Serum levels of soluble CD8, neopterin, beta 2-microglobulin and p24 antigen as indicators of disease progression in children with AIDS on zidovudine therapy

OBJECTIVE

To test the hypothesis that serum levels of soluble markers in children change after initiation of zidovudine therapy and that the extent and pattern of these longitudinal changes correlates with clinical outcome.

PATIENTS AND METHODS

We measured serum levels of soluble CD8, neopterin, beta 2-microglobulin (beta 2M), and p24 antigen, and CD4 cell counts, before the initiation of zidovudine therapy and at 12, 24 and 48 weeks of treatment in 24 HIV-1-infected children (Centers for Disease Control classification P2) and 15 controls.

RESULTS

Soluble CD8 levels were elevated before therapy in 70% of the infected children; subsequent decreases were associated with lower risk of disease progression. The mean serum neopterin level before treatment was elevated in infected children; decreases in neopterin levels marginally reflected improved or stable clinical status. Serum beta 2M levels and CD4+ cell counts were not associated with clinical outcome. Only 10 out of the 24 patients had detectable levels of serum p24 antigen before treatment; again, the amount of decline after initiation of therapy did not predict clinical outcome.

CONCLUSION

Decreasing levels of soluble CD8 and neopterin in HIV-1-infected children receiving zidovudine therapy might reflect a good response to treatment and a slowing of disease progression.

Assessment of the effects of instrumentation, monoclonal antibody, and fluorochrome on flow cytometric immunophenotyping: a report based on 2 years of the NIAID DAIDS flow cytometry quality assessment program

This study of the effect on CD4%, CD8%, CD3+8+%, and CD3% of flow cytometer, monoclonal antibody, and fluorochrome was based on 71 whole-blood samples, each evaluated by 42 to 59 laboratories during 2 years of a flow cytometry quality assessment program. For the 24 HIV-positive specimens, FACScans produced significantly lower CD4% values than EPICS-Cs or EPICS Profiles, and for the 47 HIV-negative specimens, FITC was associated with significantly lower CD4% values than PE or RD1, but differences were never larger than 2% and regressions accounted for only 3-12% of the variability. The labs using the most common CD4 technique had significantly higher between-laboratory variability than all other labs grouped together. For both CD8 and CD3+8+, measurements on FACScans were significantly higher than measurements on EPICS, and measurements using Leu2 were significantly higher than measurements using T8, with regressions accounting for 12-31% of the variability. The machine differences in medians were 3-7% for labs using Leu2-FITC. It might be worthwhile to discourage the use of Leu2-FITC for measuring CD8% but no change in instrument, monoclonal antibody, or fluorochrome would greatly improve interlaboratory agreement on CD4%.

A study of tobacco carcinogenesis. XLVII. Bioassays of vinylpyridines for genotoxicity and for tumorigenicity in A/J mice

3-Vinylpyridine is formed from nicotine during the smoking of tobacco products. Consequently it is found in mainstream and side-stream smoke of cigarettes and cigars and in environmental tobacco smoke. In this study, 3-vinylpyridine and its isomers 2- and 4-vinylpyridine as well as styrene (vinylbenzene) were bioassayed for mutagenicity in Salmonella typhimurium strains TA 1535, TA 1538, TA 98 and TA 100 and for their genotoxicity in the rat hepatocyte DNA-repair test. In both in vitro assays-all three vinylpyridines and styrene were inactive. In a test for tumorigenicity in which the test compounds were injected intraperitoneally into A/J mice (total dose 200 mumol/animal) there was no significant incidence of lung adenoma nor of any other type of tumors.

Lymphocyte subsets in healthy children during the first 5 years of life

OBJECTIVE

To assess whether relative and absolute values of CD4 and CD8 lymphocytes and CD4/CD8 ratio change in relation to age, and to estimate the fifth and 95th percentiles for these values in children of various ages.

PATIENTS AND METHODS

Phenotypic analysis of lymphocyte subsets was performed on blood samples from 208 healthy children, aged 1 through 59 months, using standard flow cytometric techniques.

