[Research Progress on the Effect of Synthetic Cathinones on Animal Behavior]

Abstract

Synthetic cathinones are a class of new psychoactive substances with a structure similar to amphetamine drugs, which can produce excitatory effects similar to drugs such as amphetamine and cocaine after being taken. In recent years, the abuse of synthetic cathinones worldwide has become increasingly serious, posing a serious threat to social security and public health. This article focuses on several common synthetic cathinones, collects their research results in animal autonomous activity experiments and drug dependence model experiments and summarizes their relevant experimental conclusions in animal body temperature regulation, learning and memory, and anxiety, in order to provide data reference and method guidance for the domestic development of related drug research.

[Current practice patterns of preoperative bowel preparation in elective colorectal surgery: a nation-wide survey of Chinese surgeons]

Objective: To understand the current practice of preoperative bowel preparation in elective colorectal surgery in China. Methods: A cross-sectional questionnaire survey was conducted through wechat. The content of the questionnaire survey included professional title of the participants, the hospital class, dietary preparation and protocol, oral laxatives and specific types, oral antibiotics, gastric intubation, and mechanical enema before elective colorectal surgery. A stratified analysis based on hospital class was conducted to understand their current practice of preoperative bowel preparation in elective colorectal surgery. Result: A total of 600 questionnaires were issued, and 516 (86.00%) questionnaires of participants from different hospitals, engaged in colorectal surgery or general surgeons were recovered, of which 366 were from tertiary hospitals (70.93%) and 150 from secondary hospitals (29.07%). For diet preparation, the proportions of right hemicolic, left hemicolic and rectal surgery were 81.59% (421/516), 84.88% (438/516) and 84.88% (438/516) respectively. The average time of preoperative dietary preparation was 2.03 days. The study showed that 85.85% (443/516) of surgeons chose oral laxatives for bowel preparation in all colorectal surgery, while only 4.26% (22/516) of surgeons did not choose oral laxatives. For mechanical enema, the proportions of right hemicolic, left hemicolic and rectal surgery were 19.19% (99/516), 30.04% (155/516) and 32.75% (169/516) respectively. Preoperative oral antibiotics was used by 34.69% (179/516) of the respondents. 94.38% (487/516) of participants were satisfied with bowel preparation, and 55.43% (286/516) of participants believed that preoperative bowel preparation was well tolerated. In terms of preoperative oral laxatives, there was no statistically significant difference between different levels of hospitals [secondary hospitals vs. tertiary hospitals: 90.00% (135/150) vs. 84.15% (308/366), χ(2)=2.995, P=0.084]. Compared with the tertiary hospitals, the surgeons in the secondary hospitals accounted for higher proportions in diet preparation [87.33% (131/150) vs. 76.78% (281/366), χ(2)=7.369, P=0.007], gastric intubation [54.00% (81/150) vs. 36.33% (133/366), χ(2)=13.672, P<0.001], preoperative oral antibiotics [58.67% (88/150) vs. 24.86% (91/366), χ(2)=12.259, P<0.001] and enema [28.67% (43/150) vs. 15.30% (56/366), χ(2)=53.661, P<0.001]. Conclusion: Although the preoperative bowel preparation practice in elective colorectal surgery for most of surgeons in China is basically the same as the current international protocol, the proportions of mechanical enema and gastric intubation before surgery are still relatively high.

[Feasibility and safety of the medial approach "four-step method" in the laparoscopic mobilization of splenic flexure]

Objective: To investigate the feasibility and safety of the medial approach "four-step method" in the laparoscopic mobilization of splenic flexure. Methods: A retrospective cohort study was performed. Clinical data of 157 colorectal cancer patients undergoing the medial approach "four-step method" in the laparoscopic mobilization of splenic flexure at Gastrointestinal Surgical Department of Guangdong Provincial People's Hospital from July 2015 to June 2018 were retrospectively analyzed. Of 157 cases, 17 were transverse colon cancer, 94 were descending colon cancer, 25 were sigmoid cancer and 21 were rectal cancer; 89 were male and 68 were female; mean age was (61.8±10.3) years and mean body mass index was (23.2±3.7) kg/m(2). The medial approach "four-step method" in the laparoscopic mobilization of splenic flexure was performed as follows: (1) The root vessels were treated with the "provocation" technique to expand the Toldt's gap. This expansion was extended from the lateral side to the peritoneum reflex of left colonic sulcus, from the caudal side to the posterior rectal space, and from the cephalad side to the lower edge of pancreas. (2) The left colonic sulcus was mobilized, converging with the posterior Toldt's gap. Mobilization was carried out from cephalad side to descending colon flexure, freeing and cutting phrenicocolic ligament and splenocolic ligament, and from caudal side to peritoneal reflex. (3) Gastrocolic ligament was moblized. Whether to enter the great curvature of stomach omentum arch when the gastrocolic ligament was cut, that was, whether to clean the fourth group of lymph nodes, should be according to the tumor site and whether serosal layer was invaded. (4) Transverse mesocolon was moblized and transected at the lower edge of the pancreatic surface, merging with the posterior Toldt's gap, and from lateral side to lower edge of the pancreatic body, merging with the lateral left paracolonic sulcus. Safety and short-term clinical efficacy of this surgical procedure was summarized. Results: All the patients completed this procedure. During operation, 3 cases were complicated with organ injury, including 1 case of colon injury, 1 case of spleen injury and 1 case of pancreas injury. No operative death and conversion to open surgery was found. The average operation time was (147.5±35.1) minutes, the average intra-operative blood loss was (40.8±32.7) ml and the average number of harvested lymph node was (16.1±5.8), including (4.0±2.3) of positive lymph nodes. The first exhaust time after surgery was (41.3±20.6) hours, the fluid intake time was (1.5±1.3) days, the postoperative hospital stay was (5.2±2.3) days. Eight (5.1%) cases developed postoperative complications, and all were improved and discharged after conservative treatments. According to the TNM classification system, postoperative pathology revealed that 31 patients were stage I, 51 were stage II, 53 were stage III, 22 were stage IV. Conclusion: The medial approach "four-step method" is safe and feasible, which can effectively decrease the operation difficulty of the laparoscopic mobilization of the splenic flexure.

