Whole genome gene expression changes and hematological effects of rikkunshito in patients with advanced non-small cell lung cancer receiving first line chemotherapy

It has been demonstrated that the traditional Chinese medicine rikkunshito, ameliorates anorexia in several types of human cancer and attenuates lung injury by inhibiting neutrophil infiltration. The current study investigated the clinical and hematological effects of rikkunshito and its underlying mechanisms of action in the treatment of advanced non-small cell lung cancer (NSCLC). The Illumina microarray BeadChip was used to analyze the whole-genome expression profiles of peripheral blood mononuclear cells in 17 patients with advanced NSCLC. These patients were randomized to receive combination chemotherapy (cisplatin and gemcitabine) with (n=9, CTH+R group) or without (n=8, CTH group) rikkunshito. The primary endpoint was the treatment response and the categories of the scales of anorexia, nausea, vomiting and fatigue; secondary endpoints included the hematological effect and whole genome gene expression changes. The results of the current study indicated that there were no significant differences in clinical outcomes, including treatment response and toxicity events, between the two groups. Median one-year overall survival (OS) was 12 months in the CTH group and 11 months in the CTH+R group (P=0.058 by log-rank test), while old age (>60 years old) was the only independent factor associated with one-year OS (hazard ratio 1.095, 95% confidence interval, 1.09–1.189, P=0.030). Patients in the CTH+R group experienced significantly greater maximum decreases in both white cell count (P=0.034) and absolute neutrophil count (P=0.030) from the baseline. A total of 111 genes associated with neutrophil apoptosis, the cell-killing ability of neutrophils, natural killer cell activation and B cell proliferation were up-regulated following rikkunshito treatment. A total of 48 genes associated with neutrophil migration, coagulation, thrombosis and type I interferon signaling were down-regulated following rikkunshito treatment. Rikkunshito may therefore affect the blood neutrophil count when used with combination chemotherapy in patients with NSCLC, potentially by down-regulating prostaglandin-endoperoxidase synthase 1, MPL, AMICA1 and junctional adhesion molecule 3, while up-regulating elastase, neutrophil expressed, proteinase 3, cathepsin G and cluster of differentiation 24.

Aberrant Toll-like receptor 2 promoter methylation in blood cells from patients with pulmonary tuberculosis

OBJECTIVES

Toll-like receptor 2 (TLR2) is a major mediator of innate immunity against tuberculosis (TB). This study aimed to determine if TLR2 promoter DNA methylation is associated with pulmonary TB.

METHODS

The DNA methylation levels of 20 CpG sites over the TLR2 promoter region and TLR2 gene/protein expressions of immune cells of the blood were examined in 99 sputum culture-positive pulmonary TB patients and 77 healthy subjects (HS).

RESULTS

TB patients had higher methylation levels over five CpG sites (3, 7, 9, 13, and 18), lower TLR2 gene expression, lower TLR2 expression on monocyte, higher TLR2 expression on NK cell, and higher serum TNF-α/IFN-γ levels than HS after adjusting for confounding factors. Patients with a high bacillary load had lower methylation levels at CpG-15, -17, and -20. Patients with drug-resistant TB had higher CpG-18 methylation levels and lower TLR2 expression on NK cell. Patients with far advanced lesion on chest radiograph had higher serum TNF-α level and higher TLR2 expression on NK cell. Patients with a high TLR2 expression on NK cell had lower one-year survival. CpG-18 methylation level, TLR2 expressions on monocyte/NK cell, and TNF-α/IFN-γ levels were all reversed to normal after 6-month anti-TB treatment.

CONCLUSIONS

Aberrant methylation of certain CpG sites over TLR2 promoter region is associated with active pulmonary TB or its phenotypes, probably through the down-regulation of TLR2 expression.

A New Phenanthrene Alkaloid, Romucosine I, form Rollinia mucosa Baill

Bioactivity-directed fractionation led to the isolation of a new N-(methoxycarbonyl) phenanthrene alkaloid, romucosine I (1), along with three known N-(methoxycarbonyl) alkaloids, romucosine C (2), tuduranine (3), and promucosine (4). The structures of these compounds were identified on the basis of spectral data and chemical evidence. A proposed biogenesis about these isolates is also reported in this paper

Contrast-enhanced microCT (EPIC-μCT) ex vivo applied to the mouse and human jaw joint

OBJECTIVES

The temporomandibular joint (TMJ) is susceptive to the development of osteoarthritis (OA). More detailed knowledge of its development is essential to improve our insight into TMJ-OA. It is imperative to have a standardized reliable three-dimensional (3D) imaging method that allows for detailed assessment of both bone and cartilage in healthy and diseased joints. We aimed to determine the applicability of a contrast-enhanced microCT (µCT) technique for ex vivo research of mouse and human TMJs.

METHODS

Equilibrium partitioning of an ionic contrast agent via µCT (EPIC-µCT) was previously applied for cartilage assessment in the knee joint. The method was ex vivo, applied to the mouse TMJ and adapted for the human TMJ.

