Topical glucocorticosteroid (fluticasone propionate) inhibits cells expressing cytokine mRNA for interleukin-4 in the nasal mucosa in allergen-induced rhinitis

Allergen-induced late nasal responses are associated with recruitment and activation of T lymphocytes and eosinophils and preferential mRNA expression for T-helper type 2 (Th2) cytokines. We tested the hypothesis that topical corticosteroids may inhibit late responses by inhibiting cells expressing mRNA for Th2 cytokines. A randomized double-blind placebo-controlled trial of topical corticosteroid (fluticasone propionate) was performed in 48 adult grass pollen-sensitive patients. Nasal biopsies were taken at baseline and repeated 24 hr after local nasal allergen provocation following 6 weeks treatment with either fluticasone propionate 200 micrograms or placebo nasal spray twice daily. Baseline mRNA expression for interleukin-4 (IL-4) (P = 0.01) and IL-5 (P = 0.002) was higher in the patients than in normal controls. Topical corticosteroid treatment significantly inhibited immediate nasal symptoms, with almost complete inhibition of the late response following allergen challenge. This was associated with a marked decrease in the allergen-induced increases in cells expressing mRNA for IL-4 (P = 0.002) but not for IL-5. Inhibition of the late response was also accompanied by decreases in CD25+ cells, presumed T lymphocytes and eosinophils. A significant correlation was observed between the decreases in IL-4 mRNA+ cells and in eosinophils after treatment (r = 0.46, P < 0.05). These results suggest that prolonged treatment with topical corticosteroid inhibits allergen-induced early and late nasal responses and the associated tissue eosinophilia, and that, at least in part, this may result from inhibition of cells expressing mRNA for IL-4.

Privatization of the medical market in socialist China: a historical approach

A Socialist-Market Economy was defined as a target model for China's economic reform by China's 14th National Congress in 1992. Such an innovative change in China's more than a decade long economic reform has brought both new challenges and opportunities for its health care system reform as it moves toward a market determination mechanism and involvement of the private sector. A better understanding of the nature and history of the Chinese private medical market and its dynamic socio-economic environment would certainly shed a great deal of light onto the accomplishments of the health care reform. Research in this area, however, is almost non-existent at either national or international levels. The present study attempts to fill this gap by providing a comprehensive assessment of both historical and prospective development of the Chinese private medical market. Three stages are defined to present the tortuous development of this market over the last four decades, coupled with our critiques of the underlying merits and problems. Predictions are also made on the future perspective of the private market, and its possible impact and role in shaping the reform of the entire Chinese health care system. The government's role as well as its future strategy to cope with the issues surrounding Chinese health care reform are also summarized. The study concludes with five health policy recommendations aimed at facilitating China's health care reform via more market-oriented determination of resources allocation, production, and distribution, coupled with promotion of the private sector's involvement while minimizing its potential adverse side effects.

Relationships among numbers of bronchoalveolar lavage cells expressing messenger ribonucleic acid for cytokines, asthma symptoms, and airway methacholine responsiveness in atopic asthma

BACKGROUND

We recently demonstrated that T lymphocytes in bronchoalveolar lavage (BAL) fluid from atopic asthmatic patients were activated and expressed increased cytokine messenger ribonucleic acid (mRNA) for "TH2-type" cytokines, particularly IL-4 and IL-5, when compared with those in normal control subjects. This pattern of cytokines may determine the nature of the cellular infiltrate in the bronchial mucosa in asthma and hence the bronchial hyperresponsive (BHR) and symptoms that characterize this condition.

METHODS

To examine the association between these cytokines and clinical measures of asthma severity we have extended our studies of BAL cells from subjects with atopic asthma. Numbers of BAL cells with positive in situ hybridization signals for IL-2, IL-3, IL-4, IL-5, granulocyte macrophage colony-stimulating factor (GM-CSF), and interferon-gamma were counted on cytocentrifuge preparations. Results were compared between patients with symptomatic (n = 19) and asymptomatic asthma (n = 10), and associations were sought with airway methacholine responsiveness, resting airway caliber, and asthma symptom scores.

RESULTS

There were increased proportions of cells positive for IL-3 (p < 0.05), IL-4 (p < 0.005), IL-5 (p < 0.005), and GM-CSF (p < 0.005) mRNA in BAL fluid from patients with symptomatic asthma when compared with that from subjects free of symptoms, but no difference between the groups in numbers of cells expressing IL-2 and interferon-gamma mRNA. There were significant associations among numbers of cells expressing mRNA for IL-4, IL-5, and GM-CSF, and airflow restriction, BHR, and Aas asthma score.

CONCLUSIONS

These findings support the hypothesis that cytokines contribute to airway events that determine asthma symptoms and BHR.

