Long-term follow-up of collagenous colitis after induction of clinical remission with budesonide

BACKGROUND

Budesonide (Entocort) is effective for the treatment of collagenous colitis.

AIM

To assess the long-term outcome of patients after induction of clinical remission by budesonide treatment.

METHODS

Fifty-one patients with chronic diarrhoea and histologically proven collagenous colitis were enrolled in randomized, placebo-controlled crossover trial using budesonide 9 mg daily for 6 weeks. Patients in clinical remission after either initial or crossover budesonide treatment were followed using standardized questionnaires. Clinical relapse was defined as five or more loose stools/day for at least 4 consecutive days.

RESULTS

A total of 33 patients achieved clinical remission (85% per-protocol). During a median follow-up of 16 months, clinical relapse occurred in 20 patients (61%), after a median time of 2 weeks (range: 1-104, mean: 10 weeks). Patient age <60 years was identified as a significant risk factor for clinical relapse (OR = 7.4, P = 0.048). Budesonide was used for treatment of clinical relapse in 80% of patients achieving clinical response in all of them.

CONCLUSIONS

Budesonide is effective in the treatment of collagenous colitis. Clinical relapses may occur in a considerable number of patients, particularly in those <60 years. Treatment of clinical relapse with budesonide appears to be an effective option.

Expression of HSV-TK suicide gene in primary T lymphocytes: the dog as a preclinical model

Expression of suicide genes (e.g. herpes simplex virus thymidine kinase,HSV-TK) in T cells is an appealing approach to regulate graft-versus-host disease in adoptive immunotherapy. Here we report the optimization of retroviral infection of canine T cells. Canine T cells were stimulated either with phytohemagglutinin (PHA, 2 microg/ml) for 24-72 hours or with 100 U/ml interleukin-2 for seven days. Stimulated cells were co-cultivated with irradiated virus-producing cells. Transduction efficiencies ranged from 4% to 45% using PG13, a gibbon ape leukemia virus envelope (env) pseudotyped packaging cell line. Infection of cells with GPenvAM12, expressing the amphotropic Moloney murine leukemia virus env, did not yield a satisfactory percentage of transduced cells. Enrichment of transduced cells was performed using immunoselection, and gave a purity of up to 98%. Transfusion of 1 x 10(6) transduced cells per kilogram body weight showed that transduced cells could convert mixed chimerism to 100% and transfer immunity to a specific antigen. Transduced cells were repeatedly detected in peripheral blood and bone marrow by polymerase chain reaction with primers specific for the HSV-TK gene. We have demonstrated the feasibility of using the canine model to study gene therapy as a preclinical model.

Quantitative analysis of plasmid forms by agarose and capillary gel electrophoresis

Plasmids may appear in different forms: circular with different degrees of coiling, partially cleaved or linear, and multimeric as concatamers or catenates. Capillary gel electrophoresis (CGE) of plasmid samples allows the determination of plasmid form distribution. Monomeric and dimeric plasmid DNA forms were separated by both CGE and agarose gel electrophoresis (AGE). The pattern of isoform bands from AGE was compared to the corresponding peak pattern from CGE, and differences in the relative mobility of the plasmid forms between the two methods were found. The comparison of AGE and CGE allows the assignment of AGE bands to CGE peaks. Additionally, the different isoforms can now be quantified by CGE. Routine plasmid form analysis by CGE may be automated, allowing easy, fast, and highly reliable quantification. CGE also offers high resolution and the amount of DNA required is very low. Therefore this method is very useful for the analysis of therapeutics based on plasmid DNA during their production, isolation, and formulation.

Assessing medical students' competence in obtaining informed consent

BACKGROUND

Medical schools increasingly place emphasis on preparing students to perform routine, ethically important clinical activities with sensitivity and acumen. A method for evaluating students' skills in obtaining informed consent that was created at our institution is described.

METHODS

Formal assessment of medical students' professional attitudes, values, and ethics skills occurs in the context of three required and developmentally attuned comprehensive examinations. A videotaped station tested senior medical students' ability to obtain informed consent from a standardized patient who expresses concern about undergoing cardiac catheterization. Two checklists were completed by the patient. Videotapes were reviewed by a faculty member, and students' reactions to the assessment experience were documented.

