Characterization of allergens from Penicillium oxalicum and P. notatum by immunoblotting and N-terminal amino acid sequence analysis

BACKGROUND

Penicillium species are important causative agents of extrinsic bronchial asthma. However, little is known about the allergens of these ubiquitous fungal species. Objective The object was to analyse the composition, the allergenic cross-reactivity and the N-terminal sequences of allergens from two prevalent airborne Penicillium species, P. oxalicum and P. notatum.

METHODS

The allergenic composition and the immunoglobulin (Ig)E cross-reactivity were analysed by immunoblot and immunoblot inhibition, respectively, using sera from asthmatic patients. The N-terminal amino acid sequences of major allergens were determined by Edman degradation. Allergens identified were also characterized by immunoblotting using monoclonal antibody (MoAb) PCM39 against the alkaline serine proteinase major allergen of P. citrinum.

RESULTS

Among the 70 asthmatic sera tested, 18 (26%) and 17 (24%) had IgE immunoblot reactivity towards components of P. oxalicum and P. notatum, respectively. Major allergens (> 80% frequency of IgE-binding) from both species are the 34 and 30 kDa proteins of P. oxalicum and the 34 and 32 kDa proteins of P. notatum. IgE cross-reactivity among these major allergens and the 33 kDa major allergen of P. citrinum can be detected by immunoblot inhibition studies. The N-terminal amino acid sequences of the 34 kDa allergen of P. oxalicum and of the 32 and the 28 kDa allergens of P. notatum share homology with sequences of the vacuolar serine proteinase from Aspergillus fumigatus. The N-terminal amino acid sequence of the 34 kDa allergen of P. notatum shows sequence homology with that of alkaline serine proteinase from P. citrinum. Results obtained from immunoblotting showed that MoAb PCM39 reacted with the 34, 30 and 16 kDa IgE-binding components of P. oxalicum, and with the 34, 32 and 28 kDa IgE-binding components of P. notatum.

CONCLUSIONS

Results obtained suggest that the 34 kDa major allergen of P. oxalicum may be a vacuolar serine proteinase. The 34 and the 32 kDa major allergens of P. notatum may be the alkaline and the vacuolar serine proteinases of P. notatum, respectively. The 30 and 16 kDa IgE-binding components of P. oxalicum and the 28 kDa IgE-binding component of P. notatum may be breakdown products of the 34 and the 32 kDa major vacuolar serine proteinase allergens of P. oxalicum and P. notatum, respectively.

Effects of glutamatergic, cholinergic and gabaergic antagonists on tectal cells in toads

The present paper using microiontophoresis analysis describes transmitters and their receptor subtypes used in retinotectal and isthmotectal transmission, and suggests several modes converging retinotectal and isthmotectal afferents on tectal neurons in toads (Bufo bufo gargarizans). Neuronal responses of tectal cells were extracellularly recorded to both visual stimulation and electrical stimulation of the nucleus isthmi, and effects of glutamatergic, cholinergic, GABAergic and glycinergic antagonists on these responses examined. Visual responses in 80% of tectal cells were reversibly blocked by the N-methyl-D-aspartate antagonist 3-Rs-2-carboxypiperazin-4-yl-propyl-1-phosphonic acid, and those of the remaining 20% of cells by the muscarinic antagonist atropine, suggesting that there may be at least two kinds of retinotectal synapse that use glutamate and N-methyl-D-aspartate receptors, and acetylcholine and muscarinic receptors, respectively. Electrical stimulation of the nucleus isthmi elicited excitatory responses in 67% of tectal cells, excitatory-inhibitory responses in 16% of cells, and inhibitory responses in 17% of cells examined. The excitatory responses were reversibly abolished by atropine, but not affected by either 3-Rs-2-carboxypiperazin-4-yl-propyl-1-phosphonic acid or the alpha-amino-3-hydroxy-5-methyl-4-isoxazole-propionate antagonist 6-cyano-7-nitroquinoxaline-2,3-dione, whereas the inhibitory responses were released by the GABA receptor A antagonist bicuculline, but not influenced by the GABA receptor B antagonist 2-hydroxysaclofen and glycinergic antagonist strychnine. Excitatory and inhibitory components in the excitatory-inhibitory responses were blocked by atropine and bicuculline, respectively. It appears that glutamatergic and cholinergic afferents from the retina, and cholinergic and GABAergic afferents from the nucleus isthmi may converge on tectal neurons in at least five modes of synaptic connections, in agreement with the heterogeneous populations of tectal cells in amphibians.

