Death risk predictors among peritoneal dialysis and hemodialysis patients: a preliminary comparison

Variables associated with survival among 1,522 peritoneal dialysis patients and 16,404 hemodialysis patients who received treatment during 1992 were evaluated. Analysis was performed separately for the treatment types and for the combined patient group. In general, the associates of survival appear similar among patients receiving peritoneal or hemodialysis. Important variables appear related to nutrition, acid-base status (which is related to nutrition), and age.

Effects of doxorubicin on cardiomyocytes with reduced level of superoxide dismutase

Our previous studies have shown that isolated adult rat cardiomyocytes with normal and reduced Cu/Zn SOD activities are equally susceptible to extracellularly generated oxidants (hydrogen peroxide, glucose oxidase/glucose and xanthine oxidase/xanthine systems). In the present study we exposed myocytes with reduced SOD activity to doxorubicin (adriamycin). Cardiotoxicity of doxorubicin has been attributed to the production of superoxide anion inside the cell. Cardiomyocytes with reduced SOD activity, but normal ATP content and viability, were obtained by the treatment of isolated cells with diethyldithiocarbamate (DDC). DDC-treated myocytes were significantly less resistant to doxorubicin than controls. Doxorubicin-stimulated superoxide anion formation, measured by the rate of SOD-inhibitable acetylated cytochrome C reduction, was significantly higher in the cytosolic fraction of DDC-treated cells compared to controls. These results indicate that for isolated cardiac myocytes an essential part of cytotoxicity of doxorubicin can be explained by the formation of superoxide anion and that the level of intracellular SOD activity should be considered as a significant factor for cell protection.

Interactions of phosphorylation and dimerizing domains of the alpha-subunits of Na+/K(+)-ATPase

Chemical cross-linking studies are among a number of experimental approaches that have suggested the functional significance of higher association states of alpha,beta-protomers of Na+/K(+)-ATPase. Formation of the phosphointermediate of the enzyme on Asp369 of the alpha-subunit is known to induce oxidative cross-linking of the alpha-subunits catalyzed by Cu(2+)-phenanthroline. To localize the phosphorylation-induced alpha,alpha-interface, we cleaved alpha at Arg438-Ala439 by controlled proteolysis and exposed the partially cleaved enzyme to the cross-linking reagent. In addition to the alpha,alpha-dimer, two other phosphorylation-induced cross-linked products were obtained. Using gel electrophoretic resolution of the cross-linked 32P-labeled enzyme, N-terminal analyses of the products, and their reactivities with sequence-specific antibodies, the two products were identified as a homodimer of the C-terminal 64-kDa fragment of alpha and a heterodimer of alpha and the 64-kDa peptide. The latter dimer was also obtained when the cross-linked alpha,alpha-dimer was formed first and then subjected to proteolysis. The findings localize the dimerizing domain to the C-terminal side of Ala439 and indicate that intersubunit proximities of dimerizing domains are regulated by phosphorylation-dephosphorylation of Asp369 during the reaction cycle of the enzyme.

Zinc sulphadiazines: novel topical antimicrobial agents for burns

Two new zinc sulphadiazine (Zn(SD)2)-amine complexes, zinc sulphadiazine-methylamine (Zn(SD)2(CH3NH2)2) and zinc sulphadiazine-ethylenediamine (Zn(SD)2(C2H8N2)3.H2O), were prepared and compared with silver sulphadiazine (AgSD). The compounds were readily obtained by reaction of zinc nitrate hexahydrate with sulphadiazine or its salt in methylamine and ethylenediamine, respectively. Structure was established by X-ray crystallography and ultraviolet-visible, infrared and nuclear magnetic resonance spectroscopy. The products were effective, in-vitro, against Gram-positive and Gram-negative bacteria as well as fungus. However, their activity is partially reversed by p-aminobenzoic acid. Further investigations in burned mice revealed that these compounds displayed a potential value in the prevention and treatment of wound healing, and diminution of mortality and weight loss. The toxicity of Zn(SD)2 derivatives was much lower than that of AgSD. The better aqueous solubility and skin permeability may explain the reason for their superiority over AgSD in the efficacy for topical therapy. Zn(SD)2(CH3NH2)2 was consistently more potent and was chosen for further development in clinical uses. The similarity in complexation between Zn(SD)2(CH3NH2)2 and AgSD may be significant to distinguish that from any other Zn(SD)2 derivative in bioactivity.

