First-in-Class Humanized Antibody against Alternatively Spliced Tissue Factor Augments Anti-Metastatic Efficacy of Chemotherapy in a Preclinical Model of Pancreatic Ductal Adenocarcinoma

Alternatively spliced tissue factor (asTF) promotes the progression of pancreatic ductal adenocarcinoma (PDAC) by activating β1-integrins on PDAC cell surfaces. hRabMab1, a first-in-class humanized inhibitory anti-asTF antibody we recently developed, can suppress PDAC primary tumor growth as a single agent. Whether hRabMab1 has the potential to suppress metastases in PDAC is unknown. Following in vivo screening of three asTF-proficient human PDAC cell lines, we chose to make use of KRAS G12V-mutant human PDAC cell line PaCa-44, which yields aggressive primary orthotopic tumors with spontaneous spread to PDAC-relevant anatomical sites, along with concomitant severe leukocytosis. The experimental design featured orthotopic tumors formed by luciferase labeled PaCa-44 cells; administration of hRabMab1 alone or in combination with gemcitabine/paclitaxel (gem/PTX); and the assessment of the treatment outcomes on the primary tumor tissue as well as systemic spread. When administered alone, hRabMab1 exhibited poor penetration of tumor tissue; however, hRabMab1 was abundant in tumor tissue when co-administered with gem/PTX, which resulted in a significant decrease in tumor cell proliferation; leukocyte infiltration; and neovascularization. Gem/PTX alone reduced primary tumor volume, but not metastatic spread; only the combination of hRabMab1 and gem/PTX significantly reduced metastatic spread. RNA-seq analysis of primary tumors showed that the addition of hRabMab1 to gem/PTX enhanced the downregulation of tubulin binding and microtubule motor activity. In the liver, hRabMab1 reduced liver metastasis as a single agent. Only the combination of hRabMab1 and gem/PTX eliminated tumor cell-induced leukocytosis. We here demonstrate for the first time that hRabMab1 may help suppress metastasis in PDAC. hRabMab1's ability to improve the efficacy of chemotherapy is significant and warrants further investigation.

Polycythemia vera: 2024 update on diagnosis, risk-stratification, and management

DISEASE OVERVIEW

Polycythemia vera (PV) is a JAK2-mutated myeloproliferative neoplasm characterized by clonal erythrocytosis; other features include leukocytosis, thrombocytosis, splenomegaly, pruritus, constitutional symptoms, microcirculatory disturbances, and increased risk of thrombosis and progression into myelofibrosis (post-PV MF) or acute myeloid leukemia (AML).

DIAGNOSIS

A working diagnosis is considered in the presence of a JAK2 mutation associated with hemoglobin/hematocrit levels of >16.5 g/dL/49% in men or 16 g/dL/48% in women; morphologic confirmation by bone marrow examination is advised but not mandated.

CYTOGENETICS

Abnormal karyotype is seen in 15%-20% of patients with the most frequent sole abnormalities being +9 (5%), loss of chromosome Y (4%), +8 (3%), and 20q- (3%).

MUTATIONS

Over 50% of patients harbor DNA sequence variants/mutations other than JAK2, with the most frequent being TET2 (18%) and ASXL1 (15%). Prognostically adverse mutations include SRSF2, IDH2, RUNX1, and U2AF1, with a combined incidence of 5%-10%.

SURVIVAL AND PROGNOSIS

Median survival is ⁓15 years but exceeds 35 years for patients aged ≤40 years. Risk factors for survival include older age, leukocytosis, abnormal karyotype, and the presence of adverse mutations. Twenty-year risk for thrombosis, post-PV MF, or AML are ⁓26%, 16% and 4%, respectively.

RISK FACTORS FOR THROMBOSIS

Two risk categories are considered: high (age >60 years or thrombosis history) and low (absence of both risk factors). Additional predictors for arterial thrombosis include cardiovascular risk factors and for venous thrombosis higher absolute neutrophil count and JAK2V617F allele burden.

TREATMENT

Current goal of therapy is to prevent thrombosis. Periodic phlebotomy, with a hematocrit target of <45%, combined with once- or twice-daily aspirin (81 mg) therapy, absent contraindications, is the backbone of treatment in all patients, regardless of risk category. Cytoreductive therapy is reserved for high-risk disease with first-line drugs of choice being hydroxyurea and pegylated interferon-α and second-line busulfan and ruxolitinib. In addition, systemic anticoagulation is advised in patients with venous thrombosis history.

ADDITIONAL TREATMENT CONSIDERATIONS

At the present time, we do not consider a drug-induced reduction in JAK2V617F allele burden, which is often incomplete and seen not only with peg-IFN but also with ruxolitinib and busulfan, as an indicator of disease-modifying activity, unless accompanied by cytogenetic and independently-verified morphologic remission. Accordingly, we do not use the specific parameter to influence treatment choices. The current review also includes specific treatment strategies in the context of pregnancy, splanchnic vein thrombosis, pruritus, perioperative care, and post-PV MF.

Phage therapy in a lung transplant recipient with cystic fibrosis infected with multidrug-resistant Burkholderia multivorans

BACKGROUND

There is increased interest in bacteriophage (phage) therapy to treat infections caused by antibiotic-resistant bacteria. A lung transplant recipient with cystic fibrosis and Burkholderia multivorans infection was treated with inhaled phage therapy for 7 days before she died.

METHODS

Phages were given via nebulization through the mechanical ventilation circuit. Remnant respiratory specimens and serum were collected. We quantified phage and bacterial deoxyribonucleic acid (DNA) using quantitative polymerase chain reaction, and tested phage neutralization in the presence of patient serum. We performed whole genome sequencing and antibiotic and phage susceptibility testing on 15 B. multivorans isolates. Finally, we extracted lipopolysaccharide (LPS) from two isolates and visualized their LPS using gel electrophoresis.

RESULTS

Phage therapy was temporally followed by a temporary improvement in leukocytosis and hemodynamics, followed by worsening leukocytosis on day 5, deterioration on day 7, and death on day 8. We detected phage DNA in respiratory samples after 6 days of nebulized phage therapy. Bacterial DNA in respiratory samples decreased over time, and no serum neutralization was detected. Isolates collected between 2001 and 2020 were closely related but differed in their antibiotic and phage susceptibility profiles. Early isolates were not susceptible to the phage used for therapy, while later isolates, including two isolates collected during phage therapy, were susceptible. Susceptibility to the phage used for therapy was correlated with differences in O-antigen profiles of an early versus a late isolate.

CONCLUSIONS

This case of clinical failure of nebulized phage therapy highlights the limitations, unknowns, and challenges of phage therapy for resistant infections.

Valproate-related neutropenia and lithium-related leukocytosis in patients treated with clozapine: a retrospective cohort study

BACKGROUND

Neutropenia is a noteworthy side effect of clozapine, which might warrant this drugs' discontinuance for safety. Studies have revealed that the risk of neutropenia increases with concurrent administration of valproate, but the evidence was limited. Conversely, lithium may have an ameliorating effect on clozapine-induced neutropenia. This study explored the effects of valproate and lithium on white blood cell counts in patients treated with clozapine.

