Pharmacokinetics of enantiomers of trans-tramadol and its active metabolite, trans-O-demethyltramadol, in human subjects

AIM

To study the stereoselectivity in pharmacokinetics of the enantiomers of trans-tramadol (trans-T) and its active metabolite, trans-O-demethyltramadol (M1) in human subjects.

METHODS

Trans-T hydrochloride sustained-release tablets were taken orally by 12 healthy male volunteers. After a multiple dosage schedule, the serum concentrations of (+)-trans-T, (-)-trans-T, (+)-M1, and (-)-M1 were determined in serum by high performance capillary electrophoresis (HPCE).

RESULTS

(+)-Trans-T, (-)-trans-T, (+)-M1 and (-)-M1 in human serum were separated by HPCE. The linear range was 2.5-320 microg/L for the enantiomers of trans-T, and 2.5-50 microg/L for the enantiomers of M1. For the enantiomers of trans-T and M1, the intra-day and inter-day RSD were less than 15 % and 20 %, and the relative recoveries were 94.3 %-106.2 % and 90.4 %-107.8 %, respectively; the limit of quantitation was 1.25 microg/L. The serum concentrations of the enantiomers of trans-T reached a steady state in 12 subjects on d 4 after the initial administration. The steady state serum concentrations of (+)-trans-T were higher than that of (-)-trans-T at every sampling points in the subjects. The differences were significant in the main pharmacokinetic parameters between (+)-trans-T and (-)-trans-T except Tmax. The serum concentrations of (-)-M1 were higher than that of (+)-M1 in most subjects and at most sampling time points. There were significant differences in Cmax and Cmin between the enantiomers of M1.

CONCLUSION

The pharmacokinetics of trans-T and M1 was found to be stereoselective. (+)-Trans-T was shown to be absorbed completely, but eliminated more slowly. The pharmacokinetic stereoselectivity of M1 was different among human subjects.

Identification of rice varieties with high tolerance or sensitivity to lead and characterization of the mechanism of tolerance

Pb inhibits plant growth. To study Pb tolerance in rice (Oryza sativa), we screened 229 varieties for Pb tolerance or sensitivity. Three-day-old seedlings were treated for 12 d with 20 microM Pb solution. Based on the dry weight of the root, three Pb-tolerant (var CH-55, var KH-2J, var Kumnung) and three Pb-sensitive (var Aixueru, var C-9491, var Milyang23) rice varieties were selected. The root biomasses of the tolerant varieties were approximately 10-fold higher than those of the sensitive ones. The greatest morphological difference between the two groups was in the growth of the adventitious roots, as tolerant lines were able to develop adventitious roots after 6 d of Pb treatment, whereas sensitive ones did not develop any even after 15 d. The growth of adventitious roots in the tolerant varieties was dependent on a mechanism, whereby Pb was altered to a form that cannot be taken up by the tissue, because (a) the solution in which the tolerant varieties of rice had grown still contained Pb but nevertheless did not affect the root growth of new rice seedlings, and (b) the adventitious roots of tolerant seedlings developed in Pb solution contained little Pb. The oxalate content in the root and root exudate increased upon Pb treatment in the tolerant varieties, whereas the opposite was observed for the sensitive ones. Oxalate added to the growth solution ameliorated the inhibition of root growth by Pb. These results suggest that compounds such as oxalate secreted from the root may reduce the bio-availability of Pb, and that this may constitute an important Pb tolerance mechanism in the tolerant rice varieties studied here.

Effect of preparation temperature on the characteristics and release profiles of PLGA microspheres containing protein fabricated by double-emulsion solvent extraction/evaporation method

This study describes the influence of preparation temperature on the various characteristics and release profiles of poly(DL-lactide-co-glycolide) (PLGA) microspheres. The bovine serum albumin (BSA)-loaded microspheres were prepared using the water-in-oil-in-water (w/o/w) technique with poly(vinyl alcohol) as surfactant in the external aqueous phase. We have varied the preparation temperature to observe its effect on microsphere characteristics such as the microsphere shrinking rate during formation, particle size, density, surface and internal morphology, BSA encapsulation efficiency, BSA initial release, microsphere degradation and BSA in vitro release behaviour. During fabrication, a low preparation temperature of 5 degrees C gives the fastest initial but the slowest overall shrinking rate. Microspheres formed at high temperatures of 38 degrees C and 42 degrees C on the other hand have the lowest initial yet the highest overall shrinking rate. Subsequently, microsphere mean size increases and the particle size distribution widens with increase in the preparation temperature. Although all the microspheres have a porous surface as well as internal structure, microspheres fabricated at high temperatures have a uniform internal pore distribution and a very thin dense skin layer, while microspheres fabricated at lower temperatures have a thicker but porous skin layer and bigger pores in the middle of the sphere. Microspheres formed at 33 degrees C are found to give the highest initial burst release. In terms of in vitro release, microspheres fabricated at low temperatures (5 degrees C, 15 degrees C and 22 degrees C) exhibit similar, steady rates. Microspheres formed at higher temperatures however give very low release rates after their initial release. The results obtained suggest that preparation temperature significantly affects microsphere formation, resulting in their structural and protein release profile differences. These differences ultimately work together to affect the initial release and overall release patterns of the microspheres.

Different forms of HSV-1 VP22a within purified virion and infected cells

Utilizing the monoclonal antibody MCA406, our experimental data suggest that the herpes simplex virus type 1 (HSV-1) protein, VP22a, is present in the purified virus in a different form from that present within infected cells, namely the virion and infected-cell form, respectively. It seems reasonable to suggest that two different forms of VP22a are synthesized during the HSV-1 productive cycle. Using varying quantities of reducing agents, both inter- and intramolecular disulfide linkages were demonstrated in this protein family. Moreover, the VP22a-virion form could not be detected under nonreducing conditions by monoclonal antibody, even in the presence of proteolysis inhibitors, i.e. aprotinin, phenyl-methane-sulfonyl fluoride (PMSF) and soybean trypsin inhibitor. Varying temperature had little effect on the breakdown of VP22a disulfide bonds. A higher molecular-weight band, present in the nonreduced gel tracks, clearly indicates the presence of intermolecular disulfide bonds. Similarly, the appearance of bands of lower apparent molecular weight in the nonreduced tracks suggests the presence of intramolecular disulfide bonding. The VP22a infected-cell form may be modified to the virion form during the capsid-assembly process, prior to full capsid formation.

