[Specification of statistical graphics in medical research]

Statistical graphics has a long history and is an important mean to present study design, analysis results and conclusions of medical research. A survey of statistical graphs of recent publications in Chinese and English academic journals shows that scientific and technical specifications of statistical graphics are still lacking. Based on the requirements of statistical graphics in prestigious medical journals (NEJM, Lancet, JAMA and The BMJ), this paper summarizes the technical requirements, key points of design of statistical graphs and practical conditions of common statistical graphs to provide reference for clinical researchers.

[Analysis of influencing factors of ureteral anastomotic stenosis following urinary diversion after laparoscopic radical cystectomy]

Objective: To investigate the influencing factors of ureteroenteric strictures (UES) in patients undergoing laparoscopic radical cystectomy plus urinary diversion (UD). Method: A total of 412 patients who underwent UD after radical prostatectomy from January 2008 to December 2016 were retrospectively included in this study. Age, gender, body mass index (BMI), diversion type, time to diagnosis of UES, duration of ureteral stent, postoperative complications, including urinary tract infections, ureteroenteric leakage and UES were collected. Kaplan-Meier curves were used to describe time to developing UES. Prognostic factors of UES were analyzed using COX proportional hazard regression model. Result: Median follow-up time was 37 (IQR 17-120) months. A total of 59 patients (70 sides) developed UES, including 34 cases on the left side, 14 cases on the right side and 11 cases on both sides, following UD after radical cystectomy. The median time to diagnosis of UES was 7 (IQR 4-11) months. The total incidence of UES was 14.3%. The incidence of UES was 10.9%, 13.3% and 14.1% at 1, 3 and 5 years after UD, respectively. Cox proportional hazard regression model analysis demonstrated that BMI≥25kg·m(-2) (P=0.008), ureteroenteric leakage (P=0.001) and urinary tract infections (P=0.037) were the independent risk factors associated with UES following UD after radical cystectomy. Conclusion: The incidence rate of UES following UD after radical cystectomy was relatively high, which occurs more common on the left side. Obese patients, combined with ureteroenteric leakage, urinary tract infection after UD, are more likely to develop into UES.

Exopolysaccharide from Paecilomyces lilacinus modulates macrophage activities through the TLR4/NF‑κB/MAPK pathway

Multiple exopolysaccharides (EPSs) have been isolated from various organisms in extreme environments and have yielded a variety of activities. The present study evaluated the immunomodulatory capabilities of an EPS (termed PH‑EPS) derived from the fungus Paecilomyces lilacinus PH0016, which was isolated from a tropical and hyperhaline environment in southern China. The macrophage RAW 264.7 cell line was used to investigate the mechanism of PH‑EPS‑induced macrophage activation. The results indicated that RAW 264.7 macrophages were activated by PH‑EPS, in an effect slightly inferior to lipopolysaccharide (LPS), as evidenced by secretion of interleukin (IL)‑1β, tumor necrosis factor (TNF)‑α and nitric oxide (NO), and by significantly increased phagocytosis in the cells treated with PH‑EPS. Nuclear factor (NF)‑κB p65 was significantly translocated into the nucleus in the PH‑EPS‑treated cells. In addition, expression of inducible NO synthase (iNOS) and IκB‑α degradation were enhanced in PH‑EPS‑treated cells. The phosphorylation levels of p38, JNK and ERK were also significantly increased in the PH‑EPS‑treated cells. Furthermore, IL‑1β and TNF‑α production was markedly decreased in PH‑EPS‑treated cells when the mitogen‑activated protein kinase (MAPK) pathways were blocked by the inhibitor Dectin‑1 and by antibodies against Toll‑like receptor 4 (TLR4). The present results indicated that PH‑EPS from Paecilomyces lilacinus possessed the capability of activating RAW 264.7 cells via the TLR4/NF‑κB/MAPKs signaling pathway.

[Surgical technique and outcomes of uteri retrieval from brain-dead multi-organ donors: a preclinical research of human uterine transplantation]

Objective: To evaluate the surgical technique and outcomes of uteri retrieval from brain-dead multi-organ donors.This study is a preclinical research of human living uterine transplantation. Methods: From May, 2015 to May, 2017, four uteri retrieval procedures, characterized with radical hysterectomy and uterine vascular pedicles dissection, were performed in multi-organ brain-dead donors.The uterus was the third authorized organ after the kidney and liver retrieval procedures in the first two cases.The uterine pedicles included the uterus, ovaries, fallopian tubes, the upper one-third of the vagina and internal iliac vessels or external iliac vessels.The perfusion of the uterus was conducted after the retrieval for evaluating the availability, followed by histopathological examination of the uterine issues per 30 minutes. Results: Since the uterine vein was quite difficult to identify and dissect in the first two case, which result in the rupture of triple uterine veins.Therefore, the uterine venous vessels including uterine vein connected with internal iliac vein and internal iliac arteries were selected as vascular grafts and dissected successfully in the last two cases, which could be perfused with the mixture of 4 ℃ heparinized physiological saline through each artery because of shortening the surgical time and arranging the uterine procurement as the first authorized organ procedure.Mean (SD) operative time was 152.5±39.0 min (115-215 min, n=4). Conclusion: Our preliminary experience indicated that the uterus could be retrieved from the brain-dead multi-organ donors and transplanted to the recipient.The attempt of skeletonizing the uterine veins should be replaced by dissection of internal iliac vein.

[Relationship between c-kit mRNA expression and prognosis in patients with rectal carcinoma]

Objective: To investigate the correlation between c-kit mRNA expression and prognosis in patients with rectal carcinoma. Methods: The expression of c-kit mRNA in rectal carcinoma tissues(n=66) was detected by multiplex branched-DNA liquid chip method. According to the expression level, the patients were classified into the c-kit mRNA high expression group and the low group. We analyzed the relationship between the c-kit mRNA expression and the clinicopathological characteristics of patients, as well as the factors affecting patients'prognosis. Results: Of the 66 rectal carcinoma patients, 18(27.3%)cases were c-kit mRNA high expression. No significant correlation was found between the c-kit mRNA expression and gender, age, preoperative carcinoembryonic antigen, preoperative hemoglobin, distance to verge, lymph node metastasis, tumor thrombus, T stage, TNM stage and tumor differentiation (P>0.05). In follow-up, 34 patients died, 32 patients and 36 patients were recurrence or metastasis. The 1-, 3-, 5-year overall survival(OS) of c-kit mRNA high expression group were 100.0%, 77.8%, 77.8%, respectively, while those of the low one were 93.8%, 56.3%, 45.8%, respectively. The difference was statistically significant(P=0.025). Lymph node metastasis, T stage and TNM stage were also significant associated with OS(P<0.05). The 1-, 3-, 5-year disease free rate (DFS)of the c-kit mRNA high expression group were 100.0%, 77.8% and 77.8%, respectively, while those of the low one were 77.1%、43.8% and 41.7%, respectively, and the difference between the two groups was significant (P=0.044). As a reslut, c-kit mRNA expression (P=0.038) and TNM stage (P=0.039) were the independent prognostic factors affecting the OS in rectal cancer patients. Conclusions: Low expression of c-kit was associated with poor prognosis of rectal carcinoma. And the mechanism underlying this phenomenon deserves further exploration.

