The role of human papillomavirus type 16 and the fragile histidine triad gene in the outcome of cervical neoplastic lesions

The presence of high-risk human papillomavirus, loss of heterozygosity on chromosome 3p and fragile histidine triad gene expression were assessed as potential markers of cancer and CIN progression in 83 cervical cancers and 74 cervical intraepithelial neoplasia grade 1 lesions. Human papillomavirus type 16 was an indicator of vascular involvement in cancers. Loss of heterozygosity, especially in the fragile histidine triad gene intron 5, was an indicator of high-grade tumours, greater tumour depth and lymph node involvement. Abnormal fragile histidine triad gene expression was more frequent in cervical intraepithelial neoplasia grade 1 lesions with increased risk of disease progression.

A role of P301L tau mutant in anti-apoptotic gene expression, cell cycle and apoptosis

In exploring the causative role of the most common Pro(301)-to-Leu (TauP301L) tau missense mutation associated with neurodegenerative tauopathies, we examined TauP301L-mediated apoptotic cell death and the expression of a cluster of genes involved in the inhibition of apoptosis (IAPs) in human neuroblastoma SH-SY5Y cells. Our research found that the expression of TauP301L, but not wild-type tau, down regulated the expression of IAPs, including survivin, which plays a role in the mitotic spindle checkpoint. The inhibition of IAPs coincided with the activation of the pro-apoptotic caspase 3, but preceded apoptotic cell death by TUNEL. Furthermore, TauP301L altered the expression of the cell cycle regulatory proteins and induced the cell cycle arrest at G(2)/M phase. Our studies demonstrate that TauP301L downregulates the expression of genes that protect against apoptosis and regulate cell cycle progression. These results suggest a novel mechanism of apoptotic cell death in TauP301L-expressing cells that involves survivin-mediated activation of cell cycle checkpoint.

The effect of water quality and NOM character on the ozonation of MIB and geosmin

The ozonation of MIB and geosmin was studied in synthetic waters containing two natural organic material (NOM) fractions and sodium bicarbonate. The ozonation of both compounds was found to be affected by the character of the NOM fractions, with higher apparent rate constants observed in the fraction containing higher UV/visible absorbing properties. As the concentration of bicarbonate was increased, the destruction of both compounds decreased. MIB was found to be more resistant to ozonation than geosmin.

Management of women who test positive for high-risk types of human papillomavirus: the HART study

BACKGROUND

Certain types of human papillomavirus (HPV) are the primary cause of almost all cervical cancers. HPV testing of cervical smears is more sensitive but less specific than cytology for detecting high-grade cervical intraepithelial neoplasia (CIN2+). HPV testing as a primary screening approach requires efficient management of HPV-positive women with negative or borderline cytology. We aimed to compare the detection rate and positive predictive values of HPV assay with cytology and to determine the best management strategy for HPV-positive women.

METHODS

We did a multicentre screening study of 11085 women aged 30-60 years. Women with borderline cytology and women positive for high-risk HPV with negative cytology were randomised to immediate colposcopy or to surveillance by repeat HPV testing, cytology, and colposcopy at 12 months.

FINDINGS

HPV testing was more sensitive than borderline or worse cytology (97.1% vs 76.6%, p=0.002) but less specific (93.3% vs 95.8%, p<0.0001) for detecting CIN2+. Of 825 randomised women, surveillance at 12 months was as effective as immediate colposcopy. In women positive for HPV at baseline, who had surveillance, 73 (45%) of 164 women with negative cytology and eight (35%) of 23 women with borderline cytology were HPV negative at 6-12 months. No CIN2+ was found in these women, nor in women with an initial negative HPV test with borderline (n=211) or mild (32) cytology.

INTERPRETATION

HPV testing could be used for primary screening in women older than 30 years, with cytology used to triage HPV-positive women. HPV-positive women with normal or borderline cytology (about 6% of screened women) could be managed by repeat testing after 12 months. This approach could potentially improve detection rates of CIN2+ without increasing the colposcopy referral rate.

