[Treatment of patent ductus arteriosus in very preterm infants in China]

Objective: To describe the current status and trends in the treatment of patent ductus arteriosus (PDA) among very preterm infants (VPI) admitted to the neonatal intensive care units (NICU) of the Chinese Neonatal Network (CHNN) from 2019 to 2021, and to compare the differences in PDA treatment among these units. Methods: This was a cross-sectional study based on the CHNN VPI cohort, all of 22 525 VPI (gestational age<32 weeks) admitted to 79 tertiary NICU within 3 days of age from 2019 to 2021 were included. The overall PDA treatment rates were calculated, as well as the rates of infants with different gestational ages (≤26, 27-28, 29-31 weeks), and pharmacological and surgical treatments were described. PDA was defined as those diagnosed by echocardiography during hospitalization. The PDA treatment rate was defined as the number of VPI who had received medication treatment and (or) surgical ligation of PDA divided by the number of all VPI. Logistic regression was used to investigate the changes in PDA treatment rates over the 3 years and the differences between gestational age groups. A multivariate Logistic regression model was constructed to compute the standardized ratio (SR) of PDA treatment across different units, to compare the rates after adjusting for population characteristics. Results: A total of 22 525 VPI were included in the study, with a gestational age of 30.0 (28.6, 31.0) weeks and birth weight of 1 310 (1 100, 1 540) g; 56.0% (12 615) of them were male. PDA was diagnosed by echocardiography in 49.7% (11 186/22 525) of all VPI, and the overall PDA treatment rate was 16.8% (3 795/22 525). Of 3 762 VPI who received medication treatment, the main first-line medication used was ibuprofen (93.4% (3 515/3 762)) and the postnatal day of first medication treatment was 6 (4, 10) days of age; 59.3% (2 231/3 762) of the VPI had been weaned from invasive respiratory support during the first medication treatment, and 82.2% (3 092/3 762) of the infants received only one course of medication treatment. A total of 143 VPI underwent surgery, which was conducted on 32 (22, 46) days of age. Over the 3 years from 2019 to 2021, there was no significant change in the PDA treatment rate in these VPI (P=0.650). The PDA treatment rate decreased with increasing gestational age (P<0.001). The PDA treatment rates for VPI with gestational age ≤26, 27-28, and 29-31 weeks were 39.6% (688/1 737), 25.9% (1 319/5 098), and 11.4% (1 788/15 690), respectively. There were 61 units having a total number of VPI≥100 cases, and their rates of PDA treatment were 0 (0/116)-47.4% (376/793). After adjusting for population characteristics, the range of standardized ratios for PDA treatment in the 61 units was 0 (95%CI 0-0.3) to 3.4 (95%CI 3.1-3.8). Conclusions: From 2019 to 2021, compared to the peers in developed countries, VPI in CHNN NICU had a different PDA treatment rate; specifically, the VPI with small birth gestational age had a lower treatment rate, while the VPI with large birth gestational age had a higher rate. There are significant differences in PDA treatment rates among different units.

[Value of the monocyte-to-lymphocyte ratio in the prognostic evaluation of hepatitis B-related acute-on-chronic liver failure]

Objective: To investigate the predictive value of the monocyte-to-lymphocyte ratio (MLR) for survival in patients with hepatitis B-related acute-on-chronic liver failure (HBV-ACLF). Methods: 92 cases with HBV-ACLF who were admitted to the General Hospital of Western Theater Command from October 2014 to October 2017 were selected. Clinical indicators were retrospectively collected, and their survival condition was followed up for 90 days, with the end point as death or liver transplantation. MLR levels predictive value among patients after 90 days of involvement was compared by analyzing the differences between the survival and death groups and its correlation with various indicators of liver function for prognosis. Results: 92 cases were included in this study, with a 90-day survival rate of 52% (48/92), and a mortality rate of 48% (44/92). MLR for survival and death groups were 0.520 (0.310, 0.828) and 0.740 (0.440, 1.120), respectively. MLR level was significantly higher in the death than survival group (P<0.05). Receiver operating characteristic curve (ROC) analysis showed that the area under the ROC curve (AUC) and 95% confidence interval for the survival group was 0.640 (0.527-0.754). The cutoff value for MLR was 0.399 at which the sensitivity and specificity were 0.864 and 0.396, respectively. Survival analysis showed that the 90-day survival rate was significantly lower in the high MLR group than corresponding low MLR group (P=0.011). Logistic multivariate regression analysis showed that after adjusting for other factors, MLR level was an independent prognostic factor in patients with HBV-ACLF. Conclusions: MLR can be used as a potential prognostic indicator for patients with HBV-ACLF, and its clinical value needs to be verified by large-scale prospective randomized trials.

