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Background To compare the risks of major osteoporotic, vertebral, and non-vertebral fractures between patients who discontinued anti-osteoporosis medications. Methods We conducted a comparative effectiveness study with a nationwide population-based cohort study design. Patients aged ≥50 years admitted between 2012 and 2015 for incident hip fractures and receiving denosumab or bisphosphonates with sufficient compliance for at least one year were included. Patients were categorized into persistent or non-persistent denosumab or bisphosphonates users based on their subsequent use pattern. The main outcomes were subsequent hospitalizations for a major osteoporotic, vertebral or non-vertebral fracture. Multivariate, time-varying Cox proportional hazards model was used to evaluate the risk of major outcomes. Results Compared with persistent denosumab users, non-persistent denosumab users had a significantly higher risk of major osteoporotic fractures (Hazard ratio (HR) = 1.60; 95% confidence interval (CI), 1.20 to 2.14),vertebral fractures (HR = 2.18; 95% CI, 1.46 to 3.24) and death (HR = 3.57; 95%CI, 2.63-4.84). However, the increased risk of fracture was not found in both persistent and non-persistent bisphosphonates users. Noteworthy, the increased risk of vertebral fractures in non-persistent denosumab users was more pronounced within one-year post discontinuation (HR = 2.90, 95% CI, 1.77 to 4.74) and among patients who discontinued from 2-year denosumab therapy (HR = 3.58; 95% CI, 1.74 to7.40). Discussion Discontinuation of denosumab resulted in an increased risk of major osteoporotic fractures, especially vertebral fractures. The increased risk tends to reveal within one-year post discontinuation and be greater after a longer treatment duration. Notably, only fracture with hospitalization was identified as our research outcome, the real risk of osteoporotic fracture post discontinuation is believed to be higher, especially for vertebral fracture. This article is protected by copyright. All rights reserved.

Cadmium (Cd) is a hazardous environmental pollutant with high toxicity to plants, which has been detected in many wetlands. Clonal integration (resource translocation) between connected ramets of clonal plants can increase their tolerance to stress. We hypothesised that clonal integration facilitates spread of amphibious clonal plants from terrestrial to Cd-contaminated aquatic habitats. The spread of an amphibious grass Paspalum paspaloides was simulated by growing basal older ramets in uncontaminated soil connected (allowing integration) or not connected (preventing integration) to apical younger ramets of the same fragments in Cd-contaminated water. Cd contamination of apical ramets of P. paspaloides markedly decreased growth and photosynthetic capacity of the apical ramets without connection to the basal ramets, but did not decrease these properties with connection. Cd contamination did not affect growth of the basal ramets without connection to the apical ramets, but Cd contamination of 4 and 12 mg·l-1 significantly increased growth with connection. Consequently, clonal integration increased growth of the apical ramets, basal ramets and whole clones when the apical ramets were grown in Cd-contaminated water of 4 and 12 mg·l-1 . Cd was detected in the basal ramets with connection to the apical ramets, suggesting Cd could be translocated due to clonal integration. Clonal integration, most likely through translocation of photosynthates, can support P. paspaloides to spread from terrestrial to Cd-contaminated aquatic habitats. Amphibious clonal plants with a high ability for clonal integration are particularly useful for re-vegetation of degraded aquatic habitats caused by Cd contamination.

Objectives To investigate effects of TiO2 nanotubes of different diameters on J744A.1 macrophage behaviour, secretion and expression of pro-inflammatory cytokines and chemokines. Materials and methods Macrophage-like J744A.1 cells were cultured on three types of Ti surface: mechanically polished titanium plus 30 and 80 nm TiO2 nanotube surfaces, for 4, 24 and 48 h. Macrophage adhesion and proliferation were assessed using CCK-8 assay. Levels of pro-inflammatory cytokines (TNF-α, IL-1β and IL-6) and chemokines (MCP-1 and MIP-1α) secreted into the supernatant were measured using the Cytometric Bead Arrays kit. TNF-α, MCP-1 and MIP-1α gene expression were quantitatively analysed by real-time PCR. Results These show that TiO2 nanotube surfaces, especially of 80 nm TiO2 nanotube, benefited macrophage adhesion and proliferation, and reduced protein secretion and mRNA expression of TNF-α, MCP-1 and MIP-1α. IL-1β and IL-6 were undetectable on all the surfaces at all times. Conclusions TiO2 nanotube surfaces, especially of 80 nm TiO2 nanotube, reduced inflammatory response in vitro, which might be part of a basis for rapid osseointegration in implants with TiO2 nanotube surfaces in animal studies.

