Double blind, randomised, placebo controlled study of oral vancomycin in prevention of necrotising enterocolitis in preterm, very low birthweight infants

AIMS

To evaluate the effectiveness of oral vancomycin in the prophylaxis of necrotising enterocolitis in preterm, very low birthweight infants.

METHODS

A prospective, double blind, randomised, placebo controlled study in a tertiary referral centre of a university teaching hospital was conducted on 140 very low birthweight infants consecutively admitted to the neonatal unit. The babies were randomly allocated to receive oral vancomycin (15 mg/kg every 8 hours for 7 days) or an equivalent volume of placebo solution. Prophylaxis was started 24 hours before the start of oral feeds. All suspected cases of necrotising enterocolitis were investigated with a full sepsis screen and serial abdominal radiographs. Necrotising enterocolitis was diagnosed and staged according to modified Bell's criteria.

RESULTS

Nine of 71 infants receiving oral vancomycin and 19 of 69 infants receiving the placebo solution developed necrotising enterocolitis (p = 0.035). Infants with necrotising enterocolitis were associated with a significant increase in mortality (p = 0.026) and longer duration of hospital stay (p = 0.002).

CONCLUSIONS

Prophylactic oral vancomycin conferred protection against necrotising enterocolitis in preterm, very low birthweight infants and was associated with a 50% reduction in the incidence. However, widespread implementation of this preventive measure is not recommended, as it would only be effective in necrotising enterocolitis caused by Gram positive organisms and could increase the danger of the emergence of vancomycin resistant or dependent organisms. Its use should be restricted to a high prevalence nursery for a short and well defined period in a selected group of high risk patients.

Differential coupling of G alpha q family of G-protein to muscarinic M1 receptor and neurokinin-2 receptor

The ligand binding signals to a wide variety of seven transmembrane cell surface receptors are transduced into intracellular signals through heterotrimeric G-proteins. Recently, there have been reports which show diverse coupling patterns of ligand-activated receptors to the members of Gq family alpha subunits. In order to shed some light on these complex signal processing networks, interactions between G alpha q family of G protein and neurokinin-2 receptor as well as muscarinic M1 receptor, which are considered to be new therapeutic targets in asthma, were studied. Using washed membranes from Cos-7 cells co-transfected with different G alpha q and receptor cDNAs, the receptors were stimulated with various concentrations of carbachol and neurokinin A and the agonist-dependent release of [3H]inositol phosphates through phospholipase C beta-1 activation was measured. Differential coupling of G alpha q family of G-protein to muscarinic M1 receptor and neurokinin-2 receptor was observed. The neurokinin-2 receptor shows a ligand-mediated response in membranes co-transfected with G alpha q, G alpha 11 and G alpha 14 but not G alpha 16 and the ability of the muscarinic M1 receptor to activate phospholipase C through G alpha q/11 but not G alpha 14 and G alpha 16 was demonstrated. Clearly G alpha q/11 can couple M1 and neurokinin-2 receptor to activate phospholipase C. But, there are differences in the relative coupling of the G alpha 14 and G alpha 16 subunits to these receptors.

Cytokine gene expression in nasal polyps

Nasal polyps are the most common mass lesion of the nasal cavity. Various pathogenetic mechanisms have been proposed. However, the cause is still largely unknown, and treatment methods have not been changed for several hundred years. In order to investigate the role of cytokines in the pathogenesis of nasal polyps, expression of cytokine messenger RNAs (mRNAs) in nasal polyps was investigated. We performed reverse transcriptase-polymerase chain reaction and Southern blot to examine gene expression of the cytokines interleukin (IL)-1 beta, IL-6, IL-8, transforming growth factor (TGF)-beta, IL-4, IL-5, and interferon (IFN)-gamma and compared the results with the gene expressions of these cytokines in normal nasal mucosa. Nasal polyp tissues were obtained from 14 patients undergoing polypectomy for nasal obstruction. Among them, 4 patients suffered from associated perennial allergic rhinitis. The mRNAs of IL-4 and IL-5 (Th2 cytokines) as well as IFN-gamma (Th1 cytokine) were expressed in all of the nasal polyps obtained from the 14 patients, irrespective of the presence or absence of allergy, while 2, 0, and 4 of 6 normal turbinate mucosae expressed IL-4, IL-5, and IFN-gamma mRNAs, respectively. The mRNAs of IL-1 beta, IL-6, IL-8, and TGF-beta were expressed in 6, 1, 2, and 3 of 6 normal turbinate mucosae, respectively, while the mRNAs of these cytokines were expressed in all of the 14 polyp tissues except IL-6 mRNA, which was expressed in 13 nasal polyp tissues. There were no differences in the mean density ratios of each cytokine band on Southern blot between polyp tissues with allergy and those without allergy. These results suggest that many cytokines are produced in nasal polyps, that they may play important roles in the pathogenesis of nasal polyps, and that allergy per se may not play a fundamental role in the pathogenesis of nasal polyps.

