Characterization of endothelial-like cells derived from human mesenchymal stem cells

BACKGROUND

Blood-derived endothelial progenitor cells (EPC) have been used to treat ischemic disease. However, the number of EPC that can be obtained from adult blood is limited.

OBJECTIVE

To characterize endothelial-like cells obtained from human bone marrow and determine their ability to stimulate new blood vessel formation in vivo.

METHODS

Mononuclear cells (MNC) were isolated from human bone marrow or umbilical cord blood and cultured in endothelial growth medium (EGM-2). Mesenchymal stem cells (MSC) were isolated from bone marrow and induced to differentiate into endothelial-like cells (MSCE), or adipocytes or osteocytes by growth in EGM-2, adipogenic or osteogenic medium.

RESULTS

Cells obtained by culturing bone marrow MNC in EGM-2 formed cord- or tube-like structures when grown on Matrigel(TM) and expressed several endothelial marker proteins. However, cell morphology and the profile of endothelial marker protein expression were different from those of cord blood-derived EPC (cbEPC). Cells with a similar phenotype were obtained by differentiation of MSC into MSCE, which was accompanied by an increase of endothelial marker proteins and a diminished capacity to differentiate into adipocytes. Subcutaneous implantation of MSCE in collagen plugs in non-obese diabetic-severe combined immunodeficient (NOD-SCID) mice resulted in formation of functional blood vessels that had incorporated the MSCE.

CONCLUSIONS

Our results show that MSCE and cbEPC are different cell types. The formation of functional blood vessels by MSCE, combined with high yields and a reduced capacity to differentiate into other cell types compared with MSC, makes these cells potentially useful for autologous therapy of ischemic disease.

Evaluation of the rpoB macroarray assay to detect rifampin resistance in Mycobacterium tuberculosis in Beijing, China

The aim of this study was to evaluate the modified rifampin oligonucleotide (RIFO) macroarray method to detect mutations in the hot-spot region of the rpoB gene, associated with rifampin (RIF) resistance in Mycobacterium tuberculosis. The study sample included 123 strains of M. tuberculosis isolated in the Beijing, China, area in 2002-2005, including 73 RIF-resistant and 40 pansusceptible strains. The genotypic assay successfully identified 91.8% of the RIF-resistant strains, whereas no mutations were found in RIF-susceptible strains. The most frequently detected rpoB mutations were in the codons 516, 526, and 531, together accounting for 74% of RIF-resistant strains. Spoligotyping subdivided all strains into 11 unique profiles and 3 profiles shared by 3, 4, and 103 strains, respectively. The 113 strains belonged to the Beijing family genotypes, defined by the specific spoligotype signature (absence of signals 1-34) and deletion of the RD105 region. The rpoB S531L (TCG-->TTG) mutation was found in 57.4% of the RIF-resistant strains of the Beijing genotype. A mutation in the rpoB hot-spot region was found in 51 of the 55 (92.7%) multidrug-resistant strains (i.e., resistant to at least RIF and isoniazid), thus demonstrating the added utility of the modified RIFO method to predict multidrug resistance. The RIFO method is relatively simple to perform and allows straightforward interpretation of results; consequently, it can be used in clinical diagnostic laboratories as a fast complement to phenotypic methods.

Cytotoxicity of a newly synthesized nitroxide derivative of 4-ferrocenecarboxyl-2,2,6,6-tetramethylpiperidine-1-oxyl in high metastatic lung tumor cells

Low molecular weight nitroxides are widely used as electron paramagnetic resonance (EPR)-detectable spin labels in the biological and pathological areas. A novel nitroxide derivative, 4-ferrocenecarboxyl-2,2,6,6-tetramethyl piperidine-1-oxyl (FC-TEMPO), was synthesized for evaluating the effects of spin label compounds on tumor cells and firstly its biological effects on tumor and normal cells were evaluated. The cytotoxicity of FC-TEMPO in the high metastatic lung carcinoma cells (95-D) showed that it markedly inhibited the viability of cancer cells in a dose-dependent manner, while it was less toxic to a normal human cell line. Further studies found that FC-TEMPO suppressed the growth of tumor cells by induced apoptosis through activating caspase-3 but not caspase-8 which was proved by caspase inhibitors, and the cell cycle arrest at G1 phase. Moreover, the concomitant increase of superoxide dismutase (SOD) and catalase (CAT) activity was observed. Taken together, these results might provide a base for further anticancer investigations of nitroxides and their potential pharmacological applications.

