Two-year outcomes of radiofrequency device treatment of the nasal valve for nasal airway obstruction.

BACKGROUND: Temperature-controlled radiofrequency (TCRF) device treatment of nasal valve dysfunction (NVD) was superior to a sham procedure control in reducing the symptoms of nasal airway obstruction (NAO) in this randomised controlled trial (RCT). METHODOLOGY: Two-year outcomes for 108 patients actively treated in a prospective, multicenter, patient-blinded RCT were used to determine treatment effect durability and changes in medication/nasal dilator usage. A responder was defined as ≥ 20 reduction in NOSE score or 1 reduction in severity class. RESULTS: The mean (SD) age of patients was 48.5 (12.3) years; 66 (61.1%) women. Baseline NOSE score was 76.3. The 2-year responder rate was 90.4% and NOSE score treatment effect was -41.7; 54.7% improvement. Of 57 patients using medications/nasal dilators at baseline, 45 (78.9%) either stopped all use (33.3%) or stopped/decreased (45.6%) use in >=1 class at 2 years. Concurrent septal deviation, septal swell body, or turbinate enlargement did not significantly affect the odds of exhibiting a NOSE score of ≤ 25 at 2 years. CONCLUSIONS: TCRF device treatment of NVD resulted in significant and sustained improvements in the symptoms of NAO at 2 years, accompanied by a substantial reduction in medication/nasal dilator use.

Resolution of acute onset hemichorea-hemiballismus after treatment with intravenous tissue plasminogen activator.

Hyperkinetic movement disorders are uncommon after acute ischemic stroke. Since these movement disorders are rarely the initial manifestation of acute cerebral ischemia, their presence may result in diagnostic uncertainty or it may inappropriately delay intravenous thrombolytic therapy for ischemic stroke. Hemichorea-hemiballism (HC-HB) is one of the more frequently encountered hyperkinetic movement disorders occurring in conjunction with stroke. Although HC-HB may result from a stroke mimic, the acute onset should prompt rapid evaluation and consideration for the presence of stroke along with its time-dependent therapies including recombinant tissue plasminogen activator (rtPA). In this article, we describe a case of a patient with acute cerebral ischemia presenting clinically with HC-HB, who was given intravenous rtPA therapy despite an initially negative, early diffusion-weighted magnetic resonance imaging (MRI). Follow-up brain MRI performed 24 hours after the initiation of thrombolytic therapy confirmed acute infarction in the contralateral striatum. The patient had near-complete resolution of her HC-HB on discharge and had no complications related to the administration of intravenous rtPA.

Comparison of poultry processing equipment surfaces for susceptibility to bacterial attachment and biofilm formation.

During processing of poultry meat products, broiler carcasses come in contact with many solid surfaces. Bacteria from the carcasses can attach to wet equipment surfaces, form biofilms, and provide a source of cross-contamination for subsequent carcasses. In this study an array of common equipment surface materials was compared for susceptibility to bacterial attachment and biofilms. To model mixed microbial populations relevant to poultry processing, samples were taken directly from the processing line and exposed to the surface materials. Whole carcasses were rinsed with phosphate-buffered saline (100 mL), and the rinse was diluted in nutrient broth. Absorbance values (412 nm) of the suspensions at varying dilutions containing test surfaces were compared hourly with controls without test surfaces. The kinetics of bacterial attachment and biofilm formation on test surfaces were determined under the influence of pH, time, and bacterial cell density, and the elemental composition of the surface materials was determined by energy-dispersive X-ray analysis. Our results showed that surfaces vary in affinity for bacterial attachment and biofilm formation. Analysis by spectrophotometry and scanning electron microscopy confirmed that attachment to stainless steel, polyethylene, and belting was not significantly different from controls. Attachment to picker-finger rubber was significantly less than attachment to stainless steel and the other surfaces. In fact, picker-finger rubber inhibits bacterial contamination. An increased understanding of bacterial attachment and biofilm formation will assist in the development of interventions to counteract these processes and, thereby, enhance plant sanitation and pathogen control.

A novel relationship between O-antigen variation, matrix formation, and invasiveness of Salmonella enteritidis.

Salmonella enterica Enteritidis in chickens serves as a reservoir for salmonellosis in humans and the structure of its lipopolysaccharide (LPS) has been used to assess invasiveness. Culture from chick spleens generated colonies with an unusual wrinkled morphology, and it is designated the lacy phenotype. The characterize the nature of the morphological change, three isogenic variants were compared. Only the lacy phenotype produced a temperature-dependent cell surface matrix composed of several proteins in association with LPS high molecular weight O-antigen. Flagellin and a 35 kDa protein were identified as specific proteinaceous components of matrix. Both proteins cross-reacted with a monoclonal antibody previously determined to specifically detect the g-epitope of the Enteritidis monophasic flagella (H-antigen). These results suggest that O-antigen in association with protein contributes to cross-reactivity between molecules. The lacy phenotype was more organ invasive in 5-day-old chicks than isogenic variants producing low molecular weight O-antigen. However, it was no more efficient at contaminating eggs after oral inoculation of hens than a variant that completely lacked O-antigen, thus the lacy phenotype is classified as an intermediately invasive organism. The distinctive colonial phenotype of SE6-E21lacy was used to investigate environmental factors that decreased O/C ratios and contributed to attenuation. In so doing, it was found that growth in complement at 46 degrees C caused matrix producing cells to hyperflagellate and migrate across agar surfaces. These results suggest that the structure of O-antigen might influence the secretion and/or the function of Enteritidis cell-surface proteins. The data also reveal a greater heterogeneity than has been assumed in the phenotype, and possibly the infectious behaviour, of Enteritidis.

