[Immunogenicity of group A+C meningococcal polysaccharide conjugate vaccine in infants: A phase Ⅲ clinical trial study]

Objective: To evaluate the immunogenicity of group A+C meningococcal polysaccharide conjugate vaccine in infants under 2 years old. Methods: From March 2017 to June 2018, 1 932 healthy infants in Biyang County, Henan Province, who were not vaccinated with meningococcal meningitis vaccine and whose axillary temperature was ≤37.0 ℃, were recruited as participants. The 3 months and 6-11 months old infants were allocated to the experiment group and the control group in a ratio of 1∶1. Infants aged 12-23 months were allocated to the 1-dose group, the 2-dose group and the control group in a ratio of 1∶1∶1, with 276 infants in each group. The infants in the experiment group were intramuscularly injected with freeze-dried group A+C meningococcal polysaccharide conjugate vaccine to be evaluated, and infants in the control group received intramuscular injection of commercially available freeze-dried group A+C meningococcal conjugate vaccine. The venous blood of infants was collected 30 days before the first dose and after the last dose of inoculation, and the antibody seroconversion of each group was determined and compared. Results: The completion rate of immunogenicity study was 95.2% (1 839/1 932). Before inoculation, there was no statistical difference in the geometric mean titer and positive rate of group A+C antibodies between the experiment group and the control group in 3 months and 6-11 months old infants (all P values >0.05). The geometric mean titers and positive rate of group A antibodies in the 1-dose group were higher than those in the control group (all P values <0.05), but there was no statistical difference between the 2-dose group and the control group (all P values >0.05) in infants aged 12-23 months. After inoculation, the differences (95%CI) in the positive conversion rate of group A+C antibodies between the experiment group and the control group were -0.12% (-6.01%-5.77%) and 0.82% (-4.23%-5.86%) in the 3 months old infants. At the age of 6-11 months, the differences were 6.75% (1.71%-11.79%) and -4.32% (-8.73%-0.08%), respectively. At the age of 12-23 months, the differences were 1.02% (-3.80%-5.83%) and -4.40% (-7.79%- -1.01%) in the 2-dose group and -7.22% (-12.90%- -1.54%) and -18.61% (-23.75%- -13.46%) in the 1-dose group, respectively. The geometric mean titers of group A+C antibodies in the 3 months old infants were 48.50 and 63.12, respectively, which had no significant difference from the control group (43.02 and 57.99, respectively) (both P values <0.05). The geometric mean titers of group A+C antibodies in the 6-11 months and 12-23 months old infants were 84.09 and 92.51 (2-dose group), which were higher than those in the corresponding control group (43.10 and 61.83, respectively) (all P values <0.001). Conclusion: Group A+C meningococcal conjugate vaccine has good immunogenicity in infants under 2 years old.

[ Ⅲ ]

Objective: The aim of this study was to evaluate the safety and immunogenicity of the first domestic ACYW135 meningococcal conjugate vaccine and a control vaccine named AC group meningococcal conjugate vaccine for 3 months (90-119 days) infants. Methods: From February 2017 to June 2018, a randomized, blinded, and similar vaccine-controlled clinical trial design was adopted at the Henan Vaccine Clinical Research Base. The subjects were 3 months old healthy infants, a total of 720, based on a 1∶1 ratio. The random allocation table for entry was randomly assigned to the experimental group and the control group. According to the 3, 4, and 5 month-old vaccination procedures, the subjects were vaccinated with test vaccine (ACYW135 group meningococcal conjugate vaccine) and control vaccine (group A group C meningococcal polysaccharide conjugate vaccine), of which 720 were given the first dose, 696 were given the second dose (test group: 346; control group: 350), and 692 were given the third dose (test group: 344; Control group: 348). Results: The overall adverse reaction rate of the test vaccine was 21.90% (230 cases), which was lower than the 32.04% (339 cases) of the control vaccine (P<0.001). The incidence of systemic adverse reactions was 19.52% (205 cases), which was lower than that of the control vaccine (27.69%) (293 cases) (P<0.001). The local adverse reaction rate was 3.04% (32 cases), which was lower than the control group (7.84%) (83 cases) (P<0.001). The graded adverse reaction test vaccine was 0.57% (6 cases), which was lower than the control group of 2.36% (25 cases) (P<0.001). The positive conversion rate of anti-bacterial serum antibodies showed that there was no significant difference between the test vaccine group A (91.42%), C (88.76%) and the control vaccine (92.92%) (87.02%) (P>0.05). Group Y and W135 was 88.17% (298 cases), 99.41% (336 cases), respectively. The GMT results showed that the test vaccine group A was 56.24, the control vaccine was 57.43 (P>0.05); the group C test vaccine (43.53) was higher than the control group (27.28) (P<0.001). The group Y and W135 are 89.22 and 140.66, respectively. Among them, the proportion of the group C GMT antibody ≥ 1∶128 for test vaccine (31.07%, 105 cases) was higher than the control vaccine (16.22%, 55 cases) (P<0.001). Conclusion: ACYW135 group meningococcal conjugate vaccine has more safety and immunogenicity after application to 3 month old infants.

Comparison Between Acupuncture and Biofeedback as Adjunctive Treatments for Primary Insomnia Disorder

Context • Insomnia affects from 5% to 35% of the general population worldwide. Primary insomnia disorder is the most frequently diagnosed, sleep-related disorder. Pharmacological treatments remain the most widely used treatments for insomnia. Nonpharmacological treatments for primary insomnia disorder have been found to be effective. Objective • This study intended to determine the appropriateness of acupuncture and biofeedback as adjuncts to medication for primary insomnia disorder. Design • The research team designed a randomized, controlled study. Setting • The study took place in a psychosomatic clinic at a regional general hospital in southern Taiwan. Participants • Participants were patients at the clinic with primary insomnia disorder who had never received prior hypnotic medication or alternative treatments. Intervention • All participants received 10 mg of zolpidem. The participants were divided into 3 groups: (1) acupuncture adjunctive to zolpidem (AAZ) group- 18 patients received 1 acupuncture session weekly; (2) biofeedback adjunctive to zolpidem (BAZ) group- 17 patients received 1 biofeedback session weekly; and (3) control (OZ) group-14 patients received only zolpidem. Patients visited the clinic 1 ×/wk for 4 wk, at baseline and on days 7, 14, and 21 of the intervention. Outcome Measures • The Pittsburgh Sleep Quality Index (PSQI) was used to measure outcomes. Treatment success was defined as a final PSQI score of ≤5. The generalized estimating equation (GEE) was used for statistical analysis. Results • Using analysis of variance, the reduction in the PSQI scores were (1) 3.72 for the AAZ group, (2) 2.00 for the BAZ group, and (3) 2.29 for the OZ group (P = .28). The GEE analysis indicated no differences in the therapeutic effects among the 3 groups: P = .37 for the AAZ group vs the OZ group and P = .07 for the BAZ group vs the OZ group, when the PSQI of the OZ group was set to 0. The AAZ group had a significantly higher score than the OZ group for the sleep duration domain (B = 3.01, P < .001), whereas the BAZ group had a significantly higher score than the OZ group on the sleep disturbance domain (B = 6.78, P < .001). Higher scores indicate more difficulty in a domain. Conclusions • The change in the PSQI score and the success rate were better in the acupuncture group. The heterogeneity in primary insomnia disorder might mean that different therapeutic compositions are needed.