Chronic hyperplastic sinusitis: association of tissue eosinophilia with mRNA expression of granulocyte-macrophage colony-stimulating factor and interleukin-3

BACKGROUND

We investigated the association among tissue eosinophilia, cellular infiltration, and cytokine mRNA expression in chronic hyperplastic sinusitis (CHS).

METHODS

Percutaneous biopsies of the maxillary sinuses and nasal polyps were performed in 12 adult patients (six men and six women) of whom seven were nonallergic and 11 were asthmatic. Tissues were compared with biopsy specimens from the inferior and middle turbinates of normal control subjects.

RESULTS

Histologically, an eosinophil-predominant inflammatory infiltrate was seen in 10 of 12 patients, whereas a mild to moderate neutrophilic infiltrate was seen in 4 of 12 patients. As determined by immunocytochemistry, diseased tissues and normal control tissues differed significantly in terms of the number of activated (EG2+) eosinophils (p = 0.005) but not in terms of CD3+ or CD4+ T lymphocytes, elastase-positive neutrophils or CD68+ macrophages. The number of eosinophils did not correlate with that of any other cell type. By in situ hybridization, CHS tissues showed significantly higher numbers of granulocyte-macrophage colony-stimulating factor (GM-CSF) and interleukin (IL)-3 mRNA-positive cells than normal control tissues (p = 0.002 and 0.0005, respectively) per high-powered field. There was a significant correlation between the number of infiltrating EG2+ eosinophils and cells that expressed mRNA for GM-CSF (r = 0.60, p = 0.041) or IL-3 (r = 0.69, p = 0.013). Furthermore, epithelial cells did not show detectable mRNA expression for GM-CSF or IL-3. No significant correlation was found between IL-5 mRNA expression and infiltrating EG2+ eosinophils in diseased tissues. However, the IL-5 density was significantly higher in the five patients with CHS who had positive allergy skin test results than in the seven patients with negative skin test results (p = 0.017) or in normal control subjects.

CONCLUSIONS

Our data support a role for GM-CSF and IL-3 in the eosinophilia characteristic of CHS and show that IL-5 mRNA expression is not a prominent feature of nonallergic inflammation. The cellular sources of GM-CSF and IL-3 in CHS remain to be definitely determined.

Increases in activated T lymphocytes, eosinophils, and cytokine mRNA expression for interleukin-5 and granulocyte/macrophage colony-stimulating factor in bronchial biopsies after allergen inhalation challenge in atopic asthmatics

Immunohistology and in situ hybridization were used to evaluate the presence, activation status, and cytokine mRNA profile of cells in the bronchial mucosa during human allergen-induced asthma. Fifteen atopic asthmatic subjects underwent inhalation challenge with allergen and with allergen diluent, performed in random order separated by an interval of at least 3 wk. Bronchial biopsies were obtained 24 h after challenge. Immunostaining revealed increases in the numbers of secreting eosinophils (EG2+; P < 0.05) and in interleukin-2 receptor (IL-2R)-positive cells (CD25+; P < 0.01) after allergen compared with diluent challenge. No differences were observed in the numbers of total leukocytes (CD45+), T lymphocytes (CD3+, CD4+, and CD8+), elastase-positive neutrophils, macrophages (CD68+), or mast cell subtypes (MCT+ or MCTC+). In situ hybridization revealed significant increases in the numbers of cells expressing mRNA for IL-5 (P < 0.02) and granulocyte/macrophage colony-stimulating factor (P < 0.01) after allergen compared with diluent challenge. A significant inverse relationship was observed between the number of cells expressing mRNA for IL-4 and for interferon-gamma (r = -0.75, P < 0.02). The results support the view that cytokines possibly from activated T lymphocytes may contribute to local eosinophil accumulation during allergen-induced asthma.

Expression and generation of interleukin-8, IL-6 and granulocyte-macrophage colony-stimulating factor by bronchial epithelial cells and enhancement by IL-1 beta and tumour necrosis factor-alpha

