Seroepidemiology of cryptosporidiosis in children in Papua New Guinea and Australia

Enzyme immunoassays (EIA) were used to measure serum antibodies to Cryptosporidium in four immunocompetent adults with recent proven cryptosporidial infection, 379 healthy children and 73 adult volunteers in Melbourne, Australia, and 205 children in Papua New Guinea (PNG) (47 healthy children; 158 with pneumonia). Antibodies peaked 3-6 weeks after infection and fell to baseline within a few months. A high level (5000 EIA units/ml) or a significant change between paired sera, of IgG or IgM, were taken as evidence of recent infection and found in 24% of PNG children and in 8% of children and 5% of adults in Melbourne. Among PNG children with pneumonia who had high cryptosporidial antibody levels, those with measles (6/8) were significantly more likely (P = 0.002) to have diarrhoea than the remainder (4/28). Symptomatic cryptosporidiosis may be associated with transient immune suppression due to viral infection. This study indicates that serological surveys can contribute to an understanding of the epidemiology of cryptosporidosis.

Immunomodulation of experimental autoimmune myasthenia gravis with linomide

Linomide, a synthetic immunomodulator, increases natural killer (NK) activity and markedly activates several lymphocyte populations in both experimental animals and humans. It has been shown to ameliorate the autoimmune manifestations of lupus-like disease in MRL/lpr mice and the clinical and pathological signs of acute and chronic-relapsing experimental autoimmune encephalomyelitis (EAE) in SJL/J mice. We examined the effect of linomide (100 mg/kg/day; administered in drinking water) on rabbits and rats with experimental autoimmune myasthenia gravis (EAMG). Following immunization with Torpedo acetylcholine receptor (AChR), all control rabbits developed clinical signs of severe weakness and exhibited a decrement of muscle action potential upon repetitive stimulation. In contrast, mild signs of weakness appeared in only two of five linomide-treated rabbits, with EMG borderline positive in one of them. Booster immunization with Torpedo AChR induced severe relapse and death in two EAMG control rabbits, whereas the two linomide-treated animals remained free of myasthenic symptoms. The serum level of antibodies against both Torpedo and rat AChR were markedly suppressed in the linomide-treated animals. Similar inhibition of clinical signs of EAMG was observed in the EAMG rat model. Furthermore, the in vitro proliferative response of lymph node cells to Torpedo AChR and the purified protein derivative of Mycobacterium tuberculosis was significantly lower in the linomide-treated EAMG rats than in the controls. Linomide may constitute a new immunomodulating agent for the treatment of myasthenia gravis.

Low resolution electromagnetic tomography: a new method for localizing electrical activity in the brain

This paper presents a new method for localizing the electric activity in the brain based on multichannel surface EEG recordings. In contrast to the models presented up to now the new method does not assume a limited number of dipolar point sources nor a distribution on a given known surface, but directly computes a current distribution throughout the full brain volume. In order to find a unique solution for the 3-dimensional distribution among the infinite set of different possible solutions, the method assumes that neighboring neurons are simultaneously and synchronously activated. The basic assumption rests on evidence from single cell recordings in the brain that demonstrates strong synchronization of adjacent neurons. In view of this physiological consideration the computational task is to select the smoothest of all possible 3-dimensional current distributions, a task that is a common procedure in generalized signal processing. The result is a true 3-dimensional tomography with the characteristic that localization is preserved with a certain amount of dispersion, i.e., it has a relatively low spatial resolution. The new method, which we call Low Resolution Electromagnetic Tomography (LORETA) is illustrated with two different sets of evoked potential data, the first showing the tomography of the P100 component to checkerboard stimulation of the left, right, upper and lower hemiretina, and the second showing the results for the auditory N100 component and the two cognitive components CNV and P300. A direct comparison of the tomography results with those obtained from fitting one and two dipoles illustrates that the new method provides physiologically meaningful results while dipolar solutions fail in many situations. In the case of the cognitive components, the method offers new hypotheses on the location of higher cognitive functions in the brain.

Analyses of 94 consecutive spinal cord injury patients using ASIA definition and modified Frankel score classification

Serial neurological examinations were analysed on 94 consecutive spinal cord injury (SCI) patients admitted for rehabilitation to the Swiss Paraplegic Center at the Clinic Balgrist Zurich, Switzerland between 1987 and 1992. Patients' data were examined adopting ASIA and modified Frankel definitions in order to compare the two classifications in terms of consistency and prognostic value. The modified Frankel definition was subdivided into five categories (A, B, C, D and E). On admission (discharge) 43 (37) patients were classified as Frankel A, 23 (11) patients in group B, 26 (42) patients in group C, 2 (2) patients as Frankel D and 0 (2) patients in group E. A qualitative analysis of the results on the base of a maximal score of 100 points (A = 0, B = 25, C = 50, D = 75 and E = 100 points) suggested a mean score improvement from 21.5 (+/- 22.5) to 29.0 (+/- 26.3) or 7.5 (+/- 7.1), regarding all 94 patients during follow up (admission/discharge). The median improvement was one modified Frankel grade (A/B to B/C). No detailed assessments were yielded concerning motor and sensory functions. Using ASIA definition, a continuous numerical score of motor and sensory function was observed. Recovery during follow up was determined by detailed motor and sensory function. For all 94 patients (quadriplegics and tetraplegics), the average motor recovery according to the ASIA definition was 9.4 (+/- 9.6). The mean ASIA motor score improved from 52.2 (+/- 17.3) on admission to 61.6 (+/- 17.9) on discharge.(ABSTRACT TRUNCATED AT 250 WORDS)

Immunoglobulin G antibody responses to polyvalent pneumococcal vaccine in children in the highlands of Papua New Guinea

The immunoglobulin G (IgG) antibody responses to a pneumococcal polysaccharide vaccine were examined for 480 children aged 3 months to 5 years and living in Tari, Southern Highlands Province, Papua New Guinea. Antipneumococcal IgG to the seven serotypes most frequently causing invasive disease (types 2, 5, 6B, 7F, 14, 19F, and 23F) was measured by an enzyme-linked immunosorbent assay in serum collected before vaccination and 1 and 6 months after vaccination. Prevaccination antibody levels fell rapidly after 3 months of age and remained low throughout the first 2 years of life. One month after vaccination, geometric mean titers of antipneumococcal IgG to serotypes 2, 7F, 23F, and 5 were at least twice those of antibodies in nonvaccinated children of the same age from the ages of 5, 6, 9, and 12 months onwards, respectively; postvaccination antibody responses to serotypes 6B, 14, and 19F rose gradually during the second year of life. Elevated antibody titers to serotypes 2 and 7F were maintained 6 months after vaccination. Thus, young Papua New Guinean children are capable of mounting a good immune response to some pneumococcal capsular polysaccharides from a young age, and the antibody responses to capsular polysaccharides are consistent with studies in developed countries. However, in Papua New Guinea, the serogroup distribution of invasive disease matches the immunogenic components of the pneumococcal polysaccharide vaccine more closely than in developed countries, a fact which helps to explain the results of controlled trials in Papua New Guinea, in which this vaccine prevented death and severe morbidity from pneumonia in young children.