[Strategy and clinical outcome of deceased donor kidney transplantation for presensitized recipients]

Objective: To explore the management strategy and clinical outcome of renal transplantation in presensitized recipients using deceased donor kidneys. Methods: From January 2011 to June 2018, twenty-one presensitized patients, including 8 with positive donor specific antibodies (DSA) and 13 with positive panel-reactive antibodies (PRA) but no DSA, received renal retransplantation from deceased donors in our center. The incidence of delayed graft function (DGF) and acute rejection (AR), changes of DSA, and the graft and patient survival were retrospectively analyzed. Results: None of the renal allografts had primary non-function (PNF) and DGF after transplantation. Four of the 13 recipients with PRA(+)/DSA-had a total of 5 episodes of acute cell-mediated rejection (CMR), while 5 of 8 recipients with pre-existing DSA(+) developed AR, including 3 cases with CMR alone and 2 cases with mixed AR. All episodes of rejection were successfully reversed after targeted treatment. Interestingly, of the 8 recipients with positive preformed DSA, 4 cases with positive DR-DSA and/or class Ⅰ-DSA had their DSA disappeared after transplantation, whereas DQ-DSA remained positive in 4 of 5 recipients. After a median follow-up of 26 months, all recipients maintained normal renal allograft function, and the survival rates of both graft and recipient were 100%. Conclusions: With the use of deceased donors, kidney transplantation can be successfully performed in presensitized patients by appropriate HLA-matching screening, choosing donor kidneys with good quality, and the combination of optimal perioperative treatment.

Increased Group 2 Innate Lymphoid Cells Are Correlated with Eosinophilic Granulocytes in Patients with Allergic Airway Inflammation

The T helper 2 (Th2)-type response was considered the hypostasis of allergic airway diseases, including asthma and allergic rhinitis (AR). However, more recent studies have suggested that allergic airway inflammation also depends on innate immunity and is closely related to group 2 innate lymphoid cells (ILC2s). This study evaluated the ILC2 levels of asthma subjects, patients with asthma and AR, and healthy individuals, regarding how to investigate the relationship between clinical data and ILC2 levels. It was found that asthma patients and asthma with AR patients had higher ILC2 levels compared to healthy subjects. ILC2s were positively correlated with the percentage of eosinophils in patients with asthma and AR, but not with pulmonary function. ILC2 levels were higher in mild asthma subjects than in patients with severe asthma. This study provides a new interpretation of the pathogenesis of allergic airway inflammation and may provide a new direction for the diagnosis and assessment of allergic airway diseases.

Clinical Characteristics and Allergen Sensitization Patterns of Patients with Local Allergic Rhinitis in Southern China

BACKGROUND

Local allergic rhinitis (LAR) is characterized by the production of specific IgE (sIgE) in the nasal mucosa without evidence of systemic atopy. The characteristics of LAR in Caucasians have been well documented. LAR is understudied in China, with prevalence, patient demographics, symptomatology, and the allergen sensitization profile being poorly understood. The purpose of this study is to investigate the demographics, characteristics, and allergen sensitization profile of patients with LAR in Southern China.

METHODS

A total of 194 patients with rhinitis and 13 healthy subjects were enrolled in the current study. The patients' demographic data, clinical history, and symptoms were recorded. Local and systemic sIgE to a wide panel of specific allergens were measured in the nasal secretion and serum samples.

RESULTS

Among the rhinitis patients, 115 were classified as allergic rhinitis (AR; 59.3%), 15 as LAR (7.7%), and 64 as non-AR (33.0%). The demographic characteristics, duration, frequency, and severity of symptoms were similar, although LAR exhibited higher symptom scores for nasal itch. Monosensitization was the predominant pattern of sensitization in both AR (109 out of 115, 95%) and LAR (14 out of 15, 93%). House dust mite was the dominant allergen in AR patients (109 out of 115, 95%), while pollen was the dominant allergen in LAR patients (11 out of 15, 73%).

CONCLUSION

The prevalence of LAR patients in Southern China was 7.7%. Pollen was the most common sensitizing allergen for the local LAR patients, which differs from Caucasian studies, in which house dust mite was the dominant sensitizing allergen. Monosensitization was the predominant pattern in both AR and LAR.

[Clinical efficacy of tonsillectomy in renal transplant patients with recurrent IgA nephropathy]

Objective: To investigate the therapeutic efficacy of tonsillectomy for patients with recurrence of IgA nephropathy (IgAN) after kidney transplantation. Methods: From May 2014, tonsillectomy was performed in 11 renal transplant patients with biopsy-proved recurrent IgAN. In a median follow-up of 14 (4-38) months, data of proteinuria, hematuria, estimated glomerular filtration rate (eGFR), and serum levels of IgA in these patients were compared before and after tonsillectomy.Patient's survival and renal graft survival were also summarized. Results: A remission of proteinuria was observed in 8 patients after tonsillectomy, and this status maintained well in the subsequent follow-up.Three patients had no or minimal reduction of proteinuria after tonsillectomy and returned to dialysis within 1 year after tonsillectomy.Possible causes could be severe primary IgAN of crescentric glomerulonephritis, IgAN recurrence in kidney retransplantation, and late tonsillectomy after IgAN recurrence.Serum levels of IgA significant decreased and no patients developed acute rejection or infection after tonsillectomy.In the 1-year follow-up, no patients died and grafts survived well in 8 out of 11 patients. Conclusions: Tonsillectomy may represent an effective and reliable way to treat recurrence IgAN after kidney transplantation, and may be applied widely in the future clinical management. However, early intervention is critical and effects may depend on the pathological features of primary IgAN.