We have tested the hypothesis that the bronchial epithelium has the capacity to generate and release cytokines that could contribute to inflammatory events associated with inflammatory lung diseases. Messenger RNA (mRNA) for interleukin-6 (IL-6), IL-8 and granulocyte-macrophage colony-stimulating factor (GM-CSF) was identified in human bronchial epithelial cell primary cultures, characterized on the basis of staining for cytokeratin, using both in situ hybridization and Northern blotting. Using in situ hybridization we have shown that the majority of the cells expressed mRNA for IL-6 and IL-8, whereas fewer than 20% of cells expressed message for GM-CSF. The numbers of cells expressing message were increased by culture with tumour necrosis factor-alpha (TNF-alpha) (20 ng/ml, 24 hr). These observations were substantiated by Northern blotting, which showed that both TNF-alpha and IL-1 beta were able to induce a dose-dependent increase in IL-8-specific mRNA. Immunoreactive IL-6 and GM-CSF were detected and quantified in the culture supernatants by ELISA, and IL-8 by radioimmunoassay. The levels of immunoreactivity were increased by incubation of epithelial cells with either IL-1 beta or TNF-alpha for 24 hr. A transformed tracheal epithelial cell line (9HTEo-) expressed mRNA for IL-6, IL-8 and GM-CSF but, whereas levels of immunoreactive IL-6 in culture supernatants were comparable with those in primary cell cultures, levels of IL-8 were low and GM-CSF trivial. These observations indicate that the bronchial epithelium has the potential to be a major source of IL-8 and a number of other cytokines, and that production can be amplified substantially by IL-1 beta and TNF-alpha. The bronchial epithelium is ideally situated to modulate inflammatory and immunological events in and around the airways, and these observations suggest that it could contribute to promote and sustain inflammatory and immunological processes in inflammatory lung diseases such asthma.

Human eosinophils synthesize and secrete interleukin-6, in vitro

Using the technique of in situ hybridization, we have shown that resting, unstimulated, human peripheral blood eosinophils, obtained from subjects with greater than 8% eosinophilia, transcribe and translate messenger RNA (mRNA) for interleukin-6 (IL-6). After incubation for 24 hours in culture medium alone, approximately 19% of eosinophils were positive for IL-6 mRNA. This may be a reflection of their in vivo activation, but also may suggest that the gene for this cytokine is constitutively expressed in eosinophils. After stimulation with interferon gamma (IFN gamma) (500 U/mL), the percentage of IL-6-mRNA+ cells increased to 51.3%. This was accompanied by an enhancement of intensity of the hybridization signals. The specificity of the IL-6 probe and the hybridization signals was confirmed by the use of an IL-6 sense probe and RNase pretreatment of cell preparations. Evidence for the translation of IL-6 mRNA was obtained by immunocytochemical staining. Normal and activated eosinophils gave IL-6-specific immunoreactivity with a polyclonal antihuman IL-6 antibody. A higher percentage of positive cells was detected among activated eosinophils than those treated with medium alone. Using a specific immunoenzymetric assay, we detected 190.15 +/- 18.1 and 403.32 +/- 213.6 pg/mL of IL-6 in supernatants of unstimulated and IFN gamma-treated (24 and 48 hours) eosinophils, respectively. These data indicate that eosinophils are an important cellular source of IL-6.

Preliminary report on seroepidemiology of HCV and HBV infection in northern China

1 141 serum samples from various population groups in north China were examined for C100-3Ab by ELISA. Antibody to C100-3 antigen derived from HCV genome (C100-3A) and HBsAg were measured in 438 normal population in Beijing. The C100-3Ab positive rate was 2.1% and the HBsAg positive rate was 2.5%. There is increased occurrence with age. In 649 cases of chronic liver diseases, the HBsAg positive rate was 87.1% in chronic persistent hepatitis (CPA), 88.8% in chronic active hepatitis (CAH), 64.9% in liver cirrhosis (LC) and 67.3% in hepatocellular carcinoma (HCC). The C100-3Ab positive rate was 10.5% (CPH), 12.1% (CAH), 42.6% (LC) and 38.4% (HCC). It is noteworthy that the C100-3Ab positive rate significantly increased with disease progression from CPH to CAH, LC and HCC. Prevalence of cases positive for both C100-3Ab and HBsAg was 0% in the normal population, 6.7% in CPH, 8.4% in CAH, 31.1% in LC and 28.8% in HCC. Investigation of patients with HCV infection showed that only 36.8% had blood transfusions. HCV and HBV infection may play important pathogenic roles in CPH, CAH, LC and HCC in north China.

TNF alpha mRNA expression in allergic inflammation

Using the technique of in situ hybridization, we have attempted to identify messenger RNA for tumour necrosis factor-alpha (TNF alpha) in cells infiltrating allergen-induced late phase reaction (LPR) of the skin and the nose of atopic subjects. We have also compared the number of TNF alpha mRNA positive cells in bronchoalveolar lavage (BAL) from atopic asthmatics and normal controls. Twenty-four hours after local allergen challenge, 12/14 skin biopsies and 9/10 nasal biopsies had positive hybridization signals for TNF alpha mRNA whereas only 4/14 and 2/10 biopsies were positive in the relevant diluent controls. Compared with diluent sites significantly increased numbers of cells expressing mRNA for TNF alpha were observed in the LPR of skin (P less than 0.004) and nose (P less than 0.006). All BAL from asthmatics (n = 10) and from normal volunteers (n = 10) had cells showing positive hybridization signals for TNF alpha mRNA but these were at increased frequency in asthmatics (P less than 0.001). These results suggest that TNF alpha may be an important cytokine in atopic allergic inflammation.