Oral administration of the oxidant-scavenger N-acetyl-L-cysteine inhibits acute experimental autoimmune encephalomyelitis

The prevention of acute experimental autoimmune encephalomyelitis (EAE) by N-acetyl-L-cysteine (NAC), a potent free radical scavenger, is described. Administrated ad libitum to SJL/J mice at a dosage of 0.2-2 mg/ml in drinking water from the day of the encephalitogenic injection, the agent significantly inhibited the induction of acute EAE. The improvement in clinical condition was dose-dependent. A complete protective effect required administration of the agent at an early stage. Examination of lymphocytes from NAC-treated EAE mice showed that at early stages (days 9 and 15) post encephalitogenic injection the anti-oxidant enhanced the specific lymphocyte proliferative response to the immunizing antigens. Examination of the mitogenic stimulation of lymphocytes from naive animals in the presence of NAC in vitro indicated that the scavenger enhanced the stimulative effect of LPS in a dose-dependent manner. The immunomodulative capacity of the anti-oxidant NAC suggests that free radicals are involved in the pathogenesis of acute EAE.

Inoculation of BCL1 lymphoma cells into CSJL/J F1 mice inhibits acute experimental autoimmune encephalomyelitis

T cell vaccination, which protects rodents against experimental autoimmune encephalomyelitis (EAE), has been shown to induce anti-idiotypic response in the T cell compartment. CD5 B cells (B1 cells) are the main source of natural autoantibodies, and are often characterized by high idiotypic connectivity. In this study we examined the possibility that idiotypic connectivity in the B cell compartment may also play a role in the regulation of EAE. We inoculated CSJLF1 mice (H-2d,s) with a CD5 B cell line, the BCL1 lymphoma cells (H-2d), and subsequently induced EAE. The injection of as few as 1,000 BCL1 lymphoma cells significantly blocked the development of EAE. Injection of CD5-negative myeloma cells (SP2) had no effect on the pathogenesis of the disease. Unlike control animals, lymphocytes from BCL1 lymphoma-injected mice significantly proliferate in response to interleukin-5, a growth factor to CD5 B cells. The proliferative response of lymphocytes from BCL1 inoculated mice to mitogenic stimulation was rather unchanged, indicating that no general immunosuppression has been induced by inoculating BCLJ lymphoma. These experiments suggest that CD5 B cells may be involved in the regulation of EAE.

Diazepam and sulpiride effects on frequency domain EEG source locations

Effects of an anxiolytic (diazepam; n = 13) and an antipsychotic (sulpiride; n = 6) on the location of EEG model sources in the frequency domain were studied in normal volunteers in 19-channel eyes-closed EEG before and 1, 15, 30, 45 and 60 min after i.v. injections. Ten 2-second epochs from each recording were subjected to the fast Fourier transformation (FFT) Dipole Approximation which results in a single-source (in terms of phase angle) potential distribution map for each frequency point. Three-dimensional model dipole sources were fitted into the maps. Differences in source location before and after injection were computed, and differences between drugs were evaluated. The source location in the beta band shifted significantly more towards superior and anterior areas after diazepam than sulpiride, most prominently in the first minute after injection; during this time, conventional beta band power was significantly increased after diazepam versus sulpiride at all recording sites. The results demonstrate that the FFT dipole approximation adds direct 3-dimensional topographical information to power spectral results in pharmaco-EEG.

Event-related potential maps depend on prestimulus brain electric microstate map

The brain functional microstate immediately before each of about 3000 identical tone stimuli was classified using extracted reference-free descriptors (locations of maximal and minimal potential) of the landscape of the brain's momentary electric field, in 8 volunteers. Six prestimulus microstate map classes occurred more than 30 times in each subject, and were clustered into two map class types (totals of 242 and 283 cases, respectively, on the average per subject). Event-related potential (ERP) map series were averaged for each subject and prestimulus map class. Map descriptors were extracted from the ERP maps at times of maximal Global Field Power during the component time windows N100, P200 and P330. Discriminant functions were estimated; for the maps of N100 and P330, the discriminant scores differed significantly between the maps associated with the two prestimulus map class types (paired t-tests, df = 7, p = .014 and p = .005, respectively). The dominant axis of the poststimulus class type II ERP maps deviated clockwise from that of the type I ERP maps in all components. We conclude that subtle changes in the brain's spontaneous momentary functional microstate (as classified by spatial descriptors of a single map) influence event-related information processing by the brain, following common rules over subjects.

Space-oriented EEG segmentation reveals changes in brain electric field maps under the influence of a nootropic drug

Map landscape-based segmentation of the sequences of momentary potential distribution maps (42-channel recordings) into brain microstates during spontaneous brain activity was used to study brain electric field spatial effects of single doses of piracetam (2.9, 4.8, and 9.6 g Nootropil UCB and placebo) in a double-blind study of five normal young volunteers. Four 15-second epochs were analyzed from each subject and drug condition. The most prominent class of microstates (covering 49% of the time) consisted of potential maps with a generally anterior-posterior field orientation. The map orientation of this microstate class showed an increasing clockwise deviation from the placebo condition with increasing drug doses (Fisher's probability product, p < 0.014). The results of this study suggest the use of microstate segmentation analysis for the assessment of central effects of medication in spontaneous multi-channel electroencephalographic data, as a complementary approach to frequency-domain analysis.

