Singapore Armed Forces Medical Corps-Ministry of Health clinical practice guidelines: management of heat injury.

The Singapore Armed Forces (SAF) Medical Corps and the Ministry of Health (MOH) have published clinical practice guidelines on Management of Heat Injury to provide doctors and patients in Singapore with evidence-based guidance on the prevention and clinical management of exertional heat injuries. This article reproduces the introduction and executive summary (with recommendations from the guidelines) from the SAF Medical Corps-MOH clinical practice guidelines on Management of Heat Injury, for the information of readers of the Singapore Medical Journal. Chapters and page numbers mentioned in the reproduced extract refer to the full text of the guidelines, which are available from the Ministry of Health website: http://www.moh.gov.sg/mohcorp/publications.aspx?id=25178. The recommendations should be used with reference to the full text of the guidelines. Following this article are multiple choice questions based on the full text of the guidelines.

A comparison of aluminum levels in tea products from Hong Kong markets and in varieties of tea plants from Hong Kong and India.

This study project aimed to investigate the concentrations of aluminum (Al) in tea products available in Hong Kong markets. Tea samples consisting of 47 different tea bags and 28 samples of tea leaves were analysed for concentrations of Al. All tea samples released Al (0.70-5.93 mg L(-1)) during a standard infusion period. In comparison to the Joint FAO/WHO Provisional Tolerable Weekly Intake guideline of 7 mg Al kg(-1) body weight, it was concluded that tea made with these tea leaves will not impose adverse human health impacts. The relative effects of age, soil available Al, and genetic differences on the levels of Al accumulated by tea bushes were investigated. It was found that there was no definite trend between the amount of Al accumulated and the age of tea bushes. The soil available Al influenced the levels of Al in Camellia sinensis to a certain extent, but it was evident that the ability of different varieties of C. sinensis to accumulate Al was variable. C. sinensis accumulated Al in all stages of growth. Young seedlings had lower contents of Al while the mobility of Al within the tea bushes was high. In a manner typical of hyperaccumulators, Al was not retained in the roots, but was consistently transported to the shoots. Aluminum in the tea bush was distributed between the different parts in the following order: mature leaves>roots>branches>young leaves.

Formaldehyde-treated, heat-inactivated virions with increased human immunodeficiency virus type 1 env can be used to induce high-titer neutralizing antibody responses.

The lack of success of subunit human immunodeficiency virus (HIV) type 1 vaccines to date suggests that multiple components or a complex virion structure may be required. We hypothesized that the failure of current vaccine strategies to induce protective antibodies is linked to the inability of native envelope structures to readily elicit these types of antibodies. We have previously reported on the ability of a formaldehyde-treated, heat-inactivated vaccine to induce modest antibody responses in animal vaccine models. We investigated here whether immunization for HIV with an envelope-modified, formaldehyde-stabilized, heat-inactivated virion vaccine could produce higher-titer and/or broader neutralizing antibody responses. Thus, a clade B vaccine which contains a single point mutation in gp41 (Y706C) that results in increased incorporation of oligomeric Env into virions was constructed. This vaccine was capable of inducing high-titer antibodies that could neutralize heterologous viruses, including those of clades A and C. These results further support the development of HIV vaccines with modifications in native Env structures for the induction of neutralizing antibody responses.

Polychlorinated biphenyls and organochlorine pesticides in human adipose tissue and breast milk collected in Hong Kong.

Contamination from persistent organic pollutants is a pervasive global problem that urgently demands global concern and action. In the present study, concentrations of organochlorine (OC) pesticides and polychlorinated biphenyls (PCBs) were determined in 37 samples of female adipose tissue collected in Hong Kong hospitals. Among the pollutants analyzed, DDTs (2.79 ng/g fat), HCHs (0.72 ng/g fat), and PCBs (0.19 ng/g fat) were prominent compounds in most of the adipose tissue. p,p'-DDE and hexachlorinated biphenyls were found in all samples, whereas heptachlor epoxide and dieldrin were found only in some samples. An estimation of toxic equivalency concentration (TEQ) due to dioxin-like coplanar PCBs was also performed. The estimated TEQ(PCBs) was 2.01 pg/g fat. This study also compared our previous results obtained from the milk samples of the same donors. Significant correlations are obtained for DDTs and HCHs between milk and adipose tissue. Detailed review of available information concerning OC pesticides and PCBs in different ecological compartments indicated that bioconcentration and biomagnification of these contaminants are common phenomena of the Pearl River Delta region, which has undergone rapid socioeconomic change in the past 20 years. It is suggested to establish a regional organization in order to coordinate the monitoring of persistent organic pollutants in the region.