[Effects of urethral fibrosis on urinary control after laparoscopic radical prostatectomy]

Objective: To determine the influence of urethral fibrosis on the recovery of urinary continence after laparoscopic radical prostatectomy. Method: A retrospective study of 203 patients from January 2010 to January 2014 who were underwent laparoscopic radical prostatectomy for prostate cancer in the First Affiliated Hospital of Fujian Medical University. The patients were divided into 2 groups according to preoperative T2-weighted magnetic resonance imaging of fibrosis status of the urethral wall and periurethral tissue. One hundred and forty-four(≤2 grade) and 59 (≥3 grade) were classified into the no/mild and severe urethral fibrosis groups respectively. Urinary continence at 1, 3, 6, 12 months after operation were compared between this two groups respectively. Result: There was no significant difference in the two groups with respect to age, body mass index (BMI), Charlson comorbidity index (CCI), international prostate symptom score (IPSS), prostate volume, preoperative prostate-specific antigen value, nerve-sparing procedure, postoperative Gleason score and pathological stage. The operation was completed successfully in all cases. With a median follow-up time of 15 months (ranged from 12 to 24 months), there was no statistical difference between the two groups in urinary continence at 1 month after operation (P>0.05). The incidences of continence in patients with no/mild fibrosis were significantly higher at 3, 6, 12 months after operation than those with severe fibrosis. (In the no/mild fibrosis group and severe fibrosis group, the continue rate at 3 mouths was 50.0% vs 28.8% P=0.005; at 6 mouths was 91.0% vs 59.3% P<0.001; at 12 mouths was 98.6% vs 88.1% P=0.003). Conclusion: Preoperative urethral fibrosis could be a significant predictor of recovery of the long-term urinary continence status after laparoscopic radical prostatectomy. Compared with no/mild fibrosis, severe fibrosis had worse long-term continence status.

Histidine-tryptophan-ketoglutarate solution decreases mortality and morbidity in high-risk patients with severe pulmonary arterial hypertension associated with complex congenital heart disease: an 11-year experience from a single institution

Cardioplegic reperfusion during a long term ischemic period interrupts cardiac surgery and also increases cellular edema due to repeated solution administration. We reviewed the clinical experiences on myocardial protection of a single perfusion with histidine-tryptophan-ketoglutarate (HTK) for high-risk patients with severe pulmonary arterial hypertension associated with complex congenital heart disease. This retrospective study included 101 high-risk patients undergoing arterial switch operation between March 2001 and July 2012. We divided the cohort into two groups: HTK group, myocardial protection was carried out with one single perfusion with HTK solution; and St group, myocardial protection with conventional St. Thomas' crystalloid cardioplegic solution. The duration of cardiopulmonary bypass did not differ between the two groups. The mortality, morbidity, ICU stay, post-operative hospitalization time, and number of transfusions in HTK group were lower than those in St group (P<0.05). Univariate and multivariate analysis showed that HTK is a statistically significant independent predictor of decreased early mortality and morbidity (P<0.05). In conclusion, HTK solution seems to be an effective and safe alternative to St. Thomas' solution for cardioplegic reperfusion in high-risk patients with complex congenital heart disease.

Relationship Between Hematocrit Level and Cardiovascular Risk Factors in a Community-Based Population

BACKGROUND

This study aimed to determine the relationship between hematocrit (HCT) levels and cardiovascular risk factors in a community-based population of middle-aged adults.

METHODS

From April 2011 to February 2012, a total of 1,884 middle-aged adults were selected from a community-based population in China. Blood and urine samples were collected for routine blood and urine tests, and measurement of plasma glucose and lipid levels. Baseline information including traditional cardiovascular risk factors was obtained by standard questionnaire to analyze. We evaluated the distribution of the HCT values for middle-aged adults with or without cardiovascular risk factors. There were 548 males and 1,336 females in this study. The mean age of all subjects was 54.7 ± 6.7 years. There were 1,209 subjects with risk factors and 675 without risk factors.

RESULTS

The HCT levels in subjects with risk factors were higher than those without risk factors (P = 0.005). According to a simplified tool for evaluation of the 10-year risk of ischemic cardiovascular diseases (CVDs) in Chinese populations, all subjects were divided into four groups: the ultralow-risk group (1,367, 72.6%), low-risk group (232, 12.3%), intermediate-risk group (201, 10.7%), and high-risk/ultrahigh-risk group (84, 4.4%). Compared with HCT levels in the ultralow-risk group, significant differences were found in the low-risk, intermediate-risk, and high-risk/ultrahigh-risk groups (all P < 0.05).

CONCLUSION

Our results indicate that elevated HCT levels may be positively associated with cardiovascular risk factors. Thus, the combination of HCT values and cardiovascular risk factors may enable early diagnosis of CVDs.

[Investigation on species composition of cockroaches and bacteria-carrying on their bodies in five cities of Hainan]

"ZA-type" cages were used to capture cockroaches in 267 sites of 5 cities in Hainan. Species were identified and bacteria were isolated by routine method. 441 cockroaches were collected and identified as five species belonging to two genera, 75.3% being Periplaneta americana. More cockroaches were found in sewerage. Bacteria were detected from 82.4% of cockroaches, including Escherichia coli, Pseudomonas aeruginosa, Salmonella sp, Staphylococcus aureus, Shigella sp, Bacillus proteus and sort of mycetes. Therefore, the dominant species is Periplaneta americana in Hainan, and the high bacteria-carrying behavior of cockroaches indicates its importance in disease transmission.

Ecological stabilization of thickened wastewater sludge from CAST process

Wastewater sludge ecological stabilization (WWSES) pilot scale experiments were conducted for thickening treatment and disposal of sludge which came from Cyclic Activated Sludge Technology (CAST) process. The study was performed over the periods from June to November 2005 and from May to November 2006, on a bed of 80 m2. The sludge loadings were stopped for the winter from December 2005 and resumed in May 2006. The results shows that dried sludge layer has higher permeation coefficients of 0.15-1.3 m/h. It is suggested that the percolate did not filtrate downwards evenly, part of percolate filtrates downwards along stems, roots and cracks existing in dried sludge which have lower flow resistance. The relationship of dried sludge thickness and operation time is in accord with quadratic equation under fluctuating sludge loadings. Linear regression equation can indicate dried sludge thickness variation under fixed sludge loading. In comparison with natural ones, coarse protein content of Phragmites australis roots in the system is twice as high, coarse fiber content of roots, coarse fat content of stems and leaf are obviously higher; and coarse protein content of Typha augustifolia in the system are obviously higher, while coarse fat and coarse fiber contents have no significant difference.

Influence of L-methionine-deprived total parenteral nutrition with 5-fluorouracil on gastric cancer and host metabolism

AIM: To investigate the influence of L-methionine-deprived total parenteral nutrition with 5-FU on gastric cancer and host metabolism.

METHODS: N-methyl-N’-nitro-nitrosoguanidine (MNNG) induced gastric cancer rats were randomly divided into four groups: Met-containing TPN group (n = 11), Met-deprived TPN group (n = 12), Met-containing TPN+5-FU group (n = 11) and Met-deprived TPN+5-FU group (n = 12). Five rats in each group were sacrificed after 7 d of treatment and the samples were taken for examination. The remaining rats in each group were then fed separately with normal diet after the treatment until death, the life span was noted.

RESULTS: The tumors were enlarged in Met-containing group and shrank in Met-deprived group markedly after the treatment. The DNA index (DI) of tumor cells and the body weight (BW) of rats had no significant change in the two groups, however, the ratio of tumor cells’ S phase was increased. The ratio of G2M phase went up in Met-containing group, but down in Met-deprived group. In the other two groups that 5-FU was added, the BW of rats, and the diameter of tumors, the DI of tumor cells, the S and G2M phase ratio of tumor cells were all decreased, particularly in Met-deprived plus 5-FU group. Pathological examination revealed that the necrotic foci of the tumor tissue increased after Met-deprived TPN treatment, and the nucleoli of tumor cells enlarged. In -MetTPN+5-FU group, severe nuclear damage was also found by karyopyknosis and karyorrhexis, meanwhile there was slight degeneration in some liver and kidney cells. The serum free Met and Cysteine decreased markedly (P ＜ 0.001), while other amino acids, such as serum free serine and glutamine increased significantly (P ＜ 0.005). All the rats died of multiple organ failure caused by cancer metastasis. The average survival time was 18.6 d in Met-containing TPN group, 31 d in Met-deprived TPN group, 27.5 d in Met-containing TPN+5-FU group, and 43 d in Met-deprived TPN+5-FU group (P ＜ 0.05).

