[Association between short-term exposure to ambient nitrogen dioxide and the risk of heart failure hospitalization]

Objective: To assess the association between short-term exposure level of nitrogen dioxide and the hospitalization risk of heart failure. Methods: Based on China-PEACE Retrospective Heart Failure Study, 117 364 hospitalized patients with heart failure were recruited from 92 hospitals in 62 cities throughout China between January 1, 2015 and December 31, 2015. The daily exposure level of nitrogen dioxide, temperature, and humidity in the same cities during the same period were also collected. We applied the generalized additive model and Bayesian hierarchical model to quantify the lagged effect and cumulative effect of short-term (0-3 days) exposure to ambient nitrogen dioxide on the hospitalization risk of heart failure. We further conducted stratified analyses by age, region, and season to identify any difference in the associations between short-term nitrogen dioxide exposure and heart failure among subgroups. Results: The mean age for participants in the analysis was (70.32±12.22) years. The median, minimum and maximum of daily nitrogen dioxide concentration in 62 cities from January 1, 2015 to December 31, 2015 was 26.4 μg/m³, 2.33 μg/m³ and 150.25 μg/m³, respectively. The exposure level of nitrogen dioxide at the same day was associated with the hospitalization risk of heart failure (OR=1.022, 95%CI: 1.012, 1.031). Significant effects were also observed in the moving average concentrations from lag 0-1 to lag 0-3 day (OR=1.020, 95%CI: 1.009, 1.030; OR=1.016, 95%CI: 1.004, 1.028; OR=1.013, 95%CI: 1.001, 1.026). Moreover, all of the associations between short-term exposure to nitrogen dioxide and the risk of heart failure hospitalization were statistically significant, with no significant difference in all subgroups stratified by age, region, and season. Conclusion: A higher level of short-term exposure to nitrogen dioxide could trigger more hospitalizations with heart failure.

Integrative analysis of the characteristics of lipid metabolism-related genes as prognostic prediction markers for hepatocellular carcinoma

OBJECTIVE

Dysregulated lipid metabolism has been reported in the progression of hepatocellular carcinoma (HCC). In the present study, we investigated the molecular characteristics of lipid-metabolism-related genes (IMRGs) as prognostic markers for HCC.

MATERIALS AND METHODS

Multi-dimensional bioinformatics analyses were performed to comprehensively analyze IMRGs, and to construct prognostic prediction signatures.

RESULTS

Data of 770 HCC patients and their corresponding 776 IMRGs were downloaded from three databases. Patients were classified into 2 molecular clusters that were associated with overall survival, clinical characteristics, and immune cells. The biological functions of the IMRGs differentially expressed between the 2 clusters were associated with tumor-related metabolic pathways. A 6 IMRG signature (6-IS), consisting of FMO3, SLC11A1, RNF10, KCNH2, ME1, and ZIC2, was established as an independent prognostic factor for HCC. The performance of the signature of 6-IS prognostic was verified in a validation set and compared to an external data set. It was revealed that the 6-IS could effectively predict the prognosis of patients with HCC.

CONCLUSIONS

This study provides new insights into the role of IMRGs in the pathogenesis of HCC, and presents a novel signature (6-IS) to predict the prognosis of HCC.

Effects of Glycyrrhiza polysaccharide in diet on growth performance, serum antioxidant capacity, and biochemistry of broilers

In the present study, we analyzed the effects of Glycyrrhiza polysaccharide (GCP) on growth performance, serum antioxidant capacity, and biochemistry of broilers. A total of 600, one-day-old AA broilers randomly divided into 5 treatment groups with 6 replicate pens of 20 birds per cage received dietary supplementation with GCP (0, 200, 500, 1,000, and 1,500 mg/kg) for 42 d. The supplementation of GCP linearly decreased (P < 0.05) feed conversion rate on day 22 to 42. Dietary supplementation with GCP reduced (P < 0.05) serum total cholesterol on day 21 and 42 and linearly improved (P < 0.05) albumin and high-density lipoprotein cholesterol. Dietary supplementation with 1,000 or 1,500 mg/kg GCP significantly increased (P < 0.05) serum total superoxide dismutase (T-SOD) activity on day 21 and 42 and reduced (P < 0.05) serum malondialdehyde content on 21 d. Dietary supplementation with 1,000 or 1,500 mg/kg GCP significantly improved (P < 0.05) interleukin-1β (IL-1β) and interferon-γ (IFN-γ) expressions in liver on day 21 and 42. At the end of the experiment, we randomly selected 20 broilers from 3 treatment groups (0, 1,000, and 1,500 mg/kg), respectively, to perform an lipopolysaccharide (LPS)-induced acute stress experiment. The 60 broilers were divided into 6 treatment groups with 10 birds per cage. The experiment was designed as a 3 × 2 factorial arrangement with GCP (0, 1,000, or 1,500 mg/kg) and LPS (injection of saline or 1 mg/kg body weight) levels as treatments. When the grouping was finished, the broilers were immediately intraperitoneally injected with LPS or normal saline. Six hours after challenged, serum antioxidant and liver immunity were analyzed. The results showed that dietary GCP prevented LPS-induced reductions in T-SOD activity and increases in malonaldehyde content (P < 0.05). Also, dietary GCP supplementation mitigated the LPS-induced increase in IL-1β and IFN-γ in the liver. Supplementation with 1,500 mg/kg GCP showed the most optimal effect in broilers. GCP has the potential to be used as feed additive in broilers.

