Bootstrap methods for adaptive designs

Adaptive designs generate dependent sequences of random variables that are not exchangeable. Therefore, it is not obvious how to employ a resampling scheme for confidence interval estimation. We propose a simple procedure where observed response rates from an adaptive experiment are input to a simulation program. The program then generates sequences from the adaptive sampling scheme. We compare, via simulation, three bootstrap confidence intervals with the asymptotic confidence interval for two adaptive designs useful for clinical trials. A simple ranking of simulated response rates yields a confidence interval approximation with coverage close to 1-alpha in most cases. The method allows us to incorporate such complexities as staggered entry and delayed response. We give an example of its utility on a clinical trial of fluoxetine in depression.

Rickettsia prowazekii transports UMP and GMP, but not CMP, as building blocks for RNA synthesis

Rickettsia prowazekii, the etiological agent of epidemic typhus, is an obligate intracellular bacterium and is apparently unable to synthesize ribonucleotides de novo. Here, we show that as an alternative, isolated, purified R. prowazekii organisms transported exogenous uridyl- and guanylribonucleotides and incorporated these labeled precursors into their RNA in a rifampin-sensitive manner. Transport systems for nucleotides, which we have shown previously and show here are present in rickettsiae, have never been reported in free-living bacteria, and the usual nucleobase and nucleoside transport systems are absent in rickettsiae. There was a clear preference for the monophosphate form of ribonucleotides as the transported substrate. In contrast, rickettsiae did not transport cytidylribonucleotides. The source of rickettsial CTP appears to be the transport of UMP followed by its phosphorylation and the amination of intrarickettsial UTP to CTP by CTP synthetase. A complete schema of nucleotide metabolism in rickettsiae is presented that is based on a combination of biochemical, physiological, and genetic information.

[Experiment and clinical application of targeting treatment with adriamycin magnetic albumin microspheres in human gastric carcinoma]

OBJECTIVE

To study the pharmacokinetics in experimental animals and observe the concurrent anticancer effects in human advanced gastric cancer as an adjuvant chemotherapy, when adriamycin magnetic albumin microspheres (ADM-MAM) were combined with external static magnetic fields.

METHODS

The drug concentration of targeting tissues in the animals and the stability of ADM-MAM in human gastric juices were determined. Clinical and histopathological changes were observed in 55 cases of advanced gastric carcinomas after targeting treatment.

RESULTS

The peak concentrations of the targeting tissue were highest after ADM-MAMs were administered for 2 hours and remained at the high level for a long time. ADM-MAM maintained its stability in human gastric juices. Targeting treatment improved the patients' symptoms, raised the rated of tumor resection, prolonged patients' lifetime, and enhanced histopathological effects (P < 0.01).

CONCLUSIONS

The administration of ADM-MAM combined with the external static magnetic fields is effective for targeting location and is of clinical value as a preoperative adjuvant chemotherapy for human advanced gastric carcinoma.

Detection of p53 protein accumulation in sputum and lung adenocarcinoma associated with indoor exposure to unvented coal smoke in China

Lung cancer in Xuan Wei (XW), China has been linked to exposure to unvented coal smoke and adenocarcinoma, especially bronchioloalveolar carcinoma, is most common. p53 mutations occur commonly in lung cancers and usually generate detectable levels of p53 protein accumulation. Sputum is noninvasive to collect and ideal for screening p53 abnormalities. p53 protein accumulation was detected by immunohistochemistry in lung tumors and sputa from XW lung cancer patients to determine (1) the role of p53 in lung pathogenesis, and (2) feasibility of detecting p53 protein accumulation in sputum, p53 protein accumulation was detected in 73% (22/30) of lung adenocarcinomas from XW females exposed to coal emissions and significantly higher than the control cases (33%, p < 0.05). In sputum, we detected p53 overexpression in tumor cells in 54% (13/24) of XW cases and also in dysplastic cells (50% or 4/8). These findings suggest that p53 abnormalities is important in XW lung cancer etiology.