CONCLUSION: Met-deprived TPN causes methionine starvation of tumor cells, and can enhance the anti-tumor effect of 5-FU and prolong the life span of gastric cancer-bearing rats.

Steroid-induced acute psychosis in a child with asthma: report of one case

A 5-year-old girl was admitted due to severe asthmatic attack. She was treated with methylprednisolone (40 mg i.v. q6h), aminophylline (loading with 5 mg/kg and maintained with 0.6 mg/kg/hr i.v. drip), nebulized terbutaline sulphate (5 mg q6h), oral procaterol 12.5 micrograms bid, along with oxygen therapy. Acute psychotic reaction with visual hallucination, delusion, panic reaction and myoclonic movement of hands developed on day 3 of admission. The patient had no previous history of psychiatric problems. The theophylline level was 9.89 micrograms/ml at the moment of psychotic reaction. After the dose of methylprednisolone was reduced from 40 mg to 20 mg i.v. q6h and shifted to other anti-asthma treatment by procaterol metered dose inhaler via spacer, the psychotic reaction disappeared a few hours later. The psychotic reaction was thought to be due to steroid therapy since no other causes could explain the psychotic reaction.

Recurrent chromosome changes in 62 primary gastric carcinomas detected by comparative genomic hybridization

Comparative genomic hybridization (CGH) has been applied to detect recurrent chromosome alterations in 62 primary gastric carcinomas. Several nonrandom chromosomal changes, including gains of 8q (31 cases, 50%), 20q (29 cases, 47%) with a minimum gain region at 20q11. 2-q12, 13q (21 cases, 34%) with a minimum gain region at 13q22, and 3q (19 cases, 31%) were commonly observed. The regions most frequently lost included: 19p (23 cases, 37%), 17p (21 cases, 33%), and 1p (14 cases, 23%). High copy number gain (DNA sequence amplification) was detected in 6 cases. Amplification of 8q23-q24.2 and 20q11.2-q12 were observed in 3 cases. Gain of 20q and loss of 19p were confirmed by fluorescence in situ hybridization using corresponding bacterial artificial chromosomes (BAC) clones from those regions. The gain and loss of chromosomal regions identified in this study provide candidate regions involved in gastric tumorigenesis.

Topology of catalytic portion of prostaglandin I(2) synthase: identification by molecular modeling-guided site-specific antibodies

Prostaglandin I(2) synthase (PGIS) is an eicosanoid-synthesizing cytochrome P450, located in the endoplasmic reticulum (ER) membrane. The membrane topology of the catalytic portion of PGIS is still unknown. General models of the membrane topology of microsomal P450s have been proposed in two forms: (a) large part of the polypeptide exposed on the cytoplasmic side with an NH(2)-terminal membrane anchor to the ER membrane and (b) deep immersion of the polypeptide in the membrane, as described by J. P. Miller et al. (1996, Biochemistry 35, 1466-1474). We have characterized the membrane topology of catalytic portion of PGIS using molecular modeling-guided site-specific antibodies. A 3D working model of PGIS was constructed by homology modeling using P450(BM-3) crystal structure as a template (S. K. Shyue et al., 1997, J. Biol. Chem. 272, 3657-3662). Three hydrophilic peptides corresponding to different regions of the surface portion of PGIS with residues 109-127 (P109-127), 353-368 (P353-368), and 411-431 (P411-431) predicted from the model and an NH(2)-terminal hydrophobic peptide (residues 1-28, P1-28) were synthesized and used to prepare site-specific antibodies. All three of the hydrophilic peptide antibodies have high titer and are specifically recognized human PGIS, as shown by binding assays and Western blot analysis. In contrast, the hydrophobic NH(2)-terminal peptide has a much lower titer binding to the PGIS protein. The overall arrangement of the PGIS polypeptide with respect to the endoplasmic reticulum (ER) membrane was examined by immunocytochemistry techniques in transiently transfected COS-1 cells with recombinant human PGIS cDNA and in ECV cells expressing endogenous PGIS. The immunofluorescence staining for the cells with selective permeabilization of the plasma membrane using streptolysin O indicated that all three of the hydrophilic peptide antibodies bound to the cytoplasmic surface of the ER membrane. These results provide direct experimental evidence supporting the predicted 3D protein topological model in which the segments are located on the protein surface and the membrane topological model in which PGIS is largely exposed on the cytoplasmic side of the ER membrane. It also led us to conclude that the PGIS substrate, prostaglandin H(2) (PGH(2)), produced by prostaglandin H(2) synthase (PGHS) in the ER lumenal side must pass through the ER membrane barrier to the catalytic site of the PGIS in the cytoplasmic side of the ER membrane.

Effect of ice water ingestion on asthmatic children after exercise challenge

Both exercise and ice water ingestion are known to be trigger factors for an asthma attack in ethnic Chinese asthmatic children. The purpose of this study was to investigate whether ice water ingestion further deteriorates pulmonary function of asthmatic children after exercise. Thirty Chinese asthmatic children underwent exercise challenge by ergocyclometer for 6 minutes and then were further challenged by immediate ingestion of ice water (200 ml, 0-4 degrees C), warm water (200 ml, 37 degrees C) or no ingestion on three different days in one week. Each patient completed the three different water ingestion tests after exercise challenge. The FEV1, FEF25-75%, and PEF tests were performed at baseline and again at 5, 15, 30, 60, 90 minutes after exercise plus water ingestion challenge. After the spirometric test at 90 minutes, 3 puffs (0.6 mg) of hexoprenaline from a metered dose inhaler were given and then a further spirometric test was performed 15 minutes later. The FEV1 and PEF were significantly decreased after exercise plus the 3 different water ingestion challenge except for the FEV1 in the patients who ingested nothing (p = 0.051) and PEF in the patients who ingested warm water (p = 0.163). FEF25-75% of the three tests was not significantly decreased. Exercise-induced asthma (EIA) developed in about two thirds of the 30 patients, regardless of whether ice water, warm water or nothing at all was ingested after exercise challenge. There was no statistically significant difference in spirometric data among the 3 different water tests at various time points. The mean percentage increase of FEV1, FEF25-75% and PEF after bronchodilator therapy were all the lowest in the ice water test, and the greatest in the warm water test. A statistically significant difference was found between ice water and warm water tests for FEV1 and PEF (p = 0.0293 and p = 0.0308 respectively). In conclusion, about two thirds of the asthmatic children in this series had EIA. Those who ingested warm water after exercise had a better bronchodilator response than those who ingested ice water.

The PTEN/MMAC1/TEP tumor suppressor gene decreases cell growth and induces apoptosis and anoikis in breast cancer cells

The PTEN/MMAC1/TEP (PTEN) tumor suppressor gene at 10q23.3 is mutated in multiple types of sporadic tumors including breast cancers and also in the germline of patients with the Cowden's breast cancer predisposition syndrome. The PTEN gene encodes a multifunctional phosphatase capable of dephosphorylating the same sites in membrane phosphatidylinositols phosphorylated by phosphatidylinositol 3'-kinase (PI3K). We demonstrate herein that loss of PTEN function in breast cancer cells results in an increase in basal levels of phosphorylation of multiple components of the P13K signaling cascade as well as an increase in duration of ligand-induced signaling through the P13K cascade. These alterations are reversed by wild-type but not phosphatase inactive PTEN. In the presence of high concentrations of serum, enforced expression of PTEN induces a predominant G1 arrest consistent with the capacity of PTEN to evoke increases in the expression of the p27Kip1 cyclin dependent kinase inhibitor. In the presence of low concentrations of serum, enforced PTEN expression results in a marked increase in cellular apoptosis, a finding which is consistent with the capacity of PTEN to alter the phosphorylation, and presumably function, of the AKT, BAD, p70S6 kinase and GSK3 alpha apoptosis regulators. Under anchorage-independent conditions, PTEN also induces anoikis, a form of apoptosis that occurs when cells are dissociated from the extracellular matrix, which is enhanced in conjunction with low serum culture conditions. Together, these data suggest that PTEN effects on the PI3K signaling cascade are influenced by the cell stimulatory context, and that depending on the exposure to growth factors and other exogenous stimuli such as integrin ligation, PTEN can induce cell cycle arrest, apoptosis or anoikis in breast cancer cells.