[The efficacy of sublingual specific immunotherapy in children with allergic rhinitis]

Objective:To investigate the efficacy of single-allergen sublingual immunotherapy (SLIT) in children with allergic rhinitis and the potential relationship between sensitization status and efficacy and analyze the possible relationships between sensitized state and clinical efficacy. Method:One hundred and thirty children, aged 4-15 years old, with mites-induced respiratory allergic diseases had been arranged into the treatment group (n=70) or control group (n=50) and received SLIT with standardized dermatophagoides farinae extracts and pharmacotherapy for 1 year. Rhinitis and asthma symptoms and medications, visual analogue scale (VAS), skin prick test (SPT) and peak expiratory flows (PEF) were evaluated. After treatment, patients in the poly-sensitized group who completed the study had been analyzed as subgroup 1 (n=33) and subgroup 2 (n=37) according to the number of coexist allergens. Result:The global clinical parameters had been significantly improved after treatment. The treatment and control group rhinitis symptom score, symptomatic medication score and VAS scores were significantly reduced after 52 weeks treatment (all P<0.05). SLIT group dust mite grade skin reactions decreased after 52 weeks treatment (P<0.05). Dust mite skin reactions grade was greater than before treatment in the control group (P>0.05). Between the two groups, SLIT group rhinitis symptom score at 24 weeks, 36 weeks, 52 weeks were lower than the control group, the difference was statistically significant (P<0.05). SLIT group symptomatic medication score and VAS scores at 36 weeks and 52 weeks compared with the control group, the difference was statistically significant (P<0.05). Dust mite SLIT group grade skin reactions grade was lower than the control group at 52 weeks, the difference was statistically significant (P<0.05). In addition to the 36 weeks poly-sensitized group symptoms of allergic rhinitis score was lower than mono-sensitized group (P＜0.05) and at 24 weeks poly-sensitized group VAS score was lower than single allergy group (P<0.05), the comparison between subgroup 1 and subgroup 2 indicated that, there was no significant difference in symptoms scores, SPT, PEF and VAS at each scheduled follow-up visit. Conclusion:This study shows that SLIT can significantly reduce rhinitis symptoms and drug use, and improve the children with allergies. An equivalent efficacy of single-allergen SLIT is found in poly-sensitized and mono-sensitized children. The number of coexist positive allergens has a limited impact on the efficacy from a long-term perspective.

[A case of esophageal tracheal fistula caused by button cell]

Summary Button batteries are a common emergency in children with esophageal foreign bodies, which need to be removed in time,otherwise serious complications will occur. This article reports a case of esophageal tracheal fistula caused by button cell. It is helpful for differential diagnosis and clinical treatment of esophageal foreign bodies in children caused by button cell.

[Analysis of related factors of coins foreign bodies crossing the esophagus in 204 cases of children]

Objective:To analyze the related factors of coins crossing the esophagus by themselves in children. Method:Two hundred and four cases with coin esophageal foreign bodies in our hospital from April 2016 to June 2017 were selected,the sex, age, size and texture of foreign body and the time of foreign body insertion were analyzed.Result:Of the 204 children, 46 had esophageal foreign bodies falling off the digestive tract below the esophagus,44 cases were discharged by themselves，2 children were removed under digestive endoscopy，1 coins formed diverticulum at the entrance of esophagus.Conclusion:Coins pass over the esophagus, basically seen within 24 hours，unrelated to age，sex or coin size，but related to the quality of the coin.

[The prenatal genetic diagnosis of a family with complete androgen insensitivity syndrome]

Objective: To identify the Androgen Receptor (AR) gene mutation of one family with complete androgen insensitivity syndrome (CAIS) and to establish the methods of prenatal genetic diagnosis for CAIS. Methods: The AR gene exons of the family were amplified by PCR and sequenced directly. Linkage analysis was performed by using the CAG repeats in the exon1 of AR gene to assure accuracy of the prenatal diagnosis. Results: We found a frameshift mutation c. 2546del A (p. Asn849Ile fsX34) in the exon7 of AR gene in the proband.The mutation had not been reported before.The mother of the proband went through two times prenatal genetic diagnosis for her next pregnancies, both fetuses were male and did not get the mutation.The results of the linkage analysis were consistent with the sequencing results. Conclusion: A novel AR mutations in a CAIS family have been confirmed. The method of prenatal genetic diagnosis was established, and worked effectively in the CAIS family.

Inhibition of miR-141 reverses cisplatin resistance in non-small cell lung cancer cells via upregulation of programmed cell death protein 4

OBJECTIVE

MicroRNAs are a class of essential regulators in cancer, and previous studies have shown that miR-141 is a tumor suppressor in non-small cell lung cancer (NSCLC). However, it is still unknown whether it regulates chemosensitivity. We aimed to investigate the role of miR-141 in cisplatin resistance in NSCLC cells.

MATERIALS AND METHODS

MiR-141 expression in A549 and A549/DDP cell lines have been quantified by real-time PCR. Protein level of PDCD4 and caspase-3 have been determined by Western blot analysis. Drug sensitivity and apoptosis have been determined by MTT assay and TUNEL assay, respectively. Luciferase activity assay was employed to validate the relationship between 3'UTR of PDCD4 mRNA and miR-141.