[Analysis on depression state outcomes and influencing factors of persistent depression in pregnant and perinatal women in China]

Objective: To investigate the depression status of pregnant and perinatal women in early, medium-term, late pregnancy and postpartum period in China and the outcomes of depression in each period, analyze the influential factors of depression status. Methods: By using the pregnant and perinatal women mental health cohort established by National Center for Women and Children's Health of Chinese Center for Disease Control and Prevention, Haidian District Maternal and Child Health Hospital of Beijing, Women Health Center of Shanxi, Jilin Women and Children Health Hospital, Zhuhai Center for Maternal and Child Health Care and Shenzhen Maternity and Child Healthcare Hospital of Guangdong province, a follow up study was conducted at 7 time points during pregnancy and perinatal period in pregnant and perinatal women in Beijing, Shanxi, Jilin and Guangdong from August 1, 2015 to October 31, 2016. The self-filled questionnaire and Edinburgh Postpartum Depression Scale (EPDS) were used to obtain the general demographic information and depression status of the pregnant and perinatal women, and the depression status and natural outcomes of the pregnant and perinatal women were analyzed. Results: A total of 1 284 pregnant and perinatal women were recruited. In this study, a total of 1 210 subjects who completed follow-up at least 6 times and postpartum 42 day follow up were included in the final analysis. The EPDS depression score at the gestation week 13 was used to indicate the depression status in early pregnancy, the average EPDS score of gestation week 17 and 24 were used to indicate the depression status in medium-term pregnancy, and the average EPDS score of gestation week 31 and 37 were used to indicate depression in late pregnancy. The average EPDS score of postpartum day 3 and 42 were used to indicate postpartum depression status. A total of 321 (26.5%), 218 (18.0%), 189 (15.6%) and 219 (18.1%) pregnant and perinatal women were found to have depression, respectively, in early, medium-term and late pregnancy and in postpartum period. The depression status in early, medium-term and late pregnancy and postpartum period were positively correlated (P<0.001), the correlation between early and middle pregnancy was strong (r=0.678), the correlation between medium-term and late pregnancy was strong (r=0.771), and the correlation between postpartum period and late pregnancy was strong (r=0.706). Among the pregnant women with depression in early pregnancy, 26.2% were depressed during the whole study period, 42.7% were depressed during postpartum period, and the results of multifactorial analysis showed that the education level of college or above of the pregnant and perinatal women (OR=0.437, 95%CI: 0.212-0.900, P=0.025), exercise during pregnancy (OR=0.586, 95%CI: 0.348-0.987, P = 0.044), high marital satisfaction (OR = 0.370, 95%CI: 0.221-0.620, P<0.001), normal body mass index (BMI) (OR=0.516, 95%CI: 0.270-0.985, P=0.045) reduced the risk for depression. Unsatisfactory living environment (OR=1.807, 95%CI: 1.074-3.040, P=0.026) increased the risk for depression. Conclusions: In pregnant and perinatal women in China, the detection rate of depression in early pregnancy was highest compared with those in medium-term and late pregnancy. The detection rate of depression increased again in postpartum period. The depression status detected in the early pregnancy remained in the medium-term and late pregnancy and postpartum period. Exercise, BMI, educational level, living environment satisfaction and marital satisfaction can affect the incidence of depression in pregnant and perinatal women.

[Analysis of prognosis-related factors in patients with hepatitis B virus-related acute-on-chronic liver failure]

