Do dialysis patients need extra folate supplementation?

To assess folate status and to evaluate the need for conventional folate supplementation in patients on dialysis, we measured serum folate, vitamin B12, and red cell folate concentrations by radioimmunoassay. Thirty-four continuous ambulatory peritoneal dialysis (CAPD) patients and 60 hemodialysis (HD) patients who had not been supplemented with folate were enrolled. Serum folate levels (5.8 +/- 3.6 ng/mL vs 2.0 +/- 1.1 ng/mL, p < 0.001) and vitamin B12 levels (831.4 +/- 416.9 pg/mL vs 513.9 +/- 213.3 pg/mL, p < 0.001) were significantly higher in CAPD patients than HD patients. The red cell folate levels (849.7 +/- 489.4 ng/mL vs 491.0 +/- 253.2 ng/mL, p < 0.001) were also significantly higher in CAPD patients. The incidences of folate deficiency in CAPD and HD patients were overestimated using the cut-off value for serum folate concentration (3.0% vs 71.7%, respectively), but the incidence of true folate deficiency was lower using the cut-off value for red cell folate level (0.0% vs 10.0%, respectively). In conclusion, the true incidence of folate deficiency in stable CAPD and HD patients is surprisingly low, even in patients who may not be taking folate supplements. The need for conventional folate supplementation in patients with end-stage renal disease on dialysis must therefore be re-evaluated. Before the decision is made to use folate supplementation, measurement of red cell folate is essential to assess of folate reserves of the patients on dialysis.

Clinical improvement and immunohistochemical findings in severe atopic dermatitis treated with interferon gamma

BACKGROUND

Several clinical studies have focused on the therapeutic effects of interferon gamma (IFN-gamma) in patients with severe atopic dermatitis (AD), although the dosage of recombinant IFN-gamma (rIFN-gamma), therapeutic schedule, and the degree of clinical improvement were different among studies. Although the exact mechanism of action of IFN-gamma therapy in AD is not clear, the beneficial effects of IFN-gamma have been attributed mainly to an immunomodulating effect on the expression of certain immunologic markers.

OBJECTIVE

Our purpose was to study the therapeutic effect of two different dosages of rIFN-gamma on AD and to investigate the change of lesional expression of infiltrating inflammatory cell markers associated with rIFN-gamma therapeutic efficacy.

METHODS

Fifty-one patients with severe recalcitrant AD were treated with rIFN-gamma. Twenty patients were treated with 0.5 x 10(6) IU/m(2) of rIFN-gamma (low-dose [LD] group); 21 patients received 1.5 x 10(6) IU/m(2) of rIFN-gamma (high-dose [HD] group); and 10 patients received placebo. The patients were injected subcutaneously 3 times a week for 12 weeks. Immunohistochemical study was performed in 20 patients of the HD group in the initial visit and after completion of rIFN-gamma therapy with a panel of 14 monoclonal antibodies as markers of inflammatory cells and cytokines.

RESULTS

The disease severity of the 2 groups treated with rIFN-gamma was reduced significantly at the end of treatment compared with that of the placebo group (P<.05). More rapid clinical improvement and more effective treatment outcome were seen in the HD group than in the LD group for the initial 6-week treatment period; however, the clinical improvement in both of the treated groups was stable and maintained after week 8 of treatment. Immunohistochemical findings showed statistically significant reduction in the lesional expression of CD25 and EG2 cells that infiltrated into skin after rIFN-gamma therapy.

CONCLUSION

This study demonstrated that rIFN-gamma therapy for AD is safe and effective. In the early phase of therapy, a higher dosage of rIFN-gamma is more effective; and for the maintenance of clinical improvement, a lower dosage of rIFN-gamma is recommended when high cost and effectiveness of rIFN-gamma are considered. The therapeutic efficacy of rIFN-gamma in AD might be in part related to the decreased number of CD25(+) and EG2(+) inflammatory cells infiltrated into skin.

