Spectrum of cutaneous granulomatous lesions: A 5-year experience in a tertiary care centre in Sarawak.

INTRODUCTION: Granulomatous skin lesions can have various histopathological features leading to diagnostic confusion. The study aimed to determine the frequency and pattern of different granulomatous skin lesions. MATERIALS AND METHODS: This was a 5-year retrospective study done between April 2017 and March 2022 at Dermatology Department, Sarawak General Hospital. Subjects with a clinicopathological diagnosis of granulomatous diseases were included in the analysis. RESULTS: A total of 1718 skin biopsies were done during the study periods, with 49 (2.8%) confirmed granulomatous skin lesions. Most patients were aged 40-60 with a male predominance of 51%. Most of the skin biopsy samples were taken from the upper limb (36%). In this study, epitheloid granuloma was the commonest subtype (21, 43%) followed by suppurative granuloma (12, 24%), tuberculoid granuloma (8, 16%) and foreign body granuloma (5, 10%). The commonest aetiology of granulomatous skin lesions in our study was infections (30, 61%) followed by foreign body inoculation (8, 16%). Fungal infection was the most common infective cause, followed by cutaneous tuberculosis. CONCLUSION: The major cause of granulomatous dermatoses in developing countries is still infections, fungal and tuberculosis being the leading causes.

[Prostate health index for the diagnosis of prostate cancer in Asians in Macau with a PSA level of 4－10 µg/L].

OBJECTIVE: To evaluate the prostate health index (PHI) as a tool for the diagnosis of PCa with a PSA level of 4－10 µg/L and determine the best cut-off value of PHI. METHODS: Fifty-eight patients with a PSA level of 4－10 µg/L underwent transrectal ultrasound-guided prostatic biopsy in our hospital between April 2017 and June 2019. We constructed receiver operating characteristic (ROC) curves for the relationship of the biopsy results with the level of PSA, the ratio of ［－2ï¼½ proPSA to fPSA and PHI, and calculated the area under the ROC curves (AUC). RESULTS: Prostatic biopsy revealed 18 cases of PCa in the 58 patients (31.0%). Statistically significant differences were observed between the PCa and non-PCa groups in ［－2ï¼½ proPSA, %［－2ï¼½ proPSA and PHI, but not in tPSA, % fPSA and PSA-density. The AUCs of PSA, % fPSA, PSA-density, ［－2ï¼½ proPSA, %［－2ï¼½ proPSA and PHI were 0.556, 0.407, 0.533, 0.746, 0.751 and 0.774, respectively. The specificity of PHI was 27.50% (95% CI: 14.6%－43.9%), the highest among the above predictors at 90% sensitivity. By applying PHI to this cohort, 13 cases (22.4%) of unnecessary biopsy could be avoided. CONCLUSIONS: The application of PHI can increase the accuracy of PCa prediction and reduce unnecessary prostatic biopsy.、.

Crassulacean Acid Metabolism in the Strangler Clusia rosea Jacq.

Observations of malic acid fluctuation, leaf anatomy, and stable carbon isotopic composition showed that the epiphytic strangler Clusia rosea, growing on Saint John, U.S. Virgin Islands, has crassulacean acid metabolism. This hemiepiphyte may be the only woody dicotyledonous tree species among the many thousands of flowering species in the 30 or more plant families that shows this type of metabolism. The finding has implications with respect to water balance during the process whereby Clusia rosea establishes itself as a tree, since crassulacean acid metabolism is a photosynthetic adaptation to water-stressed environments.

Effect of Severe Water Stress on Aspects of Crassulacean Acid Metabolism in Xerosicyos.