Detection of candidates for cancer cell motility inhibitory protein in the Dunning adenocarcinoma model.

The more differentiated components of a primary tumor may produce substances that reduce the growth rate and metastatic potential of more aggressive components. In the Dunning R-3327 prostatic adenocarcinoma model, cancer cell motility is required for metastatic potential. Medium conditioned by the non-motile, non-metastatic G subline contains proteins of molecular weight 50-100 kDa that inhibited the motility of the highly motile, highly metastatic MAT-LyLu subline. G subline-conditioned medium was separated by DEAE-cellulose chromatography using a linear gradient of 0-0.5 M NaCl in 100 mM Tris at pH 8.3. The motility inhibitory activity of G-conditioned medium was localized to column fractions 51-70 that contained 18% of the applied protein and only 6.5% of the proteins secreted by the G cells. Analysis of pooled fractions 51-60 and 61-70 by two-dimensional gel electrophoresis identified five protein families, with a total of 12 charged proteins of molecular weights approximating 66, 54, 50, 41 and 34 kDa, that were not present or present in reduced quantities in column fractions that did not inhibit motility. Isolation and identification of motility inhibitory protein may prove it the first substance discovered that is produced by a more differentiated component of a neoplasm that directly inhibits a metastasis-associated property.

Carbon monoxide poisoning among recreational boaters.

OBJECTIVE: To describe the case characteristics of a series of patients poisoned with carbon monoxide (CO) while boating for recreation. DESIGN: Cases of patients referred for treatment of CO poisoning with hyperbaric oxygen were reviewed. Those cases that occurred during recreational boating were selected for analysis. SETTING: A private, urban, tertiary care center studied from July 1984 to June 1994. PATIENTS: Thirty-nine patients ranging in age from 6 months to 69 years who were poisoned in 27 separate incidents. MAIN OUTCOME MEASURES: Characteristics of the poisoning incidents were assessed at initial patient presentation, immediately following treatment, and with follow-up telephone interviews. RESULTS: Of 512 patients treated for acute unintentional CO poisoning, 39 cases (8%) occurred in 27 incidents related to recreational boating activities. Individuals typically lost consciousness as a result of the poisoning. Most cases occurred aboard a boat that was older than 10 years, had an enclosable cabin, was longer than 22 feet, was powered by a gasoline engine, and was without a CO detector on board. CONCLUSIONS: Carbon monoxide poisoning is a serious hazard associated with recreational boating. The installation of CO detectors aboard boat types typically associated with this syndrome should be strongly encouraged.

Na(+)-dependent and -independent Cl-/HCO3- exchangers in cultured rabbit esophageal epithelial cells.

BACKGROUND: The mechanisms by which esophageal epithelial cells regulate intracellular pH (pHi) in a physiological solution are unknown. METHODS: Basal-type esophageal cells growing in primary culture were loaded with the fluorescent dye 2',7'-bis(carboxyethyl)-5(6)-carboxyfluorescein (BCECF) to study pHi by microfluorimetry. RESULTS: The pHi in HEPES buffer was 7.7 +/- 0.03, a value higher than that in CO2/HCO3- buffer, 7.2 +/- 0.1. Cells in HEPES switched to CO2/HCO3- buffer rapidly acidified to pHi of 7, then alkalinized to a new steady-state pHi. The mechanisms for alkalinization in CO2/HCO3- were dependent on two exchangers, one amiloride-sensitive and the other 4,4'-diisothiocyanatostilbene-2,2'-disulfonic acid (DIDS)-sensitive, the latter dependent on Nao and Cli, and so indicative of an Na(+)-dependent Cl-/HCO3- exchanger. Cells in a CO2/HCO3- buffer rapidly alkalinized to pH 8.2 when switched to HEPES, then acidified to a new steady-state pHi. Acidification in HEPES was largely caused by a DIDS-sensitive, Clo-dependent, non-Nao-requiring mechanism, indicative of a cell-acidifying Na-independent Cl-/HCO3- exchanger. CONCLUSIONS: In a physiological buffer, esophageal cells have at least three exchangers for regulation of pHi.

Malate content of picoliter samples of Raphanus sativus cytoplasm.

