Weissellicin L, a novel bacteriocin from sian-sianzih-isolated Weissella hellenica 4-7.

AIM: To identify and characterize novel bacteriocins from Weissella hellenica 4-7. METHODS AND RESULTS: Weissella hellenica 4-7, isolated from the traditional Taiwanese fermented food sian-sianzih (fermented clams), was previously found to produce a bacteriocin active against Listeria monocytogenes and some other Gram-positive bacteria. Bacteriocin activity decreased slightly after autoclaving (121°C for 15 min), but was inactivated by protease K and trypsin. Mass spectrometry analysis revealed the bacteriocin mass to be approximately 3205·6 Da. N-terminal amino acid sequencing yielded a partial sequence, NH2 -KGFLSWASKATSWLVGP, by Edman degradation. The obtained partial sequence showed high homology with leucocin B-TA33a; however, at least two different residues were observed. No identical peptide or protein was found, and this peptide was therefore considered to be a novel bacteriocin produced by W. hellenica 4-7 and termed weissellicin L. CONCLUSIONS: The findings obtained in the current study suggest a novel bacteriocin produced by W. hellenica 4-7. SIGNIFICANCE AND IMPACT OF THE STUDY: Bacteriocins from Weissella remain rare, and this study is the second report of a bacteriocin produced by W. hellenica.

Off-pump coronary artery bypass grafting is a safe and effective treatment modality for Asian patients requiring coronary revascularisation.

INTRODUCTION: Off-pump coronary artery bypass grafting (OPCABG) is gaining widespread acceptance as the preferred choice for myocardial revascularisation. However, no definite data exist as to whether it is better than conventional CABG. We aimed to study the efficacy of the procedure in our patients, which constituted of a predominantly Asian population. METHODS: Between January 2000 and December 2002, 1062 patients underwent isolated coronary artery bypass in our institution. 184 patients (17.3 percent) underwent OPCABG. Patients were preoperatively prospectively risk stratified under the EuroSCORE risk assessment model under high, medium and low risk classes thereby making them comparable. Post-operative complications, intensive care unit stay, hospital stay, types of grafts done were then analysed in these different risk classes. RESULTS: The incidence of off-pump procedures showed a gradual increase over the last three years in this institution. A reduction in the number of post-operative complications, hospital stay, intensive care unit stay and mortality in the off-pump group was observed. Certain differences were found to be statistically significant. CONCLUSION: Off-pump CABG is a safe and viable alternative to conventional CABG as a treatment modality for surgical coronary revascularisation.

Interleukin-7 enhances cell-mediated immune responses in vivo in an interleukin-2-dependent manner.

We have engineered recombinant vaccinia virus vectors expressing murine interleukin-7 (IL-7) in order to study the activity of this factor during virus infection. Virus-encoded IL-7 dramatically increased splenic cellularity in infected mice and enhanced the proliferative activity of T cells and their capacity to secrete IL-2 and IL-6, but not IFN-gamma, TNF-alpha or IL-4. Numbers of splenic CD4+ and CD8+ T lymphocytes were elevated two- to threefold. IL-7 also mediated a marked enhancement of both antigen-specific and nonspecific cellular immune activity. Total splenic antiviral cytotoxic T cells (CTL), natural killer (NK), and lymphokine-activated killer cells (LAK) responses were augmented significantly in mice given VV-HA-IL-7 compared with those given control virus, with accelerated clearance of the former. The enhanced antiviral cellular immune activity mediated by IL-7 was critically dependent on IL-2 produced by the host, but occurred independently of IFN-gamma. The ability of IL-7 to induce cellular immune responses in vivo may have applications in antiviral immunotherapy, particularly in cases of immunodeficiency.

Acute effects of cigarette smoking on left ventricular function at rest and exercise.

In this study we investigated the acute effects of cigarette smoking on cardiac function during exercise in 12 normal young males. Radionuclide angiocardiography was used to assess cardiac performance at rest and during upright-bicycle exercise on two consecutive days. On the second day each subject smoked three cigarettes. Exercise studies were continued until 85% of age-predicted heart rate for an individual was achieved. At rest cigarette smoking induced significant increases in resting heart rate, blood pressure, and contractility and significant decreases in end-systolic volume and pulmonary transit time. Comparison of hemodynamic data during exercise before and after smoking showed the only significant change to be a decrease in pulmonary transit time. These results suggest that cigarette smoking in healthy young males does not significantly alter cardiac function during submaximal exercise.

