Defect of cell-mediated immune response against hepatitis B virus: an indication for pathogenesis of hepatitis-B-virus-associated membranous nephropathy

To elucidate the questions of why not all patients with hepatitis B virus (HBV) infection develop HBV membranous nephropathy (HBVMN), we first measured serum HBe circulating immune complex (CIC) during the acute nephrotic phase of HBVMN and in HBV carriers. We found that the level of HBe CIC was low in the HBVMN patients and absent either in HBsAg+/HBeAg+ patients without HBVMN or HBsAg+/HBeAg- asymptomatic carriers. Second, we needed to characterize the cellular immune response to HBV in patients with HBVMN. However, lack of a suitable autologous effector/target cell system makes a precise study of HBVMN pathogenesis difficult. In the present study, we established a model system by using autologous HBcAg-expressing Epstein-Barr-virus-immortalized lymphoblastoid cell lines (LCL) as stimulator/target cells. Both proliferative response after stimulation with HBcAg and cytotoxic activity against autologous HBcAg-expressing LCL of the peripheral blood T cells obtained from the HBVMN patients and HBsAg carriers could be measured. Using autologous HBcAg-expressing LCL as stimulator/target cells for the study of HBcAg-specific cytotoxic T lymphocytes, we found that HBVMN patients had lower cytotoxic activity than did both HBV carriers and HBsAg-/HBsAb+, HBeAg-/HBeAb+ children. From the in vitro cytokine production study of peripheral blood T cells after stimulation with HBcAg, we found that T-helper-cell-1-related IL-2 and IFN-gamma productions were very low in HBVMN patients but T-helper-cell-2-related IL-10 production was higher in HBsAg+/HBeAg+ patients with HBVMN than in those without HBVMN. Based on these findings, we conclude that HBVMN children seem to have an inadequate cellular immune response to HBcAg.

Ameliorative effect of traditional Chinese medicine prescriptions on alpha-naphthylisothiocyanate and carbon-tetrachloride induced toxicity in rats

Syh-Mo-Yin (SMY), Guizhi-Fuling-Wan (GFW), Shieh-Qing-Wan (SQW) and Syh-Nih-San (SNS) are prescriptions of Traditional Chinese Medicine (TCM) for liver disease. The effects of these four prescriptions against experimental liver injury induced by alpha-Naphthylisothiocyanate (ANIT) and carbon tetrachloride (CCl4) were studied. Rats treated with ANIT (100 mg/kg) exhibited elevations of serum total bilirubin (TBI), alkaline phosphatase (ALP), glutamate-oxalatetransaminase (sGOT) and glutamate-pyruvate-transminase (sGPT) as well as cholestasis and parenchymanecrosis. In rats receiving SMY, SQW and SNS treatment after ANIT challenged, the biochemical and morphological parameters of liver injury were significantly reduce. Elevated lipid peroxidation (LPO) level in liver tissue, associated with an increase in serum GOT and GPT level, was observed in CCl4-treated rats. Treatment with these four prescriptions on CCl4-induced liver injury rats showed a remarkable hepatoprotective effect. A significant decrease in peroxidative level suggested that these prescriptions have anti free radical properties.

Bronchoconstriction and eosinophil recruitment in guinea pig lungs after platelet activating factor administration

Using a forced expiratory maneuver to measure flow volume loops, we evaluated the ability of platelet activating factor (PAF) to induce acute bronchospasm and in histological changes associated with bronchial asthma in guinea pigs. We determined both the dose-response curve and the time course of PAF-induced bronchoconstriction. Eight guinea pigs with weights ranging from 350 to 450 g were anesthetized, tracheotomized, and then paralyzed with gallamine. Baseline pulmonary function tests (PFT) were done. Different doses (25, 50, 100, 200, and 500 ng/kg) of PAF were injected through the jugular vein, and serial PFTs were done at 30 sec, 2, 5, and 20 min after each dose of PAF. Acetylcholine provocation testing was done following the 200 ng/kg dose of PAF. The PFTs included a forced expiratory maneuver, airway opening pressure (PaO), and total lung compliance (TLC). After all PFTs were completed, cell counts were done on fluid obtained from bronchoalveolar lavage (BAL) and the lungs were removed for histological study. Eight other guinea pigs were used as controls. The results showed that with increasing doses of PAF from 25 ng/kg to 200 ng/kg, all lung function parameters, including vital capacity, peak flow, MFEF 75%, MFEF 50%, MFEF 25%, and total lung compliance, gradually decreased. However, a further increase of the dose of PAF up to 500 ng/kg did not result in continued worsening of PFTs. The most severe bronchoconstriction occurred 30 sec after PAF was injected, and it gradually resolved thereafter. PAF injection also induced a severe inflammatory reaction of the airway and lung tissue, characterized by congestion, edema, inflammatory cell (especially lymphocytes and eosinophils) infiltration, and desquamation of bronchial epithelial cells. In conclusion, in the guinea pig model, PAF can induce acute reversible bronchospasm and bronchial hyperreactivity, as well as the typical histological changes of bronchial asthma.

