A Randomized Standard-of-Care Controlled Trial of Xenogeneic Platelet-Rich Plasma Lotion to Reduce Acute Radiation Dermatitis in Breast Cancer Patients

PURPOSE/OBJECTIVE(S)

Breast cancer patients experience acute radiation dermatitis (ARD) during radiation therapy (RT). The Multinational Association for Supportive Cancer Care published clinical practice guidelines for the prevention and treatment of ARD in 2013, and mild bathing at the irradiated site is the standard health education. This study examined the prophylactic effect of the newly developed xenogeneic platelet-rich plasma (PRP) lotion on acute radiation dermatitis (ARD) for breast cancer patients.

MATERIALS/METHODS

Ductal carcinoma in situ and early-stage breast cancers were enrolled after breast conserving surgery. Hypo-fractionated whole breast irradiation (42.5 Gy in 16 fractions) followed by tumor bed boost (10 Gy in 5 fractions) was used. Patients were randomly assigned to the Standard of Care (SOC) group (n = 48) or the PRP lotion group (n = 52). In both groups, patients were educated with standard health education on topical skin care. In the PRP lotion group, patients were instructed to apply the provided lotion twice a day, starting from the first day of RT: the first application within 1 hour after the daily RT session, the second at bedtime, and continue during the weekends. Patients were instructed not to apply the lotion within 6 hours before daily RT. We recorded the following skin reaction every week during RT and two weeks after RT: ARD was graded following the RTOG definition by two radiation oncologists; Dermatology Life Quality Index (DLQI) and Visual Analogue Scale for Pain (VAS Pain) were subjectively scored by patients to present patient-reported outcomes. The statistical software was used for all statistical analyses.

RESULTS

The patient characteristics in both groups were balanced except for a higher body mass index in the PRP lotion group. One patient did not complete RT in the SOC group due to pain intolerance. The severity of ARD grading in both groups is shown in Table. In comparison to the SOC group, the PRP lotion group demonstrated significantly reduced and delayed progression of ARD (p<0.01) and VAS Pain (p<0.01) during the whole RT course and two weeks after RT. The DLQI significantly improved at the 2nd week (p = 0.003), 3rd week (p = 0.01), 4th week (p<0.001), and the two weeks post-RT (p<0.001) period; however, this was not observed during the 1st week (p = 0.68). Similarly, the DLQI value progressively worsened two weeks after RT in the SOC group but not in the PRP lotion group.

CONCLUSION

This is the first study to use xenogeneic PRP lotion to prevent ARD clinically. The outcome of this study validated the prophylactic effects of xenogeneic PRP lotion on ARD, subsequently leading to an improved quality of life across the RT course.

Passive dual-probe near-field microscopy

Accurate and simultaneous multiposition near-field measurements are essential to study the time-dependent local dynamics, including heat and carrier transfer. The existing passive long-wavelength infrared (LWIR) scattering-type scanning near-field optical microscopy (s-SNOM) systems with a single probe cannot perform precise near-field measurements of the heat or carrier transporting process at the nanoscale level. Therefore, in this study, we developed a passive LWIR s-SNOM system with two probes. To test the effectiveness of the proposed passive LWIR dual-probe s-SNOM system, each probe was precisely controlled using a shear-force feedback system, and the mechanical interference between the probes was used to monitor the distance between the probes. We achieved simultaneous near-field measurements at two different positions 500 nm apart using the proposed passive LWIR dual-probe s-SNOM system. The simultaneously detected near-field signals from two different points were extracted individually, making this technique an effective nanoscale analysis tool for local carrier dynamics.

Passive near-field imaging via grating-based spectroscopy

Passive scattering-type scanning near-field optical microscopy (s-SNOM) has recently been developed for studying long-wavelength infrared (LWIR) waves. It detects surface-localized waves without any external illumination or heating and enables the imaging of hot-electron energy dissipation and nanoscale Joule heating. However, the lack of a wavelength selection mechanism in the passive LWIR s-SNOM makes it difficult to perform a thorough analysis of the surface-localized waves. Here, we develop a novel passive scanning near-field optical spectroscopy with a diffraction grating. The spectroscopic optics are designed to exhibit a high signal efficiency and mechanical performance at the temperature of liquid helium (4.2 K). Using the developed passive LWIR near-field spectroscopy, the spectral information of thermally excited evanescent waves can be directly obtained without any influence from the external environment factors, including environmental heat. We have detected the thermally excited evanescent waves on a SiC/Au micropatterned sample at room temperature with a spatial resolution of 200 nm and a wavelength resolution of 500 nm at several wavelengths in the range of 14-15 µm. The obtained spectra are consistent with the electromagnetic local density of states calculated based on the fluctuation-dissipation theorem. The developed passive LWIR near-field spectroscopy enables the spectral analysis of ultrasmall surface-localized waves, making it a high-performance surface analysis tool.

Large Collective Lamb Shift of Two Distant Superconducting Artificial Atoms

Virtual photons can mediate interaction between atoms, resulting in an energy shift known as a collective Lamb shift. Observing the collective Lamb shift is challenging, since it can be obscured by radiative decay and direct atom-atom interactions. Here, we place two superconducting qubits in a transmission line terminated by a mirror, which suppresses decay. We measure a collective Lamb shift reaching 0.8% of the qubit transition frequency and twice the transition linewidth. We also show that the qubits can interact via the transmission line even if one of them does not decay into it.

Detection and identification of occult HBV in blood donors in Taiwan using a commercial, multiplex, multi-dye nucleic acid amplification technology screening test

BACKGROUND

The ability of a new generation commercial, multiplex, multi-dye test from Roche, the cobas TaqScreen MPX test, version 2.0, to detect and identify occult HBV infections was evaluated using routine donor samples from Kaohsiung Blood Bank, Taiwan.

