D-penicillamine-induced polymyositis in patients with rheumatoid arthritis

Among 329 patients with rheumatoid arthritis treated with D-penicillamine (DP), we found 4 cases of polymyositis. This incidence was significantly higher than the expected coincidence of rheumatoid arthritis and polymyositis/dermatomyositis or than the presumed frequency of this complication among patients treated with DP. In the present report, we summarize and discuss the clinical findings in DP-induced polymyositis/dermatomyositis in our patients and others described in the literature.

Nude mice bearing human primary hepatocellular carcinoma that produces hepatitis B surface, core, and e antigens, as well as deoxyribonucleic acid polymerase

A primary hepatocellular carcinoma, from a patient carrying hepatitis B virus, was transplanted to athymic nude mice, and maintained through eight passages involving 39 mice. Hepatitis B surface and e antigens were detected in the circulation of tumor-bearing mice. Hepatitis B surface, core, and e antigens were demonstrated in tumor cells. Hepatitis B core particles were visualized in the tumor extract by immune electron microscopy, and they exhibited an activity of deoxyribonucleic acid polymerase. In the tumor tissue, deoxyribonucleic acid of hepatitis B virus was present both in integrated and extrachromosomal forms. Nude mice carrying the tumor would provide opportunities for studying the replication of hepatitis B virus and the expression of its various proteins, and also for evaluating the efficacy of virustatic drugs in interrupting the persistent infection.

[Clinical observation of non-gonococcal urethritis]

Sixty-one male urethritis cases, 28 gonococcal urethritis and 33 nongonococcal urethritis (NGU), were out-patients at the Department of Urology, Asahi General Hospital, during the 4 months, Oct. 1, 1984-Jan. 31, 1985. Thirteen of the 33 NGU patients (39.4%) were infected with C. trachomatis (CT). The efficacy of Doxycycline and the route of infection was studied in the cases of CT-positive CT-negative-NGU. CT infection from prostitutes was not so frequent as in the other pathogen infection of NGU. The efficacy of Doxycycline (100 mg b.i.d. for 2 weeks) against CT infection was excellent in the disappearance of subjective complaints and that of white blood cells in the urethral discharge in the CT positive-NGU group (13/13), in comparison with CT negative-NGU group (7/18). The efficacy of Doxycycline against CT was also confirmed from the follow-up study by the isolation of CT and by detection of CT antigen from urethral swabs using FITC conjugated monoclonal antibody against CT antigen.

Membranous glomerulonephritis associated with hepatitis B antigen in children: a comparison with idiopathic membranous glomerulonephritis

The laboratory and pathological findings are reported for 16 children with membranous glomerulonephritis (MGN) associated with hepatitis B virus (HBV) infection and compared with those of 12 children with idiopathic MGN. Serum hepatitis B surface antigen (HBsAg) was found in all children with HBV associated MGN and serum hepatitis B e antigen (HBeAg) in 11 of the 15 examined. Five patients with HBV associated MGN, but none with idiopathic MGN, showed reduced serum C3 values. Otherwise there was no difference in laboratory findings. HBeAg was detected in the glomeruli of all 7 patients with HBV-associated MGN examined but HBsAg was not detected. Of the 14 children with HBV-associated MGN examined by electron microscopy, all but one showed small mesangial deposits and 4 subendothelial deposits, whereas of 9 with idiopathic MGN only 2 showed mesangial deposits and none subendothelial deposits. Thus most of the children with HBV-associated MGN are characterized by some laboratory and pathological features of membrano proliferative glomerulonephritis in addition to those of idiopathic MGN. These observations are consistent with HBV inducing a spectrum of glomerulopathy from typical MGN to typical membranoproliferative glomerulonephritis.

A multicenter double-blind controlled study of lobenzarit, a novel immunomodulator, in rheumatoid arthritis

A multicenter double-blind study was carried out in patients with rheumatoid arthritis (RA) by comparing treatment with a novel immunomodulator, lobenzarit, disodium 4-chloro-2, 2'-iminodibenzoate, with an inert placebo. Both groups of patients received 75 mg/day of indomethacin as a basal regimen during the study period of 16 weeks. Group 1 (115 patients) received 240 mg/day lobenzarit, 80 mg TID, and Group 2 (115 patients) received placebo TID orally. A statistically significant improvement was noted in the number of swollen joints and in the Lansbury index at Weeks 12 and 16 in Group 1 as compared to Group 2. Overall clinical effectiveness was significantly higher in Group 1 (63%) than in Group 2 (43%). Incidence of side effects was 38% in Group 1 and 22% in Group 2. The most frequent side effect in both groups was gastrointestinal upset. Our data confirm that lobenzarit is a useful agent in the treatment of patients with RA.