Role of intracellular SOD in oxidant-induced injury to normal and copper-deficient cardiac myocytes

Previous studies have shown that susceptibilities of hepatocytes and endothelial cells to H2O(2)-induced injury are altered by changes in the intracellular activity of Cu,Zn-containing superoxide dismutase (CuZn-SOD). To evaluate the role of intracellular CuZn-SOD in oxidant-induced injury to rat cardiac myocytes, cells with reduced CuZn-SOD activity but normal ATP content were either isolated from the hearts of adult copper-deficient rats or obtained by treatment of normal isolated adult myocytes with diethyldithiocarbamate. These myocytes and controls with normal CuZn-SOD activity were exposed to either reagent H2O2 or oxidants generated by extracellular glucose oxidase plus glucose or xanthine oxidase plus xanthine. It was shown that myocytes with CuZn-SOD activities reduced by 70-90% were equally susceptible to H2O2 and the two oxidant-generating systems as the control myocytes. The findings suggest that in adult cardiac myocytes, in contrast to the situation in some other cells, intracellular CuZn-SOD may not have a significant defensive role against acute H2O(2)-induced injury. The possibility remains, however, that changes in the activity of this enzyme, e.g., in copper deficiency, may be relevant to the ability of myocytes to cope with chronic oxidative stress resulting from imbalance between intracellular oxygen radical-generating and -scavenging systems.

Functional coupling of phosphorylation and nucleotide binding sites in the proteolytic fragments of Na+/K(+)-ATPase

Cleavage of the alpha-subunit of Na+/K(+)-ATPase by trypsin at Arg438-Ala439 causes enzyme inhibition which has been suggested to be due to altered alignment of phosphorylation site on the 48-kDa N-terminal fragment with nucleotide binding site on the 64-kDa C-terminal fragment. Our aims were to test this hypothesis and to assess the effect of the cleavage on the enzyme's two ATP sites. Na(+)-dependent phosphorylation of the partially cleaved enzyme by ATP showed that K0.5 values of ATP for phosphorylations of intact alpha and 48-kDa peptide were the same (0.4 microM). Unchanged interactions among the residues across the cleavage site were also indicated by data showing that reaction of fluorescein isothiocyanate with the 64-kDa peptide blocked phosphorylation of the 48-kDa peptide by ATP. ATP is known to block the reaction of fluorescein isothiocyanate with the enzyme. Experiments on the partially cleaved enzyme showed that K0.5 of ATP for protection of alpha was 30-60 microM, and the value for the protection of interacting 48-kDa and 64-kDa peptides was 1-3 mM. Evidently, while the cleavage does not affect the high affinity catalytic site, it disrupts the allosteric low affinity ATP site. Experiments on reconstituted preparations showed that the cleavage abolished ATP-dependent Na+/K+ exchange, Pi+ATP-dependent Rb+/Rb+ exchange, ATP-dependent Na+/Na+ exchange, and ADP+ATP-dependent Na+/Na+ exchange activities. Selective disruption of the low affinity ATP site accounts for the inhibitions of all functions involving K+(Rb+), based on the established role of this site in the control of K+ access channels. Cleavage-induced inhibitions of other activities, however, suggest additional roles of the low affinity ATP site in the reaction cycle.

Different oxidant sensitivities of the alpha 1 and alpha 2 isoforms of Na+/K(+)-ATPase expressed in baculovirus-infected insect cells

Inhibition of Na+/K(+)-ATPase by partially reduced oxygen metabolites is an early event in the course of cell injury caused by oxidative stress. We showed before that isoforms of the enzyme obtained from different sources have different oxidant sensitivities. To evaluate the role of tissue-specific impurities in this difference, cDNAs of alpha 1 and alpha 2 isoforms were expressed in Sf-9 insect cells, and the effects of H2O2 on the resulting isolated enzymes were studied. The expressed alpha 2 was significantly more sensitive than alpha 1 to H2O2. These findings, together with our previous data showing different oxidant sensitivities of alpha 1 and alpha 3 in a cardiac enzyme preparation, indicate that differential oxidant sensitivities of Na+/K(+)-ATPase isoforms of various tissues are dictated by the primary sequences of alpha 1, alpha 2, and alpha 3 subunits.