[Docetaxel in the treatment of advanced breast cancer ]

OBJECTIVE

To evaluate the efficacy, toxicity and safety of an new domestic docetaxel in the treatment of pretreated advanced breast cancer.

METHODS

Fourty-four breast cancer patients who had failed in first-line chemotherapy were included in this trial. They received docetaxel as the second-line chemotherapy. Docetaxel was administered alone at a dose of 70 mg/m2 every 3 weeks. The use of granulocyte colony-stimulating factor to prevent granulocytopenia was not permitted. The response rate and toxicity were evaluated by World Health Organization toxicity scale and performance status by Karnofsky scale.

RESULTS

Of the 41 evaluable patients, 4 achieved complete response and 14 partial remission, with a response rate and clinical benefit rate of 43.9% and 85.4%, respectively. Grade 3 or grade 4 neutropenia developed in 42.9%, alopecia in 7.1% and vomiting in 4.8% of these patients. Fluid retention was not observed in this series.

CONCLUSION

Three-week administration of docetaxel alone at a dose of 70 mg/m2 is effective and tolerable. It provides an alternative for the pretreated advanced breast cancer patients.

Maximum independent set on diluted triangular lattices

Core percolation and maximum independent set on random graphs have recently been characterized using the methods of statistical physics. Here we present a statistical physics study of these problems on bond diluted triangular lattices. Core percolation critical behavior is found to be consistent with the standard percolation values, though there are strong finite size effects. A transfer matrix method is developed and applied to find accurate values of the density and degeneracy of the maximum independent set on lattices of limited width but large length. An extrapolation of these results to the infinite lattice limit yields high precision results, which are tabulated. These results are compared to results found using both vertex based and edge based local probability recursion algorithms, which have proven useful in the analysis of hard computational problems, such as the satisfiability problem.

Role of LPS-stimulated human monocyte-derived dendritic cells in the modulation of autologous CD4+ CD25+ T Cell activation

Dendritic cells (DC) are now recognized as the most potent professional antigen presenting cells (APC). Several studies on cancer immunotherapy using different approaches to induce cytotoxic T lymphocytes (CTL) in vivo recognizing tumor-associated antigens have been reported. However, the efficacy of immunotherapy in vivo may be limited by the local or systemic suppression of CTL generation or function. To explore the ability of lipopolysaccharide (LPS) stimulated human monocyte-derived DC involved in activity of autologous CD4(+)CD25(+) T cells, HLA-A2 restricted p53(264 - 272) peptide was used as tumor antigen, DC generated with LPS (DC-LPS(+)) or without LPS (DC-LPS(-)) were co-cultured with autologous T cells respectively. The results showed that CD4(+)CD25(+) T cell population in the DC-LPS(+) activated T cells was lower than that in the DC-LPS(-) activated T cells. This finding suggest that the relationship between DC-LPS(+) and population of CD4(+)CD25(+) T cells exists and this property may contribute to regulation of T cell responses to tumor-associated antigens.

Genetic profile of 15 STR loci in the Min Nan population in Southeast China

Genetic profile of 15 short tandem repeats (STR) loci were determined in a Chinese Han population from the Min Nan mountainous area, Southeast China.