A low voltage-activated Ca2+ current mediates cytokine-induced pancreatic beta-cell death

Insulin-dependent diabetes mellitus is characterized by the selective destruction of pancreatic beta-cells. Chronic treatment with cytokines induced a low voltage-activated (LVA) Ca2+ current in mouse beta-cells. The concomitant increase in the basal cytoplasmic free Ca2+ concentration ([Ca2+]i) was associated with DNA fragmentation and cell death. Antagonists of LVA Ca2+ channels prevented this elevation of basal [Ca2+]i and DNA fragmentation and reduced the percentage of cell death. Exposure to cytokines did not affect the profile of Ca2+ currents or basal [Ca2+]i in glucagon-secreting alpha-cells. An increased Ca2+ signal through LVA Ca2+ channels may thus be a key feature in cytokine-induced beta-cell destruction.

Pilot study of schistosomiasis control in Poyang lake region

AIM

To perform a longitudinal survey of the control of schistosomiasis in Fanhu Village hyperendemic for schistosomiasis, Poyang Lake region of Jiangxi Province from 1992 to 1996.

METHODS

Annual mass chemotherapy and health education were implemented in all investigated individuals, in 1996, artesunate was used in high risk population in transmission season as a prophylactic measure.

RESULTS

The prevalence of S. japonicum infection reduced from 26.0% in 1992 to 10.7% in 1994, the intensity of infection (geometric mean of EPG of feces) in residents decreased from 1.92 in 1992 to 0.55 in 1994, and the morbidity indicators such as hepatomegaly and splenomegaly in the cases also have been improved significantly after chemotherapy. In 1995, both the infection rate and intensity of infection of schistosomiasis were recurred from 10.7% and 0.55 in 1994 to 18.4% and 1.04 respectively due to the floods. In 1996, the infection rate reduced to 5.0% and the intensity of infection also decreased to 0.25 due to the additional measure.

CONCLUSION

A mass chemotherapy in conjunction with health education and oral artesunate for preventing reinfection in transmission season is effective for the control of schistosomiasis in lake regions.

[The relationship between Helicobacter pylori and expression of c-met oncogene in gastric precancerous lesions]

OBJECTIVES

To determine whether there is a relationship between the presence of H. pylori and alteration of c-met oncogene and to estimate the role of H. pylori in the development of gastric carcinoma.

METHODS

110 patients with histopathologically proven chronic gastritis were studied. We demonstrated expression and overexpression rates of c-met oncogene by using immunohistochemical staining.

RESULTS

For chronic superficial gastritis, chronic atrophic gastritis, intestinal mataplasia and dysplasia, the expression rates were 22.2%, 44.1%, 67.5% and 61.9%. The overexpression rates were 5.5%, 26.4%, 37.8% and 38.1% respectively. The positive rates of c-met oncogene protein were high among patients infected with H. pylori than those with no H. pylori infection (63% vs 32%). In the precancerous lesions of cellular atrophy, intestinal mataplasia and dysplasia, the expression rates of H. pylori positive patients were higher (68.9%) than those of H. pylori negative patients (30.5%) (P < 0.05).

CONCLUSIONS

H. pylori is involved in the expression of c-met oncogene.

[Cloning and analysis of the regulatory gene fragment induced with seed extract in Rhizobium huakuii strain 7653R]

The large plasmids of strain 7653R were digested with restriction enzyme EcoRI. Their DNA fragments were cloned into the expression vector pMP220 to construct a lacZ fusion pool, which were transferred into the recipient strain 7653R. Tri-transconjugants were selected onto plates containing X-gal and seed extract. Five blue colonies were assayed of their beta-galactosidase activity after incubation with or without seed extract. A positive induced strain HN18 was obtained. Hybridization of nodDABC probe on the recombinant plasmid pHN18 showed a 1.7 kb positive band. The evidence makes a deduction that the pHN18 contains a promoter of nod operon.

Northern blot identification of mRNA containing sequence for protein allergen, Alt a1, in eight strains of Alternaria alternata

BACKGROUND

Concentrations of Alt a1, a major allergen from Alternaria alternata extracts, exhibit significant batch-to-batch variability. This variability may result from basic strain-related genetic differences or from environmental influences such as growth conditions or extraction methods.

