CYP2K6 from zebrafish (Danio rerio): cloning, mapping, developmental/tissue expression, and aflatoxin B1 activation by baculovirus expressed enzyme

A full-length zebrafish (Danio rerio) cytochrome P450 (CYP) 2K6 cDNA, was obtained (GenBank accession No. AF283813) through polymerase chain reaction cloning using degenerated primers based on a consensus CYP2 sequence and the heme-binding domain. This first CYP2K family member cloned from zebrafish had 1861 bp which contained 27 bp of 5'-untranslated region (5'-UTR), an open reading frame (ORF) of 1518 bp, and a 300 bp 3'-UTR with a poly A tail. The deduced 506 amino acid sequence of CYP2K6 had 63%, 62% and 59% identity with rainbow trout CYP2K1, CYP2K4 and CYP2K3, respectively; and 45%, 42%, and 42% identity with rabbit CYP2C1, human CYP2C19 and mouse CYP2C39, respectively. CYP2K6 mapped to 107.49cR on LG3 using the LN54 radiation hybrid panel. Its mRNA was detected at 5 days post-fertilization and in the adult liver and ovary among nine tissues examined. The ORF, including the 27 bp of the 5'-UTR, was cloned into pFastBac donor vector and then transferred into the baculovirus genome (bacmid DNA) in DH10Bac competent cells. The recombinant bacmid DNA was used to infect Spodoptera frugiperda insect cells to express the CYP2K6 protein (Bv-2K6). As its ortholog, rainbow trout Bv-2K1 [Yang, Y.H., Miranda, C.L., Henderson, M.C., Wang-Buhler, J.-L., Buhler, D.R., 2000. Heterologous expression of CYP2K1 and identification of the expressed protein (Bv-2K1) as lauric acid (omega-1)-hydroxylase and aflatoxin B1 exo-epoxidase. Drug Metab. Disp. 28,1279-83.], Bv-2K6 also catalyzed the conversion of aflatoxin B1 (AFB1) to its exo-8,9-epoxide as assessed by the trapping of a glutathione (GSH) adduct in the presence of a specific mouse alpha class glutathione S-transferase. The identity of the AFB1-GSH adduct was verified by liquid chromatography-mass spectrometry (LC-MS) and mass spectrometry-mass spectrometry (MS-MS) analysis. Although rainbow trout Bv-2K1 was capable of oxidizing lauric acid, zebrafish Bv-2K6 protein showed no activity against this substrate.

Sera from children with active Henoch-Schönlein purpura can enhance the production of interleukin 8 by human umbilical venous endothelial cells

OBJECTIVE

To investigate the ability of sera from children with active Henoch-Schonlein purpura (HSP) to enhance endothelial interleukin (IL) 8 production and intercellular adhesion molecule (ICAM)-1 expression.

METHODS

Nine children with active HSP and nine normal healthy children were enrolled. IL8 serum levels of patients and controls at different stages were analysed. Production of IL8 and expression of ICAM-1 by human umbilical venous endothelial cells were detected (ELISA for IL8, flow cytometry for ICAM-1) and compared under various stimuli, including sera of patients at different stages, sera of controls, and medium alone.

RESULTS

Serum levels of IL8 were increased at the acute stage. Levels of IL8 in supernatants from human umbilical venous endothelial cells (HUVEC) co-cultured with sera from children with active HSP were significantly higher than those from HUVEC without any treatment (p = 0.001), HUVEC treated with inactive sera (p = 0.004), and HUVEC treated with sera from healthy controls (p = 0.004). Sera from patients and from controls did not enhance the expression of ICAM-1 on HUVEC.

CONCLUSIONS

Some factors may be present in sera from children with active HSP that could activate endothelial cells to produce IL8. This process may account, in part, for the mechanisms of perivascular neutrophil infiltration and leucocytosis in HSP.

