A blackberry-dill extract combination synergistically increases skin elasticity.

BACKGROUND: The loss of structural elastin due to intrinsic and extrinsic ageing results in the skin's inability to stretch and recoil (decrease in elasticity) and manifests as loss of skin firmness and sagging. While other extracellular matrix (ECM) components such as collagen and hyaluronic acid are continually synthesized and assembled through life, elastic fibres are not. Elastic fibre assembly and functionality require fibre cross-linking, induced by the lysyl oxidase-like (LOXL) enzymes, which sharply decrease during ageing. OBJECTIVE: To evaluate the enhanced elastogenic effect of a blackberry-dill extract combination, which was hypothesized to induce elastin fibre component synthesis, fibre cross-linking and reduce elastin fibre degradation. METHODS: The blackberry and the dill extracts were tested separately and in combination to confirm single ingredient bioactivity and synergistic benefits. Human skin explants, dermal fibroblasts, elastase assays, ELISAs, quantitative real-time PCRs and spectrofluorometer measurements were used. Moreover, a double-blinded, placebo-controlled clinical study was carried out to assess skin elasticity using Cutometer and histologically from biopsies. RESULTS: The blackberry extract induced elastin gene expression, elastin promoter activity and inhibited elastic fibre degradation by matrix metalloproteinases (MMPs) 9 and 12. The dill extract induced elastin, collagen and LOXL1 gene expression, resulting in enhanced fibre cross-linking in human skin explants. Clinically, the blackberry and dill combination treatment displayed synergistic pro-elasticity activity as compared to each ingredient alone and placebo. CONCLUSION: Taken together, these results demonstrated the two multimodal plant-based extracts complemented each other in terms of bioactivity and resulted in a synergistic elastogenesis induction.

CONTEXTE: la perte de l'élastine structurelle causée par un vieillissement intrinsèque et extrinsèque provoque l'incapacité de la peau à s'étirer et à rebondir (diminution de l'élasticité) et se manifeste comme une perte de fermeté et un relâchement de la peau. Alors que d'autres composants de la matrice extracellulaire (MEC), tels que le collagène et l'acide hyaluronique sont continuellement synthétisés et assemblés tout au long de la vie, les fibres élastiques ne le sont pas. L'assemblage et la fonctionnalité des fibres élastiques nécessitent une réticulation des fibres, causée par les enzymes de type lysyle oxydase (LOXL), qui diminuent fortement au cours du vieillissement. OBJECTIF: évaluer l'effet élastogène amélioré d'une combinaison d'extrait de mûre et d'aneth, qui était supposée induire la synthèse des composants des fibres d'élastine, la réticulation des fibres et réduire la dégradation des fibres d'élastine. MÉTHODES: les extraits de mûre et d'aneth ont été testés séparément et ensemble pour confirmer la bioactivité d'un seul ingrédient et les avantages synergiques. Des explants de peau humaine, des fibroblastes cutanés, des dosages d'élastase, des ELISA, des analyses PCR quantitatives en temps réel et des mesures de spectrofluorimètre ont été utilisés. De plus, une étude clinique en double aveugle, contrôlée par placebo, a été réalisée pour évaluer l'élasticité de la peau à l'aide du cutomètre et histologiquement à partir de biopsies. RÉSULTATS: l'extrait de mûre a induit l'expression génique de l'élastine, l'activité de promoteur de l'élastine et a inhibé la dégradation des fibres élastiques par des métalloprotéinases matricielles (MPM) 9 et 12.L'extrait d'aneth a causé l'expression génique de l'élastine, du collagène et du gène LOXL1, entraînant une amélioration de la réticulation des fibres dans les explants de peau humaine. Cliniquement, le traitement par une combinaison de mûre et d'aneth a montré une activité de pro-élasticité synergique par rapport à chaque ingrédient seul et au placebo. CONCLUSION: ensemble, ces résultats ont démontré que les deux extraits de plantes multimodales se complètent en termes de bioactivité et ont entraîné une induction synergique de l'élastogenèse.

Long-term results of single-stage reduction surgery for the treatment of macrodactyly.