Induction of humoral immune responses following vaccination with envelope-containing, formaldehyde-treated, thermally inactivated human immunodeficiency virus type 1.

The lack of success of subunit human immunodeficiency virus type 1 (HIV-1) vaccines to date suggests that multiple components or a complex virion structure may be required. We previously demonstrated retention of the major conformational epitopes of HIV-1 envelope following thermal treatment of virions. Moreover, antibody binding to some of these epitopes was significantly enhanced following thermal treatment. These included the neutralizing epitopes identified by monoclonal antibodies 1b12, 2G12, and 17b, some of which have been postulated to be partially occluded or cryptic in native virions. Based upon this finding, we hypothesized that a killed HIV vaccine could be derived to elicit protective humoral immune responses. Shedding of HIV-1 envelope has been described for some strains of HIV-1 and has been cited as one of the major impediments to developing an inactivated HIV-1 vaccine. In the present study, we demonstrate that treatment of virions with low-dose formaldehyde prior to thermal inactivation retains the association of viral envelope with virions. Moreover, mice and nonhuman primates vaccinated with formaldehyde-treated, thermally inactivated virions produce antibodies capable of neutralizing heterologous strains of HIV in peripheral blood mononuclear cell-, MAGI cell-, and U87-based infectivity assays. These data indicate that it is possible to create an immunogen by using formaldehyde-treated, thermally inactivated HIV-1 virions to induce neutralizing antibodies. These findings have broad implications for vaccine development.

Assessment of metal and nutrient concentrations in river water and sediment collected from the cities in the Pearl River Delta, South China.

The effects of anthropogenic activities, industrialization and urbanization on the accumulation of heavy metals and nutrients in sediments and water of rivers in the Pearl River Delta region were examined. Most sediments were seriously contaminated with Cd, Pb, and Zn in accordance with the classification by Hong Kong Environmental Protection Department. Total phosphorus (P) and nitrogen (N) concentrations in sediments ranged from 0.02% to 0.12% and 0.06% to 0.64%, respectively. High carbon (C), N, P and sulphur (S) levels at Yuen Long Creek were related to the discharge of industrial effluents along the river. The enrichment of P and ammoniacal-nitrogen (NH4+-N) in water were obvious. For most sites, the P concentration exceeded 0.1 mg/l, which is the recommended concentration in flowing water to encourage excessive growth of aquatic plants. Nine out of the 16 sites studied had NH4+-N concentration over 2 mg/l. The rivers in the south of Deep Bay (Hong Kong) had high nutrient exports compared with the rivers in the east region and western oceanic water. The concentrations of nitrate-nitrogen NO3--N in surface water were under the maximum contaminant level in public drinking water supplies (10 mg/l) except for one site. Although the concentrations of heavy metals in overlying water were low, their accumulations were significant. High contents of nickel (Ni) and zinc (Zn) in water were found at certain locations, suggesting the occurrence of some local contamination. These preliminary results indicated that river and sediment transported pollutants is likely one of the factors for the water quality degradation of Deep Bay water.

Organochlorine hydrocarbons in human breast milk collected in Hong Kong and Guangzhou.