Localization and source of gamma aminobutyric acid immunoreactivity in the isthmic nucleus of the frog Rana esculenta

The distribution of gamma-aminobutyric acid (GABA)-containing neurons and nerve fibers was studied in the isthmic nucleus of the frog Rana esculenta using light and electron microscopical immunohistochemical techniques. Approximately 0.5% of isthmic cells showed GABA immunopositivity, and the majority of these cells was found in the anterior one-third of the nucleus. A meshwork of GABA-immunostained fine beaded axons filled the entire isthmic nucleus. The GABA-immunoreactive terminals formed pericellular basket-like structures around a few cells both in the medulla and the cortex of the isthmic nucleus. To determine the source of GABA-positive fibers in the isthmic nucleus lesion experiments were carried out. After unilateral tectal ablation no change was observed in GABA immunoreactivity. Hemisectioning the tegmentum close to the anterior border of the isthmic nucleus, transection of the caudal tectal commissure and decussatio veli, or electrical lesioning of the anterodorsal tegmental nucleus all resulted in a moderate decrease in the density of GABA-positive fibers. Our results suggest that the majority of GABA-positive fibers derives from local GABA-positive cells, but some GABAergic afferents seem to arise in the tegmentum.

Stimulus features eliciting visual responses from neurons in the nucleus lentiformis mesencephali in pigeons

The purpose of the present study was to find out what particular stimulus features, in addition to the direction and velocity of motion, specifically activate neurons in the nucleus lentiformis mesencephali (nLM) in pigeons. Visual responses of 60 nLM cells to a variety of computer-generated stimuli were extracellularly recorded and quantitatively analyzed. Ten recording sites were histologically verified to be localized within nLM with cobalt sulfide markings. It was shown that the pigeon nLM cells were specifically sensitive to the leading edge moving at the optimal velocity in the preferred direction through their excitatory receptive fields (ERFs). Generally speaking, nLM cells preferred black edges to white ones. However, this preference cannot be explained by OFF-responses to a light spot. The edge sharpness was also an essential factor influencing the responsive strength, with blurred edges producing little or no visual responses at all. These neurons vigorously responded to black edge orientated perpendicular to, and moved in, the preferred direction; the magnitude of visual responses was reduced with changing orientation. The spatial summation occurred in all neurons tested, characterized by the finding that neuronal firings increased as the leading edge was lengthened until saturation was reached. On the other hand, it appeared that nLM neurons could not detect any differences in the shape and area of stimuli with an identical edge. These data suggested that feature extraction characteristics of nLM neurons may be specialized for detecting optokinetic stimuli, but not for realizing pattern recognition. This seems to be at least one of the reasons why large-field gratings or random-dot patterns have been used to study visual responses of accessory optic neurons and optokinetic nystagmus, because many high-contrast edges in these stimuli can activate a neuron to periodically discharge, or groups of neurons to simultaneously fire to elicit optokinetic reflex.

Tegmental inhibition on isthmic neurons is mediated by the decussatio veli in amphibians

This in vitro study on toads (Bufo bufo gargarizans) provides the first electrophysiological evidence that electrical stimulation of the decussatio veli in the midbrain tegmentum predominantly produced inhibition on neurons extracellularly recorded from the nucleus isthmi (NI). These cells were distributed throughout the nucleus. The present study lends strong support to the suggestion that the extratectal input to NI is mainly inhibitory and gives a good explanation for the previously reported inhibition of isthmic neurons by the contralateral optic nerve stimulation (Wu and Wang, 1995a).

Normal pressure hydrocephalus in a patient with systemic lupus erythematosus: a case report

Neuropsychiatric symptoms in systemic lupus erythematosus (SLE) are varied. The exact etiology and appropriate treatment are difficult to determine. We describe a 43-year-old woman who was diagnosed 18 years earlier with SLE. She developed dementia, gait disturbance, urinary incontinence and deterioration of consciousness. Her cerebrospinal fluid pressure was not elevated. Brain computerized tomography scan revealed enlarged ventricle and cortical sulci. Normal pressure hydrocephalus (NPH) was diagnosed. She was treated by establishing a ventriculo-peritoneal shunt, resulting in the return of normal consciousness. But she still had slurred speech, slow mentation and poor calculation ability. Her urinary incontinence persisted. Along with a literature review on NPH, we discuss its etiology, diagnosis and treatment.

