Respiratory microbiome profiles are associated with distinct inflammatory phenotype and lung function in children with asthma

BACKGROUND

Respiratory microbiome studies have fostered our understanding of various phenotypes and endotypes of heterogeneous asthma. However, the relationship between the respiratory microbiome and clinical phenotypes in children with asthma remains unclear. We aimed to identify microbiome-driven clusters reflecting the clinical features of asthma and their dominant microbiotas in children with asthma.

METHODS

Induced sputum was collected from children with asthma, and microbiome profiles were generated via sequencing of the V3-V4 region of the 16S rRNA gene. Cluster analysis was performed using the partitioning around medoid clustering method. The dominant microbiota in each cluster was determined using the Linear Discriminant Effect Size analysis. Each cluster was analyzed for association among the dominant microbiota, clinical phenotype, and inflammatory cytokine.

RESULTS

Eighty-three children diagnosed with asthma were evaluated. Among four clusters reflecting the clinical characteristics of asthma, cluster 1, dominated by Haemophilus and Neisseria, demonstrated lower post-bronchodilator (BD) forced expiratory volume in 1 second (FEV1)/forced vital capacity (FVC) than that in the other clusters and more mixed granulocytic asthma. Neisseria negatively correlated with pre-BD and post-BD FEV1/FVC. Haemophilus and Neisseria positively correlated with programmed death-ligand (PD-L)1.

CONCLUSION

To our knowledge, this study is the first to analyze the relationship between an unbiased microbiome-driven cluster and clinical phenotype in children with asthma. The cluster dominated by Haemophilus and Neisseria showed fixed airflow obstruction and mixed granulocytic asthma, which correlated with PD-L1 levels. Thus, microbiome-driven unbiased clustering can help identify new asthma phenotypes related to endotypes in childhood asthma.

Effect of Ursodeoxycholic Acid on the Biodistribution and Excretion of Technetium-99m Radiopharmaceuticals in Rat: A Potential Image Quality Enhancer

PURPOSE

This study aimed to investigate the effect of ursodeoxycholic acid (UDCA) on the biodistribution and excretion of technetium-99m (Tc-99m)-labeled radiopharmaceuticals.

MATERIALS AND METHODS

Tc-99m hydroxy-methylene-diphosphonate (HDP), Tc-99m pertechnetate, and Tc-99m dimercaptosuccinic acid (DMSA) were injected via the tail vein of rats. After 30 min, the control group was administered saline, and the UDCA group was given UDCA orally. Scintigraphy images were acquired after 30 min and 1, 2, 3, and 4 h. Radioactivity and rate of change were compared. Tc-99m mercaptoacetyltriglycine (MAG₃) imaging was also performed.

RESULTS

In image analysis of Tc-99m HDP, radioactivity of the buttock was lower in the UDCA group at 4 h. Rates of change in the buttock were significantly different at 3 h-30 min and 4 h-30 min, and buttock radioactivity in the UDCA group had decreased more. In analysis of Tc-99m pertechnetate, radioactivity of the buttock was higher in the control group. Rates of change in the thyroid gland and buttock were different at 1 h-30 min, 3 h-30 min, and 4 h-30 min, with radioactivity in the UDCA group decreasing more. In the analysis of Tc-99m DMSA, while the radioactivity of the kidneys in the control group showed little decrease at 1 h-30 min, that in the UDCA group increased. In the analysis of Tc-99m MAG₃ images, radioactivity and radioactivity/total body radioactivity (TBA) values for the kidneys were higher in the UDCA group at 2 min. At 5 and 10 min, radioactivity/TBA values for soft tissue in the UDCA group were lower than those in the control group.

CONCLUSION

This study demonstrated that administration of UDCA increases renal excretion and soft tissue clearance of radiopharmaceuticals. This investigation could contribute to the broadening of applications of UDCA.

Activated leucocyte cell adhesion molecule (ALCAM/CD166) regulates T cell responses in a murine model of food allergy

Food allergy is a major public health problem. Studies have shown that long-term interactions between activated leucocyte cell adhesion molecule (ALCAM/CD166) on the surface of antigen-presenting cells, and CD6, a co-stimulatory molecule, influence immune responses. However, there are currently no studies on the functions of ALCAM in food allergy. Therefore, we aimed to identify the functions of ALCAM in ovalbumin (OVA)-induced food allergy using ALCAM-deficient mice. Wild-type (WT) and ALCAM-deficient (ALCAM^-/- ) mice were sensitized intraperitoneally and with orally fed OVA. The mice were killed, and parameters related to food allergy and T helper type 2 (Th2) immune responses were analysed. ALCAM serum levels increased and mRNA expression decreased in OVA-challenged WT mice. Serum immunoglobulin (Ig)E levels, Th2 cytokine mRNA and histological injuries were higher in OVA-challenged WT mice than in control mice, and these were attenuated in ALCAM^-/- mice. T cell proliferation of total cells, CD3⁺ CD4⁺ T cells and activated T cells in immune tissues were diminished in OVA-challenged ALCAM^-/- mice. Proliferation of co-cultured T cells and dendritic cells (DCs) was decreased by the anti-CD6 antibody. In addition, WT mice sensitized by adoptive transfer of OVA-pulsed ALCAM^-/- BM-derived DCs showed reduced immune responses. Lastly, serum ALCAM levels were higher in children with food allergy than in control subjects. In this study, serum levels of ALCAM were elevated in food allergy-induced WT mice and children with food allergy. Moreover, immune responses and T cell activation were attenuated in OVA-challenged ALCAM^-/- mice. These results indicate that ALCAM regulates food allergy by affecting T cell activation.