RESULTS

We observed that miR-141 expression was significantly up-regulated in cisplatin-resistant A549/DDP cells compared with the parental cell line A549; and PDCD4, an important apoptosis regulator, was found to be down-regulated. Luciferase activity assay and Western blot analysis confirmed that PDCD4 is a direct target of miR-141. Inhibition of miR-141 in A549/DDP cells markedly increased cisplatin sensitivity and apoptosis, which was partially abrogated by PDCD4 inhibition, indicating that PDCD4 is a functional target of miR-141 in of the regulation of cisplatin sensitivity.

CONCLUSIONS

Our data showed that miR-141 participates in regulating cisplatin sensitivity in non-small lung cancer cells via PDCD4 inhibition, and suppression of miR-141 might be a therapeutic method to overcome cisplatin resistance in clinical practice.

Hemerythrin is required for Aeromonas hydraphlia to survive in the macrophages of Anguilla japonica

Survival in host phagocytes is an effective strategy for pathogenic microbes to spread. To understand the mechanisms of Aeromonas hydrophila survival within host macrophages, a library of mini-Tn10 transposon insertion mutants was constructed. The M85 mutant, whose survival in host macrophages was only 23.1% of that of the wild-type (WT) strain, was utilized for further study. Molecular analysis showed that a 756-bp open reading frame (ORF) (GenBank accession No. CP007576) in the M85 mutant was interrupted by mini-Tn10. This ORF encodes for a 183-amino acid protein and displays the highest sequence identity (99%) with the hemerythrin (Hr) protein of A. hydrophila subspecies hydrophila ATCC 7966. The survival of the WT, M85 mutant, and complemented M85 (Hr) strains were compared in host macrophages in vitro, and the results showed that M85 exhibited defective survival, while that of M85 (Hr) was restored. To investigate the possible mechanisms of A. hydrophila survival in host macrophages, the expression of Hr under hyperoxic and hypoxic conditions was evaluated. The results revealed that the expression of this protein was higher under hyperoxic conditions than under hypoxic conditions, which indicates that Hr protein expression is sensitive to O2 concentration. Hydrogen peroxide sensitivity tests further suggested that the M85 mutant was more sensitive to oxidative stress than the WT and M85 (Hr) strains. Taken together, these results suggest that the Hr protein may act as an O2 sensor and as a detoxifier of reactive oxygen species, and is required for A. hydrophila survival within host macrophages.

Adult diaphyseal both-bone forearm fractures: A clinical and biomechanical comparison of four different fixations

BACKGROUND

Although there have been a small number of studies reporting single bone fixation of either radius or ulna as well as hybrid fixation, the paucity of data for the hybrid fixation method still remains.

HYPOTHESIS

Hybrid fixation with plate and IM nailing would achieve good fixation and functional outcome, minimal damage to soft tissues and lower re-fracture risk.

MATERIALS AND METHODS

Forty cadavers (20 males, 20 females; mean age 68.06, SD 1.58years) were selected in biomechanical study under axial loading, bending loading, and torsional loading. Eighty-seven patients (47 males, 40 females; mean age 38.03±0.88years) were enrolled in the clinical study and randomly received different fixation: both-bone plate fixation or both-bone intramedullary nailing, plate fixation of ulna and intramedullary nailing of radius and intramedullary nailing of ulna and plate fixation of radius.

RESULTS

In the biomechanical study, intramedullary nailing of ulna and plate fixation of radius had similar results with that using both-bone plate method under axial, bending and torsional loading (All P>0.05), suggesting the more stable fixation compared with the other two groups (All P<0.05). In clinical research, both-bone intramedullary nailing was related to shortest operative time, smallest wound size and periosteal stripping area compared with other three groups (P<0.05). Patients receiving intramedullary nailing of ulna and plate fixation of radius showed the lowest incidence of postoperative complications and the best functional recovery outcome comparing with other three groups of patients (Both P<0.05).

CONCLUSION

The hybrid fixation method of intramedullary nailing of ulna and plate fixation of radius showed good stability in biomechanics, fewer complications and better functional clinical outcomes.

LEVEL OF EVIDENCE

Level II, prospective randomised study.

Influence of water chemistry and dissolved organic matter (DOM) molecular size on copper and mercury binding determined by multiresponse fluorescence quenching

The effects of water chemistry (i.e. pH and Ca(2+) concentration) dissolved organic carbon (DOC) concentration) and DOM quality (i.e. composition and molecular weight) on metal complexation were successfully investigated by a combination of tangential flow filtration, excitation-emission matrix fluorescence, parallel factor analysis (PARAFAC), and fluorescence quenching on four freshwater samples and one extracted Suwannee River fulvic acid (SRFA). Two terrestrial and one microbial humic-like components were found in this study. Despite strong correlation between the Ryan-Weber model and the multiresponse model, the latter is more appropriate for the calculation of binding parameters in multiple-ligand DOM system. Decreasing pH from 6 to 4 significantly reduced logK-Cu(2+) from 5.22±0.24 to 4.60±0.30 at pH 6 and 4, respectively (p<0.001), while the impacts of Ca(2+) and DOC were not discernible at concentrations<100ppm and<2.06ppm, respectively. For natural freshwater DOM binding, the three humic-like components had similar logK values for both metals. High molecular weight (>1kDa) DOM generally had higher logK and binding fluorophore abundance than bulk (unfractionated) and low molecular weight (<1kDa) DOM for both metals. This trend however was not always true for Hg(2+) where the binding parameters were quite variable. Overall the combined results provide evidence that binding parameters are not only affected by water chemistry, but also depend on DOM molecular weight.

