"Triple incision plasty". A convenient procedure for preputial relief.

Circumcision is the accepted operation to treat phimosis. However, when the purpose is to achieve retractility of a narrow foreskin to avoid further scarring and phimotic development after recurrent balanitis, a preputial plasty might be sufficient. Several methods with single or multiple incisions have been introduced throughout the years. None of them seems to have gained general acceptance. Single plasties tend to give cosmetically unsatisfactory results with an apparent cleft or deformity, while the multiple ones, where the deformity is more or less spread around the circumference, are not always easily done, at least not in children. Still, circumcision seems to remain the standard procedure for preputial relief. A simple technique, where three longitudinal incisions are transversely sutured, is described. It has been used in a series of 63 consecutive patients with good results, and seems to offer a good compromise between simplicity and cosmetical demands.     

Human brain atlas: For high-resolution functional and anatomical mapping

We present the new computerized Human Brain Atlas (HBA) for anatomical and functional mapping studies of the human brain. The HBA is based on many high-resolution magnetic resonance images of normal subjects and provides continuous updating of the mean shape and position of anatomical structures of the human brain. The structures are transformable by linear and nonlinear global and local transformations applied anywhere in 3-D pictures to fit the anatomical structures of individual brains, which, by reformatting, are transformed into a high-resolution standard anatomical format. The power of the HBA to reduce anatomical variations was evaluated on a randomized selection of anatomical landmarks in brains of 27 young normal male volunteers who were different from those on whom the standard brain was selected. The HBA, even when based only on standard brain surface and central structures, reduced interindividual anatomical variance to the level of the variance in structure position between the right and left hemisphere in individual brains. © 1994 Wiley-Liss, Inc.     

Immunogenicity and antigenicity in rabbits of a repeated sequence of Plasmodium falciparum antigen Pf155/RESA fused to two immunoglobulin G-binding domains of staphylococcal protein A.

A synthetic gene encoding a tetramer of the repeated subunit EENVEHDA of the Plasmodium falciparum antigen Pf155/RESA was expressed in a dual-expression system. The resulting fusion proteins, designated ZZ-M1 and BB-M1, comprised the EENVEHDA repeats and either two immunoglobulin G-binding domains from staphylococcal protein A or the human serum albumin-binding domains from streptococcal protein G, respectively. The soluble fusion proteins were affinity purified to homogeneity in one-step procedures. ZZ-M1 was used for immunization of rabbits. The rabbit antisera reacted with BB-M1 in an enzyme-linked immunosorbent assay and with Pf155/RESA in immunofluorescence of infected erythrocytes and immunoblotting. Inhibition studies revealed that the antibodies mainly recognized epitopes formed by two or more EENVEHDA subunits and were remarkably specific for Pf155/RESA. Importantly, the antibodies also inhibited P. falciparum merozoite reinvasion in vitro efficiently, indicating that they reacted with biologically important epitopes exposed on the native antigen. Immunization with Freund complete adjuvant resulted in high levels of specific immunoglobulin G antibodies over a 1-year period, whereas the antibody response obtained after immunization without adjuvant was generally weaker, immunoglobulin G and M mediated, and not sustained for longer periods. However, these titers were restored after booster injection. Taken together, the results support the usefulness of recombinant gene constructs of this type as immunogens for malaria vaccines.     

Passive immunization of Aotus monkeys with human antibodies to the Plasmodium falciparum antigen Pf155/RESA.

In order to assess the protective effects of anti-Pf155/RESA antibodies of different specificities in vivo, passive immunizations of Aotus monkeys were performed. Antibodies reactive with the Pf155/RESA repeat sequences (EENV)2 and EENVEHDA were isolated from the immunoglobulin G (IgG) fraction of a pool of plasmas from Liberia by affinity chromatography on synthetic peptides. The two fractions of antibodies differed in specificity but displayed similar capacities to inhibit merozoite invasion in Plasmodium falciparum in vitro cultures. Four groups of monkeys (named groups I to IV) were injected with (i) 160 mg of total control IgG, (ii) 2 mg of IgG affinity purified on (EENV)2, (iii) 2 mg of IgG affinity purified on EENVEHDA, and (iv) 160 mg of total immune IgG, respectively. The monkeys were then challenged with P. falciparum-infected erythrocytes, and the levels of parasitemia and hematocrits as well as other serological parameters were determined daily. Although all groups developed parasitemia, groups II and IV tended to show lower mean daily levels. Three monkeys of group II and two monkeys (each) of groups III and IV self cured the infections, but so did one monkey from the group treated with control IgG (group I). The serum levels of transfused antibodies were low at the peak of parasitemia, suggesting that clearance of parasites was mediated by immune responses mounted by the monkeys. The results indicate that antibodies to epitopes formed by repeats of Pf155/RESA may depress P. falciparum parasitemias and thus that immunogens based on such repeats should be suitable components in a subunit vaccine against asexual stages of P. falciparum.     

Absence of antigenic diversity in Pf155, a major parasite antigen in membranes of erythrocytes infected with Plasmodium falciparum.

Pf155 is a merozoite-derived polypeptide antigen which the parasite Plasmodium falciparum deposits in the membranes of erythrocytes at invasion. Eleven laboratory strains or clones of P. falciparum and a large number of isolates obtained from patients from different parts of the world were studied for antigenic diversity in Pf155. Immunoglobulin G antibodies from different serum samples from P. falciparum-infected donors were affinity purified on monolayers of glutaraldehyde-fixed and air-dried erythrocytes infected with P. falciparum of different origins and tested in different combinations by immunoblotting, reinvasion inhibition, and a modified immunofluorescence procedure in which the membranes of recently infected erythrocytes were stained. Similar experiments were performed with monoclonal and oligoclonal antibodies specific for different epitopes in the C-terminal region of Pf155. No strain- or isolate-associated antigenic diversity or size variation of Pf155 was detected, indicating that the immunodominant regions of this antigen are highly conserved throughout the world.     