Relationship between sputum clusterin levels and childhood asthma

BACKGROUND

Clusterin is a sensitive cellular biosensor of oxidative stress and has been studied as a biomarker for inflammation-associated diseases. Clusterin levels in childhood asthma have not been evaluated.

OBJECTIVES

(1) To evaluate sputum clusterin levels in children with asthma compared to a control group. (2) To assess the relationships between sputum clusterin levels and airway inflammation, pulmonary function, and bronchial hyperresponsiveness.

METHODS

This study included 170 children aged 5-18 years with stable asthma (n = 91), asthma exacerbation (n = 29), or no asthma (healthy controls; n = 50). Induced sputum, pulmonary function, and methacholine challenge tests were performed. Stable asthma was classified into two groups according to the severity. Clusterin levels in sputum were measured using an enzyme-linked immunosorbent assay.

RESULTS

Children with stable asthma had a higher clusterin level than healthy controls [4540 (3872-5651) pg/mL vs. 3857 (1054-4369) pg/mL, P < 0.001]. The clusterin level was also more elevated in eosinophil-dominant sputum than in non-eosinophilic sputum in stable asthma [5094 (4243-6257) pg/mL vs. 4110 (1871-4839) pg/mL, P = 0.0017]. Clusterin levels were associated with asthma severity. Paradoxically, clusterin levels were lower during asthma exacerbation than in stable asthma [1838 (350-4790] pg/mL vs. 4540 (3872-5651) pg/mL, P < 0.001]. Clusterin levels were strongly correlated with the methacholine concentration that caused a 20% decrease in the forced expiratory volume in 1 s (r = -0.617, P < 0.001); there was no significant correlation between clusterin levels and other pulmonary function parameters.

CONCLUSIONS AND CLINICAL RELEVANCE

Clusterin levels were altered in children with stable asthma and asthma exacerbation because of its antioxidant and anti-inflammatory effects. Clusterin may be a marker that reflects airway inflammation and severity of symptoms, and it can be used in the assessment and management of childhood asthma.

IgE cross-reactivity of peanut with walnut and soybean in children with food allergy

BACKGROUND

Peanut allergies are common and can be life-threating for sensitised individuals. Peanut allergens share significant amino acid homology with those of other legumes and tree nuts, but their cross-reactivity still remains unclear.

OBJECTIVE

We sought to determine the clinical significance of the cross-reactivity of peanut allergens with those of walnut and soybean.

METHODS

Pooled sera from eight subjects with both peanut and walnut specific IgE were investigated in an inhibition test. After the sera were incubated with either peanut or walnut protein extracts, the quantity of IgE antibodies against the peanut and walnut was measured using an immunoCAP test. Likewise, pooled sera from 18 subjects with both peanut and soybean specific IgE antibodies were incubated with either peanut or soybean protein extracts and evaluated with a peanut and soybean immunoCAP test. SDS-PAGE and immunoblotting were also performed with peanut, walnut and soybean protein extracts and relevant sera.

RESULTS

Peanut specific IgE was inhibited up to 20% and 26% by walnut and soybean protein extracts, respectively. In reverse, walnut and soybean specific IgE were inhibited up to 21% and 23% by peanut protein extracts, respectively. In the immunoblot analysis, pooled serum from the subjects with peanut specific IgE antibodies reacted with walnut protein extracts significantly.

CONCLUSION

Although the clinical significance of the cross-reactivity of peanut specific IgE with walnut and soybean protein extracts has not been established, we believe that individuals who are allergic to peanuts need to be cautious about consuming walnuts and soybeans.

Hepatocellular Carcinoma with Metastasis to the Spleen in a Holstein Cow

Hepatocellular carcinoma (HCC) with metastasis to the spleen in a Holstein cow was studied by histopathologic and immunohistochemical methods. The tumor was characterized by a pseudoglandular (acinar) pattern with an associated fibrous stroma. Individual cells often had a “hepatoid” appearance but were interspersed with scattered cells exhibiting a clear, periodic acid-Schiff (PAS)-positive cytoplasm and small eccentric nuclei. This pattern was present in nodules found in both liver and spleen. Moreover, hepatoid tumor cells were positive for alpha-fetoprotein. Immunohistochemical studies suggest that myofibroblasts were responsible for the production of fibrous septa surrounding the pseudoglandular structures of bovine HCC. In summary, our histologic and immunohistochemical findings support a diagnosis of primary HCC with splenic metastasis. Furthermore, the associated stromal response appears to be of a myofibroblast origin. The primary etiology of bovine HCC and the significance of the intralesional, PAS-positive clear cells remain undetermined.

Pandemic influenza virus, pH1N1, induces asthmatic symptoms via activation of innate lymphoid cells

BACKGROUND

The pandemic strain of the influenza A virus (pH1N1) in 2009 caused many complications in patients. In this study, we introduce asthmatic symptoms as a complication of pH1N1 infection in children, not having a relationship with asthma history. The aim of this study was to quantify asthmatic symptoms in pH1N1-infected children and elucidate the underlying mechanisms of airway hyper-responsiveness (AHR) induced in a murine model of pH1N1 infection.

METHODS

As a retrospective study, pH1N1-infected children who were hospitalized with moderate to severe acute asthmatic symptoms were enrolled and administered a methacholine challenge test (MCT) at 3 months post-discharge. Additionally, the induction of AHR by pH1N1 infection was measured by MCT in wild-type and Rag1(-/-) mice. The effect of the innate immune response on the development of AHR following pH1N1 infection was investigated.

RESULTS

More than 70% of the pH1N1-infected children without a pre-infection diagnosis of asthma had a negative response on the MCT. None of these children had recurrent wheezing or asthma during the 3 years following pH1N1 infection. The development of AHR in pH1N1-infected mice was associated with an elevation in IL-33 and innate lymphoid cells 2 (ILC2).