OBJECTIVE

The objective of this work is to determine if strain-to-strain allergen variability in Alternaria alternata, Alt a1 allergen occurs at the nucleic acid level.

METHODS

We compared the content of mRNA for a segment known to contain sequence coding for the reported N-termini of this allergen in eight strains of Alternaria obtained from three individual sources grown under identical conditions. RNA was extracted from rapidly growing mycelia and analyzed by northern blot analysis for the content of a specific segment containing sequence for the Alt a1 allergen. Blots were also analyzed for the content of a specific 5.8S rRNA segment.

RESULTS

The size of the mRNA for this protein was about 700 bases. Sequence for the specific segment was found in all of the eight strains tested. When normalized for extraction variabilities using the content of 5.8S rRNA, the calculated concentrations of Alt a1 mRNA of seven of the eight strains were similar.

CONCLUSIONS

The results of these experiments suggest that this Alt a1 related allergen sequence is found in many strains of Alternaria and that variabilities in allergen protein content noted previously result from posttranslational events.

Increased reactivity to endothelin of pulmonary arteries in long-term post-obstructive pulmonary vasculopathy in rats

Post-obstructive pulmonary vasculopathy (POPV) describes the constellation of findings following chronic ligation of one pulmonary artery, including bronchial angiogenesis, pulmonary vasculopathy and increased vasoreactivity to pharmacologic agents. Previously, we found in rats with POPV of 28 days duration that maximal responses to endothelin-1 (ET-1) and ET-3 of pulmonary arteries but not veins were increased, and that relaxation of arteries to ET-1 was reduced, attributable to an elevated proportion of ETA over ETB receptors. To determine the reactivity of pulmonary vessels and airways to ET in protracted POPV, we ligated the left main pulmonary artery of nine rats. Eleven months later, using a lung explant technique, we compared contractile responses of pulmonary vessels and airways to ET-1 and ET-3 in POPV lungs with controls. Morphometric measurements were made on the vessels, and immunoreactivity to ET-1 and endothelin converting enzyme (ECE-1) studied. We found contractile responses to ET-1 and ET-3 significantly increased in arteries, but not veins or airways. Morphometry showed arteries and veins had reduced diameters with muscle thickening only in veins. Expression of ET-1 and ET-3 in vascular endothelial cells and airway epithelial cells were not altered significantly. Our data suggest that protracted POPV selectively enhanced the contractility of pulmonary arteries to ET, and is not attributable to medial muscle thickening.

[Determination of avermictin in avermictin tablet by high performance liquid chromatography]

A method for the separation and determination of avermictin in avermictin tablet by reversed-phase high performance liquid chromatography (RP-HPLC) was developed. Operating conditions were as follows: TSK-GEL C18 column, 250 mm x 4.6 mm i.d., MeOH-H2O (75:25, V/V) mobile phase with a flow rate of 1.0 mL/min, and UV detection at 245 nm. The results showed that the active constituents avermictin B1a and B1b can by separated effectively. The relative standard deviations were 2.56% and 1.31%, respectively (n = 6). The method is accurate, rapid and simple, and provides a scientific basis for industrial production and quality control of avermictin tablet.

[Grouping of thoracic lymph nodes on CT scan according to American Thoracic Society classification]

OBJECTIVE

To assess the usefulness of the classification developed by the American Thracic Society (ATS) in the grouping of thoracic lymph nodes on CT scan.

METHODS

Ten patients suffered from lymphoma (5 cases), sarcoidosis (2 cases) and metastatic lymphadenopathy (3 cases) were examinated with CT. The intrathoracic lymph nodes were grouped according to the ATS nodal classification.

RESULTS

Six areas were divided on the CT scans: (1) between the upper margin of the sixth cervical vertebra and the pulmonary apex, including nodes in group 1R/L; (2) between the pulmonary apex and the upper margin of the aortic arch, including nodes in group 2R/L and 6; (3) between the upper margin of aortic arch and the carina, including nodes in group 4R/L, 5, 6 and 10R; (4) within 3 cm below carina, including nodes in group 7 and 10R/L; (5) between 3 cm from subcarina and the top of diaphragm, including nodes in group 8R/L and 14R/L; (6) intrapulmonary area, distal to the upper lobe bronchi, including nodes in group 11R/L.