STUDY DESIGN AND METHODS

A total of 5973 samples were tested by nucleic acid amplification technology (NAT); 5898 in pools of six, 66 in pools of less than six and nine samples individually. NAT-reactive samples were retested with alternative NAT tests, and follow-up samples from the donors were tested individually by NAT and for all the HBV serological markers.

RESULTS

Eight NAT-only-reactive donors were identified, and follow-up samples were obtained from six of the donors. The results indicated that all eight donors had an occult HBV infection with viral loads <12 IU/ml.

CONCLUSION

The cobas(®) TaqScreen MPX test, version 2.0, has an advantage over the current Roche blood screening test, the cobas TaqScreen MPX test, for screening donations in countries with a high prevalence of occult HBV infections since the uncertainty associated with identifying samples with very low viremia is removed by the ability of the test to identify the viral target in samples that are reactive with the cobas TaqScreen MPX test, version 2.0.

Functional characterisation of a complex mutation in the α(1,4)galactosyltransferase gene in Taiwanese individuals with p phenotype

BACKGROUND AND OBJECTIVE

Individuals with p phenotype lack P1, P(k) and P antigens on red blood cells, presumably as a result of deficiency in the enzyme α(1,4)galactosyltransferase (A4GALT). The aim of this study was to explore the molecular background of a Taiwanese family with p phenotype.

MATERIALS AND METHODS

Blood samples from two p siblings and seven family members were investigated. The coding region of the A4GALT gene was analysed by polymerase chain reaction and direct sequencing. The wild- and mutant-complementary DNAs (cDNAs) of A4GALT were cloned into an expression vector and transfected to Chinese hamster ovary (CHO) cells. P(k) expression on the transfected cells was analysed by flow cytometry and the activities of A4GALT were measured by high-performance liquid chromatography.

RESULTS

The two individuals with p phenotype were homozygous for the complex mutation, which was caused by a combined deletion and insertion between nt 418 and 428. No expression of P(k) and no enzyme activity were observed in cells transfected with the mutant construct.

CONCLUSION

The first case of p phenotype in Taiwan was caused by a non-functional allele resulting from a homozygous complex mutation of A4GALT gene.

Difficulty in securing treatment for degenerative hip disease in a patient with Down syndrome: the gap remains open

In 2002, the office of the U.S. surgeon general published a report detailing the discrepancies between the quality of healthcare afforded to persons with and without mental retardation. This article examines the case of a female resident of a developmental center with profound mental retardation due to Down syndrome and degenerative hip disease. Although she was in urgent need of a total hip replacement, the operation was denied or delayed by several different surgeons. Using a survey of physician attitudes, we examine several possible motivations behind the surgeons' reluctance to perform the procedure and conclude that these reasons were not appropriate in this case. Finally, we reiterate the surgeon general's call to eradicate preconceptions held in the medical community about the population of persons with mental retardation that result in similar failures to provide adequate care.

Monitoring Aspergillus species by quantitative PCR during construction of a multi-storey hospital building

During the enlargement of an existing hospital, quantitative polymerase chain reaction (PCR) was used to monitor Aspergillus spp. populations within the construction site. The rapid availability of results meant that the construction schedule was largely uninterrupted, while assuring that the new construction was free from contamination by the targeted Aspergillus spp.

Molecular genetic analysis of the Bel phenotype

BACKGROUND AND OBJECTIVES

In addition to the common ABO phenotypes, numerous phenotypes with a weak expression of the A or B antigens on the red blood cells have been found. This study describes the molecular genetic analysis of the Bel phenotype in Taiwanese individuals.

MATERIALS AND METHODS

The exon 6-7 region of the ABO gene of an individual with the Bel phenotype was amplified by the polymerase chain reaction (PCR), cloned, and the sequences of the exons and their adjacent splice sites were analysed. A PCR-based restriction fragment length polymorphism (RFLP) analysis was designed to detect the 502C>T nucleotide change identified in the Bel allele. Six unrelated individuals with the Bel phenotype were analysed, and samples from 40 randomly selected individuals with the common B phenotype were also assessed.

RESULTS

All six unrelated Taiwanese individuals with the Bel phenotype were shown to possess a B gene with the 502C>T mutation. The mutation was not detected in the general group B population. The 502C>T nucleotide change predicts an amino acid alteration of Arg168-->Trp in the encoded B transferase.

CONCLUSIONS

The results suggest a new molecular basis, a 502C>T missense mutation in the B allele, for the Bel phenotype and an association of the Bel502C>T allele with the Bel phenotype in the Taiwanese population.

A unique 502C>T mutation in exon 7 of ABO gene associated with the Bel phenotype in Taiwan

BACKGROUND

The ABO system includes many variant subgroups. Some of them are difficult to identify serologically, leading to mistyping of blood groups. For example, Bel is often typed as O blood group.

STUDY DESIGN AND METHODS

DNA sequencing and a molecular approach were explored to accurately determine the genotypes of Bel subgroups. Seven Bel blood donors and 106 individuals with other blood groups were analyzed serologically and molecularly.

RESULTS

The serologic results of these seven Bel blood donors showed that their RBCs do not react with anti-B or anti-A,B, and their B antigen was detected by adsorption and elution methods. Sequencing results for exons 6 and 7 of ABO genes showed a new Bel allele with a C>T substitution at nucleotide position 502 in exon 7 of the ABO gene in all seven cases but not in other blood groups. Consequently, an amplification-created restriction site protocol was designed to detect the 502C>T genotype in Bel subgroup cases.