Source localization of brain electric field frequency bands during conscious, spontaneous, visual imagery and abstract thought

This paper addresses the issue of mind-brain correspondence, using a novel way to reduce brain electric field data in the frequency domain to estimates of intracerebral model source locations, and applying this method to brain electric data collected during the 2-s epochs immediately before the randomly solicited reports of spontaneous, conscious, covert experiences from 12 normal volunteers. The mentation reports were classified into visual imagery and abstract thought. The mean locations of the EEG model sources associated with abstract thoughts were generally more anterior and deeper than those of visual imagery, particularly significant for the delta/theta band; the finding was common across subjects. Thus, different brain functional states involving different geometries of activated neural populations exist during conscious, spontaneous, task-free mentations of the visual imagery type and of the abstract thought type.

Inhibition of acute, experimental autoimmune encephalomyelitis by the synthetic immunomodulator linomide

Linomide (LS-2616, quinoline-3-carboxamide) is a synthetic immunomodulator that stimulates natural killer cell activity and activates several lymphocytic subpopulations in experimental animals and humans. In this study we determined the effect of oral treatment with linomide on the development of experimental autoimmune encephalomyelitis, an animal model for immune-mediated human demyelinating disorders. Experimental autoimmune encephalomyelitis was induced in SJL/J mice and in an outbred strain of rats (Sabra) by subcutaneous injection of spinal cord homogenate in adjuvant followed by inoculation with Bordetella pertussis. Linomide was administered in drinking water, at an estimated dose of 50 to 100 mg/kg/day. None of the linomide-treated mice (0/41) and Sabra rats (0/15) developed any clinical or pathological signs of experimental autoimmune encephalomyelitis, whereas almost all control animals (48/53 and 18/19, respectively) were severely paralyzed and 64.5% died from the disease. Lymphocytes obtained from linomide-treated animals had reduced in vitro proliferative responses to guinea pig myelin basic protein, proteolipid protein of the myelin, and tuberculin-purified protein derivative, unlike antigen-independent proliferation which was rather unaffected. Natural killer cell activity (tested by a cytotoxic assay on radiolabeled YAC-1 target cells) was significantly enhanced in mice treated with linomide. Our results indicate that modulation of the immune system with linomide leads to complete inhibition of experimental autoimmune encephalomyelitis in the absence of systemic immunosuppression. Linomide could therefore be of use in future clinical trials for the treatment of human autoimmune demyelinating disorders.

Localization of sources of brain alpha/theta/delta activity and the influence of the mode of spontaneous mentation

A method is described that accounts for multichannel brain field data (EEG) epochs, after transformation into the frequency domain, by a single oscillating dipole source in terms of phase angles. The method produces a potential distribution for each frequency point ('FFT dipole approximation'). These maps can be subjected to conventional equivalent dipole source fittings in terms of amplitudes. We studied the equivalent source locations for the different temporal EEG frequency bands (delta/theta/alpha) in 12 normal subjects during the collection of reports of spontaneous thoughts. Some of the thought reports were classed into two modes, 'visual imagery' and 'abstract', and the associated equivalent source locations during the 2 s immediately prior to these reports were computed. Different equivalent source locations were found for the different spectral components of the EEG, implying that different neural generator populations generate the different frequencies. Further, the different types of spontaneous thought, i.e. different modes of cortical functioning, were found to be associated with the activity of different neuronal generator sources that operated at the same frequency at different source locations.

Data-determined window size and space-oriented segmentation of spontaneous EEG map series

For the segmentation of series of momentary potential distribution maps into epochs of quasi-stable landscape (brain electric microstates), the maps are reduced to extracted landscape descriptors. Changes of the descriptors over time are recognized as segment terminators. The selection of the descriptors' tolerated variance (the window size) determines the result. We present a window-determining function which allows a data-driven determination of the optimal window size, based on equal weight given to the recognition of similarity and dissimilarity between maps. Segmentations based on two map descriptors (locations of extreme potentials and centroids) were used on 211 two-second map epochs from 8 normal subjects for validation of the window-determining function and to establish normative data. Using the data-determined window sizes for segmentation, the mean duration of the obtained microstates across subjects did not differ between descriptors (144 and 143 msec, respectively). Random permutation of the maps in time produced significantly shorter segments, ensuring that the segmentation disclosed real properties of the original data and not artifacts of the procedure.

Prevention and reversal of adoptively transferred, chronic relapsing experimental autoimmune encephalomyelitis with a single high dose cytoreductive treatment followed by syngeneic bone marrow transplantation

A chronic relapsing form of experimental autoimmune encephalomyelitis (CR-EAE) was induced in SJL/J mice by adoptive transfer of lymph node cells (LNC) sensitized to guinea pig myelin basic protein (GMBP). We examined the efficacy of high dose immunosuppressive regimens (cyclophosphamide [CY] 300 mg/kg or total body irradiation [TBI] 900 cGy) followed by syngeneic bone marrow transplantation (SBMT) in prevention and treatment of already established CR-EAE. Treatment with TBI and SBMT on day 5 after the induction of CR-EAE, just before the onset of clinical signs, completely inhibited the appearance of the paralytic signs. The same treatment, applied 4 d after the clinical onset of the disease, led to a significant regression of the paralytic signs and to a total inhibition of spontaneous relapses during a follow-up period of 2 mo. Challenge of mice with GMBP+CFA 78 d after the passive induction of CR-EAE induced a relapse of the disease 7 d later in almost all of the untreated mice; in contrast, the same challenge given to TBI+SBMT-treated mice caused a delayed relapse (30 d later) in only a minority (3/7) of the challenged mice. In vitro lymphocytic proliferative responses to GMBP and purified protein derivative were significantly lower in TBI/SBMT-treated mice before and after the GMBP challenge, although these mice were fully immunocompetent, as evidenced by their normal lymphocytic proliferation to concanavalin A (ConA) and the FACS analysis of their lymphocytic subpopulations. A similar beneficial therapeutic effect was observed in mice treated with CY followed by SBMT, after the onset of CR-EAE. Our results could support possible clinical applications of similar therapeutic strategies, involving acute immunosuppression followed by stem cell transplantation and retolerization of the reconstituting immune cells in life-threatening neurological and multisystemic autoimmune diseases.