A therapeutic role for cyclooxygenase-2 inhibitors in a transgenic mouse model of amyotrophic lateral sclerosis

Recent studies indicate that the proinflammatory enzyme cyclooxygenase (COX)-2, an enzyme involved in inflammatory cascades but also normal neuronal activities, is elevated in the brain and spinal cord of amyotrophic lateral sclerosis (ALS) patients and ALS mouse model systems. On the basis of this evidence, we explored the impact of COX-2 inhibition on the onset and progression of ALS-like disease in the G93A human superoxide dismutase (SOD)1 mouse model of ALS. We found that prophylactic administration of nimesulide, a preferential COX-2 inhibitor, in the feed resulted in a significant delay in the onset of ALS type motor impairment. This delay of ALS symptomatology temporally overlapped with the inhibition of prostaglandin E2 elevation in the spinal cord of SOD1-G93A transgenic mice relative to untreated SOD1-G93A controls. This study strongly supports a role for COX-2 in the pathophysiology of ALS and provides the first experimental evidence that prophylactic treatment with COX-2 inhibitors can significantly delay the onset of motor dysfunction in the SOD1-G93A transgenic mouse model of ALS.

Treatment options for microcystin toxins: similarities and differences between variants

Over sixty variants of the blue-green algal toxin microcystin have been identified. The two microcystin variants LR and LA vary in only one amino group ie. arginine for microcystin LR and alanine for microcystin LA. In the literature to date, the general consensus has been that m-LR and m-LA should respond similarly to a range of water treatment processes. This is the case for ozonation and biodegradation by organisms colonising granular activated carbon filters; there is negligible difference in the response to these processes between the two variants. However, the adsorption of m-LR onto activated carbon is significantly higher than that of m-LA. This result is surprising as m-LA has a lower molecular weight, and is more hydrophobic, factors that would be expected to favour the adsorption of this compound over m-LR. This trend is also seen for the variants RR and YR. The effect is seen on both negatively and positively charged carbons, indicating that the difference between the variants is not caused by electrostatic interactions with the carbon surface. Electrostatic shielding experiments suggest that electrostatic repulsion between the adsorbed m-LA molecules, with a net charge of -2, may be responsible for the low adsorption. The other variants tested have a lower net charge and therefor experience lower intermolecular repulsion in the adsorbed state.

Efficacy of a specially designed hip protector for hip fracture prevention and compliance with use in elderly Hong Kong Chinese

BACKGROUND

Hip protectors, while effective in prevention of hip fractures, have been designed for a Caucasian body build and may not be suitable for Asian subjects living in a subtropical climate.

OBJECTIVE

Hip protectors and accompanying shorts were specially designed for use for the Chinese body build and subtropical climate, and tested for compliance and efficacy in fracture prevention.

METHOD

A pragmatic study examining compliance with the wearing of hip protectors, and effectiveness in preventing hip fractures (using a case control design), in 302 subjects wearing hip protectors and 352 control subjects.

RESULTS

Overall compliance varied from 55 to 70%. The relative risk for hip fracture was 0.18 (0.04-0.79), relative risk reduction 82%, and the number of subjects needing to wear a hip protector to prevent one fracture was 33 (19-117).

CONCLUSION

Hip protectors adapted for use in Chinese people appear to reduce hip fractures in routine clinical practice.

High-throughput Proteomics and Protein Biomarker Discovery in an Experimental Model of Inflammatory Hyperalgesia

OBJECTIVE

The goal of this study was to derive a systematic approach for the identification of protein species profiles that selectively identify subgroups of similar but distinct pain models and correlate with the therapeutic efficacy (or lack thereof) of drug intervention.

METHODS

Using high-throughput surface-enhanced laser desorption ionization (SELDI) mass spectrometry proteomic technology based on ProteinChip arrays, we conducted a comparative analysis of the profile of protein expression in cerebral spinal fluid (CSF) from rats exposed to either injection of complete Freund's adjuvant (CFA) [a model of inflammatory pain] or chronic constriction injury (CCI) [a model of neuropathic pain]. The CFA model was then further studied for the effects of treatment with the NSAID, nimesulide (a preferential cyclo-oxygenase [COX]-2 inhibitor).

RESULTS

Among other observations, we found that the content of two metal (copper) binding protein species (2.9 and 3.2kDa) and three anionic protein species (4.0, 6.9 and 8.2kDa) were increased in the CSF of rats with inflammatory pain in a time-dependent fashion, at 7 and 14 days after CFA injection. These changes were highly selective for the CFA model, as no detectable increase in these protein biomarkers was found in the CCI neuropathic pain model. Further, we found that most of the changes in the biomarker protein species induced by the inflammatory pain were prevented by treatment with nimesulide and correlated with the antihyperalgesic effect of this drug.

