The impact of smoking on tuberculosis treatment outcomes: a meta-analysis

BACKGROUND: Cigarette smoking contributes to tuberculosis (TB) epidemiology. However, limited evidence exists on how smoking impacts TB treatment outcomes such as treatment loss to follow-up and culture conversion.METHODS: This meta-analysis assessed current evidence of the impact of active cigarette smoking on TB treatment outcomes. PubMed, Scopus, Embase, and the Cochrane Library were searched for English-language articles published from database inception through 2017. Articles addressing active pulmonary TB and cigarette smoking were identified and data abstracted. Smokers were defined as those who smoked every day or some days at the time of interview/diagnosis. Non-smokers did not smoke at the time of interview/diagnosis. Unfavorable outcomes included any outcome other than cure or completion of TB treatment. Three different data sets were examined: 8 articles addressing unfavorable treatment outcomes, 9 analyzing only treatment loss to follow-up, and 5 addressing delayed smear or culture conversion. Studies that had <20 subjects or that addressed only populations with comorbidities were excluded.RESULTS: We identified 1030 studies; 21 studies fulfilled the inclusion/exclusion criteria. Smokers had greater odds of unfavorable outcomes (pooled odds ratio [pOR] 1.23, 95%CI 1.14-1.33), delayed smear or culture conversion (pOR 1.55, 95%CI 1.04-2.07), and treatment loss to follow-up (pOR 1.35, 95%CI 1.21-1.50).CONCLUSION: Cigarette smoking is associated with negative treatment results and delayed conversion to negative smear or culture, suggesting smoking is an important factor for consideration in TB elimination efforts.

Probing head-to-toe deformation law assessment for abdominal tumor through respiratory movement simulation and CTVision radiation research

This paper aims to explore head-to-toe deformation law for abdominal tumor with CTVision and selfdesigned respiratory movement simulation mold and meanwhile verify the accuracy and correctness of the treatment. In experimental group, a self-designed respiratory movement mold was used. The image was scanned out by CT scanning based on the movement state and then sent to the planning system to compare the location variation of tumor and formulating the treatment plan accordingly, followed by verification and verified derivation values observation. A total of 21 cases of abdominal tumor were included in the case group. Their breathing movement was detected under a simulated locator and then the data was recorded. The image was scanned and sent to the planning system to compare the location variation of the tumor, the patients then underwent 3D conformal therapy (3D-CRT) and we performed verification and observed verified derivation values. Finally, the results of the case group and the experimental group were compared. The mean of the verified derivation values was smaller than respiratory motion values in experimental group (t=-10.78, P=0, P < 0.05); the mean of verified derivation values of the patients was smaller than respiratory motion values in group f, g, h, i, j, l, n, o, p, q, r, s t, u in the case group (P < 0.05); no remarkable difference was found between the two values in group a, b, c, k and m (P < 0.05); group e was unable to undergo the statistical test since its standard deviation was 0; the mean of the verified derivation values was higher than respiratory motion values in group d (P < 0.05). In conclusion, radiation therapy applied with CTVision proved to be accurate and convincing in the treatment of abdominal tumor.

Safety and radiation-enhancing effect of sodium glycididazole in locoregionally advanced laryngeal cancers previously treated with platinum-containing chemotherapy regimens: A preliminary report

PURPOSE

To determine the safety and radiation-enhancing effect of sodium glycididazole in laryngeal squamous cell carcinoma (stage T3-4,N0-3,M0) with conventional radiotherapy.

PATIENTS AND METHODS

Patients with locoregional advanced laryngeal cancer (stage T3-4,N0-3,M0) were included: group 1(control, n=30)were not administered of sodium glycididazole; group 2 (test, n=30) received sodium glycididazole at a dose of 700 mg/m(2) intravenous infusion 30 minutes before radiotherapy three times a week. Surrogate end-points of efficacy were tumor and nodal size. Safety parameters were vomiting, nausea, mucositis, laryngeal edema, esophagus and skin reaction, dysphagia, dyspnea, neurological deficit. Patients were evaluated weekly during treatment for 7 weeks and thereafter monthly for 3 months.

RESULTS

In the test, the overall response rate was 88.89% (95%CI, 71.00-97.00%) at 7 weeks and 92.59% (95%CI, 76.00 to 99.00%) at 1 month of follow-up. In the control, the overall response rate was 62.5% (95%CI, 41.00 to 81.00%) at 7 weeks and 58.33% (95%CI, 37.00 to 78.00%) at 1 month of follow-up. The short-term locoregional response rate was better in the test group at 7 weeks (p=0.027) and at 1 month (p=0.005) of follow-up. The test group had significantly more nausea and vomiting in weeks 1 (p=0.047), 2 (p=0.007), and 3 (p=0.01) of treatment.

CONCLUSIONS

The study indicates sodium glycididazole is an effective radiation-enhancing agent that improves short-term locoregional control and is well tolerated in patients with locoregionally advanced laryngeal cancer.

3D time-resolved MR angiography (MRA) of the carotid arteries with time-resolved imaging with stochastic trajectories: comparison with 3D contrast-enhanced Bolus-Chase MRA and 3D time-of-flight MRA

BACKGROUND AND PURPOSE

Time-resolved MR angiography (MRA) offers the combined advantage of large anatomic coverage and hemodynamic flow information. We applied parallel imaging and time-resolved imaging with stochastic trajectories (TWIST), which uses a spiral trajectory to undersample k-space, to perform time-resolved MRA of the extracranial internal carotid arteries and compare it to time-of-flight (TOF) and high-resolution contrast-enhanced (HR) MRA.

MATERIALS AND METHODS

A retrospective review of 31 patients who underwent carotid MRA at 1.5T using TOF, time-resolved and HR MRA was performed. Images were evaluated for the presence and degree of ICA stenosis, reader confidence, and number of pure arterial frames attained with the TWIST technique.

RESULTS

With a consensus interpretation of all sequences as the reference standard, accuracy for identifying stenosis was 90.3% for TWIST MRA, compared with 96.0% and 88.7% for HR MRA and TOF MRA, respectively. HR MRA was significantly more accurate than the other techniques (P < .05). TWIST MRA yielded datasets with high in-plane spatial resolution and distinct arterial and venous phases. It provided dynamic information not otherwise available. Mean diagnostic confidence was satisfactory or greater for TWIST in all patients.

