Sera from children with active Henoch-Schönlein purpura can enhance the production of interleukin 8 by human umbilical venous endothelial cells

OBJECTIVE

To investigate the ability of sera from children with active Henoch-Schonlein purpura (HSP) to enhance endothelial interleukin (IL) 8 production and intercellular adhesion molecule (ICAM)-1 expression.

METHODS

Nine children with active HSP and nine normal healthy children were enrolled. IL8 serum levels of patients and controls at different stages were analysed. Production of IL8 and expression of ICAM-1 by human umbilical venous endothelial cells were detected (ELISA for IL8, flow cytometry for ICAM-1) and compared under various stimuli, including sera of patients at different stages, sera of controls, and medium alone.

RESULTS

Serum levels of IL8 were increased at the acute stage. Levels of IL8 in supernatants from human umbilical venous endothelial cells (HUVEC) co-cultured with sera from children with active HSP were significantly higher than those from HUVEC without any treatment (p = 0.001), HUVEC treated with inactive sera (p = 0.004), and HUVEC treated with sera from healthy controls (p = 0.004). Sera from patients and from controls did not enhance the expression of ICAM-1 on HUVEC.

CONCLUSIONS

Some factors may be present in sera from children with active HSP that could activate endothelial cells to produce IL8. This process may account, in part, for the mechanisms of perivascular neutrophil infiltration and leucocytosis in HSP.

Inhibition of Listeria monocytogenes in fish and meat systems by use of oregano and cranberry phytochemical synergies

Optimized phenolics from oregano and cranberry extracts were evaluated for antimicrobial activity against Listeria monocytogenes in laboratory media and in beef and fish. The antimicrobial activity increased when oregano and cranberry extracts were mixed at a ratio of 75% oregano and 25% cranberry (wt/wt) with 0.1 mg of phenolic per disk or ml, and the efficacy was further enhanced by lactic acid. The inhibition by phytochemical and lactic acid synergies was most effective when beef and fish slices were stored at 4 degrees C.

Twenty-year follow-up of the Carpentier-Edwards standard porcine bioprosthesis in the Oriental population

AIM

The 20-year period long-term results of porcine bioprosthetic valve use are limited. In addition, the majority of these reports come from Western countries. Given the scanty information reported in Oriental countries, this study was therefore designed to examine 20-year long-term results in patients who received a Carpentier-Edwards porcine bioprosthetic valve in an effort to contribute further information on the long-term clinical performance of porcine prosthetic valves from a viewpoint of results in the Oriental population.

METHODS

From July 1979 to April 2001, 82 patients received valve replacement with a standard Carpentier-Edwards porcine valve. There were 40 men and 42 women with a mean age of 42.3+/-15.1 years (range 16 to 73 years). Follow-up time extended more than 20 years (mean 10.9+/-3.2 years, range 0.5 to 21.5 years ) for a total of 719.5 patient-years.

RESULTS

The overall operative mortality was 16.9% (14 of 83 procedures). At 5, 10, 15, and 20 years, the actuarial survival rate of patients was 71.7%, 66.9%, 55.5%, and 44.4%, respectively. Actuarial estimates of freedom from structural valvular deterioration (SVD) at 5, 10, 15, and 17 years were 96.3%, 64.0%, 24.3%, and 24.3%, respectively; from reoperation 96.3%, 64.5%, 24.5%, and 24.5%; from operated valvular endocarditis 96.8%, 92.6%, 92.6%, and 92.6%; and from overall thromboembolism 96.3%, 88.5%, 67.2%, and 52.2%. In normal sinus rhythm, actuarial estimates of freedom from thromboembolism at 5, 10, 15, and 17 years were 100.0%, 100.0%, 81.8%, and 81.8%, respectively. Whereas for those in patients with atrial fibrillation, the estimates of freedom from thromboembolism were 94.5%, 82.4%, 57.7%, and 38.5%.