CONCLUSION

This study demonstrates that CSF biomarker profiles, as detected by SELDI technology, can consistently and reproducibly differentiate inflammatory from neuropathic pain, and reflect the analgesic action produced by the preferential COX-2 inhibitor, nimesulide. The characterisation and identification of these biomarkers will provide invaluable insight into the pathophysiology of pain mechanisms, in addition to further understanding of the value of nimesulide in the treatment of inflammatory pain.

From cDNA microarrays to high-throughput proteomics. Implications in the search for preventive initiatives to slow the clinical progression of Alzheimer's disease dementia

Alzheimer's disease (AD) is the most common form of dementia, affecting as many as four million elderly people. lt results from abnormal changes in the brain that most likely begin long before cognitive impairment and other clinical symptoms become apparent. Little is known about the changes preceding or accompanying initiation of the disease. Using cDNA microarray, we previously reported candidate gene products whose expression is altered in the cerebral cortex of cases at risk for AD dementia. However, it is possible that the cDNA microarray evidence might have underestimated post-transcriptional modifications, and as a result, provided only a partial view of the biological problem of interest. Based on this hypothesis, we initiated a series of parallel high-throughput proteomic studies. We found that, consistent with the cDNA microarray evidence, the expression of proteins involved in synaptic activities was also altered in the brains of early AD cases. These studies support the feasibility and usefulness of high-throughput cDNA and protein microarray techniques to examine the sequential changes of distinctive gene expression patterns in the brain as a function of the progression of AD dementia. Our preliminary results also support the utility of high-throughput proteomic methodologies as a means to identify novel AD biomarkers from cerebral spinal fluid and/or from serum.

Abnormal FHIT expression profiles in cervical intraepithelial neoplastic (CIN) lesions

Abnormal fragile histidine triad transcripts were found in 20-30% of CIN2/3 lesions and 11% of normal cervical biopsies by RT-PCR. Bi-allelic loss of the fragile histidine triad gene and the loss of fragile histidine triad protein expression detectable by immunochemical staining with a polyclonal fragile histidine triad specific antibody was rare. The genomic changes showed no association with the presence of human papillomavirus types which carry high risk for cervical cancer (high risk human papillomavirus) as assessed by a type-specific multiplex PCR. The presence of abnormal fragile histidine triad transcripts in a subset of CIN2/3 lesions with no high risk human papillomavirus suggests that this could be an independent risk factor associated with an alternative carcinogenic pathway.

Expression of CD26 and its associated dipeptidyl peptidase IV enzyme activity enhances sensitivity to doxorubicin-induced cell cycle arrest at the G(2)/M checkpoint

CD26, a M(r) 110,000 surface-bound ectopeptidase with dipeptidyl peptidase IV (DPPIV) activity, has an array of diverse functional properties, with a role in T-cell physiology and the development of certain human cancers. In this study, we report that surface expression of CD26, through its associated DPPIV enzyme activity, enhanced sensitivity of Jurkat T-cell transfectants to G(2)-M arrest induced by the chemotherapeutic drug, doxorubicin. This was associated with disruption of cell cycle-related events, including hyperphosphorylation and inhibition of p34(cdc2) kinase activity, phosphorylation of cdc25C, and alteration in cyclin B1 expression. In addition, we demonstrate that the addition of exogenous soluble DPPIV enhanced sensitivity of lymphoid tumor cell lines to doxorubicin, suggesting a potentially useful clinical role for CD26/DPPIV in the treatment of selected human hematological malignancies.

Gene expression profiling of the tau mutant (P301L) transgenic mouse brain

To provide a global analysis of the influence of Tau neuropathology at molecular level, we used cDNA arrays representing 8832 genes to determine the mRNA expression profile in transgenic mice expressing the most common frontotemporal dementia and parkinsonism linked to chromosome 17 (FTDP-17) Tau mutation (P301L) (Nat. Genet. (2000) 402). Genes whose expression is associated with development of neurofibrillary tangles and neuron loss in P301L mice with motor and behavioral deficits were identified. The data suggest that a major mechanism underlying P301LTau neurodegeneration primarily involved altered expression of genes contributing to inhibition of apoptosis and intracellular transport. We propose that the expression of mutated P301L may lead to select altered expression of genes which may cause neurodegeneration in FTDP-17.