CONCLUSION

The TWIST technique consistently obtained pure arterial phase images while providing dynamic information. It is rapid, uses a low dose of contrast, and may be useful in specific circumstances, such as in the acute stroke setting. However, it does not yet have spatial resolution comparable with standard contrast-enhanced MRA.

Dynamic sagittal half-Fourier acquired single-shot turbo spin-echo MR imaging of the temporomandibular joint: initial experience and comparison with sagittal oblique proton-attenuation images

BACKGROUND AND PURPOSE

Our aim was to assess dynamic half-Fourier acquired single-shot turbo spin-echo (HASTE) MR imaging of the temporomandibular joint (TMJ) using parallel imaging, in comparison with static proton density (Pd) imaging.

MATERIALS AND METHODS

Thirty-four TMJs from 17 subjects (7 volunteers, 10 patients) were imaged in a multichannel head coil on a 1.5 T magnet by using a 35-second dynamic sagittal HASTE acquisition (TR/TE, 1180/65 msec; matrix, 128 x 128; section thickness, 7 mm; 30 images) and sagittal oblique Pd in closed- and open-mouthed positions (TR/TE, 1800/12 msec; matrix, 256 x 256; section thickness, 2 mm; 15 sections). Images were reviewed by 3 readers and rated for confidence of disk position, presence of motion artifact, range of motion, and presence of disk displacement on a 5-point scale. Consensus review of cases was also performed to assess disk dislocation and limited range of motion.

RESULTS

More static examinations were rated as having motion artifact (19.6% versus 6.9%, P=.016), limited range of motion (30.4% versus 17.7%, P=.016), and disk dislocations (31.4% versus 22.6%, P=.071). Confidence ratings were higher on dynamic examinations (4.11 versus 3.74, P=.018). Chi-squared tests demonstrated no significant difference in consensus reviews of the 2 examination types.

CONCLUSION

Dynamic HASTE TMJ MR imaging is a time-efficient adjunct to standard MR imaging protocols, producing fewer motion artifacts, additional range of motion information, and a dynamic assessment of disk position, when compared with static imaging. Further study is needed to evaluate the role of this sequence in diagnosing disk displacement.

Benefit of inhibiting SSAO in relapsing experimental autoimmune encephalomyelitis

We have developed several series of potent and selective small molecule inhibitors of SSAO (AOC3/VAP-1) that also block trafficking of leukocytes to sites of inflammation. Blocking of SSAO-mediated leukocyte adhesion has recently been shown efficacious in several models of inflammatory diseases. We have examined the potential of SSAO inhibitors in neurological diseases, having previously demonstrated the efficacy of SSAO inhibition in a rat model of stroke. Here we show the effect of the small molecule SSAO inhibitor LJP 1207 (IC(50) human SSAO 17 nM; ratio IC(50) SSAO:MAO >5000), on relapsing-remitting experimental autoimmune encephalomyelitis (EAE), a mouse model that shares many characteristics with human multiple sclerosis. Clinical efficacy was observed when dosing with LJP 1207 was initiated either at the peak of initial flare or during remission. These data demonstrate the potential clinical benefit of small molecule anti-SSAO therapy in this model.

Activin signal transduction in the fetal rat adrenal gland and in human H295R cells

The presence of activin A and its effects have previously been documented in the adrenal gland, particularly in the human fetal adrenal gland and the rat adrenal gland. The primary signaling pathway of activin involves interactions between receptor and intracellular (Smad) proteins that have not been completely described in the adrenal gland. In this study, we demonstrate that the components of the activin signaling cascade are present in two complementary models, the fetal rat adrenal gland and the human adrenocortical cell line, H295R, by means of RT-PCR, western analysis, and immunoprecipitation techniques. Using the cell line, activin signaling was analyzed using an activin-responsive reporter gene, p3TP-luc, and luciferase assays to assess transcriptional activity with co-expression of the different activin receptors and Smads to demonstrate the functionality of the signaling cascade. In the fetal rat adrenal gland, the relative amounts of mRNA of the type II receptors, RII and RIIB, were regulated by gestational age, such that the RIIB levels increased after birth while RII levels fell. Using immunodetection techniques, the activin receptors and the different Smad proteins were detected in the rat fetal adrenal glands. Notably, the presence of Smad4 protein is significantly increased after birth in the rat adrenal gland. RT-PCR established a similar profile in the H295R cells. Using p3TP-luc, the H295R cells show transcriptional activation of this activin-responsive reporter in the presence of activin A. Co-expression of type I and type II receptors as well as Smads, results in ligand-independent transcriptional activity in addition to an activin-stimulated response. In determining activin's effects on adrenal function, adrenal steroid production was evaluated by incubation of the H295R cells with increasing doses of activin A and inhibin A, resulting in a detectable increase in P450c17 expression. Co-incubation of activin A with follistatin diminishes this response. These results are consistent with a role for activin A in the adrenal gland by demonstrating that the elements of the activin signaling pathway are present, intact, and functional. This suggests that in the adrenal gland the components of the activin receptor/Smad pathway are dynamically changing in the transition from fetal to neonatal life, and are important to the function of this organ.

Definition of the supraclavicular and infraclavicular nodes: implications for three-dimensional CT-based conformal radiation therapy

PURPOSE

To delineate with computed tomography (CT) the anatomic regions containing the supraclavicular (SCV) and infraclavicular (IFV) nodal groups, to define the course of the brachial plexus, to estimate the actual radiation dose received by these regions in a series of patients treated in the traditional manner, and to compare these doses to those received with an optimized dosimetric technique.

MATERIALS AND METHODS

Twenty patients underwent contrast material-enhanced CT for the purpose of radiation therapy planning. CT scans were used to study the location of the SCV and IFV nodal regions by using outlining of readily identifiable anatomic structures that define the nodal groups. The brachial plexus was also outlined by using similar methods. Radiation therapy doses to the SCV and IFV were then estimated by using traditional dose calculations and optimized planning. A repeated measures analysis of covariance was used to compare the SCV and IFV depths and to compare the doses achieved with the traditional and optimized methods.

RESULTS

Coverage by the 90% isodose surface was significantly decreased with traditional planning versus conformal planning as the depth to the SCV nodes increased (P < .001). Significantly decreased coverage by using the 90% isodose surface was demonstrated for traditional planning versus conformal planning with increasing IFV depth (P = .015). A linear correlation was found between brachial plexus depth and SCV depth up to 7 cm.

