Biliary excretion of furosemide glucuronide in rabbits

Furosemide (F) was administered to rabbits intravenously and intraduodenaly and the biliary excretion was studied. The major metabolite excreted in bile was furosemide glucuronide (FG). F and acyl migration isomers of FG (FG-iso) were also excreted in bile. The biliary excretion rates of total F (F+FG+FG-iso) following intraduodenal administration of F were much smaller than those following intravenous administration. The fraction of (F+FG-iso) in bile following intraduodenal administration of F were larger than those following intravenous administration. Stability of FG or FG-iso in bile and supernatant solution of the duodenum homogenate of rabbits was studied. FG was unstable in both media and its degradation followed apparent first-order kinetics in both media. In bile, FG degraded to produce several FG-iso and F, while in the supernatant solution of the duodenum homogenate, it hydrolyzed immediately to F. FG-iso were hardly detected in the supernatant solution. These results indicated that FG excreted in bile degraded easily to FG-iso and F. FG might easily hydrolyze to F enzymatically in the duodenum, and the resultant F might be reabsorbed from the intestinal tract. Unabsorbed FG-iso and F might be excreted in the feces.

Correlation between sperm morphology using strict criteria in original semen and swim-up inseminate and human in vitro fertilization

To study the value of sperm morphology using strict criteria in raw semen and in swim-up inseminate of human in vitro fertilization (IVF), 135 cycles of IVF with normal sperm concentration and motility were recruited. At least two mature oocytes were recovered in each cycle. The correlation between the percentages of normal forms and fertilization rates of mature oocytes was analyzed. The results demonstrate that the percentage of normal forms in both the raw semen and swim-up sample of patients with poor fertilization was significantly lower than in those with acceptable fertilization. The percentages of normal forms both in raw semen and in swim-up sample were significantly correlated with fertilization rates in vitro, however, the former seemed to have a better correlation (r = .51 and .19, respectively). Regarding the percentages of normal forms in raw semen, the fertilization rate in patients with normal forms < 4% was 6 +/- 11%, for 4-14% it was 58 +/- 36%, and for > 14% it was 88 +/- 20%. The fertilization rates were significantly different among these three groups of patients. The evaluation of sperm morphology using strict criteria in raw semen before IVF is predictive of fertilization outcome and may also help doctors to choose an optimal method of treatment for patients.

Ketone EC50 values in the Microtox test

The Microtox EC50 values for the following ketones are reported in the following homologous series: straight chain methyl ketones (acetone, 2-butanone, 2-pentanone, 2-hepatonone, 2-octanone, 2-decanone, and 2-tridecanone); methyl ketones substituted at one alpha carbon (3-methyl-2-butanone; 3,3-dimethyl-2-butanone); methyl substituted at two alpha carbons (2,4-dimethyl-3-pentanone; 2,2,4,4-tetramethyl-3-pentanone); phenyl groups replacing methyl in acetone (acetophenone; benzophenone); methyl groups substituted at the alpha carbons of cyclohexanone; and 2,3- 2,4-, and 2,5-hexanediones, most for the first time. While there were linear relationships between log EC50 and MW for the straight chain methyl ketones, and for methyl substitution at the alpha carbon for methyl ketones, there were no other linear relationships. As molecular weight increased, the EC50 values of soluble ketones decreased; as distance between two carbonyl groups decreased so too did EC50 values. Thus, for the ketones the geometry around the carbonyl group is an important determinant of toxicity as well as MW, water solubility, and octanol/water coefficient.

Cytomegalovirus infection and viral shedding in the genital tract of infertile couples

The prevalence of cytomegalovirus (CMV) infection and viral shedding in infertile couples in Taiwan and its role in infertility were studied. Two hundred fifty couples were enrolled in this study. Anti-CMV IgG was measured in serum samples from these infertile couples. Viral shedding examined by DNA hybridization was detected in semen from the husband and cervical mucus from the wife. Anti-CMV IgG was detected in 249 (99.6%) of the 250 male serum samples and in 247 (98.9%) of the 250 female serum samples. Viral shedding was detectable in 83 (33.5%) of 248 semen samples and 83 (33.7%) of 246 cervical mucus samples by dot-blot DNA hybridization assay. Semen quality was not apparently affected by the existence of viral shedding. The co-shedding rate in semen and cervical mucus was high (15.9%). It is concluded that the seroprevalence and genital tract viral shedding were relatively high in infertile couples in Taiwan. Viral shedding did not affect the semen quality. Nevertheless, screening of donor semen is recommended.