RESULTS

Seventy-one senior students participated, and all performed well. Mean scores of 6.3 out of 7 (range 5 to 7, SD = 0.5) on the informed consent checklist and 8.7 out of 9 (range 6 to 9, SD = 0.5) on the communication skills checklist were obtained. Students endorsed the importance of the skills tested.

CONCLUSIONS

This method of examining medical students' abilities to obtain informed consent has several positive features and holds promise as an ethics competence assessment tool.

Interdisciplinary ambulatory education and service in primary care at the University of New Mexico

To compete and survive in a managed care market, academic health centers must develop integrated delivery systems in general and an integrated primary care system in particular. However, the departmental-based structure at most academic health centers is ill-suited to this purpose. Service and education are usually segregated by department, and the professional activities of primary care faculty in different departments are fragmented, leaving them weakened as a political force within the institution. The University of New Mexico established a model of integrated primary care education and service by creating three interdisciplinary primary care clinics staffed by primary care residents and faculty. The clinics attracted a substantial portion of each department's faculty and residents. The clinics united primary care providers from different departments as a stronger, more unified voice in negotiating with the hospital and in fostering needed changes for primary care in the institution. Interdisciplinary teams require considerable time and labor both in planning (because of joint decision making) and in operation. Better staff structures and staff development must be learned through trial and error because there are not established benchmarks for interdisciplinary teams. Governance presents problems, primarily because loyalties to departments may supersede those to the clinic practice, and sometimes the departments' teaching priorities are challenged by clinic directors' need to ensure filling their interdisciplinary staff needs. These obstacles to collaboration can be addressed creatively, and ultimately the comprehensiveness and quality of care convinces providers and the institution.

Up-regulation of major histocompatibility complex class II antigen expression in the central nervous system of dogs with spontaneous canine distemper virus encephalitis

Major histocompatibility complex class II (MHC II) and canine distemper virus (CDV) antigen expression were compared by immunohistochemistry in the cerebellar white matter of ten dogs with naturally occurring canine distemper encephalitis. In addition, infiltrating mononuclear cells were characterized by employing poly- and monoclonal antibodies directed against human CD3, canine MHC II, CD5, B cell antigen and CDV-specific nucleoprotein. Positive antigen-antibody reaction was visualized by the avidin-biotin-peroxidase complex method on frozen sections. Histologically, neuropathological changes were categorized into acute, subacute, and chronic. In control brains, MHC II expression was weak and predominantly detected on resident microglia of the white matter and on endothelial, perivascular and intravascular cells. In CDV antigen-positive brains, MHC II was mainly found on microglia and to a lesser extent on endothelial, meningeal, choroid plexus epithelial, ependymal and intravascular cells. In addition, virtually all of the perivascular cells expressed MHC II antigen. CDV antigen was demonstrated most frequently in astrocytes. Of the perivascular lymphocytes, the majority were CD3-positive cells, followed by B cells. Only a small proportion of perivascular cells expressed the CD5 antigen. In addition, B cells and CD3 and CD5 antigen-positive cells were found occasionally in subacute and frequently in chronic demyelinating plaques. In acute encephalitis, CDV antigen exhibited a multifocal or diffuse distribution, and MHC II was moderately up-regulated throughout the white matter and accentuated in CDV antigen-positive plaques. In subacute encephalitis, moderate multifocal CDV antigen and moderate to strong diffuse MHC II-specific staining, especially prominent in CDV antigen-positive lesions, were observed. In chronic encephalitis, CDV antigen expression was restricted to single astrocytes at the edge of the lesions or was absent, while MHC II expression, especially prominent on microglia, was strongly up-regulated throughout the white matter, most pronounced in demyelinated plaques. In summary, in acute and subacute lesions without perivascular cuffs, MHC II expression correlated with the presence of CDV antigen. In contrast, in chronic lesions, MHC II expression on microglial cells was the most prominent despite a few CDV antigen-positive astrocytes, indicating that nonviral antigens may play an important role as triggering molecules for the process of demyelination.

