Etiologies of acute undifferentiated fever and clinical prediction of scrub typhus in a non-tropical endemic area.

Scrub typhus usually presents as acute undifferentiated fever. This cross-sectional study included adult patients presenting with acute undifferentiated fever defined as any febrile illness for ≤ 14 days without evidence of localized infection. Scrub typhus cases were defined by an antibody titer of a ≥ fourfold increase in paired sera, a ≥ 1:160 in a single serum using indirect immunofluorescence assay, or a positive result of the immunochromatographic test. Multiple regression analysis identified predictors associated with scrub typhus to develop a prediction rule. Of 250 cases with known etiology of acute undifferentiated fever, influenza (28.0%), hepatitis A (25.2%), and scrub typhus (16.4%) were major causes. A prediction rule for identifying suspected cases of scrub typhus consisted of age ≥ 65 years (two points), recent fieldwork/outdoor activities (one point), onset of illness during an outbreak period (two points), myalgia (one point), and eschar (two points). The c statistic was 0.977 (95% confidence interval = 0.960-0.994). At a cutoff value ≥ 4, the sensitivity and specificity were 92.7% (79.0-98.1%) and 90.9% (86.0-94.3%), respectively. Scrub typhus, the third leading cause of acute undifferentiated fever in our region, can be identified early using the prediction rule.

Extensive intramuscular venous malformation in the lower extremity.

Typical venous malformations are easily diagnosed by skin color changes, focal edema or pain. Venous malformation in the skeletal muscles, however, has the potential to be missed because their involved sites are invisible and the disease is rare. In addition, the symptoms of intramuscular venous malformation overlaps with myofascial pain syndrome or muscle strain. Most venous malformation cases have reported a focal lesion involved in one or adjacent muscles. In contrast, we have experienced a case of intramuscular venous malformation that involved a large number of muscles in a lower extremity extensively.

Extensive Intramuscular Venous Malformation in the Lower Extremity

Typical venous malformations are easily diagnosed by skin color changes, focal edema or pain. Venous malformation in the skeletal muscles, however, has the potential to be missed because their involved sites are invisible and the disease is rare. In addition, the symptoms of intramuscular venous malformation overlaps with myofascial pain syndrome or muscle strain. Most venous malformation cases have reported a focal lesion involved in one or adjacent muscles. In contrast, we have experienced a case of intramuscular venous malformation that involved a large number of muscles in a lower extremity extensively.

Molecular mechanism of bis(maltolato)oxovanadium(IV)-induced insulin signaling in 3T3-L1 and IM9 cells: impact of dexamethasone.

The organovanadium compound bis(maltolato)oxovanadium(IV) (BMOV) enhanced the tyr-phosphorylation of major upstream insulin signaling proteins including the vital site-specific phosphorylation of insulin receptor beta (IRbeta) in IM9 and 3T3-L1 cells in dose- and time-dependent manners more efficiently than insulin. Nevertheless, insulin in general had a synergistic impact on those phosphorylations in both cell lines, while its presence was obligatory to induce Tyr(972)-phosphorylation of IRbeta in IM9 cells at 18-h treatment with BMOV. However, prolonged exposure of cells to BMOV caused depletion in IR level and using IM9 cells we found that this event was counteracted by insulin, where monensin, a monocarboxylic acid ionophore made an additive impact, suggesting that a novel mechanism is being involved in the recycling of internalized IR in BMOV-treated cells. On the other hand, dexamethasone elevated the IR level in both cell lines. However, no correlation was found between the cellular content and the degree of phosphorylation of IRbeta in cells receiving combined treatment of BMOV, and dexamethasone with short insulin post-exposure. BMOV also induced the phosphorylation of Thr(308) and Ser(473) of Akt in both cell lines receiving insulin post-treatment, while dexamethasone decreased those phosphorylations. However, this activation/deactivation of Akt did not correlate with the phosphorylation status of Ser(9) and Ser(259) of glycogen synthase kinase (GSK)-3beta and Raf respectively. Taken together, it is conceivable that BMOV and/or dexamethasone modulate insulin signaling by acting differentially on the components of the insulin signaling network. We also consider that the observed dexamethasone-mediated modulation of insulin receptor kinase in BMOV-treated 3T3-L1 cells probably occurs through the activation/deactivation of some mechanism which needs further studies for proper characterization.

Overexpressed LEF-1 proteins display different nuclear localization patterns of beta-catenin in normal versus tumor cells.