Levels of anti-pneumococcal antibodies in young children in Papua New Guinea

Anti-pneumococcal polysaccharide antibody (anti-PPS) levels were measured in 153 serum samples collected from children aged between 2 and 47 months living in the highlands of Papua New Guinea (PNG). Fifty-seven of the samples were collected during acute episodes of lower respiratory tract infection (ALRI). Total IgA and IgG increased steadily with age; however, no association was found between the levels of these antibodies and the health status of the child. Total IgM levels showed little relationship to the age of the child but under 12 months of age levels were somewhat higher on average in children with pneumonia. For most of eight pneumococcal serotypes tested, specific IgG levels were found to decline rapidly in the first 6-8 months, reaching a minimum at approximately 12 months of age. Serotype 3 was exceptional in having very low titres in the youngest children. A separate analysis of 24 cord sera suggested that antibodies to this serotype do not usually cross the placenta in PNG. Children with pneumonia tended to have lower levels of specific IgG than healthy controls of the same age. Specific anti-PPS IgA levels were found to increase steadily with age, but were not associated with health status.

Acquisition and invasiveness of different serotypes of Streptococcus pneumoniae in young children

Rates of acquisition and mean duration of nasal carriage of different serotypes of Streptococcus pneumoniae have been estimated by fitting a stochastic model to longitudinal carriage data in children from Papua New Guinea. Immunogenicity and two indices of relative invasiveness were determined for each serotype. Immunogenic serotypes were less frequently acquired and were carried for shorter periods, but no relationship between immunogenicity and invasiveness was apparent using either index of invasiveness. Frequent invasion was associated with a high acquisition rate and high frequency and prolonged duration of carriage. Carriage studies can provide a broad indication of which serotypes cause invasive disease but not the proportion of disease due to individual serotypes; some serotypes which cause invasive disease (e.g. serotype 46) are not found even in extensive carriage studies. The antibiotic resistance of carriage organisms, however, does approximate the resistance patterns of invasive organisms and thus may be used to monitor changing patterns of antimicrobial susceptibility in the community.

Treatment of chronic-relapsing experimental autoimmune encephalomyelitis with the synthetic immunomodulator linomide (quinoline-3-carboxamide)

Linomide is a synthetic immunomodulator that enhances natural killer cell activity and significantly activates several lymphocytic cell subpopulations in both experimental animals and humans. In this study we examined the effect of linomide (80 mg per kg per day in drinking water) on mice with chronic-relapsing experimental autoimmune encephalomyelitis (CR-EAE), a T-cell-mediated organ-specific autoimmune disease that resembles human multiple sclerosis. None of the mice (n = 17) that were treated with linomide from day 7 after disease induction developed any clinical or histopathological signs of CR-EAE, as compared to 19 of 20 untreated controls that were severely paralyzed and had extensive demyelinating lesions in the central nervous system. Linomide-treated animals were also resistant to an induced attack by a booster injection with a murine spinal cord homogenate. When administered to mice exhibiting severe clinical signs of paralysis, linomide inhibited both spontaneous and induced relapses. Linomide treatment protected mice from passively induced CR-EAE as well, when given from the day of injection with myelin-basic-protein-specific lymphocytes. Lymphocytes obtained from linomide-treated mice had a reduced in vitro proliferative response to the myelin basic protein and to the tuberculin purified protein derivative, whereas the mitogenic response to concanavalin A was not affected. Natural killer cell and lymphokine-activated killer cell activities were enhanced. These results suggest that linomide regulates autoimmunity in the absence of systemic immunosuppression. Since linomide is very well tolerated in experimental animals and humans, it might be used in the treatment of multiple sclerosis.

Adaptive segmentation of spontaneous EEG map series into spatially defined microstates

Space-oriented segmentation can decompose multi-channel EEG map series into time segments characterized by quasi-stationary field map configurations. This assesses the dynamics of the underlying processes as activities of different neural generator ensembles. Our method of space-oriented segmentation describes the scalp field at times of maximal field strength (Global Field Power) by the locations of the centroids of positive and negative map areas. A quantitative measure of the simultaneous distance of the centroid locations evaluates the similarity between consecutive maps. A segment is defined as a sequence of maps that do not differ from each other by more than a present value. Finally, the average centroid locations for each segment are entered into an agglomerative clustering procedure to obtain a set of distinct classes of field configurations. Four records of 16 s of 42-channel resting EEG (band-pass filtered 2-16 Hz) from six subjects were analyzed. Average segment duration was 157.9 ms. Most segments belonged to a small number of classes (from 2 to 6, mean 3.7 classes for 90% of analysis time). The most frequent class showed an anterior-posterior field orientation and covered from 45 to 74% (mean 55% across subjects) of total time, with an average duration of 265 ms. The procedure was also tested using temporally and spatially unstructured data (white noise and randomly shuffled EEG) to ascertain that the methods reflect the spatio-temporal structure of the EEG processes.

Dimensional complexity of EEG brain mechanisms in untreated schizophrenia

The dimensional complexity of left temporal-parietal and parietal-occipital electroencephalographic (EEG) recordings was assessed by computing the correlation dimension during 20 sec in six recording conditions from 15 first-episode acute schizophrenics before medication, 12 other medication-free individuals clinically and socially remitted after a first schizophrenic episode, 17 medication-free neurotics and 17 controls. The correlation dimension of the temporal-parietal EEG differed between groups [analysis of variance (ANOVA)] (p < 0.004), whereas neurotics (different from schizophrenics at p < 0.002) and remitted schizophrenics showed intermediate values. There was no overall significant difference between groups in the parietal-occipital EEG. Differences of the correlation dimension of the temporal-parietal versus the parietal-occipital EEG were significant between groups (ANOVA p < 0.05); first-episode schizophrenics differed from controls (p < 0.002) and remitted patients (p < 0.08). Increased dimensional complexity of schizophrenic EEG was found in one of two examined brain regions. The higher dimensional complexity of functional brain mechanisms in schizophrenics versus normals is reminiscent of the loosened organization of thought, and of suggestions of certain superior abilities in the patients.