Objective: To investigate the prognosis-related factors and its predictive value in patients with hepatitis B virus-related acute-on-chronic liver failure (HBV-ACLF). Methods: Sixty-three cases with HBV-ACLF were enrolled. According to the prognosis of 4-weeks, patients were divided into survival and death group. Univariate and multivariate analyses were performed on the clinical data of the two groups of patients to screen the risk factors affecting prognosis, evaluate its predictive value, and compare them with the MELD score, CTP score, and CLIFACLF score. The data were analyzed using t-test, Mann-Whitney U test, χ (2) test. Multiple logistic regression analysis was used for multiple risk factors. Results: There were 63 cases with HBV-ACLF, with 16 cases (25.40%) in the 4-week survival group, and 47 cases (74.60%) in the death group. The survival group age was 38.38 ± 14.50 years, which was significantly lower than the age of the death group 52.28 ± 12.51 years (P < 0.001). The survival group alpha-fetoprotein (AFP) level was 91.21 (8.38 ~ 154.10)μg/L, which was significantly higher than the level of the death group [12.60 (5.70 ~ 33.80) μg/L, P = 0.039]. The survival group alanine aminotransferase (ALT) level was 925.65 (523.43 ~ 1 364.80) U/L, which was much higher than that of the death group [371.60 (117.30 ~ 895.30) U/L, P = 0.040]. The survival group serum sodium level was (136.59 ± 4.03) mmol /L, which was significantly higher than the level of the death group [(132.22 ± 6.37) mmol/L, P = 0.013]. The survival group ascites severity level was much lower than that of the death group (P = 0.008). The survival group creatinine level was 56.50(49.43 ~ 86.25) μmol/L, which was much lower than the level of the death group [86.20 (68.00 ~ 143.00) μmol/L, P = 0.003]. Multivariate logistic regression analysis showed that ascites (OR = 0.470, 95% CI: 0.226 ~ 0.977) and age (OR = 0.941, 95% CI: 0.888 ~ 0.996) were risk factors affecting the HBV-ACLF prognosis. The area under the curve predicted liver failure prognostic score for ascites and age was 0.821, and the sensitivity and specificity were 68.8% and 87.2%, which was higher than the area under the curve predicted by the MELD score, CTP score, and CLIFACLF score, respectively. Conclusion: Age and ascites can be used to predict the clinical outcome in patients with HBV-ACLF. Younger patients without ascites have a higher survival rate at 4-weeks, but older patients with ascites are more likely to have a lower survival rate.

[Relationship of quality and duration of sleep with hypertension among adults in Guangzhou]

Objective: To explore the relationship of sleep quality and sleep duration with hypertension among adults aged 30-79 years old in Guangzhou. Methods: According to multi-stage stratified cluster sampling, 12 747 residents aged 30-79 years old were sampled and surveyed in Guangzhou from January 2018 to March 2019. Data on general demographic characteristics, sleep quality, sleep duration and hypertension were collected through questionnaire survey, the Pittsburgh sleep quality index (PSQI) and physical examination. Multivariate logistic regression models were used to analyze the putative association between sleep quality, sleep duration and hypertension. Restrictive cubic spline curve was used to draw the dose-response relationship curve between sleep quality, sleep time and hypertension. Results: The mean age of the subjects was (52.68±12.17) years, the prevalence of hypertension was 36.6% (4 664/12 747), the average score of PSQI was (4.70±2.88), and the average sleep time was (7.00±1.32) hours. The prevalence of hypertension was positively associated with the PSQI score. Compared to the subjects with a score less than 3, OR (95%CI) of hypertension with a PSQI score of 3-5, 5-8, ≥9 were 1.14 (1.02-1.27), 1.17 (1.03-1.34), 1.41 (1.21-1.64), respectively. The relationship between sleep duration and hypertension appeared U-shaped. Compared with 6 to 8 hours sleep duration, both sleep duration<6 hours with OR(95%CI) of 1.27(1.12-1.43) or >8 hours with OR(95%CI) of 1.20(1.05-1.38) was associated with hypertension. Conclusion: Both poor sleep quality, longer or shorter sleep duration were responsible for increased risk of cognitive impairment in older Chinese.

[Tolerance and pharmacodynamics phase Ⅰ clinical trial study of chimeric anti-CD20 monoclonal antibody IBI301 in Chinese patients with CD20-positive non-Hodgkin's lymphoma]

目的

通过剂量递增的Ⅰ期临床试验，评价重组人-鼠嵌合抗CD20单克隆抗体注射液IBI301单次给药在经治疗达客观缓解的CD20⁺ B细胞非霍奇金淋巴瘤患者中的耐受性、安全性及药效学特征。

