[ALPK3 gene-related pediatric cardiomyopathy with craniofacial-skeletal features: a report and literature review]

Objective: To explore the clinical characteristics and mutation spectrum of ALPK3-related pediatric cardiomyopathy and craniofacial-skeletal abnormalities in children. Methods: The clinical data during a follow-up of 11 years including clinical features, echocardiogram, electrocardiogram, cardiac magnetic resonance, genetic testing, and other data of a child firstly diagnosed with ALPK3 gene-related cardiomyopathy and craniofacial-skeletal abnormalities in China were collected retrospectively. The literatures containing the keyword of "ALPK3 gene" published in the China National Knowledge Infrastructure, Wanfang database and PubMed were collected up to November 2020. Then, the clinical features and gene mutations of ALPK3 gene-related pediatric cardiomyopathy with craniofacial-skeletal features were summarized. Results: A female patient aged 10 months who presented with an enlarged heart for 2 months, was admitted to the hospital and initially diagnosed with endocardial elastic fibrosis. The echocardiography showed features of dilated left ventricle (LV) and LV systolic dysfunction. Low-set ears, webbed neck, a grade 2/6 systolic murmur at lower left sternal area and bilateral absent flexion creases of dig were observed. After treatment, the size and function of the heart recovered to normal at age 13 months. However, the ventricular septum and LV wall were thicker than normal values. Then, the diagnosis was revised to hypertrophic cardiomyopathy(HCM) and suspected congenital malformation syndrome. LV hypertrophy (LVH) progressed slowly before the age of 8 years and then progressed rapidly. At age 9 years, compound heterozygous ALPK3 mutations (c.721dup, p.Y241Lfs*42(exon 1) and c.4840C>T, p.R1614*(exon 10)) were detected in the proband and the mutations had not been reported previously. Then, the final diagnosis of ALPK3 gene-related pediatric cardiomyopathy with craniofacial-skeletal features was made. During the follow up of 11 years, regular follow-up echocardiographic images showed progressive LVH. At age 11 years, electrocardiogram showed LVH, ST-T changes in multiple-lead, T wave inversion, and prolonged QT intervals. Cardiac magnetic resonance showed biventricular hypertrophy and late gadolinium enhancement showed non-uniform enhancement of left and right ventricular myocardium. A total of 7 articles published in English were retrieved, and no Chinese literature was found. Twenty-eight cases were reported in the articles plus the patient in this study. Twenty-four mutations were reported worldwide, 18 patients carried homozygous mutations and 10 patients compound heterozygous mutations. Eleven patients showed dilated cardiomyopathy (DCM) at early stage of disease, and 10 of them transitioned to HCM at the disease progression stage. Eight patients presented with HCM at early stage of disease. Nine patients initially exhibited a mixed phenotype of DCM and HCM, and 6 of them eventually progressed to HCM. Electrocardiogram showed prolonged QT interval. Extracardiac features included short stature, special face, cleft palate, webbed neck, joint contracture, and scoliosis, etc. Conclusions: Progressive myocardial hypertrophy is a major feature of ALPK3 gene-related cardiomyopathy with craniofacial-skeletal malformations. Precise diagnosis depends on molecular genetic techniques. More cases should be accumulated for further analysis on the genotype-phenotype correlation and prognosis assessment.

[Value of gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid enhanced magnetic resonance imaging and diffusion-weighted MR imaging in predicting microvascular invasion in hepatocellular carcinoma and the prognostic significance]

Objective: To investigate the combined value of gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid (Gd-EOB-DTPA) enhanced magnetic resonance imaging (MRI) and diffusion-weighted imaging (DWI) in predicting pathological microvascular invasion (pMVI) preoperatively, and to determine the relationship between prediction results and prognosis in hepatocellular carcinoma (HCC) patients. Methods: A total of 181 newly diagnosed HCC patients were enrolled in this study. Imaging characteristics and the apparent diffusion coefficient (ADC) value of DWI were analyzed. The differences of imaging characteristics and ADC values between different pMVI groups were analyzed.Multivariate logistic regression and receiver operating characteristic (ROC) curve were used to analyze the value for pMVI prediction by using significant parameters. The patients were grouped based on MRI predicted MVI (mrMVI), and the relationship between mrMVI and recurrence free survival time (RFS) was analyzed. Results: Fifty-one patients were pMVI positive and 130 patients were pMVI negative. The ADC value in pMVI positive group were (1.10±0.17)×10(-3) mm(2)/s, significantly lower than (1.27±0.22)×10(-3) mm(2)/s of pEMVI negative group (P<0.001). The incidence rates of incomplete enhancing "capsule" , non-smooth tumor margin, arterial peritumoral enhancement, mosaic architecture and peritumoral hypointensity on hepatobiliary phase (HBP) in pMVI positive group were significantly higher than those of negative group (all P<0.05). Multivariate logistic regression analysis showed that tumor margin, arterial peritumoral enhancement, peritumoral hypointensity on HBP and ADC value were independently associated with pMVI. ROC analysis showed that the area under curve, sensitivity and specificity of pMVI predicted by combined parameters were 0.830, 76.5% and 81.5%, respectively. The median RFS of mrMVI positive group was 23.6 months, significantly lower than 38.2 months of mrEMVI negative group (P=0.004). Conclusion: Tumor margin, arterial peritumoral enhancement, peritumoral hypointensity on HBP and ADC value are independent predictors of pMVI in HCC, and mrMVI is related with RFS.

