LJP patients. It was demonstrated that the bacterial extract was chemotactic for neutrophils. When neutrophils were pre-incubated with the bacterial extract, chemotaxis toward zymosan-activated serum, FMLP and the bacterial extract was inhibited in two different chemotaxis assays (Boyden chamber and under-agarose). Bacterial extract had no effect on random migration in either assay. Pre-incubation with the extract induced increased expression of CD11b/CD18 (Mac-1), Gp110, and FMLP receptors and increased F-actin polymerization following FMLP or PMA stimulation compared to cells not treated with the extract. Treatment of the bacterial extract with proteinase K or phenol extraction reversed the PMN chemotaxis inhibition activity, but increased significantly the random migration of PMNs. Heating the bacterial extract to 56 degrees C had no effect on its activity. The component(s) in the bacterial extract that inhibits chemotaxis is therefore a protein(s), not sensitive to 56 degrees C, and is not endotoxin. This study suggests that A. actinomycetemcomitans may contribute to the pathogenesis of localized juvenile periodontitis by inhibiting chemotaxis. Interference with chemotaxis by A. actinomycetemcomitans, however, occurs through a mechanism other than inhibition of actin assembly, reduction of CD11b/CD18 or Gp110 expression, or blockage/downregulation of FMLP receptors.


Tissue expansion as an alternative to skin grafting for closure of skin deficits.

Recent advances in the technical aspects of tissue expanders for closure of skin deficits have led to an overall reduction in the high rate of complications typically associated with their usage. The authors provide a review of the recent refinements in the technique of the tissue expansion process. A discussion of current and future applications using this technique in the treatment of various lower extremity pathologies, including clubfoot, is presented. A case report on the use of a subcutaneous tissue expander for the treatment of a failed skin graft of the medial ankle is included.


Epidemiology of podiatric injuries in US Marine recruits undergoing basic training.

The authors determined the incidence of podiatric injuries that occurred during 233,946 recruit days at risk among US Marine Corps recruits undergoing basic training at the Marine Corps Recruit Depot, San Diego, CA, between February 5 and April 25, 1990. Training-related initial injuries to the foot occurred at a rate of 3.0 new injuries per 1,000 recruit days. The highest specific rates of injury occurred with stress fractures to the foot (0.56 per 1,000 recruit days), ankle sprains (0.53 per 1,000 recruit days), and Achilles tendinitis (0.39 per 1,000 recruit days).


The aggregation of the 5' insulin gene polymorphism in insulin dependent (type I) diabetes mellitus families.

Population studies have suggested an increased frequency of small DNA insertions (class I alleles) 5' to the insulin gene in insulin dependent (type I) diabetes mellitus (IDDM). The present study examined this relationship within families. Forty-one families with at least one diabetic offspring were studied. Analysis of the insulin gene polymorphism was performed by digestion of DNA with Bg1I, SstI, RsaI, or PvuII and hybridisation with an insulin gene probe or polymorphic region specific probes. An increased frequency of class I alleles was found among the parents of diabetics (p = 0.02), as well as a trend towards increased frequency of parents homozygous for class I alleles and matings of two homozygous subjects. This increased homozygosity for class I alleles was present in non-diabetic sibs as well (p = 0.01). These results show that ascertainment through an offspring with IDDM selects for families with high frequencies of homozygosity for the class I allele and thus suggests that the insulin gene polymorphism is indeed providing part of the genetic predisposition to IDDM. When the major portion of genetic predisposition is provided by other genes (estimates are that HLA accounts for 30 to 70% in IDDM), identification of additional susceptibility genes becomes difficult. Even when formal linkage analysis is uninformative, our studies indicate that analysis for aggregation of specific alleles within families is a useful approach to this problem.


Site specific screening for point mutations in ornithine transcarbamylase deficiency.

Ornithine transcarbamylase (OTC) deficiency is a frequent X linked disorder of the urea cycle which is responsible for lethal neonatal hyperammonaemia in males and for various clinical symptoms in heterozygous females. In order to improve the efficiency of our screening for mutant genotypes, we focused on molecular domains of functional or structural importance in the OTC gene, namely the carbamyl phosphate binding domain (encoded by the third exon) and the MspI restriction sites (CCGG) of the coding sequence (located in exons 2 and 7 respectively), as they contain mutation hot spots (CpG doublets). Using this procedure, we were able to identify three new mutant genotypes in OTC deficient children including one nonsense mutation (E 87 K, G 50 ter, G 162 R). Since genetic counselling for OTC deficiency is frequently difficult, molecular screening directed towards specific sites of the coding sequence could allow rapid detection of mutant genotypes and help solve diagnostic problems, especially when carrier status cannot be clarified easily.


Genetic variation at fibrinogen loci and plasma fibrinogen levels.

In view of the controversy regarding genetic variation at the fibrinogen loci and plasma fibrinogen levels, we have analysed DNA polymorphisms at the alpha (TaqI), beta (BclI and HaeIII), and gamma (KpnI/SacI) fibrinogen loci in 247 subjects whose plasma fibrinogen was determined by clotting and nephelometric assays. Strong linkage disequilibrium was found between the alpha/TaqI and gamma/KpnI/SacI markers and between the beta/BclI and beta/HaeIII markers. A lesser association was found between the alpha/TaqI and beta/BclI loci, beta/BclI and gamma/KpnI/SacI markers, alpha/TaqI and beta/HaeIII markers, and the gamma/KpnI/SacI and beta/HaeIII markers. This is consistent with the known physical order of these loci and suggests a relative excess of recombination in the alpha/gamma to beta interval. Plasma fibrinogen levels, by either assay method, when corrected or uncorrected for age, sex, and smoking habit, did not show any statistically significant associations with the four fibrinogen polymorphisms examined at the alpha, beta, and gamma fibrinogen loci either singly or when analysed as a haplotype.


