Acute exacerbation in patients with liver cirrhosis: a clinicopathological study

The incidence, clinicopathologic features and etiology of acute exacerbation occurring in patients with liver cirrhosis were assessed prospectively among 332 hepatitis B surface antigen (HBsAg) positive and 71 HBsAg negative patients. During an 11-year period and a mean follow-up duration of 26.8 months, 148 acute exacerbation occurred in 107 HBsAg positive patients and 32 episodes occurred in 18 HBsAg negative patients. The calculated annual incidence was 11.5%. The clinical, laboratory and histologic features were similar to those in patients with chronic hepatitis. Confluent hepatic necrosis and alphafetoprotein elevation over 100 ng/ml occurred frequently, particularly in HBeAg positive patients. In general, acute exacerbations in HBsAg negative patients were less severe than their HBsAg positive counterparts. Of the exacerbations in HBsAg positive patients, 54.8% of the HBeAg positive ones and 38.6% of the HBeAg negative ones were attributable to hepatitis B virus reactivation, while 4.8% and 7.9%, respectively, were due to hepatitis delta virus superinfection. The others might be the results of hepatitis non-A, non-B virus superinfection or increased piecemeal necrosis. The immediate outcome of acute exacerbations in cirrhotic patients was usually good, although 13.8% developed hepatic decompensation and 4.4% died. Further follow-up study is required to evaluate the long-term effect of the frequent occurrence of bridging hepatic necrosis, high elevation of alphafetoprotein and hepatic decompensation during acute exacerbation in cirrhotic patients.

Oral complications associated with endotracheal general anesthesia

A series of 745 consecutive cases of endotracheal anesthesia were collected at the National Taiwan University Hospital. Evaluation of the oral conditions was performed before, during and after the anesthesia. Injuries to oral structures were recorded. An 18% incidence of oral injuries was noted and the frequency for dental damage was 12.1%. Maxillary incisors, especially the left ones, were accident-prone. Risk factors identified in this study included large decay or restoration, advanced periodontitis, presence of dental prosthesis, shedding deciduous tooth, class II jaw relationship and anterior crowding. More than one third of the complications occurred during the maintenance or emergence stage of the anesthesia. Recommendations for prevention and management of this problem were given.

Genotype-restricted growth and aging patterns in hematopoietic stem cell populations of allophenic mice

We have studied contributions to hematopoiesis of genetically distinct stem cell populations in allophenic mice. Chimeras were made by aggregating embryos of inbred strains known to differ with respect to stem cell population kinetics. One partner strain (DBA/2) has previously been shown to normally have a stem cell (CFU-S) population of which 24% are in S-phase of the cell cycle, whereas the homologous population of the other partner strain (C57BL/6) was characterized by having only 2.6% in cycle (7). Contributions of the chimeric stem cell population to mature blood cell pools were studied throughout the life of the mice and intrinsic differences in stem cell function and aging were reflected in dynamic patterns of blood cell composition. The DBA/2 stem cell population was eclipsed by stem cells of the C57BL/6 genotype and, after 1.5-3 yr, the hemato-lymphoid composition of 22 of 27 mice studied for this long had shifted by at least 25 percentage points toward the C57BL/6 genotype. 8 of the 27 had hematolymphoid populations solely of C57BL/6 origin. To test whether or not a population of stem cells with an inherently higher cycling rate (DBA/2) might have a competitive advantage during repopulation, we engrafted allophenic marrow into lethally irradiated (C57BL/6 x DBA/2)F1 recipients. DBA/2 hematopoiesis was predominant early, far outstripping its representation in the marrow graft. Perhaps as a consequence of inherently greater DBA/2 stem cell proliferation, the populations of developmentally more restricted precursor populations (CFU-E, BFU-E, CFU-GM, CFU-GEMM) showed an overwhelming DBA/2 bias in the first 2-3 mo after engraftment. However, as in the allophenic mice themselves during the aging process, the C57BL/6 genotypic representation was ascendant over the subsequent months. The shift toward C57BL/6 genotype was first documented in the marrow and spleen precursor cell populations and was subsequently reflected in the circulating, mature blood cells. Bone marrow-derived stromal cell cultures from engrafted mice were studied and genotypic analyses showed donor representation in stromal cell populations that reflected donor hematopoietic contributions in the same recipient. Results from these studies involving two in vivo settings (allophenic mice and engraftment by allophenic marrow) are consistent with the notion that a cell autonomous difference in stem cell proliferation confers on one population a competitive repopulating advantage, but at the expense of longevity.