CONCLUSION

Conformal optimized planning provided improved dosimetric coverage compared with standard techniques.

Serum levels of activin A and inhibin A and the subsequent development of preeclampsia

OBJECTIVE

To determine whether serum levels of activin A and inhibin A are altered in patients before development of preeclampsia.

METHODS

Blood samples were collected from patients during the second trimester of prenatal care. We identified patients who subsequently developed preeclampsia and matched them with patients who had no evidence of preeclampsia during their gestation. Matching criteria included gestational age at blood sampling, gestational age at delivery, and birth weight. Assays were then performed to assess the levels of activin A and inhibin A in the control and study groups. A power calculation determined that 12 patients who subsequently developed preeclampsia, if matched with controls in a 1:2 ratio, would allow the detection of differences in analyte levels that were 60% as large as those previously reported between patients already diagnosed with preeclampsia and matched controls.

RESULTS

Twelve patients with preeclampsia were identified and matched with 24 controls. No differences in serum levels of activin A or inhibin A were detected between the two groups. Because of the significant overlap of analyte levels between the two groups, no cutpoint that would allow identification of patients destined to become preeclamptic could be determined.

CONCLUSION

These data suggest that activin A and inhibin A cannot be used as markers for later development of preeclampsia in a low-risk population.

Implications of decidualization-associated protease expression in implantation and menstruation

During progesterone-induced decidualization of estradiol (E2)-primed human endometrial stromal cells (HESCs), the interstitial-type extracellular matrix (ECM) of the follicular phase endometrium is transformed in the luteal phase to a mixture of residual interstitial- and new basal laminar-type components. This transformation is accelerated by reduced proteolytic activity of HESCs undergoing decidualization (DZ). In cultured HESCs, progestins, but not E2, induce the expression of several DZ markers, and E2 enhances these effects despite the lack of response to E2 alone. Using this well-characterized in vitro DZ model we evaluated the expression of plasminogen activators (PAs), which degrade ECM components that undergo rapid turnover, and matrix metalloproteinases (MMPs), which degrade the bulk of ECM components. Medroxyprogesterone acetate (MPA) inhibited the catalytic activity of urokinase-type PA (uPA) and tissue-type PA (tPA) as well as the expression of such MMPs as interstitial collagenase (MMP-1) and stromelysin-1 (MMP-3). Moreover, E2 + MPA elicited greater inhibitory effects on the expression of all of these proteases. Progestin inhibition of PA activities reflected reciprocal upregulation in the output of the PA inhibitor PAI-1, which produced large molar excesses of PAI-1 compared with the PAs in HESC-conditioned medium. By contrast, the tissue inhibitor of the MMPs, TIMP1, as well as gelatinase A (MMP-2), was constitutively expressed by the HESCs. In the absence of implantation, menstruation-associated degradation of the functional endometrial ECM is triggered by withdrawal of circulating ovarian steroids. This process was evaluated in cultured HESCs that were first decidualized during 10 days of exposure to E2 + MPA, and then withdrawn to steroid-free medium with and without the antiprogestin RU 486. As expected, steroid withdrawal reversed progestin-inhibited PA activity as well as the expression of MMP-1 and MMP-3 and progestin-enhanced PAI-1; much greater reversal was observed in medium supplemented with RU 486. Unlike the changes in PAI-1, neither TIMP1, nor MMP-2 expression was affected by withdrawal to steroid-free or to RU 486-medium. By altering the composition of the ECM of the luteal phase endometrium, progestin-elicited inhibition of the PAs, uPA and tPA, as well as that of the MMPs, MMP-1 and MMP-3, modulates trophoblast adhesion, migration and differentiation. Conversely, steroid withdrawal elicited increases in uPA, MMP-1 and MMP-3 activities would promote endometrial sloughing by degrading the mixture of decidual cell-derived basement membrane-like proteins and interstitial components that comprise the stromal ECM of the perimenstrual endometrium.

Identification of naturally occurring follistatin complexes in human biological fluids

Follistatin (FS) binds activin and inhibin proteins. Many organs are sensitive to activin and inhibin; thus the formation of FS-activin/inhibin complexes is important to our understanding of ligand activity. Other investigators studying FS have detected large molecular weight immunoreactive FS bands (greater than the expected molecular weight of FS alone) that have not been well characterized. The goal of this study was to identify naturally occurring FS monomers and FS-activin/inhibin complexes in several organ systems. The pituitary, ovary, kidney, and urine were chosen for this investigation. Molecular masses were assigned to in vitro assemblies of complexes containing recombinant inhibin or activin with FS for comparison with naturally occurring FS forms. The recombinant complex of FS-activin was primarily 97-kDa size, while FS-inhibin complexes were detected in a range of molecular sizes from 66 kDa to 97 kDa, 133 kDa, and > 220 kDa. FS-containing complexes of 66-kDa, 97-kDa, and 133-kDa were identified in the tissues examined and in pregnant urine. Our study points to the assembly of a series of FS-activin/inhibin complexes in a variety of organ systems that may impact upon the available amount of free versus bound (or "complexed") ligand, which must be considered when investigating the biology of activin- or inhibin-responsive cells. In addition, urine may be an important biological fluid that can be used to measure significant changes in circulating FS complexes.

Chronic antagonism of nuclear factor-kappaB activity in cytotrophoblasts by dexamethasone: a potential mechanism for antiinflammatory action of glucocorticoids in human placenta