CONCLUSION

A novel 502C>T mutation was found in the Bel subgroup in Taiwan and successfully developed a rapid and accurate molecular protocol to detect this mutation. To our knowledge, the new Bel allele that was found is unique in Taiwanese residents.

hTid-1, a human DnaJ protein, modulates the interferon signaling pathway

The Jak family of protein-tyrosine kinases are crucial for the signaling of a large number of different polypeptide ligands, including the interferons, many cytokines, erythropoietin, and growth factors. Through their interaction with receptors, the Jaks initiate a signaling cascade resulting in the activation of gene transcription and ultimately a cellular response to various ligands. In addition to their role in cellular signaling, alteration of Jak activity has been implicated in several disease states. In identifying Jak2-interacting proteins with the yeast two-hybrid system, we cloned the human homologue of the Drosophila melanogaster tumor suppressor gene lethal () tumorous imaginal discs, which encodes the protein Tid56. Drosophila Tid56 and its human homologue hTid-1 represent members of the DnaJ family of molecular chaperones. The TID1 gene encodes two splice variants hTid-1(S) and hTid-1(L). We confirmed the interaction between Jak2 and hTid-1(S) or hTid-1(L) by immunoprecipitation from COS-1 cells expressing these proteins. The interaction between endogenous hTid-1 and Jak2 was shown in HEp2 cells. We further showed that hTid-1 interacts with the human interferon-gamma (Hu-IFN-gamma) receptor subunit IFN-gamma R2. In addition, using a chimeric construct where the extracellular domain of IFN-gamma R2 was fused to the kinase domain of Jak2, we showed that hTid-1 binds more efficiently to the chimera with an active kinase domain than to a similar construct with an inactive kinase domain. Additionally, the data demonstrate that hTid-1 isoforms as well as Jak2 interact with Hsp70/Hsc70 in vivo, and the interaction between Hsp70/Hsc70 and hTid-1 is reduced after IFN-gamma treatment. Furthermore, both hTid-1(S) and hTid-1(L) can modulate IFN-gamma-mediated transcriptional activity.

Cloning and functional expression of the mucrosobin protein, a beta-fibrinogenase of Trimeresurus mucrosquamatus (Taiwan Habu)

A venom-specific cDNA encoding for a thrombin-like enzyme designated as mucrosobin has been cloned and sequenced from the cDNA library of the venomous gland of Trimeresurus mucrosquamatus. The full-length cDNA of mucrosobin was assembled by oligonucleotide screening and 5'-rapid amplification of cDNA ends. The amino acid sequence deduced from the cDNA consists of 257 amino acid residues with a putative signal peptide of 24 residues. It is highly homologous to the other thrombin-like enzymes (batroxobin, mucofirase, and calobin), suggesting that it is a serine proteinase with a conserved catalytic triad of His(41), Asp(84) and Ser(179) in the deduced form of mucrosobin protein. Northern blot analysis revealed that the mucrosobin gene encodes an mRNA of 1.5 kb and suggested a tissue-specific expression in the venomous gland. In an effort to study the biological property of mocrosobin, we have expressed the 28-kDa protein as inclusion bodies in Escherichia coli. For analyzing enzymatic activity, the inclusion bodies were solubilized and the recombinant protein was refolded with a two-step dialysis protocol. The refolded recombinant protein exhibited a specific beta-fibrinogenolytic activity. This study offers a possibility of using genetic engineering to acquire a functional snake venom protein with therapeutic potential.

Colon epithelial cell death in 2,4,6-trinitrobenzenesulfonic acid-induced colitis is associated with increased inducible nitric-oxide synthase expression and peroxynitrite production

Peroxynitrite, derived from the reaction of nitric oxide (NO(.)) with superoxide (O(2)), is a potent nitrating and oxidizing agent that can induce apoptosis in a variety of different cell types. In the present study, we investigated the possible role of peroxynitrite as a mediator of colon epithelial cell death in rat colitis. Rat colon inflammation was induced by intracolonic administration of 2,4,6-trinitrobenzenesulfonic acid (TNBS) and rats were sacrificed 24 h after TNBS administration. Expression of inducible nitric-oxide synthase (iNOS) was detected by reverse transcription-polymerase chain reaction and immunohistochemistry. The enzymatic activities of Ca(2+)-independent iNOS and Ca(2+)-dependent constitutive nitric-oxide synthase were determined biochemically. Evidence of peroxynitrite-mediated cell injury was detected by immunostaining of nitrotyrosine. Apoptosis was examined by in situ terminal deoxynucleotidyl transferase dUTP nick-end labeling (TUNEL) assay and DNA gel electrophoresis. To evaluate the specific contribution of peroxynitrite to the observed cell injury, a selective iNOS inhibitor, L-N(G)-[1-iminoethyl]lysine (L-NIL), was administered after TNBS induction. Morphological examination and analysis of TUNEL/cytokeratin double immunofluorescence revealed significant apoptosis in mucosal epithelial cells. Nitrotyrosine was colocalized with TUNEL, strongly demonstrating the association of peroxynitrite with the apoptotic death of colon epithelial cells. The administration of L-NIL reduced iNOS activity in 24-h lesions by 92% and also significantly attenuated both nitrotyrosine staining and apoptotic cell counts in the colon epithelium. These results strongly suggest that local elevated level of peroxynitrite produced from increased iNOS expression and activity is a major contributor to colon epithelial apoptosis during colon inflammation.

Long-term beta-blocker therapy improves autonomic nervous regulation in advanced congestive heart failure: a longitudinal heart rate variability study

BACKGROUND

beta-Blocker therapy is believed to modulate the detrimental effect of overcompensating neurohormonal activation in chronic heart failure. However, clinical doubts remain, particularly the physiologic sympathovagal balance.