We report the long-term results of a single-stage reduction procedure for the treatment of macrodactyly. Six patients (eight cases) were included. These patients underwent a single-stage operation that included debulking with resection of the hypertrophied digital nerve and distal interphalangeal joint fusion or corrective osteotomy. Plain radiographs and functional parameters were assessed. Aesthetic improvement was achieved in all patients. The mean ratios of the lengths and circumference differences between the affected digit and the corresponding normal digit on the other hand were 1:1 and 1:1, respectively. The mean range of motion in the proximal interphalangeal joint was 76°. A sensory deficit in the lateral pulp of the distal phalangeal area was observed in three fingers. The Disabilities of the Arm, Shoulder and Hand score ranged from 0 to 9 (mean 4). The long-term results of the single-stage reduction procedure were satisfactory, as demonstrated by the excellent adjustment of the length and acceptable circumference of the affected digits. LEVEL OF EVIDENCE: IV.

Effects of low-fat milk consumption on metabolic and atherogenic biomarkers in Korean adults with the metabolic syndrome: a randomised controlled trial.

BACKGROUND: Previous studies of the health effects of low-fat milk or dairy consumption on the metabolic syndrome have yielded inconsistent results. The present study aimed to investigate the effects of low-fat milk consumption on traits associated with the metabolic syndrome, as well as inflammatory and atherogenic biomarkers, in Korean adults with the metabolic syndrome. METHODS: Overweight Koreans with the metabolic syndrome (n = 58) were recruited and randomly assigned to either the low-fat milk or control group. The low-fat milk group was instructed to consume two packs of low-fat milk per day (200 mL twice daily) for 6 weeks, and the control group was instructed to maintain their habitual diet. Clinical investigations were conducted during the screening visit, on study day 0, and after 6 weeks. RESULTS: No significant differences in changes in body mass index, blood pressure, lipid profile and adiponectin levels, as well as levels of inflammatory markers, oxidative stress markers and atherogenic markers, were found between the low-fat milk and control groups. However, compared to the controls, significant favourable decreases in serum soluble vascular adhesion molecule-1 and endothelin-1 levels were found in the 12 subjects with high blood pressure and in the 18 subjects with hypertriglyceridaemia in the low-fat milk group. CONCLUSIONS: The present study did not demonstrate an overall beneficial effect of low-fat milk consumption in subjects with the metabolic syndrome. However, low-fat milk consumption may have a favourable effect on atherogenic markers in subjects with high blood pressure or hypertriglyceridaemia.

The anticancer effect of chaetocin is enhanced by inhibition of autophagy.

Chaetocin is a fungal metabolite that possesses a potent antiproliferative activity in solid tumors by inducing cell death. Although recent studies have extended the role of chaetocin in tumors, the underlying molecular mechanisms such as the downstream cascade that induces cell death has not clearly been elucidated. In this study, we show that chaetocin is able to induce both apoptosis and autophagy in several hepatoma cell lines including HepG2, Hep3B and Huh7 cell lines. Moreover, we found that the inhibition of caspase-3/7 activity by z-VAD-fmk treatment was able to block chaetocin-mediated cell death, whereas blocking autophagy by Bafilomycin A1 or the knockdown of autophagy protein 5 enhanced cell death mediated by chaetocin. These findings suggest that chaetocin has a potent anticancer effect against hepatoma. Inhibition of autophagy may potentiate anticancer effects of chaetocin thus providing evidence that combined treatment with chaetocin and autophagy inhibitors will be an effective strategy for treating cancer.

Endoscopic Treatment for Persistent Hematospermia: A Novel Technique Using a Holmium Laser.

PURPOSE: We present our endoscopic technique for treating ejaculatory duct and seminal vesicle diseases with a holmium laser. MATERIALS AND METHODS: Fifteen patients with persistent hematospermia were enrolled in this study from June 2007 to April 2014. All patients had failed medical treatments. All patients were evaluated with transrectal ultrasound and pelvic computed tomography or magnetic resonance imaging. We performed endoscopic treatment with a semi-rigid ureteroscope after dilation using a guidewire and ureteral serial dilator. A holmium laser was used to incise the obstructed ejaculatory duct, coagulate hemorrhagic mucosa, and fragment stones in the ejaculatory duct or seminal vesicles. Stones were removed using a basket and forceps. RESULTS: The mean duration of hematospermia was 30.6 months. Mean patient age was 45.3 years. The mean serum levels of prostate-specific antigen and testosterone were 1.36 and 4.95 ng/mL, respectively. No operative complications were encountered. Mean operative time was 35.4 min. Seven patients had ejaculatory duct or seminal vesicle stones, which were subsequently determined to be carbonate apatite, mucin, struvite, and calcium oxalate dehydrate stones. Mean duration of follow-up was 32.1 months. Although two patients showed recurrent hematospermia 11 and 12 months after the operation, hematospermia resolved in 13 patients (86.7%). The infertile patient showed an improved semen finding and had a successful pregnancy. CONCLUSION: Endoscopic treatment using a holmium laser is minimally invasive and was effective for treating ejaculatory duct and seminal vesicle diseases, which are the main cause of hematospermia.