In southern China, the awareness of persistent organic pollutant contamination has been increasing as a considerable number of past studies in Hong Kong had reported their trail in the coastal sediments, green-lipped mussels, muscle and viscera of pond fish, and foodstuffs. Hence there is an urgent need to assess their existence, contamination profiles, and potential impact on the public. In the present study, a survey was conducted to examine p,p'-DDT, p,p'-DDE, beta-HCH, and PCB concentrations in human breast milk, one of the most reliable bioaccumulation indicators. Milk samples (115 from Hong Kong and 54 from Guangzhou), in the lactation period from 3-5 weeks were analyzed. The results demonstrated that the mean levels of p,p'-DDT (Hong Kong: 0.39; Guangzhou: 0.70 microg/g of fat), p,p'-DDE (2.48; 2.85), and beta-HCH (0.95; 1.11) were 2-15-fold higher when compared with studies conducted elsewhere ( i.e., United Kingdom, Germany, Sweden, Spain, and Canada), and in contrast the concentration of PCBs (0.035; 0.031) was about 10 times lower. When compared to a similar study conducted 10 years ago in Hong Kong ( p,p'-DDT 2.17 microg/g of fat, p,p'-DDE 11.67, beta-HCH 15.96, and PCB 0.64), a considerable reduction in the levels of their contaminations was observed. The drastic reduction in body burdens in 10 years' time is presumably the result of effective regulatory actions. It is worth noting that body burden correlated positively with maternal age (total DDT, r = 0.93; beta-HCH, r = 0.91; PCBs, r = 0.77) and with historical record of seafood consumption (total DDT, r = 0.89; beta-HCH, r = 0.98; PCBs, r = 0.91) (p < 0.001) and potential uptake of the POPs by breastfed infants may pose adverse health hazards.

Anticancer effect of a lentiviral vector capable of expressing HIV-1 Vpr.

A lentiviral vector capable of expressing the HIV-1 vpr gene (Vpr lentiviral vector) was constructed, and its in vivo anticancer effect was determined against cutaneous tumors derived from the AT-84 oral cancer cells in immunocompetent mice. A single intratumoral injection of the Vpr lentiviral vector not only significantly reduced the primary tumor volume but also completely regressed tumors in >40% of animals. More interestingly, the mice of which the primary tumors were completely regressed by the Vpr lentiviral vector were additionally protected from a secondary challenge of AT-84 cells. These data suggest that the Vpr lentiviral vector elicits its anticancer activity in part by the activation of the immune system. The above suggestion is additionally supported by the failure of the lentiviral vector to demonstrate anticancer activity in immunocompromised nude or SCID mice. The Vpr lentiviral vector offers a powerful new strategy for cancer gene therapy and may be useful for the control of solid tumors, such as human oral squamous cell carcinomas.

Assessment of clinical preparations for single gold and ceramometal crowns.

OBJECTIVE: Single-crown preparations at a dental teaching hospital were compared with guidelines advocated in the dental literature. METHOD AND MATERIALS: Sixty-three single complete gold crown and 151 single ceramometal crown preparations were evaluated. Impression silhouettes were measured for occlusal and axial wall tooth reductions, shoulder widths, internal shoulder angles, and axial wall convergence angles. Marginal designs, the presence of retention grooves and undercuts, and the types of cores present were also recorded. RESULTS: Cuspal reduction was generally inadequate for the ceramometal crowns, and central fossa reduction was insufficient for both complete gold crowns and ceramometal crowns. The facial shoulder widths were also generally underprepared for the ceramometal crowns. Axial wall convergence angles for both complete gold crowns and ceramometal crowns were generally much greater than recommended. Large faciolingual convergence angles for anterior ceramometal crowns were associated with the absence of cingulum walls. Few preparations had retention grooves or undercut areas. CONCLUSION: Although strict guidelines for tooth preparations for complete crowns are available and well known to dentists, the preparations in this study did not always conform to these recommendations.

alpha(4)-integrin mediates neutrophil-induced free radical injury to cardiac myocytes.

