Alternaria alternata NADP-dependent mannitol dehydrogenase is an important fungal allergen.

BACKGROUND: Alternaria alternata is one of the most important allergenic fungi worldwide. Mannitol dehydrogenase (MtDH) has previously been shown to be a major allergen of Cladosporium herbarum and cross-reactivity has been demonstrated for several fungal allergens. OBJECTIVE: The present study's objective was to clone the MtDH from an A. alternata cDNA library, express and purify the recombinant non-fusion protein and test its IgE-binding properties. Methods A cDNA library prepared from A. alternata hyphae and spores was screened for mannitol dehydrogenase by DNA hybridization with the radioactively labelled C. herbarum homologue as a probe. The resulting clone was sequenced and heterologously expressed in Escherichia coli as a recombinant non-fusion protein, which was purified to homogeneity and analysed for its IgE-binding capacity. RESULTS: The coding sequence of the full-length cDNA clone comprises 798 bp encoding a protein with a molecular mass of 28.6 kDa and a predicted pI of 5.88. Protein sequence analysis revealed an identity of 75% and a homology of 86% between the MtDHs of A. alternata and C. herbarum. The functional mannitol dehydrogenase was expressed in the E. coli strain BL21(DE3) transformed with the vector pMW172 and purified to homogeneity. The enzyme catalyses the NADPH-dependent conversion of d-fructose to d-mannitol. In IgE-ELISA and immunoblots, MtDH is recognized by 41% of A. alternata-allergic patients. In vivo immunoreactivity of the recombinant MtDH was verified by skin prick testing. Finally, inhibition-ELISA experiments confirmed cross-reactivity between the MtDHs of A. alternata and C. herbarum. CONCLUSION: Mannitol dehydrogenase (Alt a 8) represents an important new allergen of the ascomycete A. alternata that might be suitable for improving diagnostic and therapeutic procedures.

Factors Influencing Lesion Detection in SPECT Lung Images.

An earlier localization ROC (LROC) study that found attenuation correction (AC) degraded the detection of solitary pulmonary nodules (SPN) in hybrid SPECT lung images had several potential shortcomings related to the simulation methods. We sought to address these issues with a revised LROC study. Clinical Tc-99m NeoTect scans acquired with a simultaneous transmission-emission protocol defined the normal cases in a single-slice LROC study. Abnormal cases contained a simulated 1-cm lung lesion. Four rescaled-block-iterative EM (RBI) reconstruction strategies applied: 1) AC, scatter correction (SC), and resolution compensation (RC); 2) AC only; 3) RC only; and 4) no corrections (NC). Images from these strategies underwent 3D Gaussian post-smoothing. Performances were defined by the average area under the LROC curve obtained from three human observers. The strategy ranking in order of decreasing performance was: 1) RBI with RC; 2) RBI with all corrections; 3) RBI with AC; and 4) RBI with no corrections. A multireader-multicase (MRMC) analysis only found significant patient and patient-strategy effects. The conflicting results concerning AC from this study and the previous one may revolve around lesion masking effects, which, by design, were not a factor in the current study.

Comparing filtered backprojection and ordered-subsets expectation maximization for small-lesion detection and localization in 67Ga SPECT.

UNLABELLED: Iterative reconstruction of SPECT images has recently become clinically available as an alternative to filtered backprojection (FBP). However, there is conflicting evidence on whether iterative reconstruction, such as with the ordered-subsets expectation maximization (OSEM) algorithm, improves diagnostic performance over FBP. The study objective was to determine if the detection and localization of small lesions in simulated thoracic gallium SPECT images are better with OSEM reconstruction than with FBP, both with and without attenuation correction (AC). METHODS: Images were simulated using an analytic projector acting on the mathematic cardiac torso computer phantom. Perfect scatter rejection was assumed. Lesion detection accuracy was assessed using localization receiver operating characteristic methodology. The images were read by 5 nuclear medicine physicians. For each reconstruction strategy and for each observer, data were collected in 2 viewing sessions of 100 images. Two-way ANOVA and, when indicated, the Scheffé multiple comparisons test were applied to check for significant differences. RESULTS: Little difference in the accuracy of detection or localization was seen between FBP with and without AC. OSEM with AC extended the contrast range for accurate lesion detection and localization over that of the other methods investigated. Without AC, no significant difference between OSEM and FBP reconstruction was detected. CONCLUSION: OSEM with AC may improve the detection and localization of thoracic gallium-labeled lesions over FBP reconstruction.

[Psychological and psychodynamic education of physicians]. / A propos de la formation psychologique et psychodynamique des médecins.

Not every Doctor needs a training in the doctor-patient relationship and in the knowledge of the psychodynamics issues of his patients. But it is a must for the doctors who treat and look after their patients. The people in charge of this training should consider the importance of the unconscious and consequently of the psychoanalytical dimension. The resistances against the psychodynamic approach by the reduction to the common sens, the use of the parallel medicines or the systemic and cognitive approaches. The need and desire of this type of formation in relation to the professional personality of the Doctor.