In vivo CD3+CD25+ lymphocyte subpopulation is down-regulated without increased serum-soluble interleukin-2 receptor (sIL-2R) by gonadotropin releasing hormone agonist (GnRH-a)

PROBLEM

To test further whether the suppression of the CD3+CD25+ lymphocyte subpopulation by gonadotropin-releasing hormone agonist (GnRH-a) is related to the change in levels of cytokines and soluble interleukin-2 receptor (sIL-2R).

METHOD

Twenty-seven infertile patients were enrolled under the long protocol of GnRH-a agonist (buserelin acetate) and superovulation with gonadotropin from our IVF-ET program. Peripheral B cells, NK cells, CD4+ and CD8+ T cells and the expression of CD69, CD25, HLA-DR, and CD71 antigens on the T cells were serially examined by dual-color flow cytometry. Serum levels of cytokines and sIL-2R were measured.

RESULTS

The B cells, NK cells, T cells, CD4+, CD8+ T cells, CD3+DR+, and CD3+CD71+ lymphocyte subpopulations were not changed after the use of GnRH-a. The CD25+ T cell subpopulation was significantly down-regulated, but the CD69+ T cell subpopulation was increased when the GnRH-a was used for approximately 2 wk. The serum levels of interleukin-1 beta (IL-1 beta), interleukin-2 (IL-2), interleukin-4 (IL-4), interferon-gamma (IFN-gamma), and sIL-2R were not changed.

CONCLUSION

The GnRH-a had a transiently suppressive effect on CD25+ T cells, but a stimulatory effect on CD69+ T cells. However, the serum level of cytokines or sIL-2R did not change. These immunological modulations seems to be the result of interaction between GnRH-a and estrogen.

Hormonal studies and Doppler flow imaging of ovarian lipoid cell tumors: report of two cases

Ovarian lipoid cell tumors are very rare. We report two cases with abnormal menstruation, hirsutism, clitoromegaly and marked elevations of serum testosterone. Sonography revealed unilateral adnexal solid tumors. Flow velocity wave form study showed apparent flow within the tumor with the resistance index ranging from 0.42 to 0.49 in both cases. Unilateral oophorectomy and contralateral ovarian biopsy were performed. Frozen sections showed lipoid cell tumors without malignant change. During surgery, direct ovarian venipuncture showed a discrepancy in testosterone level in the bilateral ovaries of both patients and large ovarian-peripheral venous gradients in case 2. The testosterone concentration returned to normal postoperatively in both cases. Flow velocity wave form study and direct ovarian venipuncture are useful tools for evaluation of androgen-secreting tumors preoperatively and intraoperatively.

Delayed maternal death after perimortem cesarean section

We report a case of perimortem cesarean section performed on a multigravida with congestive heart failure. This patient had a past history of repeated episodes of acute myocarditis and this time, congestive heart failure attacked her at the 36th week of gestation. The maternal condition deteriorated rapidly with frequent attacks of ventricular fibrillation and cardiac arrest, which gradually became unresponsive to active cardio-pulmonary resuscitation (CPR). The fetal condition also worsened accordingly. Cesarean section was therefore performed and a 2590 gm depressed female baby was delivered in less than one minute after skin incision and about twenty-seven minutes after the maternal condition became extremely unstable. The Apgar scores were 1 at one min, 4 at five min and 6 at ten min. The mother improved soon after delivery of the fetus and her consciousness returned. However, her condition deteriorated again and she died four hours after operation. The fetus survived and follow-up 21 months after delivery was normal.