Cytoskeletal elements regulate the distribution of nerve growth factor receptors in PC12 cells.

Nerve growth factor receptor (NGFR)-like immunoreactivity (IR) was studied in PC12 cells treated for 96 hr with NGF (40 ng/ml), using immunogold labeling and electron microscopic morphometric analysis. The cells were exposed to the anti-NGFR antibody 192-IgG, followed by immunoglobulin (IgG) conjugated with colloidal gold. PC12 cells exhibited occasional gold label (positive NGFR-IR) on all surfaces. Cells treated with colcemid (0.05 micrograms/ml) or cytochalasin D (2 micrograms/ml), which limit microtubule (MT) and microfilament (MF) formation, respectively, displayed an increased NGFR-IR in terms of gold labeling. NGFR-IR was also seen on taxol (0.85 micrograms/ml)-exposed cells, an agent that promotes MT assembly. Cells treated simultaneously with cytochalasin D and taxol had a dramatically augmented NGFR-IR on their surfaces, which exceeded levels obtained with either agent alone. Prominent NGFR-IR was localized frequently in coated endocytotic vesicles, in smooth endoplasmic reticulum, and in secondary multivesicular lysosomes, in both treated and untreated cells. The results suggest that a large number of NGFRs (positive NGFR-IR) in PC12 cells are cryptic and not available for ligand binding. Changes in cytoskeletal organization that may affect mobility of integral membrane proteins can modulate the distribution of NGFR-IR on neuronal surfaces.


Buserelin treatment of cryptorchidism: a randomized, double-blind, placebo-controlled study.

The objectives of the study were to determine whether a low dose of a luteinizing hormone-releasing hormone analogue (buserelin) has an effect on testicular descent, if buserelin affects germ cell maturation and epididymal development, the incidence of retractile testes in the controlled trials, and if the subsequent administration of human chorionic gonadotropin has any effect on the groups treated. The study was double blind, placebo controlled in which patients with cryptorchidism were assigned randomly into 3 groups: buserelin treatment (22), surgical treatment (18) or placebo control group (19). The 3 groups of patients were similar before treatment in regard to testicular position, chronological and bone age, height and weight, luteinizing hormone, follicle-stimulating hormone, testosterone, penile size and the volume of the contralateral testis. Buserelin (20 micrograms). administered daily in a nasal spray significantly induced testicular descent compared to the group treated with a placebo (p less than 0.01). A normal epididymis was found more often in boys with successful descent (p less than 0.003). Boys treated with buserelin had the highest number and the best maturation index of the germ cells; human chorionic gonadotropin influenced the descent in both groups but it was more efficacious when it was administered after treatment with buserelin, although it had no additional effect on germ cell maturation. None of the boys had retractile testes. Buserelin was capable of inducing testicular descent in addition to increasing simultaneously the number of germ cells and provoking further development of the epididymis.


Is a testis located at the superficial inguinal pouch (Denis Browne pouch) comparable to a true cryptorchid testis?

In a clinical study 96 prepubertal boys with 100 testes located in the superficial inguinal pouch underwent routine orchiopexy. Of 65 patients 45 (69%) who had received hormonal treatment before the surgical procedure had a closed processus vaginalis compared with only 11 of 35 (31%) who had not (p less than 0.0002). A normal epididymis was also present significantly more often in those patients receiving hormonal treatment than in those who did not (p less than 0.039). While those testes located in the superficial inguinal pouch had significantly better histology and a greater number of germ cells than those located in a high inguinal or abdominal position (p less than 0.01), the number of germ cells per tubule was nonetheless lower than that seen in the normal controls (p less than 0.01). In conclusion, a testis located at the superficial inguinal pouch behaves as a true cryptorchid testis. Furthermore, hormonal treatment before surgery has a significant effect on epididymal development and closure of the processus vaginalis.


Epididymal anomalies associated with hydrocele/hernia and cryptorchidism: implications regarding testicular descent.

Controversy exists regarding the role of the epididymis in testicular descent, as epididymal abnormalities have been reported in 36 to 79% of boys with an undescended testis. Although most undescended testes are associated with a patent processus vaginalis, the incidence of epididymal abnormalities in descended testes with a patent processus has not been reported. Epididymal morphology was examined in 81 boys with a hydrocele/hernia without cryptorchidism (90 testes) and 100 children undergoing orchiopexy (115 testes). Boys with an intra-abdominal undescended testis were excluded. Among 48 boys with a hydrocele/hernia 24 (50%) had an epididymal abnormality if the processus was patent and communicated with the testis (complete hernia), compared to 4 of 42 patients (10%) if there was not a communication with the testis (p less than 0.01). Among the 96 children with an undescended testis 68 (71%) had an epididymal abnormality if there was a patent processus, compared to 3 of 19 boys (16%) without a patent processus (p less than 0.01). These data suggest that most epididymal abnormalities probably do not contribute to testicular maldescent.


An absent testis is associated with contralateral testicular hypertrophy.

