Design of vaccine equivalence/non-inferiority trials with correlated multiple binomial endpoints

Immunogenicity trials that study the immune responses to vaccination are often used in the vaccine development process as alternatives to clinical efficacy trials. The comparisons of immune responses among various treatment groups are conducted in a non-inferiority or equivalence framework. When there exists a level of immune response that correlates with protection against disease, it is of interest to compare the proportion of responders as defined as response above a specific level or as a predefined increase in immune levels for post-vaccination levels above pre-vaccination levels. Since vaccines often contain several antigens, the correlations between the immune responses need to be taken into account in the analysis. In this paper, we describe appropriate testing methods for demonstrating the non-inferioritylequivalence of two treatments on each of the binomial endpoints. We conduct a comprehensive simulation study to shed light on how the Type I error and power are affected and to what extent when correlated multiple binomial endpoints are present in the vaccine trials. We also illustrate the computation of power for assessment of non-inferioritylequivalence in real studies.

Overexpression of phosphatase of regenerating liver-3 in breast cancer: association with a poor clinical outcome

BACKGROUND

Increasing evidence has suggested that phosphatase of regenerating liver-3 (PRL-3) plays an important role in cancer cell migration, invasion and metastasis. However, the correlation between the PRL-3 expression and clinical outcome in breast cancer has not been investigated.

PATIENTS AND METHODS

Using a PRL-3-specific monoclonal antibody 3B6, PRL-3 expression was assessed by immunohistochemistry in tumor tissues from 382 breast cancer patients with a median follow-up of 65 months.

RESULTS

We found that 34.8% patients expressed a high level of PRL-3 protein in their tumors. Patients with a high level of PRL-3 in the tumor had a worse disease-specific survival (DSS) rate than those with a low level of PRL-3 (74.0% versus 84.9%, P = 0.011), and PRL-3 remained an independent prognostic marker for DSS (HR 1.8, 95% CI 1.1-2.9, P = 0.019) in multivariate analysis. More importantly, in 219 node-negative patients, PRL-3 showed a significant correlation with DSS in univariate analysis (P = 0.014) and retained a borderline significance (HR 2.65, 95% CI 0.92-7.64, P = 0.071) in multivariate analysis.

CONCLUSIONS

Our results suggest that PRL-3 may serve as an unfavorable prognostic marker in breast cancer, especially for patients with node-negative diseases. Thus, our findings may provide useful information for individualized therapy in the clinical setting.

DNA markers associated with low Fusarium head blight incidence and narrow flower opening in wheat

Fusarium head blight (FHB) of wheat, caused by Fusarium graminearum, is an important fungal disease in many wheat-growing areas of the world. The objectives of this study were to determine the relationship between width and duration of flower opening and incidence of FHB in wheat, and to identify DNA markers associated with narrow flower opening and low FHB incidence. It was hypothesized that wheat lines whose flowers open briefly and narrowly have a reduced risk of infection. To test the hypothesis, we crossed wheat cultivars Patterson and Goldfield to generate a population of 100 random F(2)-derived recombinant inbred lines (RILs). Florets of Patterson open wide; florets of Goldfield tend to stay closed. The population of RILs was characterized for FHB incidence and flower opening width (FOW) and duration in the F(7:9) and F(7:10) generations. Of the 305 simple sequence repeat primer pairs screened on the parents, 79 amplified polymorphic DNA bands. Pooled DNA from each of the two bulks was tested with these 79 SSR primer pairs. Four markers were found to have significant marker-trait association with low FHB incidence and narrow flower opening. The major QTL effect associated with narrow flower opening and low FHB incidence was found between the map interval Xbarc200-Xgwm210, explaining 29% of the phenotypic variation for FHB incidence averaged over six replicated tests in Indiana in 2002 and 2003. This adds credence to the hypothesis that narrow flower opening is responsible for low FHB incidence in this population. Breeding wheat lines for both morphological avoidance, such as narrow flower opening, and physiological resistance to FHB may be valuable in future breeding research to reduce crop production and grain quality losses in wheat due to FHB.

Two cis-acting elements in negative RNA strand of Hepatitis C virus involved in synthesis of positive RNA strand in vitro

Sequences at the 3'-ends of both positive and negative strands of Hepatitis C virus (HCV) RNA harbor cis-acting elements required for RNA replication. However, little is known about the properties of the negative RNA strand as a template for the synthesis of positive RNA strand. In this study, a purified recombinant HCV RNA-dependent RNA polymerase (RdRp) was used to investigate the synthesis of positive RNA strand using the 3'-terminal region of negative RNA strand ((-)3'T RNA) as template. A mutagenesis analysis was performed to evaluate the role of the 3'-proximal stem-loop and the first 3'-cytidylate (3'C) of the negative RNA strand in the synthesis of the positive RNA strand. A negative RNA strand of wild type (wt) HCV as template was able to direct the synthesis of a full-length positive RNA strand. Deletion of the 3'-proximal stem-loop resulted in an approximately 90% decrease in RNA synthesis. Disruption of the 3'-proximal stem-loop structure by nucleotide substitutions led to a 70-80% decrease in RNA synthesis. However, the restoration of the stem-loop by compensatory mutations in the stem region restored also the RNA synthesis. Likewise, the deletion or substitution of the first 3'C by guanylate (G) led to a 90% decrease in the RNA synthesis; while the substitution by adenylate (A) or uridylate (U) resulted in a 60-80% decrease in the RNA synthesis only. These findings demonstrate that the 3'-proximal stem-loop and the first 3'C of the negative RNA strand of HCV are two cis-acting elements involved in the synthesis of the positive RNA strand.