Primary nasopharyngeal polyps: a case series on a rare clinical entity

Primary non-neoplastic polyps originating from the nasopharynx have not been reported in the English language literature. We present the clinical and histopathological features of three primary nasopharyngeal polyps. Clinical data of three patients with primary nasopharyngeal polyps treated at the Department of Otolaryngology, The First Affiliated Hospital of Sun Yat-sen University between 2005 and 2015 were analyzed and presented. Three male patients from 45 to 63 years presented with nasopharyngeal masses. CT or MRI examination showed nasopharyngeal space-occupying lesions. Two patients were initially diagnosed with nasopharyngeal angiofibroma and one patient with nasopharyngeal carcinoma. After surgical excision, based on the histological examination, the tissue masses were all diagnosed as inflammatory polyps. Histologically, the polyps demonstrated significant oedema, collagen deposition, leukocytic infiltration, and epithelial remodelling. Primary nasopharyngeal polyps represent a distinct clinical entity and should be considered in the differential diagnosis of nasopharyngeal masses.

[Effectiveness and safety of conversion therapy with the combination of sirolimus with low dose cyclosporine in renal transplantation recipients: a five-year clinical observation]

OBJECTIVE

To assess the effectiveness and safety of the conversion therapy from traditional cyclosporine (CsA) triple immunosuppression therapy to sirolimus (SRL) combined with low dose CsA and prednisone (Pred) in renal transplantation recipients in a five-year follow-up period.

METHODS

A prospective, open-label non-randomized study was performed with 46 renal allograft recipients who visited Tongji Hospital regularly for follow-up visits between January 2007 and May 2011 and were taking CsA+ mycophenolate mofetil (MMF)+ Pred. Conversion therapy to SRL+ low dose CsA+ Pred was initiated after renal transplantation. The recipients were allocated to 2 groups according to their renal function and proteinuria before the conversion: active conversion group [n=27, serum creatinine (SCr) ≤ 140 μmol/L with no or minimal proteinuria] and passive conversion group [n=19, SCr>140 μmol/L with less than moderate proteinuria]. After conversion, dosages of SRL and CsA were adjusted for trough levels of 5-7 μg/L and 20-60 μg/L, respectively. SCr and urine protein were compared before and after the conversion in five-year follow-up. Incidence of acute rejection, renal graft survival and SRL-related adverse effects of the immunosuppressive regimen were also observed.

RESULTS

After conversion, an average 63% dose reduction of CsA was achieved in all the patients. In the active conversion group, the mean SCr level was (110±19) μmol/L at the time of conversion. Eight patients in this group withdrew from the study during the follow-up period for the following reasons: arthralgia (1 case), deteriorated proteinuria (2 cases), chronic diarrhea (2 cases), mild or suspicious acute rejection (2 cases), and recurrent fever (1 case). The rest patients (19/27) with a mean follow-up time of 5 years had a stable SCr level [(103±12) μmol/L] and a 100% 5-year graft survival. In the passive conversion group, the mean SCr level was (205±45) μmol/L at the time of conversion. There were 4 patients quitting the study, 2 for deteriorated proteinuria and 2 for lost to follow-up. Chronic allograft failure developed in 10 patients in this group 1-50 months after conversion, while the remaining 5 patients had a stable SCr during the 5-year follow-up period [(218 ±46) μmol/L before conversion vs (205±73) μmol/L 5 years after conversion]. The overall 5-year graft survival after the conversion therapy in the passive conversion group was 33.3%, significantly lower than that of the active conversion group (P<0.001). Acute rejection was observed in 2 cases in the active conversion group, while not observed in the passive conversion group. None of the patients developed leukopenia, thrombocytopenia, oral ulcer, or pneumonia in the follow-up.

CONCLUSIONS

The combination therapy of SRL and low dose of CsA is overall a safe and effective maintenance immunosuppressive regimen, but it is important to initiate at an appropriate stage. More favourable long-term benefits may be obtained from the conversion therapy in patients with normal or only slightly impaired renal graft function. It may offer an option of individualized immunosuppressive therapy after renal transplantation.

Histopathological features of sinonasal inverted papillomas in chinese patients

OBJECTIVES/HYPOTHESIS

Nasal inverted papilloma (IP) is a benign tumor with high recurrence rates. Evidence of inflammation has been reported in IP in Caucasian studies. This study aimed to investigate the histopathological patterns and their associations with clinical characteristics in Chinese patients with IP.

STUDY DESIGN

Basic science study.

METHODS

IP tissues were obtained from 50 Chinese patients with unilateral IPs. Biopsies of inferior turbinate mucosa from 17 healthy subjects were used as controls. The histological patterns and severity of epithelial remodeling and inflammatory cell infiltration were evaluated and analyzed for associations with clinical characteristics.

RESULTS

Thirty-one percent of IP specimens were classified as grade I (mild remodeling) and 49% as grade II (moderate and severe remodeling). Concomitant inflammatory nasal polyps were found in 14 patients (28%). Recurrent IP was strongly associated with grade II (odds ratio: 5.81, 95% confidence interval: 1.34-25.18). Except CD4(+) T cells, quantities of neutrophils, macrophages, eosinophils, CD8(+) T cells, and FoxP3(+) T-reg cells were significantly elevated in IP. Of these, neutrophils were the predominant cell type in IP.

CONCLUSIONS

Inflammation may have potential roles in IPs and the higher grade of epithelial remodeling was associated with the recurrence of IPs.

LEVEL OF EVIDENCE

NA.

Epidemiological characterization and risk factors of allergic rhinitis in the general population in Guangzhou City in china

The prevalence of allergic rhinitis (AR) in China has increased with an apparent geographic variation. The current study aims to investigate the AR prevalence/classification, diagnosis/treatment conditions, trigger factors, and risk factors in the general population of Guangzhou, the third biggest city in China. A cross-sectional survey was performed in the citizens in Guangzhou from December 2009 to March 2010 by using a stratified multistage cluster sampling method. All subjects were asked to complete a comprehensive questionnaire via a face to face interview. A total of 9,899 questionnaires were valid. The prevalence rate of AR in the general population of Guangzhou was 6.24%, with a significant higher prevalence in urban area (8.32%) versus rural area (3.43%). Among the AR subjects, most (87%) were diagnosed with intermittent AR and 87% suffered from moderate-severe symptoms. High percentages of the AR patients did not have previously physician-based diagnosis (34%) or specific medical treatment (55%). Morning time, winter season, and cold air were the most common trigger factors of AR. Family history of AR, current living place, living place during babyhood, smoking, home renovation, and pet ownership were the significant risk factors associated with AR prevalence in the population. The study demonstrated comprehensive epidemiological and clinical information about the AR in Guangzhou population. Change of living environment and lifestyles had strong impacts on the prevalence of AR. Public health policies should help the patients benefit from a proper diagnosis/treatment and specifically target the local risk factors, in order to control the AR incidence.