Effects of lung cancer cell-associated B7-H1 on T-cell proliferation in vitro and in vivo

B7 homolog 1 (B7-H1) is the most potent immunoinhibitory molecule in the B7 family. In this study, we examined the effects of tumor-associated B7-H1 on T-cell proliferation in lung cancer. The expression of B7-H1 in human adenocarcinoma A549 and mouse Lewis lung carcinoma (LLC) cells were examined by flow cytometry. To assess the in vitro effect of tumor-associated B7-H1 on T-cell proliferation, we isolated T cells from peripheral blood mononuclear cells (PBMCs) of healthy individuals, labeled them with carboxyfluorescein succinimidyl ester, and co-cultured them with A549 cells in the absence or presence of anti-B7-H1 antibody. For in vivo analysis, LLC cells were subcutaneously injected into mice treated or not with anti-B7-H1 antibody. T-cell proliferation in both in vitro and in vivo assays was analyzed by flow cytometry. In vitro, co-culturing T cells with A549 cells significantly inhibited the proliferation of the former compared with the proliferation of T cells alone (P<0.01), and the addition of B7-H1 blocking antibody dramatically reversed the inhibition of T-cell proliferation by A549 cells. Similarly, in mice bearing LLC-derived xenograft tumors, in vivo administration of anti-B7-H1 antibody significantly increased the total number of spleen and tumor T cells compared to levels in control mice that did not receive anti-B7-H1 antibody. Functionally, in vivo administration of anti-B7-H1 antibody markedly reduced tumor growth. Tumor-associated B7-H1 may facilitate immune evasion by inhibiting T-cell proliferation. Targeting of this mechanism offers a promising therapy for cancer immunotherapy.

[Epidemiology of pertussis in adults and related factors in Tianjin, 2005-2014]

OBJECTIVE

To understand the epidemiological characteristics of pertussis in adults and related factors in Tianjin.

METHODS

Descriptive epidemiological analysis was conducted by using the epidemiological data of pertussis in adults in Tianjin during 2005-2014. The transmission routes of family cluster cases were analyzed. ELISA was conducted to detect pertussis immunity levels in adults aged 18-83 years.

RESULTS

The pertussis cases in adults accounted for 28.57%(252/882)of the total cases in Tianjin , the annual incidence of pertussis in adults was 0.16/100 000. The highest incidence was 0.46/100 000 in 2013. The age specific proportion of the cases was highest in age group 21-30 years(36.12%, 91/252). Three household transmission routes of pertussis were identified, the major one was adult-to-infant(77.78%,98/126). The parents were the infection sources of 81.64% of infant cases(80/98). Of the 904 study subjects, the average positive rate of antibody against pertussis was 55.20%(95%CI: 51.96%-58.44%). There were significant differences in antibody positive rate among different age groups(P= 0.015), and which had the linear correlation with the reported annual incidence(r=0.98, P=0.003)and showed upward trend(χ(2)=11.79, P=0.001).

CONCLUSION

The study indicated that adults have become the population at high risk for pertussis and the major infection sources for infants in Tianjin. The positive rate of antibody against pertussis was low in adults. It is suggested to conduct pertussis vaccination in adults.

[Study on the expression of T, B lymphocyte antigen and platelet antibodies in patients with platelet transfusion refractoriness]

目的

探讨T、B淋巴细胞，血小板膜糖蛋白和血小板抗体在血小板输注无效中作用。

方法

选择41例临床确诊血小板输注无效患者为研究对象，以27例血小板输注有效患者为对照组，采用流式细胞术检测两组患者外周血细胞毒性T淋巴细胞（CD3 ⁺CD4⁻CD8⁺）、辅助性T淋巴细胞（CD3 ⁺ CD4⁺CD8⁻）、B淋巴细胞（CD19⁺）比例和血小板膜糖蛋白CD41а、CD61的表达，采用固相凝集法检测两组患者血清中的血小板抗体。

结果

与对照组比较，血小板输注无效组患者：①辅助性T细胞比例明显下降（36.60%对48.53%），细胞毒性T细胞比例显著增高（53.26%对44.02%），二者比值下降（0.85对1.31），差异均有统计学意义（P值均<0.05）；②B淋巴细胞比例差异无统计学意义（3.02%对2.85%，P=0.901）；③CD41а阳性细胞率[（88.10±12.75）%对（51.69±24.45）%，P=0.001]和CD61阳性细胞率[（88.36±12.31）%对（51.83±24.48）%，P<0.001]均显著升高；④血小板抗体阳性率显著增高（85.37%对14.82%，P<0.05）。

结论

细胞毒性T淋巴细胞的激活、辅助性T细胞的抑制、血小板膜糖蛋白CD41а和CD61的表达以及血小板抗体的产生均在血小板输注无效的发生过程中发挥重要作用。

NO-releasing xanthine KMUP-1 bonded by simvastatin attenuates bleomycin-induced lung inflammation and delayed fibrosis

BACKGROUND AND PURPOSE

Pulmonary fibrosis (PF) is a progressing lung injury initiated by pulmonary inflammation (PI). Bleomycin (BLM) is the most common pathogenesis of PF through early PI and extensive extracellular matrix deposition. This study is aimed to determine whether NO-releasing KMUP-1 inhibits PI and PF, and if so, the benefits of KMUP-1S resulted from simvastatin (SIM)-bonding to KMUP-1.