Surgical exploration was done in 109 boys ages birth through 9 years with unilateral impalpable testes by physical examination under anesthesia. Of the patients 51 (47%) had an absent testis and 58 had intra-abdominal testes. At open biopsy of the contralateral descended testis the 3 dimensions of the exposed testis were recorded and testicular volume was calculated. The mean volume of the contralateral descended testes of boys with an absent testis was greater than that of boys with intra-abdominal testes at all ages. The differences were significant (p = 0.0019 to 0.0117) from birth through year 4 but not from years 5 through 9. However, the standard deviations ranged from 27 to 74% of the means, and there was broad overlap of the volumes of the 2 groups. These findings indicate that, although the volume of the contralateral descended testis of boys with an absent testis is significantly greater than that of boys with intra-abdominal testes, the volume of the contralateral descended testis is not a reliable criterion for differentiating an absent testis from an intra-abdominal testis in a boy with a unilateral impalpable testis. Surgical exploration continues to be the method of choice for making the diagnosis of an absent testis.


The management of the impalpable testis by surgery alone.

We evaluated 68 prepubertal boys with 84 impalpable testes who were operated upon without using any other diagnostic maneuvers. Of the testes 18 (22%) were absent (anorchism or 'vanished') and 38 (45%) could be placed in a scrotal position with standard orchiopexy. A staged, Fowler-Stephens or microvascular procedure was required for 28 testes (33%), involving orchiectomy in 2 cases, and succeeded in a scrotal position for another 24 testes. In 1 boy 2 testes were fixed outside the inguinal canal. Reexamination after 3 to 9 years showed that 42 of 55 operated testes (76%) were in scrotal position without atrophy, 10 had atrophied and 3 were removed at the second stage operation. We conclude that an exclusive surgical approach has the advantage of providing diagnosis and therapy, and, therefore, it is an effective method.


The value of laparoscopy for 106 impalpable testes relative to clinical presentation.

Laparoscopy was done in 104 consecutive patients with 106 impalpable testes. Three clinical presentations were identified and the value of laparoscopy in each was analyzed. 1) For unilateral impalpable and contralateral normal testes laparoscopic identification of testicular absence was made in 27% of the cases and intra-abdominal testes were found in 16%. Therefore, laparoscopy was of value in 43% of the cases. 2) For bilateral undescended testes (1 or both impalpable) laparoscopy was diagnostic in 75% of the cases (17% had blind-ending spermatic vessels above the internal ring and 58% had intra-abdominal testes). 3) For patients with previous negative inguinal exploration laparoscopic diagnosis was made in 100%.


Laparoscopy for nonpalpable testes in childhood: is inguinal exploration also necessary when vas and vessels exit the inguinal ring?

Laparoscopy has proved to be a safe method for determining the status for nonpalpable testes. In a combined series 52 boys with 57 nonpalpable testes were evaluated laparoscopically. Of the 57 nonpalpable testes 26 were located above the internal inguinal ring (abdominal), 4 were found more distally, and blind-ending vas and vessels terminated in the abdomen in 3, and beyond the internal ring (vanished testes) in 24. Of 29 abdominal testes primary orchiopexy was performed in 15, 4 were removed, the vessels were transected (Fowler-Stephens) in 5, stage 1 of staged repairs was done in 2, distinct laparoscopic evidence of blind-ending vessels and vas obviated further surgery in 2, and testis was not identified either laparoscopically or by abdominal exploration. Finally, inguinal exploration in 28 children in whom vas and vessels were found to exit the internal ring resulted in localization of 4 testes that were brought into the scrotum. Removal of 23 testicular nubbins and their evaluation histologically resulted in identification of viable tubular structures in 3. We recommend inguinal exploration in all children who on laparoscopy are found to have vas and vessels exit the internal ring, and removal of testicular nubbins.


Stimulation of Na absorption by the antiasthmatic kampo drug Saiboku-to in cultured airway epithelium.

To study the effect of the Kampo drug Saiboku-to (TJ-96) on ion transport function of airway epithelial cells, we studied bioelectric properties of cultured tracheal epithelium from dogs under short-circuit conditions in vitro. Addition of TJ-96 (1 mg/ml) to the mucosal solution of the Ussing chamber increased the epithelial short-circuit current (SCC) from 6.5 +/- 0.7 to 11.4 +/- 1.6 microA/cm2 (P less than 0.001). This effect was dose-dependent, with the maximal increase from the baseline value and the concentration required to produce a half-maximal effect (EC50) being 70.5 +/- 12.6% (P less than 0.001) and 3 micrograms/ml, respectively; and there were corresponding increases in transepithelial potential difference and cell conductance. Submucosal addition of TJ-96 likewise increased SCC, although the magnitude of the response was smaller as compared with the response to the mucosal addition. The TJ-96-induced increase in SCC was not affected by diphenylamine-2-carboxylate or furosemide but abolished by amiloride. Intracellular cyclic AMP levels were dose-dependently increased by TJ-96. These results indicate that TJ-96 may selectively stimulate Na absorption across the tracheal epithelium, probably through intracellular accumulation of cyclic AMP.


Specific point mutations that activate v-abl are not found in Philadelphia-negative chronic myeloid leukaemia, Philadelphia-negative acute lymphoblastic leukaemia or blast transformation of chronic myeloid leukaemia.

