Uterine Prolapse.

This JAMA Insights in the Women's Health series discusses diagnosis of uterine prolapse and available surgical and nonsurgical treatment options.

Ballroom dancing and cervical radiculopathy: a case report.

Dance injuries associated with cervical radiculopathy have not been described in the literature. This report describes the case of an international-style ballroom dancer who developed a cervical radiculopathy as a result of frequent lateral rotation and hyperextension of the cervical spine during dancing. The patient's symptoms and signs suggestive of a left C7 radiculopathy were confirmed and documented by both magnetic resonance imaging and electrodiagnostic testing. The patient was treated conservatively with activity modification, nonsteroidal anti-inflammatory drugs, and alternative medicine approaches, including herbs and acupuncture. Her neck pain and cervical radicular symptoms declined in severity, but continued even 4 1/2 months after the onset of her symptoms. She did not wish to try steroids either through an oral or epidural route and refused surgical intervention. This case report illustrates an unconventional manner in which a left cervical radiculopathy was clinically produced. The neck motions and positions of frequent hyperextension and lateral rotation demonstrated by this ballroom dancer simulated a pattern and sequence of movements that promoted the development of signs and symptoms of a left cervical radiculopathy.

Expression and hypomethylation of alpha-fetoprotein gene in unicentric and multicentric human hepatocellular carcinomas.

The messenger RNA and DNA methylation of the alpha-fetoprotein gene were studied in 101 resected primary hepatocellular carcinomas, of which 93 were unicentric and 8 were multicentric. Fifty-five were 5 cm or less in diameter (small) and 46 were more than 5 cm in diameter (large). In 48.5% of the cases, we detected alpha-fetoprotein messenger RNA in hepatocellular carcinomas, more frequently in large (60.9%) than in small (38.2%; p < 0.00001) but not in any of the nontumorous livers. The alpha-fetoprotein messenger RNA was detected in 83%, 70% and 6.8% of patients with serum alpha-fetoprotein levels of 320 ng/ml or more, 100 to 319 ng/ml and less than 100 ng/ml, respectively. This finding suggests that alpha-fetoprotein gene expression in hepatocellular carcinoma contributes to the serum alpha-fetoprotein elevation in patients with hepatocellular carcinoma. alpha-Fetoprotein messenger RNA appeared as a major band of 2.4 kb, with two minor species of about 6.5 and 3.6 kb in the hepatocellular carcinoma and the fetal liver. Hypomethylation of the 5' end of the alpha-fetoprotein gene was detected in 78.3% of hepatocellular carcinomas expressing alpha-fetoprotein messenger RNA but infrequently (16.7%) in hepatocellular carcinomas with no detectable alpha-fetoprotein messenger RNA (p < 0.0003). This finding suggests that hypomethylation at the 5' region of the gene is associated with alpha-fetoprotein gene reexpression in hepatocellular carcinoma. The alpha-fetoprotein gene expression helped to differentiate unicentric from multicentric hepatocellular carcinomas and to identify other hidden alpha-fetoprotein-secreting hepatocellular carcinomas.(ABSTRACT TRUNCATED AT 250 WORDS)

Cathepsin B and D, and Ca2+-dependent neutral protease activities in the retina of taurine-depleted rats.

Rats were treated with guanidinoethanesulfonic acid (GES), a taurine transport inhibitor, which reduces the tissue content of taurine. The quantity of taurine in the rat retinas after GES treatment was reduced by 46% after the first week, 60% after the second week, and 67% after the third week. Activities of cathepsin B and D were not significantly altered when calculated on the basis of either protein or DNA content in the taurine-depleted retinas. However, cytosolic Ca2+-dependent neutral protease activity in retinas from GES-treated rats increased by 55% after the third week.

Identification of low-Ca2+- and high-Ca2+-requiring neutral proteases in rat retina.

Two low-Ca2+-requiring proteases (calpain I) and one high-Ca2+-requiring protease (calpain II) have been separated from the cytosol of rat retina by DEAE-cellulose column chromatography. Calpain I was half-maximally activated at 3 microM free Ca2+ and fully activated at 10 microM free Ca2+. Half-maximal activation of calpain II was at 0.4 mM free Ca2+ while full activation was observed at 0.8 mM free Ca2+. Calpain activity has also been demonstrated in sealed rod outer segments. The soluble fraction of the rod outer segments contained 89% of the enzyme activity. The possible role of calpain in retina is discussed.

Identification and partial purification of a nucleotide-stimulated protease in rat retina.