CONCLUSION

The division of lymph nodes into six areas on CT scan makes the ATS lymph node classification more easily applicable.

Endothelin reactivity and receptor profile of pulmonary vessels in postobstructive pulmonary vasculopathy

Chronic ligation of one pulmonary artery results in pulmonary vascular remodeling and bronchial angiogenesis, collectively known as postobstructive pulmonary vasculopathy (POPV). To determine whether the reactivity of pulmonary vessels to endothelins (ET) was altered in POPV and to explore potential mechanisms, we ligated the left main pulmonary artery of 18 rats. Four weeks later, using a lung explant technique, we compared POPV lungs with controls for contractile responses of intrapulmonary vessels to ET-1 and ET-3 and for relaxant responses to ET-1 and sodium nitroprusside (SNP) after precontraction with U-46619. Morphometric measurements were made on vessels studied pharmacologically. Competition receptor binding studies with 125I-labeled ET-1 and unlabeled ET-1 and BQ-123 were performed using membrane proteins of pulmonary vessels. We found, in arteries, that contractile responses to ET-1 and ET-3 were significantly increased and that relaxant responses to ET-1 but not to SNP were reduced; in veins, only relaxation to SNP was increased. Morphometry showed that arteries and veins in POPV had reduced diameters without altered muscle thickness. Receptor binding studies showed that the proportion of ETA receptors in arteries was significantly increased in POPV (66%) vs. controls (54%). We conclude that, in POPV, the increase in reactivity to ET-1 and ET-3 is primarily related to an augmented proportion of ETA receptors.

Impact mass chemotherapy with praziquantel on schistosomiasis control in Fanhu village, People's Republic of China

The paper describes the endemic situation of schistosomiasis japonica in Fanhu village, Poyang Lake region, China and the effect of the strategy of combining annual mass chemotherapy with health education on schistosomiasis control in the community. The results showed that the prevalence of infection with schistosome reduced form 26.0% in 1992 to 10.7% in 1994, the intensity of infection in residents decreased from 1.92 in 1992 to 0.55 in 1994 and the condition of hepatomegaly, splenomegaly and liver fibrosis also improved after chemotherapy in the individuals in the case prospective study. Moreover, the future strategies of schistosomiasis control in this area have been suggested according to the transmission of schistosomiasis in the lake region and the effect of anti-schistosomiasis control indifferent populations.

[The relationship of the permeability coefficients of testosterone with solubility parameters of vehicles]

The effects of vehicles on the penetration through rat skin of testosterone were investigated. The solubilities of testosterone in various vehicles and the fluxes through rat abdomen skin had been determined. The solubility parameters of testosterone (delta i) and vehicles (delta v(n)) were calculated by Hildebrand's method. There was a good inverse parabola correlation between the log permeability coefficients (logp) and (delta v(n)). When delta v(n) approched delta i the permeability coefficients of testosterone approched the minimum as its limit.

[A study on polycyclic aromatic hydrocarbon-DNA adduct in lung cancer patients exposed to indoor coal-burning smoke]

The objective of this study is to explore the etiology and early risk evaluation of lung cancer in Xuanwei County, Yunnan Province of China. Polycyclic aromatic hydrocarbon (PAH)-DNA adduct in brushing cells from fibrobronchoscopy was determined in 30 cases with lung cancer in Xuanwei County and 10 controls in Kunming, Yunnan Province by 32P-postlabelling assay. Results showed that PAH-DNA levels in lung cancer patients of Xuanwei County were much more higher than those in controls. It suggested that air pollution caused by indoor coal-burning associated directly with the occurrence of lung cancer, and detection of DNA adduct could be used as an indicator for its risk assessment in population.