The involvement of the BCRlABL fusion gene in patients with Philadelphia (Ph) chromosome positive chronic myeloid leukaemia (CML) and acute lymphoblastic leukaemia (ALL) is well characterised, but the molecular events underlying the cases of Ph-negative CML and ALL that lack BCR gene involvement and those that cause transformation of Ph-positive CML are unknown. The murine ABL gene can be activated by genetic events that do not involve the BCR gene, including the introduction of two specific point mutations in exons VII and XI respectively, as found in the homologous sequence of the v-abl oncogene. We therefore sought evidence for analogous point mutations in the ABL gene in patients with Ph-negative, BCR-negative CML (n = 25), Ph-negative ALL (n = 18) and in Ph-positive CML in transformation (n = 28). We used restriction fragment length polymorphism and single strand conformational polymorphism techniques to analyse DNA amplified fragments of selected ABL coding regions from leukaemia cells. We identified only normal wild-type DNA sequences. The absence of these transforming point mutations does not exclude the possibility that the ABL gene in such patients could be activated by other means.


XbaI RFLP of ETS-1 oncogene in chronic B-cell leukaemia.

The influence of a polymorphic variant of the ETS-1 oncogene on the predisposition to develop chronic B-cell leukemia (CLL) was investigated. A total of 59 patients with CLL and 59 controls were examined for the frequency of an XbaI restriction fragment length polymorphism RFLP of the ETS-1 oncogene which has been reported to occur more frequently in patients with hematological malignancies than in normal controls. We found no significant difference in the allele frequency between the CLL patients and the normal controls. These data suggest that the presence of the XbaI RFLP is not associated with CLL.


Remission induction of acute promyelocytic leukemia by all-trans-retinoic acid: molecular evidence of restoration of normal hematopoiesis after differentiation and subsequent extinction of leukemic clone.

Sequential molecular and cellular changes during remission induction were investigated in a case of acute promyelocytic leukemia (APL) treated with all-trans-retinoic acid (ATRA). By means of clonality analysis, the assessment of the retinoic acid receptor alpha gene alterations, as well as conventional cytologic studies, it was demonstrated that remission induction of APL by ATRA proceeds in two steps: first, the differentiation of the leukemic clone to mature granulocytes and its subsequent extinction; second, proliferation/differentiation of the residual normal clones to restore polyclonal hematopoiesis.


Solid-phase extraction and GC/MS confirmation of barbiturates from human urine.

A highly selective and sensitive procedure has been developed for isolating and identifying barbiturates in human urine. With a new disposable bonded silica gel solid-phase extraction (SPE) column and hexobarbital as an internal standard (IS), amobarbital, butabarbital, pentobarbital, phenobarbital, secobarbital, and methaqualone were selectively isolated from endogenous urine components. Capillary gas chromatography/ion trap mass spectrometry (GC/MS) analysis of the extracts generated a full mass spectrum for the detection, identification, and quantitation of barbiturates. Linear quantitative response curves for the drugs have been generated over a concentration range of 20-500 ng/mL. Overall extraction efficiencies for drugs averaged greater than 90%, and the quantitative response curves exhibited correlation coefficients of 0.996 to 0.999.


Tissue distribution of methylenedioxymethamphetamine.

Two cases of death involving methylenedioxymethamphetamine (MDMA) are reported; one case is a fatal acute overdose and the other is a drug-related death. The tissue distribution of MDMA is reported in both cases.


Maternal inheritance of atopic IgE responsiveness on chromosome 11q.

Atopy is a common familial state underlying allergic asthma and rhinitis. Lately, we have assigned a gene for atopy to chromosome 11q by linkage to the marker D11S97. Since previous studies have suggested that the risk of atopy is higher for children of atopic mothers than for those of atopic fathers, we sought differences between maternal and paternal patterns of transmission at the 11q13 locus among pairs of siblings in families affected by atopy. When we defined atopy as the presence of a positive skinprick test (greater than or equal to 2 mm) to any of a panel of common allergens, a higher than normal concentration of total serum IgE, or a positive radioallergosorbent test for a specific IgE, we found that 125 (62%) of the sibling-pairs affected by atopy shared the maternal 11q13 allele and 78 (38%) did not. This distribution differs significantly from the expected 50/50 distribution (p = 0.001). Of paternally derived alleles, 83 (46%) were shared and 96 (54%) were not (not significantly different from 50/50). The result was similar whatever definition of atopy was used and with other genetic markers on 11q. These findings show that transmission of atopy at the chromosome 11q locus is detectable only through the maternal line. The pattern of inheritance is consistent either with paternal genomic imprinting or with maternal modification of developing immune responses.


Toxicity and deaths from 3,4-methylenedioxymethamphetamine ("ecstasy")

The risk of adverse reactions to 3,4-methylenedioxymethamphetamine (MDMA), more commonly known as "ecstasy", is now widely known in both the USA and UK, but the patterns of illness remain varied. We report our experience during 1990 and 1991. There has been a recent increase in cases of severe toxicity following recreational misuse of small amounts of MDMA. Among 7 fatalities, the pattern of toxicity included fulminant hyperthermia, convulsions, disseminated intravascular coagulation, rhabdomyolysis, and acute renal failure. Until now, there have been few reports of this type of toxicity from MDMA, which may be related both to the potential of the drug to alter thermoregulation and to the circumstances of misuse. In addition, we have monitored 7 cases of hepatotoxicity and suspect that the frequency of this complication is increasing; a history of MDMA misuse should be sought in young people presenting with unexplained jaundice or hepatomegaly. We also describe 5 subjects involved in road traffic accidents in whom MDMA was identified. Misuse of MDMA can have severe acute toxic effects; few data are available concerning long-term morbidity, and this deserves close monitoring in future.