Deposition of hepatitis B e antigen in membranous glomerulonephritis: identification by F(ab')2 fragments of monoclonal antibody

The pathogenic ability of hepatitis B e antigen (HBeAg) to induce membranous glomerulonephritis was evaluated by the most specific method presently available. Monoclonal antibody was raised against HBeAg, and F(ab')2 fragments were obtained and labeled with fluorescence. By this reagent, 10 out of 16 patients with membranous glomerulonephritis with hepatitis B surface antigen in the serum revealed granular deposition of HBeAg along glomerular capillary walls. Among the cases with glomerular HBeAg deposits, nine had detectable HBeAg in the serum and one had antibody to HBeAg (anti-HBe). The specificity of HBeAg staining was ascertained by blocking and inhibition tests, and the fluoresceinated anti-HBe F(ab')2 reagent did not stain the glomerular immune deposits in the patients with membranous glomerulonephritis who did not carry hepatitis B virus (HBV). None of the studied patients showed deposition of hepatitis B surface or core antigens in the glomerulus. On the basis of these results, immune complexes involving HBeAg may induce membranous glomerulonephritis in persons who carry HBV.

Cervical cord compression due to extradural granulation tissue in rheumatoid arthritis. A review of five cases

Five patients with long-standing, severe rheumatoid arthritis who developed cervical myelopathy at the subaxial levels are presented. In each patient the myelopathy occurred in the absence of major subluxation. At laminectomy the cause of the cord compression was found to be a band-like mass of ligamentous and granulation tissue in the posterior half of the extradural space, extending to the underlying portion of the dura and forming a constricting ring. In three patients this constricting ring was released by longitudinal division of the dura followed by application of a fascial patch graft. This release seems to be essential for effective decompression of the cord and good neurological recovery was achieved in these three patients. Of the other two patients, the result was fair in one and poor in the other, this latter result being due to severe intra-operative bleeding with a massive wound haematoma.

Beta-propiolactone for the inactivation of non-A/non-B type 1 hepatitis virus capable of inducing cytoplasmic tubular ultrastructures in chimpanzees

Non-A/Non-B type 1 hepatitis virus may be recognized because it induces characteristic tubular ultrastructures in the hepatocyte cytoplasm of chimpanzees. 3 chimps received 0.1 ml of a chimp serum containing more than 100 chimp infecting units of non-A/non-B type 1 hepatitis virus after it had been treated with beta-propiolactone with or without combined ultraviolet irradiation. All of the chimps escaped infection throughout the observation period of 23 weeks. The treatment of the serum with beta-propiolactone at the mildest condition employed (0.05%, 4 degrees C, 20 min) was still effective in inactivating the virus. The susceptibility of the chimps was ascertained by the subsequent challenge with 0.1 ml of the untreated serum which invariably induced non-A/non-B type 1 hepatitis in them. On the basis of these results, beta-propiolactone was extremely efficacious for the cold sterilization of non-A/non-B type 1 hepatitis virus.

DNA-protein complex from hepatitis B virus

Hepatitis B virus (HBV) DNA labelled with [3H] or [alpha-32P]dTTP in vitro was isolated from Dane particles by CsCl-guanidine hydrochloride density gradient centrifugation. Virtually all HBV DNA extracted as above contained a knob on the double-stranded region visible by electron microscopy. Proteinase K removes the know from HBV DNA. The HBV DNA-protein complex was efficiently bound to nitrocellulose membrane filters. When the radioactively labelled HBV DNA-protein complex was digested with restriction endonuclease Hae III or Hind II and subjected to polyacrylamide gel electrophoresis, some radioactivity did not enter the gel. Restriction endonuclease fragments did not remain on the top of the gel after proteinase K treatment and no new band was detected. The possible role of the knob protein in the replication of HBV DNA is discussed.