Co-culture with Vero cell monolayer maintains the motility of asthenozoospermic semen samples

The clinical effectiveness of co-culture with Vero (Green monkey kidney) cell monolayer in maintaining the motility and viability of fresh asthenozoospermic semen (18 samples) and frozen-thawed semen with poor motility (motility fraction < 50%) (15 samples) in a 24-h period was evaluated. Co-culture with Vero cell monolayer in human tubal fluid (HTF) medium for 24 h resulted in a statistically better maintenance of motility percentage (P < 0.005), mean amplitude of lateral head displacement (ALH) (P < 0.005), and mean track speed (VCL) (P < 0.05) than culture in HTF medium alone. However, these motility parameters (motility percentage, ALH, VCL) declined soon after removal of spermatozoa from the monolayer. Co-culture with Vero cell monolayer also maintained the viability percentage of these sperm samples (52% of the original value) after the 24-h period compared with culture in HTF medium alone (22% of the original) (52% versus 22%, P < 0.05). It is concluded that Vero cell monolayer is effective in the maintenance of motility and viability of asthenozoospermic semen or frozen-thawed semen with poor motility. This co-culture system may be beneficial in enhancing the in-vitro performance of asthenozoospermic semen samples in the practice of assisted reproductive technology. However, its safety needs further evaluation.

Peptides extracted from Vero cell cultures overcome the blastocyst block of mouse embryos in a serum-free medium

PURPOSE

The aim of this work was to evaluate the effect of a Vero cell coculture system on the development of mouse embryos.

METHODS

Mouse embryos were randomly divided and cultured in human tubal fluid (HTF) medium with/without Vero cell monolayers, conditioned medium (CM) obtained from Vero cell cultures, and HTF medium supplemented with peptides extracted from CM. The concentrated CM was examined by SDS/PAGE.

RESULTS

The development of mouse embryos was blocked at the blastocyst stage in pure HTF medium (1.4% hatching at day 5). This "blastocyst block" was overcome by coculture with Vero cell monolayers (48.1% hatching at day 5; 1.4 vs 48.1%; P < 0.001). CM and the addition of 5% fetal bovine serum (24.1 and 34.9% hatching, respectively, at day 5) were also able to enhance the process of hatching. In the other experiment, the addition of peptides extracted from Vero cell cultures also overcame the blastocyst block (12.5%) compared with pure HTF medium (2.1%) (P < 0.05). Electrophoretic separation revealed several classes of polypeptides consistently secreted into CM obtained from Vero cell cultures. Most peptides occurred in the M(r) range between 6.5 kd and 35.9 kd.

CONCLUSION

A developmental block (blastocyst block) of mouse embryos in a serum- and protein-free medium (HTF) was discovered in this study. This block was effectively overcome by HTF plus serum and coculture with Vero cell monolayers and also by the peptides extracted from Vero cell-conditioned medium. We speculate that certain factors secreted or converted by Vero cells may be critical in hatching of mouse embryos. Further study of these factors may be helpful in delineating its mechanism.

Effects of pulmonary air embolism on discharge of slowly adapting pulmonary stretch receptors

Pulmonary air embolism (PAE) usually causes small-airway collapse. Local transpulmonary pressure (Ptr) is thought to be closely associated with the activity of slowly adapting pulmonary stretch receptors (SAPSRs). To test whether discharge of SAPSRs located distal to collapsed airways is closely related to the overall Ptr, we studied 65 SAPSRs in anesthetized paralyzed open-chest dogs that were ventilated at constant tidal volume and frequency. PAE increased both Ptr and total pulmonary resistance but decreased dynamic lung compliance. Three groups of SAPSRs were identified on the basis of their locations in intrapulmonary airways. Group I had 29 SAPSRs located in airways < 1 mm in diameter. Group II had 10 SAPSRs that were found in intrapulmonary airways between 1 and 2 mm in diameter. PAE decreased the activity of 31 of the 39 SAPSRs in these two groups. Their activity during PAE was not related to Ptr. The 26 SAPSRs in group III were in airways > 2 mm in diameter. PAE increased the peak firing rate of 18 of these receptors, and there was a close relationship between the discharge frequency of these SAPSRs and the Ptr during PAE. In groups I and II, the dissociation between Ptr and SAPSR activity during PAE may have been caused by peripheral airway collapse. Activity of central fibers was blocked at higher temperatures than activity of peripheral fibers. We suggest that the response of a SAPSR to PAE depends on the location of the receptor within the lungs, and we speculate that threshold and fiber type are also related to location.