Effects of oleanolic acid and ursolic acid on inhibiting tumor growth and enhancing the recovery of hematopoietic system postirradiation in mice

Two triterpene acids, oleanolic acid (OA) and ursolic acid (UA) were examined for their ability to inhibit the tumor growth and modify hematopoiesis after irradiation in three experimental systems: (a) in vivo anti-tumor activity of implanted tumor by ascitic cells was found to be augmented by addition of OA and UA at a high concentration and inhibited in a dose-dependent manner; (b) in the sublethal whole-body irradiated mice treated with the drugs in the 30 min preirradiation period, enhanced effects of OA and UA on peripheral leukocytes were observed by a different significance, and (c) when these chemicals were administered i.p. to mice 30 min before 4 Gy irradiation, both OA and UA enhanced the postirradiation responses of splenic blastogenesis by PHA. UA was a more potent tumorigenic inhibitor than OA. Combining with the gamma-irradiation, however, there was no significant synergetic effect on their anti-tumor activity. The beneficial effects of OA and UA on hematopoiesis and immunocompetence under this study, suggested they might partially play a role in anti-cancer and, furthermore, with the ability to decrease undesirable radiation damage to the hematopoietic tissue after radiotherapy.

Maximal forced expiratory maneuver to measure airway obstruction in anesthetized guinea pigs

Our purpose was to develop a method using a maximal forced expiratory flow (MFEF) for the study of airway hyperreactivity in guinea pigs induced by ovalbumin inhalation challenge. Eight guinea pigs (weight range 350-450 g) were sensitized by inhaled ovalbumin (group I) 2 times during a 1-week interval and then subjected to provocation with ovalbumin 1 week later. Pulmonary function tests at baseline and after acetylcholine challenge were performed 72 h later. Eight weight-matched normal guinea pigs served as controls (group II). All animals were anesthetized, paralyzed with gallamine, and ventilated via tracheostomy. They were given varying doses of acetylcholine (25, 50, 75, 100 micrograms/kg) injected through a jugular venous catheter. Five seconds after acetylcholine injections, pulmonary function was examined, including maximal forced expiratory maneuver, peak airway pressure (PaO) and total lung compliance. After completing the pulmonary function tests, bronchoalveolar lavage (BAL) was performed with 20 ml normal saline divided into two doses. Thereafter, the lungs were removed and examined histologically. The results showed that guinea pigs treated with ovalbumin had worse pulmonary function tests than normal controls, characterized by lower peak flow, MFEF 75%, MFEF 50% and vital capacity. The ovalbumin-presensitized guinea pigs also demonstrated severe bronchoconstriction in response to acetylcholine, characterized by larger decreases in peak flow, MFEF 75%, MFEF 50% and in vital capacity than the control group. Total cell count, the percentage and absolute number of eosinophils and lymphocytes were increased, and the percentage of macrophages was decreased in the BAL fluid of these animals. Finally, ovalbumin-sensitized guinea pigs had a severe inflammatory reaction in airway and lung tissue, characterized by congestion, edema and inflammatory cell infiltration (especially lymphocytes and eosinophils) and desquamation of bronchial epithelial cells. In conclusion, a forced expiratory maneuver can be used to perform pulmonary function tests in guinea pigs.