CONCLUSIONS

This study demonstrates that pH1N1 infection directly induces transient asthmatic symptoms in patients regardless of their medical history. pH1N1 infection was shown to stimulate the rapid development of AHR and Th2-type cytokine secretion in mice via the activation of ILC2; it may be activated independently of adaptive immunity.

[Genital reassignment surgery in male-to-female transsexuals: do we have guidelines or standards?]

BACKGROUND

In 2011 the WPATH (World Professional Association for Transgender Health) published the 7th version of their "Standards of Care" for diagnosis and treatment of transsexual people. In face of further recent peer-reviewed reports of experienced centres on surgical sex reassignment it should be examined whether or not genital sex reassignment in male-to-female transsexuals actually can be based on evidence-based guidelines or standards.

RESULTS

The indication for surgery is widely standardised and evidence-based. Most critical steps of the operation are also founded on grade B recommendations. Most experienced authors rely on penoscrotal pedicled flaps for neovaginal lining. The topic of ideal reconstruction of the vulva, especially the clitoro-labial complex is still a field of debate. Due to the high frequency of further corrective surgeries which exceeds 50% in most experienced centres, some authors prefer a primary 2-step procedure for genital reassignment.

CONCLUSIONS

The indication and principal operative steps in surgical genital reassignment in male-to-female patients rely on evidence-based recommendations. By respecting these recommendations subjective success rates of over 80% can be expected.

Myoid angioendothelioma of the spleen mimicking metastatic disease in a patient with rectal cancer: a radiologic-pathologic correlation

Myoid angioendothelioma of the spleen is an uncommon, benign vascular tumor that is morphologically characterized by a composite of vascular spaces and stromal cells with myoid feature. Herein, we report a case of the myoid angioendothelioma of the spleen, concurrent with rectal adenocarcinoma. A 41-year-old woman presented with hematochezia for several weeks. Grossly, the rectal mass was a 2.5 × 2-cm ulcerative fungating lesion. The splenic mass was a 2.2 × 2-cm well-circumscribed lesion. Microscopically, the rectal mass was a well-differentiated adenocarcinoma that invaded into the pericolic adipose tissue. The splenic mass was composed of slit-like vascular spaces and fascicles of elongated stromal cells. Vascular endothelial cells were immunopositive for CD31, factor VIII-related antigen, and CD34 but negative for CD8. Stromal cells were immunopositive for smooth muscle actin but negative for desmin.

Chitinase induce the release of IL-8 in human airway epithelial cells, via Ca2+-dependent PKC and ERK pathways

Chitinases are produced in significant quantities by hosts defending against infections with chitin-containing organisms. However, little is known about the immune response of exogenous chitinase in human epithelial cells. IL-8 has been suggested to have a role in the pathogenesis of the allergenic inflammation of bronchial asthma. We examined whether Streptomyces griseus (S. griseus) chitinase-induced IL-8 on airway epithelium and identified the involvement of intracellular signalling pathways. H292 cells were treated with S. griseus chitinase with different concentrations and times. The IL-8 levels were determined by specific human IL-8 enzyme-linked immunosorbent assay (ELISA) and reverse transcriptase polymerase chain reaction. Using a series of pharmacological inhibitors, we examined the upstream signalling pathway responsible for IL-8 expression in response to S. griseus chitinase. Cells exposed to S. griseus chitinase showed higher level of IL-8 protein production and mRNA expression. Cells stimulated by S. griseus chitinase resulted in the activation of protein kinase C (PKC), extracellular signal-regulated kinase (ERK) and nuclear factor kappa-B (NF-kB) pathways. Inhibitors of Ca(2+)-dependent PKC (Ro-31-8220, calphostin C and Go6976) significantly abolished chitinase-induced expression of IL-8. However, Ca(2+)-independent PKC inhibitor (rottlerin) did not inhibit IL-8 expression. Through ERK inhibitor (U0126) and NF-kB inhibitor (caffeine acid phenethyl ester) treatment, it was proven that ERK and NF-kB regulated chitinase-induced IL-8 expression. We concluded that S. griseus chitinase-induced IL-8 expression was regulated by the activation of Ca(2+/-)-dependent PKC, ERK and NF-kB in human airway epithelial cells.

Increased serum B cell-activating factor level in children with atopic dermatitis

BACKGROUND

B cell-activating factor (BAFF) is a tumour necrosis factor superfamily member best known for its role in the survival and maturation of B cells. BAFF activity is seen in naïve and effector/memory T cells.

AIM

To investigate the level and role of BAFF in serum of patients with atopic dermatitis (AD).

METHODS

Levels of serum BAFF, a proliferation-inducing ligand (APRIL) and total serum IgE level, and total eosinophil count were measured in 245 children.

RESULTS

Patients were characterized as having atopic eczema (AE) (n = 90) or non-AE (n = 77); the remainder were healthy control subjects (n = 78). Serum BAFF level in children with AE (1625.04 +/- 708.32 pg/mL) was significantly higher than in non-AE children (1194.69 +/- 448.44 pg/mL, P < 0.0001) or healthy controls (1062.89 +/- 444.74 pg/mL, P < 0.0001). Serum APRIL level was not different between the three groups. Serum BAFF level significantly correlated with total serum IgE level (gamma = 0.42, P < 0.0001) and total eosinophil count. It was also positively correlated with serum BAFF and egg-specific IgE level (gamma = 0.252, P = 0.045) in AE.

CONCLUSIONS

Serum BAFF level is high in AE and might be a useful marker for AE.