Perceptual alternation in obsessive compulsive disorder--implications for a role of the cortico-striatal circuitry in mediating awareness

Mounting evidence suggests that obsessive compulsive disorder (OCD) results from functional aberrations of the fronto-striatal circuitry. However, empirical studies of the behavioral manifestations of OCD have been relatively lacking. The present study employs a behavioral task that allows a quantitative measure of how alternative percepts are formed from one moment to another, a process mimicking the brain state in which different thoughts and imageries compete for access to awareness. Eighteen patients with OCD, 12 with generalized anxiety disorder, and 18 normal subjects participated in the experiment, in which they viewed one of the three Schröder staircases and responded by pressing a key to each perceptual reversal. The results demonstrate that the patients with OCD have a higher perceptual alternation rate than the normal controls. Moreover, the frequency of perceptual alternation is significantly correlated with the Yale-Brown obsessive compulsive and the Hamilton anxiety scores. The increase in the frequency of perceptual reversals cannot easily be accounted for by learning or by different patterns of eye fixations on the task. These results provide further evidence that an impairment of the inhibitory function of the cortico-striatal circuitry might underlie the etiology of OCD. The implications of the results for a general role of the cortico-striatal circuitry in mediating awareness are discussed.

A brain-enriched polypyrimidine tract-binding protein antagonizes the ability of Nova to regulate neuron-specific alternative splicing

The Nova paraneoplastic antigens are neuron-specific RNA binding proteins that participate in the control of alternative splicing. We have used the yeast two-hybrid system to isolate Nova interacting proteins and identify an RNA binding protein that is closely related to the polypyrimidine tract-binding protein (PTB). The expression of this protein, brPTB, is enriched in the brain, where it is expressed in glia and neurons. brPTB interacts with Nova proteins in cell lines and colocalizes with Nova within neuronal nuclei. We previously found that Nova binds to a pyrimidine-rich RNA element present upstream of an alternatively spliced exon, E3A, in glycine receptor alpha2 (GlyRalpha2) pre-mRNA, and this binding is implicated in Nova-dependent regulation of splicing. Cotransfection assays with a GlyRalpha2 minigene demonstrate that brPTB antagonizes the action of Nova to increase utilization of GlyRalpha2 E3A. brPTB binds to a 90-nt GlyRalpha2 RNA adjacent to the Nova binding site, but with an affinity that is more than 10-fold lower than Nova. When a putative binding site for brPTB on the GlyRalpha2 RNA is mutated, binding is abolished and the inhibitory effect on Nova-dependent exon selection disappears. These results suggest that brPTB is a tissue-restricted RNA binding protein that interacts with and inhibits the ability of Nova to activate exon selection in neurons.

Bis(dicyclohexylammonium) adipate monohydrate

In the asymmetric unit of the title compound, 2C(12)H(24)N(+).C(6)H(8)O(4)(2-).H(2)O, the carboxylate ion lies about an inversion center, the water molecule is on a twofold axis and the sec-ammonium cation is in a general position. Cations link the oxygen ends of two adjacent carboxylate anions to form an eight-membered ring [N.O 2.683 (3) and 2.711 (3) A]. The ion pair propagates as a linear chain and adjacent chains are linked through the water molecules [O.O 2.966 (3) A] into layers.

Self-destructive acts occurring during medical general hospitalization

Although several articles about suicide in general hospitals have been published, the rates of self-destructive individuals among various diseases and departments have not been reported previously. Moreover, self-destructive acts in Chinese general hospital inpatients have been neglected. We retrospectively investigated self-destructive incidents among medical general inpatients. A total of 75 self-destructive incidents, including 15 fatalities, were identified during the 10-year study period. The self-destructive rate was 8.7 per 100,000, and the fatality rate was 1.8 per 100,000 admissions. The highest self-destructive rate occurred in patients admitted to the rehabilitation ward (33.4 per 100,000) followed by the neurology ward (29.9 per 100,000). The highest fatality rate occurred among patients in the neurology ward (6.7 per 100,000). The majority of self-destructive patients suffered from a chronic or terminal illness with the most frequent types of illnesses being malignant neoplasm (31.1%), neurological disease (20.3%), and chronic obstructive pulmonary disease (COPD, 10.8%). COPD patients had the highest rate of self-destructive behavior (64.0 per 100,000) and the highest fatality rate (16.0 per 100,000) due to these incidents. The most common self-destructive incident was knife-cutting. More than one-half (53.4%) of the self-destructive incidents occurred within the first 2 weeks of admission, and nearly one-half (46.7%) occurred during the night shift. Moreover, the majority of severe or fatal incidents also occurred during the night shift. The results suggest that close supervision of high-risk patients should be mandatory within the first 2 weeks following admission, especially during the night shift.

Nova-1 regulates neuron-specific alternative splicing and is essential for neuronal viability

We have combined genetic and biochemical approaches to analyze the function of the RNA-binding protein Nova-1, the paraneoplastic opsoclonus-myoclonus ataxia (POMA) antigen. Nova-1 null mice die postnatally from a motor deficit associated with apoptotic death of spinal and brainstem neurons. Nova-1 null mice show specific splicing defects in two inhibitory receptor pre-mRNAs, glycine alpha2 exon 3A (GlyRalpha2 E3A) and GABA(A) exon gamma2L. Nova protein in brain extracts specifically bound to a previously identified GlyRalpha2 intronic (UCAUY)3 Nova target sequence, and Nova-1 acted directly on this element to increase E3A splicing in cotransfection assays. We conclude that Nova-1 binds RNA in a sequence-specific manner to regulate neuronal pre-mRNA alternative splicing; the defect in splicing in Nova-1 null mice provides a model for understanding the motor dysfunction in POMA.

Depressive disorders in Chinese patients with Alzheimer's disease

OBJECTIVE

The present study was to investigate the prevalence and potential risk factors of depressive disorders in Chinese patients with Alzheimer's disease (AD).

METHOD

A series of consecutive AD patients from the Memory Disorders Clinic of the Veterans General Hospital, Taipei were studied. Psychiatric diagnosis was made according to DSM-III-R criteria with the use of the Structured Clinical Interview for DSM-III-R (SCID). The Chinese version of the Cognitive Abilities Screening Instrument (CASI) and the Hamilton Depression Rating Scale (HDRS) were also applied. Primary caregivers were interviewed for the Clinical Dementia Rating (CDR) scale, the Barthel Index and the Alzheimer's Deficit Scale (ADS).

RESULTS

Among 141 AD patients, seven (5.0%) were diagnosed with major depression, 11 (7.8%) with dysthymia and five (3.5%) with depressive disorder not otherwise specified. Women were at elevated risk for depressive disorders and had more severe symptoms of depression.

CONCLUSIONS

The prevalence of depressive disorders among Chinese AD patients is in the middle of the range of western findings. The risk factor for depression is female gender.