[Predictive value of neutrophil/lymphocyte ratio on myocardial injury in severe COVID-19 patients]

Objective: To explore the predictive value of neutrophil/lymphocyte ratio (NLR) on myocardial injury in severe COVID-19 patients. Methods: In this single-center retrospective cohort study, we collected and analyzed data form 133 severe COVID-19 patients admitted to Renmin Hospital of Wuhan University (Eastern District) from January 30 to February 18, 2020. Patients were divided into myocardial injury group (n=29) and non-myocardial injury group (n=104) according the presence or absence of myocardial injury. The general information of patients was collected by electronic medical record database system. All patients were followed up for 30 days, the organ injury and/or dysfunction were monitored, the in-hospital death was compared between the two groups, and the disease progression was reevaluated and classified at 14 days after initial hospitalization. Logistic regression analysis was performed to identify risk factors of myocardial injury in severe COVID-19 patients. The ROC of NLR was calculated, and the AUC was determined to estimate the optimal cut-off value of NLR for predicting myocardial injury in severe cases of COVID-19. Results: There was statistical significance in age, respiratory frequency, systolic blood pressure, symptoms of dyspnea, previous chronic obstructive pulmonary disease, coronary heart disease history, white blood cells, neutrophils, lymphocytes, platelets, C-reactive protein, platelet counting, aspartate transaminase, albumin, total bilirubin, direct bilirubin, urea, estimated glomerular filtration rate, total cholesterol, low-density lipoprotein cholesterol, D-dimer, CD3⁺, CD4⁺, partial pressure of oxygen, partial pressure of CO₂, blood oxygen saturation, other organ injury, clinical outcome and prognosis between patients with myocardial injury and without myocardial injury (all P<0.05). Multivariate logistic regression analysis showed that NLR was a risk factor for myocardial injury (OR=1.066，95%CI 1.021-1.111，P=0.033). ROC curve showed that NLR predicting AUC of myocardial injury in severe COVID-19 patients was 0.774 (95%CI 0.694-0.842), the optimal cut-off value of NLR was 5.768, with a sensitivity of 82.8%, and specificity of 69.5%. Conclusion: NLR may be used to predict myocardial injury in severe COVID-19 patients.

Identification of novel candidate autoantibodies in Alzheimer's disease

BACKGROUND AND PURPOSE

Accumulated failures in Alzheimer's disease (AD) clinical trials have highlighted an urgent need to identify additional biomarkers involved in AD. Recently, mounting evidence reported that autoantibodies are ubiquitous in human sera. However, it is unknown whether autoantibodies are upregulated in amyloid-tau biomarker-confirmed AD.

METHODS

A total of 40 subjects with mild dementia (Clinical Dementia Rating = 1) were stratified into AD (n = 16) and non-AD (n = 24) groups according to their cerebrospinal fluid levels of tau and Aβ₄₂ . Their sera were collected and analyzed using a microarray containing > 1600 potential human autoantigens. Autoantibodies that were present exclusively in the AD group were identified and selected using the penetrance-based fold change method with the following criteria: penetrance fold change_(AD)  ≥ 2, frequency_(AD)  ≥ 15% and frequency_(non-AD)  = 0%.

RESULTS

All controls and samples passed the quality control criteria and were further used for biomarker analysis. Six autoantibodies with elevated responses to the following autoantigens were found exclusively in the AD group: nucleosome assembly protein 1-like 3 (31.3%, 5/16 subjects) and microtubule-associated protein 4, pantothenic acid kinase 3, phosphoinositide-3-kinase regulatory subunit 1, protein tyrosine phosphatase type IVA member 1 and SRY (sex-determining region Y)-box 15 (all 18.8%, 3/16 subjects).