Enhancement of mucosal IgA responses by interleukins 5 and 6 encoded in recombinant vaccine vectors.

The expression of the genes for murine interleukin-5 (IL-5) or IL-6 in recombinant vaccinia virus vectors markedly increased IgA reactivity to co-expressed heterologous antigen in the lungs of mice inoculated intranasally with the viruses. These elevated local IgA responses reached a peak four times higher than those elicited by control viruses 14 days after infection and these peak levels were maintained for at least four weeks. Elevated IgA responses, reaching a peak 3-4 weeks after immunization, were also observed in the lungs of mice inoculated with IL-6 expressed by another vector, fowlpox virus. The results indicate that these factors enhance the development of mucosal IgA reactivity in vivo and suggest that their expression in mucosal vaccine vectors may stimulate local immune responses. The approach described in this study may be useful in stimulating mucosal immunity to a wide range of vector-encoded antigens, not only for vaccination against disease but also for immunocontraception by the co-expression of antigens involved in reproduction.

Inflammatory myopathies.

Inflammatory myopathies encompass a wide range of disorders. This article deals with the idiopathic inflammatory myopathies. Classification and diagnostic criteria proposed by Bohan and Peter are still widely used. Diagnosis is based on clinical features, muscle enzyme abnormalities, electromyographic findings and muscle biopsy results. There are known associations with malignancy and lung disease which may affect the prognosis. Management consists of the prudent use of corticosteroids. In refractory cases, cytotoxic agents, cyclosporin and plasmapheresis have been used.

Gout.

Gout is a common disease in the primary health care setting. Diagnosis of primary gout is definite if urate crystals are present in synovial fluid or tophi. The colchicine therapeutic trial is a useful diagnostic aid but not specific. Secondary gout is associated with myeloproliferative disease. Non-steroidal anti-inflammatory agents or colchicine are the main stays of treatment in acute gouty arthritis. In the inter-critical period, uricosuric agents or allopurinol can be used to control hyperuricaemia. Allopurinol is the treatment of choice in secondary gout. Asymptomatic hyperuricaemia is not an indication for therapy.

Bone mineral density measurements using the Hologic QD2000 in 175 Singaporean women aged 20-80.

AIMS: The first aim is to obtain a reference database of bone mineral density (BMD) measurements for Singaporean women across different age groups and to compare this with an American database using the same machine. The second is to study the lifestyle factors that may influence bone mass in these women. METHODS: Subjects were recruited from hospital staff and their relatives. They needed to fulfil inclusion criteria and those with confounding factors such as being on hormone replacement therapy (HRT) were excluded. A lifestyle questionnaire was administered. RESULTS: Across every five-year age band, the mean BMD measurements of the Singaporean women were 3%-8% lower than their American counterparts at the AP spine and 6%-11% lower at the femoral neck. 40.6% either drank milk, ate cheese or took calcium supplements everyday. 16.6% did some form of weight bearing exercise at least once a week. CONCLUSION: A local reference database is needed for the accurate interpretation of BMD measurements as there is significant variation compared to Caucasian values.

Renal arteriovenous fistula following kidney biopsy in systemic lupus erythematosus.

Patients with lupus nephritis frequently undergo renal biopsies. A rare complication of this procedure is the development of renal arteriovenous fistulas. We report two patients with systemic lupus erythematosus (SLE) who developed this vascular complication several years after renal biopsy.

Medical treatment of osteoporosis--increasing options.

INTRODUCTION: Many drugs are now available for the prevention and treatment of osteoporosis. They have differing levels of evidence of efficacy and each may be used according to clinical indications. METHODS: A Medline search of clinical drug trials using various therapeutic agents used for osteoporosis was carried out. RESULTS: Several randomised controlled trials have been carried out using many agents. The agents with the best data to date with regards to the prevention of spine as well as hip fractures in patients with prevalent fractures belong to alendronate and risedronate. Parathyroid hormone has been shown in one trial to reduce the risk of non-vertebral fractures. For reduction of spine fractures, in addition to the above two bisphosphonates, many agents, in particular raloxifene, have been shown to be clearly beneficial. Weaker data exist for hormone replacement, calcitonin, cyclical etidronate and the vitamin D analogues calcitriol and alfacalcidol. CONCLUSION: There are many therapeutic agents shown to be clearly effective in the treatment of osteoporosis.