Circulating interleukin 17 is increased in the acute stage of Kawasaki disease

OBJECTIVES

During the acute phase, patients with Kawasaki disease (KD), an acute systemic vasculitis, demonstrate a drastic increase in serum interleukin-6 (IL-6), which parallels the duration of the fever. Recently, IL-17 has been reported to induce IL-6 production. The aim of this study was to elucidate the involvement of IL-17 in the pathogenesis of KD.

METHODS

Serum samples were obtained from patients with KD (n=30) and normal controls (n=20), and the concentrations of IL-17 and IL-6 measured using enzyme-linked immunosorbent assay (ELISA).

RESULTS

Compared with the normal controls (2.08 +/- 2.14 pg/mL), serum IL-17 was markedly elevated in patients with acute KD (25.47 +/- 5.05 pg/mL): levels gradually decreased in the subacute phase (5.94 +/- 2.83 pg/mL). In the acute phase, levels of IL-6 were 83.52 +/- 19.12 pg/L, which correlated well with the serum levels of IL-17.

CONCLUSION

These results suggest that IL-17 may be involved in the development of, or the effects of inflammation in KD.

Regulation of German cockroach extract-induced IL-8 expression in human airway epithelial cells

BACKGROUND

Cockroaches have been known as a cause of respiratory allergies such as asthma. IL-8 plays an integral role in the coordination and persistence of the inflammatory process in the chronic inflammation of the airways in asthma.

OBJECTIVE

We investigated the mechanism by which German cockroach extract (GCE) triggers IL-8 release from human airway epithelial cells.

METHODS

Chemical inhibitors were pretreated before addition of GCE for promoter activity and protein synthesis of IL-8. The Transcriptional activity of IL-8 promoter was analysed by mutational, deletional anaylsis and electrophoretic mobility shift assay (EMSA).

RESULTS

Stimulation of H292 cells with GCE resulted in a time- and concentration-dependent induction of IL-8 transcription and protein synthesis. IL-8 promoter deletion analysis indicated that position -132 to +41 was essential for GCE-induced IL-8 transcription, and mutants with substitutions in activator protein (AP)-1, nuclear factor (NF)-IL6 and NF-kappaB-binding sites revealed a requirement for NF-kappaB and NF-IL6, but not AP-1, in GCE-induced activation of the IL-8 promoter. The DNA-binding activities of NF-kappaB and NF-IL6 were induced by GCE, as determined by EMSA. The chemical inhibition of extracellular signal-regulated kinase (ERK) attenuated GCE-induced transcriptional activity and protein synthesis. In addition, through aprotinin treatment and PAR2 small interfering RNA transfection, it was proven that protease of GCE is consistent with the regulation of GCE-induced IL-8.

CONCLUSION

We conclude that GCE with protease activity-induced IL-8 expression is regulated by transcriptional activation of NF-kappaB and NF-IL6 coordinating with the ERK pathway in human airway epithelial cells.

Basement membrane thickening and clinical features of children with asthma

BACKGROUND

Asthma is a chronic inflammatory disease, characterized by airway inflammation, bronchial hyper-responsiveness, and airway obstruction. Although asthma induces partially reversible airway obstruction, obstruction can sometimes become irreversible. This may be a consequence of airway remodeling, which includes a number of structural changes, such as epithelial detachment, basement membrane (BM) thickening, smooth muscle hypertrophy, and new vessel formation. This study evaluated children with asthma for the presence of BM thickening.

METHODS

Eighteen children with asthma and 24 control subjects underwent flexible bronchoscopy with endobronchial biopsy. Light microscopy was used to measure BM thickness in paraffin-embedded biopsy sections. The association between BM thickening and age, sex, duration of asthma, asthma severity, FEV(1), FEV(1)/FVC, FEF(25-75%), methacholine PC(20), eosinophil count, and presence of atopy was examined.

RESULTS

Basement membrane thickness was greater in subjects with asthma (8.3 +/- 1.4 microM) than in control subjects (6.8 +/- 1.3 microM, P = 0.0008). Multiple regression analysis revealed that sex, FEV(1)/FVC, total IgE, and atopy (IgE for Dermatophagoides pteronyssinus >0.34 kUA/l) were significant predictive factors for BM thickness. There was no significant association between BM thickness and age, duration of asthma, FEV(1), FEF(25-75%), methacholine PC(20), eosinophil count, or asthma severity.

CONCLUSIONS

Basement membrane thickening has been known to be present in children with asthma. In addition, we report an association between BM thickness and sex, FEV(1)/FVC, total IgE, and the presence of IgE specific to D. pteronyssinus.

Increased serum thymus and activation-regulated chemokine and cutaneous T cell-attracting chemokine levels in children with atopic dermatitis

BACKGROUND

Thymus and activation-regulated chemokine (TARC) and cutaneous T cell-attracting chemokine (CTACK) are responsible for the trafficking of T helper type 2 lymphocytes into sites of allergic inflammation.

OBJECTIVE

We tested whether these cytokines are useful markers for childhood atopic dermatitis (AD), and evaluated age-related differences in the levels of these chemokines.

METHODS

Serum TARC and CTACK levels, total serum IgE levels, total eosinophil counts, and specific IgE levels were measured in 401 children. The patients were characterized as having atopic eczema (n=157), non-atopic eczema (n=107), or as healthy control subjects (n=137).

RESULTS

Both TARC and CTACK levels in children with AD were significantly higher than those in healthy control subjects. Serum TARC and CTACK levels significantly correlated with disease severity both in children with atopic eczema and in children with non-atopic eczema. Serum TARC levels in children with AD significantly correlated with their serum CTACK levels. Serum TARC and CTACK levels decreased in accordance with their ages.

CONCLUSION

Serum TARC and CTACK levels might be useful markers for disease severity both in children with atopic eczema and with non-atopic eczema. Serum TARC and CTACK levels decreased in accordance with their ages.