In vivo and in vitro studies of Th17 response to specific immunotherapy in house dust mite-induced allergic rhinitis patients

T helper (Th)17 cells have been implicated in the development of allergic rhinitis (AR), but their response to specific immunotherapy (SIT) remains unclear. We investigated the impact of SIT on Th17 response and Th1/Th2 changes in AR patients. Blood samples from AR patients (n = 20) who were monosensitized to house dust mite (HDM) were collected before the initiation of SIT (SIT-untreated) and after the end of 2-year SIT (SIT-treated) treatment. Twenty healthy volunteers were recruited as controls. In vitro HDM stimulation in peripheral blood mononuclear cells (PBMCs) was also performed. Expression levels of Th17 associated genes were determined in both PBMCs and plasma by PCR and ELISA, while Th17/Th1/Th2/IL10 producing cell proportions were evaluated in PBMCs by flow cytometry. The SIT effect was evaluated by assessing clinical symptoms. mRNA levels of Th17 specific genes (IL17 and RORC) were increased in SIT-untreated AR versus controls, and decreased following SIT treatment. SIT can change the production of Th17 associated genes (reduction of IL17, IL6, and IL23, but increase of IL27) in plasma from AR patients. Th2/Th1 ratio and proportions of Th17 cells were suppressed while IL10 producing CD4⁺ T cells were elevated after SIT. In vitro HDM challenge presents concordant patterns with in vivo findings: 1) increase of Th2 and Th17 response in AR patients; 2) suppression of IL10 producing CD4⁺ T cells in SIT-untreated AR but elevation in SIT-treated AR patients. Most importantly, a positive correlation between IL17 mRNA/protein levels and clinical symptom scores was observed. SIT significantly inhibits Th17 mediated inflammation in AR and IL17 may be a useful biomarker for both AR severity and SIT therapeutic effect.

Trial Registration

Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12613000445774

Down-regulation of EMP1 is associated with epithelial hyperplasia and metaplasia in nasal polyps

AIMS

The aim of this study was to assess protein and mRNA expression of epithelial membrane protein 1 (EMP1) in the nasal mucosa of patients with nasal polyps (NP), and to determine what changes occur in response to glucocorticosteroid (GC) treatment.

METHODS AND RESULTS

NP tissue was obtained from 55 patients, 18 of whom were treated with nasal GCs (i.e. these 18 patients had NP biopsies taken before and after treatment). Biopsies of inferior turbinate mucosa from 30 healthy subjects were used as controls. Quantitative PCR and immunohistochemistry were performed to determine the expression levels of EMP1. EMP1 mRNA expression was significantly lower (2.77-fold) in tissues from NP patients before GC treatment when compared to controls, but was increased in these patients after GC treatment. EMP1 staining in nasal epithelium co-localized with both basal (p63(+)) and differentiated (CK18(+)) epithelial cells. Their immunoreactivity was significantly greater in controls than NP patients. EMP1 mRNA levels were lower in the epithelium with severe hyperplasia (1.79-fold) or with metaplasia (1.85-fold) as compared to those with mild to moderate hyperplasia or non-metaplastic epithelium, respectively. Positive correlations between EMP1 and other epithelial cell-related gene (e.g. JUN, PTGS2, AREG etc.) mRNAs were observed.

CONCLUSIONS

EMP1 could be a biomarker for aberrant epithelial remodelling and metaplasia in chronic inflammatory upper airway mucosa (e.g. NP).

Long-term efficacy of specific immunotherapy on house dust mite-induced allergic rhinitis in China

OBJECTIVE

Although the effect of specific immunotherapy (SIT) on allergic rhinitis (AR) has been well documented in developed countries, its long-term efficacy in patients in developing countries (such as China) is poorly understood. This study investigated the long-term therapeutic and preventive effects of SIT on house dust mite (HDM)-induced AR in patients from China.

DESIGN

Historical cohort study.

SETTING

University hospital.

SUBJECTS AND METHODS

One hundred forty-six AR patients with/without asthma allergic to HDM were investigated for 5 years after initiation of a 3-year course of subcutaneous SIT (SIT group, n = 106) or no SIT (control group, n = 40). The clinical responses of all patients were evaluated at baseline, the stop point of SIT (third year), and 2 years after SIT termination (fifth year), by clinical index including symptom and rescue medication scores (SMS), visual analog scale (VAS), total immunoglobulin E (tIgE), and specific IgE (sIgE). Asthma was assessed by clinical evaluation.

RESULTS

The decrease of SMS and VAS from baseline was significantly improved in the SIT group compared with controls at both the third and fifth year. For patients without asthma at baseline, the odds ratio for no asthma was 3.57 (95% confidence interval, 1.05-12.91; P < .05) in favor of SIT. The serum sIgE/tIgE ratio was significantly increased after SIT treatment in the SIT group, but it was not related to SIT efficacy.

CONCLUSION

SIT has a long-term effect of improving clinical symptoms and reducing the risk of development of asthma in Chinese AR patients.

Oral steroids enhance epithelial repair in nasal polyposis via upregulation of the AP-1 gene network

BACKGROUND

Chronic mucosal inflammation, epithelial damage and aberrant tissue remodelling are common features in nasal polyposis (NP). A study was undertaken to characterise the gene expression profile in NP tissues and to explore the molecular mechanisms underlying the ameliorative effects of glucocorticosteroids (GCs) in NP.

METHODS

Two sets of NP biopsies (before and after GC treatment) were taken from 10 patients with untreated (GC-naïve) bilateral NP. Biopsy specimens of inferior turbinate from 6 patients who underwent surgery for nasal septal deviation served as nasal mucosal controls. DNA microarrays containing 38 500 genes were used to characterise the global gene expression profile. Functional network analysis was applied to identify the key molecular pathways and genes in response to GC treatment (GC-treated). Selected genes were retested by quantitative RT-PCR and immunohistochemistry in the same polyps and control samples.