RESULTS

EPIC-µCT (30-min immersion time) was applied to mouse mandibular condyles, and 3D imaging revealed an average cartilage thickness of 110 ± 16 µm. These measurements via EPIC-µCT were similar to the histomorphometric measures (113 ± 19 µm). For human healthy OA-affected TMJ samples, the protocol was adjusted to an immersion time of 1 h. 3D imaging revealed a significant thicker cartilage layer in joints with early signs of OA compared with healthy joints (414.2 ± 122.6 and 239.7 ± 50.5 µm, respectively). A subsequent significant thinner layer was found in human joints with late signs of OA (197.4 ± 159.7 µm).

CONCLUSIONS

The EPIC-µCT technique is effective for the ex vivo assessment of 3D cartilage morphology in the mouse as well as human TMJ and allows bone-cartilage interaction research in TMJ-OA.

Euphol from Euphorbia tirucalli selectively inhibits human gastric cancer cell growth through the induction of ERK1/2-mediated apoptosis

Gastric cancer is one of the most common malignancies worldwide, and the main cause of cancer-related death in Asia. The present study assessed the anticancer effects of euphol, a triterpene alcohol with anti-inflammatory and antiviral activities on human gastric cancer cells. Euphol showed higher cytotoxicity activity against human gastric CS12 cancer cells than against noncancer CSN cells. In addition, it up-regulated the pro-apoptotic protein BAX and down-regulated the prosurvival protein Bcl-2, causing mitochondrial dysfunction, possibly by caspase-3 activation. The anti-proliferative effects of euphol were associated with the increased p27(kip1) levels and decreased cyclin B1 levels. Inhibition of ERK1/2 activation by PD98059 reversed euphol-induced pro-apoptotic protein expression and cell death. Taken together, these findings suggest that euphol selectively induced gastric cancer cells apoptosis by modulation of ERK signaling, and could thus be of value for cancer therapy.

Prednisolone treatment and restricted physical activity further compromise bone of mdx mice

OBJECTIVES

The purpose of this study was to determine the extent to which prednisolone treatment and restricted physical activity caused deleterious changes in inherently compromised mdx bone.

METHODS

Four week-old male mdx mice (n=36) were treated for 8-wk either with or without prednisolone (0.8-1.3 mg/kg/d) and were housed in traditional or small cages (restricted activity). Tibial bone strength, geometry, and intrinsic material properties were assessed at the mid-shaft by three-point bending and micro-computed tomography (μCT).

RESULTS

Three-point bending results showed that both prednisolone and restricted activity reduced bone strength (7%), however stiffness was only reduced in restricted-activity mice. μCT analyses showed that cortical bone area and cortical thickness were 13% smaller in restricted-activity mice, and may have accounted for their compromised bone strength. Intrinsic material properties, including volumetric bone mineral density (vBMD) and modulus of elasticity, were not impacted by either treatment, however, vBMD tended to be lower in restricted-activity mice (p=0.06).

CONCLUSIONS

These data show that prednisolone treatment and restricted physical activity independently accentuate reductions in the strength and geometry of mdx bone, but do not influence intrinsic material properties.

Pregnenolone derivatives as potential anticancer agents

Pregnenolone (1) was used as a template to develop new anticancer compounds. Ring-D modification of 1 resulted in the synthesis of benzylidenes 2-17, pyrazolines 18-76, pyrazoles 85-91, hydrazones 77-84, and oximes 92-107 derivatives. The structure of compound 107 was also deduced through single crystal X-ray diffraction studies. The inclusion of furanyl and pyridyl rings to pregnenolone skeleton increases the cytotoxicity of all compounds significantly. Among benzylidene derivatives, only heterocyclic enone 8 (IC50=0.74 μM/mL against HepG2), and 17 (IC50=4.49 μM/mL against HepG2, IC50=5.01 μM/mL against MDA-MB-230 cancer cell line) exhibited a significant activity. The cytotoxicity data of pyrazoline derivatives 18-76 revealed that only furanyl bearing pyrazolines 40, 42-44, 48, and 49 exhibited significant activities. While all (O-carboxymethyl) oximes, hydazones, and pyrazoles derivatives of pregnenolone did not show any significant activity against both the cell lines. Thus the furanyl bearing enone 8 (IC50=0.74 μM/mL against HepG2), and its pyrazoline derivative 48 (IC50=0.91 μM/mL against MDA-MB-230 cancer cell lines) were identified as the most active compounds in all derivatives of pregnenolone.

A novel synthetic protoapigenone analogue, WYC02-9, induces DNA damage and apoptosis in DU145 prostate cancer cells through generation of reactive oxygen species

The protoapigenone analogue WYC02-9, a novel synthetic flavonoid, has been shown to act against a variety of experimental tumors. However, its effects on prostate cancer and its mechanism of action are unknown. Thus, WYC02-9 was investigated for its cytotoxicity against DU145 prostate cancer cells, as was the underlying mechanisms by which WYC02-9 might induce DNA damage and apoptotic cell death through reactive oxygen species (ROS). WYC02-9 inhibited the cell growth of three prostate cancer cell lines, especially DU145 cells. In DU145 cells, WYC02-9 increased the generation of intracellular ROS, followed by induction of DNA damage and activation of the ATM-p53-H2A.X pathway and checkpoint-related signals Chk1/Chk2, which led to increased numbers of cells in the S and G2/M phases of the cell cycle. Furthermore, WYC02-9 induced apoptotic cell death through mitochondrial membrane potential decrease and activation of caspase-9, caspase-3, and PARP. The above effects were all prevented by the ROS scavenger N-acetylcysteine. Administration of WYC02-9 in a nude mouse DU145 xenograft model further identified the anti-cancer activity of WYC02-9. These findings therefore suggest that WYC02-9-induced DNA damage and mitochondria-dependent cell apoptosis in DU145 cells are mediated via ROS generation.