Delusional disorder: retrospective analysis of 86 Chinese outpatients

Patients who visited the psychiatric outpatient service of Chang Gung Medical Centre, Tao-Yuan, Taiwan during an 8-year period were studied retrospectively. Among the 10,418 outpatients, 86 (0.83%) were diagnosed as having DSM-IV delusional disorder (DD), including 61 (70.9%) with persecutory type, 12 (14.0%) with the mixed type, seven (8.1%) with jealous type, two (2.3%) with somatic type, two (2.1%) with unspecified type, one (1.2%) with erotomanic type, and another one with grandiose type. The ratio of women to men was 0.86. The mean age at onset was 42.4 +/- 15.41 years, with women being older than men. Thirty-seven cases (43.0%) presented with depressive symptoms at their first visit. Subjects were divided into four groups: persecutory type, jealous type, mixed type and others. There were no significant differences between the four groups in terms of gender, age at onset, time-lapse before seeking psychiatric help, the presence of hallucination or the presence of depression.

Case report: portal vein thrombosis associated with hereditary protein C deficiency: a report of two cases

Protein C deficiency is one of the causes of curable or preventable portal vein thrombosis. We report two patients of portal vein thrombosis associated with hereditary protein C deficiency. The first patient presented with continuous right upper quadrant pain and high fever. The abdominal sonography revealed normal liver parenchyma but portal vein and superior mesenteric vein thrombosis. Based on a 55% (normal 70-140%) plasma protein C level, he was diagnosed as having protein C deficiency. A trace of his family history showed that his elder brother also had protein C deficiency with a 50% plasma C level. Both patients received anticoagulant therapy. The younger brother showed good response. Unfortunately, the elder one suffered from recurrent episodes of variceal bleeding and received a life-saving splenectomy and devascularization. We herein remind clinicians that early screening and therapy are helpful in preventing late complications of protein C deficiency with portal vein thrombosis.

Progressive myoclonic epilepsies syndrome (Ramsay Hunt syndrome) with mental disorder: report of two cases

Ramsay Hunt syndrome (RHS) is a rare condition within the progressive myoclonic epilepsies syndrome (PME), with a triad of action myoclonus, grand mal seizure and severe cerebellar ataxia. There are few reports about the psychiatric disturbances associated with PME or RHS. The present study examines the evidence that RHS may accompany an organic mental syndrome, ethanol's effective suppression of myoclonus, and the possible resultant problem of alcohol dependence in RHS patients. Two brothers with the previous long-standing diagnosis of RHS and their mental symptoms of persecutory delusion and depression are reported, as well as the additional problem of alcohol dependence in one of them. The cerebellar dysfunction found in RHS may be associated with an underlying organic condition. Determination of the relationship between cerebellar dysfunction and psychosis in RHS will require further study. Although the mechanism of the suppression of myoclonus by alcohol remains unclear, patients should be allowed to drink socially, and alcohol consumption should not be totally prohibited. However, effective treatment of the problems of alcohol tolerance, abuse, or dependence requires the cooperation of both neurologists and psychiatrists.

Genital tuberculosis with peritonitis mimicking Meigs' syndrome: a case report

A 19-year-old girl presented with genital tuberculosis (TB) complicated with peritonitis and pleural effusion. In addition to oligomenorrhea, her initial presentation included symptoms of intermittent high fever, exertional dyspnea, productive cough and body weight loss. Acid-fast bacilli were identified by sputum culture. She continued to suffer from persistent abdominal discomfort and body weight loss after eight months of anti-TB treatment. Finally, exploratory laparotomy was performed under the suspicion of Meigs' syndrome or TB peritonitis. Operative findings included diffusely granulomatous change over the peritoneum, ovaries, endometrium, intestine and liver. Histologic examination of the ovaries and endometrium showed caseous necrosis associated with Langhan's giant cells and epithelial cells. Acid-fast stain revealed numerous acid-fast bacilli. She was discharged after two months of anti-TB treatment. Anti-TB therapy was continued for one year after discharge. During 3 years of post-discharge follow up, she was free of abdominal discomfort and had given birth to two healthy children.

Capgras syndrome: analysis of nine cases

Three hundred and sixty-four patients, 158 males and 206 females, were admitted to an acute psychiatric ward between November 1994 and October 1995, and only 9 patients (2 males and 7 females) fulfilled the clinical criteria for Capgras syndrome. The crude prevalence of Capgras syndrome in the acute psychiatric ward was 2.5% (1.3% for men and 3.4% for women), which is not uncommon. Medical records and laboratory examinations, including brain images and electroencephalographic examinations (EEG), were reviewed in the nine patients with Capgras syndrome. Four cases were proven to have apparently abnormal anatomical lesions on EEG, brain computed tomography, magnetic resonance imaging or single photon emission computed tomography (99mTc-HMPAO) examinations and five cases were associated with major physical illness. These findings support that organic factors could be important in the pathogenesis of Capgras syndrome.

Preparing for the third millennium: the views of life informatics

The chief aspects of this paper are the condition of the birth of life informatics and its tasks, basic concepts, principles, and structure. There are three phases of combining informatics with medicine: product, technological, and theoretic application of which the goals are respectively the informatization of numerical and word processing, data of medical treatment, and the knowledge of medicine. While reached the third phase we have dealt with two types of biological information, physical and nonphysical, i.e., body information (i.e., the information about body's components and structure), and life information (i.e., the information about life codes and life programs). Life informatics is a main branch of bioinformatics. It is a new member of the medical informatics family, and as such is younger than health informatics, nursing informatics, and dental informatics. It's task is to assist biologists and medical doctors to recognize and interfere the human life information procedure just as they are doing well with human body's matter and energy system. Its basic concepts are life information, life information medicine, and life information therapy. Its most important principles are information materialism, general informatics, and information determinism. Its main branches are biomolecule, cellular, organic, individual, and social informatics. In the third millennium, the life informatics will be a leading discipline in biology, medicine and informatics, which will gradually influence modern philosophy and other humanities.

Activation of indices of cell-mediated immunity in bipolar mania

BACKGROUND

Evidence supports that macrophages as well as lymphocytes and their products may be involved in the pathophysiology of psychiatric disorders. Whether patients with bipolar disorder have activation or reduction of immunity during a manic episode remains unclear.

METHODS

The purpose of this case-control study was to investigate the lymphocyte proliferation to phytohemagglutinin (PHA), concanavalin A, and pokeweed mitogen, and plasma levels of soluble interleukin-2 receptor (sIL-2R) and sIL-6R in patients with bipolar mania (DSM-III-R). The subjects were 23 physically healthy patients with Young Mania Rating Scale (YMRS) scores > or = 26 as well as aged < or = 45 years and 23 age- and gender-matched normal control subjects. The above immune variables were measured in acute mania and consequent remission (YMRS scores < or = 12) among bipolar patients.

RESULTS

The lymphocyte proliferation to PHA and the plasma sIL-2R levels, but not sIL-6R, of bipolar patients were significantly higher in acute mania than in consequent remission. These elevations were not due to differences in medication status. Only in acute mania were the plasma sIL-2R levels of patients significantly higher than control subjects. A positive correlation between the changes of manic severity and plasma sIL-2R levels was observed. Remitted bipolar patients and normal control subjects did not differ in any of these measures.