METHODS

We retrospectively investigated the electronic medical records from one tertiary psychiatric hospital in Taiwan and enrolled patients discharged between January 1, 2006, and December 31, 2017, with clozapine prescriptions. We scrutinized their demographic data, medications, and hematological results at discharge and during follow-up outpatient clinic visits over the subsequent 3 years. Patients were classified into four groups: clozapine only (CLO), clozapine and valproate (CLO + VAL), clozapine and lithium (CLO + Li), and clozapine, valproate, and lithium (CLO + VAL + Li). We also identified hematological events (neutropenia or leukocytosis) of these patients during outpatient follow-ups.

RESULTS

Of the included 1084 patients, 55(5.1%) developed neutropenia. Concurrent valproate use (odds ratio [OR] = 3.49) and older age (p = .007) were identified as risk factors. Moreover, 453 (41.79%) patients developed leukocytosis. Younger age; male sex; and concurrent use of lithium (OR = 3.39, p < .001), clozapine daily dosage, and benzodiazepines were the risk factors for leukocytosis.

CONCLUSION

Concurrent valproate use and older age are associated with the development of neutropenia in patients treated with clozapine. Concurrent lithium usage, younger age, male sex, and concurrent benzodiazepine use might be related to leukocytosis.

Long-lasting leukocytosis in patients with schizophrenia treated with clozapine after electroconvulsive therapy : ECT stabilizes white blood cell count

INTRODUCTION

The present study was conducted to investigate the possible hematologic impact of long-term electroconvulsive therapy (ECT) in patients with drug-resistant schizophrenia and receiving clozapine therapy.

SUBJECTS AND METHODS

In this retrospective study, clinical charts of 57 hospitalized patients with schizophrenia who required clozapine therapy because of active psychotic symptoms resistant to other antipsychotics were examined. For 18 who underwent ECT, the first assessment was conducted at the end of that therapy (average two months after start, 7.68 sessions) and the second two months later. As for the 39 patients who did not undergo ECT, the first and second assessment points were at two and four months, respectively, after a randomly chosen time point.

RESULTS

Multiple regression analysis revealed that modified ECT (m-ECT) (ß = 0.346, p = 0.005), gender (males showed greater increase) (ß = 0.273, p = 0.023), and disease duration (longer associated with greater increase) (ß = 0.258, p = 0.033) were correlated with a change in white blood cell (WBC) count (ΔR2 = 0.277, p < 0.001) at the first assessment point. At the second assessment point, multiple regression analysis showed that m-ECT (ß = 0.262, p = 0.039), gender (males showed greater increase) (ß = 0.264, p = 0.036), and disease duration (longer associated with greater increase) (ß = 0.234, p = 0.068) were again correlated with changed WBC count (ΔR2 = 0.203, p < 0.007).

DISCUSSION

An increase in leukocytes may have a protective influence against the adverse myelosuppressive effects of clozapine. However, a simple mobilization of leukocytes from bone marrow to peripheral circulation may not enhance the immune system, leading to only a masking of the effects of a potential immuno-insufficient state in the treated patient. In either case, should leukocytosis be induced and then remain for an extended period, hematologists, as well as psychiatrists involved in electroconvulsive intervention for clozapine-treated patients, must keep this factor in mind.

Comparison of tick-borne encephalitis between children and adults-analysis of 669 patients

The aim of our study was to compare the course of TBE in children and adults. A retrospective analysis of the medical records of 669 patients was performed. The patients were categorized into 2 groups: Group I with 68 children and group II with 601 adults. TBE symptoms in children were milder compared with adults, with meningitis in 97% of cases. In adults, meningoencephalitis and meningoencephalomyelitis made up 49.26% of cases. Nausea and vomiting are more frequent in children, while neurological manifestations are more frequent in adults. There were no differences in CSF pleocytosis at the onset of disease in both groups, while CSF protein concentration was higher in adults. Children treated with corticosteroids over 7 days had higher checkup pleocytosis than pleocytosis at the onset of disease compared with adults. Corticosteroid use prolongs the disease duration but does not influence the development of TBE sequelae. Children had more favourable outcomes than adult patients.

Autoimmune Neurology of the Central Nervous System

PURPOSE OF REVIEW

This article reviews the rapidly evolving spectrum of autoimmune neurologic disorders with a focus on those that involve the central nervous system, providing an understanding of how to approach the diagnostic workup of patients presenting with central nervous system symptoms or signs that could be immune mediated, either paraneoplastic or idiopathic, to guide therapeutic decision making.

RECENT FINDINGS

The past decade has seen a dramatic increase in the discovery of novel neural antibodies and their targets. Many commercial laboratories can now test for these antibodies, which serve as diagnostic markers of diverse neurologic disorders that occur on an autoimmune basis. Some are highly specific for certain cancer types, and the neural antibody profiles may help direct the physician's cancer search.

SUMMARY

The diagnosis of an autoimmune neurologic disorder is aided by the detection of an objective neurologic deficit (usually subacute in onset with a fluctuating course), the presence of a neural autoantibody, and improvement in the neurologic status after a course of immunotherapy. Neural autoantibodies should raise concern for a paraneoplastic etiology and may inform a targeted oncologic evaluation (eg, N-methyl-D-aspartate [NMDA] receptor antibodies are associated with teratoma, antineuronal nuclear antibody type 1 [ANNA-1, or anti-Hu] are associated with small cell lung cancer). MRI, EEG, functional imaging, videotaped evaluations, and neuropsychological evaluations provide objective evidence of neurologic dysfunction by which the success of immunotherapy may be measured. Most treatment information emanates from retrospective case series and expert opinion. Nonetheless, early intervention may allow reversal of deficits in many patients and prevention of future disability.

Systemic Proteasome Inhibition Induces Sustained Post-stroke Neurological Recovery and Neuroprotection via Mechanisms Involving Reversal of Peripheral Immunosuppression and Preservation of Blood-Brain-Barrier Integrity

In view of its profound effect on cell survival and function, the modulation of the ubiquitin-proteasome-system has recently been shown to promote neurological recovery and brain remodeling after focal cerebral ischemia. Hitherto, local intracerebral delivery strategies were used, which can hardly be translated to human patients. We herein analyzed effects of systemic intraperitoneal delivery of the proteasome inhibitor BSc2118 on neurological recovery, brain injury, peripheral and cerebral immune responses, neurovascular integrity, as well as cerebral neurogenesis and angiogenesis in a mouse model of transient intraluminal middle cerebral artery occlusion. Systemic delivery of BSc2118 induced acute neuroprotection reflected by reduced infarct volume when delivered up to 9 h post-stroke. The latter was associated with reduced brain edema and stabilization of blood-brain-barrier integrity, albeit cerebral proteasome activity was only mildly reduced. Neuronal survival persisted in the post-acute stroke phase up to 28 days post-stroke and was associated with improved neurological recovery when the proteasome inhibitor was continuously delivered over 7 days. Systemic proteasome inhibition prevented stroke-induced acute leukocytosis in peripheral blood and reversed the subsequent immunosuppression, namely, the reduction of blood lymphocyte and granulocyte counts. On the contrary, post-ischemic brain inflammation, cerebral HIF-1α abundance, cell proliferation, neurogenesis, and angiogenesis were not influenced by the proteasome inhibitor. The modulation of peripheral immune responses might thus represent an attractive target for the clinical translation of proteasome inhibitors.