Circulating glucocorticoids are present in increasing quantities as human gestation progresses, peaking during labor whether it occurs before or at term. Although the precise role of glucocorticoids in pregnancy is not well defined, it is clear that glucocorticoids suppress inflammation in many cell types by antagonizing the acute stimulatory actions of members of the Rel/nuclear factor-kappaB (NF-kappaB) family on cytokine gene expression. In the present study we tested the hypothesis that during pregnancy, glucocorticoids chronically suppress inflammation in the human placenta. Cytotrophoblasts obtained from human term placentas were maintained for 48 h in culture medium supplemented with 10% charcoal-stripped calf serum with and without 100 nmol/L dexamethasone (DEX). Enzyme-linked immunosorbent assay studies revealed that cytotrophoblasts constitutively express interleukin-8 (IL-8), a known mediator of placental inflammation, between 24-96 h of culture. A 48-h treatment of cytotrophoblasts with 100 nmol/L DEX significantly reduced the production of IL-8 to 24+/-1% of control levels (P < 0.01). DEX and cortisol mediated a dose-dependent inhibition of IL-8 expression, with ED50 values of 5 and 50 nmol/L, respectively. DEX treatment also significantly reduced levels of IL-6 and tumor necrosis factor-alpha in culture medium, suggesting that glucocorticoids coordinately reduce cytokine levels in cytotrophoblasts. As cytokine expression is regulated by NF-kappaB and activator protein-1 (AP-1) transcription factors, electrophoretic mobility shift assays (n = 4) were used to determine whether DEX treatment altered the binding of nuclear proteins from cytotrophoblasts to labeled oligonucleotides corresponding to the kappaB and AP-1 response elements. We observed that a 48-h treatment of cytotrophoblasts with 100 nmol/L DEX markedly reduced binding of nuclear extracts from cytotrophoblasts to the kappaB response element. DEX treatment promoted a relatively smaller reduction of binding to the AP-1 response element. Northern blotting experiments revealed that DEX treatment did not alter the level of IkappaB, p50, or p65 messenger ribonucleic acid, suggesting that the antiinflammatory action of glucocorticoid in cytotrophoblasts did not directly involve alterations in the level of NF-kappaB proteins. Our results demonstrate a novel chronic suppressive action of glucocorticoid on cytokine production and nuclear binding of NF-kappaB and AP-1 proteins in cytotrophoblasts, providing a potential mechanism through which glucocorticoids may suppress inflammation at maternal-fetal interfaces across gestation.

Decidual cell regulation of hemostasis during implantation and menstruation

Progesterone stimulation of the estradiol (E2)-primed human endometrium initiates DZ of the stromal cells around the spiral arterioles. Under continued steroid stimulation, DZ spreads wave-like to establish the decidual cell as a major cell type of the luteal phase and pregnant endometrium. Because of their widespread distribution throughout the endometrium and concentration at perivascular sites, decidual cells are spatially and temporally positioned to mediate the opposing requirements of maintaining hemostasis during endovascular trophoblast invasion, yet promoting menstrual hemorrhage in the absence of implantation. The experimental results summarized in this review indicate that the paradoxical properties manifested by endometrial stromal/decidual cells are controlled by several proteins with either hemostatic or ECM-degrading or vasoactive activity, and that their expression is altered in response to changes in levels of circulating ovarian steroids during the menstrual cycle. These conclusions are drawn primarily from studies with a well-characterized in vitro model of DZ using monolayers of stromal cells derived from specimens of predecidualized endometrium. Thus, progestins modify the expression of several DZ-related markers in the cultured stromal cells, and E2 enhances these effects despite the lack of response to E2 alone. These responses are consistent with the differential actions displayed by E2 and progesterone in vivo, by which E2 primes the endometrium for the decidualizing effects of progesterone by elevating progesterone receptor levels. Accordingly, during steroid-induced in vitro DZ, a marked increase in the expression of stromal cell TF and PAI-1 and reciprocal inhibition of tPA activity suggest mechanisms to account for the absence of hemorrhage during invasion of the endometrial vasculature by implanting trophoblasts. In contrast to steroid-induced DZ, the events of menstruation are initiated in response to a decline in circulating levels of ovarian steroids. Accordingly, subjecting in vitro decidualized stromal cells to steroid withdrawal results in pronounced reversal in the expression of all of the end points listed above. Consequently, the local hemostatic environment is transformed into a hemorrhage-promoting milieu. Taken together with vascular injury resulting from ischemia induced by spiral artery vasoconstriction, the net effect is attainment of two prerequisites for menstrual hemorrhage, vascular injury and inadequate hemostasis.

Tepoxalin, a novel dual inhibitor of the prostaglandin-H synthase cyclooxygenase and peroxidase activities

Prostaglandin-H synthase-1, the rate-limiting enzyme in prostaglandin synthesis, has both cyclooxygenase (CO) and peroxidase (PO) activities. While most nonsteroidal anti-inflammatory drugs (NSAIDs) inhibit only the CO activity, we describe an inhibitor, tepoxalin, that inhibits both the CO (IC50 = 0.1 microM) and the PO (IC50 = 4 microM) activities. Unlike many NSAIDs which are competitive inhibitors of CO, tepoxalin is a noncompetitive inhibitor of CO and its inhibitory effect on PO but not CO is reversed by excess heme. Moreover, inhibition of the PO activity by tepoxalin is not dependent on the enzymatic turnover of the CO activity. The hydroxamic acid of tepoxalin is responsible for the PO inhibition since a carboxylic acid derivative of tepoxalin retains full CO but not PO inhibition. We postulated that the hydroxamic group might confer the ability to inhibit PO on conventional CO inhibitors. This idea was supported by the observation that naproxen hydroxamic acid, but not naproxen showed PO inhibition. Furthermore, tepoxalin's carboxylic acid analogue and naproxen each competitively relieved PO inhibition by their respective hydroxamic acids. The intracellular activity of PO as monitored by the release of reactive oxygen species was also inhibited by both tepoxalin and naproxen hydroxamic acid. These observations suggest a strategy for design of novel compounds to inhibit prostaglandin synthase PO. The therapeutic implications of these novel PO inhibitors are discussed.

Tepoxalin, a novel immunosuppressive agent with a different mechanism of action from cyclosporin A

Tepoxalin, a compound previously identified as a dual cyclooxygenase/lipoxygenase (CO/LO) inhibitor, is a potent inhibitor of T cell proliferation. Comparing the suppressive effects of tepoxalin and cyclosporin A (CsA) on OKT3-, PMA-, IL-2-, and PMA+ionomycin-induced T cell proliferations revealed marked differences in the mechanism of action between the two compounds. Whereas CsA was most effective in suppressing OKT3-stimulated proliferation, tepoxalin was more potent in inhibiting PMA-, PMA+ionomycin-, and IL-2-induced proliferation. Quantitative PCR (QPCR) assays used to detect cytokine messages showed that tepoxalin blocked IL-2 mRNA transcription in PMA- and PMA+ionomycin-, but not OKT3-stimulated T cells whereas CsA was most potent in inhibiting OKT3-induced IL-2 mRNA induction in these cells. Both tepoxalin and CsA did not inhibit the expression of IL-2R; however, only tepoxalin, but not CsA, inhibited the proliferation of IL-2-dependent blasts and the transcription of IFN-gamma, an IL-2-dependent target gene. Moreover, addition of exogenous IL-2 restored OKT3-induced proliferation to CsA- but not tepoxalin-treated cells. These data suggest that tepoxalin, but not CsA, suppressed T cell proliferation by inhibiting IL-2-induced signal transduction. Consistent with these findings, tepoxalin, unlike CsA, which was most potent when added at the initiation of OKT3 stimulation, was equally active, regardless of whether it was added at the beginning or 48 h after culture initiation. The difference in mechanism of action between tepoxalin and CsA was confirmed further by the synergistic suppressive effects on T cell proliferation upon co-administration of the two compounds.

