A pilot study of cytoreductive chemotherapy combined with infusion of additional peripheral blood stem cells reserved at time of harvest for transplantation in case of relapsed hematologic malignancies after allogeneic peripheral blood stem cell transplant

Reharvesting leukocytes from donors for a donor leukocyte infusion (DLI) is inconvenient and occasionally impossible in case of unrelated donors. It is well known that the effect of a growth factor-primed DLI is comparable to that of a nonprimed DLI. In total, 42 patients with hematologic malignancies and a high risk of relapse were allocated, on an intent-to-treat basis, a peripheral blood stem cell transplantation (PBSCT) from HLA-matched sibling donors, and then at the time of harvest, additional peripheral blood stem cells (PBSCs) were also reserved for a therapeutic primed DLI in case of relapse. In all, 12 patients who relapsed after allogeneic PBSCT were treated with mainly cytarabine-based chemotherapy followed by a cryopreserved PBSC infusion. The median dose of CD3+ and CD34+ cells for the primed DLIs was 1.43 x 10(8)/kg and 4.75 x 10(6)/kg, respectively. Six of the 12 relapsed patients exhibited a complete response after the primed DLI, plus their 1-year survival rate was 33%. The new development or progression of graft-versus-host disease after a primed DLI was observed in 50% of the patients. Overall, the survival at 1 year was 16.7%. Accordingly, the induction of a graft-versus-leukemia effect through a primed DLI, using additional PBSCs reserved at the original time of harvest, would appear to be feasible for patients with relapsed hematologic malignancies. Furthermore, this approach is also more convenient for donors.

Differential expression of six novel peroxidase cDNAs from cell cultures of sweetpotato in response to stress

Six peroxidase (POD) cDNAs were isolated from suspension cultures of sweetpotato (Ipomoea batatas) by cDNA library screening, and their expression was investigated with a view to understanding the physiological functions of each POD in relation to environmental stress. The gene products encoded by these cDNAs could be divided into two groups, anionic PODs (SWPA4, SWPA5, SWPA6) and basic PODs (SWPB1, SWPB2, SWPB3), on the basis of the predicted pI values of the mature proteins. RT-PCR analysis revealed that the six POD genes showed diverse expression patterns in various tissues of intact plants, a various stages of growth in suspension cultures, and in leaf tissues exposed to different stresses. The six genes from which they were derived are predominantly expressed in cultured cells of sweetpotato. Thus, transcripts of swpa4 were not detected in any tissues of the intact plant. The genes swpa6 and swpb1 were highly expressed in root tissues, whereas swpa6 and swpb3 were highly expressed in stem tissues. During suspension culture, the expression patterns of the six genes differed from each other. The level of swpa4, swpa5, swpb2 and swpb3 transcripts progressively increased during culture, whereas swpa6 and swpb1 showed high expression levels regardless of the age of the culture. In leaf tissues the six POD genes responded differently to various abiotic stresses. In particular, swpa4 was highly induced by several abiotic stresses, including exposure to hydrogen peroxide (440 mM) or NaCl (100 mM), and wounding of leaf tissues, suggesting that this POD gene is inducible by many stresses. Based on the different expression patterns of these POD genes, we propose that each POD may have different enzymatic properties and physiological functions during cell growth and development.

Impact of transplanted CD34+ cell dose in allogeneic unmanipulated peripheral blood stem cell transplantation

The impact of the CD34+ cell dose on chronic graft-versus-host disease (cGVHD) and the clinical outcome was analyzed in 41 consecutive adult patients submitted to allogeneic peripheral blood stem cell transplantation from HLA-identical siblings. The patients were classified into 'low' or 'high' CD34+ cell dose groups based on whether they received less or more than a median CD34+ cell dose of 10.5 x 10(6)/kg, respectively. There was a significant difference in the incidence of extensive cGVHD (low vs high group, 25.0 vs 66.7%, P=0.021) and relapse (47.6 vs 20.0%, P=0.049) between the two groups. With a median follow-up of 335 days, the 3-year survival estimate for the whole population was 47.9%, while that for the low and high groups was 29.9 and 67.8%, respectively (P=0.0434). An inverse relation was noted between the relapse rate and the incidence of extensive cGVHD (P=0.043). It would appear reasonable that the optimal dose of CD34+ cells should be determined based on the disease status or aggressiveness of the malignant cells in each patient. Yet, in the case of patients with a high risk of relapse, transplantation with a CD34+ cell dose of >10.5 x 10(6)/kg would seem to be acceptable to minimize the risk of relapse.