Therapeutic Efficacy of Leukocytapheresis in a Pregnant Woman with Refractory Adult-onset Still's Disease

This is the first report of the efficacy of leukocytapheresis (LCAP) in a patient with refractory adult onset Still's disease (AOSD) during pregnancy. A 32-year-old Chinese pregnant woman with AOSD who had been treated with prednisolone failed to achieve disease stabilization. The patient's disease was successfully controlled with the initiation of LCAP. Subsequently, she gave birth via Caesarean section to a 1,878 g baby boy at 34 weeks of gestation while maintaining remission. We conclude that LCAP is an alternative treatment in pregnant patients with refractory AOSD, particularly in those concerned about potential teratogenic and other adverse effects.

The role of therapeutic leukapheresis in hyperleukocytotic AML

PURPOSE

Hyperleukocytosis in AML with leukostasis is a serious life-threatening condition leading to a high early mortality which requires immediate cytoreductive therapy. Therapeutic leukapheresis is currently recommended by the American Society of Apheresis in patients with a WBC>100 G/l with signs of leukostasis, but the role of prophylactic leukapheresis before clinical signs of leukostasis occur is unclear.

PATIENTS

We retrospectively analyzed the role of leukapheresis in 52 patients (median age 60 years) with hyperleukocytotic AML with and without clinical signs of leukostasis. Since leukapheresis was performed more frequently in patients with signs of leukostasis due to the therapeutic policy in our hospital, we developed a risk score for early death within seven days after start of therapy (EDd7) to account for this selection bias and to independently measure the effect of leukapheresis on EDd7.

RESULTS

20 patients received leukapheresis in combination to chemotherapy compared to 32 patients who received chemotherapy only. In a multivariate logistic regression model for the estimation of the probability of EDd7 thromboplastin time and creatinine remained as independent significant parameters and were combined to create an EDd7 risk score. The effect of leukapheresis on EDd7 was evaluated in a bivariate logistic regression together with the risk score. Leukapheresis did not significantly change early mortality in all patients with a WBC≥100 G/l.

DISCUSSION

Prophylactic leukapheresis in hyperleukocytotic patients with and without leukostasis did not improve early mortality in our retrospective study. Larger and prospective clinical trials are needed to validate the risk score and to further explore the role of leukapheresis in AML with hyperleukocytosis.

Cranial irradiation in adults diagnosed with acute myelogenous leukemia presenting with hyperleukocytosis and neurologic dysfunction

This study describes our institution's experience using whole brain radiation therapy (WBRT) to treat patients with acute myelogenous leukemia (AML) presenting with hyperleukocytosis. After approval by the institutional review board, we identified patients with AML and hyperleukocytosis using hospital records. The primary endpoints in the study included alleviation of neurological symptoms (or prevention if prophylactic RT was used), overall survival, development of intracranial hemorrhage (ICH) and ≥ grade 3 toxicities using the Common Terminology Criteria for Adverse Events version 4.0 (CTCAE v4.0). Eighteen patients received WBRT for the treatment of AML hyperleukocytosis. Thirteen patients received treatment in order to control neurological symptoms. Clinical assessment showed that 12 of 13 patients (92%) achieved resolution of neurological symptoms either concurrent with RT or immediately after RT. The mean overall survival for all of the patients who received WBRT was 14.2 months (95% confidence interval, 5.4-23.0). No patient who received RT experienced ≥ grade 3 toxicity. Two (6%) patients developed ICH following therapy. Our institution's experience demonstrates that WBRT may be utilized as part of multimodality therapy in order to alleviate or prevent neurological symptoms in patients with AML presenting with leukostasis.

Arsenic methylation metabolism and liver injury of acute promyelocytic leukemia patients undergoing arsenic trioxide treatment

Although arsenic is effective in the treatment of acute promyelocytic leukemia (APL), as a well-known environmental toxicant, the side effects of arsenic treatment and arsenic methylation metabolism of the patients are rarely reported. In this manuscript, we investigated 23 APL patients treated with 10 mg arsenic trioxide daily, detected the arsenic metabolites in urine samples collected on the 0, 10th, and 20th day of arsenic treatment. At the same time, liver function and blood routine examination were also investigated in these APL patients. We found that, urinary monomethylated arsenic proportion (MMA%) increased, but dimethylated arsenic proportion (DMA%), the first methylation ratio (FMR) and the secondary methylation ratio (SMR) decreased with consecutive administration of arsenic trioxide. After adjustment for age impact, no statistical difference was observed in urinary arsenic concentrations and arsenic methylation capacity between male and female at the same treatment time point. During arsenic trioxide treatment of APL, transient elevation of serum aminotransferases was found in the blood samples, which indicated that liver injury occurred and probably reversible. Leukocytosis developed in 5 of the 23 patients with the administration of arsenic trioxide. No statistical difference was observed in the other blood routine examination parameters. These results demonstrated that the capacity of arsenic methylation decreased and transient liver injury occurred during arsenic trioxide treatment of APL, which indicated that the side effects of clinical arsenic treatment can not be ignored.

Extreme hyperleucocytosis of the premature

Physiological leucocytosis is common in neonates. Leukemoid reaction is defined as a variable degree of leucocytosis with immature precursors, similar to that occurring in leukaemia but because of other causes. Leukemoid reactions are well-recognised in the neonatal intensive care unit population and are associated with antenatal corticosteroids, Down's syndrome, chorioamnionitis, funisitis and perinatal infections. However, extreme hyperleucocytosis, exceeding a white blood cell count of 100×10(9)/l is rare. In the 7-year period from 2005 to 2012 three premature infants in our hospital presented with extreme hyperleucocytosis. Since there were no signs of neonatal leukaemia, transient myeloid disorder or leucocyte adhesion defect, a leukemoid reaction owing to antenatal corticosteroids, chorioamnionitis and funisitis was diagnosed. No obvious complications of hyperleucocytosis were observed. Therapy was not necessary and the leucocytes normalised spontaneously. In our small case series, extreme hyperleucocytosis in prematures occurred in the absence of leukaemia and had a mild course.