Tepoxalin, a novel immunosuppressive agent with a different mechanism of action from cyclosporin A

Tepoxalin, a compound previously identified as a dual cyclooxygenase/lipoxygenase (CO/LO) inhibitor, is a potent inhibitor of T cell proliferation. Comparing the suppressive effects of tepoxalin and cyclosporin A (CsA) on OKT3-, PMA-, IL-2-, and PMA+ionomycin-induced T cell proliferations revealed marked differences in the mechanism of action between the two compounds. Whereas CsA was most effective in suppressing OKT3-stimulated proliferation, tepoxalin was more potent in inhibiting PMA-, PMA+ionomycin-, and IL-2-induced proliferation. Quantitative PCR (QPCR) assays used to detect cytokine messages showed that tepoxalin blocked IL-2 mRNA transcription in PMA- and PMA+ionomycin-, but not OKT3-stimulated T cells whereas CsA was most potent in inhibiting OKT3-induced IL-2 mRNA induction in these cells. Both tepoxalin and CsA did not inhibit the expression of IL-2R; however, only tepoxalin, but not CsA, inhibited the proliferation of IL-2-dependent blasts and the transcription of IFN-gamma, an IL-2-dependent target gene. Moreover, addition of exogenous IL-2 restored OKT3-induced proliferation to CsA- but not tepoxalin-treated cells. These data suggest that tepoxalin, but not CsA, suppressed T cell proliferation by inhibiting IL-2-induced signal transduction. Consistent with these findings, tepoxalin, unlike CsA, which was most potent when added at the initiation of OKT3 stimulation, was equally active, regardless of whether it was added at the beginning or 48 h after culture initiation. The difference in mechanism of action between tepoxalin and CsA was confirmed further by the synergistic suppressive effects on T cell proliferation upon co-administration of the two compounds.

The role of progestationally regulated stromal cell tissue factor and type-1 plasminogen activator inhibitor (PAI-1) in endometrial hemostasis and menstruation

The physiologic mechanisms whereby the human endometrium maintains hemostasis during endovascular trophoblast invasion, yet permits menstrual hemorrhage, are unknown. This paradoxical relationship was investigated by evaluating endometrial expression of tissue factor (TF), the primary initiator of hemostasis, and plasminogen activator inhibitor-1 (PAI-1), the primary inhibitor of fibrinolysis. We observed increased immunostaining for TF and PAI-1 in sections of decidualized stromal cells from luteal phase and gestational endometrium. To determine whether TF and PAI-1 expression are directly linked to decidualization, both endpoints were monitored in a well described in vitro model of decidualization. Thus, confluent stromal cell cultures were exposed to vehicle control, 10(-8) M estradiol (E2), 10(-8) to 10(-6) M medroxyprogesterone acetate (MPA) or both E2 + MPA for 2-24 days in serum-containing or defined media. The progestin enhanced the content of stromal cell-associated immunoreactive and functionally active TF and PAI-1 released into the medium and elevated levels of stromal cell TF and PAI-1 mRNA. While E2 alone was ineffective, it greatly augmented MPA-enhanced TF and PAI-1 protein and mRNA content. Dose-dependent effects on TF and PAI-1 content were observed between 10(-8) to 10(-6) M MPA +/- E2. Similar results were observed for decidual cells derived from first trimester endometrium and cultured in type 1 collagen gels. Following optimal induction of TF and PAI-1 expression by E2 + MPA in stromal cell cultures, removal of these steroids greatly reduced levels of both TF and PAI-1 protein and mRNA within 4 days. These studies suggest a mechanism whereby endometrial hemostasis is maintained during trophoblast invasion yet reduced at the end of nonfertile cycles to permit menses.

Four-year cross-lagged associations between physical and mental health in the Medical Outcomes Study

This article provides an application of structural equation modeling to the evaluation of cross-lagged panel models. Self-reports of physical and mental health at 3 different time points spanning a 4-year interval were analyzed to illustrate the cross-lagged analysis methodology. Data were collected from a sample of 856 patients with hypertension, diabetes, heart disease, or depression (or any combination of these) participating in the Medical Outcomes Study. Cross-lagged analyses of physical and mental health constructs revealed substantial stability effects across time. A structural model with standard effects revealed positive effects of physical health on mental health but negative (suppression) effects of mental health on physical health. The effects of mental health on physical health became nonsignificant when the model was revised by adding nonstandard effects (direct effects of measured variable residuals on latent variables). Recommendations for structural equation modeling of cross-lagged panel data are provided.

Four-year cross-lagged associations between physical and mental health in the Medical Outcomes Study

This article provides an application of structural equation modeling to the evaluation of cross-lagged panel models. Self-reports of physical and mental health at 3 different time points spanning a 4-year interval were analyzed to illustrate the cross-lagged analysis methodology. Data were collected from a sample of 856 patients with hypertension, diabetes, heart disease, or depression (or any combination of these) participating in the Medical Outcomes Study. Cross-lagged analyses of physical and mental health constructs revealed substantial stability effects across time. A structural model with standard effects revealed positive effects of physical health on mental health but negative (suppression) effects of mental health on physical health. The effects of mental health on physical health became nonsignificant when the model was revised by adding nonstandard effects (direct effects of measured variable residuals on latent variables). Recommendations for structural equation modeling of cross-lagged panel data are provided.

