Severe hypothermia with cardiac arrest: complete neurologic recovery in a 4-year-old child

A 4-year-old girl was lost for 17 hours in a snowstorm. Upon discovery, her core temperature was 72 degrees F (22 degrees C). While undergoing endotracheal intubation in the emergency department, she experienced sudden ventricular fibrillation and cardiac arrest. Closed chest cardiopulmonary resuscitation (CPR) was instituted, and standard rewarming measures were begun. Despite this, neither core temperature, nor the patient's arrhythmia, changed. An infraumbilical "mini-laparotomy" incision was made, with placement of a large silicone peritoneal dialysis catheter into the abdomen. This was then connected to a rapid infuser device, with the delivery of 1L of warmed, normal saline every 90 seconds. The core temperature reached 29 degrees C in 15 minutes, and a palpable pulse was detected. Lavage was continued until core temperature reached 34 degrees C, at which time transport to the pediatric intensive care unit was arranged. She was extubated the next day and discharged home, on the fourth hospital day, with apparent complete neurologic recovery. This is the first report of the successful use of rapid high-volume peritoneal lavage for the treatment of accidental severe hypothermia in a pediatric patient.

Bowel dysfunction following spinal cord injury

STUDY DESIGN

Review.

OBJECTIVES

To outline the present knowledge of bowel dysfunction following spinal injury, and look at future directions of management and research.

SETTING

Spinal Unit and Colorectal Unit, Christchurch, New Zealand.

METHODOLOGY

Review.

RESULTS

The underlying physiology of colorectal motility and defecation is reviewed, and consequences of spinal cord injury on defecation are reported. A discussion of present management techniques is undertaken and new directions in management and research are suggested.

CONCLUSION

There is need for more intervention in regard to bowel function that could improve quality of life, but there is also a need for more research in this area.

Improved version 2.0 qualitative and quantitative AMPLICOR reverse transcription-PCR tests for hepatitis C virus RNA: calibration to international units, enhanced genotype reactivity, and performance characteristics

Version 2.0 qualitative and quantitative AMPLICOR reverse transcription-PCR tests for HCV were designed to improve on the performance of first version of the hepatitis C virus (HCV) tests. The new tests were calibrated in international units, the new commonly accepted standard unit of measurement for HCV RNA. The sensitivity of the qualitative tests was enhanced by modifying the specimen processing procedure to achieve a limit of detection 50 IU/ml. The limit of detection for the quantitative tests was 600 IU/ml. Modifications to the amplification reaction mixture and thermal cycling conditions enabled all genotypes to be amplified with similar efficiency. The quantitative tests exhibited a linear range extending from 500 to 500,000 IU/ml and excellent reproducibility, with coefficients of variation ranging from 18 to 39%, within the linear range. These data indicate that the version 2. 0 AMPLICOR HCV tests will improve diagnosis of HCV infection and will yield more-accurate titers for prognosis and for monitoring therapeutic efficacy, particularly at low viral loads. Furthermore, it will be possible to compare the performance characteristics and viral load measurements of AMPLICOR tests to those of other tests that adopt the international unit as the standard of measurement.

Differential effects of tri-n-butylstannyl benzoates on induction of apoptosis in K562 and MCF-7 cells

Tributyltin compounds have been shown to induce apoptosis by causing extracellular Ca2+ influx and generating reactive oxygen species (ROS). Several organotin compounds were reported to have differential cytotoxicity on various human cell lines depending on the length of the alkyl chain. In this report, the cytotoxic effects of three tri-n-butylstannyl (halo)benzoate compounds-tri-n-butylstannyl benzoate (TBSB), tri-n-butylstannyl-2,6-difluorobenzoate (TBSDFB) and tri-n-butylstannyl-2-iodobenzoate (TBSIB)-were studied on lymphocytic cells of human leukemic K562 lineage and epithelial cells of human breast cancer MCF-7 cells lineage. K562 cells were found to be more sensitive to these compounds than MCF-7 cells. Although the induction of apoptosis by the above compounds in K562 cells resulted from the extracellular Ca2+ influx and the generation of ROS, the initial amount of extracellular Ca2+ influx was greater in TBSB-treated K562 cells than the cells treated with either TBSDFB or TBSIB. Similarly, DNA fragmentation by endonucleases was observed as an early event in TBSB-treated K562 cells, which might be correlated with the initially greater extracellular Ca2+ influx. In contrast, MCF-7 cells were found to undergo apoptosis mainly because of the generation of ROS. The present results suggest that the differential effects of tributyltin compounds on induction of apoptosis in K562 and MCF-7 cells are largely attributable to the extent of extracellular Ca2+ influx.