Elevated serum levels of a c-erbB-2 oncogene product in oral squamous cell carcinoma patients

OBJECTIVES

Amplification of the proto-oncogene c-erbB-2 (HER-2/neu) has been shown to be a prognostic marker in many kinds of cancer including oral squamous cell carcinoma (OSCC). In order to obtain further information on the c-erbB-2 gene product p185, it is necessary to quantify expression levels. In this study we used an enzyme-linked immunosorbent assay (ELISA) for the extracellular domain of p185 to determine whether a soluble oncoprotein fragment can be detected in the serum of OSCC patients.

METHOD

Sera from 84 OSCC patients, 51 breast cancer patients (as positive controls), and 15 healthy controls were assayed in an ELISA. To study c-erbB-2 overexpression in OSCC, and breast cancer tissue samples we used an immunohistochemical technique.

RESULTS

The mean serum value (ng/ml, mean/SD) for the normal controls was 8.46/1.29. We chose the 95% level of normal controls as a cut-off to distinguish individuals with elevated levels. The breast cancer patients' and OSCC patients' serum values were 13.83/6.82 and 13.1/4.56, respectively. Significant differences (P < 0.0001) were observed between normal control and OSCC, normal control and the breast cancer group. Immunohistochemically detectable p185 (intermediate to high) was noted in 30 of 61 OSCC, and 24 of 51 breast cancer patients. There was a trend of association of serum oncoprotein fragment levels with tumor stages, but not with tumor sizes, nodal stages, metastases, and oral habits including betel quid chewing, alcohol drinking and smoking in the OSCC group.

CONCLUSION

The results of the present study raise the possibility that soluble c-erbB-2 protein levels in serum is a useful parameter for monitoring the disease status as well as the effect of therapy on patients with OSCC.

Research on solid-state fermentation on rice chaff with a microbial consortium

A microbial consortium of Trichoderma reesei AS3.3711, Aspergillus niger 3.316 and Saccharomyces cerevisiaes AS2.399 was constructed to decomposed rice chaff on the basis of the characters of each microorganism and the mechanism of cellulases. In this experiment, rice chaff was pretreated before fermentation with NaOH so that the lignin structure of rice chaff was degraded and hemicellulose was dissolved partly, which remove the protection of lignin and hemicellulose on cellulose and demolish its special crystal structure. After pretreatment, rice chaff can be degraded more easily with the microbial consortium. The optimal technical paths and technological methods were achieved for intenerating rice chaff with the microbial consortium perfectly through orthogonal experiment. According to the technological methods, some experiments were done at 30 degrees C with pH 4.5. It was found that the highest filter paper enzyme activity (FPA) was 5.64 U/g and the ratio of cellulose degradation (RCD) was 28.05%.

Thermodynamics of Diamond Nucleation on the Nanoscale

To have a clear insight into the diamond nucleation upon the hydrothermal synthesis and the reduction of carbide (HSRC), we performed the thermodynamic approach on the nanoscale to elucidate the diamond nucleation taking place in HSRC supercritical-fluid systems taking into account the capillary effect of the nanosized curvature of the diamond critical nuclei, based on the carbon thermodynamic equilibrium phase diagram. These theoretical analyses showed that the nanosize-induced interior pressure of diamond nuclei could drive the metastable phase region of the diamond nucleation in HSRC into the new stable phase region of diamond in the carbon phase diagram. Accordingly, the diamond nucleation is preferable to the graphite phase formation in the competing growth between diamond and graphite upon HSRC. Meanwhile, we predicted that 400 MPa should be the threshold pressure for the diamond synthesis by HSRC in the metastable phase region of diamond, based on the proposed thermodynamic nucleation on the nanoscale.

Clinical diagnosis of group B streptococci by scpB gene based PCR

BACKGROUND & OBJECTIVES

The goal of the present study was to improve and simplify the diagnosis of Streptococcus agalactiae (group B Streptococcus, GBS) infection for routine clinical practice.