RESULTS

64 genes were differentially expressed in GC-treated vs GC-naïve NP tissues. The highest scoring network was assembled around activation protein 1 (AP-1), a heterodimer of c-Fos and c-Jun oncoprotein, and five AP-1-related genes (COX-2, IL-6, AREG, HBEGF and EGR1) with tissue repair function. Quantitative PCR confirmed that AP-1 and its related genes were markedly repressed in GC-naïve polyps and were upregulated after GC treatment. Immunohistochemical staining indicated that epithelial restitution in GC-treated polyps was associated with increased expression of c-Jun protein.

CONCLUSIONS

Oral steroids promote epithelial repair in NP via upregulation of the AP-1 (especially c-Jun) network and its related genes.

Ganoderma lucidum polysaccharide peptide reduced the production of proinflammatory cytokines in activated rheumatoid synovial fibroblast

The aim of the current study was to elucidate the potential therapeutic effect of Ganoderma lucidum polysaccharide peptide (GL-PP) in rheumatoid arthritis (RA). The effects of GL-PP on cell proliferation and cytokine production were studied in RA synovial fibroblasts (RASF). GL-PP significantly inhibited the proliferation of RASF. Following the incubation with GL-PP, production of interleukin (IL)-6 and monocyte chemoattractant protein (MCP)-1 in RASF were significantly increased as expressed as percentage change from basal values. However, the actual effects were minimal due to the low basal values. When RASF were activated by IL-1beta or lipopolysaccharides, IL-8 and MCP-1 production increased many folds. GL-PP significantly suppressed their productions. The inhibitory effects of GL-PP on cytokine production in RASF were at least in part, by inhibiting the nuclear factor-kappa B (NF-kappaB) transcription pathway. Our results demonstrated that GL-PP had the unique ability to modulate cytokine production in RASF and warrants further investigation into its mechanism of action.

The survival and value of liver transplantation for liver carcinoma: a single-center experience

Liver transplantation for liver carcinoma with cirrhosis is a treatment still in dispute. The objectives were to summarize the survival and cost of 50 liver transplant cases performed for liver carcinoma over nearly 3 years.

METHODS

We performed 138 liver transplants from January 1999 to February 2002. There were 50 cases (36.2%) of liver carcinoma with HBV cirrhosis, which were divided into three stages based on the tumor pathology: Stage 1 cases showed a single mass (< or = 5 cm), 4 cases; Stage 2, a single mass > 5 cm or intrahepatic multiple masses without PV cancer embolus, 32 cases; and Stage 3: tumor invasion of the PV or perihepatic lymph nodes or organs, 14 cases. All patients received three to six courses of chemotherapy postoperatively.

RESULTS

All four cases of stage 1 survived > 1 year; one of them is at 3 years with good liver function and tumor free. The mean half-year medical cost was $27.100 +/- 108 in stage 1. The half-year survival and medical costs were 62.5% and $31,500 +/- 260 in stage 2 and 15.0% and $35,500 +/- 134 in stage 3.

CONCLUSION

Liver transplantation is an effective treatment for early-stage liver carcinoma, that achieves good medical and economic results, but should be limited to advanced liver cancer.

[A new triterpene from the fruiting bodies of Ganoderma lucidum]

AIM

To study the chemical constituents of the fruiting bodies of Ganoderma lucidum.

METHODS

Individual constituents, isolated and repeatedly purified on silica gel column, were identified by physicochemical constants and structurally elucidated by spectral methods.

RESULTS

From the alcohol extract, compound 2 was obtained and identified as 3 beta,7 beta-dihydroxy-4,4,14 alpha-trimethyl-11,15-dioxo-5 alpha-chol-8-en-24-oic acid. In addition, two known compounds, lucidenic acid A (1) and C (3) were obtained.

CONCLUSION

Compound 2 is a new triterpene compound.

Effects of aminoguanidine on nitric oxide production induced by inflammatory cytokines and endotoxin in cultured rat hepatocytes

AIM: To study the effects of aminoguanidine (AG) and two L-arginine analogues N^ω-nitro-L-arginine methyl ester (L-NAME) and N^ω-nitro-L-arginine (L-NNA) on nitric oxide (NO) production induced by cytokines (TNF-α, IL-1β, and IFN-γ) and bacterial lipopolysaccharide (LPS) mixture (CM) in the cultured rat hepatocytes, and examine their mechanisms action.

METHODS: Rat hepatocytes were incubated with AG, L-NAME, L-NNA, Actinomycin D (ActD) and dexamethasone in a medium containing CM (LPS plus TNF-α, IL-1β, and IFN-γ) for 24 h. NO production in the cultured supernatant was measured with the Griess reaction. Intracellular cGMP level was detected with radioimmunoassy.

RESULTS: NO production was markedly blocked by AG and L-NAME in a dose-dependent manner under inflammatory stimuli condition triggered by CM in vitro. The rate of the maximum inhibitory effects of L-NAME (38.9%) was less potent than that obtained with AG (53.7%, P < 0.05). There was no significant difference between the inhibitory effects of AG and two L-arginine analogues on intracellular cGMP accumulation in rat cultured hepatocytes. Non-specific NOS expression inhibitor dexamethasone(DEX) and iNOS mRNA transcriptional inhibitor ActD also significantly inhibited CM-induced NO production. AG (0.1 mmol·L^-1) and ActD (0.2 ng·L^-1) were equipotent in decreasing NO production induced by inflammatory stimuli in vitro, and both effects were more potent than that induced by non-selectivity NOS activity inhibitor L-NAME (0.1 mmol·L^-1) under similar stimuli conditions (P < 0.01).

CONCLUSION: AG is a potent selective inhibitor of inducible isoform of NOS, and the mechanism of action may be not only competitive inhibition in the substrate level, but also the gene expression level in rat hepatocytes.