Azidothymidine induces apoptosis in mouse myeloma cell line Sp2/0

Azidothymidine (AZT), which has been extensively used as an antiviral agent in the treatment of AIDS, showed strong inhibition of growth of Sp2/0 cells in vitro. AZT-treated cells showed a decrease in viability in a dose-dependent manner. AZT specifically induced typical apoptotic cell death with DNA double-strand cleavage and subsequent formation of apoptotic bodies. The induction of DNA double-strand cleavage into the oligonucleosomal ladder by AZT was protected in the presence of thymidine or uridine. An increase in endonuclease activity from nuclear extract of AZT-treated cells was observed. The enzyme activity was found to be Ca(2+)-and Mg(2+)-dependent and was inhibited by zinc acetate. A marked enhancement of PARP activity was observed in AZT-treated cells. These observations show that AZT can trigger both morphological and biochemical changes typical of apoptosis in the mouse myeloma cell line Sp2/0.

Effect of nucleic acid reactive antibodies on tumor cells grown in vivo

Nucleic acid reactive antibodies have been reported to inhibit various nucleic acid mediated functions in cell free systems. These antibodies were also shown to inhibit the growth of transformed cells in culture due to the high rate of endocytosis in transformed cells as compared to normal cells. In this report, we have tested the possibility of nucleic acid reactive antibodies inhibiting the growth of tumor cells in vivo. The life span of mice bearing Dalton's lymphoma ascites tumor cells was increased, when they were immunized with conjugates of guanosine-BSA, GMP-BSA and tRNA-MBSA complex before transplanting the tumor cells. A similar effect was also observed when mice were injected intraperitoneally with antibodies to guanosine or GMP along with the tumor cells. The specificity was ascertained, as immunization with non-specific antigens did not show any significant effect on tumor bearing mice. The results shows that nucleic acid reactive antibodies inhibit the growth of tumor cells in vivo.

Antibodies raised against guanosine bind to double-stranded DNA

Antibodies elicited against guanosine have been reported to bind to single-stranded DNA. Using an avidin-biotin microELISA, we report that these antibodies also bind to double-stranded DNA. The binding is specific and is completely inhibited by the homologous hapten. The cross-reactivity of double-stranded DNA binding antibodies to single-stranded DNA is low. The antibodies are shown to bind to the topoisomers of plasmid DNA as assessed by a gel retardation assay.

Inhibition of in vitro aminoacylation and translation by RNA reactive antibodies

Antibodies were raised against guanosine-BSA, GMP-BSA and tRNA-mBSA conjugates separately in rabbits. Binding characteristics of these antibodies to various RNAs were studied using a sensitive avidin-biotin micro ELISA. These antibodies inhibited in vitro aminoacylation of tRNA in a dose dependent manner. This inhibition was reversed by the addition of the respective homologous haptens thereby showing the specificity of these antibodies. In vitro translation of endogenous mRNAs in rabbit reticulocyte lysate was also inhibited by these antibodies in a dose dependent manner.

Inhibition of in vitro transcription by adenosine antibodies

Antibodies against adenosine markedly inhibited in vitro transcription in isolated BHK 21 nuclei in a dose-dependent manner. The inhibition was specific as it could be completely reversed by the addition of homologous hapten. Addition of RNA at low concentration reversed the inhibition, whereas excess DNA did not have any effect. Adenosine antibodies also inhibited in vitro transcription with calf thymus DNA and E. coli RNA polymerase. Antibodies that react with DNA but not with RNA such as anti-dpA, anti-dpC and anti-DNA failed to inhibit in vitro transcription in isolated nuclei as well as with calf thymus DNA and E. coli RNA polymerase. The results strongly indicate that the binding of adenosine antibodies to RNA is responsible for the inhibition of transcription.

Base-specific binding of adenosine antibodies to double-stranded DNA

Antibodies raised against adenosine have been reported to react with single-stranded DNA but not with double-stranded DNA. Using a highly sensitive avidin-biotin microELISA we report that these antibodies also react with double-stranded DNA. The binding was specific as it was completely inhibited by the homologous hapten. The results indicate that the antibody populations binding to ssDNA and dsDNA are not cross-reactive. The antibodies were shown to react with the topoisomers of plasmid DNA as assessed by gel retardation assay. The antibodies showed differential binding to restriction fragments of DNA indicating that some of the A residues in dsDNA are accessible to the antibodies.