Analysis of terpene compounds in Cimicifuga foetida L. by reversed-phase high-performance liquid chromatography with evaporative light scattering detection

An RP-HPLC method with evaporative light scattering detection (ELSD) was developed for the analysis of terpene compounds in traditional Chinese medicine. Actein, 27-deoxyactein and cimicifugoside in a typical Chinese medicine of Cimicifuga foetida L. were quantitatively analyzed. Comparing ELSD with UV detection under the same eluent conditions, the former showed better sensitivity and a more stable baseline. The ELSD responses versus sample size of three terpenes and those in double logarithmic were investigated. The good calibration curves in double logarithmic coordinator for actein, 27-deoxyactein and cimicifugoside were obtained. Three solutions for the extraction of the terpene compounds were also compared, the results indicated that methanol-water (80:20) is the best among them. The method was applied to quantify actein, 27-deoxyactein and cimicifugoside in Cimicifuga foetida L. from Hunan, China. It was shown that ELSD is an effective detection method for the analysis of the non-volatile terpenes in traditional Chinese medicine.

Antimicrobial activity of ergokonin A from Trichoderma longibrachiatum

AIMS

Natural fungal products were screened for antifungal compounds. The mode of action of one of the hits found and the taxonomy of the producing organism were analysed.

METHODS AND RESULTS

An extract from a Trichoderma species showed a more potent activity in an agar-based assay against the null mutant fks1::HIS strain than against the wild-type strain, suggesting that it could contain a glucan synthesis inhibitor. The active component was identified as the known compound ergokonin A. The compound exhibited activity against Candida and Aspergillus species, but was inactive against Cryptococcus species. It induced alterations in the hyphal morphology of Aspergillus fumigatus. The identification of the producing isolate was confirmed by sequencing of the rDNA internal transcribed spacers and comparison with the sequences of other Trichoderma species. The analysis showed that the producing fungus had a high homology with other strains classified as Trichoderma longibrachiatum and its teleomorph Hypocrea schweinitzii.

CONCLUSIONS

The antifungal activity spectrum of ergokonin A and the morphology alterations induced on A. fumigatus are consistent with glucan synthesis as the target for ergokonin A. The production of ergokonin A is not uncommon, but is probably restricted to Trichoderma species.

SIGNIFICANCE AND IMPACT OF THE STUDY

The discovery that ergokonin A could be an inhibitor of glucan synthesis, having a structure very different to other inhibitors, increases the likelihood that orally active agents with this fungal-specific mode of action may be developed.

Evaluation of Chlamydia pneumoniae 43- and 53-kilodalton recombinant proteins for serodiagnosis by Western Blot

Chlamydia pneumoniae is a common cause of respiratory infection. It has also been shown to be associated with coronary heart disease. Two proteins that have been reported to be recognized frequently during human infection are proteins having molecular masses of 43 and 53 kDa. In order to develop a useful alternative serological test to the microimmunofluorescence (micro-IF) assay, recombinant 43-kDa and 53-kDa chlamydia-specific proteins were evaluated in dot blot and/or for comparison to the standard micro-IF test. Primers for amplification were derived from genome sequence information for two C. pneumoniae genes (CPn0809 and CPn0980) encoding 53-kDa proteins and four C. pneumoniae genes (CPn0562, CPn0927, CPn0928, and Cpn0929) encoding 43-kDa proteins of unknown function, which were Chlamydia specific and not found in Chlamydia trachomatis. The 53-kDa protein product of CPn0809 or the N-terminal 18-kDa portion had better specificity than any of the 43-kDa recombinants but was much less sensitive than micro-IF. In contrast, the 53-kDa protein encoded by CPn0980 was recognized by 11 of 12 (92%) acute-phase sera, 35 of 46 (76%) chronic sera, 0 of 12 micro-IF-negative sera (C. pneumoniae and C. trachomatis negative), and 1 of 12 (8%) C. pneumoniae negative, C. trachomatis positive sera. Thus, it appears that the 53-kDa protein encoded by CPn0980 has potential use for serodiagnosis of C. pneumoniae infection.

[Preparation and evaluation of phosphatidylcholine coated on silica as the biomembrane stationary phase]

The method of reverse phase evaporation is used to coat phosphatidylcholine(PC) directly on the surface of silica, which is used as biomembrane chromatographic solid phase to study the interactions between drugs and biomembrane. It was observed that the solid phase coated phosphatidylcholine had a good stability at 20 degrees C-30 degrees C, and the stability would be improved by the presence of appropriate amount of cholesterol in phosphatidylcholine. The content of cholesterol in phosphatidylcholine, the nature of buffer, the concentration of salt in buffer and the pH of mobile phase could all affect chromatographic retention of drugs on the prepared biomembrane column. Six compounds, polyethylene glycol, mannitol, salicylic acid, warfarin, hydrocortisone, and cortisone have been tested. The biomembrane chromatographic stationary phase coated PC with silica as matrices can be simply prepared and it is possible to simulate the human's physiological environment by the biomembrane chromatographic system, so it is a useful method to study drug absorption and distribution in human body.

Chromatographic separation of proteins on metal immobilized iminodiacetic acid-bound molded monolithic rods of macroporous poly(glycidyl methacrylate-co-ethylene dimethacrylate)

Continuous rod of macroporous poly(glycidyl methacrylate-co-ethylene dimethacrylate) was prepared by a free radical polymerization within the confines of a stainless-steel column. The epoxide groups of the rod were modified by a reaction with iminodiacetic acid (IDA) that affords the active site to form metal IDA chelates used for immobilized metal affinity chromatography (IMAC). The efficiency of coupling of IDA to the epoxide-contained matrix was studied as a function of reaction time and temperature. High-performance separation of proteins, based on immobilized different metals on the column, were described. The influence of pH on the adsorption capacity of bovine serum albumin on the Cu2+-IDA continuous rod column was investigated in the range from 5.0 to 9.0. Purification of lysozyme from egg white and human serum albumin (HSA) on the commercially available HSA solution were performed on the naked IDA and Cu2+-IDA continuous rod columns, respectively; and the purity of the obtained fractions was detected by matrix-assisted laser desorption-ionization time-of-flight mass spectrometry.