Ultrasound of the tibia--precision error, left versus right sides and correlation with bone mineral density.

Ultrasound of the tibia measures the speed of sound through cortical bone and is a measure of bone density and strength. Ten subjects were measured twice each on the same side by a single operator using the Myriad Soundscan 2000. Intra-operator precision error expressed as CV% was 0.3%. Inter-operator precision error was also found to be 0.3% when results on the same ten subjects by two operators were analysed. Seventy-four subjects had their speed of sound (SOS) measured on both the left and right tibiae by a single operator. The Pearson correlation co-efficient was 0.83. Fifty subjects had their SOS measured as well as their bone mineral density (BMD) determined by dual energy X-ray absorptiometry (DEXA) using the Hologic QDR 2000. BMD measurements were made at the lumbar spine AP view, neck of femur, trochanter, Ward's triangle and total hip. Pearson correlations between these various sites and SOS were as follows: SOS versus BMD AP spine r = 0.61, P < 0.0001; SOS versus neck of femur r = 0.68, P < 0.0001; SOS versus trochanter r = 0.71, P < 0.0001; SOS versus Ward's triangle r = 0.7, P < 0.0001; SOS versus total hip r = 0.67, P < 0.0001. In conclusion, ultrasound of the tibia is a precise and promising tool in the assessment of osteoporosis. Further studies are needed to document its clinical usefulness.

Lipid disorders and rheumatic diseases.

Lipid abnormalities can exist in patients with rheumatic diseases. Many mechanisms give rise to these abnormalities and include treatment with corticosteroids and upregulation of certain cytokines in active rheumatic disease. Premature atherosclerosis can occur in these patients with significant morbidity and mortality. Greater awareness and earlier treatment of these lipid problems may lead to better outcomes.

Osteoporosis--the need for a paradigm shift.

Osteoporosis is a potentially devastating illness and causes morbidity and mortality from fragility fractures at the wrist, spine and hip. Currently, the illness can be detected before the fractures occur using dual energy X-ray absorptiometry and many preventive and therapeutic options exist. Efforts should be directed at helping the population at large achieve a healthy peak bone mass and adopt lifestyle habits which benefit bone mass. For those at high risk of fractures or who have already suffered an osteoporotic fracture, many pharmacological agents have been shown to reduce the risk of subsequent fractures. Hormone replacement therapy and bisphosphonates have the best efficacy data at present but there are likely to be more options in the near future. Hence, there is a need for a paradigm shift in that osteoporosis should not be thought of as an illness that starts at the point of fracture. Instead, it should be actively assessed and treated before fractures occur.

Mitral valve prolapse--a review.

Mitral valve prolapse is one of the more common cardiac conditions in our community. The prevalence is difficult to assess due to differences in diagnostic criteria and population selection. The prevalence in the community has been estimated to be from 5 to 15%. In females there is a decline in prevalence with increasing age which is not observed in males. 30% of subjects with mitral valve prolapse have relatives with the same condition. Strahan et al suggested that mitral valve prolapse was inherited as an autosomal dominant trend with its manifestations modified by age and other factors.

The safety of weekly low dose oral methotrexate in an Oriental population with rheumatoid arthritis.

A retrospective review of 50 oriental patients with rheumatoid arthritis treated with weekly oral methotrexate showed adverse events in 15 (30%) patients with 19 occurrences (38%) of leucopaenia (4%), pancytopaenia (2%), gastrointestinal symptoms (18%), hepatic transaminase elevation (6%), rash (2%) and infections (6%). The median duration of treatment with methotrexate was 11 months (range 1 to 105 months). Pancytopaenia occurred in 1 patient with renal failure. All adverse events resolved with cessation of therapy and on several occasions, despite continued therapy. Methotrexate was discontinued permanently in 2 and temporarily in 7 patients as a result of adverse events. No recurrence of adverse events was noted on restarting methotrexate therapy in patients with non life-threatening adverse events. No increase in adverse events was noted in 14 patients treated with a combination of methotrexate and anti-malarial therapy. We conclude that methotrexate was well tolerated by the Oriental patients with rheumatoid arthritis in our study and could be safely restarted in those patients with non life-threatening adverse events.

Primary hyperparathyroidism: a case with severe skeletal manifestations.