A preliminary exploration of the relationship between tumour necrosis factor (TNF) and monocytic in vitro production of interleukin-1 (IL-1) and internal organ dysfunction in severely burned patients

Biological assays were adopted in this study to examine the changes in serum tumour necrosis factor (TNF) activity and blood monocytic in vitro production of interleukin 1 (IL-1) in 24 severely burned patients. The myocardial and hepatic enzymes (which included aspartate aminotransferase (AST), creatine kinase (CPK), lactate dehydrogenase (LDH), alpha hydroxybutyric dehydrogenase (alpha-HBDH) and alanine amino-transferase (ALT) and some indices of biochemical metabolism (including lactic acid (LA), total protein (TP), albumin (Alb) and colloid osmotic pressure (COP)) were simultaneously measured. The results showed an evident increase in serum TNF activity and a decrease in in vitro production of IL-1 postburn; all the changes in TNF and IL-1 were correlated significantly with those of myocardial and hepatic enzymes in MOF patients. Furthermore, there were marked fever, hypoproteinaemia, tissue ischaemic and hypoxic symptoms such as hyperlacticaemia, and signs reflecting tissue hypercatabolic states. These all suggested that TNF and IL-1 might play important roles in the development of MOF.

[Results of school children with enterobiasis in Tainan city, treated with mebendazole]

There were 2,471 school children suffering from enterobiasis in six primary schools of Tainan city. The infected children in five primary schools, Po-Ai, Yung-Hua, Fu-Hsiao, Pao-Jeng and Hsin-Nan, were treated with one single dosage of 100 mg mebendazole. In Shih-Men primary school, the sixth, the students were given placebos as a control group. Negative conversion rates of infected children were examined after three weeks of chemotherapy and school children in the six primary schools were surveyed for enterobiasis two months after chemotherapy to obtain infection rates. The method of examination was two consecutive-day adhesive cellophane perianal swabs. With the purpose of evaluating the efficiency of treatment, positive reduction rates were used and calculated according to the infection rates of school children gained before and after chemotherapy. Those rates in Pao-Jeng, Fu-Hsiao, Yung-Hua, Po-Ai and Hsin-Nan were 62.1%, 47.8%, 41.8%, 37.1% and 3.3%, respectively, and in Shih-Men 3.9%. Judging the data obtained from each grade or each class of schools showed that the efficacy of chemotherapy in reducing the rate of infection was variable. Hence, one single dose of mebendazole and education on personal hygiene were not sufficient to reduce the prevalence of enterobiasis in primary schools. This was because the cycle of E. vermicularis was relatively short, cutting out the routes of transmission was very difficult, and the factors involved were very complex. Overall, though the positive reduction rate presented in Hsin-Nan primary school showed nearly no success in reducing the infection, the other four schools showed valuable rates. Whether continue a treatment, of about three-months in duration, can inhibit the prevalence of enterobiasis among children in primary schools or not will need further study.

Differentiation of oval cells into duct-like cells in preneoplastic liver of rats placed on a choline-deficient diet supplemented with ethionine

Feeding male Wistar rats a choline-deficient diet containing 0.07% DL-ethionine (CDE diet) for up to 5 weeks results in the production of two distinct non-parenchymal cell populations, oval and duct-like cells. These cells can undergo replication and display different patterns of expression of glutathione S-transferases (GSTs) and pyruvate kinases (PKs). Oval cells were first detected around the periportal region after 1 week of CDE treatment and infiltrated the parenchyma after 2 weeks. Duct-like structures first appeared as isolated ducts in the parenchymal region at 2 weeks and were easily detected after 2.5 weeks. These duct-like structures differed from the bile ducts which reside in the portal region. Large concentrations of duct-like structures in cyst-like clusters were detected after 5 weeks. Enlargement of these structures from single ducts to clusters of up to 20 ducts was observed over 3-5 weeks of CDE treatment. The number of cells forming a duct increased from 5 to 30 cells. We established a double immunocytochemical staining technique to characterize the oval and duct-like cells for their expression of GSTs and PKs. pi GST and M2-PK, which are fetal hepatocytes isoenzymes, are present in virtually all the oval and duct-like cells. Most of the oval cells are devoid of the adult hepatocytes markers, alpha GST, mu GST and L-PK. There are two sub-populations of duct-like cells, one which expresses only fetal markers and the other which co-expresses the adult and fetal isoenzymes. Hence, oval cells display characteristics of fetal hepatocytes and some duct-like cells appear more mature than oval cells. Using a combination of double immunocytochemical and [3H]thymidine labelling techniques we have established that oval cells differentiate into duct-like cells.

[Testis yolk sec tumor--a case report]

A 16-months old normal boy, a right testicular mass was discovered incidentally by his grandmother. Right inguinal orchiectomy was performed. Histological examination showed yolk sac tumor of testis. A preoperative alpha-fetoprotein level was markedly elevated at 13568.9 ng/ml, by the end of the twelve postoperative months, the serum alpha-fetoprotein levels was 118 ng/ml. The patient is doing well one-year postoperatively.