Despite the knowledge of many genetic alterations present in breast cancer, the complexity of this disease precludes placing its biology into a simple conceptual framework. Toll-like receptor 4 (TLR4) plays important roles in regulating innate immunity and may affect the development of cancers. Polymorphisms in TLR4 gene have been shown to be associated with impaired immune responses. Here, we investigated the association of TLR4 polymorphisms with breast cancer. Four functional TLR4 polymorphisms (-2242T/C, Asp299Gly, Thr399Ile, and +3725G/C) were genotyped in a total of 665 breast cancer patients and 768 healthy controls. Data were analyzed using the chi-squared test. Results showed that the prevalence of TLR4 +3725GC and CC genotypes were significantly increased in breast cancer cases when compared with controls [odds ratio (OR) = 1.37, 95% confidence interval (CI) = 1.08-1.73, P = 0.008 and OR = 2.34, 95% CI = 1.66-3.35, P

Background and Objectives In China, paid donation is prohibited by law. There is little literature assessing donor motivation in China, and comparison with western countries such as Canada is important in understanding the application of Western literature. We compared motivational factors in donors from the city of Xi’an, China, with Canadian donors matched for age, sex and donation status. Materials and Methods A total of 218 donors in Xi’an completed an interview about motivation as did 218 Canadian donors matched for age, sex and donation status. Frequencies and percentages of responses to questions were tabulated and compared using the Chi-squared test. Results Donors in Xi’an and Canada felt a personal responsibility to donate blood (81·2% vs. 78·0%, P = 0·2057), but Xi’an donors were more likely to consider blood donation a social responsibility (81·7% vs. 45·2%, P

Objective This study examines the short-term and long-term effects of a cognitive training (CT) program in enhancing cognitive function of older people with subjective memory complaints. Methods A single-blind randomized placebo-controlled trial was carried out in a sample of 223 older adults aged 65 years or above with subjective memory complaints in Hong Kong. They were randomly assigned to either receive CT (intervention group, N = 111) or attend health-related educational lectures only (control group, N = 112). Participants' cognitive abilities were assessed by the Chinese version of Mattis Dementia Rating Scale at baseline, immediately after the training, and nine months after the training. Results Significant interaction effect of CT and education was detected on participants' CT gains at both T2 (F(2, 200) = 6.329, p = 0.002, η2 = 0.060) and T3 (F(2, 189) = 3.294, p = 0.039, η2 = 0.034). Conclusions Cognitive training was effective in enhancing the overall cognitive functioning of less educated older adults with subjective memory complaints. The positive effect was durable for at least nine months in two cognitive areas, namely conceptualization and memory. Copyright © 2012 John Wiley & Sons, Ltd.

This article reviews the various aspects of non-immune hydrops fetalis, including the historical background, aetiology, clinical presentation, antenatal diagnosis and perinatal management, as well as presenting some data on cases of non-immune hydrops fetalis treated in the newly established Obstetrics Department of the Chinese University of Hong Kong at the Prince of Wales Hospital.

To date, a number of genes that are expressed in the early stages of infection have been reported, while few genes that are expressed during the course of colonization, after the initiation of plant infection, have been studied. Plant inoculations, real-time polymerase chain reaction (PCR), gene cloning, protein expression and bioinformatics analysis were combined to identify a novel gene, MgNIP04, in the rice blast fungus, Magnaporthe grisea. Bioinformatics analysis showed that the amino acid sequence contained a signal peptide. The wounded inoculation resulted in necrosis specks when the total expressed proteins including MBP-MgNIP04 was inoculated on the wounded rice leaves, which demonstrated the protein directly interacted with rice. The real-time PCR result of infected leaves showed that it is upregulated during late stages of infection of rice. Additionally, the copies of the gene expression absolute quantity of the gene were 7.61x10 2 , 1.06 x 10 3 , 1.31 x 10 3 , 4.13 x 10 3 , and 4.00 x 10 3 , at 24, 48, 72, 96 and 168 h postinoculation (HPI), respectively. The higher copies of MgNIP04 were found at 96 and 168 HPI. The copies of MgNIP04 in mycelia of Y98-63C, Y99-16, 94-64-1b and 95-23-4a were significantly lower than those of infected leaves. Through the above bioinformatics and experimental analysis, our result suggested that the MgNIP04 was novel pathogenicity-related protein in rice blast fungus.