Previous work has demonstrated that circulating neutrophils (polymorphonuclear leukocytes [PMNs]) adhere to cardiac myocytes via beta(2)-integrins and cause cellular injury via the nicotinamide adenine dinucleotide phosphate (NADPH) oxidase enzyme system. Since PMNs induced to leave the vasculature (emigrated PMNs) express the alpha(4)-integrin, we asked whether (a) these PMNs also induce myocyte injury via NADPH oxidase; (b) beta(2)-integrins (CD18) still signal oxidant production, or if this process is now coupled to the alpha(4)-integrin; and (c) dysfunction is superoxide dependent within the myocyte or at the myocyte-PMN interface. Emigrated PMNs exposed to cardiac myocytes quickly induced significant changes in myocyte function. Myocyte shortening was decreased by 30-50% and rates of contraction and relaxation were reduced by 30% within the first 10 min. Both alpha(4)-integrin antibody (Ab)-treated PMNs and NADPH oxidase-deficient PMNs were unable to reduce myocyte shortening. An increased level of oxidative stress was detected in myocytes within 5 min of PMN adhesion. Addition of an anti-alpha(4)-integrin Ab, but not an anti-CD18 Ab, prevented oxidant production, suggesting that in emigrated PMNs the NADPH oxidase system is uncoupled from CD18 and can be activated via the alpha(4)-integrin. Addition of exogenous superoxide dismutase (SOD) inhibited all parameters of dysfunction measured, whereas overexpression of intracellular SOD within the myocytes did not inhibit the oxidative stress or the myocyte dysfunction caused by the emigrated PMNs. These findings demonstrate that profound molecular changes occur within PMNs as they emigrate, such that CD18 and associated intracellular signaling pathways leading to oxidant production are uncoupled and newly expressed alpha(4)-integrin functions as the ligand that signals oxidant production. The results also provide pathological relevance as the emigrated PMNs have the capacity to injure cardiac myocytes through the alpha(4)-integrin-coupled NADPH oxidase pathway that can be inhibited by extracellular, but not intracellular SOD.

Human immunodeficiency virus Env-independent infection of human CD4(-) cells.

CD4(-) epithelial cells covering mucosal surfaces serve as the primary barrier to prevent human immunodeficiency virus type 1 (HIV-1) infection. We used HIV-1 vectors carrying the enhanced green fluorescent protein gene as a reporter gene to demonstrate that HIV-1 can infect some CD4(-) human epithelial cell lines with low but significant efficiencies. Importantly, HIV-1 infection of these cell lines is independent of HIV-1 envelope proteins. The Env-independent infection of CD4(-) cells by HIV-1 suggests an alternative pathway for HIV-1 transmission. Even on virions bearing Env, a neutralizing antibody directed against gp120 is incapable of neutralizing the infection of these cells, thus raising potential implications for HIV-1 vaccine development.

Anticancer agents suppressive for adult parasites of filariasis in Mongolian jirds.

Eight chemical structures not previously reported to possess antifilarial activity have been identified. A total of 79 compounds with anticancer properties were evaluated for possible macrofilaricidal activity against Brugia pahangi and Acanthocheilonema viteae transplanted into male Mongolian jirds (Meriones unguiculatus). All eight active compounds were suppressive for the onchocerciasis type (Acanthocheilonema viteae) of the disease. None was macrofilaricidal for the lymphatic form (Brugia pahangi). These new structures may represent a nucleus around which effective drugs can be synthesized.

Human immunodeficiency virus type 1 vpr induces apoptosis through caspase activation.

Human immunodeficiency virus type 1 (HIV-1) Vpr is a 96-amino-acid protein that is found associated with the HIV-1 virion. Vpr induces cell cycle arrest at the G(2)/M phase of the cell cycle, and this arrest is followed by apoptosis. We examined the mechanism of Vpr-induced apoptosis and found that HIV-1 Vpr-induced apoptosis requires the activation of a number of cellular cysteinyl aspartate-specific proteases (caspases). We demonstrate that ectopic expression of anti-apoptotic viral proteins, which inhibit caspase activity, and addition of synthetic peptides, which represent caspase cleavage sites, can inhibit Vpr-induced apoptosis. Finally, inhibition of caspase activity and subsequent inhibition of apoptosis results in increased viral expression, suggesting that therapeutic strategies aimed at reducing Vpr-induced apoptosis in vivo require careful consideration.

Lentiviral delivery of HIV-1 Vpr protein induces apoptosis in transformed cells.

Most current anticancer therapies act by inducing tumor cell stasis followed by apoptosis. HIV-1 Vpr effectively induces apoptosis of T cells after arrest of cells at a G(2)/M checkpoint. Here, we investigated whether this property of Vpr could be exploited for use as a potential anticancer agent. As a potentially safer alternative to transfer of genes encoding Vpr, we developed a method to efficiently introduce Vpr protein directly into cells. Vpr packaged into HIV-1 virions lacking a genome induced efficient cell cycle arrest and apoptosis. Introduction of Vpr into tumor cell lines of various tissue origin, including those bearing predisposing mutations in p53, XPA, and hMLH1, induced cell cycle arrest and apoptosis with high efficiency. Significantly, apoptosis mediated by virion-associated Vpr was more effective on rapidly dividing cells compared with slow-growing cells, thus, in concept, providing a potential differential effect between some types of tumor cells and surrounding normal cells. This model system provides a rationale and proof of concept for the development of potential cancer therapeutic agents based on the growth-arresting and apoptotic properties of Vpr.