Acrosin activity of human sperm did not correlate with IVF

To evaluate the predicting value of sperm acrosin activity in human, the acrosin activity index (AAI) was measured in 95 semen samples from patients participating in an IVF program. All patients had at least two mature oocytes. Of 95 patients, 84 had successful fertilization and 11 failed to fertilize all oocytes in vitro. The numbers of mature oocytes were similar between fertilization and nonfertilization groups. The mean AAI, measured using a commercially available (Accu-Sperm) acrosin activity assay, was greater in the fertilization group than in the nonfertilization group, but the difference was not significant. There was no correlation between AAI and the in vitro fertilization rate of mature oocytes. The relation between AAI and semen parameters also showed no significant difference. It would appear that measurement of AAI inaccurately reflects in vitro fertilizability of human sperm.

Sharing of human leukocyte antigens in couples with unexplained infertility affects the success of in vitro fertilization and tubal embryo transfer

OBJECTIVE

The purpose was to test further our hypothesis that genes, or genetic defects, linked to the major histocompatibility complex affect reproduction by correlating human leukocyte antigen sharing with the success or failure of in vitro fertilization and tubal embryo transfer in couples having unexplained infertility.

STUDY DESIGN

Seventy-six couples with unexplained infertility who failed superovulation and intrauterine insemination at least three times were typed for human leukocyte antigens and treated by in vitro fertilization and tubal embryo transfer. The results were correlated with the sharing of human leukocyte antigens in the couples.

RESULTS

Thirty-four of the women had successful pregnancies, 36 did not become pregnant, and six became pregnant but aborted shortly thereafter. There was a highly significant excess of human leukocyte antigen sharing in the couples who failed treatment: three of the A, B, DR, and DQ antigens (p = 0.015) or two of the B, DR, and DQ antigens (p = 0.015). No specific human leukocyte antigen alleles were present in excess.

CONCLUSIONS

Genes, or genetic defects, linked to the major histocompatibility complex significantly affect the success of in vitro fertilization and tubal embryo transfer just as they affect the prevalence of recurrent spontaneous abortion, cancer, and congenital anomalies. It appears as if the critical genes, or genetic defects, are located in the B-DR-DQ region of the major histocompatibility complex.

Antihypertensive principles from the leaves of Melastoma candidum

Three active principles were isolated from the leaf of Melastoma candidum using the screening of hypotensive effects on spontaneously hypertensive rats (SHR). Intravenous injection of castalagin, procyanidin B-2, or helichrysoside into SHR lowered the mean blood pressure in a dose-dependent manner, with helichrysoside being the most potent compound. Plasma noradrenaline (NA) levels, both basal in SHR and elevated in normal rats through cold-stress stimulation, were attenuated by these compounds in a way which was not influenced by adrenalectomy. Decrease of NA release from sympathetic nerves was assumed to be responsible. Moreover, the hypertensive effect of various vasoconstrictors in anesthetized rats was reduced by helichrysoside. The same results were also observed in castalagin or procyanidin B-2 treated animals. The results indicate that the three principles possess the ability to lower blood pressure through a decrease of sympathetic tone as well as due to direct vasodilatation in SHRs.

Expression of the Epstein-Barr virus latent membrane protein (LMP) in insect cells and detection of antibodies in human sera against this protein

Recombinant baculoviruses containing the complete LMP and truncated LMP genes were generated and high levels of the LMP proteins were expressed in Spadoptera Frugiperda insect cells. A specific rabbit antiserum directed against the N-terminal part of LMP was obtained by immunizing the rabbits with Escherichia coli-expressed trpE-N-terminal part of LMP fusion protein. A total of 127 human sera were studied for their immune response to the recombinant full-length LMP. In immunofluorescence analysis, all sera tested showed no detectable reaction with the recombinant full-length LMP. In immunoprecipitation-immunoblotting analysis, however, sera from patients with nasopharyngeal carcinoma (5/22), patients with Hodgkin's disease (16/27), patients with other diseases exhibiting high EA-IgG titers (3/52), and VCA-IgG-positive healthy individuals (2/26) were shown to contain antibodies against this recombinant LMP. The expressed LMP proteins provided a sufficient and economic source of the proteins for further serological and biological studies.