A nucleotide-stimulated protease of rat retina was partially purified by DEAE-cellulose column chromatography. A 50-fold increase of an ATP-stimulated protease activity over a cytosol fraction was achieved by this chromatography. Maximum stimulation of protease activity by ATP was achieved at 2 mM. The pH optimum of the ATP-stimulated protease activity was between 7.5 and 8.5. 2 mM GTP stimulated the protease activity by 91%. 5 mM cyclic AMP stimulated the protease activity by 73% while 5 mM cyclic GMP stimulated the activity by 84%. The possible role of the nucleotide-stimulated protease in retina and potential involvement of the protease with inherited retinal dystrophy are discussed.

Intracellular distribution and properties of cathepsin B in the rat retina and its inhibition by a cytosolic fraction.

The intracellular distribution and properties of cathepsin B in the rat retina are similar to those of cathepsin B in other mammalian tissues. The specific activity of cathepsin B was highest in the mitochondrial-lysosomal fraction [1650 +/- 450 pmole mg-1 protein hr-1 (mean +/- S.D.)]. Inhibition of cathepsin B activity by a cytosol fraction of retina is also described.

Decrease of lactoferrin concentration in the tears of myotonic muscular dystrophy patients.

Tears from myotonic muscular dystrophy (MMD) patients and normal controls were analyzed for their tear proteins by sodium dodecyl sulfate-polyacrylamide gel electrophoresis. Lactoferrin comprised about 18% of the total tear protein in MMD patients as opposed to about 27% in normals. The albumin content relative to total protein in MMD tears was about 25% while the same value for normals is 13%. The lactoferrin/albumin ratio, was about 0.8 for MMD patients and about 2.1 for normals.

Changes in lysosomal enzyme activities of eye tissues in endotoxin-induced inflammation.

Lysosomal enzyme activities in rabbit ocular tissues were examined at various times after the intravitreal injection of endotoxin. Lysosomal enzyme activities in the aqueous, vitreous, and pigment epithelium-choroid were elevated 3 h after injection. It is deduced from the fluorescein-labeled dextran and SDS-polyacrylamide gel electrophoresis analysis of the aqueous, vitreous, and pigment epithelium-choroid from endotoxin injected rabbits that the elevation of lysosomal enzyme activities are probably due to a breakdown in blood-ocular barriers.

Protease activities in human tears.

Several protease activities were measured in human tears by six specific substrates. The specific activity of cathepsin B-like enzyme was 7-fold higher in Orientals than in Caucasians. The trypsin-like and cathepsin C-like enzyme activities also showed 3 to 4-fold higher in Orientals than in Caucasians. However, the deviation in the activities of these two enzymes was high in both Orientals and Caucasians. Similar results were obtained when comparing the protease activities of tear collected by glass capillary and a filter-paper strip method. Since a surface-active small molecular weight fraction can be produced by incubation of freshly collected tears for 4 hours at 37 degrees C, the low molecular weight surfactant may be a proteolytic product.

Surface membrane enzyme, chemotactic peptide binding activities, and chemotactic responsiveness of rabbit peripheral and peritoneal neutrophils.

The chymotrypsin-like esterase activity of plasma membrane and the ecto-5'nucleotidase and ecto-p-nitrophenyl phosphatase activities in peritoneal neutrophils are 2- and 3-fold higher than peripheral blood neutrophils. The binding of the chemotactic peptide, formyl norleucyl-leucyl-phenyl-alanine to peritoneal neutrophils is 6- to 7-fold higher than to peripheral blood neutrophils. The chemotactic responsiveness of peritoneal neutrophils to the chemotactic peptide is 5-fold greater than peripheral blood neutrophils. However, there was no significant difference in the chemotactic responsiveness to complement component C5a between the blood and peritoneal cells.

The application of the approximation method of equivalent square for magavoltage photon beams.

In treatment planning of radiation fields, it is essential to know the dose received at various tissue levels in the irradiated volume. For a certain radiation quality and source to skin distance, radiation dose at maximum build-up or at a depth in tissue is a function of the size and shape of the radiation field. It has been established that the quilibrium dose as the depth dose along the central axis of the beam for a rectangular field can be determined by applying the equivalent square technique. The approximation method of area/perimeter of different portal sizes used in practice for finding the equivalent squares of a rectangular field has been tested on a 35 MV Clinac Linear Accelerator for the purpose of treatment planning. Data were taken for 8 and 25 MV x-rays at depths of maximum build-up regions and at 10 cm depth below the surface of an adequate water phantom. Maximum variation of dose calculation from the above method is less than 1.6% for routine clinical usage, while less than 3.2% for extreme rectangular field sizes. Dose variation is improved as the depth in phantom is increased.