A longitudinal study of the association between tooth loss and age-related hearing loss

The purpose of this study was to investigate cross-sectional and longitudinal associations between hearing acuity and tooth loss in 1156 US veterans taking part in the Veterans Affairs' Normative Aging (NAS) and Dental Longitudinal (DLS) Studies in the Boston, MA, area. The mean age was 48 years (SD = 8.9), 5.3% were edentulous, and 15.4% had < 17 teeth at baseline. Hearing acuity was determined by puretone, air- and bone-conduction audiometry, and speech discrimination tests at triennial examinations over a 20-year follow-up period. Hearing decline was defined as a change from baseline in the average puretone air-conduction thresholds of > or = 20 dB at 0.25, 0.5, 1, 2, 3, 4, 6, and 8 kHz. The explanatory variables of interest were change since baseline in dentate status (cut points at < 1, < 17, and < 20 teeth), and in the number of teeth lost (linear). Linear and logistic regression models--which controlled for baseline audiological status, age, air-bone gap, and otoscopic examination at current visit--showed that subjects who went from having > or = 17 to < 17 teeth had 1.64 times (95% CI, 1.24-2.17) as high odds of having hearing decline as those with no change in their dentate status. For every tooth lost since baseline, there was a 1.04 times as high odds (95% CI, 1.02-1.06) for hearing decline, when additional baseline and time-varying covariates were taken into account in the model.

[Corrosion and haemocompatibility of 316L stainless steel with electroplated Rh film]

In this study, surface modification by electroplating Rh on 316L stainless steel was carried out in order to improve the corrosion resistance and blood compatibility of implants. XPS was used to characterize the Rh film. The corrosion behavior of 316L stainless steel with electroplated Rh and non-treated was studied in Tyrode's biological solution. Additionally, the haemocompatibility of 316L stainless steel with electroplated Rh was evaluated by preliminary hemolysis test. The results showed that the corrosion resistance of 316L stainless steel with electroplated Rh was improved, and hemolysis decreased, which indicated that electroplating Rh can improve the blood compatibility of 316L stainless steel.

Arundifungin, a novel antifungal compound produced by fungi: biological activity and taxonomy of the producing organisms

Echinocandins, the lipopeptide class of glucan synthase inhibitors, are an alternative to ergosterol-synthesis inhibitors to treat candidiasis and aspergillosis. Their oral absorption, however, is low and they can only be used parenterally. During a natural product screening program for novel types of glucan synthesis inhibitors with improved bioavailability, a fungal extract was found that inhibited the growth of both a wild-type Saccharomyces cerevisiae strain and the null mutant of the FKS1 gene (fks1::HIS). The mutant strain was more sensitive to growth inhibition, suggesting that the fungal extract could contain an inhibitor of glucan synthesis. A novel acidic steroid, named arundifungin, was purified from a fungal extract obtained from a liquid culture of Arthrinium arundinis collected in Costa Rica. Arundifungin caused the same pattern of hallmark morphological alterations in Aspergillus fumigatus hyphae as echinocandins, further supporting the idea that arundifungin belongs to a new class of glucan synthesis inhibitors. Moreover, its antifungal spectrum was comparable to those of echinocandins and papulacandins, preferentially inhibiting the growth of Candida and Aspergillus strains, with very poor activity against Cryptococcus. Arundifungin was also detected in nine other fungal isolates which were ecologically and taxonomically unrelated, as assessed by sequencing of the ITS1 region. Further, it was also found in two more Arthrinium spp from tropical and temperate regions, in five psychrotolerant conspecific isolates collected on Macquarie Island (South Pacific) and belonging to the Leotiales, and in two endophytes collected in central Spain (a sterile fungus belonging to the Leotiales and an undetermined coelomycete).

[A clinical analysis of 102 cases of chronic n-hexane intoxication]

OBJECTIVE

Chronic n-hexane exposure can result in n-hexane intoxication which is mainly characterized by a series of manifestations of peripheral nerve lesions. The disease was sometimes misdiagnosed as "unknown multiple peripheral neuropathy". 102 cases of n-hexane intoxication were investigated and reported in order to call attention to the disease.

METHODS

All the 102 cases, male 30, female 72; age 17 - 29, mean (21 +/- 3) were n-hexane workers. During the hospitalization the following data were collected: medical history, neurological check up, electromyogram, electrocardiogram, serum biochemical analysis, ophthalmologic study and the metabolite of n-hexane- the urinary 2, 5-hexanedione level. The airborne n-hexane levels of the working environment were also measured.

RESULTS

The average incubation period of the 102 cases was (8.3 +/- 2.6) months. The average course of the disease was (12.1 +/- 4.2) months. Airborne n-hexane concentration of the working places ranged from 188.0 to 7,848.6 mg/m(3). The most common prodromes were headache, anorexia, dizziness and weight loss. The main clinical manifestations of the disease were ascending abnormal sensation. Sensory loss and dyskinesia began from the distant parts of the limbs. The patient had reduction or disappearance of tendon reflexes, weakness and muscle atrophy in the limbs. Electromyography showed a neuropathic pattern, which was parallel to the clinical symptoms and signs. Delayed worsening of symptoms and signs after cessation of n-hexane exposure was observed in some cases. All the 102 cases recovered totally after treatment with Vitamin B, Chinese traditional medicine, physical therapy and training.

CONCLUSION

The main lesion of the disease is multiple peripheral neuropathy. Diagnosis should be made according to the history of n-hexane exposure, the typical clinical manifestations of peripheral neuropathy as well as the neuropathic changes on electromyography. Therapeutic measures for peripheral neuropathy of other etiologies may be used and the prognosis is optimistic if correct diagnosis is made and further exposure stopped.