Mechanisms of the mouse orphan nuclear receptor TR2-11-mediated gene suppression

The mouse orphan nuclear receptor TR2-11 functions as a repressor for reporter genes containing a direct repeat-5 or direct repeat-4 hormone response element. The functional domains responsible for its suppressive activity are defined, including the DNA-binding domain and the ligand-binding domain. The C-terminal 30 amino acid residues can be deleted without compromising its suppressive activity, whereas a deletion for 40 amino acids completely abolishes the suppressive activity and receptor dimerization, and reduces the DNA-binding affinity. Point mutation at three conserved leucine residues located on the predicted dimer interface abolishes the suppressive activity, receptor dimerization and its DNA binding property. However, mutation at two consecutive glutamate residues located within the hinge between the last two helices of the ligand-binding domain (helix 10 and helix 11 according to the human retinoid receptor X alpha structure) drastically reduces its DNA-binding affinity and abrogates the suppressive activity without compromising its ability to dimerize, indicating that receptor dimerization property can be functionally uncoupled from its suppressive activity. A transferable, active silencing activity is encoded within the DEF segment of the receptor molecule, as evidenced by the suppression of a GAL4 reporter by a chimeric protein containing the DNA-binding domain of GAL4 and the DEF segment of TR2-11. Moreover, the C-terminal 49 amino acid sequence is required for this trans-suppressive activity. It is suggested that TR2-11 functions as a repressor, mediated by mechanisms requiring high affinity DNA binding, receptor dimerization, and active silencing.

Molecular and biochemical characterization of cytosolic phosphoglucomutase in maize. Expression during development and in response to oxygen deprivation

Phosphoglucomutase (PGM) catalyzes the interconversion of glucose (Glc)-1- and Glc-6-phosphate in the synthesis and consumption of sucrose. We isolated two maize (Zea mays L.) cDNAs that encode PGM with 98.5% identity in their deduced amino acid sequence. Southern-blot analysis with genomic DNA from lines with different Pgm1 and Pgm2 genotypes suggested that the cDNAs encode the two known cytosolic PGM isozymes, PGM1 and PGM2. The cytosolic PGMs of maize are distinct from a plastidic PGM of spinach (Spinacia oleracea). The deduced amino acid sequences of the cytosolic PGMs contain the conserved phosphate-transfer catalytic center and the metal-ion-binding site of known prokaryotic and eukaryotic PGMs. PGM mRNA was detectable by RNA-blot analysis in all tissues and organs examined except silk. A reduction in PGM mRNA accumulation was detected in roots deprived of O2 for 24 h, along with reduced synthesis of a PGM identified as a 67-kD phosphoprotein on two-dimensional gels. Therefore, PGM is not one of the so-called "anaerobic polypeptides." Nevertheless, the specific activity of PGM was not significantly affected in roots deprived of O2 for 24 h. We propose that PGM is a stable protein and that existing levels are sufficient to maintain the flux of Glc-1-phosphate into glycolysis under O2 deprivation.