A preliminary study on the radioprotection of mouse hematopoiesis by dang-gui-shao-yao-san

The purpose of this study reported here was to investigate the ability of Dang-Gui-Shao-Yao-San (DGSYS), known to elevate hematopoietic functions, to protect mice undergoing treatment with whole body single X-irradiation. DGSYS given at doses of 10 and 20 mg/20 g body weight, once a day, for 7 consecutive days before irradiation protected ICR strain mice from the sublethal effects of radiation in a dose-dependent manner. Prior administration of 20 mg/20 g DGSYS increased the number of femoral spleen colony-forming units (CFU-S) that survived irradiation, and significantly ameliorated leukopenia, thrombocytopenia and the degression of hematocrits after irradiation. These results suggest that DGSYS may be effective in the prevention of hematopoietic injury caused by sublethal dose irradiation.

Antiplatelet and antiproliferative effects of SCH 51866, a novel type 1 and type 5 phosphodiesterase inhibitor

SCH 51866 is a potent and selective PDE1 and PDE5 inhibitor. The antiplatelet, antiproliferative, and hemodynamic effects of SCH 51866 were compared with those of E4021, a highly selective PDE5 inhibitor. SCH 51866 inhibited PDE1 and PDE5 isozymes with a 50% inhibitory concentration (IC50) of 70 and 60 nM, respectively. SCH 51866 and E4021 inhibited washed human platelet aggregation induced by collagen with an IC50 of 10 and 4 microM, respectively, and attenuated (p < 0.05) the adhesion of 111indium-labeled platelets to the nylon filament-injured rat aorta. The doses of SCH 51866 and E4021 that inhibited platelet adhesion caused significant increases in platelet cyclic guanosine monophosphate (cGMP; p < 0.05). SCH 51866 (1-10 mg/kg, p.o. twice daily) but not E4021 (3-30 mg/kg, p.o twice daily) inhibited neointima formation in the carotid arteries of spontaneously hypertensive rats (SHRs) subjected to balloon angioplasty. Moreover, SCH 51866 (0.3-10 mg/kg, p.o.) elicited dose-dependent reduction in blood pressure in SHRs, whereas E4021 (3-30 mg/kg, p.o.) did not affect blood pressure in SHRs. In conclusion, the data suggest that inhibition of PDE1 and PDE5 isozymes by SCH 51866 exerts antiplatelet and vascular protective effects. In comparison, inhibition of PDE5 alone by E4021 exhibited antiplatelet effects without affecting neointima formation.

Determination of plasma concentrations of SCH 44643 by a GC method and correlation of plasma concentration and anti-PAF activity in cynomolgus monkeys

Inhibiting the action of platelet-activating factor (PAF) is a new therapeutic approach for the treatment of allergic disorders. SCH 44643 is a new orally-active antagonist of response to both PAF and histamine. This study was done to determine plasma drug concentrations using a GC method and to compare them to ex-vivo anti-PAF activity in the plasma of cynomolgus monkeys following a single oral (12.5 mg kg-1) administration. The GC method involved organic solvent extraction of monkey plasma followed by a GC analysis in a RTX-1 capillary column with a nitrogen/phosphorus detector. The method showed good precision (RSD < 8%) and accuracy (bias < 9%) with a limit of quantitation of 20 ng ml-1. The plasma profiles of SCH 44643 concentration and anti-PAF activity were very similar in each of the six monkeys. There was an excellent correlation (r = 0.9003) between anti-PAF activity and plasma concentration of SCH 44643, suggesting that the anti-PAF activity in cynomolgus monkeys was primarily due to unchanged SCH 44643, rather than its potential metabolite(s).

Recovery of the hematopoietic system by Si-Jun-Zi-Tang in whole body irradiated mice

The herbal formulation Si-Jun-Zi-Tang reduced the decrease of leukocytes, erythrocytes, thrombocytes and hematocrit in irradiated mice. In general, its protection was more effective in leukocytes and thrombocytes than other hematocytes. Protection of bone marrow stem cells by Si-Jun-Zi-Tang was markedly enhanced by increased radiotolerance under the dose ranging from 0 to 5 Gy. This increased radiotolerance led to a prolonged shoulder in the survival curve but did not influence the D0 value. Si-Jun-Zi-Tang exerted a beneficial effect on clinical syndromes such as anemia. From the results in this study, we concluded preliminarily that the most effective concentration with least toxicity was about 20 mg/20 g body weight. At this dose, levels of leukocytes as well as thrombocytes were enhanced significantly after chi-irradiation. Elevation of erythrocytes and hematocrits could also be found but was not significant.