METHODS

To respond to clinical concern about worsening autonomic nervous perturbation in beta-blocker therapy of advanced congestive heart failure, 15 consecutive patients were longitudinally studied to elucidate the evolution of cardiac function versus 24-hour heart rate variability (HRV) before and after 1, 3, and 6 to 9 months of atenolol-combined therapy.

RESULTS

Two patients died prematurely within 1 month. All 13 surviving patients showed improvement in New York Heart Association functional class, with decrease in left ventricular end-systolic and end-diastolic dimensions and increase in fraction shortening and ejection fraction by echocardiography after at least 3 months of atenolol use. The retarded therapeutic effect was accompanied by a general rise of total, very low, low-, and high-frequency components (9.0 +/- 0.5, 8.8 +/- 0.5, 6.2 +/- 0.6, and 6.1 +/- 0.5 vs 10.9 +/- 0.3, 10.7 +/- 0.4, 8.6 +/- 0.3, and 7.8 +/- 0.3; all P <.02) of daily HRV. This implied recovery of parasympathetic and baroreceptor function. Return of sympathovagal interaction was further supported by the suppression of Cheyne-Stokes type HRV as detected by Wigner-Ville distribution.

CONCLUSIONS

Long-term beta-blocker therapy for advanced congestive heart failure upwardly regulates the autonomic nervous interaction in synchrony with the evolution of cardiac function performance.

Peroxynitrite induces apoptosis of HL-60 cells by activation of a caspase-3 family protease

Apoptosis is an active process critical for the homeostasis of organisms. Enzymes of the caspase family are responsible for executing this process. We have previously shown that peroxynitrite (ONOO-), a biological product generated from the interaction of nitric oxide and superoxide, induces apoptosis of HL-60 cells. The aim of this study was to elucidate the mechanisms involved in the execution process of peroxynitrite-induced apoptosis. Proteolytic cleavage of poly(ADP-ribose) polymerase, an indication of caspase-3 family protease activation and an early biochemical event accompanying apoptosis, was observed in a time-dependent manner during peroxynitrite-induced apoptosis of HL-60 cells. Activation of caspase-3 during peroxynitrite-induced apoptosis was substantiated by monitoring proteolysis of the caspase-3 proenzyme and by measuring caspase-3 activity with a fluorogenic substrate. Furthermore, pretreatment of HL-60 cells with N-acetyl-Asp-Glu-Val-Asp-aldehyde, a specific inhibitor of caspase-3, but not N-acetyl-Tyr-Val-Ala-Asp-aldehyde, a specific inhibitor of caspase-1, decreased peroxynitrite-induced apoptosis. These results suggest that the activation of a caspase-3 family protease is essential for initiating the execution process of peroxynitrite-induced apoptosis of HL-60 cells.

Reactive oxygen species participate in peroxynitrite-induced apoptosis in HL-60 cells

Peroxynitrite (ONOO-) is a physiological product generated by the interaction of superoxide (O2.-) and nitric oxide (.NO). We have previously shown that peroxynitrite induces apoptosis in HL-60 cells. In the present study, we demonstrated that peroxynitrite generates reactive oxygen species (ROS) in HL-60 cells. Brief exposure of HL-60 cells to ONOO- induced elevation of lucigenin chemiluminescence, indicating generation of superoxide anion. Exogenous superoxide dismutase (SOD), a scavenger of O2.-, fully abolished the chemiluminescence response, further supporting this notion. Following O2.- generation, the accumulation of hydrogen peroxide (H2O2) was observed. The addition of SOD exacerbated but that of catalase attenuated peroxynitrite-induced DNA fragmentation, suggesting that this H2O2 production contributes to the apoptotic process. In addition, pre-treatment of HL-60 cells with N-acetyl-L-cysteine (15 mM), a ROS scavenger, fully scavenged peroxynitrite-elicited ROS generation and effectively inhibited (ONOO-)-induced apoptosis, further enforcing this hypothesis. In summary, our results suggest that (ONOO-)-stimulated ROS formation may serve as a mechanism for the propagation of peroxynitrite-mediated apoptotic cell death in an intact cell system.

Leukotriene B4 modulates in vivo expression of delayed-type hypersensitivity by a receptor-mediated mechanism: regulation by lipoxin A4

Leukotriene B4 (LTB4) is a potent proinflammatory arachidonic acid metabolite whose actions are mediated by specific receptors. Recent characterization of a high-affinity LTB4 receptor on the surface of guinea pig CD4+ T lymphocytes prompted examination of a possible role of LTB4 in modulating in vivo expression of delayed-type hypersensitivity (DTH) to tuberculin (PPD). In the absence of PPD, intradermal injections of LTB4 or LTB4/LTD4 receptor antagonists did not elicit delayed-onset erythema at 24 h. When injected together with PPD, LTB4 (1 fmol to 1 pmol) caused a significant 25 to 30% decrease in DTH expression, whereas LTB4 receptor antagonists SC-41930, LY-223982, ONO-4057 (0.1-10 nmol), caused a highly significant (P < .01) 25 to 50% increase. The effect of SC-41930 on DTH expression was inhibited by a 10-fmol dose of LTB4. LTD4 receptor antagonist LY-171883 had no effect on DTH expression. Lipoxin A4 (LXA4) interferes with binding of LTB4 to T lymphocytes or neutrophils by reducing LTB4 receptor density. It caused a small but significant enhancement of DTH expression at 1-nmol doses when injected with PPD. Lipoxin B4 had no effect. Enhancement or inhibition of grossly visible delayed skin responses to PPD by LTB4. LTB4 receptor antagonists or LXA4 was not associated with qualitative or quantitative changes in superficial or deep dermal mononuclear cell infiltrates at the reaction site. We conclude that LTB4 modulates visible expression of DTH in vivo by a receptor-mediated mechanism.