方法

纳入9例受试者，按剂量递增原则设125、375和500 mg/m²三个剂量组，每组3例逐组完成试验。3组受试者均接受单次IBI301静脉输注，125、375、500 mg/m²组IBI301的中位暴露量分别为243、690、980 mg。观察IBI301给药后不良事件（AE）发生情况。采用流式细胞术检测外周血CD19⁺、CD20⁺ B细胞比例，采用速率散射比浊法检测血清IgG、IgM水平，进行药效学评价。

结果

9例受试者发生52例次AE，包括：125 mg/m²组18例次，375 mg/m²组14例次，500 mg/m²组20例次。其中不良反应共26例次，22例次与试验药物可能有关，4例次可能无关；对症处理后均消失或恢复至基线水平。常见的AE包括WBC降低、上呼吸感染、ANC降低、消化不良、高尿酸血症、感觉异常、口腔黏膜炎和头晕。研究中未出现AE导致的用药暂停、受试者退出或试验提前中止，未发生严重AE（SAE）及剂量限制性毒性（DLT）事件。所有受试者CD20⁺、CD19⁺ B细胞比例均有不同程度下降，而IgG和IgM水平无明显变化。

结论

IBI301耐受性良好，受试者出现的不良反应均恢复，未发生SAE及DLT事件。IBI301对CD20⁺ B细胞有较好的清除作用。

[A case report of tracheotomy complicated by hemorrhage after radical operation of tongue]

A 55-year old middle-aged male presented swelling lymph nodes in neck and mass in left tongue for three mouths. Physical examination shows a size 5 cm×5 cm mass in tongue and went over the midline. The mandibular lymph nodes were touched with moderate tenderness and little mobility in bilateral. The laboratory results, function of the kidney and heart liver, nasopharyngeal fiber area were basically normal. The result of CT and MRI shows the mass reached the lingual muscle layer and several suspected metastatic lymph nodes in neck. Pathological examination shows much atypical squamous cell reached muscle layer, diagnosed as highly differentiated squamous cell carcinoma. We determined to treat the patient with removal of primary lesion and bilateral neck dissection. We performed tracheotomy after the operation. During the surgeon's blunt dissection of the trachea surrounding tissue, the hemorrhage occurred. After staunching the blood, we transferred sternocleidomastoid muscle flap to fill the soft gas space and finished the surgery.

[Chronic neutrophilic leukemia complicated with multiple myeloma: two cases report and literature review]

OBJECTIVE

To explored the diagnosis and treatment of chronic neutrophilic leukemia (CNL) complicated with multiple myeloma (MM).

METHODS

The clinical features and molecular biological characteristics of 2 patients with CNL complicated with MM were summarized, and the diagnosis and treatment of the patients were retrospectively reviewed.

RESULTS

The diagnosis of CNL complicated with MM was established in 2 cases. Case 1 had CSF3R mutation (P733T), but CSF3R-exon 14 mutation and SETBP1 mutation were all negative. The neutrophil count returned to normal when MM was successfully treated in case 1. When the patient relapsed, neutrophil count increased again.

CONCLUSION

Coexistence of CNL and MM is rare. CSF3R is a very important molecular marker for CNL. To the best of our knowledge, it's the first time to report the coexistence of CNL and MM carried CSF3R mutation (P733T). Chemotherapy regimens for MM may be effective in the treatment of CNL complicated with MM.

Associations between INSR and MTOR polymorphisms in type 2 diabetes mellitus and diabetic nephropathy in a Northeast Chinese Han population

We explored the associations of INSR and mTOR, 2 key genes in the insulin signaling pathway, and the susceptibility to type 2 diabetes mellitus and diabetic nephropathy. Three single-nucleotide polymorphisms (SNPs) (rs1799817, rs1051690, and rs2059806) in INSR and 3 SNPs (rs7211818, rs7212142, and rs9674559) in mTOR were genotyped using the Sequenom MassARRAY iPLEX platform in 89 type 2 diabetes patients without diabetic nephropathy, 134 type 2 diabetes patients with diabetic nephropathy, and 120 healthy control subjects. Statistical analysis based on unconditional logistic regression was carried out to determine the odds ratio (OR) and 95% confidence interval (95%CI) for each SNP. Combination analyses between rs2059806 and rs7212142 were also performed using the X(2) test and logistic regression. Among these 6 SNPs, 4 (rs1799817, rs1051690, rs7211818, and rs9674559) showed no association with type 2 diabetes mellitus or diabetic nephropathy. However, rs2059806 in INSR was associated with both type 2 diabetes mellitus (P = 0.033) and type 2 diabetic nephropathy (P = 0.018). The rs7212142 polymorphism in mTOR was associated with type 2 diabetic nephropathy (P = 0.010, OR = 0.501, 95%CI = 0.288- 0.871), but showed no relationship with type 2 diabetes mellitus. Combination analysis revealed that rs2059806 and rs7212142 had a combined effect on susceptibility to type 2 diabetes mellitus and diabetic nephropathy. Our results suggest that both INSR and mTOR play a role in the predisposition of the Han Chinese population to type 2 diabetic nephropathy, but the genetic predisposition may show some differences.