[The effects of teprenone on the ulcer healing rate and the quality of healing in the treatment of active gastric ulcers]

One hundred and six patients with active gastric ulcer proven by endoscopy were randomly allocated to receive cimetidine 800 mg at bedtime + teprenone 50 mg thrice daily; or cimetidine 800 mg at bedtime alone in a trial comparing the ulcer healing rate and the quality of healing at 4 or 8 weeks. At 4 weeks 72.4% (42/58) of those on cimetidine + teprenone and 52.1% (25/48) on cimetidine alone had ulcers healed in comparison of 93.1% (54/58) and 89.6% (43/48) respectively at 8 weeks. The difference was significant at 4 weeks, indicating the ulcer heal more rapidly in the combination therapy group. The stage S2 achievement rates were 34.5% (20/58) and 10.4% (5/48) at 4 weeks (P < 0.05), 50.0% (29/58) and 20.8% (10/48) at 8 weeks (P < 0.05) respectively, indicating the quality of ulcer healing was much better in the combination therapy group. The gastric mucosal hexosamine levels increase significantly after treatment (17.79 +/- 2.00 micrograms/mg) as compared to that before treatment (14.27 +/- 2.47 micrograms/mg) in the combination therapy group, indicating that teprenone stimulates macromolecular glycoprotein synthesis in gastric mucosa. This is thought to be a significant factor in the healing process of gastric ulceration.

CONCLUSION

It is reasonable to administer teprenone, an agent increasing mucosal resistance, concurrently with H2 blockers in the treatment of active gastric ulcers.

Shedding of L-selectin as a mechanism for reduced polymorphonuclear neutrophil exudation in patients with the systemic inflammatory response syndrome

BACKGROUND

It has been recently shown that patients with the systemic inflammatory response syndrome (SIRS) have reduced neutrophil exudation.

OBJECTIVE

To determine whether reduced neutrophil exudation, seen in patients with SIRS, is related to differential expression of cell adhesion molecules (CAMs), by studying endothelial and neutrophil CAM expression.

SETTING

A tertiary care surgical intensive care unit in a university teaching hospital.

DESIGN

Twenty-six patients with SIRS were compared with 18 healthy age-matched control subjects. Blister-type skin windows were created. Exudative neutrophils were harvested, and CAM expression was quantitated by using flow cytometry. Endothelial CAM expression was studied with immunohistochemical methods by using skin biopsy specimens that were taken following subdermal injections of saline solution or tumor necrosis factor alpha.

RESULTS

Despite a significant reduction in neutrophil exudation in patients, we found no difference in the baseline expression of the endothelial intercellular adhesion molecule 1, P-selectin, or E-selectin in patients vs that in control subjects. There was a significant increase in E-selectin staining in response to recombinant human tumor necrosis factor alpha in patients with SIRS, but not in control subjects. However, up-regulation of P-selectin did not occur in patients in response to recombinant human tumor necrosis factor alpha, as was observed in control subjects. L-selectin expression on circulating neutrophils was lower in patients than in control subjects, while soluble serum L-selectin levels were higher.

CONCLUSIONS

Alterations in neutrophil L-selectin, not endothelial CAMs, are important in decreased neutrophil exudation. Reduced levels of neutrophil L-selectin associated with increased levels of serum L-selectin in patients with SIRS suggest premature intravascular shedding of neutrophil L-selectin. This would compromise the initial interaction between neutrophils and the endothelium, and, consequently, impede exudation.

Experimental study on the early efficacy of excimer laser with adjunctive balloon angioplasty in dog's femoral artery

The effect of domestically-manufactured excimer laser with adjunctive balloon angioplasty in achieving revascularization and reduction of residual stenosis was assessed. 20 femoral arteries with thrombosis and occlusion from 12 dogs were subject to angiography. At first excimer laser angioplasty was done followed by balloon angioplasty. The diameter and residual stenosis of revascularized vessel were measured. The result showed that 17 out of 20 vessels (85%) were revascularized. The diameter of revascularized vessel by excimer laser were 1.22 +/- 0.14 mm, while residual stenoses were 54% +/- 5%. After adjunctive balloon angioplasty the diameter and residual stenoses were 2.04 +/- 0.16 mm and 20% +/- 7% respectively (P < 0.05 and P < 0.01). Complication in form of vasoperforation occurred in 3/20 vessels (15%). It is concluded that China- manufactured excimer laser angioplasty is effective when used for revascularization. While the reduction of narrowing and residual stenoses was enhanced after adjunction of balloon angioplasty. This method can be employed in treating peripheral occlusive disease effectively and safely.