Self-reported prevalence and risk factors of asthma among Korean adolescents: 5-year follow-up study, 1995-2000

OBJECTIVES

The International Study of Asthma and Allergies in Childhood (ISAAC) questionnaires have shown that the prevalence of childhood asthma is increasing worldwide. Although Asian countries used to have lower prevalence rates of allergic disease than Western countries, this prevalence is increasing in several Asian countries. To determine whether the prevalence of childhood asthma is changing in Korean adolescents, we compared findings from nationwide cross-sectional surveys in 1995 and 2000 on populations of middle-school children using the Korean version of the ISAAC questionnaire.

METHODS

We developed Korean versions of the ISAAC written (WQ) and video (AVQ) questionnaires for allergic diseases. In 1995, the enrolled population consisted of 15,481 children, ages 12-15, and encompassing all three grades in middle school, selected from 34 schools across the nation; the response rate was 97.3%. In 2000, 15,894 children were selected from 31 of the same schools, and the response rate was 96.4%. The SAS system version 8.0 was utilized for all statistical analyses.

RESULTS

The WQ showed that the lifetime and 12-month prevalence of wheeze did not change from 1995 to 2000. While the 12-month prevalence rates of sleep disturbed by wheezing and night cough increased, the rates of severe attack of wheezing and exercise-induced wheeze did not change, over this period of time. The lifetime prevalence of asthma diagnosis, however, increased significantly, from 2.7% in 1995 to 5.3% in 2000, as did the 12-month prevalence of asthma treatment, from 1.0% in 1995 to 1.9% in 2000. The AVQ also showed increases in the lifetime and 12-month prevalence rates of wheeze at rest, exercise-induced wheeze, nocturnal wheeze, nocturnal cough, and severe wheeze over this period of time. These were especially because of significant increases in the Provincial cities of Korea. Interestingly, the 12-month prevalence of wheeze was consistently high in Cheju with low air pollution indices, whereas this rate was low in Ulsan and Ansan with very high air pollution indices. Risk factor analysis showed that body mass index (BMI), passive smoking, and living with a dog or cat, but not air pollution, were associated with higher risk of wheeze.

CONCLUSIONS

In the 5-year period from 1995 to 2000, the prevalence of asthma symptoms has increased in Korean adolescents, much of it because of increases in Provincial Centers. BMI, passive smoking, and living with a dog or cat are important risk factors. Environmental factors other than air pollution may be associated with increases in asthma, especially in Provincial Centers.

Prediction of buckwheat allergy using specific IgE concentrations in children

INTRODUCTION

Buckwheat (BW) is considered to be one of the most important food allergens, and positive skin tests are found in about 5% of Koreans. We investigated the positive and negative predictive values of BW-specific IgE in subjects with a BW allergy in order to reduce the need for buckwheat challenge, which can be more riskier than other causes of food allergies.

METHODS

Twenty-eight BW allergic subjects with symptoms after BW Open food challenge and 16 asymptomatic control subjects with positive skin test to BW were recruited. Serum samples from all patients were analyzed for BW-specific IgE antibodies using the Pharmacia CAP System.

RESULTS

According to the receiver operator characteristic (ROC) analysis, the optimal cutoff level of BW-specific IgE, as the definitions of serum BW-specific IgE positive, was 1.26 kUA/l. With this selected cutoff level, the sensitivity, specificity, positive and negative predictive values were 93.10, 93.33, 79.75 and 97.96%, respectively.

CONCLUSION

The use of the optimal cutoff level, 1.26 kUA/l, that simultaneously maximizes sensitivity and specificity, would be helpful for avoiding unnecessary risky challenge in children with a strong clinical history and skin test responses.

Staphylococcal enterotoxin B upregulates fas-mediated apoptosis of peripheral blood mononuclear cells in childhood atopic dermatitis

Staphylococcal infection-producing superantigens, such as staphylococcal enterotoxin B (SEB), are presumed to play an important role of inflammatory processes in atopic dermatitis (AD). The aim of this study was to elucidate the apoptotic response of peripheral blood mononuclear cells (PBMCs) from children with AD. PBMCs from AD children were sampled and cultured with SEB stimulation. Levels of apoptosis and Fas expression were measured using flow cytometry; the soluble Fas ligand (sFasL) was also measured using the enzyme-linked immunosorbent assay method, and the expression of FasL in PBMCs was observed using reverse transcriptase-polymerase chain reaction. There was no difference in the initial levels of apoptosis and Fas expression in precultured PBMCs of AD patients and healthy donors. After culturing for 48 h under SEB stimulation, the apoptosis level and Fas expression were significantly upregulated in the PBMCs from AD children compared with that from the normal controls. In patients, the sFasL was significantly increased, and the expression of FasL was observed in messenger RNA of peripheral monocytes. These results suggest that the Fas/FasL system is involved in the apoptosis induced by SEB in AD, with simultaneous increases in sFasL and expression of FasL.

Task preparation and task repetition: two-component model of task switching

The switch cost (the disadvantage of performing a new task vs. a repeated task) has been attributed to lack of preparation for the switched task or priming of the repeated task. These sources were examined by manipulating foreknowledge of task transition (repeat or switch), response-to-stimulus interval (RSI), and practice level. Regardless of foreknowledge, the cost decreased with RSI and practice. The reduction was greater with foreknowledge than with no foreknowledge, and the amount of switch cost did not depend on foreknowledge. These results suggest that the switch cost with foreknowledge may consist of both inadequate preparation and repetition benefit but the switch cost with no foreknowledge may reflect repetition benefit only. An ACT-R (adaptive control of thought-rational) model was proposed, accommodating both preparation and priming effect with 2 independent processes: conflict resolution among productions and decay of chunk activation.

