Novel platelet antiaggregating substances

We describe herein a novel action of four stable analogs of the hepoxilins. These analogs inhibit to different degrees, the aggregation of washed human platelets evoked by collagen. One of the analogs, PBT-3, is particularly effective with an IC(50) = 8 x 10(-7) M. The other analogs are about 5-fold less active, but all analogs are about 500-fold more active than the native hepoxilins. The PBT analogs inhibit the collagen-enhanced formation of thromboxane A(2) and HHT but do not affect the formation of 12-HETE or the release of arachidonic acid except at doses higher than those needed to block platelet aggregation. These results demonstrate that these novel compounds may have potential for development into drugs in the treatment of thromboxane-mediated cardiovascular disease.

[Observation of preventing of bone loss during early postmenopause by percutaneous estradiol in Chinese postmenopausal women]

OBJECTIVE

To investigate the optimal regimen for application of percutaneous estradiol gel in preventing bone loss in Chinese postmenopausal women.

METHODS

A 3-year open randomized clinical study was designed. The percutaneous estradiol gel was used in a cyclic regimen combined with micronized progesterone (MP) or medroxyprogesterone acetate (MPA). Sixty healthy women (naturally menopause for 1 to 5 years) were recruited and divided into four groups according to estrogen dosage and two kinds of progestin. All were given for 25 d/month. The cortical bone mineral density (BMD) of right radius was measured by single photon absorptiometry. The trabecular BMD in lumbar vertebrae was measured by quantitative CT. The spine and hip BMD were also measured by dual energy X-ray absorptiometry at baseline, 6, 12, 18, 24 and 36 months, respectively. The bone metabolic markers, scores of menopausal symptoms were also evaluated.

RESULTS

Fifty-nine patients (98%) completed 1 year and 56 patients (93%) 2 years, 51 (85%) 3 years of study. The symptoms were alleviated by 80% after 6 months treatment on average. By the end of 24 month, the mean increases of BMD ranged from 4.3% to 7.5% in trabecular bone, and by the end of 36 month 4.2% to 6.2% in the lumbar (L) 2-4, 1.6% to 3.8% in the femur neck, with significant differences (P < 0.05). Comparing the 4 groups with each other, no significant differences (P > 0.05) were found in improvement of symptoms, bone markers and BMD.

CONCLUSIONS

Both daily estrogen containing 0.75 mg and 1.5 mg E2 are effective to prevent the early postmenopausal bone loss and improve the menopausal symptoms. During 3 years treatment, the BMD of lumbar increased continuously and the BMD of hip increased in the first 2 years and then plateau.

[A clinical evaluation on reconstruction in extended partial laryngectomy for transglottic cancer]

OBJECTIVE

Transglottic cancer has been a definite indication for total laryngectomy in decades, compromising function of the larynx. The purpose of this study is to present a new radical surgery of extended partial laryngectomy and reconstruction to restore the essential function of larynx.

METHODS

Forty-one cases of transglottic cancer were treated by extended vertical laryngectomy (26/41), extended frontolateral laryngectomy (5/41) and subtotal laryngectomy (10/41); the defects of larynx were reconstructed by rotary door myocutaneous flap in twenty-seven cases, by sternohyoideus flap in seven cases, by osteomuscular flap in five cases and by sternocleidomastoid flap in two cases.

RESULTS

The 3 and 5 year survival rates were 85.7% (30/35) and 74.1% (20/27) respectively, those for stage III were 84.6% (22/26) and 76.2% (16/21), for stage IV were 3/4 and 1/2 respectively. All cases resumed acceptable voice, 92.7% (38/41) and enjoyed satisfactory phonation. The over-all decannulation rate was 87.8% (36/41), those with rotary door myocutaneous flap was 96.3% (26/27), with sternohyoideus flap was 5/7, with osteomuscular flap was 4/5 and with sternocleidomastoid flap was 1/2. All patients had normal swallow function.

CONCLUSION

Extended partial laryngectomy is a kind of radical operation in selected cases of transglottic cancer. The method of reconstruction with rotary door myocutaneous flap can improve curative effect and the essential functions of the larynx.

Expression of epidermal growth factor in salivary adenoid cystic carcinoma

This study used an immunohistochemical technique to assess the expression of epidermal growth factor (EGF) in 40 specimens of salivary adenoid cystic carcinoma (ACC), 7 specimens of labial glands adjacent to mucocele, and 5 specimens of normal submandibular glands. In normal submandibular glands, immunohistochemically detectable EGF was demonstrated in all ductal segments, including intercalated, striated, and excretory duct cells. No EGF positive staining was found in acinar compartments. including serous and mucous acinar cells. In degenerated labial glands adjacent to mucocele, no EGF staining was detected in the remaining acinar and ductal cells. In salivary ACCs, positive EGF immunostaining was observed in one of the 5 (20%) ACCs with a solid pattern and in 13 of the 35 (37.1%) ACCs with a tubular-cribriform pattern. The overall EGF expression rate in 40 salivary ACCs was 35%. Positive EGF staining was predominantly found in tubular structures in the tubular ACCs and in duct-like structures in large cribriform patterns or in the stroma of the cribriform ACCs. There was no significant correlation between EGF expression in salivary ACCs and any of the clinicopathological parameters including patient age and sex, cancer location, TNM status, clinical stage, histologic type, perivascular or perineural invasion, focal necrosis of tumor, and cellular atypia. We conclude that the duct segments of the normal submandibular gland are the sites of EGF synthesis and secretion. In degenerated labial glands adjacent to mucocele, EGF synthesis is completely inhibited. Furthermore, EGF is mainly biosynthesized in cells forming tubular or duct-like structures in tubular or cribriform salivary ACCs, and EGF may play a biologic role, particularly as a mitogen in salivary ACC growth.

[The effects of iron supplementation on auditory brain-stem response with iron deficiency anemia in rats]

OBJECTIVE

To evaluate the therapeutic methods of sensorineural hearing loss with iron deficiency anemia and their effects.

METHOD

Sixty-eight Wistar rats were randomly divided into 3 groups: Group A (iron deficiency group A) 24 rats, group B (iron deficiency group B) 24 rats and group C (control group) 20 rats. Group A and B were fed with iron deficiency diet for 6 weeks. By analyzing ABR and DPOAE, hearing loss was detected in group A and B. Then, group A was given iron supplementation diet and hyperbaric oxygen therapies, and group B was given iron supplementation diet only.