Global analysis of endothelial cell line proliferation patterns based on nutrient-depletion models: implications for a standardization of cell proliferation assays

It is known that cell populations growing in different environmental conditions may exhibit different proliferation patterns. However, it is not clear if, despite the diversity of the so-observed patterns, inherent cellular growth characteristics of the population can nevertheless be determined. This study quantifies the proliferative behaviour of the permanent endothelial human cell line, Eahy926, and establishes to which extent the estimation of the cell proliferation rate depends on variations of the experimental protocols. Cell proliferation curves were obtained for cells cultured over 16 days and the influences of cell seeding densities, foetal bovine serum content and frequency of culture medium changes were investigated. Quantitative dynamic modelling was conducted to evaluate the kinetic characteristics of this cell population. We proposed successive models and retained a nutrient-depletion toxicity dependant model, which takes into account the progressive depletion of nutrients, as well as the increase of toxicity in the cell culture medium. This model is shown to provide a very good and robust prediction of the experimental proliferation curves, whatever are the considered frequency of culture medium changes and serum concentrations. Thus, the model enables an intrinsic quantification of the parameters driving in vitro EAhy926 proliferation, including proliferation, nutrient consumption and toxicity increase rates, rather independently of the experiments design. We therefore propose that such models could provide a basis for a standardized quantification of intrinsic cell proliferation kinetics.

Poly[[diaquabarium(II)]-mu5-m-phenylenedioxydiacetato]: a three-dimensional barium(II) coordination polymer

In the title coordination polymer, [Ba(1,3-BDOA)(H2O)2]n (where 1,3-BDOA2- is the m-phenylenedioxydiacetate dianion, C10H8O6), each Ba(II) ion is ten-coordinated by six carboxyl O atoms and two ether O atoms from different 1,3-BDOA(2-) ligands, as well as by two water molecules, thus defining a dodecahedron. The Ba(II) atoms are covalently linked by 1,3-BDOA2- ligands in different crystallographic directions, giving rise to a three-dimensional open framework. The crystal structure is further stabilized by hydrogen bonds and pi-pi stacking interactions. In previously studied polymers of this type, the 1,3-BDOA2- ligand showed multiple bridging modes with metal ions, including bi-, tri-, tetra- and hexadentate. The title Ba(II) complex represents a novel three-dimensional coordination polymer constructed by octadentate bridging 1,3-BDOA2- ligands.

Screening differentially expressed genes in mouse hepatocarcinoma ascites cell line with high potential of lymphatic metastasis

AIM: To screen genes differentially expressed in mouse hepatocarcinoma ascites cell line with high potential of lymphatic metastasis.

METHODS: A subtracted cDNA library of mouse hepatocarcinoma cell line with high potential of lymphatic metastatic Hca-F and its synogenetic cell line Hca-P with a low metastatic potential was constructed by suppression subtracted hybridization(SSH) method. The screened clones of the subtracted library were sequenced and GeneBank homology search was performed.

RESULTS: Fourteen differentially expressed cDNA fragments of Hca-F were obtained with two novel genes.

CONCLUSION: SSH is a useful technique to detect differentially expressed genes and an effective method to clone novel genes.

Gene expression spectra in human leukemia HL-60 cells treated with EGCG

To decipher the molecular mechanism of EGCG induced HL-60 cell apoptosis, alterations of gene expression spectra in HL-60 cell line cells after treatment with EGCG were screened by cDNA chip, and analyzed with the GenePix 3.0 twice; and the cDNA chip results further identified by RT-PCR. Ninety-seven genes among the total 8398 (1.15%) showed consistent significant differential expression in the duplicated cDNA chip assessments. Thirty-nine genes (40.2%) were up-regulated and 58 genes (59.8%) were down-regulated; and the randomly selected four performed RT-PCR results agreed with the cDNA chip data. The results suggest that the apoptosis of HL-60 cells induced by EGCG is a progressive transformation process regulated by a variety of genes.

