The effects of Ma-Xing-Gan-Shi-Tang on respiratory resistance and airway leukocyte infiltration in asthmatic guinea pigs

Ma-Xing-Gan-Shi-Tang (MXGST), a traditional Chinese medicine, has been used in treatment of the bronchial asthma for several centuries. However, the therapeutic mechanisms of this Chinese medicine are still far from clear. To understand the mechanism of anti-asthmatic property of MXGST, a guinea pig model of allergic asthma was used to investigate the effects of MXGST on Dermatophagoides pteronyssinus-induced early and late asthmatic responses and airway inflammation, and examine direct beta2-adrenoceptor agonist activity in guinea-pig isolated trachea. Administration of MXGST (10 g/kg) extracts significantly inhibited the antigen induced immediate asthmatic responses (IAR) in actively sensitized guinea pig. MXGST caused concentration-dependent relaxation in strips of guinea pig trachea contracted with carbachol, and ICI-118551, a selective beta2-adrenoceptor antagonist, significantly inhibit the relaxation caused by MXGST. Furthermore, examination of bronchoalveolar lavage fluid (BALF) revealed that MXGST significantly inhibited the increase in neutrophil in the airway at 1, 6 and 24 hr after antigen challenge. Histopathologic examination results showed that MXGST suppressed the neutrophil infiltration into lung tissue. In conclusion, we suggest that the anti-asthmatic effects of MXGST are mainly due to its stimulation of beta2-adrenoceptors on bronchial smooth muscle and its anti-inflammatory ability to inhibit the neutrophil into the airway. The precise mechanism of action of MXGST in asthma remains to be elucidated.

Effect of San-Ao-Tang on immediate and late airway response and leukocyte infiltration in asthmatic guinea pigs

San-Ao-Tang (SAT), a traditional Chinese medicines, has been used to treat patients with the bronchial asthma for several centuries. However, the therapeutic mechanisms of this Chinese medicine are still far from clear. To understand the mechanism of antiasthmatic property of SAT, a guinea pig model of allergic asthma was used to investigate the effects of SAT on Dermatophagoides pteronyssinus-induced immediate and late asthmatic responses and airway inflammation. Our results showed that administration of SAT (10 g/kg) extracts significantly inhibited the antigen induced immediate asthmatic responses (IAR) in actively sensitized guinea pig. Examination of bronchoalveolar lavage fluid (BALF) revealed that SAT significantly inhibited the increase in neutrophil in the airway at 1, 2, 4, 6, 8 hr after antigen challenge. Histopathologic examination showed SAT suppressed the neutrophil infiltration into lung tissue. These results suggest that the antiasthmatic effect of SAT be mainly due to its bronchodilator effect and its ability to inhibit the neutrophil into the airway. The precise mechanism of action of SAT in asthma remains to be elucidated.

Cell adhesion mechanisms: modeling using derivatized beads and sea urchin cell systems

Agarose beads derivatized with amino acids, peptides, carbohydrates and lectins were used to systematically determine what types of molecules, isolated from all others, can make adhesive bonds strong enough to hold cell-like beads together. The results indicated that strong adhesion occurred when at least one of the two members of certain bead pairs was derivatized with molecules that were dimers or trimers but not monomers. Also, beads derivatized with phosphorylated amino acids, but not their non-phosphorylated counterparts, adhered to beads derivatized with positively charged peptides. Adhesion was sensitive to ionic strength and pH of the medium. It was proposed that adhesion occurred between the phosphate groups of the phosphoamino acids and amino and guanidinium groups of the peptides. Cooperative bonding can explain the stability of the adhesion observed in this system. Information gained from the bead modeling work was used to design experiments to examine the role of phosphorylated molecules in modulating adhesion in sea urchin systems. Phosphoamino acids inhibited sperm-egg interaction, but not reaggregation of blastula cells. Inhibitors of alkaline phosphatase, however, did inhibit reaggregation. The results suggest that cell surface phosphorylated molecules may modulate cellular adhesiveness, in some systems promoting, while in others inhibiting adhesion.