Characterization and functional analysis of the porcine lactoferrin gene promoter

Lactoferrin, a ferric binding glycoprotein found in milk, can possibly prevent microbial infection of the mammary gland and gastrointestinal tract. To define the regulation of the porcine lactoferrin gene (pLTF), we cloned its 5'-flanking region from a porcine liver genomic library and analyzed the 5' upstream region of approx. 4kb, two exons, and an intron. The transcription start site was localized by primer extension to residue G, which is 41 nucleotides upstream from the ATG start codon. The pLTF 5'-flanking region possesses several putative cis-acting regulatory elements found in both housekeeping and inducible genes; to define their function, they were inserted into a chloramphenicol acetyltransferase reporter construct. The region up to -156 sufficed for basic promoter activity, whereas the region up to -780 was required for maximal promoter activity in porcine testis cells (STcells), kidney cells (PK15 cells) and human mammary epithelial cells (HBL-100 cells). Detailed analysis of this proximal region by DNase I footprinting and electrophoretic mobility shift assays reveals that the ubiquitous factors SP1, AP2 and the mammary gland-specific factor (MGF) might play significant roles in regulating the transcription of the pLTF gene.

Differences between women and men with chronic renal disease

BACKGROUND

The purpose of the present study was to compare the participation of women and men in the protocols of the Modification of Diet in Renal Disease (MDRD) study, a multicenter prospective randomized clinical trial, and to assess gender differences in their renal outcomes.

METHODS

Of the 840 participants in the MDRD study, 332 (39.5%) were women who were assigned randomly to the dietary protein and blood pressure groups and followed for a median of 2.2 years. A subgroup analysis of the MDRD study database was carried out to compare women and men participants in recruitment, baseline characteristics, adherence to protocol requirements, safety and outcomes, and progression of renal disease and its response to dietary and blood pressure interventions.

RESULTS

Adherence by women to the requirements of the protocol including diet, record keeping, office visits, glomerular filtration rate (GFR) measurements and urine collections was equivalent to that of men. Women had different renal diagnoses, less proteinuria and lower serum creatinine levels for given GFRs than men. When participants were grouped above and below age 52, the younger women had lower mean arterial pressure than did the men. Older women compared with younger had higher mean arterial pressure, body weight and body mass index, and total low density lipoprotein cholesterol. These differences were not seen between males of the same two age groups. During follow-up, the rate of GFR fall was slower in women, especially in the younger group. However, the association between gender and the rate of fall in GFR was attenuated and became non-significant after adjusting for differences in blood pressure, proteinuria and high density lipoprotein cholesterol. In analyses of the full cohort, there were no significant differences between women and men in the effects of the low protein or low blood pressure intervention in patients with either moderate (study A) or advanced (study B) renal disease. However, in subgroup analyses of patients in study A, there was some evidence of a lesser effect in women than in men.

CONCLUSIONS

This exploratory analysis of the MDRD study indicates a slower mean GFR decline in women as compared with men. The slower mean GFR decline and suggestive evidence of a lesser beneficial effect of the low protein diet and low blood pressure interventions in women suggest that gender differences should be considered in trials of the effects of these interventions on the progression of renal disease. Also, the participation of women in the MDRD study was excellent and equivalent to that of men.

Centrifugal innervation modulates visual activity of tectal cells in pigeons

Centrifugal modulation of visual responsiveness of tectal cells by the isthmo-optic nucleus (ION) through the retina was studied in homing pigeons. Visual activity evoked by computer-generated stimuli was reduced by an average of 59% in tectal cells whose receptive fields (RFs) either overlapped with, or were close to, those of isthmo-optic cells whose activity was blocked by the injection of lidocaine through micropipettes. Activity usually recovered to 87% of pre-drug controls in 8-17 min (average 12.3 min) after stopping lidocaine injections. Those tectal cells whose RFs were far from those of ION cells did not show clear-cut changes in their visual responsiveness to isthmo-optic lidocaine application. The spatial relationship between receptive fields of tectal and isthmo-optic cells, saline controls, as well as the specificity, reproducibility and reversibility of effects of ION-injected lidocaine on tectal activity, show that this chemical action is pharmacological, not toxicological. Neuronal circuitry underlying centrifugal modulation of tectal activity by isthmo-optic cells is discussed.

Alkaline serine proteinase: a major allergen of Aspergillus oryzae and its cross-reactivity with Penicillium citrinum

BACKGROUND

Aspergillus species are common indoor airborne fungi and have been considered as causative agents of human allergic disorders. However, allergens of different Aspergillus species have not been effectively characterized. The object of this study was to identify and characterize IgE-binding components of Aspergillus oryzae.