Antitumor effects of human ribonuclease inhibitor gene transfected on B16 melanoma cells

Human ribonuclease inhibitor (RI) is a cytoplasmic acidic protein. The experiment demonstrated that it might effectively inhibit tumor-induced angiogenesis and inhibit tumor growth. Ribonuclease inhibitor is constructed almost entirely of leucine-rich repeats, which might be involved in unknown biological effects besides inhibiting RNase A and angiogenin activities. The exact molecular mechanism of antitumor on ribonuclease inhibitor remains unclear so far. In order to further understand the function of ribonuclease inhibitor and investigate the relationship with tumor growth, our study established a transfection of human ribonuclease inhibitor cDNA into the murine B16 cells by the retroviral packaging cell line PA317. The cell line transfected with a stably high expression of ribonuclease inhibitor was identified. We found that the transfected ribonuclease inhibitor could obviously inhibit cell proliferation, regulate cell cycle and induce cell apoptosis in vitro. Mice that were injected with the B16 cells transfected RI cDNA showed a significant inhibition of the tumor growth with lighter tumor weight, lower density of microvessels, longer latent periods, and survival time than those in the other two control groups. In conclusion, the results reveal the novel mechanism that antitumor effect of ribonuclease inhibitor is also associated with inducing apoptosis, regulating cell cycle and inhibiting proliferation besides antiangiogenesis. These results suggest that ribonuclease inhibitor might be a candidate of tumor suppressor gene in some tissues. RI could become a target gene for gene therapy. Our study may be of biological and clinical importance.

Characteristics of patients suffering from tuberculous pleuritis with pleural effusion culture positive and negative for Mycobacterium tuberculosis, and risk factors for fatality

SETTING

A 2500-bed hospital.

OBJECTIVES

To clarify characteristics of tuberculous pleuritis (TP) with pleural effusion culture positive and negative for Mycobacterium tuberculosis (PECP-MT and PECN-MT) and to identify risk factors for fatality.

PATIENTS AND METHODS

Retrospective analysis of TP patients with PECP-MT and PECN-MT, and review of medical charts of deceased patients.

RESULTS

Of 126 patients enrolled (28 PECP-MT and 98 PECN-MT), those with PECP-MT had a higher prevalence of steroid use (SU) (14.3% vs. 2.0%; P = 0.022) and concurrent tuberculosis involving another site (7.2% vs. 0.0%; P = 0.048), increased neutrophils (36.4% vs. 16.6%; P = 0.020) and decreased glucose levels (mean 88.7 vs. 127.6 g/dl; P = 0.012) in pleural effusion, and a higher fatality rate (28.0% vs. 3.1%; P < 0.001). Deceased patients (n = 10) were older (mean 74.2 vs. 64.4 years; P = 0.047), had a higher incidence of acute renal failure (ARF) (50.0% vs. 11.7%; P = 0.007), and a higher prevalence of malignancy (40.0% vs. 6.3%; P = 0.006), history of stroke (30.0% vs. 7.2%; P = 0.048) and SU (20.0% vs. 1.8%; P = 0.034).

CONCLUSION

SU, concurrent tuberculosis involving another site, increased neutrophils and decreased glucose levels in pleural effusion may be predictive factors for PECP-MT. Malignancy, ARF and SU, and perhaps being elderly or history of stroke, are risk factors for fatality in patients with TP.

Infectious tolerance mediated by CD8+ T-Suppresor Cells After UV-B–irradiated donor-specific transfusion and rat heart transplantation

AIMS

CD8+CD28- human T-suppressor cells (Ts), which can be generated in vitro, act directly on APC rendering them tolerogenic to unprimed and primed CD4+ T cells. The aim of this study was to investigate the possibility that CD8+ T cells mediate the induction of tolerance in a heart transplantation model in rodents.

MATERIALS AND METHODS

Blood from Lewis rats was UV-B-irradiated and transfused into ACI recipients on days -21, -14, and -7 before heart allograft transplantation on day 0. CD4(+) and CD8(+) T cells were positively selected from ACI rats, which had tolerated Lewis heart allografts for more than 100 days and were adoptively transferred to naive ACI rats pretreated (day -1) with gamma irradiation. These ACI rats underwent transplantation with Lewis hearts 24 hours after adoptive transfer of putative T-suppressor cells.