Pregnancy after transfer of frozen-thawed human embryos

Cryopreservation of human embryos has been successfully applied in in vitro fertilization (IVF) and embryo transfer (ET) programs at the National Taiwan University Hospital since 1988. Our preliminary results with 120 frozen-thawed embryos in 31 transfer cycles showed that the survival rate of frozen embryos was 66%. Following transfer, the implantation rate and clinical pregnancy rate were 6.5% and 13%, respectively. Four clinical pregnancies and one preclinical pregnancy following a frozen-thawed embryo transfer were achieved. Two normal male babies have been delivered and another pregnancy is progressing without any problem.* Unfortunately, one pregnancy was terminated due to intrauterine fetal death discovered at the 10th week of gestation; chromosome abnormality (47, XX, +5) of the fetus was found. The single preclinical pregnancy showed an elevation of serum beta-human chorionic gonadotropin levels for three consecutive weeks following ET, but no definite gestational sac was visualized by transvaginal ultrasound.

Enzyme inhibitory assay using monoclonal antibody against acid alpha-D-glucosidase in prenatal diagnosis to identify homozygotes of Pompe's disease

From January 1985 to January 1990, measurements of acid alpha-D-glucosidase activity in amniocytes or chorionic villus samplings were done for 24 pregnant mothers who were carriers of Pompe's disease. 6 women had two subsequent pregnancies. Amniotic fluid was obtained by transabdominal amniocentesis performed on 10 of them, while chorionic villus samplings were obtained in the other 20. The results showed that 7 (23.3%) cases were homozygotes, 16 (53.4%) cases were heterozygotes, and 7 (23.3%) cases were normal. Pregnancies were terminated in the homozygotic group. Final diagnosis was confirmed by either skin fibroblast culture or clinical course. However, we found that there was overlap in the acid alpha-D-glucosidase activity of amniocytes between homozygotes and heterozygotes due to residual activity of neutral alpha-D-glucosidase. In an attempt to identify heterozygotes for Pompe's disease, we established an enzyme inhibitory assay using monoclonal antibody (mAb) against acid alpha-D-glucosidase. Comparing the differences in alpha-D-glucosidase activity before and after mAb treatment the homozygotes were significantly lower than heterozygotes (P less than 0.001). There was no more overlap in the difference of acid alpha-D-glucosidase activity before and after mAb treatment between heterozygotes and homozygotes in amniocytes. This modified enzyme inhibitory assay should facilitate homozygote detection. Comparing acid alpha-D-glucosidase activity between CVS and amniocytes, the enzyme activity in CVS is about 5 times higher than in amniocytes. There was no overlap in the acid alpha-D-glucosidase activity between homozygotes and heterozygotes. Therefore, CVS is better than amniocentesis in the prenatal diagnosis of Pompe's disease.

Inhibition of host-versus-graft and graft-versus-host responses after small bowel transplantation in rats by rapamycin

The effect of rapamycin (RAPA) on both host-versus-graft (HVG) and graft-versus-host (GVH) immune responses was examined in small bowel transplant models using strongly histoincompatible donor-recipient combinations. Normal Wistar Furth (WFu; RT-1u) recipients rejected Buffalo (BUF; RT-1b) small bowel allografts within a mean survival time (MST) of 10.5 +/- 0.5 days. Administration of RAPA (0.8 mg/kg) by continuous intravenous infusion for 14 days via an osmotic pump prolonged graft survival to 25.0 +/- 4.6 days (P = 0.01). In a second strain combination, the 12.5 +/- 2.2 day survival of Brown Norway (BN; RT-1n) small bowel allografts in Lewis (RT-1l) recipients was prolonged to 21.6 +/- 2.0 and 28.5 +/- 2.8 days by 14 days of i.v. RAPA at doses of 0.8 and 1.6 mg/kg, respectively. In this model RAPA is five times more effective than cyclosporine, which at 4.0 mg/kg prolongs BN small bowel allografts in Lewis recipients to 21.6 +/- 6.3. To isolate HVG and GVH immune responses, (BN x Lewis)F1 hybrid rats served as the graft donor or host, respectively. In the HVG model, (BN x Lewis)F1 small bowel allografts, which were rejected by normal Lewis recipients at 12.2 +/- 3.6 days, were prolonged to 40.8 +/- 5.8 days (P = 0.001) by RAPA (0.8 mg/kg x 14 days). In the GVH model, the ability of Lewis small bowel allografts to produce severe GVH disease in untreated (BN x Lewis)F1 recipients at 12.3 +/- 2.8 days was delayed to 21.3 +/- 5.2 days by 0.8 mg/kg RAPA (P = 0.025). Thus, RAPA protects small bowel allografts more effectively against HVG than GVH immune responses.