CONCLUSIONS

Although some identified autoantigens are linked to AD and cognitive dysfunction, the increased autoantibody levels have not been reported in AD. Autoantibodies may provide deeper insights into the pathogenesis of AD and serve as diagnostic biomarkers; their corresponding antigens can be further studied to assess their potential as therapeutic targets.

[Conservative treatment and surgical treatment of cervical cellulitis combineing mediastinal pleural abscess]

Objective:To explore the diagnosis, treatment and curative effect of cervical cellulitis combineing mediastinal pleural abscess. Method:Clinical data of 37 patients with the cervical cellulitis and mediastinal pleural abscess were analyzed, all patients were confirmed using ultrasond, X-ray, CT, puncture and microbiology examination. The result will analysis the diagnosis, treatment and curative effect through the comparison of conservative treatment and surgical treatment. Result:Twenty-three cases of patients were underwent tracheotomy because of difficulty in breathing and successfully extubated after treatment. Nine cases of patients were given anti-infection treatment and recovered after conservative treatment. Twenty-one cases of neck multiple pus cavity were underwent cavity incision, full removal of necrotic tissue and pipe flushing; 7 cases of patients with neck and mediastinal abscess and within which 2 cases were with toxic shock were underwent adequate drainage of lavage and abscess incision through jugular joint path; the companion of pyothorax in 2 cases were underwent the chest closed drainage. All patients were giving sensitive antibiotic after drug sensitive test, anti-shock treatment and supportive treatment. All the patients were recovered and discharged. The average hospitalization days with conservative treatment of these patients were 15.7 days, and the average hospitalization days with surgical treatment of patients were 25.3 days. Conclusion:The condition of cervical cellulitis is complex, a few case can be cured with conservative treatment. The others progress rapidly when merging mediastinal pleural abscess can cause serious complications, surgical treatment is risky, fully abscess incision, lavage drainage and combine with sensitive antibiotics and supportive treatment are the keys to therapy.

Identifying the superior measure of rapid fibrosis for predicting premature cirrhosis after liver transplantation for hepatitis C

BACKGROUND

Hepatitis C virus (HCV) recurrence post liver transplant is universal, with a subgroup of patients developing rapid hepatic fibrosis. Various clinical definitions of rapid fibrosis (RF) have been used to identify risks for rapid progression, but their comparability and efficacy at predicting adverse outcomes has not been determined.

METHODS

Retrospective data analysis was conducted on 100 adult patients with HCV who underwent liver transplantation at a single center. We measured year 1 fibrosis progression (RF defined as METAVIR F score ≥ 1 at 1-year liver biopsy), time to METAVIR F2-stage fibrosis, and fibrosis rate (calculated using liver biopsies graded by METAVIR scoring F0-4; fibrosis rate = fibrosis stage/year post transplant). RF was defined as ≥ 0.5 units/year.

RESULTS

Multivariate analysis revealed that donor age and peak HCV viral load were significant risks for RF, when fibrosis rate was used to define RF. Advanced donor age was a risk for rapid progression to F2-stage fibrosis, whereas genotype 2 or 3 HCV infection was protective. Fibrosis rate had the strongest correlation with time to cirrhosis development (P < 0.0001, r = -0.76) and was the most accurate predictor of rapid graft cirrhosis (P < 0.0001, area under the curve 0.979, sensitivity 100%, specificity 94%).

CONCLUSION

Different measures of RF progression identify different risks for RF and are not directly comparable. Fibrosis rate was the most accurate predictor of rapid graft cirrhosis.

Using heavy metals to detect the human disturbances spatial scale on Chinese Yellow Sea coasts with an integrated analysis

An integrated approach involving landuse patterns obtained from landuse data and heavy metal contents of the top 10 cm surface soil layer samplings was proposed to detect the characteristic spatial scale of non-point source human disturbances on the Yellow Sea coast in China. Circular plots, with radii of 200, 500, 1000, 1500, and 2000 m were set up to represent five spatial scales. We proposed a human impact index (HII) using the landuse data to model the human disturbances. Multivariate statistics of the 10 heavy metals, Cr, Co, Fe, Mn, Ni, V, Zn, Cu, Ti, and Sr, were done. Finally curve estimation between HII and heavy metals was also done. The results showed that: (1) multivariate statistics, including principal component analysis, cluster analysis and the 1-tailed Pearson correlation analysis showing that elements Cr, Cu, Fe, Mn, Ni, V, Zn, and Co could be interpreted as anthropogenic elements and (2) of all the heavy metals showing statistical significance from the curve estimation, in general, the 1000 m scale HII had the best modeling result. We concluded that the characteristic spatial scale of human disturbances on Yellow Sea coast might be 1000 m.