METHODS

Allergens of A. oryzae were identified by immunoblot analysis using sera from asthmatic patients. The N-terminal amino acid sequences of allergens thus identified were determined by Edman degradation. The antigenic and the allergenic cross-reactivities between allergens of different fungi were analyzed by immunoblotting and immunoblot inhibition analysis, respectively, using a monoclonal antibody (MoAb) 55A against the 33-kD major allergen of Penicillium citrinum and a mixture of IgE-containing asthmatic serum samples.

RESULTS

Thirteen components of A. oryzae ranging in apparent molecular weight from 16 to 42 kD react with IgE antibodies. A 34-kD component that showed intense IgE-binding reactivity and was detectable in the highest frequency in our asthmatic serum samples tested was considered a major allergen of A. oryzae. The 34-kD component also reacted with MoAb 55A. Results from immunoblot inhibition studies also demonstrated the IgE cross-reactivity between the 34-kD major allergens of A. oryzae and P. citrinum. In addition, the sequence of the N-terminal 18 amino acid residues of the 34-kD major allergen of A. oryzae was found to be identical to that of the alkaline serine proteinase from the same Aspergillus species.

CONCLUSION

The 34-kD major allergen of A. oryzae is an alkaline serine proteinase. There is IgE cross-reactivity between the major serine proteinase allergens of A. oryzae and P. citrinum.

A new slicing method for the lower vertebrate brain: brain mould and adjustable stage

This paper describes a new method for slicing the lower vertebrate brain which is too small and soft to be sliced using conventional methods. The brain is sliced in a pre-prepared agar mould glued to a special stage placed in a conventional vibratome. The mould is constructed from a plaster model prepared by embedding a paraformaldehyde fixed brain in a paraffin and vaseline mixture. The brain to be sliced is placed within two prepared agar half cylinders which are in turn placed in a pre-prepared larger agar collar glued to a special stage. The study describes in detail the preparation of the interlocking collar and inner cylinders of agar. The plexiglass stage allows the agar block containing the brain, to be rotated and inclined to improve the angle of cut. By using this method, small and soft brain even with thin walls and large ventricles could be sliced coronally, sagittally, horizontally or obliquely. Brain slices obtained by this method have good viability showing spontaneous and evoked activity.

Sensitization to Blomia tropicalis among asthmatic patients in Taiwan

House dust mites have been reported as one of the most important allergens in Taiwan especially in asthmatic patients. This study was conducted to determine the allergenicity of Blomia tropicalis and sensitization of asthmatic patients in Taiwan. Serial dust samples were collected every month between July 1993 and June 1994 from 13 houses of mite-allergic patients. About 1 m2 surface area of a quilt was vacuumed. The floating method was used to collect mites, then identification and counting were performed. Results showed that Dermatophagoides pteronyssinus and B. tropicalis were the two most common species of mites found in allergenic patients' houses in Taipei. D. pteronyssinus accounted for 52.1% of the total number of mites and was found in every house. B. tropicalis, although not present in every sample, accounted for 44.3% of the total number of mites. The skin test positive reaction to B. tropicalis, D. pteronyssinus and Dermatophagoides farinae were 73.3, 88.3 and 85.0% as determined from 60 allergic patients who attended our allergy clinics. The extract prepared from B. tropicalis was used to determine the allergenicity and contained at least 30 protein components when silver stained. The most frequently detected allergens were proteins with molecular weights of 14.3, 106.5, 94.0, 72.0, 91.9, 63.7, 100.3, 43.6, 27.3, 62.0, 34.7, 18.3, 41.1 and 21.9 kD. The frequency of IgE binding of patient sera to those proteins were 87.0, 65.2, 56.5, 43.4, 39.1, 39.1, 34.8, 30.4, 30.4, 17.4, 17.4, 17.4, 13.0 and 8.7%. The results from immunoblot inhibition showed that there was IgE cross-reactivity among the B. tropicalis and D. pteronyssinus. However, there were two major allergenic components of B. tropicalis not inhibited by D. pteronyssinus with molecular weights of about 14.3 and 27.3 kD. The use of B. tropicalis extract for diagnostic purposes to identify patients with specific sensitivity should be considered in Taiwan.