Over the years, patients with primary hyperparathyroidism are often asymptomatic and diagnosis is suspected on the incidental finding of hypercalcaemia. We report a patient, a middle-aged man from northern Sumatra, with a florid but uncommon presentation of severe bone pains and bilateral femoral neck fractures. He was found to have a solitary parathyroid adenoma which was successfully removed surgically. Postoperatively, the patient had severe symptomatic hypocalcaemia that required aggressive replacement therapy with calcium, magnesium and active vitamin D. He was well clinically and had significant improvement of biochemical indices on follow-up at 3 months. This report is followed by a review on the management of this condition.

Clinical usefulness of needle muscle biopsy in twenty-four patients with proximal weakness.

Muscle biopsy is an important tool in the evaluation of muscle disease. This was performed on twenty-four patients using the percutaneous needle method. Useful findings were obtained in all twenty-four patients. The method is safe, convenient and reliable and should be considered as a practical alternative to open muscle biopsy.

Measuring health-related quality of life in Singapore: normal values for the English and Chinese SF-36 Health Survey.

OBJECTIVE: To determine norms for assessing Health-related Quality of Life (HRQOL) in Singapore using the Short Form 36 Health Survey (SF-36). MATERIALS AND METHODS: Mean SF-36 scores were calculated for 24 population subgroups (categorised by age, gender, ethnicity and questionnaire language) and for subjects with self-reported co-morbid conditions using data from a community-based survey in Singapore. RESULTS: The English and Chinese SF-36 was completed by 4122 and 1381 subjects, respectively, 58% (n = 3188) of whom had self-reported co-morbid conditions. SF-36 scores varied in subgroups differing in age, gender and ethnicity. In general, subjects with self-reported co-morbid conditions had lower SF-36 scores than those without these conditions, the magnitude of which exceeded 20 points in several instances. A method for calculation of SF-36 scores adjusted for age, gender, ethnicity and questionnaire language is described. CONCLUSION: We present norms for English and Chinese SF-36 versions in Singapore and describe potential uses for these data in assessing HRQOL in Singapore.

Initial construct cross-cultural validation of the Short Form 36 for quality of life assessment of systemic lupus erythematosus patients in Singapore.

The objective of this study was to determine if the Short Form 36 (SF-36) Health Survey Questionnaire measures differences in quality of life between lupus patients and healthy controls in Singapore. A cross-sectional pilot study was conducted on consecutive English-speaking, female Chinese lupus patients seen at a Rheumatology unit. Healthy volunteers were recruited as controls during the same time period. All subjects completed the United Kingdom version of the SF-36. Lupus disease activity was assessed using the British Isles Lupus Assessment Group (BILAG) index and converted to a global score. Lupus-related damage was measured using the Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SLICC/ACRDI). The main outcomes measured were the mean SF-36 scale scores for lupus patients and healthy controls. Thirty-six lupus patients and 76 controls were included in the study. All subjects were English-speaking, Chinese female between 21 and 53 years of age. The mean age of patients and controls was 31.9 and 29.0 years respectively. Lupus patients had lower mean scale scores than controls for physical functioning (73.0 versus 89.7, P < 0.0027), bodily pain (71.0 versus 81.4, P < 0.027), physical role functioning (55.7 versus 89.5, P < 0.0001) and general health (47.4 versus 51.8, P < 0.05). Mean scale scores for vitality, social and emotional role function and mental health were similar in both groups. Ten patients had active disease (BILAG global scores of 3 to 14) and 13 patients had lupus-related damage (Damage Index scores of 1 to 7). These preliminary data suggest that the SF-36 Health Survey may be able to measure differences in quality of life between lupus patients and healthy controls in Singapore.

Clinical predictors of nephritis in systemic lupus erythematosus.

We identified clinical predictors of lupus nephritis presenting more than 6 months after the diagnosis of lupus in a cohort of 335 lupus patients. Almost 24% (80/335) of patients developed nephritis more than 6 months after the diagnosis of lupus. Using a Cox proportional hazards model, we found hypertension, thrombocytopaenia and leukopaenia to be associated with lupus nephritis presenting more than 6 months after diagnosis, with adjusted relative risks of 2.5 (95% CI 1.3 to 4.7), 4.3 (95% CI 1.7 to 10.8) and 3.2 (95% CI 1.7 to 6.2) respectively. In this cohort, hypertension, thrombocytopaenia and leukopaenia were associated with lupus nephritis presenting more than 6 months after the diagnosis of lupus.