Objectives To explore the relationship between the levels of maternal oxidative stress and glycaemia during pregnancy and to compare the predictive values of 8-epimer of prostaglandin F2alpha (8-isoPGF2α) and mean arterial pressure (MAP) in midpregnancy for the development of hypertensive complications in later pregnancy. Design Prospective observational study as an ancillary study to the Hyperglycaemia and Adverse Pregnancy Outcome (HAPO) study. Setting Obstetric clinics and wards of a university teaching hospital in Hong Kong. Population Selected women with singleton pregnancies attending the antenatal clinic. Methods Pregnant women who met HAPO inclusion criteria were recruited for the study. Glucose tolerance was assessed by a 75-g 2-hour oral glucose tolerance test (OGTT) at 24–32 weeks of gestation. Fasting plasma samples for 8-isoPGF2α estimation and urine samples for 8-isoPGF2α and 2,3-dinor 8-isoPGF2α assays were collected and blood pressures measured during the OGTT visit. Random plasma and urine samples were also obtained at 34–37 weeks. Glucose results were unblinded to the attending obstetrician if limits preset under the HAPO protocol were met. Main outcome measures Maternal plasma 8-isoPGF2α and urinary 8-isoPGF2α and 2,3-dinor 8-isoPGF2α both at the time of OGTT (24–32 weeks) and at 34–37 weeks of gestation. Incidence of pre-eclampsia and gestational hypertension. Results Of the 408 women who attended for OGTT at 24–32 weeks, two met the glucose criteria for unblinding and 25 had missing 8-isoPGF2α values and thus were excluded from analysis. Of the 381 women, 338 (88.7%) attended for random plasma samples at 34–37 weeks. Significant correlations were observed between maternal fasting plasma isoprostane and both fasting (r= 0.20; P < 0.001) and 2-hour (r= 0.39; P < 0.001) plasma glucose levels at the time of OGTT. Gestational hypertension/pre-eclampsia occurred in 17 (4.2%) women, and at the time of OGTT, they had significantly higher fasting plasma 8-isoPGF2α (P < 0.001), urine 8-isoPGF2α (P < 0.005) and urine 2,3-dinor 8-isoPGF2α to creatinine ratios (P < 0.001), as well as higher MAP (P < 0.001) than women who remained normotensive. At 34–37 weeks, only random plasma 8-isoPGF2α was significantly higher (P < 0.001) among the women with gestational hypertension/pre-eclampsia. Conclusions Plasma markers of oxidative stress were positively correlated with plasma glucose at the time of OGTT (24–32 weeks). Women who subsequently developed gestational hypertension/pre-eclampsia had significantly higher plasma and urine markers of oxidative stress at the time of OGTT but only higher plasma markers at 34–37 weeks. Plasma 8-isoPGF2α appears to be a very good predictor of subsequent gestational hypertension/pre-eclampsia when measured at the time of OGTT, but its ability to discriminate deteriorates as pregnancy advances.

We describe clinical and pathological features of a case of paralytic rabies with acute axonal neuropathy that closely resembled axonal Guillain-Barre syndrome. This case emphasizes that there is overlap of both clinical and pathological features in paralytic rabies and axonal Guillain-Barre syndrome. These findings raise the possibility that infectious and autoimmune etiologies can lead to similar morphological changes in the nerves.

New novel fire-resistant and heat-resistant cyclotriphosphazene-containing polyimide resins were prepared in situ by the polymerization of (p-aminophenoxy)(phenoxy)cyclotriphosphazenes with 3,3′,4,4′-benzophenonetetracarboxylic acid or 3,3′,4,4′-diphenylsulfonetetracarboxylic acid and a crosslink agent, 5-norbornene-2,3-dicarboxylic acid and were used as polymer matrix compositing with a woven carbon fiber to prepare nadic-end-capped cyclotriphosphazene-containing polyimide/carbon fiber composites. The thermal stability, flame retardance, morphology of the surface fracture, and some physical properties of the composites were investigated by thermogravimetric analysis, scanning electron microscopy, and a material testing system, respectively. The composites had good thermal stability, flame retardance, and mechanical properties. © 2003 Wiley Periodicals, Inc. J Appl Polym Sci 90: 810–818, 2003

In an arid region of Baja California Sur, Mexico, field observations, combined with chemical and physical analyses, mineral analysis and scanning electron microscopy of unweathered and weathered volcanic rocks, revealed the presence of rock-colonizing plants (most are tree-shaped cacti, possibly rock weathering), growing in volcanic rocks without benefit of soil. Many are at the seedling stage. At least four cactus species (Pachycereus pringlei [S. Wats] Britt. and Ross, Stenocereus thurberi [Engelm.] Buxb. subsp. thurberi, Mamillaria fraileana [Britt. and Rose] Boed., Opuntia cholla F. A. C. Weber), and one tree (wild fig, Ficus palmeri [S. Wats]) were capable of cracking, growing in and colonizing cliffs and rocks formed from ancient lava flows and, consequently, forming soil for succession by other plant species. This study shows that plant colonization of volcanic rocks may assist soil formation, which eventually leads to accumulation of soil, water and nutrients in a desert terrestrial ecosystem that otherwise lacks these essential plant-growth variables.