CONCLUSIONS

Cell-mediated immunity activation in bipolar mania was demonstrated and may be through a specifically state-dependent immune response.

Only relatively higher and lower Li+ ratio might predict clinical responses

OBJECTIVE

To revisit the controversial issue regarding any possible relationship between Li+ ratio and clinical response with a view to explaining the contradictory reports on the subject.

METHOD

Analysis of Li+ ratio and clinical response in 98 bipolar patients. The patients selected in this study were based on the following criteria: (i) fulfilment of DSM-III-R criteria for bipolar disorder; (ii) indication for long-term lithium therapy; (iii) continued lithium therapy for at least 2years; (iv) had data on lithium ratio. Clinical responses were classified into good responders and poor responders (partial responder +nonresponder).

RESULTS

High lithium ratio (> or = 0.50) was associated with better clinical response (chi2 =5.80, d.f.=1, P< 0.05). In a further analysis, subjects with lithium ratios in the range (mean +1SD) or (0.50-0.67) and mean - 1SD or (0.32-0.49) showed the highest and lowest response rates. However, lithium ratios lower than 0.32 appear to be associated with a high response rate.

CONCLUSION

The inconsistent results concerning the association between lithium ratio and clinical response reported since the 1970s may have been at least partially due or related to the inadequate inclusion of extreme lithium ratio data. However, this hypothesis needs to be tested in a larger, prospective study.

Reversible neurotoxicity induced by a combination of clozapine and lithium: a case report

A combination of clozapine and lithium can be used in the treatment of refractory schizophrenia, schizoaffective disorder and bipolar disorder with rapid cycling. We report a patient with refractory bipolar disorder who developed side-effects after combination therapy with clozapine and lithium at usual therapeutic dosages. Reversible neurotoxicity developed twice during the therapeutic course, once with the restarting of lithium, the other with increasing the dose of lithium, despite the lithium concentrations being less than 0.5 mEq/l. Neurotoxicity manifested as ataxia, coarse tremor, myoclonus, facial spasm and increased deep tendon reflex. While the mechanism causing toxicity is not clear, interaction between the serotonergic effect of clozapine and lithium may be the cause. This report is evidence that a combination of clozapine and lithium may increase the risk of neurotoxicity. We suggest the need to keep clozapine and lithium at lower dosages and closely monitor their side-effects as necessary when these drugs are used concomitantly.

Crystal structures of Nova-1 and Nova-2 K-homology RNA-binding domains

BACKGROUND

Nova-1 and Nova-2 are related neuronal proteins that were initially cloned using antisera obtained from patients with the autoimmune neurological disease paraneoplastic opsoclonus-myoclonus ataxia (POMA). Both of these disease gene products contain three RNA-binding motifs known as K-homology or KH domains, and their RNA ligands have been identified via binding-site selection experiments. The KH motif structure has been determined previously using NMR spectroscopy, but not using X-ray crystallography. Many proteins contain more than one KH domain, yet there is no published structural information regarding the behavior of such multimers.

RESULTS

We have obtained the first X-ray crystallographic structures of KH-domain-containing proteins. Structures of the third KH domains (KH3) of Nova-1 and Nova-2 were determined by multiple isomorphous replacement and molecular replacement at 2.6 A and 2.0 A, respectively. These highly similar RNA-binding motifs form a compact protease-resistant domain resembling an open-faced sandwich, consisting of a three-stranded antiparallel beta sheet topped by three alpha helices. In both Nova crystals, the lattice is composed of symmetric tetramers of KH3 domains that are created by two dimer interfaces.

CONCLUSIONS

The crystal structures of both Nova KH3 domains are similar to the previously determined NMR structures. The most significant differences among the KH domains involve changes in the positioning of one or more of the alpha helices with respect to the betasheet, particularly in the NMR structure of the KH1 domain of the Fragile X disease protein FMR-1. Loop regions in the KH domains are clearly visible in the crystal structure, unlike the NMR structures, revealing the conformation of the invariant Gly-X-X-Gly segment that is thought to participate in RNA-binding and of the variable region. The tetrameric arrangements of the Nova KH3 domains provide insights into how KH domains may interact with each other in proteins containing multiple KH motifs.

Catatonic features: differential diagnosis and treatments at an emergency unit

During a 2-year period, 34 patients of catatonic features in Chinese ethnic background Taiwanese were brought to the emergency unit of Chang Gung Memorial Hospital at Linkou. The ratios of the causes of catatonic features by schizophrenic disorders, mood disorders, neuroleptic-induced disorders, and general medical conditions were 26, 9, 24 and 41%, respectively. After the treatments of antipsychotics, benzodiazepam, or electroconvulsive therapy (ECT), 24 patients (70.6%) showed complete remission, seven patients (20.6%) showed partial remission, and three patients (8.8%) showed no response (two died). Additionally, a suggestive period is proposed in order to distinguish acute and insidious onset catatonic conditions to help clinicians in deciding on probability immediately. The patients were grouped into four diagnostic categories; namely, schizophrenic disorders, mood disorders, neuroleptic-induced disorders, and general medical conditions for comparison. One-way ANOVA and Duncan's multiple-range test were used for continuous variables, and the Chi-squared test was used for categorical variables. The mean duration of 'insidious onset catatonic condition' (including schizophrenic disorders and general medical conditions) before seeking medical help was longer than 3.33 weeks, while the mean duration of 'acute catatonic condition' (including mood disorders and neuroleptic-induced disorders) was shorter than 1.83 weeks. These findings suggest that 2-3 weeks would be a cut-off point for acute or insidious onsets of catatonic conditions.

Regulation of gibberellin biosynthesis genes during flower and early fruit development of tomato

Gibberellins (GAs) are essential for the development of fertile flowers in tomato, and may also be required immediately after fertilization. In the GA-biosynthetic pathway, the reactions catalyzed by GA 20-oxidases have been implicated as site of regulation. To study the regulation of GA biosynthesis in flower and early fruit development, we isolated three tomato GA 20-oxidase cDNA clones, Le20ox-1, -2 and -3. The three genes showed different organ-specific patterns of mRNA accumulation. Analysis of the transcript levels of the three GA 20-oxidase genes, as well as those of copalyl diphosphate synthase (LeCPS) and GA 3 beta-hydroxylase (Le3OH-2) during flower bud and early fruit development, revealed temporally distinct patterns of mRNA accumulation. Up until anthesis, transcripts were observed for LeCPS, Le20ox-1, -2 and Le3OH-2, with an accumulation of Le20ox-1 mRNA. In contrast to the high level of Le3OH-2 transcripts in the fully open flower, mRNA levels of Le20ox-1, -2 and LeCPS were reduced at this stage. After anthesis, LeCPS and Le20ox-1 transcripts increased again. In addition, Le20ox-3transcripts increased whereas the transcripts of Le3OH-2 decreased to an undetectable level. In situ hybridization results demonstrated that during early stages of bud development, Le20ox-2 transcripts were localized in the tapetum and placenta. The presented results supply novel data about localization of GA biosynthesis gene transcripts, and indicate that transcript levels of GA biosynthesis genes are all highly regulated during flower bud development.

