Comparisons of geniposidic acid and geniposide on antitumor and radioprotection after sublethal irradiation

The antitumor effects of two iridoid compounds, geniposidic acid (GA) and geniposide (GP), were investigated in mice along with their possible effects on radioprotection after sublethal X-irradiation. Decreases in the growth of the implanted tumor by ascitic cells were a result of intraperitoneal administration of GA and GP at high concentrated levels. This result was achieved by exerting the levels of dosage in a dose-dependent manner. Except on the 12th day after treatment by the dosage of 500 mg/kg, reduced radiation effects of mice treated with the drugs in the 30 min preirradiated period by GA and GP on peripheral leukocytes were not observed significantly by the sublethal whole-body X-irradiation. And except on the 7th day after treatment, when these two compounds were administered i.p. to mice 30 min before 4 Gy irradiation, neither GA nor GP enhanced significantly the postirradiation responses of splenic blastogenesis by PHA. In addition, GA might be a more potent tumor growth inhibitor than GP when combined with the X-irradiation, though there was no significant synergetic effect on their combined antitumor activity. The preliminary results of GA and GP on hematological and blastogenic observations in this study suggested that they may very well, partially, play a role in an effective anticancer product with the ability to decrease undesirable radiation damage to the hematologic tissue after high dose irradiation.

Effects of oleanolic acid and ursolic acid on inhibiting tumor growth and enhancing the recovery of hematopoietic system postirradiation in mice

Two triterpene acids, oleanolic acid (OA) and ursolic acid (UA) were examined for their ability to inhibit the tumor growth and modify hematopoiesis after irradiation in three experimental systems: (a) in vivo anti-tumor activity of implanted tumor by ascitic cells was found to be augmented by addition of OA and UA at a high concentration and inhibited in a dose-dependent manner; (b) in the sublethal whole-body irradiated mice treated with the drugs in the 30 min preirradiation period, enhanced effects of OA and UA on peripheral leukocytes were observed by a different significance, and (c) when these chemicals were administered i.p. to mice 30 min before 4 Gy irradiation, both OA and UA enhanced the postirradiation responses of splenic blastogenesis by PHA. UA was a more potent tumorigenic inhibitor than OA. Combining with the gamma-irradiation, however, there was no significant synergetic effect on their anti-tumor activity. The beneficial effects of OA and UA on hematopoiesis and immunocompetence under this study, suggested they might partially play a role in anti-cancer and, furthermore, with the ability to decrease undesirable radiation damage to the hematopoietic tissue after radiotherapy.

A preliminary study on the radioprotection of mouse hematopoiesis by dang-gui-shao-yao-san

The purpose of this study reported here was to investigate the ability of Dang-Gui-Shao-Yao-San (DGSYS), known to elevate hematopoietic functions, to protect mice undergoing treatment with whole body single X-irradiation. DGSYS given at doses of 10 and 20 mg/20 g body weight, once a day, for 7 consecutive days before irradiation protected ICR strain mice from the sublethal effects of radiation in a dose-dependent manner. Prior administration of 20 mg/20 g DGSYS increased the number of femoral spleen colony-forming units (CFU-S) that survived irradiation, and significantly ameliorated leukopenia, thrombocytopenia and the degression of hematocrits after irradiation. These results suggest that DGSYS may be effective in the prevention of hematopoietic injury caused by sublethal dose irradiation.

Humoral and cellular immune responses to hepatitis B vaccination in hepatitis B surface antigen-carrier children who cleared serum-hepatitis B surface antigen