Pituitary-adrenal suppression in preterm, very low birth weight infants after inhaled fluticasone propionate treatment

Systemic corticosteroids prescribed for treatment of pulmonary diseases in preterm, very low birth weight infants caused severe suppression of the hypothalamic-pituitary-adrenal axis and produced serious physiological and metabolic disturbances. However, the effect of inhaled corticosteroids on their pituitary-adrenal functions is not known. We prospectively evaluate the pituitary-adrenal function using the human CRH stimulation test in a cohort of very low birth weight infants at risk for hypothalamic-pituitary-adrenal axis suppression in a double blind, randomized pilot study designed for assessing the efficacy and adverse effects of inhaled fluticasone propionate in newborn preterm infants who required mechanical ventilation for treatment of respiratory distress syndrome. Twenty-five preterm (< 32 gestational weeks), very low birth weight (< 1500 g) infants were randomized to receive inhaled fluticasone propionate (n = 13) or a placebo inhaler (n = 12). The medication was given every 12 h (fluticasone propionate, 1,000 micrograms/day) for 14 days. All surviving infants had their pituitary-adrenal functions assessed by human CRH test on the following morning immediately after completion of the 2-week course. All basal (0 min) and post-stimulation (15, 30, and 60 min) plasma ACTH and serum cortisol concentrations were significantly suppressed in the inhaled fluticasone group compared to their corresponding levels in the placebo group [basal plasma ACTH concentrations (F = 6.0; P = 0.02), poststimulation plasma ACTH concentrations (F > 8.6; P < 0.01), basal serum cortisol concentrations (F = 5.6; P = 0.03), and poststimulation serum cortisol concentrations (F > 15.6; P < 0.001)]. This is the first study in very low birth weight infants that demonstrates unequivocally that cumulative high dose inhaled corticosteroids can induce moderately severe suppression of both the pituitary and adrenal glands. The systemic bioactivity is probably associated with pulmonary vascular absorption, which effectively circumvents the hepatic first pass metabolism. Until the question of safety can be adequately addressed, inhaled fluticasone propionate should be used with cautionin preterm infants.

Validity of the specialized columnar epithelium as a diagnostic criterion of the short segment Barrett's esophagus

OBJECTIVE

In the areas where intestinal metaplasia of the stomach is highly prevalent, diagnosing Barrett's esophagus solely by the presence of specialized columnar epithelium in the distal esophagus may lead to many false positive diagnoses. The aim of this study was to test validity of the specialized columnar epithelium as a diagnostic criterion of the short segment Barrett's esophagus in Korea.

METHODS

During routine gastroscopy, the length of columnar-lined esophagus was measured and biopsy samples were taken from the mucosa immediately distal to the squamocolumnar junction. Under light microscopy, alcian blue-positive cells were identified.

RESULTS

Prevalence of the specialized columnar epithelium in cases without the columnar-lined esophagus and with the short segment columnar-lined esophagus were 57.1% and 31.2%, respectively (P = 0.0281). The specialized columnar epithelium is frequently seen around the cardia in Koreans with or without the columnar-lined esophagus.

CONCLUSION

Simple presence of the specialized columnar epithelium is not a valid criterion for a diagnosis of Barrett's esophagus. We propose that both the short segment Barrett's esophagus and the goblet cell metaplasia of the cardia might be grouped together under a title of "the specialized columnar epithelium around the gastroesophageal junction" as a potential preceding condition of adenocarcinoma around the cardia.

[Inhibitory effect of methanol extract of Boschniakia rossica Fedtsch. et Flerov on rat hepatic preneoplastic lesions induced by diethylnitrosamine]

OBJECTIVE

To investigate the inhibitory effect of Boschniakia rossica(BR) on hepatocarcinogenesis in rats.

METHOD

Based on immunohistochemistry techniques, the expression of placental form glutathione S-transferase(GST-P), mutant p53 and p21 protein were investigated in hepatic preneoplastic lesions induced by Solt-Farber protocol in the liver of rats that had been treated with the above method, administered with BR extract and of control group.

RESULT

The extract of BR(500 mg/kg) has inhibitory effect on the formation of diethylnitrosamine-induced GST-P-positive foci in F344 rat and the expression of mutant p53 and p21 protein was lower than that of hepatic preneoplastic lesions, and the increasing gamma-glutamyltranspeptidase(gamma-GT) activity in rat liver treated with Solt-Farber protocol was decreased by the extract of BR.

CONCLUSION

These results indicate that BR has inhibitory effect on DEN induced hepatic preneoplastic lesions in F344 rat.