RESULTS

Regression analysis demonstrated that CD4 and CD8 lymphocyte counts declined significantly with advancing age (P less than .000001 and P = .03, respectively). Since CD4 and CD8 counts depend on total lymphocyte count, the percentage of total lymphocytes of each phenotype was also analyzed and demonstrated that the CD4 percentage was highly age dependent (P less than .000001). The CD8 percentage increased with age (P = .0001) but not as much as the CD4 percentage decreased. Median CD4 counts (fifth and 95th percentiles) for children 2 through 3, 4 through 8, 12 through 23, and 24 through 59 months of age were 2.83 (1.46 to 5.11), 2.95 (1.69 to 4.61), 2.07 (1.02 to 3.60), and 1.80 (0.90 to 2.86) x 10(9)/L, respectively.

CONCLUSION

Healthy children's CD4 lymphocyte counts are considerably higher than previously established adult values. These data demonstrate that age is an important consideration in interpretation of lymphocyte subsets in children. This may be especially relevant in children who are infected with the human immunodeficiency virus, where CD4 lymphocyte values play a central role in monitoring disease progression and determining thresholds for medical interventions.

Detection of Clostridium difficile from an enhancement broth by gas-liquid chromatography

Gas-Liquid chromatography (GLC) was used to detect the presence of isocaproic acid produced by Clostridium difficile from 54 stool samples grown in cycloserine-cefoxitin broth. Isocaproic acid was detected in 12 samples of which 5 were confirmed to be Clostridium difficile by culture and biochemical tests. The detection of isocaproic acid by GLC together with the presence of presumptive colonies on primary selective culture media provides a more rapid laboratory diagnosis for Clostridium difficile.

The spliced leader gene of Angiostrongylus cantonensis

A 5' leader sequence has been identified on mRNAs of the parasitic nematode Angiostrongylus cantonensis. A 720-bp XhoI restriction fragment containing the gene encoding the leader sequence has been cloned and sequenced. It contains a 22-nt sequence identical to that of the leader sequence of Caenorhabditis elegans, a consensus splice site and a putative Sm antigen binding site. The gene is present as a tandem repeating unit of approximately 60 copies, and unlike C. elegans it is not associated with the 5S ribosomal RNA gene. The SL-RNA is 110 nt long and the sequence and primer extension studies suggest that it is transcribed from the tandemly repeating SL gene. It is precipitable from cell-free extracts of adult nematodes by anti-Sm anti-sera, and from RNA by anti-TMG anti-sera, thus suggesting its inclusion with small nuclear ribonucleoproteins in RNA splicing.

Absolute configuration of 7,12-dimethylbenz[a]anthracene-DNA adducts in mouse epidermis

32P-Postlabeling was used to monitor the formation of DMBA-DNA adducts in mouse epidermis from each enantiomer of the trans 3,4-dihydrodiol. It was shown that the (4R,3R)-dihydrodiol is converted to the anti (4R,3S)-dihydrodiol (2S,1R)-epoxide which reacts with deoxyguanosine and deoxyadenosine residues in epidermal DNA to yield two of the major adducts formed when DMBA itself binds to epidermal DNA. The third major DMBA-derived adduct with deoxyadenosine residues was shown to arise from the (4S,3R)-dihydrodiol through the intermediacy of the syn (4S,3R)-dihydrodiol (2S,1R)-epoxide.

Electrical stimulation treatment of dog's denervated orbicularis oculi muscle

In this investigation, the electrophysiology and pathology of denervated orbicularis oculi muscles have been studied in dogs during chronic electrical stimulation. The orbicularis oculi muscles were unilaterally denervated in 8 dogs, and 4 of these muscles were directly stimulated on a daily basis for 75 days. No difference in minimum stimulus intensities evoking orbicularis oculi muscle twitch contraction appeared between denervated treated and nontreated muscles. A significant reduction of minimum stimulus intensities evoking upper eyelid complete closure (blink), however, was found in the denervated treated muscles between 10 and 30 days (p less than 0.01). At 28 and 75 days, orbicularis oculi muscle biopsies showed no difference in muscle fiber diameter between denervated treated and nontreated muscles. At 75 days, type II muscle fiber distribution, however, was significantly increased in denervated treated muscles compared with denervated nontreated muscles (p less than 0.01). These findings of orbicularis oculi muscle electrophysiology were consistent with a transient reversal of denervation changes by electrical stimulation, partially supported by muscle biopsies.