[Electromyographical study of the straight leg raising test in lumbar disc herniation]

The straight leg raising test is one of the most reliable test for the diagnosis of the disc herniation. It is well known that the pain is produced by the increased tension of the affected root. However, the patient's response to the pain evoked by the straight leg raising test is not uniform. In some patients the leg is raised beyond the straight leg raising positive angle without resistance and some young patients show the tight hamstrings phenomenon. To elucidate these phenomena, the muscle action of erector spinae, gluteus maximus and biceps femoris evoked by this test was studied electromyographically. The results are as follows: 1) The muscle action patterns in the patients of disc herniation which are not observed in normal group are classified into four groups, namely LGB type (erector spinae, gluteus maximus and biceps femoris act), GB type (gluteus maximus and biceps femoris act), G type (gluteus maximus only acts), B type (biceps femoris only act). These abnormal muscle actions disappear under general anesthesia and are different from the actions which are recorded when the patients resist passive straight leg raising intentionally. 2) In the case of L4-5 intervertebral disc herniation mainly gluteus maximus acts as the resisting force against the passive straight leg raising. On the other hand, biceps femoris acts mainly in the case of L5-S1 disc herniation. 3) The group of younger age and less degenerated disc shows more resistance against straight leg raising and records the action potential of resisting muscles in earlier stage of the leg raising test.

Interim results of a multicenter open study with auranofin in Japan

We report the results of 47 of 116 rheumatoid patients, who took auranofin (AF) for more than 6 months. After 8-12 weeks of treatment with AF 3 mg bid, a remarkable improvement was observed especially in numbers of tender and swollen joints and duration of morning stiffness. The mean activity index before AF was 70.1% and the index decreased linearly for 6 months to 53.5%. AF was particularly effective in patients with high rheumatoid activity, as well as in those of short duration of disease and Stages I and II. Radiographic examination showed a possible prevention by AF of progression of bone destruction in the joints. A total of 86 side effects were reported in 50 cases: 36 gastrointestinal; 34 mucocutaneous and 16 others. Most side effects cleared during the treatment and no serious side effects were reported. Drug administration was discontinued in only 11 cases (9.5%). Blood gold level reached a plateau after 9 weeks (mean level was 0.67 micrograms/ml). Urinary excretion rate was parallel with the blood gold level.

[Clinical trial of cisplatin in the treatment of ovarian carcinoma]

Cisplatin (cis-diamminedichloroplatinum) was administered to 20 patients with histologically proven ovarian cancer. Ten of 20 patients were evaluable. They consisted of 1 patient by single use and 9 by combined use. The dose of cisplatin in single administration was 50 mg/m2, and the schedule for combined administration was as follows: cisplatin (50mg/m2, i.v. day 1), adriamycin (40 mg/m2, i.v. day 1), cyclophosphamide (350 mg/m2, i.v. day 1) and 5-FU (350 mg/m2, i.v. day 1-5). This was repeated every three weeks. The side effects of cisplatin and in its combination use were relatively severe. All of 20 patients showed severe nausea and vomiting, but fortunately there were no signs of hepatotoxicity, bone marrow or renal impairments during these courses. As the result, according to the response criteria of Koyama-Saito's group, out of 10 evaluable patients, the response rate consisting of partial and complete responses was 50% (CR: 3 cases, RP: 2 cases). It is shown that cisplatin is effective and useful in chemotherapy for the patients with ovarian carcinoma.

Non-A, non-B (type 1) hepatitis agent capable of inducing tubular ultrastructures in the hepatocyte cytoplasm of chimpanzees: inactivation by formalin and heat

We have reported two kinds of viruslike particles derived from human sera that induced morphologically and serologically different types of non-A, non-B hepatitis in chimpanzees. A chimp serum containing one such agent capable of inducing a type of hepatitis with cytoplasmic tubular ultrastructures (non-A, non-B, type 1) was titrated for its infectivity in chimps. Two chimps who received 1 ml of a 10(-2) dilution of the original serum developed the characteristic morphological changes in the liver together with elevated serum transaminase levels, while the other two who received 1 ml of a 10(-4) dilution failed to show such changes. The two who escaped the infection were proven to be susceptible to the agent, because they developed non-A, non-B, type 1 hepatitis when they were challenged by 1 ml of a 10(-1) dilution of the same serum on the 23rd week after the first inoculation. One milliliter of a 10(-1) dilution containing more than 10 chimp infecting units were inactivated in the presence of 1/2000 formalin or by heating at 100 degrees C for 5 min and then given to four other chimps. None of them developed clinical or histologic evidence of non-A, non-B, type 1 hepatitis, thereby indicating that both formalin and heat could destroy the ability of the agent to induce this type of hepatitis.