Possible presence of enhancing antibodies in idiopathic thrombocytopenic purpura

It is difficult to detect IgG anti-platelet autoantibodies in idiopathic thrombocytopenic purpura (ITP). Recently, it was reported that reactivity with glycoprotein IIb/IIIa was lost when IgG anti-GPIIb/IIIa antibodies from seven ITP patients were digested with pepsin to yield F(ab')2 fragments. These findings suggested that some IgG antiplatelet autoantibodies in ITP may be of low affinity and thus require the presence of 'enhancing' anti-IgG antibodies (i.e. rheumatoid factors, RFs) for detection. To test this hypothesis, we used a phage display technique to isolate five IgG RFs from an ITP patient (patient 1). Sequence analysis revealed that these RFs consisted of two clones, represented by GG3 and GG48. Both representative RFs bound specifically to IgG Fc fragments with apparent dissociation constants of 8.2 x 10(-8) M and 8.8 x 10(-7) M, respectively. Moreover, IgG RFs were subsequently found in a serum sample from patient 1. Combined, these results suggest that IgG RFs may occur in ITP, and may be required for the detection of some IgG anti-platelet autoantibodies and for the corresponding antibody-mediated platelet destruction in autoimmune ITP.

The neuronal RNA-binding protein Nova-2 is implicated as the autoantigen targeted in POMA patients with dementia

Paraneoplastic opsoclonus myoclonus ataxia (POMA) is a neurologic disorder thought to be mediated by an autoimmune attack against onconeural disease antigens that are expressed by gynecologic or lung tumors and by neurons. One POMA disease antigen, termed Nova-1, has been identified as a neuron-specific KH-type RNA-binding protein. Nova-1 expression is restricted to specific regions of the central nervous system, primarily the hindbrain and ventral spinal cord, which correlate with the predominantly motor symptoms in POMA. However, POMA antisera recognize antigens that are widely expressed in both caudal and rostral regions of the central nervous system, and some patients develop cognitive symptoms. We have used POMA antisera to clone a cDNA encoding a second POMA disease antigen termed Nova-2. Nova-2 is closely related to Nova-1, and is expressed at high levels in neurons during development and in adulthood, and at lower levels in the adult lung. In the postnatal mouse brain, Nova-2 is expressed in a pattern that is largely reciprocal with Nova-1, including high levels of Nova-2 expression in the neocortex and hippocampus. Functional characterization of Nova-2 in RNA selection and nitrocellulose filter-binding assays reveals that Nova-2 binds RNA with high affinity and with sequence specificity that differs from Nova-1. Our results demonstrate that the immune response in POMA targets a family of highly related sequence-specific neuronal RNA-binding proteins. The expression pattern of the Nova-2 protein is likely to underlie the development of cognitive deficits in some POMA patients.

The increasing use of anticonvulsants in prophylactic treatment of bipolar disorder

The medical records of patents with bipolar disorders who received prophylactic drug treatments during three time periods from January 1983 to December 1984, January 1988 to December 1989, and from January 1993 to December 1994, were reviewed retrospectively. The percentage of lithium monotherapy sharply decreased from 96% (51/53) in the first study period to 51.9% (83/160) in the third study period. Carbamazepine monotherapy and combination of lithium and carbamazepine increased from 3.8% in the first study period to 45.6% in the third study period. These results suggest that anticonvulsants may become one of the major drug treatment strategies for bipolar disorder in the future.

Differential transactivation of human metallothionein-IIa in cisplatin-resistant and -sensitive cells

Cells with acquired anticancer drug resistance frequently exhibited broad cross-resistance to other anticancer agents. Increased human metallothionein (hMT) IIa transcription has been found in some cells with acquired resistance to cisplatin (CP). A panel of 5'hMT-IIa promoter deletions linked to the chloramphenicol acetyl transferase ((5'-hMT-IIaCAT) were used to demonstrate that certain cis-elements are important for the increased hMT-IIa transcription in CP-resistant cells (SCC25/CP) compared to CP-sensitive cells (SCC25). We further identified trans-acting factor differences between SCC25 and SCC25/CP cells using gel mobility shift assays. Significant increases in binding of specific factors to the -286 to -160 and -96 to -51 region were seen in CP-resistant SCC25/CP cells compared to sensitive SCC25 cells. Using cross-competition and super gel shift analyses, we identified enhanced Spl and AP-2 binding activity in SCC25/CP cells. By Western blot analysis and immunoprecipitation, we demonstrated that the level of Spl was unchanged between the two cells types whereas AP-2 was elevated twofold in SCC25/CP cells. Our results indicated that the selection of CP-resistant phenotype in SCC25/CP was accompanied by increased Spl and AP-2 DNA binding activities, which are likely not only to enhance hMT-IIa transcription but could also alter expression of other genes responsible for a broader anticancer drug cross-resistance. Thus, altered trans-acting factors could account for the complex cross-resistant phenotype found in some anticancer drug-resistant cells.

Emotional symptoms are secondary to the voice disorder in patients with spasmodic dysphonia

The aims of this study were to evaluate the emotional status and life quality of the patients with spasmodic dysphonia (SD) before and after botulinum toxin treatment, and to ascertain whether SD is a somatoform disorder. Ten patients with spasmodic dysphonia were injected unilaterally into the vocal cord with botulinum toxin. Before botulinum toxin treatment, two clinician's rating scales--Hamilton Depression Rating Scale (HDRS) and Hamilton Anxiety Rating Scale (HARS), and three self-rating psychometrics--Zung's Self-Rating Depression Scale (SDS), Life Quality Scale (GHQ/QL-12), and Symptom Distress Checklist (SCL-90) were applied. Self-rating scales were also administered in 20 matched normal controls. The patients were reevaluated 1 month after botulinum toxin treatment. The Clinical Global Impression Scale (CGI) was also rated by the patients themselves and a speech pathologist. The mean scores of SD patients were significantly higher than that of controls in SDS, and subscales of somatization, obsessive-compulsive symptoms, depression, anxiety, and psychoticism in SCL-90. The mean score of GHQ/QL-12 was significantly higher in the control group. The scores of HDRS, SDS, GHQ/QL-12 and subscales of somatization, depression, and anxiety in SCL-90 showed significant improvement after botulinum treatment. In CGI, seven patients were rated as improved by patients themselves and the speech pathologist. The patients with SD had more anxiety, depression and somatization symptoms, and poor life quality than normal controls. Their emotional status and life quality improved after botulinum toxin treatment. The results suggest that the emotional symptoms of patients with SD are mainly secondary to voice disorder.