RESULT

The auditory thresholds and period latencies (PL) of I waves of ABR and DPOAE amplitude in 2 kHz and 3 kHz within group A and B were significantly different before and after treatment (P < 0.05). But the effects of treatment between these two groups had not significant differences (P > 0.05).

CONCLUSION

It suggested that good results can be obtained by early iron supplementation in iron deficiency hearing loss cases. Hyperbaric Oxygen therapy may not be necessary.

How to use progestin in hormone replacement therapy: an animal experiment

OBJECTIVE

To determine whether continuous or cyclic hormone replacement therapy (estrogen and progestogen) is better.

METHODS

One hundred and forty Sprague-Dawley rats were randomly divided into seven groups. The 1st and 2nd groups were normal estrous and ovariectomy (OVX) controls. Treatment of the other groups imitated the clinical regimen (continuous and cyclic) with estradiol valerate (E2V) and medroxy progesterone (MPA) in different ratios of combination. The rats were sacrificed and sections of uterus were stained with HE and histochemical methods to detect mitosis and proliferating cell nuclear antigen (PCNA), respectively. The mitotic index (MI) and PCNA index were calculated.

RESULTS

The MI and PCNA index were similar in luminal and glandular cells. Both markers were low in the two control groups. When E2V was given for 1 to 6 days, both the MI and PCNA index increased with duration of treatment. When MPA was added, both markers were reduced to a very low level. In the continuous regimen, both markers decreased as the MPA dosage increased. The ratio of E2V: MPA = 1:0.5 was enough to suppress markers to a low level similar to that of normal estrous rats. A further increase in the ratio to 1:1.0 showed no further decrease in PCNA index. In the cyclic regimen, MPA was added for the last 5 days. The mitotic index reached a significantly low level near 0 in all ratios, but the PCNA index in each subgroup was still as high as the positive control, even though the dosage of MPA was increased several times to 1:8.0. When MPA was added for the last 10 days, the PCNA index at a ratio of 1:4.0 could be reduced to a low level.

CONCLUSION

The results of this study suggest that the continuous regimen was better than the cyclic regimen in postmenopausal hormone replacement therapy (HRT). Progestin should be given for at least 10 days in the cyclic regimen.

Some nutritional and functional properties of defatted wheat germ protein

Defatted wheat germ protein (DWGP) was isolated by alkaline extraction at pH 9.5 and subsequent isoelectric precipitation at pH 4.0, and its nutritional and functional properties were studied. The results showed that the amino acid content of defatted wheat germ was as high as 26.793 g/100 g, and the contents of eight essential amino acids were all relatively high. The isoelectric point of DWGP was 4.0. When pH >6.0, the DWGP had high solubility with a nitrogen solubility index of 70%. The emulsifying activity and emulsifying stability of DWGP were similar to those of bovine serum albumin and a little higher than those of casein. DWGP had good foaming capacity, but its foaming stability (FS) was not very good. However, the FS of DWGP can be improved through physical, chemical, or enzymatic methods. Moreover, DWGP had excellent water retention (WR); especially at pH 8.0 and a temperature of 70 degrees C, the WR of DWGP was the highest at 229.4%. DWGP offers is a potential source of functional protein isolate for possible food applications.

[Application of mitotic index and proliferating cell nuclear antigen index in monitoring the change of rat endometrium after administration of estrogen and progestin]

OBJECTIVE

To investigate the mitotic index (MI) and proliferating cell nuclear antigen (PCNA) index in monitoring the rat endometrium during estrogen and progestin administration.

METHODS

One hundred and sixty Sprague-Dolly rats were randomly divided into seven groups. The 1st and 2nd group were normal estrous (E) and ovariectomized (OVX) control. The other groups received estradiol (E2V) only or combined with medroxyprogesterone(MPA) which imitated the clinical regimen in different dosage and different time before sacrificed. Uteri sections were stained with HE and immunohistochemical procedures to detect mitosis and PCNA.

RESULTS

The MI and PCNA index were similar in the luminal and glandular cells. Both markers were low in the two control groups and increased with the E2V dosage in the treatment group. But if E2V was given for 1 to 21 days, the MI increased during the first 3 days and then dropped to low level and kept to the end. PCNA index increased in the first 3 days and decreased to a low level on the 4th day and then increased gradually to a high level until the last day. In the continuous regimen, both markers decreased as the MPA dosage increased. In the cyclic regimen, The MI reached to a significant low level nearly to zero in almost each ratio. Addition of MPA for 10 days, PCNA index at the ratio of 1:4.0 could be reduced to a low level and addition for 5 days, PCNA index in each subgroup was still as high as the positive control even though the dosage of MPA increased several times to 1:8.0.

CONCLUSIONS

This study suggests that PCNA index can reflect both the effect of estrogen and progestogen. PCNA index is better than mitotic index in reflecting the change of endometrium.

Expression of interleukin-2 receptor by activated peripheral blood lymphocytes upregulated by the plasma level of interleukin-2 in patients with recurrent aphthous ulcers

This study used flow cytometry to determine the peripheral blood lymphocyte subsets and a sandwich enzyme immunoassay to measure the plasma levels of interleukin-2 (IL-2) and soluble IL-2 receptor (sIL-2R) in 34 patients in different stages of recurrent aphthous ulcers (RAU) and in 32 age/sex-matched normal control subjects. In the exacerbation stage of RAU, a significant increase in the percentages of CD3+ (p < 0.001), CD4+ (p < 0.001), CD4+ IL-2R+ (p < 0.001), CD8+ IL-2R+ (p < 0.01) and IL-2R+ cells (p < 0.001), in the CD4+/CD8+ (p < 0.01) and CD4+/CD3+ CD8+ ratios (p < 0.01), and in the plasma level of IL-2 (p < 0.001) was found in the patients as compared with the levels in the normal control subjects. However, in the post-exacerbation stage of RAU, there was a significant decrease in the percentage of CD4+ cells (p < 0.05) and in the CD4+/CD8+ (p < 0.01) and CD4+/CD3+ CD8+ ratios (p < 0.001), as well as a significant increase in CD8+ cells (p < 0.001) in the patients, as compared with the levels in the normal control subjects. Because the CD4+, CD4+ IL-2R+ and CD8+ IL-2R+ cell counts and the plasma level of IL-2 increased simultaneously in the patients in the exacerbation stage of RAU, we suggest that the markedly increased plasma level of IL-2 may have been secreted by the increased number of activated CD4+ cells, and that the expression of IL-2R by activated peripheral blood lymphocytes was upregulated by the plasma level of IL-2 in patients with RAU. In addition, the increase and then decrease of the CD4+/CD8+ ratio in the RAU patients and the increased number of CD4+ IL-2R+ and CD8+ IL-2R+ activated T cells in the RAU patients support the role of cell-mediated cytotoxicity in the immunopathogenesis of RAU.