Different sensitivities of native and oxidized forms of Na+/K(+)-ATPase to intracellular proteinases

Inactivation of Na+/K(+)-ATPase by partially reduced oxygen metabolites has been implicated in ischemia-reperfusion injury to heart and other organs. Because oxidation of many proteins makes them more susceptible to degradation by intracellular proteinases, we studied the effects of several such proteinases on native and H2O2-oxidized preparations of Na+/K(+)-ATPase from canine kidney (containing alpha 1 isoform of the catalytic subunit) and rat axolemma (containing alpha 2 and alpha 3 isoforms). Lysosomal cathepsin D degraded the native and the oxidized preparations at acid pH, but it was significantly more effective against the oxidized forms. m-Calpain had little or no effect on the native Na+/K(+)-ATPase preparations, but it digested the oxidized alpha-subunits of the axolemma and the kidney enzymes. mu-Calpain's effects were similar to those of m-calpain. Multi-catalytic proteinase which is known to degrade a large number of oxidized proteins, did not affect the native or the oxidized forms of Na+/K(+)-ATPase. The findings suggest that (a) during oxidative stress there may be accelerated degradation of the oxidatively damaged Na+/K(+)-ATPase, either through internalization and transport to lysosomes, or by the action of calpains at the membrane; and (b) those isoforms of the enzyme that are more sensitive to oxidants are more susceptible to degradation by the above processes.

[The roles of macrophage in immune dysfunction following severe thermal injury]

This experimental study in serious scald mice showed that the cytosolic free calcium ion concentration and the capacity of secreting TNF-alpha of macrophage (M phi) were obviously increased while the secretion of IL-1 was significantly decreased, and accompanied with simultaneous apparent rising of serum TNF-alpha in early postburn period. These indicate that M phi have been highly or even over activated after burn. But the ability of antigen presentation of M phi during this period was deeply suppressed rendering the obvious declination of activity and proliferation response of antigen pulsed lymphocytes. It might be concluded that the defective antigen presentation of M phi played a critical role in early immune dysfunction of severe scald mice, and the highly activated or even overactivated M phi by excessive secretion of TNF-alpha were the molecular basis of the alterations of M phi function.

Differential regulation of superoxide dismutase in copper-deficient rat organs

The effects of dietary copper deprivation on the activities, immunoreactive protein concentrations, and mRNA abundance of copper/zinc- and manganese-superoxide dismutase (Cu/Zn- and Mn-SOD) were examined in liver, heart, and brain of weanling rats fed a Cu-deficient diet for 4 weeks. Hepatic Cu/Zn-SOD activity, enzyme content, and mRNA abundance were significantly reduced, and, conversely, the activity, protein, and mRNA levels of Mn-SOD were significantly elevated in Cu-deficient rats. In Cu-deficient heart, the activity and protein content for Cu/Zn-SOD were reduced, whereas those for Mn-SOD were increased; the levels of mRNAs for these two enzymes was unaffected. Dietary Cu deficiency was without effect on the activities, enzyme contents, and mRNA abundance of brain Cu/Zn- and Mn-SOD. These results indicate that SODs from liver, heart, and brain exhibit differential sensitivities to dietary Cu deprivation, and that different mechanisms (transcriptional, posttranscriptional, or posttranslational) may be involved in their regulation.

Different sensitivities of the Na+/K(+)-ATPase isoforms to oxidants

Inhibition of Na+/K(+)-ATPase by partially reduced oxygen metabolites has been suggested to be involved in ischemia-reperfusion injury to heart and other organs. Since various isoforms of the enzyme have different sensitivities to ouabain and several other inhibitors, we studied the effects of H2O2 and the hydroxyl radical on enzyme activity and phosphoenzyme formation in Na+/K(+)-ATPase preparations with known alpha-subunit isoform composition in order to assess the oxidant sensitivities of the isoforms. Rat axolemma enzyme (alpha 2 and alpha 3) which has higher sensitivity than the rat kidney enzyme (alpha 1) to ouabain also showed higher oxidant sensitivity than the kidney enzyme. No significant difference between the oxidant sensitivities of the alpha 2 and alpha 3 of the axolemma was noted. In the ferret heart enzyme (alpha 1 and alpha 3), we confirmed that alpha 3 has higher ouabain sensitivity than alpha 1, and we established that alpha 3 also has higher oxidant sensitivity than alpha 1. The rat kidney enzyme (alpha 1) and the canine kidney enzyme (a variant of alpha 1 with much higher ouabain sensitivity than the rat kidney enzyme) exhibited similar oxidant sensitivities. The findings suggest that (a) oxidant sensitivity is related to structural features that distinguish alpha 1 from alpha 2 and alpha 3, rather than to features that control ouabain sensitivity; and (b) different isoform compositions of the various tissues may contribute to their relative susceptibilities to oxidant stress.