Influence of cross-sex transmission on measles mortality in rural Senegal.

Previous studies of measles mortality in West Africa have shown a significantly higher case-fatality rate (CFR) among girls than among boys. This study aimed to find out whether the male/female difference in CFR is related to different risks for boys and girls of being infected as secondary rather than index cases and of transmission from someone of the same or the opposite sex. The study was conducted in Niakhar, a rural area of Senegal (population 24,000). All cases of measles reported between March, 1983, and December, 1986, were investigated to determine source of infection and pattern of transmission. For each case, the closest source of infection was judged the most likely. Death was attributed to measles if it occurred within 6 weeks of the onset of rash. Girls had a higher measles CFR than boys (53 deaths/722 cases [7.3%] vs 45/778 [5.8%]); the relative risk of death was 1.30 (95% confidence interval [CI] 0.89-1.90). Secondary cases infected by a child of the opposite sex had a 2.44 (1.48-4.02) times higher risk of death than did secondary cases infected by a child of the same sex. The risk of cross-sex transmission of infection was significantly greater for female than for male secondary cases (1.26 [1.09-1.47]). When this difference in risk of exposure to infection from the opposite sex was taken into account, the difference in risk of death between girls and boys disappeared (1.06 [0.66-1.69]). Within families, the CFR was higher in huts with 1 boy and 1 girl affected than in huts of either 2 boys or 2 girls affected (relative risk 2.16 [0.99-4.70]). Measles infection contracted from a person of the opposite sex is more severe. Variation in exposure may be an important determinant of sex differences in case fatality.


Chromosome status of untransferred (spare) embryos and probability of pregnancy after in-vitro fertilisation.

Many spontaneous abortions are associated with chromosomal abnormality of the fetus. In in-vitro fertilisation (IVF) the chromosome status of untransferred ("spare") embryos and subsequent fate (pregnancy or not) of the transferred sibling embryos might be related. Since the spare and transferred embryos of a patient's cycle genetically are full siblings, the inherited chromosomal abnormalities in spare embryos have a 50% probability of also appearing in transferred embryos. We have tested whether chromosome analysis of spare embryos has predictive power for transferred embryos. 48 couples with a total of 437 embryos were selected because their spare embryos (1-4 per couple; 76 total) were successfully analysed for chromosome status. 16 patients became pregnant. These women produced a higher proportion of chromosomally normal spare embryos (9/24; 37.5%) than those who did not achieve pregnancy (1/52; 1.9%). The proportion of patients who had only normal embryos was significantly higher (p = 0.012) in the pregnant group than in the non-pregnant group, and the proportion of patients who had only abnormal embryos was significantly higher (p = 0.001) in the non-pregnant group. Patients with preclinical and clinical pregnancy losses had only chromosomally abnormal spare embryos; by contrast, 50% of spare embryos from patients with ectopic pregnancies were normal. The proportion of spare embryos that were normal (13%, 10/76), was similar to the livebirth rate of 11% per transferred embryo (19 infants from 171 transferred embryos). These results suggest that chromosome analysis of spare embryos may have predictive value for their transferred sibling embryos. We conclude that improving detection of chromosomally normal embryos for transfer should improve the success rate in IVF.


Magnetic resonance imaging of anal fistulae.

Success of surgery for an anal fistula depends on accurate assessment of the fistula; however, such assessment is technically difficult. We have done a prospective study that determined the accuracy of magnetic resonance imaging (MRI) in demonstrating the course of fistulae, by comparing MRI scan interpretations with subsequent operative findings. 16 patients (mean [range] age 42 [24-66] years) had MRI followed by surgery within a mean of 22 (1-101) days. MRI scan interpretations agreed precisely with independently documented operative findings in 14 of 16 patients. MRI is an accurate method of delineating anal fistulae, and should be considered for patients with difficult fistulae that recur despite skilled attention because it demonstrates abnormalities that might otherwise be missed.


Risk of pneumonia in patients previously treated in hospital for pneumonia.

Although elderly patients who are admitted to hospital for any disease have a higher risk of pneumonia subsequently, whether those treated in hospital for pneumonia are at even greater risk is unknown. Therefore we retrospectively assessed morbidity and mortality due to pneumonia after discharge in 573 consecutive patients admitted to hospital for pneumonia, gastrointestinal infection, renal infection, or erysipelas. Average follow-up was 34 months. The incidence rate for pneumonia was 5.45 times higher in the group of patients discharged after pneumonia than in the other groups combined (95% confidence interval 2.89-10.26; p less than 0.001), and this group also had more deaths due to pneumonia (p = 0.06). For patients 50 years or older Streptococcus pneumoniae is the main cause of pneumonia. Pneumococcal vaccination after hospital treatment for an episode of pneumonia might be a cost-effective means of preventing disease in this group.


Effect of indomethacin plus ranitidine in advanced melanoma patients on high-dose interleukin-2.

Preclinical models of advanced melanoma have shown that chronic indomethacin therapy combined with interleukin 2 (IL-2) can eradicate experimental metastases. A phase II trial was done in patients with advanced melanoma. Indomethacin and ranitidine were begun at least one week before IL-2. Of the objective responses in 3 patients, 2 were achieved on ranitidine and indomethacin alone, before start of IL-2. Indomethacin and ranitidine may be responsible for some responses in melanoma patients previously attributed to IL-2.


A fifty-year follow-up of congenital rubella.

