[A clinical study on the effect of nattokinase on carotid artery atherosclerosis and hyperlipidaemia].

Objective: To evaluate the efficacy of oral nattokinase (NK) in the reduction of common carotid artery intimal medial thickness (CCA-IMT) and carotid artery plaque size and in lowering blood lipids, and to explore the underlying mechanism of actions of NK and its potential clinical use. Methods: All enrolled patients were from the Out-Patient Clinic of the Department of TCM at the 3(rd) Affiliated Hospital of Sun Yat-sen University. Using randomised picking method, all patients were randomly assigned to one of two groups, NK and Statin (ST) group. NK Group-patients were given NK at a daily dose of 6 000 FU and ST Group-patients were treated with statin (simvastatin 20 mg) daily. The treatment course was 26 weeks. CCA-IMT, carotid plaque size and blood lipid profile of the patients were measured before and after treatment. Results: A total of 82 patients were enrolled in the study and 76 patients (NK 39, ST 37) completed the study. Following the treatments for 26 weeks, there was a significant reduction in CCA-IMT and carotid plaque size in both groups compared with the baseline before treatment. The carotid plaque size and CCA-IMT reduced from(0.25±0.12)cm(2) to (0.16±0.10)cm(2) and from (1.13±0.12)mm to (1.01±0.11)mm, repectively. The reduction in the NK group was significantly profound (P<0.01, 36.6% reduction in plaque size in NK group versus 11.5% change in ST group). Both treatments reduced total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C) and triglyceride (TG). While the reduction in both groups was shown to be statistically significant (P<0.01), the reduction of TC, LDL-C and TG in ST group was significantly greater (P<0.05). In addition, NK significantly increased the level of high-density lipoprotein cholesterol (HDL-C) (P<0.05), in contrast, HDL-C in the ST group did not change. The lipid lowering effect observed in the NK group was not correlated to the reduction of CCA-IMT and carotid artery plaque size (r=0.35, P=0.09). Conclusions: Our findings from this pioneer clinical study suggests that daily NK supplementation is an effective way to manage the progression of atherosclerosis and potentially may be a better alternative to statins which are commonly used to reduce atherosclerosis and further to prevent cardiovascular attack and stroke in patients. The mechanism underlying the reduction of carotid atherosclerosis by NK may be independent from its lipid-lowering effect, which is different from that of statins.

Vitrectomy with subretinal tissue plasminogen activator and ranibizumab for submacular haemorrhages secondary to age-related macular degeneration: retrospective case series of 45 consecutive cases.

PurposeTo assess the efficacy of small-gauge vitrectomy with subretinal recombinant tissue plasminogen activator (rtPA) and ranibizumab for submacular haemorrhages secondary to neovascular age-related macular degeneration (nAMD), and to identify the factors associated with visual outcome.MethodsA retrospective case series was performed, including all patients who had small-gauge vitrectomy with subretinal rtPA and ranibizumab for submacular haemorrhages secondary to nAMD. All patients received three consecutive monthly injections of ranibizumab after the surgery, and were reviewed monthly and treated on a pro re nata regime.ResultsA total of 45 eyes of 45 patients were included in the study. Mean age was 77.07±9.67 years, and 32 of 45 patients (71.1%) were women. Surgery was performed on average 6.98±5.70 days after the onset of symptoms, and patients were observed for a follow-up period of 12.9±10.8 months. On average, visual acuity improved -0.59±0.61 LogMAR between presentation and last follow-up. Visual acuity improved in 33 patients (73.3%), remained unchanged in 10 patients (22.2%), and worsened in 2 patients (4.4%). Multiple linear regression showed that patients with smaller haemorrhages (P=0.012) and prompt surgery (P=0.008) had better final visual acuities. A haemorrhage area of ≤30 mm(2) had 91.3% sensitivity and 73.3% specificity for predicting a final visual acuity ≥6/60.ConclusionSmall-gauge vitrectomy with subretinal rtPA and ranibizumab is effective for improving visual acuity in patients with submacular haemorrhages secondary to nAMD. Small haemorrhage area and prompt surgery are associated with better final visual acuity.