Structure and biological evaluation of novel cytotoxic sterol glycosides from the marine red alga Peyssonnelia sp

Bioactivity-guided fractionation of the extract from a Fijian red alga Peyssonnelia sp. led to the isolation of two novel sterol glycosides 19-O-β-d-glucopyranosyl-19-hydroxy-cholest-4-en-3-one (1) and 19-O-β-d-N-acetyl-2-aminoglucopyranosyl-19-hydroxy-cholest-4-en-3-one (2), and two known alkaloids indole-3-carboxaldehyde (3) and 3-(hydroxyacetyl)indole (4). Their structures were characterized by 1D and 2D NMR and mass spectral analysis. The sterol glycosides inhibited cancer cell growth with mean IC₅₀ values (for 11 human cancer cell lines) of 1.63 and 1.41μM for 1 and 2, respectively. The most sensitive cancer cell lines were MDA-MB-468 (breast) and A549 (lung), with IC₅₀'s in of 0.71-0.97μM for 1 and 2. Modification of the sterol glycoside structures revealed that the α,β-unsaturated ketone at C-3 and oxygenation at C-19 of 1 and 2 are crucial for anticancer activity, whereas the glucosidic group was not essential but contributed to enhanced activity against the most sensitive cell lines.

Bioactive bromophycolides R-U from the Fijian red alga Callophycus serratus

Four new bromophycolides, R-U (1-4), were isolated from the Fijian red alga Callophycus serratus and were identified by 1D and 2D NMR and mass spectroscopic analyses. These compounds expand the known structural variety of diterpene-benzoate macrolides and exhibited modest cytotoxicity toward selected human cancer cell lines. Bromophycolide S (2) also showed submicromolar activity against the human malaria parasite Plasmodium falciparum.

New cytotoxic lupane triterpenes from Perrottetia arisanensis

Eight new lupane triterpenes, including 7beta-cis-coumaroylbetulinic acid (1), 7beta-trans-coumaroylbetulinic acid (2), 7beta-cis-coumaroyl-3-epi-betulinic acid (3), 7beta-trans-coumaroyl-3-epi-betulinic acid (4), 7beta-cis-coumaroylbetulonic acid (5), 7beta-trans-coumaroylbetulonic acid (6), 7beta-hydroxybetulinaldehyde (7) and 28-norlup-20(29)-ene-3alpha,17beta-diol (8), together with fifteen known compounds were isolated from the bioactive methanol extract of the stems of Perrottetia arisanensis. The structures of the new compounds were elucidated by spectroscopic and HR-ESI-MS analysis. All new compounds were evaluated for their cytotoxicity against six human cancer cell lines. Among them, lupane triterpene coumaroyl esters 1-6 showed moderate cytotoxicity with IC (50) values ranging from 3.75 to 21.29 microM. This is the first report for lupane triterpenes with a phenylpropane moiety substituted at C-7.

Antimalarial bromophycolides J-Q from the Fijian red alga Callophycus serratus

Bromophycolides J-Q (1-8) were isolated from extracts of the Fijian red alga Callophycus serratus and identified with 1D and 2D NMR spectroscopy and mass spectral analyses. These diterpene-benzoate macrolides represent two novel carbon skeletons and add to the 10 previously reported bromophycolides (9-18) from this alga. Among these 18 bromophycolides, several exhibited activities in the low micromolar range against the human malaria parasite Plasmodium falciparum.

Acasiane A and B and farnesirane A and B, diterpene derivatives from the roots of Acacia farnesiana

Four new diterpenes, acasiane A ( 1), acasiane B ( 2), farnesirane A ( 3), and farnesirane B ( 4), along with three known diterpenes ( 5 - 7), two triterpenes ( 8 and 9), and eight flavonoids ( 10 - 17) were isolated from the roots of Acacia farnesiana. The structures and relative configurations of these compounds were determined by various spectroscopic and x-ray analyses. All isolated compounds were evaluated for their in vitro cytotoxic activities against six human cancer cell lines (Hep G2, Hep 3B, MDA-MB-231, MCF-7, A549, and Ca9 - 22) with the MTT method. Betulinic acid ( 8) displayed moderate cytotoxicity (1.70 - 5.74 microg/mL) towards five human cancer cell lines and the flavonoids had slight effects. In addition, 8, diosmetin ( 13), and 3',4',5-trihydroxy-7-methoxyflavone ( 15) slightly inhibited superoxide anion generation or elastase release by human neutrophils, indicating moderate anti-inflammatory activities.