Detection of high-risk HPV types by the hybrid capture 2 test

A hybrid capture test that can be used to detect at least 13 high-risk HPV types (referred to collectively as HPV-HR) in cervical scrapes (Hybrid Capture 2 probe set B, HC2-B) was evaluated. The HC2-B test is accurate and highly reproducible and the results obtained show excellent agreement with those obtained by a multiplexed type-specific polymerase chain reaction (mts-PCR). An additional assay to identify a subset of HPV-HR types may improve specificity without compromising sensitivity in HC2-B positive specimens with a test result close to the cut-off value given by 1 pg/ml HPV DNA.

In vitro and in vivo antitumor effect of the anti-CD26 monoclonal antibody 1F7 on human CD30+ anaplastic large cell T-cell lymphoma Karpas 299

CD26 is a M(r) 110,000 surface glycoprotein with diverse functional properties, including having a potentially significant role in tumor development, and antibodies to CD26 mediate pleomorphic cellular functions. In this report, we show that binding of soluble anti-CD26 monoclonal Ab 1F7 inhibits the growth of the human CD30+ anaplastic large cell T-cell lymphoma cell line Karpas 299 in both in vitro and in vivo experiments. In vitro experiments show that 1F7 induces cell cycle arrest at the G1-S checkpoint, associated with enhanced p21 expression that is dependent on de novo protein synthesis. Furthermore, experiments with a severe combined immunodeficient mouse tumor model demonstrate that 1F7 treatment significantly enhances survival of tumor-bearing mice by inhibiting tumor formation. Our data therefore suggest that anti-CD26 treatment may have potential clinical use for CD26+ hematological malignancies.

Malignant pleural mesothelioma

Malignant pleural mesothelioma remains a difficult tumor to treat, much less cure. Currently, the best chance for long-term survival lies with early diagnosis and aggressive surgical extirpation, but given the typically long delay between the onset of symptoms and diagnosis, this is only possible with a high index of suspicion and an aggressive diagnosis workup. Early referral to a tertiary center experienced in the treatment of MPM may be important for several reasons: (1) decreased risk of tumor spread along multiple thoracenesis/biopsy tracts, (2) the availability of specialized pathologic assays for definitive diagnosis, (3) the availability of critical staging modalities (aggressive mediastinoscopy +/- thoracoscopy, MRI scans performed according to specific mesothelioma protocols, and perhaps PET scans), (4) surgical experience with pleurectomy/decortication and/or extrapleural pneumonectomy, that may decrease morbidity and mortality, and (5) the availability of novel adjuvant protocols. Single-modality therapy is unlikely to result in long-term survival. Aggressive surgery is required for optimal debulking, and extrapleural pneumonectomy may offer better local control compared with pleurectomy/ecortication. Delivery of optimal radiation schedules, which may involve large fractions as well as large total doses, is limited by the presence of nearby dose-limiting structures. Current chemotherapy is severely lacking in producing objective responses and improved survival although gemcitabine and IL-2 may be active agents to be combined with radiation and/or other agents. Hyperthermia, photodynamic therapy, intracavitary therapy, and gene therapy are all relatively new techniques under active investigation that should be supported by enrollment in on-going protocols. Predictably, many of these techniques provide greater benefit when used in the setting of adjuvant protocols or minimal residual disease, emphasizing the importance of multimodality therapy.

Irinotecan plus cisplatin in advanced gastric or gastroesophageal junction carcinoma

A phase II study was conducted to assess the response rate and toxicity profile of the combination of irinotecan (CPT-11, Camptosar) and cisplatin (Platinol) administered weekly to patients with untreated advanced adeno-carcinoma of the stomach or gastroesophageal junction. Patients with histologic proof of adenocarcinoma of the stomach or gastroesophageal junction and with adequate liver, kidney, and bone marrow functions were included. Patients were treated with 65 mg/m2 of irinotecan plus 30 mg/m2 of cisplatin, both administered intravenously 1 day per week for 4 consecutive weeks, followed by a 2-week recovery period. Response rate, time to progression, survival, and toxic effects were analyzed. Thirty-six (95%) of 38 registered patients were assessable for toxicity and response. The median number of 6-week cycles per patient was 2.5 (range: 1 to 7 cycles). Four patients (11%) achieved a complete response and 17 (47%) had a partial response for an overall response rate of 58%. Median time to progression of carcinoma was 24 weeks, and median survival was 9 months (range: 1 to 23+ months). There was one treatment-related death. Major toxic effects included diarrhea, neutropenia, and fatigue. The combination of irinotecan and cisplatin is active against gastric or gastroesophageal adenocarcinoma and should undergo further study. The addition of other active drugs or radiation therapy to this regimen would be of interest.