Dysphagia caused by a fetus-in-fetu in a 27-year-old man

Mechanical obstruction of the distal esophagus by a fetus-in-fetu is an extremely rare condition that has not been previously reported. We present the case of a 27-year-old man who presented with dysphagia caused by fetus-in-fetu contained within a retroperitoneal cystic cavity. The tumor, noticed since childhood, did not cause any symptoms until a year before presentation when symptoms of dysphagia developed. We propose including this entity in the differential diagnosis of a retroperitoneal mass.

TGF-beta1 null mutation leads to CD154 upregulated expression in affected tissues

The TGF-beta1(-/-) mouse is a murine model for systemic autoimmune disease. The aim of this study is to elucidate the immunological mechanism that leads to multifocal tissue inflammation and autoantibody production in TGF-beta1(-/-) mice. Heart, lung, liver, and salivary gland from TGF-beta1(-/-) were assessed for CD154 expression by RT-PCR and immunohistochemistry. Compared to wild-type littermates, CD154 expression was elevated in all tissues studied. Furthermore, IL-12 mRNA was expressed in the salivary gland and heart of TGF-beta1(-/-) mice and not in wild-type littermates. This suggests that the CD154 pathway is activated in these tissues. This shows that TGF-beta1 regulates CD154 expression leading to spontaneous IL-12 production and autoimmunity.

Analysis of bioactive components in traditional Chinese medicines by molecular biochromatography with alpha1-acid glycoprotein stationary phase

Molecular biochromatography with alpha1-acid glycoprotein (AGP) stationary phase was proposed to screen and analyse the biologically active components in traditional Chinese medicines (TCMs) with extracts from Radix Salviae miltiorrhizae as a tested sample. More than ten peaks were resolved based on their affinity to AGP. The effects of concentrations of acetonitrile, pH, concentration of inorganic salt and temperature on the retention behaviors of several major active components were also investigated, and it was found that the hydrophobic effect is the major contributor to retention. Tanshinone IIA was identified as one of the principal bioactive components, which is the marker for the quality control of Radix Salviae miltiorrhizae and a complicated remedy named YiXiTongMai. The amount of tanshinone IIA in Radix Salviae miltiorrhizae and YiXiTongMai determined by this method was 2.9 mg/g (net weight, RSD 4.9%, n=5) and 0.078 mg/g (net weight, RSD 2.5%, n=3), respectively. The possibility for fast differentiation of the TCM sources was also studied by the comparison of the fingerprint of chromatograms for eight typical TCMs on the AGP column. It was observed that different TCMs showed different fingerprint characteristics. Even for the same plant, Rhizoma cimicifugae from three different geographical sources, although there were common characteristics, distinct differences in types and concentrations of biologically active components were clearly observed. It was shown that molecular biochromatography was an effective and fast way for the analysis and screening of biologically active compounds in traditional Chinese medicines.

[Epidemiological investigation on incidence of bronchial asthma in urban population of Shenyang]

OBJECTIVE

Try to find out asthma incidence in urban population of Shenyang.

METHOD

From December 1998 to June 1999, 24 176 residents (11 955 male and 12 221 female persons) living in two residential districts from an industrial and a cultural region were selected as subjects of epidemic investigation by random sampling. The subjects were asked questions concerning the epidemic investigation. The lung functions were measured for subjects suspicious for asthma.

RESULTS

299 cases (102 male and 197 female) were diagnosed as asthma. The incidence of asthma was 1.24% (male 0.85% and female 1.61%). The female incidence of asthma was significantly higher than that in male (P < 0.01). Of the asthma patients, 80 cases (26.76%) were found with heredity background in their families; and 73 cases (24.41%) were found complicated with COPD.

CONCLUSION

The investigation basically reflected the true condition of asthma incidence in urban population of Shenyang.

[Correction of polypronuclear zygotes in 31 cases by micromanipulation]

OBJECTIVE

To study the development of polypronuclear zygotes corrected by micromanipulation.

METHODS

Thirty one cases of polypronuclear zygotes were corrected during September to December of 1999 through micromanipulation to remove supernumerary pronucleus from polypronuclear zygotes at 37 degrees C and observing their development 24 and 48 hours later to compare with the normal pre-embryos.

RESULTS

17 in 31 (55%) cases of corrected polypronuclear zygotes developed to 2 to 4-cell pre-embryoes 24 hours later. There was significant difference while compare with the normal zygotes. However 48 hours later the cleavage rate of the two group of preembryos was the similar.

CONCLUSION

The correction of polypronuclear zygotes by micromanipulation may in some way cause damage to the cleavage ability in part of the zegotes, but the remaining can develope normally.

[Syntheses of polymer coated silica packing materials and their retention behaviors for reversed-phase liquid chromatography]

The polymer coated silica packings C or D with methylmethacrylate(MMA) or MMA-ethylene dimethacrylate(EDMA) monomer were prepared. For the packing materials the polymer coated degree, effects of cross-linking agent and retention behavior were characterized by diffuse reflectance infrared Fourier transform spectroscopy, elemental analysis, size exclusion chromatography and reversed-phase liquid chromatography. The results showed that polymer coated degree on silica depended on the amount of monomer, and the volume of micropore of the meterials, which was controlled more by the cross-linked structure than by the linear structure. The hydrophobicity, retention ratio and number of theoretical plate (80% methanol and 60% acetonitrile) of the packing materials in comparison with those of C18 are discussed. The polymer coated silica packings C and D showed the same stereoselectivity for separation of aromatic compounds, such as triptycene.