Valproate versus diazepam for generalized convulsive status epilepticus: a pilot study

BACKGROUND AND PURPOSE

Evidence-based data to guide the management of status epilepticus (SE) after failure of primary treatment are still scarce and the alternate needs to be found when phenytoin (PHT) is not available or contraindicated. Comparison of intravenous (IV) valproate (VPA) and diazepam (DZP) infusion has not been conducted in adults with SE. This prospective randomized controlled trial is thus designed to evaluate the relative efficacy and safety of IV VPA and continuous DZP infusion as second-line anticonvulsants.

METHODS

After failure of first-line anticonvulsants treatment, patients with generalized convulsive status epilepticus (GCSE) were randomized to receive either IV VPA or continuous DZP infusion. Primary outcome was the proportion of patients with effective control. Side effects were also evaluated.

RESULTS

There were 66 cases enrolled, with the mean age of 41 ± 21 years. Seizure was controlled in 56% (20/36) of the DZP group and 50% (15/30) of the VPA group (P = 0.652). No patient in the VPA group developed respiratory depression, hypotension, or hepatic dysfunction, whereas in the DZP group, 5.5% required ventilation and 5.5% developed hypotension. Time (hour) for regaining consciousness after control was near-significantly longer in the DZP group [13(3.15-21.5)] than in the VPA group [3(0.75-11)] (P = 0.057). Virus encephalitis and long duration of GCSE were independent risk factors of drug resistance.

CONCLUSIONS

  Both IV VPA and continuous DZP infusion are effective second-line anticonvulsants for GCSE. IV VPA was well tolerated and free of respiratory depression and hypotension, which may develop in the DZP group. Outcome parameters were not significantly different between groups.

Inflammatory pseudotumoural endotracheal mucormycosis with cartilage damage

Mucormycosis is a rare opportunistic infection usually associated with immunosuppression, diabetes mellitus or haematological malignancy. Herein, we report an unusual case of mucormycosis in a 46-yr-old male patient with diabetes presenting with an endotracheal mass obstructing the trachea and cartilage damage. Histological examination of the bronchoscopy biopsy specimens revealed invasive mucormycosis. The patient was treated with intravenous amphotericin B followed by removal of the lesion via bronchoscopy.

Effects of the preparation methods of hydroxypropyl methylcellulose/polyacrylic acid blended films on drug release

Hydroxypropyl methylcellulose (HPMC)/polyacrylic acid (PAA) blended films were prepared under different conditions (i.e. temperature, solvent, and cross-linking agent). The effects of hydrogen-bonding interactions or a chemical reaction between the two-component polymers in the blended films on drug release were studied. Two model drugs were used for comparison: a water-soluble drug, dl-propranolol hydrochloride, and a lipophilic drug, ketoprofen. The H-bonding interaction of HPMC/PAA was found to be stronger in the blended films prepared from H2O than that from H2O/EtOH. However, the H-bonding effect between HPMC and PAA on drug release is indistinct. Chemical esterification of the carboxylic acid groups of PAA with the hydroxyl groups of HPMC was proposed from the solid-state NMR, ESCA, and FTIR studies when the blended films were dried at 110 degrees C. This chemical reaction also resulted in insolubilization of the blended films.

Recycling and reuse of wastewater from a new-developed community using sand filtration, ultrafiltration, and ozonation

In this study, the pilot apparatus combined with sand filtration, ozonation and ultrafiltration was established. Wastewater from the secondary treatment effluent in the new-developed community was taken as the sample for looking into the feasibility of domestic wastewater reuse and recycling. The test results by sand filtration, sand filtration/ultrafiltration, sand filtration/ozonation, and sand filtration/ultrafiltration/ozonation were compared for looking for appropriate treatment processes applied in the domestic wastewater reuse and recycling. Finally, cost analysis was carried out and sand filtration/ozonation process was suggested to be one of the best processes. The total cost is about 0.1-0.32 USD dollars per cubic meter of produced water by considering the capital and operation cost for five years in the small domestic wastewater treatment plant (50-750 CMD).

Synthesis and properties of a naproxen polymeric prodrug

A water-soluble polymeric prodrug containing a naproxen moiety was synthesized. The carboxylic groups of naproxen were condensed with the hydroxyl groups of 2-hydroxyethyl methacrylate (HEMA) to produce a drug-linked monomer, denoted HN. The polymeric prodrug was prepared by copolymerization of HN with methacrylic acid. The molar percentage of HN in the polymeric prodrug was 26 mol%, as determined by 1H NMR. To investigate the pertinence of this polymeric prodrug, the hydrolysis was studied in-vitro with or without esterase or lipase. The kinetics of enzymatic catalysis was calculated from a Lineweaver-Burk plot. The anti-inflammatory activity was evaluated using the carrageenan-induced oedema test. The polymeric prodrug released a major fraction of the free naproxen and a significant fraction of the hydroxyethyl ester derived-naproxen. The maximum hydrolysis rate Vmax, and the Michaelis constant Km were calculated to be 2.16 x 10(-5) equiv. mol L-1 min-1 and 5.11 x 10(-2) equiv. mol L-1. The maximum anti-inflammatory inhibition of free naproxen appeared at 2 h and quickly decreased thereafter. In contrast, the polymeric prodrug showed a maximum at around 2-3 h and then slowly decreased. This indicates that the polymeric prodrug displays greater potency than free naproxen in the inhibition of acute inflammatory processes over long periods.