The immune responses to hepatitis B vaccine were studied in 11 hepatitis B surface antigen (HBsAg) carrier children who had cleared HBsAg but failed to develop hepatitis B surface antigen antibodies (anti-HBs) in sera (group 1), 5 HBsAg carrier children who had cleared HBsAg and developed detectable anti-HBs in sera (group 2), and 5 healthy subjects seronegative for all hepatitis B virus (HBV) markers (group 3). After receiving three doses of HB vaccine, group 1 subjects failed to develop detectable anti-HBs. Subsequently, each subject of the three groups was given one dose of the same vaccine for a cellular immunity study, and a measurable proliferation of peripheral blood mononuclear cells (PBMC) to HBsAg was detected in 1 of 8 (12.5%), 0 of 5, and 4 of 5 (80%) of the cases in each group, respectively, after vaccination. The removal of CD8+ cells enhanced the HBsAg blastogenic response in group 3 but did not reverse the unresponsiveness in group 1 and group 2 subjects. The addition of interleukin (IL)-2 in culture reversed unresponsiveness in all cases except one case in group 1. Compared with before vaccination, PBMC from group 2 subjects produced significantly less interferon gamma (IFN-gamma) and more IL-4 in response to HBsAg after vaccination, a cytokine response not observed in group 1 subjects. HLA typing indicated that 3 of 10 patients in group 1 (30%) and 1 of 5 patients in group 2 (20%) had HLA-DRw14-DRw52, a marker previously linked to low anti-HBs response to hepatitis B vaccine in Taiwan. We conclude that the underlying causes of poor anti-HBs response in group 1 subjects are multifactorial, including specific failure of antigen presentation or T-cell activation, or the lack of T helper (Th)2 cell-like response to HBsAg. HLA-DRw14-DRw52 does not confer absolute nonresponsiveness to HBsAg. These patients are not benefited by hepatitis B immunization.

Recovery of the hematopoietic system by Si-Jun-Zi-Tang in whole body irradiated mice

The herbal formulation Si-Jun-Zi-Tang reduced the decrease of leukocytes, erythrocytes, thrombocytes and hematocrit in irradiated mice. In general, its protection was more effective in leukocytes and thrombocytes than other hematocytes. Protection of bone marrow stem cells by Si-Jun-Zi-Tang was markedly enhanced by increased radiotolerance under the dose ranging from 0 to 5 Gy. This increased radiotolerance led to a prolonged shoulder in the survival curve but did not influence the D0 value. Si-Jun-Zi-Tang exerted a beneficial effect on clinical syndromes such as anemia. From the results in this study, we concluded preliminarily that the most effective concentration with least toxicity was about 20 mg/20 g body weight. At this dose, levels of leukocytes as well as thrombocytes were enhanced significantly after chi-irradiation. Elevation of erythrocytes and hematocrits could also be found but was not significant.

Seroepidemiology of hepatitis B virus infection in children: Ten years of mass vaccination in Taiwan

OBJECTIVE

To study the seroepidemiology of hepatitis B virus (HBV) infection in children 10 years after a mass hepatitis B vaccination program was begun in Taiwan.

DESIGN

Cross-sectional seroprevalence survey.

SETTING

Cheng-Chung/Chung-Cheng District, Taipei, Taiwan, 1994.

SUBJECTS AND METHODS

Serum samples from 1515 healthy children younger than 12 years were tested for HBV markers. The results were compared with a baseline seroepidemiologic study conducted just before the vaccination program was launched in 1984 and with a subsequent study in 1989 in the same area.

MAIN RESULTS

Eighty-seven percent of the children had received at least 3 doses of HBV vaccine. The overall prevalence rate of hepatitis B surface antigenemia decreased from 9.8% in 1984 to 1.3% in 1994. A statistically significant decrease was observed in every age group from 1 to 10 years. The overall prevalence rate of hepatitis B core antibody was 26% in 1984, 15% in 1989, and 4.0% in 1994. This suggests that the risk of horizontal HBV infection has decreased over time, not only because of the protective effect of the vaccine but also because the infection source has diminished. A high prevalence rate of hepatitis B surface antibody (79%) was noted in 1994 as anticipated.

CONCLUSIONS

The Taiwanese mass vaccination program has protected most children younger than 10 years from becoming carriers, reducing both perinatal and horizontal HBV transmission. Mass HBV vaccination has proved to be a successful method to control HBV infection in this hyperendemic area.

The role of transplacental hepatitis B core antibody in the mother-to-infant transmission of hepatitis B virus

AIMS/METHODS

To investigate the influence of transplacental hepatitis B core antibody (anti-HBc) on perinatal hepatitis B virus (HBV) transmission, we studied the anti-HBc titers in 294 mother-neonate pairs.