50 patients with congenital rubella, born in 1939-43, were reviewed in 1967. Here we report their outcome in 1991. Since 1967, there have been 7 deaths (3 cardiovascular, 3 malignant disease, 1 AIDS). 40 had full clinical assessment. The prevalence of diabetes mellitus is similar to that in 1967: 4 of the 5 reported diabetic then, remain so, and there is 1 new case. 1 subject has malignant melanoma and 3 have died from cancer. Although the incidence of malignant disease is not increased, the death rate is (standardised mortality rate 6.0, 95% CI 1.24-17.57). Longer follow-up will be required to confirm this observation.


Variations in the expression of pili: the effect on adherence of Neisseria meningitidis to human epithelial and endothelial cells.

The effect of variations in Neisseria meningitidis pili on bacterial interactions with three epithelial cell lines as well as human umbilical vein endothelial cells was studied using a panel of seven strains expressing Class I or Class II pili. Comparison of adherence of piliated and pilus-deficient variants of each strain to epithelial cells suggested that Class I pili may mediate bacterial adherence with all three epithelial cell lines. In contrast, Class II pili of the strains used did not increase bacterial adherence to Hep-2 larynx carcinoma cells, although an increase in adherence to Chang conjunctival and A549 lung carcinoma epithelial cells was observed in the Class II pili-expressing strains. In addition to these interclass functional variations, differences in adherence to epithelial cells were also observed among Class I and Class II strains. Functionally different pilin variants of one Class I strain, MC58, were obtained by single colony isolation. One piliated variant was identified which had concurrently lost the ability to adhere to both Chang and Hep-2 cells ('non-adherent' phenotype; adherence of less than 2 bacteria per cell). In addition, several adherent pilin variants were isolated from non-adherent Pil- and Pil+ bacteria by selection on Chang cells (adherence of 10-25 bacteria per cell). In contrast to epithelial cells, all variant pili, whether of Class I or Class II, adhered to endothelial cells in substantially larger numbers (greater than 50 bacteria per cell) and therefore implied the existence of distinct mechanisms in pilus-facilitated interactions of N. meningitidis with endothelial and epithelial cells.


Psychoactive drug prescribing in the Tasmanian community.

To gather data on the prescribing of psychoactive drugs (benzodiazepines, antidepressants and antipsychotics) using a network of Tasmanian community pharmacies. The prescribing of psychoactive drugs in the community was studied during 1989 using data retrospectively obtained from computerised dispensing systems in 11 community pharmacies in Tasmania. The data collection procedure included all prescriptions dispensed in the pharmacies, irrespective of supply under the Pharmaceutical Benefits Scheme, the Repatriation Pharmaceutical Benefits Scheme or as a private prescription. Results of the pooled data were quantified by both the number of prescriptions and the defined daily doses (DDDs) dispensed for the psychoactive drugs. When extrapolated to the population of Tasmania, the estimated annual prescribing rates for the benzodiazepines, antidepressants and antipsychotics (including lithium) were 853.3, 316.2 and 54.8 prescriptions per 1000 persons, respectively. Prescriptions for the psychoactive drugs accounted for 13.2% of all prescriptions dispensed. In terms of DDDs, the estimated prescribing rates for the total Tasmanian population for the benzodiazepines, antidepressants and antipsychotics were 47.8, 12.5 and 2.1 DDDs per 1000 persons per day, respectively. The rate of benzodiazepine prescribing appeared to be high in comparison with the limited Australian data available. The relative prescribing rates of the long acting benzodiazepine hypnotics, flunitrazepam and nitrazepam, were also disturbingly high. This study has demonstrated the potential value of comprehensive pharmacoepidemiological data obtained from a network of community pharmacists and will form the basis for future studies using an expanded collection procedure.


Update: CD4+ T-lymphocytopenia in persons without evident HIV infection--United States.

On July 31, 1992, CDC reported five cases of CD4+ T-lymphocytopenia in persons without evident human immunodeficiency virus (HIV) infection in the United States. As of August 5, 1992, CDC has received reports of nine additional persons with similar clinical presentations. All persons who have been reported to CDC meet the three criteria for CD4+ T-lymphocytopenia without evident HIV infection. Another 21 persons suspected to have this condition have been described, 10 of whom reside in the United States. This report summarizes the 14 cases reported to CDC and provides information on the national surveillance system established to determine the prevalence and distribution of this condition.(ABSTRACT TRUNCATED AT 250 WORDS)


A controlled trial comparing continued zidovudine with didanosine in human immunodeficiency virus infection. The NIAID AIDS Clinical Trials Group.

Although zidovudine is effective in patients with human immunodeficiency virus (HIV) infection, its efficacy may decline with prolonged use. Didanosine is another inhibitor of HIV reverse transcriptase. We evaluated the effectiveness of changing anti-HIV treatment from zidovudine to didanosine. This multicenter, double-blind study involved 913 patients who had tolerated zidovudine for at least 16 weeks. The patients had the acquired immunodeficiency syndrome (AIDS), AIDS-related complex with less than or equal to 300 CD4 cells per cubic milliliter, or asymptomatic HIV infection with less than or equal to 200 CD4 cells per cubic milliliter. They were randomly assigned to receive 600 mg per day of zidovudine, 750 mg per day of didanosine, or 500 mg per day of didanosine. There were significantly fewer new AIDS-defining events and deaths among the 298 subjects assigned to 500 mg per day of didanosine than among the subjects who continued to receive zidovudine (relative risk, 1.39; 95 percent confidence interval, 1.06 to 1.82; P = 0.015). With 750 mg of didanosine, there was no clear benefit over zidovudine (relative risk, 1.10; 95 percent confidence interval, 0.86 to 1.42). The efficacy of didanosine was unrelated to the duration of previous zidovudine treatment. In the two didanosine groups, there were improvements in the number of CD4 cells (P less than 0.001 for both groups) and in p24 antigen levels (P = 0.03 in the 500-mg group; P = 0.005 in the 750-mg group), as compared with the zidovudine group. Changing treatment from zidovudine to 500 mg per day of didanosine appears to slow the progression of HIV disease.