Ozonation of domestic secondary effluent for recycling and reuse--a pilot plant study

In this study, a pilot plant combined ozonation with sand filtration is established. Wastewater from the secondary effluent was taken as the sample for looking into the feasibility of domestic wastewater recovery and recycling. At the beginning, a series of hydraulic analysis and ozone transfer tests was conducted in the bubble column reactor. From these tests, it was found that when the gas flow is controlled to within 0.2 to approximately 1.0 L/min and liquid flow within 0.5 to approximately 2.5 L/min, using series connected mixing tank model for our calculation, the result J (CSTR) is 1 to approximately 2. From the ozone transfer test it is known that the smaller the gas flow, the better the transfer rate, and the same pattern occurs on ozone gas concentration. After sand filtration and ozone treatment, the G/L ratio within the ozone column reactor can be maintained within 0.2 to approximately 0.4 and the ozone dosage within 8 to approximately 12 mg/L. The removal rate for coliform bacillus, BOD, turbidity and color is 99.96%, 62.2%, 89.6% and 67% respectively. After ozonation treatment, coliform bacillus content can be controlled under 10 CFU/mL, BOD under 10 mg/L, turbidity within 2.0 to approximately 2.5 (NTU), and color within 10.3 to approximately 13.7 degree. The recycled water is almost colorless and odorless, and is capable of reaching the reference standard for recycled water.

Study of cytochrome P4502E1 mRNA level of mononuclear cells in patients with alcoholic liver disease

BACKGROUND

Cytochrome P-4502E1 (CYP2E1) is an important enzyme because of its unique ability to convert many substrates to cytotoxins. The increased production of reactive intermediates by elevated enzyme concentrations leads to various pathological conditions. Therefore, it is important to detect induced CYP2E1 levels in alcoholic individuals to avoid xenobiotic-promoted liver injury. In the present investigation, we detected CYP2E1 mRNA levels of mononuclear cells obtained from 10 ml of blood by using competitive polymerase chain reaction (PCR) method.

METHODS

Mononuclear cells were obtained from healthy individuals who did and did not drink habitually and patients with alcoholic liver disease (ALD). Complementary DNA synthesis was performed with RNA obtained from mononuclear cells by reverse transcription-PCR. Competitive PCR of CYP2E1 was performed with the sense (5'-CTGCAACGTCATA-GCCGACA-3') and antisense (5'-TCCATTTCCACGAGCAGGCA-3') primer and competitor DNA. Competitive PCR of beta-actin also was performed. Electrophoresis was scanned, and each band was digitized. The concentration of CYP2E1 and beta-actin mRNA was calculated from the ratio of competitor DNA.

RESULTS

In healthy individuals who did and did not drink habitually, CYP2E1 mRNA levels were 103.3 copies/microl RNA and 101.7 copies/microl RNA, respectively. In actively drinking patients with ALD, CYP2E1 mRNA levels were 103.5 copies/microl RNA, but those levels decreased to 101.7 copies/microl RNA after 4 days of abstinence. No significant difference was observed in CYP2E1 mRNA levels between alcoholic fibrosis and cirrhosis. As control, we measured beta-actin mRNA levels in mononuclear cells in all samples. The mean value of beta-actin mRNA was 104.3 copies/microl RNA in all cases, which included patients with ALD.

CONCLUSIONS

The results demonstrated that it is possible to measure the CYP2E1 mRNA levels of mononuclear cells in a 10 ml blood sample. The CYP2E1 mRNA level in mononuclear cells increases during drinking and decreases in abstinence for a short period of 3 to 4 days. It is concluded that CYP2E1 mRNA level may be used as an effective marker for alcoholic intake.

[Tetrandrine loaded sustained-release microcapsules for lung targeting]

AIM

To prepare lung targeted tetrandrine (TET) loaded sustained-release drug delivery system by microencapsulation, decrease the toxicity and enhance the therapeutic function of anti-pulmonary hypertension of TET.

METHODS

Albumin microcapsules were produced by spray drying-thermal denaturation, a new technique. Some characterization of the prepared microcapsules was evaluated. Distribution of the microcapsules and their anti-pulmonary hypertension effect in vivo were investigated.

RESULTS

The spherical microcapsules showed a drug loading of 37.88%. Compared to the original drug, the rate of TET released from the positively charged microcapsules in vitro was significantly decreased and fitted well by Higuchi equation. The TET concentrations in mouse lungs of TET microcapsules were significantly higher than those of TET injection, and the mean retained time of TET in lungs was prolonged from 157.1 h to 223.6 h after microencapsulation. The in vitro--in vivo correlation was established and confirmed (P < 0.001).

CONCLUSION

The new spray drying-thermal denaturation method allows the preparation of drug loaded albumin microcapsules with desired results. The prepared microcapsules were found to have the potential function of delivering TET to pulmonary artery via i.v., with low toxicity and high efficacy.

Isolation, purification, and characterization of a killer protein from Schwanniomyces occidentalis

The yeast Schwanniomyces occidentalis produces a killer toxin lethal to sensitive strains of Saccharomyces cerevisiae. Killer activity is lost after pepsin and papain treatment, suggesting that the toxin is a protein. We purified the killer protein and found that it was composed of two subunits with molecular masses of approximately 7.4 and 4.9 kDa, respectively, but was not detectable with periodic acid-Schiff staining. A BLAST search revealed that residues 3 to 14 of the 4.9-kDa subunit had 75% identity and 83% similarity with killer toxin K2 from S. cerevisiae at positions 271 to 283. Maximum killer activity was between pH 4.2 and 4.8. The protein was stable between pH 2.0 and 5.0 and inactivated at temperatures above 40 degrees C. The killer protein was chromosomally encoded. Mannan, but not beta-glucan or laminarin, prevented sensitive yeast cells from being killed by the killer protein, suggesting that mannan may bind to the killer protein. Identification and characterization of a killer strain of S. occidentalis may help reduce the risk of contamination by undesirable yeast strains during commercial fermentations.