Protection against autoimmune disease by bacterial agents. II. PPD and pertussis toxin as proteins active in protecting mice against experimental autoimmune encephalomyelitis

Bordetella pertussis and Mycobacterium tuberculosis, routinely used to promote the development of autoimmune disease, were recently reported to also be effective in inducing protection against an autoimmune disease. Thus, we previously demonstrated that SJL/J and (SJL/J x BALB/c)F1 mice that are genetically susceptible to experimental autoimmune encephalomyelitis (EAE) become highly refractory to the induction of the disease following their exposure to B. pertussis and M. tuberculosis. In the present study, the pertussis toxin (PT) from B. pertussis and the purified protein derivative (PPD) of M. tuberculosis, were found to be sufficient to fully protect against EAE and thus may be the major bacterial components responsible for conferring protection. The 65-kDa heat-shock protein played only a marginal role in the protection against EAE induced by these bacteria. Both PT and PPD were protective when given before, but not after, the encephalitogenic challenge, and minute amounts (5-50 ng) emulsified in oil were sufficient to confer long-lasting resistance to EAE. The effect of PT or PPD on EAE differed from that of mitogens or bacterial superantigens, suggesting that their protection ability was not attributable merely to mitogenic or superantigenic properties. The mechanism of protection is not yet clear. Preliminary studies revealed a complex mechanism of protection whereby PPD and PT may operate differently. Thus, only PPD-induced, but not PT-induced, protection was transferrable by CD4+ T lymphocytes bearing an alpha beta T cell antigen receptor. Neither PT nor PPD had a protective effect on EAE mediated by preformed pathogenic T lymphocytes and it is most likely that they exert their protection by affecting the development of such T lymphocytes. How bacteria such as B. pertussis and M. tuberculosis can either enhance the development of an autoimmune disease or protect against the disease is not yet clear. However, identifying PT and PPD as the bacterial components active in protection may allow a better understanding of the modulatory effects of bacteria and point to the potential use of such bacterial products in immunomodulation of autoimmune diseases.

Global dimensional complexity of multi-channel EEG indicates change of human brain functional state after a single dose of a nootropic drug

Viewing the multi-channel EEG as a sequence of momentary field maps corresponds to the concept of a trajectory in K-dimensional state space (K = number of channels). This approach permits a quantitative, single value measure of complexity of the brain state trajectory, the global correlation dimension that describes the ensemble characteristics of all recorded channels. In 5 normal volunteers, 4 records of 16-channel resting EEG were obtained during each of 4 randomized sessions (double blind design) after a single dose of placebo or 2.9 g or 4.8 g or 9.6 g piracetam. The global correlation dimension of a 40 sec epoch from each record was estimated, using 50 computational runs with 8192 point pairs. The results were combined for the two intermediate doses and averaged over repeated records. The dimensionality decreased from placebo (median = 5.89) to low dose (median = 5.72) to high dose (median = 5.59), significant in a Friedman ANOVA at P < 0.02, with significant differences between placebo vs. high and low vs. high dose. Thus, the subtle change of brain global functional state after a single dose of piracetam is reflected by the non-linear measure of global dimensional complexity of the multi-channel EEG.

Single doses of piracetam affect 42-channel event-related potential microstate maps in a cognitive paradigm

We examined whether a single administration of piracetam produces dose-dependent effects on brain functions in healthy young men. In 6 subjects, 42-channel event-related EEG potential maps (ERP) were recorded during a task requiring subjects to watch single digits presented in a pseudorandom order on a screen and to press a button after all triplets of three consecutive odd or even digits. The ERP maps to the three digits of the correctly detected triplets were analyzed in terms of their mapped ERP field configuration (landscape). Different landscapes of the maps indicate different configuration of the activated neural population and therefore reflect different functional microstates of the brain. In order to identify these microstates, adaptive segmentation of the map series based on their landscapes was done. Nineteen time segments were found. These segments were tested for direct effects on brain function of three single doses of piracetam (2.9, 4.8 or 9.6 g) and a placebo given double-blind in balanced order. Piracetam mainly affected the map landscape of the time segments following the triplet's last digit. U-shaped dose-dependent effects were found; they were strongest after 4.8 g piracetam. Since these particular ERP segments are recognized to be strongly correlated to cognitive functions, the present findings suggest that single medium doses of piracetam selectively activate differently located or oriented neurons during cognitive steps of information processing.

EEG reactivity in high and low symptomatic schizophrenics, using source modelling in the frequency domain

A dipole localization method in the frequency domain was used (FFT Dipole Approximation) to assess spatial differences in the spectral EEG reactivity (orienting response) between high and low symptomatic schizophrenics. Frequency bands of interest were determined empirically by comparing the two dichotomized patient groups with two matched control groups. Evidence for a correlation between EEG reactivity and severity of schizophrenic symptomatology was found, especially in the higher beta frequency range (16-25.5 Hz). Opposite effects were found in the two beta ranges of 20.5-22.5 Hz and 23.0-25.5 Hz, supporting the hypothesis that different EEG frequency bands have specific functional significances and that these bands are not necessarily those that are conventionally selected.

Antigenuria in healthy Papua New Guinean children with nasal Haemophilus influenzae type b carriage

In 100 healthy children under the age of 3 years living in the vicinity of Goroka, Papua New Guinea, the nares were cultured for Haemophilus influenzae type b (Hib), and a urine sample was obtained for measurement of Hib polysaccharide (PS) by ELISA. Hib carriage was detected in nine children and Hib PS was detected in the urine of 11. Hib PS was found in seven of nine Hib nasal carriers compared with four of 91 healthy children without Hib in their nares (p < 0.001). The range of urine antigen concentrations in the two groups was similar (0.6 to 2.7 ng/ml). The relative risk of antigenuria in the carriers, compared with the children with negative nares cultures, was 58 (95% confidence interval, 10.5-324). These data extend previous observations from Hib carriers studied in the United States and show that Hib carriage in children from a developing country is associated with antigenuria. Further studies are needed to determine whether carriers and patients can be differentiated by differences in the magnitude of the concentration of Hib PS excreted in urine.

Bacterial agents protect against autoimmune disease. I. Mice pre-exposed to Bordetella pertussis or Mycobacterium tuberculosis are highly refractory to induction of experimental autoimmune encephalomyelitis

Infectious agents have often been implicated in the etiology of autoimmune diseases. Here we show that bacteria may also play a role in resistance to autoimmune diseases. SJL/J and (SJL/J x BALB/c)F1 mice are genetically susceptible to induction of experimental autoimmune encephalomyelitis (EAE), a murine model for human demyelinating autoimmune diseases such as multiple sclerosis. We studied the effect of several bacteria on the development of EAE and found that exposure of SJL/J or (SJL/J x BALB/c)F1 mice to Mycobacterium tuberculosis or Bordetella pertussis consistently rendered mice highly refractory to subsequent induction of the disease. Other bacteria such as Escherichia coli, Shigella and Staphylococcus aureus were found to be less effective, or were protective only if specific immunization procedures were used. Furthermore, M. tuberculosis and B. pertussis were protective irrespective of the route of administration and minute amounts (as low as 0.5 micrograms) of M. tuberculosis were sufficient to protect EAE-susceptible mice against induction of the disease. Interestingly, these bacteria, which are commonly used to promote development of EAE, conferred the highest degree of protection against the disease. The M. tuberculosis-induced protection was found to be associated with active suppression mechanisms mediated by T lymphocytes capable of transferring protection to naive syngeneic mice. These findings indicate that certain bacteria may protect against the development of autoimmune diseases. These results also suggest the potential use for still-unidentified bacterial agents in the manipulation of certain autoimmune diseases.