Objective. To determine the relative importance of thyroid hormones and human chorionic gonadotropin in the etiology of hyperemesis gravidarum. Design. A prospective study comparing the hormonal status in women with hyperemesis gravidarum (5-18 weeks), with healthy pregnant controls, matched for gestational age. Sensitive thyroid stimulating hormone, free thyroxine, free triiodothyronine and total beta human chorionic gonadotropin were measured by immunoassays. The hormone results for hyperemesis gravidarum group ( n =58) were compared with pregnant control women ( n =58) using the Mann Whitney test. Stepwise logistic regression analysis was performed to determine which variables were significantly associated with hyperemesis gravidarum and to estimate the probability of each woman having hyperemesis gravidarum. The strength of the resulting association was tested by generating a receiver operating characteristic curve for predicting hyperemesis gravidarum using these probabilities. Results. Maternal age ...

The application of NADPH-sulfite reductase, produced from Escherichia coli, on mackerel surimi was investigated. The activity of this reductase was very stable. There was about 70%, 80%, and 90% activity left even after 8–wk storage at 25 °C and 12–wk storage at 4 or -30 °C, respectively. Increase in mackerel-surimi gel properties containing reductase was consistent with the amounts of reactive sulfhydryl groups detected. SDS-PAGE indicated that NADPH-sulfite reductase could reconstitute myosin heavy-chain and increase soluble actomyosin. From the data obtained, E. coli NADPH-sulfite reductase effectively improved the gel properties of mackerel surimi.

Objective: To describe factors associated with breastfeeding failure during the first 6 months post-partum in a sample of Hong Kong Chinese women participating in a longitudinal study of maternal nutrition. Methodology: Forty-four Hong Kong Chinese lactating mothers who intended to breastfeed exclusively for at least 3 months were recruited and followed for 6 months post-partum. Demographic data were compared with 20 mothers who intended to use formula feeding. Mothers were followed up at 2 and 6 weeks and 3 and 6 months and details of infant feeding practices were obtained. Information was sought on breastfeeding management in hospital, reasons for discontinuation of breastfeeding or for providing supplements to babies and intention to seek, and sources of, lactation support. Results: Thirty-nine mothers who planned to breastfeed completed the follow up. Compared with mothers in the formula-feeding group, breastfeeding mothers were more likely to be professionals or housewives. Continuation of any breastfeeding (total and partial) was noted in 30 (77%), 22 (57%), 16 (41%) and 12 (31%) mothers at 2 and 6 weeks and 3 and 6 months post-partum, respectively. The majority (97%) of mothers stated that they were given information on the benefits and management of breastfeeding. However, late initiation of breastfeeding and providing supplements to babies were common. Perceptions of insufficient milk supply (44%), breast problems (31%) and being too tired (28%) were the main reasons stated for stopping breastfeeding or for providing supplements to babies. Midwives from the postnatal wards and hotlines were the main sources of lactation support. Conclusions: These results highlight difficulties in sustaining breastfeeding, either exclusive or partial, in Hong Kong Chinese women. Despite being recruited on the basis of intending to exclusively breastfeed for 3 months, less than half these mothers were still breastfeeding and only approximately one-third were exclusively or predominantly breastfeeding at 3 months. More needs to be done within the hospital environment to initiate breastfeeding immediately after birth and to avoid giving unnecessary supplements and more effort is needed to foster a mother’s confidence, commitment and knowledge of breastfeeding.

The interactions between electrons and SiO 2 are of interest to modern materials characterization and processing technologies. In this work, electron-beam-irradiation-induced modification has been investigated in a superficial oxide (SiO 2 /Si) and a buried oxide in Cu/TaN/SiO 2 /Si using atomic force microscopy (AFM) and Auger electron spectroscopy (AES). In the superficial oxide layer, a hole of 15 nm deep and 2.5 μm wide was observed, after the oxide had been irradiated by a 20 keV 50 nA electron beam rastering over 1.5 x 1.5 μm 2 for 30 min. In the buried layer, however, bumps of 40-90 nm high and ∼10 μm wide were generated after irradiation of a 20 keV 150 nA electron beam rastering over 1.5 x 1.5 μm 2 for 5-40 min. Surrounding the hole and the bumps were halo-like features. In the bumps, small holes were visible. The observations have been explained by proposing a model whereby, upon irradiation by electron beams, both the swelling and the loss occur in the SiO 2 layer. The swelling happened as a result of the generation of voids inside the irradiated volume, whereas the loss was attributed to the desorption of O 2 formed by the oxygen atoms originally dwelling at the surface and those diffused to the surface. It is suggested that the TaN barrier layer, which prevented oxygen diffusion from the oxide, played a prominent role in the swelling of the buried SiO 2 . The damage to SiO 2 was demonstrated further with Auger depth profiling analyses, and the corresponding artefact appearing in the analysis was discussed.