Dexamethasone for the prophylaxis of radiation-induced emesis: a National Cancer Institute of Canada Clinical Trials Group phase III study

PURPOSE

To investigate the efficacy of dexamethasone as a prophylactic antiemetic for patients receiving fractionated radiotherapy to the upper abdomen in a randomized controlled trial.

PATIENTS AND METHODS

One hundred fifty-four patients planned to receive fractionated radiotherapy to fields involving the upper abdomen (minimum total dose, 20 Gy; minimum number of fractions, five) were randomized to receive prophylactic dexamethasone (2 mg orally three times a day [tid], starting in the morning of first treatment and continuing until after their fifth treatment) or placebo. The primary end point of the study was the proportion of patients free from emesis during the study period. Secondary end points included a quality-of-life assessment using the core questionnaire of the European Organization for Research and Treatment of Cancer and side effects of dexamethasone therapy in this population of patients.

RESULTS

Fifty-four (70%) out of 75 patients receiving dexamethasone had complete protection versus 37 (49%) out of 75 patients on placebo (P = .025). Most emetic episodes occurred during the initial phase of treatment. Although there was no difference in global quality of life between the two sets of patients, patients receiving dexamethasone had less nausea and vomiting and less loss of appetite but more insomnia.

CONCLUSION

Dexamethasone 2 mg tid seems to be an effective prophylactic antiemetic in this situation. Side effects were acceptable, but there seemed to be no overall effect on global quality of life.

Strong association of antiepithelial cell antibodies with HLA-DR3 or DR7 phenotype in patients with recurrent oral ulcers

BACKGROUND

Previous studies showed that antiepithelial cell antibodies (anti-ECA) were present in 71% (15/21) of patients with recurrent oral ulcers (ROU) and that there was a strong association of human leukocyte antigen (HLA)-DRw9 with ROU in Chinese patients. In this study, we assessed anti-ECA in a larger group of Chinese patients with ROU (n = 88) in order to further investigate the association of anti-ECA with HLA-DR and -DQ antigens.

METHODS

The anti-ECA in the sera of ROU patients were detected by an indirect immunofluorescence technique with rat esophagus as the substrate, and the HLA-DR and -DQ antigens in ROU patients were typed by a standard microcytotoxicity assay using Terasaki's oriental tray.

RESULTS

The rate of anti-ECA positivity was significantly higher (p < 0.0001) in ROU patients (68%) than in healthy control subjects (0%). Furthermore, the rate of anti-ECA positivity in patients with major or minor oral ulcers (72%) was significantly higher (29%) than that in patients with herpetiform ulcers (p < 0.05). There was a significant increase in the frequency of DR3 or DR7 antigen expression (p < 0.0001, pc [p corrected] < 0.001, relative risk [RR] = 4.3, etiologic fraction = 0.41) in anti-ECA-positive ROU patients compared with the corresponding frequencies in healthy control subjects. There was also a significant increase in the frequency of DR7 or DRw9 antigen expression (p < 0.005, pc < 0.05, RR = 4.7, etiologic fraction = 0.45) compared to healthy controls.

CONCLUSIONS

Because only DR3 or DR7 antigen occurred more frequently in anti-ECA-positive than in anti-ECA-negative ROU patients (p < 0.0007, pc < 0.05, RR = 19.6, etiologic fraction = 0.51), we concluded that the gene coding for DR3 or DR7 antigen may contribute to the presence of anti-ECA in Chinese patients with ROU.

Association of HLA-te22 antigen with anti-nuclear antibodies in Chinese patients with erosive oral lichen planus

The purpose of this study was to determine the frequencies of the presence of serum anti-nuclear antibodies (ANA) and smooth muscle antibodies (SMA) in 76 patients with oral lichen planus (OLP), in 77 patients with other oral mucosal diseases, and in 41 healthy control subjects. HLA phenotypes in some of the patients with OLP and recurrent aphthous ulcers (RAU) were determined to show whether there was an association of HLA antigens with the presence of autoantibodies. Indirect immunofluorescence techniques with mouse liver or stomach as the substrate were used to detect the serum ANA or SMA, respectively. The B lymphocytes isolated from peripheral blood were used for HLA typing by means of a standard microcytotoxicity assay. We found that the positive rate of serum ANA in patients with OLP (29%, p < 0.01), especially in patients with erosive OLP (34%, p < 0.001), was significantly higher than that in the normal control subjects (5%). The frequency of serum SMA in patients with OLP (20%, p < 0.01), in patients with RAU (17%, p < 0.01), or in patients with oral squamous cell carcinomas (41%, p < 0.001) was also significantly higher than that in normal control individuals (0%). In the erosive OLP group, the HLA-Te22 antigen occurred more frequently in patients with positive ANA (75%, p < 0.05) than in those with negative ANA (25%). We conclude that there is an association of HLA-Te22 antigen with ANA in Chinese patients with erosive OLP.

[Application of high frequency radiosurgical knife in the treatment of cervical diseases]

OBJECTIVE

To investigate the indication, resection scope of loop electrosurgical excision procedure (LEEP) and pathological characteristics.

METHODS

176 cases with abnormal cytological and colposcopical findings, including cervical intraepithelial neoplasia (CIN) and atypical squamous cells of undermined significance (ASCUS), were studied. Conization of cervix was performed in 63 cases of > or = CIN2, of which 33 cases with LEEP and 30 by traditional electrosurgical knife (TEK) as controls. Cervical biopsy was performed in 113 cases of CIN1 and ASCUS, of which 60 cases by LEEP and 53 by cervical biopsy forceps (CBF) as controls.

RESULTS

Three months after conization of cervix the cytological persistent rate of disease was 6.1% in LEEP group and 6.7% in TEK group (P > 0.05). The operation duration of LEEP is (5.0 +/- 0.5) min, and is much shorter than TEK [(15.0 +/- 0.4) min]. The bleeding and recovery time of the cervix are also shorter (P < 0.01). Three months after cervical biopsy the cytological persistent rate of diseases was only 1.7% in LEEP group, significantly less than that in CBF group (35.8%).