Formation of 20-hydroxyeicosatetraenoic acid, a vasoactive and natriuretic eicosanoid, in human kidney. Role of Cyp4F2 and Cyp4A11

20-hydroxyeicosatetraenoic acid (20-HETE), an omega-hydroxylated arachidonic acid (AA) metabolite, elicits specific effects on kidney vascular and tubular function that, in turn, influence blood pressure control. The human kidney's capacity to convert AA to 20-HETE is unclear, however, as is the underlying P450 catalyst. Microsomes from human kidney cortex were found to convert AA to a single major product, namely 20-HETE, but failed to catalyze AA epoxygenation and midchain hydroxylation. Despite the monophasic nature of renal AA omega-hydroxylation kinetics, immunochemical studies revealed participation of two P450s, CYP4F2 and CYP4A11, since antibodies to these enzymes inhibited 20-HETE formation by 65. 9 +/- 17 and 32.5 +/- 14%, respectively. Western blotting confirmed abundant expression of these CYP4 proteins in human kidney and revealed that other AA-oxidizing P450s, including CYP2C8, CYP2C9, and CYP2E1, were not expressed. Immunocytochemistry showed CYP4F2 and CYP4A11 expression in only the S2 and S3 segments of proximal tubules in cortex and outer medulla. Our results demonstrate that CYP4F2 and CYP4A11 underlie conversion of AA to 20-HETE, a natriuretic and vasoactive eicosanoid, in human kidney. Considering their proximal tubular localization, these P450 enzymes may partake in pivotal renal functions, including the regulation of salt and water balance, and arterial blood pressure itself.

Clinical significance of hepatitis GB virus C infection in alcoholic liver disease

Recently, hepatitis GB virus C (HGBV-C) has been recovered from patients with non-A-E hepatitis. However, it has been unclear whether HGBV-C may be related to the development of alcoholic liver disease (ALD) or not. In this study, we determined HGBV-C RNA in sera from alcoholic patients without markers for hepatitis C and B viruses to evaluate the role of HGBV-C in ALD. Serum samples were obtained from 68 patients with ALD and 40 nonalcoholic patients with chronic type C liver disease. HGBV-C RNA was detected in only 3 of 68 (4.4%) patients with ALD, in 2 of 27 patients with hepatic fibrosis, and in 1 of 5 patients with chronic hepatitis. There was no HGBV-C RNA in sera from patients with fatty liver, alcoholic hepatitis, or cirrhosis. Serum levels of AST, ALT, and gamma-glutamyltranspeptidase in alcoholic patients with, as well as without, HGBV-C RNA decreased to normal levels after abstinence. In addition, an inflammatory change was not observed in liver biopsy specimens obtained from two HGBV-C-positive patients with alcoholic hepatic fibrosis. Our results clearly suggest that the prevalence of HGBV-C infection in patients with ALD is rare and that HGBV-C may not play an important role in the development of liver disease in alcoholics.

Intravenous pretreatment of hypertonic saline can prevent systemic hypotension induced by spinal anesthesia

BACKGROUND

Hypertonic saline improves organ perfusion and patient survival during hemorrhagic shock because it expands plasma volume and increases tissue oxygenation. Its beneficial results have been reported in patients suffering from hypotension during spinal anesthesia. The purpose of this study was to compare the influence between prehydration with 3% hypertonic saline and with isotonic lactated Ringer's solution on the hemodynamic changes and serum electrolyte concentrations in patients undergoing spinal anesthesia.

METHODS

Sixty ASA class I patients scheduled for herniorrhapy under spinal anesthesia were assigned randomly into two groups. Group 1 = patients were prehydrated with isotonic lactated Ringer's solution at 7 mg/kg (n = 30); Group 2 = patients were given prehydration with 3% hypertonic saline at 7 ml/kg (n = 30). Following prehydration, arterial blood pressure and heart rate were recorded and serum electrolyte concentrations were measured.

RESULTS

The incidence of hypotension was 17/30 (57%) in the isotonic lactated Ringer's solution group as against 7/30 (23%) in the hypertonic saline group (p < 0.05). There was no significant difference between two groups in relation to the level of anesthesia or maximal heart rate, and electrolyte imbalance did not occur in either group.

CONCLUSIONS

Prior to spinal anesthesia, hydration with small amount of hypertonic saline is effective to minimize hypotension associated with spinal anesthesia. If so administered it would not increase bodily sodium load and unlike isotonic crystalloid solution it dose not cause accumulation of water in the body on equipollent basis.

[Clinical application of the forced inspiratory volume-time curve. A preliminary study]

The forced inspiratory volume-time curve in 25 health subjects with normal ventilation function and 25 patients with COPD were determined, and MMIF, FIV were calculated from the curves. The PImax was measured in the same 50 subjects by modified Blac method sequentially. A close relationship between MMIF, FIV and PImax was found. This result indicated that MMIF and FIV could be indeed for evaluation of strength of respiratory, muscles. Additional observations of MMIF, FIV and PImax in 50 patients with COPD before and after inotropic drugs, aminophylline and CNB, further proved the validity of MMIF and FIV.