Autotransplantation of parathyroid glands into subcutaneous forearm tissue for renal hyperparathyroidism

BACKGROUND

Autotransplantation of diseased parathyroid glands into subcutaneous adipose tissue has been mentioned previously, but as far as we know there is no previous systemic study concerning parathyroid function after subcutaneous autotransplantation.

METHODS

From January 1993 to June 1996, total parathyroidectomy and autotransplantation were carried out in 46 patients with renal hyperparathyroidism. The symptoms and signs before operation were intractable pruritus in 29 patients (63%), bone pain in 27 patients (58.7%), general weakness in 17 patients (37%), soft tissue calcification in 15 patients (32.6%), bone fracture in one patient, and failure to thrive in one patient. Twenty-four patients (group A) underwent autotransplantation of 60 mg of a diffuse hyperplastic parathyroid gland into subcutaneous forearm tissue, and 22 patients (group B) underwent autotransplantation of 15 pieces (60 mg) of 1 mm3 tissue into forearm muscles, as mentioned previously. Four patients in group A and one in group B who had high levels of intact parathyroid hormone (I-PTH) immediately after operation were excluded. After the operation, calcium carbonate, 1.5 to 16 gm daily, and calcitriol, 0.25 to 1.5 micrograms/daily, were prescribed according to the patients' calcium levels.

RESULTS

After 6 months, all patients in both groups were given calcium carbonate, 1 gm/day, and calcitriol, 0.25 microgram/day, for parathyroid suppression, and none had to take more medicine to maintain calcium levels. There were no significant differences between the two groups regarding serum calcium, phosphorous, alkaline phosphatase, and I-PTH levels 1 week, 3 to 6 months, and 1 year after operation. Eighteen patients in group A and 19 patients in group B had normal levels of I-PTH 1 year after operation. In the follow-up period from 1 to 3 1/2 years, only one patient in group A had a subnormal I-PTH level and one in group B had graft-dependent hyperparathyroidism.

CONCLUSIONS

We therefore suggest that autotransplantation of a parathyroid gland into forearm subcutaneous tissue for renal hyperparathyroidism is as effective as autotransplantation into forearm muscles and can be done easier.

Skin injury in the operating room

Skin injury occurring in the operating room may occur as a result of electrical current, thermal injury, chemical irritation and mechanical stress. Between 1 December 1996 and 28 February 1997, 19 cases of skin injury from a total of 3657 operations were noted in our hospital. These injuries tend to be ignored because of their early spontaneous healing. We suggest that medical staff should pay more attention to this complication and prevent it from occurring.

Metastatic leiomyosarcoma of the thyroid: a case report

Metastatic malignant tumors of the thyroid are rarely encountered clinically. Most arise from primary sites in the lung, breast, kidney or gastrointestinal tract. Their clinical presentation may mimic a primary thyroid tumor and include signs and symptoms such as enlargement of the neck, hoarseness and dysphagia. Without a history of carcinoma in other organs, management as for primary thyroid tumor is often undertaken and misdiagnosis is common. This report concerns a 63-year-old female patient with a rapidly progressive enlargement of the neck. She had had a primary leiomyosarcoma lesion in her left leg that had been well controlled after wide excision. Bilateral pulmonary metastases were noted two years later without local recurrence. She receive wedge lung resections several times. To relieve progressive shortness of breath, debulking surgery of the thyroid was performed and metastatic leiomyosarcoma was proved. The related clinical data of this rare metastatic leiomyosarcoma of the thyroid is presented and the literature is reviewed.