Women with a history of gestational diabetes (GDM) are at increased risk of developing diabetes compared with other women. There are few data on associations between GDM and cardiovascular risk factors. Between 1988 and 1995, 801 Chinese women with a history of GDM were recruited for a 75g oral glucose tolerance test (OGTT) and assessment of various cardiovascular risk factors, namely obesity, hypertension and dyslipidaemia, 6 weeks after delivery at the Diabetes Centre of the Prince of Wales Hospital. Another 431 women with no past history of diabetes or GDM recruited in a diabetes prevalence study were used as control subjects. After adjustment for age, body mass index and smoking, the prevalence of glucose intolerance remained higher in women with a history of GDM when compared to normal controls. The relative risks of obesity, hypertension, dyslipidaemia, diabetes and impaired glucose tolerance in women with a history of GDM comparing to normal subjects were, respectively, 2.4, 7.5, 2.4, 8.1 and 5.0. After excluding those with abnormal glucose tolerance, subjects with a history of GDM still had more adverse cardiovascular risk factors, including higher blood pressure, glycaemic and lipid parameters, than control subjects (after adjustment for age, body mass index and smoking). In conclusion, compared with normal subjects, Chinese women with a history of GDM had an 8-fold increased risk of having diabetes based on their OGTTs performed 6 weeks postdelivery. These women also have increased rates of other cardiovascular risk factors including obesity, high blood pressure and dyslipidaemia.

Immunopathological studies suggest that the target of immune attack is different in the subtypes of Guillain-Barre syndrome (GBS). In acute motor axonal neuropathy (AMAN), the attack appears directed against the axolemma and nodes of Ranvier. In acute inflammatory demyelinating polyneuropathy (AIDP), the attack appears directed against a component of the Schwann cell. However, the nature of the antigenic targets is still not clear. We prospectively studied 138 Chinese GBS patients and found that IgG anti-GD1a antibodies were closely associated with AMAN but not AIDP. With a cutoff titer of greater than 1:100, 60% of AMAN versus 4% of AIDP patients had IgG anti-GD1a antibodies; with a cutoff titer of greater than 1:1,000, 24% of AMAN patients and none of the AIDP patients had IgG anti-GD1a antibodies. In contrast, low levels of IgG anti-GM1 antibodies (> 1:100) were detected in both the AMAN and the AIDP forms (57% vs 35%, NS). High titers of IgG anti-GM1 (>1:1,000) were more common in the AMAN form (24% vs 8%, NS). Serological evidence of recent Campylobacter infection was detected in 81% of AMAN and 50% of AIDP patients, and anti-ganglioside antibodies were common in both Campylobacter-infected and noninfected patients. Our results suggest that IgG anti-GD1a antibodies may be involved in the pathogenesis of AMAN.

Bone marrow necrosis is a rare clinical condition often associated with hematological malignancy. The mechanism by which malignant disease causes marrow necrosis is unknown. We present a case of a patient with newly diagnosed pancytopenia with bone marrow biopsy evidence of extensive marrow necrosis. Upon further work-up utilizing Tc bone scan directed bone marrow biopsy, a massive CD8+ T cell marrow infiltrate was discovered engulfing AML-M2 blasts. The role of Tc bone scans in the work-up of bone marrow necrosis as well as the potential mechanism of AML-M2 induced marrow necrosis in the setting of reactive CD8+ T cell infiltration is discussed.

A series of (2-hydroxyethylmethacrylate)(n-propoxy)cyclotriphosphazenes (HPCP) has been prepared by the reaction of N3P3Cl6 with n-propanol and 2-hydroxyethylmethacrylate (HEMA) sequentially in the appropriate solvents. These phosphazene compounds are characterized by a combination of Fourier transform infrared, ultraviolet, and nuclear magnetic resonance spectroscopies. It was found that the compounds were soluble in most of the organic solvents, exhibited an absorption between 207–216 nm, and were curable by UV irradiation. After curing, the surfaces of the HPCP-coated woodblocks were transparent and had a fire-retardant property, which has been ascribed to the intumescent behavior during the burning process. © 1998 John Wiley & Sons, Inc. J Appl Polym Sci 69: 115–122, 1998