RESULTS

Adoptive transfer of CD8(+) T cells from tolerant ACI to naive ACI rats significantly prolonged Lewis heart mean allograft survival time (MST +/- SD) to 69 +/- 13 days as compared with 15 +/- 1 and 14 +/- 1 days in animals adoptively transferred with CD4+ T cells or untreated controls, respectively (P < .001). Similarly, adoptive transfer of CD8(+) T cells from secondary ACI recipients to naive syngeneic animals also significantly prolonged survival of heart allografts to MST +/- SD of 72 +/- 4 for CD8(+) and 15 +/- 4 days for CD4(+) T cells (P < .001).

CONCLUSIONS

These data demonstrate that allogeneic tolerance induced in ACI recipients by treatment with UV-B-irradiated blood from Lewis donors is mediated by CD8+ T-suppressor cells.

Analysis of STR polymorphisms in the Chao Shan population in South China

Chao Shao area is a littoral under the jurisdiction of Guangdong province, abutting on Fujian. Historically, the area was relatively isolated from other parts of China until 1990s, when it started to take a small number of immigrants from other regions. People residing in this area speak in unique dialect and have distinct lifestyle. Allele frequencies for the 15 short tandem repeats (STR) loci included in the AmpFLSTR Identifiler kit were obtained from a sample of 144 unrelated Chinese born and living in the Chao Shan area, South China.

Two two-dimensional MnIIand NaIcoordination polymers constructed by the flexible benzene-1,4-dioxyacetate ligand

Two new two-dimensional coordination polymers, poly[[[aqua(2,2'-bipyridine-kappa2N,N')manganese(II)]-mu3-p-phenylenebis(oxyacetato)-kappa3O:O':O''] dihydrate], {[Mn(C10H8O6)(C10H8N2)(H2O)].2H2O}n, (I), and poly[[di-mu-aqua-bis[aquasodium(I)]]-mu4-p-phenylenebis(oxyacetato)-kappaO:O',O'':O''',O'''':O'''''], [Na2(C10H8O6)(H2O)4]n, (II), have been synthesized and characterized by X-ray single-crystal diffraction. In (I), there are two 1,4-BDOA2- [p-phenylenebis(oxyacetate) or, more commonly, benzene-1,4-dioxyacetate] ligands, each lying about inversion centres, while in (II), there is one such ligand and it also has crystallographically imposed inversion symmetry. In (I), each Mn(II) atom displays an octahedral MnN2O4 configuration, defined by three carboxyl O atoms of different 1,4-BDOA2- groups, two N atoms of one 2,2'-bipyridine ligand and one water molecule. In (II), each Na(I) atom is octahedrally coordinated by one ether O atom, two carboxyl O atoms of different 1,4-BDOA2- ligands and three water molecules. The metal ions in complexes (I) and (II) are bridged by 1,4-BDOA2- groups into two-dimensional layer structures. Furthermore, three-dimensional supramolecular networks are constructed via hydrogen bonds in (I) and (II), and by additional pi-pi stacking interactions in (I).

[Phase III randomized clinical trial of intratumoral injection of E1B gene-deleted adenovirus (H101) combined with cisplatin-based chemotherapy in treating squamous cell cancer of head and neck or esophagus]

BACKGROUND & OBJECTIVE

H101 is an E1B-55 kDa gene-deleted replication-selective adenovirus, which showed a significant antitumor activity. This study was to compare effects and toxicities of intratumoral H101 injection combined with cisplatin plus 5-fluorouracil (PF) regimen or adriamycin plus 5-fluorouracil (AF) regimen versus PF or AF regimen alone in treating patients with head and neck or esophagus squamous cell cancer.

METHODS

A total of 160 patients were recruited. PF regimen (cisplatin 20 mg/m(2) ivgtt, qd x 5d; 5-fluorouracil 500 mg/m(2) ivgtt, qd x 5d) was administered to patients have no history of PF chemotherapy,or sensitive to PF chemotherapy,while AF regimen (adriamycin 50 mg/m(2) iv,d1; 5-fluorouracil 500 mg/m(2) ivgtt, qd x 5d) was administered to patients didn't response to PF regimen. All patients were randomized to either receive intratumoral H101 injection (5.0 x 10(11)-1.5 x 10(12) VP/day for 5 consecutive days every 3 weeks) or not. Treatment repeated every 3 weeks,all patients have to receive at least 2 cycles of chemotherapy.