Selective activation of oncogenic Ha-ras-induced apoptosis in NIH/3T3 cells

A Ha-ras transformant '7-4', derived from mouse NIH/3T3 fibroblasts, was used to study the relationship between overexpression of activated Ha-ras and cell apoptosis. This cell line contains an inducible Ha-rasVal12 oncogene, which was under the regulation of the Escherichia coli (E. coli) lac operator/repressor system. We demonstrate that overexpression of activated Ha-ras oncogene by exogenous isopropyl-beta-D-thiogalactoside (IPTG) under serum-depleted conditions can stimulate cell apoptosis. Cell cycle analysis showed that most of the 7-4 cells with Ha-ras overexpression accumulated at S-phase and that the expression level of p34cdc2 kinase was decreased, suggesting that p34cdc2 may be involved in 7-4 cell apoptosis. Overexpression of bcl-2 transgene in these cells blocked Ha-ras-induced apoptosis, and this blockage was confirmed downstream of Ha-ras gene expression. Cycloheximide blocked the apoptosis of 7-4 cells in a dose-dependent manner, indicating that specific protein regulating apoptosis may be synthesized through Ha-ras overexpression. Ha-ras overexpression-triggered apoptosis was also prevented in the 7-4 derivatives that express either dominant-negative rasAsn17 or dominant-negative raf-1C4B to suppress Ha-ras signal transduction at different stages, indicating that overexpression of activated Ha-ras can induce cell apoptosis and that raf-1 pathway activity is required for this process.

Massive subdural haematoma: an unusual complication of septicaemia in preterm very low birthweight infants

Non-traumatic massive subdural haematoma is a rare condition in newborn infants and is usually associated with hereditary coagulation disorders or congenital vascular malformation. Its occurrence in preterm very low birthweight infants secondary to systemic bacterial infection has not been reported. We describe two extremely preterm neonates who developed massive subdural haematoma as a result of gram-negative septicaemia and disseminated intravascular coagulation. Both infants suffered severe parenchymal cerebral injury and hydrocephalus. Clinicians should be aware of this unusual and catastrophic complication if a very low birthweight infant with severe sepsis and disseminated intravascular coagulation suddenly deteriorates despite successful treatment with antibiotics. Radiological imaging by cranial ultrasound or computed tomography scanning should be routinely considered in all such infants for the detection of intracranial bleeding.

Characterization of the structural proteins of hepatitis C virus expressed by an adenovirus recombinant

Human adenoviruses have been used for mammalian expression vectors and recombinant vaccines for heterologous antigens. We constructed and characterized an infectious adenovirus recombinant containing core-E1-E2 genes of hepatitis C virus (HCV). The core protein was produced mainly during the early phase of viral infection. Expression of HCV E1 and E2 envelope proteins was detected by an immunoprecipitation with HCV-positive patient's sera. The purified E1 and E2 proteins appeared to be composed of mainly a heterodimeric form via noncovalent interaction, as previously observed in other mammalian expression systems. A small portion of E1 and E2 monomers as well as E1E2 aggregates by interdisulfide linkage were detected. Apparently heterodimeric E1E2 complexes were serologically reactive. The results suggest that adenovirus is an useful HCV antigen-expression vector.

Early recognition of unsuspected malignant hyperthermia and successful management of serve myoglobinuric renal failure in subsequent rhabdomyolysis: a case report

Malignant hyperthermia (MH) is a rare inherited disorder of skeletal muscle, its inheritance being autosomal dominant and its mutant gene located on chromosome 19. MH is occasionally observed during general anesthesia when using some special triggering agents. In the susceptible patient, it presents with a fulminant skeletal muscle hypermetabolic crisis and proceeds to serve rhabdomyolysis. Once rhabdomyolysis is established, acute renal failure is not an inevitable consequence, yet it is the fatal complication if the condition is not appropriately managed. We describe a case of acute renal failure in the setting of rhabdomyolysis in unsuspected MH, resulting in full recovery after intermittent hemodialysis. In this case, we emphasize the importance of early recognition of MH and the favorable prognosis of subsequent myoglobinuric renal failure if treated appropriately.

Semiquantitative Epstein-Barr virus (EBV) polymerase chain reaction for the determination of patients at risk for EBV-induced lymphoproliferative disease after stem cell transplantation