Protection of the spinal cord with pentobarbital and hypothermia

BACKGROUND

Ischemic spinal cord damage during thoracic aortic operations has not been eliminated despite application of various adjuncts. We experimentally investigated the protective effects of pentobarbital and hypothermia on the spinal cord subjected to ischemia.

METHODS

Among nine groups of 6 rabbits each, groups AI to AIII underwent 20-minute infrarenal aortic occlusion, and groups BI to BVI underwent 40-minute occlusion. Five milligrams per kilogram of pentobarbital was administered to groups AII and BII; 10 mg/kg in groups AIII, BIII, and BVI; 20 mg/kg in group BIV; and none in groups AI, BI, and BV. In groups BV and BVI, hypothermia was induced. Forty-eight hours postoperatively, the motor function of the lower limbs was evaluated.

RESULTS

Statistically significant recovery of motor function was observed in animals in groups AII, AIII, BIII, BIV, BV, and BVI.

CONCLUSIONS

Pentobarbital showed dose-dependent protective effects of the spinal cord. Moderate hypothermia alone also showed protective effects. Combined use of pentobarbital and hypothermia resulted in highly significant recovery of spinal cord function.

Case report: right subclavian artery pseudoaneurysm due to perforation of esophageal cancer

A 51-year-old man presented with massive hematemesis. Perforation of upper esophageal cancer, which had already occurred at least six days earlier, progressed to upper mediastinitis. The mediastinitis contiguous to the right subclavian artery was considered to have caused a pseudoaneurysm. Rupture of the pseudoaneurysm into the esophagus resulted in massive hematemesis. Both enhanced computed tomography and angiography were diagnostic for the pseudoaneurysm. Transluminal endovascular stent-grafts placement was successful in preventing subsequent hemorrhage.

Effect of kanglemycin C on lymphocyte proliferation induced by tetradecanoylphorbol acetate and ionomycin

AIM

To compare the suppressions of kanglemycin C (Kan) with that of cyclosporine (Cyc) on lymphocyte proliferations induced by tetradecanoylphorbol acetate (TPA) with ionomycin (IM), and concanavalin A (Con A).

METHODS

Cell proliferation was quantified with 3-(4, 5-dimetyl-thiazol-2-yl)-2, 5-diphenyltetrazolium bromide (MTT) or [3H]thymidine ([3H]TdR) incorporating method. Calcineurin (CN) activity was measured with molybdate dye colorimetry.

RESULTS

Kan (8, 40, 80, and 400 nmol.L-1) strongly suppressed splenocyte proliferation induced by TPA and IM, and the suppressive effect of Kan gradually decreased along with the increasing concentrations of TPA (1-100 micrograms.L-1) and IM (125-500 micrograms.L-1). But, the suppression of Cyc on the splenocyte proliferation induced by TPA was mild. Cyc suppressed CN activity of mouse splenocytes stimulated by Con A stronger than Kan. Moreover, Kan and Cyc strongly suppressed spleen enriched T-cell proliferation induced by Con A and TPA + IM, and the suppression of Kan on proliferation was partly attenuated by exogenous IL-2.

CONCLUSION

Kan competitively suppressed the proliferation induced by TPA and IM, and Cyc mainly suppressed IM part of the proliferation induced by TPA and IM.

Suppressive effect of kanglemycin C on T- and B-lymphocyte activation

AIM

To elucidate the suppressive effect of kanglemycin C (Kan) on lymphocyte proliferation and T-lymphocyte subsets.

METHODS

Splenocyte proliferation was quantified with [3H]thymidine ([3H]TdR) pulsing method or 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) colorimetery. L3T4+ and Lyt2+ T-cell subsets were measured with fluorescence-activated cell sorter (FACS). Splenocyte viability was assessed with trypan blue exclusion.

RESULTS

Like ciclosporin (Cic), Kan 8, 40, 80, and 400 nmol.L-1 inhibited the proliferation of 20%-80% incubated mouse splenocytes stimulated by concanavalin A (Con A) 5 mg.L-1, phytohemagglutinin (PHA) 5 mg.L-1, tetradecanoylphorbol acetate (TPA) 10 micrograms.L-1 + ionomycin (IM) 0.5 mg.L-1, and alloantigen (mixed lymphocyte reaction). Kan had no toxicity to the splenocytes at the treated doses. Suppression by Kan was declined with addition time of Kan after culture onset. Furthermore, the suppressive effect of Kan on splenocyte proliferation stimulated by lipopolysaccharides (LPS) 10 mg.L-1 was similar to that on splenocyte proliferation mediated by Con A. Unlike Cic, Kan reversed the ratio of L3T4+/Lyt2+ T-cell subsets.

CONCLUSION

Kan had a suppressive action on proliferation of T- and B-lymphocytes and had a selective effect on helper-inducer T-lymphocyte (Th) subset from Cic. Suppression by Kan was time-dependent and not associated with toxicity of Kan.

Stent grafting for aortic dissection

We report the successful treatment of a patient with Stanford type B aortic dissection, "thrombosed" type with ulcer-like projections, by insertion of a stent-graft. The false lumen completely disappeared within 1 year after surgery. This maturing procedure is promising in the treatment of thrombosed, aggravated aortic dissection.

Dinoprostone potentiates cytokines and lipopolysaccharides inducing nitric oxide production in cultured rat hepatocytes

AIM

To study the effects of dinoprostone (Din) on nitric oxide (NO) production induced by lipopolysaccharides (LPS) and cytokines mixture (CM) in cultured rat hepatocytes, and the role of cAMP signaling pathway in the induction process.

METHODS

Rat hepatocytes were incubated with indometacin (Ind), Din, forskolin (For), or dibutyryl cyclic GMP (db cGMP) in a medium containing CM (LPS plus TNF-alpha, IL-1 beta, and IFN-gamma) for 24 h. NO production in the cultured supernatant was measured with the Griess reaction. Intracellular cAMP level was measured with radioimmunoassay.

RESULTS

NO production stimulated by CM was markedly attenuated by Ind in the cultured supernatant, whereas Din and For increased nitrite concentration in the medium. In the presence of CM, both Din and For increased intracellular cAMP level, and had no effect on cAMP level in absence of the stimuli; db cGMP had no influence on the cAMP and NO production both in the presence and absence of same stimuli.