Resistance to tobamoviruses in transgenic tobacco plants expressing the coat protein gene of pepper mild mottle virus (Korean isolate)

Red pepper, one of the most important vegetable crops in Korea, is severely affected by viral diseases causing 20-50% reduction in product yield. A pepper strain of tobacco mosaic virus (TMV-p) is the most common virus in red pepper. To study the molecular structure of the TMV-p virus, we generated cDNA clones of the viral genome. Partial sequencing of a few cDNA clones revealed that TMV-p shares a 98% identity at the nucleotide level with the Spanish isolate of pepper mild mottle virus (PMMV-s). This suggests that TMV-p should be reclassified as the Korean isolate of PMMV (PMMV-k). The coat protein (CP) gene together with the 3' untranslated region of the PMMV-k virus was obtained by reverse transcriptase-polymerase chain reaction (RT-PCR) using oligomers deduced from the sequence of PMMV-s. The sequence analysis of the CP gene and the 3' untranslated region further confirmed that PMMV-k is highly related to PMMV-s. The CP gene and the 3' untranslated region of PMMV-k were cloned into a plant expression vector and the construct was introduced into tobacco plants. The transgenic plants expressing the PMMV-k CP gene were delayed in developing systemic disease or failed to develop symptoms at all after inoculation with PMMV-k. Delay of symptoms was also observed when the plants were inoculated with TMV-OM which shares a 74% homology with PMMV-k in the amino acid sequence of the CP region. In a local lesion host, the CP expressing plants exhibited a greatly reduced number of necrotic lesions as compared to control plants after inoculation with TMV-OM. Our results show that CP-mediated viral resistance is readily applicable in the case of PMMV-k and can provide resistance to other viruses in the tobamovirus group.

Delayed immune-mediated hepatitis after three cycles of pembrolizumab for the treatment of sinonasal melanoma

Immune checkpoint inhibitors (ICIs) are monoclonal antibodies that induce the anti-tumor effects of T cells by targeting co-inhibitory immune checkpoints. The development of ICIs has revolutionized the clinical practice of oncology, leading to significant improvements in outcomes; therefore, ICIs are now standard care for various types of solid cancers. Immune-related adverse events, the unique toxicity profiles of ICIs, usually develop 4-12 weeks after initiation of ICI treatment; however, some cases can occur >3 months after cessation of ICI treatment. To date, there have been limited reports about delayed immune-mediated hepatitis (IMH) and histopathologic findings. Herein, we present a case of delayed IMH that occurred 3 months after the last dose of pembrolizumab, including histopathologic findings of the liver. This case suggests that ongoing surveillance for immune-related adverse events is required, even after cessation of ICI treatment.

An Update on the Chemical Constituents and Biological Properties of Selected Species of an Underpinned Genus of Red Algae: Chondrus

Macroalgae, particularly red seaweeds, have attracted significant attention due to their economic and health benefits. Chondrus, a red algae genus, despite its economic importance, seems to be undervalued. Among all its species, Chondrus crispus has been meticulously documented for its biological properties, and little is known about other species. No comprehensive review of the biological properties of this genus has been acknowledged. Thus, this review aimed to summarize the available information on the chemical constituents and biological properties of a few selected species, including Chondrus crispus, Chondrus ocellatus, Mazzaella canaliculata, and Chondrus armatus. We compiled and discovered that the genus is offering most of the important health-promoting benefits evidenced from in vitro and in vivo studies focused on antimicrobial, immunomodulation, neuroprotection, anti-atopic, anti-inflammatory, anti-viral, anti-diabetic, cytoprotective, antioxidant, anti-coagulation, nephroprotective, anti-tumor, and anti-venom activity, which speaks about the potential of this genus. Data on clinical studies are limited. Further, around 105 chemical constituents have been reported from Chondrus spp. Given its significance, further investigation is warranted, in the form of meticulously planned cell, animal, and clinical studies that concentrate on novel health-enhancing endeavors, in order to unveil the full potential of this genus. The review also outlines challenges and future directions.

Biomass-Derived Carbon Dots as Fluorescent Probes for Label-Free Sensing of Hemin and as Radical Scavengers