Identification and characterization of a high-affinity leukotriene B4 receptor on guinea pig T lymphocytes and its regulation by lipoxin A4

A single class of high affinity leukotriene B4 (LTB4) receptors has been identified on the surface of guinea pig peritoneal exudate T lymphocytes. The Kd of these receptors is 1.6 nM, with a Bmax of 25.2 fmol/10(7) cells (1500 sites/cell). Receptor binding activity can be blocked by specific LTB4 receptor antagonists, but not by a specific LTD4 receptor antagonist, lipoxins A4 or B4 (LXA4, LXB4) or K252a, a protein kinase C inhibitor. Pretreatment of T lymphocytes with phorbol myristyl acetate or LXA4, reduced LTB4 receptor density in a concentration-dependent manner, although similar concentrations of LXB4 had no effect. LTB4 receptor down-modulation by LXA4 was reversed by K252a. 4 alpha-Phorbol 12,13-didecanoate, an inactive structural analogue of phorbol myristyl acetate, did not activate protein kinase C or decrease LTB4 receptor density. These results suggest that LTB4 receptor density on T cells may by ultimately down-regulated by a protein kinase C-dependent mechanism and are consistent with a physiological role of LXA4 in the modulation of inflammatory process.

Twice-per-day fractionated high versus continuous low dose rate intracavitary therapy in the radical treatment of cervical cancer: a nonrandomized comparison of treatment results

PURPOSE

To compare the efficacy of two twice-per-day fractionated high dose rate (HDR) brachytherapies with a historical control group treated with low dose rate (LDR) brachytherapy for cervical cancer patients.

METHODS AND MATERIALS

From 1985 to 1988, 92 patients with cancer of the cervic were treated by remote-controlled, HDR brachytherapy, six fractions of 7 Gy per fraction (42 Gy) at point A (HDR-6). Fifty-seven patients were treated with four fractions of 8 Gy per fraction (32 Gy) at point A (HDR-4). A twice-per-day program was used for all HDR patients by two split courses. As a historical control, treatment results of 259 patients treated with LDR brachytherapy (40 Gy in two split courses) were compared with those of the two HDR regimens. All patients received whole pelvic external irradiation, 36-45 Gy (mostly 40 Gy) before brachytherapy.

RESULTS

Five-year local control rates were not significantly different for the three groups (HDR-6 = 82.0%, HDR-4 = 85.5%, and LDR = 89.5%, respectively). Five-year survival rates were also comparable (67.7%, 77.9%, and 74.1%, respectively). However, late complications were lower in HDR-4 than HDR-6 (11.0% vs. 25.6%).

CONCLUSIONS

Both 5-year local control and survival rates were comparable among the three groups. However, HDR-4, which was more biologically equivalent to our LDR regimen, showed fewer complications compared to HDR-6. In addition, our twice-per-day schedule shortened the hospital stay.

Peroxynitrite-induced apoptosis in HL-60 cells

Peroxynitrite (ONOO-), an anion and a potent oxidant, generated by the interaction of nitric oxide (NO) and superoxide is able to induce apoptosis in HL-60 human leukemia cells in a time- and concentration-dependent manner. Characteristic morphology of apoptosis can be observed 3 h after HL-60 cells are exposed to 10 microM ONOO-. Treatment of HL-60 cells with increasing concentrations of ONOO- from 1 to 100 microM confirms the concentration dependence of apoptosis as evidenced by: 1) degradation of nuclear DNA of these cells into integer multiples of approximately 200 base pairs; 2) colorimetric DNA fragmentation assay; and 3) evidence of condensation of chromatin and nuclear fragmentation shown by propidium iodide staining. Under the same conditions, peroxynitrite causes apoptosis in another transformed cell line, U-937 cells, but is ineffective at inducing apoptosis in normal endothelial cells derived from human umbilical cord and normal human peripheral blood mononuclear cells. This direct evidence of peroxynitrite inducing apoptosis implicated a new function of this potent oxidant.

The study of anticardiolipin antibodies and interleukin-6 in cerebrospinal fluid and blood of Chinese patients with systemic lupus erythematosus and central nervous system involvement

Anticardiolipin (ACL) antibodies and interleukin-6 (IL-6) in cerebrospinal fluid (CSF) may be involved in the mechanism of lupus patients with central nervous system (CNS) involvement. ACL antibodies of 3 isotypes and IL-6 were measured in paired CSF and serum samples from 14 lupus patients with CNS involvement, 5 lupus patients without CNS involvement and 7 patients with non-inflammatory neurological diseases. ACL antibodies, IgG and IgM isotypes, and IL-6 were significantly increased in CSF from lupus patients with CNS involvement as compared with other 2 groups of patients. Both ACL antibodies and IL-6 decreased after neurological activity subsided. These results suggest increased ACL antibodies and IL-6 in CSF are involved in immune responses within CNS in lupus patients. Quantitation of CSF ACL antibodies may be helpful in evaluating neurological activity of lupus patients with CNS involvement.

Measurement of anti-endothelial and anti-cardiolipin autoantibodies and intercellular adhesion molecules-1 in patients with systemic and cutaneous vasculitis

Two types of autoantibodies and intercellular adhesion molecule-1 (ICAM-1) were measured in patients with vasculitis. There were 13 patients with systemic vasculitis, and 12 with cutaneous vasculitis. The measured antibodies included antiendothelial cell antibodies (AECA) and anti-cardiolipin (ACL) antibodies of three isotypes. Results showed that patients with systemic vasculitis had elevated levels of ICAM-1 and IgG isotype ACL antibodies. Higher levels of ICAM-1 and IgG isotype ACL antibody were found in patients with systemic vasculitis than in those with cutaneous vasculitis. Levels of ICAM-1 and IgG isotype ACL antibodies also decreased after disease activity subsided in patients with systemic vasculitis. Measurement of ICAM-1 and autoantibodies may be useful in evaluating the extent of involvement, and for following the disease course.