A quantitative study of environmental asbestos exposure in Honolulu

The increased use of asbestos in various industries in past decades has led to increases in environmental asbestos pollution. Incidental exposure to asbestos is inevitable, and has generated public concern. We performed the following study aimed at determining the level of environmental asbestos exposure in Honolulu, and our results indicate that the levels of environmental asbestos in Honolulu are the lowest in the nation.

Correlations between scores on Chinese versions of long and short forms of the Geriatric Depression Scale among elderly Chinese

A total of 187 elderly Chinese from the community were interviewed with the Chinese versions of the Geriatric Depression Scale-the long form and the short form. The scores on a proposed new version of the short form were also calculated. Cronbach alpha for the Geriatric Depression Scale-long form was .86. The correlations were significant between scores on the long and short forms (r = .94, p < .05) and between these on the long and new short forms (r = .91, p < .05). Cronbach coefficient alpha for the short form was .77 and for the new short form .81. Results of our study indicated that responding by these elderly persons on both short forms is acceptably internally consistent in comparison with those on the original Geriatric Depression Scale.

Single dose pharmacokinetic study of lithium in Taiwanese/Chinese bipolar patients

OBJECTIVE

The purpose of this study is to investigate the single dose pharmacokinetics of lithium in Taiwanese/Chinese bipolar patients for future interracial comparisons.

METHOD

Eight bipolar patients took 900 mg of lithium carbonate after overnight fasting. Blood samples of 5 mL were taken after 15 min, 30 min, 45 min, 1 h, 2 h, 3 h, 4 h, 7 h, 9 h, 15 h, 25 h and 31 h after dosing. The computer programs CSTRIP and PCNONLIN were used for pharmacokinetic analysis.

RESULTS

The pharmacokinetic parameters obtained were as follows: Cmax, 0.970 +/- 0.170 (SD) mmol/L; Tmax, 1.59 +/- 0.78 h; AUC31 h = 548.9 +/- 135.4 mmol x m/L; AUC to infinity = 722.6 +/- 262.7 mmol x m/L; beta-half-life = 16.3 +/- 7.18 h; kappa-half-life = 0.613 +/- 0.442 h; Cl(oral) = 1.13 +/- 0.39 mL/min/kg; Vd/F = 1.43 +/- 0.387 L/kg. Most of the pharmacokinetic parameters were within the ranges reported in investigations of Caucasian subjects.

CONCLUSIONS

This study showed that racial differences in lithium pharmacokinetics might not exist. We suggest that methodological designs, including method of blood sampling, measurement of lithium, and pharmacokinetic and statistical calculations, be standardised if future cross-ethnic comparisons are to be conducted.

Growth and clonogenic assays compared for irradiated MCF-7 and Colo-205 cell lines

Clonogenic assays have been the golden standard for the assessment of cytotoxic injury from irradiation or drugs. Since such assays are time consuming, growth assays, often with automatic quantifying equipment, are frequently used. Since these procedures do not immediately reflect loss of clonogenic capacity, it was considered important to validate the two procedures using gamma-irradiation (0, 2 and 4 Gy) of two human cell lines (MCF-7 and Colo-205). The cells were growing exponentially in 96-well plates and crystal violet staining resulted in optical densities proportional to cell number. The homogeneity of optical densities within the plates was optimal if the wells to be measured were surrounded by liquid-containing ones. The slopes of the exponential growth curves were decreased upon irradiation. An "apparent cell survival", the mean of the three lowest ratios between irradiated and control cells, was defined. It was compared with the SF2 and SF4 as found in parallel Courtenay-Mills assays. In this work we found a modest underestimation of cell survival using the growth assay, ranging from 0 to 17 per cent in absolute terms.

Schizophreniform-like psychotic disorder induced by phentermine: a case report

Phentermine is a central nervous system stimulant that can increase brain dopamine levels and has a structure similar to amphetamine. We report a case of schizophreniform-like psychotic disorder induced by phentermine in a young woman without a personal or family history of psychiatric disorders. The patient had taken phentermine 30 mg daily for more than three years. Psychotic symptoms developed acutely after she increased the phentermine dosage to 150-180 mg/day for one month due to an increase in work load. After discontinuation of phentermine and administration of neuroleptics, the psychotic symptoms subsided in two weeks. This is the first documented case of phentermine psychosis in Taiwan. This report will review the literature and discuss the prognosis of central nervous system stimulant-related psychotic disorders.

The correlation of depression with functional activity in Parkinson's disease

We evaluated 109 Chinese patients with Parkinson's disease (PD) in three ways: using a standardized psychiatric interview for depression and anxiety, using standardized neurological evaluation for motor disability, and using cognitive assessment for cognitive impairment. Six of the 109 patients who had dementia and another two afflicted with organic delusional disorder were excluded from further analysis. The remaining 101 PD patients were divided into the following three groups according to the DSM-III-R criteria: major depressive disorder (n = 18), other depressive disorders (n = 25) including dysthymic disorder and depressive disorder not otherwise specified, and no depression (n = 58). The frequency of major depressive disorder of the 109 PD patients was 16.5%, and the frequency of major and other depressive disorders, taken together, was 42.2%. Using the percentage points measured on the Schwab & England Activities of Daily Living Scale as the dependent variable to fit a multivariate regression model, we found the lower score significantly correlated with the diagnosis of depressive disorder and higher score of the Hamilton Depression Rating Scale, in addition to motor disability and disease severity of PD. Given the high frequency of depression and the significant correlation between depression and performance in daily functional activites, we believe that an evaluation of PD patients for coexisting depression is necessary for a better therapeutic outcome.

Depressive disorders among older residents in a Chinese rural community

BACKGROUND

Two recent surveys of depression among Chinese elderly people sampled different populations, used different case ascertainment methods and resulted in a seven-fold difference in prevalence rates. The present study was conducted to compare prevalence rates obtained with two commonly used methods in the same population, and to examine the risk factors for depression.

METHODS

The target population included all residents aged 65 years and over in a rural Chinese community. Participants were interviewed for demographic and medical information, examined by a neurologist and administered Chinese versions of the Geriatric Depression Scale-Short Form (GDS-S), the Cognitive Abilities Screening Instrument (CASI) and an Activities of Daily Living (ADL) form. Individuals who screened positive on the GDS-S were also interviewed by a psychiatrist for diagnosis according to the DSM-III-R criteria.

RESULTS

Among the 1313 participants, 26% screened positive on the GDS-S and 13% were diagnosed as having a depressive disorder, including 6.1% with major depression. Individuals with depressive disorders were more likely to have poor ADL scores, lower CASI scores, and chronic physical illnesses. They were also more likely to be female, older, illiterate and without a spouse, but adding these variables did not increase the overall association with the GDS-S score.

CONCLUSIONS

Depression was quite common in this Chinese rural geriatric population. The prevalence rate was twice as high when judged by depression symptomatology rather than clinical diagnosis. The critical risk factors were functional impairments, poor cognitive abilities and the presence of chronic physical illnesses.