Meta-analysis: proton pump inhibitor or H2-receptor antagonist for Helicobacter pylori eradication

AIM

To compare H2-receptor antagonists and proton pump inhibitors as adjuvants to triple therapy for Helicobacter pylori eradication.

METHODS

H. pylori-infected patients with peptic ulcer were randomized to receive either 300 mg nizatidine or 30 mg lansoprazole plus 1 g amoxicillin and 500 mg clarithromycin taken b.d. for 7 days. H. pylori eradication was assessed 4 weeks after therapy. Using meta-analytical techniques, we combined the results of this study with other randomized controlled comparisons of H2-receptor antagonists and proton pump inhibitors as adjuvants to triple therapy.

RESULTS

One hundred and one patients were randomized. H. pylori eradication was 94% (47/50) [95% confidence interval (CI), 83-99%] (intention-to-treat) in the H2-receptor antagonist group vs. 86% (44/51) (95% CI, 74-94%) in the proton pump inhibitor group (P = 0.3). There has been a total of 12 similar studies (1415 patients). The overall efficacy was similar in intention-to-treat analysis: 78% (549/701) with H2-receptor antagonists vs. 81% (575/714) with proton pump inhibitors (odds ratio, 0.86; 95% CI, 0.66-1.12). A non-significant trend favouring H2-receptor antagonist (79% vs. 69%; odds ratio, 1.14; 95% CI, 0.76-1.71; P = 0.5) was seen in the comparison of clarithromycin-containing regimens. In contrast, in non-clarithromycin-containing trials, there was a slight, but significant, advantage with proton pump inhibitors (85% vs. 78%; odds ratio, 0.64; 95% CI, 0.45-0.92; P = 0.02).

CONCLUSION

Overall, proton pump inhibitor and H2-receptor antagonist antisecretory agents appear to be similarly effective as adjuvants for H. pylori triple therapy. It is unlikely that the direct anti-H. pylori effect of proton pump inhibitors is responsible for their ability to enhance anti-H. pylori therapy.

Effect of cooking on the formation of N-nitrosodimethylamine in Korean dried seafood products

Only N-nitrosodimethylamine (NDMA) was detected when N-nitrosamines (NA) were analysed in seven dried seafood products, either uncooked or cooked. The cooking methods used were a briquet fire, a gas range, an electric oven, a microwave oven, a steam cooker and an electric coil cooker. The contents of NDMA ranged from 1.0 to 46.9 microgram kg(-1) in uncooked products. When these samples were cooked, regardless of the cooking method, the content of NDMA tended to increase, ranging from 1.1 to 630.5 microgram kg(-1). In general, indirect heating such as a steam cooker and a microwave oven, as compared with direct heating such as a gas range and a briquet fire, caused less increase in NDMA during cooking.

Characterization of porcine uterine estrogen sulfotransferase

A quantitative trait locus (QTL) for uterine capacity is located on chromosome 8. Comparison of porcine and human genetic maps suggested that the estrogen sulfotransferase (STE) gene may be located near this region. The objectives of this study were to clone the full coding region for STE, compare endometrial STE gene expression between Meishan and White composite pigs during early pregnancy, and map the STE gene. We obtained a clone (1886 bp) containing the full coding region of STE by iterative screening of an expressed sequence tag library. Endometrial STE mRNA expression in White composite gilts was determined by Northern blotting on days 10, 13, and 15 of the estrous cycle; and on days 10, 13, 15, 20, 30, and 40 of pregnancy. STE mRNA expression was elevated (P < 0.01) on days 20 and 30 of pregnancy compared to other days of the cycle or pregnancy. Endometrial STE mRNA expression during early pregnancy, determined using real-time RT-PCR, was elevated (P < 0.01) on day 20 compared to day 15, decreased (P = 0.02) between days 20 and 30, and decreased further (P < 0.01) between days 30 and 40 in both Meishan and White composite pigs. Expression of STE mRNA was greater (P = 0.01) in White composite pigs compared to Meishan pigs. Using a microsatellite from an STE containing BAC genomic clone, the STE gene was mapped to 65 centimorgans on chromosome 8. Because STE mRNA expression differs between Meishan and White composite pigs, the STE gene may be a candidate for the uterine capacity QTL.