Guillain-Barre syndrome (GBS) is the commonest cause of acute flaccid paralysis worldwide. Recent pathological and electrodiagnostic studies indicate that there are different patterns within this syndrome. The demyelinating pattern predominates in North America and Europe, whereas axonal variants of GBS occur more frequently in Northern China. Infection with Campylobacter jejuni is one of the most frequently recognized antecedent events in all variants of GBS. The lipopolysaccharides of these organisms share ganglioside-like epitopes with peripheral nerves, and patients with GBS have antiganglioside antibodies. These observations have given rise to the hypothesis that “molecular mimicry” is the immunopathogenic mechanism of injury to peripheral nerve fibers. With this hypothesis in view, we summarize our experience of GBS as it occurs in Northern China. To explore the role of molecular mimicry in this cohort we sought evidence of preceding Campylobacter infection and correlated this with clinical characteristics and antiganglioside serology. Based on our results we propose a sequence of pathogenic events leading to peripheral nerve injury in GBS.

The localization, mode of action, and roles of complement in the Guillain-Barre syndrome have been controversial. We used high-resolution immunocytochemistry to localize complement activation products in early stages of the acute inflammatory demyelinating polyneuropathy (AIDP) pattern of Guillain-Barre syndrome. Three AIDP subjects who were autopsied had had symptoms for 3 to 9 days at the time of death. Immunocytochemistry was performed on etched, epoxy resin-embedded sections, and the next thin section was compared by electron microscopy (thick/thin sections). Many fibers had a rim of the complement activation marker C3d and the terminal complement complex neoantigen C5b-9 along the outer surface of the Schwann cells. Ultrastructural analysis of these C3d-positive fibers showed mild vesicular changes of the outermost myelin lamellae. Vesicular degeneration was seen before the invasion of macrophages into the myelin, and was the predominant change in the subject with symptoms for 3 days. C3d staining was not found on myelin membranes. The results suggest that at least some forms of AIDP are complement mediated. We speculate that complement is activated by antibody bound to epitopes on the outer surface of the Schwann cell and that the resulting complement activation initiates the vesiculation of myelin.

The concept of a severe motor-sensory neuropathy of acute onset caused by an immune attack on the axon ("axonal" Guillain-Barre syndrome) has been advanced primarily based on electrodiagnostic and limited pathological data, but remains controversial. At autopsy some cases demonstrate unusually severe inflammatory demyelinating neuropathy. There are conflicting data about whether antecedent Campylobacter jejuni infection is associated with "axonal" Guillain-Barre syndrome. We report 4 individuals from Hebei Province, China, who died 7, 7, 18, and 60 days after onset of a syndrome diagnosed clinically as Guillain-Barre syndrome. High titers of antibodies recognizing C. jejuni, consistent with recent infection, were found in the 2 patients tested. At autopsy the 3 with early disease had ongoing wallerian-like degeneration of fibers in the ventral and dorsal roots and in the peripheral nerves, with only minimal demyelination or lymphocytic infiltration. All 3 had numerous macrophages in the periaxonal space of myelinated internodes, and rare intraaxonal macrophages as well. Examination of the patient having the syndrome for 60 days confirmed the extensive loss of large fibers in the spinal roots and nerves, and the paucity of demyelination and remyelination. These observations confirm predictions that some patients with severe motor-sensory Guillain-Barre syndrome, as defined clinically, have predominantly axonal lesions of both motor and sensory fibers, even in the early stages of the disease, and that axonal Guillain-Barre syndrome can follow C. jejuni infection. The pathology supports the possibility that such cases of motor-sensory axonal Guillain-Barre syndrome represent the most severe end of a spectrum of immune attack directed toward epitopes on the axon.