Beta-catenin not only plays a role in cadherin-dependent cell adhesion, but also interacts with T-cell factor (TCF)/lymphoid enhancer factor-1 (LEF-1) to affect gene expression. In this report, we describe the effects of exogenous LEF-1 and of treatment with leptomycin B (LMB), a specific inhibitor of CRM1-medicated nuclear export, on the nuclear localization and export of beta-catenin. Normal epithelial cells overexpressing LEF-1 accumulate nuclear beta-catenin in a LEF-1 concentration-dependent manner. Nuclear beta-catenin, once imported from the cytoplasm, is rapidly removed from the nucleus. Treatment with LMB results in dramatic retention of nuclear beta-catenin in normal epithelial cells transfected with LEF-1, and this effect is intensified by treatment of N-Acetyl-leucyl-leucyl-norleucinal together with LMB. Colon carcinoma cells containing an adenomatous polyposis coli mutation retain significant amounts of LEF-1 induced nuclear beta-catenin considerably after the time-point when beta-catenin disappears from the nuclei of LEF-1 transfected normal epithelial cells. beta-Catenin binds directly to CRM1, and overexpression of CRM1 reduces nuclear beta-catenin-mediated transactivation function.

Analysis of glycated insulin by MALDI-TOF mass spectrometry.

Non-enzymatic glycation of protein is mediated via an interaction between the aldehyde group of a reducing sugar and available alpha- or epsilon-amino moieties of the protein. The above event can alter the biological activity of the protein and therefore, it is of particular interest to monitor the glycation of proteins having important functional roles in metabolism. In the present study, matrix-assisted laser desorption/ionization time of flight mass spectrometry (MALDI-TOF-MS) has been used to determine the non-enzymatic glycation of bovine insulin. The degree of insulin glycation was increased in both concentration- and time-dependent manner in relation to exposure to glucose, and the event was more pronounced for monoglycation reaction than that noticed for the diglycation of the hormone. Enzymatic digestion of insulin preparations with endoproteinase Glu C has revealed that each of the B 1-13 and B 22-30 peptide fragments of glycated insulin contains a site of binding of a single glucose molecule. Finally, attempt has been made in order to increase the sensitivity of the glycation assay through efficient enrichment of the glycated insulin on magnetic beads containing immobilized 3-aminophenylboronic acid (APBA) on their surface.

Identification of MYCBP as a beta-catenin/LEF-1 target using DNA microarray analysis.

Abnormal activation of the beta-catenin signaling pathway can cause various types of cancer. Activation of Wnt pathway leads to stabilization of the beta-catenin protein, which results in its translocation to the nucleus and the formation of complexes with lymphoid enhancer factor-1 (LEF-1) and other T-cell factor (TCF) family of transcription factors to affect the transcription of target genes. However, the entrapment pattern of beta-catenin in the nucleus of normal epithelial cells differs from that in colon carcinoma cells. Normal epithelial cells may have different binding partners of beta-catenin and LEF-1 compared to tumor cells, which may result in differential expression of target genes. To investigate LEF-1-induced gene expression profiles, we used DNA microarrays to search the alterations of gene expression in normal epithelia versus cancer cells. Here, we reported 10 potential targets genes of beta-catenin/LEF-1. We showed that the expression of c-myc binding protein (MYCBP) in colon carcinoma cells was consistently upregulated by overexpressed LEF-1, which is confirmed by microarray data, RT-PCR and luciferase assay. We suggest that the MYCBP gene can be a direct target of beta-catenin/LEF-1 pathway through its LEF-1 binding site(s) in the MYCBP promoter, and that MYCBP up-regulation in colon carcinoma cell may play a co-activator role of c-MYC.

Wnt-7a causes loss of differentiated phenotype and inhibits apoptosis of articular chondrocytes via different mechanisms.

Although regulation of chondrogenesis and cartilage development by Wnt signaling is well established, the function of Wnt in the maintenance and destruction of cartilage remains largely unknown. Here we investigated the involvement and regulatory mechanisms of Wnt signaling in cartilage destruction. We found that interleukin-1beta, the primary pro-inflammatory cytokine involved in cartilage destruction, induces expression of Wnt-5a and -7a in primary culture articular chondrocytes. The level of beta-catenin was also increased in chondrocytes of arthritic cartilage, suggesting the association of Wnt/beta-catenin signaling with arthritic cartilage destruction. In addition, our results show that Wnt-7a induces dedifferentiation and inhibits NO-induced apoptosis of primary culture articular chondrocytes. Wnt-7a induces dedifferentiation of articular chondrocytes by stimulating transcriptional activity of beta-catenin, whereas NO-induced apoptosis is inhibited via the activation of cell survival signaling, such as phosphatidylinositol 3-kinase and Akt, which block apoptotic signaling cascade. Our results collectively suggest that Wnt-7a is associated with cartilage destruction by regulating the maintenance of differentiation status and the apoptosis of articular chondrocytes via different mechanisms.