The significance of changes in serum tumour necrosis factor (TNF) activity in severely burned patients

In order to explore the pathogenesis of postburn internal organ injury (OI) and multiple organ failure (MOF), serum TNF activity was measured by biological assay in 24 severely burned patients. Parameters related to internal organ functions were simultaneously measured. The results showed an obvious increase in serum TNF activity accompanied by increased serum myocardial and hepatic enzymes, plasma lactate and aggregations of WBC in internal organ tissues. Serum protein levels decreased substantially. These changes were more marked in patients suffering from both OI and MOF. It is suggested that large amounts of TNF are produced postburn and might have an important role in the development of OI and MOF.

[Teratoma of testis--a case report]

A case of mature testicular teratoma in a 5-year-old child is presented. The level of serum beta-human chorionic gonadotropin (beta-HCG), alpha-fetoprotein (alpha-AFP), and carcinoembryonic antigen (CEA) were all within normal limit one year post-operatively. We discussed the clinical features, treatment and the result of this patient and reviewed the literature.

Serosurveys of spotted fever and murine typhus in local residents of Taiwan and Thailand compared with Japan

To estimate the prevalence of spotted fever (SF) and murine typhus (MT) rickettsioses in Southeast Asia, we performed serosurvey by immunoperoxidase test on local residents in Taiwan and Thailand, comparing them with those of Japan. In Japan, the prevalence of antibodies (1:80 as cut-off level) to some SF/MT antigens was noticeable in Japanese SF-endemic areas or a high-risk groups. In Tainan, Taiwan, SF antibodies were not so prevalent (3.5 to 4.4%), but MT antibodies were more prevalent (23.9%). In Chiang Rai in northern Thailand SF antibodies were markedly prevalent (9.0 to 21.3%); the reactivity with Thai tick 118 strain alone was 8.2%, but MT was less (2.5%). These results suggest that these rickettsioses may be latently distributed in various parts of Asia.

Allosteric regulation of the access channels to the Rb+ occlusion sites of (Na+ + K+)-ATPase

Previous work on the role of occluded Rb+ (a K+ substitute) in the reaction cycle of (Na+ + K+)-ATPase has focused on the kinetics of the dissociation of the enzyme-Rb+ complex at 20-24 degrees C. Doing experiments at 4 degrees C, we have made the following observations on the equilibrium binding levels and the kinetics of binding and release of Rb+. 1) The plot of bound Rb+ as a function of [Rb+] showed occupancy of high affinity sites, followed by binding to sites of lower affinity. The estimated number of Rb+ sites/active site was two to three, but a higher number was not ruled out. Release of bound Rb+ was slow and not monoexponential, the major portion being in a pool with a half-life of 4-5 h. Dissociation curves were identical at different levels of site occupancy. Rb+ binding also had fast and slow phases, requiring about 24 h to reach steady state at vastly different [Rb+]. These data suggest that (a) Rb+ occlusion sites are confined within the protein matrix and connected to the medium by narrow access channels that are heterogeneous in size, and (b) channel heterogeneity is distinct from differences in occlusion site affinities. 2) ATP, at a low affinity allosteric site, had no significant effect on the maximal level of bound Rb+ at any [Rb+], but it accelerated both the fast and the slow phases of Rb+ binding and release, and it increased the ratio of fast to slow phases. Evidently, ATP activates the channels (lowers the energy barrier for access) without altering binding site affinities. 3) Na+ was a competitive inhibitor of Rb+ at the occluded sites, but it also acted at an allosteric site to activate the access channels. Rb+ and K+ also had allosteric effects: although they did not affect the access channels directly, they blocked the allosteric effect of Na+. 4) Ouabain was an access channel inhibitor. It reduced the rates of binding and release of Rb+, blocked channel activation by ATP and Na+, but seemed to have no effect on the events at the occluded sites. The existence of heterogeneous access channels to the ion transport sites and the demonstration of channel regulation by the physiological ligands of the enzyme suggest the necessity of the inclusion of such allosteric mechanisms in the reaction cycle of (Na+ + K+)-ATPase.