Lupane-type triterpenoids from Microtropis fokienensis and Perrottetia arisanensis and the apoptotic effect of 28-hydroxy-3-oxo-lup-20(29)-en-30-al

Seven new lupane triterpenoids were isolated from bioactive methanol extracts of Microtropis fokienensis (1- 4) and Perrottetia arisanensis (4-7), along with 18 known compounds. The structures of the new compounds were elucidated on the basis of spectroscopic data analysis. All triterpenoids were evaluated for their in vitro cytotoxicity toward seven human cancer cell lines. Compound 8 (28-hydroxy-3-oxo-lup-20(29)-en-30-al) was among the most cytotoxic substances obtained and was found to induce apoptosis of human leukemia HL60 cells and mediate cleavage of PARP and up-regulation of Bax proteins.

Antitumor agents. 261. 20(S)-protopanaxadiol and 20(s)-protopanaxatriol as antiangiogenic agents and total assignment of (1)H NMR spectra

Angiogenesis is a critical step in tumor progression and involves several steps including endothelial cell (EC) proliferation, migration, and matrix remodeling. We investigated the antiangiogenic effects of 20( S)-protopanaxadiol ( 1) and 20( S)-protopanaxatriol ( 2), the sapogenins of two major ginseng saponins, in an angiogenesis model of human umbilical vein endothelial cells (HUVECs). These compounds inhibited the proliferative activity of HUVECs in a dose-dependent manner and have potential as anticancer drug candidates. In addition, we report the complete and unambiguous assignment of (1)H NMR spectra of 1 and 2, based on analyses of 2D NMR spectra including COSY, NOESY, HSQC, and HMBC. This report is the first to completely assign the (1)H NMR signals of 2, together with correction of data for 1 from prior reports.

Separation and characterization of active flavonolignans of Silybum marianum by liquid chromatography connected with hybrid ion-trap and time-of-flight mass spectrometry (LC-MS/IT-TOF)

Silychristins A (1) and B (2), silydianin (3), silybins A (4) and B (5), and isosilybins A (6) and B (7) are major bioactive flavonolignans in silymarin, a herbal remedy derived from the milk thistle Silybum marianum. In this study, the seven major active flavonolignans including the diastereomers 1/ 2, 4/ 5, and 6/ 7 were completely separated using semi-micro-high performance liquid chromatography (HPLC) with a Nucleosil 100-3 C 18 HD column and a MeOH/water/formic acid mobile phase system. The collision-induced dissociation (CID) MS/MS and MS (3) spectra of these flavonolignans were studied systematically using hybrid ion-trap and time-of-flight (IT-TOF) mass spectrometry. Efficient differentiation between the seven flavonolignans (1- 7) was possible based on comparison of the resultant CID-MS/MS or MS (3) spectra. Each characteristic MS/MS or MS (3) fragmentation pattern was elucidated with high-resolution mass spectra by IT-TOF. The results with the present methodology show that liquid chromatography-mass spectrometry IT-TOF (LC-MS/IT-TOF) can be useful for general screening of active natural products from plant extracts and for the specific quality control of silymarin.

Chest radiographic presentation in patients with dengue hemorrhagic Fever

There has been no previously reported case series study regarding chest radiographic (CXR) presentations in dengue hemorrhagic fever (DHF) patients. We retrospectively studied 363 DHF patients from June to December 2002 in southern Taiwan, and a total of 468 CXRs were obtained and reviewed. More than 50% of these showed abnormalities after the 3rd day, with infiltration only and small pleural effusion as the major findings. Progressive changes during the first week and improvements during the second week were observed in these abnormal CXRs. The CXR presentation was also significantly correlated with laboratory findings (white blood cell count, platelet levels, activated partial thromboplastin time, and alanine aminotransferase and albumin levels), as well as the clinical course (renal insufficiency, liver function impairment, upper gastrointestinal bleeding, combination bacterial infection, and duration of admission) and outcome (mortality). The CXR may therefore be a modality for evaluating the clinical course of DHF and should be made during first week after the onset of illness.

First total synthesis of protoapigenone and its analogues as potent cytotoxic agents

Protoapigenone (1), isolated from Thelypteris torresiana, previously showed significant cytotoxic activity against five human cancer cell lines. In a continued structure-activity relationship study, the first total synthesis and modification of 1 were achieved. All synthesized compounds and related intermediates were evaluated for cytotoxic activity against five human cancer cell lines, HepG2, Hep3B, MDA-MB-231, MCF-7, and A549. Among them, 24 showed 2.2-14.2-fold greater cytotoxicity than 1 and naphthyl A-ring analogues remarkably enhanced the activity.

Acute respiratory failure in adult patients with dengue virus infection

To investigate clinical course and outcome of dengue with acute respiratory failure (ARF), and to identify related risk factors for acquiring ARF in dengue, we retrospectively studied 11 dengue patients with ARF. From June to December 2002, a total of 606 adult patients were diagnosed as having dengue. Eleven (1.8%) of 606 dengue patients had complications of ARF. The main causes of ARF were sepsis (n = 6, 54.5%) and upper gastrointestinal (UGI) bleeding (n = 3, 27.3%). The mortality rate was 72.7% (n = 8). Additionally, univariate analysis showed that age, dyspnea, cough, prothrombin time, activated partial thromboplastin time, aspartate aminotransferase, alanine aminotransferase, blood urea nitrogen, creatinine, albumin, renal insufficiency, acute renal failure, acute hepatic failure, UGI bleeding, and combination bacterial infection were significantly predictive variables associated with dengue patients with ARF.