In vitro IgE production by interleukin 4-stimulated human peripheral blood mononuclear cells is suppressed by rapamycin

Rapamycin (RAPA) is a new immunosuppressant which is 50-fold to 100-fold more potent than cyclosporin A (CyA) in inhibiting cellular immune responses and allograft rejection in animal models of organ transplantation. The drug's effect on in vitro IgE synthesis by interleukin (IL)4-stimulated human peripheral blood mononuclear cells was examined and compared with CyA's effect in this study. RAPA was found to be about 100-fold more potent than CyA in inhibiting IgE synthesis. Its inhibitory effect on IgE production was significant if it was added to the culture before Day 6 of a 14-day culture. The suppression was accompanied by the inhibitory effect on cell proliferation and on IgE-binding factor (IgE-BF) production. IL2 was able to partially reverse CyA- but not RAPA-induced inhibition of IgE production. Commercial B cell growth factor (cBCGF) was not able to reverse either RAPA- or CyA-induced suppression of IgE synthesis. The strong inhibitory effect of RAPA in IgE synthesis may be useful in certain clinical applications where overproduction of pathogenic IgE is a key issue. RAPA can also be used as a tool to dissect the regulation of IgE production.

Intestinal permeability and bacterial translocation following small bowel transplantation in the rat

In addition to its role in absorbing nutrients, the intestinal mucosa provides an important barrier against toxins and bacteria in the bowel lumen. The present study evaluated gut barrier function following orthotopic (in continuity) intestinal grafting in rats. Graft histology, intestinal permeability, and bacterial translocation to the grafted mesenteric lymph nodes, the host's liver, and the host's spleen were assessed on the 3rd, 5th, and 7th postoperative days. The study group received no immunosuppression after allotransplantation. The two control groups included rats with isografts and rats with cyclosporine-treated allografts. On the 7th POD, the study animals had moderate transmural inflammation due to rejection, with normal histology in the isografts and CsA-treated allografts; increased intestinal permeability, measured by urinary excretion of oral 51Cr-EDTA (P less than 0.01); and increased number of bacteria in the MLN and spleen (P less than 0.05). The number of bacteria in the MLN and spleen of the study group positively correlated with the changes in intestinal permeability (P less than 0.05). Rejection of the orthotopic intestinal graft leads to increased intestinal permeability and bacterial translocation from the lumen of the graft to the host's reticuloendothelial system. Measures to improve gut barrier function and antibiotic therapy during rejection episodes may help reduce the incidence of septic complications after intestinal grafting.

Immunological characterization of the Epstein-Barr virus phosphoprotein PP58 and deoxyribonuclease expressed in the baculovirus expression system