Production of a recombinant protein from Alternaria containing the reported N-terminal of the Alt a1 allergen

Allergen content of extract derived from Alternaria is somewhat variable. Allergenic molecules from Alternaria that appear as differing molecular size bands on IgE probed immunoblots may have a great deal of sequence homology and differ only in the length of the amino acid chain. One method to study this problem is to produce recombinant proteins from Alternaria. To explore these possibilities, the following experiments were performed. A strain of Alternaria was grown on minimum salts and glucose in a fermentation container with constant stirring and aeration. Rapidly expanding mycelia were removed from the culture and mRNA was extracted. Purified mRNA was reacted with reverse transcriptase and an aliquot of first copy single strand DNA was enriched for the presence of DNA coding for an Alternaria allergen by PCR amplification. Modified DNA was then spliced into lambda gt11 phage and yielded a recombinant library with 10(5) PFU. The library was screened for the presence of allergenic proteins using IgE containing human sera from Alternaria-sensitive patients. Positive plaques were cloned. PCR analysis of positive clones using an oligonucleotide from the reported N-terminal sequence of Alt a1 indicated an insert of 295 base pairs. Sequence analysis yielded a reading frame containing 84 amino acid and confirmed that this segment contained the code for the reported N-terminal amino acid sequence of Alt a1. A computer search for this sequence found no homologous proteins in the Entrez sequences. Northern blotting studies on RNA purified from nine strains of Alternaria with the radiolabeled 247 BP DNA fragment indicated that this sequence was present in all strains. The 247 BP nucleotide was spliced into the Pflag vector and clones containing insert in the proper reading frame were identified. The presence of recombinant protein in the clones was verified by SDSPAGE time studies. Protein produced in time studies was shown by immunoblotting and sandwich EIA to bind human IgE from Alternaria sensitive patients. This recombinant protein, containing amino acid sequence for Alt a1, is bound by human IgE and therefore should be useful as a model for studying allergy to the native Alternaria glycoprotein. Further research should define where this sequence occurs in the Alternaria genome and should determine the sequence of the entire protein.

Human exposure and dosimetry of polycyclic aromatic hydrocarbons in urine from Xuan Wei, China with high lung cancer mortality associated with exposure to unvented coal smoke

The lung cancer mortality rate in Xuan Wei (XW) county, China, is 5-fold the national average of China; the rate for women is the highest in China. Xuan Wei residents have been exposed to unvented coal or wood smoke during cooking or heating in homes. This study investigated indoor air exposure and dosimetry of polycyclic aromatic hydrocarbons (PAHs) in XW residents using smoky coal. Indoor air particles collected during cooking in four XW homes using smoky coal were analyzed for PAHs by GC/MS. Urine samples from 16 XW non-smoking women and six XW smoking men, eight Kunming non-smoking controls and four non-smoking Chinese American controls were analyzed for PAHs and hydroxy-PAHs by GC/MS. The results showed that XW residents were exposed to PAHs at occupational levels. The potent carcinogen, dibenzo[a,l] pyrene (4.9 +/- 1.3 micrograms/m3) was found in the indoor air of the XW homes. The levels of urinary hydroxy-PAH were higher than those of the parent compounds in most subjects, indicating that most PAHs were metabolized. In urine, the mean levels of 9-hydroxy BaP (BaP) and BaP are 1.5 +/- 0.5 mumol/mol creatinine and 0.5 +/- 0.3 microns/mol for XW men, 1.9 +/- 0.9 microns/mol and 0.5 +/- 0.3 microns/mol for XW women. In general, the levels of PAH metabolites in urine were higher in the XW residents than in Kunming and Chinese American controls; however only the concentrations of 9-hydroxy BaP in XW women showed statistically significant difference from the Kunming controls (P < 0.05 by ranking test). The mean levels of 3 methylated-PAHs analyzed were 4.8-fold higher than that of the parent PAHs in XW subjects. This is consistent with previous findings that alkylated PAHs are the major mutagens in the XW indoor air and may be etiologically important in XW lung cancer.