Red cell membrane protein phosphorylation in hemolytic anemias and muscular dystrophies.

We review our current understanding of membrane phosphorylation in normal and abnormal erythrocytes. The major phosphoproteins in red blood cell (RBC) membranes are spectrin (band 2), bands 3, 2.1, and 4.5, and glycophorin A. At least two protein kinases can be distinguished on the basis of their stimulation by cyclic AMP and salt; they are present both in the membrane and in the cytosol. Analysis of the conflicting data on endogenous membrane-protein phosphorylation in abnormal RBCs indicates a considerable variability of phosphorylation rates which largely depends on the manner of preparation of ghosts and enzyme assay conditions. This variability reflects differences in the partitioning of protein kinases between the membrane and cytosol, the specificity and accessibility of membrane-protein substrates, and reaction kinetics. We select examples of data from several hemolytic anemias to illustrate that precautions are needed to interpret abnormalities of membrane-protein phosphorylation properly; we discuss possible new methodological approaches.

The validity of the approximation method "area/perimeter" as applied to 8 and 25-MV photon beams.

The approximation method of area/perimeter for different portal sizes used in practice for finding the equivalent squares of a rectangular field has been tested on a 35-MV Clinac Linear Accelerator for the purpose of treatment planning. Data were obtained for 8 and 25-MV x-rays at depths of maximum build-up regions, and at 10 cm depth below the surface of a suitable water phantom. Maximum variation of dose calculation from the above method is less than 1.6% for routine clinical usage while less than 3.2% for extreme rectangular field sizes. Dose variation improves as the depth in phantom increases.

The evidence for the existence of chymotrypsin-like esterase activity in the plasma membranes of rabbit neutrophils and the specific chemotactic peptide binding activity of the subcellular fractions.

1. Light- and heavy-plasma membrane fractions have been isolated from rabbit neutrophils and a chymotrypsin-like esterase has been shown to be present in these fractions. 2. The molecular weight of the chymotrypsin-like esterase of rabbit neutrophil plasma membrane was estimated to be about 200 000. 3. About 93% of the chymotrypsin-like esterase of the plasma membranes is esterase 1 and the susceptibility to potential inhibitors was similar in light- and heavy-plasma membrane. 4. Chemotactic peptide, [3H]formyl-norleucyl-leucyl-phenylalanine [3H]formyl-Nle-Leu-Phe) binding by subcellular fractions shows that the highest specific binding was observed in the light-plasma membrane was about 2-fold higher than the heavy-plasma membrane, about 37-fold higher than the nuclear fraction, about 3-fold higher than lysosomal fraction and about 10-fold higher than the microsomal fraction.

General equations for the calculations of biologic effect ratios for parallel opposing fields.

The tolerance level of normal tissue, which is the concept of NSD, is the limiting factor in radiation therapy. It is well known that the two parallel opposing fields should be treated at each session instead of alternating one field per session. The biologic effect ratios between the normal tissue at the depth of maximum build-up and the midline for parallel opposing fields were published by ELLIS et coll. General formulae are now presented providing biologic effect ratio at any two locations in terms of per cent depth doses in the treatment volume for parallel opposing fields. Examples at the depth of maximum build-up and certain depth of the connective tissue at the tumor site are also given.

Polynomial and power law of central axis backscatter factors for external and gamma-ray sources.

A third-degree polynomial and power-law analysis with the method of least-squares fit are computed for backscatter factor with a continuous variation of field size and different beam quality of radiation from 1.0-mm Al external x ray to 60Co gamma ray. Three coefficients are required for a third-degree polynomial and two coefficients for power law method of each beam quality.

Chemotactic activity from rabbit peritoneal neutrophils. Lack of identity with N-acetyl-DL-phenylalanine beta-napthyl esterase.

The chemotactic and N-acetyl-DL-phenylalanine beta-naphthyl esterase activities of rabbit peritoneal neutrophils are separable from each other by both DEAE cellulose and Sephadex G-100 column chromatography. Partially purified esterase obtained from DEAE-cellulose chromatography had molecular weight of 70 000. However, the partially purified fraction contained chemotactic activities with major activity in molecular weight of 28000 and minor activities in the molecular weights of 45000, 21900, 14500 and 10500. Esterase activity is inhibited by 10(-7) M p-nitrophenylethyl-5-chloropentylphosphonate but chemotactic activity is not.