Use of capsule endoscopy to diagnose colon diseases

AIM: To explore the use of capsule endoscopy to detect colon disorders following the completion of small intestine disease diagnosis on the basis of implementation of energy consumption control for the endoscope, body position adjustment and food serving.

METHODS: Seventy-six patients who received capsule endoscopy examination to exclude ileus were divided into two study groups: Group 1 (n = 39) and Group 2 (n = 37). Patients in Group 1 were examined by ordinary procedures. In contrast, patients in Group 2 were examined by modified procedures. The endoscope was manipulated to reduce the frequency of photographing and the brightness of endoscopic image before the capsule reached the duodenum. Within two hours after the capsule traveled inside the duodenum, the position of the moving capsule was observed continuously while the patient's body position was adjusted. The patients were laid flat with buttocks slightly elevated when the capsule moved into the colon. Meanwhile, the patients were served with food. When the capsule reached the hepatic flexure, the patients were laid on their left side. When the capsule reached the splenic flexure, the patients were laid in flat position. After the capsule battery was exhausted, the recorder was retrieved. The position of the capsule inside the patient's body was examined by X-ray.

RESULTS: Endoscopic capsules worked for 4 ± 0.9 h in the colon in Group 1. The capsules reached the recta in only four cases, and remained in the ileocecus in the other 35 cases, of which two cases of ileocecal polypi were detected. In contrast, endoscopic capsules worked for 5 ± 0.7 h in the colon in Group 2. The movement inside the colon was active after the patients took food. The capsules reached beyond the colon ascendens in 19 (51.4%) cases. Seven (18.9%) cases of colon diseases were detected in Group 2. Statistical differences were noted in the detection rate of colon diseases and the working duration of endoscopic capsules between the two groups (both P < 0.05). Moreover, a significant difference was observed in the effective rate of colon detection between the two groups (P < 0.01).

CONCLUSION: Implementation of battery energy control, patient position adjustment, and food serving during capsule endoscopy can effectively prolong the working duration of endoscopic capsules in the colon and increase the detection rate of colon diseases.

Recent progress in clinical applications of capsule endoscopy

Capsule endoscopy has been widely used since it was approved by the Food & Drug Administration in the USA in 2001. It plays an important role in the investigation of obscure gastrointestinal bleeding, Crohn's disease and complications of coeliac disease, and surveillance of polyposis syndromes in adults. Despite a lag in its use in paediatrics, capsule endoscopy offers an accurate and effective means of investigating the small bowel in children. It has opened up new horizons and provided a noninvasive approach to identify occult lesions in the small bowel. This article reviews the recent advance in clinical applications of capsule endoscopy.

Increased expression of NF-κB p65 in CagA+ H. pylori-related gastric precancerous lesions and carcinoma

AIM: To determine the expression of nuclear factor kappa B (NF-κB) in human gastric precancerous lesions and carcinoma and its correlation with CagA⁺H. pylori infection.

METHODS: The expression of NF-κB p65 was detected by immunohistochemistry (SABC assay), and H. pylori were examined using 14C-breath test, rapid urease test and Warthin-Starry staining in patients with chronic superficial gastritis (CSG: n = 34), intestinal metaplasia (IM: n = 31), atypical dysplasia (AD: n = 34) and gastric cancer (GC: n = 55). Serum CagA IgG antibody was detected by dot immunogold filtration assay. The correlations of NF-κB p65 expression with CagA⁺H. pylori infection as well as the histological types, clinicopathological stages and lymph node metastasis were analyzed.