Incomplete pancreas divisum coexistent with anomalous union of pancreaticobiliary duct--report of a Chinese patient

The coexistence of incomplete pancreas divisum and anomalous union of pancreaticobiliary duct is uncommon and, to the best of our knowledge, has been reported only in three patients who also presented with choledochal cysts. We have encountered a 54-year-old patient with symptom of intermittent right upper quadrant pain. Endoscopic retrograde cholangiopancreatography revealed coexistence of incomplete pancreas divisum and anomalous union of pancreaticobiliary duct, but no dilatation of bile duct.

Comparative bioavailability of ceftibuten in capsule and suspension forms

The comparative bioavailability of ceftibuten, a new third-generation cephalosporin antibiotic given orally once daily, in capsule and suspension dosage forms, was assessed in healthy male subjects. In three separate studies, subjects received either a 400-mg dose as a suspension or one laboratory-batch, 400-mg capsule; one laboratory-batch, 400-mg capsule or two laboratory-batch, 200-mg capsules; or one production-batch, 400-mg capsule or two laboratory-batch, 200-mg capsules. Plasma samples were assayed for ceftibuten using high-performance liquid chromatography, and the data were assessed using pharmacokinetic and statistical methods. Confidence intervals for the maximum plasma concentration and the area under the plasma concentration-time curve extrapolated to infinity were within 80% to 125% of guidelines, demonstrating the bioequivalence of the two treatments within each of the three studies. One 400-mg capsule (laboratory or production batch) was bioequivalent to two 200-mg capsules used in a clinical efficacy trial; the 400-mg suspension was bioequivalent to a 400-mg capsule (laboratory batch). Thus we concluded that the capsule and the suspension dosage forms were bioequivalent.

Suicide and parasuicide in psychiatric inpatients: ten years experience at a general hospital in Taiwan

We investigated 64 suicidal acts of 62 psychiatric inpatients over a 10-yr. period. The findings indicated the frequency of suicidal behavior of psychiatric inpatients was 0.91% of total admissions, two thirds of the patients who attempted suicide were diagnosed with schizophrenia or depression, and patients suffering from depression, substance abuse, and personality disorders had a higher parasuicide rate, among whom those diagnosed bipolar disorder with depressive episode had an extremely high parasuicide rate. Most of the incidents occurred in concealed places, and most of the patients used nonviolent methods. About half of the incidents occurred during the evening shift and depressed patients tended to attempt suicide during the night shift. Most suicidal attempts were unsuccessful and led to minor injury. There were two deaths.

Influence of food on the oral bioavailability of loratadine and pseudoephedrine from extended-release tablets in healthy volunteers

The effect of a high-fat breakfast on the bioavailability of the components of an extended-release tablet containing 10 mg loratadine in the immediate-release coating and 240 mg pseudoephedrine sulfate in the extended-release core was studied in 24 healthy male volunteers in a single-dose, two-way crossover study. The drug was administered after a 10-hour overnight fast or within 5 minutes of consuming a standardized high-fat breakfast. Serial blood samples were collected over a 48-hour period, and plasma was analyzed for loratadine and its active metabolite descarboethoxyloratadine (DCL), and pseudoephedrine. For pseudoephedrine, maximum concentration (Cmax) and area under the concentration-time curve extrapolated to infinity (AUCzero-infinity) were similar after both treatments, indicating no relevant food effect on the bioavailability of pseudoephedrine. Also, the absorption profiles of pseudoephedrine (from Wagner-Nelson analysis) were similar for the fed and fasted treatments, indicating no apparent differences in absorption. Plasma concentration-time profiles and values for Cmax and AUCzero-infinity of DCL were similar for the two treatments, indicating no relevant food effect on the pharmacokinetics of DCL. In contrast, for loratadine, administration with food resulted in a significantly increased mean Cmax (53%) and AUC from time zero to the final quantifiable sample (AUCif) (76%). However, the resultant Cmax and AUC of loratadine under fed conditions were well below those previously obtained at steady-state after multiple-dose administration of loratadine (40 mg/day) that were shown to be safe and well-tolerated in several clinical studies. The effect of food on the bioavailability and pharmacokinetic profiles of the components of a combination loratadine/pseudoephedrine extended-release tablet is not likely to be clinically significant.