CONCLUSION

This study demonstrates the very satisfactory 20-year period long-term performance of freedom from bleeding events, thromboembolism (except in patients with atrial fibrillation), and valvular endocarditis in Oriental patients undergoing replacement with a porcine valve. However, the remarkable rate of SVD and reoperation ensued at 6 years after bioprosthesis implanted which does not differ from the series reported from Western countries.

Cross-limb vascular shunting as an auxiliary to major limb revascularisation

A 40-year-old male motorcyclist suffered a near-total amputation of his right foot. His limb was successfully salvaged with the aid of a cross-leg vascular shunt. Temporary arterial flow from the contralateral limb was transmitted via a pressure monitor tube to perfuse the avulsed part. This allowed the surgeon to carry out unhurried wound debridement, dissection of vital structures and skeletal fixation. The cannulation port was placed well distal to the proposed definitive anas<$>tomosis, to reduce damage to the endothelium. This procedure could be a valuable adjunct in major limb replantation, particularly in cases of prolonged ischaemia.

Effects of veratrine and paeoniflorin on isolated mouse vas deferens

In this study, we attempted to identify the interactions and mechanisms between veratrine and paeoniflorin on isolated mouse vas deferens. Paeoniflorin had no effect on isolated mouse vas deferens. Veratrine (1 x 10(-5) approximately 1 x 10(-3) g/ml) could directly induce contraction of isolated rat and mouse vas deferens. The concentration induced by veratrine (1 x 10(-5) g/ml) was completely inhibited by Ca2+-free solution and verapamil (1 x 10(-5) M), in both the epididymal and the prostatic portions of isolated mouse vas deferens. Naloxone (1 x 10(-5) M) did not alter the contraction induced by veratrine (1 x 10(-5) g/ml) in either the epididymal or the prostatic portions of isolated mouse vas deferens. Paeoniflorin (4.8 x 10(-5) g/ml) inhibited the contraction induced by veratrine (1 x 10(-5) g/ml) in both the epididymal and the prostatic portions of isolated mouse vas deferens. Paeoniflorin (4.8 x 10(-5) g/ml) potentiated norepinephrine (1 x 10(-5) M)-induced phasic contraction in the epididymal portion, but decreased contractions in the prostatic portion. Paeoniflorin (4.8 x 10(-5) g/ml) increased KCI (56 mM)-induced phasic contraction in the epididymal portion, but decreased the tonic contraction in either the epididymal or the prostatic portion. Veratrine (1 x 10(-5) g/ml)-induced contractions could be decreased by pretreatment with ryanodine (1 x 10(-5) M) in both the epididymal and the prostatic portions. Pretreatment with the combination of paeoniflorin (4.8 x 10(-5) g/ml) and ryanodine (1 x 10(-5) M) did not potentiate the inhibition of paeoniflorin in the veratrine-induced contraction in both the epididymal and the prostatic portions of isolated mouse vas deferens.

Clinical characteristics of neonatal lupus erythematosus

Neonatal lupus erythematosus is a rare disorder caused by transplacental autoantibodies from the mother to the fetus. This syndrome is characterized by congenital heart block and/or cutaneous lesion. A total of 10 cases of neonatal lupus erythematosus were diagnosed at the National Taiwan University Hospital from 1988 through 1998. The incidence of cardiac anomaly and other clinical features in patients with neonatal lupus erythemayosus in this study was compared with those in previous studies. Results showed that 50% of patients had congenital heart block and/or cutaneous lesion, which is compatible to previous statistics. However, the findings showed that 80% of the patients were female and 90% of the mothers had acquired an autoimmune disorder, which were much higher compared with that of other studies. To date, no definite treatment is suggested prenatally to prevent the occurrence of congenital heart block, but careful maternal screening and serial fetal echocardiogram are warranted.