Catheter-related complications of continuous ambulatory peritoneal dialysis

OBJECTIVE

To assess the effectiveness of continuous ambulatory peritoneal dialysis (CAPD) with particular reference to morbidity.

DESIGN

Open study.

SETTING

Two city general hospitals.

SUBJECTS

104 Adults and 11 children with end stage renal failure.

MAIN OUTCOME MEASURE

Morbidity.

RESULTS

There were 29 complications (25%), the most common being obstruction of the tube (n = 8, 7%), and migration of the tube (n = 7, 6%). Others were peritonitis (n = 5), haemorrhage (n = 4), infection at the exit site (n = 3), and leakage of fluid (n = 2). All were readily treatable.

CONCLUSIONS

Fixing the catheter in two places may prevent its migration. The complication rate of CAPD is acceptable, and in children with end stage renal failure it is a suitable alternative to haemodialysis while they are waiting for renal transplantation.

Interferon in combination with antitumourigenic phenyl derivatives: potentiation of IFN alpha activity in-vitro

Any attempt to eradicate the heterogeneous cell population of a tumour mass would require the use of appropriate combination treatment protocols. The antitumour effects of interferon alpha (IFN alpha) in combination with AS2-1, the hydrolysis product of 3-phenylacetyl-amino-2,6-piperidinedione, were examined using several human tumour cell lines as a model. These included the malignant melanoma A375, adenocarcinoma of the prostate PC3 (hormone-insensitive bone metastasis), and the erythroleukaemia line K562. AS2-1 suppressed tumour growth through non-toxic mechanisms, with 1 mg/ml causing approximately 50% inhibition of the melanoma and prostate tumour cell proliferation. By contrast, primary normal human skin fibroblasts were significantly less sensitive to the antiproliferative effect of AS2-1. Suppression of tumour growth was seen also with AS2-1 treatment of the erythroleukaemia K562; in these cultures the drug also induced dose-dependent differentiation, as indicated by the increased haemoglobin production. Interestingly, addition of low doses of IFN alpha markedly enhanced the antitumour and differentiating effects observed with AS2-1. Treatment with 200-300 IU/ml of IFN (which caused about 20% inhibition of growth) together with 1 mg/ml of AS2-1 resulted in over 80% inhibition of the melanoma and prostate cancer cell proliferation, suggesting a synergistic activity of the two agents. This was substantiated by quantitative analysis of the differentiation induced in K562 erythroleukaemia. It appears, therefore, that IFN alpha and AS2-1 may act through synergistic mechanisms to effectively inhibit tumour growth and promote differentiation in a variety of human malignant cell lines.

Plesiomonas shigelloides--associated diarrhea

Although Plesiomonas shigelloides is considered to be a cause of diarrhea in the Orient, it has infrequently been noted to be associated with diarrhea in Taiwan. Six cases of various extent of diarrhea were found to be associated with P. shigelloides in stool culture in this department between January 1987 and December 1988. Only two of them had history of chronic diarrhea and the others had mild or even no symptom. All six strains of this organism were susceptible to most commonly used antibiotics, but resistant to ampicillin, carbenicillin, clindamycin, oxacillin, penicillin, and vancomycin. Those which required least minimal inhibitory concentration (MIC) were cefazolin, ceftazidime, cefuroxime, ciprofloxacin, and trimethoprim/sulfamethoxazole. Our experiences showed that P. shigelloides may cause mild diarrhea in normal hosts. It sometimes is an incidental finding. An oxidase test for this organism should be included as routine culture of the stool specimen, but treatment is not always necessary.