Helicobacter pylori infection and normal colorectal mucosa-adenomatous polyp-adenocarcinoma sequence: a meta-analysis of 27 case-control studies

AIM

The study aimed to determine whether Helicobacter pylori infection is associated with colorectal adenocarcinoma and to quantify the extent of the risk.

METHOD

A literature search was performed to identify studies published between 1995 and 2012 for relevant risk estimates. Fixed and random effect meta-analytical techniques were conducted for colorectal adenocarcinoma and adenomatous polyp.

RESULTS

Twenty-seven case-controlled studies involving 3450 adenocarcinoma patients, 1304 adenomatous polyp patients and more than 4000 controls were included. Helicobacter pylori was associated with an increased risk of colorectal adenocarcinoma and adenomatous polyp [odds ratio (OR) 1.24, 95% CI 1.12-1.37, P = 0.66; OR 1.87, 95% CI 1.53-2.28, P = 0.81]. There was a significant association between the CagA-positive strain and adenocarcinoma risk (OR 1.22, 95% CI 1.08-1.37, P = 0.05). In addition, there was an increased risk of tubular adenoma and villous adenoma formation (OR 3.06, 95% CI 1.98-4.73, P = 0.14; OR 2.05, 95% CI 0.84-4.97, P = 0.86).

CONCLUSION

The meta-analysis suggests a promoting effect of Helicobacter pylori on the risk of adenocarcinoma. It also suggests that Helicobacter infection might have its influence at the start of the adenomatous polyp disease sequence.

In vivo study of four preparative extracts of Clematis terniflora DC. for antinociceptive activity and anti-inflammatory activity in rat model of carrageenan-induced chronic non-bacterial prostatitis

AIM OF THE STUDY

The present study was conducted to evaluate the anti-inflammatory and antinociceptive activities of Clematis terniflora DC. extracts and fractions and to further support its traditional use as Chinese folk medicine in treatment of urinary infections, especially the disease of prostatitis.

MATERIALS AND METHODS

The antinociceptive activity of its water extract (WE), 70% ethanol extract (EE), water eluted part of EE from AB-8 macroporous resin (WEPMR) and 70% ethanol eluted part of EE from AB-8 macroporous resin (EEPMR) was conducted using mice writhing test with different doses. Then the anti-inflammatory activity of the four parts was evaluated on rat models of carrageenan-induced chronic non-bacterial prostatitis (CNP). Preliminary study was taken to determine the phytochemical compositions of the four preparative extracts.

RESULTS

Significant writhing inhibitory effect was found with EE at small (7.5 g/kg body wt.), moderate (15 g/kg body wt.) and large (30 g/kg body wt.) doses (doses here are presented as crude herbs) as well as EEPMR at moderate and large doses by oral administration (OA) (p≤0.01). Data from prostatic index, lecithin microsome density and white blood cell level showed that moderate dose of EE and EEPMR both had significant (p≤0.05 or p≤0.01) inhibition effect on carrageenan-induced inflammation in rat prostate. The HPLC analytical results showed that flavonoids were the main active compounds in WE, EE and EEPMR. And most flavonoids were accumulated into the part of EEPMR by AB-8 macroporous resin leaving only few compounds in WEPMR. No acute toxicity was identified in oral administration of the four parts at a dose of 100g/kg body wt.

CONCLUSIONS

The results described here suggest that extracts of the aerial part of Clematis terniflora DC. might be of therapeutic interest in the treatment of prostatitis.