METHODS

A total of 71 clinical samples were tested by microbiologic culture, counter immunoelectrophoresis (CIE) and PCR described in the literature. Southern hybridization was accomplished with the Enzo(TM) "DNA Labeling and Detection Kit", Roche (Germany). The computer techniques were used for selection of the specific primers and for analysis of the sizes of PCR products.

RESULTS

The primers for the regions around the 51 bp deletion in C5a peptidase gene (scpB) of GBS were selected. PCR analysis revealed the 255 bp amplification fragment in GBS, 306 bp fragment in groups A and G streptococci (GAS, GGS) and did not reveal any fragments in other bacterial species. Among 71 urine and serum clinical samples tested, none were found to be GBS positive by microbiologic culture, 16 samples by CIE, 36 by PCR. The specificity of amplification was confirmed by Southern hybridization.

INTERPRETATION & CONCLUSION

The 51 bp deletion in scpB gene in comparison with scpA and scpG genes can be used as a diagnostic tool for identification of GBS. The 51 bp deletion based PCR proved to be faster and more reliable test than microbiologic culture or CIE.

Percutaneous intratumoral injection of traditional Chinese herbal compound medicine Star-99 in treatment of hepatocellular carcinoma of mice

BACKGROUND

Unresectable hepatocellular carcinoma (HCC) lacks effective therapy and entails very poor progress. In 1991, we found that Chinese herbal compound Star-99 has potentially effect on HCC. The purpose of this study was to probe the anti-cancer effect and the mechanism of focal injection of Chinese herbal compound Star-99 into HCC of mice.

METHODS

In 32 nude mice transplanted with human hepatocellular carcinoma SMMC-7721, 16 received hypodermic implant and the other 16 orthotopic liver transplant. They were randomly divided into three groups: Star-99 group (Chinese herbal compound, 16 mice), alcohol group (8) and saline group (8), respectively. Intratumoral injection of Star-99, alcohol and saline was carried out 10 days after transplantation of HCC. Twenty days after the first injection, the nude mice were killed after being injected every 5 days with a total of 4 injections in each mouse. Tumor tissues were examined pathologically or via an electron microscope and flow cytometrical (FCM) DNA analysis. The three diameters of the tumor were measured with high-frequency ultrasound before and after injection, and the growth index was calculated with the following formula: volume of tumor (after treatment-before treatment)/volume of tumor (before treatment). Double-blind method was applied in the experiment.

RESULTS

The growth index of the Star-99 group (0.068+/-0.022) and the alcohol group (0.079+/-0.024) was markedly lower than that of the saline group (4.345+/-1.453, P<0.01), but there was no significant difference between the Star-99 and alcohol groups. Coagulation (8/8) was the major pathological change in the alcohol group. In the Star-99 group, however, the phenomenon of lymphocytes attacking cancer cells could even be seen under the electron microscope. The typical apoptosis cells and apoptosis bodies as well as the collagen fibrae lined in mass could also be seen in the group (14/16). FCM DNA analysis showed that the rate of apoptosis in the Star-99 group (93.8%) was significantly higher than that in the alcohol (12.5%) and saline groups (12.5%) (P<0.01).

CONCLUSIONS

This study shows that Star-99 markedly inhibits and destructs hepatocellular cancer cells. Star-99 is effective to directly destroy the membrane, cytoplasm and nuclei of tumor cells, causing their crumbling, activate the immune function and inflammatory reaction of nude mice, and induce the apoptosis of cancer cells. The effect of Star99 is significantly different from that of alcohol that mainly causes coagulation of cancer cells. Star-99 is feasible in the treatment of HCC.