Receptive field properties of visual neurons in the avian nucleus lentiformis mesencephali

The receptive field (RF) properties of visual neurons extracellularly recorded from the nucleus lentiformis mesencephali (nLM) in pigeons (Columba livia) were quantitatively analyzed using a workstation computer. These cells were actively spontaneous, and direction-and velocity-selective. Using spatial gratings as visual stimuli, these cells could be divided into three groups: uni- (74%), bi- (17%), and omnidirectional (9%) cells in terms of their directionality. On the basis of their velocity selectivity, they could be named slow cells (84%), preferring low velocity (0.1-11 degrees/s), and fast cells (14%), preferring rapid motion (34-67 degrees/s), with one cell (2%) responding maximally to an intermediate velocity of 18 degrees/ s. These two properties were correlated in the way that all unidirectionals were slow cells, omnidirectionals were fast cells, and bidirectionals were either slow or fast cells including the intermediate cell. Using small targets as visual stimuli, it was found that the majority of cells examined had RFs that each consisted of an excitatory RF (ERF) and an inhibitory RF (IRF) that overlapped. The unidirectionals were mainly of this type of RF structure, whereas the omnidirectionals apparently had ERFs alone. The direction preference of ERF was opposite to that of IRF for unidirectional cells tested, whereas they were perpendicular to each other for one bidirectional cell. The overall responses of these cells resulted from interaction between excitation and inhibition induced by directionally different motion. Under certain conditions, visual responses of a particular cells to a small target moving through its ERF were equal in responsive strength to those to whole-field gratings swept over the screen. It was suggested that optokinetic nystagmus produced by wholefield gratings results from population activity of large group(s) of neurons in some optokinetic nuclei, at least one of which is nLM.

Isolation and expression of a porcine lactoferrin gene

OBJECTIVE

To elucidate the spatial and temporal expression of a porcine lactoferrin (LTF) gene.

ANIMALS

4 female and 4 male Large White pigs.

PROCEDURES

We examined LTF expression in various organs excised from the pigs, using northern blot hybridization with a porcine LTF cDNA probe. Antibodies against porcine LTF were raised in rabbits and were used along with immunohistochemical staining to localize the LTF protein.

RESULTS

High amounts of porcine LTF mRNA were detected in the secreting mammary gland and epididymis. This distribution is consistent with that of porcine LTF examined by immunohistochemistry. In female pigs, porcine LTF mRNA concentration increased remarkably in the ductal cells of the lactating mammary gland then significantly decreased at day 21 after parturition. Furthermore, specific staining for LTF was observed in the epithelial cells of the gastrointestinal tract of female pigs, but not in the uterus, ovaries, spleen, kidneys, pancreas, muscles, heart, brain, lungs, or liver of postpartum female pigs, or in the testes of male pigs.

CONCLUSIONS

Gene expression of porcine LTF is closely related to lactation in the mammary gland. Distribution of LTF in the epididymis suggests that LTF may have a regulatory role in development of the reproductive tract of male pigs.

Effect of dietary protein restriction on nutritional status in the Modification of Diet in Renal Disease Study

The safety of dietary protein and phosphorous restriction was evaluated in the Modification of Diet in Renal Disease (MDRD) Study. In Study A, 585 patients with a glomerular filtration rate (GFR) of 25 to 55 ml/min/1.73 m2 were randomly assigned to a usual-protein diet (1.3 g/kg/day) or a low-protein diet (0.58 g/kg/day). In Study B, 255 patients with a GFR of 13 to 24 ml/min/1.73 m2 were randomly assigned to the low-protein diet or a very-low-protein diet (0.28 g/kg/day), supplemented with a ketoacid-amino acid mixture (0.28 g/kg/day). The low-protein and very-low-protein diets were also low in phosphorus. Mean duration of follow-up was 2.2 years in both studies. Protein and energy intakes were lower in the low-protein and very-low-protein diet groups than in the usual-protein group. Two patients in Study B reached a "stop point" for malnutrition. There was no difference between randomized groups in the rates of death, first hospitalizations, or other "stop points" in either study. Mean values for various indices of nutritional status remained within the normal range during follow-up in each diet group. However, there were small but significant changes from baseline in some nutritional indices, and differences between the randomized groups in some of these changes. In the low-protein and very-low-protein diet groups, serum albumin rose, while serum transferrin, body wt, percent body fat, arm muscle area and urine creatinine excretion declined. Combining patients in both diet groups in each study, a lower achieved protein intake (from food and supplement) was not correlated with a higher rate of death, hospitalization or stop points, or with a progressive decline in any of the indices of nutritional status after controlling for baseline nutritional status and follow-up energy intake. These analyses suggest that the low-protein and very-low-protein diets used in the MDRD Study are safe for periods of two to three years. Nonetheless, both protein and energy intake declined and there were small but significant declines in various indices of nutritional status. These declines are of concern because of the adverse effect of protein calorie malnutrition in patients with end-stage renal disease. Physicians who prescribe low-protein diets must carefully monitor patients' protein and energy intake and nutritional status.