Emigrated neutrophils regulate ventricular contractility via alpha4 integrin.

We have previously shown that CD18 and alpha4 integrin were important in the adherence of emigrated neutrophils to cardiac myocytes. Whether either of these molecules is important in myocyte dysfunction is unclear. In this study, we measured contractility as an index of myocyte function. Control contractility was compared with shortening response in myocytes exposed to neutrophils in the presence and absence of anti-CD18 or anti-alpha4 antibodies. Control unloaded cell shortening, expressed as a percentage of resting cell length, measured 10.06+/-1.16% (n=10) at 5 minutes. Circulating neutrophils caused a 35% reduction in cell shortening, an event prevented by anti-CD18, but not by anti-alpha4 antibody. When emigrated neutrophils were added to the myocytes, a profound reduction (50%) in unloaded cell shortening was noted. A significant increase in CD18 and alpha4 integrin was found on emigrated neutrophils. Addition of anti-CD18 antibody did not protect the myocyte from the emigrated neutrophils, whereas the addition of an anti-alpha4 antibody significantly reduced neutrophil-induced cell shortening, despite some neutrophils still adhering to the myocytes. Furthermore, emigrated neutrophils were able to cause myocytes to go into contracture within 5 minutes in the presence of neutrophils with or without anti-CD18 antibody. In addition to the impairment in unloaded cell shortening, at later times (10 minutes), neutrophils also caused a 40% reduction in the rate of contraction and relaxation. The addition of either anti-CD18 or anti-alpha4 antibody protected the myocytes from these changes. The data suggest that immunosuppression of CD18 on emigrated neutrophils was only partially effective in reducing myocyte dysfunction. In contrast, immunosuppression of the alpha4 integrin alone was sufficient to dramatically reduce all parameters of cell dysfunction measured in this study.

Polyamines: agents with macrofilaricidal activity.

There is a need for effective macrofilaricidal drugs. The polyamine metabolism of filarial worms has been recognized as a possible target for effective drug action. In an attempt to identify agents that might provide leads in developing an effective macrofilaricide, 78 polyamine compounds were selected from among > 250,000 structures that have been amassed by the Walter Reed Army Institute of Research, in the U.S.A. These thousands of agents have been chosen principally for drug-development programmes for other parasitic diseases. The 78 prospective drugs selected were evaluated for their macrofilaricidal activity against Brugia pahangi and Acanthocheilonema viteae, in male Mongolian jirds (Meriones unguiculatus). The animal models using these two parasites were designed to mimic, in so far as possible, human lymphatic filariasis and onchocerciasis, respectively. Thirteen of the compounds were found to be active although none of these has been previously reported to be macrofilaricidal. Two were suppressive for B. pahangi and 11 for A. viteae. These active agents may represent a nucleus around which highly effective drugs can be synthesised.

The functional paradox of CD43 in leukocyte recruitment: a study using CD43-deficient mice.

Although there is considerable evidence implicating a role for CD43 (leukosialin) in leukocyte cell-cell interactions, its precise function remains uncertain. Using CD43-deficient mice (CD43(-/-)) and intravital microscopy to directly visualize leukocyte interactions in vivo, we investigated the role of CD43 in leukocyte-endothelial cell interactions within the cremasteric microcirculation under flow conditions. Our studies demonstrated significantly enhanced leukocyte rolling and adhesion after chemotactic stimuli in CD43(-/-) mice compared with wild type mice. Using an in vitro flow chamber, we established that the enhanced rolling interactions of CD43(-/-) leukocytes, primarily neutrophils, were also observed using immobilized E-selectin as a substrate, suggesting that passive processes related to steric hindrance or charge repulsion were likely mechanisms. Despite increased adhesion and rolling interactions by CD43(-/-) leukocytes, we uncovered a previously unrecognized impairment of CD43(-/-) leukocytes to infiltrate tissues. Oyster glycogen-induced neutrophil and monocyte infiltration into the peritoneum was significantly reduced in CD43(-/-) mice. In response to platelet activating factor, CD43(-/-) leukocytes were impaired in their ability to emigrate out of the vasculature. These results suggest that leukocyte CD43 has a dual function in leukocyte-endothelial interactions. In addition to its role as a passive nonspecific functional barrier, CD43 also facilitates emigration of leukocytes into tissues.