Vegetation composition of roadside verges in Scotland: the effects of nitrogen deposition, disturbance and management.

Vehicular emissions of NO(x) and NH(3) result in elevated concentrations of nitrogen at roadside verges. To determine the extent that vehicular nitrogen emissions, disturbance and management affect the vegetation composition of road verges, a survey of 92 verges in Scotland was carried out with sites stratified by background nitrogen deposition and road type. NO(x) and NH(3) concentrations were monitored at 15 key sites for a year, and showed a decreasing gradient with increasing distance from the road. Ellenberg fertility indices of the vegetation communities also showed a general decrease with increasing distance from the road, but there was no straightforward correlation with NO(x) and NH(3) air concentrations between sites. Cover of bare ground, ruderal species and salt-tolerant species were highest at the verge edge. The proximity of the verge to traffic is important both in terms of NO(x) and NH(3) gradients, but also for deposited salt, grit and physical disturbance.

Changing landscapes, habitats and vegetation diversity across Great Britain.

This paper describes how Countryside Survey 2000 (CS2000) and earlier Countryside Surveys in 1990 and 1984, can be used to develop an integrated view of the changes in land cover, landscape and biodiversity that have taken place at the regional scale in Great Britain. A particular concern is to develop an understanding of how the national patterns of stock and change are distributed across Great Britain, and whether such changes are leading to more or less regional differentiation in our landscapes and biodiversity. A further concern is how the structure of landscape is changing.A description of the major Environmental Zones that make up Great Britain is given. Analysis of the regional patterns of change observed suggests that there has been considerable geographical variation in the gains and losses of the stock of the Biodiversity Action Plan Broad Habitats. Between 1984 and 1990, in the lowlands of the south and west of England and Wales, there were significant increase in the area of the Arable and Horticultural and Broadleaved Woodland Broad Habitats, and a marked loss of Improved Grassland. Over the same period, in the uplands of England and Wales, significant losses of Acid Grassland were observed, with associated gains in Improved Grassland. The Environmental Zones in Scotland were more stable in terms of the changes in stock of Broad Habitats. In addition to the analysis of net changes in stock of the Broad Habitats, the paper provides an analysis of the exchanges of land between major cover categories or each of the Environmental Zones. In contrast to the regionally concentrated changes in habitat stock, more ubiquitous and uniform changes in habitat quality were detected between 1990 and 1998, which continue trends observed for the 1980s. The quality of freshwater habitats increased. However, there were declines in the quality for some terrestrial biotopes, as indicated by the loss of species diversity from agricultural habitats, and the gains in diversity in semi-natural habitats, such as Acid Grasslands, more usually associated with vegetation types that are poor in species. An important driver of qualitative change appears to be widespread nutrient enrichment from nitrogen. However, such processes are probably superimposed upon more local factors, such as changes in the way land is managed for agriculture. The importance of understanding the various drives of change for future countryside policy is emphasized.

Repair of pectus excavatum deformities in children: a new perspective of treatment using minimal access surgical technique.