CONCLUSION

LEEP is indicated to conization of cervix of CIN2-3 and cervical biopsy of CIN1 and ASCUS. It is safe and time-saving. The optimal depth of cervical conization and biopsy was 7 mm and 4 mm respectively in the cervix, and 15 mm and 4 mm respectively in the cervical tube. It can offer intact sample for pathological diagnosis, and has special value for detecting cervical microinvasive carcinoma and local minor carcinoma.

A role for intracellular calcium in tight junction reassembly after ATP depletion-repletion

The integrity of the tight junction (TJ), which is responsible for the permeability barrier of the polarized epithelium, is disrupted during ischemic injury and must be reestablished for recovery. Recently, with the use of an ATP depletion-repletion model for ischemia and reperfusion injury in Madin-Darby canine kidney cells, TJ proteins such as zonula occludens-1 (ZO-1) were shown to reversibly form large complexes and associate with cytoskeletal proteins (T. Tsukamoto and S. K. Nigam, J. Biol. Chem. 272: 16133-16139, 1997). In this study, we examined the role of intracellular calcium in TJ reassembly after ATP depletion-repletion by employing the cell-permeant calcium chelator 1, 2-bis(2-aminophenoxy)ethane-N,N,N',N'-tetraacetic acid-AM (BAPTA-AM). Lowering intracellular calcium during ATP depletion is associated with significant inhibition of the reestablishment of the permeability barrier following ATP repletion as measured by transepithelial electrical resistance and mannitol flux, marked alterations in the subcellular localization of occludin by immunofluorescent analysis, and decreased solubility of ZO-1 and other TJ proteins by Triton X-100 extraction assay, suggesting that lowering intracellular calcium potentiates the interaction of TJ proteins with the cytoskeleton. Coimmunoprecipitation studies indicated that decreased solubility may partly result from the stabilization of large TJ protein-containing complexes with fodrin. Although ionic detergents (SDS and deoxycholate) appeared to cause a dissociation of ZO-1-containing complexes from the cytoskeleton, sucrose gradient analyses of the solubilized proteins suggested that calcium chelation leads to self-association of these complexes. Together, these results raise the possibility that intracellular calcium plays an important facilitatory role in the reassembly of the TJ damaged by ischemic insults. Calcium appears to be necessary for the dissociation of TJ-cytoskeletal complexes, thus permitting functional TJ reassembly and paracellular permeability barrier recovery.

[Induction and validation of arterial calcium overload in rats]

OBJECTIVE

To induce arterial calcium overload (ACO) in rats and analyze its features.

METHODS

Arterial calcium content and intracellular calcium content were determined by atomic absorption spectrometer and electron probe microanalysis, respectively. The morphological changes of endothelial cells and vascular smooth muscle cells were studied with scanning and transmission electron microscopes. DNA contents and its mass distribution were determined by DNA imaging analysis. Arterial collagen and elastin contents were determined biochemically.

RESULTS

Seven days after the induction of ACO with selected regimen, massive calcium was found accumulating in the arterial wall, including the cytoplasm and mitochondrion of the medial smooth muscle cells, indicating both extracellular and intracellular calcium overload. Degeneration of aortic endothelial cells was found at the early stage of ACO under scanning and transmission electron microscope. At the late time of ACO, significant proliferation and sclerotic reactions of arteries occurred, including the proliferation of smooth muscle cells, matrix remodeling, and damage of elastic structure. The average DNA content per smooth muscle cell was elevated, and more cells entered the S phase of proliferating cycle since day 7. On the other hand, total collagen content of aorta was increased 7 days after induction of ACO, and rose continuously at day 14 (P < 0.05). Functional studies showed that arterial elasticity was significantly impaired.

CONCLUSION

Our method could induce ACO/constantly in rats, and the ACO model shares the similarities with the characterization of human arteriosclerosis on many aspects.

[Synergistic interaction between Ys-96, a bisbenzylisoquinoline compound derived from Stephania tetrandra, and adriamycin or vincristine against human cancer cell lines in vitro]

OBJECTIVE

To study in vitro the anticancer interaction between Ys-96, a bisbenzylisoquinoline compound derived from Stephania tetrandra, and adriamycin or vincristine against human cancer cell lines.

METHOD

Using human breast cancer cell MCF-7 and its adriamycin-resistant cell line MCF-7/Adr, and human nasopharyngeal cancer cell KB and its vincristine-resistant cell line KBv200 in an in vitro system, anticancer interaction between Ys-96 and adriamycin or vincristine was evaluated with a method reported by Berenbaum.

RESULT

The SFIC values (sum of fractional inhibitory concentration) of the combinations with 3 different ratios between Ys-96 and adriamycin or vincristine were markedly less than 1.0, and the shapes of all the isobologram curves were concave.

CONCLUSION

The synergistic interaction between Ys-96 and adriamycin or vincristine against the above human cancer cell lines was positively observed in vitro.

Novel targets for therapeutic intervention against ischemic brain injury

Ischemic stroke is a major health care problem worldwide, and the mechanisms that lead to ischemic brain injury are not completely defined. In the past few years, the identification of many molecules that participate in neuronal death and particularly in apoptosis, has shed light on the development of neuroprotective therapy. Glycine site antagonism of N-methyl-D-aspartate (NMDA) receptors may offer an alternative means to a blockade of glutamate neurotoxicity, which lacks most side effects associated with competitive and noncompetitive NMDA receptor antagonists. Inflammatory processes executed by some proinflammatory molecules contribute to secondary brain injury. Neutral protease calpain is capable of degrading critical cytoskeletal and regulatory proteins, mainly causing postischemic neuronal necrosis. Caspases, a family of cysteine proteases, are at the heart of the apoptotic pathway. Severe DNA damage induced by oxidative stress or apoptotic stimuli activates poly(ADP-ribose) polymerase, causing a rapid depletion of nuclear NAD pools, cellular energy, and thiols. Inhibition of these inducible molecules is expected to achieve effective neuroprotection without serious side effects because the molecules seem relatively unimportant in normal neurotransmission. In the future, the efficacy of these novel strategies should be confirmed in larger study populations, individually and in combinations, before considering clinical application.