Seroepidemiology of HCV and HBV infection in northern China

The HCVAb positive rate in normal population in Beijing was 2.1% and HBsAg positive rate was 2.5%. There is an increasing tendency in the aged group. Plasmapheresis might have been the major cause of HCV transmission in blood donors in the Hebei area. There was a high prevalence of HCVAb and HBsAg in chronic liver diseases in the Beijing area and the HCVAb-positive rate significantly increased corresponding to disease progression.

Age-related differences in the metabolism of proteoglycans in bovine articular cartilage explants maintained in the presence of insulin-like growth factor I

Articular cartilage explants from bovine calf and steer were cultured for up to 19 days in medium with or without 20% fetal bovine serum (FBS) or insulin-like growth factor I (IGF-I). Lower concentrations of IGF-I were required for maximal stimulation of PG synthesis in calf than in steer. In calf, but not in steer, IGF-I was as effective as 20% FBS in stimulating PG synthesis. The stimulation by IGF-I or FBS was not accompanied at either age by alterations in the composition of the aggregating PGs nor by changes in the proportions of CS-rich and CS-poor PG subpopulations. In calf, IGF-I and FBS did not markedly alter the rate of turnover of either the 35S-PGs synthesized in vitro or the unlabeled PGs. In steer, explants cultured in the absence of IGF-I or FBS exhibited very fast rates of turnover and depletion of matrix PG with time; IGF-I and FBS were both effective in reducing the turnover rate of 35S-PGs and unlabeled PGs and in preventing PG depletion.

[Serum isoforms of creatine kinase MM (MM3/MM1 ratio) in the diagnosis of acute myocardial infarction]

The reliability of serum MM3/MM1 ratio as a marker for AMI was evaluated in 81 consecutive coronary-care admission. Of these, 62 patients were diagnosed as definite infarction and 19 patients as angina, using WHO criteria. The MM3/MM1 ratio in the admission serum sample was 1.85 +/- 2.01 in 62 patients with definite infarction; in contrast, the MM3/MM1 ratio was 0.24 +/- 0.14 in 19 patients with angina (P less than 0.01 for MI group vs angina group). Among the AMI patients admitted within 12 h after onset, the diagnostic accuracy of the ratio MM3/MM1 was higher than CK, CK-MB, LDH, LD1/LD2 and GOT and similar to Mb in the initial serum samples. It seems that the MM3/MM1 ratio was a better enzyme marker than the others in the early stage of AMI, especially before 12 h.

Estimating starch availability and protein degradation of steam-flaked and reconstituted sorghum grain through a gas production technique

Five steam-flaked sorghum grain (SFSG) samples with bulk densities of 476, 412, 347, 309 and 283 g/liter made by adjusting tension between mill rollers and three reconstituted sorghum grain (RSG) samples with reconstitution times of 10, 20 and 30 d and a control sample were analyzed for gas production kinetics (rumen liquor fermentation) and enzymatic glucose release (amyloglucosidase). Protein degradation was estimated from 6-h gas production and residual ammonia in the liquid. Gas production followed first-order kinetics (r2 greater than .98; P less than .01) and was used to describe rate and extent of digestion kinetics. Rate of gas production increased as processing degree increased. The magnitude of increase in gas production, however, was much less for RSG than for SFSG. Linear relationships were observed between enzymatic glucose release and the gas production rate constant k as well as gas production at 4,6 and 8 h (r2 greater than .98; P less than .01). Protein degradation decreased with processing degree of SFSG but increased with reconstitution time. A technique based on 6-h gas production and residual ammonia in the liquid is proposed to estimate both ruminal starch availability and ruminal protein degradability for processed sorghum grain.

Investigation of anti-HCV in 391 serum samples in China

391 serum samples from healthy blood donors, HBsAg positive blood donors and patients with different kinds of liver diseases in northern China were tested for anti-HCV by ELISA. Of the healthy donors, 4.6% (7/151) were anti-HCV positive; of the HBsAg positive donors, 32.4% (24/74) were positive; and of the liver disease patients, 5.4% (9/166) were positive. Among the 24 cases of HBV-HCV double infection, 10 were assayed for serum ALT level. 40% (4/10) of them were abnormal. The causes of the surprisingly high rate of HCV infection, both in healthy donors and in HBsAg positive donors, were discussed. This is the first report on the distribution of anti-HCV in certain population in China.

Pygmaeoherin: A Novel Coumarin from Pygmaeopremna herbacea

A new 6-oxygenated coumarin, pygmaeoherin, was isolated from roots of PYGMAEOPREMNA HERBACEA. Its structure was determined by spectroscopic methods. An NOE experiment played an important role in confirming the structure.