A simple method to prepare intact yeast chromosomal DNA for pulsed field gel electrophoresis

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The reproducibility of measuring the anorectal angle in defecography

Dynamic proctography is a radiographic procedure that has become widely used in the evaluation of pelvic floor function. The anorectal angle (ARA) is one parameter which is usually quantified during this examination. To determine the accuracy with which this measurement can be made, three physicians independently measured the resting and squeezing ARAs of 22 women. The coefficient of variation and the kappa statistic were used to describe the degree of agreement among the three examiners. These analyses revealed poor agreement among examiners for all 22 patients taken as individuals, (kappa less than or equal to 0.40; mean coefficient of variation at rest = 18 percent; mean coefficient during squeezing = 21 percent). These results suggest that measurements of ARAs will vary among examiners for any particular patient, even though individual examiners may demonstrate consistency in recording ARA data. There is wide interobserver variation in the measurement of the ARA from lateral radiographs, making quantification an exercise of only limited clinical value.

Influence of dissolution rate and pH of oral medications on drug-induced esophageal injury

The in vitro dissolution time and pH were measured for 16 drug products in capsule or tablet form representative of oral medications known to cause esophageal injury. The test drugs included Vibramycin, Minocin, quinidine sulfate, Cleocin HCl, Indocin, Tolectin 200, ferrous sulfate, vitamin C, aspirin, Procardia, phenobarbital, Dilantin, Butazolidin, Noctec, K-Dur, and Quinaglute. Artificial saliva (10 mL) was placed in a small beaker along with a pH probe connected to a digital display pH meter and a strip-chart recorder. The salivary pH was measured at baseline and continuously during the dissolution of each test medication and the time taken for complete dissolution was recorded. This experiment was repeated six times for each drug. Baseline and final dissolution pH were compared statistically for differences using the Wilcoxon matched-pairs signed-ranks test. Significance was established at the 0.05 level. Only three medications tested (vitamin C, aspirin, and Dilantin) produced a dissolution pH outside the range of physiological esophageal pH values. Although the majority of the test drugs significantly altered the baseline pH, the final dissolution pH did not fall outside the physiologic range. Nine of the 16 test drugs dissolved completely within 10 minutes, whereas the remaining 7 drugs took 30 minutes or longer (up to 24 hours) to dissolve. We conclude that the dissolution pH of potentially caustic medications does not appear to be a primary mechanism of drug-induced esophageal injury, whereas a rapid dissolution rate may play an important role in the pathogenesis of the lesion.

The cause of dysphagia in uncomplicated sliding hiatal hernia and its relief by hiatal herniorrhaphy. A roentgenographic, manometric, and clinical study

Patients with an uncomplicated sliding hiatal hernia frequently experience dysphagia. The present study shows, using video barium contrast esophagograms, that the cause of dysphagia in 60% of these patients is an obstruction to the passage of the swallowed bolus by diaphragmatic impingement on the herniated stomach. Manometrically this was reflected by a double-hump high pressure zone (HPZ) at the gastroesophageal junction, and specifically to the length and amplitude of the distal HPZ and the length of the intervening segment between the two HPZs. The former represents the degree of the diaphragmatic impingement on the herniated stomach and the latter the size of the supradiaphragmatic herniated stomach. Surgical reduction of the hernia resulted in relief of dysphagia in 91% of the patients.

Iopamidol as a gastrointestinal contrast agent. Lack of peritoneal reactivity

The ideal contrast agent in patients suspected of having gastrointestinal perforation is an iso-osmolar, or nearly iso-osmolar substance, that causes no peritoneal reaction. Iopamidol is a nonionic water-soluble contrast medium that may be considered in such situations. Intraperitoneal injections of ionic and nonionic contrast agents were compared in rats to study potentially harmful peritoneal inflammation. Only intraperitoneal barium injection produced any significant tissue reaction, such as adhesions and ascites. There was no difference between iopamidol and the other water-soluble contrast agents. Iopamidol may satisfy the need for nonreactive and nearly iso-osmolar contrast agents for evaluating patients with possible bowel perforation. However, the high cost of this agent may make its clinical application impractical.