Neuronal cyclooxygenase 2 expression in the hippocampal formation as a function of the clinical progression of Alzheimer disease

BACKGROUND

Prior studies have shown that cyclooxygenase 2 (COX-2), an enzyme involved in inflammatory mechanisms and neuronal activities, is up-regulated in the brain with Alzheimer disease (AD) and may represent a therapeutic target for anti-inflammatory treatments.

OBJECTIVE

To explore COX-2 expression in the brain as a function of clinical progression of early AD.

DESIGN AND MAIN OUTCOME MEASURES

Using semiquantitative immunocytochemistry, we analyzed COX-2 protein content in the hippocampal formation in 54 postmortem brain specimens from patients with normal or impaired cognitive status.

SETTING AND PATIENTS

Postmortem study of nursing home residents.

RESULTS

The immunointensity of COX-2 signal in the CA3 and CA2 but not CA1 subdivisions of the pyramidal layers of the hippocampal formation of the AD brain increased as the disease progressed from questionable to mild clinical dementia as assessed by Clinical Dementia Rating. COX-2 signal was increased in all 3 regions examined among cases characterized by severe dementia.

CONCLUSION

Neuronal COX-2 content in subsets of hippocampal pyramidal neurons may be an indicator of progression of dementia in early AD.

Altered expression of a-type but not b-type synapsin isoform in the brain of patients at high risk for Alzheimer's disease assessed by DNA microarray technique

Using a cDNA microarray representing 6794 distinct human genes, we identified candidate genes whose expression is altered in cerebral cortex of cases of early Alzheimer's disease (AD); among these was the synaptic vesicle protein synapsin II, which plays an important role in neurotransmitter release. While other candidate genes are presently under investigation in our lab, in this study we discuss the regulation of synapsin gene expression during the transition from normal cognitive function to early AD. We found a selective decrease in the expression of the synapsin splice variants I-III of the a-type isoform in the entorhinal (EC, BM36) but not visual cortex (VC, BM17) of cases characterized by the earliest clinically detectable stage of AD. In contrast, we found no changes in synapsin splice variant II of the b-type isoform. Alteration of synapsin expression at the earliest clinical stage of AD may suggest novel strategies for improved treatment.

Phase I study of irinotecan and concurrent radiation therapy for upper GI tumors

Irinotecan (Camptosar) is an active chemotherapeutic agent for lung, gastric, esophageal, and colorectal cancers and a potent radiosensitizer. This phase I study was designed to assess the maximum tolerated dose of weekly irinotecan combined with concurrent radiotherapy for patients with locally advanced, unresectable gastric, gastroesophageal junction, or esophageal cancer. Patients who received previous chemotherapy (excluding irinotecan) or who experienced recurrent cancer after surgery were eligible for this protocol. The total dose of radiation did not exceed 50.4 Gy (28 fractions of 1.8 Gy each). The starting dose level of irinotecan was 30 mg/m2 infused over 90 minutes given weekly for 5 weeks. Subsequent dose levels were increased in 10 mg/m2 increments to 40, 50, 60, and 70 mg/m2. Of 15 patients who have been enrolled to date, all are evaluable for toxicities and 12 for response. Major hematologic toxicities (grade 3/4) were neutropenia, chills, hemorrhage, and anemia. Grade 3/4 gastrointestinal toxicities included nausea, vomiting, dehydration, anorexia, and constipation. Other severe nonhematologic toxicities included fatigue, hypotension, and hypothermia, as well as cardiovascular toxicities. There was no severe diarrhea and no treatment-related deaths. Of the 12 evaluable patients, 7 (58%) responded, including 2 complete responses; 4 (30%) had no change and 1 had progressive disease. Survival ranged from 1 month to 15 months, with a median survival of 8 months. When the total dose of irinotecan given concurrently with radiotherapy was higher than 250 mg/m2, patients experienced significantly more severe grade 3/4 toxicities than with lower doses (P = .04), with no improvement in response rate. It was concluded that weekly doses of irinotecan of up to 60 mg/m2 with concurrent radiotherapy given over 5 weeks was feasible and demonstrated good response. This regimen did not cause severe diarrhea or pneumonitis, but neutropenia and fatigue were major toxicities. The study continues to accrue.

Immediate response of glenohumeral abduction range of motion to a caudally directed translational mobilization: a fresh cadaver simulation

OBJECTIVE

To investigate the immediate effect of caudal glide translational mobilization on the range of motion (ROM) of passive glenohumeral abduction with a fresh cadaver model to simulate the mobilization movement performed by a physical therapist treating patients with glenohumeral hypomobility.

