Spontaneous bacterial and fungal peritonitis in patients with liver cirrhosis: A literature review.

Spontaneous bacterial (SBP) and spontaneous fungal peritonitis (SFP) can be a life-threatening infection in patients with liver cirrhosis (LC) and ascites. One of the possible mechanisms of developing SBP is bacterial translocation. Although the number of polymorphonuclear cells in the culture of ascitic fluid is diagnostic for SBP, secondary bacterial peritonitis is necessary to exclude. The severity of underlying liver dysfunction is predictive of developing SBP; moreover, renal impairment and infections caused by multidrug-resistant (MDR) organism are associated with a fatal prognosis of SBP. SBP is treated by antimicrobials, but initial empirical treatment may not succeed because of the presence of MDR organisms, particularly in nosocomial infections. Antibiotic prophylaxis is recommended for patients with LC at a high risk of developing SBP, gastrointestinal bleeding, or a previous episode of SBP, but the increase in the risk of developing an infection caused by MDR organisms is a serious concern globally. Less is known about SFP in patients with LC, but the severity of underlying liver dysfunction may increase the hospital mortality. SFP mortality has been reported to be higher than that of SBP partially because the difficulty of early differentiation between SFP and SBP induces delayed antifungal therapy for SFP.

A rotating cerium anode X-ray system allows visualization of intramural coronary vessels after cardiac stem cell therapy for myocardial infarction.

Conventional angiography is insufficient for evaluating the therapeutic effect of cardiac regeneration therapy. A microangiographic X-ray system using a cerium anode was developed. Cerium has a characteristic X-ray with a peak at 34.6 keV, which allows visualization of tiny amounts of iodine. The performance of the cerium anode X-ray system was evaluated in two excised normal canine hearts and in excised ischemic canine hearts treated with c-kit-positive cardiac stem cells (5 canines) or without cells (5 control canines). In the normal canines, branches penetrating from the left anterior descending artery into the myocardium were visualized, down to third-order branches. In just the treated hearts treated with stem cells, small vessels characterized by irregular vessel walls were observed. The cerium anode X-ray system allowed visualization of microvessels in excised ischemic canine hearts, and may evaluate the effect of cardiac stem cell therapy.

Common and specific risk factors for ischemic stroke in elderly: Differences based on type of ischemic stroke and aging.

BACKGROUND: The risk factors among the types of ischemic stroke (atherothrombotic cerebral infarction: ATI, cardio-embolic infarction: CEI, lacunar infarction: LI) in aged stroke patients have rarely been compared to each other. METHODS: We compared the clinical parameters of 300 elderly patients with ischemic stroke, age 65-98years, to 100 age-matched control patients. RESULTS: Comparison by parametric test and logistic regression analysis between all 300 and 100 control patients showed higher systolic and diastolic blood pressures (p<0.001, p=0.03), lower estimated glomerular filtration rate (eGFR) (p=0.01), larger cardiothoracic ratio (CTR) (p<0.001), smoking (p<0.01) and possibly poor adherence to anti-hypertensive agents in the ischemic stroke patients (p<0.001). Comparisons among three types (n=100 for each) showed the highest atheromatous risk factors for ATI to be hemoglobin A1c (p=0.01) and low-density lipoprotein (p<0.001) and for CEI to be largest cardiac load, indicated by largest left atrial dimension (p<0.001), and CTR (p<0.001). Triglyceride level was found to be a borderline risk factor for LI (p=0.054). Comparison between those aged <74 versus ≥75years (n=150 for each) showed a lower eGFR (p=0.02) and larger right atrial dimension (p<0.001) in patients ≥75. CONCLUSION: The risk factors were quite different among the subtypes and aging.

Evaluation of Intracranial Microvessel Visualization in Mouse and Dog Models by Using a New Rotating Cerium Anode X-ray System.