Background. Cancer in pregnancy is rare and hepatocellular carcinoma (HCC) in pregnancy even rarer. The impact of pregnancy on the prognosis of patients with different types of cancer remains controversial. Reported cases of HCC in pregnancy are largely isolated and highly scattered. Thus, the effect of pregnancy on the prognosis of patients with HCC and the risk factors of developing HCC in pregnancy are not well documented. Methods. A series of five patients with HCC in pregnancy seen at two different centers is reported. A Medlar search for articles between 1957 and 1993 with the key words“Hepatocellular Carcinoma” and “Pregnancy” was conducted. All reported cases were combined and analyzed in terms of race, age, parity, hepatitis B surface antigen status, cirrhosis, serum alpha-fetoprotein (AFP) levels at presentation, history of taking oral contraceptive pills and fetal and maternal outcome. The impact of pregnancy on 12 other malignancies as reported in the medical literature also was reviewed. Results. To the authors' knowledge, The five cases reported here constitute the largest series of HCC in pregnancy. A literature search revealed 23 additional cases. Analysis of the 28 cases suggests that the rarity of HCC in pregnancy results from a combination of three factors: the male predominance of HCC, the late age at which the tumor usually presents in women, and decreased fertility in women with advanced cirrhosis (hepatitis is a predisposing factor for HCC development). Long term use of oral contraceptives and high parity enhance the risk. Elevated AFP level is useful for diagnosis. The median survival is shorter than for patients who are not pregnant. There is no significant difference in survival between pregnant and not pregnant women matched by tumor stage, age, and other clinical parameters in most malignancies except in some tumors like lymphoma, thyroid cancer, and nasopharyngeal carcinoma. Conclusion. Pregnancy has an adverse effect on the prognosis of patients with HCC, lymphoma, thyroid cancer, and nasopharyngeal carcinoma but not of most other malignancies. Measurement of AFP level is recommended for screening HCC in pregnant women at high risk. Cancer 1995;75:2669–76.

In northern China, annual epidemics of acute-onset flaccid paralysis diagnosed clinically as Guillain-Barré syndrome have been recognized for at least 20 years. On the basis of an historical analysis of more than 3,200 patients, distinctive features include most cases occurring during the summer months among children and young adults, most of whom reside in rural areas. Of 90 patients with acute flaccid paralysis, 88 had a distinctive pattern that shares clinical and cerebrospinal fluid findings with demyelinating Guillain-Barré syndrome, but that differs from Guillain-Barré syndrome physiologically and pathologically. The clinical course is marked by rapidly progressive ascending tetraparesis, often with respiratory failure, but without fever, systemic illness, or sensory involvement. Cerebrospinal fluid is acellular, and elevations of protein content occur in the second or third week of illness. Electrodiagnostic studies show normal motor distal latencies and limb conduction velocities, but reduced compound muscle action potential amplitudes. Sensory nerve action potentials and, when elicitable, F waves are within the range of normal. Recovery is usually good. Autopsy studies have shown Wallerian-like degeneration of motor fibers. These studies establish that this is a distinctive syndrome, distinguishable from poliomyelitis and demyelinating Guillain-Barré syndrome.

Not all nitrogen (N) inputs have been accounted for in forested ecosystems. We sought to account for N2 fixation and dry deposition using a lysimeter mass—balance approach. Large sand—filled, field lysimeters were used to construct 5—yr nitrogen budgets for two N2—fixing trees, two pines, and a nonvegetated control soil. This approach is a promising and straightforward technique for quantifying otherwise difficult—to—measure fluxes. Accurate assessment of changes in N storage combined with direct measurement of N inputs in precipitation and losses from leaching allowed as to estimate fluxes. Gains of N in pine systems were greatest in vegetation and litter, overshadowing combined losses from mineral soil and leaching by about threefold. Rapid acetylene reduction in pine rhizospheres and in cultures from washed roots suggests that unexplained gains are due to associative N2 fixation. These results provide strong evidence for N2 fixation in pine systems of °50 kg°ha—1°yr—1 N. The symbiotic N2—fixing trees black locust and black alder fixed 2 and 5 times more N2, respectively, than did pines. In all systems, input in precipitation and dry deposition were relatively unimportant to the N budget. Unexplained losses of N from the nonvegetated control suggest that denitrification is an important flux. Mineral soil organic matter declined sharply and significantly in pines (20%) and even more so in the nonvegetated control (40%). Symbiotic N2—fixing trees caused a small, nonsignificant increase in mineral soil organic matter and large, significant increases in litter layer organic matter and large, significant increases in litter layer organic matter. Bulk density (0—20 cm) declined by 5% under symbiotic N2—fixing trees and increased by 5% in one pine sandbox. Correction for soil expansion or collapse did not greatly alter estimates of unexplained N or N2 fixation. Pines with rhizospheres that fix N2 at the rates we observed might be used to restore degraded land and to create silvicultural systems that are N self sufficient. We first need to better understand the microbiology, tree genetics, and soil conditions that lead to rapid N2 fixation in pine ecosystems.

Three patients with extranodal peripheral T-cell lymphoma and a distinctive clinical presentation are described. They had acute onset of fever, weight loss, progressive liver failure, bleeding diathesis, pancytopenia, and myelodysplastic changes in the bone marrow. Each patient had one or more paraneoplastic complications: severe rhabdomyolysis with myoglobinuria and secondary renal failure, cutaneous vasculitis, gluten-sensitive enteropathy, polyserositis, and increased macrophages with hemophagocytic activity. They did not have peripheral lymphadenopathy. The complex clinical presentations simulated collagen vascular disorders, systemic infections, or severe liver disease rather than a malignant lymphoma. Routine histologic studies revealed a small population of lymphoma cells in the bone marrow, spleen, and liver. Immunophenotyping studies demonstrated their T-cell phenotype, and cytogenetic analysis showed the clonality in Patients 1 and 2; clonal T-cell receptor gene rearrangement was found in Patients 2 and 3. These studies should be considered in the evaluation of patients with constitutional symptoms, liver failure, coagulopathy, and pancytopenia even in the absence of peripheral lymphadenopathy.