[Sonographic appearances of mesenteric cysts--report of 2 cases]

Mesenteric cyst is defined as a cystic mass located in the mesentery, and has rarely been reported. Before the clinical use of ultrasound (US), the imaging diagnosis of the abdominal mass depended on plain X-ray films and contrast examinations to delineate the space occupying lesion. The later use of US enables us to readily identify mass character. For example, whether it is cystic or solid, with or without septum, or whether there is sediment in the cyst. US examination is the method of choice in evaluating abdominal masses. Two cases of pediatric mesenteric cysts were brought to our hospital on account of complication. US of the first patient revealed a huge cystic mass with sediment and septae in central abdomen. Mild hydronephrotic change of the right kidney was found. The pathology showed nonepithelial lining multiloculated cyst surrounded by a thick, fibrotic granulomatous wall with suppurative cell infiltration and some calcifications. The histopathological diagnosis was an infected pseudocyst. The other patient had a cyst which twisted the jejunum and resulted in intestinal obstruction. US found dilated intestinal loops and a septate cystic mass in epigastrium. The pathology showed a multiloculated cyst with mesothelial lining, representing a mesothelial cyst. Both patients were treated surgically and had an uneventful recovery. In this article we described and explained the findings on US, discussed the differential diagnoses and compared different imaging modalities.

[Duplex Doppler ultrasound of internal jugular vein ectasia. Case report]

A seven-year-old boy, who complained of painless swelling mass over the right neck on exertion, was diagnosed as right internal jugular vein ectasis by the duplex Doppler ultrasound. The caliber of the right internal jugular vein was prominently dilated when Valsalva maneuver was done, the duplex Doppler ultrasound showed an essentially flat wave from that indicated the swelling mass to be a venous structure. The clinical manifestation, etiology, pathological findings and diagnostic methods of the internal jugular vein ectasia were reviewed with emphasis on the advantages of duplex Doppler ultrasound in confirming the diagnosis.

Mucosal intussusception to avoid ascending cholangitis

Many methods have been devised to prevent ascending cholangitis following Kasai's hepatic portoenterostomy for biliary atresia. To investigate the effectiveness of mucosal intussusception in preventing ascending cholangitis, 20 mongrel dogs were randomized to undergo Roux-en-Y cholecystjejunostomy and common bile duct ligation with or without mucosal intussusception. Aeromonas hydrophila was instilled into the gastrointestinal tract. Bacterial cultures were grown from samples taken from the gallbladders and lower jejunum, and blood chemistry and barium studies were performed. The barium studies showed satisfactory lack of reflux in all ten dogs with mucosal intussusception. Only two of them had positive cultures for Aeromonas from the gallbladder 3 days after bacterial instillation into the jejunum. All ten dogs in the control group had positive cultures for Aeromonas from the gallbladder. Our results showed that the mucosal intussusception group had a significantly lower rate of recovery of organisms from the gallbladder compared with the control group when the organisms were instilled into distal intestine (P less than 0.05). The method is worthy of clinical trial as a means of preventing or treating ascending cholangitis.

Immune-specific interferon production by peripheral blood mononuclear leukocytes from patients with primary and recurrent oro-labial herpes simplex virus infections

Immune-specific IFN (IFN) is produced by the peripheral blood mononuclear leukocytes (PBML) of greater than 95% of HSV-seropositive humans with infrequent recurrences of herpes labialis [Green, Yeh, and Overall, 1981]. However, herpes virus-induced immune-specific IFN was produced by PBML from only 33 of 48 (68.8%) persons with frequent recurrences (2-12 episodes a year). Two of eight subjects with primary herpes gingivostomatitis also failed to produce immune-specific IFN during either the acute or convalescent phases of their initial HSV infection. These data suggest that some persons have a defective immune-specific IFN response that exists from the time of their primary oro-labial HSV type 1 infection. This defect may predispose to a higher frequency of disease in some individuals.

Activity of human recombinant and lymphoblastoid interferons in human and heterologous cell lines

Three human alpha interferon (HuIFN-alpha) preparations currently being used in clinical trials, rIFN-alpha A, rIFN-alpha 2, and lymphoblastoid IFN (LYM-IFN) had appreciable activity against encephalomyocarditis and vesicular stomatitis viruses (VSV) in guinea pig transformed and guinea pig embryo cells, but not mouse L or rabbit kidney cells. The level of activity in guinea pig cells, compared with human WISH cells, was 182% (range 9%-1,900%). These results suggest that the guinea pig may be useful for testing the antiviral, anticancer, or immunomodulatory activity of Hu alpha IFNs in vivo.