Apolipoprotein E in Taiwan Chinese patients with dementia

To clarify whether Alzheimer's disease (AD) and vascular dementia (VaD) share the same risk factors in Taiwan Chinese patients. Using the criteria of the NINCDS- ADRDA and NINDS-AIREN, 154 AD patients, 30 VaD patients, and 112 controls were enrolled. Their apolipoprotein E (ApoE) genes, extracted from peripheral blood leukocytes, were analyzed. The epsilon4 allele frequency was significantly higher in AD patients than in the control group. The odds ratio of carrying at least one copy of the epsilon4 allele in AD patients is 2.7 compared with control subjects. There was no significant difference between the VaD patients and the control subjects in their ApoE epsilon4 or epsilon2 allele frequency. The present study demonstrates a strong association between the ApoE epsilon4 allele and AD, but not between the ApoE epsilon4 allele and VaD. This suggests that AD and VaD do not share the same pathogenesis and deserve further investigation.

[Dynamic changes in collagen type I and collagen type III in rabbits infected with Schistosoma japonicum and the effect of gamma-interferon]

OBJECTIVE

To observe the dynamic changes in collagen type I and collagen type III in rabbits with schistosomiasis japonica and the treatment effect of gamma-interferon on the degradation of collagens in schistosomal hepatic fibrosis.

METHODS

Each rabbit was infected with 80 +/- 1 S. japonicum cercariae. Liver operations were done at different time points after infection and the liver specimens were embedded with paraffin and stained with alpha-SMA, HE and picric acid-Sirius red. The stained slides were observed under polarizing microscope and different collagen areas calculated by computer imagine analysis system. At the 16th week after infection, the infected rabbits received a single dose of praziquantel and gamma-interferon for 8 weeks.

RESULTS

The area percent of collagen type I at the 28th week after infection (40.14 +/- 17.00) increased about seven fold compared with the 8th week group (5.73 +/- 3.40). The area percent of collagen type III at the 28th week after infection (6.80 +/- 5.19) increased about six fold compared with the 8th week group (1.15 +/- 1.34). The alpha-SMA positive cells also increased significantly. After gamma-interferon treatment, the area percent of collagen type I and type III decreased significantly, from 18.51 +/- 7.52 and 4.63 +/- 3.64 (before treatment) to 3.09 +/- 1.54 and 0.40 +/- 0.37 (0 and 4 weeks after treatment) (P < 0.01). However, after the withdrawl of gamma-interferon treatment, the collagen degradation was reversible.

CONCLUSION

Gamma-interferon is effective in the treatment of hepatic fibrosis in rabbits infected with S. japonicum, the effect being reversible.

The presence of insertion elements IS861 and IS1548 in group B streptococci

The presence of insertion elements (IS) IS861 and IS1548 in the collection of 211 Streptococcus agalactiae strains isolated from pregnant women and dairy cows was assayed. IS861 was found in 67 human strains (59%) and 36 bovine strains (37%), IS1548 in 13 human strains (12%) and 16 bovine strains (16%). Two combinations, IS861+ IS1548- and IS861- IS1548-, were widely distributed in both human and bovine strains. The copy number and the restriction fragment length polymorphism (RFLP) of the two IS were determined in human group B streptococcus (GBS) strains. A minimum of 8 copies of IS1548 were detected in GBS strains while the copy number of IS861 varied from 1 to 9. The number of different hybridizing patterns with IS861 and IS1548 probes was 9 and 6, respectively. These hybridization patterns were divided into several clusters. All strains with IS were also clustered according to pulsed field-gel electrophoresis (PFGE) patterns. A correlation was found between the results of PFGE- and IS-based clustering.

Antimicrobial susceptibility of Haemophilus influenzae among children in Beijing, China, 1999-2000

A study on the nasopharyngeal carriage and antimicrobial susceptibility of Haemophilus influenza among children was conducted in Beijing Children's Hospital from April to May 2000. The study included 292 children between 1 and 60 mo of age with acute upper respiratory tract infection. Nasopharyngeal swabs from these patients were cultured, and 105 Haemophilus influenzae strains were isolated, 3 of which were type b. Antibiotic susceptibility of the strains was determined using disk diffusion and E-tests and the results compared with those of isolates from children with pneumonia in 1999. The carriage rate of Haemophilus influenzae was 36.0% (105/292). It was found that 4.8% and 1.0% of isolates were resistant to ampicillin and cefaclor, respectively, and 5.7%, 16.2% and 77.1% were resistant to chloramphenicol, tetracycline, and sulphamethoxazole/trimethoprim, respectively. Amoxicillin/clavulanic acid, cefuroxime, ceftriaxone, azithromycin, and clarithromycin were uniformly active to all strains. Compared with the data from 1999, there was a significant increase in resistance to tetracycline (from 12.7% in 1999 to 16.2%) and sulphamethoxazole/trimethoprim (from 40.5% in 1999 to 77.1%).