[Determination of the aconitine alkaloids in traditional Chinese medicine chuanwu and caowu by high performance capillary electrophoresis(HPCE)]

A simple and rapid method for the simultaneous assay of three aconitine alkaloids (mesaconitine (MA), hypaconitine (HA) and aconitine (A) in the traditional Chinese medicines, Chuanwu and Caowu, by high performance capillary electrophoresis has been established, using tetracaine as an internal standard. The experimental conditions were as follows, the electrophoretic medium was composed of V[70 mmol/L Tris-borate (pH 8.49)]: V(methanol) = 60:40, uncoated capillary used was 50 cm x 50 microns i.d. and detection was carried out with a UV monitor at 235 nm. The separation was achieved by optimizing the cartridge temperature, the applied voltage, and the pH as well as the concentration of the buffer, and organic modifier. The calibration curve showed a good linearity in the mass concentration range of 0.0115-0.8330 g/L (r = 0.9996) for MA, 0.0089-0.6440 g/L (r = 0.9997) for HA, and 0.0083-0.6000 g/L(r = 0.9997) for A. The recoveries ranged from 93.0% to 104.0% with relative standard deviations from 0.68% to 1.7%. The total time for separation and determination was within 23 min. By means of this method, three aconitine alkaloids in Chuanwu and Caowu have been determined.

Tardive dyskinesia and serum iron indices

BACKGROUND

This study was undertaken to evaluate whether peripheral (serum) markers of iron status are associated with severity of the choreoathetoid movements seen in tardive dyskinesia (TD).

METHODS

Serum iron indices (ferritin, iron, and total iron binding capacity) and fluphenazine levels were measured in a group of 30 male DSM-III diagnosed schizophrenic patients chronically treated with fluphenazine decanoate. The severity of choreoathetoid movements was assessed with the Abnormal Involuntary Movement Scale (AIMS), and akathisia was assessed with the Barnes scale.

RESULTS

A significant positive correlation was observed between AIMS scores and serum ferritin. This relationship remained significant after controlling for age and plasma fluphenazine levels. No significant correlations were observed between serum iron or total iron binding capacity and choreoathetoid movement ratings. There were no significant associations between serum iron indices and akathisia ratings.

CONCLUSIONS

The data suggest that choreoathetoid movements are associated with serum ferritin levels in chronically medicated male schizophrenic patients. This relationship does not seem to be caused by an association of these variable with age or plasma fluphenazine levels. In addition, the relationship seems to be specific, since other iron indices and another extrapyramidal side effect (akathisia) do not demonstrate a similar relationship. In view of reports that antipsychotic medications change normal iron metabolism and increase iron uptake into the brain, the current results could be interpreted to suggest that serum ferritin levels may be a risk factor for TD in patients treated with "classic" antipsychotic medications.

Effects of molecular structures on the olfactory responses of phospholipid membranes to four alcohols

In order to understand the relationship between phospholipid molecular structures and their olfactory responses to odorants, we designed and synthesized four phosphatidylcholine analogues with different long hydrocarbon (CH) chains and selected three natural phospholipids with different head-groups. By using interdigital electrodes (IEs) as olfactory sensors (OSs), we measured the responses of the IEs coated with these seven different lipid membranes to four alcohol vapors in a gas flow system. The IEs voltage changes were recorded and the voltage-relative saturate vapor pressure (V-P/P degree) curves were also plotted. It was found that with a methyl (-CH3) placed at the C-8 position in the 18-carbon chain, the olfactory responses could be improved about ten times and with conjugated double bonds (C-C) in the long chains, the sensitivity could be increased by 3-4 orders of magnitude. As to head-groups, choline is preferred over ethanolamine and serine in phospholipid structures in terms of high olfactory sensitivity. These results are expected to be useful in further designing and manufacturing lipid-mimicking OSs.

Oxygenation predicts radiation response and survival in patients with cervix cancer

BACKGROUND AND PURPOSE

Hypoxia appears to be an important factor in predicting tumor relapse following radiation therapy. This study measured oxygenation prior to treatment in patients with cervix cancer using a polarographic oxygen electrode to determine if oxygenation was an important prognostic factor with regard to tumor control and survival.

MATERIALS AND METHODS

Between May 1994 and June 1997, 74 eligible patients with cervix cancer were entered into an ongoing prospective study of tumor oxygenation prior to primary radiation therapy. All patients were evaluated with an Eppendorf oxygen electrode during examination under anesthesia. Oxygenation data are presented as the hypoxic proportion, defined as the percentage of pO2 readings of <5 mm Hg (abbreviated as HP5).

RESULTS

The HP5 ranged from 2 to 99% with a median of 52%. With a median follow-up of 1.2 years, the disease-free survival (DFS) rate was 69% for patients with HP5 of < or =50% compared with 34% for those with HP5 of >50% (log-rank P = 0.02). Tumor size above and below the median of 5 cm was also significantly related to DFS (P = 0.0003) and patients with bulky hypoxic tumors had a significantly lower DFS (12% at 2 years) than either bulky oxygenated or non-bulky oxygenated or hypoxic tumors (65%, P = 0.0001).

CONCLUSIONS

Hypoxia and tumor size are significant adverse prognostic factors in a univariate analysis of disease-free survival in patients with cervix cancer. A high risk group of patients with bulky hypoxic tumors have a significantly higher probability of relapse and death.

Outcome in breast cancer managed without an initial axillary lymph node dissection

PURPOSE

The role of an elective axillary lymph node dissection (AxLND) in the initial management of patients with early stage breast cancer has recently become controversial. The objective of this current study is to review the reasons as to why patients from a single institution were managed without an initial AxLND and their outcome in terms of survival and recurrence rates.

MATERIALS AND METHODS

A retrospective analysis was conducted on 126 women referred to the Princess Margaret Hospital with the diagnosis of breast cancer who did not undergo an initial AxLND.

RESULTS

The median age of this population was 69 years, with the vast majority (93%) being post-menopausal. Fifty-seven patients had T1 tumors and the remainder had T2-3 tumors. Adjuvant radiation therapy to the breast was administered to 65 patients and systemic adjuvant treatment was administered to 24 patients. In approximately one-third of these cases, the reasons cited for not performing an AxLND were related to the patient's age, a medical contraindication, or the patient's choice. The 5-year actuarial cause-specific survival was 92%; the local breast relapse-free rate (RFR) was 85% and the axillary RFR was 86%. No patients in this study experienced debilitating symptoms from their axillary disease. Only 16 patients underwent a subsequent AxLND, with the lymph nodes being pathologically uninvolved in six of these patients.

CONCLUSION

This study supports the concept that. in selected patients, adopting an approach of a delayed AxLND does not appear to compromise the patients' outcome, with only 13% of patients requiring a subsequent AxLND.