Metabolism and activation of aflatoxin B1 by reconstituted cytochrome P-450 system of rat liver

Metabolism and activation of aflatoxin B1, a potent hepatocarcinogenic and mutagenic mycotoxin of Aspergillus flavus, were investigated in the reconstituted enzyme system composed of purified NADPH-cytochrome P-450 reductase and cytochrome P-450 or P-448 of rat liver. The aflatoxin M1 formation was strictly mediated by P-448 purified from the liver microsomes of polychlorobiphenyl- and 3-methylcholanthrene-treated rats, while the aflatoxin Q1 formation, as well as the binding of DNA, were catalyzed by both P-450 and P448. Differences between the kinetic data on metabolism and activation of aflatoxin B1 obtained with the reconstituted cytochrome systems and those obtained with the microsomal and nuclear systems were discussed, and the significance of these biochemical data in the in vivo carcinogenicity of aflatoxin B1 was evaluated.

Pale eosinophilic inclusions simulating ground-glass appearance of cells of hepatocellular carcinoma

Pale eosinophilic inclusions simulating ground-glass appearance were observed in cells of hepatocellular carcinoma. They were round or elliptical in shape, and their size was about 14 micrometers in diameter. Light eosinophilia and fine granulation with homogeneous appearance were delineated from other cellular materials. They were negative for HBsAg, blood plasma proteins including alpha 1-antitrypsin, and alpha-fetoprotein by immunohistochemical stainings. Ultrastructurally, they were well-demarcated and consisted of homogeneous finely granular matrix. Histological, histochemical and ultrastructural features were different from several intracellular inclusions hitherto reported on hepatocellular carcinoma. These changes may represent a deposition of secretory proteinous materials in cells of hepatocellular carcinoma, but their chemical and antigenetical content could not be identified.

Demonstration of two different types of non-A, non-B hepatitis by reinjection and cross-challenge studies in chimpanzees

Utilizing immune electron microscopy, viruslike particles were identified in the serums of three apparently healthy, HBsAg-negative blood donors. The serum from one of the donors, when injected into two susceptible chimpanzees, induced non-A, non-B hepatitis with an increase in SGPT level and pathological changes in the liver compatible with acute hepatitis but none of the cytoplasmic ultrastructures previously noted by electron microscopy in non-A, non-B hepatitis. These two chimps did not contract hepatitis when the same inoculum was given again 17 wk after the first injection. When they were subsequently challenged, however, by a chimp inoculum containing viruslike particles known to induce non-A, non-B hepatitis with cytoplasmic tubular ultrastructures, they developed high SGPT levels and these characteristic ultrastructures in their hepatocytes. A third chimp was initially injected with the chimp inoculum containing viruslike particles known to induce hepatitis with tubular ultrastructures, reinjected with the same agent, and then challenged by the human serum containing viruslike particles capable of inducing non-A, non-B hepatitis without tubular ultrastructures. He developed biochemical and pathological evidence of acute hepatitis after the first and the third, but not after the second inoculations. There are at least two kinds of viruslike particles which are associated with infectivity for two different types of non-A, non-B hepatitis; these have been tentatively designated NANB-1 and NANB-2.

Hepatitis B e antigen-mediated membranous glomerulonephritis. Correlation of ultrastructural changes with HBeAg in the serum and glomeruli

Immunopathologic findings in the glomeruli of six children with membranous glomerulonephritis who were carriers of hepatitis B virus were compared with serum markers of hepatitis B virus infection. Four of the patients were positive for hepatitis B e antigen (HBeAg) in the serum, were grossly proteinuric, and had abnormal liver function tests. Deposition of HBeAg, together with immunoglobulins and beta 1C, was found in the glomeruli of these patients. On electron microscopy, numerous electron-dense deposits were identified on and within the glomerular basement membrane. The remaining two patients were seropositive for antibody against HBeAg (anti-HBe); although they had previously suffered from active membranous glomerulonephritis with massive proteinuria, they were no longer proteinuric at the time of the last renal biopsy. Deposition of HBeAg was not detected in their glomeruli. Electron microscopic observation disclosed numerous electron-lucent areas which had replaced electron-dense deposits, indicating regression of the disease processes. These results delineate the etiologic role of HBeAg in maintaining active membranous changes and suggest that patients with HBeAg-mediated membranous glomerulonephritis may remit as they seroconvert from HBeAg to anti-HBe.