Carbon dots (CDs) derived from biomass are promising fluorescent probes for specific analyte detection due to their specificity, biocompatibility, selectivity, and sensitivity. In this work, carbon dots were prepared hydrothermally from natural material, Myrica esculenta fruits (hereafter referred to as MPCDs), without adding any chemicals. The prepared MPCDs were characterized using optical, microscopic, and spectroscopic methods that revealed the presence of numerous functional groups and fluorescent properties. MPCDs exhibited exceptional characteristics such as water solubility, photostability, excitation-dependent fluorescence emission, and ionic stability. Transmission electron microscopy found that the average size of the MPCDs was 8 nm. MPCDs exhibited remarkable sensing ability for hemin, with a good linearity (R2 = 0.999) and a lower limit of detection of 14.1 nM. MPCDs demonstrated fluorescence quenching-based detection of hemin, primarily owing to ground state complex formation and the inner filter effect. Furthermore, the prepared material exhibited excellent antioxidant potential against 2,2'-azino-bis (3-ethylbenzothiazoline-6-sulfonic acid) and 2,2-diphenyl-1-picrylhydrazyl radicals with EC50 values of 25.4 and 205.4 µg/mL, respectively. The study suggests that CDs from Myrica esculenta fruits could be used as optical sensors for hemin detection as well as to scavenge selected radicals.

Acute Abdomen in a Cervical Spinal Cord Injury Patient: A Case Report and Review of the Literature

Acute abdomen, including appendicitis, is an emergent condition requiring early detection and, often, immediate surgical intervention. Although patients with spinal cord injury (SCI) have an incidence of acute abdomen similar to that of the general population, diagnosing them is even more difficult and complex than it is in the general population. Because of the disruption of normal sensory pathways, the early symptoms are subtle and physical examination of the abdomen is often not helpful. In addition, because of concomitant common conditions in SCI patients, such as urinary tract infection, atelectasis, pneumonia, and decubitus ulcer, laboratory results are not reliable. Delayed diagnoses lead to higher mortality rates among SCI patients with acute abdomen than those of the general population. We report a case of appendicitis in a patient with cervical SCI and discuss the clinical characteristics and diagnostic pitfalls of acute abdomen in SCI patients.

The effect of temperature on antidromic median sensory conduction

It has been well documented that sensory nerve conduction studies are influenced by many factors. Twenty-two healthy subjects were electrophysiologically evaluated to measure the onset latency, peak latency and amplitude (baseline to negative peak) after cooling the non-dominant hand. The distal onset latency was prolonged by 0.06 msec/degrees C, peak latency by 0.1 msec/degrees C and the amplitude was increased by 1.8 microV/degrees C by cooling hand skin temperature from 34 to 26 degrees C. These results can be used to extrapolate the value at normal physiologic skin temperature for the subject whose temperature is lower than normal. The results were compared with previous reports.

Homologous monocuspid valve patch in right ventricular outflow tract reconstruction

BACKGROUND

In the surgical repair of tetralogy of Fallot or pulmonary atresia, pulmonary regurgitation may be detrimental in the postoperative period. We have used homograft monocuspid valve patch to prevent pulmonary insufficiency.

METHODS

From September 1996 to December 1998, twenty-five patients, 4 months to 8 years of age (median 10.1 months) had homograft monocuspid valve in the procedure of right ventricular outflow tract reconstruction. The function of the monocuspid valve was assessed by echocardiogram and graded as trivial to mild, mild to moderate, moderate, and severe. We evaluated the degree of pulmonary insufficiency before discharge, at 3-6 months, and at 12 months after the operation.

RESULTS

There was one hospital death due to fulminate adeno viral pneumonia. On echocardiogram, 21 patients (88%, 21/24) had no significant pulmonary insufficiency. Only one patient (4.5%) showed a moderate degree of pulmonary insufficiency. At 3-6 months, seventeen of twenty-one (81%) patients had no significant pulmonary insufficiency. There were fourteen patients who had follow-up over 1 year, and no patients showed newly developed significant pulmonary insufficiency.

CONCLUSIONS

We concluded that the homograft monocuspid valve patch for right ventricular outflow tract reconstruction has provided excellent early results for the prevention of pulmonary insufficiency. However these effects are limited in duration and further close follow-up should be needed.

Risk of dementia according to smoking cessation after newly diagnosed atrial fibrillation: a nationwide cohort study

Background

Incident atrial fibrillation (AF) is associated with an increased risk of dementia. There are limited data about the impact of smoking cessation after AF diagnosis on the risk of incident dementia.

Purpose

To evaluate the association between changes in smoking status after newly diagnosed AF and the risk of dementia.