Effects of blood pressure control on progressive renal disease in blacks and whites. Modification of Diet in Renal Disease Study Group

African Americans (blacks) have a disproportionately high incidence of end-stage renal disease due to hypertension. The Modification of Diet in Renal Disease (MDRD) Study found that strict blood pressure control slowed the decline in glomerular filtration rate (GFR) only in the subgroup of patients with proteinuria. The present report compares the effects of blood pressure control in black and white MDRD Study participants. Fifty-three black and 495 white participants with baseline GFRs of 25 to 55 mL/min/1.73 m2 were randomly assigned to a usual or low mean arterial pressure (MAP) goal of < or = 107 or < or = 92 mm Hg, respectively. GFR decline was compared between randomized groups and correlated with the level of achieved blood pressure. The mean (+/-SE) GFR decline over 3 years in the low blood pressure group was 11.8+/-7.3 mL/min slower than in the usual blood pressure group among blacks (P=.11) compared with 0.3+/-1.3 mL/min slower among whites (P=.81) (P=.12 between blacks and whites). In both blacks and whites, higher baseline urine protein excretion was associated with a greater beneficial effect of the low MAP goal on GFR decline (P=.02 for both races). Combining both blood pressure groups and controlling for baseline characteristics, higher follow-up achieved MAP was associated with faster GFR decline in both blacks (P<.001) and whites (P=.002), with a sevenfold stronger relationship in blacks (P<.001). These secondary analyses support the prior recommendation for a lower than usual blood pressure goal (MAP < or = 92 mm Hg) in black and white patients with proteinuria (> 1 g/d). In addition, a lower level of blood pressure control may be even more important in blacks than in whites in slowing the progression of renal disease.

Cross-sectional study of quality of life and symptoms in chronic renal disease patients: the Modification of Diet in Renal Disease Study

The purposes of this study were to measure health-related quality of life in the Modification of Diet in Renal Disease clinical trial; correlate quality of life measures with demographic, medical, and laboratory variables; and compare quality of life in various chronic diseases. The 1,284 patients enrolled in the baseline period of the Modification of Diet in Renal Disease study who completed at least one measurement of quality of life or symptoms served as the subjects of this study. The Quality of Well-Being (QWB) scale, which was a general health-related quality of life index, the Symptom Checklist-90R (SCL-90R), which provided a global measure of mental health, and the Patient Symptom Form, which assessed the frequency of symptoms specific to this population, were used as measurements. The mean +/- SD QWB score was 0.74 +/- 0.09. Using multivariate analysis, there was a significant negative correlation between the overall QWB score and age and female gender, and a significant positive correlation between the QWB and level of education, income, and glomerular filtration rate (GFR). For the SCL-90R subscores, the mean normalized Global Symptom Index was 49.7 +/- 9.6, the Positive Symptom Total was 47.9 +/- 10.4, and the mean Positive Symptom Distress Index was 51.3 +/- 12.6. Using multivariate analysis, significant inverse relationships were seen between each of the SCL-90R subscores and income, serum albumin level, and GFR. The most commonly reported medical symptoms in this cohort included tiring easily, weakness, lack of pep or energy, difficulty sleeping, and abdominal bloating or gas. Symptoms in which the severity index score had a negative correlation with GFR included tiring easily, weakness, lack of pep and energy, muscle cramps, easy bruising or bleeding, bad taste in mouth, and hiccoughs. In conclusions, patients with moderate to advanced renal insufficiency have a reduced quality of life and an increased frequency and severity of both symptoms and psychological distress, with the magnitude of these changes negatively correlated with GFR.

NSAID-induced gastrointestinal damage. Epidemiology, risk and prevention, with an evaluation of the role of misoprostol. An Asia-Pacific perspective and consensus

The problem of nonsteroidal anti-inflammatory drug (NSAID)-induced gastrointestinal toxicity was reviewed by members of the Asia Pacific League of Associations for Rheumatology (APLAR) in a consensus conference in September 1992. This paper by the participants presents the consensus conclusions incorporating knowledge from recent publications. There had been a high level of concern that much of the toxicity had resulted from extensive and indiscriminate prescribing of NSAIDs. The implementation of evidence-based guidelines was considered likely to be able to effect a substantial reduction in toxicity without significant loss of overall therapeutic benefit. The evidence from which such guidelines could be developed is critically appraised.