OBJECTIVE: Lacunar stroke may be caused by infarction of small perforating branches of the middle cerebral artery. We developed a microangiographic X-ray system using a cerium anode to evaluate the perforating branches. METHODS: Iodine has K-edges at 33.2 kilo electron volts. Cerium yields a characteristic X-ray of 34.6 kilo electron volts, therefore, the cerium anode X-ray system could detect tiny amounts of contrast material. First, an X-ray chart was used to evaluate the resolution. Second, the brains of mice were dissected and irradiated. Third, the brains of dogs were excluded and irradiated. Fourth, iodine was perfused into the carotid artery of living dogs during brain imaging. RESULTS: In the first experiment, the cerium anode X-ray system elicited 4.86 clear line pairs. In mice, the perforating branches of the middle cerebral artery could be visualized. The perforating branches were clearly observed in dog brains ex situ even through an acrylic plate, but not in conventional X-ray images. Iodine moving inside the perforating branches was visualized in dog brains in situ using the cerium anode X-ray system. CONCLUSION: The cerium anode X-ray system allowed us to visualize the perforating branches of the middle cerebral artery in living dogs.

The vital prognosis of elderly adults living in a group home in their mid-eighties.

The purpose of the present study is to evaluate the vital prognoses of elderly people in their mid-eighties living in a group home (GH) compared to age- and sex-matched outpatient clinic (OPC) in an observational study conducted over 6 years. We investigated the association between mortality and general, cardiac, and nutritional parameters, including eicosapentaenoic acid (EPA) in 54 GH residents (83 ± 8 years old) and 57 OPC attendees (83 ± 5 years old). Kaplan-Meier curves and Cox proportional hazard ratio analyses were used to assess the association between EPA drug administration and mortality in the GH residents and OPC attendees, respectively. The 54 GH residents had higher mortality and poorer nutritional states, as indicated by lower EPA/arachidonic acid values (median 0.20 vs 0.55, p < 0.001), and BMI under the condition without EPA drug administration (1800 mg daily) than did the OPC group. The significant factors that differed between survivors and deceased in the GH residents and OPC attendees were nutritional and cardiac factors. Cox proportional hazard ratio analysis confirmed that a possible determinant of the prognosis was a lower incidence of EPA drug administration and lower hemoglobin in GH. Kaplan-Meier curves and Cox proportional hazard ratio analyses revealed that EPA drug administration significantly reduced the relative mortality by 82 % in the GH residents (p < 0.001) but not in the OPC attendees. The vital prognosis in individuals from GHs was potentially improved by EPA drug administration, which was not the case in the OPC group; however, further prospective studies are needed.

Nutrition-dependent eicosapentaenoic acid deficiency in care house residents.

OBJECTIVE: We have identified that vital prognosis of adults in a group home (GH) in their mid-80s is associated with lower eicosapentaenoic acid (EPA) levels. We investigated the cause of EPA deficiency in residents in a GH and the effect of EPA treatment on cardiac function and nutritional function in 130 older adults. METHODS: We compared blood chemistry data among three age- and sex-matched groups-outpatient clinic (OPC) attendees (n = 54, 87 ± 5 y old), GH residents (n = 40, 85 ± 8 y old), and older adults in a geriatric welfare home for the elderly (GWHE) (n = 36, 87 ± 6 y old)-using non-parametric test. Furthermore, we investigated the sequential changes in blood chemistry and cardiac function at 4 to 12 mo after the initiation of EPA administration (1800 mg/d). RESULTS: Non-parametric test revealed that the EPA/arachidonic acid ratio as well as EPA levels were lower in the GH and GWHE residents than in the OPC attendees (OPC: 0.56 ± 0.3, GH: 0.23 ± 0.12, GWHE: 0.31 ± 0.1). Fish consumption was lower in the GH and GWHE group than in the OPC group. Repeated measured analyses using analysis of variance revealed that EPA administration increased serum EPA levels (54.0 ± 29.0 to 210.5 ± 50.6 µg/mL, P < 0.001); decreased arachidonic acid, docosahexaenoic acid, triacylglycerol, and LDL cholesterol levels at 4.5 ± 3.4 mo after administration; and reduced the severity of supraventricular arrhythmias on ambulatory electrocardiogram at 12.5 ± 4.5 mo (P < 0.05). CONCLUSION: EPA deficiency in GH residents could be related to the nutritional characteristics of older adults in care facilities. EPA treatment induced changes in various lipids and reduced the severity of supraventricular arrhythmias.

Concomitant Thyroid Disorders and Inflammatory Bowel Disease: A Literature Review.