RESULTS

The anti-HBc titer was highest (10(5.13 +/- 0.80) to 10(4.36 +/- 0.97) in mothers, 10(5.13 +/- 0.76) to 10(5.52 +/- 0.98) in infants) in the 200 hepatitis B e antigen (HBeAg) positive hepatitis B surface antigen (HBsAg) carrier mothers and their infants, second highest (10(4.51 +/- 0.76) and 10(4.68 +/- 0.76)) in the 60 HBeAg-negative HBsAg carrier mothers and their infants, and lowest (10(3.11 +/- 0.76) and 10(3.24 +/- 0.83)) in the 34 non-carrier mothers and their infants (p < 0.05). One hundred and ninety-two infants of HBeAg-positive carrier mothers received hepatitis B immunoglobulin as well as hepatitis B vaccines, and were followed prospectively from birth. Ten infants became HBsAg carriers, and their mothers had significantly lower anti-HBc titers than those of the mothers of 182 infants who did not become carriers (p = 0.003), while maternal serum hepatitis B virus DNA levels (29.9 +/- 23.6 versus 39.9 +/- 58.1 pg/10 ml) did not differ in those two groups (p > 0.25). The same trend was observed in the infants' anti-HBc titers in those two groups (p = 0.0006).

CONCLUSIONS

The association of lower anti-HBc titers in HBeAg-positive carrier mother-infant pairs and the development of carrier status in the infants suggests a positive role of anti-HBc in the modulation of mother-to-infant transmission of HBV. A high maternal anti-HBc level in serum may be a negative predictor of immunoprophylaxis failure in high-risk infants.

Protection of mouse bone marrow by Si-WU-Tang against whole body irradiation

The ability of Si-Wu-Tang to eliminate bone marrow damage after radiation was assessed using both a clonogenic assay (survival of colony forming units spleen--CFUs) of stem cell survival and a hematopoietic functional assay including the changes of hemograms and hematocrit. Cell survival curves and dose-response curves for radiation alone and Si-Wu-Tang administration with radiation were constructed over the dose range of 1 to 9 Gy. Si-Wu-Tang was given 7 days before irradiation at a consecutive fractionated dose of 20 mg/20 g body weight. The radioresistance of stem cells treated by Si-Wu-Tang was higher than that of those treated by irradiation alone. However, the anti-radiation effect of leukocytes was not as significant as that of erythrocytes, thrombocytes and hematocrit. These data suggest that the anti-radiation effect by Si-Wu-Tang is dependent on dose and will be less after 4 Gy irradiation. Hemograms with a short turnover period, such as leukocytes, may be less affected after Si-Wu-Tang administration.

Case report: paucity of interlobular bile ducts in Chinese children

Sixteen Chinese children with cholestasis since early infancy were diagnosed to have paucity of interlobular bile ducts (PILBD) or its equivalent. Twelve children belonged to the syndromic group of PILBD and four children belonged to the non-syndromic group. A definite histological diagnosis of bile duct paucity was established in only two children (aged 4 and 9 months) during the first percutaneous needle biopsy. In the remaining 14 children a varying degree of bile duct destruction was evident in the follow up percutaneous or wedge liver biopsies. The evolving changes were characterized by inflammatory infiltration near or at the ductal wall, the presence of dysmorphic ductules, the degeneration of ductal epithelia and a progressive decrease of interlobular bile ducts. Of 10 children who underwent laparotomy for definite diagnosis, kasai operation was performed in two of them. In the syndromic PILBD group, all children, including two paired siblings, had at least three of five major clinical features. Hypoplasia of the extrahepatic biliary tree was found in five children and atresia of the extrahepatic bile duct was found in one. Three of six children studied were shown, by polymerase chain reaction, to have cytomegalovirus infection in the liver. This study demonstrates that bile duct paucity is a result of progressive bile duct destruction. A definitive diagnosis is difficult to make in early infancy. Thus, the careful evaluation of extrahepatic features in cholestatic children and follow-up liver biopsies are indicated. Although the pathogenetic mechanism of PILBD is unknown, bile duct destruction is the common pathway leading to paucity of bile ducts irrespective of syndromic or non-syndromic types.