Malate, which plays many essential roles in plant metabolism, is a potent in vitro inhibitor of the cytosolic enzyme phosphoenolpyruvate carboxylase (PEPC). Because PEPC activity leads to malate biosynthesis, malate is assumed to attenuate its own synthesis in situ. To test this hypothesis, we measured directly the malate content of picoliter samples of Raphanus root-hair cytoplasm using quantitative histochemical techniques. We also obtained an estimate for malate accumulation in these cells. These values were compared with the PEPC activity of individual root hairs (less than 2 ng). The results indicate that high cytoplasmic malate concentration does not severely inhibit PEPC in situ. We suggest that the focus for studies on the regulation of organic anion accumulation be on the interactive effects of malate and other PEPC effectors.

Free-standing cancer centers: rationale for improving cancer care delivery.

Free-standing cancer centers (FSCC) represent a growing trend in cancer care delivery within community practice. The critical components to FSCC are multidisciplinary cancer care, a complete menu of direct care and support services, a commitment to clinical trials and clinical investigation, and a comprehensive program for quality assurance. The advantages of FSCC to the community, to hospital programs, to the practicing surgical, medical, and radiation oncologists, and to the third-party carriers, including health maintenance organizations, are detailed. The development of an FSCC depends on the resolution of issues of (a) competition (between hospitals, hospitals and physicians, therapeutic disciplines, regional comprehensive cancer centers and FSCCs) and (b) concerns about conflict of interest. The ideal model of FSCC may well be represented by the joint venture of community hospital(s) and the community oncologists.

Monoclonal antibody against chicken type IX collagen: preparation, characterization, and recognition of the intact form of type IX collagen secreted by chondrocytes.

A series of monoclonal antibodies was prepared against the pepsin-resistant fragment of type IX collagen designated HMW. One of these antibodies (called 2C2) was selected for further analysis. Antibody 2C2 showed no cross-reactivity with other collagen types by inhibition enzyme-linked immunosorbent assays. It recognized an epitope present in native HMW, but failed to recognize any of the three chains of HMW fractionated after denaturation followed by reduction and alkylation of interchain disulfide bridges. Electron microscopic observations after rotary shadowing showed that the location of the epitope for antibody 2C2 was close to the carboxy-terminus of HMW. Immunofluorescent staining of sections of embryonic and adult cartilage with antibody 2C2 after removal of proteoglycans by testicular hyaluronidase digestion showed that type IX collagen is distributed throughout the cartilage matrix, and is not present in other connective tissues or skeletal muscle. The intact type IX collagen molecule, which was secreted by a suspension culture of freshly isolated embryonic chick chondrocytes, was recognized by rotary shadowing in the presence of antibody 2C2 after first precipitating the procollagens from the culture medium with ammonium sulfate (30%). Two different collagenous molecules were present in the precipitate: a longer molecule of type II procollagen (average length, 335 nm) with both amino- and carboxy-propeptides still remaining uncleaved, and a shorter molecule (average length, 190 nm) which was identified as type IX collagen. Antibody 2C2 consistently bound to the shorter molecules at a site located 136 nm from a distinctive knob at one end of the molecule, and did not bind to any specific site on the type II procollagen molecules. The structure of the intact type IX collagen molecule with the location of both collagenous and noncollagenous domains was as predicted after converting the nucleotide sequence of a cDNA clone encoding for one of the chains of type IX collagen to an amino acid sequence (Ninomiya, Y., and B. R. Olsen, 1984, Proc. Natl. Acad. Sci. USA, 81:3014-3018).

Soft tissue fibrosarcoma. A case report and review of the literature.

The soft tissue fibrosarcoma usually presents as an enlarging, painless mass. Pain is usually a result of pressure on surrounding structures. Fibrosarcomas arise from connective tissue and demonstrate no calcification on x-ray studies. These expansile tumors are firm, round or lobulated, and well encapsulated. Their level of malignancy is graded on the basis of various degrees of differentiation of the anaplastic spindle-cells of which they are composed. Treatment generally consists of wide excision or radical local resection. Five-year survival estimates vary from 60 to 90 percent. The lung is the usual site of metastasis. A case of subungual fibrosarcoma of the great toe is presented.

Adherence and colonization of Mycoplasma pulmonis to genital epithelium and spermatozoa in rats.

Mycoplasma pulmonis is the etiological agent of a naturally occurring genital disease in rats. Transmission and scanning electron microscopic evaluations of the genital tracts of naturally and experimentally infected female rats show M. pulmonis in close association with both squamous and nonsquamous epithelial cells, although more frequently with the latter. In contrast to other species of mycoplasmas, M. pulmonis adhesion to epithelial cells appears to be mediated by a generalized interaction of the mycoplasma membrane with the host cell membrane, rather than by a specialized attachment tip. Extensive studies of all levels of the male genital tract have not yet been performed, but M. pulmonis can be demonstrated in the urethra and epididymis in animals showing evidence of chronic inflammation. Adherence of M. pulmonis to rat spermatozoa in vitro is associated with a decrease in motility. Addition of anti-M. pulmonis antibody following organism attachment results in marked agglutination of the spermatozoa. Further study of mechanisms involved in M. pulmonis adherence and subsequent mycoplasma host cell interactions is expected to contribute to an understanding of mechanisms involved in reproductive failure.