CONCLUSION

Din potentiates cytokines and LPS to induce NO production in rat hepatocytes, and the induction may be regulated via intracellular second messenger cAMP signaling pathway.

Kanglemycin C vs ciclosporin on immunosuppression in mice

AIM

To study inhibitory effects of kanglemycin C (Kan) on the mouse immune system, and compare with the effects of ciclosporin (Cic).

METHODS

Delayed hypersensitivity (DH) and cyclophosphamide-potentiated DH induced by dinitrofluorobenzene (DNFB); heart allograft and skin allograft; hemolysin; the phagocytosis of the peritoneal macrophage.

RESULTS

Kan (12.5, 25, 50 mg.kg-1.d-1, ig, 8 d) markedly inhibited DH and cyclophosphamide-potentiated DH induced by DNFB (P < 0.01), prolonged survival times of heart and skin allografts (P < 0.01), and decreased the content of hemolysin (P < 0.01), but had no significant effect on the neutral-red phagocytosis of the peritoneal macrophage (P > 0.05).

CONCLUSION

Kan had marked suppressive effects on cell-mediated and humoral-mediated immune responses, but no effect on phagocytosis of macrophage.

[A case report of chronic dissecting aortic aneurysm (Stanford type A) with circumferential detachment of the intima]

A 57-year-old man underwent Bentall's procedure (Piehler's modification) and partial aortic arch replacement for Stanford type A chronic aortic dissection. Circumferential detachment of intima with intimal intussusception into the aortic arch was found at the time of operation. Preoperative findings did not show the intimal tear involving entire circumference of the ascending aorta. He was asymptomatic but coughing before consulting our hospital. He was discharged from the hospital 26 days after operation.

[Effects of Tremella polysaccharide on cytoplasmic free calcium concentration in murine splenocytes]

Effects of Tremella polysaccharides (TP) isolated from Tremella fuciformis Berk. on the cytoplasmic free calcium concentration in murine splenocytes were observed using Fura-2, a fluorescence indicator, technique. TP increased the cytoplasmic free calcium concentration of Fura-2-loaded murine splenocytes in a concentration-dependent manner and showed synergetic effect with Con A. No effect was found in the release of intracellular calcium without extracellular calcium. Verapamil (10 micrograms.ml-1), a calcium channel blocker, was shown to inhibit the effect of TP on cytoplasmic free calcium, indicating that TP can affect the influx of extracellular calcium.

Effects of 10-hydroxy-2-decenoic acid on phagocytosis and cytokines production of peritoneal macrophages in vitro

AIM

To study the effect of 10-hydroxy-2-decenoic acid (HDA) on the macrophages activity of rats in vitro.

METHODS

To measure the effects of HDA on phagocytosis, the production of antitumor cytokines tumor necrosis factor (TNF) and interleukin-1 (IL-1) in vitro.

RESULTS

HDA 50, 100 mg.L-1 promoted phagocytic activity from 0.353 +/- 0.017 to 0.39 +/- 0.04 and 0.382 +/- 0.017 A, increased TNF and IL-1 production from 0.23 +/- 0.07% to 0.43 +/- 0.04%, 0.47 +/- 0.04% and from 2384 +/- 180 to 2943 +/- 295, 3825 +/- 450 dpm, respectively.

CONCLUSION

The upregulating effects of HDA on phagocytosis of PMO and production of TNF, IL-1 contribute to the host antitumor and immunomodulating mechanism.

[Reoperation for malfunction of Ionescu-Shiley bovine pericardial bioprosthetic valves in the mitral position--special consideration with emergency operation]

Sixty-eight patients have had mitral valve replacement with Ionescu-Shiley bovine pericardial bioprosthesis from 1981 to 1984. Thirty five patients were required reoperation due to primary tissue failure of the bioprosthesis, 10 (28.6%) were on emergency basis and 25 (71.4%) were on elective. Hospital deaths were two (20.0%) on emergency and four (16.0%) on elective. Clinical features of emergency cases were as follows: progressive congestive heart failure in eight, severe hemolysis with massive hemoglobinuria in eight and acute renal failure in four. Cusp tears were observed in all valves, 8.1 +/- 1.5 mm in emergency group and 4.2 +/- 3.6 mm in elective group. Neointimal ingrowth over Dacron cloth of the inner surface of the stent was absent in 29 valves (89.2%). Calcification was observed in seven valves, however these were not dominant causes of primary tissue failure. Clinical symptoms were correlated with structural deterioration of explanted valves. Structural deterioration of the bioprosthesis may occur suddenly and progressively. Our experience demonstrated that life-threatening prosthetic valve failure may occur with a relatively high incidence and that careful follow-up is needed for Ionescu-Shiley bovine pericardial bioprosthesis.

Subchronic in vivo treatments of morphine inhibit T-cell proliferation by acting on macrophages

The purpose of this study was to examine the possible effects of in vivo morphine (Mor) treatments on macrophage involvement in the mediation of reductions in T-cell functions. Male BALB/c mice were exposed to multiple sc injections of Mor in increasing doses twice a day for 4 days. T-lymphocyte proliferation in response to alloantigen was significantly affected by Mor, while Mor treatment failed to suppress PMA/A23187-induced macrophage-depleted lymphocyte proliferation. Interestingly, after separation of lymphocytes and macrophages from control or Mor-treated mice, Con A-stimulated T-cell proliferation was suppressed only when Mor-treated macrophages were combined with control or Mor-treated lymphocytes. Further, addition of exogenous interleukin (IL)-1 and IL-2 promoted the proliferative responses of lymphocytes obtained from Mor-treated mice to Con A. Studies of the mechanism of suppression show that macrophages are the primary target cells, since macrophage-depleted lymphocyte preparations produced little suppression, and that prostaglandin E2 and reactive oxygen intermediates (ROI) are important mediators possessing immunoinhibitory activities, since indomethacin or scavengers of ROI abrogated the suppression. These results demonstrate that Mor-triggered release of inhibitory macrophage metabolites and decrement in soluble cytokines production are involved in the immunosuppressive effects caused by subchronic in vivo repetitive administrations of the drug of abuse.