Immunophenotyping of canine bronchoalveolar and peripheral blood lymphocytes

The immunophenotype of canine lymphocytes obtained by bronchoalveolar lavage (BAL) was investigated and compared with that of peripheral blood leukocytes (PBL). Indirect immunofluorescence, generated by monoclonal antibodies (mAb) specific for canine CD5, CD4, CD8, CD45pan, CD45RA, MHCII and THY-1, was detected by flow cytometry. In comparison with PBL, in BAL there are fewer lymphocytes positive for CD45RA (75.4 +/- 12.6% vs. 42.3 +/- 9.4%; P < 0.05) and MHCI I (97.0 +/- 2.9% vs. 74.0 +/- 7.6%; P < 0.01), while there are more cells positive for CD8 (19.0 +/- 3.6% vs. 29.5 +/- 12.0%; P < 0.05). Thus there is a lower CD4/CD8 ratio in the cell compartment accessible by BAL (2.2 +/- 0.3 vs. 1.3 +/- 0.6; P < 0.005). The immunophenotype may be stable over time, as indicated by reexamination of cells obtained from one dog at four times over 1 year. Investigating the phenotype of lymphocytes from three different locations of the right lung, the cranial lobe lymphocytes show a lower CD4/CD8 ratio in comparison with PBL (1.81 +/- 0.35 vs. 1.12 +/- 0.31, n = 5; P < 0.02). In general, less MHCII positive lymphocytes (P < 0.001) and greater immunophenotype variability of results were found in these separate samples compared with pooled samples from these locations.

[The initial results of spiral CT angiography in demonstrating stenoses of the a. carotis]

PURPOSE

To determine the value of spiral CT angiography in Maximum Intensity Projection (MIP)-technique for evaluation of carotid artery stenosis.

METHODS

A comparison of the MIP technique with intraarterial DSA was done in 24 patients with 40 stenoses. Quantification of stenosis was determined according to the NASCET study: mild (0-29%), moderate (30-69%), severe (70-99%) and occlusion (100%).

RESULTS

Totally the correlation of spiral CT angiography with DSA was 80% (r = 0.93; p = 0.0001). In the moderate stenosis group (r = 1; p = 0.1573), severe stenosis group (r = 0.89; p = 0.002) and the occlusion group (r = 1; p = 0.0009) there was a good correlation with DSA. In the mild stenosis group (r = 0.55; p = 0.0704) correlation of spiral CT angiography with DSA was poor. Spiral CT angiography allows an excellent delineation of calcifications. Tandem lesions and collateral flow cannot be shown with spiral CT angiography.

CONCLUSION

Intraarterial DSA remains the gold standard for evaluation of carotid artery stenosis, because DSA is the modality which shows the whole length of the carotid artery and yields information on tandem lesions and collateral flow.

Prevention of graft-versus-host disease in DLA-haplotype mismatched dogs and hemopoietic engraftment of CD6-depleted marrow with and without cG-CSF treatment after transplantation

Prevention of graft-versus-host disease by depletion of CD6-positive T cells was studied in the dog. Donors were DLA-homozygous, recipients DLA-heterozygous with one DLA haplotype identical to the donor. Seven control dogs received untreated marrow and died of GvHD after full hemopoietic recovery within 28 days of transplantation. For prevention of GvHD, immunomagnetic separation of T cells with a monoclonal antibody against human CD6 that crossreacted with canine T cells was evaluated. Depletion of CD6-positive cells depleted CD4-positive cells completely, but only part of CD8-positive cells and DR-positive cells. CD6-depleted marrow exhibited strong nonspecific "natural" suppression of the generation of cytotoxic T cells in vitro. Eleven dogs received CD6-depleted marrow. Only 1 dog developed GvHD and died. Sustained engraftment was seen in 8 dogs. Hemopoietic recovery was delayed and slower after transplantation of CD6-depleted marrow than after transplantation of untreated marrow. Four of these dogs were treated with G-CSF, and this accelerated the recovery of leukocytes, but did not prevent rejection. Chimerism was mixed in 7 of 10 evaluable dogs and 1 dog recovered its own hemopoiesis 2 years after transplantation. CD6 depletion prevents GvHD across a DLA-haplotype difference, but rejection and mixed chimerism may occur. Treatment with G-CSF accelerates leukocyte recovery, but cannot prevent rejection.

