Strain variation in glycosaminoglycan recognition influences cell-type-specific binding by lyme disease spirochetes

Lyme disease, a chronic multisystemic disorder that can affect the skin, heart, joints, and nervous system is caused by Borrelia burgdorferi sensu lato. Lyme disease spirochetes were previously shown to bind glycosaminoglycans (GAGs). In the current study, the GAG-binding properties of eight Lyme disease strains were determined. Binding by two high-passage HB19 derivatives to Vero cells could not be inhibited by enzymatic removal of GAGs or by the addition of exogenous GAG. The other six strains, which included a different high-passage HB19 derivative (HB19 clone 1), were shown to recognize both heparan sulfate and dermatan sulfate in cell-binding assays, but the relative efficiency of binding to these two GAGs varied among the strains. Strains N40, CA20-2A, and PBi bound predominantly to heparan sulfate, PBo bound both heparan sulfate and dermatan sulfate roughly equally, and VS461 and HB19 clone 1 recognized primarily dermatan sulfate. Cell binding by strain HB19 clone 1 was inhibited better by exogenous dermatan sulfate than by heparin, whereas heparin was the better inhibitor of binding by strain N40. The GAG-binding preference of a Lyme disease strain was reflected in its cell-type-specific binding. Strains that recognized predominantly heparan sulfate bound efficiently to both C6 glioma cells and EA-Hy926 cells, whereas strains that recognized predominantly dermatan sulfate bound well only to the glial cells. The effect of lyase treatment of these cells on bacterial binding was consistent with the model that cell-type-specific binding was a reflection of the GAG-binding preference. We conclude that the GAG-binding preference varies with the strain of Lyme disease spirochete and that this variation influences cell-type-specific binding in vitro.     

Pineal yolk sac tumour with a solid pattern: a case report in a Chinese adult man with Down's syndrome

Intracranial germ cell tumours are rare. The incidence of primary intracranial yolk sac tumour is even more uncommon, with only two reported cases being associated with Down's syndrome in the English literature. This report details the findings of yolk sac tumour in the pineal region affecting a 22 year old Chinese man with Down's syndrome. Histology revealed yolk sac tumour with only a solid pattern, potentially mimicking the more common germinoma in the pineal region. No other germ cell components were identified. This is the third report of intracranial yolk sac tumour manifesting in a patient with trisomy 21. The pathology of this tumour and its differential diagnoses are discussed.     

The failure of physician education as a cost containment strategy. Report of a prospective controlled trial at a university hospital

To test the hypothesis that physician education is an effective strategy to reduce total hospital costs, we evaluated three educational interventions at a large university hospital. This prospective controlled study spanned two academic years and involved 1,663 patients and 226 house staff. In the first year, weekly lectures on cost containment (medicine and surgery) and audit with feedback (medicine only) both failed to produce a significant change in total hospital charges. The "dose" of the intervention was increased on medicine in the second year by combining the lecture and audit strategies. Again, total charges did not change significantly. While decreased use occurred for certain selected services, the impact was not great enough to affect total hospital charges significantly. We conclude that, in the absence of other cost containing incentives, physician education alone is not an effective hospital cost containment strategy.     

Prevalence and Associated Factors of Sarcopenia in Singaporean Adults—The Yishun Study