[A case report of a successful surgery for thoracoabdominal aortic aneurysm under partial cardiopulmonary bypass with selective perfusion of major abdominal branches]

A 69-year-old man showed gradually developing thoracoabdominal aortic aneurysm (TAAA) after coronary artery bypass grafting. The patient underwent graft replacement of TAAA uneventfully under partial cardiopulmonary bypass with selective perfusion of major abdominal branches. The major abdominal branches and two pairs of intercostal arteries were reconstructed. The patient showed no organ failure or spinal damage postoperatively. Partial cardiopulmonary bypass with selective perfusion of abdominal branches successfully protected both the visceral organs and the spinal cord from ischemia in a TAAA surgery.

Correction of truncus arteriosus with autologous arterial flap in neonates and small infants

BACKGROUND

This study describes the results of techniques using the autologous truncal wall and part of the pulmonary artery for correction in anticipation of the growth of the pulmonary tract in patients with truncus arteriosus.

METHODS

Seven consecutive patients with truncus arteriosus were reviewed. The posterior wall of the pulmonary tract was obtained by anastomosing the lower edge of the truncal arteriotomy to the upper corner of the ventriculotomy from the truncus in types I and II. Anterior translocation of the pulmonary artery was performed in a type III. A pericardial patch with or without a monocusp was placed to complete the right ventricular outflow tract.

RESULTS

There were two hospital deaths, one of which was unrelated to a cardiac problem. Postoperative right-to-left ventricular peak pressure ratio was less than 0.55. There was one left pulmonary stenosis due to monocusp adherence in the late postoperative period. The sizes of the pulmonary tract at anastomosis were between 107% and 166% of the normal value between 7 months and 3.8 years of follow-up.

CONCLUSIONS

The use of autologous arterial wall instead of a conduit is recommended for the repair of truncus arteriosus to expect growth of the pulmonary tract.

[Report of a case with re-mitral valve replacement for Björk-Shiley Delrin disc valve prosthesis--disc wear of the Delrin disc 20 years after implantation]

We reported a patient in whom slight congestive heart failure gradually developed 20 years after mitral valve replacement with a Delrin disc Björk-Shiley valve prosthesis. Although no evident cause of prosthetic valve malfunction could be detected preoperatively, the mitral prosthesis was excised and replaced uneventfully with a 29 mm St. Jude Medical valve prosthesis. At gross inspection, marked wears of the Delrin disc surface and strut shaped indentations were present. These disc variance, occurred much earlier than initially predicted by Dr. Björk, allowed prosthetic valve malfunction. The patient with this specific model should be carefully followed-up, if necessary, performed reoperation.

[A case of a univentricular heart developed subaortic stenosis after fontan operation]

The patient was a seven-old-boy with univentricular heart of left ventricular morphology with transposition of the great arteries and coarctation of the Aorta. Pulmonary artery banding and coarctactomy (subclavian flap method) were performed as prior surgery during infancy and significant subaortic stenosis (SAS) was not identified before or immediately after Fontan operation. SAS was suspected in an ejection murmur that developed without symptoms two years and five months after Fontan operation. It became clear that the SAS was caused by both restrictive ventricular septal defect and narrowing of outlet chamber (right ventricle). Surgery was performed with myectomy in the outlet chamber, enlargement of ventricular septal defect and a patch enlargement of the right ventricle outflow tract for relief of the SAS. Postoperative pressure gradient across the subaortic component was decreased, however, valve regurgitation remained grade I to II. The mechanisms of SAS after Fontan operation are related to hypertrophy of the subaortic component that incorporates the infundibulum and trabeculae. Careful morphological investigation is essential in patients with risk factors for SAS Mild deterioration of the ventricular compliance due to progressive SAS may result in reduction of the cardiac function and patient's quality of life. Adequate surgical treatment to relieve the SAS is considered essential before and after Fontan operation.

Truncus arteriosus with interrupted aortic arch: successful correction using autologous flap

A newborn baby with type II truncus arteriosus and type B interrupted aortic arch was successfully treated by creating a pulmonary tract using autologous flap made from truncal wall without excision of the pulmonary artery and by reconstructing the aortic arch with direct anastomosis. This method provided excellent hemodynamics with wide reconstruction of the pulmonary tract without conduit.

[Repeat open heart surgery in a case associated with persistent left superior vena cava: a method of simple occlusion of L-SVC using an alternative extra-pericardial approach and retrograde cardioplegia]

Twelve years ago, we reported a method of extrapericardial approach to the L-SVC. Since then we have used this approach and performed simple occlusion of L-SVC during cardiopulmonary bypass without any cerebral complications. We have been expecting for a long time and have believed that this method will be very valuable especially in repeat open heart surgery. A case of 49-year-old man successfully underwent a redo operation for mitral and tricuspid valve replacement using extrapericardial occlusion of the L-SVC and retrograde cardioplegia. Although there was a pitfall for retrograde cardioplegia in the persistent L-SVC and a possibility of steal of cardioplegic fluid through a branch of the accessory hemiazygos vein during retrograde cardioplegia for a case with persistent L-SVC, sufficient cardiac protection was obtained in the case presented.

Effects of Tremella polysaccharides on immune function in mice

It was found in vitro that Tremella polysaccharides (TP) (50, 100, 150 and 200 micrograms/ml) augmented lymphocyte proliferation induced by Con A and did not antagonize the suppressive effect of hydrocortisone on lymphocyte proliferation. In vivo TP promoted the plaque-forming cell (PFC) response to SRBC in mice. TP 50 and 100 mg/kg ip for 5 d produced 77.6% and 81.8% increases in PFC response respectively. At the doses of 150 and 200 micrograms/ml, TP decreased the interleukin 2 (IL-2) activities in the supernatant of culture media of mouse spleen cells. TP (50 micrograms/ml) enhanced the lymphocyte proliferation induced by Con A and increased the PFC response to SRBC by 47.1% in 14-month-old mice.