[The diagnostic value of transbronchial needle aspiration in patients with extrabronchial bronchogenic carcinoma]

Tissue pathologic and cytologic examination of 47 cases with suggestive extrabronchial bronchogenic carcinoma using the four technics of transbronchial needle aspiration (TBNA), bronchial biopsy, brushing and washing through the fiberoptic bronchoscopy were reported. For any one case, any one or more of the above said technic showed positivity will be regarded as positive case. The results showed that the total positive rate was 82.9%. The diagnostic rate of using TBNA alone was 68.1% that of bronchial biopsy 63.8% and bronchial brushing 70.2% (P > 0.05), but obviously higher than the bronchial washing (34.0%) (P < 0.05). Thus the deficiency of any one above said technic will be complemented by one of the other technics. The results also showed that TBNA is especially suitable for use in the squamous and small cell types of lung cancer. Complications of pneumothorax or bleeding were not found with the TBNA technic. We, therefore, recognize that the TBNA is one of a high positive rate, easily performed and with few complications diagnostic technic for extrabronchial bronchogenic carcinoma, and it should be recommended for clinical application.

[The diagnosis of smear negative pulmonary tuberculosis in superior segment of lower lobe]

20 cases of tuberculosis in the superior segment of the lower lobe of the lung were misdiagnosed as lung cancer, pneumonia, bronchiectasis and inflammatory pseudoneoplasm were reported. The final diagnosis were confirmed by fiberoptic bronchoscopy (FOB). The causes of the misdiagnoses were: (1) the hilar mass shadow found on the PA chest film, mistaken for central type lung cancer; (2) the mass shadow found on the lateral chest film, mistaken for peripheral lung cancer; (3) the patients with fever, cough and expectoration accompanied by exudative infiltrative shadow, mistaken for pneumonia; (4) patients with recurrent attacks of hemoptysis but the lesions overshadowed by the spinal column on the lateral chest film were misdiagnosed as bronchiectasis. The author suggested PA and lateral chest films taken simultaneously were needed. The special points, to which should be pay attention during reading the films were listed and noted. FOB examination including TBLB, brushing and BALF for pathologic and AFB determination could be of help to confirm the diagnosis.

[Aggressive fibrous histiocytoma of bone--report of two cases]

Three osseous tumors multicentrically arising in the radius, ulna, and metacarpal bones of a 10-year-old girl and another in the femur of a 75-year-old man are reported. These lesions were designated as aggressive fibrous histiocytoma because of the benign cytological appearance with aggressive roentgenographic findings. These tumors were composed mainly of spindle cells tightly packed in a storiform pattern. Clear histiocytes and multinuclear giant tumor cells were occasionally seen. Variable amounts of collagen fiber were found. Both patients have been followed for 32 and 21 months respectively without evidence of local recurrence or distant metastasis.

[Evaluation of three multiple regression equations of rheogram of pulmonary impedance for pulmonary artery pressure measurement]

This paper reports the use of 3 multiple regression equations (designated as A, B, and C), established by right cardiac catheterization and rheogram of pulmonary impedance examination simultaneously, for the determination of mean pulmonary artery pressure (PAP) in 100 healthy persons and 129 cases of chronic cor pulmonale on exacerbation. By analysis and comparison of the PAP values obtained from these 3 equations, the results showed that on equation B the upper limit of the PAP in 95% normal value range was 2.439 kPa (18.34 mmHg), which correspond to the upper limit of normal value range of the PAP 2.394 kPa (18.0 mmHg) as measured by right cardiac catheterization. Also, the range 1.032-2.597 kPa (7.761-19.530 mmHg) and standard deviation 0.383 kPa (+/- 2.88 mmHg) of PAP value in healthy persons, using the equation B for measurement were less than those on equation A and C. Thus, it was illustrated that the values of PAP were more stable on equation B than those on the other equations. On the other hand, the results obtained from the PAP test with these 3 equations in 100 healthy persons and 129 cases of chronic cor pulmonale on exacerbation, indicated that the specificity on equation B for healthy persons was higher, while using equation B the sensitivity and specificity for cor pulmonale patients were higher than those equation A or C. Therefore, we suggest that equation B is more conformable to the actual circumstances and suitable for clinical application.

[Mucus histochemical study of bilirubin cholangiolithiasis in rabbit model]

Sulfated mucopolysaccharides have an important role in pigment gallstone formation. In this experiment, the animal model of bilirubin cholangiolithiasis was made with Japanese hybrid big-ear white rabbits. The source, nature, quantity and distribution of sulfated mucopolysaccharides in the cause of bilirubin cholangiolithiasis were observed by means of mucous histochemical study. There were three characteristic pathologic changes observed in this experiment: 1. In normal condition, the sulfated mucopolysaccharides were secreted by epithelium of biliary tracts and the quantity was minimum. When bacterial infection was present in the biliary tracts, they were secreted mainly by the proliferative glands in submucosa of the bile duct; 2. In 26 rabbits where the bilirubin cholangiolithiasis developed, there were many proliferative glands in submucosa of the bile duct. Most of the glands produced sulfonated acid mucin. In 5 rabbits where the gallstones did not develop in the stone growing stage, the proliferative glands were not present in the bile duct. It was suggested that there was a close relationship between the proliferative glands and the formation of bilirubin cholangiolithiasis, and 3. The glands in submucosa of the biliary tract provided the refuge where the bacteria could not be cleaned out easily and so it was difficult to control the infection of the biliary tract.