Risk factors of wheeze and allergy after lower respiratory tract infections during early childhood

Lower respiratory tract infections (LRIs) during early childhood can lead to bronchial hyperreactivity or recurrent obstructive bronchitis. The role of LRIs in the pathogenesis of allergic diseases such as allergic rhinoconjunctivitis, atopic eczema, and bronchial asthma is less clear. The aim of this retrospective study was to determine the incidence of subsequent wheezing and atopy, and the known risk factors for allergic sensitization in 74 children hospitalized for acute LRIs of various etiologies from January 1994 through December 1994. Results showed that there are no differences in outcomes between patients with respiratory syncytial virus LRI, Chlamydia pneumoniae LRI, and LRIs caused by other agents. Although lower respiratory tract illnesses, especially those caused by respiratory syncytial virus during infancy, were associated with an increased risk of subsequent wheezing during early childhood, wheezing tended to disappear with increasing age in many children. This study also found recurrent episodes of wheezing during the first 5 years of life, and symptoms suggestive of allergic rhinoconjunctivitis were the only factors predictive of subsequent diagnosis of asthma for children who had LRIs during early childhood. In conclusion, this study suggests that prevention of recurrent wheezing LRIs and good control of allergic rhinoconjunctivitis is critical for preventing subsequent development of bronchial asthma.

The outcome of failed free flaps in head and neck and extremity reconstruction: what is next in the reconstructive ladder?

The indications for free flaps have been more or less clarified; however, the course of reconstruction after the failure of a free flap remains undetermined. Is it better to insist on one's initial choice, or should surgeons downgrade their reconstructive goals? To establish a preliminary guideline, this study was designed to retrospectively analyze the outcome of failed free-tissue transfers performed in the authors hospital. Over the past 8 years (1990 through 1997), 3361 head and neck and extremity reconstructions were performed by free-tissue transfers, excluding toe transplantations. Among these reconstructions, 1235 flaps (36.7 percent) were transferred to the head and neck region, and 2126 flaps (63.3 percent) to the extremities. A total of 101 failures (3.0 percent total plus the partial failure rate) were encountered. Forty-two failures occurred in the head and neck region, and 59 in the extremities. Evaluation of the cases revealed that one of three following approaches to handling the failure was taken: (1) a second free-tissue transfer; (2) a regional flap transfer; or (3) conservative management with debridement, wound care, and subsequent closure by secondary intention, whether by local flaps or skin grafting. In the head and neck region, 17 second free flaps (40 percent) and 15 regional flaps (36 percent) were transferred to salvage the reconstruction, whereas conservative management was undertaken in the remaining 10 cases (24 percent). In the extremities, 37 failures were treated conservatively (63 percent) in addition to 17 second free flaps (29 percent) and three regional flaps (5 percent) used to salvage the failed reconstruction. Two cases underwent amputation (3 percent). The average time elapsed between the failure and second free-tissue transfer was 12 days (range, 2 to 60 days) in the head and neck region and 18 days (range, 2 to 56 days) in the extremities. In a total of 34 second free-tissue transfers at both localizations, there were only three failures (9 percent). However, in the head and neck region, seven of the regional flaps transferred (47 percent) and four cases that were conservatively treated (40 percent) either failed or developed complications that lengthened the reconstruction period because of additional procedures. Six other free-tissue transfers had to be performed to manage these complicated cases. Conservative management was quite successful in the extremities; most patients' wounds healed, although more than one skin-graft procedure was required in 10 patients (27 percent). In conclusion, a second free-tissue transfer is, in general, a relatively more reliable and more effective procedure for the treatment of flap failure in the head and neck region, as well as failed vascularized bone flaps in the reconstruction of the extremities. Conservative treatment may be a simple and valid alternative to second (free) flaps for soft-tissue coverage in extremities with partial and even total losses.

Myasthenia gravis and Waldenström's macroglobulinemia: a case report and review of the literature

An elderly man with ocular type myasthenia gravis (MG) was found to have monoclonal gammopathy (IgM). Waldenström's macroglobulinemia (WM) was proven later. This is the second case report of MG associated with WM. However, this case is unique due to the presence of anti-acetylcholine receptor (anti-AChR) antibody (IgG). MG is considered to be an autoimmune disease and WM an immunoproliferative disorder. The association of MG and WM is not clear.