Pyrroloquinoline quinone nutritional status alters lysine metabolism and modulates mitochondrial DNA content in the mouse and rat

Pyrroloquinoline quinone (PQQ) added to purified diets devoid of PQQ improves indices of perinatal development in rats and mice. Herein, PQQ nutritional status and lysine metabolism are described, prompted by a report that PQQ functions as a vitamin-like enzymatic cofactor important in lysine metabolism (Nature 422 [2003] 832). Alternatively, we propose that PQQ influences lysine metabolism, but by mechanisms that more likely involve changes in mitochondrial content. PQQ deprivation in both rats and mice resulted in a decrease in mitochondrial content. In rats, alpha-aminoadipic acid (alphaAA), which is derived from alpha-aminoadipic semialdehyde (alphaAAS) and made from lysine in mitochondria, and the plasma levels of amino acids known to be oxidized in mitochondria (e.g., Thr, Ser, and Gly) were correlated with changes in the liver mitochondrial content of PQQ-deprived rats, but not PQQ-supplemented rats. In contrast, the levels of NAD dependent alpha-aminoadipate-delta-semialdehyde dehydrogenase (AASDH), a cytosolic enzyme important to alphaAA production from alphaAAS, was not influenced by PQQ dietary status. Moreover, the levels of U26 mRNA were not significantly changed even when diets differed markedly in PQQ and dietary lysine content. U26 mRNA levels were measured, because of U26's proposed, albeit questionable role as a PQQ-dependent enzyme involved in alphaAA formation.

MHC class I multimers

T lymphocytes play a key role in the immune response to both foreign and self peptide antigens, which they recognize in combination with MHC molecules. In the past it has been difficult to analyse objectively the specificity, frequency and intensity of T cell responses. The recent application of fluorescent-labelled MHC class I multimers, however, has provided a powerful experimental approach to the direct visualisation of antigen-specific T cells. As a result, our perspective of how T cells respond to both viruses and other antigens in vivo has been greatly enhanced.

An inhibitor of type-1 cyclo-oxygenase in tissues from human pregnancy

BACKGROUND

Previous work has shown that first trimester human decidua contains a protein which directly inhibits the activity of type-1 cyclo-oxygenase (COX-1).

METHODS

Activity assays for cyclo-oxygenase types I and II were developed. Cell cytosol was prepared from a number of different sources: human placenta and decidua (first and third trimester), two placental cell-lines (BeWo and TCL-1), an endometrial stromal cell-line and K562 erythroleukemia cells. The effects of all cytosols on activity of type I cyclo-oxygenase, and of cytosols from BeWo choriocarcinoma and decidual cells on type II enzyme, were tested.

RESULTS

Cytosols from first trimester human placenta, two placental cell-lines, an endometrial stromal cell-line and K562 erythroleukemia cells all inhibited the type I enzyme. The inhibitor protein could not be detected in third trimester human decidual cells after labor, and was present only at very low levels in third trimester decidua prior to the onset of labor. Cytosols from BeWo and decidual cells had no effect on the activity of the type-2 cyclo-oxygenase enzyme.

CONCLUSIONS

The inhibitor of type I cyclo-oxygenase was not specific to pregnancy-related tissues, and may be a general regulator of this enzyme. Lower levels of inhibitor were present at term, but the physiological significance of this is unclear. The cytosolic inhibitor appears to be specific to the type I enzyme.

Nebulized nitroglycerin in children with pulmonary hypertension secondary to congenital heart disease

Pulmonary hypertension continues to be a major cause of morbidity and mortality, despite new treatments. Since inhaled nitric oxide has been reported to be effective in some cases, we investigated using nebulized nitroglycerine to treat pulmonary hypertension in children with congenital heart disease. Four children (ages 6-72 months) with severe pulmonary hypertension secondary to congenital heart disease (all with membranous ventricular septal defect, undergoing cardiac catheterization) were given 3 cc of nebulized normal saline over 10 min as placebo control, followed by nebulized nitroglycerine (20 micrograms/Kg in 3 cc normal saline). Normal saline administration did not elicit any change, but nitroglycerine administration resulted in the following changes (mean +/- SE, paired statistics): systolic pulmonary artery pressure from 68 +/- 8 to 53 +/- 6 at 10 min into treatment (P 0.006), mean pulmonary artery pressure 47 +/- 4 to 38 +/- 4 (P 0.005), heart rate 131 +/- 8 to 127 +/- 7 (P 0.13), systolic blood pressure 85 +/- 8 to 88 +/- 3 (P 0.7), mean blood pressure 59 +/- 6 to 63 +/- 4 (P 0.5). These results indicate that nebulized nitroglycerine may be an effective, easy to administer, inexpensive, and safe alternative for treatment of severe pulmonary hypertension in children with congenital heart disease, especially in areas where other treatments such as extracorporeal membrane oxygenation or inhaled nitric oxide are inaccessible.