Methods

Among patients with new-onset AF between 2010 and 2016, those who received a national health checkup exam within 2 years before and after the AF diagnosis were included. Patients who had prevalent dementia were excluded. Subjects were categorized into 4 groups according to the status of smoking before and after AF diagnosis: (1) never smoker; (2) ex-smoker; (3) quit-smoker after AF diagnosis; and (4) current smoker. The primary outcome was incident dementia during follow-up.

Results

A total of 126,252 patients were included (mean age 63, SD 12.0; men 62%; mean CHA2DS2-VASc 2.7). During a median 3 years of follow-up, dementia occurred in 5,925 patients (1.11 per 1000 person-years [1000PY]) (Alzheimer's dementia 1.5 per 1000 PY and vascular dementia 0.24 per 1000 PY, respectively). Never smokers, ex-smokers, quit-smokers, and current smokers were 52%, 27%, 7%, and 14% of the total study population, respectively. After multivariable adjustment, quit-smokers showed a higher risk of dementia than never smokers (hazard ratio [HR] 1.16, 95% confidence interval [CI] 1.03–1.32), but the risk was significantly decreased when compared to current smokers (HR 0.83, 95% CI 0.72–0.95). Alzheimer's dementia and vascular dementia showed consistent results as main (Figure).

Conclusion

All types of smoking were associated with a significantly higher risk of dementia in patients with new-onset AF. Smoking cessation after AF diagnosis showed a lower risk of dementia compared to patients smoking persistently. These findings may support the promotion of smoking cessation to lower the risk of dementia in patients with new-onset AF.

Funding Acknowledgement

Type of funding sources: None.

Effects of Aleurone Layer Extract From Black Rice (Oryza sativa L.) on Bone Mineral Density and Bone-Related Biomarkers of Ovariectomized Rats (FS14-05-19)

Objectives

Black rice contains functional compounds, including anthocyanins. In a previous study, black rice increased bone mineral density and strength in ovariectomized rats, although its biological effects on bone-related markers have not been evaluated. The aleurone layer of black rice (BRA) contains most of anthocyanins of black rice. This study examined the effects of BRA extract on bone mineral density and bone-related markers of ovariectomized rats.

Methods

We compared the anthocyanin amount between BRA and whole grain of black rice and evaluated whether BRA extract can effectively improve bone health in ovariectomized rats at 30 mg/kg body weight (BRA30) and 90 mg/kg body weight (BRA90). These amounts are approximately one seventh and one half of the level (200 mg/kg body weight) used in the previous experiments. We compared its effects on bone-related biomarkers with those of isoflavones, which have been used to improve bone health in postmenopausal women.

Results

The cyanidin 3-glucoside and peonidin-3-glucoside contents in BRA were 7.18 mg/g and 1.79 mg/g, respectively, which are 5.5-fold and 4.2-fold higher than those in the whole grain of black rice. Supplementation with BRA extract significantly decreased body weight compared with the control group of ovariectomized rats not treated with BRA extract. Mineral density of tibia was significantly higher in the BRA90 group than in the control group. The breaking force of tibia and femur and the concentrations of serum and bone calcium were higher in BRA30 and BRA90 than in the control. However, urinary pyridinoline level, serum alkaline phosphatase activity, and parathyroid hormone concentration decreased in the BRA groups compared to the control group.

Conclusions

The results suggest that BRA has more anthocyanin than whole grain black rice and can improve bone health by modulating bone metabolism and reducing postmenopausal osteoporosis. Furthermore, the BRA extract showed similar or even higher effect on bone-related biomarkers than isoflavones and hence can be used as a good food source to manage bone health of most postmenopausal women.

Funding Sources

PJ01327901, National Institute of Agricultural Sciences.

The effects of epidermal growth factor and chondroitin sulfate on the animal corneal endothelial cell culture