Microsurgical tissue transplantation or replantation in patients with psychoneurological impairment

Sometimes patients with a psychoneurological impairment present with a traumatic injury that requires either microsurgical replantation or free-tissue transfer. We reviewed 38 patients undergoing 40 microvascular operations; the patients included 26 patients with psychological impairment (group 1), 3 with mental disability (group 2), and 9 with an acquired head injury and consciousness disturbance (Glasgow Coma Scale score < or =14) (group 3). Patients with a psychological impairment, especially those with a self-inflicted injury, are often uncooperative and do not recognize the necessity of restorative procedures. A multidisciplinary approach by the trauma surgeon, plastic surgeon, psychiatrist, and neurosurgeon, with coordinated assistance from the physician, nurse, therapist, and family, is required for treatment. In our study the success rate of replantation was 77.8 percent (14 of 18); for free tissue transfer the success rate was 95.5 percent (21 of 22). The overall success rate of microsurgical procedures (87.5 percent, 35 of 40) was similar to that in the population at large. Patients with psychological impairment tend to be lost during follow-up; therefore, their functional results may be poorer than expected. Nonetheless, patients with psychological impairment should not be deprived of the benefits of restorative surgery.

Rehabilitation fees, length of stay and efficiency for hospitalized stroke patients: a preliminary study based on function-related groups

The purpose of this study was to examine the relationships between severity of disability and factors such as rehabilitation fees, length of stay and efficiency for hospitalized stroke patients. One hundred and seven first-time stroke patients were studied consecutively for this study. They were recruited from a rehabilitation ward in a university medical center during 1997. Functional ability was evaluated using the Functional Independence Measure (FIM) instrument on admission and discharge. Stroke patients who presented with similar degrees of disability were put together using the admission FIM score (FIM Function-Related Groups, FIM-FRGs) for further analysis. Twenty-eight (26.2%) patients examined were categorized as severely disabled (scored 18-36), 48 (44.8%) moderately disabled (scored 37-72) and 31 (29.0%) mildly disabled (scored 73-126). The average expense on rehabilitation fees, for the average rehabilitation length of stay (LOSR) of 34.7 +/- 16.7 days, was NT$ 27,645 +/- 13,812. The FIM score improved from 56.8 +/- 24.2 on admission to 76.6 +/- 26.2 at discharge, with a rehabilitation efficiency index (EIR) of 0.7 +/- 0.7. Further analysis indicated that there were significant differences among the three disability groups on rehabilitation fees and LOSR while EIR was unaffected. The findings of this study suggest that FIM-FRGs can differentiate different rehabilitation needs in terms of rehabilitation fees and LOSR; therefore, a prospective case payment system based on FIM-FRGs is suggested for stroke rehabilitation reimbursement scheme in the future.

A double-blind, placebo-controlled, and randomized study of loratadine (Clarityne) syrup for the treatment of allergic rhinitis in children aged 3 to 12 years

Allergic rhinitis is a common disease in children, and antihistamines are the key medication. However, traditional tablets are not convenient and lead to low compliance in young children. The aim of this double-blind, placebo-controlled, parallel, randomized study was to evaluate the effectiveness and safety of loratadine syrup for the treatment of children aged 3 to 12 years with allergic rhinitis. Sixty children with allergic rhinitis due to dust mites were enrolled. They were randomized into 2 parallel groups: one group received loratadine syrup 5 mg or 10 mg daily for 3 weeks, and the other group received placebo. The patients returned to special clinics for symptoms evaluation at day 7 and day 21, and the parents were requested to record disease severity daily. Both evaluations, physician's and parents', were recorded with a 4-point scale for 5 symptoms: sneezing, rhinorrhea, nasal congestion, nasal itching and ocular symptoms. Forty-six patients completed the study, 22 in the loratadine group and 24 in the placebo group. At the initial visit, the total symptom score (TSS) in both groups was not significantly different (p = 0.39). The TSS of the loratadine syrup group at day 7 and day 21 was lower than those of the placebo group (p = 0.003, p = 0.06). The daily card scores in the experimental group were also significantly lower than those of the placebo group (week 1, p = 0.014; week 2, p = 0.029; week 3, p = 0.014). No adverse reactions were recorded in both groups. This study revealed that loratadine syrup 5 mg or 10 mg once a day improved symptom scores of children with allergic rhinitis effectively and safely.