Rotavirus gastroenteritis associated with afebrile seizure in childhood

From September 1994 to April 1995, we encountered eight children, two boys and six girls, (aged 1 year 6 months to 9 years), presented with acute diarrhea followed by afebrile, generalized tonic-clonic seizures, or transient loss of consciousness with urine incontinence. Their biochemical data, including serum electrolyte levels, were within normal limits. The infective agent causing diarrhea was later proved by stool examination to be rotavirus, judged to be serotype G1 by reverse transcription - polymerase chain reaction (RT-PCR) typing. Cerebrospinal fluid (CSF) examinations performed in seven of the eight patients were within normal limits, and cultures for bacteria and virus were negative. The electroencephalograms (EEGs) performed from 1 to 13 days after seizure showed abnormal in six, and normal in two, patients. Follow-up EEGs, performed from 4 to 11 months after onset of seizure, were all normal. None had seizure recurrence despite the fact that no long-term anticonvulsant had been given. From observation here, the authors emphasize that there is a close relationship between rotavirus and afebrile seizure, and the course of afebrile seizure following rotavirus gastroenteritis is usually benign. Further studies are needed to elucidate the underlying pathogenesis.

Inhibition of macrophage scavenger receptor activity by tumor necrosis factor-alpha is transcriptionally and post-transcriptionally regulated

Regulation of expression of the scavenger receptor is thought to play a critical role in the accumulation of lipid by macrophages in atherosclerosis. Tumor necrosis factor-alpha (TNF-alpha) has been shown to suppress macrophage scavenger receptor function (van Lenten, B.J., and Fogelman, A.M. (1992) J. Immunol. 148, 112-6). However, the mechanism by which it does so is unknown. We evaluated the mechanism by which TNF-alpha inhibited macrophage scavenger receptor surface expression and binding of acetylated low density lipoprotein (aLDL). Binding of aLDL to phorbol 12-myristate 13-acetate (PMA)-differentiated THP-1 macrophages was suppressed by TNF-alpha in a dose-dependent manner. Inhibition of aLDL binding was paralleled by a reduction of macrophage scavenger receptor protein as detected by the Western blot. TNF-alpha partially decreased macrophage scavenger receptor mRNA steady state levels in PMA-differentiated THP-1 macrophages, a result that was confirmed by reverse transcription-polymerase chain reaction. PMA increased the luciferase activity driven by the macrophage scavenger receptor promoter in the transfected cells, whereas TNF-alpha partially reduced luciferase activity. However, macrophage scavenger receptor mRNA half-life was dramatically reduced in cells treated with TNF-alpha relative to untreated cells. Reduction in macrophage scavenger receptor message in response to TNF-alpha was dependent on new protein synthesis because it was blocked by cycloheximide. These results indicate that TNF-alpha regulates macrophage scavenger receptor expression in PMA-differentiated THP-1 macrophages by transcriptional and post-transcriptional mechanisms but principally by destabilization of macrophage scavenger receptor mRNA.

Hepatitis C viral infection in thalassemic children: clinical and molecular studies

To determine and correlate the liver function profile, hepatitis C virus (HCV) genome, anti-HCV, genotypes, quantitation, and nucleotide sequence variability in polytransfused thalassemic children, 61 such children were studied prospectively for 4 y. Twenty-six had HCV infection. The average age, number of transfusions, and alanine aminotransferase (ALT) levels of the HCV-infected group were higher than those of the 35 children without HCV infection. None was infected after the initiation of anti-HCV screening in donor blood. Liver biopsies were performed in six HCV-infected and eight HCV-noninfected thalassemic children, and portal fibrosis was found more frequently in the HCV-infected group. Quantitation of HCV RNA was done by the competitive polymerase chain reaction method, and the titer was about 1 x 10(6) to 5 x 10(8) copies/mL. The titer did not change significantly over the 4-y follow-up period and did not correlate with ALT levels. Nineteen HCV-infected patients were genotyped; 15 were Okamoto/Simmonds type II/1b, two were type III/2a, and two were type IV/2b. The hypervariable region of the HCV genome (E2/NS1) was cloned and sequenced in two serum samples from one patient collected at a 2-y interval, as the ALT levels decreased. The variation rate was estimated to be 1.2-1.7 x 10(-2)/nucleotide/y. The results showed that, in polytransfused thalassemic children, 43% (26/61) contracted HCV. We conclude that HCV infection may cause elevated ALT levels and portal fibrosis of the liver, whereas the viral titer and genotypes do not parallel ALT levels.

Least microtransfusion from mother to fetus in elective cesarean delivery

OBJECTIVE

To examine the variability of maternal-fetal microtransfusion in different modes of delivery, as measured by hepatitis B surface antigen (HBsAg) and placental alkaline phosphatase.