Evaluation of antiallergic and anti-anaphylactic activity of ethanolic extract of Sanseveiria trifasciata leaves (EEST) in rodents

AIM OF THE STUDY

The leaves and rhizomes of Sansevieria trifasciata are used in folk medicine for treating bronchitis, asthma, cough, snake bite and insect bite etc. The ethanolic extract elicited analgesic, anti-inflammatory and antipyretic activity. Hence, it was decided to study the antiallergic activity of ethanolic extract of S. trifasciata (EEST) on various animal models as well as in vitro conditions, and also to understand possible mechanism of action.

MATERIALS AND METHODS

Ethanolic extract of S. trifasciata leaves (EEST) were prepared by cold maceration followed by concentration and evaporation under reduced pressure on a rotary evaporator to obtain semisolid mass. The various phytoconstituents were analyzed. The acute toxicity study of EEST was carried out in mice. The antiallergic and anaphylactic activities were evaluated using animal models viz. milk induced eosinophilia and leukocytosis, compound 48/80 induced mast cell degranulation, active and passive cutaneous anaphylaxis and histamine induced pedal edema. In addition, EEST effect on Shultz-Dale reaction in sensitized guinea pig ileum in ex vivo and antioxidant activity by free radical scavenging by DPPH method (in vitro) were also studied.

RESULTS

EEST treatment at 100mg/kg and 200mg/kg p.o inhibited (a) milk-induced increased eosinophilia, leukocytosis, monocytes and neutrophils. (b) Prevented passive cutaneous and active anaphylactoid reactions. (c) Prevented compound 48/80 induced degranulation of sensitized mesenteric mast cells. (d) Inhibited histamine induced pedal edema formation significantly. EEST pretreatment inhibited Shultz-Dale reaction in guinea pig ileum and also elicited potent antioxidant activity.

CONCLUSION

Experimental findings demonstrate promising antiallergic and anti-anaphylactic activity of EEST and also elicited potent antioxidant activity. The antiallergic and anti-anphylactic activity might be due to inhibition of release of chemical mediators from mast cells largely by phytoconstituents like steroidal saponins, triterpenoids and flavonoids present in EEST.

Antihistaminic and antiallergic actions of extracts of Solanum nigrum berries: possible role in the treatment of asthma

ETHNOPHARMACOLOGICAL RELEVANCE

Berries of the plant Solanum nigrum Linn (Solanaceae) are used for the treatment of asthma in folk medicine and ancient books.

AIM OF STUDY

To evaluate potential of the plant berries in the treatment of asthma.

MATERIALS AND METHODS

Petroleum ether, ethanol and aqueous extracts of S. nigrum berries (50, 100 and 200mg/kg, i.p.) were screened for the treatment of asthma by the various methods viz. effect on clonidine and haloperidol induced catalepsy, milk-induced leucocytosis and eosinophilia, mast cell stabilizing activity in mice and studies on smooth muscle preparation of guinea pig ileum (in vitro). Active petroleum ether extract was standardized by HPTLC.

RESULTS

The petroleum ether extract of S. nigrum berries inhibited clonidine-induced catalepsy significantly but not haloperidol-induced catalepsy. Petroleum ether extract significantly inhibited increased leukocyte and eosinophil count due to milk allergen and showed maximum protection against mast cell degranulation by clonidine. Petroleum ether extract resisted contraction induced by histamine better than other extracts. All the results are dose dependant. Active petroleum ether extract showed presence of antiasthmatic compound, β-sitosterol.

CONCLUSION

The petroleum ether extract of S. nigrum berries can inhibits parameters linked to the asthma disease.

Anti-inflammatory effects of ethanolic extract from Lagerstroemia indica on airway inflammation in mice

AIM OF THE STUDY

In the present study, we investigated whether the Lagerstroemia indica Linn (LI) extract has an anti-inflammatory effect on lung inflammation in ovalbumin-induced asthmatic mice.

MATERIALS AND METHODS

The LI extract was obtained from dried and powdered whole plants of LI using 80% ethanol. ELISA was performed to evaluate cytokine concentration. BALB/c mice were used as a mouse model of asthma after asthmatic induction by ovalbumin sensitization and inhalation. We examined the effects of the LI extract on leukocyte infiltration and mucus secretion using cell count and histological stain.

RESULTS

The amount of cytokines, such as interleukin (IL)-2, IL-4, IL-5, IL-13, and TNF-α, was increased in Jurkat cells using the extract from house dust mites. Increased cytokine concentrations were inhibited by the LI extract. The LI extract suppressed the increased expression of IL-6 after treatment with mite extract of EoL-1 cells and THP-1 cells. In an in vivo experiment using asthmatic mice, the LI extract significantly inhibited leukocytosis and eosinophilia in bronchoalveolar lavage (BAL) fluid and lung tissue samples. The LI extract inhibited the increase in mucus secretion by goblet cells, blocked the production of reactive oxygen species in BAL fluid cells, and blocked the protein expression of IL-5 in BAL fluid. The concentration of ovalbumin-specific IgE in BAL fluid was weakly inhibited by the LI extract.

CONCLUSIONS

These results suggest that the LI extract may be used as a valuable agent for treating allergic diseases such as asthma due to its anti-inflammatory property.

Evaluation of antiasthmatic activity of Clitoria ternatea L. roots

AIM OF STUDY

Clitoria ternatea L. (Family: Fabaceae) is being used in traditional medicine for the treatment of severe bronchitis and asthma. So the aim of study was to evaluate antiasthmatic activity of ethanol extract of Clitoria ternatea roots.

MATERIALS AND METHODS

In the present study ethanol extract of Clitoria ternatea root (ECTR) was evaluated for preliminary phytochemical screening, acute toxicity studies and antiasthmatic activity using milk induced leucocytosis and eosinophilia in mice, egg albumin induced mast cell degranulations in rats and passive cutaneous anaphylaxis in rats at doses (100-150 mg/kg ip).

RESULTS

The results of present investigation showed that the LD(50) of ECTR is more than 1,300 mg/kg. ECTR significantly decreases milk induced leucocytosis and eosinophilia, protects egg albumin induced degranulations of mast cells in mice and inhibits area of blue dye leakage in passive cutaneous anaphylaxis in rats at (100-150 mg/kg, i.p.). Phytochemical studies observed the presence of steroids, saponin, flavonoids, and glycosides.

CONCLUSION

The present investigation concludes that the antiasthmatic activity of ECTR may be due to the presence of flavonoids or saponins.

Response to chemotherapy in a case of gastric adenocarcinoma producing granulocyte colony-stimulating factor

BACKGROUND

Little is known about the patient characteristics and tumor characteristics associated with a high level of granulocyte colony-stimulating factor (G-CSF) and leukocytosis. Moreover, the prognosis of G-CSF-producing gastric cancer has been extremely poor.