Regulation of NF-kappa B, AP-1, NFAT, and STAT1 nuclear import in T lymphocytes by noninvasive delivery of peptide carrying the nuclear localization sequence of NF-kappa B p50

Activation of T lymphocytes by Ags or cytokines results in translocation of the transcription factors NF-kappa B, AP-1, NFAT, and STAT from the cytoplasm into the nucleus. The first step in the nuclear import process is recognition of a nuclear localization sequence (NLS) within the karyophilic protein by a cytoplasmic receptor such as the importin (karyopherin)-alpha subunit. The NLSs of NF-kappa B, AP-1, and NFAT differ and the NLS of STAT1 has not yet been identified. Herein we demonstrate that the inducible nuclear import of NF-kappa B, AP-1, NFAT, and STAT1 in Jurkat T lymphocytes is significantly inhibited by a cell-permeable peptide carrying the NLS of the NF-kappa B p50 subunit. NLS peptide-mediated disruption of the nuclear import of these transcription factors results in inhibition of I kappa B alpha and IL-2 gene expression, processes dependent on NF-kappa B or the combination of NF-kappa B, AP-1, and NFAT. Further, we show that inhibitory NLS peptide interacts in vitro with a cytoplasmic NLS receptor complex comprised of the Rch1/importin (karyopherin)-beta heterodimer expressed in Jurkat T cells. Taken together, these data indicate that the inducible nuclear import of NF-kappa B, AP-1, NFAT, and STAT1 in Jurkat T cells can be regulated by NLS peptide delivered noninvasively to the cytoplasm of Jurkat T cells to target members of the importin (karyopherin)-alpha beta NLS receptor complex.

Genetic engineering of proteins with cell membrane permeability

The discovery of methods for generating proteins with inherent cell membrane-translocating activity will expand our ability to study and manipulate various intracellular processes in living systems. We report a method to engineer proteins with cell-membrane permeability. After a 12-amino acid residue membrane-translocating sequence (MTS) was fused to the C-terminus of glutathione S-transferase (GST), the resultant GST-MTS fusion proteins were efficiently imported into NIH 3T3 fibroblasts and other cells. To explore the applicability of this nondestructive import method to the study of intracellular processes, a 41-kDa GST-Grb2SH2-MTS fusion protein containing the Grb2 SH2 domain was tested for its effect on the epidermal growth factor (EGF)-stimulated signaling pathway. This fusion protein entered cells, formed a complex with phosphorylated EGF receptor (EGFR), and inhibited EGF-induced EGFR-Grb2 association and mitogen-activated protein kinase activation.

Conformational and topological requirements of cell-permeable peptide function

Cell-permeable peptide import recently was developed to deliver synthetic peptides into living cells for studying intracellular protein functions. This import process is mediated by an N-terminal carrier sequence which is the hydrophobic region of a signal peptide. In this study, the conformational consequence of the interaction of cell-permeable peptides with different mimetic membrane environments was investigated by circular dichroism analysis. We showed that cell-permeable peptides adopted alpha-helical structures in sodium dodecyl sulfate (SDS) micelles or aqueous trifluoroethanol (TFE). The potency of these peptides in forming helical structures is higher in an amphiphilic environment (SDS) than in a hydrophobic environment (TFE), suggesting that some hydrophilic molecules associated with the cell membrane may be involved in peptide import. We also studied topological requirements of cell-permeable peptide function. We demonstrated that peptides containing the carrier sequence in their C-termini can also be imported into cells efficiently. This important discovery can avoid repetitious synthesis of the membrane-translocating sequence for peptides with different functional cargoes and is potentially useful for developing a cell-permeable peptide library. Finally, we showed that, when a retro version of the carrier sequence was used, the peptide lost its translocating ability despite retaining a high content of alpha-helical structure in mimetic membrane environments. This suggests that the propensity of peptides to adopt a helical conformation is required but not sufficient for cellular import and that other structural factors such as the side-chain topology of the carrier sequence are also important. Our studies together contribute to the more rational design of useful cell-permeable peptides.

Structural characterization and topology of the second potential membrane anchor region in the thromboxane A2 synthase amino-terminal domain

Thromboxane A2 synthase (TXAS) has been proposed to have two membrane-bound regions located in the NH2-terminal domain [Ruan, K.-H., Wang, L.-H., Wu, K. K., and Kulmacz, R. J. (1993) J. Biol. Chem, 268, 19483-19489; Ruan, K.-H., Li, P., Kulmacz, J. R., and Wu, K. K. (1994) J. Biol. Chem, 269, 20938-20942]. To test this hypothesis, a solution structure in membrane mimetic environments of a synthetic peptide corresponding to the second region of the NH2-terminal domain (TXAS residues 33-60) has been investigated by circular dichroism (CD), 2D nuclear magnetic resonance (NMR) spectroscopy, and peptidoliposome reconstitution. CD spectroscopy indicated that the peptide adopted a structure with significant alpha-helical content in 30% trifluoroethanol (TFE) or in dodecylphosphocholine (DPC) micelles, which mimic hydrophobic membrane environment. Through a combination of 2D NMR experiments in the presence of TFE or DPC micelles, complete 1H NMR assignments of the peptide have been obtained and the structure of the peptide has been determined. NH2-terminal segment of the peptide takes on a well-defined alpha-helical conformation; the center segment of the peptide, containing three prolines, adopts a bent conformation, and the C-terminal segment of the peptide exists in a mixture of rapidly interconverting conformations. These results provide direct structural evidence that residues 33-60 of the TXAS NH2-terminal domain contain a second membrane anchor region, with at least residues 35-46 having their helical structure expected for hydrophobic interaction with the membrane. The orientation of the peptide in DPC micelles was evaluated from the effect of incorporation of a spin-label 12-doxylstearate into the micelles. The peptide portions, found to be immersed in the micelles, include the helical segment, the bent segment, and some hydrophobic residues within the C-terminal segment. Two additional synthetic peptides, one corresponding to the NH2-terminal helical segment (TXAS residues 33-46) and the other including the bent and the C-terminal segments (TXAS residues 47-60) were analyzed for their ability to incorporate into peptidoliposomes. The helical peptide readily incorporated into liposomes; the other peptide did not. These results support the presence of a second functional membrane anchor region localized to the helical segment within TXAS residues 33-46, with passive membrane contacts in the bent and the C-terminal segments of the peptide (TXAS residues 47-60) due to immersion of the helical in the membrane.

An alternative to phosphotyrosine-containing motifs for binding to an SH2 domain

Shc is an important signalling protein whose overexpression leads to cell transformation in NIH 3T3 fibroblasts. Although the formation of Shc/Grb2 complexes involving Shc tyrosine residue 317 is necessary to induce this transformation, the Shc proteins in these Shc-overexpressing cells are not substantially tyrosine-phosphorylated. This observation led to our hypothesis that the non-phosphorylated Tyr317-containing region of Shc might have specific affinity for the Grb2 protein. We show here that cell-permeable peptides encompassing the Shc Tyr317 region, 312FDD-PSYVNVQNL323, can bind to the SH2 domain of Grb2 regardless of the state of tyrosine phosphorylation. When delivered into cells, both phosphorylated and non-phosphorylated Shc peptides inhibit growth factor-induced Shc/Grb2 protein-protein interaction. The non-phosphorylated Shc peptides with single point mutations at Asp313, Asp314, or Tyr317 are inactive, suggesting that these residues play an important role in Grb2 protein recognition. Our findings represent the first paradigm of the specific interaction between an unphosphorylated tyrosine-containing region and an SH2 domain and have important implications for understanding the mechanism of cell transformation by Shc overexpression.