Interleukin 6 gene promoter polymorphism is not associated with Kawasaki disease

We examined the IL-6 gene promoter and detected several interesting promoter polymorphisms: GGGCTG insertion at +162 bp and G deletion at +168 bp positions (M1), A to G substitution at -594 bp (M2) of the reported IL-6 promoter sequence. Other rare variations were also observed at several positions: -583 bp (T insertion), -507 bp (C insertion), -71 bp (T deletion), +17 bp (C insertion), and +121 bp (GC insertion). Although Kawasaki disease (KD) patients demonstrate a drastic increase in serum interleukin-6 (IL-6) during the acute phase that parallels the duration of fever, there were no significant differences in the nucleotide sequence between the KD patients and normal control group. By transient transfection with IL-6 gene promoter-luciferase fusion plasmids into CV-1 cells, we tested the functional significances of the polymorphisms. Mutations at +162 bp, +168 bp and -594 bp significantly decreased luciferase expression (P < 0.05), suggesting the promoter elements flanking the mutated nucleotides are important in transcriptional activation.

Production of granular activated carbon from waste walnut shell and its adsorption characteristics for Cu(2+) ion

Production of granular activated carbon by chemical activation has been attempted employing walnut shells as the raw material. The thermal characteristics of walnut shell were investigated by TG/DTA and the adsorption capacity of the produced activated carbon was evaluated using the titration method. As the activation temperature increased, the iodine value increased. However, a temperature higher than 400 degrees C resulted in a thermal degradation, which was substantiated by scanning electron microscopy (SEM) analysis, and the adsorption capacity decreased. Activation longer than 1h at 375 degrees C resulted in the destruction of the microporous structure of activated carbon. The iodine value increased with the increase in the concentration of ZnCl2 solution. However, excessive ZnCl2 in the solution decreased the iodine value. The extent of activation by ZnCl2 was compared with that by CaCl2 activation. Enhanced activation was achieved when walnut shell was activated by ZnCl2. Applicability of the activated carbon as adsorbent was examined for synthetic copper wastewater. Adsorption of copper ion followed the Freundlich model. Thermodynamic aspects of adsorption have been discussed based on experimental results. The adsorption capacity of the produced activated carbon met the conditions for commercialization and was found to be superior to that made from coconut shell.

Effects of repetition and foreknowledge in task-set reconfiguration

To examine the roles of executive control and automatic activation in task switching, we manipulated foreknowledge as well as task transitions. In Experiments 1 and 2, performance with foreknowledge was faster than performance with no foreknowledge, but the amount of switch cost did not depend on foreknowledge. This result suggests that switch costs primarily reflect persisting activation rather than inadequate preparation. In Experiment 3, switch cost was greater with foreknowledge about task transition alone than with foreknowledge about both task transition and identity, suggesting that foreknowledge about specific task identity did allow preparation for a switched task. We argue that task repetition and foreknowledge effects are independent. Although foreknowledge allows preparation for both repeated and switched tasks, repeating the same task has benefits over task switching regardless of foreknowledge.

A horseshoe kidney detected incidentally by Tc-99m DISIDA hepatobiliary scintigraphy

Horseshoe kidney is a common renal fusion anomaly that is usually asymptomatic in adults. A horseshoe kidney was detected incidentally on Tc-99m DISIDA hepatobiliary scintigraphy performed to evaluate acute cholecystitis. The diagnosis was first suggested on hepatobiliary scintigraphy and confirmed by computed tomography.

The role of prefrontal cortex and posterior parietal cortex in task switching

Human ability to switch from one cognitive task to another involves both endogenous preparation without an external stimulus and exogenous adjustment in response to the external stimulus. In an event-related functional MRI study, participants performed pairs of two tasks that are either the same (task repetition) or different (task switch) from each other. On half of the trials, foreknowledge about task repetition or task switch was available. On the other half, it was not. Endogenous preparation seems to involve lateral prefrontal cortex (BA 46/45) and posterior parietal cortex (BA 40). During preparation, higher activation increases in inferior lateral prefrontal cortex and superior posterior parietal cortex were associated with foreknowledge than with no foreknowledge. Exogenous adjustment seems to involve superior prefrontal cortex (BA 8) and posterior parietal cortex (BA 39/40) in general. During a task switch with no foreknowledge, activations in these areas were relatively higher than during a task repetition with no foreknowledge. These results suggest that endogenous preparation and exogenous adjustment for a task switch may be independent processes involving different brain areas.

Effects of repetition and foreknowledge in task-set reconfiguration

To examine the roles of executive control and automatic activation in task switching, we manipulated foreknowledge as well as task transitions. In Experiments 1 and 2, performance with foreknowledge was faster than performance with no foreknowledge, but the amount of switch cost did not depend on foreknowledge. This result suggests that switch costs primarily reflect persisting activation rather than inadequate preparation. In Experiment 3, switch cost was greater with foreknowledge about task transition alone than with foreknowledge about both task transition and identity, suggesting that foreknowledge about specific task identity did allow preparation for a switched task. We argue that task repetition and foreknowledge effects are independent. Although foreknowledge allows preparation for both repeated and switched tasks, repeating the same task has benefits over task switching regardless of foreknowledge.

Technetium-99m MDP bone scintigraphic findings of hypercalcemia in accelerated phase of chronic myelogenous leukemia

Hypercalcemia in accelerated phase of chronic myelogenous leukemia (CML) is very rare. Its pathogenesis is considered humoral hypercalcemia of malignancies mediated by parathyroid hormone-related protein (PTHrP). In severe hypercalcemia, calcifications in kidneys, skin, vessels, heart, and stomach may occur. Our two cases were admitted because of severe hypercalcemia in accelerated phase of CML. On Tc-99m methylene diphosphonate (MDP) bone scintigraphies, a marked tracer accumulation was seen in the lung, heart, stomach and kidney. We report increased tracer accumulation of multiple organs on Tc-99m MDP bone scintigraphy in two rare hypercalcemic patients with CML.