HYPOTHESIS: Minimally invasive correction of pectus excavatum (PE) deformities of the anterior chest wall in children is safe and effective. DESIGN: Prospective cohort study. SETTING: Tertiary pediatric referral center. PATIENTS: Between February 1996 and July 2000, 36 patients underwent minimally invasive repair (MIR) of PE deformities, and 6 patients had traditional Ravitch repairs (RR). MAIN OUTCOME MEASURES: Morbidity, operating time, estimated blood loss, days to tolerating a regular diet, and length of hospital stay. RESULTS: Thirty-six children underwent MIR for moderate to severe chest wall deformities, with a mean operative time of 1.6 hours, a mean blood loss of 22 mL, a mean time to tolerating a regular diet of 2.9 days, no intensive care unit admissions, and a mean length of hospital stay of 5.5 days. Six children had RR procedures performed for moderate to severe deformity, with a mean operative time of 5.2 hours, a mean blood loss of 222 mL, a mean time to tolerating a regular diet of 3.3 days, 2 patients admitted to the intensive care unit, and a mean length of hospital stay of 4.5 days. Complications for both procedures consisted mainly of postoperative pneumothorax. CONCLUSIONS: The MIR technique for PE is less invasive, less morbid, and better tolerated than traditional open RR of this common pediatric chest wall deformity. Elective surgical reconstruction can be safely performed in children rather than limiting repair to only symptomatic patients with severe deformities.

Balloon dilation of esophageal strictures in children.

Esophageal strictures in children may develop as a primary constriction, secondary to a surgically repaired esophageal atresia (with or without tracheoesophageal fistula), as a result of chemical injury after caustic ingestion, or following esophageal surgery. Traditional treatment of esophageal strictures has been limited to dilation (using bougie dilators) with esophagoscopy under general anesthesia. Recent reports have shown success with fluoroscopically guided balloon catheter dilation. Eight children (aged 2 months to 14 years) were treated with balloon catheter dilation for focal strictures of the esophagus. In six of the eight cases, complete resolution of the strictures was achieved after an average of 7.5 dilations (range, 1 to 14). Two of the eight patients moved to another part of the country and did not complete treatment. There has been no morbidity or mortality. In selected centers, balloon catheter dilation under fluoroscopic guidance has become a safe treatment of benign esophageal strictures in children. It should be considered the treatment of choice in the initial management of esophageal narrowing and appears to be safer than the more traditional methods of esophageal dilation.

Spontaneous rupture of a choledochal cyst: clues to diagnosis and etiology.

A healthy 3-year-old black girl had acute onset of abdominal pain, vomiting, and elevated aminotransferase, amylase, and lipase levels. Sonographic evaluation suggested a choledochal cyst, but hepatobiliary scintigraphy clearly showed an extrahepatic biliary leak. Exploratory laparotomy confirmed bile peritonitis and a ruptured choledochal cyst. Other cases with this unusual presentation is reviewed in the literature. An anomalous insertion of the pancreatic duct into the common duct appears to facilitate reflux of pancreatic secretions into the biliary tree and may contribute to formation and even perforation of a choledochal cyst.

Acalculous cholecystitis in Crohn's disease.

A 15-year-old boy with Crohn's ileocolitis developed marked gallbladder enlargement. Ultrasonographic findings were consistent with acalculous cholecystitis (AAC) or hydrops. At laparotomy a gangrenous gallbladder was found. The diagnostic modalities currently used to distinguish between hydrops, a benign condition generally treated expectantly, and AAC, a potentially life-threatening condition requiring surgical treatment are reviewed. Failure to distinguish between these two conditions with acalculous gallbladder enlargement and similar clinical and radiologic features may have serious consequences.

Hypertension associated with unilateral hydronephrosis as a complication of Crohn's disease.

Obstructive uropathy with hydronephrosis is a well-known complication of Crohn's disease. The treatment for this condition is still controversial. This is the case study of a 14-year-old girl with documented right-sided obstructive uropathy secondary to Crohn's disease associated with renin-mediated hypertension secondary to her obstructive uropathy. The patient had complete resolution of her hypertension following surgery, which involved only resection of the involved bowel without ureterolysis.

Atresia of the esophagus. New trends in the management of high-risk neonates.