G-protein signaling abnormalities mediated by CD95 in salivary epithelial cells

Salivary epithelial cells from patients with primary Sjögren's syndrome (SS) undergo Fas-mediated apoptosis. Bcl-2 and Bcl-xL are apoptosis suppressing oncogenes. Very little is known about the role of these oncogene molecules in salivary epithelial cells. To investigate the possible prevention of salivary glandular destruction in SS by Bcl-2 and Bcl-xL, stable transfectants expressing these molecules were made from HSY cells, a human salivary epithelial cell line. HSY cells were transfected with an expression vector for human Bcl-2 or Bcl-xL. Stable transfectants were selected and apoptosis was induced by anti-Fas antibody. Apoptosis was quantified by propidium iodide staining followed by flow cytometry. Caspase activity was detected by immunohistochemical analysis and enzyme cleavage of DEVD-AMC, a fluorescent substrate. Response to carbachol, a muscarinic receptor agonist, and EGF was measured by Ca2+ mobilization and influx. Fas-mediated apoptosis was significantly inhibited in Bcl-2 and Bcl-xL transfectants compared to wild-type and control transfectants (empty vector). Surprisingly, caspase activity was not inhibited in Bcl-2 and Bcl-xL transfectants. Activation of the Fas pathway in the Bcl-2 and Bcl-xL transfectants by antibody also inhibited carbachol and EGF responsiveness (i.e., Ca2+ mobilization and/or influx) by 50-60%. This Fas-mediated inhibition of cell activation was partially or completely restored by specific peptide interference of caspase enzyme activity. The prevention of Fas-mediated apoptosis by the overexpression of Bcl-2 and Bcl-xL in salivary gland epithelial cells results in injured cells expressing caspase activity and unable to respond normally to receptor agonists. Such damaged cells may exist in SS patients and could explain the severe dryness out of proportion to the actual number of apoptotic cells seen on salivary gland biopsy.

The discovery of enfumafungin, a novel antifungal compound produced by an endophytic Hormonema species biological activity and taxonomy of the producing organisms

In a screening of natural products with antifungal activity derived from endophytic fungi, we detected a potent activity in a culture belonging to the form-genus Hormonema, isolated from leaves of Juniperus communis. The compound is a new triterpene glycoside, showing an antifungal activity highly potent in vitro against Candida and Aspergillus and with moderate efficacy in an in vivo mouse model of disseminated candidiasis. The agent is especially interesting since its antifungal spectrum and its effect on morphology of Aspergillus fumigatus is comparable to that of the glucan synthase inhibitor pneumocandin B,,, the natural precursor of the clinical candidate MK-0991 (caspofungin acetate). An additional search for other Hormonema isolates producing improved titers or derivatives resulted in the isolation of two more strains recovered from the same plant host showing identical activity. The producing isolates were compared with other non-producing Hormonema strains by DNA fingerprinting and sequencing of the rDNA internal transcribed spacers. Comparison of rDNA sequences with other fungal species suggests that the producing fungus could be an undetermined Kabatina species. Kabatina is a coelomycetous genus whose members are known to produce Hormonema-like states in culture.

Efficacy of the echinocandin caspofungin against disseminated aspergillosis and candidiasis in cyclophosphamide-induced immunosuppressed mice

The in vivo efficacy of the echinocandin antifungal caspofungin acetate (caspofungin; MK-0991) was evaluated in models of disseminated aspergillosis and candidiasis in mice with cyclophosphamide (CY)-induced immunosuppression. Caspofungin is a 1, 3-beta-D-glucan synthesis inhibitor efficacious against a number of clinically relevant fungi including Aspergillus and Candida species. Models of CY-induced transient or chronic leukopenia were used with once daily administration of therapy initiated 24 h after microbial challenge. Caspofungin was effective in treating disseminated aspergillosis in mice that were transiently leukopenic (significant prolongation of survival at doses of > or =0.125 mg/kg of body weight and a 50% protective dose [PD(50)] of 0.245 mg/kg/day at 28 days after challenge) or chronically leukopenic (50 to 100% survival at doses of > or =0.5 mg/kg and PD(50)s ranging from 0.173 to 0.400 mg/kg/day). Caspofungin was effective in the treatment and sterilization of Candida infections in mice with transient leukopenia with a 99% effective dose based on reduction in log(10) CFU of Candida albicans/gram of kidneys of 0.119 mg/kg and 80 to 100% of the caspofungin-treated mice having sterile kidneys at caspofungin doses from 0.25 to 2.0 mg/kg. In Candida-infected mice with chronic leukopenia, caspofungin was effective at all dose levels tested (0.25 to 1.0 mg/kg), with the log(10) CFU of C. albicans/gram of kidneys of caspofungin-treated mice being significantly lower (>99% reduction) than that of sham-treated mice from day 4 to day 28 after challenge. Also, 70 to 100% of the caspofungin-treated, chronic leukopenic mice had sterile kidneys at caspofungin doses of 0.5 to 1.0 mg/kg from day 8 to 28 after challenge. Sterilization of Candida infections by caspofungin in the absence of host leukocytes provides compelling in vivo evidence for fungicidal activity against C. albicans. Further human clinical trials with caspofungin against serious fungal infections are in progress.

Photocatalytic degradation of AZO dyes by supported TiO2 + UV in aqueous solution

The photocatalytic degradation performance of photocatalysts TiO2 supported on 13-X, Na-Y, 4A zeolites with different loading content was evaluated using the photocatalytic oxidation of dyes direct fast scarlet 4BS and acid red 3B in aqueous medium. The results showed that the best reaction dosage of TiO2-zeolite catalysts is about 2 g/l and the photocatalytic kinetics follows first order for all supported catalysts. The photocatalytic activity order of the three series catalysts is 13X type >Y type >4A type. The physical state of titanium dioxide on the supports is evaluated by X-ray photoelectron spectra (XPS), powder X-ray diffraction (XRD), BET, and FTIR.