IgG rheumatoid factors isolated by the surface-displaying phage library technique

Our analysis of IgG rheumatoid factors (RFs) from three patients with rheumatoid arthritis (RA) revealed that most contained significant numbers of skewed mutations per V region, suggesting that these RFs arose from antigen-driven responses. To further study IgG RFs in RA, we used pComb3 vector to construct an IgG1,lambda combinatorial antibody library from a synovial fluid sample. After panning against human IgG, Fab fragments from 71/96 phage clones bound to Fc-coated wells. Sequence analysis of 20 randomly chosen Fc-binders showed that 17 (85%) clones had identical heavy (H) and light (L) chain V regions, represented by Humha311 and Humla211, respectively. Of the remaining three clones, two had the same Humla211 L chain, but each with a different H chain V region. All the putative germline V genes for these RFs also encode RF in RA patients. However, none of these RF V regions are similar to those of the two IgG RFs derived by the hybridoma technique from the same synovial fluid. The Humha311 H chain has two frameshifts: a one-base insertion upstream of the JH region and a four-base deletion near the end of the CH1 region, resulting in a mainly unconventional amino acid sequence in the CH1 region. In the future, it will be important to study the presence of IgG molecules with such unconventional CH1 amino acid sequences, and the effects of these amino acid sequences on the structures and immunological properties of the IgG molecules.

Suicide and parasuicide in psychiatric inpatients: ten years experience at a general hospital in Taiwan

We investigated 64 suicidal acts of 62 psychiatric inpatients over a 10-yr. period. The findings indicated the frequency of suicidal behavior of psychiatric inpatients was 0.91% of total admissions, two thirds of the patients who attempted suicide were diagnosed with schizophrenia or depression, and patients suffering from depression, substance abuse, and personality disorders had a higher parasuicide rate, among whom those diagnosed bipolar disorder with depressive episode had an extremely high parasuicide rate. Most of the incidents occurred in concealed places, and most of the patients used nonviolent methods. About half of the incidents occurred during the evening shift and depressed patients tended to attempt suicide during the night shift. Most suicidal attempts were unsuccessful and led to minor injury. There were two deaths.

Bipolar disorder following a stroke involving the left hemisphere

OBJECTIVE

Post-stroke mania has rarely been noted and researched, and reported cases have mostly involved the non-dominant hemisphere. In this paper, we report a case of bipolar disorder secondary to a stroke over the dominant hemisphere.

CLINICAL PICTURE

A 48-year-old, right-handed man had a cerebral infarct over the left temporal region. He became depressed after the stroke, and 4 months later developed a manic episode.

TREATMENT

The patient was treated with haloperidol and lorazepam.

OUTCOME

The symptoms subsided within 2 months after treatment.

CONCLUSIONS

It is premature to consider mania to be a syndrome of the right, or non-dominant, hemisphere. We suggest that further study focusing on specific anatomical regions, rather than laterality, will help to elucidate the interrelationship between mood and brain function.

Efficient lipofection with cisplatin-resistant human tumor cells

Seven of seven different cisplatin-resistant human tumor cell lines showed elevated lipofection activity as compared with their sensitive parent cells, although the degree of enhancement was not quantitatively correlated with the degree of cisplatin resistance. Enhanced transfection was seen by using the same reporter gene driven by three different promoter/enhancer sequencer or by using different reporter genes driven by the same promoter/enhancer. Cells resistant to actinomycin D, bleomycin, and nitrogen mustards were not more transfectable than the sensitive parent cells. Although the mechanism of enhanced transfection in cisplatin-resistant cells is not known, data indicated that enhanced transcription, multidrug-resistant phenotype, and methallothionein overexpression do not play a role.

The onconeural antigen Nova-1 is a neuron-specific RNA-binding protein, the activity of which is inhibited by paraneoplastic antibodies

Nova-1, a protein expressed in tumors and neurons, is a target antigen in a human paraneoplastic motor disorder [paraneoplastic opsoclonus-myoclonus ataxia (POMA)]. We evaluated the relationship between the function of Nova-1 and its role as a disease antigen. We show that Nova-1 is a neuron-specific RNA-binding protein with sequence and functional similarities to FMR-1. Nova-1 mRNA is restricted to the subcortical nervous system, and the protein binds to RNA with high affinity. Nova-1 KH domains mediate this RNA binding, and point mutations within them abrogate binding. POMA disease antisera (6/6) recognize the third KH domain but not an inactive point mutant, and affinity-purified antibody blocks Nova-1 RNA binding. Thus, a cardinal feature of POMA is the production of antibodies that inhibit Nova-1-RNA interactions, suggesting such inhibition may cause the neurological disease.

Sequence analyses and antigenic epitope mapping of the putative RNA-directed RNA polymerase of five U.S. bluetongue viruses

We determined the complete nucleotide sequences of the cognate L1 double-stranded RNA segments of bluetongue virus (BTV) serotypes 2, 11, 13, and 17, which encode the putative RNA-directed RNA polymerase VP1. Each L1 gene contained 3944 nucleotides and was 10 bases shorter than the previously reported L1 gene of BTV 10. A single open reading frame which could encode the reported VP1 protein, 1302 amino acids in size, began with an initiation codon at nucleotides 12-14 and a termination codon at nucleotides 3918-3920. Analyses of the nucleotides of L1 genes and the deduced amino acid sequences of VP1 proteins of the five U.S. BTV serotypes indicated that the most recently isolated BTV-2 serotype from Florida was more distantly related than BTV-10, 11, 13, and 17, which were isolated primarily in the western U.S.A. The results are consistent with our hypothesis that BTVs-10, -11, -13, and -17 are derived from a single and common gene pool, and that BTV-2 belongs to a second, distinct gene pool. These genetic distinctions also reflected well with the known geographic distribution of the five U.S. BTV serotypes in North America. This putative RNA-directed RNA polymerase (149 KDa) was a basic protein, and the deduced amino acid sequences of the VP1 proteins contained seven highly conserved hydrophobic domains and many other sequence motifs which were also found in other known RNA polymerases. Four immunodominant but linear antigenic epitopes conserved among the VP1 of five U.S. BTVs were also been identified and mapped using monospecific oligoclonal antibodies.