In-vitro study on ureteral smooth muscle contractility with tamsulosin, nifedipine, and terpene mixture (Rowatinex®).

AIM: The aim of this study was to evaluate whether tamsulosin, an alpha-blocker, has an effect on decreasing spontaneous ureteral contractility with or without phenylephrine, an alpha-agonist. Additionally, nifedipine and a terpene mixture (Rowatinex®) were tested and compared with each other. METHODS: We obtained ureteral segments from freshly killed eight-week-old rabbits. Preparation was performed in an aerated Krebs buffer (95% oxygen and 5% carbon dioxide) at a constant temperature of 37 °C. All segments were suspended into organ tissue baths containing aerated Krebs buffer using stainless steel hangers and clips. The ureter was divided into four segments: upper, middle, low and uretero-vesical junction. Each ureteral segment was suspended longitudinally and circularly by opposite corners, respectively. Tamsulosin, nifedipine, and the terpene mixture were separately applied into the segments. Contractile activities of each drug were recorded and analyzed by the PowerLab data acquisition system (AD instruments CO., USA). The area under the curve was compared between before and after each drug application for each 5 minutes with or without pheylephrine. Statistical analysis was performed using the unpaired Student's t test. RESULTS: Under Krebs solution, ureteral smooth muscle contractility was significantly decreased in all segments over 10(-6) M in tamsulosin, 10(-7) M in nifedipine and 0.001x1 concentrations in the terpene mixture (P=0.038). However, under Krebs solution with 10(-5) M phenylephrine, there was no significant difference at all concentrations in tamsoluin and nifedipine. In contrast to tamsolusin and nifedipine, there was a significant decrease in ureteral smooth muscle contractility in most of segments at 0.01x1 concentrations (P=0.042) in the terpene mixture. CONCLUSION: Tamsulosin, nifedipine, and the terpene mixture showed the effect on spontaneous ureteral contractility. In particular, the terpene mixture might have the better effect on decreasing ureteral smooth muscle contractility.

Γ-glutamyl transferase as an early and sensitive marker in ethanol-induced liver injury of rats.

γ-Glutamyl transferase (GGT) has been regarded as a biological marker of heavy alcohol consumption or hepatobiliary disease such as fatty liver. However, the role of GGT is unknown in the molecular pathway during alcohol-induced liver injury. To determine the role of GGT in alcohol-induced liver injury, Sprague-Dawley rats were administered 22% and 38% ethanol for 3 days as acute and 5 weeks as subchronic model. In serologic analysis, the level of GGT was significantly increased and the level of alanine aminotransferase, aspartate aminotransferase, and total bilirubin were not changed at 3 days and 5 weeks. In histologic analysis, ethanol exposure induced granular deposit formation and sinusoidal dilation in the acute model for 3 days. In the subchronic model for 5 weeks, ethanol exposure further increased the granular deposit formation, sinusoidal congestion, and mild fatty liver change. To determine whether ethanol-exposed liver is associated with changes of antioxidants levels, we performed reverse-transcriptase polymerase chain reaction (RT-PCR) analysis on ethanol-exposed livers of rats. In RT-PCR analysis, the mRNA levels of GPX1 and SOD1 were significantly increased as well as up-regulation of CYP2E1. In the glutathione assay, the level of glutathione was significantly reduced in response to ethanol in rats. Therefore, in this study, ethanol increased the level of serum GGT but depleted the level of glutathione. Moreover, the CYP2E1 was rapidly reflected to ethanol in rats. Taken together, our findings suggest that the elevated GGT is associated with cellular antioxidant defense system, and the CYP2E1 can be used for early diagnosis in alcohol-related diseases.

Road traffic noise: annoyance, sleep disturbance, and public health implications.