GM-CSF-based mobilization effect in normal healthy donors for allogeneic peripheral blood stem cell transplantation

It is important to optimize methods to mobilize hematopoietic stem cells into peripheral blood (PB) for successful allogeneic peripheral blood stem cell (PBSC) transplantation. Our primary intent was to investigate the role of GM-CSF for mobilization in normal healthy donors and to compare its efficacy in mobilizing stem cells alone, in concurrent combination and in sequential combination with G-CSF in this study. We analyzed the results of the PBSC harvest through large volume leukapheresis from 48 normal healthy donors mobilized by three different regimens including GM-CSF. Donors were assigned sequentially to one of the following regimens for mobilization: GM-CSF 10 microg/kg/day alone (group 1, n = 9); concurrent combination (group 2, n = 20) of G-CSF 5 microg/kg/day and GM-CSF 5 microg/kg/day; sequential combination (group 3, n = 19) of GM-CSF alone 10 microg/kg/day for 3 days followed by G-CSF alone 10 microg/kg/day for 2-3 days. The harvested CD34(+) cell count (P < 0.05) was statistically higher in group 3 than in group 1 or 2. Pre-collection WBC count in donors (P < 0.05), harvested MNC (P < 0.05) and CD3(+) cell count (P < 0.05) of group 2 or 3 were significantly higher than those of group 1. Recipients who received stem cells mobilized with combination regimens showed an earlier recovery of WBC and platelets count than those with GM-CSF alone. The incidence of acute graft-versus-host disease was not statistically different among three recipient groups. GM-CSF-based mobilization was well tolerated in normal healthy donors. The sequential combination regimen appears to be an excellent mobilization strategy and might be preferred as the optimal method in some clinical situations that need a higher number of stem cells.

Effect of rebamipide in treatment of Helicobacter pylori-associated duodenal ulcer: attenuation of chemokine expression and nitrosative damage

Production of cytokines along with increased activity of nitric oxide synthase has been implicated as one of the contributing mechanisms of Helicobacter pylori-mediated gastroduodenal diseases. We aimed to evaluate the effect of rebamipide in treating Helicobacter pylori-associated duodenal ulcers in terms of cytokine production and nitrosative damage of the gastric mucosa. In patients with duodenal ulcers, rebamipide or placebo were given randomly after eradication. Mucosal cytokine production was measured by enzyme linked immunoassay, and nitrotyrosine immunoexpression was measured by immunohistochemistry. The inflammatory activity and degree of neutrophil infiltration were graded accordingly. The mucosal production of RANTES, interleukin-8, and TNF-alpha showed a significant decrease after eradication in patients with rebamipide after-treatment. The nitrotyrosine immunoreactivity of gastric epithelium was significantly decreased in the rebamipide group. Rebamipide treatment after eradication resulted in a significant reduction in chemokine production along with nitrotyrosine immunoexpression in Helicobacter pylori-associated duodenal ulcers.

Effects of risperidone on information processing and attention in first-episode schizophrenia

Risperidone appears to have a beneficial effect in several areas of cognitive function in schizophrenic patients. In previous studies, however, the clinical characteristics of the subjects differed between studies, and were heterogeneous even in single study. Most of the subjects were previously exposed to different kinds of neuroleptics and some of them were treatment-resistant. The aim of this study is to evaluate the effect of risperidone on attention and information processing in a homogeneous subgroup of schizophrenic patients, i.e. drug-naïve first-episode inpatients. In the patient group (n=17), cognitive tests and clinical assessments were performed before and after 8 weeks of risperidone treatment. The same cognitive tests were administered to the control group (n=24). The delay between test and retest was 8 weeks. Before treatment, the patient group performed significantly worse than control group on the tests measuring continuous attention, vigilance, and the speed of information processing. After treatment (the average dose of risperidone was 7.3mg/day), in spite of significant improvement of the clinical symptoms, the patients did not show any significant improvement or worsening in most of the items of these tests. The control group did not show any practice effect. These results suggest that first-episode schizophrenic patients have deficits in sustained attention and vigilance to visual stimuli, as well as the speed of information processing to visual and auditory stimuli, and these deficits are unrelated to clinical symptoms and remain stable during the early phase of treatment. This study did not receive pharmaceutical company financial support.