A general method for screening mAbs specific for G-protein coupled receptors as exemplified by using epitope tagged BLR1-transfected 293 cells and solid-phase cell ELISA

Monoclonal antibodies (mAb) against G-protein coupled receptors are rare. In this study we describe a cell ELISA-based screening system for monoclonal antibodies specific for the G-protein coupled receptor BLR1 (Eur. J. Immunol. 1992. 22:2795) using human embryonic kidney 293 cells transfected with a modified human BLR1 cDNA directing the synthesis of an epitope tagged BLR1 protein. Lou/C rats were immunized with BLR1 transfected, tagged 293 cells and after fusion of spleen cells with X63 Ag8.653 myeloma cells supernatants were tested for BLR1 specific antibodies by comparing the binding to BLR1 transfected 293 cells and to untransfected control cells immobilised on poly-L-lysine coated microtiter plates. Cells were fixed with 2% paraformaldehyde and permeabilized using digitonin in order to allow binding of mAb directed against intracellular epitopes. This mild fixation retained excellent morphology of 293 cells and allowed reliable binding to the trays. Screening of approximately 2500 supernatants identified 19 antibodies binding to BLR1 transfected 293 cells but not to control 293 cells. One of these mAb specifically bound to the G-protein coupled receptor BLR1.

Identification and characterization of a mouse monoclonal antibody (M10) directed against canine (dog) CD8+ lymphocytes

Monoclonal antibodies (mAb) were produced by immunizing BALB/c mice with non-adherent dog lymphocytes. M10 was specific for a subset of dog lymphocytes. M10 belonged to the IgG1 subclass and reacted with 26% of dog peripheral blood lymphocytes, 24% of spleen lymphocytes, 81% of thymus cells, 1.2% of bone marrow cells (5.8% of bone marrow lymphocytes) and 23% of PHA-stimulated lymphocytes. Immunohistology of snap-frozen thymus and spleen showed that the spleen B-cell area stained negative, whereas the spleen T-cell area and the thymus medulla exhibited positive reaction in 20-30%. The thymus cortex was strongly positive. M10 diminished cell lysis by 58% in cell mediated lysis assays (CML). Immunoblot assays revealed that M10 recognized an antigen with a molecular weight of 76 kD under non-reducing and 33 kD under reducing conditions. Finally, M10 bound to a canine CD8 alpha transfected rat T-cell line (NB2). These findings characterize M10 as an antibody directed against the dog CD8 antigen.

New isoflavonoids as inhibitors of porcine 5-lipoxygenase

The inhibitory activity of new isoflavonoids on 5-lipoxygenase of porcine leukocytes was investigated. Isoflavans (I) proved to be stronger inhibitors than isoflavones (II). The isoflavans containing ortho-hydroxy groups in ring A showed the lowest Ki values (0.8-50 microM). In comparison, isoflavans with meta-dihydroxy groups exhibited Ki values higher than 150 microM. The effect of commercial antioxidants was tested also on porcine 5-lipoxygenase. Butylated hydroxyanisole (Ki: 25 microM) and butylated hydroxytoluene (Ki: 55 microM) revealed moderate inhibitory activity, whereas L-ascorbic acid, L-ascorbyl palmitate, dl-alpha-tocopherol and n-propyl gallate showed weak inhibitory activities (Ki: 100-260 microM).

Streptozotocin diabetes in spontaneously hypertensive rats

The aim of our experiments was to find out to what extent male spontaneously hypertensive (SH) as well as normotensive Wistar-Kyoto (WKY) and Wistar-Schönerlinde (WS) rats developed changes of the endocrine pancreas function in response to streptozotocin (SR). 4 week old WS, WKY and SH rats were given ip. injections of 70 or 100 mg SR/kg and were killed at an age of 8 weeks, after which blood glucose, and in isolated islets, insulin-leakage, insulin secretion and insulin biosynthesis were determined; histologically the relative volume density of islet tissue was estimated. The results demonstrated that the intensity of the SR-caused damage to the endocrine pancreas differs considerably in the three strains of rats. The damage increases in the order WS, WKY, SH rats. These findings are indicative of the role played by genetic predisposition and of an increase in damage to the endocrine pancreas due to hypertension.