Fractionation and analysis of Artemisia capillaris Thunb. by affinity chromatography with human serum albumin as stationary phase

A method for the screening and analysis of biologically active compounds in traditional Chinese medicine is proposed. Affinity chromatography using a human serum albumin (HSA) stationary phase was applied to separate and analyze the bioactive compounds from Artemisia capillaris Thunb. Five major peaks and several minor peaks were resolved based on their affinity to HSA, two of them were identified as scoparone (SCO, 6,7-dimethoxycoumarin) and capillarisin (CAP). CAP shows a much higher affinity to HSA than SCO. The effects of acetonitrile concentration, eluent pH, phosphate concentration and temperature on the retention behaviors of several major active components were also investigated, and it was found that hydrophobicity and eluent pH play major roles in changing retention values. The results demonstrate that the affinity chromatography with a HSA stationary phase is an effective way for analyzing and screening biologically active compounds in traditional Chinese medicine.

Discovery of novel antifungal (1,3)-beta-D-glucan synthase inhibitors

The increasing incidence of life-threatening fungal infections has driven the search for new, broad-spectrum fungicidal agents that can be used for treatment and prophylaxis in immunocompromised patients. Natural-product inhibitors of cell wall (1,3)-beta-D-glucan synthase such as lipopeptide pneumocandins and echinocandins as well as the glycolipid papulacandins have been evaluated as potential therapeutics for the last two decades. As a result, MK-0991 (caspofungin acetate; Cancidas), a semisynthetic analogue of pneumocandin B(o), is being developed as a broad-spectrum parenteral agent for the treatment of aspergillosis and candidiasis. This and other lipopeptide antifungal agents have limited oral bioavailability. Thus, we have sought new chemical structures with the mode of action of lipopeptide antifungal agents but with the potential for oral absorption. Results of natural-product screening by a series of newly developed methods has led to the identification of four acidic terpenoid (1,3)-beta-D-glucan synthase inhibitors. Of the four compounds, the in vitro antifungal activity of one, enfumafungin, is comparable to that of L-733560, a close analogue of MK-0991. Like the lipopeptides, enfumafungin specifically inhibits glucan synthesis in whole cells and in (1,3)-beta-D-glucan synthase assays, alters the morphologies of yeasts and molds, and produces a unique response in Saccharomyces cerevisiae strains with point mutations in FKS1, the gene which encodes the large subunit of glucan synthase.

Breast-feeding in Bangkok, Thailand: current status, maternal knowledge, attitude and social support

BACKGROUND

The promotion of breast-feeding is one of the essential interventions for reduction of infant mortality and improving infant development worldwide. The aim of the present study was to examine the current status of infant feeding and the influences of suspected family sociodemographic characteristics and social support as well as maternal knowledge, attitudes and behaviours in infant feeding since the Baby-Friendly Hospital Initiative was launched in Thailand.

METHODS

A total of 221 mother-infant pairs were randomly drawn from six health care centers in Bangkok from 20 April to 1 May 1998. Health care staff, using a structured questionnaire, interviewed the mothers in the health care centers.

RESULTS

Most sampled mothers believed that breast milk was the best food for their infants and knew that breast milk had many advantages for infants, mothers and families. Ninety-five percent of mothers breast-fed their infants up to 3 months postpartum, but the prevalence of exclusive breast-feeding was relatively low (62.4%). Multiple logistic regression analyses revealed that the following factors independently increased the risk of mixed or formula feeding during the first 3 months of life: (i) mothers with a full-time job; (ii) grandmothers and other people as the main child caretakers; (iii) mothers who did not have an antenatal plan of exclusive breast-feeding; and (iv) newborns' non-exclusive breast-feeding in hospitals after birth. However, the mother being a housewife, mother as the main child caretaker, an antenatal plan of exclusive breast-feeding and exclusive breast-feeding in hospital were more likely to improve exclusive breast-feeding.

CONCLUSION

The prevalence of exclusive breast-feeding was relatively low. Antenatal plans for exclusive breast-feeding and newborn feeding type in hospital after birth may play key roles in the duration of exclusive breast-feeding. These findings suggest the importance of strengthening implementation of the Baby-Friendly Hospital policy and prenatal health education regarding breast-feeding.

Monocyte rescue of human T cells from apoptosis is CD40/CD154 dependent

The induction of T-cell apoptosis is regulated in part by monocytes (CD14+ cells). Human peripheral blood monocytes inhibited the spontaneous cell death of activated T cells in vitro. The inhibition of T-cell apoptosis did not require autologous monocytes. Inhibition required direct contact with monocytes and was not due to a soluble factor. Furthermore, treatment of monocytes with actinomycin D, cycloheximide and paraformaldehyde abrogated the anti-apoptotic activity of these cells. Blocking antibody to CD40 and CD154 (CD40 ligand) decreased the ability of monocytes to aid in T-cell survival, whereas, blocking LFA-1/I-CAM-1, Fas ligand and the CD4/major histocompatibility complex class II interaction did not affect the influence of monocytes on T-cell survival. This shows that monocytes rescue of activated T cells from apoptosis is dependent upon CD40/CD154 interaction.

Effects of air pollution on respiratory health of adults in three Chinese cities

The authors examined potential associations between air-pollution exposures and respiratory symptoms and illnesses of 4,108 adults who resided in 4 districts of 3 large, distinct Chinese cities. Data on respiratory health outcomes and relevant risk factors for parents and children were obtained via standardized questionnaires in the winter of 1988. (The effects in children were described previously.) The yearly averages of ambient levels of total suspended particles in the 4 districts for the years 1985-1988 differed greatly. The authors constructed logistic-regression models to assess the respiratory health parameters of parents of the children. The results revealed significant and strong effects, by district, on prevalence rates of cough, phlegm, persistent cough and phlegm, and wheeze for both the mothers and the fathers. In addition, the odds ratios increased as ambient total suspended particle concentration increased across the 3 urban districts. Other local within-city risk factors, however, may have confounded the total suspended particles-effects association, especially for asthma prevalence. Findings for adults were similar to those found for their children. A strong adverse effect of active tobacco smoking on the fathers' respiratory health was observed. The children appeared to be more strongly affected by passive smoking exposure received in their homes than their mothers.