D609-sensitive tyrosine phosphorylation is involved in Fas-mediated phospholipase D activation

Both Fas and PMA can activate phospholipase D via activation of protein kinase Cbeta in A20 cells. Phospholipase D activity was increased 4 fold in the presence of Fas and 2.5 fold in the presence of PMA. The possible involvement of tyrosine phosphorylation in Fas-induced activation of phospholipase D was investigated. In five minute after Fas cross-linking, there was a prominent increase in tyrosine phosphorylated proteins, and it was completely inhibited by D609, a specific inhibitor of phosphatidylcholine-specific phospholipase C (PC-PLC). A tyrosine kinase inhibitor, genistein, can partially inhibit Fas-induced phospholipase D activation. There were no effects of genistein on Fas-induced activation of PC-PLC and protein kinase C. These results strongly indicate that tyrosine phosphorylation may in part account for the increase in phospholipase D activity by Fas cross-linking and D609 can block not only PC-PLC activity but also tyrosine phosphorylation involved in Fas-induced phospholipase D activation.

Cecal rupture by Anoplocephala perfoliata infection in a thoroughbred horse in Seoul Race Park, South Korea

A 7-year-old Thoroughbred horse was admitted to the Equine Hospital, Korea Racing Association with signs of colic. Based on the size of impactions, the clinical signs, the results of abdominal paracentesis and medical treatment, the prognosis was poor. The horse died 3 hours later following hopeless discharge. At necropsy, the caecum and large colon were fully filled with fecal contents and there was a rupture (10 cm in dia) in the latero- ventral caecum. The mucosa of the ileo-caecal and caeco- colic valves appeared to the hyperemic, edematous and ulcerous. There were many tapeworms in the affected mucosa. Histopathologically, lesions included hyperaemia, a deep necrotic inflammatory lesion and ulcers in the mucosa and submucosa of ileo-caecal and caeco-colic valves. One hundred thirty four faecal samples were obtained from 16 stables and submitted to parasitic examination. A total of 4 genera of eggs were recovered: Stongylus spp (82.1%), Anoplocephala perfoliata (10.5%), Bovicola equi (0.7%) and Parascaris equorum (1.5%). The major findings in this study are the presence of A perfoliata and its suspected association with the colic which led into an eventual caecal rupture. This study indicates the needs for an epidemiological survey of colic that is associated with Anoplocephala.

Low-density lipoprotein-antioxidant constituents of Saururus chinensis

A new diarylbutane lignan, saururin A (1), and a known 8-O-4'-type neolignan, machilin D (2), were isolated from a total methanol extract of the underground parts of Saururus chinensis. The structures of 1 and 2 were elucidated by spectroscopic data analysis. Compounds 1, 2, and virolin (3) (the methyl ether of 2) exhibited significant low-density lipoprotein (LDL)-antioxidant activity in the thiobarbituric acid-reactive substance (TBARS) assay with IC(50) values of 8.5, 2.9, and 4.3 microM, respectively.

Expression of mucosal cyto-chemokine mRNAs in patients with Helicobacter pylori infection

BACKGROUND

Helicobacter pylori-induced destruction of the gastroduodenal mucosal barrier is initiated with mucosal infiltration of inflammatory cells. Cytokines and chemokines have been suggested to play important roles in the migration and activation of these inflammatory cells into the mucosa. The present study aimed to investigate expression rates of cyto-chemokine mRNAs using gastric mucosal biopsy specimens.

METHODS

In 98 patients infected with Helicobacter pylori, mucosal mRNA expression rates of cytokines (IL-1 beta, IL-6, and IL-10), C-C chemokines (macrophage inflammatory protein 1 alpha (MIP-1 alpha), and macrophage inflammatory protein 1 beta (MIP-1 beta), monocyte chemotactic and activating factor (MCAF), regulated on activation, normal T cell expressed and presumably secreted (RANTES)) and C-X-C chemokines (IL-8 and growth regulated a (GRO-alpha)) were examined using reverse transcription polymerase chain reaction (RT-PCR).