Metabolism of aflatoxin B1 in the isolated nuclei of rat liver

The nuclear biotransformation of aflatoxin B1 in vitro was observed with regard to inducer specificity, pH dependency, time course, kinetics, inhibitor sensitivity, and nuclear localization, and these data were compared with those from the microsomal transformation of aflatoxin B1. The nuclei and microsomes are capable of metabolizing aflatoxin B1 into aflatoxin M1, aflatoxin Q1, and two unidentified fluorescent compounds in the presence of fortified NADPH generating system. Pretreatments of rats by 3-methylcholanthrene or polychlorinated biphenyl enhanced both the nuclear and microsomal C-9 alpha-hydroxylation of aflatoxin B1 into aflatoxin M1 and phenobarbital or polychlorinated biphenyl induced aflatoxin Q1 production. The optimal pHs for aflatoxin M1 and Q1 were 8.3 and 7.4, respectively, both in the nuclei and microsomes. Kinetic analysis revealed the Km of aflatoxin M1 formation in methylcholanthrene-induced nuclei was 9.4 x 10(-5) M, and this value was very close to that obtained with the microsomes. Inhibitor experiments revealed a high sensitivity of aflatoxin M1 formation to 7,8-benzoflavone and a low sensitivity of aflatoxin Q1 to SKF 525A. These findings and data on the detergent treatment of nuclei suggest that the nuclear cytochrome P-448 system, induced by 3-methylcholanthrene and localized in the outer membrane, catalyzes the aflatoxin M1 formation, and the cytochrome P-450 system induced by phenobarbital biotransforms aflatoxin B1 into aflatoxin Q1. Pretreatment of rats by phenobarbital was found to induce microsomal degradation or detoxication of aflatoxin B1 into water-soluble metabolites, and no such an induction was observed in the nuclei.

Glomerulonephritis associated with arteritis in marmosets infected with hepatitis A virus

Seven of 8 marmosets (Saguinus oedipus and Saguinus labiatus) injected i.v. with different inocula of hepatitis A virus isolated from patients in the acute phase of disease developed proliferative glomerulonephritis associated with arteritis. The glomerulonephritis was characterized by immunofluorescent and electron-dense deposits and hypercellularity. Although no antigenic component of the glomerular immune complex was detected, this glomerulonephritis and arteritis may be diagnosed morphologically as an immune complex disease. These findings show the possibility of the appearance of exohepatic disease as an immunologically mediated disease in human hepatitis A virus infection.

[Mixed culture of sperm and lymphocyte in infertility with unexplained cause and its clinical implications (author's transl)]

Mixed culture of sperm and lymphocytes were performed in the samples of 32 infertile couples with unexplained cause, 16 couples with proven fertility and 47 virginal women in order to investigate the role of cellular-immunologic factors in infertility. 1) The means of stimulation index (S.I.) and the standard deviation in mixed cultures with donor's sperm were, 2.51 +/- 1.08 in infertile, 2.25 +/- 0.79 in fertile and 1.96 +/- 0.71 in virgin group. The S.I. of the virgin group was significantly lower (p less than 0.01) than that of the other two groups. 2) The means of S.I. in mixed cultures with husband's sperm were, 2.96 +/- 1.43 in infertile and 2.44 +/- 1.24 in fertile women. There was no significance in the S.I. of these two groups. 3) It was found during two years' prospective observation that 14 of 32 unexplainedly infertile couples achieved pregnancy. Retrospective analysis disclosed that there was no significant difference between pregnant and non-pregnant groups, when S.I. with husband's sperm were compared. Neither, no difference between S.I. with husband's sperm and donor's sperm was revealed in non-pregnant group. In conclusion, no evidence was obtained that unexplainedly infertile women, as a group, were suffered from immunologic factors.

The neuropathology of intervertebral discs removed for low-back pain

Thirty lower lumbar intervertebral discs (IVDs) removed for low-back pain were examined. There is a profuse non-myelinated axonal network and abundant free nerve terminals in the outer (lateral) half of the annulus fibrosus. The inner annulus and the nucleus pulposus did not contain nerve terminals. No significant changes in the nerve networks could be demonstrated in degenerate IVDs: in particular, ingrowth of nerve terminals into foci of granulomatous tissue was not seen. Early foci of degeneration are clearly shown by Marshall's silver method for metalophil cells. Mucinous filaments are argyrophilic and can be mistaken for axonal structures in the nucleus pulposus.