CASE REPORT

A 72-year-old man presented with fatigue and body weight loss. Laboratory testing showed pronounced leukocytosis (white blood cell count, 34900×106/L). Bone marrow aspiration biopsy excluded leukemia and metastatic leukemoid reaction. G-CSF-producing cancer was suspected as the cause of the abnormally elevated serum G-CSF level (293 pg/ml). Gastrointestinal endoscopy showed type 3 gastric cancer, and the biopsy specimens were histologically proven to include moderately to well differentiated adenocarcinoma with positive expression of G-CSF. Abdominal computed tomography showed a lymph node lesion and multiple hepatic metastatic lesions. This patient was diagnosed as having stage IV gastric cancer that produced G-CSF. We treated the patient with 3 chemotherapy regimens, and he survived for almost 2 years after diagnosis.

CONCLUSIONS

The possibility of a G-CSF-producing tumor should be investigated in patients who present with severe leukocytosis in the absence of infection. This unusual gastric cancer should be treated as soon as possible after diagnosis.

[Factor V Leiden and C677T MTHFR thrombophilic mutations associated with hyperfibrinogenemia, persistent high CRP and leucocytosis in newborn baby with perinatal infection--a clinical case]

We present a clinical case of newborn baby with perinatal infection. Despite the solidity antibiotic therapy and good condition of the neonate, we observed hyperfibrinogenemia, persistent high CRP and leucocytosis. These inflammatory markers and the extravasation of blood during correction of anaemic syndrome draw attention to the role of other causal factors. DNA analysis for thrombophilic mutations identifies factor V Leiden and C677T MTHFR variant.

Management of hyperleukocytosis and prevention of tumor lysis syndrome with low-dose prednisone continuous infusion in children with acute lymphoblastic leukemia

INTRODUCTION

The standard management of childhood acute lymphoblastic leukemia with hyperleukocytosis is unclear and its treatment has focused on prompt leukocytoreduction. Cytoreductive therapies have been used for the prevention of tumor lysis syndrome, but the outcomes have been variable and their benefits have not been proven in controlled clinical trials. This condition needs further investigation to develop effective therapeutic strategies.

METHODS

In the present prospective trial, 15 children with acute lymphoblastic leukemia and hyperleukocytosis (range 101-838 x 10(9)/l) were treated with intravenous low-dose prednisone continuous infusion (6 mg/m(2)/24 h). Doses were increased daily and on approximately the fifth day, the full dose of prednisone (60 mg/m(2)/day) was applied.

RESULTS

The mean reduction in white blood cell count achieved by this treatment was 34.4% on first day, 56.9% on second day and 76.6% on third day. The treatment was well tolerated. None of the 15 patients developed life-threatening metabolic disorders or required dialysis.

CONCLUSIONS

Intravenous low-dose prednisone continuous infusion treatment can prevent the progression to tumor lysis syndrome and it may be used for the patients presenting with white blood cell counts between 100 and 400 x 10(9)/l in centers where leukoapheresis is not readily available.

[Retinoic acid in treating acute promyelocytic leukemia with hyperleukocytosis and its therapeutic strategy]

In order to investigate the occurrence of hyperleukocytosis in treating acute promyelocytic leukemia (APL) patients with all trans retinoic acid (ATRA) and to explore the influence of the level of leucocyte on curative effect of ATRA, the APL patients were divided into three different groups according to the count of leucocyte in peripheral blood. Patients with WBC count less than 30x10(9)/L were administered with ATRA alone (the first group), patients with WBC count more than 30x10(9)/L were administered with ATRA alone (the second group) and patients with WBC count more than 30x10(9)/L were treated with ATRA+cytotoxic drugs (the third group). The results showed that hyperleukocytosis were found in 23 out of 39 patients (58.97%). Total remission rates in the second group and in the third group were 91.3%. The remission rates in the first, second and third groups were 100%, 87.5% and 90.9%, respectively. It is concluded that the ATRA in combination with cytotoxic drugs can efficiently control the occurrence of hyperleukocytosis during ATRA-treating APL and reduce the early mortality.

[Association of antioxidants and natural immune activators in the treatment of astheno-teratospermia and abacterial leukocytosis]

AIM

Leukocytes are often present in human seminal plasma and more frequently in infertile men. Leukocytospermia is associated with sperm morphological and functional alterations. Immune cell activation leads to an increase of free radical production, without any antioxidant defence activation. Leukocyte presence during sperm maturation and migration through male genital tract and consequently exposure to reactive oxygen species led to sperm alteration: axonemal, acrosomal and nuclear structure damage, associated with necrosis. In order to evaluate the immune-modulating and antioxidative activity of beta-glucan, fermented papaya and lactoferrin associated with vitamins C and E, we analysed sperm characteristics of selected infertile male with astheno-teratospermia and abacterial leukocytosis.

METHODS

We selected 20 patients referred to our Sterility Centre for semen analysis with leukocyte concentration higher than 1x106 cell/mL. Seminal quality evaluation was performed according to WHO guidelines (1999) using Papanicolau and eosin staining, before and after three months of treatment with beta-glucan, papaya, lactoferrin, vitamin C and E.

RESULTS

After therapy, seminal analysis showed a significant reduction of leukocyte concentration and an increase of sperm motility and normal sperm morphology.

CONCLUSION

Our results suggest that a combined immunomodulating and antioxidant treatment protect sperm cells during maturation and migration through the male genital tract, resulting in a functional rescue demonstrated by the improvement of semen quality.

Routine cerebrospinal fluid enterovirus polymerase chain reaction testing reduces hospitalization and antibiotic use for infants 90 days of age or younger

OBJECTIVE

The goal was to evaluate the impact of cerebrospinal fluid enterovirus polymerase chain reaction testing on the length of hospitalization and the duration of antibiotic use for infants < or = 90 days of age with suspected aseptic meningitis.

METHODS

This retrospective cohort study was conducted at an urban, tertiary-care children's hospital. Data were collected for 478 patients < or = 90 days of age for whom cerebrospinal fluid enterovirus polymerase chain reaction testing was performed during the enteroviral seasons of 2000 to 2006. The length of hospitalization and the duration of antibiotic use were assessed.

RESULTS

Cerebrospinal fluid enterovirus polymerase chain reaction test results were positive for 154 patients (34.8%). The mean length of stay was 3.65 days. The median polymerase chain reaction turnaround time was 23 hours. In multivariate analysis, having a positive cerebrospinal fluid enterovirus polymerase chain reaction result was associated with a 1.54-day decrease in the length of stay and a 33.7% shorter duration of antibiotic use. When patients were stratified according to the presence or absence of pleocytosis, both groups demonstrated significant reductions in the length of stay with positive cerebrospinal fluid enterovirus polymerase chain reaction results (1.32 and 1.38 days, respectively). Furthermore, increasing the polymerase chain reaction turnaround time by 24 hours increased the length of stay by 13.6% for patients with positive cerebrospinal fluid enterovirus polymerase chain reaction results.

CONCLUSIONS

Having positive cerebrospinal fluid enterovirus polymerase chain reaction results decreases the length of hospitalization and the duration of antibiotic use for young infants. These results support the routine use of this test during periods of peak enterovirus prevalence.