Electrophysiological study of the denervated orbicularis oculi muscle in dogs

This study investigated the electrophysiology of the denervated orbicularis oculi muscle and its clinical application. Orbicularis oculi muscle denervation was achieved by complete transection of the seventh nerve in ten dogs. The parameters studied were the electrical requirements needed to cause a minimal perceptible contraction (twitch) and a complete eyelid closure (blink). Twitch and blink curves were generated. The findings are summarized as follows: (1) Minimum intensities for direct twitch of denervated orbicularis oculi muscle were significantly lower than intensities of normal orbicularis oculi muscle twitch (p less than 0.01) when long stimulus duration (5 to 400 ms) was used. (2) Minimum intensities for direct blink of denervated orbicularis oculi muscle were not significantly different from stimulus intensities for blink of normal orbicularis oculi muscle if long stimulus duration (5 to 400 ms) was used. Twitch and blink curves could be used to clinically follow the orbicularis oculi muscle movement return after operations performed in patients affected by lagophthalmos.

Myocardial uptake and clearance of T1-201 in healthy subjects: comparison of adenosine-induced hyperemia and exercise stress

Pharmacologic stress testing with dipyridamole is useful in patients undergoing thallium-201 myocardial perfusion scintigraphy who cannot adequately exercise. Because dipyridamole increases coronary blood flow by reducing the metabolism of adenosine, the authors compared the uptake and clearance of T1-201 following exercise stress testing (EST) and resting intravenous infusion of adenosine (AI) in crossover fashion in 20 healthy men. No perfusion defects or areas of redistribution were noted in any of the scans. Mean absolute myocardial T1-201 uptake was 1.3 times greater with AI than with EST. Mean absolute extracardiac uptake was 2.0 times greater with AI. Mean T1-201 myocardial clearance was virtually the same in all AI and EST views. During AI, 70% of the subjects experienced subjective side effects, mean arterial blood pressure decreased by 15%, and heart rate increased by 48%. The effects of adenosine on T1-201 kinetics in the myocardium are similar to those of EST. Adenosine may be useful as a pharmacologic stress agent in patients undergoing T1-201 myocardial perfusion scintigraphy.

DNA adducts from carcinogenic and noncarcinogenic enantiomers of benzo[a]pyrene dihydrodiol epoxide

The characterization of eight benzo[a]pyrene-deoxyribonucleoside adducts derived from reaction of the anti-dihydrodiol epoxide and deoxyguanylic and deoxyadenylic acids is described. It is reported that the epoxide ring is opened by the purine amino groups to yield similar amounts of both cis and trans products. NMR data show that the 7- and 8-hydroxyl groups are pseudodiaxial in the cis products and pseudodiequatorial in the trans products, and we suggest that these products arise from reaction with the diaxial and diequatorial conformers of the dihydrodiol epoxides, respectively. The chiral nature of the interactions of these metabolites with DNA restricts the range of products formed with this macromolecule, and a trans product with deoxyguanosine is the major product formed with either enantiomer of the anti-dihydrodiol epoxide.

Absolute stereochemistry of the major 7,12-dimethylbenz[alpha]anthracene- DNA adducts formed in mouse cells

In recent work we assigned partial structures to individual 7,12-dimethylbenz[alpha]anthracene (DMBA)--deoxyribonucleoside bisphosphates separated by TLC after postlabeling with [32P]ATP. We have now been able to postlabel DNA adducts formed in cells exposed to either the (4R,3R)- or (4S,3S)-dihydrodiol of DMBA and thereby to assign absolute stereochemistry to the 2-, 3- and 4- positions in the major DMBA-DNA adducts. It is found that the major anti dihydrodiol epoxide-DNA adducts arise from the (4R,3S)-dihydrodiol (2S,1R)-epoxide and that the major syn dihydrodiol epoxide-DNA adducts arise from the (4S,3R)-dihydrodiol (2S,1R)-epoxide.