Conservation of a 31-bp bovine subrepeat in centromeric satellite DNA monomers of Cervus elaphus and other cervid species

A centromeric satellite DNA clone was isolated from the genome of the European red deer (Cervus elaphus hippelaphus) and designated Ce-Pst1. This clone was localized to the centromeric region of all red deer chromosomes with the exception of a single pair of metacentric autosomes and the Y chromosome. DNA sequence analysis of the 806-bp Ce-Pst1 clone showed 73.0-78.9% sequence homology to four previously isolated cervid centromeric satellite DNA clones, suggesting that the Ce-Pst1 clone is yet another member of the major cervid centromeric satellite DNA family. Using a DNA sequence comparison system, internal 31-bp tandem subrepeats were found in the Ce-Pst1 clone as well as in the other previously reported cervid centromeric satellite DNA monomer sequences. A 31-bp consensus sequence was constructed for each cervid monomer clone and shown to be highly homologous to the 31-bp subrepeat consensus sequence found in bovine 1.715 centromeric satellite DNA. The identification of internal subrepeats in the satellite monomers studied could suggest that amplification of an ancestral 31-bp DNA sequence may have contributed to the genesis of major cervid centromeric satellite DNA. The homology between the 31-bp subrepeats found in cervid and bovid centromeric satellite DNAs substantiates the theory that amplification of this 31-bp DNA sequence may have occurred before the evolutionary separation of these two families 20-25 million years ago.

Limb lengthening over an intramedullary nail. An animal study and clinical report

With the goal of reducing the duration of external fixation in limb lengthening, the authors investigated the feasibility of limb lengthening over an intramedullary nail that could be statically locked when the desired length was achieved, permitting early removal of the external fixation device. In a preliminary study, 8 minigoats underwent 2.0-cm lengthening of the tibia by means of a uniplanar external fixator. Half of the goats had a reamed nail placed in the tibia at the initial surgery. By 10 weeks after lengthening, there no difference in radiographic, histologic, or biomechanical evidence of bone regeneration was found between the tibiae that were nailed and those that were not. In a following clinical series, 15 patients underwent tibial or femoral lengthening by means of a circular frame fixator with a reamed intramedullary nail in place. The postoperative course was uneventful except for 1 infection. The distraction gaps became ossified from 6 months to 1 year, and only 2 patients needed additional bone graftings. The joint function of the lengthened limb at last followup was good. Gradual limb lengthening with a reamed intramedullary nail in place is safe and effective and allows for early removal of the external fixation device.

Comparison between nocturnal nasal positive pressure ventilation combined with oxygen therapy and oxygen monotherapy in patients with severe COPD

We evaluated the benefits of O2 therapy and nocturnal nasal positive pressure ventilation (NPPV) with or without O2 in patients with severe chronic obstructive pulmonary disease (COPD). Twelve patients with severe COPD and nocturnal oxygen desaturation, who had not been receiving long-term O2 therapy and who could tolerate more than 2 wk of NPPV therapy, were enrolled in this study in a stable condition. Data on pulmonary function tests (PFTS), arterial blood gases (ABG), right and left ventricular ejection fractions (RVEF and LVEF) from nuclear medicine studies, and overnight sleep studies were collected at the beginning of the study and after each 2 wk of therapy with O2, NPPV, or NPPV with O2. Patients received O2 monotherapy or NPPV for sequential 2-wk periods in a randomized, cross-over design, followed by 2 wk of NPPV with O2. Hypoxic and hypercapnic ventilatory responses (HVR) in the study group, as measured by mouth occlusion pressure in the first 100 ms of inspiration against an occluded airway (P0.1), were compared with normal controls and repeated after 2 wk of therapy with NPPV with O2. The results revealed no significant changes in the percent of each sleep stage regardless of the treatment modality. However, sleep efficiency was poorer when NPPV was used than when it was not used. NPPV alone did not improve nocturnal oxygenation when compared with the baseline sleep study. Oxygen monotherapy was better than NPPV therapy for improving nocturnal oxygenation. NPPV plus O2 therapy showed no benefits over O2 monotherapy in either RVEF or LVEF, ABG, or HVR. In conclusion, for severe COPD patients, O2 therapy is more effective than NPPV for improving nocturnal oxygenation.