[Antimicrobial chemotherapy of infection in intensive care conditions]

Antimicrobiologic chemotherapy is a cornerstone in the modern concept of treatment of sepsis. It is supported by a number of measures of intensive care. Externally acquired infections followed by sepsis mainly affect immunocompromised patients. They represent the minority. On the other hand, nosocomial infections play a dominant role in intensive care units. Nosocomial pneumonias and infections caused by intravascular plastics or endoprotheses are the most important reasons of sepsis. Initial antimicrobiologic therapy considers both the infectious focus and the specific epidemiology and resistance of microorganisms present in the department: it comprises the drawing of 2 to 3 blood cultures, taking of urinary cultures, tracheal secretion, liquor and wound-swaps for microbiologic examination. A gramstaining of the preparation can be helpful. In case the focus of the sepsis is not known, the first step of treatment consists of a combination of piperacilline or cephalosporins with aminoglycosides. If the septic state does not improve within 48 hours, a glycopeptide should be added against staphylococci (second step). If the combination fails, imipenem/cilastatin and aminoglycosides are administered as the third step. Normally, the result of cultures and resistogram already are available by this time. Today aminoglycosides are preferably given once daily, the serum level is monitored, and the toxicity of aminoglycosides is thus diminished.

Delineation of tissue damage mechanisms in experimental autoimmune encephalomyelitis (EAE). I. Cell detachment and lysis induced by encephalitogenic CD4+ T lymphocytes

Myelin basic protein (MBP) reactive CD4+ T lymphocytes, capable of inducing experimental autoimmune encephalomyelitis (EAE), were examined for their ability to damage target cells of central nervous system (CNS) origin. Damage was assessed by monitoring detachment of adherent astrocytes from substratum and astrocyte lysis. MBP-specific, but non-encephalitogenic CD4+ T cells mediated astrocyte detachment but not lysis. However, encephalitogenic CD4+ T cell lines were more efficient in causing astrocyte detachment and could also cause astrocyte lysis. The detachment and lytic activities of the MBP-reactive T cell lines tested were often independent of the presence of specific antigen, and were not restricted to syngeneic major histocompatibility (MHC) antigens. MBP often augmented the detaching and, if lytic, lytic activities of these T cells. The encephalitogenic CD4+ T cells also detached and lysed allogeneic 'bystander' fibroblasts in the presence of unlabelled syngeneic astrocytes, suggesting the involvement of a soluble mediator(s). Although MBP is essential for the initiation of EAE, the presence of MBP on cells of CNS origin, such as astrocytes and oligodendrocytes, does not appear to be necessary for their damage by MBP-specific CD4+ T cells. Immune CD4+ T cells, which penetrate the CNS, may disorganize brain tissue structure by lysing astrocytes directly and by damaging other brain cells indirectly by soluble mediators. Thus cellular detachment, in addition to cell lysis, mediated by MBP-specific CD4+ cells may contribute to EAE pathogenesis.

Chronic-relapsing experimental autoimmune encephalomyelitis (CR-EAE): treatment and induction of tolerance, with high dose cyclophosphamide followed by syngeneic bone marrow transplantation

We examined the effect of acute immunosuppression with high dose cyclophosphamide (CY), followed by syngeneic T-cell-depleted bone marrow transplantation (SBMT) on chronic-relapsing autoimmune encephalomyelitis (CR-EAE) induced in SJL/J mice by immunization with mouse spinal cord homogenate (MSCH) in adjuvant. Treatment of mice on day 9 post immunization, before the appearance of clinical signs of the disease, delayed the onset of paralysis, but did not affect its clinical course. Treatment on day 2-3 after the first clinical signs led to complete regression of the disease. During a period of 3 months, only one of the 15 mice treated after the the onset of CR-EAE relapsed, as compared to a total of 21 relapses in the 15 untreated animals. A rechallenge with MSCH in adjuvant on day 78 after immunization induced a severe relapse in all untreated mice, with 78% mortality; in contrast, only 25% of mice treated with CY and SBMT relapsed when similarly rechallenged. Lymphocytes from mice treated with CY and SBMT showed reduced in vitro proliferative responses to myelin basic protein (GMBP) and PPD, even after the rechallenge with MSCH. Our results show that high dose CY for elimination of immunocompetent lymphocytes, followed by SBMT rescue, suppresses CR-EAE and induces tolerance to the immunizing antigens. These results may encourage attempts to apply a similar therapeutic principle in life-threatening human neurological autoimmune diseases.

Epidemiology of acute respiratory tract infections, especially those due to Haemophilus influenzae, in Papua New Guinean children

Acute lower respiratory tract infections (ALRI) are the most common cause of death in Papua New Guinean children. Haemophilus influenzae and Streptococcus pneumoniae are almost universally carried in the nasopharynx from a young age and commonly cause disease. While most H. influenzae isolates from blood and cerebrospinal fluid are serotype b, other serotypeable and nonserotypeable H. influenzae are more frequently isolated in Papua New Guinea than in developed countries. Low levels of antipneumococcal antibody, malnutrition, and upper respiratory carriage of invasive pneumococcal serotypes are associated with increased risk of ALRI. An oral H. influenzae vaccine given to adults with chronic bronchitis reduced the bacterial load in sputum and may thereby help reduce transmission of bacteria in the community. The efficacy of conjugate H. influenzae type b vaccine in preventing pneumonia must be determined in developing countries; vaccines against other types of H. influenzae will also be needed to control pneumonia and meningitis.