RESULTS: The expression of NF-κB p65 in CSG, IM, AD, GC was 15.0%, 41.9%, 64.7%, and 78.2%, respectively, and there were significant differences between them (χ² = 43.98, P <0.01). The rates of H. pylori infection were 70.0%, 67.7%, 73.5%, and 54.5%, respectively, and there were no significant differences between them (P > 0.05). The percentage of CagA⁺H. pylori infection were 53.6%, 61.9%, 68.0%, and 73.3%, respectively, and there were no significantdifferences (P > 0.05). In IM, the positive rate of NF-κB p65 expression in H. pylori or CagA⁺H. pylori positive patients were significantly higher than that in patients without H. pylori infection or with CagA- H. pylori infection (57.1%, 76.9% vs 10%, 25.0%, P <0.05). In GC patients, the positive expression of NF-κB p65 was correlation with the T stages(χ² = 5.91, P <0.05)and lymph node metastasis (χ² = 7.47, P <0.01), but not with the pathohistological types (P > 0.05).

CONCLUSION: NF-κB is constitutively activated in human gastric precancerous lesions and carcinoma tissue and correlates with tumor progression. The early activation may be related to CagA⁺H. pylori infection.

Relationship of Helicobacter pylori related gastritis, gut hormones and gastroesophageal reflux disease

AIM: To evaluate the relationship of H. pylori infection, H. pylori -related gastritis, serum gastrin and motilin levels and esophageal lesions in gastroesophageal reflux disease (GERD).

METHODS: All 53 GERD patients were divided into non-erosive reflux disease (NERD group, 32 cases) and reflux esophagitis (RE group, 21 cases ) by endoscopy. The degrees of gastritis in antrum and body as well as esophagitis were evaluated by pathological examinations. Fasting serum gastrin and motilin concentrations were determined by radioimmunoassay. H. pyloriwas examined by serum H. pylori-antibody, Warthin-Starry stain, urease-dependent test (rapid urease test or ¹⁴C-breath test).H. pylori infection was affirmed when at least two of three tests were positive. 20 normal persons were as controls. In NERD group, 18 were H. pylori positive and 14 were negative. In RE group 12 were H. pylori positive and 9 were negative. According to the classification of esophagitis, 11 were ClassⅠ, 7 ClassⅡ and 3 Class Ⅲ. There were 30 H. pylori (+) and 23 H. pylori (-) in 53 GERD patients.

RESULTS: As compared with healthy controls, fasting serum motilin levels in RE group were significantly lower (360±126 vs 440±110 mg/L, ^aP < 0.05) and those in NERD group were similar (P > 0.05). No differences in gastrin levels were found between NERD or RE group and controls (both P > 0.05). The serum gastrin levels in H. pylori (+) GERD were significantly higher than controls (35.8±11.6 vs 28.5±10.6 mg/L, ^bP < 0.05). In H. pylori (+) GERD patients, gastritis grades in the antrum and gastric body were significantly higher than that in H. pylori (-) patients (χ² = 32.97, χ² = 15.67, both P < 0.005). The esophagitis grades were similar in H. pylori (+) and H. pylori (-) GERD (χ² = 0.82, P > 0.05). The gastritis grades were not associated with the esophagitis degrees, but with H. pylori infection.

CONCLUSION: Motilin is involved in the pathogenesis of RE. H. pylori can lead to hypergastrinemia and gastritis in the antrum and gastric body.

Preoperative TN staging of esophageal cancer: Comparison of miniprobe ultrasonography, spiral CT and MRI

AIM: To evaluate the value of miniprobe sonography (MPS), spiral CT and MR imaging (MRI) in the tumor and regional lymph node staging of esophageal cancer.

METHODS: Eight-six patients (56 men and 30 women; age range of 39-73 years, mean 62 years) with esophageal carcinoma were staged preoperatively with imaging modalities. Of them, 81 (94%) had squamous cell carcinoma, 4 (5%) adenocarcinoma, and 1 (1%) adenoacanthoma. Eleven patients (12%) had malignancy of the upper one third, 41 (48%) of the mid-esophagus and 34 (40%) of the distal one third. Forty-one were examined by spiral CT in whom 13 were co-examined by MPS, and forty-five by MRI in whom 18 were also co-examined by MPS. These imaging results were compared with the findings of the histopathologic examination for resected specimens.

RESULTS: In staging the depth of tumor growth, MPS was significantly more accurate (84%) than spiral CT and MRI (68% and 60%, respectively, P < 0.05). The specificity and sensitivity were 82% and 85% for MPS; 60% and 69% for spiral CT; and 40% and 63% for MRI, respectively. In staging regional lymph nodes, spiral CT was more accurate (78%) than MPS and MRI (71% and 64%, respectively), but the difference was not statistically significant. The specificity and sensitivity were 79% and 77% for spiral CT; 75% and 68% for MPS; and 68% and 62% for MRI, respectively.