Stellettins L and M, cytotoxic isomalabaricane-type triterpenes, and sterols from the marine sponge Stelletta tenuis

Two new isomalabaricane-type triterpenes, stellettins L (1) and M (2), and three new sterols (3-5) were isolated from the marine sponge Stelletta tenuis collected in the South China Sea. Chemical structures were established from spectroscopic data and comparison with known compounds. In addition, spectroscopic data reported for the known sterol 24-methylene-27-methylcholest-5-en-3beta-ol-7-one (6) were revised. Compounds 1 and 2 exhibited significant cytotoxic activity against stomach cancer (AGS) in vitro.

Bronchial epithelial-myoepithelial carcinoma

An epithelial-myoepithelial tumor is an extremely rare pulmonary neoplasm. Only 21 cases have been reported to date. This report presents a case of left main bronchial epithelial-myoepithelial carcinoma in a 43-year-old woman. No mediastinal lymph nodes were enlarged in computed tomographic scan, and no tumor growth was noted beyond the bronchial cartilage layer by endobronchial ultrasound imaging. This report highlights the usefulness of endobronchial ultrasound imaging for determining the depth of tumor invasion and choosing an alternative approach to surgical resection.

Novel Flavonoids of Thelypteris torresiana

In our continuing research on cytotoxic components from the Formosan pteridophyte Thelypteris torresiana (GAUD.) ALSTONONE, two new compounds, a novel flavonoid, flavotorresin (1), and a flavonoid diglycoside, multiflorin C (2), along with five known compounds, were isolated. The structural elucidation was established on the basis of spectroscopic data analysis. The possible biosynthetic pathway of the flavonoids from this fern is summarized.

Endobronchial ultrasonography with distance for peripheral pulmonary lesions

BACKGROUND

We assessed the effectiveness of applying the distance from the orifice of the bronchus to visualized peripheral pulmonary lesion (PPL) under endobronchial ultrasonography (EBUS) to transbronchial biopsy (TBB), as an alternative to EBUS with a guide sheath (GS) and fluoroscopy.

PATIENTS AND METHODS

From October 2004 to July 2005, a total of 158 consecutive patients with solitary PPLs, which were not visualized under flexible video bronchoscopy, were received EBUS for advanced localization subsequently. One hundred and thirteen of 158 patients with solitary PPLs which were visualized on EBUS image were included in this prospective study and randomly divided into two groups for TBB using different methods. In group EBUS-D (57 patients) the distance from the bronchial orifice to pulmonary lesion was measured, then the biopsy forceps were advanced to this measured distance and biopsy followed. In group EBUS (56 patients) the biopsy forceps were advanced regardless of distance. The diagnostic yields were then compared.

RESULTS

TBBs in group EBUS-D patients had a significantly higher diagnostic yield (45/57, 78.9%) than group EBUS patients (32/56, 57.1%) [P=0.013]. Size and location of lesion, duration of EBUS, diagnosis of malignancy, and whether the probe was located within the lesion on EBUS image did not differ between these two groups. Mild bleeding occurred in three patients in group EBUS-D and two in group EBUS. One group EBUS patient had a self-limited pneumothorax.

CONCLUSIONS

Measuring and applying the distance between the orifice of bronchus and the lesion could increase the diagnostic yield of EBUS-guided TBBs for PPLs.

Exercise capacity and pulmonary function in hospital workers recovered from severe acute respiratory syndrome

BACKGROUND

Persistent impaired pulmonary function and functional capacity are common among survivors of severe acute respiratory syndrome (SARS). Whether the impairment was caused by SARS or pre-existing physical condition remains unclear.

OBJECTIVE

This study investigated the influence of SARS on exercise capacity and pulmonary function of previously healthy medical staff.

METHODS

Pulmonary function tests, including spirometry and carbon monoxide diffusing capacity (DLCO), as well as symptom-limited cardiopulmonary exercise testing (CPET) with an incremental protocol using an electronically braked cycle ergometer, were performed by 13 previously healthy hospital workers 14 months after SARS recovery. Other 14 age- and sex-matched healthy medical workers completed CPET simultaneously, and exercise capacities of these two groups were compared.

RESULTS

Most values of spirometry performed were within normal range. Only one showed mildly restrictive abnormality with decreased forced expiratory volume in 1 s (72.2% predicted) and forced vital capacity (68.1% predicted). Eight subjects had decreased DLCO levels (mean 79.37 +/- 7.73%), and low exercise capacity was noted in 9 subjects. Discordance in impairment of the measured DLCO and exercise capacity was revealed by comparison. Besides, there was no significant difference in results of CPET between subjects recovered from SARS and those never infected.

CONCLUSIONS

Minor pulmonary function defects as well as decreased exercise capacity were detected in previously healthy medical staff after recovering from SARS. No significant correlation between exercise capacity and pulmonary function was found.

Computational simulations of the human magneto- and electroenterogram

Many functional pathologies of the small intestine are difficult to diagnose clinically without an invasive surgical intervention. Often such conditions are associated with a disruption of the normal electrical activity occurring within the musculature of the small intestine. The far field electrical signals on the torso surface arising from the electrical activity within the small intestine cannot be reliably measured. However, it has been shown that abnormal electrical activity in the small intestine can be distinguished by recording the magnetic fields of intestinal origin immediately outside the torso surface. We have developed an anatomically-based computational model to simulate slow wave propagation in the small intestine, the resulting cutaneous electrical field and the magnetic field outside the torso. Using both a one-dimensional and a three-dimensional model of the duodenum we investigate the degree of detail that is required to realistically simulate this far field activity. Our results indicate that some of the qualitative behavior in the far field activity can be replicated using a one-dimensional model, although there are clear situations where the greater level modeling detail is required.