Once the reconstruction of esophageal atresia in infancy was reported, immediate repair became standard practice. High-risk infants carry an operative mortality of 30% to 80%. Staged surgical procedures were introduced to improve survival. "Delayed" reconstruction of esophageal atresia in selected cases has been reported to improve survival and eliminate staged surgical procedures. Between 1982 and 1986, 21 newborns were diagnosed as having esophageal atresia. Eight infants (32%) underwent "immediate" repair. In 13 infants repair was "delayed" for seven to 252 days. Four neonates with "pure" esophageal atresia underwent primary anastomosis, one was awaiting surgery, and another died in the postnatal period. As more high-risk infants survive the perinatal period, surgical reconstruction must be planned to maximize operative survival. The goal of delayed management of esophageal atresia is to restore intrinsic esophageal continuity.

Treatment of essential hypertension with beta-blocker plus diuretic: a study of 1402 patients treated by general practitioners with acebutolol 200 mg combined with hydrochlorothiazide 12.5 mg ('Secadrex') once daily for 3 months.

One thousand four hundred and two patients with essential hypertension were treated by their general practitioners for 3 months with one tablet daily consisting of 200 mg acebutolol plus 12.5 mg hydrochlorothiazide: 813 were newly diagnosed and 589 were known hypertensives already on treatment. There was no 'wash-out' period before the latter changed to the study treatment. Newly diagnosed hypertensives had an average initial mean arterial pressure (MAP) of 129.9 mm Hg which fell on average by 18.2% during the study: 79% of patients had good results with final MAP levels less than 113 mm Hg (equivalent to e.g., 160/90 mm Hg), and a further 7% also had good results in that MAP fell more than 15%, another 12.5% had moderate results (falls of 5% to 15%): and only 1.5% had poor results (fell less than 5%). Known hypertensives had an average MAP of 127 mm Hg on previous treatment, which fell on average by 15.4% during this study: 70% of patients had good results with final MAP levels less than 113 mm Hg and a further 7% also had good results in that MAP fell more than 15%: 18% had moderate results and 3% poor results. Pulse rate fell by 12.5% in newly diagnosed and 10% in known treated hypertensives. If allowance is made for withdrawals due to side-effects and to the need for more than one tablet of Secadrex daily, then over all 75.7% had a good blood pressure response to study medication, 13.7% a moderate response and 10.7% a poor response. Adverse effects caused the withdrawal of 4% of newly diagnosed and 5% of treated hypertensives, predominantly nausea/vomiting, lassitude/fatigue and malaise.(ABSTRACT TRUNCATED AT 250 WORDS)

DNA polymerase from mesophilic and thermophilic bacteria. III. Lack of fidelity in the replication of synthetic polydeoxyribonucleotides by DNA polymerase from Bacillus licheniformis and Bacillus stearothermophilus.

1. DNA polymerase from the mesophile Bacillus licheniformis and the thermophile Bacillus stearothermophilus has been used to study the replication of poly(dA-dT)-poly(dA-dT) and poly(dC)-poly(dG) templates at 37, 45, and 55 degrees C. 2. Incorporation of non-complementary deoxyribonucleoside triphosphates (misincorporation) occurred with both enzymes and both templates. Non-specific incorporation (de novo polynucleotide synthesis, random attachment to existing strands, and tritium exchange of nucleotides) accounted for, at most, a small fraction of the total observed misincorporation. The error rates at 37 degrees C for the complete system were as follows:: B. licheniformis: dATP, 1/61; dCTP, 1/830; dGTP, 1/360; dTTP, 1/65; B. stearothermophilus: dATP, 1/68; dCTP, 1/1430; dGTP, 1/440; dTTP, 1/67. For both organisms, the error rate for dCTP and dGTP was independent of incubation temperature; the error rate for dATP and dTTP was 5-50-fold greater than that for dCTP or dGTP and increased significantly from 37 to 55 degrees C. 3. The ratio of dATP to dTTP incorporation with the poly(dA-dT)-poly-(dA-dT) template was independent of temperature and close to unity. The ratio of dCTP to dGTP incorporation with the poly(dC)-poly(dG) template decreased from approx. 0.2 to 0.05 for the mesophile and from approx. 0.06 to 0.03 for the thermophile as the temperature increased from 37 to 55 degrees C.