Summary: We report the cases of 2 pregnant women who developed diabetic ketoacidosis (DKA) in the third trimester as the first presentation of diabetes mellitus; both cases were associated with intrauterine fetal death.

Diagnosis of central nervous system (CNS) non-Hodgkin's lymphomas may be difficult despite the use of sophisticated scans and routine cytologic methods. The use of an immunoalkaline phosphatase technique to examine cerebrospinal fluid (CSF) containing many mononuclear cells is described. Monoclonal proliferations of B-lymphocytes were demonstrated in six patients with neurologic abnormalities, whose clinical findings and subsequent clinical courses were those of lymphoma. The diagnosis of CNS lymphoma could not be made, despite multiple diagnostic procedures, until the immunocytochemical studies were performed. In three other patients, a lymphoproliferative disorder was suspected; however, examination of CSF showed many T-lymphocytes but no monoclonal B-lymphocytes, consistent with a reactive lymphocytosis. The subsequent clinical courses of these patients have shown no evidence of CNS lymphoma. Immunocytochemical studies of CSF lymphocytes are useful in differentiating benign from malignant proliferations.

Mycelial growth of Phellinus weirii (Murr.) Gilb., a root pathogen of conifers in the Pacific Northwest, was studied in defined liquid media with different carbon and nitrogen sources and vitamins. The fungus grew significantly more on glucose, xylose, maltose, or fructose than on other carbon sources. Starch did not support growth. Maximum growth occurred in 4 weeks on all carbon sources except dextrin and sucrose, with which maximum growth occurred in 3 weeks. Of the nitrogen sources, peptone supported the best growth of the fungus; glutamic acid, serine, aspartic acid, alanine, leucine, ammonium sulphate, and urea supported significantly better growth than tyrosine, arginine, methionine, threonine, and glycine. Potassium nitrate, phenylalanine, sodium nitrate, lysine, proline, and cysteine inhibited growth. Thiamine hydrochloride was not absolutely required for growth of P. weirii, but better growth was obtained with its addition. The fungus showed no significant responses to a range of other vitamins. PHELLINUS WEIRII (Murr.) Gilb. [Poria weirii (Murr.) Murr.] is recognized as a widespread and highly destructive pathogen on conifer roots and is responsible for the extensive killing of immature Douglas fir [Pseudotsuga menziesii (Mirb.) Franco] in the Pacific northwestern United States. Although the disease has been studied by several investigators (Buckland, Molnar, and Wallis, 1954; Mounce, Bier, and Nobles, 1940; Childs and Nelson, 1971; Wallis and Reynolds, 1962, 1965) little has been reported on its nutritional requirements. Therefore, we initiated studies on its carbon, nitrogen, and vitamin requirements in chemically defined media; such information is essential for interpreting the complex interactions between P. weirii, its substrate, and antagonists in relation to biological control of the disease. MATERIALS AND METHODS-The experiments were conducted with 250-ml erlenmeyer flasks containing 50 ml of Trione's (1964) synthetic medium, modified by substitution with compounds to be tested. Culture T-124 of P. weirii, used for these studies, had been isolated from an infected Douglas fir near Quilcene, Washington, more than 5 years earlier. It has been maintained as a stock culture on malt agar. For the experiment with carbon sources, the sucrose of the original medium formulation was

Adenocarcinoma of the prostate may occasionally present as distant metastatic disease. This tumor, if accurately identified, is amendable to effective treatment with hormonal manipulations. We have seen nine patients with prostatic cancer presenting as metastatic adenocarcinoma of undetermined origin: two presented with involvement in the lung and the mediastinum, five with left supraclavicular lymphadenopathy and two with known prostatic cancer with stable disease presented with supraclavicular lymphadenopathy. By employing an immunoperoxidase technique using prostatic acid phosphatase as the marker for the prostatic cells, we demonstrated the presence of the prostatic enzyme antigen in the paraffin embedded tissues from the metastatic tumor. This finding directed further investigation of the prostate gland leading to the discovery of the primary tumor in all nine patients. It may be beneficial to use this technique in all male patients with adenocarcinoma of undetermined primary site.