Xerosicyos danguyi H.Humb. (Cucurbitaceae) is a Crassulacean acid metabolism (CAM) species native to Madagascar. Previously, it was shown that when grown under good water conditions, it is a typical CAM plant, but when water stressed, it shifts to a dampened form of CAM, termed CAM-idling, in which stomata are closed day and night but with a continued, low diurnal organic acid fluctuation. We have now studied the kinetics of some metabolic features of the shift from CAM to CAM-idling under severe water stress and the recovery upon rewatering. When water is withheld, there is a steady decrease in relative water content (RWC), reaching about 50%, at which point the water potential decreases precipitously from about -2 or -3 bars to -12 bars. Abscisic acid (ABA) increases sharply at about 75% RWC. Stomata close, which limits CO2 uptake, and there is a dampened diurnal organic acid fluctuation typical of CAM-idling. Throughout an extended stress period to 50% RWC, there is no change in chlorophyll, protein, and ribulose bisphosphate carboxylase activity compared with the well-watered plants. Despite the fact that the tissue was already in CAM, the stress is accompanied by an increase in phosphoenolpyruvate carboxylase (PEPc) mRNA, extractable PEPc activity, and PEPc protein (such that the specific activity remained approximately constant) and a decrease in the apparent Km(PEP). It is not known if the changes in Km(PEP) in response to drought are related to or are separate from the increases in PEPc protein and mRNA. The changes in Km(PEP) could be in response to the decreased endogenous levels of organic acids, but evidently are not an assay artifact. The increases in PEPc protein and mRNA appear to be related to the water-stress treatment and may result from the increased concentration of ABA or the decreased levels of endogenous organic acids. When rewatered, the metabolism quickly returns to the well-watered control typical of CAM.

Ecophysiological comportment of the tropical CAM-tree Clusia in the field: II. Modes of photosynthesis in trees and seedlings.

Measurements were performed on leaves of Clusia rosea Jacq. trees in the moist central mountains (330 to 365 m above sea level) and at the dry south coast of St John Island (US Virgin Islands, Lesser Antilles). Seedlings of C. rosea were also studied in the central hills. During the study period (March 1989) all trees showed crassulacean acid metabolism (CAM), in which net CO2 uptake extended for a remarkably long time in the morning (phase II of CAM: until about 11 to 12 h) and contributed about 1/3 of total net CO2 -uptake. During the night (phase I of CAM) malic acid and citric acid were accumulated concurrently at a molar ratio of malic: citric acid of about 1.6. Internal recycling of respiratory CO2 was 20% of total CO2 fixed during the night. Water-use-efficiency (mol CO2 taken up: mol H2 O transpired) was 0.014 to 0.022. The pH of leaf-cell sap at the end of the dark period was 2.85. This would still allow an H+ -ATPase at the tonoplast to transport 2H+ into the vacuole per ATP hydrolysed when operating near thermodynamic equilibrium. Free sugars, glucose and fructose, and starch were used as precursors for the CO2 -acceptor phosphoenolpyruvate during the dark period; contributions of the two hexoses were about equal and together four-times that of starch. Xylem tensions showed increases of up to 8 bar during day-time. Leaf-sap osmotic pressures did not change significantly; the trend was a small decline during day-time. Among the seedlings, three different modes of photosynthesis were encountered, namely C3 -photosynthesis in terrestrial and in epiphytic seedlings, continuous stomatal opening and CO2 -uptake day and night in epiphytic seedlings, and CAM in seedlings growing in the tanks of Aechmea lingulata (L.) Baker.

Ecophysiological comportment of the tropical CAM-tree Clusia in the field: I. Growth of Clusia rosea Jacq. on St John, US Virgin Islands, Lesser Antilles.

Clusia rosea Jacq. is abundant in the moist parts of the Caribbean island of St John (US Virgin Islands, Lesser Antilles) but relatively rare along the dry south coast. Three types of seedlings were encountered, terrestrial seedlings, seedlings growing as humus-epiphytes on other trees, and seedlings growing inside the tanks of the bromeliad Aechmea lingulata (L.) Baker. Free-living trees grow from terrestrial seedlings or from epiphytic seedlings strangling and shading their host trees. Leaf-Na+ levels were always low (1-4 mequiv I-1 tissue water); trees close to the shore were not affected by salinity. In leaves of mature C. rosea trees, levels of Ca2+ , Mg2+ and K+ were about 60-90, 40-50, 45-55 mequiv I-1 tissue water, respectively. Epiphytic seedlings tended to contain lower levels of these inorganic cations than seedlings growing terrestrially or in the tanks of Ae. lingulata. Epiphytic seedlings contained significantly less nitrogen than terrestrial seedlings. In the leaves of mature trees N-levels were independent of altitude and location on the island, but shaded leaves had significantly higher N-levels than exposed leaves. Light compensation point of photosynthesis in epiphytic seedlings performing C3 -photosynthesis was 17-5 (µmol photons m-2 s-1 ), photosynthesis was saturated at about 300µmol photons m-2 s-1 showing a maximum rate of CO2 -uptake of 2-3 µmol m-2 s-1 .

