Studies in the setting of polyelectrolyte cements

Specimens of zinc polycarboxylate dental cement have been prepared with methanol or methanol/water mixtures as solvent. Such cements set at a reduced rate compared with those activated by water alone, and final materials are about 50% weaker in compression. Methanol reduces the dielectric constant of the solvent system compared with water alone and such a reduction inhibits ionic reactions and causes the polyacid to adopt a coiled configuration in solution. Both of these effects are assumed to contribute to the observed reduction in setting rate. The reduction in setting rate was confirmed using infrared spectroscopy.     

Molecular analysis of the malR gene of Clostridium butyricum NCIMB 7423, a member of the LacI-GalR family of repressor proteins

OBJECTIVE: The purpose of our study was to evaluate helical CT using axial, coronal, and three-dimensional (3D) reconstruction in the examination of potential kidney donors and to compare the results with angiography and surgery when possible. We also reviewed previously published reports. SUBJECTS AND METHODS: Thirty-six patients underwent unenhanced and enhanced helical CT (3-mm collimation, 150-170 ml of i.v. contrast material injected at 4 ml/sec; pitch 1.5; 17-sec scan delay) with coronal and 3D shaded-surface-display reconstructions made from 1.5-mm overlapping reconstructions. All CT scans were interpreted independently of each other by two observers unaware of other findings. A third observer, who was aware of other findings, also interpreted the images. Results were compared with angiography (24 cases) and surgery (24 cases). Our results are compared with those of other investigators. RESULTS: Axial CT was the best method for detecting accessory arteries (24%) and early branching (10%); it also detected relevant venous and ureteral anatomy and incidental findings. The coronal and 3D images rarely added information that resulted in changed patient treatment. CT findings were concordant with those of digital angiography in 89% of kidneys and were 98% concordant with surgery. CONCLUSION: Helical CT can show arterial, venous, and ureteral anatomy and can also show important incidental findings. If only helical CT is used, a few small accessory vessels and an occasional renal artery stenosis may be missed. Axial images are generally diagnostic and may be supplemented by multiplanar and 3D images read concurrently.     

Elevated alpha-fetoprotein secondary to Hodgkin's lymphoma

We describe the case of a 26-year-old man with an elevated level of alpha-fetoprotein who had no evidence of intragonadal or extragonadal germ cell tumor. The patient was found to have Hodgkin's lymphoma within an anterior mediastinal mass. We review the significance of elevated alpha-fetoprotein levels and discuss the clinical relevance of this unusual presentation of a possible primary Hodgkin's lymphoma.     

Estrogen regulates the association of intermediate filament proteins with nuclear DNA in human breast cancer cells

In a previous study we showed that the levels of the intermediate filament proteins, cytokeratins 8, 18, and 19, in the nuclear matrix-intermediate filament (NM-IF) fraction from the hormone-dependent and estrogen receptor (ER)-positive human breast cancer cell line T-47D5 were regulated by estrogens. In contrast, estrogens did not regulate the cytokeratins in the NM-IF fraction of the hormone-independent and ER-positive cell line, T5-PRF. In this study, human breast cancer cells were treated with cis-diamminedichloroplatinum to cross-link protein to nuclear DNA in situ, and proteins bound to DNA were isolated. We show that cytokeratins 8, 18, and 19 of T-47D5 and T5-PRF were associated with nuclear DNA in situ. The levels of the cytokeratins 8, 18, and 19 bound to nuclear DNA or associated with the cytoskeleton of T-47D5 human breast cancer cells decreased when estrogens were depleted or the pure antiestrogen ICI 164,384 was added. In contrast, the cytokeratin levels associated with nuclear DNA or cytoskeleton were not significantly affected by estrogen withdrawal or antiestrogen administration in T5-PRF cells. These observations suggest that estrogen regulates the organization of nuclear DNA by rearrangement of the cytokeratin filament network in hormone-dependent, ER-positive human breast cancer cells and that this regulation is lost in hormone-independent, ER-positive breast cancer cells.     