Developmental regulation of glucocorticoid-mediated effects on extracellular matrix protein expression in the human placenta

The extracellular matrix (ECM) protein fibronectin (FN) is a critical regulator of uterine-placental adherence. In the present report we compared the effects of glucocorticoids on FN expression in cytotrophoblast cultures isolated from human first trimester and term placentas to elucidate potential steroid-dependent cellular mechanisms associated with human parturition. Based on immunoassays, treatment of first trimester cytotrophoblasts with 10(-7) M dexamethasone (DEX) for 2 cr 4 days reduced medium levels of oncofetal FN (onfFN; i.e. FNs bearing an oncofetal epitope) to approximately 80% of control levels. Conversely, treatment of cytotrophoblasts isolated from term placentas with DEX dramatically reduced medium levels of onfFN to approximately 12% of control values. Treatment of both first trimester and term cells with 10(-6) M progestin, mineralocorticoid, or estrogen had no significant effect on onfFN expression in either cell type. Glucocorticoids specifically down-regulated medium levels of onfFN in term cells, but not in first trimester cells. In contrast, DEX treatment promoted an approximately 3- to 7-fold increase in levels of hCG in both first trimester and term cytotrophoblasts, suggesting that the effects of glucocorticoid on FN and hCG expression are elicited through independent cell-signaling pathways. In first trimester cells, DEX promoted a reduction in rates of FN and laminin synthesis to 60-70% of control levels. In term cells, DEX treatment reduced levels of FN and laminin synthesis to approximately 10% of control levels. Similarly, DEX treatment down-regulated levels of FN mRNA to approximately 60% and 10% of control values in first trimester and term cells, respectively. The first trimester of human pregnancy is associated with low levels of glucocorticoids and reduced glucocorticoid responsiveness. These conditions would favor high levels of placental ECM protein synthesis, thus stabilizing uterine-placental adherence. Conversely, elevated levels of glucocorticoids near parturition and increased glucocorticoid responsiveness would inhibit placental ECM protein synthesis, reducing uterine-placental adherence and promoting the separation of placenta from uterus.

Steroid regulation of oncofetal fibronectin expression in human cytotrophoblasts

Oncofetal fibronectin (onfFN) is a uniquely glycosylated form of FN suggested to play a critical role in uterine/placental adherence during pregnancy. In the present study we have examined steroid regulation of onfFN in highly purified preparations (> or = 95%) of cytotrophoblasts isolated from human term placentas. Based on immunoassays, relative to controls, treatment of cytotrophoblasts with 10(-6) M medroxyprogesterone acetate (MPA) down-regulated media levels of onfFN 25, 53, 59, and 62% on days 1, 2, 3 and 4, respectively. The pattern of steroid regulation and levels of total FN were nearly identical to that of onfFN suggesting that chronic steroid treatment regulates synthesis of FN and not its oncofetal glycosylation. MPA treatment induced a 2-fold stimulation in media levels of hCG indicating that increased placental function was associated with steroid-mediated changes in FN expression. Steroid specificity experiments demonstrated that MPA, cortisol, and dexamethasone were potent inhibitors of onfFN expression whereas estradiol (E2), deoxycorticosterone, testosterone, progesterone, and the synthetic progestin OD-14, were not. This suggested that glucocorticoids and not progestins may be the physiologic regulators of placental FN expression and that MPA may mediate its matrix-modifying activity through a glucocorticoid-like mechanism. Treatment of cells with dexamethasone (10(-7) M) did not affect the levels of total protein synthesis or the release of human placental lactogen to the culture medium. This indicated that steroid-mediated down-regulation of onfFN expression in cytotrophoblasts did not result from a general reduction of protein synthesis. Based on densitometric scanning of Western blots, MPA and dexamethasone treatments down-regulated media levels of onfFN 70% relative to control levels. Northern blotting revealed that MPA and dexamethasone mediated a 60-90% reduction in steady state levels of FN mRNA in the presence or absence of E2. Our in vitro model may provide a unique system to evaluate steroidal effects on extracellular matrix (ECM) protein expression. In addition, we suggest that steroids may critically regulate placental ECM protein synthesis, and thus affect trophoblast/uterine adherence throughout pregnancy and expulsion of the placenta and membranes following delivery of the fetus.

A comparative study of complement activation by Denaflex, Bioflow, and BioPolyMeric vascular grafts

This study was performed to evaluate the degree of complement activation by three bovine arterial graft materials: Bioflow (Bio-Vascular Inc., a bovine artery fixed with dialdehyde starch), BioPolyMeric (St. Jude Medical Inc., a collagen conduit of bovine arterial origin, tanned with glutaraldehyde and covered with a Dacron mesh), and Denaflex (Baxter Edwards CVS Division, a bovine artery fixed with polyepoxy compounds). The grafts were rinsed by following the manufacturer's recommended procedures and thereafter incubated with normal human serum. CH50 assays were performed on the serum after incubation, and the percentage of complement activation for each sample was calculated relative to its control serum. The results indicated that the BioPolyMeric grafts activated the most complement, with about a 48% decrease in the CH50. The BioPolyMeric graft is composed of an outer polyester mesh and an inner collagenous tubing, exhibiting a nonreversible negative surface charge. After the polyester mesh was removed, the BioPolyMeric graft showed the highest complement activation in this study, suggesting that the glutaraldehyde fixed graft is more prone to complement activation than either the polyepoxy compound or dialdehyde starch fixed grafts. The complement fragment, C5a, generated during complement activation is strongly chemotactic for polymorphonuclear leukocytes and monocytes, which likely play early and long-lasting roles in regulating tissue reaction to the implanted graft.

[Surgical correction of congenital cryptotia]

From 1983 to 1988, we have operated on eight cases of cryptotia. The method of operation was to deepen the cephalo-auricular sulcus and to obtain a normal position of the ear. 1. The local flap usually used is either a V-Y advancement flap or a rotated flap. The author designs two V flaps, the upper one near the auricle is rotated to provide tissue between the upper part of the auricle and temporal region which should be dissected deep enough. The other V-Y advancement flap is used to increase the transverse length of the auricle. 2. The contracted transverse, oblique and superior auricular muscular fibres are dissected. In children the insertion of the superior auricular muscle is transposed and sutured to the eminentia fossae. 3. The repair of the cartilagenous deformity of the auricle includes placing two to three parallel incisions on the back of the superior part and elevating and suturing the angulated superior third helix to the cut edge of the back of the auricle. Good results were obtained in all cases.