Prevalence of hypertension in 1,795 subjects with chronic renal disease: the modification of diet in renal disease study baseline cohort. Modification of Diet in Renal Disease Study Group

The Modification of Diet in Renal Disease Study was a multicenter trial of the effect of protein restriction and strict blood pressure control on the progression rate of chronic renal failure of multiple causes. At the first baseline visit, 1,795 screened patients with renal disease had blood pressure measured, antihypertensive medications recorded, glomerular filtration rate (GFR) determined by 125I-iothalamate clearance, a nutritional assessment, and a 24-hour urine collection to determine sodium and potassium levels. A total of 1,494 patients in this cohort were classified as hypertensive (83%) and the remainder (301 patients) as nonhypertensive. Ninety-one percent of the hypertensive subjects were on treatment, 54% being controlled to a blood pressure of < or = 140/90 mm Hg. To better understand the factors that contribute to the development of hypertension in chronic renal disease, some determinants of the prevalence of hypertension in this cohort were investigated. Compared with normotensive subjects, hypertensive patients were older (51.2 +/- 12.7 years v 46.6 +/- 13.1 years [mean +/- SD]), had a higher body mass index (BMI; 27.5 +/- 4.7 kg/m2 v 25.4 +/- 4.2 kg/m2), and had a lower GFR (37.8 +/- 19.6 mL/min/1.73 m2 v 50.1 +/- 25 mL/min/1.73 m2). All these differences were significant (P < 0.01). The prevalence of hypertension was significantly higher for men than for women (86% v 80%; P = 0.001), and for blacks than for whites (93% v 81%; P < 0.001). The prevalence of hypertension was higher in subjects with glomerular disease than in those with tubulointerstitial disease (85% v 62.6%; P < 0.001). The prevalence of hypertension varied inversely with GFR (from 66% at a GFR of 83 mL/min/1.73 m2 to 95% at a GFR of 12 mL/min/1.73 m2). The prevalence of hypertension varied directly with BMI (from 70% with a BMI at the 10th percentile to 94% with a BMI at the 97th percentile). This relationship was independent of GFR. Multiple logistic regression analysis showed five predictors in decreasing order of significance as determined by chi-square values: GFR, 83.2; BMI, 36.7; black race, 19.9; increasing age, 14.5 (all P < 0.001); and male gender, 5.1 (P = 0.024). Salt intake was not a determinant of blood pressure status. These results confirm previous reports indicating that hypertension in renal disease is determined by the level of renal function. For the first time, three factors known to predict blood pressure levels in populations with normal renal function were also shown to be determinants of blood pressure in renal disease: BMI, black race, and age. In addition, the data suggest that hypertension is inadequately treated in more than half of patients with chronic renal disease in the United States.

Single-unit responses to whole-field visual stimulation in the pretectum of Rana pipiens

Visually responsive single units were recorded from the pretectal region that includes the large-celled nucleus lentiformis mesencephali (nLM) in the leopard frog, Rana pipiens. During monocular stimulation of the contralateral eye, 60 single units responding to movement of a large-field, random-dot pattern were quantitatively analyzed using horizontal and vertical directions at each of four pattern velocities (0.4-40 degrees/s). All units were spontaneously active, motion sensitive, and the majority showed 'on'-'off' responses. Several different response profiles were observed, including velocity-sensitive units with peak response at 10 degrees/s, most of which showed directional selectivity, and speed-sensitive units that showed increasing spike frequencies as pattern velocity increased, but little or no directional selectivity. About one-third of all unit analyzed were direction-selective, and 55% of those responded optimally to the temporal-to-nasal (T-N) direction of motion. T-N units were recorded primarily from an area that lies dorsolaterally between nLM and the optic tectum, in the 'peri-nLM' region. The pronounced monocular optokinetic nystagmus (OKN) response asymmetry that occurs in anurans appears to be reflected in the response profiles of the T-N direction selective units.

The relationship of aging to endotoxin shock and to production of TNF-alpha

BACKGROUND

Aged people are considered prone to gram-negative bacteremia and septic shock. This relationship was tested in murine endotoxin shock.