EXPERIMENT APPROACH

C57BL/6 male mice were intra-tracheally administered BLM (4 U/kg) at day 0. KMUP-1 (1-5 mg/kg), KMUP-1S (2.5 mg/kg), SIM (5 mg/kg), Plus (KMUP-1 2.5 mg/kg + SIM 2.5 mg/kg), and clarithromycin (CAM, 10 mg/kg) were orally and daily administered for 7 and 28 days, respectively, to mice, sacrificed at day-7 and day-28 to isolate the lung tissues, for examining the inflammatory and fibrotic signaling and measuring the cell population and MMP-2/MMP-9 activity in broncholaveolar lavage fluid (BAL).

KEY RESULTS

KMUP-1 and KUP-1S significantly decreased neutrophil counts in BAL fluid. Fibroblastic foci were histologically assessed by H&E and Masson's trichrome stain and treated with KMUP-1 and references. Lung tissues were determined the contents of collagen and the expressions of TGF-β, α-SMA, HMGB1, CTGF, eNOS, p-eNOS, RhoA, Smad3, p-Smad3, MMP-2 and MMP-9 by Western blotting analyses, respectively. These changes areregulated by NO/cGMP and inhibited by various treatments. KMUP-1 and KMUP-1S predominantly prevented HMGB1/MMP-2 expression at day-7 and reduced TGF-β/phosphorylated Smad3 and CTGF at day-28.

CONCLUSIONS AND IMPLICATIONS

KMUP-1 and KMUP-S restore eNOS, inhibit iNOS/ROCKII/MMP-2/MMP-9, attenuate histologic collagen disposition and reduce BALF inflammatory cells, potentially useful for the treatment of BLM-lung PF.

Toxic epidermal necrolysis after sun-exposure probably due to lamotrigine and chlorpromazine

Toxic epidermal necrolysis is a life-threatening disease. It may be induced by many kinds of drugs especially anti-epileptics such as lamotrigine, but less sun-exposure related. Lamotrigine has been effective for partial complex seizure and bipolar disorder and caused serious side effects such as Stevens-Johnson syndrome or toxic epidermal necrolysis. We reported a case of the patient who developed the manic episode and received lamotrigine and chlorpromazine drugs. After combination of lamotrigine and chlorpromazine, the patient developed skin rash to toxic epidermal necrolysis after sun-exposure. We had discontinued both drugs, given supportive treatment, and let him prevent sun-exposure greatly. The disease process got subsided nearly 4 weeks later. Clinicians should carefully prescribe mood stabilizer and photo-toxic or photosensitivity medications with higher drug-eruption rate.

Purple urine bag syndrome in nursing homes: ten elderly case reports and a literature review

Purple urine bag syndrome (PUBS) is a rare occurrence, in which the patient has a purple-colored urine bag following urinary catheterization for hours to days. Most of authors believe it is a mixture of indigo (blue) and indirubin (red) that becomes purple. Previous study showed that PUBS occurred predominantly in chronically catheterized, constipated women. We collected 10 elderly patients with PUBS in two nursing homes. The first two cases were identified by chart review in 1987 and 2003, and then later eight cases (42.1%) were collected among 19 urinary catheterized elderly in the period between January 2007 and June 2007. In the present report, PUBS probably can occur in any patients with the right elements, namely urinary tract infection (UTI) with bacteria possessing these enzymes, diet with enough tryptophan, and being catheterized. Associations with bed-bound state, Alzheimer’s, or dementia from other causes are reflections of the state of such patients who are at higher risk for UTI, and hence PUBS occurred. Although we presented PUBS as a harmless problem, prevention and control of the nosocomial catheter-associated UTIs (CAUTIs) has become very important in the new patient-centered medical era. Thus, we should decrease the duration of catheterization, improve catheter care, and deploy technological advances designed for prevention, especially in the elderly cared for in nursing homes.

Total knee arthroplasty after failed dome osteotomy

A retrospective, clinical and radiographic analysis was done between a study group of 15 patients with 17 total knee arthroplasties done following failed, proximal-tibial dome osteotomies and a control group of 14 patients with 17 primary arthroplasties. The groups were matched according to age of patients, type of prosthesis, primary disease and length of follow-up. The average length of follow-up was 59.4 months (range, 25-146 mo) in the study group and 62.3 months (range, 43-140 mo) in the control group. On the basis of the knee rating scale of the American Knee Society, 94% of the patients had either an excellent or a good result in the study group. There were no significant differences in knee scores, function scores, or range of motion of the knee between the two groups during the follow-up period. Although two overcorrected valgus knees and one severe varus knee necessitated an autogeneic bone graft for tibial defects at the time of implantation of the secondary prosthesis, dome osteotomy does not appear to compromise a subsequent arthroplasty.

Local capsaicin application to the stellate ganglion and stellatectomy attenuate neurogenic inflammation in rat bronchi

The present study investigated the contributions of vagal and nonvagal sensory nerve fibers on neurogenic inflammation in rat bronchial airways. A surgical procedure was developed via the rat mediastinum ventral intercostal space to prepare an intercostal opening without causing pneumothorax for performing stellate ganglionectomy alone, thoracic vagus nerve section alone, and stellatectomy plus thoracic vagotomy, and for injecting capsaicin (2 microl, 10 mg/ml) and 6-hydroxydopamine (2 microl, 50 mg/ml) into the ganglion. One week later in our procedure, we investigated if neurogenic inflammation induced by an intravenous injection of capsaicin (300 nmol/ml/kg) and innervation density of substance P-immunoreactive sensory axons could be decreased after chronic denervation in the rat lower airways. The major findings were that surgical removal of the right stellate ganglion and local capsaicin application resulted in a significant attenuation of neurogenic plasma extravasation in the right bronchial tree evoked by systemic capsaicin application. Reduction of neurogenic plasma extravasation was totally abolished by combined stellatectomy and thoracic vagotomy. The number of substance P-containing axons was also greatly decreased following these surgical and capsaicin treatments. It is concluded that sensory nerve fibers from both vagal source and nonvagal (spinal) source, which associated with the stellate ganglion, contributed significantly to neurogenic inflammation in the bronchial airways with a slightly higher contribution from the vagus nerve.