Bronchoscopic electrocautery for palliation of post-anastomotic tracheal stricture in a patient with complete tracheal transection following blunt chest trauma

There are many strategies available to treat palliation of airway obstruction due to benign or malignant conditions. The initial choice depends on the urgency of the situation, the extent of the disease process as assessed bronchoscopically, as well as the individual experience and preference of the physician. We present a rare case of complete tracheal transection following a traffic accident. Respiratory distress, which resulted from post-anastomotic tracheal stricture, developed progressively about 2 months after surgical repair. Symptomatic relief and improved ventilatory function were achieved in this patient once patency of the trachea was restored successfully using bronchoscopic electrocautery. The technique is a straightforward, safe, and quick method to palliate airway obstruction.

New cytotoxic flavonoids from Thelypteris torresiana

During our search for anti-tumor agents from pteridophytes, three new flavonoids, protoapigenone (1), 5',6'-dihydro-6'-methoxyprotoapigenone (2), and protoapigenin (3), along with four known compounds, protoapigenin 4'- O-beta- D-glucoside (4), apigenin 4'- O-beta- D-glucoside (5), kaempferol 3- O-alpha- L-rhamnopyranoside (6), kaempferol 3,7-di- O-alpha- L-rhamnopyranoside (7), were isolated from Thelypteris torresiana using bioactivity-guided fractionation methods . The structures of the new isolates were elucidated by 1D- and 2D-NMR spectral analysis. Among the 7 compounds, protoapigenone (1) exhibited significant anti-tumor activities toward Hep G2, Hep 3B, MCF-7, A549, and MDA-MB-231 with IC50 values of 1.60, 0.23, 0.78, 3.88 and 0.27 microg/mL, respectively.

A cluster of patients with severe acute respiratory syndrome in a chest ward in southern Taiwan

Objective

Severe acute respiratory syndrome (SARS) is an emerging and easily clustering infectious disease. We describe an outbreak of SARS in a chest ward of a medical center in southern Taiwan and seek to identify the risk factors of those SARS patients who required mechanical ventilation. We focus on previous health patients.

Design

This retrospective case series was collected during the SARS outbreak. Degrees of severity were established, based on whether intubation and mechanical ventilation was necessary.

Setting

A 2500-bed medical center in southern Taiwan.

Patients

Forty-four patients exhibited symptoms that met the modified World Health Organization (WHO) definition of SARS. These included of three subgroups: health-care workers (n=16), relatives (n=14), and patients already admitted for other ailments (n=14). Of these, 20 eventually required mechanical ventilation.

Measurements and results

Laboratory analyses showed statistically significant differences between intubated and nonintubated patients in white blood cell count, neutrophil percentage, and C-reactive protein level as well as in age and underlying malignancy. Risk factors for SARS patients who had been healthy prior to their illness included old age, high peak fever grade, increased neutrophil count, increased neutrophil percentage, and close or prolonged contact with a SARS patient.

Conclusions

Old age, high white blood cell counts, high peak grade fever, and close or prolonged contact with a SARS patient increase the risk of intubation in previous healthy SARS patients.

The high value of high-resolution computed tomography in predicting the activity of pulmonary tuberculosis

SETTING

A 2500-bed medical centre in southern Taiwan.

OBJECTIVE

To study the clinical value of high-resolution computed tomography (HRCT) in predicting the activity of pulmonary tuberculosis (TB).

DESIGN

HRCTs were performed prospectively in 148 patients whose chest radiographs (CXRs) showed highly suspicious signs of pulmonary TB, predominantly upper lung field infiltration. The HRCT findings, interpreted independently by a pulmonologist and a radiologist, were used to predict the activity of pulmonary TB.

RESULTS

Pulmonologist-interpreted and radiologist-interpreted HRCTs showed high sensitivity (both 93%), specificity (83 vs. 88%), accuracy (86 vs. 90%), positive predictive values (76 vs. 83%) and negative predictive values (both 95%). Kappa statistic indicates good inter-reader agreement.

CONCLUSION

HRCT has a high value in predicting the activity of pulmonary TB. It is a useful tool in this regard when a patient with suspected pulmonary TB lacks microbiologic proof, when clinical condition makes invasive diagnosis impossible or when a patient has completed anti-tuberculosis treatment with no compatible unequivocal CXR.