[Expression and significance of neuropeptide and neurotensin in the extract of platelet of chronic renal failure patients during hemodialysis]

The aim of this study was to investigate the change of neuropeptide Y(NPY) content and neurotensin (NT) content of the platelet from chronic renal failure (CRF) patients during hemodialysis (HD) and explore its mechanism of action. Platelet was separated from the patients' plasma and the NPY and and NT contents of the platelet and plasma were dynamically observed pre-HD and post-HD. 30 healthy people were chosen as the controls. The results showed the NPY and NT contents of the platelet extract were (58.18 +/- 21.29) ng/10(9) and (25.38 +/- 13.43) ng/10(9) respectively. The NPY content of the platelet extract of the CRF patients was obviously decreased and the NT content of the plasma was obviously increased however, the NT contents of the platelet extract and the plasma were both higher than those in the control group. The NPY content of the platelet extract and NT content of the plasma at the post-HD obviously increased as compared with pre-HD, but the NT content of the platelet extract and the NPY content of the plasma obviously decreased. There was an obvious correlation between NPY and NT. The authors conclude that during the period of CRF, the immunoreactions which mainly involve bio-active substances such as NPY, NT and 5-hydroxytryptamine released by the platelet to interfer the vasoconstrictive effect are the main pathologic factors to induce renal hypertensin and renal vasospasm.

Determination of ginsenoside Rg3 in plasma by solid-phase extraction and high-performance liquid chromatography for pharmacokinetic study

A method using high-performance liquid chromatography (HPLC) and solid-phase extraction (SPE) is described for the determination of ginsenoside Rg3 in human plasma. A 2.5-ml volume of plasma was mixed with 2.5 ml 60% methanol aqueous solution, and centrifuged at 1100 g for 10 min, the supernatant fluid was further purified by SPE with 200 mg/5 ml 40 microns octadecyl silica and separation was obtained using a reversed-phase column under isocratic conditions with ultraviolet absorbance detection. The intra- and inter-day precision, determined as relative standard deviations, were less than 5.0%, and method recovery was more than 97%. The lower limit of quantitation, based on standards with acceptable RSDs, was 2.5 ng/ml. No endogenous compounds were found to interfere with analyte. A good linear relationship with a regression coefficient of 0.9999 in the range of 2.5 to 200 ng/ml was observed. This method has been demonstrated to be suitable for pharmacokinetic studies in humans. Method development for determination of drug with low UV absorption by SPE and HPLC is also discussed.

[Apoptosis of cultured human trophoblasts induced by tumor necrosis factor-alpha and interferon-gamma]

OBJECTIVE

To investigate the potential role of tumor necrosis factor-alpha (TNF-alpha) and interferon-gamma (IFN-gamma) in inducing apoptosis of human trophoblast during early pregnancy and its mechanism.

METHODS

Human trophoblast of early gestation were cultured in vitro. Having cultured with TNF-alpha and IFN-gamma for 36 hours, their cytotoxic activity was determined by viable cell calculation. Apoptotic morphology was observed under light and electronic microscope. DNA fragment pattern and apoptotic index were analysed by agarose gel electrophoresis and flow cytometer assay (FCM) respectively. Adherent cell analysis and sorting interactive laser cytometer was used to examine the changes of cellular reactive oxygen species (ROS) caused by TNF-alpha.

RESULTS

TNF-alpha alone significantly decreased the number of viable cells at the concentration of 1,000, 3,000 and 5,000 U/ml (P < 0.05). While combined with IFN-gamma, TNF-alpha decreased the number of viable cells more markedly. Electronic microscopic examination showed chromatin aggregating beneath the nuclear envelope, nuclear contraction and apoptotic bodies. Agarose gel electrophoresis of fragmented DNA showed a ladder-like pattern. FCM showed that the apoptotic index of trophoblasts was TNF-alpha concentration dependent. Cellular ROS was increased by TNF-alpha.

CONCLUSION

TNF-alpha and IFN-gamma could induce apoptosis of human trophoblasts during early pregnancy, partly through the mechanism of ROS.

[Kaposi's sarcoma of eyelid and conjunctiva]

OBJECTIVE

To investigate the clinical and histopathological features of ocular adnexal Kaposi's sarcoma.

METHODS

12 consecutive cases of ocular adnexal Kaposi's sarcoma confirmed histopathologically were retrospectively analyzed from Ndola Central Hospital of Zambia in January, 1995-May, 1996. Histopathologic sections of 6 cases were reviewed.

RESULTS

Among the 12 patients who were all young African males, the serum samples of 4 patients showed positive for human immunodeficiency virus (HIV) test. Most patients had acquired immunodeficiency virus syndrome (AIDS) related symptoms.

CONCLUSIONS

Ocular adnexal Kaposi's sarcoma is a common ocular manifestation in AIDS and may be the first sign. It is classified into three stages clinically and histopathologically, that is a continuous process.

A parallel study on the effects in treatment of impotence by tonifying the kidney with and that without improving blood circulation

141 cases of functional impotence of the kidney-deficiency type were treated by tonifying the kidney. On them, 103 cases at the same time were treated by improving blood circulation and the other 38 cases by the former only. As a result the total effective rate and the markedly effective rate in the former were 84.46% and 46.60% respectively; but in the latter, 60.55% and 13.15%. A significant difference was found in Ridit analysis (P < 0.05), indicating that method of tonifying the kidney with improving blood circulation is much better than by simply tonifying the kidney alone.