IRF-1-mediated CAS expression enhances interferon-gamma-induced apoptosis of HT-29 colon adenocarcinoma cells

The expression of CAS is reported to be upregulated in a variety of human tumor cells, and such expression correlates with the development of tumors. CAS also plays a role in apoptosis. We investigated whether CAS expression affects the susceptibility of tumor cells to IFN-gamma-induced apoptosis. Our data show that IFN-gamma treatment induces CAS expression in HT-29 tumor cells. IFN-gamma-induced gene expression is primarily mediated by the transcriptional factor, IRF-1. Our data show that IRF-1 mediates IFN-gamma-induced CAS expression. Transfection of HT-29 cells with CAS expression vector did not induce apoptosis of cells; nevertheless, CAS overexpression greatly enhanced IFN-gamma-induced apoptosis of cells. CPP32 is regarded as one of the central apoptosis executioner molecules. CAS overexpression enhances IFN-gamma-induced CPP32 expression. These results indicate that tumor cells highly expressing CAS may be more susceptible to apoptosis induced by reagents that are capable of inducing CAS expression. Thus, CAS may be a target for the elimination of tumors.

Neurophysiological effects of recurrent laryngeal and thoracic vagus nerves on mediating the neurogenic inflammation of the trachea, bronchi, and esophagus of rats

The present study aims to investigate the neurophysiological effects of recurrent laryngeal nerve and thoracic vagus nerve on the non-cholinergic regulation of neurogenic plasma extravasation of the rat trachea, bronchi, and esophagus. Through thoracotomy, three nerve components, the right thoracic vagal trunk, thoracic vagus nerve, and recurrent laryngeal nerve, were identified. The experiment was sequentially conducted in four steps. First, the individual nerve component was electrically stimulated and the induced inflammatory responses, as quantified by the area density of India ink-labelled blood vessels in the trachea, bronchial trees and esophagus, were compared. Second, we assessed the relative importance of medial and lateral side of the right thoracic vagus nerve in inducing the inflammatory responses by alternative stimulation of one side with simultaneous severance of the other side of this nerve. Third, we examined the effects of transection of the lateral half of the right thoracic vagus nerve on the degeneration of axon fibers located at the following three sites: the nerve segment proximal to cutting site, bronchial and esophageal nerve branches. Finally, we directly observed the inflammatory histopathology of the right lower trachea after stimulation of the medial half of the right thoracic vagus nerve with transection of its lateral half. In this study, we found that the right recurrent laryngeal nerve was predominant in mediating the neurogenic inflammatory responses of upper and dorsal portions of trachea, whereas the right thoracic vagus nerve was predominant in mediating those of the right lower ventral wall of trachea, right main bronchus, and right lobar bronchial trees. The axon fibers of the right thoracic vagus nerve responsible for mediating the neurogenic inflammatory responses of the right lower ventral trachea were mainly accumulated in the medial half, whereas those innervating the right main bronchus, right lobar bronchial trees, and lower esophagus were largely in the lateral half of this nerve. Transection of the lateral half of the right thoracic vagus nerve resulted in significant degeneration of myelinated fibers in its bronchial and esophageal nerve branches. Histopathological examination of the right lower trachea after electrical stimulation of the medial half of thoracic vagus nerve demonstrated the silver-stained leaky venules with accumulations of inflammatory cells. We thus concluded that afferent C-fibers to upper and dorsal portions of trachea were mainly from recurrent laryngeal nerve. In contrast, the neurogenic inflammatory responses of the right lower trachea were predominantly mediated by the medial half of the right thoracic vagus nerve, and those of the right main bronchus, bronchial trees and lower esophagus were largely by the lateral half of this nerve.

Rhenium-188-Labeled DTPA: a new radiopharmaceutical for intravascular radiation therapy

Balloon angioplasty is a standard treatment for artherosclerotic coronary artery disease. However, its clinical value is reduced by a high restenosis rate. A new concept in preventing restenosis is the use of a liquid-filled balloon containing a beta-emitting radioisotope. In this study, we performed biodistribution studies of Re-188 perrhenate and Re-188 diethylenetriaminopentaacetate (DTPA) to assess the resulting organ dose values in the event of balloon rupture if these agents are used for the clinical inhibition of restenosis after percutaneous transluminal coronary angioplasty (PTCA). After injecting Re-188 preparations intravenously, rats were killed at 10 min, 30 min, 60 min, 2 h, and 6 h (n = 5 per group). Tissue concentrations were calculated and expressed as percent injected dose per gram or per milliliter (%ID/g or %ID/mL). In addition, urine excretion and thyroid gland uptake were evaluated in rats (n = 5 per group) with a gamma camera after administration of 37 MBq (1 mCi) of each agent. Our data showed that both agents were excreted primarily via urine. However, the excretion of Re-188 DTPA was much faster than that of Re-188 perrhenate via the urinary system. The biodistribution data revealed that radioactivity levels in the stomach and the thyroid gland were high in the perrhenate group but low in the Re-188 DTPA group. The concentration levels in other tissues including lung, liver, testis, muscle, and blood were low throughout this study for both agents. The thyroid radiation value in the Re-188 perrhenate group was 0.163 mGy/MBq, which was much higher than that of the Re-188 DTPA group (0.0167 mGy/MBq). The stomach radiation value was as high as 0.127 mGy/MBq for Re-188 perrhenate, compared with 0.013 mGy/MBq for Re-188 DTPA. In conclusion, in the event of balloon rupture, the release of Re-188 DTPA results in lower radiation doses than Re-188 perrhenate, especially to the thyroid gland and the stomach. Our data suggest that Re-188 DTPA is a useful radiopharmaceutical for endovascular irradiation.