Clinical features of rheumatic carditis in adolescents and adults

A retrospective study on the clinical features of acute rheumatic fever (RF) with carditis in 45 patients, 15 years of age and older (range 15-61), is described. Nineteen patients were seen at initial attack; the remaining 26 patients (28 recurrences) were admitted because of RF recurrence. Of the total 47 episodes, carditis was manifested by a significant murmur without previous RF or any known rheumatic heart disease in 40%; change in the character of a murmur under observation or the appearance of a new murmur in 15%; and acute pericarditis in 19%. Congestive heart failure of recent onset was noted in 85% of the episodes, while classical polyarthritis or polyarthralgia occurred in 57%. The aortic valve was newly damaged or preexisting aortic regurgitation worsened in 12 episodes. Twenty-nine patients were followed for 1/2-16 years. Of 11 patients with an initial attack who were maintained on regular prophylaxis (intramuscular benzathine penicillin 1,200,000 units every 4 weeks), the mitral valve murmur disappeared in 3 and none of the patients had recurrence. Of the remaining 18 patients with no or incomplete prophylaxis, 1 died from congestive heart failure 6 months later, and 3 had recurrences with involvement of the aortic valve. In conclusion, RF with carditis in adolescents and adults in our practice at the National Taiwan University Hospital is likely to show more cardiac problems and complications than that seen in the West. Although active rheumatic carditis among this patient population is relatively uncommon, recurrences with subsequent involvement of the aortic valve (aortic regurgitation) do occur.(ABSTRACT TRUNCATED AT 250 WORDS)

Idiotype-specific T helper clones recognize a variable H chain determinant

Previously we described a Th clone specific for a regulatory idiotype on 3A4, an anti-Id mAb that mimics a murine L1210/GZL tumor-associated Ag. In our studies, we determined the molecular target on the stimulating anti-Id antibody that is recognized by the Th clone. The Th clone responds with proliferation to the H chain of 3A4 but not to the L chain. Furthermore, the 3A4 chain stimulates this Th clone more efficiently than either the intact 3A4 or the Fab fragments, and the presentation by APC of the H chain is more resistant to chloroquine treatment than the presentation of the intact 3A4 molecule. These results suggest that regulatory T cells "see" their target idiotopes as linear sequence determinants present on isolated Ig chains, and show that this might have biologic advantages with respect to the mechanism of Ag presentation.

Temporal feature extraction and clustering analysis of electromyographic linear envelopes in gait studies

A technique for automatically clustering linear envelopes of the EMG during gait has been developed which uses a temporal feature representation and a maximum peak matching scheme. This new technique provides a viable way to define compact and meaningful EMG waveform features. The envelope matching is performed by dynamic programming, providing qualitatively the largest numbers of matched peaks and quantitatively a minimum distance measurement. The resulting averaged EMG profiles have low statistical variation and can serve as templates for EMG comparison and further classification.

Idiotype-specific T helper clones recognize a variable H chain determinant

Previously we described a Th clone specific for a regulatory idiotype on 3A4, an anti-Id mAb that mimics a murine L1210/GZL tumor-associated Ag. In our studies, we determined the molecular target on the stimulating anti-Id antibody that is recognized by the Th clone. The Th clone responds with proliferation to the H chain of 3A4 but not to the L chain. Furthermore, the 3A4 chain stimulates this Th clone more efficiently than either the intact 3A4 or the Fab fragments, and the presentation by APC of the H chain is more resistant to chloroquine treatment than the presentation of the intact 3A4 molecule. These results suggest that regulatory T cells "see" their target idiotopes as linear sequence determinants present on isolated Ig chains, and show that this might have biologic advantages with respect to the mechanism of Ag presentation.