METHODS

We recruited 97 HBsAg-positive pregnant women. The mode of delivery included elective cesarean in 16, normal spontaneous vaginal delivery in 56, vacuum or forceps delivery in 12, and emergency cesarean after labor in 13. We measured HBsAg and placental alkaline phosphatase levels in 97 pairs of maternal and fetal blood samples collected at delivery.

RESULTS

The mean maternal placental alkaline phosphatase levels did not differ among these four groups. The mean cord placental alkaline phosphatase level of the elective cesarean group was the lowest (P < .05). All samples of cord sera for this group were negative for HBsAg, compared with 38 of 56, eight of 12, and seven of 13 in the spontaneous vaginal, vacuum or forceps, and emergency cesarean groups, respectively (P < .05).

CONCLUSION

The level of mother-to-fetus microtransfusion least in the elective cesarean group, as revealed by both the lowest cord placental alkaline phosphatase and HBsAg levels. These observations may have implications for reducing perinatal transmission of blood-borne viruses.

Distraction lengthening of a replanted digit

The Ilizarov technique was used to lengthen a replanted middle finger on a musician's left hand. Bone consolidation was achieved in 6 months without the need for a bone graft. The elongated digit has good sensibility, appropriate stability, and sufficient length, which were essential for a good performance in her profession. The unique indication to apply the callus distraction technique in such a special condition was described, and the relative merits of other treatment alternatives were discussed.

The significance of spontaneous hepatitis B e antigen seroconversion in childhood: with special emphasis on the clearance of hepatitis B e antigen before 3 years of age

To investigate the significance of spontaneous hepatitis B e antigen (HBeAg) seroconversion during childhood, 415 hepatitis B surface antigen (HBsAg) carrier children (ages 0 to 15 years) were prospectively followed for 7.1 +/- 2.9 years. Hepatitis B virus (HBV) markers and liver function profiles of each child were tested at least once every 6 months. Among them, 50 were initially anti-HBe positive and 140 seroconverted from HBeAg to anti-HBe during follow-up. Before HBeAg seroconversion, jaundice occurred in 9 and alanine transaminase (ALT) activities elevated in 99 of the 140 seroconverters. Serum ALT returned to normal in all patients within 1 to 5 years of seroconversion. Six had reelevated ALT later after seroconversion. Only 7 (9.7%) of the 72 carrier infants seroconverted before 3 years of age. The peak ALT levels in five of them exceeded 100 IU/L, and two had jaundice before HBeAg seroconversion. One of the early seroconverters developed hepatocellular carcinoma (HCC) at 11 years of age, although his liver function profiles remained normal after HBeAg seroconversion. Liver biopsy specimens from 30 children during the anti-HBe-positive stag e showed inactive cirrhosis in 2 (including one with HCC), chronic hepatitis with marked fibrosis in 1, mild activity and moderate fibrosis in 2, mild activity and mild fibrosis in 9, and minimal histologic changes in the remaining 16. Although most will achieve a normalization of ALT and inactive liver histologic changes, the seroconversion of HBsAg carrier children from HBeAg to anti-HBe is not necessarily an indicator of favorable prognosis; a small proportion of children will develop cirrhosis or even HCC.

The association of syndromic paucity of the interlobular bile ducts and congenital mechanical obstruction of the small intestine

Three patients with congenital mechanical intestinal obstruction and features of syndromic paucity of the interlobular bile ducts (SPILBD) are presented. Two of them have siblings with syndromic paucity of the interlobular bile ducts. Two patients had jejunoileal atresia, while the other had a meconium plug with intestinal perforation. All subjects underwent surgery for intestinal obstruction within the first 24 h of life. Progressive disappearance of the bile ductules was observed in one case. We believe that an insult such as vascular insufficiency to both bile ductal epithelium and the small intestine may be the cause of this congenital disorder.

Percutaneous endoscopic gastrostomy in infants

After a trial of 1 month of nasogastric tube feeding, three infants (aged 5-14 mo) underwent percutaneous endoscopic gastrostomy (PEG) to enable long-term enteral feeding. The Ponsky-pull technique was employed for PEG insertion. In two patients, the procedure was complicated by superficial wound infection at the cutaneous exists of the PEG tubes: one with Pseudomonas sp and the other staphylococcal colonization. Both responded well to antibiotic treatment. All patients obtained good nutritional support. The preliminary experience reported here suggests that, even in infants, PEG is a safe and easy nonsurgical method of enteral feeding.