CONCLUSION: MPS is superior to spiral CT or MRI for T staging, especially in early esophageal cancer. However, the three modalities have the similar accuracy in N staging. Spiral CT or MRI is helpful for the detection of far-distance metastasis in esophageal cancer.

Structural and functional studies of cinnamomin, a new type II ribosome-inactivating protein isolated from the seeds of the camphor tree

Cinnamomin is a new type II ribosome-inactivating protein (RIP). Its A-chain exhibits RNA N-glycosidase activity to inactivate the ribosome and thus inhibit protein synthesis, whereas the glycosylated B-chain is a lectin. The primary structure of cinnamomin, which exhibits approximately 55% identity with those of ricin and abrin, was deduced from the nucleotide sequences of cDNAs of cinnamomin A- and B-chains. It is composed of a total of 549 amino-acid residues: 271 residues in the A-chain, a 14-residue linker and 264 residues in the B-chain. To explore its biological function, the cinnamomin A-chain was expressed in Escherichia coli with a yield of 100 mg per L of culture, and purified through two-step column chromatography. After renaturation, the recovery of the enzyme activity of the expressed A-chain was 80% of that of native A-chain. Based on the modeling of the three-dimensional structure of the A-chain, the functional roles of five amino acids and the only cysteine residues were investigated by site-directed mutagenesis or chemical modification. The conserved single mutation of the five amino-acid residues led to 8-50-fold losses of enzymatic activity, suggesting that these residues were crucial for maintaining the RNA N-glycosidase activity of the A-chain. Most interestingly, the strong electric charge introduced at the position of the single cysteine in A-chain seemed to play a role in enzyme/substrate binding.

[Studies on chemical constituents in the roots of Rabdosia japonica (Burm.f). Hara var. glaucocalyx (Maxin) Hara]

OBJECTIVE

To isolate and elucidate the chemical constituents in the roots of Rabdosia japonica.

METHOD

The constituents were extracted by ether and isolated by chromatography on silica gel and ODS. The structures were determined by IR, H NMR, 13C NMR and MS spectra respectively.

RESULT

Four compounds were elucidated as glaucocalgxin A, oleanolic acid, ursolic acid and daucosterol.

CONCLUSION

Oleanolic acid and daucosterol were isolated from this plant for the first time.

[Effects of 7 d head-down tilt (-20 degrees) immobilization on pharmacokinetics of gentamicin in rabbits]

OBJECTIVE

To observe pharmacokinetic changes under simulated weightlessness in relevant to body flood flow changes.

METHOD

Gentamicin was selected as probe drug in the present study, and rabbits exposed to Head-Down Tilt (HDT, -20 degrees) immobilization were selected as simulated weightlessness animal model. Seven rabbits were treated inf. with 3 mg/kg of gentamicin sulfate pre-HDT and 7 d after HDT. Gentamicin blood samples within 4 h after administration were analyzed by TDxFLx.

RESULT

The distribution of gentamicin postponed significantly: a significant decrease in alpha from (0.1838 +/- 0.1076) min-1 before HDT to (0.0591 +/- 0.0334) min-1 after HDT; a significant increase in t1/2 alpha from (5.30 +/- 3.55) min to (15.04 +/- 7.49) min; a significant decrease in k12 from (0.1025 +/- 0.0721) min-1 to (0.0181 +/- 0.0161) min-1, a increase trend in V(C) and V(D). After HDT, CL(S) of gentamicin increased from (2.2 +/- 0.5) ml min-1 kg-1 to (2.7 +/- 0.3) ml min-1 kg-1.

CONCLUSION

Simulated weightlessness might induce pharmacokinetic changes.

[Counteracting effect of Chinese herbs-compounds on "blood stasis" induced by bed rest]

Objective. To observe the improved effect of syndromes of blood stasis by taking Chinese medicine during bed-rest simulated weightlessness. Method. Ten subjects were randomly divided into two groups: Chinese medicine group and control group. Both of them were exposed to HDBR -6 degrees for a week. The Chinese medicine group took Chinese medicine during the bed rest, and the control group took sugar water. Result. Syndromes of blood stasis of Chinese medicine group had a significant relief. And some physiological parameters, such as blood pressure, pulse graph, and amount of urine, maintained the level of pre-bed rest. While the control group was more severe than the Chinese medicine group in syndromes of blood stasis. Conclusion. Chinese medicine can be a measure in preventing the effect of weightlessness.