In order to investigate the effects of different culture media containing various concentrations of epidermal growth factor (EGF) and chondroitin sulfate (CDS) on the growth of cultured corneal endothelial cell, pig corneal endothelial cells were used for this study. The cells were divided into 7 groups and each group was cultured with a medium containing: 1. Eagle's minimal essential medium with Earle's salt (EMEM) only; 2. EMEM + EGF (10 ng/ml); 3. EMEM + EGF (100 ng/ml); 4. EMEM + CDS (1 mg/ml); 5. EMEM + CDS (25 mg/ml); 6. EMEM + EGF (10 ng/ml) + CDS (1 mg/ml); 7. EMEM + EGF (100 ng/ml) + CDS (25 mg/ml), respectively. The results are shown below: (1) High concentration of EGF (100 ng/ml) stimulated the growth of pig corneal endothelial cells, shortened doubling time and the cells reached confluence earliest in group 3. But a low concentration of EGF (10 ng/ml) showed no effects on the growth of pig corneal endothelial cells. (2) A high concentration of CDS (25 mg/ml) might retard the growth of pig corneal endothelial cell, but a low concentration of CDS (1 mg/ml) has no retarding effects on the growth of pig corneal endothelial cells. (3) A high concentration of EGF could "antagonize" the CDS induced growth retarding effects of endothelial cells. (4) Those cells cultured with a medium containing high concentrations of EGF had more mitotic activity, including many prominent binuclear and polynucleolar cells. (5) The cells cultured with a medium containing high concentrations of CDS showed a more flat-shaped morphology under observation with a phase contrast microscope.(ABSTRACT TRUNCATED AT 250 WORDS)

Identification of the erythropoietin receptors of erythroleukemic cells

Erythropoietin (epo) is the physiologic regulator of red blood cell development. We have demonstrated the presence of epo receptors on two erythroleukemia cell lines, IW32 and IW201. IW32 produces epo constitutively while IW201 is a nonproducing cell line. Neither cell lines respond to epo to differentiate. In this study, we have shown that these cells bound 125I-epo specifically. Binding could be displaced by the presence of unlabeled epo but not by insulin or epidermal growth factor. In contrast to that found in epo responsive cells isolated from Friend virus infected mouse spleen, which were reported to contain both "high" and "low" affinity receptors, our finding indicated only a single class of "low" affinity receptors with apparent dissociation constants of 1.7 nM and 2.0 nM for IW32 and IW201 cell lines, respectively. It is suggested that the absence of "high" affinity receptors may account for the lack of responsiveness of these cells to epo.

Local antiinflammatory activity of acid ester derivatives of prednisolone

The antiinflammatory activity of two steroid acid esters, methyl prednisolonate and methyl 20-dihydroprednisolonate, synthesized by modifying the 17 beta ketol side chain of prednisolone has been investigated in the cotton pellet granuloma bioassay in rats. The inhibitory effect of the ester derivatives on granuloma formation was equivalent to that of the parent compound. At dose of 5 mg/cotton pellet, methyl prednisolonate exhibited a highly significant thymolytic effect comparable to that of prednisolone, while methyl 20-dihydroprednisolonate had a weaker thymolytic effect. However, the local antiinflammatory activity of the two esters was not accompanied by a decrease in adrenal weight observed with the parent compound.

[Development in the National Hospice Care Service in Korea]

The urgent needs to establish hospice care systems in Korea arise from the following reasons: (1) a drastic increase in chronically ill patients with the increase of aged population: (2) rapid changes in living environment from the traditional habitation (e.g., Many Koreans living in apartment complexes, which is the most popular form of modern residence in recent years, prefer to die in the hospital.): the overall increase in patients with advanced cancer: (4) recent trends in early discharge of terminally ill patients from the limited hospital facilities to accommodate other medical insurance beneficiaries: (5) easy acceptance of euthanasia owing to the recent social atmosphere that belittles the dignity of human life: (6) medical and nursing care of AIDS patient in terminal stage: (7) and the problem associated with inhumane medical care system, overtreatment, and groundless fears against narcotics. Terminally ill patients were used to be treated in the hospital in the past. In these days, however, they are forced to have home cares with little assistance from the qualified medical personnel because of insufficient hospital facilities, which are even short for the need of emergency patients and provide priority cares to medical insurance beneficiaries with other acute problems. And yet, neither are there any administrative organizations nor systematic medical studies that deal with the level of terminally ill patient's need, their family's problems and resources of hospice care systems in Korea. Thus, most patients are not able to get appropriate medical care at the terminal stage of their lives. The objective of this study is to make comprehensive database for various hospice care organization currently in operation, link them through medical information system, and develop an easily accessible hospice care model that meets the need of most Korean people. Our survey results may be summarized as follows: Nationally there are 40 organizations that provide partial or full hospice care. However, these organizations are not linked to any formal medical service network. Furthermore, the objective of hospice care, care principles, personnel with appropriate training, educational programs, standard for care, costs, consulting service to patients' family members, the extent of medical care from professional staff members, status of hospice facility, and management of those institutions are neither clearly defined nor organized compared to the international hospice care standards. The surveys on patients of terminal stage, grouped in hospice and non-hospice care patients, reveal what they want visiting nursing care to help their pain control, psychological, social and spiritual demands. While the more than 90% of hospice care patients want to reduce their pains, the non-hospice care patients, in addition to their desire for pain control, demanded more psychological, social and spiritual helps as well. The results of this research could be utilized to (1) define the standard of hospice care, (2) provide the guidance for hospice medical care costs, (3) establish the database of hospice care systems, (4) develop softwares, (5) build communication network through Medinet, and (6) provide an organized visiting home nursing care system. These information should be a valuable resource to many medical staffs who are involved in cancer therapy, nursing care, and social welfare programs.