Ultrasound-guided percutaneous drainage of liver abscess in children

This study's purpose was to investigate the effectiveness of ultrasound-guided percutaneous drainage (US-PD) as treatment modality for pediatric pyogenic liver abscess when compared with other modalities. Ten consecutive patients, aged from 2 months to 22 years, were enrolled in this study. In addition to antibiotics, US-PD was attempted in each case unless the procedure was judged unsuitable. Six patients were treated with US-PD while four were not, for various reasons. US-PD was performed under an intravenous anesthesia and with the aid of real-time sonography. An indwelling pigtail catheter was usually inserted during US-PD. Fever subsided within one to six days, but the abscess cavity closed later. Failure to respond to US-PD may relate to the huge size of abscess cavity; surgical drainage provides an option. A trend toward a shorter hospital stay and defervescence day was found in the US-PD group than in the non-US-PD group. Prognosis was generally good and none in this series died of this disease or the procedure. Klebsiella pneumoniae was the pathogen most frequently encountered. Seven of the ten patients had underlying disease, and hemoglobinopathy was frequently associated. In conclusion, adequate drainage is recommended as the most effective treatment modality for pediatric liver abscess, and US-PD is the first choice.

Altered cholesterol trafficking in herpesvirus-infected arterial cells. Evidence for viral protein kinase-mediated cholesterol accumulation

Herpesvirus infection of arterial smooth muscle cells has been shown to cause cholesteryl ester (CE) accumulation. However, the effects of human herpes simplex virus type 1 (HSV-1) infection on cholesterol binding and internalization, intracellular metabolism, and efflux have not been evaluated. In addition, the effects of viral infection on signal transduction pathways that impact upon cholesterol metabolism have not been studied. We show in studies reported herein that HSV-1 infection of arterial smooth muscle cells enhances low density lipoprotein (LDL) binding and uptake which parallels an increase in LDL receptor steady state mRNA levels and transcription of the LDL receptor gene. HSV-2 also increases CE synthesis and 3-hydroxy- 3-methylglutaryl-CoA reductase activity but concomitantly reduces CE hydrolysis and cholesterol efflux. Interestingly, this viral infection was associated with a time-dependent decrease in protein kinase A activity and an increase in viral-induced protein kinase (VPK) activity commensurate with the accumulation of esterified cholesterol. The relationship between increased VPK activity and alterations in CE accumulation in virally infected cells was explored using an HSV-1 VPK- mutant in which the portion of the HSV-1 genome encoding VPK had been deleted. Cholesteryl ester accumulation was significantly increased (> 50-fold) in HSV-1-infected cells compared to uninfected cells. However, the HSV-1 VPK- mutant had no significant effect on CE accumulation. The relationship between VPK activity and these alterations in cholesterol metabolism was further supported by the observation that staurosporine and calphostin C (protein kinase inhibitors) reduced protein kinase activity in HSV-1-infected cells. These results suggest several potential mechanisms by which alterations in kinase activities in response to HSV-1 infection of vascular cells may alter cholesterol trafficking processes that eventually lead to CE accumulation.

Mass spectrometric analysis of rat liver cytosolic glutathione S-transferases: modifications are limited to N-terminal processing

Cytosolic glutathione S-transferases (GSTs) from rat livers were purified using an S-hexylglutathione affinity column. The GST subunits were resolved by reverse-phase HPLC and their molecular masses were determined by electrospray mass spectrometry. The major hepatic GSTs detected were subunits 1, 1', 2, 3 and 4, with molecular mass of 25,520, 25,473, 25,188, 25,782 and 25,571 Da respectively. Subunits 6, 7 and 10 are minor components, with molecular mass of 25,551, 23,308 and 25,211 Da respectively. Alternatively, the hepatic GSTs were purified using a glutathione affinity column. Subunits 1, 1', 2, 8 and 10 were eluted from this column with GSSG, the oxidized form of glutathione. Subunit 8 has a molecular mass of 25,553 Da. The remaining proteins on the glutathione affinity column were removed with glutathione and S-hexylglutathione. Subunits 2, 3, 4 and 6 could be detected in the eluate. We could not detect any significant difference in molecular mass between GSTs isolated from male and female rat livers. Cytosolic GSTs were isolated from livers of buthionine sulphoximine-treated female rats for MS analysis. The molecular masses obtained were identical to those determined for the controls.