Asthma induced by ice water ingestion in ethnic Chinese asthmatic children: a challenge

The purpose of this study was to investigate the relationship between ice water ingestion and the induction of asthmatic symptoms and signs in ethnic Chinese asthmatic children. Sixty asthmatic children with a positive history of exacerbation of symptoms after drinking ice water were divided randomly into two groups: 34 children were instructed to drink 250 ml of 0-4 degrees C ice water within one minute, and 26 to drink 250 ml of 25 degrees C warm water. All of the asthmatic children were stable when studied. Twenty-three healthy children as controls were asked to drink 250 ml of 0-4 degrees C ice water. The three groups had forced expiratory volume in one second (FEV1) performed at baseline and at 5, 15, 30, 60, and 90 minutes after challenge. After the spirometric test at 90 minutes the patients of the two asthmatic groups received three puffs (0.6 mg) of hexoprenaline MDI and a further spirometric test was performed 5 min after the inhalation. Cough and wheeze were monitored throughout the course of the test. The mean FEV1 after challenge decreased significantly only in the ice-water asthmatic group (p = 0.004). Compared with the baseline data, the mean FEV1 at various periods after challenge was only significantly decreased at 60 min (p = 0.035). After hexoprenaline inhalation the FEV1 significantly increased in the two asthmatic groups (p < 0.001). A significant difference in FEV1 change was noted among the three groups (p = 0.015). Nine cases (26%) from the ice water asthmatic group, three (12%) from the warm-water asthmatic group, and none of the ice-water normal control group showed a decrease of FEV1 greater than 15% (p = 0.018). The greatest difference occurred between the two ice water groups. All six cases who developed symptoms after challenge, accompanied by a simultaneous decrease of FEV1 greater than 15%, belonged to the ice-water asthmatic group. Forty-seven percent of the ice-water asthmatic group and 4% each of the two other groups had cough and/or wheeze after challenge (p = 0.0002).

IN CONCLUSION

Ice water ingestion may induce or exacerbate asthma in ethnic Chinese asthmatic children.

[Environmental pollution, human exposure and its health effect of sodium pentachlorophenate in schistosomiasis prevalent area]

Sodium pentachlorophenate (Na-PCP) has been used in China for years as an molluscacide to kill oncomelania, which is an intermediate host of Schistosome. To evaluate the effects of its long-term successive usage on environment, human exposure and health, studies were carried out in Sichuan, Jiangxi, Jiangsu and Fujian provinces, with a time gap of more than one month between sample collection and last spray of Na-PCP. Results indicated that PCP contents in surface water, soil, sediment, animals and plants were significantly higher in studied areas than in control areas. The daily intake and the content in urine of PCP were also sigificantify higher in studied areas. But, there was no difference on physical and biochemical examinations except that a 22%-28% decrease of blood cholinesterase activity was found in studied areas. The health effect of impurities in Na-PCP, dioxins and furans, was assessed and discussed.

Controlling epidermal growth factor (EGF)-stimulated Ras activation in intact cells by a cell-permeable peptide mimicking phosphorylated EGF receptor

Epidermal growth factor (EGF)-stimulated Ras activation involves specific interactions between the EGF receptor (EGFR), the adaptor proteins Grb2 and Shc, and the nucleotide exchange factor Sos-1. Study and control of these protein-protein interactions in vivo can be greatly promoted by introducing intracellular reagents that mimic EGFR functions. Here, we showed that a synthetic phosphopeptide encompassing the autophosphorylation site 1068 of EGFR formed a complex with endogenous Grb2 after this peptide was delivered into intact cells by a cell-permeable peptide import technique. Consequently, this intracellular peptide inhibited EGF-induced EGFR/Grb2 associations but not EGFR/Shc or Shc/Grb2 associations. Peptide-mediated disruption of the EGF/Grb2/Sos-1 cascade led to reduced Ras activation and mitogen-activated protein kinase activation. These results indicate that the binding of Grb2 to the phosphorylated Tyr-1068 of EGFR is crucial to the EGF-induced Ras/mitogen-activated protein kinase signaling pathway. The application of cell-permeable peptides to this study demonstrates a useful biochemical tool to probe and control various intracellular processes involved in signal transduction and gene transcription.

Identification of a functionally important sequence in the cytoplasmic tail of integrin beta 3 by using cell-permeable peptide analogs

Integrins are major two-way signaling receptors responsible for the attachment of cells to the extracellular matrix and for cell-cell interactions that underlie immune responses, tumor metastasis, and progression of atherosclerosis and thrombosis. We report the structure-function analysis of the cytoplasmic tail of integrin beta 3 (glycoprotein IIla) based on the cellular import of synthetic peptide analogs of this region. Among the four overlapping cell-permeable peptides, only the peptide carrying residues 747-762 of the carboxyl-terminal segment of integrin beta 3 inhibited adhesion of human erythroleukemia (HEL) cells and of human endothelial cells (ECV) 304 to immobilized fibrinogen mediated by integrin beta 3 heterodimers, alpha IIb beta 3, and alpha v beta 3, respectively. Inhibition of adhesion was integrin-specific because the cell-permeable beta 3 peptide (residues 747-762) did not inhibit adhesion of human fibroblasts mediated by integrin beta 1 heterodimers. Conversely, a cell-permeable peptide representing homologous portion of the integrin beta 1 cytoplasmic tail (residues 788-803) inhibited adhesion of human fibroblasts, whereas it was without effect on adhesion of HEL or ECV 304 cells. The cell-permeable integrin beta 3 peptide (residues 747-762) carrying a known loss-of-function mutation (Ser752Pro) responsible for the genetic disorder Glanzmann thrombasthenia Paris I did not inhibit cell adhesion of HEL or ECV 304 cells, whereas the beta 3 peptide carrying a Ser752Ala mutation was inhibitory. Although Ser752 is not essential, Tyr747 and Tyr759 form a functionally active tandem because conservative mutations Tyr747Phe or Tyr759Phe resulted in a nonfunctional cell permeable integrin beta 3 peptide. We propose that the carboxyl-terminal segment of the integrin beta 3 cytoplasmic tail spanning residues 747-762 constitutes a major intracellular cell adhesion regulatory domain (CARD) that modulates the interaction of integrin beta 3-expressing cells with immobilized fibrinogen. Import of cell-permeable peptides carrying this domain results in inhibition "from within" of the adhesive function of these integrins.

Alterations in enzymatic functions in hepatocytes and hepatocellular carcinomas from Ras-transduced livers resemble the effects of insulin

An understanding of how oncogenes affect differentiated liver functions might lead to improved treatments for liver cancer or other disorders where liver-specific functions are compromised. A retroviral vector that coexpressed beta-galactosidase (beta-gal) and activated Ras genes (Ras-gal) was transduced into a small fraction of adult rat hepatocytes in vivo. Hepatocytes from Ras-gal-transduced diethylnitrosamine-untreated livers and hepatocellular carcinomas (HCC) from Ras-gal-transduced diethylnitrosamine-treated rats were analyzed for liver functions by performing histochemical assays on liver sections. Ras-gal-transduced hepatocytes failed to express gluconeogenic, ketogenic, and urea pathway enzymes. In contrast, several enzymes involved in fat synthesis were strongly activated, and microvesicular fat accumulated. These metabolic changes are induced in normal livers by insulin, a hormone that activates p21-ras. The deregulation of p21-ras may inhibit these liver-specific functions and may induce fat synthesis in both malignant and nonmalignant liver diseases. Furthermore, treatment with drugs that inhibit the attachment of p21-ras to the plasma membrane might reverse these changes. The alterations in enzymatic functions in the HCCs were similar to those observed in the hepatocytes, although each of the two cancers had a region that abruptly lost its expression of liver-specific enzymes and acquired the expression of genes that are more characteristic of oval or bile ductule cells. This suggests that a single genetic event in a malignant cell may dramatically alter its apparent phenotype. The identification of this putative gene might lead to insights into the regulation of the phenotype of normal cells in the liver.