Diabetogenic effects of N-nitrosomethylurea in rats

The influence of a single i.v. injection of 75 or 175 mg N-nitrosomethylurea (NMU)/kg into Wistar rats on plasma glucose, i.p. glucose tolerance, plasma insulin and glucagon, glucose stimulated insulin secretion and release as well as on the biosynthesis of insulin in isolated pancreatic islets have been investigated at set intervals between the 3rd day and the 6th week post injectionem. At the end of the experimental period all NMU-treated animals were alive but had significantly reduced body mass. All animals remained normoglycemic even after the glucose load. 3 days after drug application plasma insulin decreased only insignificantly in the 175 mg NMU-group, whereas plasma glucagon was significantly reduced in both drug-groups; after 3 and 6 weeks the reduction of plasma glucagon was still about 30 percent. In isolated islets the glucose stimulated insulin secretion, the percent stimulation of insulin release and insulin biosynthesis were significantly decreased.

Effect of streptozotocin on transaminases, creatinine and urea in serum of rats

This study investigates the diabetes-induced lesions in liver and kidney and in addition the possible side effects of the diabetogenic substance streptozotocin (SR) on these organs in non-diabetic animals. 5-week-old female Wistar rats were injected 65 or 130 mg SR/kg body mass. Some animals of the drug group did not become hyperglycemic; thus it was possible to separate the drug effect from the diabetic influence on liver and kidney. In serum investigations some metabolic changes concerning the activities of the liver enzymes aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase and the concentrations of urea and creatinine up to 30 days after drug application were studied. SR in hyperglycemic animals causes a time and dose dependent rise in all investigated parameters. Also in normoglycemic rats a significant increase in alkaline phosphatase and in creatinine was observed after 10 days. After 21 and 30 days there were no differences compared to untreated control rats, whereas elevated levels were observed in the hyperglycemic rats. Thus our results support the view of a short damaging effect of SR on liver and kidney without inducing a diabetic state; in hyperglycemic rats the damaging effect is more pronounced.

No diabetogenic effect of N-nitrosomethylurea on pregnant BALB/c mice and their progeny

Our studies give evidence that N-nitrosomethylurea applied to BALB/c mice one day before or after mating or during pregnancy (12th day) even in small (16 or 32 mg/kg) and repeated doses (16 mg/kg on 5 consecutive days, total dose 80 mg/kg) is a more toxic than potent diabetogenic agent. Mortality rises in parent mice and their progeny with no influence on glucose tolerance test and blood glucose level over the whole investigation period (4 hours-12 weeks).

Imipramine and social-vocational adjustment in chronic depression

The authors compared the effects of 6 weeks of imipramine treatment with 6 weeks of placebo treatment on social and vocational impairment in chronic depression. Imipramine was associated with significantly greater pre- to posttreatment improvement of social-vocational impairments in chronic depression, suggesting that these impairments may have represented affective symptoms rather than characterologic deficits.

Imipramine treatment for chronic depression

Antidepressant drugs in the treatment of chronic depressions have received little systematic study. We used a two-week, single-blind placebo washout followed by a six-week, double-blind comparison of imipramine hydrochloride and placebo in a sample of 76 outpatients with DSM-III dysthymic disorder entered into a trial at two centers. Subjects were preponderantly female, had insidious onset at an early age, and had depressions of moderate severity; 96% also met the DSM-III criteria for major depressive disorder at the time of presentation. Sixty percent had a history of persistent depressive symptoms sufficient to meet criteria for major depression for longer than two years. Markedly favorable responses occurred in 45% of imipramine-treated (n = 29) and 12% of placebo-treated (n = 25) patients and, respectively, 59% and 13% of those who completed the study. Imipramine produced significant advantage in measures of depressive symptoms, global severity of illness, and self-rated social and vocational function. Recovered patients experienced remission from both long-standing symptoms and deficits as well as more recently exacerbated aspects of their syndrome. Patients with pure dysthymic disorder of a mild, subsyndromal type were uncommon in these clinical settings. However, anti-depressant medication was effective for many moderately severe chronic depressions, which had previously been untreated or undertreated, presumably related to misdiagnosis.

Temperature preference of drinking water in rats

The water temperature preference of adult male albino rats was studied. Deprived and normally hydrated animals were exposed at peak hours of consumption to a choice between 12 degrees C and 30 degrees C water or to 12 degrees C and 34 degrees C water. Food intake was not restricted. There was a clear preference for the warmer water. It is concluded that oropharyngeal temperature cues influence water intake.