[The diagnostic value of so-called "post-cholecystectomy bile duct dilatation"]

In 1706 gallstone operations the diameter of the common bile ducts was determined in 990 cases during telecholangiography using a so-called functional cholangiodiametry. The data of 213 postoperative determinations of the common bile duct diameters performed during the follow-up period did not support the existence of a postcholecystectomic compensatoric dilation of the common bile duct. Ultrasound and ERCP failed to find postoperative bile duct dilation in patients without complaints following cholecystectomy and in persons with complaints of extrabiliary origin. In conclusion we found that biliopancreatic and organic reasons (residual calculi, papillary stenosis, bile duct stenosis, chronic pancreatitis) can always be detected as the underlying cause of a significant bile duct dilation.

Studies on hypomethylation of liver DNA during early stages of chemical carcinogenesis in rat liver

Our finding that the inhibitors of DNA methylation, 5-azacytidine, 5-azadeoxycytidine or adenosine dialdehyde, given after a carcinogen all potentiated initiation suggested that hypomethylation of DNA during repair synthesis of DNA might play a role in the initiation of the carcinogenic process. To examine this aspect further, we have asked the question, do the nodules which develop from initiated cells after promotion with 1% orotic acid exhibit an altered methylation pattern in their DNA? The methylation status of the DNA from nodules has been examined using the restriction endonucleases HpaII/MspI and HhaI which distinguish between methylated and unmethylated cytosines in their nucleotide recognition DNA 5'-CCGG and 5'-GCGC respectively. The proto-oncogenes, c-myc, c-fos and c-Ha-ras, in the DNA were primarily studied in this investigation because of their possible involvement in cell proliferation and/or in cell transformation and tumorigenesis. The results indicate that in the nodule DNA, c-myc and c-fos are hypomethylated in the sequence of CCGG while the c-Ha-ras shows hypomethylation in the alternating GCGC sequence. This methylation pattern seen in the nodule DNA is not found in the DNA of the non-nodular surrounding liver or liver tissue after exposure to promoter or carcinogen alone. It is also not found in the DNA of regenerating liver. It is particularly significant that the methylation patterns in the c-myc and c-Ha-ras regions are similar to those found in several cancer tissues. The results suggest that this methylation pattern is acquired early in the carcinogenic process and raises the question whether it has any bearing on the process.

Antibodies raised against denatured DNA bind to double-stranded DNA

Antibodies raised against denatured DNA complexed with methylated bovine serum albumin have been reported to react with ssDNA but not with dsDNA. Using a highly sensitive avidin-biotin microELISA, we report that such antibodies also bind to dsDNA. Antibodies which reacted with ssDNA and dsDNA were found to be of IgG type. The antibodies did not react with tRNA and rRNA. The binding of antibodies to dsDNA was partially inhibited by individual deoxyribonucleotides. ssDNA as well as dsDNA inhibited the binding of antibodies to dsDNA. The binding of these antibodies to supercoiled and relaxed forms of pBR322 DNA was demonstrated by gel retardation assay. The cross-reaction with ssDNA was observed even after affinity purification on native DNA-cellulose. The antibodies were also shown to bind to poly(dA-dT).poly(dA-dT).

Inhibition of in vitro amino acylation and translation by adenosine antibodies

Adenosine antibodies markedly inhibited in vitro amino acylation of tRNA in a dose-dependent manner. The inhibition was specific as it was reversed by the homologous hapten. Addition of excess tRNA reversed the inhibition indicating that binding of antibodies to tRNA is responsible for inhibition. Adenosine antibodies also inhibited in vitro translation of endogenous mRNAs in rabbit reticulocyte lysate in a dose-dependent manner. The homologous hapten reversed the inhibition showing thereby the immunospecificity of inhibition.

Binding of deoxyadenylate and deoxycytidylate antibodies to double-stranded DNA

Antibodies raised against deoxyadenylate and deoxycytidylate were found to react with double stranded DNA as assessed by highly sensitive avidin-biotin microELISA. The binding was specific as it was completely inhibited by the homologous hapten. The antibodies did not react with tRNA and rRNA. These antibodies were also shown to react with supercoiled and relaxed forms of pBR322 DNA as demonstrated by gel retardation assay.