Terbutaline nebulization and epinephrine injection in treating acute asthmatic children

Ninety children with acute asthma, equally divided into two study groups, were studied to compare the efficacy and safety of nebulized terbutaline with injected epinephrine in the treatment of acute exacerbation. The terbutaline group received 2 ml (5,0 mg) terbutaline solution diluted with 2 ml 0.9% saline for inhalation over 10 minutes; the epinephrine group received 0.01 ml/kg of 1:1000 epinephrine (maximum 0,3 ml) through subcutaneous injection at deltoid area. Spirometry, pulse oximetry, and clinical severity scoring system were evaluated at baseline and again 15 minutes after treatment. The baseline data of the two groups were not significantly different. The clinical severity score and spirometry of both groups were significantly improved after treatment. Compared with the terbutaline group, the epinephrine group had better mean oxygen saturation (SaO2; p < 0.001), frequency of oxygen desaturation (p = 0.0028) and forced expiratory flow 25-75% (FEF25-75%, p = 0.027). For those patients with initial forced expiratory volume in one second (FEV1) lower than 60% of predicted value, epinephrine treatment was more effective in the improvement of FEV1, FEF25-75%, and oxygen saturation (SaO2) (p = 0.011, 0.012, and 0.006, respectively). A Significantly higher rate of adverse effects occurred in patients given epinephrine (47% vs 11%, p = 0.0002); these included pallor, tremor, dizziness, headache, palpitation, soreness of legs, numbness of extremities, cold sweating, general weakness and nausea. Considering the general trend to noninvasive therapy in children and the more frequent adverse effects after epinephrine injection, such nebulized beta-2 agonists as terbutaline appear preferable for initial therapy of acute asthma if oxygen is supplemented to prevent possible hypoxemia. However, parenteral epinephrine still is worth trying, particularly in any severe, life-threatening attack.

Role of the nuclear localization sequence in fibroblast growth factor-1-stimulated mitogenic pathways

Fibroblast growth factor-1 (FGF-1) is a potent mitogen for mesoderm- and neuroectoderm-derived cell types in vitro. However, a mutant FGF-1 with deletion in its nuclear localization sequence (NLS, residues 21-27) is not mitogenic in vitro. We demonstrated that synthetic peptides containing this NLS were able to stimulate DNA synthesis in a FGF receptor-independent manner after they were delivered into living NIH 3T3 cells by a cell-permeable peptide import technique. The stimulation of maximal DNA synthesis by these peptides required the presence of peptides during the entire G1 phase of the cell cycle. The mitogenic effect was specific for the NLS of FGF-1 because a peptide with double point mutations at lysine residues was inactive in stimulating DNA synthesis. Our results suggest that the NLS plays an important role in the mitogenic pathway initiated by exogenous FGF-1 by its direct involvement in the nuclear transport and signaling of internalized FGF-1.

Ras-transduced diethylnitrosamine-treated hepatocytes develop into cancers of mixed phenotype in vivo

The cell of origin of hepatocellular carcinoma (HCC) is controversial. A method for marking cells of different lineages in vivo and then determining their carcinogenic potential should resolve this issue. A retroviral vector expressing activated ras and beta-gal genes (Ras-gal) was transferred into adult rat hepatocytes in vivo, and some animals were treated with diethylnitrosamine (DEN). Bile ductule cells and the putative stem cells of the liver (the oval cells) did not appear to be transduced by this method. At 1 month after transfer, 5-bromo-4-chloro-3-indolyl-beta-D-galactopyranoside staining was performed on transduced rat livers to determine the blue cluster size. Eight % of the clusters in Ras-gal-transduced, DEN-treated livers contained at least twice as many cells as the largest cluster in Ras-gal-transduced, DEN-untreated rats, demonstrating that they had acquired markedly abnormal growth properties. When the retroviral vector containing beta-gal without ras (Gal-509) was transferred into DEN-treated rats, 2.5% of the cells were present in clusters containing at least twice as many cells as the largest cluster in Gal-509-transduced, DEN-untreated animals. Thus, p21-ras may increase the percentage of cells that acquire mutations in response to DEN, or it may behave synergistically with other mutations to increase the replication rate of cells. Occasional foci in Ras-gal-transduced, DEN-treated rats had extramedullary hematopoiesis. Forty % of the Ras-gal-transduced, DEN-treated rats developed unifocal HCC, mixed HCC/cholangiocarcinoma (CC), or CC at 3-6 months after transduction, suggesting that hepatocytes can develop into HCC or CC if sufficient genetic alterations occur.

Inhibition of nuclear translocation of transcription factor NF-kappa B by a synthetic peptide containing a cell membrane-permeable motif and nuclear localization sequence

To control agonist-induced nuclear translocation of transcription factor kappa B (NF-kappa B) in intact cells, cell-permeable synthetic peptides were devised. Their import into intact cells was dependent on a hydrophobic region selected from the signal peptide sequences and was verified by their inaccessibility to extracellular proteases and by confocal laser scanning microscopy. When a cell-permeable peptide carried a functional cargo representing the nuclear localization sequence of NF-kappa B p50, it inhibited in a concentration-dependent manner nuclear translocation of NF-kappa B in cultured endothelial and monocytic cells stimulated with lipopolysaccharide or tumor necrosis factor-alpha. Synthetic peptide analogues with deleted hydrophobic cell membrane-permeable motif or with a mutated nuclear localization sequence were inactive. Cell membrane-permeable peptides were not cytotoxic within the concentration range used in these experiments. These results suggest that cell-permeable synthetic peptides carrying a functional cargo can be applied to control signal transduction-dependent subcellular traffic of transcription factors mediating the cellular responses to different agonists. Moreover, this approach can be used to study other intracellular processes involving proteins with functionally distinct domains.

Metered dose inhaler and nebuliser in acute asthma

One hundred and eleven children with acute asthma were studied to compare delivery of terbutaline by either a metered dose inhaler (MDI) with a valved holding chamber or a nebuliser driven by air. Eligible patients were randomised; the MDI group received three puffs (0.75 mg) of terbutaline and the nebuliser group received 2 ml (5.0 mg) terbutaline solution diluted with 2 ml 0.9% saline for inhalation over 10 minutes. Patients were evaluated by spirometry, pulse oximetry, and clinical severity scoring system at baseline and again 15 minutes after the beginning of treatment. The baseline data of the two groups were not significantly different. All parameters of spirometry, except the peak expiratory flow (PEF) for the nebuliser group, and clinical severity score for both groups significantly improved after terbutaline treatment. Compared with the nebuliser group, the MDI group after treatment had better mean (SD) oxygen saturation (SaO2; 96.82 (1.63)% v 95.44 (1.88)%), frequency of oxygen desaturation (23.2% v 47.3%), absolute increase of PEF (32.6 (37.7) l/min v 10.2 (34.7) l/min), and SaO2 (0.54 (1.64)% v -0.47 (1.84)%). There was also a mean (SD) per cent increase of forced expiratory volume in one second (22.9 (21.0)% v 15.4 (16.1)%), PEF (27.7 (38.4)%) v 7.7 (25.1)%), and SaO2 (0.58 (1.72)% v -0.47 (1.93)%). In conclusion, aerosol treatment by MDI (with a valved holding chamber) in this study proved to be superior to nebuliser treatment in terms of SaO2 and some measurements of spirometry. Respiratory therapists working with children with severe asthma should be aware of the possibility of oxygen desaturation, especially when using room air as the driving gas for nebulisation.

Clinical evaluation of the diagnostic value of measuring IgG antibody to 3 mycobacterial antigen preparations in the capillary blood of children with tuberculosis and control subjects

SETTING

Department of Paediatrics in a University Hospital.

OBJECTIVE

To evaluate ABC-ELISA as serodiagnostic tests for tuberculosis in children.

DESIGN

An avidin-biotin-peroxidase conjugated anti-human immunoglobulin (ABC) enzyme-linked immunosorbent assay (ELISA) was established to measure serum immunoglobulin G (IgG) antibodies to polymerized old tuberculin (OT), tuberculin purified protein derivative (PPD) and the 30,000 dalton (30 kDa) native antigen of Mycobacterium tuberculosis, in 122 tuberculosis patients and 187 healthy children.