Comparative anti-caries effects of tablet and liquid fluorides in cleft children

Children with cleft lip and/or palate are at a higher risk for developing caries of the primary incisors compared with non-cleft children. To determine whether fluoride in tablet or liquid form would be more efficacious with children with cleft lip and/or palate, a two-year clinical investigation was conducted to test the anti-caries effects. One-hundred and fifteen cleft children (59 boys and 56 girls) between 22 and 26 months old were randomly selected into control, tablet and liquid fluoride groups. The amount of administered fluoride was 0.25 mg F daily in non-fluoridated Taiwan. Dental examinations were conducted using mirrors and #23 explorers. Caries were assessed using the DMF index in the baseline, first year and second year. The results showed that children in the tablet and liquid groups had a significantly lower DMFT increment than in the control group (p < 0.05). In the DMFS index, children in the liquid group showed a significantly lower caries increment than in the control group (p < 0.01), and children in the tablet group presented a borderline, but non-significant statistical difference when compared with the control group (p = 0.065). No significant statistical difference was found in either DMFT or DMFS between tablet and liquid fluoride administrations (p = 0.521 and p = 0.383, respectively). It is concluded that dietary fluoride supplements in liquid form show efficacy in reducing early childhood caries in the cleft children. Liquid fluoride showed slightly better numerical anti-caries effect than tablet fluoride, which is possibly due to its ease of administration with small children.

Undiagnosed glucose intolerance encountered in clinical practice: reappraisal of the use of the oral glucose tolerance test

BACKGROUND

In 1997, the Expert Committee of the American Diabetes Association (ADA) revised the diabetes mellitus (DM) diagnostic criteria to facilitate the diagnosis of DM on the basis of fasting plasma glucose (PG). The major purpose of the study is to evaluate if oral glucose tolerance test (OGTT) is still needed after the revision of criteria.

METHODS

From September 1994 to March 1995, 247 ambulatory subjects referred by clinicians for 75-g OGTT were recruited for the study. Fasting and 2-h PG and serum insulin concentrations were determined. Additional fasting blood samples were collected for the measurement of HbA1c. We used the receiver operating characteristic (ROC) curve to locate a cut-point of fasting PG corresponding to 2-h PG of 200 mg/dl.

RESULTS

The optimal fasting PG level depicted by ROC curve was more than 105 mg/dl, giving 80.6% sensitivity and 85.6% specificity for the diagnosis of DM in clinical setting. If fasting PG > or = 126 mg/dl was employed, the specificity was 98.3% but the sensitivity went down to 42.6%. High rates of glucose intolerance would remain undiagnosed in subjects with fasting PG less than 126 mg/dl (41.6% of them being IGT and 38.6% DM), if the OGTT was exempted from clinical practice. HbA1c more than 6.2% could be a clue to recognize undiagnosed DM, but was unable to separate impaired glucose tolerance (IGT) from non-DM.

CONCLUSIONS

In the population studied, undiagnosed glucose intolerance can still be encountered in a large number of subjects with fasting PG less than 126 mg/dl. OGTT is still indispensable in clinical setting for the diagnosis of DM and IGT after the revision of diagnostic criteria.