Cytokines secreted by lymphokine-activated killer cells induce endogenous nitric oxide synthesis and apoptosis in DLD-1 colon cancer cells

IL-2-activated killer lymphocytes (LAK cells) secrete inflammatory cytokines such as interferon-gamma (IFN-gamma) and tumor necrosis factor alpha (TNFalpha) that can induce nitric oxide (NO) synthesis. We evaluated whether LAK cells could activate NO synthesis in human cancer cells. LAK cells and their culture supernatants induced NO synthesis in DLD-1 colon cancer cells in a dose-dependent manner. NO synthesis was inhibited completely by blocking antibodies to IFN-gamma, demonstrating a key role for this LAK cell cytokine in regulating NO synthesis. The addition of TNFalpha antibodies resulted in partial inhibition. Induction of iNOS mRNA and protein expression in DLD-1 cells was detected. Endogenous NO production inhibited DLD-1 cell proliferation and induced apoptosis, processes that were inhibitable by the NO synthase inhibitor N(G)-monomethyl-l-arginine. Our study has identified a novel, non-contact-dependent LAK cell cytotoxic mechanism: induction of growth inhibition and programmed cell death due to endogenous NO synthesis in susceptible human cancer cells.

Receptor-mediated activation of murine peritoneal macrophages by antithrombin III acts as a costimulatory signal for nitric oxide synthesis

We evaluated the effect of antithrombin III (ATIII), a serine protease inhibitor (SERPIN), on induction of nitric oxide (NO) synthesis in murine peritoneal macrophages. Incubation of macrophages with ATIII plus interferon-gamma (IFN-gamma) but not ATIII alone induced nitrite accumulation (a metabolite of NO) in a dose-dependent manner. Expression of the inducible nitric oxide synthase isoform was confirmed by Western blot. NO synthesis was inhibited by NG-monomethyl-l-arginine, by complexing ATIII with thrombin or by rabbit anti-human ATIII antiserum. Addition of polymyxin B to macrophage cultures failed to inhibit ATIII/IFN-gamma-induced NO synthesis, excluding lipopolysaccharide contamination. 125I-ATIII bound to macrophages in a dose-dependent, specific, and saturable manner, with a Km of approximately 7.1 nM. Our results demonstrate that ATIII, but not ATIII/thrombin complex, acts to costimulate macrophage activation and NO synthesis via a novel receptor mediated mechanism, which may indicate a role for SERPINs in macrophage activation.

Uptake of gallium-67 in transfected cells and tumors absent or enriched in the transferrin receptor

Gallium-67 has been a controversial tumor-imaging agent in nuclear medicine for decades. This controversy centers on why tumors are variable in gallium-avidity, whether 67Ga uptake is a transferrin-independent or dependent process, and whether tumors and normal tissues differ in mechanism of uptake. If the factors that control uptake of 67Ga were understood better, then efforts to improve oncologic imaging with 67Ga by increasing the tumor activity, or by decreasing the background, may be warranted.

METHODS

Conventional systems for evaluating the mechanism and control of 67Ga uptake have significant limitations. We have endeavored to circumvent these by developing a pair of transfected cell lines. One cell line has no transferrin receptor. In the other, the human transferrin receptor has been restored by transfection and is over-expressed constitutively, without the necessity to manipulate factors such as cell growth or iron content. The uptake of 67Ga, both as a citrate salt and as a gallium-transferrin complex, was examined in these pairs of cells in vitro. The effect of calcium and of soluble (ionic) iron concentration on 67Ga uptake also was determined. Tumors were grown as explants of these cells in nude mice and comparisons of uptake of 67Ga by these tumors in vivo were made.

RESULTS

The in vivo uptake of 67Ga is significantly increased in tumors in which the transferrin receptor is overexpressed, compared to those without a functional transferrin receptor. However, a notable amount of accumulation of 67Ga also occurs, both in vitro and in vivo, by a transferrin-independent route. In vitro experiments demonstrate that the uptake of 67Ga by the transferrin-independent route can be enhanced further to levels that equal or exceed those achieved by the transferrin-dependent route by increasing the content of calcium or iron salts in the incubation medium.

CONCLUSION

Significant transferrin-independent uptake of 67Ga occurs both in vitro and in vivo. This uptake can be stimulated further in vitro, suggesting that in vivo enhancement might also be possible to enhance the utility of the radiometal for tumor imaging.

Renal angiomyolipoma: selective arterial embolization--effectiveness and changes in angiomyogenic components in long-term follow-up

PURPOSE

To evaluate the efficacy of selective arterial embolization in symptomatic renal angiomyolipoma (AML) and the change in angiomyogenic components during long-term follow-up after embolization.

MATERIALS AND METHODS

Fourteen adult patients with symptomatic AMLs underwent 16 selective arterial embolizations. The embolic materials used were absolute alcohol with (n = 5) or without (n = 3) iodized oil, Gianturco coils (n = 4), and polyvinyl alcohol foam powder with gelatin sponge (n = 2). Follow-up ultrasonography and computed tomography (CT) were performed in six and 14 patients, respectively. The effectiveness of selective arterial embolization was evaluated on the basis of the area of the angiomyogenic components in the AML on initial and follow-up images and clinical improvement.

RESULTS

All patients showed devascularization of the tumor on the postembolization angiograms. In 13 patients, clinical symptoms disappeared. The follow-up period was 7-72 months (mean, 33 months). One patient underwent nephrectomy at 7 months after embolization because of a large cystic lesion found at 1 month. In long-term CT follow-up (> or =12 months) in 12 patients, nearly all angiomyogenic components disappeared, but fatty components partially shrank with liquefactive necrosis in tumors.