The open reading frames of the phosphoprotein pp58 (BMRFI) and the deoxyribonuclease (BGLF5) of the Epstein-Barr-virus (EBV) strain M-ABA were cloned in the baculovirus expression vectors pAc373 and pAc360 and expressed in the Spodoptera frugiperda (SF158) insect cells. The recombinant phosphoprotein pp58 expressed in SF158 cells was recognized by the anti-pp58 rabbit anti-sera which were generated by immunizing rabbits with a TrpE-BMRFI fusion protein expressed in E. coli. DNA-cellulose chromatography showed that the recombinant pp58 exhibited DNA-binding activities. Immunofluorescence, immunoblot and ELISA analysis indicated that sera from patients with nasopharyngeal carcinoma (NPC) contained antibodies against pp58. The recombinant EBV DNase expressed in SF158 cells was recognized by the anti-EBV DNase rabbit anti-sera which were generated by immunizing rabbits with a TrpE-C-terminal part of BGLF5 fusion protein expressed in E. coli. The anti-EBV DNase rabbit anti-sera recognized also a protein of about 52 kDa in the EBV-harboring human B-cell lines Raji, Jijoye, B95-8, M-ABA and BL74 induced by TPA and n-butyrate. The recombinant EBV DNase exhibited exonuclease and endonuclease activities, a requirement for magnesium, and a high pH optimum (8.0). Its enzyme activities could be inhibited by sera from NPC patients and anti-EBV DNase rabbit anti-sera. Comparable studies of Raji EBV-DNase and recombinant EBV-DNase implied that recombinant EBV-DNase could also be used in the enzyme activity assay for the detection of NPC. In contrast to the enzyme inhibition test, immunofluorescence and immunoblot analysis demonstrated that the recombinant EBV DNase exhibited only a weak immunological reaction with NPC sera.

A comparison of heterotopic and orthotopic intestinal transplantation in rats

Two surgical techniques are commonly used for small intestinal transplantation: heterotopic (accessory) intestinal grafting (HIT), where the small bowel is initially defunctioned with restoration of intestinal continuity at a later date, and orthotopic (in continuity) intestinal grafting (OIT), where the small bowel is immediately anastomosed to the native intestine. The present experiments were undertaken to compare the advantages and disadvantages of these two surgical models. Graft barrier function (intestinal permeability), intestinal histology, and graft survival were evaluated after heterotopic and orthotopic intestinal transplantation in the following groups of rats: group 1: isografts, group 2: untreated allografts, group 3: low-dose cyclosporine-treated allografts (subcutaneous CsA 2 mg/kg/day), and group 4: high-dose CsA-treated allografts (subcutaneous CsA 4 mg/kg/day). Intestinal permeability was consistently higher after HIT than OIT in all of the groups (ANOVA; P less than 0.01). Histological evidence of rejection appeared earlier after HIT than OIT (HIT 5th postoperative day (POD); OIT 7th POD; P less than 0.05). The mean survival of untreated allografts was longer after HIT than OIT (HIT 15.7 +/- 6 days, OIT 9.2 +/- 1 days, P less than 0.05). The rats treated with low-dose CsA after OIT lost weight and died of rejection after a mean survival time of 17.7 +/- 2 days, while the rats treated with low-dose CsA after HIT remained well until sacrifice on POD 28 (P less than 0.01). The rats with isografts and rats with allografts treated with high-dose CsA remained well after HIT and OIT until sacrifice on the 28th POD. These data suggest that nutrients and other factors in the succus entericus may improve gut barrier function and delay the onset of rejection after OIT. However, rejection of the orthotopic intestinal graft is usually fatal, while rejection of the heterotopic graft is often surprisingly well tolerated. These factors must be taken into consideration when choosing a surgical technique for intestinal transplantation in humans.

Refined technique for intestinal transplantation in the rat

Unlike other solid organ transplants, intestinal transplantation (IT) remains a highly experimental procedure. Rejection, sepsis, and graft-versus-host disease have been the major barriers to successful IT in humans. These problems can be studied in the rat model, but this requires a reliable surgical technique that will produce high survival rates and excellent graft function. Herein, we review 400 consecutive IT in rats and describe important technical aspects of surgery. Technical modifications that have helped to reduce the morbidity after IT in rats include 1) minimizing mechanical and ischemic injuries to grafts during the donor procedure, 2) marking the portal vein and aortic conduit with sutures to ensure correct orientation of the graft, 3) using a macaroni noodle to stent the intestinal anastomosis, and 4) administering large volumes of crystalloid to maintain a normal blood pressure during the donor and recipient surgeries. The survival rate in 298 rats with accessory, heterotopic grafts was 90%. The survival rate in 102 rats with orthotopic (in continuity) graft (OIT) was 86%. Rats have survived more than 500 days after OIT, maintaining normal weights, intestinal function, and intestinal histology.