Monoclonal antibody to HER-2/neureceptor modulates repair of radiation-induced DNA damage and enhances radiosensitivity of human breast cancer cells overexpressing this oncogene

The management of human breast cancer frequently includes radiation therapy as an important intervention, and improvement in the clinical efficacy of radiation is desirable. Overexpression of the HER-2 growth factor receptor occurs in 25-30% of human breast cancers and correlates with poor clinical outcome, including earlier local relapse following conservative surgery accompanied by radiation therapy. In breast cancer cells with overexpression of HER-2 receptor, recombinant humanized monoclonal antibodies (rhuMAbs) to HER-2 receptors (rhuMAb HER-2) decrease cell proliferation in vitro and reduce tumor formation in nude mice. Therapy with rhuMAb HER-2 enhances tumor sensitivity to radiation at doses of 1-5 Gy, exceeding remission rates obtained with radiation alone. This benefit is specific to cells with HER-2 overexpression and does not occur in cells without overexpression. Treatment of cells with radiation (2-4 Gy) alone provokes a marked increase in unscheduled DNA synthesis, a measure of DNA repair, but HER-2-overexpressing cells treated with a combination of rhuMAb HER-2 and radiation demonstrate a decrease of unscheduled DNA synthesis to 25-44% of controls. Using an alternate test of DNA repair, i.e., radiation-damaged or undamaged reporter DNA, we introduced a cytomegalovirus-driven beta3-galactosidase into HER-2-overexpressing breast cancer cells that had been treated with rhuMAb HER-2 or control. At 24 h posttransfection, the extent of repair assayed by measuring reporter DNA expression was high after exposure to radiation alone but significantly lower in cells treated with combined radiation and rhuMAb HER-2 therapy. To further characterize effects of rhuMAb HER-2 and the combination of antibody and radiation on cell growth, analyses of cell cycle phase distribution were performed. Antibody reduces the fraction of HER-2-overexpressing breast cancer cells in S phase at 24 and 48 h. Radiation treatment is also known to promote cell cycle arrest, predominantly at G1, with low S-phase fraction at 24 and 48 h. In the presence of rhuMAb HER-2, radiation elicits a similar reduction in S phase at 24 h, but a significant reversal of this arrest appears to begin 48 h postradiation exposure. The level of S-phase fraction at 48 h is significantly greater than that found at 24 h with the combined antibody-radiation therapy, suggesting that early escape from cell cycle arrest in the presence of antireceptor antibody may not allow sufficient time for completion of DNA repair in HER-2-overexpressing cells. Because it is well known that failure of adequate p21WAF1 induction after DNA damage is associated with failure of cell cycle arrest, we also assessed the activity of this critical mediator of the cellular response to DNA damage. The results show induction of p21WAF1 transcripts and protein product at 6, 12, and 24 h after radiation treatment; however, increased levels of p21WAF1 transcript and protein are not sustained in HER-2-overexpressing cells exposed to radiation in the presence of rhuMAb HER-2. Although transcript and protein levels increase at 6-12 h, they are both diminished by 24 h. Levels of p21WAF1 transcript and protein at 24 h are significantly lower than in cells treated by radiation without antibody. A reduction in the basal level of p21WAF1 transcript also occurred after 12-24 h exposure to antibody alone. The effect of HER-2 antibody may be related to tyrosine phosphorylation of p21WAF1 protein. Tyrosine phosphorylation of p21WAF1 is increased after treatment with radiation alone, but phosphorylation is blocked by combined treatment with antireceptor antibody and radiation. This dysregulation of p21WAF1 in HER-2-overexpressing breast cells after treatment with rhuMAb HER-2 and radiation appears to be independent of p53 expression levels but does correlate with reduced levels of mdm2 protein. (ABSTRACT TRUNCATED)

Bioequivalence of a prednisolone tablet administered as a single oral dose in healthy male volunteers

OBJECTIVE

A bioequivalence study ofprednisolone as Nisolone (test) tablets versus Delta-Cortef (reference) tablets was conducted.