ObjectivesTo describe the normative values of sarcopenia among community-dwelling adults (≥21 years of age); compare the prevalence of sarcopenia using Asian Working Group for Sarcopenia criteria, 2014 (AWGS2014), Asian Working Group for Sarcopenia criteria, 2019 (AWGS2019), and European Working Group on Sarcopenia in Older People criteria, 2018 (EWGSOP2) guidelines; and identify factors associated with sarcopenia.DesignParticipants were recruited through random sampling. Sarcopenia assessments were performed using a dual-energy x-ray absorptiometry scan (muscle mass), handgrip test (muscle strength), and usual walking test (physical performance). Questionnaires were administered to evaluate lifestyle and cognition.Setting and ParticipantsIn total, 542 community-dwelling Singaporeans were recruited (21?90 years old, 57.9% women).MethodsWe assessed anthropometry, body composition, and questionnaire-based physical and cognitive factors, and estimated sarcopenia prevalence according to the AWGS2014, AWGS2019, and EWGSOP2 recommendations, and examined associations using logistic regression.ResultsAccording to AWGS2019, the Singapore population-adjusted sarcopenia prevalence was 13.6% (men 13.0%; women 14.2%) overall, and 32.2% (men 33.7%, women 30.9%) in those aged 60 years and above. The cut-offs derived from young adult reference group for low appendicular lean mass index were 5.28 kg/m2 for men and 3.69 kg/m2 for women (lower than AWGS recommended cut-off); for gait speed it was 0.82 m/s, (AWGS2019 recommended cut-off 1.0 m/s, AWGS2014 cut-off was 0.8 m/s); and for handgrip strength it was 27.9 kg/m2 for men and 16.7 kg/m2 for women (close to AWGS2019 recommendation). Age, sex, marital status, alcoholism, physical activity, body mass index, waist circumference, and global cognition were associated with sarcopenia (P < .05).Conclusions and ImplicationsThis is the first study to provide reference values of muscle mass, strength, and gait speed across the adult lifespan of Singaporeans. Using AWGS2019 criteria, sarcopenia is prominent in older age (32.2% in ≥60 years old), but it is already nontrivial (6.9%) among young and middle-age persons. Multidomain lifestyle modifications addressing muscle strength, cognition, and nutrition over the adult lifespan are important to delay the development of sarcopenia.     

Introducing this Special Issue on the "Mental Health of Asian Americans and Pacific Islanders"

There are approximately 1.4 million Asian American and Pacific Islanders who are suffering from some form of psychiatric disorder. Given the extent of this problem, I wish that we could provide specific epidemiological estimates of psychiatric disorders among Asian Americans. Unfortunately, there are few, if any, reliable and valid community-based epidemiological data on Asian Americans at this point. Given this state of affairs, it is quite important that we continue to do research on the mental needs and problems among Asian Americans so that we can provide the much needed mental health services.     

Mothers of Vietnamese Amerasians: Psychological Distress and High-Risk Factors

PURPOSE: The goal of the present article is to provide information useful to clinical caseworkers and mental health professionals on the nature and correlates of psychological distress as well as high­risk factors related to the adaptation of mothers of Vietnamese Amerasians (MVAs) in the United States. METHODOLOGY: By using a series of psychological distress instruments, the psychological distress levels of MVAs were compared to that of Amerasian adolescents. PRINCIPAL FINDINGS: The data enabled us to identify possible high­risk factors related to the adaptation and adjustment of MVAs in the United States. The MVAs as a group were experienceing about equal levels of distress as the Amerasian adolescents. However, differences began to emerge when we used the clinical cutoff method and found that there were differences between the two groups in two of the measures. The MVAs had a significantly higher proportion who were in the clinical range as compared to the Amerasian adolescent group. The conditions that were found to put the MVAs at higher risk for psychological distress include: Feeling distant from Amerasian child, feeling close to Vietnamese child, having no relatives in the United States, higher number of years of schooling, lower income, higher number of times with serious illness, missing work due to serious illness, higher number of months at the resettlement camp, greater amount of knowledge about American husband, not being officially married to American husband, and lack of support from American husband. CONCLUSIONS: The psychological instruments used in this study were not refined enough to be used for diagnosis of specific psychological disorders. Differences between Amerasian adolescents and MVAs pointed out the importance of examining both the groups' level of distress and the propotions in each grouop who were experiencing clinical levels of distress. The high risk factors identified in the current study may be used to examine potential sources of psychological distress for MVAs. RELEVANCE TO ASIAN AMERICAN AND PACIFIC ISLANDER POPULATIONS: This article is particularly relevant to Vietnamese and Amerasian. KEY WORDS: Psychological distress, high risk factors, MVAs, Ameriasian adolescents.