Adjuvant chemotherapy after radical hysterectomy for cervical carcinoma

Three hundred and sixty-eight cases of invasive cervical cancer (stage IB through early stage IIB) were treated with radical abdominal hysterectomy and bilateral pelvic lymphadenectomy at Chang Gung Memorial Hospital. Of these patients, 172 were classified postoperatively as a high-risk group after surgical-pathological assessment of tumor extent. Among these high-risk patients, 40 received adjuvant chemotherapy with cisplatin, vinblastine, and bleomycin (PVB), 38 received adjuvant radiotherapy, and 79 refused adjuvant treatment. The 3-year cumulative disease-free survival rate was 91.6% for the low-risk group and 59.7% for those at high risk. Among patients in the high-risk group, the 3-year survival rate was 75.0% for patients treated with adjuvant chemotherapy and 46.8% for those not treated with adjuvant therapy (P less than 0.05). The preliminary results of this pilot study showed a significant activity of adjuvant chemotherapy, which warrants further investigation of its role in the treatment of cervical cancer.

Double-lined nomogram of cervical dilatation in Chinese primigravidas

By studying normal labors in 500 Chinese primigravidae, a nomogram has been constructed to show the normal progression of cervical dilatation starting from cervical os of 3 cm dilatation. Paralleled 'alert' lines and 'action' lines were derived from this nomogram. Clinical evaluation of this double-lined nomogram showed that poor progression of cervical dilatation resulting in an abnormal outcome can be predicted at earlier stages. The use of this nomogram together with the partogram greatly improved the management of labor in the individual patient and the guidance of the labor ward as a whole.

Computed tomography in the evaluation and treatment of endometrial carcinoma

Since patients with endometrial carcinoma tend to be elderly, diabetic and hypertensive, individualization of treatment is very important. The therapy for each patient with endometrial carcinoma should be individualized and determined by the stage and factors predisposing to extrauterine spread of the tumor. Such risk factors include the grade of the tumor and depth of myometrial invasion. Unfortunately, staging based on pelvic examination is inaccurate in endometrial carcinoma and the depth of myometrial invasion cannot be assessed preoperatively. In order to assess its uses in the staging and treatment planning of endometrial cancer, CT was performed in 28 previously untreated patients with endometrial cancer. Twenty patients subsequently underwent surgery and the CT findings were correlated with the surgical and pathologic findings. CT proved to be useful in determining the depth of myometrial invasion and whether cervical involvement is present or not. Such information provided by CT helps to plan treatment more adequately and accurately for the individual patients.

Studies on the purification and characterization of human urinary plasminogen and plasmin

A new method is described for the preparation of highly purified human plasminogen and plasmin with specific activity of 32 CTA units per mg of protein. With this method, the purification of the urinary plasminogen + plasmin antigenic materials from patients with chronic glomerulonephritis, disseminated intravascular coagulation syndrome and severe toxemia of pregnancy was performed, and the resulting highly purified proenzyme and enzyme were analyzed by immunoelectrophoresis, separative agar electrophoresis, gel filtration and SDS-gel electrophoresis. Our findings indicated that urinary plasmin reflects more closely the extent of intraglomerular fibrinolysis, while urinary plasminogen reflects non-selective proteinuria in patients with chronic glomerulonephritis or severe toxemia of pregnancy.

Urinary fibrinolysis in toxemia of pregnancy

Serial determinations of urinary plasmin level by radiocaseinolytic assay were performed in 40 healthy women and 29 patients with various types of toxemia throughout pregnancy, labor and the puerperium. The results indicate that: 1. The urinary plasmin level in normal pregnancy increased significantly from the third trimester to the early puerperium. 2. In mild pre-eclampsia, a significant rise in urinary plasmin level from 26 weeks of gestation to the 4th day post-partum. 3. In severe pre-eclampsia, a progressive decrease in late pregnancy was found. After delivery, in the early puerperium, the urinary plasmin level of the patients with a rapid clinical was significantly higher than that of the patients with the sequelae of toxemia. Our study showed that serial assays of urinary plasmin activity can provide a reliable and sensitive index of severity, progression and natural history of toxemia of pregnancy.