Perceived self-efficacy and outcome expectancies in coping with chronic low back pain

The purposes of this study were to explore the coping strategies used by patients with chronic low back pain, to test hypothesized mediators of the relationship between self-efficacy and pain outcomes, and to determine the roles of self-efficacy and outcome expectancies in coping with pain in patients (N = 85) with chronic low back pain. The most common coping behaviors were reporting pain, using pain medications, and coping self-statements. Patients' self-efficacy to cope with pain was inversely correlated with pain intensity. Self-efficacy was positively correlated with perseverance of coping effort. Perseverance of coping effort was found to mediate the effects of self-efficacy on pain outcomes; however, level of distress was not found to be a mediator. Outcome expectancies were positively correlated with perseverance of coping effort. These findings are discussed in terms of implications for practice and directions for future research.

Experience in thoracoscopic sympathectomy for hyperhidrosis with concomitant pleural adhesion

Thoracoscopic (transthoracic endoscopic) sympathectomy, known worldwide as the best method for treatment of hyperhidrosis, is regarded as having two major contraindications: pleural adhesion and coagulopathy. We embarked on this study to prove that it is possible and highly feasible to do thoracoscopic sympathectomy, even in the presence of severe pleural adhesion, as long as the surgeon knows anatomy and is well-trained in performing this procedure. From October 1, 1989, through December 31, 1992, we treated 719 cases of hyperhidrosis palmaris (325 male and 394 female patients), by the thoracoscopic method at Tainan Municipal Hospital. Among them, 24 cases (3.5%), 19 male and 5 female patients, had concomitant pleural adhesions. The causes of pleural adhesion were pulmonary tuberculosis, chronic bronchitis, previous operations for hyperhidrosis, and a few with uncertain origins. Except for the first encountered case of hyperhidrosis with pleural adhesion, which was treated by mini-thoracotomy after failure of a thoracoscopic approach through the right thoracic cavity, the remainder of the 23 cases were treated successfully by the thoracoscopic method. In cases with bilateral pleural adhesions, the right thoracic cavity was more frequently involved and more severely. The incidence of pleural adhesion in hyperhidrosis is 3.5% in our series; all, except the first case, were treated thoracoscopically. Coagulopathy is for us, therefore, the only remaining contraindication of thoracoscopic sympathectomy.

Pelvic mass caused by polyethylene wear after uncemented total hip arthroplasty

A 50-year-old man developed a pelvic mass following uncemented total hip arthroplasty. The mass communicated with the hip via an acetabular defect after loosening of the acetabular component. Operative and histologic findings revealed a foreign body reaction to polyethylene debris. Revision arthroplasty and excision of the pelvic mass were performed successfully through a single incision. A mass adjacent to a loose prosthesis may present as polyethylene failure following total hip arthroplasty. Revision arthroplasty and excision of the mass after an accurate diagnosis are recommended.

Sensitive high-performance liquid chromatographic method for the determination of a benzonaphthazepine antipsychotic agent, SCH 39166, and its active metabolite, SCH 40853, in human plasma and its cross-validation with a gas chromatographic method

A sensitive high-performance liquid chromatographic (HPLC) method was developed for the determination of a benzonaphthazepine antipsychotic agent, SCH 39166, and its active metabolite, SCH 40853. The HPLC method required a single-step organic extraction at alkali pH followed by HPLC analysis utilizing a CN column with UV detection at 205 nm. The limit of quantitation was 1 ng/ml for SCH 39166 and 0.5 ng/ml for SCH 40853. The HPLC method was cross-validated with a previously reported GC method by the analysis of 73 plasma samples spiked with various concentrations of SCH 39166 and SCH 40853. The correlation coefficient was 0.9969 for SCH 39166 and 0.9984 for SCH 40853. Both GC and HPLC methods were used for the determination of plasma concentrations and yielded similar pharmacokinetic parameters for SCH 39166 and SCH 40853 in man following oral administration of SCH 39166 (100 mg).