The aim of this report was to review and summarize the literature on cases of concomitant inflammatory bowel disease (IBD) and thyroid diseases. We included the following previous case reports of concomitant IBD and thyroid diseases: 16 cases of ulcerative colitis (UC) and Graves' disease (GD), 3 cases of Crohn's disease (CD) and GD, 10 cases of CD and Hashimoto's thyroiditis (HT), 4 cases of IBD and subacute thyroiditis (SAT) or SAT-like symptoms, and 13 cases of IBD (12/13 cases were CD) and amyloid goiter. There might be no obvious differences of prevalence of thyroid dysfunction (hyper- or hypothyroidism), GD, and thyroid cancer between IBD patients and general populations. However, concomitant UC and HT might be relatively common in patients with multiple autoimmune disorders, and AG is one of the complications with CD patients. There might be no obvious differences of fatal prognoses between IBD patients with thyroid diseases and patients with thyroid diseases without IBD.

Severity of white matter hyperintensities in older adults aged in their mid 80s and its relationship with hemodynamic and cardiac parameters.

AIM: In the present study, we analyzed the severity of white matter hyperintensities detected on magnetic resonance imaging of the brain in older Japanese adults who were aged in their mid 80s, and examined its relationships with the clinical parameters. METHODS: To identify factors related to the severity of white matter hyperintensities in 33 older adult attendees of our outpatient clinic and 17 older adults living in a group home, we carried out logistic regression analyses and/or correlation analyses. RESULTS: Cognitive function and activities of daily living were significantly correlated with the severity of white matter hyperintensities. Multivariate analysis identified activities of daily living, but not cognitive function, as being independently associated with the severity of white matter hyperintensities. Several hemodynamic and cardiac parameters, including diastolic blood pressure, hemoglobin, serum level of N-terminal pro-brain natriuretic peptide, cardiothoracic ratio on the chest X-ray, severity of supraventricular arrhythmias on a Holter electrocardiogram and serum levels of docosahexaenoic acid, were significantly correlated with the severity of white matter hyperintensities. In contrast, the serum cholesterol, glycosylated hemoglobin value and systolic blood pressure were not correlated with the severity of white matter hyperintensities. CONCLUSIONS: The severity of white matter hyperintensities detected on magnetic resonance imaging of the brain in older Japanese patients aged in their mid 80s was significantly correlated with activities of daily living, hemodynamic and cardiac parameters, and the serum level of docosahexaenoic acid.

Clinical Characteristics of Concomitant Systemic Lupus Erythematosus and Primary Biliary Cirrhosis: A Literature Review.

Although autoimmune diseases often coexist, concomitant cases of systemic lupus erythematosus (SLE) and primary biliary cirrhosis (PBC) are uncommon. In this review paper, 34 cases of SLE with concomitant PBC found in English and Japanese scientific literature and Japanese proceedings were reviewed and summarized, including cases with liver dysfunction complicated by SLE. Of the 34 reported concomitant cases of SLE and PBC, 97.1% (33/34) were females, and PBC was diagnosed initially in 69.0% (20/29), except for five cases in which both SLE and PBC were simultaneously diagnosed. Sjögren's syndrome was the most common autoimmune disease complicating concomitant SLE and PBC (23.5%, 8/34). Five deaths have been reported: two elderly patients died of liver failure because of the worsening of PBC, and another two patients died from pulmonary infection associated with SLE pharmacotherapy. It is uncertain whether concomitant cases occur by chance or share a common immunological or genetic basis.

Protective effect of tryptophan against dextran sulfate sodium- induced experimental colitis.

BACKGROUND/AIMS: Little is known about the anti-colitis effect of tryptophan or its metabolites. Here, the protective effect and its mechanism of tryptophan administration on dextran sulfate sodium -induced colitis in mice was studied. MATERIALS AND METHODS: Twenty C57black6 female mice were equally divided into the control group, and treatment group. The control group received a standard CE-2 diet, while the tryptophan group received a CE-2 diet containing 0.5% l-tryptophan. After one week on this diet, all mice were orally administered a solution of 3.5% dextran sulfate sodium for 12 days to induce colitis. Changes in body weight and bloody stool frequency were monitored during dextran sulfate sodium administration. At 12 days post initial dextran sulfate sodium administration, all mice were sacrificed and the histology of their colonic tissue was examined. The nitrotyrosine levels in colonic tissues in both groups, and nitrate and nitrite levels in the urine of the control group, the tryptophan group and the group of mice without dextran sulfate sodium administration was measured. RESULTS: The tryptophan group showed significantly attenuated body weight loss, bloody stool frequency and ameliorated histological changes of colitis. While tryptophan treatment significantly reduced nitrotyrosine level in the colonic tissues, there was no significant reduction in urine nitrate and nitrite levels compared with the (dextran sulfate sodium-induced) control group. CONCLUSION: Tryptophan treatment ameliorated dextran sulfate sodium-induced colitis in this study. One of the anti-colitis mechanisms of tryptophan treatment is attributable to an anti-nitration effect, and may not be via the suppression of nitric oxide generation.