[Reversal effect of Ys-96, a bisbenzylisoquinoline, on adriamycin or vincristine resistance in human cancer cells in vitro]

OBJECTIVE

Reversal effect of Ys-96, a bisbenzylisoquinoline, on the resistance of human cancer cells to adriamycin or vincristine was studied in vitro.

METHOD

In an in vitro culture system of human cancer cells MCF-7 and its adriamycin-resistant line MCF-7/Ad or KB and its vincristine-resistant line KBv200, the sensitivity(IC50) of the resistant cell lines to adriamycin or vincristine was evaluated with a MTT assay.

RESULT

IC50 value of adriamycin or vincristine in combination with Ys-96 at a concentration of 1.00 mumol/L against MCF-7/Ad or KBv200 was found to be close to that of adriamycin alone or vincristine alone against the sensitive cell line MCF-7 or KB.

CONCLUSION

The drug resistance of MCF-7/Ad or KBv200 could be essentially reversed by Ys-96 at a concentration of 1.00 mumol/L.

[Both myeloma cells and bone marrow stromal cells are involved in the overproduction of interleukin 6 in multiple myeloma]

OBJECTIVE

To investigate the mechanism of interleukin 6 (IL-6) overexpression in multiple myeloma(MM).

METHODS

Human myeloma cells(KM3) and bone marrow stromal cells(BMSCs) were fixed by paraformaldehyde. KM3 cells and BMSCs (fixed and non-fixed) were co-cultured in 10%FCS-RPMI1640. IL-6 activity in the supernatant was determined by B9 cell proliferation test.

RESULTS

Both non-fixed myeloma cells and BMSCs could automatically secret IL-6, while the fixed cells did not. Co-cultures of fixed one with non-fixed the other of either kind of the cells could significantly increase the IL-6 activity in the supernatants. The promoting effect on IL-6 production was greater in BMSCs from MM patients than that in BMSCs from normal controls.

CONCLUSION

There exists dual mechanism of IL-6 overproduction in MM, i.e. both autocrine and paracrine of IL-6 are involved in the pathogenesis of MM.

Preliminary evidence for an association of Epstein-Barr virus with pre-ulcerative oral lesions in patients with recurrent aphthous ulcers or Behçet's disease

In this study we used the polymerase chain reaction (PCR), slot blot and Southern blot hybridization, direct sequencing and in situ hybridization (ISH) to show the possible presence of EBV-DNA in pre-ulcerative oral aphthous lesions of patients with recurrent aphthous ulcers (RAU) or Behçet's disease (BD). For this purpose, formalin-fixed biopsy specimens were obtained from 13 pre-ulcerative oral aphthous lesions of nine RAU and four BD patients. Five specimens of normal oral mucosa (NOM) from five normal control subjects and 10 specimens of oral erosive or ulcerative lesions from 10 patients with erosive lichen planus (ELP) were also included. EBV-DNA was detected by PCR in 5 of the 13 (38.5%) pre-ulcerative oral aphthous lesions, two from RAU patients and three from BD patients. However, no EBV-DNA was demonstrated in five NOM specimens from normal control subjects and in 10 specimens of oral lesions from ELP patients. EBV-DNA was also demonstrated in patients' peripheral blood lymphocytes and/or plasma, suggesting that the lymphocytes may be the reservoir of latent EBV infection and there is EBV shedding in the plasma. EBV-DNA was detected by ISH in only one PCR-positive case; the reaction product was found to deposit on the nuclei of some of the epithelial cells and lymphocytes. By immunohistochemistry, expression of Epstein-Barr nuclear antigen and EBV/C3d receptors was also noted in some of the epithelial cells and lymphocytes in this ISH-positive case. Therefore, we suggest that the epithelial cells of pre-ulcerative oral aphthous lesions may be infected by EBV through EBV-infected lymphocytes; also, the cytotoxic T lymphocyte-induced lysis of the EBV-infected epithelial cells, but not the virus-induced cytolysis, may be the main mechanism causing oral ulcer formation. Our data provide preliminary evidence for an association of EBV with pre-ulcerative oral aphthous lesions in RAU and BD patients.

[Synovial sarcoma in the head and neck with 3 case reports]

Synovial sarcoma in the head and neck with 3 cases are reported. Some clinical features and experiences of surgical excision are analysed according to our materials and review of the literature. We believe that the key to prevent synovial sarcoma from recurrence and matastasis is to avoid local excision, and pay more attention to this disease before operation. It is not sensitive to radiation therapy.

[Disturbance of iron metabolism and sudden hearing loss: a prospective and retrospective survey]

Two hundred and eighteen patients with disorders of disturbance of iron metabolism, 215 with hematonosis and 4850 in a normal control group were studied in a prospective with sudden hearing loss and were meanwhile investigated in a retrospective review in order to evaluate the relationship between the disorders of disturbance of iron metabolism and sudden hearing loss. The findings revealed a significantly higher incidence of sudden hearing loss in the cases of disturbance of iron metabolism, than in the patients with hematonosis as well as in the normal control group. Iron deficiency and iron deficiency anemia were found in 60.84% of 429 patients with sudden hearing loss. We concluded that the risk of disturbance of iron metabolism in the cochlea will significantly increase when systemic disturbance of iron metabolism is present although the one does not necessarily indicate the other. It seems that acute disturbance of iron metabolism in cochlea causes sudden hearing loss directly or provides a pathologic basis for the disorder.

In vitro assembly of the component chains of fibrinogen requires endoplasmic reticulum factors

Human fibrinogen (340 kDa) is a dimer, with each identical half-molecule composed of three different polypeptides (Aalpha, 66 kDa; Bbeta, 55 kDa; and gamma, 48 kDa). To understand the mechanisms of chain assembly, a coupled in vitro transcription translation system capable of assembling fibrinogen chains was developed. Fibrinogen chain assembly was assayed in an expression system coupled to rabbit reticulocyte lysate in the presence or absence of dog pancreas microsomal membranes. Fibrinogen chain assembly required microsomal membranes and oxidized glutathione. Co-expression of two of the chains, Bbeta and gamma or Aalpha and gamma, yielded free chains and two-chain complexes. Unlike combinations of Aalpha with gamma and Bbeta with gamma, co-expression of Aalpha and Bbeta did not form a single two-chain complex but produced a mixture of two-chain complexes. Co-expression of all three chains yielded free chains, two-chain complexes, and higher molecular weight complexes that corresponded to a half-molecule and to fully formed fibrinogen. Upon treatment of this mixture with thrombin and factor XIIIa, a gamma.gamma dimer, similar to that obtained from cross-linked human fibrin, was produced, indicating that properly folded fibrinogen was formed in vitro. Molecular chaperones may participate in fibrinogen assembly, since antibodies to resident proteins of the endoplasmic reticulum (BiP, Hsp90, protein disulfide isomerase, and calnexin) co-precipitated the chaperones together with nascent fibrinogen chains and complexes.