Acute lupus pneumonitis mimicking pulmonary tuberculosis: a case report

We report a case of systemic lupus erythematosus in a 15-year-old girl with initial presentation as acute lupus pneumonitis. A fulminant course with pancytopenia and respiratory distress were developed 3 weeks after symptom onset. Chest radiographs revealed an interstitial pattern with miliary nodules over bilateral lower lung fields that mimics miliary tuberculosis. The patient was treated with intravenous immunoglobulin and antituberculosis drugs because the infection-associated hemophagocytic syndrome and pulmonary tuberculosis could not be excluded from the clinical course. The response to antituberculosis treatment, however, was poor and her respiratory condition deteriorated rapidly to impending respiratory failure 1 week after admission. Systemic lupus erythematosus with acute lupus pneumonitis was then diagnosed based on the fulminant clinical course and accordant laboratory results. Corticosteroid (methylprednisolone) and cytotoxic agent (cyclophosphamide) pulse therapies were applied twice and once, respectively. She recovered gradually after receiving the immunotherapy.

ATM-dependent phosphorylation of human Rad9 is required for ionizing radiation-induced checkpoint activation

ATM (ataxia-telangiectasia-mutated) is a Ser/Thr kinase involved in cell cycle checkpoints and DNA repair. Human Rad9 (hRad9) is the homologue of Schizosaccharomyces pombe Rad9 protein that plays a critical role in cell cycle checkpoint control. To examine the potential signaling pathway linking ATM and hRad9, we investigated the modification of hRad9 in response to DNA damage. Here we show that hRad9 protein is constitutively phosphorylated in undamaged cells and undergoes hyperphosphorylation upon treatment with ionizing radiation (IR), ultraviolet light (UV), and hydroxyurea (HU). Interestingly, hyperphosphorylation of hRad9 induced by IR is dependent on ATM. Ser(272) of hRad9 is phosphorylated directly by ATM in vitro. Furthermore, hRad9 is phosphorylated on Ser(272) in response to IR in vivo, and this modification is delayed in ATM-deficient cells. Expression of hRad9 S272A mutant protein in human lung fibroblast VA13 cells disturbs IR-induced G(1)/S checkpoint activation and increased cellular sensitivity to IR. Together, our results suggest that the ATM-mediated phosphorylation of hRad9 is required for IR-induced checkpoint activation.

Solitary fibrous tumor of the liver

Solitary fibrous tumor of the liver is a rare neoplasm. So far, 21 cases have been described in the English literature. We reported an additional case. Our patient, a 75-year-old man, suffered from abdominal fullness and body weight loss of 6 kg over 6 months, and chills and fever for 2 months. Hypoglycemia was noted at admission. Both abdominal sonography and CT showed a huge mass occupying the right lobe of liver. Liver biopsy showed fibrous tumor. Right lobectomy was performed and the tumor was resected. Pathological examination showed spindle-shaped and fibroblast-like cells within the collagenous stroma. On immunohistochemical stains, these spindle tumor cells showed CD34 positive reactivity. The post-operative course was uneventful and there was no more hypoglycemia. The patient recovered smoothly, regained his body weight, and was alive without evidence of disease recurrence at the last follow-up visit in November, 2000.

Intractable ventricular tachycardia in a patient with left ventricular epicardial lipoma

Primary cardiac lipomas are rare and are often reported as incidental findings during operations or autopsies. Lipoma-induced arrhythmia, especially ventricular tachycardia (VT), is an unusual complication of primary cardiac lipoma. We describe the case of a 43-year-old woman who presented with VT without any cardiac abnormality except for a left ventricular tumor. Electrophysiologic study (EPS) failed to detect the origin of the arrhythmia, although VT could be induced by EPS preoperatively. Due to suspicion of a relationship between the tumor and the VT, wide tumor resection was performed using cardiopulmonary bypass support. The excised lipoma measured about 10 x 8 x 3 cm and weighed 120 g, and was without pathohistologic evidence of malignant change. The patient was well without further postoperative need for antiarrhythmic drugs at 36 months' follow-up, and VT was no longer inducible on subsequent EPS mappings.