Photosynthesis in epiphytic and rooted Clusia rosea Jacq.

Clusia rosea Jacq. is a hemiepiphyte having Crassulacean Acid Metabolism (CAM). In its natural habitat Clusia begins its life cycle as an epiphyte and eventually becomes a rooted tree. These two stages of the life cycle of Clusia represent markedly different water regimes. Our CO2 exchange, stomatal conductance, titratable acidity, and stable carbon isotope ratio measurements indicate that Clusia has a flexible photosynthetic mode, where CO2 is fixed mostly via CAM during its epiphytic stage, when water availability is low, and via both CAM and C3 during its rooted stage.

Phosotynthesis in hemiepiphytic species of Clusia and Ficus.

Hemiepiphytic species in the genera Clusia and Ficus were investigated to study their mode of photosynthetic metabolism when growing under natural conditions. Despite growing sympatrically in many areas and having the same growth habit, some Clusia species show Crassulacean acid metabolism (CAM) whereas all species of Ficus investigated are C3. This conclusion is based on diurnal CO2 fixation patterns, diurnal stomatal conductances, diurnal titratable acidity fluctuations, and δ13C isotope ratios. Clusia minor, growing in the savannas adjacent to Barinas, Venezuela, shows all aspects of Crassulacean acid metabolism (CAM) on the basis of nocturnal gas exchange, stomatal conductance, total titratable acidity, and carbon isotope composition when measured during the dry season (February 1986). During the wet season (June 1986), the plants shifted to C3-type gas exchange with all CO2 uptake occurring during the daylight hours. The carbon isotope composition of new growth was-28 to-29‰ typical of C3 plants.

CO(2) Metabolism in Corn Roots. III. Inhibition of P-enolpyruvate Carboxylase by l-malate.

Phosphoenolpyruvate carboxylase was purified from corn root tips about 80-fold by centrifugation, ammonium sulfate fractionation, and anion exchange and gel filtration chromatography. The resulting preparation was essentially free from malate dehydrogenase, isocitrate dehydrogenase, malate enzyme, NADH oxidase, and pyruvate kinase activity. Kinetic analysis indicated that l-malate was a noncompetitive inhibitor of P-enolpyruvate carboxylase with respect to P-enolpyruvate (K(I) = 0.8 mm). d-Malate, aspartate, and glutamate inhibited to a lesser extent; succinate, fumarate, and pyruvate did not inhibit. Oxaloacetate was also a noncompetitive inhibitor of P-enolpyruvate carboxylase with an apparent K(I) of 0.4 mm. A comparison of oxaloacetate and l-malate inhibition suggested that the mechanisms of inhibition were different. These data indicated that l-malate may regulate CO(2) fixation in corn root tips by a feedback or end product type of inhibition.

Effects of abscisic acid on CAM in Portulacaria afra.

Water stress induces Crassulacean acid metabolism (CAM)(†) in Portulacaria afra as manifested by day stomatal closure, organic acid fluctuation, and night CO2 uptake. We now have evidence that abscisic acid treatment of leaves causes partial stomatal closure that is accompanied by the induction of CAM in a manner similar to water stress. There appears to be an inverse relationship between exogenous CO2 uptake and decarboxylation of organic acids in that organic acids remain high during the day providing stomata are open. When stomata close, there is consumption of organic acids by decarboxylation. The hypothesis is that stomatal opening controls CAM in this species.

Carbon Flow and Metabolic Specialization in the Tissue Layers of the Crassulacean Acid Metabolism Plant, Peperomia camptotricha.