BACKGROUND: The WHO has recognized environmental noise as harmful pollution that causes adverse psychosocial and physiologic effects (i.e., annoyance and sleep disturbance) on human health. In Europe, noise-related health studies have been actively conducted, but the U.S. has lagged behind in this research field. PURPOSE: This research predicted ambient levels of road traffic noise for a highly urbanized area: Fulton County GA. Assessment was made of noise impacts on the population, focusing on annoyance and sleep disturbance. METHODS: All the data sets were collected during 2009-2011, and data analysis was performed in 2010-2011. The study used a sound-propagation model for noise-level prediction and derived noise-impact indicators for annoyance and sleep disturbance from exposure-response models. Then, annoyed and sleep-disturbed populations were predicted with the use of each noise-impact indicator. RESULTS: It was predicted that 109,967 people would be at risk of being highly annoyed, with 19,621 people at risk for high sleep disturbance for Fulton County GA. Noise-impact indicators such as the percentage of those who were highly annoyed and who had high levels of sleep disturbance were expected to be valuable metrics to compare noise equity among urban communities. CONCLUSIONS: Many residents of the greater Atlanta area may be exposed to noise levels that put them at risk of being highly annoyed or having high levels of sleep disturbance. These results, if generalized to other urban areas with high levels of road traffic, indicate that it may be important for the public's health to update existing noise-related policies or develop new ones to control and abate noise concerns in urban communities.

Modeling of road traffic noise and estimated human exposure in Fulton County, Georgia, USA.

Environmental noise is a major source of public complaints. Noise in the community causes physical and socio-economic effects and has been shown to be related to adverse health impacts. Noise, however, has not been actively researched in the United States compared with the European Union countries in recent years. In this research, we aimed at modeling road traffic noise and analyzing human exposure in Fulton County, Georgia, United States. We modeled road traffic noise levels using the United States Department of Transportation Federal Highway Administration Traffic Noise Model implemented in SoundPLAN®. After analyzing noise levels with raster, vector and façade maps, we estimated human exposure to high noise levels. Accurate digital elevation models and building heights were derived from Light Detection And Ranging survey datasets and building footprint boundaries. Traffic datasets were collected from the Georgia Department of Transportation and the Atlanta Regional Commission. Noise level simulation was performed with 62 computers in a distributed computing environment. Finally, the noise-exposed population was calculated using geographic information system techniques. Results show that 48% of the total county population [N=870,166 residents] is potentially exposed to 55 dB(A) or higher noise levels during daytime. About 9% of the population is potentially exposed to 67 dB(A) or higher noises. At nighttime, 32% of the population is expected to be exposed to noise levels higher than 50 dB(A). This research shows that large-scale traffic noise estimation is possible with the help of various organizations. We believe that this research is a significant stepping stone for analyzing community health associated with noise exposures in the United States.

The characteristics of gait disturbance and its relationship with posterior tibial somatosensory evoked potentials in patients with cervical myelopathy.

STUDY DESIGN: Prospective case control study. OBJECTIVE: This study is to investigate the gait characteristics of cervical myelopathy (CM) and to assess the relationship between presence of abnormality of posterior tibial somatosensory evoked potential (PTSEPs) and gait parameters. SUMMARY OF BACKGROUND DATA: Many of CM patients suffer from gait disturbance so that the assessment of walking ability and its restoration are one of main concerns. METHODS: The patients were recruited who had suffered from gait disturbance and were diagnosed as CM by cervical magnetic resonance image (MRI). All subjects underwent three-dimensional gait analysis and PTSEP. Normal persons were recruited as control groups and underwent gait analysis. The CM patients were divided into two groups such as normal and abnormal SEP groups, and two groups were compared as to presence of signal change in MRI and gait parameters. RESULTS: CM groups revealed significantly lower gait velocity, decreased step length and stride length, and increased double support time. They showed significantly decreased maximal knee flexion angle in swing phase, the decreased plantarflexion angle at push off, and the increased maximal dorsiflexion angle at swing phase in comparison with control group. Abnormal SEP group demonstrated the lower gait velocity and cadence, smaller plantarflexion angle at push off and the larger maximal dorsiflexion angle at swing phase in comparison with normal SEP group. There was no significant relationship between presence of SEP abnormality and signal change of MRI. CONCLUSION: CM patients compensated stabilizing balance by decreasing gait velocity and step length as well as increasing step width and double support time. Considering the presence of abnormality of PTSEP was closely related to typical gait characteristics of CM patient, the gait deviation of CM patients was attributed to impaired proprioception of lower limbs and poor stability.

Three-dimensional gait analysis of patients with weakness of ankle dorsiflexor as a result of unilateral L5 radiculopathy.