CONCLUSION

Selective arterial embolization is an effective and safe treatment of AML. The angiomyomatous components crucial for the prevention of bleeding were very sensitive to the embolization.

Effects of nitric oxide (NO) synthesis inhibition on antitumor responses during interleukin-2 (IL-2) treatment of mice

OBJECTIVES

To evaluate if L-arginine: NO pathway is activated in tumor tissues during IL-2 therapy and to evaluate whether IL-2 induced NO synthesis represents an antitumor effector mechanism or an inhibitory factor against therapeutic effects of IL-2.

METHODS

Four groups [untreated control, NG-monomethyl-L-arginine (MLA) therapy only, IL-2 therapy only, IL-2/MLA therapy groups] of BALB/c mice were injected intraperitoneally with 2 x 10(8) Meth A tumor cells on day 0. MLA was administered subcutaneously with Alzet continuous infusion pumps on day 2. IL-2 therapy (180,000 IU s.c. every 12h for 5 days) was started on day 3. NO production within ascites tumors was assessed by measuring nitrite concentrations in cultures of ascites cells harvested on day 8. Survival and the rate of body weight increment of the mice were measured to evaluate therapeutic responses. Daily urinary nitrate excretion was monitored to demonstrate the effectiveness of MLA in inhibiting NO synthesis.

RESULTS

Nitrite production in supernatants of Meth A ascites cell cultures was 63 +/- 14 microM in IL-2 treated mice and 3.2 +/- 1.5 microM in untreated controls (p < 0.001). MLA prevented the IL-2 therapy induced increase in nitrite production. IL-2 therapy did not decrease the rate of body weight increment and marginally prolonged mean survival to 18.2 days, compared to 16.6 days in control mice (p = 0.255). MLA administration decreased the rate of body weight increment and prolonged mean survival of IL-2 treated mice (21.8 days, p = 0.001 versus IL-2 alone). Interestingly, the MLA treatment increased the rate of body weight increment and diminished the survival of control mice to 11.6 days (p = 0.003). MLA administration via Alzet continuous infusion pumps achieved approximately 60% suppression of urinary nitrate excretion by control mice. Subcutaneous IL-2 treatment strongly induced nitric oxide synthesis (up to 3.5 mumoles of urinary nitrate/ mouse/day). MLA also effectively suppressed IL-2 induced NO production.

CONCLUSION

L-arginine: NO pathway can be activated in malignant ascites by IL-2 therapy and NO synthesis functions as an inhibitory mechanism against IL-2 induced anti-tumor effects.

Esophagorespiratory fistulae due to esophageal carcinoma: palliation with a covered Gianturco stent

PURPOSE

To evaluate therapeutic effects and complications of a covered Gianturco stent for esophagorespiratory fistulae.

MATERIALS AND METHODS

Of 95 patients with esophageal carcinomas, 10 had esophagorespiratory fistulae and were treated with a silicone-covered Gianturco stent. The authors retrospectively assessed patients' food intake capacity and delayed problem of the stent.

RESULTS

All fistulae were occluded without immediate complications. Two patients could swallow all foods; four, most foods; three soft foods; and one, only liquids. Clinical problems occurred between 1 and 24 weeks in four patients: reopened fistula (n = 1), recurrent fistula (n = 1) (both patients were successfully treated with another esophageal stent), and dyspnea (n = 2) due to tracheal compression by stent and tracheal invasion by tumor (one patient was treated with a tracheal stent).

CONCLUSION

A silicone-covered modified Gianturco stent is effective for palliation of esophagorespiratory fistulae caused by esophageal cancer. Simultaneous use of a tracheal stent is recommended for extrinsic tracheal narrowing by the proximal tip of the stent and invasion by tumor.

Balloon dacryocystoplasty: results in the treatment of complete and partial obstructions of the nasolacrimal system

PURPOSE

To evaluate the effectiveness of balloon dacryocystoplasty (DCP) in the treatment of complete and partial obstruction of the nasolacrimal system (NLS).

MATERIALS AND METHODS

Fluoroscopically guided balloon DCP was attempted in 57 eyes of 50 consecutive patients with complete obstruction of the NLS and 24 eyes of 22 patients with partial obstruction of the NLS. With nasal endoscopic guidance, a 0.018-inch guide wire was introduced through the superior punctum into the inferior meatus of the nasal cavity and pulled out through the nare with a hemostat. A deflated angioplasty balloon catheter was introduced in a retrograde direction over the guide wire, and the balloon was dilated.

RESULTS

Initial technical and clinical success was achieved in 29 of 57 eyes (51%) with complete obstruction and 17 of 24 eyes (71%) with partial obstruction. The 2-year cumulative clinical patency rates were 25% and 20% for partial and complete obstructions, respectively. The overall cumulative patency rate for all 81 eyes was 23%.

CONCLUSION

Balloon DCP is simple and safe but has high failure and recurrence rates.

Adult presentation of congenital cystic adenomatoid malformation of the lung: a case report

Adult presentation of congenital cystic adenomatoid malformation(CCAM) of the lung is so rare that only 5 cases have been reported in the literature to date. We report the case of a 19-year-old female with CCAM in the left lower lobe. Computed tomography showed a multilobulated cystic lesion with multiple air-fluid levels and also showed focal enhancement of the solid component in the eccentrical portion of the lesion. Thoracic aortogram and selected bronchial arteriograms show a slightly enlarged and tortuous bronchial artery feeding the multilobulated cystic lesion. We present the clinical and radiological features of our case with a brief review of the literature.