Investigation into bacteremia and spontaneous bacterial peritonitis in patients with liver cirrhosis in Japan.

BACKGROUND/AIMS: Liver cirrhosis patients tend to develop bacteremia, but relatively little has been reported about the situation in Japan. Therefore, we investigated the microorganisms involved and the outcome among liver cirrhosis patients with bacteremia, including spontaneous bacterial peritonitis. METHODS: The subjects were 236 patients who underwent a total of 377 blood cultures and 30 patients diagnosed with spontaneous bacterial peritonitis, among 6,096 inpatients with liver cirrhosis admitted to several hospitals during the period 1991-2009. RESULTS: The rate of positive blood culture was 37.1% (140/377), and the isolated microorganisms were predominantly Gram-negative bacteria. In patients with confirmed bacteremia, the Child-Pugh score and serum blood urea nitrogen and creatinine levels were significantly higher than in non-bacteremia cases. Moreover, short-term mortality (within 1 month) was 48.2% (53/110), being significantly higher than that among non-bacteremia cases (18.8%; 22/117). Among spontaneous bacterial peritonitis cases, mortality within one month was 33.3% (10/30). Again, the Child-Pugh score and serum blood urea nitrogen and creatinine levels were significantly higher among the fatalities than among survivors. CONCLUSIONS: These results indicate that severity of liver dysfunction and severity of renal dysfunction are both important determinants of short-term mortality among liver cirrhosis patients with bacteremia and spontaneous bacterial peritonitis in Japan.

Therapeutic effects of four molecular-weight fractions of Kurozu against dextran sulfate sodium-induced experimental colitis.

BACKGROUND/AIMS: Kurozu has been reported to ameliorate colitis in mice and to have an anti-oxidative effect. However, the active components and mechanism of action remain unknown. Here, as a first step to identify the active components, we chromatographically fractionated Kurozu and investigated the anti-colitis activity of the fractions, focusing on anti-nitration activity. METHODS: Kurozu was divided into 4 molecular-weight fractions (fraction I, >4,000 daltons; II, 2,000~4,000 daltons; III, 800~2,000 daltons; IV, <800 daltons). Forty C57black6 mice were divided into 5 groups as follows: the control group received standard CE-2 diet, and Groups I~IV received CE-2 diet containing Kurozu fractions I~IV, respectively. Dextran sulfate sodium was administered to the mice for 12 days to induce colitis. Body weight and bloody stool frequency were monitored as indices of severity of colitis after administration of dextran sulfate sodium, and at 12 days, all mice were sacrificed for examination of colonic pathology and nitrotyrosine production in the colon tissues. RESULTS: Colitis was markedly ameliorated in Group III, followed by Group II, while Group IV showed little difference from the control. The colonic nitrotyrosine level in Group III was significantly reduced compared with the control. CONCLUSIONS: The major protective components in Kurozu appear to have molecular weights in the range of 800~4,000 daltons, and their action appears to be related, at least in part, to anti-oxidative and anti-nitration effects.

Protective effects of fermented rice vinegar sediment (Kurozu moromimatsu) in a diethylnitrosamine-induced hepatocellular carcinoma animal model.