Viruslike particles in a plasma fraction (fibrinogen) and in the circulation of apparently healthy blood donors capable of inducing non-A/non-B hepatitis in humans and chimpanzees

Two patients who had received a fibrinogen preparation contracted hepatitis of non-A/non-B etiology 3 and 8 wk after the injection. A chimpanzee inoculated with the same preparation developed hepatitis 11 wk later, with an increase in SGPT and a liver pathology compatible with acute viral hepatitis. His preacute serum containing the presumptive etiologic agent induced hepatitis in another chimpanzee. Electron microscopic observation of the liver of these chimpanzees biopsied during preacute and acute stages revealed peculiar tubular structures composed of two unit membranes with electron-opaque material in between. Using the serum obtained from infected chimpanzees at convalescence as an antibody reagent, viruslike particles were identified in the fibrinogen preparation by immune electron microscopy. When the serum of 100 apparently healthy blood donors with SGPT value of 80 Karmen units/ml or higher was tested for viruslike particles, eight were found to be positive. Furthermore, one of these sera, when a 5-ml amount was injected into each of two chimpanzees, induced hepatitis with viruslike particles in the circulation and characteristic tubular changes in the liver. On the basis of the results obtained, the viruslike particles in the fibrinogen preparation, as well as in the circulation of apparently healthy donors, were capable of inducing hepatitis of non-A/non-B category with a liver pathology characterized by tubular structures. The detection of non-A/non-B viral particles, especially when refined to routine laboratory tests, may open the way for the specific diagnosis, exclusion of contaminated blood from transfusion, and eventual prophylaxis by vaccination.

[Immunological analysis of hydatidiform mole and invasive mole (author's transl)]

Thirty-two cases of hydatidiform mole without endometrial invasion of chorial tissue and 17 of invasive mole were studied to ascertain whether these two diseases can be differentiated by various immune parameters. All of hydatidiform 11 of invasive mole were sampled at a state of "mole in utero" (pre-evacuation), but 6 of invasive mole were at a post-evacuation state, respectively. The results were summarized in the following items; 1. Serum total protein, especially albumin decreased with no significant difference in both groups. Globulin fractionation (alpha 1, alpha 2, beta, gamma-globulin) showed no characteristic changes. 2. A variation of immunoglobin (IgG, IgM, IgA) was similar in both. 3. Beta 1 C (a component of complement) increased in two groups, but no difference was revealed. 4. Leucocytosis was observed, but lymphocytosis was not detected in both groups. 5. Active E-RFC slightly increased, although total E-RFC and EAC-RFC were within normal range. But these findings were not statistically different in both. 6. In vitro lymphocyte-PHA-response was fairly depressed without a significant difference in two groups. 7. Suppressive effect of serum on lymphocyte-response was also slightly strengthened, but a difference in both was not significant. 8. The results of immune skin tests (PHA, PPD, SK-SD, Candida) could not be debated with liquid numbers studied.

Diagnosis of type A hepatitis by fecal IgA antibody against hepatitis A antigen

A method was developed for the early diagnosis of type A hepatitis. The method involved the detection of fecal antibody against hepatitis A antigen (HAAg). We followed 6 patients who contracted type A hepatitis in an outbreak for the fecal excretion of HAAg and antibody against HAAg (anti-HA) by immune electron microscopy. Fecal anti-HA appeared soon after the disappearance of HAAg, at around the zenith of serum transaminase, and persisted approximately 4 mo after the development of hepatitis. Fecal anti-HA was of IgA class, since it was completely absorbed by an anti-IgA column, but not affected by anti-IgG or anti IgM column. Owing to its early appearance and short duration, fecal anti-HA allows an early diagnosis of type A hepatitis by the test of a single specimen. Fecal anti-HA would be assumed to herald the termination of the period during which patients should be segregated from the community to prevent secondary infection.

Tubular forms of hepatitis B surface antigen bind with the nucleus of 22-nm spherical HBsAg particles

Spherical hepatitis B surface antigen particles (HbsAg) of 22-nm diameter were treated with sodium dodecylsulphate in the absence of reducing agents, and their nuclei were exposed. Factors that interact with the nucleus of HbsAg were detected in the serum of HBsAg carriers who were seropositive for hepatitis B e antigen and identified as tubular forms of HBsAg. The other categories of hepatitis B antigen, Dane particles, and 22-nm spherical HBsAg did not bind with the nucleus of HBsAg. When tubular forms of HBsAg had been treated with a proteolytic enzyme, they lost the reactivity to bind with the nucleus of HBsAg. On the basis of the results obtained, tubular forms of HBsAg bear the receptor of protein nature for the nucleus of 22-nm spherical HBsAg. The receptor allows rapid determination of tubular forms by a haemagglutination method for the evaluation of their clinical and epidemiological implications.