CONCLUSION

H. influenzae isolates from outpatients in Beijing Children's Hospital had low ampicillin resistance and were sensitive to amoxicillin/clavulanic acid. Sulphamethoxazole/ trimethoprim resistance rates increased rapidly compared with those in the 1999 data. Further surveillance investigations are important for the choice of empiric therapy of acute respiratory tract infection.

Genetic diversity of Cheju horses (Equus caballus) determined by using mitochondrial DNA D-loop polymorphism

We used sequence polymorphism of the mitochondrial DNA D-loop (968 bp excluding the tandem repeat region) to determine genetic diversity of horses inhabiting Cheju (a southern island of Korea). Seventeen haplotypes with frequencies from 1.5 to 21.5% were found among 65 Cheju horse samples. Genetic diversity (h) of the 17 haplotypes was calculated to be 0.91, indicating that the extant Cheju horse population consists of diverse genetic groups in their maternal lineage. Phylogenetic analysis showed that 17 types of Cheju (D-loop sequences determined), 5 Mongolian, 6 Arabian, 3 Belgian, 2 Tsushima, 2 Yunnan, 1 Przewalskii, and 3 Thoroughbred horses (published sequences for the latter seven breeds) showed that Cheju horses were distributed into many different clusters in the tree. Four Mongolian horses clustered with separate Cheju horse groups, showing that some Cheju horses are clearly of Mongolian origin. The analysis of partial sequences (284 bp) of the D-loop of 109 horses showed that Thoroughbred, Mongolian, Lipizzan, and Arabian breeds are as diverse as Cheju horses. Our data together with others suggest that most horse breeds tested with reasonably sufficient numbers of samples are diverse in their maternal lineages and also are not uniquely different from each other.

Chromosomal analysis of group B streptococcal clinical strains; bac gene-positive strains are genetically homogenous

A collection of 45 epidemiologically unrelated Streptococcus agalactiae strains (group B Streptococcus, GBS), belonging to different serotypes, isolated from pregnant women in China and Russia was studied. Strains were characterized by pulsed-field gel electrophoresis (PFGE) employing hybridization with nine genes potentially involved in virulence. Molecular sizes of GBS genomes varied from 2030 to 2290 kb. Location of the genes under study bac, bca, glnA, scpB, cyl, hylB, lmb, scaA and cfb on the GBS genomes was found to be conserved irrelevant to the serotype. Potential virulence genes scpB, hylB, lmb were located on a 91-kb SmaI fragment that is equal to 4.5% of total genome. Ribotyping of the strains under study revealed three different HindIII, nine EcoRI and 12 PvuII ribotypes among 45 strains. A strong correlation between the PvuII ribotype and the presence of the bac gene was observed, with 21 of 22 bac-positive strains belonging to the same PvuII ribotype P1. PFGE patterns of bac-positive strains were also similar. The possibility of close genetic relatedness of all bac-positive strains is discussed.