METHODS

Balb/c mice of various ages (1.4-13.4 months) were intraperitoneally injected with lipopolysaccharide (LPS), and rates of survival were observed. The production of TNF-alpha in vivo induced by LPS was measured.

RESULTS

The survival rates were the smallest in the oldest and youngest groups. Production of TNF-alpha attained a maximum at 2 h after LPS injection and was smaller in the oldest group; it had a reciprocal relationship to survival rates in each group except the youngest group.

CONCLUSION

Old and young mice had smaller rates of survival and greater production of TNF-alpha following endotoxin shock induced by LPS.

Immunohistochemical study of arginase in cancer of the stomach

High levels of arginase have been detected in gastric adenocarcinoma. To examine the hypothesis that this is due to macrophage infiltration into the tumour, we localized the cellular distribution of arginase by immunohistochemical staining. We examined gastric adenocarcinomas and their corresponding normal tissues (n = 45), leiomyomas (n = 2), leiomyosarcomas (n = 3), human gastric adenocarcinoma cell lines (n = 3), and benign gastric ulcers (n = 4) by the avidin-biotin-peroxidase complex technique. Macrophages with strong arginase immunoreactivity were observed infiltrating both gastric normal and cancer tissues. No arginase immunoreactivity was observed in normal mucosal gland, muscular and serosal tissues or benign gastric ulcers. The immunoreactivity of arginase was positive but heterogeneous in most specimens of gastric adenocarcinoma (62.2%) and was absent from gastric intestinal metaplasia, leiomyomas and leiomyosarcomas. Among the 28 neoplasms with arginase immunoreactivity, scattered immunoreactivity was also noted in adjacent dysplastic glands in 12 (42.8%) specimens. Arginase immunoreactivity was observed in all three gastric cancer cell lines. Arginase is present in the cytoplasm but not in the nucleus. These data suggest that the high arginase levels in adenocarcinoma cancer tissues originate largely from cancer cells.

Serum interleukin-6 levels reflect disease status of gastric cancer

OBJECTIVES

Interleukin-6 (IL-6) has been shown to be associated with cancer development. However, its role in gastric cancer patients has never been investigated. Our intent was to investigate this role.

METHODS

Using enzyme-linked immunosorbent assay, we determined the IL-6 levels in sera of patients with gastric cancer (n = 218), benign gastric lesions (n = 9), and hepatitis B (n = 9), and in normal subjects (n = 85). C-reactive protein (CRP) levels and Helicobacter pylori antibodies were simultaneously determined in 150 and 133 gastric cancer patients, respectively. Serial serum IL-6 levels were also measured in 14 gastric cancer patients. Six gastric cancer cell lines were examined for IL-6 secretion. For comparison, serum carcinoembryonic antigen levels in all gastric cancer patients were also determined.

RESULTS

Mean IL-6 levels were significantly higher in patients with gastric cancer (10.0 +/- 9.5 pg/ml) than in patients with benign gastric lesions (2.6 +/- 0.5 pg/ml), in hepatitis B carriers (2.8 +/- 0.9 pg/ml), and in normal subjects (2.5 +/- 0.3 pg/ml). Gastric cancer patients with IL-6 > 10 pg/ml increased in a stage-related manner (p = 0.0001). Serum IL-6 levels increased when four patients had recurrence, whereas IL-6 levels decreased in 10 patients with a disease-free status after gastric resection. Serum IL-6 levels correlated moderately with serum CRP levels (r = 0.5, p < 0.01), but not with H. pylori antibody titers (p = 0.23). Serum IL-6 levels correlated with survival, but not as an independent prognostic indicator. Conversely, patients with CEA > 5 ng/ml increased in a stage-related manner, but this is not an effective reflection of disease progression. Five of six gastric cancer cell lines secrete IL-6.

CONCLUSIONS

Serum IL-6 levels correlate with disease status of gastric cancer and may be used as a new tumor marker for monitoring treatment and response of gastric cancer patients.

Bronchial responsiveness of aged asthmatic patients to bronchodilator and methacholine

Geriatric asthma is characterized by prolonged illness, lower remission rate, poor response to therapy and higher mortality rate. We studied bronchodilator response and methacholine challenge in 25 aged non-smoking asthmatic patients; thirty-two young asthmatic patients were included as control. The elderly patients had poorer baseline pulmonary function and were more responsive to a bronchodilator than the younger patients. The response to bronchoprovocation did not show any difference between the two groups. Our findings suggested that the airways of elderly asthmatics are as sensitive as those of younger patients and should not be under-treated.