[Effects of levonorgestrel subdermal implants on estradiol and progesterone receptors of endometrium and ovarian tissues in rats]

OBJECTIVE

To study the influence of subdermal implantation of levonorgestrel (LNG) on the levels of estradiol receptor (ER) and progesterone receptor (PR) in ovaries and endometrium of rats.

METHODS

45 female mature rats were divided into 3 groups: control group, silicon tube group and LNG implants group. Using single-point determination at saturating concentration method, ER and PR levels of both ovaries and endometrium were measured at 15, 30 and 45 days after subdermal implantation of LNG or silicon tube, and compared with that of the control group.

RESULTS

ER and PR levels in LNG group were significantly lower than those in the other 2 groups (P < 0.01). The concentration of ER and PR decreased gradually as implantation prolonged.

CONCLUSION

subdermal implantation of LNG resulted in the reduction of ER and PR levels in ovaries and endometrium of rats, which may be related to the mechanism of contraception and breakthrough bleeding after implantation.

Dependence of epithelial intercellular junction biogenesis on thapsigargin-sensitive intracellular calcium stores

Perturbation of potentially regulatable endoplasmic reticulum (ER) calcium stores with the Ca-ATPase inhibitor, thapsigargin (TG), perturbs the formation of desmosomes and tight junctions during polarized epithelial cell biogenesis, despite the development of cell contact. In a Madin-Darby canine kidney cell model for intercellular junction assembly, TG treatment inhibited the development of transepithelial electrical resistance (TER), a measure of tight junction assembly, in a dose-dependent manner. The TG-induced inhibition of tight junction assembly was paralleled by a defect in the sorting of the tight junction protein, ZO-1. An even more dramatic delay in sorting of the desmosomal protein, desmoplakin, was observed in the presence of TG. In addition, while both ZO-1 and desmoplakin-I in control cells were shown to become associated with the Triton X-100 insoluble cytoskeleton during intercellular junction assembly, prior treatment with 100 nM TG diminished this biochemical stabilization into the detergent-insoluble fraction, particularly in the case of ZO-1. Although spectrofluorimetric measurements in fura-2 loaded Madin-Darby canine kidney cells confirmed the occurrence of TG-mediated release of calcium from internal stores, total cytosolic calcium during junction assembly remained similar to untreated cells. Therefore, the presence of cytosolic calcium alone is not sufficient for normal intercellular junction biogenesis if intracellular stores are perturbed by TG. The results indicate the presence of calcium-sensitive intracellular mechanisms involved in the sorting and cytoskeletal stabilization of both tight junction and desmosomes and suggest a role for calcium-dependent signaling pathways at an early (possibly common) step in polarized epithelial biogenesis.

[Reversal of adriamycin or vincristine resistance by tetrandrine in human cancer cells in vitro]

In an in vitro culture system of human cancer cells MCF-7 and its adriamycin-resistant line MCF-7/Ad or KB and its vincristine-resistant line KBv200, tetrandrine was found to exhibit significantly selective anticancer activity against the drug-resistant cancer cell MCF-7/Ad. In addition, essentially complete reversal effects of tetrandrine on drug resistance were observed in MCF/Ad or KBv200.

Human cytomegalovirus as a potential etiologic agent in recurrent aphthous ulcers and Behçet's disease

In a preliminary study on anti-human cytomegalovirus (HCMV) antibody (Ab) by ELISA, the serum anti-HCMV/IgG Ab concentrations in 22 patients with recurrent aphthous ulcers (RAU) in the remission stage were found to be significantly higher than in 22 control subjects (121 +/- 42 vs 100 +/- 27, P < 0.05) and in 39 patients with RAU in the active stage (121 +/- 42 vs 88 +/- 45, P < 0.01). Therefore, the potential of HCMV as an etiologic agent in RAU was proposed and studies using the polymerase chain reaction (PCR) and in situ hybridization (ISH) have been performed to investigate the possible presence of HCMV DNA in pre-ulcerative oral aphthous lesions in patients with RAU or Behçet's disease (BD) of the mucocutaneous type. For this purpose, formalin-fixed biopsy specimens were obtained from 13 pre-ulcerative oral aphthous lesions, 2 samples of normal oral mucosa and 1 ileal mucosal lesion from 9 RAU patients and 4 BD patients. Five specimens of normal oral mucosa from 5 normal control subjects and 12 specimens of oral erosive or ulcerative lesions from 12 patients with erosive lichen planus (ELP) were also included. By PCR, HCMV DNA was detected in 5 of the 13 (38.5%) pre-ulcerative oral aphthous lesions, 3 from RAU patients and 2 from BD patients. The ileal mucosa specimen was also HCMV DNA-positive, whereas HCMV DNA was not demonstrated in any of the 7 specimens of normal oral mucosa from RAU patients and normal control subjects; 12 specimens of oral lesions from ELP patients were similarly negative. ISH did not detect HCMV DNA in any of the biopsy specimens from RAU patients and control subjects. Our findings suggest that HCMV may be an etiologic agent in some cases of RAU and BD.

Comparing techniques of measuring tumor hypoxia in different murine tumors: Eppendorf pO2 Histograph, [3H]misonidazole binding and paired survival assay

Using five transplantable murine tumors (SCC-VII, B16F1, KHT-C, KHT-LP1, RIF-1), measurements of tumor hypoxia have been made with two techniques which have the potential to be used for assessing oxygenation in human tumors (the Eppendorf pO2 Histograph and binding of [3H]misonidazole) and have been compared with an established radiobiological technique, the paired survival assay. There were significant differences in the pO2 measurements made in individual tumors both within and between the five different tumor types. Significant differences between the tumor types were also found for the [3H]misonidazole binding. A correlation was observed between the mean values of the hypoxic proportion as measured by the paired survival assay and the mean binding of [3H]misonidazole as measured by both tumor activity in dpm/100 mg tissue (r = 0.94, P = 0.02) and the tumor-to-muscle activity ratio (r = 0.87, P = 0.06). No biologically significant correlation was seen between the mean values of the hypoxic proportion from anesthetized mice as measured by the paired survival assay (range 20-58%) and the pooled Eppendorf pO2 Histograph measurements made on groups of tumors. These results with the Eppendorf pO2 Histograph are similar to those reported by others. When both Eppendorf pO2 Histograph measurements and paired survival measurements were made on the same individual KHT-C tumors, it was again found that there was no correlation between the two measurements of hypoxia.