Leaves of Peperomia camptotricha contain three distinct upper tissue layers and a one-cell thick lower epidermis. Light and dark CO(2) fixation rates and the activity of ribulose bisphosphate carboxylase/oxygenase and several C(4) enzymes were determined in the three distinct tissue layers. The majority of the C(4) enzyme activity and dark CO(2) fixation was associated with the spongy mesophyll, including the lower epidermis; and the least activity was found in the median palisade mesophyll. In contrast, the majority of the C(3) activity, that is ribulose bisphosphate carboxylase/oxygenase and light CO(2) fixation, was located in the palisade mesophyll. In addition, the diurnal flux in titratable acidity was greatest in the spongy mesophyll and lowest in the palisade mesophyll. The spatial separation of the C(3) and C(4) phases of carbon fixation in P. camptotricha suggests that this Crassulacean acid metabolism plant may have low photorespiratory rates when it exhibits daytime gas exchange (that is, when it is well watered). The results also indicate that this plant may be on an evolutionary path between a true Crassulacean acid metabolism plant and a true C(4) plant.

Relationship between Respiration and CAM-Cycling in Peperomia camptotricha.

Mature leaves of well-watered Peperomia camptotricha show Crassulacean acid metabolism (CAM). Young leaves show CAM-cycling in which CO(2) uptake occurs during the day concomitant with a marked diurnal fluctuation of organic acids as in CAM. Evidence is presented suggesting that respiration is the source of CO(2) for nocturnal acid synthesis in leaves exhibiting CAM-cycling. Respiratory quotients for these leaves were consistently much less than unity despite the fact that the leaves metabolize starch. The conservation of CO(2) by refixation into acids at night represents about 17% of the total photosynthetically fixed CO(2) and about 50% of the total respiratory CO(2).

Physiological Changes in Portulacaria afra (L.) Jacq. during a Summer Drought and Rewatering.

The changes of titratable acidity, enzyme activity, water status, and pigment composition were studied in Portulacaria afra (L.) Jacq. during a normal summer drought and rewatering. Two groups of plants were grown outside under a clear plastic canopy with water stress initiated at 2-week intervals in May 1986. Drought resulted in a linear decrease of fresh weight for 80 days and there was no further fresh weight change for the next 65 days. Nocturnal CO(2) uptake remained measurable for 83 days. Cessation of exogenous CO(2) uptake corresponded to the point where the pressure potential (Psi(p)) became zero. Ribulose-1, 5-bisphosphate (RuBP) and phosphoenolpyruvate carboxylase were reduced to 50% of this activity by the end of the drought period. Phosphoenolpyruvate carboxykinase activity was undetectable after 120 to 140 days of drought. Chlorophyll (Chl) levels decreased with a preferential loss of Chl a over Chl b. Carotenoid content was relatively constant over the course of the drought period. After 145 days of drought, plants responded to rewatering within 24 hours; Psi(p) became positive and daytime CO(2) uptake resumed after 24 hours. After 3 days, RuBP carboxylase activity reached control levels. Activity of the CAM pathway recovered after 5 days, as noted by increased diurnal acid fluctuations. Phosphoenolpyruvate carboxylase and phosphoenolpyruvate carboxykinase activity fully recovered within 6 days. Chl levels were greater than control levels within 5 days. Chl a/b ratios took 27 days to return to control levels. The results indicated that P. afra can withstand a normal summer drought by utilizing the CAM and CAM-idling pathway for 130 to 140 days. The plants respond rapidly to rewatering because of the conservation of enzyme activity and the quick recovery of Psi(p).

Effects of Various Levels of CO(2) on the Induction of Crassulacean Acid Metabolism in Portulacaria afra (L.) Jacq.