Idiotype matching: correlation of expression of protective idiotype in sera with survival of tumor mice

A monoclonal anti-Id, 2F10, has previously been shown to protect against transfer of L1210/GZL tumor cells in DBA/2 mice and also to have therapeutic effects in mice with growing tumor. In this study we have measured expression of an idiotope which reacts with a tumor-protective anti-idiotypic antibody, 2F10, in the sera of mice bearing the L1210/GZL tumor. The levels of antibodies binding to 2F10, referred to as the "2F10 idiotope," are different in individual mice and also fluctuate over time. A statistical analysis demonstrated a significant correlation between these changes in 2F10 levels in mice with tumors and their survival times. Increasing 2F10 idiotope in sera of tumor mice correlated with long-term survival, whereas a decreasing trend was found in mice which died shortly after tumor transfer. Correlations between the 2F10 idiotope and survival were observed in groups of mice which had received surgery, cyclophosphamide, a combination of cyclophosphamide and anti-idiotype, or no treatment at all. No correlation between a nonrelated idiotope and survival was noted. Although 2F10 is an idiotope expressed by an anti-tumor-associated Ag antibody, the correlation between anti-tumor-associated Ag titers and survival was significantly lower than that between the 2F10 idiotope and survival. This demonstrates that 2F10 is preferentially associated with antibodies which are involved in tumor regression. Thus, the 2F10 idiotope in sera of tumor-bearing mice has predictive value for survival and tumor regression.

Idiotype matching: correlation of expression of protective idiotype in sera with survival of tumor mice

A monoclonal anti-Id, 2F10, has previously been shown to protect against transfer of L1210/GZL tumor cells in DBA/2 mice and also to have therapeutic effects in mice with growing tumor. In this study we have measured expression of an idiotope which reacts with a tumor-protective anti-idiotypic antibody, 2F10, in the sera of mice bearing the L1210/GZL tumor. The levels of antibodies binding to 2F10, referred to as the "2F10 idiotope," are different in individual mice and also fluctuate over time. A statistical analysis demonstrated a significant correlation between these changes in 2F10 levels in mice with tumors and their survival times. Increasing 2F10 idiotope in sera of tumor mice correlated with long-term survival, whereas a decreasing trend was found in mice which died shortly after tumor transfer. Correlations between the 2F10 idiotope and survival were observed in groups of mice which had received surgery, cyclophosphamide, a combination of cyclophosphamide and anti-idiotype, or no treatment at all. No correlation between a nonrelated idiotope and survival was noted. Although 2F10 is an idiotope expressed by an anti-tumor-associated Ag antibody, the correlation between anti-tumor-associated Ag titers and survival was significantly lower than that between the 2F10 idiotope and survival. This demonstrates that 2F10 is preferentially associated with antibodies which are involved in tumor regression. Thus, the 2F10 idiotope in sera of tumor-bearing mice has predictive value for survival and tumor regression.

Changes in timing of fertility--a Canadian experience

This paper examines the patterns of timing of births of women using data from the Canadian Fertility Survey of 1984. Semi-Markovian schemes are applied to the maternity histories of the 5315 sample women in their reproductive ages in order to measure the intensity and timing of childbearing. Age-and-duration-specific transition probabilities are found to have substantially changed for the more recent birth cohorts compared to the older cohorts.

Cotyledon Cells and Seed Growth Relationships in CO2-enriched Peanut1

Seed size is a dynamic component of seed yield. Factors affecting seed size in peanut (Arachis hypogaea L.) are not well defined. The objectives of this study were to investigate the effects of CO2 enrichment and timing of pod formation on cotyledon cell and seed growth in virginia-type peanut. The results indicated that the number of cotyledon cells was relatively constant across all the treatments. However, size of cotyledon cells and seed growth rate (SGR) increased in the pods developed in high CO2 conditions. Striking differences in both cell size and SGR also existed between early and late formed pods. Our data indicate that assimilate supplies strongly limit cotyledon cell size, and accordingly affect SGR and final seed size