[Counteracting effect of Chinese herbs on "insufficiency of spleen qi" induced by simulated weightlessness]

Objective. To observe the counteracting effect of a Chinese herb-compound on "insufficiency of spleen qi" induced by simulated weightlessness. Methods. Animal and human experiment were carried out to the Chinese herb-compound (Dangshen, Baizhu, Fuling etc). Result. This compound protected the tail suspended rats from atrophy of spleen, thymus, soleus and gastrocnemius muscles, prevented excessive decrease of body weight effectively; at the same time it relieved the symptoms of the subjects greatly. Conclusion. It demonstrated that the compound decreased the "insufficiency of spleen qi" of both animals and human subjects.

[Comparison between two anti-motion sickness drugs]

Objective. To test the validity of an animal model in selecting anti-motion sickness drugs, and compare the effects of two drugs. Method. Anti-motion sickness effects of two drugs (Cyclizine and Scopolamin-d-amphetamin compound) were observed in rats with motion sickness (MS) induced by rotatory stimulation and the amount of Kaolin ate by rats was taken as an evaluation criterion. Result. The consumption of Kaolin by the rats decreased significantly after administration of both drugs, and the effect of Scopolamin-d-amphetamin compound was better than those of Cyclizine under the same condition. Conclusion. It suggests that the rat model of motion sickness is practical and useful in studying anti-motion sickness drugs.

Biliary complications after liver transplant: the Victorian experience

BACKGROUND

Biliary complications remain a continuing problem in liver transplantation. The goals of this study were to document the frequency of biliary complications following orthotopic liver transplantation in the Victorian programme, and to examine associations with suspected risk factors with reference to biliary stenosis.

METHODS

Data were collected from 129 consecutive transplants in 123 patients (106 adults, 17 children) at the Austin Hospital, Melbourne during the period 1988-94. The 2 year actuarial survival was 88%. Biliary reconstruction was by end-to-end anastomosis in 89 patients and Roux-en-Y in 40. Complications were suspected on clinical, biochemical or microbiological evidence. Biliary stenoses were considered to be radiological evidence of duct narrowing.

RESULTS

Biliary complications occurred in 19% and biliary stenosis in 8.5%. Of the stenoses, 1/35 occurred in the first 20 month period, 9/47 in the second and 1/47 in the third. There was a significant difference between the middle period and other periods (P<0.05, Chi-square test). This change may be related to incomplete flushing of bile from the donor liver. Recurrence of the original disease was suspected for one stenosis. The length of the donor bile duct from hilum to anastomosis, cold ischaemia time and total hepatic artery flow at transplant did not relate to stenosis. Cholangitis was not diagnosed in patients without strictures. Strictures were managed by dilatation (5/11) and by operative repair (6).

CONCLUSIONS

Stenoses were not related to the length of the donor bile duct, cold ischaemia time or total hepatic artery flow. Meticulous adherence to the protocol for flushing out bile at the donor operation was associated with a significant reduction in frequency of biliary stenoses.

Transplantation studies of the role of the kidney in long-term blood pressure reduction following brief ACE inhibitor treatment in young spontaneously hypertensive rats

1. Brief treatment with angiotensin-converting enzyme (ACE) inhibitors in young spontaneously hypertensive rats (SHR) causes a persistent reduction in blood pressure associated with a relatively selective reduction in renal vascular resistance. 2. To study the possible role of the kidney in this long-term hypotensive effect, we transplanted kidneys from untreated SHR into SHR that had been treated with perindopril (3 mg/kg per day) between 6 and 10 weeks of age and also transplanted kidneys from perindopril-pretreated SHR into untreated SHR. After transplantation, the remaining native kidney was removed so that only donor kidneys remained. 3. Untreated SHR that received kidneys from perindopril-pretreated SHR showed an initial fall in blood pressure followed by a rapid increase in pressure, weight loss and early death. 4. The transplantation of kidneys from control SHR into perindopril-pretreated SHR resulted in a rise in blood pressure that obviated the long-term reduction seen normally in these animals. 5. Kidneys from perindopril-pretreated SHR may be susceptible to the high blood pressure in untreated SHR. 6. The blood pressure increase in perindopril-pretreated SHR that accompanies substitution of the native kidneys by kidneys from untreated SHR further supports the hypothesis that the kidney is responsible for the long-term pressure effects following ACE inhibition in young SHR.