In response to water stress, Portulacaria afra (L.) Jacq. (Portulacaceae) shifts its photosynthetic carbon metabolism from the Calvin-Benson cycle for CO(2) fixation (C(3)) photosynthesis or Crassulacean acid metabolism (CAM)-cycling, during which organic acids fluctuate with a C(3)-type of gas exchange, to CAM. During the CAM induction, various attributes of CAM appear, such as stomatal closure during the day, increase in diurnal fluctuation of organic acids, and an increase in phosphoenolpyruvate carboxylase activity. It was hypothesized that stomatal closure due to water stress may induce changes in internal CO(2) concentration and that these changes in CO(2) could be a factor in CAM induction. Experiments were conducted to test this hypothesis. Well-watered plants and plants from which water was withheld starting at the beginning of the experiment were subjected to low (40 ppm), normal (ca. 330 ppm), and high (950 ppm) CO(2) during the day with normal concentrations of CO(2) during the night for 16 days. In water-stressed and in well-watered plants, CAM induction as ascertained by fluctuation of total titratable acidity, fluctuation of malic acid, stomatal conductance, CO(2) uptake, and phosphoenolpyruvate carboxylase activity, remained unaffected by low, normal, or high CO(2) treatments. In well-watered plants, however, both low and high ambient concentrations of CO(2) tended to reduce organic acid concentrations, low concentrations of CO(2) reducing the organic acids more than high CO(2). It was concluded that exposing the plants to the CO(2) concentrations mentioned had no effect on inducing or reducing the induction of CAM and that the effect of water stress on CAM induction is probably mediated by its effects on biochemical components of leaf metabolism.

Kinetic Properties of Phosphoenolpyruvate Carboxylase in Peperomia camptotricha.

Kinetic characteristics of phosphoenolpyruvate carboxylase (PEPC) from the epiphytic C(3) or C(4): CAM intermediate plant, Peperomia camptotricha, were investigated. Few day versus night differences in V(max),K(m(PEP))), or malate inhibition were observed, even in extracts from water-stressed plants which characteristically perform CAM, regardless of efforts to stabilize day/night forms. The PEPC extracted from plants during the light period remained stable, without much of an increase or decrease in activity for at least 22 hours at 0 to 4 degrees C. Extracts from mature, fully developed leaves had slightly greater PEPC activity than from very young, developing leaves. Generally, however, the kinetic properties of PEPC extracted from mature leaves of plants grown under short day (SD), long day (LD), or 1-week water-stress conditions, as well as from young, developing leaves, were similar. The PEPC inhibitor, l-malate, decreased the V(max) and increased the K(m(PEP)) for all treatments. Under specific conditions, malate did not inhibit PEPC rates in the dark extracts as much as the light. The PEPC activator, glucose-6-phosphate (G-6-P), lowered the K(m(PEP)) for all treatments. At saturating PEP concentrations, PEPC activity was independent of pH in the range of 7.5 to 9.0. At subsaturating PEP concentrations, the pH optimum was 7.8. The rates of PEPC activity were lower in the light period extracts than the dark, at pH 7.1, but day/night PEPC was equally active at pH 7.8. At pH 7.5 and a subsaturating PEP concentration, G-6-P significantly activated PEPC. At pH 8, however, only slight activation by G-6-P was observed. The lower pH of 7.5 combined with l-malate addition, greatly inhibited PEPC, particularly in extracts from young, developing leaves which were completely inhibited at an l-malate concentration of 1 millimolar. However, malate did not further inhibit PEPC activity in mature leaves when assayed at pH 7.1. The fairly constant day/night kinetic and regulatory properties of PEPC from P. camptotricha are unlike those of PEPC from CAM or C(4) species studied, and are consistent with the photosynthetic metabolism of this plant.

CO(2) Metabolism in Corn Roots. I. Kinetics of Carboxylation and Decarboxylation.

The kinetics of (14)CO(2) carboxylation and decarboxylation in corn root tips were determined to ascertain the sequence of product formation and subsequent utilization, and to obtain further evidence to predict the enzymes mediating the carboxylation and decarboxylations. The carboxylation data indicated that the first product was oxaloacetate followed by malate and aspartate. Malate was the first stable product which could be detected. Decarboxylation data indicated that a large fraction of the (14)CO(2) release and turnover of (14)C was accountable for by a decrease in malate: however, essentially all labeled amino acids turned over rapidly and at a greater rate than organic acids. The data generally support the hypothesis that CO(2) fixation in corn root tips is via P-enolpyruvate carboxylase and malic dehydrogenase and that subsequent malate metabolism is for the most part by direct decarboxylation, possibly by the malic enzyme.