Randomized double blind trial of Ambroxol for the treatment of respiratory distress syndrome

In order to test the ability of Ambroxol to improve the clinical course of respiratory distress syndrome and to reduce the incidence of complications a multicentre, randomized, placebo-controlled double-blind trial was conducted. Entry was limited to infants with a birth weight below 1500 g. A total of 179 neonates were enrolled, but 31 were later excluded because they had other diseases. Of the remaining 148 babies, 74 received Ambroxol (birth weight 1190 +/- 216 g; gestational age 29.1 +/- 1.9 weeks) and 74 placebo (birth weight 1168 +/- 216 g; gestational age 28.9 +/- 1.9 weeks). In the Ambroxol group 23 (31%) and in the placebo group 27 (37%) infants died during the first 5 months of life. In 28 day-survivors Ambroxol was able to significantly improve the PaO2/FiO2 ratio, mean airway pressure, phospholipid profile of tracheal effluent and pulmonary mechanics of spontaneously breathing infants. In addition, the incidences of bronchopulmonary dysplasia (29% vs 54%), intraventricular haemorrhage (25% vs 44%) and postnatally acquired pneumonia (15% vs 36%) were significantly reduced in the Ambroxol group as compared to the control group. No adverse events attributed to the Ambroxol treatment were reported.

Prevention of experimental autoimmune encephalomyelitis and induction of tolerance with acute immunosuppression followed by syngeneic bone marrow transplantation

Experimental autoimmune encephalomyelitis (EAE) is an inducible autoimmune disease widely used as a model of the acute/relapsing stage of multiple sclerosis. In the present study we examined the effect of acute immunosuppression induced by total body irradiation (TBI) (900 to 1100 centigray (cGy)) or by a single high dose of cyclophosphamide (CY) (300 mg/kg), followed by syngeneic bone marrow transplantation (SBMT), on the development of EAE in SJL/J mice. EAE was induced in SJL/J mice by immunization with spinal cord homogenate in adjuvant. Treatment with TBI (900 cGy) and SBMT on day 6 postimmunization caused a delayed onset and a marked reduction in the incidence and severity of EAE. A higher dose of irradiation (1100 cGy) or the administration of CY followed by SBMT completely abrogated the development of paralysis. None of the 21 mice treated with CY and SBMT, and only 1 of 7 mice treated with TBI (1100 cGy) and SBMT developed clinical signs of EAE during a period of 3 months. Furthermore, mice treated with CY and SBMT became resistant to rechallenge with the same encephalitogenic inoculum. In addition, the lymphocytes obtained from these mice did not proliferate in vitro in response to myelin basic protein or tuberculin-purified protein derivative, unlike lymphocytes from immunized but untreated animals. This absence of reactivity was not associated with alterations in the proportion of the L3T4 and Lyt-2 T-cell subsets nor with a loss in T cell competence as evidenced by the full response of lymphocytes to the T cell mitogen Con A and to a nonrelevant Ag (OVA). Our results indicate that the elimination of effector lymphocytes either by myeloablative doses of CY or ionizing irradiation followed by rescue with SBMT inhibits the development of the autoimmune process in EAE and leads to induction of tolerance to the immunizing Ag by newly developing lymphocytes. This approach of combining immunoablation and reconstitution with autologous bone marrow transplantation may be applicable in the treatment of life-threatening neurologic autoimmune diseases.

Prevention of experimental autoimmune encephalomyelitis and induction of tolerance with acute immunosuppression followed by syngeneic bone marrow transplantation

Experimental autoimmune encephalomyelitis (EAE) is an inducible autoimmune disease widely used as a model of the acute/relapsing stage of multiple sclerosis. In the present study we examined the effect of acute immunosuppression induced by total body irradiation (TBI) (900 to 1100 centigray (cGy)) or by a single high dose of cyclophosphamide (CY) (300 mg/kg), followed by syngeneic bone marrow transplantation (SBMT), on the development of EAE in SJL/J mice. EAE was induced in SJL/J mice by immunization with spinal cord homogenate in adjuvant. Treatment with TBI (900 cGy) and SBMT on day 6 postimmunization caused a delayed onset and a marked reduction in the incidence and severity of EAE. A higher dose of irradiation (1100 cGy) or the administration of CY followed by SBMT completely abrogated the development of paralysis. None of the 21 mice treated with CY and SBMT, and only 1 of 7 mice treated with TBI (1100 cGy) and SBMT developed clinical signs of EAE during a period of 3 months. Furthermore, mice treated with CY and SBMT became resistant to rechallenge with the same encephalitogenic inoculum. In addition, the lymphocytes obtained from these mice did not proliferate in vitro in response to myelin basic protein or tuberculin-purified protein derivative, unlike lymphocytes from immunized but untreated animals. This absence of reactivity was not associated with alterations in the proportion of the L3T4 and Lyt-2 T-cell subsets nor with a loss in T cell competence as evidenced by the full response of lymphocytes to the T cell mitogen Con A and to a nonrelevant Ag (OVA). Our results indicate that the elimination of effector lymphocytes either by myeloablative doses of CY or ionizing irradiation followed by rescue with SBMT inhibits the development of the autoimmune process in EAE and leads to induction of tolerance to the immunizing Ag by newly developing lymphocytes. This approach of combining immunoablation and reconstitution with autologous bone marrow transplantation may be applicable in the treatment of life-threatening neurologic autoimmune diseases.

42-channel potential map series to visual contrast and stereo stimuli: perceptual and cognitive event-related segments

Event-related potential maps to perceptual (stimulus type) and cognitive (stimulus relevance) manipulations were studied in 12 healthy volunteers using 42-channel mapping. Perceptual manipulation used three types of visual stimuli: rectangles constituted by: (1) contrast; (2) different densities of monocular Dynamic Random Dots (Flat DRD); and (3) different binocular disparities of Dynamic Random Dots (Stereo DRD). Cognitive manipulation within each stimulus type consisted of presenting the rectangles horizontally and vertically, one of the two with a probability of 33%, and requesting the subjects to count and thus attend to the 'rare' rectangles. Spatial characteristics of the maps were analyzed; this allowed conclusions about the generating sources. The map series were adaptively segmented using the minima points of the grand mean Global Field Power curve. Segment strength (Global Field Power) and segment landscape (locations of extreme potentials) were assessed. Stimulus type had effects from 78 to 310 ms, stimulus relevance was effective from 210 to 1000 ms. In the 78-174 ms segment, Stereo DRD and Flat DRD stimuli produced similar map landscapes, while contrast stimuli produced different map landscapes. Attended and ignored stimuli produced contrary effects on landscapes at 210-310 ms as compared to those at 310-546 ms, indicative of different neural populations activated by attention processes during these late event-related potential segments. Interaction between perceptual and cognitive manipulation occurred at 210-310 ms when perceiving stereo stimuli and attending to relevant monocular visible stimuli produced similar map landscapes, suggesting a common brain resource during this segment for automatic figure perception and voluntary attention. The observed functional differences of the segments contribute to the identification of global functional microstates of brain electric activity.