Performance of coimmobilized yeast and amyloglucosidase in a fluidized bed reactor for fuel ethanol production

The performance of coimmobilized Saccharomyces cerevisiae and amyloglucosidase (AG) was evaluated in a fluidized-bed reactor. Soluble starch and yeast extracts were used as feed stocks. Conversion of soluble starch streams to ethanol has potential practical applications in corn dry and wet milling and in developmental lignocellulosic processes. The biocatalyst performed well, and demonstrated no significant loss of activity or physical integrity during 10 wk of continuous operation. The reactor was easily operated and required no pH control. No operational problems were encountered from bacterial contaminants even though the reactor was operated under nonsterile conditions over the entire course of experiments. Productivities ranged between 25 and 44 g ethanol/L/h/. The experiments demonstrated that ethanol inhibition and bed loading had significant effects on reactor performance.

An endogenous inhibitor of prostaglandin synthesis in human decidua

Human first trimester decidual tissue has been reported to contain an inhibitor of cyclo-oxygenase enzyme, but a careful reading of the literature indicates that the inhibitor may be human albumin. Our own studies also showed that high levels of albumin were present in samples from homogenised decidual tissues. We therefore digested the tissue to obtain isolated cells and washed them extensively to minimise contamination with blood. Homogenates of such cells did not bind arachidonic acid, and inhibited cyclo-oxygenase enzyme-1 (COX-1) activity. The cellular factor inhibited COX-1 at concentrations of 60-100 micrograms protein/ml, and was therefore more potent than human albumin (0.5-2.0 mg/ml). The inhibitory activity was lost after heat treatment (100 degrees C for 10 mins) and after digestion with trypsin or papain, but was resistant to mercaptoethanol and urea. Preliminary data indicated that the protein had a molecular weight > 30 kD.

Effects of interleukin-6 and tumor necrosis factor-alpha on prostaglandin production by cultured human fetal membranes

In this study we investigated the effects of the cytokines interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-alpha) on prostaglandin production by cultured human fetal membranes. These cytokines stimulate prostaglandin synthesis by isolated components of human fetal membranes, but their effects on the intact tissue comprising amnion, chorion and decidua were not known. TNF-alpha added to the maternal side of the membrane activated decidual production of PGF2 alpha but had no effects on synthesis of PGE2 or PGE2 metabolites. Addition of TNF-alpha to the fetal side of the membrane increased production of PGE2 by amnion and PGE2 metabolites from chorion. The addition of IL-6 to the fetal or the maternal side of the membrane increased production of PGE2 from amnion and PGE2m from chorion, suggesting that IL-6 might pass through the fetal membrane. IL-6 had no effect on decidual PGF2 alpha production. These results suggest that TNF-alpha may be involved in labor by increasing decidual prostaglandin synthesis, whereas IL-6 is less likely to have a role.

The effects of interleukins 1 alpha and 1 beta on prostaglandin production by cultured human fetal membranes

The effects of IL-1 alpha and IL-1 beta on cultured human fetal membranes were studied. These cytokines are known to regulate prostaglandin synthesis by the separated components of the fetal membranes (amnion, chorion and decidua), but their effects on intact tissue are unknown. IL-1 alpha increased PGE2 levels on the fetal side of the membrane, indicating increased production of prostaglandin from the amnion, but had little effect on levels of PGE2 on the maternal side of the membrane. Low levels of IL-1 beta (0.1-1.0 ng/ml) increased PGE2 levels on the fetal side of the membrane, and also increased the production of PGE2 metabolites and PGF2 alpha, suggesting that this cytokine stimulated the decidua as well as the amnion. High concentrations of both cytokines appeared able to stimulate prostaglandin production by the side of the membrane opposing that to which they were added, but it is not clear whether this was mediated by factors released by the stimulated membrane, or by direct transfer of small quantities of cytokines through the membrane. Taken together, these results indicate that IL-1 beta was a potent stimulator of the synthesis of prostaglandins by decidua and by amnion, whereas IL-1 alpha only stimulated the amnion.