RESULTS

The expression rates of mRNA for IL-8, GRO-alpha, MIP-1 alpha and RANTES were significantly more increased in H. pylori-positive patients than in H. pylori-negative patients. However, the expressions of IL-1 beta, IL-6 and IL-10 mRNA were statistically not different between two groups. After eradication of H. pylori, expressions of mRNA for three cytokines (IL-1 beta, IL-6 and IL-10), four C-C chemokines (MIP-1 alpha, MIP-1 beta, MCAF and RANTES) and two C-X-C chemokines (IL-8 and GRO-alpha) were significantly decreased.

CONCLUSION

These results suggest that C-X-C chemokines and some C-C chemokines play important roles in H. pylori-associated peptic ulcer diseases.

Biomechanical evaluation of diagonal fixation in pedicle screw instrumentation

STUDY DESIGN

Flexibility tests and finite element analyses were performed for the biomechanical evaluation of diagonal transfixation in pedicle screw instrumentation.

OBJECTIVE

To assess the biomechanical advantages of diagonal transfixation compared with conventional horizontal transfixation.

SUMMARY AND BACKGROUND DATA

A few pedicle screw instrumentation systems allow the use of cross-links in the diagonal direction. Such a diagonal transfixation is anticipated to improve the surgical construct stability, but its biomechanical qualities have not been completely evaluated.

METHODS

Flexibility tests were performed on 10 calf lumbar spines (L2-L5). Specimens were subjected to pure moments up to 8.2 Nm in flexion, extension, lateral bending, and extension while the resulting movements of L3 and L4 were measured by a three-dimensional motion analysis system. The tested cases included (1) intact, (2) pedicle screw fixation without transfixation after total removal of the L3-L4 disc, (3) pedicle screw fixation with diagonal transfixation, and (4) pedicle screw fixation with horizontal transfixation. Three-dimensional finite element models of the tested surgical constructs were also developed by use of three-dimensional beam elements to investigate the effect of diagonal transfixation and horizontal transfixation on the construct stability and the corresponding stress changes in the screws.

RESULTS

When compared with no transfixation, horizontal transfixation significantly improved the lateral bending and axial rotation stability by 15.7% and 13.9%, respectively, but there was no improvement of stability in flexion and extension. By contrast, diagonal transfixation significantly improved the flexion and extension stability by 12% and 10.7%, respectively, but not the lateral bending and axial rotation stability in comparison with no transfixation. Comparison between horizontal transfixation and diagonal transfixation showed that the stabilizing effect of diagonal transfixation was greater in flexion and extension (13% and 11%, P < 0.01) than that of horizontal transfixation but smaller in lateral bending (11%, P < 0.05) and axial rotation (6.6%, P > 0.1). Finite element model predictions of the motion changes were similar to the changes observed in flexibility tests. In horizontal transfixation, the load changes, compared with no transfixion, were a 0.02% increase in flexion-extension, a 27.5% increase in lateral bending, and a 58% decrease in axial rotation, and the magnitudes of the moments applied on both the right and left pedicle screws were identical. However, when diagonal transfixation was achieved by connecting the left superior screw and the right inferior screw, the loads in the left screw were increased by 11.5% in flexion-extension, 43.6% in lateral bending, and 7.9% in axial rotation, whereas the loads in the right screw were decreased by 10.9% in flexion-extension, increased by 0.06% in lateral bending, and decreased by 18.1% in axial rotation.

CONCLUSIONS

The results of this study showed that diagonal transfixation provides more rigid fixation in flexion and extension but less in lateral bending and axial rotation in comparison with horizontal transfixation. Furthermore, greater stresses in the pedicle screws were predicted in the diagonal transfixation model. These limitations of diagonal transfixation should be considered carefully for clinical application.