[Dissecting aneurysm of the aorta associated with local consumption coagulopathy]

Dissecting aneurysm of the aorta associated with local consumption coagulopathy is a rare clinical entity. We report one such case, a 71-year-old man with DeBakey type I aortic dissection and bleeding tendency. This patient had aortic dissection 4 years previous, and had developed a bleeding tendency in the last 2 years. Both computed tomographic scan and digital subtraction angiographic studies revealed DeBakey type I aortic dissection starting at the ascending aorta and extending all the way down to the renal artery, with an inlet at the aortic arch. The area of false lumen was larger than that of the true lumen, and thrombi were noted within the false lumen. A detailed blood coagulation study of this patient showed thrombocytopenia and coagulopathy. Blood coagulation studies in an additional 13 patients, who were seen at NTUH during the past 1 year with aortic dissection, but without the bleeding tendency, revealed no sign of coagulopathy. From analysis of these patients, we note that a large surface area in a false lumen, thrombus formation within a false lumen and blood flow into a false lumen with stasis seem to be the major determinants for causing coagulopathy in patients with aortic dissection. The treatment of aortic dissection with bleeding tendency caused by local consumption coagulopathy is graft replacement of the aneurysm. Hemostatic abnormalities may cause excessive blood loss during surgical operation, and careful and meticulous management of hemostasis are required.

Prediction of risk for human developmental toxicity: how important are animal studies for hazard identification?

To determine how developmental toxicity studies in animals can be used in human risk assessment, a data base was assembled from the literature. It included probable, suspected, unknown, and probably negative teratogenic or embryotoxic drugs and chemical compounds. For each of 175 substances, we recorded the results of any developmental toxicity testing in up to 14 animal species and any reports of mutagenicity or carcinogenicity. Logistic regression and discriminant analysis were used to predict a compound's effect in humans. A measure of the number of positive animal studies and bacterial mutagenicity were important predictors in both models, as were the specific results in hamsters and subhuman primates. The fact that a compound had been tested at all in subhuman primates was more important in predicting human risk than was the result itself. The methods used correctly classified the study compounds 63-91% of the time, depending upon how the suspicious and unknown compounds were treated. The models had a sensitivity of 62-75%, a positive predictive value of 75-100%, and a negative predictive value of 64-91%. These findings imply that studies in laboratory animals carry weight in predicting human developmental toxicity. The more animal species in which a compound is positive, the more likely it is to have a human effect, albeit not the same effect as in the animals. Clinicians should not ignore developmental toxicity tests in animals "because laboratory rats are not like humans."

Clinical and experimental studies of coronary heart disease treated with yi-qi huo-xue injection

The purpose of the present work was to evaluate the clinical efficacy and the mechanism of Yi-qi Huo-xue Injection (YHI) in treatment of coronary heart disease. YHI consists of Ginseng, Astragalus and Angelicae Sinensis. The 10% dextrose serves as a placebo. The results were as follows: 1. the frequency and severity of angina episodes were reduced by 90.63%; 2. the ischemic ST-T in ECG was improved in 56.25% of cases; 3. the tolerance to treadmill exercise was increased from 348.50 to 503.50 M.; 4. the left ventricular function was strengthened, PEP/LVET ratio reduced from 0.45 to 0.36, the activity of (Na(+)-K+) ATPase in myocardial cell membrane of rats inhibited by 19.2%; 5. the blood viscosity and erythrocyte electrophoretic time lowered; 6. the adhesion and aggregation of platelet in patients with CHD were inhibited by 27% and 59.4% respectively; 7. the plasma TXB2 level in CHD was reduced from 260.28 +/- 164.4 to 139.29 +/- 57.01 pg/ml; 8. the plasma 6-keto-PGF1 alpha level in CHD was increased from 33.45 +/- 22.5 to 57.48 +/- 13.1 pg/ml, and in rats from 185.77 to 366.33 pg/ml. The differences were all statistically significant (P less than 0.05-0.01) in comparison with the placebo group.