RESULTS

Among 123 accordant patients,overall response rate of PF plus H101 group (group A1) was 78.8% (41/52),of PF alone group (group B1) was 39.6% (21/53),of AF plus H101 group (group A2) was 50.0% (7/14),of AF alone group (group B2) was 50.0% (2/4). Differences of response rates between group A1 and group B1,between group A1+A2 and group B1+B2 were significant (P=0.000). Main side effects were fever (45.7%), injection site reaction (28.3%),and influenza-like symptoms (9.8%).

CONCLUSION

Intratumoral H101 injection showed a distinct efficacy in patients with squamous cell cancer of head and neck or esophagus,and was relatively safe.

Clinical benefit of gemcitabine plus cisplatin 3-week regimen for patients with advanced non-small cell lung cancer: a prospective observational study

BACKGROUND

Platinum-based chemotherapy has been proved effective in patients with advanced non-small cell lung cancer (NSCLC). This study evaluated the effectiveness and safety of first-line chemotherapy with gemcitabine plus cisplatin (GEM-Cis) 3-week regimen in routine care of Chinese patients with advanced NSCLC.

METHODS

Two hundred and twenty-one patients with NSCLC stage IIIb or IV were enrolled and 209 were eligible for effectiveness and safety analysis. The median age was 58 (range 29 to 79) years. The percents of cases in stage IV and stage IIIb were 52.2% and 47.8%; of Karnofsky performance score (KPS) less than 80 and 80 - 100 were 37.3% and 62.7% and of adeno-cancer and non-adeno-cancer were 59.8% and 40.2%. The average number of completed chemotherapy cycles was three. Measures of effectiveness included clinical benefit, significant clinical response (SCR) and adverse effects of GEM-Cis in the treatment of NSCLC at stages IIIb/IV.

RESULTS

KPS increased from 79 +/- 9 at baseline to 86 +/- 10 after chemotherapy (P < 0.01). Lung cancer symptom scale (LCSS) score of pain, dyspnea and cough increased from 77 +/- 24, 74 +/- 22 and 63 +/- 19 to 92 +/- 15, 90 +/- 14 and 86 +/- 15, respectively (P < 0.01). The clinical benefit rate was 85.2% [95% confidence interval (CI) 80.3% - 90.0%]. The SCR was 89.5% (95% CI 85.3% - 93.7%). Median survival time was 7.8 months (95% CI 7.1 months-9.1 months). Sixty-four patients (30.6%) experienced an adverse effect that was deemed clinically significant. Only one patient (0.5%) was hospitalized due to chemotherapy related adverse effects. Life-threatening toxicity was observed in two patients (1.0%).

CONCLUSION

First-line chemotherapy with GEM-Cis in the routine care of Chinese patients with advanced NSCLC is effective and safe.

Optimization of submerged culture requirements for the production of mycelial growth and exopolysaccharide by Cordyceps jiangxiensis JXPJ 0109

AIMS

The objective of the present study was to investigate the optimal culture requirements for mycelial growth and exopolysaccharide production by Cordyceps jiangxiensis JXPJ 0109 in submerged culture.