Effects of intravenous caffeine administered to healthy males during sleep

Pharmacological challenge paradigms have been useful for elucidating the phenomenology and neurobiology of panic attacks. A drawback of the pharmacological challenge method is that individual differences in baseline arousal and outcome expectancy can lead to different subjective and physiological drug responses. One method for eliminating differences in baseline arousal and expectancy is to perform pharmacological challenges during non-rapid eye movement (non-REM) sleep. In the present study, fourteen healthy male volunteers received caffeine (5 mg/kg) and placebo (normal saline) during non-REM sleep on two successive nights, in a single-blind manner. Caffeine, compared to placebo, was associated with increased arousal, sleep disruption, and elevations in adrenocorticotropic hormone (ACTH) and cortisol. In one subject, caffeine infusion during sleep induced a panic attack. These findings indicate that caffeine leads to increased arousal and hypothalamic-pituitary-adrenal axis (HPA) axis activation in the absence of high baseline anxiety and expectancy bias. Further, they suggest that similar techniques can be employed in patient populations to elucidate the neurobiology of sleep panic attacks.

Endobronchial metastatic disease

BACKGROUND

Endobronchial metastasis (EM) is rare. Patients with EM are in advanced stages of disease and have poor prognoses. However, some patients have had long-term survival after aggressive treatment.

METHODS

We retrospectively reviewed the records of 9678 patients who had undergone bronchoscopic procedures. Forty patients were diagnosed as having EM.

RESULTS

The most common site of primary tumors was the head and neck [10 nasopharyngeal carcinomas (NPC), 2 buccal cancers, 2 glossal cancers, 2 laryngeal cancers]. Clinical manifestations included cough (50%), hemoptysis (20%), dyspnea (15%), and absence of respiratory symptoms (15%). The most common findings in chest roentgenograms (CXR) were single masses (40%). The median length of survival for all patients was 12 months (range, 6 to 18 months). The median length of survival in patients whose ages were over 70 years was 1 months and in patients less than 70 years old it was 12 months (range, 7 to 19 months) (p = 0.002). In patients whose EM extent was to the main bronchus, the median length of survival was 1 month (range, 1 to 3 months) and that in those whose EM did not extend to main bronchus was 12 months (range, 11 to 21 months) (p = 0.0004). In patients whose primary tumors were due to head and neck cancer other than NPC, the survival time was 1 month (range, 1 to 11 months), and in others it was 12 months (range, 7 to 19 months) (p = 0.0008).

CONCLUSION

Three factors contributed to a poor prognosis, including the patient's age being over 70 years, primary tumors due to head and neck cancer other than NPC, and extension of the endobronchial metastatic lesion to the main bronchus.

Effect of simulated birth trauma on the urinary continence mechanism in the rat

OBJECTIVES

To examine the effect of simulated birth injury in an animal model as part of a study on the pathogenesis of stress urinary incontinence (SUI) and the urinary continence mechanism.

METHODS

A balloon was inflated in the vaginas of rats for 4 hours to simulate prolonged labor. The effect on the continence mechanism was assessed by functional, anatomic, biochemical, and histologic examinations. The functional test consisted of placing chili powder or a clipped whisker into the rat's nostrils to induce sneezing. Anatomic measurement of the genital hiatus was performed with a caliper. Serum creatine phosphokinase (CPK) and lactate dehydrogenase (LDH) were measured to examine the value of muscle injury in predicting incontinence. c-Fos immunostaining in the spinal cord was used as a marker of nerve injury. These data were then correlated with histopathologic examination of the urethra and pelvic floor tissues.

RESULTS

Four weeks after simulated birth injury, SUI was noted in 19 of 48 experimental rats. The genital hiatus was significantly wider in incontinent rats. The serum CPK and LDH levels were markedly elevated, but no difference was noted between the continent and incontinent rats. All experimental rats showed many c-Fos immunostaining neurons in the L6 to S1 spinal cord segments, but none was seen in control rats. Histologic study revealed a marked decrease of ganglion cells in the neural plexuses posterolateral to the vagina in experimental rats. After 4 weeks, muscle necrosis and degeneration, irregular shape and size of muscle fibers, and a change in the type I/II ratio were prominent features in the levator ani. In the urethra, we noted a significant decline in urethral wall musculature (both smooth and striated) in incontinent rats.

CONCLUSIONS

In this novel rat model, simulated birth injury resulted in SUI in a portion of the animals. Pathologic changes in the urethra, pelvic ganglia, and levator muscles seem to be the contributing factors to SUI.

Psychopathological dimensions in schizophrenia: a correlational approach to items of the SANS and SAPS

Seventy DSM-III schizophrenic patients were assessed for positive and negative symptoms using Andreasen's scales for the assessment of positive and negative symptoms (SANS and SAPS) on admission. The correlation structure of the items in the SANS and SAPS was explored in dimension and item levels by use of correlation plots through a distinct analytical method displaying the proximity matrix. The results revealed at least three major dimensions of symptoms delineated as Negative Symptoms, Disorganized Thoughts and Delusions and Hallucinations. The latter two dimensions were derived from the SAPS, while Negative Symptoms comprised most of the items in the SANS. Items in Disorganized Thoughts were more correlated to Negative Symptoms than to the other items in the SAPS. 'Loss of ego boundary' delusions and experience of auditory hallucinations appeared as two sub-clusters in the group of Delusions and Hallucinations. The relative independence of persecutory, grandiose, religious, somatic and reference delusions gives support to the concept that paranoid schizophrenia stands as a distinct clinical subtype of schizophrenia. The graphical method introduced here well expresses the information of correlation matrix and is useful for exploring inter-item or inter-cluster associations.