Tumor idiotype vaccines. VI. Synergistic anti-tumor effects with combined "internal image" anti-idiotypes and chemotherapy

Anti-Id antibodies that have biologic activity as stimulators of specific immunity have been used in experimental vaccines and tumor protection models. However, very little is known about the therapeutic potential of anti-Id antibodies in animals and men. In this study we explored the combination of anti-Id and chemotherapy in a murine tumor system for which we had previously generated protective anti-Id mAb. First, we investigated various protocols by using a protective anti-Id in active immunization. Mice preimmunized before tumor transfer and challenged again after tumor survived significantly longer. Next, we explored the use of soluble anti-Id as immunostimulator in tumor-bearing mice. Although this treatment did not induce long-term survival, it significantly increased survival time. Interestingly, this anti-Id effect was dose dependent, whereby large and small doses had no effect. Finally, stimulatory anti-Id therapy and cyclophosphamide (Cy) treatment was combined. Tumor bearing mice were given a single dose of Cy followed by different doses of soluble anti-Id. The optimal effect on tumor growth and survival was achieved with 80 mg/kg Cy and 10 micrograms/mouse of anti-Id, where 80% of mice survived longer than 100 days. These results provide guidelines for developing clinical protocols for cancer patients by using combination therapy of anti-Id and chemotherapy.

Tumor idiotype vaccines. VI. Synergistic anti-tumor effects with combined "internal image" anti-idiotypes and chemotherapy

Anti-Id antibodies that have biologic activity as stimulators of specific immunity have been used in experimental vaccines and tumor protection models. However, very little is known about the therapeutic potential of anti-Id antibodies in animals and men. In this study we explored the combination of anti-Id and chemotherapy in a murine tumor system for which we had previously generated protective anti-Id mAb. First, we investigated various protocols by using a protective anti-Id in active immunization. Mice preimmunized before tumor transfer and challenged again after tumor survived significantly longer. Next, we explored the use of soluble anti-Id as immunostimulator in tumor-bearing mice. Although this treatment did not induce long-term survival, it significantly increased survival time. Interestingly, this anti-Id effect was dose dependent, whereby large and small doses had no effect. Finally, stimulatory anti-Id therapy and cyclophosphamide (Cy) treatment was combined. Tumor bearing mice were given a single dose of Cy followed by different doses of soluble anti-Id. The optimal effect on tumor growth and survival was achieved with 80 mg/kg Cy and 10 micrograms/mouse of anti-Id, where 80% of mice survived longer than 100 days. These results provide guidelines for developing clinical protocols for cancer patients by using combination therapy of anti-Id and chemotherapy.

Quality control procedure for 6-[18F]fluoro-L-DOPA: a presynaptic PET imaging ligand for brain dopamine neurons

The goal of the current study was to establish a quality control procedure for clinical use of 6-[18F]fluoro-L-DOPA (6-[18F]-DOPA) as a selective presynaptic positron emission tomographic (PET) imaging ligand for brain dopamine neurons. A high performance liquid chromatographic procedure using a 5-mu C-18 reverse phase column and ion-pairing mobile phase was used for the quantification of 6-[18F]-DOPA. The radiochemical purity of 6-[18F]-DOPA was measured by 18F radioactivity in HPLC fractions while the chemical purity was determined by an amperometric electrochemical detector with a sensitivity of 25 pg. Quality control of eight consecutive batches of highly purified 6-[18F]-DOPA sample used in a pre-clinical trial revealed that the chemical and/or radiochemical purity of the PET imaging ligand, 6-[18F]-DOPA was greater than 97 +/- 0.5% with a specific activity of 365 +/- 31 mCi/mmol. The knowledge and assurance of radiochemical purity of PET ligands are essential for the interpretation of clinical PET imaging results. The assurance of such quality control would enable comparisons of 6-[18F]-DOPA/PET data obtained from various medical centers using different radiopharmaceutical procedures.