PURPOSE: L5 radiculopathy leads to weakness in ankle dorsiflexor, which can further affect ambulation status. The purpose of this study was to investigate the characteristics of gait patterns associated with L5 radiculopathy. METHOD: Nineteen patients with ankle dorsiflexor weakness due to L5 radiculopathy and 16 people with normal control underwent three-dimensional gait analysis. The comparison was made with three categories such as involved side, intact side of patients and normal control. The gait cycle was divided into 0% (initial contact), 0-20%, 20-60%, and 60-100% in order to identify the characteristics of involved side in comparison with intact side and normal control. RESULTS: Velocity, stride length, and cadence were reduced and double support time was increased in involved as well as intact sides of patients as compared to normal control. Maximal hip adduction of involved side was larger than intact side during the entire gait cycle. Maximal ankle dorsiflexion of involved side was smaller than intact side at 0-20% and 60-100%. Ankle power generation was decreased in involved side as compared to intact side and normal control. CONCLUSION: The pelvis of intact side was tilted downward due to hip abductor weakness of involved side in the stance phase whereas the pelvis of involved side was tilted upward for foot clearance in the swing phase. This contributed to increase in hip adduction of the involved side through the gait cycle. Eccentric contraction of ankle dorsiflexion that normally occurred in the loading response and the early swing phase was not sufficient and, therefore, ankle dorsiflexion was decreased in these gait cycles.

Expression of mucins and trefoil factor family protein-1 in the colon of pigs naturally infected with Salmonella typhimurium.

The expression patterns of different mucins (MUC1, MUC2, MUC4, MUC5AC, MUC5C and MUC6) and trefoil factor family protein-1 (TFF1) in the colon of healthy pigs and pigs naturally infected with Salmonella typhimurium is reported. Twenty infected pigs approximately 80-160 days of age from 20 different herds were studied. These animals had similar microscopical change in colonic tissue characterized by mucosal erosion or sloughing and acute inflammation. S. typhimurium was cultured from all lesions and the identity of each isolate was confirmed by serotyping. Immunohistochemical studies of colonic tissue revealed reduced expression of MUC4 on the surface of the cryptal epithelium of S. typhimurium-infected pigs compared with non-infected pigs (P<0.001). By contrast, colon from infected animals had increased expression of MUC5AC (P<0.0001) and TFF1 (P=0.0095) relative to controls and there was a significant positive correlation between expression of these two molecules (Spearman coefficient 0.64, P<0.0001). Further studies are needed to evaluate the functional relationship between altered expression of these molecules and inflammation in Salmonella-infected pigs.

Status analysis and strategic framework for sanitation management in Asia and Africa.

Following rapid population increase and industrial development, the ever increasing environmental pollution and the associated sanitation-related problem are no longer regional or local but have become an issue requiring global-dimensional concern and the provision of problem-solving alternatives. Especially, since most problems result from inappropriate sewerage and the lack of sewage treatment system are in a serious state occurring in economically underdeveloped regions, and as such, their significance is enormous. The United Nations Environment Programme (UNEP) has been making efforts to establish the technology selection methodology applicable in developing countries, through the accurate status, investigation and analysis of the wastewater management state in Asian and African regions, and the sanitation management guideline utilisable by political leaders or decision-makers. As part of this effort, the Korea Institute of Water Environment (KIWE), together with the UNEP, selected China and Vietnam (in Asia) and Kenya and Ethiopia (in Africa) as subject countries to investigate and perform on-site sanitation management investigations and analysis in this research. Results obtained from the on-site investigation were analysed, and in order to be helpful in establishing a strategy for sanitation management in underdeveloped countries, the strategic framework (SF) has been made based on characterised results.

Enzymatic hydrolysis of heated whey: iron-binding ability of peptides and antigenic protein fractions.