[Screening and analysis of biologically active components in traditional Chinese medicine by molecular biochromatography]

Screening of biologically active components from Chinese medicines by molecular biochromatography has been first proposed by authors. This paper summarizes their recent progresses on screening and analysis of Chinese medicines by molecular chromatography, including the comparison of the chromatograpic pattern for a number of herbal medicines, and the same kind of medicines but different sources, method development for screening and quality control of Chinese medicines, and the study on the interactions between the biologically active compounds in Chinese medicines and protein. The prospect of molecular biochromatography on study of Chinese medicines has also been highlighted.

Inappropriate apoptosis of salivary and lacrimal gland epithelium of immunodeficient NOD-scid mice

OBJECTIVE

The lesion is Sjögren's syndrome consists of lymphocytic infiltration and has a pathology characteristic of the potential apoptotic death of salivary gland secretory epithelial cells. To examine the role of the glandular epithelial cells in the pathogenesis of autoimmune exocrinopathy, we studied Fas and Fas ligand (FasL) expression and quantitated the levels of apoptosis in salivary and lacrimal glands from NOD and NOD-scid mice, an animal model that develops a Sjögren's syndrome-like pathology.

METHODS

The parotid, submandibular and lacrimal tissues of NOD, NOD-scid, and BALB/c mice were evaluated by immunohistochemical analysis for the expression of Fas and FasL. Nuclear fragmentation of DNA from the epithelial cells of exocrine tissues was evaluated by the terminal UTP nucleotide end labeling method (TUNEL). Messenger RNA was isolated from 8 and 18 week old mice and was analyzed by the reverse transcription-polymerase chain reaction (RT-PCR) for the expression of Fas and FasL.

RESULTS

We found suggestive evidence that apoptosis of the secretory epithelial cells occurs in both NOD and NOD-scid mice despite the lack of T- and B-lymphocytes in the latter. FasL mRNA and cell surface protein were expressed in salivary and lacrimal gland epithelial cells from 8 and 18 week old NOD, NOD-scid, and BALB/c mice. Fas protein and mRNA were expressed only in the exocrine glands from 18 week old NOD and NOD-scid mice. Glandular secretory epithelial cell apoptosis was elevated in both NOD and NOD-scid mice, however; there was little evidence of apoptosis in the control strain of BALB/c mice.

CONCLUSION

These results suggest a potential apoptotic process dependent on Fas:FasL interactions occurring in NOD-scid glandular secretory epithelial cells in the absence of lymphocytic infiltration.

[The technology of processing carbonized Cirsium japonicum and quality standards of its prepared pieces]

The technology of processing carbonized Cirsium japonicum was selected by using orthogonal experiment design. The result shows that the best way is to bake of 10 min at 220 degrees C. The contents of macro and trace elements in the prepared pieces significantly increased.

Incidence and outcome of Staphylococcus aureus bacteremia in hemodialysis patients

BACKGROUND

Staphylococcus aureus bacteremia is frequently associated with metastatic complications and infective endocarditis (IE). The Duke criteria for the diagnosis of IE utilize echocardiographic techniques and are more sensitive than previous criteria. The documentation of IE in patients undergoing hemodialysis (HD) has become increasingly important in order to avoid the overuse of empiric vancomycin and the emergence of antibiotic resistance.

METHODS

Patients who developed S. aureus bacteremia while undergoing HD at a tertiary medical center or one of four affiliated outpatient HD units were identified. Clinical outcome (death, metastatic complications, IE, and microbiologic recurrence) was assessed during hospitalization and at three months after discharge. Transthoracic and transesophageal echocardiograms were performed and the Duke criteria were used to diagnose IE. Pulse field gel electrophoresis was performed to confirm genetic similarity of recurrent isolates.

RESULTS

Four hundred and forty-five patients underwent hemodialysis for 5431.8 patient-months. Sixty-two developed 65 episodes of S. aureus bacteremia (1.2 episodes/100 patient-months). Complications occurred in 27 (44%) patients. Bacteremia recurred in patients who dialyzed through polytetrafluorethylene grafts (44.4% vs. 7.1%, P = 0.0.01), and there was a trend to increased recurrence in patients who received only vancomycin (19.5% vs. 7.1%, P = 0.4). IE was diagnosed in 8 patients (12%), six of whom had normal transthoracic echocardiograms.

CONCLUSIONS

Sensitive echocardiographic techniques and the Duke criteria for the diagnosis of IE should be used to determine the proper duration of antibiotic therapy in hemodialysis patients with S. aureus bacteremia. This diagnostic approach, coupled with early removal of hardware, may assist in improving outcomes.

Outcome of Staphylococcus aureus bacteremia according to compliance with recommendations of infectious diseases specialists: experience with 244 patients

To determine whether recommendations of infectious diseases specialists affect outcome for patients, we evaluated 244 hospitalized patients with Staphylococcus aureus bacteremia. We offered our management recommendations to each patient's physicians and then assessed the clinical outcome for both patients for whom our consultative advice was followed and those for whom our advice was not heeded. All patients were followed up for 12 weeks after their first positive blood culture. Our management advice was followed for 112 patients (45.9%) and partially or completely ignored for 132 patients (54.1%). Patients for whom our recommendations were followed were more likely to be cured of their S. aureus infection and less likely to relapse (P < .01), despite having significantly more metastatic infections (P < .01) at the outset of therapy, than were those for whom our recommendations were not followed. Failure to follow recommendations to remove an infected intravascular device was the most important risk for treatment failure. After controlling for other factors, logistic regression analysis revealed that patients whose intravascular device was not removed were 6.5 times more likely to relapse or die of their infection than were those whose device was removed. Our findings suggest that patient-specific management advice by infectious diseases consultants can improve the clinical outcome for patients with S. aureus bacteremia.