Spreading properties of dimyristoyl phosphatidylcholine at the air/water interface.

The spreading behavior of bulk lipid crystals and lipid dispersed in water has been investigated for dimyristoyl phosphatidylcholine at the air/water interface. The stable surface pressures reached with dispersed lipid were found to increase with lipid concentration up to a concentration of approximately 1.2 mg ml-1 where the spreading pressure approached 45 mN m-1, the value for excess lipid crystals placed on the surface (at 30.5 degrees C). These low surface pressures obtained with dispersions are attributed to the existence of 'pre-equilibria': surface pressures that appear steady because of the extremely slow approach to final equilibrium. Attainment of this pre-equilibrium condition usually takes about 20 h, whereas bulk crystals held at the surface generated a high and steady surface pressure within about 1 h. Hydration of the bulk lipid slows down the spreading rate, but does not affect the final surface pressure.

Dietary supplementation with omega-3 fatty acids prolongs platelet survival in hyperlipidemic patients with atherosclerosis.

Enhanced dietary omega-3 fatty acid consumption is thought to be associated with a reduced incidence of atherothrombotic disorders. This effect may be mediated in part through suppression of in vivo platelet activity by omega-3 fatty acids. We observed that platelet survival, a sensitive indicator of in vivo platelet activity was prolonged from 6.4 +/- 1.5 days to 7.7 +/- 1.4 days by moderate amounts of dietary omega-3 fatty acid supplementation for 6 weeks in a group of hyperlipidemic patients with preexisting, established atherothrombotic disorders. This effect on platelet survival was associated with a decrease in platelet arachidonic acid levels from 26.7 +/- 3.5% to 20.9% +/- 2.5% and a rise in platelet eicosapentaenoic and docosahexaenoic acid measurements from essentially undetectable to 2.8% +/- 1.6% and 1.9% +/- 1.0%. Plasma total cholesterol, low-density lipoprotein cholesterol, and serum apolipoprotein B levels rose significantly during the omega-3 fatty acid supplementation period. Platelet aggregation did not change. This study demonstrates that a modest amount of dietary omega-3 fatty acid supplementation can significantly effect in vivo platelet activity in a population at high risk for recurrent atherothrombotic disorders.

Bromazepam ('Lexotanil') compared with placebo: a double-blind, crossover study.

A double-blind, crossover study was carried out in 126 out-patients, most of them neurotics, to compare the efficacy and tolerance of bromazepam and placebo. Patients received either 6 mg bromazepam or placebo daily for 3 weeks and were then crossed over to the alternative treatment for a further 3 weeks. Treatment sequence was randomized. Clinical ratings of the severity of individual symptoms and the Hamilton Anxiety Rating Scale were used to measure response to treatment at the end of each period. During the first period, both bromazepam and placebo produced improvement and there was no statistically significant difference between the two groups. During the second period after crossover, however, significantly better results were achieved in patients on bromazepam than those on placebo. The incidence of side-effects, mainly drowsiness, was similar with bromazepam and placebo.

Acalculous cholecystitis: a case with variable cholescintigram.

A 62-yr-old man with acalculous cholecystitis is presented. At different stages of his disease his cholescintigram was abnormal and then normal. The case demonstrates the variations of the cholescintigram that may occur during the disease and illustrates the difficulties that may be encountered in making the diagnosis.

[Authority and psychotherapy]. / Réflexion sur autorité et psychothérapie.

After having described the differences between "authority" and "power", nowadays somewhat outdated, we show that in medicine the "authority" belongs to the physician and that the doctor's "power", always surrounded by a halo of magic, is desired by the patient. This situation is the same in psychotherapy during which the psychotherapist defines authoritatively, that is as the "author", the treatments setting whereas the patient desires on almighty therapist. The authority co-exists with power and the treatment consists in increasing the authority and even the patients power and reducing the therapists power. A few remarks on Freud's authority and on the power desired by the leaders of some psychotherapeutic schools introduce more subtle considerations on the dialectic power - authority during psychoanalytically inspired psychotherapies and group psychotherapies.

[Suicide in patients of an ambulatory psychiatric service (study of 34 suicides from 1973 to 1980 at the University Psychiatric Polyclinic in Lausanne)]. / Le suicide chez les patients d'un service psychiatrique ambulatoire (Etude de 34 suicidés de 1973 à 1980 à la Policlinique psychiatrique de Lausanne).

The study of 34 suicides who were in treatment in an ambulatory psychiatric service reveals a predominance of psychotics. Critical description of the treatment, the psychological factors leading up to the suicide (importance of professional conflicts) and the attitude of the physicians. Relationship between the depressive state and the presuicide syndrome. Remarks on foreseeing suicide and on the psychological repercussions on the psychiatrist.