Automated, quantitative cytopathic effect reduction assay for interferon

A rapid, cytopathic effect reduction assay for human interferon (IFN) is described. Dilutions of IFN were made with an automated diluter in 96-well microtiter plates. Total incubation time was 26 h. IFN titers were calculated from optical density readings of crystal violet-stained monolayers in an automated spectrophotometer, which required less than 1 min to read each plate.

Presence of interferon in acute- and convalescent-phase sera of humans with influenza or influenza-like illness of undetermined etiology

Interferon (IFN;titer, greater than 10 units) was present in the acute-phase sera of 30 of 40 subjects with culture and/or serologically documented, naturally acquired influenza A/Brazil/78 (H1N1) and in the acute-phase sera of five of 27 subjects with an influenza-like illness of undetermined etiology. No statistical correlation existed between the quantity of IFN in acute-phase serum and the course of the clinical illness. Antiviral activity in all of nine acute-phase sera and three of four sera obtained on the fifth to seventh days of illness was neutralized to greater than 50% by antibody to virus-induced human leukocyte IFN (HuIFN-alpha). In contrast, none of five sera collected between 21 and 23 days after the onset of illness contained IFN sensitive to neutralization by antibody to HuIFN-alpha. Resistance of IFN in convalescent-phase sera to neutralization by antibody to HuIFN-alpha suggests that multiple IFN species may evolve during viral infections.

Pathogenesis of herpes simplex labialis: correlation of vesicle fluid interferon with lesion age and virus titer

Of 51 patients with herpes simplex labialis, 50 had detectable interferon (IFN) in samples of lesion vesicle fluid. The median titer of vesicle fluid IFN was 8,200 U. and the range of values was 400 to 63,600 U. The amount of vesicle fluid IFN was correlated with lesion age (r = 0.32, P = 0.024) and vesicle fluid virus titer (r = 0.59, P = 0.00004), but not with the clinical severity of the disease. The presence of vesicle fluid IFN (1,500 to 28,600 U) in 15 lesions less than 12 h old emphasizes the need for early treatment in studies of antiviral agents for herpes simplex labialis.

Sequential production of IFN-alpha and immune-specific IFN-gamma by human mononuclear leukocytes exposed to herpes simplex virus

Both viral-induced interferon (IFN-alpha) and immune interferon (IFN-gamma) were produced in cultures of human peripheral mononuclear leukocytes (PML) exposed to ultraviolet (UV) light-inactivated herpes simplex virus (HSV). Comparable IFN titers (100 to 300 U) were present in supernatant media from PML of HSV-seropositive and -seronegative donors maintained for 2 days in culture. This "early" IFN was not immunologically specific and had the characteristics of IFN-alpha. In contrast, PML from 20 of 21 (95%) seropositive donors, but only 2 of 22 (9%) seronegative subjects, produced IFN in day-5 cultures that had been washed on day 2 followed by the addition of fresh media without UV-HSV (p < 0.0001). In addition,the geometric mean IFN titer of 35 U present in media from day 5 cultures of seropositive donors was significantly higher (p < 0.0001) than those from seronegative subjects (<10 IFN U). This "late" IFN was defined as immunologically specific by virtue of its being present almost exclusively in PML cultures from seropositive donors. Late-appearing, HSV-induced, immunospecific IFN-gamma had antigenic characteristics of both viral-induced IFN-aand mitogen-induced IFN-gamma. A considerable degree of overlapping sensitivity to anti-IFN-alpha and anti-IFN-gamma antibody existed in late IFN, but was not seen in standard, control specimens. The latter finding suggests that the possible existence of an IFN of antigenic character intermediate to IFN-alpha and IFN-gamma. Late IFN was not induced in PML cultures by UV-inactivated Newcastle disease virus (NDV). NDV did, however, induce high titers of early IFN-alpha in PML cultures of both HSV-seropositive and HSV-seronegative donors. HSV-stimulated lymphocyte blastic transformation occurred only in cultures of seropositive individuals, whereas none occurred in response to NDV. Delayed appearance of antiviral activity with the characteristics of IFN-gamma in HSV-stimulated PML cultures is a sensitive and specific measure of the human immune IFN response. Sequential synthesis of IFN-alpha and IFN-gamma in individual PML cultures provides an opportunity to examine regulation of IFN production in response to virus with intrinsic IFN-inducing properties.