Epstein-Barr virus-induced lymphoproliferative disease (EBV-LPD) is a serious and potentially fatal complication after allogeneic stem cell transplantation (SCT). To evaluate levels of EBV DNA in SCT patients, a semiquantitative polymerase chain reaction (PCR) assay was developed. DNA was extracted from peripheral blood leukocytes and diluted, and PCR was performed by using a primer set specific for a well-conserved sequence of the internal repeat 1 region of the EBV genome. Forty-one SCT patients were screened with this method. Thirty-seven patients received allogeneic transplants, of which 18 were T-cell-depleted marrow. Four additional patients received autologous SCT, one of which was T-cell depleted. The mean time of follow-up by EBV PCR was 147 days (range, 47 to 328 days) posttransplant. The range of EBV copies/microg DNA from normal EBV sero-positive donors was 40 to 4,000. Seven patients had >/=40,000 copies of EBV DNA/microg DNA, all of whom were recipients of T-cell-depleted SCT. Five of the seven patients with elevated levels of EBV DNA developed EBV-LPD. Four of these five patients with EBV-LPD had elevated levels of EBV DNA from 1 to 8 weeks before diagnosis. Two patients with EBV-LPD had normal levels of EBV DNA, and two patients with >/=40,000 copies EBV/microg DNA did not develop EBV-LPD. In one patient, clinical resolution of disease correlated with a decrease in EBV DNA and an increase in the level of EBV-specific cytotoxic T-cell precursors. These data indicate that the measurement of EBV viral load with semiquantitative PCR is useful in detecting EBV-LPD in high-risk patients before the onset of clinical symptoms. Because not all patients with elevated levels of EBV DNA develop EBV-LPD, semiquantitative PCR results cannot substitute for clinical, radiographic, and pathological confirmation of this diagnosis.

The commissioning of a flexible low-cost multipurpose X-ray beamline at SRRC

A low-cost multipurpose X-ray beamline has been commissioned at the bending magnet B15 of the Synchrotron Radiation Research Center (SRRC). The beamline is constructed in such a way to accommodate the various needs of small research consortia, from universities or research institutes, whose requirements of a beamline facility are quite diverse while under limited funding support. Flexibility is the special feature of this beamline. It is capable of performing quick test measurements without a prolonged reviewing process. Switching between different techniques, such as white-beam irradiation, EXAFS and X-ray scattering, can be achieved within 1 h. Novel experiments, such as energy-dispersive small-angle scattering experiments and energy-dispersive reflectivity measurements, can also be performed.

High frequency of rearrangement of the RET protooncogene (RET/PTC) in Chinese papillary thyroid carcinomas

The activation of RET protooncogene, through chromosomal translocation, is unique to papillary thyroid carcinomas. Rearrangement of the RET kinase domain to 3 partner genes has been described, of which the RET/PTC1 is the most common. To investigate the frequency of RET rearrangement in Chinese papillary thyroid carcinomas, we have performed RT-PCR to amplify specific RET/PTC transcripts. Among the papillary thyroid carcinomas of 11 patients examined, we have identified 2 containing RET/PTC1, 3 containing RET/PTC2, and 1 containing RET/PTC3 oncogenes. Although the cause of the high frequency of RET/PTC oncogenes in Chinese papillary thyroid carcinomas is unknown, our study suggests that RET rearrangement is an important genetic lesion underlying the development of thyroid papillary carcinoma in Taiwan.

Dioxin levels in the emissions from municipal waste incinerators in Taiwan

In this study, characteristics of dioxins emission from existing modern MWIs were evaluated via simultaneous sampling of flue gas and various types of fly ashes. Preliminary results showed that PCDDs congeners distributions were quite similar in flue gas and various types of ashes of both MWIs. PCDFs/PCDDs ratio in cyclone ash was lower than that in combustor ash or fabric filter ash excluding economizer ash of MWI-A. Similarly, PCDFs/PCDDs ratio in ESP ash was lower than that in boiler ash. PCDFs concentration was about 1.5 to 4.3 times higher than PCDDs concentration in flue gas of both MWIs. The mass balance factors of MWI-A (0.9 approximately 1.02) were clearly lower than that of MWI-B (7.71 approximately 15.63), indicating that de novo synthesis occurred under the operating conditions of ESP. In other words, MWIs equipped with ESP were less efficient in controlling PCDD/Fs emissions than that equipped with fabric filters.