This study evaluated the influence of various enzymes on the hydrolysis of whey protein concentrate (WPC) to reduce its antigenic fractions and to quantify the peptides having iron-binding ability in its hydrolysates. Heated (for 10 min at 100 degrees C) WPC (2% protein solution) was incubated with 2% each of Alcalase, Flavourzyme, papain, and trypsin for 30, 60, 90, 120, 150, 180, and 240 min at 50 degrees C. The highest hydrolysis of WPC was observed after 240 min of incubation with Alcalase (12.4%), followed by Flavourzyme (12.0%), trypsin (10.4%), and papain (8.53%). The nonprotein nitrogen contents of WPC hydrolysate followed the hydrolytic pattern of whey. The major antigenic fractions (beta-lactoglobulin) in WPC were degraded within 60 min of its incubation with Alcalase, Flavourzyme, or papain. Chromatograms of enzymatic hydrolysates of heated WPC also indicated complete degradation of beta-lactoglobulin, alpha-lactalbumin, and BSA. The highest iron solubility was noticed in hydrolysates derived with Alcalase (95%), followed by those produced with trypsin (90%), papain (87%), and Flavourzyme (81%). Eluted fraction 1 (F-1) and fraction 2 (F-2) were the respective peaks for the 0.25 and 0.5 M NaCl chromatographic step gradient for analysis of hydrolysates. Iron-binding ability was noticeably higher in F-1 than in F-2 of all hydrolysates of WPC. The highest iron contents in F-1 were observed in WPC hydrolysates derived with Alcalase (0.2 mg/kg), followed by hydrolysates derived with Flavourzyme (0.14 mg/kg), trypsin (0.14 mg/kg), and papain (0.08 mg/kg). Iron concentrations in the F-2 fraction of all enzymatic hydrolysates of WPC were low and ranged from 0.03 to 0.05 mg/kg. Fraction 1 may describe a new class of iron chelates based on the reaction of FeSO4 x 7 H2O with a mixture of peptides obtained by the enzymatic hydrolysis of WPC. The chromatogram of Alcalase F-1 indicated numerous small peaks of shorter wavelengths, which probably indicated a variety of new peptides with greater ability to bind with iron. Alcalase F-1 had higher Ala (18.38%), Lys (17.97%), and Phe (16.58%) concentrations, whereas the presence of Pro, Gly, and Tyr was not detected. Alcalase was more effective than other enzymes at producing a hydrolysate for the separation of iron-binding peptides derived from WPC.

Changes in external ear resonance after 3 types of surgery in the patients with chronic otitis media.

OBJECTIVE: This study was designed to identify the external ear resonance characteristics of patients with tympanic membrane perforation and to investigate subsequent changes in external ear resonance, depending on the length of the postoperative period and which of 3 different types of operation was performed: tympanoplasty with canal wall-up mastoidectomy, epitympanoplasty, and canal wall-down mastoidectomy. STUDY DESIGN AND SETTING: A total of 227 ears of 188 patients and 96 control ears comprised the study. We measured the gain and frequency of the first peak of external ear resonance with a real ear analyzer. RESULTS: Gain and frequency of the first peak recorded in the preoperative group did not differ from those of the control group. However, negative peaks appeared around 1 to 1.5 kHz in half of these ears. The gain increased markedly in all 3 postoperative groups. The canal wall-down mastoidectomy and epitympanoplasty groups showed significantly lower frequencies compared with the tympanoplasty with canal wall-up mastoidectomy and control groups, but there was no difference between them. The increased gain diminished over time, but the peak gain did not equalize with that of the controls, even after 15 months. CONCLUSIONS: Additional gain should be considered of around 1 to 1.5 kHz for hearing aid users with tympanic membrane perforation. Postoperative changes in external ear resonance should be expected in patients with chronic otitis media, suggesting that fine readjustments of the hearing aid may be necessary.

Changes in external ear resonance after ventilation tube (Grommet) insertion in children with otitis media with effusion.

OBJECTIVE: As otitis media with effusion is common in children, the effects of a ventilation tube should be taken into account in the prescription of hearing aids for children. In ears with a ventilation tube, the external auditory canal communicates directly with the middle ear space, and so the impedance of the middle ear may change. Consequently, this will affect external-ear resonance. The aim of this study is to observe the effects of the tympanic membrane perforations caused by the ventilation tube on external-ear resonance. We selected 30 ears with otitis media with effusion to measure external-ear resonance before and after ventilation tube insertion. We compared the external-ear resonance of a control group with that of the otitis media with the effusion group and two types of ventilation-tube groups, respectively. In the subjects who have otitis media with effusion, the average gain of the peak resonance was larger than that in the control group. After ventilation-tube insertion, the amplitude of the gain decreased to the same level as the control group, but a characteristic negative gain appeared around 1000 Hz in about half of all cases. This negative gain was observed more frequently in the ventilation tube with a larger diameter. The raised peak resonance gain in the otitis media with effusion group decreased to a level roughly the same as that of the control group after ventilation-tube insertion. Provision of an additional gain in the low frequencies around 1000 Hz should be considered for patients with a ventilation tube when prescribing hearing aids.