RESULTS

In those patients who had received less than 3 months of chemotherapy the sensitivities of the tests based on OT, PPD and the 30 kDa antigen were 40.3%, 50.0% and 36.1% respectively; the positive predictive values were 92.6%, 94.7% and 93.8% respectively and the negative predictive values were 58.6%, 62.9% and 57.2% respectively.

CONCLUSION

The ABC-ELISA may be useful for the diagnosis of pulmonary and extrapulmonary tuberculosis in groups of children with a high prior probability of tuberculosis. Antibodies to the 30 kDa antigen persisted longer than did those to OT and PPD.

Effects of nebulized terbutaline on oxygen saturation in acute asthmatic children

To evaluate the paradoxical effect of oxygen desaturation following beta-2 bronchodilator nebulization treatment in acute asthmatic children, a total of 47 patients, aged between 1.8 and 14 years, 27 males and 20 females, were studied. Twenty ml of nebulized normal saline (NS), followed by 10 mg (4 ml) of terbutaline sulphate solution (TSS) in 20 ml NS, were delivered by an ultrasonic nebulizer in 10 min to each patient through a connecting air tube placed in front of the nose and mouth. Oxygen saturation (SaO2) and pulse rate were monitored, using a pulse oximeter, before study and every two minutes until the end of the study. The clinical severity score and peak expiratory flow rate (PEFR) were checked before the study, at the end of inhalation of NS, and at the end of inhalation of TSS. SaO2 was increased both after nebulized NS and TSS when compared with the pre-study data (p < 0.05 and p < 0.0001, respectively). Twenty two cases (47%) during NS and 12 cases (25%) during TSS nebulization had SaO2 below the pre-study level. The mean decrease of SaO2 for the former was 1.62 +/- 0.95% (range: 1.00% to 4.26%), and 1.64 +/- 0.83% (range: 1.02% to 3.13%) for the latter (p > 0.9). No SaO2 decrease after nebulized TSS was observed in any of the seven severe asthmatic children with a prestudy SaO2 < or = 90%. The clinical severity score and PEFR were also significantly improved both after nebulized NS and TSS (p < 0.0001 and p < 0.001, respectively for NS, and both p < 0.0001 for TSS).(ABSTRACT TRUNCATED AT 250 WORDS)

[Respiratory failure after nebulized terbutaline treatment in severely wheezy infants: report of three cases]

Subjective clinical observations have suggested that nebulized bronchodilators are helpful in the treatment of some wheezy infants. Although the role of beta 2-agonists in the management of acute asthma in infants and very young children remains controversial, the use of beta 2-adrenergic agents in this age group has been widespread. beta 2-agonists nebulization continues to be the first-line treatment for acute attack of asthma, irrespective of age, in some institutes, but their uses are not without side effect especially in young wheezy infants. We report three cases of respiratory failure occurred after treatment with nebulized beta 2 bronchodilator in infants with chronic lung disease and acute wheezing. All the 3 cases were victims of prematurity. Case 1 was a case of Wilson-Mikity syndrome; case 2 was a case of bronchopulmonary dysplasia; and case 3 was a case of repeatedly wheezing infant. All 3 cases had severely wheezy dyspnea with retraction before nebulized beta 2 bronchodilator treatment. Respiratory failure was found 5 to 10 minutes after the treatment. We suggest that it must be very careful in the treatment of severely wheezy infants with beta 2-agonist nebulization, especially in cases with histories of prematurity and chronic lung disease. It is necessary to carefully monitor the vital signs of the infants during beta 2 agonist nebulization.

[The expression of C-myc, N-ras mRNA and its relations to the differentiation of preneoplastic altered hepatocytes]

The expression of C-myc and N-ras mRNA was studied in preneoplastic hepatic lesions induced by multiple small doses of diethylnitrosamine (DEN). Dot blot analysis showed that the expression of C-myc and N-ras mRNA was in elevated levels during the early stage of hepatocarcinogenesis. In situ hybridization in tissue sections demonstrated that the over-expression of C-myc and N-ras mRNA was clearly seen in some of the preneoplastic altered liver cell lesions. In comparison of these over-expressed oncogene lesions with the expression of carbamyl phosphate synthetase I (CPS I), known as a differentiation marker of hepatocytes, in serial sections revealed that almost all of the foci with over-expressed C-myc and/or N-ras mRNA also showed low expression of CPS I mRNA, which means a low differentiation nature of the liver cells. These findings suggested that the overexpression of C-myc and N-ras are closely correlated to the differentiation state of altered liver cells.

[Expression of insulin-like growth factor II mRNA and its relation to the differentiation of preneoplastic hepatocytes in rats]

Expression of insulin-like growth factor II (IGF II) mRNA was studied during the early stage of diethylnitrosamine-induced hepatocarcinogenesis in rats according to Solt-Farber's protocol. The DNA-RNA dot blot hybridization denoted that the expression of IGF II mRNA in the liver of experimental animals were 13-15 folds more than those in the normal controls, while the expression level of the uninitiated animals or the rats 24 hours after a similar 2/3 hepatectomy were similar to the normal rat's. The RNA-RNA in situ hybridization showed that the over expression of IGF II was detected in some "preneoplastic" hepatocytic foci and nodules, which was usually accompanied by altered ornithine carbamyol transferase and carbamyol phosphate synthetase I expressions, while no over expression of IGF II was seen in those foci of normal OCT and CPS I expression. Since OCT and CPS I have been used as the differentiation markers of the liver cells, it is considered that over expression of IGF II in DEN initiated liver cells is closely related to de- or aberrant differentiation of the altered hepatocytes which might play an important role in the early stage of hepatocarcinogenesis.

Enzymic activities of two-chain pepsinogen, two-chain pepsin, and the amino-terminal lobe of pepsinogen

In order to study the relationships of aspartic proteases, we have modified pepsin, a single-chain eukaryotic enzyme, to a two-chain heterodimer, which resembles aspartic proteases from retrovirus, including human immunodeficiency virus. Two fragments of pepsinogen, residues 1P-172 and 173-326, were expressed separately in Escherichia coli. Mixtures of chains were refolded from urea solutions to generate an active two-chain pepsinogen, which was converted to two-chain pepsin in acid solutions. The intramolecular and bimolecular activation constants (k1 and k2) of two-chain pepsinogen are about 1.5-fold and one-sixth, respectively, of those for pepsinogen. Structural evidence suggests that the faster k1 of two-chain pepsinogen is due to decreased interaction of the propeptide with the pepsin moiety, implying that the rate-limiting step in the intramolecular activation of pepsinogen is the "conformational dissociation" of its propeptide. Two-chain pepsin has the same Km but only one-sixth of the kcat of pepsin. Both pepsinogen chains are capable of independent refolding. The refolding of the NH2-terminal chain, which contains the propeptide and the NH2-terminal lobe, generated a small amount of proteolytic activity which is likely derived from the homodimer of the NH2-terminal lobe. It has been postulated that mammalian aspartic proteases, which contain two structurally homologous lobes, are derived in evolution from a homodimer enzyme by gene duplication and fusion (Tang, J., James, M. N. G., Hsu, I.-N., Jenkins, J. A., and Blundell, T. L. (1978) Nature 271, 618-621). The observation of the homodimer activity of the NH2-terminal lobe of pepsinogen suggests that the interface of the lobes is conservative in evolution.

The pairing of the separated A and B chains of insulin and its derivatives, FTIR studies

From the amide I bands of their deconvolved FTIR spectra, the S-thiomethyl derivatives of the insulin A, B, despentapeptide(26-30) B and desoctapeptide(23-30) B chains all contain significant amounts of ordered secondary structure. The intact B chain is considerably more ordered than either the A or the truncated B chains. Comparison of the spectra of the separated and mixed intact chains of insulin suggests further folding upon mixing of the chains leading to significant increases in ordered secondary structures, presumably because of stabilization by interaction of the chains. The interactions of the A chain with the DPI B chain appear to be weaker as compared to that with the intact B chain. The above results suggest that only the intact A and B chains contain sufficient structural information to recognize each other and interact to form a native-like structure which make the correct formation of the disulfide linkages possible.