Continuous flumazenil infusion in preventing complications arising from severe benzodiazepine intoxication

A prospective, randomly controlled study was conducted to test the effect of continuous flumazenil infusion in preventing complications arising from severe benzodiazepine (BZ) intoxication. Patients who were believed to be suffering benzodiazepine intoxication and whose Glasgow Coma Scale (GCS) score was below 10 were enrolled after showing a clear-cut response to flumazenil 0.5 or 1 mg (an improvement by 4 or more on the GCS). The patients were consecutively enrolled and randomized into two groups: a continuous infusion group (CI, n = 50) who were immediately given flumazenil 0.5 mg/h for 5 hours, and a control group (CIN, n = 50). Age, sex, incidence of underlying disease, GCS score at several time points, and complication rate were compared in the two groups. Although the CI group had a higher GCS score at most time points, the complication rate did not significantly differ between the two groups (14 of 36 in the CI group v 12 of 38 in the CIN group, P = .684). A greater incidence of underlying disease and an older age seemed to contribute to the higher complication rates in both groups. Several patients (in both groups) resedated into deeper coma after showing an initial response to flumazenil or after the cessation of flumazenil infusion. For severe BZ intoxication, treatment with flumazenil infusion should still be considered skeptically and should not be recommended as routine management BZ-intoxicated patients with an underlying disease, an older age, and resedation into a deep comatose state after showing an initial response to flumazenil should be treated in an intensive care unit.

Elevated interleukin-10 levels correlated with disease activity in systemic lupus erythematosus

OBJECTIVE

To determine serum interleukin-10 (IL-10) levels in systemic lupus erythematosus (SLE) patients and to assess their relationship with disease activity.

METHODS

Forty-one SLE patients and 35 controls were studied. Paired serum samples were collected from all SLE patients at the time of their presentation with active disease and at 4 weeks after the institution of treatment. IL-10 levels were determined in the sera and were compared with disease activity, measured using the SLE Disease Activity Index (SLEDAI) and laboratory parameters such as the circulating immune complexes (CIC), C3, C4, anti-DNA antibody, IgG, IgM, and IgA.

RESULTS

The IL-10 levels in SLE patients were significantly higher than those of controls (mean +/- SE, 29.2 +/- 6.8 vs. 3.5 +/- 0.6 pg/ml, p < 0.01). Elevated IL-10 levels correlated well with the SLEDAI in SLE patients (r = 0.46, p < 0.01), but did not correlate with other laboratory activity indices. The changes in serum IL-10 levels also correlated with the changes in the SLEDAI score during the patients' disease course (r = 0.51, p < 0.01).

CONCLUSION

Serum levels of IL-10 are elevated in SLE patients and increased IL-10 correlates well with SLE disease activity.

Cytotoxic compounds from the roots of Juglans mandshurica

Three new compounds, a diarylheptanone glucoside (1), 4,5, 8-trihydroxy-alpha-tetralone 5-O-beta-d-[6'-O-(3", 5"-dimethoxy-4"-hydroxybenzoyl)]glucopyranoside (2), and 1,4, 8-trihydroxy-3-naphthalenecarboxylic acid 1-O-beta-d-glucopyranoside methyl ester (3), were isolated from the roots of Juglans mandshurica, and their structures were elucidated on the basis of spectroscopic studies including 2D-NMR.

Interactions of the borna disease virus P, N, and X proteins and their functional implications

Borna disease virus (BDV) causes persistent central nervous system infection and behavioral disturbances in warm-blooded animals. Protein interaction studies were pursued to gain insight into the functions of the putative nucleoprotein (N), phosphoprotein (P), atypical glycoprotein (gp18), and X protein (X) of BDV. Coimmunoprecipitation experiments indicated that N and P, and P and X, form complexes in infected cells. Two-hybrid analyses confirmed interactions between P and P, P and X, and P and N, but not between P and gp18, N and gp18, X and gp18, or X and N. Analysis of P truncation mutants identified three nonoverlapping regions important for oligomerization (amino acids (aa) 135-172), and binding to X (aa 33-115) or N (aa 197-201). Coexpression of X stimulated oligomerization of P but decreased N-P complex formation. Immunocytochemistry of transfected noninfected CHO cells demonstrated that the distribution of X is dependent upon the presence of P-X expressed alone was found predominantly in the cytoplasm whereas coexpression of X and P resulted in nuclear localization. Immunocytochemistry of infected cells revealed nuclear colocalization of P and X. Interactions of P, N, and X may have implications for regulation of BDV transcription/replication and ribonucleoprotein assembly.