Effects of paeoniflorin on the formalin-induced nociceptive behaviour in mice

In this study, we attempted to identify the mechanisms of paeoniflorin on antinociceptive effects in mice. Paeoniflorin (48, 96, 240, 480 microg, i.c.v.) showed dose-related antinociception both on the early and late phases of formalin test in mice. Moreover, paeoniflorin (48 microg, i.c.v.) could potentiate the antinociception of morphrine (0.5, 1.0 mg/kg, s.c.) in the formalin test. However, the antinociceptive effects of paeoniflorin were not potentiated by L-arginine (600 mg/kg, i.p.) or antagonized by beta-funaltrexamine (beta-FNA) (10 microg, i.c.v.), ICI-174,864 (1 microg, i.c.v.) and ryanodine (10 ng, i.c.v.) on both the early and late phases of formalin test. L-NAME (75 mg/kg, i.p.) could reverse the effect of paeoniflorin on the late phase of formalin test. Naloxone (1 mg/kg, i.p.) and nor-binaltorphimine (nor-BNI) (1 microg, i.c.v.) could block the paeoniflorin-induced antinociception on the early phase of formalin test. These results suggested that the central antinociceptive effects of paeoniflorin on formalin test in mice were mediated by the activation of kappa-opioid receptor and not related to the increase of intracellular calcium.

Radix Angelica Sinensis extracts ameliorate scopolamine- and cycloheximide-induced amnesia, but not p-chloroamphetamine-induced amnesia in rats

The effects of the methanolic extract of Radix Angelica Sinensis (Umbellifera) (abbreviated as RAS extract) and n-hexane fraction of RAS extract (RAS(H) fraction) on the various drugs-induced amnesia in rats were studied by using passive avoidance task. RAS extract (1 g/kg) significantly prolonged the shortened step-through latency induced by SCOP and CXM, but not PCA. Furthermore, RAS(H) fraction (1 g/kg) also significantly prolonged the shortened step-through latency induced by SCOP and CXM but not PCA. RAS extract at any dose alone did not influence the step-through latency in the training trial produced by non-shocked rats, but it plus PCA prolonged the latency compared with PCA alone. However, RAS(H) fraction (1 g/kg) prolonged the latency in the training trial produced by non-shocked rats, but it plus any induced drugs did not differ from any induced drugs alone. These results suggest that the attenuating effects of RAS extract on the various drugs-induced amnesia were related to the memory processes. n-Hexane fraction of RAS extract might be one of the active fractions of RAS extract in the treatment of amnesia.

Beta2-agonist exerts differential effects on the development of cord blood T cells but not on peripheral blood T cells

Asthma is a chronic inflammatory disease characterized by reversible airway obstruction caused by edematous airway lining, thickened mucosal secretions, and smooth muscle constriction. Beta2-adrenoceptor agonists are widely used in the treatment of bronchial asthma because of their ability to induce relaxation of airway smooth muscle. Evidence indicates that desensitization and down-regulation of beta-adrenoceptors occurs in long-term beta2-agonist therapy, and these medications were thought to cause increased severity of, and mortality in, asthma. The purpose of this study was to delineate further the potential adverse effects of beta2-agonists on the development of T lymphocytes. T cells isolated from umbilical cord blood and adult peripheral blood were cultured in the presence of salbutamol. Intracellular staining with fluorescence-labeled antibodies was used to differentiate the frequency of type 1 T-helper (Th1) and type 2 T-helper (Th2) cells. The results showed a statistically significant inverse relationship between the concentration of salbutamol and the ratio of Th1 over Th2 on cord blood T cells. However, this trend was not observed in adult peripheral blood T cells. The data revealed another potential adverse effect in which chronic beta2-agonist exposure predisposed differentiation of T lymphocytes towards Th2 while that of Th1 was relatively suppressed, especially in cord blood T cells. Hence, beta2-agonists, despite their effect in symptomatic rescue in asthma, should not be used indiscriminately as long-term therapeutic agents.

Effects of fluoride chewing gum on stimulated salivary flow rate and fluoride content

BACKGROUND

The purposes of this study were to measure the stimulated salivary flow rates generated by sorbitol gum, fluoride gum and paraffin wax control, and to assess the salivary fluoride clearance pattern in fluoride chewing gum.