Sequential production of IFN-alpha and immune-specific IFN-gamma by human mononuclear leukocytes exposed to herpes simplex virus

Both viral-induced interferon (IFN-alpha) and immune interferon (IFN-gamma) were produced in cultures of human peripheral mononuclear leukocytes (PML) exposed to ultraviolet (UV) light-inactivated herpes simplex virus (HSV). Comparable IFN titers (100 to 300 U) were present in supernatant media from PML of HSV-seropositive and -seronegative donors maintained for 2 days in culture. This "early" IFN was not immunologically specific and had the characteristics of IFN-alpha. In contrast, PML from 20 of 21 (95%) seropositive donors, but only 2 of 22 (9%) seronegative subjects, produced IFN in day-5 cultures that had been washed on day 2 followed by the addition of fresh media without UV-HSV (p &lt; 0.0001). In addition,the geometric mean IFN titer of 35 U present in media from day 5 cultures of seropositive donors was significantly higher (p &lt; 0.0001) than those from seronegative subjects (&lt;10 IFN U). This "late" IFN was defined as immunologically specific by virtue of its being present almost exclusively in PML cultures from seropositive donors. Late-appearing, HSV-induced, immunospecific IFN-gamma had antigenic characteristics of both viral-induced IFN-aand mitogen-induced IFN-gamma. A considerable degree of overlapping sensitivity to anti-IFN-alpha and anti-IFN-gamma antibody existed in late IFN, but was not seen in standard, control specimens. The latter finding suggests that the possible existence of an IFN of antigenic character intermediate to IFN-alpha and IFN-gamma. Late IFN was not induced in PML cultures by UV-inactivated Newcastle disease virus (NDV). NDV did, however, induce high titers of early IFN-alpha in PML cultures of both HSV-seropositive and HSV-seronegative donors. HSV-stimulated lymphocyte blastic transformation occurred only in cultures of seropositive individuals, whereas none occurred in response to NDV. Delayed appearance of antiviral activity with the characteristics of IFN-gamma in HSV-stimulated PML cultures is a sensitive and specific measure of the human immune IFN response. Sequential synthesis of IFN-alpha and IFN-gamma in individual PML cultures provides an opportunity to examine regulation of IFN production in response to virus with intrinsic IFN-inducing properties.

Sensitivity of herpes simplex virus types 1 and 2 to three preparations of human interferon

Ten isolates of herpes simplex virus (HSV) type 1 and nine isolates of HSV type 2 were tested against virus-induced (alpha), fibroblast (beta), and mitogen-induced (gamma) preparations of human interferon (HuIFN). HSV type 2 was slightly more sensitive and HSV type 1 somewhat less sensitive to all three preparations of HuIFN than Sindbis and vesicular stomatitis virus-both considered to be quite sensitive to HuIFN. HSV type 2 was significantly more sensitive than HSV type 1 to each of the HuIFN preparations (P less than 0.01; Mann-Whitney ranksum test). Clinical isolates did not appear to differ from laboratory strains. These results indicate that both HSV types 1 and 1 are sensitive to the three different preparations of HuIFN. HuIFN may have a role in natural recovery from and may have potential as an antriviral chemotherapeutic agent in HSV infections in humans.

Rapid, quantitative, semiautomated assay for virus-induced and immune human interferons

An improved human interferon (IF) assay is described. This procedure is based on the ability of encephalomyocarditis virus to replicate in WISH cell microcultures with the production of discrete plaques in the presence of a liquid tissue culture medium. Performance of 50% plaque reduction endpoint assays in micro-culture required only 0.1 ml of specimen for determinations using duplicate dilutions beginning at 1:3. Semiautomated equipment facilitated simultaneous in situ dilution and distribution of multiple IF samples in cultures containing preformed WISH cell monolayers. An incubation period of 5 to 6 h was adequate for development of maximal antiviral activity by both virus- and immune-induced IF. Sensitivity of the encephalomyocarditis microplaque reduction assay was comparable to that of other commonly used techniques. The method is rapid, can be completed within 30 h from the beginning of the IF assay, and is able to accommodate as many as 40 to 50 samples at a single time. Encephalomyocarditis microplaque reduction is suitable for the quantitation of IF as an antiviral agent or a lymphokine.