Kurozu moromimatsu is the sediment of Kurozu, a jar-fermented Japanese black vinegar produced from unpolished rice. Here, we examined the protective effects of Kurozu moromimatsu in a diethylnitrosamine-induced model of hepatocellular carcinoma. Thirty-two F344 rats were divided into two groups; the control group received basal CE-2 diet, and the Kurozu moromimatsu group received CE-2 diet containing Kurozu moromimatsu. At 16 weeks after initial intraperitoneal administration of diethylnitrosamine (150 mg/kg/week), serum was collected from half the rats. These rats were sacrificed and the liver was resected for histological examination of hematoxylin-eosin-stained sections and assay of matrix metalloproteinase-2 and matrix metalloproteinase-9 levels in tumor tissues. Glutathione S-transferase placental form-positive foci were evaluated by immunostaining for glutathione S-transferase placental form. The remaining rats were maintained for evaluation of survival. There were no significant differences of serum transaminases, tumor necrosis factor-alpha, and also no marked hepatic histological differences, between the two groups. However, the size of hepatocellular carcinomas was greatly decreased and the levels of activated matrix metalloproteinase-2 and -9 were significantly reduced in the Kurozu moromimatsu group. Further, survival was significantly prolonged in the Kurozu moromimatsu group compared with the control. These results indicate that Kurozu moromimatsu inhibited the growth of hepatocellular carcinoma.

A case of primary biliary cirrhosis which developed eight years after diagnosis of systemic lupus erythematosus.

A 29-year-old Japanese female was diagnosed with systemic lupus erythematosus (SLE) at the age of 21 and went into remission after administration of prednisolone. Although no liver dysfunction had been observed upon diagnosis of SLE or during follow-up, an increase of hepatobiliary enzyme levels was seen eight years after the diagnosis of SLE. Antimitochondrial antibodies were positive. Cell infiltration around intrahepatic bile ducts and granuloma formation were observed in the liver. Therefore, she was diagnosed with primary biliary cirrhosis (PBC). Administration of ursodeoxycholic acid resulted in normalization of hepatobiliary enzyme levels. Development of PBC after SLE is extremely rare.

Protective effects of Kurozu and Kurozu Moromimatsu on dextran sulfate sodium-induced experimental colitis.

BACKGROUND: Kurozu, a traditional Japanese black vinegar made from unpolished rice, and Kurozu Moromimatsu (Kurozu-M), its sediment, are both consumed in Japan as health foods or supplements. However, it is not known whether they have anti-colitis activity. AIMS: We examined the protective effects of Kurozu and Kurozu-M in an animal model of dextran sulfate sodium (DSS)-induced colitis. METHODS: DSS-induced colitis was induced in C57 black 6 mice by orally administering 3.5% DSS solution for 12 days. The control group received basal CE-2 diet (n = 10), the Kurozu group received CE-2 containing Kurozu (n = 10), the Kurozu-M group received CE-2 containing Kurozu-M (n = 10), and the acetic acid group received CE-2 containing acetic acid (n = 10), starting a week before DSS administration. Changes of body weight and bloody stool frequency were monitored. At 12 days after DSS administration, mice were killed for pathological examination and measurement of nitrotyrosine levels in rectal tissues. RESULTS: Kurozu significantly inhibited body weight loss during 6-12 days after DSS administration and reduced bloody stool frequency during 2-12 days, and also significantly decreased nitrotyrosine levels at 12 days, compared to the control group. Kurozu-M significantly inhibited body weight loss during 6-8 days after DSS administration and reduced bloody stool frequency during 2-12 days, but tissue nitrotyrosine level was not significantly different from the control. Acetic acid had no ameliorating effect on DSS-induced colitis compared to the control group. CONCLUSIONS: Kurozu and Kurozu-M have protective effects against DSS-induced colitis. Kurozu has anti-oxidative and anti-nitration activity.

Investigation of Bacteremia due to Aeromonas Species and Comparison with That due to Enterobacteria in Patients with Liver Cirrhosis.

Background. The role of Aeromonas species (sp.) in bacteremia in Japanese patients with liver cirrhosis is poorly understood. Aim. To establish the importance of Aeromonas sp. as a cause of bacteremia in patients with liver cirrhosis. Methods. Clinical and serological features and short-term prognosis were retrospectively investigated and compared in Japanese patients with bacteremia due to Aeromonas sp. (n = 11) and due to enterobacteria (E. coli, Klebsiella sp., and Enterobacter sp.) (n = 84). Results. There were no significant differences in patients' clinical background, renal dysfunction, or short-term mortality rate between the two groups. However, in the Aeromonas group, the model for end-stage liver disease (MELD) score and Child-Pugh score were significantly higher than in the enterobacteria group. Conclusion. These results indicate that the severity of liver dysfunction in Aeromonas-induced bacteremia is greater than that in enterobacteria-induced bacteremia in Japanese patients with liver cirrhosis.