Deformed autoregulatory element from Drosophila functions in a conserved manner in transgenic mice.

The striking similarities in the structure, organization and anterior-posterior expression patterns between the murine Hox gene system and the Drosophila homeotic gene complexes, called HOM-C (ref. 3), may point to highly conserved mechanisms for specifying positional identities (reviewed in ref. 4). Strong support for this concept lies in the observation of conserved colinearity between the genomic order of the Hox/HOM genes and their unique successive expression domains along the anterior-posterior axes of both mouse and fly embryos. These unique and precise expression patterns appear to be facilitated by multiple cis-regulatory elements (reviewed in ref. 5). One of the few elements characterized in detail is the autoregulatory enhancer of the homeotic gene Deformed (Dfd), which supports expression in subregions of posterior head segments of Drosophila embryos. Here we present evidence that this enhancer is capable of conferring reporter gene expression to a discrete subregion of the hindbrain in transgenic mouse embryos. Remarkably, this anterior-posterior subregion lies within the common anterior expression domain of the Dfd cognate Hox genes in the postotic hindbrain. Our results indicate that the Dfd autoregulatory enhancer is part of a highly conserved mechanism for establishing region-specific gene expression along the anterior-posterior axis of the embryo.


A human HOX4B regulatory element provides head-specific expression in Drosophila embryos.

Like other homeobox genes of the Antennapedia and bithorax complexes (collectively called the HOM complex), the Drosophila Deformed (Dfd) gene has structural homologues in the Hox/HOX complexes of mouse and humans, one of which is human HOX4B (refs 3, 4). Previous experiments indicated that HOX4B protein can specifically activate the expression of the endogenous Dfd transcription unit in Drosophila embryos and larvae. We therefore asked whether HOX4B cis-regulatory elements could mimic the function of a Dfd autoregulatory element in Drosophila embryos. Here we show that a HOX4B upstream element can surprisingly provide expression in a posterior head segment of Drosophila. One possible mechanism for the axial position-specificity of the human element may involve the conservation of a Dfd-specific autoregulatory circuit in both arthropod and chordate lineages. This possibility is supported by the finding that a Drosophila Dfd autoregulatory element supplies spatially localized expression in the hindbrain of mouse embryos.


Faster superoxide dismutase mutants designed by enhancing electrostatic guidance.

The enzyme Cu, Zn superoxide dismutase (SOD) protects against oxidative damage by dismuting the superoxide radical O2-. to molecular oxygen and hydrogen peroxide at the active-site Cu ion in a reaction that is rate-limited by diffusion and enhanced by electrostatic guidance. SOD has evolved to be one of the fastest enzymes known (V(max) approximately 2 x 10(9) M-1 s-1). The new crystal structures of human SOD show that amino-acid site chains that are implicated in electrostatic guidance (Glu 132, Glu 133 and Lys 136) form a hydrogen-bonding network. Here we show that site-specific mutants that increase local positive charge while maintaining this orienting network (Glu----Gln) have faster reaction rates and increased ionic-strength dependence, matching brownian dynamics simulations incorporating electrostatic terms. Increased positive charge alone is insufficient: one charge reversal (Glu----Lys) mutant is slower than the equivalent charge neutralization (Glu----Gln) mutant, showing that the newly introduced positive charge disrupts the orienting network. Thus, electrostatically facilitated diffusion rates can be increased by design, provided the detailed structural integrity of the active-site electrostatic network is maintained.


Kappa opioid agonists inhibit transmitter release from guinea pig hippocampal mossy fiber synaptosomes.

Opioid agonists specific for the mu, delta, and kappa opioid receptor subtypes were tested for their ability to modulate potassium-evoked release of L-glutamate and dynorphin B-like immunoreactivity from guinea pig hippocampal mossy fiber synaptosomes. The kappa opioid agonists U-62,066E and (-) ethylketocyclazocine, but not the mu agonist [D-Ala2,N-MePhe4,Gly5-ol]-enkephalin (DAGO) nor the delta agonist [D-Pen2,5]enkephalin (DPDE), inhibited the potassium-evoked release of L-glutamate and dynorphin B-like immunoreactivity. U-62,066E, but not DAGO or DPDE, also inhibited the potassium-evoked rise in mossy fiber synaptosomal cytosolic Ca2+ levels, indicating a possible mechanism for kappa agonist inhibition of transmitter release. DAGO and DPDE were found to be without any effect on cytosolic Ca2+ levels or transmitter release in this preparation. The U-62,066E inhibition of the potassium-evoked rise in synaptosomal cytosolic Ca2+ levels was partially attenuated by the opioid antagonist quadazocine and insensitive to the delta-opioid specific antagonist ICI 174,864 and the mu opioid-preferring antagonists naloxone and naltrexone. Quadazocine also reversed U-62,066E inhibition of the potassium-evoked release of L-glutamate, but not dynorphin B-like immunoreactivity. These results suggest that kappa opioid agonists inhibit transmitter release from mossy fiber terminals through both kappa opioid and non-kappa opioid receptor mediated mechanisms.