Atypical cutaneous lesions of Lyme disease

In 30 patients with Lyme disease, the lesions of erythema chronicum migrans were absent or atypical. Thirty biopsy specimens were obtained from cutaneous lesions of these patients. The predominant histological finding was a superficial dermal and deep perivascular and interstitial infiltrate composed mostly of lymphocytes but containing a few eosinophils and plasma cells. In serial sections with a silver stain, a few Borrelia burgdorferi were found in the biopsy specimens from cutaneous lesions in five patients. Thus, there is evidence that the typical lesions of erythema chronicum migrans of the classical Lyme disease do not develop while Borrelia burgdorferi survive and persist in cutaneous lesions.

O6-methylguanine-DNA methyltransferase and human cancer chemotherapy

Two kinds of human tumor cell strains having different activity of O6-methylguanine-DNA methyltransferase (O6-MT) were transplanted into nude mice. Mice were then injected intraperitoneally (i.p.) with the bifunctional agent 1-(4-amino-2-methyl-5-pyrimidinyl) methyl-3-(2-chloroethyl)-3-nitrosourea hydrochloride(ACNU). The tumors with low O6-MT activity were quickly suppressed or cured. This result suggests that some tumors, if determined to have low O6-MT activity, might be cured if the host is treated with ACNU. This observation may open a new approach to experimental cancer chemotherapy. Treatment with ACNU of experimental animals bearing HeLaMR tumors (which have low O6-MT activity and are Mer-), resulted in the regression of the tumors or their disappearance. In animals bearing HeLaS3 tumors (which have high O6-MT activity and are Mer+) the tumors were hyperplastic.

Renal transplantation between male and female spontaneously hypertensive rats

The higher blood pressures of male compared with female spontaneously hypertensive rats (SHR) are the result of the inheritance of different sex chromosomes, although the pathophysiology has not been defined clearly. The reported hypertensive effect of kidneys transplanted from male SHR raises the possibility of a sex-specific renal abnormality, but the effects of transplanting female SHR kidneys have not been studied. To test this hypothesis, single kidneys were transplanted from male SHR into female SHR recipients and vice versa, followed by removal of the native kidneys of the recipients. Male and female SHR that had undergone uninephrectomy were used as controls. After surgery at 14 weeks of age, systolic blood pressures were measured each week until 30 weeks of age. The replacement of a SHR female kidney with a SHR male kidney was not associated with any significant rise in blood pressure, and the replacement of a SHR male kidney with a kidney from a female SHR was not associated with any reduction in blood pressure. These results indicate that the sexual dimorphism of SHR blood pressure is not the result of intrinsic renal differences between males and females and that nonrenal factors would be more likely to explain the blood pressure differences between the sexes.

Medicinal protection with Chinese herb-compound against radiation damage

Experiments were carried out on mice and the subjects irradiated for cancer therapy to evaluate the protective efficacy of a Chinese medicinal herb-compound (CMHC). The lethality and the degree of leucopenia caused by radiation in mice medicated with CMHC were significantly less in comparison with control mice (p less than 0.01 and p less than 0.001, respectively). CMHC significantly improved the WBC and the thrombocytes in irradiated workers (p less than 0.01 and p less than 0.001, respectively). The WBC count of 40 patients under radiotherapy while treated with CMHC recovered from 3450 +/- 77/c.mm to 5425 +/- 264/c.mm (p less than 0.001); whereas, in the control group, without any medication, the WBC count dropped significantly (p less than 0.001). Our results revealed the applicabilities of CMHC in protection against radiation damage in spaceflight and in other fields.

[Microvascular changes in the pyloric ring and duodenal invasion in carcinoma of the gastric antrum]

In this study, vascular perfusion of surgically removed specimen was carried out in 45 middle or late staged gastric antrum carcinomas and 5 gastric ulcers to observe the morphology of the microvasculature at the juncture of the stomach and the duodenum. It was found that: 1) The microvasculature on both side of the pylorus and the duodenum communicated through small arteriole and the morphology of the microvasculature varied with tumor-infiltrated depth. 2) The duodenum was found to be invaded by the tumor in only 2 cases in which the tumor was within 1.5 cm from the pyloric ring. 3) The mechanism by which the tumor invaded the duodenum was most likely resulted from direct extension through the interstitium when the microvasculature, the physiological and anatomical intact of the pyloric ring were destroyed by the tumor. 4) Based on the aforementioned observations, the authors propose that in gastric antrum carcinoma, the safe resection length of the duodenum is less than 3 cm when the tumor is 1.5 cm away from the pyloric ring, otherwise, more than 3 cm of the duodenum should be removed.