Toxic effects of mitomycin-C on cultured corneal keratocytes and endothelial cells

Improper use of mitomycin-C in ocular medication may result in damage to corneal cells. In this study, the toxic effects of mitomycin-C on cultured porcine keratocytes and endothelial cells were estimated by MTT, 3H-thymidine uptake and cellular counting assay methods. It was found that mitomycin-C caused a dose-dependent toxic effect to keratocytes and endothelial cells. Both cells were treated with mitomycin-C at the concentration ranging from 100, 10, 1, 0.1 to 0.01 microg/ml for 3 min, 5 min or 100 min. The 50% inhibitory dose (ID50) of mitomycin-C to keratocytes and endothelial cells as measured by MTT assay was 0.40, 0.18, 0.16 mg/ml and 0.27, 0.15, 0.14 mg/ml, respectively, after 3, 5 and 100 minutes drug treatment. The ID50 for keratocytes and endothelial cells as measured by 3H-thymidine uptake immediately, 1 day and 7 days after 100 minutes mitomycin-C treatment was 0.3, 0.0002, 143.2 microg/ml and 45.1, 101.1, 450.2 microg/ml, respectively. The ID50 for keratocytes and endothelial cells as measured by cellular counting 1 day and 7 days after mitomycin-C treatment was 232.5, 109.7 microg/ml and 239.9, 367.5 microg/ml, respectively. It is concluded that mitomycin-C is more toxic to cellular proliferation in cultured corneal keratocytes than in endothelial cells.

Thoracic vagus section distal to the recurrent laryngeal nerve reduces substance. P-immunoreactive innervation in the rat bronchial tree

The vagal nerve trunk in the mediastinum of mammals divides into two main branches, the thoracic vagus nerve and the recurrent laryngeal nerve, in which the sensory nerve axons are largely involved in neurogenic inflammation in the tracheobronchial airways. A previous study demonstrated that cutting the right-side thoracic vagus nerve but not the recurrent laryngeal nerve inhibited capsaicin-induced neurogenic inflammation in the right bronchial tree of the rat. The effect of left thoracic vagus nerve section is still not known. The main purpose of the present study was to investigate the effect of sectioning the right or left thoracic vagus nerve on the innervation density of substance P-immunoreactive axons in bilateral bronchial trees. Following nerve degeneration, the whole mounts of airway tissues were processed with substance P immunohistochemistry. Denervation of either thoracic vagus nerve reduced the innervation density of axons by 38-71% in different parts of the ipsilateral bronchial tree. The effect of right recurrent laryngeal nerve section was less specific; the innervation density was reduced by 21-39% in the trachea and bronchi of both sides. Capsaicin-induced neurogenic plasma leakage was decreased in the left mainstem bronchus and lobar bronchi after left thoracic vagus nerve section. It is concluded that the thoracic vagus nerve largely contributed to the sensory innervation in the ipsilateral bronchial airways and modulated their functions.

Anomalous pancreaticobiliary ductal union--an etiologic association of gallbladder cancer and adenomyomatosis

BACKGROUND/AIMS

Anomalous pancreaticobiliary ductal union (APBDU) has been proposed as a risk factor of gallbladder cancer. To clarify the frequency and the subtype distribution of APBDU in patients with gallbladder cancer and adenomyomatosis, a retrospective study was performed.

METHODOLOGY

The radiograms of endoscopic retrograde cholangiopancreaticography of 680 patients with well-documented biliary and pancreatic ducts from April 1992 to November 1996 were reviewed. The length of the common channel and insertion of the pancreatic duct and the bile duct were identified and recorded.

RESULTS

Gallbladder cancer and adenomyomatosis were identified in 8 and 12 patients, respectively. Patients with gallbladder cancer were significantly older (mean age: 66.5 years, p<0.01) than those with gallbladder adenomyomatosis (mean age: 42.7 years). APBDU was noted in 59 (8.7%) of 680 cases with complete pancreaticobiliary radiograms. Among them, 5 of 8 patients with gallbladder cancer coexisted with APBDU. Four (80%) belonged to the P-B type. Six of 12 patients with gallbladder adenomyomatosis had APBDU. Five (83.3%) belonged to P-B type.

CONCLUSIONS

Patients with gallbladder cancer and adenomyomatosis were frequently associated with APBDU. The close relationship and similar distribution of the P-B type of APBDU in both diseases suggest an etiologic association in various gallbladder diseases.

A novel procedure for mediastinal vagotomy inhibits neurogenic inflammation in rat bronchial tree

Tachykinin-containing sensory axons originating from the cervical vagal nerves and the first several pairs of thoracic spinal nerves are involved in neurogenic inflammation evoked by capsaicin in the bronchial tree. Unilateral degeneration of the cervical vagal trunk by surgical lesion inhibits neurogenic inflammation in the ipsilateral bronchial airways. The vagal trunk has two main branches, the thoracic vagus nerve and recurrent laryngeal nerve in the thorax. The main purpose of this study was to determine whether the thoracic vagus nerve or recurrent laryngeal nerve was significantly involved in the neural control of bronchial inflammation in the rat. A novel and safe surgical procedure was used for selectively cutting the right thoracic vagal trunk, thoracic vagus nerve, or recurrent laryngeal nerve by introducing the surgical instrument through an aperture between the first and second ribs in the ventral wall of the rostral mediastinum. This surgical operation could be completed without causing a pneumothorax. After 2 postoperative weeks, the effects of denervation on capsaicin-induced plasma extravasation in the respiratory tract were tested. Either right thoracic vagal trunk transection or thoracic vagus section significantly decreased plasma extravasation in the right bronchial tree. Thoracic vagus section was obviously more effective. Evans blue extravasation in the right lobar bronchi was reduced by 44-78% after thoracic vagal trunk transection, while that in the right mainstem and lobar bronchi was reduced by 58-81% after thoracic vagus section. Area densities of India ink-labeled leaky blood vessels in the right lobar bronchi were reduced by 40-65% after thoracic vagal trunk transection, and those in the right mainstem and lobar bronchi were reduced by 83-88% after thoracic vagus neurectomy. Recurrent laryngeal neurectomy did not change the plasma extravasation induced by capsaicin in the trachea and bronchi. These results suggest that capsaicin-sensitive fibers running in the vagal trunk, which largely mediated neurogenic inflammation in the bronchial tree, were projected into the thoracic vagus nerve which, in turn, sent these nerve fibers to the ipsilateral bronchial tree. For the trachea, the remaining sensory fibers surviving denervation might provide sufficient tachykinins to trigger neurogenic inflammation.

Effects of a program on symmetrical posture in patients with hemiplegia: A single-subject design

OBJECTIVES

Asymmetrical posture during static stance has been identified as a common problem in persons with hemiplegia. This study examined the effect of an activity-based therapy regimen on symmetric weight bearing and midline position of center of gravity (COG) in three adult subjects with hemiplegia.