Empiric Antimicrobial Therapy in Critical Illness: Results of a Surgical Infection Society Survey

BACKGROUND

Antibiotics are prescribed commonly in the intensive care unit (ICU). Often, therapy is initiated empirically; practice patterns are not well characterized. We documented approaches to empiric antibiotic therapy among members of the Surgical Infection Society (SIS).

METHODS

We sent a scenario-based questionnaire to all SIS members. The hypothetical cases addressed empiric broad-spectrum therapy for a patient with pyrexia and leukocytosis and the use of vancomycin for central venous catheter infection.

RESULTS

The 113 respondents were primarily surgeons (96%) with a university-based practice (92%). Most attended in the ICU (72%), and they had practiced for 14 +/- 8 years. Whereas 63% of the respondents identified overuse of antibiotics as a problem in their ICU, only 19% said inadequate treatment of infection was a concern. For a febrile patient with negative cultures who was receiving antibiotics, estimates of the likelihood of infection increased across the three scenarios as the degree of organ failure increased (p < 0.0001; chi-square test). Deteriorating organ function was associated with a decision to broaden empiric therapy (58% vs. 33%; p < 0.0001) and to initiate anti-fungal therapy (27% vs. 9%; p < 0.0001) rather than to stop antibiotics and re-culture (15% vs. 51%; p < 0.0001). There was considerable variability in management strategy across the scenarios: Even in the face of organ dysfunction, 58% of physicians would add or change empiric therapy, whereas 30% would not. For each scenario, 23 to 25 antibiotic regimens were designated as optimal therapy. Only 45% of the respondents would initiate empiric vancomycin for suspected central line infection. Variability in approach was not explained by critical care practice, academic position, or country.

CONCLUSIONS

Clinical deterioration is a strong determinant of a decision to initiate or broaden empiric antibiotic therapy during critical illness. The substantial variability in approach suggests a state of clinical equipoise that calls for more rigorous evaluation through a randomized controlled trial.

Correlation of leukocytospermia with clinical infection and the positive effect of antiinflammatory treatment on semen quality

OBJECTIVE

To investigate the correlation between leukocytospermia, bacteriospermia, and clinical signs of infection and to evaluate antiinflammatory therapy.

DESIGN

Prospective nonrandomized study.

SETTING

Andrologic clinic at university hospital.

PATIENT(S)

A total of 56 patients were evaluated, and 12 of them received further treatment with a Cox-2 inhibitor.

INTERVENTION(S)

Semen analysis and clinical investigation were done according to World Health Organization guidelines. Serum levels of leukocytes, C-reactive protein (CRP), and prostate-specific antigen (PSA) were measured from blood samples.

MAIN OUTCOME MEASURE(S)

Sperm concentration, leukocyte concentration, serum leukocyte count, CRP, PSA, bacterial growth.

RESULT(S)

Leukocytospermia (>1 x 10(6)/mL) was present in 60.7% of the semen samples, significant pathogenic bacterial growth was detectable in 35.7%, and 14.3% of the samples fulfilled the criteria for ejaculate signs of infection. All serum parameters were within the normal range. In abacterial leukocytospermia, treatment with a Cox-2 inhibitor decreased leukocytospermia from 5.5 x 10(6)/mL to 1.0 x 10(6)/mL (P=.001) and increased sperm concentration from 22.5 x 10(6)/mL to 48.0 x 10(6)/mL (P=.02).

CONCLUSION(S)

There was no evidence of an immune response in the peripheral blood system. In abacterial leukocytospermia, treatment with a Cox-2 inhibitor seems to be able to reduce leukocytospermia and increase sperm count.

Effects of arsenic trioxide administration styles on leukocytosis

OBJECTIVE

To study the effects of constantly slow intravenous arsenic trioxide (As2O3) infusion regimen on decreasing leukocytosis in vivo and in vitro.

METHODS

Three kinds of leukemia cells, NB4, K562, and acute promyelocytic leukemia (APL) cells, were cultured in the media with constant concentration and varying concentrations of As2O3 respectively for 24 hours. Seventy-five patients were enrolled in two groups randomly. In trial group, 37 patients received continuously slow intravenous As2O3 infusion regimen for 24 hours with an infusion rate of 8 drips per minute and total infusion duration of about 18-21 hours daily. In control group, 38 patients received routine regimen with an infusion rate of 45-55 drips per minute and total infusion duration of about 2-3 hours daily for 24 hours. The daily As2O3 dosage was 0. 16 mg/kg. The intracellular arsenic concentration was measured by atomic fluorescence assay. The apoptosis rate of cells, CD33- CD11b+ cells, and CD33+ CD11b- cells were monitored by flow cytometry.

RESULTS

The apoptosis rates of NB4, K562, and APL leukemia cells in the media with constant As2O3 concentration were 56.6% +/- 2.4%, 27.6% +/- 3.1%, and 52.2% +/- 2.8%, respectively, which were significantly higher than those with changing As2O3 concentration (23.2% +/- 2.1%, 11.0% +/- 2.5%, and 21.0% +/- 2.5%, respectively, P < 0.01). The apoptosis rates of APL, M2 type acute myeloid leukemia (AML-M2), and chronic myeloid leukemia (CML) patients in the trial group (28.5% +/- 1.9%, 9.5% +/- 0.6%, and 12.5% +/- 1.8%) were also significantly higher than those in control group (8.5% +/- 2.2%, 2. 9% +/- 0.8%, and 4.5% +/- 1.2%; P < 0.05). The ratios of CD33 CD11b- and CD33- CD11b+ cells in control group were significantly higher than those in trial group.

CONCLUSION

The continuously slow intravenous As2O3 infusion regimen can obtain high efficiency of apoptosis and low differentiation proportion, relieve leukocytosis, and gain maximal therapeutic benefit.

[Leukemoid reaction with uncommonly high leucocytosis in the course of serious infection]

We present a case of 51-year old female patient with gastrointestinal perforation and septic shock leading to leukemoid reaction with WBC 155 x 109/l. Leukemoid reaction in neoplasms and infections can mimic chronic myelogenous leukaemia and is an important diagnostic problem.

[A literature review of equine piroplasmosis after an episode of acute babesiosis in a Dutch Standardbred foal after a stay in Normandy]

Piroplasmosis, a disease endemic to most tropical and subtropical areas, appears to be spreading to more temperate zones. This article gives a review of equine piroplasmosis and describes an acute case of infection with Babesia caballi in a Dutch Standard bred foal after a short stay at a stud in Normandy (France). A 3-month-old stallion foal was presented with lethargy, fever of 41 degrees C, and pale mucosal membranes. Haematology revealed a low packed cell volume (14 l/l) leucytosis (25 G/l) and a high blood urea nitrogen concentration (20.1mmol/l). Infection with B. caballi was diagnosed on the basis of Giemsa staining blood smears and was confirmed by polymerase chain reaction in combination with RLB. Treatment with imidocarb dipropionate and a blood transfusion resolved the haemolytic crisis.