Bronchial foreign bodies in adults

Aspiration of foreign bodies into the bronchial tree is infrequently seen in adults. We reviewed 40 such cases during an 8-year period at Chang Gung Memorial Hospital, Kaohsiung. Only six patients had underlying conditions that contributed to the aspiration of foreign bodies. A positive history of aspiration was found in 18 patients (48%). Clinical manifestations were nonspecific. Chest roentgenograms were useful in 11 of the 40 patients. Bronchoscopic findings were classified into three groups: foreign bodies in the bronchial tree without granulation tissue, foreign bodies in the bronchial tree with marked granulation tissue and foreign bodies embedded in the granulation tissue. The diagnoses and removal of foreign bodies were successful in 37 patients (92%) using grasping forceps or biopsy forceps and in one patient using basket type grasping forceps. Complications of bronchoscopy were rare and not serious. The diagnosis of occult foreign bodies is often difficult and demands a high index of suspicion. Removal of endobronchial foreign bodies is usually possible with a flexible fiberoptic bronchoscope and has a high success rate.

Wegener's granulomatosis: a case report and literature review

Wegener's granulomatosis may present with a variety of findings and be difficult to diagnose. We report a case of 27-year-old man presenting with chronic cough and hemoptysis who was diagnosed by open lung biopsy to have Wegener's granulomatosis. Based on this case, we reviewed the clinical features, pathophysiology, diagnosis, treatment, and prognosis of Wegener's granulomatosis.

Pyopneumothorax associated with unsuspected endobronchial foreign body: a case report

Chronic foreign body aspiration may cause a variety of complications. Nonspecific clinical presentations and chest radiographic manifestations often result in misdiagnosis or delayed diagnosis. We report an unusual complication of chronic foreign body aspiration--pyopneumothorax--in a 52-year-old patient presenting with productive cough and intermittent fever for more than 3 months. Obstructive pneumonia was highly suspected from the computed tomographic scan of the chest. Flexible fiberoptic bronchoscopy demonstrated a fish bone in the bronchial tree. The bone was successfully removed by forceps. Thoracotomy was done later to ensue adequate drainage of the pyopneumothorax. We report this case for ongoing education to increase the index of suspicion.

Malignant fibrous histiocytoma of the trachea combined with thymic carcinoma--a case report

A 58-year-old woman was hospitalized in our hospital on July 9, 1988 with the chief complaint of progressive dyspnea for three months. She had been treated as bronchial asthma before she came to our hospital. During the hospitalization, bronchoscopic examination showed a lobulated mass arising from the left anterior lateral wall of the middle trachea. Chest CT scans showed two lesions: one was a nodular protruding mass in the middle trachea; the other was a soft tissue mass at the left thymic area. We performed a total resection of the tracheal tumor and partial resection of the mediastinal tumor. The pathological diagnosis was malignant fibrous histiocytoma of the trachea and squamous cell thymic carcinoma.

Intrathoracic meningocele in association with neurofibromatosis: report of a case

A case of intrathoracic meningocele associated with neurofibromatosis is reported. Computed tomography (CT) demonstrated that the paravertebral mass had a characteristic low attenuation coefficient compatible with liquid content. CT-myelography further confirmed the diagnosis. We recommend that though intrathoracic meningocele is rare, it should be kept in mind when making a differential diagnosis in cases where the patient has neurofibromatosis with a posterior mediastinal mass.

[Subcutaneous sarcoidosis--a case report]

A 35 year-old female patient suffered from several brownishred nodule-plaques over both legs and left knee for two months. General malaise and exertional dyspnea were also noted. Skin biopsy shows multiple epithelioid cell tubercles with asteroid body in multinucleated giant cell located in the deep dermis and subcutis. No fungus, mycobacterium or foreign body could be found by special stains. Chest X-ray reveals bilateral hilar lymphadenopathy. She had neither sensory impairment nor DM history. Based on the above findings, we believed that she is a victim of subcutaneous sarcoidosis.

Removable hub needle system for coaxial biopsy of small and difficult lesions

A 23-gauge needle with a removable hub for a modified coaxial biopsy technique is described. The needle is useful for biopsy of small (less than or equal to 2.5 cm) and difficult chest or abdominal lesions. After removal of the hub, coaxial insertion of an outer 19-gauge needle is performed. Biopsy specimens are obtained coaxially through the 19-gauge needle after the hubless needle is removed. This system permits precise biopsy of smaller lesions, when the tandem biopsy technique is not practical.

Percutaneous biopsy of difficult mediastinal, hilar, and pulmonary lesions by computed tomographic guidance and a modified coaxial technique

A technique for biopsy of small or inaccessible mediastinal, hilar, or pulmonary lesions with computed-tomographic (CT) guidance is described. A modified coaxial system was used in order to make multiple passes possible without multiple punctures. The size of the original puncture needle (23 gauge) provided the inherent safety associated with a fine needle. All repositioning was done using this needle and CT until the lesion was engaged. The hub of the needle was then cut, and a 19-gauge needle was inserted coaxially over the larger needle. After removal of the 23-gauge needle, multiple biopsy specimens were then obtained coaxially with a 22-gauge needle through the 19-gauge needle. One small pneumothorax and no bleeding occurred in 10 instances. Results suggest that the combined use of CT guidance and this modified coaxial system may offer an extra margin of safety for difficult cases.