METHOD

An ABAB single-subject design was used. The intervention program, including sanding in front of a standing table and play a bean bag game, was introduced for 30 min each day during each intervention phase. Quantitative measurements of the weight distribution and the midline position of COG were taken with the Balance Master System (version 2.20).

RESULTS

Visual inspection and statistical analysis of the data revealed a significant improvement in symmetric weight distribution and midline position of COG. The study suggests that this program may be a promising alternative to a variety of postural rehabilitation programs for persons with hemiplegia.

CONCLUSION

Insecurity caused by poor stabilization and abnormal reactions to body weight bearing in an antigravity position might contribute to asymmetric postures. Results of this study suggest that an activity-oriented program can be effective in helping the persons with hemiplegia achieve symmetric stances.

Postvagotomy changes in neurogenic plasma extravasation in rat bronchi

The present study was carried out to test if plasma extravasation induced by capsaicin (90 micrograms/kg) in the bronchi of Sprague-Dawley rats could be reduced 10-30 min (0 day), 20-24 h (1 day), 3, 7 or 14 days after unilateral midcervical vagotomy. The second aim of this study was to demonstrate if substance P (3 micrograms/kg) could intensify neurogenic plasma extravasation in the bronchi in which sensory innervation was partially deprived by vagotomy. In the rats 0 days after vagotomy (0 days postvagotomy) that received capsaicin, plasma extravasation in the mainstem and secondary bronchi ipsilateral to vagotomy did not decrease. Capsaicin-evoked plasma extravasation in the secondary bronchi ipsilateral to vagotomy decreased significantly 1, 3, 7 and 14 days after vagotomy as compared with that of 0 days postvagotomy. Differences in extravasation between the secondary bronchi of the two sides were usually significant in animals 3, 7 or 14 days postvagotomy. The effect of unilateral vagotomy on plasma extravasation in the mainstem bronchi was variable. Plasma extravasation produced by substance P in the mainstem and secondary bronchi of rats 0 days postvagotomy was similar to that of unoperated rats receiving either capsaicin or substance P. Unilateral vagotomy did not decrease the amount of substance-P-induced plasma extravasation in the mainstem or secondary bronchi ipsilateral to vagotomy in rat groups 1, 3, 7 or 14 days postvagotomy as compared with that of their contralateral bronchi. This study suggests that the secondary bronchi were the chief location of the bronchial tree that could be desensitized after unilateral cervical vagotomy to stimulation by the irritant capsaicin. This desensitization developed within 1 day after vagotomy, therefore the capsaicin-evoked neurogenic inflammation in the bronchi of the vagotomized side was reduced. Exogenous substance P resulted in mucosal edema and degranulation of goblet cells in the bronchi of both vagotomized and opposite sides. The number of mediator-sensitive blood venules did not decrease following vagotomy operation. It is suggested that substance P was insufficient after vagal denervation, but substance-P receptors on the endothelial cells and goblet cells in the denervated regions were still operative.

Unilateral cervical vagotomy decreases the magnitude of neurogenic inflammation induced by capsaicin in the ipsilateral bronchial tree of rats

Electrical stimulation of a single cervical vagus nerve produces neurogenic inflammation on the stimulated side of the bronchial tree, including the first (main) to the 4th order bronchi. In the contralateral bronchial tree, in contrast, only the proximal part of the main bronchus exhibits inflammatory changes, suggesting that vagal sensory axons present in the bronchi largely originate from the ipsilateral vagus nerve. Intravenous administration of capsaicin can evoke neurogenic inflammation in bilateral bronchial trees. Sensory axons from various sources are thought to be stimulated by this irritant. The extent to which neurogenic inflammation in both bronchial trees might be reduced by unilateral vagotomy is not known. In the present study, we sought to characterize the effect of unilateral cervical vagotomy on capsaicin-induced changes in plasma extravasation and secretory activity of goblet cells in the bronchial trees of both sides. To quantify the magnitude of neurogenic plasma extravasation, Evans blue was used as a tracer dye to measure spectrophotometrically its amount in the bronchial wall. Another tracer dye, Monastral blue, was used to localize the distribution of leaky blood vessels and to measure morphometrically their area density in the whole mounts. To investigate cell and tissue responses of the mucosa, histological methods were employed. After 2 or 4 postoperative weeks, the rats were intravenously administered with a single dose of capsaicin, 150 micrograms/kg. This resulted in different magnitudes of Evans blue extravasation in the bronchi of the two sides in vagotomized rats. Extravasation of Evans blue dye in the bronchial tree ipsilateral to vagotomy was one-half to two-thirds of that of the contralateral bronchial tree.(ABSTRACT TRUNCATED AT 250 WORDS)

[The use of rifampin in the treatment of infection due to Staphylococcus aureus]

Infection due to Staphylococcus aureus continues to be a source of significant morbidity and mortality. However, its treatment is increasingly complicated by the rising prevalence of resistance to antibiotics. Apart from the two recognized modes of staphylococcal resistance, namely, penicillinase production and intrinsic resistance, Sabath and associates have described a third type in which resistance is manifested by susceptibility to growth inhibition but tolerance to the lethal action of bactericidal agents. The mechanism of tolerance is attributed to a deficiency of autolytic enzyme activity in the part of bacteria, possibly secondary to an inhibition of autolysins in the tolerant staphylococcal strains. These strains are found in patients with infections responding poorly to treatment with cell-wall active antibiotics including vancomycin. Because of its unique mechanism of action and pharmacokinetic properties, rifampin has been reported to be the most active among 65 antistaphylococcal agents tested and have the capacity to kill intraleukocytic staphylococci. We present 2 cases who were cured following the addition of rifampin to previously established regimens. Case 1 was a 40-year-old male who had fever, cough, dyspnea, a right elbow abscess and left leg swelling for 2 weeks prior to admission. Culture of purulent material from the elbow abscess grew staphylococcus aureus. Chest X-ray showed bilateral septic embolism and phleborheography showed partial deep vein occlusion of the left ileofemoral vein. Case 2 was 22-year-old female with fever, chills and cough for 3 weeks. Blood culture grew staphylococcus aureus, and Chest X-ray revealed bilateral septic embolism with pneumonia. Neither of them responded to standard antibiotics which were judged adequate by in vitro sensitivity tests. Clinical cure was later obtained after rifampin was added to the regimens. These results suggest that rifampin may be a useful adjunct in the therapy of staphylococcal infections.