14(R),15(S)-epoxyeicosatrienoic acid (14(R),15(S)-EET) receptor in guinea pig mononuclear cell membranes

A high affinity binding site for 14(R),15(S)-EET, one of the major cytochrome P-450 metabolites of arachidonic acid (AA) in blood vessels, liver, kidney and urine of patients with pregnancy-induced hypertension, has been identified in a membrane preparation from guinea pig mononuclear (GPM) cells. Using a radioligand assay, binding of 14(R),15(S)-[3H]EET to its receptor site was saturable, specific and reversible. Scatchard analysis of saturation binding studies yielded a dissociation constant (Kd) of 5.7 x 10(-9) M, and maximum number of binding sites (Bmax) of 2.4 pmol/mg membrane protein. The specificity of the binding site was determined by competition studies. 14(S),15(R)-EET and 8,9-EET had a Ki of 6.3 and 8.8 nM, respectively, followed by 12(R)-HETE and LTD4. 12(S)-HETE and 5,6-EET were even less effective as a competitive inhibitor of radioligand and binding with Ki values from 2 to 20 microM. Receptor antagonists for TxA2, LTB4, LTD4 and PAF failed to displace 14(R),15(S)-[3H]EET from its binding site on GPM cell membranes. The results correlate well with the reported biological functions of 14,15-EET. In view of its potent biological activities, 14,15-EET may exert its cellular function through the binding and activation of its stereo-specific cell surface binding sites or receptor.

Monoclonal gammopathies and the related autoimmune manifestations in Taiwan

A total of 50,000 patients were surveyed for the presence of monoclonal immunoglobulins during the past two decades. There were 411 cases of monoclonal gammopathies including 243 cases of plasma cell neoplasms and 168 cases of secondary plasma-cell dyscrasia. Among the 227 cases of multiple myeloma and Waldenström's macroglobulinemia, there were 49.3% IgG class, 22.9% IgA class, 9.7% IgM class and 13.2% light chain type. In addition, there were 1.3% of nonexcretory myeloma including an IgM type. A relatively high frequency (4.8%) of IgD M-proteins was detected but heavy chain disease was not encountered in the present series. Purified M-components from patients with possible autoimmune manifestations were subjected to immunofluorescence studies. Autoimmune activity of M-proteins was found in a patient of Waldenström's macroglobulinemia with peripheral neuropathy, and another patient of cryofibrinogenemia with recurrent purpura and gangrene. In conclusion, a high frequency of IgD myeloma is found in Chinese patients of this area. M-components may have autoimmune activity resulting in unusual clinical manifestations.

Immunochemical characterization and therapeutic effect of house dust extract in bronchial asthma

The immunochemical characteristics of house dust extract used in hyposensitization were studied by SDS-polyacrylamide gel, isoelectrofocusing, counterimmunoelectrophoresis and Western blot. The gel electrophoregram and isoelectrofocusing plate demonstrated a complex mixture of acid proteins with molecular weights ranging from 56 to 12 KD and isoelectric point distributing from 4.6 to 5.6. The counterimmunoelectrophoresis revealed as many as five precipitating bands in sera from 60% asthmatic patients after hyposensitization. The Western blot showed heterogeneous IgE reaction bands varied from 45 to 22 KD, including a strong 27 KD reaction band found in 40% of the asthmatic patients not receiving hyposensitization. The efficacy of house dust extract hyposensitization was evaluated in 102 asthmatic patients, followed up at the Allergic Clinic since 1980. There were 42 malea and 60 females with a mean age of 30.8 (16 to 60), and the total follow-up patient-year was 512.6 with a mean of 5.0 year per patient (1 to 11). Complete remission of asthmatic symptoms and medication was found in 5% patients, and 12% patients had little or no improvement. The majority of patients (83%) had improvement in asthmatic symptoms and medication dosage. The average serum IgE levels and total eosinophil count dropped significantly after hyposensitization (p < 0.001). In conclusion, the immunochemical characteristics of house dust extract were analyzed and mite allergens, especially Group I antigens, may be the important constituents. Good therapeutic effect, both clinically and with laboratory evaluation, was obtained with more than 80% of the asthmatic patients achieving improvement under house dust hyposensitization.

Isolation of 6-mercaptopurine in human plasma by aluminum ion complexation for high-performance liquid chromatographic analysis

A sample preparation technique and a high-performance liquid chromatographic method for 6-mercaptopurine (6-MP) that is simple, sensitive and without interference from its metabolites is described. 6-Thioguanine (6-TG) is added as an internal standard to the plasma sample, which is then treated with an aqueous solution of aluminum perchlorate to denature the plasma proteins and form complexes with 6-TG, 6-MP and its major metabolite, 6-thiouric acid (6-TUA). These complexes coprecipitate with proteins on centrifugation. 6-MP and its analogues are then extracted from the precipitate with perchloric acid containing sodium hydrosulfite and the extract is chromatographed on an Ultrasphere ODS column eluted with 0.1 M phosphoric acid and 0.001 M dithiothreitol in deionized water. The eluate is monitored at 340 nm. No interfering peak was encountered in over 300 clinical plasma samples. 6-TUA was separated from 6-MP and was found to be present in much higher concentration than 6-MP itself throughout the sampling time (6 h) following oral administration of the drug.