PATIENTS AND METHODS

Eighteen healthy male Korean volunteers received both 20 mg formulations of prednisolone in this 2 x 2 crossover study with a 1-week washout period between the doses. Plasma concentrations of prednisolone were monitored over a period of 12 hours after the administration using high-performance liquid chromatography. The AUC (area under the plasma concentration-time curve from time zero to infinity) and AUCt (area under the plasma concentration-time curve from time zero to the last sampling time) were calculated using the trapezoidal rule-extrapolation method. The Cmax (maximum plasma drug concentration) and t(max) (time to reach Cmax) were compiled from the plasma concentration-time data. Analysis of variance was carried out using logarithmically transformed AUC, AUCt and Cmax and untransformed t(max).

RESULTS

The geometric mean of AUCt was 1,786 ng/ml x h (test medication) and 1,787 ng/ml xh (reference medication). A Cmax of 409 ng/ml and 404 ng/ml was achieved for the test and the reference medication, respectively. Point estimates and 90% confidence intervals for AUCt (parametric) and Cmax (parametric) were 0.989 (0.942 approximately 1.039) and 1.013 (0.934 approximately 1.100), respectively. These results satisfy the bioequivalence criteria of the European Committee for Proprietary Medicinal Products and the US Food and Drug Administration Guidelines. The corresponding value of t(max) was -0.221 (-0.415 approximately 0.000).

CONCLUSION

The 2 medications of prednisolone examined are bioequivalent and, thus, may be prescribed interchangeably.

Role of heat shock proteins in gastric inflammation and ulcer healing

With the discovery of gastric acid and pepsin in the stomach, the questions about "why does the stomach not digest itself?", "how does the stomach preserve its normal integrity under the continuous exposure to lytic materials that are secreted?", and "how does the stomach resist against overwhelming Helicobacter pylori (H. pylori) infection or persistent nonsteroidal anti-inflammatory drugs (NSAID) administration?" had been raised. The discovery of "gastric mucosal barrier" or "the presence of defense system" might be the answers to these questions. The first level of gastric mucosal barrier consists of the factors secreted into the lumen including bicarbonates, mucus, immunoglobulins, other antibacterial substances including lactoferrin, and surface active phospholipids. The second level of defense system is the gastric epithelia, which are remarkably resistant to acids or irritants and forms relatively tight barrier to passive diffusion. In addition, the epithelium is capable of undergoing extremely rapid repair and restitution if its continuity is disrupted. The third level of gastric mucosal barrier is the mucosal microcirculation in concert with sensory afferent nerves within the mucosa and submucosa. Back diffusion of acid or toxin into the mucosa results in neural system-mediated elevations of calcitonin gene related peptide, which contribute to enhancing mucosal blood flows that are very critical for limiting damage and facilitating repair. The fourth level of defense is the mucosal immune system, consisting of mast cells and macrophage, which orchestrate an appropriate inflammatory response to challenge. All the above factors are known to contribute to orchestrated artwork of "gastric mucosal protection". In recent years, heat shock proteins (HSPs) have been implicated to be an additional factor utilized for the gastric defense mechanisms at the intracellular level. Certain HSPs are expressed under non-stressful conditions and play an important role in the maintenance of normal cell integrity, but HSPs are generally considered to improve cellular recovery both by either refolding partially damaged functional proteins or increasing delivery of precursor proteins to important organelles such as mitochondria and endoplasmic reticulum, through which HSPs might complete efficient mucosal defense mechanisms and achieve ulcer healing, mostly probably protecting key enzymes related to cytoprotection. In this review, role of each heat shock protein, HSP90, HSP70, HSP27, in gastric inflammation and gastric ulcer healing will be described with general roles of HSPs.