Protective effects of etoricoxib, a selective inhibitor of cyclooxygenase-2, in experimental periodontitis in rats

BACKGROUND

The purpose of the present study was to evaluate the effect of a potent selective cyclooxygenase-2 (COX-2) inhibitor, etoricoxib, on the prevention of alveolar bone loss in experimental periodontitis induced in rats.

METHODS

Ninety Wistar rats were separated into three experimental groups. Cotton ligatures were placed at the gingival margin level of lower right first molars. The rats were randomly assigned to one of the following groups: control received a daily oral dose of 1 ml/kg of saline solution; Eto1 received 6 mg/kg of etoricoxib; Eto2 received 12 mg/kg of etoricoxib. Serum levels of etoricoxib and white blood cells were determined. Standardized digital radiographs were taken after death at 3, 5, 10, 18 and 30 days to measure the amount of bone loss at the mesial root surface of the first molar tooth in each rat.

RESULTS

One-way analysis of variance (anova) indicated that groups treated with both doses of etoricoxib had significantly (p < 0.05) less alveolar bone loss when compared to controls. Furthermore, etoricoxib treatment significantly inhibited the leukocytosis observed 3 days after the induction of periodontitis.

CONCLUSION

These data provide evidence that systemic therapy with etoricoxib can retard alveolar bone loss in a ligature-induced periodontitis model in rats.

Lack of response to imatinib mesylate in a patient with accelerated phase myeloproliferative disorder with rearrangement of the platelet-derived growth factor receptor beta-gene

Imatinib mesylate has been reported to produce positive results in atypical chronic myeloproliferative disorders (CMD) with chromosomal translocations that disrupt the platelet-derived growth factor receptor beta gene (PDGFRB). We used imatinib to treat a 49-year old man with atypical CMD in accelerated phase and the H4 (D10S170)-PDGFRB fusion gene. After 3 months of treatment, we observed grade 4 hematologic toxicity and a lack of response.

Rituximab therapy for multisystem autoimmune diseases in pediatric patients

OBJECTIVE

To evaluate the effects of rituximab (anti-CD20 monoclonal antibody) on the disease course in pediatric patients with multisystem autoimmune diseases.

METHODS

Four patients with multisystem autoimmune diseases refractory to conventional immunosuppressive medications, each with central nervous system (CNS) involvement, were treated with four weekly infusions of rituximab. Their clinical and laboratory responses were evaluated.

RESULTS

Each of the patients had improvement in clinical symptoms and laboratory parameters. One patient with autoimmune cytopenias and autoimmune CNS and peripheral nervous system disease had resolution of the cytopenias and marked improvement in neurologic symptoms; he currently receives no immunosuppressive medications. Two half-siblings with lymphoplasmacytic colitis, pulmonary nodules, and CNS disease had improvement of their symptoms. A fourth patient with chorea and seizures secondary to primary antiphospholipid antibody syndrome had improvement in fine and gross motor function and reduced seizure frequency. There were no serious adverse events.

CONCLUSIONS

The biologic response modifier rituximab, designed to eliminate B lymphocytes, was safe and effective in four pediatric patients with multisystem autoimmune disorders. It appears to be beneficial in autoimmune conditions presumably mediated by a variety of B-cell-related mechanisms, and may decrease or eliminate the need for other immunosuppressive medications.

Treatment with levofloxacin does not resolve asymptomatic leucocytospermia--a randomized controlled study

The manual of the World Health Organization defines leucocytospermia as the presence of >1 x 10(6) white blood cells per ml semen. Most authors consider leucocytospermia to be a consequence of inflammation due to bacterial infection. However, the efficacy of antibiotic therapy was not unequivocally demonstrated until now. We started a prospective, randomized, controlled study in 36 patients, who consulted our department for infertility with leucocytospermia. None of the patients reported any symptoms of genital infection. The patients were assigned randomly to two groups: group 1 received 250 mg levofloxacin once a day over 10 days, patients of group 2 received no therapy. Semen analysis was repeated 2 weeks later. After administration of levofloxacin, a mean decrease of leucocyte count of 45.8 +/- 72.2% compared with a decrease of only 3 +/- 109.2% in the untreated group was observed. However, this difference is not statistically significant. There were no significant differences between the two groups with respect to leucocyte count, sperm count and sperm cell after treatment. We conclude from our study that antibiotic therapy does not provide benefit for treatment of asymptomatic leucocytospermia.

Response to imatinib mesylate in patients with chronic myeloproliferative diseases with rearrangements of the platelet-derived growth factor receptor beta

BACKGROUND

A small proportion of patients with chronic myeloproliferative diseases have constitutive activation of the gene for platelet-derived growth factor receptor beta (PDGFRB), which encodes a receptor tyrosine kinase. The gene is located on chromosome 5q33, and the activation is usually caused by a t(5;12)(q33;p13) translocation associated with an ETV6-PDGFRB fusion gene. The tyrosine kinase inhibitor imatinib mesylate specifically inhibits ABL, PDGFR, and KIT kinases and has impressive clinical efficacy in BCR-ABL-positive chronic myeloid leukemia.

METHODS

We treated four patients who had chronic myeloproliferative diseases and chromosomal translocations involving 5q33 with imatinib mesylate (400 mg daily). Three of the four patients presented with leukocytosis and eosinophilia; their leukemia cells carried the ETV6-PDGFRB fusion gene. The fourth patient had leukocytosis, eosinophilia, and a t(5;12) translocation involving PDGFRB and an unknown partner gene; he also had extensive raised, ulcerated skin lesions that had been present for a long time.

RESULTS

In all four patients, a normal blood count was achieved within four weeks after treatment began. In the patient with skin disease, the lesions began to resolve shortly after treatment began. The t(5;12) translocation was undetectable by 12 weeks in three patients and by 36 weeks in the fourth patient. In the three patients with the ETV6-PDGFRB fusion gene, the transcript level decreased, and in one patient, it became undetectable by 36 weeks. All responses were durable at 9 to 12 months of follow-up.

CONCLUSIONS

Imatinib mesylate induces durable responses in patients with chronic myeloproliferative diseases associated with activation of PDGFRB.

Children with multiple erythema migrans: are there any pre-treatment symptoms and/or signs suggestive for central nervous system involvement?

OBJECTIVE

To establish eventual signs and symptoms suggestive for central nervous system involvement in children with multiple erythema migrans.

METHODS

Patients younger than 15 years with multiple erythema migrans, diagnosed at our department from 1996 to 2000, were included in this prospective study. Demographic, clinical and laboratory findings were obtained and compared for a group of patients with pleocytosis (interpreted as a sign of central nervous system involvement) and a group of children with normal cerebrospinal fluid findings.