Endoscopic sphincterotomy in the treatment of biliary tract diseases

Endoscopic sphincterotomy (EST) was performed in 53 patients with biliary disease. Indications for sphincterotomy were: 48 patients with choledocholithiasis, 3 patients with malignant biliary obstruction, and 2 patients with papillary stenosis. The procedure was successful in 52 patients (98.1%). In patients with choledocholithiasis, the stones were successfully removed or passed out spontaneously in 42 patients (87.5%). Endoscopic retrograde biliary drainage (ERBD) was successfully carried out in 2 cases of malignant biliary obstruction after EST. The clinical and biochemical evidence of cholestasis resolved in both patients with papillary stenosis. Complications consisted of hemorrhage (2 patients) and cholangitis (1 patient), resulting in one death. The overall complication and mortality rates were 5.7% and 1.9% respectively. Thirty-two patients received regular ultrasound examination follow-up with a mean of 13.4 months. Two patients had recurrent common bile duct stones and one had restenosis of papilla. The conditions were managed by endoscopic therapy. Endoscopic sphincterotomy is a relatively safe and effective means of relieving extrahepatic cholestasis; however, its comparison with surgical techniques needs long-term, randomized studies.

High-performance liquid chromatographic determination of mitoxantrone in plasma utilizing non-bonded silica gel for solid-phase isolation to reduce adsorptive losses on glass during sample preparation

Mitoxantrone, a highly active antineoplastic agent, was found to bind strongly to non-bonded silica gel and glassware. When a Hamilton syringe was used to load and inject a mitoxantrone solution (0.4 microgram/ml in water) on to a high-performance liquid chromatographic (HPLC) system, about 95% of the loaded compound was found to bind to the glass surface of the syringe barrel and could not be removed by rinsing with water. It could, however, be removed slowly with an acidic solution and thus a small peak of mitoxantrone was present on the chromatogram whenever a blank acidic solution was injected with the syringe. The bound mitoxantrone could be removed effectively from the syringe surface with a solution of tetramethylammonium chloride, citric acid, methanol and water (elution solvent). This binding introduces a large error in assay results and might be one of the major factors responsible for contradictory pharmacokinetic data that have been reported. A new plasma preparation scheme and an HPLC method for mitoxantrone were developed to address this binding problem. Mitoxantrone was extracted directly from plasma samples with a plastic mini-column packed with non-bonded silica gel and eluted with the above elution solvent. The eluent was analysed by HPLC on an ODS column with an absorbance detector at 658 nm. The mobile phase was 0.1 M triethylamine phosphate (pH 3.0) in water-tetrahydrofuran-methanol (69:1:30) containing 0.02 M tetramethylammonium chloride. Methylene blue was added as an internal standard. Preliminary results showed that mitoxantrone levels in human plasma followed a triphasic decay curve after an intravenous bolus injection. The terminal elimination half-lives measured in three patients (mean t1/2 gamma = 25 min) were all shorter than the published values which ranged from 56 min to 9 days.

An autopsy-proved case of AIDS in Taiwan

The first case of AIDS positively identified in a non-foreigner in Taiwan was a 25-year-old unmarried male who had practiced homosexuality for ten years. The patient began to have abdominal pain accompanied with loose stools and weight loss in June 1985, followed by fever, cough, headache, dizziness, and loss of memory. Facial hyperpigmentation and extensive oroesophageal candidiasis were noted. Laboratory studies showed severe lymphopenia with a reversed T-helper to T-suppressor ratio, cutaneous anergy and polyclonal gammopathy. Human immunodeficiency virus (HIV) antibodies were positive by ELISA and Western blot, and the virus was isolated from the blood. At autopsy, disseminated cytomegalovirus infection, extensive CNS toxoplasmosis and early lesions of Kaposi's sarcoma were demonstrated. The detection of HIV in the adrenal medulla supports the consensus that the virus is neurotropic.

Diagnostic values of IgG-albumin index and agarose gel electrophoresis in neurologic diseases

Sixty cerebrospinal fluids (CSFs) with paired serum samples from a variety of patients with neurologic diseases were studied using rate nephelometry to measure IgG-albumin index, and also agarose gel electrophoresis (EP) with protein blotting technique to characterize discrete IgG bands. The patients included: A) 16 cases of multiple sclerosis (MS); B) 23 cases of inflammatory diseases of the central nervous system (CNS); C) 21 cases of other non-inflammatory neurologic disorders. The average IgG-albumin index was 0.65 +/- 0.25 in Group A, 1.10 +/- 0.78 in B, and 0.50 +/- 0.12 in C. If 0.72 is taken as the upper normal limit, an increased index was found in 31%, 43% and 5% of Groups A, B and C, respectively. Discrete IgG bands were detected in 69%, 9% and 5% of Groups A, B and C, respectively. Gamma globulin bands were not always IgG, and true oligoclonal myeloma proteins were not encountered. It is concluded that both IgG-albumin index measurement and agarose gel EP are useful for diagnostic differentiation in neurologic diseases: the former, for inflammatory diseases of CNS; and the latter, for MS.