Effect of unilateral vagotomy on capsaicin-induced neurogenic inflammation in the trachea of rats

This study reports the effect of unilateral vagotomy on neurogenic inflammation in the trachea. Neurogenic inflammation was produced in the trachea of vagotomized rats by a venous injection of capsaicin, the pungent ingredient of red pepper. Monastral blue was used as tracer dye to label the affected blood vessels. Vagus nerves and tracheal tissues were processed for light and electron microscopy. The damaged right vagus nerve was found to have degenerated. However, unilateral vagotomy did not completely block neurogenic inflammation in the trachea ipsilaterally and contralaterally, as shown in the whole mount preparations. Microscopic observations of tracheal tissue sections showed that neurogenic inflammation did not evenly occur on both sides of the trachea. The possible reason for this is discussed.

Influence of pinealectomy on sexual behavior of normal and monosodium L-glutamate-treated rats

Subcutaneous injections of monosodium L-glutamate (MSG) were administered, as a neurotoxin, at a dose of 4 mg/g body weight to rat pups on days 1 and 3 postnatally. Pinealectomy was performed at 6 weeks of age, and animals were allowed to mature. The intact MSG-treated rats showed a decrease of lordosis quotient in females and a reduction of ejaculation frequency and an increase in mount frequency in males. Pinealectomy caused no significant improvement on sexual behavior of the saline-treated normal rats, but it caused a marked improvement of the sexual receptivity in MSG-treated female rats and reinstated ejaculation in MSG-treated males. The circulatory sex steroid levels, estrogen in females and androgen in males, were not significantly different between the intact and pinealectomized MSG-treated groups in the respective sexes, whereas the progesterone level in females was significantly elevated in the pinealectomized MSG-treated group compared with the intact MSG-treated group. These findings suggest that the pineal gland plays an inhibitory role on the sexual behavior of MSG-treated rats and the improvement of sexual behavior following pinealectomy may be dependent on certain mechanisms other than the actions of circulatory androgens or estrogens.

Trabeculectomy with simultaneous topical application of mitomycin-C in refractory glaucoma

From May 1981 to Feb. 1989 trabeculectomy with per-operative topical application of mitomycin C was performed on eyes with refractory glaucoma. All eyes had undergone prior one, two or more than two antiglaucoma surgeries without success for IOP control. Other risk factors in the present series of eyes included young age, aphakia, rubeosis and glaucoma secondary to trauma or associated with anterior uveitis. 59 eyes underwent trabeculectomy with mitomycin application. 14 eyes were lost. 45 eyes of 42 cases, 33 eyes of 31 males and 12 eyes of 11 females were followed for a period of 1 to 8 years, an average 3.0 +/- 1.9 years. The success for IOP control less than 21 mmHg was 77.8%, 35/45 eyes. The success rates were 92%, 11/12 eyes in females and 73%, 24/33 eyes in males. Complications reported in 5-fluorouracil studies such as corneal epithelial toxicity and delayed healing of conjunctival wound were not encountered. The histo-pathological changes of wound healing after trabeculectomy with topical mitomycin application was discussed. In the healing process success to achieve filtration is more likely by pharmacolocally interferring with earlier steps in the process. We recommend the use of per-operative topical application of mitomycin C during trabeculectomy in eyes with uncontrolled glaucoma and poor prognosis, specifically after previous cataract extraction or unsuccessful antiglaucoma surgery.

[Mucocele of appendix-report of three cases]

Mucocele of appendix comprises 0.07%-0.3% of the resection of appendix. Three such cases were encountered over the past four years at MMH. Tumor mass could be palpated before operation in two of our cases. The third case was found incidentally during sigmoid cancer resection. Mucocele of the appendix should be differentiated from submucosal lesion such as leiomyoma, lipoma, lymphoma in the cecum or appendiceal abscess. Recent advances of ultrasound, CAT scan as well as angiography have made correct preoperative diagnosis possible, yet literature still shows diverse opinion about its etiology (neoplastic vs. obstructive). Although most authors favor simple appendectomy for the management of this disease, some surgeons still think it should be managed aggressively with colectomy. Rupture of mucocele might result in pseudomyxoma peritonei and possibly a fetal outcome. Avoidance of iatrogenic rupture of appendix is essential. Aggressive removal of accessible masses and implants was suggested in the literature.

Inhibition of neutral endopeptidase potentiates neurogenic inflammation in the rat trachea

The present study was performed to determine whether neurogenic inflammation in the rat trachea can be exaggerated by inhibiting neutral endopeptidase, an enzyme that degrades tachykinins that are believed to mediate neurogenic inflammation. Neurogenic inflammation was produced by antidromic electrical stimulation of one vagus nerve (2.5 Hz, 1 ms, 5 V for 5 min) in the presence of atropine or by an intravenous injection of capsaicin (100 micrograms/kg). Neutrophils that adhered to the endothelium of venules were visualized and counted in tracheal whole mounts that were stained by a histochemical reaction for myeloperoxidase. Neural inflammation increased the number of adherent neutrophils. Pretreatment with the neutral endopeptidase inhibitor phosphoramidon (1.0 or 2.5 mg/kg iv) increased neutrophil adhesion induced by neural inflammation. As assessed by the amount of extravasation of Monastral blue pigment, neural inflammation also increased vascular permeability, and this change was potentiated by phosphoramidon. These results are consistent with the concept that neuropeptides released from sensory nerves in the tracheal mucosa cause neutrophils to adhere to venules and increase vascular permeability and that these effects are modulated by neutral endopeptidase.