Measurement of serum transferrin by the gamma-gamma perturbed angular correlation method. Differences between normal and cancer serum

In this work, the average perturbed angular correlation integral attenuation factor G2 of the transferrin in the serums from the normals and the patients with liver cancer were determined using time integral perturbed angular correlation method (PAC). The average values of G2 were 0.1945 +/- 0.0155 for the cancer serum transferrin and 0.2865 +/- 0.0411 for the normal serum transferrin. The difference between these two groups is significant. Mathematical deduction and theoretical analysis suggested that the equivalent radius of the transferrin molecules in the serum of cancer patients becomes smaller than normal, because of a change in the molecular conformation. Similar results were also observed in experiments with rat serum transferrin.

[Clinical and pathologic comparison of adult respiratory distress syndrome and infant respiratory distress syndrome]

The authors compared the clinical and pathological findings between adult respiratory distress syndrome (ARDS), and infant respiratory distress syndrome (IRDS). In ARDS, the most common causes were injury, infection, shock and acidosis. The clinical course was longer. The weight of the lungs increased markedly, the hyaline membrane formation in the alveoli was late in the clinical course, and the degree of edema in the interstitium of the lungs and microthrombosis within the blood vessels was more serious. The pathogenesis of ARDS was related to the activation of the complements and neutrophils by inflammation in which proteinase, oxygen radical, thromboxane, leukotriene and prostaglandin were released. Thus the endothelial cells of the blood vessels and capillary-alveoli membrane were damaged by these mediators. On the other hand, the main contributory factors of IRDS were suffocation of premature fetus by various reasons in the uterus and aspiration of meconium during delivery by the infant. The clinical course was shorter, alveolar hemorrhage and collapse were severe and hyaline membrane in alveoli was formed in early stage of the clinical course. Insufficiency of surfactant in premature fetus, damage of the surfactant system by hypoxia, aspiration of foreign materials and defect of the epithelial cells of infant were the pathogenic factors of IRDS, they resulted in increase of permeability of fluid and, as a result, led to pulmonary edema and atelectasis.

[The uremic lung]

27 cases of uremia with abnormal appearances on the chest films were analysed. The results showed that the clinical features were cough, expectoration dyspnea and hemoptysis. However, the degree of these symptoms was relatively mild as judged from the amount of pulmonary edema found on the chest films. The chest X-ray finding in these group of patients were characterized by pulmonary blood stasis, interstitial edema of the lung and edematous alveoli. The pathogenesis of uremic lung was said to be related to blood urea nitrogen and creatinine retention and the concurrent presence of left side heart failure may also play a role. Hemodialysis and other comprehensive treatments could help the patients with uremic lung for relief the symptoms. But the fundamental managements to improve the prognosis for this disease are early treatment of the primary renal diseases, in order to prevent the occurrence of renal failure. Kidney transplantation should be advised.

[The clinical significance of serum creatine phosphokinase measurement in patients with chronic cor pulmonale]

The values obtained from the measurement of serum creatine phosphokinase (SCPK) in 70 cases of chronic cor pulmonale in exacerbation and 72 cases in remission were compared with the normal value as measured in 160 healthy adults at the same period. The results showed that the normal value of SCPK was 46.50 +/- 12.71 u/L in male, while 32.51 +/- 10.8 u/L in female. The differences of the values of SCPK in male and female are highly significant statistically (P less than 0.001). Although the values of SCPK were within normal limits (M +/- 2SD) in most patients with chronic cor pulmonale (72.38-84.10%) in this paper, the values of SCPK of some of them (13.60-22.36%) were higher than normal. But in a few of the patients in exacerbation (2.27-5.26%) the SCPK values were lower than normal. The increased activity of SCPK in patients with chronic cor pulmonale may be related to the vigorous movement of the respiratory muscles. While the level of SCPK decreased to extremely low degree may indicate that the respiratory muscles may be excessively fatigue. So we suggest that the levels of SCPK which are markedly higher or lower than normal could be served as an reference index for the excessive activity or fatigue of the respiratory muscles respectively in chronic cor pulmonale.

["Effort index"--estimating abilities of respiratory muscles]

This paper analyzes the actual values of FEV1 and MBC in 240 normal subjects, 147 patients with COPD and 85 cases of cancer tumors, and shows that the actual values of MBC in both COPD patients and cancerous cases are much lower than the calculated values from FEV1. The authors believe that the ratio between the actual values of MBC and its calculated values may be used to reflect the strengths or abilities of the respiratory muscles efforted, called "Effort Index". The formula of MBC calculated from FEV1 is based on the linear regression equation formulated from the actual values of FEV1 and MBC in 240 normal subjects (aged 16-80 yrs). The "Effort Index" is equal to the actual value of MBC/the calculated value of MBC. The "Effort Index" in 240 normal subjects is 1.00 +/- 0.14 (M +/- SD), in mild, moderate and severe cases of COPD being 0.907, 0.807 and 0.626 respectively, and in markedly wasted cancer cases, 0.861 +/- 0.130. The results show that the formula of MBC calculated from FEV1 is useful only for the subjects with normal respiratory muscular abilities; while in COPD patients and markedly emaciated cancerous cases, owing to the chronically tired-out or exhausted respiratory muscular strength, the actual values of MBC are actually lower than those calculated from FEV1, hence the decreased "Effort Index".