Esophageal function in patients with reflux-induced strictures and its relevance to surgical treatment

Esophageal function was evaluated in 53 patients with increasing severity of esophageal injury caused by gastroesophageal reflux disease (study 1), and the findings were applied to the treatment of 28 patients with reflux-induced strictures (study 2). Fifty asymptomatic volunteers served as controls for both studies. In study 1 there were 14 patients without reflux complications, 14 with esophagitis grade I to III, 13 with esophageal stricture, and 12 with Barrett's epithelium (6 of whom had a stricture). The prevalence of a mechanically defective sphincter increased with the progression of the esophageal injury; 50% in the patients without complications to 84% and 92% in those with stricture or Barrett's epithelium, respectively. Similarly, a decrease in amplitude of contractions in the distal esophagus was observed in patients with stricture and patients with Barrett's epithelium. In study 2, these findings were applied in the surgical management of 28 consecutive patients with a reflux-induced stricture. Preoperative motility studies were performed after patients were dilated to 60F. Control of reflux by a Nissen fundoplication gave excellent (86%) to good (14%) results in patients who had relief of dysphagia after dilation or adequate motility, or both. Four patients with both persistent dysphagia after dilation and inadequate motility underwent resection. Transmural presented are helpful in the selection of the optimal surgical procedure for the treatment of dilatable reflux-induced strictures.

The relation of rural alcoholism to farm economy

Several studies have suggested an association between the farm crisis of the 1980's and the increase in mental health problems in rural America. A stress hypothesis for alcoholism would indeed predict such an association. The study presented herein examines the rate of new referrals for treatment of alcohol abuse and/or dependence to state-funded agencies in Nebraska. Between mid-1978 and mid-1986, the rate of subjects seeking treatment grew steadily, paralleling an increase in both population and available treatment programs. Yet, the total number of farmers seeking treatment peaked around 1982 and declined steadily thereafter, outpacing any change in the total number of farmers in the state. Possible interpretations of these findings are discussed.

A metabolite of the carcinogen 7,12-dimethylbenz[a]anthracene that reacts predominantly with adenine residues in DNA

Four 7,12-dimethylbenz[a]anthracene--deoxyribonucleoside adducts formed in mouse epidermis in vivo arise from the syn dihydrodiol epoxide metabolite of this carcinogen. With the synthetic syn dihydrodiol epoxide it was possible to identify three of these as deoxyadenosine adducts and to establish their structures. These three adducts account for the large majority of DNA adduct arising from this metabolite in vivo. The in vivo metabolite is unusual, therefore, in that it reacts almost exclusively with adenine residues in DNA while most carcinogen metabolites react preferentially with guanine residues.

Comparison of free alpha-tocopherol and alpha-tocopheryl acetate as sources of vitamin E in rats and humans

The uptake of alpha-tocopherol from 2R,4'R,8'R-alpha-tocopherol and 2R, 4'R, 8'R-alpha-tocopheryl acetate has been compared in rats and humans. The two forms of vitamin E were compared simultaneously in each subject (rat and human) by using a combination of deuterium-substitution and gas chromatography-mass spectrometry (GC-MS) to distinguish and measure the competitive uptake of alpha-tocopherol from an orally ingested mixture of the acetate and the free phenol forms. When rats were dosed in a manner analogous to that used in traditional bioassays, i.e., providing the two forms of vitamin E once daily in tocopherol-stripped corn oil for four successive days immediately prior to sacrifice, the net uptake of alpha-tocopherol from the free phenol form was only half that from the acetate. This result is consistent with the greater activity of the acetate that had been observed previously in bioassays. However, when the two forms of tocopherol were intubated into rats as a single dose mixed in with an aqueous bolus of standard laboratory diet, the amount of alpha-tocopherol taken up from the free form after 24 hr was very similar to that derived from the acetate. In five adult humans, competitive uptake studies of the two forms after a single dose taken with a meal showed that the amount of alpha-tocopherol from the free phenol form was equal to that from the acetate in plasma and red blood cells.(ABSTRACT TRUNCATED AT 250 WORDS)