Changes in epithelial secretory cells and potentiation of neurogenic inflammation in the trachea of rats with respiratory tract infections

In rats respiratory tract infections due to Sendai virus and coronavirus usually are transient, but they can have long-lasting consequences when accompanied by Mycoplasma pulmonis infections. Morphological alterations in the tracheal epithelium and a potentiation of the inflammatory response evoked by sensory nerve stimulation ("neurogenic inflammation") are evident nine weeks after the infections begin, but the extent to which these changes are present at earlier times is not known. In the present study we characterized these abnormalities in the epithelium and determined the extent to which they are present 3 and 6 weeks after the infections begin. We also determined the magnitude of the potentiation of neurogenic inflammation at these times, whether the potentiation can be reversed by glucocorticoids, and whether a proliferation of blood vessels contributes to the abnormally large amount of plasma extravasation associated with this potentiation. To this end, we studied Long-Evans rats that acquired these viral and mycoplasmal infections from other rats. We found that the tracheal epithelium of the infected rats had ten times as many Alcian blue-PAS positive mucous cells as did that of pathogen-free rats; but it contained none of the serous cells typical of pathogen-free rats, so the total number of secretory cells was not increased. In addition, the epithelium of the infected rats had three times the number of ciliated cells and had only a third of the number of globule leukocytes. In response to an injection of capsaicin (150 micrograms/kg i.v.), the tracheas of the infected rats developed an abnormally large amount of extravasation of two tracers, Evans blue dye and Monastral blue pigment, and had an abnormally large number of Monastral blue-labeled venules, particularly in regions of mucosa overlying the cartilaginous rings. This abnormally large amount of extravasation was blocked by dexamethasone (1 mg/day i.p. for 5 days). We conclude that M. pulmonis infections, exacerbated at the outset by viral infections, result within three weeks in the transformation of epithelial serous cells into mucous cells, the proliferation of ciliated cells, and the depletion of globule leukocytes. They also cause a proliferation of mediator-sensitive blood vessels in the airway mucosa, which is likely to contribute to the potentiation of neurogenic inflammation that accompanies these infections.

Unusual ultrastructural features in the superficial pineal gland of the yellow-bellied country rat (Rattus losea Swinhoe)

The ultrastructure of the superficial pineal gland of the yellow-bellied country rat (Rattus losea Swinhoe), living under natural climatic conditions at the margin of the tropical region, was studied with special reference to the seasonal changes. In the rainy season with average monthly rainfall of 400 mm (light phase of 13.5 h, and temperature of 28 degrees C) the gland was characterized by the presence of frequent large vacuoles containing flocculent material (LVFs), large condensed inclusions (LCIs) in the pinealocytes, and extensive accumulations of presumptive secretion in the extracellular compartment, suggesting an enhanced secretory activity. In the dry season with average monthly rainfall of 13 mm (light phase of 11 h, and temperature of 19 degrees C), however, the pinealocytes were characterized by the presence of numerous clear spindles, which exhibited acid phosphatase activity; at this time there were few LVFs and LCIs and rare extracellular accumulations, suggesting a declined glandular activity. We conclude that the cellular activity of the pineal gland in R. losea, living under tropical climatic conditions, is synchronized with the annual changes of rainfall, which is apparently more important than the annual changes of photoperiod and temperature.

The correlation of fine structure with endocrine function of ovarian follicle cells in tadpoles

Electron microscopic study of the ovaries of metamorphosing Rana catesbeiana tadpoles stimulated by anterior pituitary implantation revealed striking alterations of several organelles in the follicle cells and oocytes when compared with the controls. Pituitary implantation caused activation of the follicle cells as shown by activation of mitochondria, voluminous Golgi complexes, mobilization of the lipid droplets, increased rough endoplasmic reticulum, and increased numbers of glycogen granules. Activation of oocyte mitochondria was also observed. These findings are discussed with respect to the correlation of the ultrastructure and endocrine function in the tadpole ovaries.

Edema formation and degranulation of mast cells by Trimeresurus mucrosquamatus snake venom

Trimeresurus mucrosquamatus venom, carrageenin, compound 48/80, trypsin and bovine serum albumin were injected s.c. into the plantar muscle to induce edema formation in the hind paw of rats. The venom was the most potent, and it and compound 48/80 induced the maximum swelling rate of edema within 15 - 30 min after injection. The edema volume induced by the venom was dose-dependent between 2.5 and 10 micrograms. Hydrocortisone, phenylbutazone, indomethacin and diphenhydramine inhibited edema induced by the venom and other inflammatory agents. Diphenhydramine was the most effective inhibitor of edema and increased vascular permeability induced by the venom. Injection of the venom i.p. caused exocytosis and degranulation of mesentery mast cells with a decreased electron density of released granules. Systemic administration of diphenhydramine inhibited the venom-induced exocytosis. Diphenhydramine and pyrilamine inhibited the contraction of guinea-pig ileum caused by venom or compound 48/80. It is concluded that histamine released from mast cells plays an important role in the causation of the edema induced by Trimeresurus mucrosquamatus snakebites.

Synaptic junctions between the adrenergic axon varicosity and the pinealocyte in the rat

Intercellular relationships of sympathetic nerve fibers and cells in pineal glands of Long-Evans rats and yellow-bellied country rats (Rattus losea Swinhoe) were studied with conventional electron microscopy. Typical synapses were found between adrenergic axon varicosities and pinealocytes. The synaptic cleft was 20-30 nm thick and contained granular or filamentous material of moderate electron density. Some small granulated vesicles attached to, or fused with, the presynaptic axolemma, a feature suggesting an exocytotic release of the vesicle content. The occurrence of membranous cisternae or tubules in the synaptic nerve ending may connote the phenomenon of synaptic vesicle recycling. Beneath the postsynaptic pinealocyte plasmalemma there was a dense plaque corresponding to the postsynaptic density of neurons. Possible origins and functional significance of the synapse-making nerve fibers are also discussed.

Ultrastructural localization of monoamines in nerve fibers of the pineal gland in golden hamsters

Nerve terminals in the pineal glands of control, parachlorophenylalanine (PCPA)-, reserpine- and nialamide-administered hamsters were studied with glutaraldehyde-dichromate (GD) and formaldehyde-glutaraldehyde-dichromate (FGD) techniques in the electron microscope. In control pineals treated with the FGD or GD technique, clusters of electron dense reactive particles with a diameter of 20-30 nm, and mainly located in the perivascular space, were identified as dense cores of the small granulated vesicles (SGVs) in the pineal nerve fibers. After the administration of PCPA, the reactive cores were greatly decreased in number in the FGD-treated pineal blocks, whereas a lot of clusters of reactive cores were observed in the perivascular space in GD-treated specimens. After reserpine treatment, no reactive structures were revealed by GD or FGD technique. Reactive cores appeared to be increased in number and in electron density in GD- or FGD-treated pineals of hamsters after administration of nialamide. From the observations, it is concluded that the dense cores of SGVs in the pineal nerve fibers contain both primary catecholamines and 5-hydroxytryptamine although it was not determined whether both amines are located in the same or separate vesicles.