Disulfide bond formation in the regulation of eIF-2 alpha kinase by heme

The inhibition of the autophosphorylation of the heme-regulated eukaryotic initiation factor (eIF)-2 alpha kinase (HRI) by hemin is very similar to that produced by thiol oxidation by diamide. The results obtained from the analysis of sodium dodecyl sulfate-polyacrylamide gel electrophoresis of unphosphorylated and phosphorylated HRI under reducing and nonreducing conditions indicate that hemin promotes disulfide formation in HRI. Hemin-promoted disulfide formation in HRI occurs under quasi-physiological conditions, i.e. 30 degrees C, 10 min at hemin concentrations of 5-10 microM. Under nondenaturing conditions, unphosphorylated HRI, phosphorylated HRI, hemin-treated unphosphorylated HRI, and hemin-treated prephosphorylated HRI are all eluted identically on Sephacryl S-300 column chromatography with an apparent molecular mass of 290,000 daltons. It appears, therefore, that the disulfide formation promoted by hemin occurs within the unit of 290,000 daltons. In addition, hemin treatment of phosphorylated HRI results in the appearance of a disulfide-linked form of higher molecular mass when analyzed by sodium dodecyl sulfate-polyacrylamide gel electrophoresis under nonreducing conditions. A similar high molecular mass form is observed when HRI is treated with 1,6-bismaleimidohexane, a double sulfhydryl cross-linker agent, and the autophosphorylation of HRI and the phosphorylation of eIF-2 alpha by HRI are greatly diminished; these effects are similar to the effects of hemin on HRI. We conclude that disulfide formation by hemin provides a likely mechanism by which hemin prevents the activation and inhibits the activity of HRI.

Changes in photosynthesis and other chloroplast traits in lanceolate leaflet isoline of soybean

Lanceolate leaflet soybean (Glycine max L. Merrill) has been known to photosynthesize more CO(2) per unit leaf area than normal leaflet soybean. The exact reason for this increase in photosynthetic rate is still unclear. The present study was undertaken to investigate the leaf photosynthetic rate and other physiological traits in relation to chloroplast of lanceolate leaflet soybean. Ontogenic changes in apparent photosynthesis (AP) were related primarily to variations in the amount of ribulose 1,5-bisphosphate carboxylase/oxygenase (Rubisco) per unit leaf area, and only secondarily to difference in specific activity of the said enzyme. Moreover, lanceolate leaflet consistently maintained a higher leaf AP, higher Rubisco activity, and more chloroplasts per unit leaf area basis than did normal leaflet soybean throughout leaf ontogeny. However, lanceolate soybean tended to have lower AP and Rubisco activity on a chloroplast basis. The superiority of leaf AP and other leaf physiological traits, expressed on a leaf area basis, in lanceolate leaflet soybean is associated with a corresponding increase in chloroplast number.

Idiotypic intramolecular help. Induction of tumor-specific antibodies by monoclonal anti-idiotypic antibody with the help of Fc-specific T helper clones

In this study, the mechanism of anti-Id vaccination was investigated by using cloned Th cells and an anti-idiotypic mAb. 2F10, an anti-idiotypic mAb derived from an Igh1-e allotype mouse strain, which induces protection against the L1210/GZL DBA/2 tumor, was used to prime DBA/2 mice. An Fc (Igh1-e)-specific syngeneic Th clone was cocultured in the presence of 2F10 anti-Id with 2F10-Fab-primed B cells. The Th clone responded with proliferation and also provided help for 2F10-Fab-primed B cells to produce antibodies that bind to L1210/GZL and not to P815 tumor cells. Intact 2F10 anti-Id was presented to Fc-specific Th cells by Fab (or Id) primed B cells more efficiently than the fragment mixture (Fab plus Fc) of 2F10 anti-Id, indicating that 2F10-Fab (or Id)-primed B cells capture 2F10 anti-Id through surface Ig receptors. Presenting B cells are sensitive to treatment with chloroquine and must come from H-2 matched mice, indicating that the Ag presentation by Fab-primed B cells to Fc-specific Th cells requires processing and is MHC restricted. Collectively these results outline a mechanism that may operate in anti-Id therapy of tumor-bearing animals by using tumor Ag mimicking anti-idiotypic antibodies. A similar mechanism could be effective in tumor patients immunized with xenogeneic anti-idiotypic antibodies operating under the "intra(Ag) molecular help."