[A case of autoimmune hemolytic anemia caused by type A influenza infection in a patient with alcoholic liver cirrhosis].

Adult autoimmune hemolytic anemia (AIHA) caused by influenza virus infection is very rare. I report a case of AIHA induced by type A influenza infection in a patient with alcoholic liver cirrhosis. A 67-year-old man with alcoholic liver cirrhosis was hospitalized with jaundice and ascites. At 7 days after admission, type A influenza infection was diagnosed, and this progressed to hemolytic anemia. Direct and indirect Coombs' tests were positive, and his anemia was diagnosed as warm-type AIHA. Prednisolone administration improved the anemia, but the patient died due to hepatorenal syndrome 14 weeks after admission.

[Case of infectious mononucleosis with suspected primary coinfection with Chlamydophila (Chlamydia) pneumoniae and Epstein-Barr virus].

A 26-year-old male was hospitalized with fever and pharyngeal pain. Liver dysfunction and an increase in the percentage of atypical lymphocytes in the peripheral blood were detected. Computed tomography showed pneumonia involving the right lung and synpneumonic pleural effusion. Serum immunological tests showed positive results for Epstein-Barr virus (EBV) viral capsid antigen (VCA) IgM and IgG antibodies and Chlamydophila (Chlamydia) pneumoniae (C. pneumoniae) IgM and IgA antibodies on admission. The pneumonia and pleural effusion were no longer detectable after a week of treatment with starting azithromycin. At 7 weeks after admission, the liver function test results returned to within normal limits, the serum became negative for EBV VCA IgM antibody, the C. pneumoniae IgM antibody titer decreased, and the C. pneumoniae IgA and IgG antibody titers increased. This case was suspected to have infectious mononucleosis caused by primary coinfection with C. pneumoniae and EBV.

[A case of infectious mononucleosis due to Epstein-Barr virus with suspected reactivation of human herpesvirus 6].

A 24-year-old woman hospitalized with fever, general fatigue, and upper abdominal pain was found to have liver dysfunction and an increase in atypical lymphocytes in peripheral blood. Serum immunological studies showed positive Epstein-Barr virus (EBV) VCA IgM antibody and human herpesvirus 6 (HHV-6) IgM and IgG antibodies, and negative EBV VCA IgG and EBNA antibodies on admission. Liver function was back within normal limits 8 weeks after onset, EBV VCA IgM and IgG antibodies were positive, EBNA and HHV-6 IgM antibodies were negative, and the HHV-6 IgG antibody titer was 8 times higher than that on admission. This case was diagnosed as infectious mononucleosis due to EBV with suspected reactivation of HHV-6.

Kurozu moromimatsu inhibits tumor growth of Lovo cells in a mouse model in vivo.

OBJECTIVE: In Japan, rice vinegar that has been matured and fermented for years in earthenware jars is considered a health food with anticolon cancer action. It is divided into the liquid component (Kurozu) and the sediment (Kurozu moromimatsu), which contains large amounts of organic materials and minerals. The effect of Kurozu moromimatsu (Kurozu-M) on cancer has not yet been examined. In this study, we examined the activity of Kurozu-M on colon cancer and investigated the mechanisms involved, focusing on active oxygen generation, apoptosis, and metalloproteinases (MMPs). METHODS: We used Lovo cells transplanted into nude mice as an experimental model. We measured the tumor volume and MMP levels and conducted hematoxylin-eosin staining (for polymorphonuclear leukocytes), terminal deoxynucleotidyl transferase-mediated dUTP nick end-labeling staining (for apoptosis), and immunostaining for nitrotyrosine (a marker of active oxygen generation) in control, Kurozu-treated, and Kurozu-M--treated groups. RESULTS: The tumor volume was the same in the control group (231 +/- 36 mm(3)) and Kurozu group (238 +/- 52 mm(3)), but was significantly reduced in the Kurozu-M group (152 +/- 28 mm(3), P < 0.001 versus control). Apoptosis of tumor cells and accumulation of polymorphonuclear leukocytes were not observed. Nitrotyrosine production, total MMP levels, and MMP activation were significantly reduced in the Kurozu-M group. CONCLUSION: The administration of Kurozu-M prolonged the lifespan of cancer cell-transplanted mice, inhibited tumor progression, and reduced nitrotyrosine production and MMP activation, but did not induce apoptosis.