[Evaluation of evoked potential or event-related potential mapping]

Strategies for the evaluation of EP and ERP maps are discussed. Spatial interpolation is presented. The reference does not change the landscape but the wave shapes, the baselines change the landscape but not the wave shapes. Electric strength of the map is assessed using Global Field Power, whereby non-ambivalent component latencies can be established. Map landscapes are compared using Global Dissimilarity. Maps are classified using extracted landscape descriptors: locations of minimal and maximal potential, locations of the centroids of the positive and negative map area, reduction to a three-dimensional model dipole source. Adaptive segmentation into echoes of stable landscape (functional microstates) based on landscape descriptors is discussed. Diagnostic and physiological-functional interpretation of the results ought to be distinguished.

Localization of the sources of EEG delta, theta, alpha and beta frequency bands using the FFT dipole approximation

FFT dipole approximation and 3-dimensional dipole modelling were used to determine the locations of the equivalent dipole model sources of the delta, theta, alpha, beta-1 and beta-2 frequency bands in 13 normal subjects during resting. From each subject, 2 successive data sets were analysed, each consisting of 10 epochs of 2 sec randomly collected during 30 min. ANOVAs showed that over subjects, the source locations of EEG frequency bands differed significantly in the vertical and antero-posterior dimensions. Results of data set 2 confirmed those of data set 1. The source of delta was deepest and most anterior, theta more posterior and less deep, alpha most posterior and highest on the vertical dimension, beta-1 deeper and slightly more anterior than alpha, and beta-2 again more anterior and deeper than beta-1. Thus, the depth of source location was not linearly related to temporal frequency. The sources of all 5 bands were oriented in the sagittal direction; delta mean fields had steeper gradients anteriorly, alpha and beta-1 posteriorly. The power map for any frequency was well described by a single phase angle. The results indicate that the different EEG frequency bands during a given EEG epoch are generated by neural populations in different brain locations.

Mortality and morbidity from acute lower respiratory tract infections in Tari, Southern Highlands Province 1977-1983

Monthly demographic surveillance by village reporters has been ongoing in the Tari Basin since 1970. Cause of death is ascertained by verbal autopsy. 20% of deaths between 1977 and 1983 were from acute lower respiratory tract infection (ALRI). ALRI mortality rates were highest in the very young and the elderly and have risen since the early 1970s but declined in the 1981-1983 period when pneumococcal vaccine was being tested in Tari. 44% of ALRI deaths in children under 5 years of age occurred before the age of 6 months but ALRI mortality remained high during the second year of life. Utilization of health services before death was highly age-dependent, with the vast majority of young children but few elderly people receiving some form of medical attention. However, less than half the children who died of ALRI received inpatient care. Fortnightly morbidity surveillance of children between 1981 and 1983 showed that ALRI was the commonest cause of severe morbidity; children suffered 2-3 episodes of ALRI in the first year of life, 20% of which were moderate or severe disease. Improved case management, nutritional status and hygiene in addition to good coverage with pertussis and measles vaccines and immunization with efficacious pneumococcal and H. influenzae vaccines are required to reduce mortality and morbidity from ALRI.

Reduction in the incidence of acute bronchitis by an oral Haemophilus influenzae vaccine in patients with chronic bronchitis in the highlands of Papua New Guinea

Following the administration of a standardized questionnaire, 62 adult patients with chronic bronchitis were enrolled into a double-blind controlled trial of an oral killed Haemophilus influenzae vaccine in the highlands of Papua New Guinea. A 3-day course of vaccine or placebo was given monthly for 3 consecutive months. Participants were monitored weekly over 12 months for acute exacerbations; early morning sputum specimens were collected monthly and during acute exacerbations. Density of colonization by H. influenzae and H. parainfluenzae was determined by standard quantitative and semiquantitative techniques, and the latter method (quadrant score) was used to determine the density of growth of pneumococci. A total of 30 patients received vaccine and 32 placebo. The incidence rate of acute bronchitis in the vaccine group (0.011 episodes/person-weeks) was significantly lower than that in the placebo group (0.021 episodes/person-weeks), but there was no difference between the two groups in the incidence rates of more severe disease. Vaccine efficacy was maximal at times of peak incidence of disease. There was no evidence of a decline in vaccine efficacy for acute bronchitis over the 12-month follow-up period. The number of viable H. influenzae in the sputum declined in both vaccine and placebo groups over the 12-month follow-up period. The average concentration of H. influenzae in the vaccine group fell below that in the placebo group within 1 to 2 months after first immunization and remained so for 12 months, although the difference between the two groups narrowed during the follow-up period.(ABSTRACT TRUNCATED AT 250 WORDS)

Amikacin pharmacokinetics in patients receiving high-dose cancer chemotherapy

We retrospectively analyzed amikacin pharmacokinetics in 28 patients (mean age, 47.4 +/- 13.6 years) who received high-dose chemotherapy during a neutropenic febrile episode. Patients received an experimental protocol of high-dose anticancer chemotherapy. Amikacin pharmacokinetic parameters were calculated from two or more concentrations in serum around a single dose by the method of Sawchuck and Zaske (J. Pharmacokinet. Biopharm. 4:183-195, 1976). Predicted parameters were calculated by using standard methods. The observed amikacin volume of distribution and clearance were significantly greater and the elimination half-life was longer than predicted (0.38 +/- 0.13 versus 0.25 liter/kg [P = 0.0001], 1.51 +/- 0.92 versus 1.17 +/- 0.38 liters/h/kg [P = 0.012], and 3.8 +/- 2.4 versus 2.9 +/- 1.1 h [P = 0.011], respectively). Multivariate analysis revealed that albumin correlated negatively and creatinine correlated positively with the volume of distribution and the elimination half-life. Creatinine and the percentage below the ideal body weight correlated negatively and hematocrit correlated positively with clearance. Administration of dosage regimens based on predicted pharmacokinetic parameters yielded subtherapeutic amikacin concentrations in serum in our patients. Because of the increased dosage requirements and the need for adequate antibiotic treatment in this population, we suggest guidelines for empiric dosing for patients with advanced cancer receiving intensive chemotherapy.