DESIGN

Mechanical simulation of caudal glide mobilization and abduction torque range of motion (TROM) measurement of the glenohumeral joint with 2 material testing systems. Mobilizations were conducted with the glenohumeral joint positioned at a resting position (IGR) and at the end range of abduction (IGE).

SETTING

Biomechanics laboratory.

CADAVERS

Twenty fresh shoulder specimens from 10 cadavers (mean age, 68 +/- 8 yr).

MAIN OUTCOME MEASURE

Changes in TROM of the glenohumeral abduction in response to 5 bouts of caudal glide mobilization.

RESULTS

At least 3 repetitions of TROM were required to attain consistent measurements on glenohumeral abduction ROM. Significant differences were found among changes in TROM because of rest, IGR, and IGE (Kruskal-Wallis statistics, (chi2 = 14.58, p = .001). A greater increase in glenohumeral abduction TROM was found after IGE (mean +/- standard error of the mean, 4.38 degrees +/- 0.95 degrees) compared with the rest control (0.03 degrees +/- 0.07 degrees; Mann-Whitney test, p = .001, alpha = .017) or its IGR counterpart (0.26 degrees +/- 0.46 degrees, p = .001, alpha = .017).

CONCLUSION

This simulation of caudal glide translational mobilization at the end range using cadaver models improved passive glenohumeral abduction ROM but was ineffective when performed with the shoulder placed in a resting position. The mechanical responses of the glenohumeral joint to translational mobilization in a live patient may be similar, but some caution should be used in generalizing these findings.

Cytokine gene expression as a function of the clinical progression of Alzheimer disease dementia

BACKGROUND

Inflammatory cytokines have been linked to Alzheimer disease (AD) neurodegeneration, but little is known about the temporal control of their expression in relationship to clinical measurements of AD dementia progression.

DESIGN AND MAIN OUTCOME MEASURES

We measured inflammatory cytokine messenger RNA (mRNA) expression in postmortem brain specimens of elderly subjects at different clinical stages of dementia and neuropathological dysfunction.

SETTING AND PATIENTS

Postmortem study of nursing home patients.

RESULTS

In brains of cognitively normal control subjects, higher interleukin 6 (IL-6) and transforming growth factor beta1 (TGF-beta1) mRNA expression was observed in the entorhinal cortex and superior temporal gyrus compared with the occipital cortex. Compared with age-matched controls, subjects with severe/terminal dementia, but not subjects at earlier disease stages, had higher IL-6 and TGF-beta1 mRNA expression in the entorhinal cortex (P<.01) and superior temporal gyrus (P<.01). When stratified by the Consortium to Establish a Registry for Alzheimer's Disease (CERAD) neuropathological criteria, IL-6 mRNA expression in both the entorhinal cortex (P<.05) and superior temporal gyrus (P<.01) correlated with the level of neurofibrillary tangles but not neuritic plaques. However, in the entorhinal cortex, TGF-beta1 mRNA did not correlate with the level of either neurofibrillary tangles or neuritic plaques. Interestingly, in the superior temporal gyrus, TGF-beta1 mRNA expression negatively correlated with neurofibrillary tangles (P<.01) and showed no relationship to the pathological features of neuritic plaques.

CONCLUSIONS

The data are consistent with the hypothesis that cytokine expression may differentially contribute to the vulnerability of independent cortical regions during the clinical progression of AD and suggest that an inflammatory cytokine response to the pathological effects of AD does not occur until the late stages of the disease. These findings have implications for the design of anti-inflammatory treatment strategies. Arch Neurol. 2000;57:1153-1160

Hepatitis B carrier and perinatal outcome in singleton pregnancy

The objective of this article is to evaluate the effect of hepatitis B antigenemia on perinatal outcome. Perinatal outcome of 824 women with hepatitis B surface antigen (HbsAg) was compared with 6281 women without hepatitis B surface antigen (control) from June 1996 to September 1998. The maternal characteristics were comparable between the two groups. Perinatal outcome was comparable between groups. The incidences of preterm birth, premature prelabor rupture of membranes, prelabor rupture of membranes, small for gestational age, neonatal jaundice, fetal distress, perinatal asphyxia, congenital abnormality, gastrointestinal tract abnormality, and perinatal mortality were similar among the two groups. We conclude that the presence of hepatitis B surface antigen in pregnant women does not pose additional risk for the pregnancy.