Imaging of occupational lung disease

Occupational lung disease comprises a wide variety of disorders caused by the inhalation or ingestion of dust particles or noxious chemicals. These disorders include pneumoconiosis, asbestos-related pleural and parenchymal disease, chemical pneumonitis, occupational infection, hypersensitivity pneumonitis, and organic dust toxic syndrome. Most of these disorders produce diffuse lung disease. Although many of the disorders can be detected at chest radiography, high-resolution computed tomography (CT) has been shown to be superior to chest radiography in depicting parenchymal, airway, and pleural abnormalities. Some occupational lung diseases have characteristic radiologic features suggesting the correct diagnosis, whereas in others, a combination of clinical features, related occupational history, radiologic findings, and literature supporting an association between the exposure and the disease process is required for diagnosis. With advances in chest radiology, including high-resolution CT, radiologists play a key role in the clinical evaluation of occupational lung diseases and should continue their involvement in the diagnosis and treatment of these diseases.

Synthesis of a tetrahomodioxacalix[4]arene tetraamide and the crystal structure of its lead ion complex

The 1,4-alternate tetrahomodioxacalix[4]arene tetraamide 4 with four p-phenyl groups on its upper rim was synthesized. In two-phase metal picrate extraction, 4 exhibited Pb2+ selectivity with formation of a 1:1 complex in chloroform. In the solid-state structure of the 4*Pb(Pic)2 complex, Pb2+ is bound by the carbonyl oxygens of two adjacent amide groups and an aryl-alkyl ether oxygen atom of one of these amide-containing substituents. The crystal structure and 1H NMR spectrum of the 4*Pb2+ complex reveals pi-metal ion complexation of one aromatic ring in the ligand with Pb2+.

[2,13-Bis(acetamido)-5,16-dimethyl-2,6,13,17-tetraazatricyclo[16.4.0.07,12]docosane]copper(II) dichloride octahydrate

The title compound, [Cu(C(24)H(46)N(6)O(2))]Cl(2).8H(2)O, contains a centrosymmetric cation, with the anions and water molecules on general sites. The coordination geometry around the Cu(II) ion is an axially elongated octahedron, with Cu-N distances of 2.0448 (17) and 2.0847 (17) A, and a Cu-O1 distance of 2.3138 (16) A.

Seroepidemiological study of Helicobacter pylori infection in asymptomatic people in South Korea

BACKGROUND

Helicobacter pylori infection occurs throughout the world and causes gastroduodenal diseases in all age groups. The prevalence of H. pylori infection varies between countries and races. The aim of this study was to evaluate the seroprevalence of H. pylori infection in asymptomatic healthy people in South Korea.

METHODS

From March 1998 to October 1998, 5732 asymptomatic subjects who responded to the self-assessment questionnaires from 54 hospitals in South Korea were enrolled in this study. The serum levels of antibodies for H. pylori immunoglobulinG were measured by using an ELISA test.

RESULTS

The overall seroprevalence of H. pylori infection was 46.6% and there was no statistical difference between males (47.2%) and females (45.9%). In adults, a significant difference was observed between genders. According to the geographic areas, the high prevalent provinces were Kangwon (53.4%), Cheju (52.9%) and Cholla province (50.6%); Seoul (41.9%) was the lowest prevalent area. The seroprevalence increased with age and was highest when patients were aged in their 40s (78.5%). The characteristic feature of our study was that the infection rate was steeply increased in three age groups (10-12 year olds, 16-19 year olds and those aged in their 20s). In Seoul, there was no difference in the prevalence rate among the districts studied.

CONCLUSIONS

This nation-wide seroprevalence of H. pylori infection in South Korea was 46.6%, which showed the transition from a developing country to a developed country. More studies on the epidemiological factors and the route of transmission of H. pylori infection should be warranted.

Histamine release induced by dendroaspis natriuretic peptide from rat mast cells

Dendroaspis natriuretic peptide (DNP), recently isolated from the venom of the green Mamba snake Dendroaspis angusticeps, is a 38 amino acid peptide containing a 17 amino acid disulfide ring structure similar to that of the natriuretic peptide family. The natriuretic peptide family is known to induce histamine release from human and rat mast cells, but there are no published data concerning the effects of DNP on histamine release from mast cells. The purpose of this study is to investigate whether DNP induces the histamine release from rat peritoneal mast cells (RMPCs) and to determine the mechanism of DNP-induced histamine release from RPMCs. After treatment of RPMC with DNP, mast cell degranulation was observed, and calcium uptake and histamine release were measured. DNP released the histamine, induced the mast cell degranulation, and increased the calcium uptake of RPMCs, in a dose-dependent manner. The results indicate that DNP can increase Ca-uptake and induce histamine release.