Mediating mechanisms in a school-based drug prevention program: First-year effects of the Midwestern Prevention Project

Describes (a) the effects of a social-influences-based drug prevention program (the Midwestern Prevention Project) on the mediating variables it was designed to change and (b) the process by which the effects on mediating variables changed use of drugs (tobacco, alcohol, and marijuana). Students in 42 middle schools and junior high schools in Kansas City, Missouri, and Kansas City, Kansas, were measured in the fall of 1984 (N = 5,065) and again 1 year later (N = 5,008) after 24 of the schools had been through the program. Compared to students in control schools, students in program schools became less likely to express belief in the positive consequences of drug use, less likely to indicate that they would use such drugs in the future, more likely to report that their friends were less tolerant of drug use, and more likely to believe that they were better able to communicate with their friends about drug or school problems. Change in perceptions of friends' tolerance of drug use was the most substantial mediator of program effects on drug use. There was evidence that intentions to use and beliefs about the positive consequences of use may also mediate program effects on drug use.

[Corrective rhinoplasty for post-traumatic deformity of nose]

From 1981 to 1986 the author has used osteotomy technique for corrective rhinoplasty in 15 cases. They were localized depression or deviation of the nose. The depression deformity was treated by osteotomy and elevating by making cuts along the midline of the nose and on each lateral cartilage. Then the dorsum of the nose was repositioned. All 15 cases obtained satisfactory cosmetic result without any complication.

[Correction of non-traumatic retraction of a unilateral upper eyelid]

Six patients with retracted unilateral upper eyelid were operated on by cutting the levator and Muller's muscles under local anesthesia. 1% lidocaine was infiltrated into the eyelid and the tissues superficial to the orbicularis oculi muscle. It is important that the infiltration should not enter the deep layer of the muscles to avoid paralysis of the superioris levator palpebra muscle. Incision is made on the upper eyelid about 6mm above the lid margin. The cutting of the levator and Muller's muscles should be limited to the central portion and leave a strip of muscles intact on both sides. The extent of cutting is decided by adequate correction of lid retraction. With the opposite palpebral fissure as a guide the cutting is extended bilaterally until overcorrection by 1 mm is reached. Adequacy of correction is obtained when the patients can open and close the eyelid. The results in these 6 cases were satisfactory and deformities were corrected.

Estimating intervention effects in longitudinal studies

Longitudinal studies aimed at assessing the impact of interventions on disease risk factors often confront several statistical problems. These problems include 1) dependent variables measured by ordered categories, 2) numerous potentially relevant patterns of transition between outcome levels, 3) mixed units of analysis (e.g., assignment by social unit while theorizing in terms of individuals), 4) incomplete randomization, and 5) correlated estimates for successive occasions of longitudinal measurement. Longitudinal data on use of cigarettes, alcohol, and marijuana among adolescents (n = 1,244, complete data) from the Midwestern Prevention Project are used to demonstrate solutions to each of these problems: 1) a proportional odds regression model, 2) conditional logistic models of transitions with interactions between baseline level and intervention effect, 3) a logistic model estimated with linear regression methods on measures aggregated by social unit, 4) conditional and unconditional models of effect magnitude, and 5) a repeated measures logistic regression technique. Panel data fit to the various models yielded the following conclusions concerning intervention effects in the Midwestern Prevention Project: reduction in the prevalence of cigarette users in treatment schools compared with control schools (8% vs. 18% smoked in the last week at one year follow-up), mixed evidence of an effect on marijuana use, and no evidence of an effect on alcohol use.

[Corrective rhinoplasty of the congenital deviated nose]

From 1981 to 1986, a total of 11 cases of crooked nose were treated. The method include resection of the excessive portion of deviated lateral cartilage, and reduction of significantly dislocated lower part of septum, otherwise correction could not be radical.

A multicommunity trial for primary prevention of adolescent drug abuse. Effects on drug use prevalence

The entire early adolescent population of the 15 communities that constitute the Kansas City (Kansas and Missouri) metropolitan area has participated in a community-based program for prevention of drug abuse since September 1984. The Kansas City area is the first of two major metropolitan sites being evaluated in the Midwestern Prevention Project, a longitudinal trial for primary prevention of cigarette, alcohol, and marijuana use in adolescents. The project includes mass media programming, a school-based educational program for youths, parent education and organization, community organization, and health policy components that are introduced sequentially into communities during a 6-year period. Effects of the program are determined through annual assessments of adolescent drug use in schools that are assigned to immediate intervention or delayed intervention control conditions. In the first 2 years of the project, 22,500 sixth- and seventh-grade adolescents received the school-based educational program component, with parental involvement in homework and mass media coverage. Analyses of 42 schools indicate that the prevalence rates of use for all three drugs are significantly lower at 1-year follow-up in the intervention condition relative to the delayed intervention condition, with or without controlling for race, grade, socioeconomic status, and urbanicity (17% vs 24% for cigarette smoking, 11% vs 16% for alcohol use, and 7% vs 10% for marijuana use in the last month), and the net increase in drug use prevalence among intervention schools is half that of delayed intervention schools.

Longitudinal effects of the midwestern prevention project on regular and experimental smoking in adolescents

The purpose of this study was to compare longitudinal smoking prevention program effects estimated on a population-based cohort sample of sixth- and seventh-grade students (average n per year = 4,664) using different schools as units of analysis (middle/junior high school as the school of origin or high school as the endpoint school of intervention). Fifty schools in 15 school districts were demographically matched and assigned to either a school and community-based program for prevention of cigarette, alcohol, and marijuana use, or a health education as usual control group. Smoking was measured by questionnaires administered to the students. An expired air (CO) measure of smoking was also administered to increase accuracy of self-reports. Program effects were estimated with regression analyses, controlling for school-level socioeconomic status, racial/ethnic make-up, urbanicity, and grade. Using school of origin as the unit of analysis, program effects showed 1 year net reductions of -8, -6, and -5% in prevalence rates of smoking in the last month, last week, and last 24 hr; 2-year program effects showed similar net reductions of -6, -5, and -3% (P's less than 0.10-0.001). Analyses with endpoint school as the unit showed slightly weaker effects at the 2-year follow-up, the year during which 64% of students had moved to a junior high or high school. The findings are discussed in terms of the potential contamination of experimental groups in longitudinal studies from school consolidations, family mobility, and feeder patterns to high schools, and the different smoking environments represented by middle, junior high, and high schools.