Pharmacokinetics and chemotherapeutic efficacy of adriamycin encapsulated in immunoliposomes against avian myeloblastosis virus infection

Immunoliposomes were prepared using rabbit anti-AMV gp80 IgG for the targeted chemotherapy of avian myeloblastosis virus infection. Adriamycin was encapsulated into immunoliposomes and used for in vivo studies. Comparative pharmacokinetics of free drug, drug encapsulated in free liposomes and of drug encapsulated in immunoliposomes in the virus-infected cells revealed that (i) the drug encapsulated in liposomes was cleared from the plasma slowly, and (ii) the drug encapsulated in immunoliposomes accumulated in the target tissue, the bone marrow, 5- and 8.5-fold more than the drug encapsulated in free liposomes and free drug, respectively. The drug encapsulated in immunoliposomes inactivated the virus and exhibited more chemotherapeutic efficacy as compared to controls when injected up to 24 h post-infection. However, when injected 48 h post-infection the drug encapsulated in immunoliposomes did not offer any protection against the virus infection. There is no detectable antibody response against immunoliposomes in the infected animals.

Cytotoxic activity of daunomycin and adriamycin encapsulated in immunoliposomes against avian myeloblastosis virus-infected cells

Immunoliposomes were prepared using the antibody raised against the avian myeloblastosis virus envelope glycoprotein, gp80. Adriamycin was encapsulated into immunoliposomes. More drug was delivered into target cells when the drug encapsulated in immunoliposomes was incubated with the cells. The drug encapsulated in immunoliposomes was able to inhibit the RNA synthesis twice more than free drug in the virus-transformed myeloblasts. Pre-treatment of cells with ammonium chloride, reversed the effect of drug encapsulated in immunoliposomes. The drugs encapsulated in immunoliposomes had marginal effect on the RNA synthesis of non-target cells, the yolk sac cells. Colony formation by virus-transformed cells and focus formation by virus-infected yolk sac cells was inhibited significantly by the drug encapsulated in immunoliposomes.

Studies on the interaction of cupric isonicotinohydrazide with DNA

The interaction of cupric isonicotinohydrazide (CuIIINH), an antiviral compound, with calf thymus DNA was investigated by circular dichroism (CD) and nuclear magnetic resonance (NMR). Gel electrophoresis of DNA incubated with CuIIINH showed cleavage of DNA to various extents. This cleavage was found to be time and concentration dependent. In the presence of CuIIINH the positive CD band at 274 nm disappeared and the negative band at 246 nm showed a decrease in the mean residual ellipticity value, indicating binding of CuIIINH to DNA. 31P NMR studies indicated that the binding of copper in CuIIINH is to the phosphate oxygen of the DNA backbone. The binding of CuIIINH was also found to be reversible. Addition of ethylenediaminetetraacetic acid to the CuIIINH-DNA complex resulted in breaking of the complex and restoring the original structural features of the B family of DNA in the resulting fragments. At the concentration level of CuIIINH employed, both CuSO4 and INH independently did not show any interaction with DNA.

Liposome encapsulated subunit (VP1) and virion vaccines against foot-and-mouth disease

Subunit vaccine prepared from VP1 protein of foot-and-mouth disease virus (FMDV) types 0 and Asia 1 protected guinea pigs against FMD and also induced high levels of antibody. Liposomes have been used as a safe and potent immunological adjuvant for FMD vaccines. Vaccines prepared from inactivated virus types 0 and Asia 1 encapsulated in liposomes protected guinea pigs against challenge with homologous virus and showed good antibody response in pigs on a small scale field trial.

Comparative studies on growth of foot-and-mouth disease virus types 0 and Asia 1 in BHK-21 Razi cells

Growth pattern of foot-and-mouth disease virus types 0 and Asia 1 in BHK-21 Razi cells was compared; while type 0 virus grew in high titre, Asia 1 virus was produced in low titre. Inhibition of host protein synthesis in type 0 virus-infected cells was more pronounced than in Asia 1 virus-infected cells. Foot-and-mouth disease virus type 0 infected cells showed higher lactic dehydrogenase activity when compared to Asia 1 virus. A significant decrease in virus yield was observed when Actinomycin D had been added at 50 micrograms/ml to infected cells.