Design and synthesis of C-linked fucosides as inhibitors of E-selectin

Two series of C-linked fucosides as mimetics for the tetrasaccharide sialyl Lewis X have been synthesized and tested as inhibitors of E-Selectin. The fucopeptides have been prepared from three key intermediates, including alpha-C-allyl fucose, natural and unnatural amino acids bearing hydroxyl groups and an alpha, omega-diacid moiety for the imitation of the essential three parts of SLex, i.e., the Fuc, Gal, and NeuAc. The nature and distance of the linkage of the fucose moiety to the amino acids as well as the distance between the amino acids and the terminal carboxylic acid group turned out to be crucial for the biological activity. In addition the necessity of both OH groups (4- and 6-OH) in the Gal part could be confirmed. Conformational NMR study of the most active mimetic supports the structure-activity relationship. A second series of mimetics was prepared, where Fuc and Gal moieties were purely C-linked. In the synthesis of beta-C-allyl galactose an intramolecular 1,2-hydride shift led to an interesting side product. However, the substituted glycosidic oxygens led to a substantial loss of conformational constrain, which could not be compensated and resulted in low activity.

Effect of felbamate on the pharmacokinetics of lamotrigine

To assess the possible interaction between lamotrigine and felbamate, a double-blind, randomized, placebo-controlled, two-way crossover study was conducted in 21 healthy male volunteers. Volunteers were given lamotrigine (100 mg every 12 hours) and felbamate (1,200 mg every 12 hours) or matching placebo for 10 days during each period of the crossover. After morning administration on day 10, blood samples were obtained over 12 hours for measurement of lamotrigine. Felbamate increased the maximum concentration (Cmax) and and area under the concentration-time curve from time 0 to 12 hours (AUC0-12) of lamotrigine by 13% and 14%, respectively, compared with placebo. The 90% confidence intervals of the log-transformed pharmacokinetic parameters were within the 80-125% bioequivalance limits, however. Felbamate had no significant effect on the urinary excretion of lamotrigine (total), unconjugated lamotrigine, or the N-glucuronide. One volunteer discontinued the study after developing a rash while taking lamotrigine and placebo. All other adverse events were primarily related to the central nervous system and gastrointestinal tract, with a higher incidence reported during coadministration of lamotrigine and felbamate than with placebo. Overall, felbamate appears to have no clinically relevant effects on the pharmacokinetics of lamotrigine.

Clinical response of tuberculous pericarditis to medical treatment: a retrospective survey

BACKGROUND

The prevalence of tuberculosis has declined with advanced antituberculous chemotherapy. However, the occurrence of subsequent constrictive pericarditis in tuberculosis has not reduced. Clinical progress of tuberculous pericarditis was investigated in patients receiving antituberculous chemotherapy.

METHODS

Thirteen patients with tuberculous pericarditis (11 men and 2 women aged 14 to 86 years [mean 60.0 +/- 17.0]), treated initially with antituberculous medications were analyzed. All patients underwent pericardiocentesis on admission following echocardiography.

RESULTS

Dyspnea was the most common clinical pictures. Bloody effusion fluids were noted in 10 patients. Moreover, the lymphocytic fluids were present in 78% of all patients. The neutrophilic fluids tended to have a bloody color, and there was progress to constrictive pericarditis even for those on anti-tuberculous chemotherapy. Five patients with subsequent constrictive pericarditis received pericardiectomy within 3.5 months of admission. Three of them received pericardiectomy later, despite pericardial window procedure.

CONCLUSIONS

Follow-up by echocardiogram is necessary within three months after commencing medical treatment because of the high incidence of progression constrictive pericarditis despite aggressive medical treatment. Pericardiectomy seems to be the only solution to the catastrophic outcome of constrictive pericarditis.

Patient satisfaction with nursing care as an outcome variable: dilemmas for nursing evaluation researchers

Evaluation is one of the most critical phases of the nursing process because it supports the basis of the usefulness and effectiveness of nursing practice. Nursing practice is patient driven and patient centered. Accordingly, patient satisfaction has been strongly advocated by nursing professionals to be an important indicator of quality of nursing care delivery. This article discusses the conceptualization and measurement of patient satisfaction with nursing care. Also, this article examines numerous dilemmas related to conceptualization and methodology that nursing evaluation researchers confront when attempting to use patient satisfaction as an outcome variable. Based on the current knowledge regarding the nature of patient satisfaction, implications for future nursing evaluation research are proposed and discussed to overcome these dilemmas in measuring patient satisfaction as an indicator of quality of nursing care.