Herpes. Atypical clinical manifestations

Herpes simplex viruses (HSV) 1 and 2 are responsible for genital herpes which is usually recognized as vesicles that ulcerate and eventually heal but recur periodically. Atypical genital herpes is often described in immunocompromised patients and can present as large, chronic, hyperkeratotic ulcers. Acyclovir-resistant HSV is occasionally isolated from such ulcers. Most cases of HSV infection reproduce subtle signs and symptoms, or more commonly, asymptomatic viral shedding. Such subclinical presentations may be responsible for most of the 30% increase in the prevalence of genital herpes in the United States during the past two decades.     

Risk factors for HPV detection in archival Pap smears. A population-based study from Greenland and Denmark

The most important risk factor for cervical cancer is genital infection with certain types of human papillomavirus (HPV). The presence of HPV was studied in archival smears from a random sample of women living in Greenland (GW) and Denmark (DW) having, respectively, a high risk and an intermediate risk for cervical cancer. Risk factors were also examined of the original 126 Danish and 129 Greenlandic archived smears collected during October and November 1988. 125 were located from each country including all abnormal smears. HPV DNA was isolated from the smears and detected by means of a consensus polymerase chain reaction (PCR) detecting a broad spectrum of genital HPV types. HPV was detected in all the abnormal smears and in 22 and 33% respectively of the cytological normal smears from DW and GW. Risk of HPV was significantly higher in smears from women who started sexual life relatively recently (respectively, < or = 4 and < or = 6 years ago in DW and GW) compared with > or = 10 years ago (adjusted prevalence-OR: 9.3; 95% CI: 2.2-39.2 in DW and 5.9; 95% CI: 1.4-25.3 in GW). Among other important risk factors were age in both areas, lifetime number of sex partners and current smoking in DW and ever and gonorrhoea in GW. This study confirms the usefulness of the method as all abnormal smears were positive and, furthermore, the predictors for HPV presence in the normal smears corroborate with those found in recent studies of HPV in fresh cervical swabs. Thus, this method can be useful for large-scale epidemiological studies of HPV DNA in already sampled material.     

Importance of functional measures in predicting mortality among older hospitalized patients

CONTEXT: Measures of physical and cognitive function are strong prognostic predictors of hospital outcomes for older persons, but current risk adjustment and burden of illness assessment indices do not include these measures. OBJECTIVE: To evaluate and validate the contribution of functional measures to the ability of 5 standard burden of illness indices (Charlson, Acute Physiology and Chronic Health Evaluation [APACHE] II, Disease Staging, All Patient Refined Diagnosis Related Groups, and a clinician's subjective rating) in predicting 90-day and 2-year mortality among older hospitalized patients. DESIGN: Two prospective cohort studies. SETTING: General medicine service, university teaching hospital. PATIENTS: For the development cohort, 207 consecutive patients aged 70 years or older, and for the validation cohort, 318 comparable patients. MAIN OUTCOME MEASURE: Death within 90 days and 2 years from the index admission. RESULTS: In the development cohort, 29 patients (14%) and 81 patients (39%) died within 90 days and 2 years, respectively. A functional axis was developed using 3 independent risk factors: impairment in instrumental activities of daily living, Mini-Mental State Examination score of less than 20, and shortened Geriatric Depression Scale score of 7 or higher, creating low-, intermediate-, and high-risk groups with associated mortality rates of 20%, 32%, and 60%, respectively (P<.001); the C statistic for the final model was 0.69. The corresponding mortality rates in the validation cohort, in which 59 (19%) and 138 (43%) died within 90 days and 2 years, respectively, were 24%, 45%, and 60% (P<.001); the C statistic for the final model was 0.66. For each burden of illness index, the functional axis contributed significantly to the predictive ability of the model for both 90 days and 2 years. When the functional axis and each burden of illness measure were analyzed in cross-stratified format, mortality rates increased progressively from low-risk to high-risk functional groups within strata of burden of illness indices (double-gradient phenomenon). The contributions of functional and burden of illness measures were substantive and interrelated. CONCLUSIONS: Functional measures are strong predictors of 90-day and 2-year mortality after hospitalization. Furthermore, these measures contribute substantially to the prognostic ability of 5 burden of illness indices. Optimal risk adjustment for older hospitalized patients should incorporate functional status variables.