Flow cytometric immunophenotypic characterization of pediatric and adult minimally differentiated acute myeloid leukemia (AML-M0).

We reviewed the clinicopathologic and immunophenotypic profiles of 7 pediatric and 11 adult minimally differentiated acute myelogenous leukemias (AML-M0). We also compared and evaluated myeloperoxidase in leukemic blasts using standard cytochemical and polyclonal antibody immunohistochemical stains. No distinctive clinical findings were noted in either patient group; however, thrombocytopenia typically was more prominent in adults. Adult AML-M0 also was associated with an immature myeloid profile (CD34+, terminal deoxynucleotidyl transferase positive, CD13+, and CD33+), in contrast with pediatric AML-M0, which usually lacked terminal deoxynucleotidyl transferase or CD34 but expressed bright CD33 with weak or negative CD13. Coexpression of the T-cell-associated antigen CD7 was observed in both groups. Antibody immunohistochemical stains were more sensitive than cytochemical stains for detection of myeloperoxidase activity and a useful adjunct for establishing a diagnosis of myeloid leukemia in paraffin-embedded marrow tissues.

Sarcomatoid salivary duct carcinoma of the parotid gland.

Salivary duct carcinoma (SDC) is a high-grade neoplasm known to histologically resemble high-grade ductal carcinoma in situ of the breast. We describe 3 cases of sarcomatoid salivary duct carcinoma, a heretofore unreported variant of SDC. Each case was a composite of SDC and sarcomatoid carcinoma and histologically similar to reported cases arising in the breast. The clinicopathologic features, including immunohistochemistry, of 3 cases were investigated. In the 3 men, ages 56, 68, and 70 years, the resected parotid tumors measured 1.5, 3.5, and 1.5 cm, respectively. Only the 3.5-cm tumor extended beyond the parotid gland into soft tissue. This patient died at 3 years with pulmonary metastases. The other patients were free of disease at 6 and 12 months. Histologically, each case was a composite of usual-type SDC and sarcomatoid carcinoma. SDC showed typical cribriform architecture, whereas anaplastic, spindled cells constituted the sarcomatoid areas. Immunohistochemically, epithelial elements stained as follows: cytokeratin (AE1/AE3 & CAM 5.2) positive in 3 of 3 cases, EMA positive in 3 of 3 cases, vimentin negative in 3 of 3 cases, desmin negative in 3 of 3 cases, c-erbB-2 positive in 1 of 2 cases. Sarcomatoid elements stained as follows: AE1/AE3 negative in 3 of 3 cases, CAM 5.2 rare positive cell in 1 of 3 cases, EMA focally positive in 3 of 3 cases, vimentin positive in 3 of 3 cases, desmin negative in 3 of 3 cases, c-erbB-2 negative in 2 of 2 cases. Electron microscopy, performed in one case, showed scattered junctional complexes congruent with epithelial differentiation. Immunohistochemical results, EMA and CAM 5.2 positivity, and ultrastructural findings supported our belief that these unique biphasic tumors represented SDC with sarcomatoid carcinoma. We conclude an element of sarcomatoid carcinoma rarely may arise in association with SDC, and it is erroneous to diagnose such tumors as "carcinosarcoma."

True histiocytic lymphoma of the esophagus in an HIV-positive patient: an ultrastructural study.

A 56-year-old white woman, seropositive for human immunodeficiency virus for 18 months without signs of acquired immunodeficiency syndrome, presented with retrosternal pain and progressive dysphagia secondary to an exophytic esophageal mass. Biopsies of the tumor showed a malignant neoplasm composed of pleomorphic, noncohesive cells growing in a diffuse, sheet-like fashion. Immunohistochemically, tumor cells were nonreactive with epithelial, lymphoid, neural, and monocyte/macrophage markers. Despite the noncontributory immunohistochemical findings, ultrastructural study of the tumor cells revealed convincing histiocytic features. Individual cells possessed long, slender filopodial projections, prominent Golgi apparatus, residual bodies, rare lysosomes, and prelysosomes. Immunoglobulin heavy chain and T-cell receptor gamma gene rearrangement studies detected no evidence of a clonal gene rearrangement. The patient responded poorly to chemotherapy and died 5 months after her initial symptom of dysphagia.