METHOD

Six healthy subjects were instructed to chew paraffin wax control and sorbitol gum and fluoride gum (0.1 mg F/stick) 5 times per day for the experimental periods--21 days. Stimulated saliva samples were collected for each subject at 7, 14, 21 days at 3 pm after chewing of the gum. The saliva was collected at 1, 3, 5, and 8 minutes after the subject started chewing the wax or gum. Flow rates for each group and salivary fluoride content of the fluoride chewing gum were measured.

RESULTS

The overall mean salivary flow rates for the control, sorbitol gum and fluoride gum were 1.7 +/- 0.6, 2.0 +/- 0.6, and 2.1 +/- 0.7 ml/min respectively. The mean stimulated flow rate for fluoride gum was found significantly higher than that of the control (p = 0.002). However, no significant differences appeared between the control and sorbitol gum (p = 0.104), and sorbitol gum and fluoride gum (p = 0.563). The mean fluoride concentrations at different intervals during eight minutes of chewing fluoride gum were between 1.8 and 4.2 ppm.

CONCLUSION

Chewing fluoride-containing chewing gum releases fluoride at a low concentration in saliva. Fluoride chewing gum combining a salivary stimulator and caries prevention agent is a perspective method of caries prevention.

Childhood Churg-Strauss syndrome: report of a case

Churg-Strauss syndrome (CSS) (allergic granulomatosis and angitis) is an uncommon form of systemic vasculitis, which is rare in children. It is characterized by peripheral blood hypereosinophilia, systemic necrotizing vasculitis, and a preceding history of bronchial asthma. We described a boy with initial presentation of poorly controlled bronchial asthma, allergic rhinitis, recurrent sinusitis and several episodes of hemoptysis since the age of 9. He then developed purpuric skin lesions, generalized soreness, and symptoms of mononeuritis multiplex at age 11. On admission to our hospital at the age of 12, he developed marked pericardial effusion. After a series of studies including chest computed tomography (CT), skin biopsy, nerve conduction study, and serological tests for autoantibodies, CSS was diagnosed. Thereafter, he received regular corticosteroid therapy, and his symptoms were generally well-controlled with occasional acute exacerbation. The clinical characteristics, diagnosis and management of CSS in children are also reviewed.

Increased transforming growth factor-beta (TGF-beta)-secreting T cells and IgA anti-cardiolipin antibody levels during acute stage of childhood Henoch-Schönlein purpura

Henoch-Schönlein purpura (HSP) is a small vessel vasculitis characterized by increased serum IgA and IgA-dominant immune complex deposition in lesions. The involvement of IgA implies a probable role for TGF-beta, a major factor in IgA production, in the pathogenesis of HSP. Among IgA antibodies, serum IgA anti-cardiolipin antibodies (aCL) have been found in many diseases, including vasculitis. In addition to the clinical presentations and laboratory parameters, we further investigated the roles of IgA aCL and TGF-beta in childhood HSP. Twenty-six Chinese children with the diagnosis of HSP were enrolled. Blood samples from these patients were collected at both acute and convalescent stages. Intracellular staining of lymphocytes was performed to enumerate type 1 (interferon-gamma-secreting), type 2 (IL-4-secreting), and type 3 (TGF-beta-secreting) helper T cells. Serum levels of TGF-beta were detected by ELISA. Serum IgA aCL of 21 of 26 patients at the acute stage, 11 of them at the convalescent stage, were measured by ELISA. The data showed that IgA aCL serum levels were significantly elevated in patients compared with healthy controls (P < 0.001), and those patients at the convalescent stage (P < 0.001). In addition, TGF-beta-secreting T cells were significantly elevated during the acute stage, and decreased at the convalescent stage. Although more studies are needed, the high prevalence of IgA aCL and increased TGF-beta-secreting T cells in children with acute HSP revealed some points which should permit a better understanding of the pathogenesis of HSP.