Leukocyte activation does not mediate myocardial leukocyte retention during endotoxemia in rabbits.

Our goal was to determine whether coronary leukocyte retention after endotoxin infusion was due primarily to leukocyte activation. Leukocytes were activated by infusion of endotoxin into 12 blood donor rabbits. Separately, 12 isolated rabbit hearts were perfused with blood from an endotoxemic support rabbit to expose coronary endothelium to an inflammatory stimulus. During an infusion of 20 ml of donor blood into the isolated heart, the coronary transit time of leukocytes was determined by deconvolution of multiple measurements of injectate and collected leukocyte concentrations. With no leukocyte activation or inflammatory stimulation of endothelium, leukocyte transit time was 9.2 +/- 3.5 s, and 11.6 +/- 4.1 x 10(6) leukocytes were retained in the coronary circulation. Leukocyte activation alone did not alter transit time (9.8 +/- 3.2 s) or retention (9.3 +/- 4.6 x 10(6) leukocytes). Inflammatory stimulation of endothelium with and without leukocyte activation increased transit time (18.0 +/- 3.6 and 18.9 +/- 3.8 s, respectively; P < 0. 05) and retention (24.8 +/- 8.4 and 25.3 +/- 6.8 x 10(6) leukocytes, respectively; P < 0.05) to the same extent. Differential counts showed that neutrophils (but not lymphocytes) were slowed and retained. Inflammatory stimulation of endothelium caused coronary capillary endothelial swelling and pseudopod formation. Thus increased coronary neutrophil transit time and retention are due to structural changes of coronary endothelial cells or other effects of the inflammatory response occurring within coronary capillaries, not only due to activation of leukocytes.

L-2-Oxothiazolidine-4-carboxylic acid prevents endotoxin-induced cardiac dysfunction.

We tested the hypothesis that treatment with the glutathione repleting agent, L-2-oxothiazolidine-4-carboxylic acid (OTZ), could prevent endotoxin-induced ventricular dysfunction. Rabbits were treated with OTZ 2.4 g/kg (10% solution subcutaneously), or an equal volume and osmolality of saline, 24 h prior to, and again (intravenously) just prior to, infusion of 1 mg/kg E. coli endotoxin (or vehicle control). Ventricular contractility was measured in isolated hearts perfused by support rabbits. Contractility did not change in control groups (Saline/Control [n = 7] or OTZ/Control [n = 7]) over 6 h. However, Emax decreased in the Saline/Endotoxin group (-16.1 +/- 4.5% from baseline, n = 7, p < 0.05) and this was prevented by pretreatment with OTZ in the OTZ/ Endotoxin group (+6.3 +/- 4.1%, n = 7, p < 0.05 by analysis of variance). To better understand the mechanism of this effect we measured myocardial glutathione concentration and found it to be greater in OTZ/Endotoxin animals (104 +/- 4 ng/g) than in the Saline/Endotoxin animals (80 +/- 3 ng/g, p < 0.05). OTZ did not appreciably alter the endotoxin-induced increase in serum concentration of tumor necrosis factor (TNF) or the endotoxin-induced increase in myocardial leukocyte content. We conclude that oxygen radicals contribute to the early decrease in left ventricular contractility after endotoxin infusion and this decrease may be prevented by OTZ.

Cell cycle arrest by Vpr in HIV-1 virions and insensitivity to antiretroviral agents.

Expression of human immunodeficiency virus-type 1 (HIV-1) Vpr after productive infection of T cells induces cell cycle arrest in the G2 phase of the cell cycle. In the absence of de novo expression, HIV-1 Vpr packaged into virions still induced cell cycle arrest. Naturally noninfectious virus or virus rendered defective for infection by reverse transcriptase or protease inhibitors were capable of inducing Vpr-mediated cell cycle arrest. These results suggest a model whereby both infectious and noninfectious virions in vivo, such as those surrounding follicular dendritic cells, participate in immune suppression.