Enhanced IL-18 expression in common skin tumors

Interleukin-18 (IL-18) has been found to have multiple effects upon various cells involved in inflammatory response. Recently we reported that B16 murine melanoma cells are able to produce IL-18, which is involved in the regulation of intracellular reactive oxygen intermediates (ROI) and Fas-ligand expression, indicating that IL-18 plays key role in the tumor activity of melanoma. In this study, we investigated the pattern of IL-18 expression in the human system. IL-18 production was tested by enzyme linked immunosorbent assay (ELISA) assay in various tumor cell lines, including Raji (Burkitt's lymphoma), IM-9 (B lymphoblast), Jurkat (acute T cell leukemia), SK-MES-1 (squamous cell carcinoma (SCC) cell line), SK-MEL-2, G-361, DM-4, and DX-3 (melanoma cell lines). ELISA tests showed that IL-18 was highly expressed in malignant skin tumors such as SK-MES-1, SK-MEL-2, G-361, DM-4, and DX-3 cell lines, thus suggesting that IL-18 production may be associated with the malignancy of skin tumors. Here, we report that enhanced IL-18 expression is positively correlated with malignant skin tumors such as SCC and melanoma, suggesting the importance role of IL-18 in malignancy of skin tumors. Taken together, expression of IL-18 by tumor cells in human skin tissue may provide an important clue to understand the pathogenesis of malignant skin tumors.

Clinical characteristics of neonatal lupus erythematosus

Neonatal lupus erythematosus is a rare disorder caused by transplacental autoantibodies from the mother to the fetus. This syndrome is characterized by congenital heart block and/or cutaneous lesion. A total of 10 cases of neonatal lupus erythematosus were diagnosed at the National Taiwan University Hospital from 1988 through 1998. The incidence of cardiac anomaly and other clinical features in patients with neonatal lupus erythemayosus in this study was compared with those in previous studies. Results showed that 50% of patients had congenital heart block and/or cutaneous lesion, which is compatible to previous statistics. However, the findings showed that 80% of the patients were female and 90% of the mothers had acquired an autoimmune disorder, which were much higher compared with that of other studies. To date, no definite treatment is suggested prenatally to prevent the occurrence of congenital heart block, but careful maternal screening and serial fetal echocardiogram are warranted.

Risk factors of wheeze and allergy after lower respiratory tract infections during early childhood

Lower respiratory tract infections (LRIs) during early childhood can lead to bronchial hyperreactivity or recurrent obstructive bronchitis. The role of LRIs in the pathogenesis of allergic diseases such as allergic rhinoconjunctivitis, atopic eczema, and bronchial asthma is less clear. The aim of this retrospective study was to determine the incidence of subsequent wheezing and atopy, and the known risk factors for allergic sensitization in 74 children hospitalized for acute LRIs of various etiologies from January 1994 through December 1994. Results showed that there are no differences in outcomes between patients with respiratory syncytial virus LRI, Chlamydia pneumoniae LRI, and LRIs caused by other agents. Although lower respiratory tract illnesses, especially those caused by respiratory syncytial virus during infancy, were associated with an increased risk of subsequent wheezing during early childhood, wheezing tended to disappear with increasing age in many children. This study also found recurrent episodes of wheezing during the first 5 years of life, and symptoms suggestive of allergic rhinoconjunctivitis were the only factors predictive of subsequent diagnosis of asthma for children who had LRIs during early childhood. In conclusion, this study suggests that prevention of recurrent wheezing LRIs and good control of allergic rhinoconjunctivitis is critical for preventing subsequent development of bronchial asthma.

Analysis of cDNA microarray images

Microarrays are part of a new class of biotechnologies that allow the monitoring of expression levels for thousands of genes simultaneously. Image analysis is an important aspect of microarray experiments, one that can have a potentially large impact on subsequent analyses, such as clustering or the identification of differentially expressed genes. This paper reviews a number of existing image analysis methods used on cDNA microarray data. In particular, it describes and discusses the different segmentation and background adjustment methods. It was found that in some cases background adjustment can substantially reduce the precision--that is, increase the variability of low-intensity spot values. In contrast, the choice of segmentation procedure seems to have a smaller impact.

[The expression characteristics and their biological significance of epidermal growth factor and basic fibroblast growth factor in rat skins at different development stages]

OBJECTIVE

To explore the localization and expression characteristics of epidermal growth factor (EGF) and basic fibroblast growth factor (bFGF) in rat skins at different development stages (embryonic, newborn, adult).