[Application of monoclonal antibody OC 125 in gynecological oncology]

This study was undertaken to determine whether the measurement of CA125 could effect an early diagnosis and a method for monitoring the course of gynecologic tumors. CA 125 in serum of 195 patients, including 15 apparently healthy women; 39 benign gynecologic tumors; 2 borderline ovarian tumors; 139 malignancies were measured by CENTOCOR cancer antigen 125 kits. Diagnosis of all patients was confirmed by pathology. None of the healthy women; 10% of benign tumors; 78% of epithelial ovarian cancers; 31% of endometrial adenocarcinomas and one out of five adenocarcinoma of uterine cervix had CA 125 level over 65 U/ml. In addition, 23 cases of ovarian cancer were monitored serially up to 9 months. In more than 80% of these patients, CA 125 levels were correlated with the regression or progression of the disease. The significance of this assay for early diagnosis and monitoring the course of ovarian cancer is discussed. It is considered that CA 125 is a promising and useful antigenic marker for monitoring the course of ovarian cancers.

Mechanism of action of a suppressor-activating factor (SAF) produced by a human T cell line

We previously described a potent suppressor-activating factor (SAF) produced constitutively by a 6-thioguanine-resistant mutant of the human T cell line CEM. In the present study, we investigated the mechanism of action of SAF. After a brief (4- to 18-hr) exposure to SAF at 37 degrees C, T lymphocytes (either unseparated, or purified OKT4+ and OKT8+ subpopulations), but not B lymphocytes, suppressed allogeneic and syngeneic T cells in co-culture experiments, apparently via the release of a suppressor activity. The total T cell-released suppressor activity (TRSA) accumulated after 3 days culture post-treatment was about 100- to 500-fold higher than the original suppressor activity (SAF) added to trigger the release. Arresting protein or DNA synthesis, or even killing the cells did not affect the release of TRSA by T lymphocytes, but lowering the incubation temperature to 4 degrees C reduced it drastically. Pre-treatment of T lymphocytes with the metabolic inhibitor, sodium azide, or the adenylate cyclase stimulator, prostaglandin E2, or the addition of exogenous dibutyryl cAMP, all suppressed the release of TRSA. The presence of monoclonal antibody OKT3, but not OKT4 or OKT8, enhanced the release of TRSA. The presence of OKT11 blocked the release of SAF. The functional characteristics of TRSA appeared to be identical to those of SAF. However, unlike SAF, interaction of T lymphocytes with TRSA triggered only marginal enhancement of suppressor activity. In addition, the kinetics of the suppression mediated by SAF showed a much larger increment as a function of time than that mediated by TRSA. Taken together, the data suggest that SAF might represent an activated form of SAF, and that the continuous activation of SAF by lymphocytes in culture may account for its high potency in suppressing T cell proliferation in vitro.

Mechanism of action of a suppressor-activating factor (SAF) produced by a human T cell line

We previously described a potent suppressor-activating factor (SAF) produced constitutively by a 6-thioguanine-resistant mutant of the human T cell line CEM. In the present study, we investigated the mechanism of action of SAF. After a brief (4- to 18-hr) exposure to SAF at 37 degrees C, T lymphocytes (either unseparated, or purified OKT4+ and OKT8+ subpopulations), but not B lymphocytes, suppressed allogeneic and syngeneic T cells in co-culture experiments, apparently via the release of a suppressor activity. The total T cell-released suppressor activity (TRSA) accumulated after 3 days culture post-treatment was about 100- to 500-fold higher than the original suppressor activity (SAF) added to trigger the release. Arresting protein or DNA synthesis, or even killing the cells did not affect the release of TRSA by T lymphocytes, but lowering the incubation temperature to 4 degrees C reduced it drastically. Pre-treatment of T lymphocytes with the metabolic inhibitor, sodium azide, or the adenylate cyclase stimulator, prostaglandin E2, or the addition of exogenous dibutyryl cAMP, all suppressed the release of TRSA. The presence of monoclonal antibody OKT3, but not OKT4 or OKT8, enhanced the release of TRSA. The presence of OKT11 blocked the release of SAF. The functional characteristics of TRSA appeared to be identical to those of SAF. However, unlike SAF, interaction of T lymphocytes with TRSA triggered only marginal enhancement of suppressor activity. In addition, the kinetics of the suppression mediated by SAF showed a much larger increment as a function of time than that mediated by TRSA. Taken together, the data suggest that SAF might represent an activated form of SAF, and that the continuous activation of SAF by lymphocytes in culture may account for its high potency in suppressing T cell proliferation in vitro.

A mutant human T-cell line producing immunosuppressive factor(s)

6T-CEM-20, a subclone of a 6-thioguanine-resistant mutant derived from the human-T-cell line CEM, secreted into the medium, a high titered immunosuppressive factor specific for T cells. The cell-free supernatant was very potent in suppressing, via a noncytotoxic mechanism, mitogen-activated T-cell proliferation, cytotoxic T-cell functions, and pokeweed mitogen (PWM)-stimulated plaque-forming cells (PFC). Lower dilutions of the supernatant (10(-1)-10(-2] abrogated T-cell functions within 24 hr whereas higher dilutions (10(-3)-10(-7] required a culture period of up to 4 days with lymphocytes to arrest T-cell activities. The suppressive activity was most pronounced when the factor was added in the early part of the culture period. The factor was sensitive to heat treatment and both low and high pH (most stable at physiological pH). Preliminary purification with column chromatography indicates that the active moiety was contained in the high-molecular-weight fraction (MW greater than 200,000). Data from coculture experiments suggested that T lymphocytes, which were exposed for 5-12 hr to the active supernatant or the partially purified material, suppressed allogeneic T-cell proliferation in a dose-related manner. This suppressor factor which we called suppressor-activating factor (SAF) might have activated a suppressor population or induced the production of a suppressor factor which in turn mediated the observed suppression. Both the molecular structure and the detailed mechanism of action are under investigation.

Speckle reduction in holography by means of random spatial sampling

In this paper, we will illustrate a new technique by which the hologram image speckle can be reduced by spatially random sampling of the hologram aperture. The sampling procedure can be performed by a movable random mask. If the sampling function is made to be uncorrelated in subsequent spatial sampling, the speckle effect in the hologram image can be eliminated. However, an optimum sampling function may be difficult to obtain, which remains to be seen. This speckle reduction technique can be achieved only by some trade-off of the holographic resolution. A simple experimental confirmation of this technique is illustrated. Since one of the most severely limiting factors in applications of holography may be the speckle effect, this proposed technique should be added, together with the other existent techniques, to remedy this limiting factor.