Effects of gibberellins on seed germination of phytochrome-deficient mutants of Arabidopsis thaliana

Experiments were carried out to explore the involvement of gibberellins (GAs) in the light-induced germination of Arabidopsis thaliana (L.) Heynh, using wild type (WT) and phytochrome-deficient mutants (phyA, phyB and phyAphyB deficient in phytochrome A, B and A plus B, respectively). Seed germination of WT and phytochrome-deficient mutants was inhibited by uniconazole (an inhibitor of an early step in biosynthesis of GA, the oxidation of ent-kaurene) and prohexadione (an inhibitor of late steps, namely, 2 beta- and 3 beta-hydroxylation). This inhibition was overcome by simultaneous application of 10(-5) M GA4. The relative activity of GAs for promoting germination of uniconazole-treated seeds was GA4 > GA1 = GA9 > GA20. The wild type and the phyA and phyB mutants had an increased response to a red light pulse in the presence of GA1, GA4, GA9, GA20 and GA24 but there were no significant differences in activity of each GA between the mutants. Therefore, neither phytochrome A nor hytochrome B appears to regulate GA biosynthesis from GA12 to GA4 during seed germination, since the conversion of GA12 to GA9 is regulated by one enzyme (GA 20-oxidase). However, GA responsiveness appears to be regulated by phytochromes other than phytochromes A and B, since the phyAphyB double mutant retains the photoreversible increased response to GAs after a red light pulse.

Dysfunction of protein kinase FA/GSK-3 alpha in lymphocytes of patients with schizophrenic disorder

As compared to normal people, the lymphocytes of patients with schizophrenia were found to have an impairment of ATP.Mg-dependent protein phosphatase activation. More importantly, the impaired protein phosphatase activation in the lymphocytes of schizophrenic patients could be consistently and completely restored to normal by exogenous pure protein kinase FA/glycogen synthase kinase-3 alpha (kinase FA/GSK-3 alpha) (the activating factor of ATP.Mg-dependent protein phosphatase), indicating that the molecular mechanism for the impaired protein phosphatase activation in schizophrenic patients may be due to a functional loss of kinase FA/GSK-3 alpha. Immunoblotting and kinase activity analysis in an anti-kinase FA/GSK-3 alpha immunoprecipitate further demonstrate that both cellular activities and protein levels of kinase FA/GSK-3 alpha in the lymphocytes of schizophrenic patients were greatly impared as compared to normal controls. Statistical analysis revealed that the lymphocytes isolated from 37 normal people contain kinase FA/GSK-3 alpha activity in the high levels of 14.8 +/- 2.4 units/mg of cell protein, whereas the lymphocytes of 48 patients with schizophrenic disorder contain kinase FA/GSK-3 alpha activity in the low levels of 2.8 +/- 1.6 units/mg, indicating that the different levels of kinase FA/GSK-3 alpha activity between schizophrenic patients and normal people are statistically significant. Taken together, the results provide initial evidence that patients with schizophrenic disorder may have a common impairment in the protein levels and cellular activities of kinase FA/GSK-3 alpha, a multisubstrate protein kinase and a multisubstrate protein phosphatase activator in their lymphocytes.

Generation and characterization of monoclonal antibodies specific to surface antigens of human trophoblast cells

PROBLEM

To generate and utilize specific monoclonal antibodies for routine fetal cell isolation from the maternal circulation.

METHODS

Monoclonal antibodies specific to human trophoblast cell surface antigens were generated and characterized. After cell fusion, antibodies secreted by hybridomas were screened by enzyme-linked immunosorbent assay and immunohistochemical assays.

RESULTS

By using cultured BeWo choriocarcinoma cells or the membrane fraction of human placenta as the immunogen, seven (BW-108, 110, 123, 124, HP-15, 16 and 17) antibodies specific to the surface antigens of trophoblast were produced. They were shown to have little cross-reactivity to other human tissues. Among the antibodies raised against human sperm, HSA-10 was also found to cross-react with human trophoblast, but not detected in other tissues. When immobilized to magnetic beads, these antibodies were shown to react only with BeWo cells in suspension, but not blood cells and ovarian carcinoma cell line, OC-3-VGH.

CONCLUSION

Therefore, these antibodies may have potential application in fetal trophoblast cell isolation from the maternal circulation for prenatal genetic diagnosis.

[41 cases of video-assisted thoracoscopy]

Video-assisted of thoracoscopic surgery (VATS) is the minimally invasive surgery. It has characteristic of mini-incision, less pain, less bleeding, less transfusing, less affecting cardio pulmonary function. So it is one of the development directions of thoracic surgery. The authors had finished 41 cases VATS. Operative indication was expatiated. The requirement of anesthesia is lower. The patients whose pulmonary function were too severe destructive to walk could be treated by VATS. The authors discussed some questions of VATS.

Technetium-99m N,N'-bis(2-mercapto-2-methylpropyl)-2-aminobenzylamine: technetium-99m complexes of a novel bis(aminoethanethiol) ligand

A new N2S2 ligand system, N,N'-bis(2-mercapto-2-methylpropyl)-2- aminobenzylamine, U-BAT, 1, containing uneven amine groups (two amine groups with different pKa values) for complexing [TcVO]3+, was prepared. The reaction of this novel ligand with [99mTc]pertechnetate, in the presence of stannous tartrate as the reducing agent, produces the neutral and lipid-soluble [99mTc]TcVO(U-BAT), TcS2C15H23N2O, 2. However, when the same reaction was carried out at a higher pH, 9-10, and with 30 min of heating (100 degrees C), a second neutral but more lipid-soluble complex, [99mTc]TcVO(OU-BAT), TcS2C15H21N2O, 3, was isolated. The X-ray crystallography data of the 99Tc complexes show square pyramidal coordination with N2S2 as the base and the Tc = O in the apical position. Compound 3 can be derived from 2 by an oxidation of the ligand to form an imine. After iv injection into rats, the neutral and lipid-soluble technetium-99m complexes showed significant brain uptake, 1.54 and 1.07% dose/organ at 2 min for [99mTc]TcVO(U-BAT) and TcVO(OU-BAT), respectively. The novel Tc chemistry of this new ligand system may provide a useful foundation for designing Tc complexes with a built-in redox mechanism.

[Organic mental disorders in psychiatric consultation: a preliminary report]

In 200 cases for psychiatric consultation, 73 (36.5%) cases, 51 males and 22 females, were diagnosed as suffered from organic mental syndrome/disorder according to DSM-III-R criteria. Their mean age was 47.9 +/- 18.9 years. The leading psychiatric diagnosis were delirium (45.2%) and substance intoxication/withdrawal (20.5%). The main reasons for psychiatric consultation were psychotic symptoms (31.5%) and conscious disturbance (19.2%). The most common presumed etiologies for organic mental disorders were psycoactive substance related (39.7%) and metabolic (15.1%) causes. The comparisons of the results reported by several medical centers in recent years were further discussed in the text.

[Pulmonary resection by dealing with pulmonary vessels inside pericardium: report of 104 cases]

During 1985-1993, the writer had performed 104 pulmonary resections, which was 10% of the same time pulmonary resections, to treat type III center lung carcinoma by dealing with pulmonary vessels inside pericardium. The results demonstrated: one-year survival rate was 35%, while three year survival rate was 10%. The writer also found that this kind of operative mode can raise the pulmonary resection rate by 8.75%, and reduce the exploratory thoracotomy rate by 33% compared with the traditionary pulmonary resection.