Selective effects of cyanide (100 microM) on the excitatory amino acid-induced elevation of intracellular calcium levels in neuronal culture.

The effect of low concentrations of cyanide on the excitatory amino acid-induced elevations of intracellular calcium levels ([Ca2+]i) was studied in cerebellar granule cells using ratio fluorometry with fura-2. Glutamate, kainate, N-methyl-D-aspartate (NMDA), quisqualate (50 microM, each) and membrane depolarization by 40 mM KCl caused elevations of [Ca2+]i which were 10-, 10-, 3-, 2.3-, 10-fold over baseline levels, respectively. Cyanide, 100 microM, greatly augmented the increases in [Ca2+]i induced by glutamate, kainate and NMDA but not those induced by quisqualate or KCl. In the absence of these excitatory amino acids, cyanide had no significant effect in concentrations up to 400 microM. Elevations of [Ca2+]i induced by quisqualate and KCl were not significantly augmented by higher concentrations of cyanide (400 microM). Selective antagonists could block the effect of cyanide+the respective agonist; however, the calcium channel blockers, lanthanum and diltiazem lowered both NMDA- and kainate-induced elevations of [Ca2+]i, yet neither blocked increases in calcium when 100 microM cyanide was added. Collectively, these data support an interaction of cyanide with the excitatory amino acid receptor.


Colocalization of somatostatin receptors and growth hormone-releasing factor immunoreactivity in neurons of the rat arcuate nucleus.

Recent studies from our group have demonstrated an association of [125I]-labeled somatostatin (SRIF)-binding sites with a subpopulation of arcuate (ARC) neurons. The distribution of these cells was similar to that of growth hormone-releasing factor (GRF)-immunoreactive neurons, which led us to propose that at least some SRIF receptors may be directly localized to GRF-containing cells. To test this hypothesis, we have visualized radiolabeled SRIF-binding sites and GRF immunoreactivity (ir) in adjacent sections of the hypothalamus, by combined radioautography and immunohistochemistry. Adult male rats were sacrificed by decapitation and the brains were rapidly frozen and serially sectioned on a cryostat. Fifteen pairs of adjacent 6-microns-thick sections, taken at 100-microns intervals through the rostrocaudal extent of the ARC nucleus, were alternately processed for [125I]-SRIF radioautography and GRF immunohistochemistry. GRF-ir and [125I]-SRIF-labeled cells were mapped at each level and quantified with the aid of a camera lucida. The maps were subsequently superimposed to determine the extent of [125I]-SRIF/GRF-ir colocalization. GRF-ir perikarya [13.2 +/- 4.4 (mean +/- SE) cells per section] were mainly localized in the ventrolateral portion of the ARC nucleus and predominated within the caudal-most tier. [125I]-SRIF-labeled cells (35.6 +/- 6.5 cells per section) were more numerous, more evenly distributed, and extended further rostrally and caudally than GRF-ir cells. Superimposition of the camera lucida maps indicated that, overall, 33.5 +/- 10.8% of the GRF-ir cells were labeled with [125I]-SRIF in adjacent sections.(ABSTRACT TRUNCATED AT 250 WORDS)


Growth hormone-releasing hormone-synthesizing neurons are a subpopulation of somatostatin receptor-labelled cells in the rat arcuate nucleus: a combined in situ hybridization and receptor light-microscopic radioautographic study.

Distribution of growth-hormone-releasing hormone (GHRH) cell bodies and somatostatin binding sites were compared in the mediobasal hypothalamus of the rat. GHRH-synthesizing neurons were visualized by in situ hybridization, using as 35S-labelled synthetic oligonucleotide (45 mere), and 125I-Tyr0-DTrp8-somatostatin (125I-SRIH) binding sites by light-microscopic radioautography on adjacent 20-microns-thick frozen mirror sections. GHRH mRNA hybridizing cells were detected mostly in the ventrolateral portion of the arcuate nucleus (ARC) and around the perimeter of the ventromedial nucleus (VMN). Comparison with the distribution of pericellular 125I-SRIH binding sites allowed to differentiate three types of cells: (1) GHRH perikarya not associated with pericellular 125I-SRIH binding sites around the perimeter of the VMN, (2) 125I-SRIH-labelled cells, not associated with GHRH perikarya in the periventricular zone along the dorsal part of the third ventricle, and (3) in the ventrolateral portion of the ARC, GHRH mRNA-labelled neurons had the same distribution as 125I-SRIH-labelled cells. Furthermore, on adjacent sections, the number of both labelled cells were correlated (r = 0.68; p less than 0.001). In this last population, the extent of colocalization of 125I-SRIH binding sites on GHRH mRNA-labelled neurons was further investigated in adjacent 5-microns-thick sections. The proportions of cells GHRH mRNA and 125I-SRIH allowed to differentiate three subdivisions of the arcuate: the periventricular (PV), ventrobasal (VB) and lateral portions. In the PV-ARC, 27% of GHRH-synthesizing cells were coidentified as 125I-labelled while only 6% of 125I-labelled cells contained GHRH mRNA. In the VB-ARC the proportion of double-labelled cells was equivalent (31 and 26%, respectively for GHRH mRNA and 125I-SRIH).(ABSTRACT TRUNCATED AT 250 WORDS)