Arboviruses as aetiological agents of encephalitis in the People's Republic of China

A serological study was undertaken to determine the role of arboviruses as etiological agents of encephalitis in the People's Republic of China (PRC). Paired sera were collected during mosquito seasons in 1988-1990 from 614 patients with possible viral encephalitis in 15 regions of PRC and tested for haemagglutination inhibiting antibodies to selected arboviruses. Seroconversions were documented to alphavirus and flavivirus antigens in 13.0 and 18.7% of patients respectively in most of the study areas. No California group seroconversion was detected. The age of alphavirus seroconvertors ranged from 2 months to 32 years and of flavivirus seroconvertors from 6 months to 50 years, with higher numbers in males. Serious central nervous system manifestations were seen more commonly in flavivirus seroconvertors. This study affirms the importance of flavivirus as causative agents of encephalitis in PRC and provides evidence that one or more alphaviruses are causing symptomatic infections with neurological involvement in PRC.

Clinical trial of corticosteroid and beta-2 bronchodilator in acute wheezing infants

To evaluate the effect of a combination of corticosteroid and beta-2 bronchodilator on acute, young, wheezing patients, a total of 80 patients, ages below 36 months who were hospitalized for this condition during the period November 1988 to March 1990 were studied. They were divided into three groups. Group A consisted of 29 cases, under 12 months old, and treated with hydrocortisone and procaterol; Group B included 23 cases, between 12 and 36 months old, treated as in Group A; Group C, of 28 cases younger than 12 months, received neither drug. The clinical severity scores for Group B were significantly more improved than Group A on days 4 and 5 (p less than 0.05 and p less than 0.05, respectively), and better than that of Group C on days 3, 4, and 5 (p less than 0.05, 0.005, and 0.05, respectively). No significant difference was found between Group A and C from days 1 to 5. The previous wheezy coughing episodes were significantly more frequent in Group B than in Groups A and C (p less than 0.05). Two-thirds of the quick responders to hydrocortisone and procaterol were 12 months old or older. The personal and family allergic history, serum IgE level, and total eosinophil count could not be used as parameter to predict responsiveness to the combined therapy of hydrocortisone and procaterol.

FTIR studies of secondary structures of bovine insulin and its derivatives

The amide I bands of the deconvolved FTIR spectrum of bovine insulin, despentapeptide (B26-B30) insulin and desoctapeptide (B23-B30) insulin in D2O solution have been assigned to alpha-helix, the 3(10) helix, irregular helix, extended chains, beta-turns and other secondary structures. From the peak areas the relative contents of these structures obtained are in general agreement with those calculated from the known structures of porcine insulin and DPI in the crystalline state. The main difference in the structure of DOI with those of insulin and DPI is the shortening of the helix segment and an extended chain for the C terminal segment in the B chain.

Mapping the receptor-recognition site of human transforming growth factor-alpha

The receptor-recognition site human transforming growth factor-alpha (TGF alpha), a 50-residue tricyclic peptide with three disulfide bonds, was mapped by a set of 46 peptide analogs consisting of linear, monocyclic, bicyclic, and tricyclic structures representing individual and overlapping subdomains of human TGF alpha. Linear overlapping fragments ranging from 7 to 18 residues and spanning the entire length of TGF alpha as well as monocyclic analogs with one disulfide linkage were found to be inactive in both receptor-binding and mitogenic assays. Bicyclic analogs with two disulfide linkage and representing either the amino or carboxyl two-thirds of TGF alpha showed low activity at 0.1-0.9 mM concentrations. Tricyclic analogs containing all three disulfide linkages but lacking either the amino or carboxyl terminal heptapeptide was, respectively, 3% and 0.1% as active as TGF alpha. These results show that determinants for the receptor binding cannot be represented by a short continuous fragment or a single subdomain, but are located on a discontinuous surface on a folded structure with disulfide restraints. Furthermore, these results when combined with our previous results which shows that the middle subdomain (second disulfide loop) is not involved in the receptor binding suggest that the receptor-binding residues are constituted of three fragments located at the first and third subdomains as well as the external carboxyl peptide.

Serologic survey of spotted fever group rickettsiosis on Hainan Island of China

A serosurvey for antibodies to Rickettsia japonica was conducted on Hainan Island of China. Serum specimens were collected from 1,030 outpatients at hospitals in different parts of the island regardless of their diagnosis. Only two among 538 serum specimens collected in Baoting and Tongshi counties, located in the southern part of the island, were demonstrated to contain antibodies reactive with R. japonica at a high dilution. The specimens also reacted with R. rickettsii at the same titer as with R. japonica. These two specimens reacted with other pathogenic spotted fever group (SFG) rickettsiae to a lesser extent. On the other hand, the specimens were shown to possess antibodies reactive with R. typhi at a significantly lower dilution or were not reactive at all. The findings suggested the occurrence of an SFG rickettsiosis on Hainan Island. More than half of the serum specimens collected from patients with suspected rickettsial infections in the southern area were found to contain IgM and IgG antibodies to R. typhi, indicating a high incidence of murine typhus.

Synthesis and structure-activity study of myxoma virus growth factor

Myxoma virus growth factor (MGF) is an 85-residue peptide derived from the gene product of a DNA tumor virus that infects rabbits. The carboxyl domain of MGF possesses about 40% sequence homology with the epidermal growth factor (EGF). This EGF-like domain covering residues 30-83 was synthesized and found to possess putative activities of EGF. It was, however, about 200-fold less active than EGF in the competitive binding of EGF receptor in A431 cells and the stimulation of [3H]-thymidine uptake in NRK 49F cells. MGF(30-83) is a basic and a hydrophobic peptide rich in beta-sheet structure. These features in MGF tend to promote aggregation, leading to precipitation even in strongly denaturing solutions. Thus, the refolding of MGF was achieved with difficulty and resulted in low yield. To increase the synthetic yield of MGF(30-83), a cluster of acidic amino acids was added to the NH2-terminus of MGF(30-83). This approach was found to be effective in minimizing the refolding difficulties and allowed accessibility to the synthesis of analogues in this class of compounds. The relationships of structure and function of MGF were studied by using analogues with point substitution by the corresponding D-amino acid or by Ala at position 44 or 52 and analogues with deletion of basic residues from the amino terminus. Modifications of both the receptor contact and the structural residues greatly reduced the potency of MGF(30-83), and the overall result correlated well with the known structure-activity of the EGF family.

A soluble protein related to the HER-2 proto-oncogene product is released from human breast carcinoma cells

Amplified expression of p185HER-2, the protein product of the HER-2/neu proto-oncogene, appears to be involved in carcinogenesis of human mammary epithelial cells. Our data suggest that an extracellular 130 Kda glycoprotein released from breast carcinoma cells may be related to the ectodomain of p185HER-2: (1) Both cellular p185HER-2 and extracellular p130, when reduced and alkylated, reacted with antipeptide antibody against the N-terminus of the HER-2 protein [alpha N(HER-21)] and reactivity was blocked by cognate peptide; (2) Neither p130 nor other extracellular proteins reacted with antiserum against the C-terminus of p185HER-2 [alpha C(HER-2)]; (3) Partial proteolysis of p185HER-2 generated an immunoreactive fragment of 130 kDa that was similar to extracellular p130; (4) Both p130 and p185HER-2 contained carbohydrate that bound to Con-A Sepharose; (5) The amount of p130 released from breast cells corresponded to the levels of expression of cellular p185HER-2. Release of the ectodomain of p185HER-2 from breast carcinoma cells may be involved in their malignant growth and may be a useful marker for assessing the expression of p185HER-2 in human tumors.