Detection of antibodies to HTLV-III by ELISA in AIDS risk groups in Taiwan: a preliminary report

A total of 2321 serum samples were collected from a variety of AIDS risk groups. The samples were tested for anti-HTLV-III using ELISA. Low prevalences of seropositivity were detected in the high-risk groups. Among 120 homosexuals/bisexuals, one seropositive suffering from full-blown AIDS was an American traveler. Another native homosexual who yielded a high ELISA reading was a "possible" AIDS. Three hemophiliacs with strongly positive reactions received injections of a U.S.-produced factor VIII; all are asymptomatic currently. A patient with hairy cell leukemia had a markedly elevated ELISA reading. Another patient with syphilis also had a markedly high reading, despite having no other known risk factor. Among the low-risk groups a patient who had suffered from oral candidiasis for eight years had no risk factor, yet he yielded repeatedly high ELISA readings. Another patient with a weak positive reaction was a symptomless blood donor. This preliminary study concludes that Taiwan is several years behind the U.S. and is at present not an endemic area for AIDS. To achieve successful AIDS control in the future, however, the homosexuals in Taiwan should change their sexual behavior now. Since many initially weakly-reactive samples became negative on repeated testing it appears that non-specific or false positive ELISA reactions occur frequently. Accordingly when ELISA is used for diagnostic purposes, additional confirming tests are mandatory.

Anti-HTLV antibodies in cancer patients, hemophiliacs and uremics: a preliminary report

A total of 132 sera were studied for anti-HTLV antibodies using the Biotech ELISA test. Among the HTL group, two were, one, and the other two (+/-). Among 23 hemophiliacs one was. None of the lympho- and myelo-proliferative disorders, chronic uremics and normal controls showed positive results. Our results show that the ELISA anti-HTLV test is quite specific for HTL and related disorders, but the antibody titers may be low in some cases in the late stage. The significance of frequent high ELISA readings in hepatomas and NPCs awaits for further studies. The occurrence of one hemophiliac with definite positive anti-HTLV calls for a routine screening of the blood preparations for HTLV.

Sample preparation and estimation of plasma concentration of 3-deazauridine by high-performance liquid chromatography

A rapid and simple procedure for liquid chromatographic analysis of plasma 3-deazauridine (3-DU), an antineoplastic agent, was developed. The plasma was extracted with methanolic silver acetate to remove interfering ultraviolet-absorbing materials and the 3-DU partially purified on a small anion exchange column prior to chromatography on a reverse-phase (C18) column. 2'-O-Methyl-3-deazauridine was used as an internal standard. The mobile phase was 0.1 M ammonium acetate, pH 4.0, containing 5% methanol. The 3-DU was identified by its retention time and its characteristic ultraviolet absorbance ratio (280/254 nm) of 3.0. This method was used to determine the plasma concentration of 3-DU in three patients with acute leukemia. The patients received a 36-h infusion of 3-DU at a rate of 5.0 mg/kg/h. The mean steady-state plasma concentration of 3-DU at the end of the infusion was 22.1 micrograms/ml (range, 13.6-42.8 micrograms/ml) and the mean elimination half-life was 109 min (range, 92-136 min). 2,4-Dihydroxypyridine, a potential metabolite of 3-DU, was not detected in any of the plasma samples of the patients receiving a 3-DU infusion.

Immune response of neonates to pneumococcal polysaccharide-protein conjugate

Immune responses were studied in adult and young mice exposed to pneumococcal 6A and 19F polysaccharides (PSs), as well as 19F PS conjugated to proteins, e.g. human immunoglobulin G (HIgG), pneumococcal R61 cell wall polypeptide, and bovine serum albumin (BSA). Significantly higher IgM and IgG2 antibody titres were induced in mice receiving 19F PS-protein conjugates than in the control group receiving 19F PS alone. Maternal immunization with 19F PS-HIgG conjugate elicited a low immune response in the offspring. However, when young mice from immunized mothers were given and additional dose of polysaccharide-protein conjugate, they gave an antibody response greater than that of mice not given additional immunogen. Similarly, young mice exposed to 14-valent pneumococcal vaccine during gestation produced higher antibody response to 6A and 19F PSs. Secondary immunization of 19F PS or PS-protein conjugate at 1 or 2 weeks after primary immunization did not enhance antibody formation but rather suppressed the immune response to that polysaccharide.

Simplified procedure for the analysis of 3- and 4-hydroxyproline

A column chromatographic analysis for 3-hydroxyproline (3-Hyp), 4-hydroxyproline (4-Hyp), and gamma-carboxyglutamic acid (Gla) is described. The analyses of urine and plasma were performed with a JLC-6AH amino acid analyzer. A 0.15 M sodium citrate buffer, pH 2.1, was used for elution. Urinary Gla, 3-Hyp, and 4-Hyp were among the seventeen peaks eluted before aspartic acid. Hyp, Gla, glutamine, and asparagine in plasma were separated by elution with 0.2 M sodium citrate buffer, pH 3.25, containing 10% methanol. This single-column procedure achieves the sequential separation and quantitation of Gla, 3-Hyp, and 4-Hyp in urine as well as plasma, and is applicable to the diagnosis of collagen metabolism disorders.

High-performance liquid chromatographic analysis of chemical stability of 5-aza-2'-deoxycytidine

The chemical stability of 5-aza-2'-deoxycytidine (I) in acidic, neutral, and alkaline solutions was analyzed by high-performance liquid chromatography. In alkaline solution, I underwent rapid reversible decomposition to N-(formylamidino)-N'-beta-D-2-deoxyribofuranosylurea (II), which decomposed irreversibly to form 1-beta-D-2'-deoxyribofuranosyl-3-guanylurea (III). The pseudo-first-order rate constants for this reaction were determined. The decomposition of I in alkaline solution was identical to that reported previously for the related analog, 5-aza-cytidine. However, in neutral solution (or water), there was a marked difference in the decomposition of I and 5-azacytidine. The same decomposition products were formed from 5-azacytidine in neutral solution as in alkaline solution. However, in neutral solution, I decomposed to II and three unknown compounds that were chromophoric at 254 nm. Compound I was most stable when stored in neutral solution at low temperature.