A simple statistical model for prediction of acute coronary syndrome in chest pain patients in the emergency department

Background  

Several models for prediction of acute coronary syndrome (ACS) among chest pain patients in the emergency department (ED) have been presented, but many models predict only the likelihood of acute myocardial infarction, or include a large number of variables, which make them less than optimal for implementation at a busy ED. We report here a simple statistical model for ACS prediction that could be used in routine care at a busy ED.     

Effect of intravenous nitroglycerin on lipid peroxidation after thrombolytic therapy for acute myocardial infarction

Free oxygen radicals are produced after coronary artery occlusion and reperfusion. Polyunsaturated fatty acids are oxidized by free radicals to lipid peroxides. Measurements of plasma malondialdehyde (MDA) formed by the breakdown of lipid peroxides are often used as markers of lipid peroxidation. The effect of intravenous nitroglycerin on plasma MDA levels was studied in 43 patients who received thrombolytic therapy for acute myocardial infarction. Plasma MDA levels in patients were elevated on admission to the hospital compared with healthy controls, and normalized within 48 hours. A greater increase in plasma MDA concentrations after thrombolysis was found in patients with noninvasive signs of reperfusion than in patients judged to have a persistent occlusion. In the 23 patients receiving immediate intravenous nitroglycerin infusion, plasma MDA levels did not change from baseline to 90 minutes (0.92 ± 0.22 and 0.92 ± 0.23 μmol/L, p = 0.99), whereas a significant increase was found in the 20 control patients who did not receive nitroglycerin (from 0.83 ± 0.22 to 1.01 ± 0.30 μmol/L, p = 0.0004) (p = 0.036 for the difference between groups). Successful reperfusion after thrombolytic therapy entails increased lipid peroxidation. Intravenous nitroglycerin reduces lipid peroxidation during myocardial ischemia and reperfusion.     

Dopamine D2 receptor availability is linked to hippocampal–caudate functional connectivity and episodic memory

D1 and D2 dopamine receptors (D1DRs and D2DRs) may contribute differently to various aspects of memory and cognition. The D1DR system has been linked to functions supported by the prefrontal cortex. By contrast, the role of the D2DR system is less clear, although it has been hypothesized that D2DRs make a specific contribution to hippocampus-based cognitive functions. Here we present results from 181 healthy adults between 64 and 68 y of age who underwent comprehensive assessment of episodic memory, working memory, and processing speed, along with MRI and D2DR assessment with [¹¹C]raclopride and PET. Caudate D2DR availability was positively associated with episodic memory but not with working memory or speed. Whole-brain analyses further revealed a relation between hippocampal D2DR availability and episodic memory. Hippocampal and caudate D2DR availability were interrelated, and functional MRI-based resting-state functional connectivity between the ventral caudate and medial temporal cortex increased as a function of caudate D2DR availability. Collectively, these findings indicate that D2DRs make a specific contribution to hippocampus-based cognition by influencing striatal and hippocampal regions, and their interactions.Dopamine (DA) plays a key role in several cognitive processes (1–4). Reductions of D1 and D2 DA receptors (D1DRs and D2DRs) in aging (5–7) have been linked to age-related cognitive deficits (8, 9). The D1DR system has been related to functions supported by the prefrontal cortex (PFC), such as working memory and executive functions (10–12), which may reflect the relatively high density of D1DRs in the PFC (13). However, the role of D2DRs is far less clear. D2DRs are present in the PFC at very low densities (13), and evidence supporting a role for the D2DR system in working memory and executive functions is elusive (10). Pharmacological (14, 15) and PET studies assessing striatal D2DR availability (or binding potential to nondisplacable tissue uptake; BP_ND) with [¹¹C]raclopride (16, 17) have yielded mixed findings in relation to cognition. It has been hypothesized that D2DRs make a specific contribution to hippocampus-based cognitive functions (10, 18, 19). Supporting these claims, positive links between D2DR BP_ND and episodic memory are commonly observed (20–23). PET imaging of hippocampal D2DR BP_ND also provides support for this hypothesis, although some studies indicate that hippocampal D2DRs may be related to both episodic memory and PFC-based executive functions (22, 23), including verbal working memory (24). Medial temporal lobe regions have been implicated in working memory (25, 26), and D2DR-mediated modulation may be exerted via hippocampal–cortical pathways (27). In addition, a [¹¹C]raclopride task-activation PET study demonstrated contributions of striatal D2DRs to a verbal working-memory task (11).Taken together, the specific role of the D2DR system in cognition remains unclear, likely due to the fact that past studies included small and age-heterogeneous samples and lacked comprehensive test batteries that allowed systematic comparison of the role of D2DRs in different cognitive functions. Here we present results from the Cognition, Brain, and Aging (COBRA) study that include assessment of episodic memory, working memory, and processing speed, in combination with [¹¹C]raclopride PET and MRI of 181 healthy adults between 64 and 68 y of age (28). The main analyses concerned caudate D2DR–cognition associations, as this striatal region has been implicated in cognitive functioning (11, 12, 29, 30). Subsequently, whole-brain analyses were conducted to examine extrastriatal (especially hippocampal) D2DRs in relation to cognition. Finally, resting-state functional connectivity patterns were analyzed in relation to D2DR BP_ND, with special focus on interactions between the ventral caudate (31) and medial temporal cortex regions (32, 33).