Y-grafts and sequential grafts in coronary bypass surgery: a critical evaluation of patency rates

In a series of 584 patients undergoing coronary bypass, 425 patients received Y-grafts, sequential grafts, or a combination of the two. The saphenous veins from the legs frequently had Y- or double Y-branches suitable for bypasses. As many as 5 grafts have been served satisfactorily by a single proximal anastomosis. Simultaneous procedures included 45 left ventricular aneurysmectomies, 18 valve replacements, 7 carotid endarterectomies, repairs of a ventricular septal defect, an acute dissection, and coronary arteriovenous fistulas, with a total surgical mortality of 6 (1.4%). Restudy to determine graft patency was undertaken only in the 59 patients with unsatisfactory surgical results. These patients represent the worst 10% of the series in terms of surgical results. The patency rate for proximal anastomoses was 93%; Y-branchings, 93%; distal end-to-side anastomoses, 89%; and distal side-to-side anastomoses, 89%. Fifty-eight patients (98%) had at least 1 patient graft, and in 47 patients (80%) all anastomoses were patent up to six years after operation. Six patients underwent reoperation without any deaths.

Blood loss and bank blood requirement in coronary bypass surgery

With the use of nonblood prime and refinement in perfusion and surgical techniques, blood requirement for coronary bypass operations has been reduced to a minimum. Of 240 patients (average number of bypasses, 3.07; average pump time, two hours and 22 minutes), no blood was used in pump prime or before perfusion. During perfusion, 29 patients (12%) received 34 units of blood in the pump-oxygenator, and after bypass 64 patients (27%) received 65 units of blood in the operating room (average intraoperative use, 203 ml per patient). For the total hospital stay, the blood requirement was 728 ml per patient. For the last 60 patients operated on, the figure was 328 ml. There were no surgical deaths, and only 1 reexploration for postoperative hemorrhage (0.4%). Discharge hemoglobin level averaged 11.8 gm, whereas the admission hemoglobin level had averaged 13.8 gm. Autotransfusion, avoidance of entry into the pleural space, shorter perfusion time, postoperative platelet count of more than 150,000, and normal partial thromboplastin time tend to reduce blood requirement, but not to a striking degree. Bank blood requirement for the coronary bypass program accounted for 3.7% of the hospital need and 2% of the community need.

Influence of rhythm and anticoagulation upon the incidence of embolization associated with Starr-Edwards prostheses

The incidence of embolism following aortic and mitral valve replacement with Starr-Edwards prostheses has been analyzed and correlated with cardiac rhythm and anticoagulation. No embolism occurred in the aortic valve replacement group, regardless of use or nonuse of Coumadin. In the mitral group, the incidence of embolism during atrial fibrillation was approximately 1.7 times that during sinus rhythm. Coumadin prophylaxis was extremely effective. The incidence during non-anticoagulation was 40 times that during adequate anticoagulation, and seven times that during inadequate anticoagulation. Embolism occurred as late as 21 months after surgery, often shortly after termination of anticoagulation. Three of the four patients with emboli associated with bacterial endocarditis died. All nine patients with emboli not associated with infection survived, half without permanent sequelae.

Role of atelectasis in surfactant abnormalities following extracorporeal circulation. A clinical and experimental study

Surface activity of lung extracts was determined in 36 patients and 28 dogs following extracorporeal circulation. Normal results were usually found. Abnormal surface tension was demonstrated only in a few samples obtained from grossly atelectatic or congested portions of lung, normal surface tension being present in adjoining areas of the same lung. Sources of error in surface-tension measurements and factors to be considered in the interpretation of results are discussed. A possible explanation for the discrepancies in results obtained by various investigators is presented.