[Laparoscopic treatment of endometriosis with Nd: YAG laser and microwave]

A series of 200 cases of endometriosis were treated laparoscopically by Nd: YAG laser and microwave at Peking Union Medical College Hospital. All the operations were performed under local and topical anesthesia follow-up for 10-48 months revealed good results. Of 76 cases with infertility, 46 (60.5%) conceived after treatment. Of 114 cases with ovarian endometriomas, the cysts were no longer found in 81 cases (71.1%), decreased in size in 24 cases (21.0%). Of 180 cases with pain symptoms, 105 patients (58.3%) were achieved complete relief, Partial relief in 61 cases (33.9%). It has been found that laparoscopic surgery is effective to improve fertile rate for the patients with all the stages of endometriosis. The results showed that the microwave and Nd: YAG laser can be achieved with safety and success. The microwave is safer than Nd: YAG laser and is easier to operate and less expensive.

Simultaneous determination of copper and zinc in the hair of children by pH gradient construction in a flow-injection system

A flow-injection method is described for the simultaneous determination of copper and zinc with a single detector using the pH gradient technique. Zincon is used as the colour reagent for the spectrophotometric determination. The linear range for the determination of zinc is 0.4-12 micrograms ml-1 and for copper is 0.1-3.0 micrograms ml-1. About 20-30 samples can be determined in one hour. The proposed method has been applied to the determination of zinc and copper in childrens' hair.

Cyclic guanosine monophosphate responses to atrial natriuretic factor, brain natriuretic peptide, but not C-type natriuretic peptide, and the characterization of their receptors in rat medullary thick ascending limb

The effects of atrial natriuretic factor (ANF), brain natriuretic peptide (BNP), and C-type natriuretic peptide (CNP) on renal medullary thick ascending limb (mTAL) have not been fully understood. The aim of this study is to examine the second-messenger responses of rat mTAL to ANF, BNP, and CNP. Characterizations of the ANF, BNP, and CNP receptors in mTAL were also performed by radioligand studies. Results showed that ANF and BNP were both capable of eliciting cyclic guanosine monophosphate (cGMP) responses in mTAL. Conversely, no cGMP response was observed upon stimulation by CNP in mTAL. The presence of ANF receptors was demonstrated by radioligand studies. One receptor site was found, and the Kd and maximum binding capacity were 4.0 +/- 0.45 nmol/L and 277.8 +/- 47.7 fmol/mg protein, respectively. BNP receptors were also found in mTAL, and ANF and BNP were sharing the same receptor. On the contrary, no CNP receptor could be shown by radioligand studies. These results suggest that guanylyl cyclase-coupled receptors (atrial natriuretic peptide receptor-A [ANPR-A]) specific for ANF and BNP are present in rat mTAL, while those for CNP (ANPR-B) are absent. ANF and BNP but not CNP act on mTAL to control water excretion.

Critical role for intracellular calcium in tight junction biogenesis

Using the Madin Darby canine kidney (MDCK) cell "calcium switch," we have previously demonstrated that, as MDCK cells establish contact and ultimately form tight junctions, there are marked global and localized changes in intracellular calcium at the sites of cell-cell contact (Nigam et al., 1992, Proc. Natl. Acad. Sci. USA, 89:6162-6166). We have now examined whether intracellular Ca++ is critical to the biogenesis of tight junctions by chelating this ion and monitoring the formation of junctions by electrical, immunocytochemical, and biochemical criteria. Intracellular Ca++ was chelated with the cell-permeant chelators, dimethyl-BAPTA-AM and BAPTA-AM. By digital imaging of fura-2 loaded cells, it was demonstrated that both agents efficiently chelated Ca++ during the "switch" in a dose-dependent manner which paralleled their respective in vitro affinities for Ca++. Chelation of Ca++ during the switch markedly attenuated the development of transepithelial electrical resistance (TER), a measure of tight junction assembly. Immunofluorescent staining of the tight junctional protein, zonula occludens-1 (ZO-1), revealed that chelation of intracellular Ca++ retarded the movement of ZO-1 from intracellular sites to the plasma membrane during the switch. During the development of tight junctions, a fraction of ZO-1 redistributed from the Triton X-100 soluble to the Triton X-100 insoluble pool; chelation of Ca++ during the induction of cell-cell contact prevented this stabilization into the Triton X-100 insoluble fraction. Taken together, these data indicate an important role for intracellular Ca++ in tight junction biogenesis and suggest a specific role for calcium in the early sorting and possible cytoskeletal association of tight junction components.

Immunomodulation by levamisole in patients with recurrent aphthous ulcers or oral lichen planus

The purpose of this study was to evaluate the effect of levamisole on the immune system of patients with recurrent aphthous ulcers (RAU) or oral lichen planus (OLP) in an open trial. Lymphocyte subsets, serum immunoglobulins, and circulating immune complexes (CIC) in patients with RAU or OLP and in normal control subjects were determined by an indirect immunofluorescence (IIF) technique with monoclonal anti-lymphocyte antibodies, by single radial immunodiffusion, and by precipitation with 3% polyethylene glycol, respectively. In addition, the anti-nuclear antibodies (ANA) and anti-basal cell antibodies (anti-BCA) in sera were detected by an IIF technique. We found a significant improvement in clinical symptoms and normalization of the decreased CD4/CD8 ratio in RAU patients after levamisole treatment. Moreover, the decreased CD4/CD8 ratio, which persisted until the remission stage in the untreated RAU patients, reverted to normal in the active late stage in the levamisole-treated patients. This reversion of aberrant cellular immunity in an earlier stage of the ulcer cycle may explain why RAU patients experience symptom improvement after levamisole treatment. Although RAU patients treated with levamisole for 1 to 3 or 4 months still had higher than normal levels of CIC and serum immunoglobulins, the levels of their IgA and IgM returned to normal values after 4 months of levamisole treatment. The serum ANA detected in 6 patients with RAU and 3 patients with erosive OLP disappeared after 1-22 months of levamisole treatment. The disappearance of serum anti-BCA was also observed in 50% of the anti-BCA-positive patients with erosive OLP after 3-13 months of levamisole treatment.(ABSTRACT TRUNCATED AT 250 WORDS)