METHODS AND RESULTS

The effects of medium ingredients (i.e. carbon and nitrogen sources, and growth factor) and other culture requirements (i.e. initial pH, temperature, etc.) on the production of mycelia and exopolysaccharide were observed using a one-factor-at-a-time method. More suitable culture requirements for mycelial growth and exopolysaccharide production were proved to be maltose, glycerol, tryptone, soya bean steep powder, yeast extract, medium capacity 200 ml in a 500-ml flask, agitation rate 180 rev min(-1), seed age 4-8 days, inoculum size 2.5-7.5% (v/v), etc. The optimal temperatures and initial pHs for mycelial growth and exopolysaccharide production were at 26 degrees C and pH 5 and at 28 degrees C and pH 7, respectively, and corresponding optimal culture age were observed to be 8 and 10 days respectively. According to the primary results of the one-factor-at-a-time experiments, the optimal medium for the mycelial growth and exopolysaccharide production were obtained using an orthogonal layout method to optimize further. Herein the effects of medium ingredients on the mycelial growth of C. jiangxiensis JXPJ 0109 were in the order of yeast extract > tryptone > maltose > CaCl2 > glycerol > MgSO4 > KH2PO4 and the optimal concentration of each composition was 15 g maltose (food-grade), 10 g glycerol, 10 g tryptone, 10 g yeast extract, 1 g KH2PO4, 0.2 g MgSO4, and 0.5 g CaCl2 in 1 l of distilled water, while the order of effects of those components on exopolysaccharide production was yeast extract > maltose > tryptone > glycerol > KH2PO4 > CaCl2 > MgSO4, corresponding to the optimal concentration of medium was as follows: 20 g maltose (food-grade), 8 g glycerol, 5 g tryptone, 10 g yeast extract, 1 g KH2PO4, and 0.5 g CaCl2 in 1 l of distilled water.

CONCLUSIONS

Under the optimal culture requirements, the maximum exopolysaccharide production reached 3.5 g l(-1) after 10 days of fermentation, while the maximum production of mycelial growth achieved 14.5 g l(-1) after 8 days of fermentation.

SIGNIFICANCE AND IMPACT OF THE STUDY

This is the first report on the submerged culture requirements for mycelial growth and exopolysaccharide in C. jiangxiensis, and this two-step optimization strategy in this study can be widely applied to other microbial fermentation processes.

Tuberculous wrist in the era of effective chemotherapy: an eleven-year experience

BACKGROUND

The chronic course and non-specific clinical manifestations of tuberculous (TB) wrist often cause failure to make a timely diagnosis.

OBJECTIVE

To better understand the rarely encountered TB wrist.

PATIENTS AND METHODS

Retrospective review and analysis of cases of TB wrist between 1986 and 1997 in a medical centre in southern Taiwan.

RESULTS

Thirty-seven cases (16 definitive, 13 probable and eight possible) of TB wrist (25 men, 12 women; mean age, 56.3 +/- 13.0 years) were found among a total of 4970 cases of tuberculosis. The most common presenting sign and symptom (mean duration 9.4 months) were local swelling and pain over the affected wrist. The mean white blood cell (WBC) count in peripheral blood was 7.04 x 10(9)/l, and the erythrocyte sediment rates (ESR) in seven of 31 patients who had ESR assayed were normal. Forty-six per cent of the patients had abnormal chest X-ray, and 35% had had previous manipulation of the affected wrist.

CONCLUSION

Physicians should have a high index of suspicion for TB wrist among patients with chronic arthritis, even when their peripheral WBC count and ESR are normal. An abnormal chest X-ray and/or a history of previous manipulation of the affected wrist could be important clues for possible TB wrist.

The high value of high-resolution computed tomography in predicting the activity of pulmonary tuberculosis

SETTING

A 2500-bed medical centre in southern Taiwan.

OBJECTIVE

To study the clinical value of high-resolution computed tomography (HRCT) in predicting the activity of pulmonary tuberculosis (TB).

DESIGN

HRCTs were performed prospectively in 148 patients whose chest radiographs (CXRs) showed highly suspicious signs of pulmonary TB, predominantly upper lung field infiltration. The HRCT findings, interpreted independently by a pulmonologist and a radiologist, were used to predict the activity of pulmonary TB.

RESULTS

Pulmonologist-interpreted and radiologist-interpreted HRCTs showed high sensitivity (both 93%), specificity (83 vs. 88%), accuracy (86 vs. 90%), positive predictive values (76 vs. 83%) and negative predictive values (both 95%). Kappa statistic indicates good inter-reader agreement.

CONCLUSION

HRCT has a high value in predicting the activity of pulmonary TB. It is a useful tool in this regard when a patient with suspected pulmonary TB lacks microbiologic proof, when clinical condition makes invasive diagnosis impossible or when a patient has completed anti-tuberculosis treatment with no compatible unequivocal CXR.