Absence of infection in breast-fed infants born to hepatitis C virus-infected mothers

The role of breast-feeding in perinatal transmission of hepatitis C virus (HCV) was explored in 15 HCV-infected mothers and their infants. The 15 carrier mothers had anti-HCV titers ranging from 1:80 to 1:40,000 and also had HCV-ribonucleic acid with concentrations ranging from 10(4) to 2.5 x 10(8) copies/ml. Both anti-HCV antibody and HCV-ribonucleic acid were present in colostral samples in much lower levels, but none of the 11 breast-fed infants had evidence of HCV infection for up to 1 year of age. Thus breast-feeding seems safe for these infants.

Precore mutant of hepatitis B virus in childhood fulminant hepatitis B: an infrequent association

Serum HBV DNA from infants and children with fulminant hepatitis B (FHB) or acute self-limiting hepatitis B (AHB) and patients believed to be contamination sources was amplified by polymerase chain reaction (PCR) followed by direct sequencing of the precore region. A precore mutation from G to A at nucleotide 1896 was found in 5 of 14 FHB patients and in 3 of 10 AHB patients. Among the 10 infants who developed hepatitis during the first 6 months of age, the precore mutation was detected in only 2 of 7 with FHB and in 1 of 3 with AHB. In 1 infant with FHB, a shift from wild type to precore mutant predominance occurred in the serum virus population during the incubation period. Thus, the precore mutation is neither necessary nor sufficient to cause FHB in childhood, although its contributory role cannot be excluded. Factors other than precore mutations may be important in the pathogenesis of FHB.

Evaluation of the effectiveness of sensory reeducation following digital replantation and revascularization

Sensory recovery following digital replantation plays an important role in the restoration of hand function. Twelve patients with twenty-four replanted or revascularized digits were randomly selected to enter a program of sensory reeducation, and another 15 patients with 22 replanted or revascularized digits were selected as controls who did not receive sensory reeducation. A moving two-point discrimination and a Semmes-Weinstein pressure threshold test were evaluated for monitoring the sensory recovery. The period of sensory reeducation was 18.83 weeks on average, and the mean follow-up time was 11.94 months. The group that received sensory reeducation significantly improved to a better degree of moving two-point discrimination and Semmes-Weinstein threshold level by both univariate and multiple regression analysis. We suggest that sensory reeducation should be an integral part of the postoperative rehabilitation protocol following digital replantation and revascularization.

Multivariate analysis of factors influencing the functional recovery after finger replantation or revascularization

A multivariate statistical analysis was utilized to study the influence of the four preoperative (age, mechanism of injury, level of injury, and type of amputation) and one postoperative (rehabilitation) variables on the functional recovery of the replanted or revascularized finger. Statistically significant differences are summarized as follows. The young age group have a better functional recovery due to better sensory recovery than the old age group. The crush injury group have a better functional recovery, with better scores in motion and patient satisfaction, than the avulsion injury group. The middle phalangeal injury group have a better functional recovery, with better score in motion and sensation than the proximal phalangeal injury group. There is no statistically significant difference in functional recovery between the revascularized and replanted fingers, but there is a significantly better sensory recovery in the revascularized finger. The rehabilitation group has a better functional recovery, with better score in motion, subjective symptoms, and patient satisfaction, than the nonrehabilitation group.

Central pontine myelinolysis in chronic hyponatremic patient: a case report

A 59-year-old woman had chronic hyponatremia from inappropriate secretion of antidiuretic hormone (SIADH) and malnutrition after recurrent cholecystitis for 2 months. She developed dysarthria, dysphagia, bilateral ptosis, clonic convulsions and delayed onset Parkinsonian features. Magnetic resonance imaging showed increased signal density in the central pons on T2-weighted images. She was also later diagnosed as having systemic lupus erythematosus (SLE). This case is reported because central pontine myelinolysis (CPM) developed in chronic hyponatremia without correction, and manifested with atypical, delayed-onset Parkinsonian features. The patient recovered well from her neurological illness, unlike the poor outcome in previously reported cases of CPM. In addition, the coincidence of CPM and SLE has not, to knowledge, been reported before.