METHODS

Skins from embryonic, newborn and adult rats were taken, and detected by immunohistochemical technique.

RESULTS

Positive immunohistochemical signal of EGF could be found in skins from embryonic, newborn and adult rats, mainly in the cytoplasm of the epidermal cells, fibroblasts, hair follicle epithelial cells, and endothelial cells. With the increase in age, the expression amount of EGF was increased. The positive signal of bFGF could be found in skins of newborn and adult rats, while the signal of bFGF in skin of embryonic rats was negative.

CONCLUSION

The results indicate that endogenous EGF plays important role in epidermal development in embryonic stage and wound healing in adult after injury. The negative expression of bFGF in skin of embryonic rat indicate that the absence of bFGF may be one of the reasons for the non-scar healing in embryonic stage.

A double-blind, placebo-controlled, and randomized study of loratadine (Clarityne) syrup for the treatment of allergic rhinitis in children aged 3 to 12 years

Allergic rhinitis is a common disease in children, and antihistamines are the key medication. However, traditional tablets are not convenient and lead to low compliance in young children. The aim of this double-blind, placebo-controlled, parallel, randomized study was to evaluate the effectiveness and safety of loratadine syrup for the treatment of children aged 3 to 12 years with allergic rhinitis. Sixty children with allergic rhinitis due to dust mites were enrolled. They were randomized into 2 parallel groups: one group received loratadine syrup 5 mg or 10 mg daily for 3 weeks, and the other group received placebo. The patients returned to special clinics for symptoms evaluation at day 7 and day 21, and the parents were requested to record disease severity daily. Both evaluations, physician's and parents', were recorded with a 4-point scale for 5 symptoms: sneezing, rhinorrhea, nasal congestion, nasal itching and ocular symptoms. Forty-six patients completed the study, 22 in the loratadine group and 24 in the placebo group. At the initial visit, the total symptom score (TSS) in both groups was not significantly different (p = 0.39). The TSS of the loratadine syrup group at day 7 and day 21 was lower than those of the placebo group (p = 0.003, p = 0.06). The daily card scores in the experimental group were also significantly lower than those of the placebo group (week 1, p = 0.014; week 2, p = 0.029; week 3, p = 0.014). No adverse reactions were recorded in both groups. This study revealed that loratadine syrup 5 mg or 10 mg once a day improved symptom scores of children with allergic rhinitis effectively and safely.

Chronic hepatitis C virus infection associated with primary warm-type autoimmune hemolytic anemia

Autoimmune hematologic abnormalities are not well recognized in chronic hepatitis C virus infection. We demonstrate an unusual association between primary autoimmune hemolytic anemia and chronic hepatitis C virus infection. A 69-year-old woman who had a history of hepatitis C virus-related liver cirrhosis was found to have deteriorating anemia with reticulocytosis when admitted to the hospital. Laboratory work revealed both positive direct and indirect Coombs' tests, and warm-type immunoglobulin G against surface antigens of red blood cells. After prednisolone therapy, her anemia improved dramatically. To our knowledge, this is the first reported case of chronic hepatitis C virus infection linked with autoimmune hemolytic anemia in its natural course, not related to prior interferon treatment. Our report suggests that isolated autoimmune hemolytic anemia may be one of the unusual hematologic manifestations of chronic hepatitis C virus infection.

Tissue-type plasminogen activator deficiency exacerbates arthritis

Fibrin deposition, cell migration, and tissue remodeling are key components in the lesions of inflammatory joint diseases, such as rheumatoid arthritis. The plasminogen activators (PAs), namely, tissue-type PA (t-PA) and urokinase PA, are implicated in these aspects of an inflammatory response, although their precise roles are yet to be defined. We therefore used gene-deficient mice to explore their role in a two-stage arthritis model involving intraarticular methylated BSA injection, followed by systemic IL-1 treatment. We report in this study that both t-PA and urokinase PA are protective for the mild arthritis induced by intraarticular methylated BSA injection alone, since absence of either of them exacerbates the response; following s.c. IL-1 injection, t-PA(-/-) mice had particularly severe disease. Fibrin deposition appeared to parallel disease severity under the various conditions, suggesting that PA-mediated fibrinolysis may be normally playing a protective role in inflammatory joint disease.