RESULTS

Cerebrospinal fluid pleocytosis (cell counts > or = 5 x 10(6)/l) was detected in 55/214 (25.7%) children; it was lymphocytic in 94.5% of patients and ranged from 5 to 320 (median, 10 x 10(6)/l). Compared with the group with normal cerebrospinal fluid findings, patients with pleocytosis more often reported having had Lyme borreliosis in the past (8/55 versus 3/159; p = 0.0011), had longer incubation periods (25.5 versus 14 days; p = 0.0269), larger diameter of the largest erythema migrans at the time of first examination (10 versus 5.5 cm; p = 0.0055), higher frequency of associated systemic symptoms (45.5% versus 21.4%; p = 0.0011), positive meningeal signs (10.9% versus 1.9%; p = 0.0100), borrelial IgG antibodies in cerebrospinal fluid (3/49 versus 0/150; p = 0.0142) and B. burgdorferi s.l. isolated from cerebrospinal fluid (7/52 versus 1/147; p = 0.0004), but less often had mild initial disease (67.3% versus 88.7%; p = 0.0006).

CONCLUSIONS

Cerebrospinal fluid pleocytosis was detected in 25.7% of children with multiple erythema migrans. Although several clinical and laboratory abnormalities were present significantly more often in patients with elevated cell counts than with normal cerebrospinal fluid findings, discriminatory significance for the majority of these abnormalities was low, particularly because of low negative predictive values. In more than 2/3 of patients with pleocytosis the initial disease was mild, fewer than 1/2 reported systemic symptoms, and meningeal signs were expressed in only 11%.

Clinical significance of low protein phosphatase-1 activity of blasts in acute myelogenous leukemia with high white cell counts

We have previously shown that protein phosphatase-1 (PP1) is the most abundant Ser/Thr phosphatase in human adult primary leukemic cells. To determine the clinical importance of PP1 expression, we compared PP1 activity of leukemic blasts with other putative prognostic factors in 46 patients with acute myelogenous leukemia (AML) who were treated with remission induction chemotherapy. PP1 was ubiquitously but differently expressed in various FAB subtypes (M1-M5), although PP1 activity was significantly higher in blasts of AML-M4 than in AML-M2. PP1 activity was significantly lower in elderly patients > or =55 years (P=0.005), and in those with high white cell counts > or =100,000/microl (P=0.039) at initial diagnosis. Correlation was observed between PP1 activity (<0.15 vs > or =0.15 nmol/min/10(8) cells) and prognosis of AML patients. Eleven of 46 patients with less than 0.15 nmol/min/10(8) cells (low PP1 activity group) had significantly lower overall survival than those with > or =0.15 nmol/min/10(8) cells (high PP1 activity group). The median overall survival was 8 months for patients with low PP1 activity compared to 27 months for those with high PP1 activity in their AML cells. Multivariate analysis using Cox's proportional hazard model showed that low PP1 activity significantly contributed to prognosis. This preliminary study suggests that low PP1 activity may be associated with shortened survival time for AML patients with high white cell counts.

Implications of asymptomatic endocervical leukocytosis in infertility

Genital tract infection is a known cause of male and female infertility. In this retrospective study, we investigated the effect of treatment of asymptomatic cervical leukocytosis on pregnancy rates. Twenty-five infertile women with asymptomatic cervical leukocytosis received broad-spectrum antibiotic treatment (100 mg doxycycline, 200 mg ofloxacin, and 500 mg metronidazole twice a day for 7-10 days). Pregnancy rates and resolution of leukocytosis were evaluated 6 months after treatment. Eleven patients (44%) had persistent cervical leukocytosis and 16 (64%) had become pregnant within 6 months after treatment. Successful treatment of cervical leukocytosis resulted in an increase in the pregnancy rate: 13 of the 14 patients (93%) who were cured of leukocytosis became pregnant, while 3 of the 11 (27%) who did not become pregnant were cured (p = 0.002). Patients who did not achieve pregnancy were older (p = 0. 002) than those who did. Patients who were not cured were also older than those who were (p = 0.014). Our findings suggest that the treatment for cervical leukocytosis is less effective for older patients than for younger patients. However, treatment of asymptomatic cervical leukocytosis appears to help preserve the fertility of patients with this disease.

Effects of chlorpromazine on alveolar bone loss in experimental periodontal disease in rats

Chlorpromazine (CPZ), a phenothiazine derivative, possesses anti-inflammatory properties, inhibition of tumor neurosis factor-alpha (TNF-alpha) synthesis and bone resorption. TNF-alpha promotes inflammatory changes and bone resorption in periodontitis. We have studied the effect of CPZ in experimental periodontitis. Wistar rats were subjected to a ligature placement around the cervix of the right second upper molars. Alveolar bone loss was evaluated by the sum of the distances between the cusp tip and the alveolar bone along the axis of each molar root, which was subtracted from the contralateral side. Histopathological analysis of the periodontium was based on cell influx, osteoclast number, and alveolar bone and cementum integrity. Animals were weighed daily and total and differential peripheral white blood cell counts were performed 6 h and 1, 7 and 11 d after periodontitis induction. Groups were treated with CPZ 1 h before and daily up to the 11th d of periodontitis. Alveolar bone loss was inhibited 46%, 55.4%, and 76.5% by CPZ at 1, 3 and 9 mg/kg, respectively. Histological analysis showed a significant reduction of cell influx and osteoclast number, as well as preservation of the alveolar process and cementum. CPZ reversed leukocytosis but not weight loss. In conclusion, CPZ reduces bone loss in experimental periodontitis, probably via TNF-alpha blockade.

Correlation of pseudohypoxemia and leukocytosis in chronic lymphocytic leukemia

Pseudohypoxemia has been reported in leukemic patients with extreme leukocytosis, and it is characterized by a low oxygen saturation on arterial blood gas analysis despite normal saturation on pulse oximetry. We report the case of a 51-year-old man with chronic lymphocytic leukemia and an elevated white blood cell (WBC) count after splenectomy, his progressive postoperative pseudohypoxemia gradually improved as the leukocytosis was lowered by chemotherapy. We believe this is the first report to show a statistically significant correlation between the WBC count and the degree of pseudohypoxemia in a patient with leukemia.

Induced sputum for the investigation of airway inflammation: evidence for its clinical application

Airway inflammation is considered to be the primary cause of airway diseases. Its prevention and reversal are the primary aims of treatment. Measurement of the inflammation is now possible relatively noninvasively and reliably by using induced sputum cell counts. The differential count indicates the presence and type of the inflammation (eosinophilic or neutrophilic) and the total cell count the intensity. Sputum eosinophilia responds to treatment with corticosteroid, while there is increasing evidence that an isolated neutrophilia does not. Clinical judgement of airway inflammation is made difficult because of the different types of inflammation and their inconsistent correlation with the clinical features. Hence, reliable measurement of induced sputum cell counts may be useful to guide treatment in clinical practice. Consideration should now be given as to how to make it more available.