The effect of mechanical forces (vibration or external compression) on the dermal water content of the upper dermis and epidermis, assessed by high frequency ultrasound

An ultrasound scanner, is used to detect changes in water content of the upper dermis. This has previously been found to vary with age and to show diurnal variation. Furthermore, oedema due to venous disease can be shown, using this technique, to respond to elevation. In this study, the water content of the upper dermis and epidermis of the leg in 16 subjects is increased following vibration for 10 minutes using a passive exercise system. A study of pressure applied to the skin of the heel for 10 minutes in 14 volunteers also showed an increase in water content of epidermis and dermis in young persons, but less so in the elderly. It is postulated that the anatomical structure of the vascular bed of the upper dermis predisposes to transsudation when pressure to the skin is applied, thereby maintaining the resilience of the skin in the young, but less so in the elderly.

Physician control of pediatric antimicrobial use in Beijing, China, and its rural environs

BACKGROUND

Antibiotic resistance is recognized as an increasing problem in China. It is widely believed that because antibiotics are available without a prescription, changing physician prescribing behaviors will not decrease inappropriate usage. This study identified the sources of antibiotics and the important influence that physicians have on antibiotic use by children in one region of China.

METHODS

Trained medical professionals surveyed parents of children attending several kindergartens in urban Beijing and rural Gu'An, Hebei County. Parents completed a questionnaire concerning the children's recent illnesses, care-seeking patterns and antibiotic use. The team also observed hospital- and non-hospital-based pharmacy purchases of antibiotics for children, assessed the proportion accompanied by a prescription and then interviewed parents about factors influencing those purchases.

RESULTS

Of 241 urban and 143 rural kindergarten parents, 76 to 82% usually obtained children's antibiotics from a hospital pharmacy (with a prescription). For 84% the first source of care was usually a physician (primarily western medicine, sometimes traditional Chinese medicine). Only 5% of antibiotics were obtained from independent vendors without prior physician consultation. Among 229 observed antibiotic purchases 72% occurred at hospital-based facilities, even after longer observation times at nonhospital pharmacies. Prescriptions accompanied all hospital-based antibiotic purchases, contrasting with 18% of nonhospital transactions (P < 0.001). Together 86% of parents self-reported that the observed purchase stemmed from a doctor's recommendation.

CONCLUSIONS

Doctors directly and indirectly controlled the majority of antibiotic usage for childhood illnesses in Beijing and Gu'An (Hebei County). Physician education and implementation of treatment guidelines might substantially reduce inappropriate antimicrobial usage and help prevent antimicrobial resistance in this region.

Acute lupus pneumonitis mimicking pulmonary tuberculosis: a case report

We report a case of systemic lupus erythematosus in a 15-year-old girl with initial presentation as acute lupus pneumonitis. A fulminant course with pancytopenia and respiratory distress were developed 3 weeks after symptom onset. Chest radiographs revealed an interstitial pattern with miliary nodules over bilateral lower lung fields that mimics miliary tuberculosis. The patient was treated with intravenous immunoglobulin and antituberculosis drugs because the infection-associated hemophagocytic syndrome and pulmonary tuberculosis could not be excluded from the clinical course. The response to antituberculosis treatment, however, was poor and her respiratory condition deteriorated rapidly to impending respiratory failure 1 week after admission. Systemic lupus erythematosus with acute lupus pneumonitis was then diagnosed based on the fulminant clinical course and accordant laboratory results. Corticosteroid (methylprednisolone) and cytotoxic agent (cyclophosphamide) pulse therapies were applied twice and once, respectively. She recovered gradually after receiving the immunotherapy.