Prevalence of food avoidance and food allergy in Chinese patients with chronic urticaria.

BACKGROUND: Food avoidance is common among Chinese patients with chronic urticaria because food allergy is considered to be the cause of disease. The benefit of food avoidance and its relationship with food allergy is unknown. OBJECTIVES: The aims of this study were to examine the prevalence and effect of food avoidance and food allergy in patients with chronic urticaria. METHODS: Four hundred and ninety-four patients with chronic urticaria, who attended Peking University Third Hospital from January 2009 to December 2010, were studied. Food avoidance and its effect were investigated with a detailed questionnaire. Food allergy was diagnosed by serum food-specific immunoglobulin E (IgE), elimination diet based on food-specific IgE, and open food challenge. RESULTS: One hundred and fifty-eight patients (32%) avoided fish, shrimp, crab, lamb or beef prior to evaluation and 82·9% of them reported food avoidance ineffective. Out of 341 patients tested for serum food-specific IgE, 75 (22%) were positive, with soy, peanut, beef, lamb, chicken, crab and shrimp as the leading allergens. Chronic urticaria induced by food allergy was found in only 2·8% of patients. CONCLUSIONS: The prevalence of food avoidance is high and mostly ineffective in Chinese patients with chronic urticaria. Foods avoided do not correspond to serum food-specific IgE. The incidence of IgE-mediated urticaria, as demonstrated by open food challenge, is low. Physicians and patients should be aware of unnecessary dietary avoidance while seeking treatment of chronic urticaria.

Selection of amino acid sequences in the beta chain of the T cell antigen receptor.

The induction of an immune response in mammals is initiated by specifically reactive T lymphocytes. The specificity of the reaction is mediated by a complex receptor, part of which is highly variable in sequence and analogous to immunoglobulin heavy- and light-chain variable domains. The functional specificity of the T cell antigen receptor is, however, markedly different from immunoglobulins in that it mediates cell-cell interactions via the simultaneous recognition of foreign antigens and major histocompatibility complex-encoded molecules expressed on the surface of various lymphoid and nonlymphoid cells. The relation between the structure of the receptor and its functional specificity was investigated by analyzing the primary sequences of the receptors expressed by a series of T lymphocyte clones specific for a model antigen, pigeon cytochrome c. Within this set of T lymphocyte clones there was a striking selection for amino acid sequences in the receptor beta-chain in the region analogous to the third complementarity-determining region of immunoglobulins. Thus, despite the functional differences between T cell antigen receptors and immunoglobulin molecules, analogous regions appear to be important in determining ligand specificity.

Effects of post materials and length on the stress distribution of endodontically treated maxillary central incisors: a 3D finite element analysis.

Traditionally, using a long post can cause progressive removal of the root structure, complicate the ability to re-treat the tooth if necessary and make it difficult to apply an adhesive bonding agent into the root canal. It is unclear if a shorter post length can be applied when a light translucent glass fibre post and adhesive resin cement are used. The aim of this study was to evaluate the biomechanical performance of endodontically treated teeth restored with three post materials, glass-fibre, stainless steel and cast-nickel chromium posts and cores of different lengths of 7, 10 and 13 mm. A 3D finite element analysis model of the maxillary central incisor was constructed. An occlusal load of 300 N was applied to a node at the palatal surface of the crown at 45 degrees to the long axis of the tooth. von Mises stress analyses were carried out in three regions. Simulated data were collected for plotting various pattern graphics and conducting statistical tests. The pattern graphics showed that when the post length changed from 13 to 7 mm, the stress patterns were even and flat in all fibre-post groups, while the stress patterns of the metal-post groups showed an M-shaped peak and trough. Statistical tests showed that the shorter fibre post was superior to the longer metal post in some situations. Within the limitations of this study, it was concluded that when a metal post is used, the post should be as long as possible, while the biomechanical performance of a glass-fibre post combined with a composite resin core was less sensitive to post length.

Investigation of hormone-receptor interactions by means of fluorescence labeling.

Fluorescent-labeled hormones can be used to study hormone-receptor interactions by means of fluorescence polarization, visualization by fluorescence microscopy, or separation methods, e.g., dextran-coated charcoal. Subcellular fragments, single cells, and tissue preparations are amenable to study; in this work rat uterine cytosol was used unless otherwise noted. Estrone labeled with fluorescein at position 17 gives 50% inhibition in the radiometric dextran-coated charcoal assay at 8.3 X 10(-7) M as compared to 3.4 and 3.5 X 10(-8) M for diethylstilbestrol and estradiol, respectively. Scatchard plots from fluorescence polarization are hyperbolic and consistent with two classes of binding sites having association constants 5.6 X 10(10) and 6.4 X 10(7) M-1. Binding by high-affinity sites, which were present at about 3 times the concentraion of "specific" sites (radiometric dextran-coated charcoal assay), was abrogated by estradiol or diethylstilbestrol. Kinetic measurements showed that binding sites that can be blocked by excess estradiol or diethylstilbestrol are those that are both slowly associating and slowly dissociating. Staining of tissues by estrone labeled with fluorescein at position 17 as seen in the fluorescence microscope showed specificity. In normal rat uterus only epithelial cells were stained. In one human infiltrating ductal carcinoma only the malignant ductoid elements stained, while in another there was essentially no staining.

Cell source and biological characteristics of murine bone marrow-derived colony-promoting activity.

A murine colony-promoting activity (CPA) was found in the supernatants of Dexter long-term bone marrow cultures (LTBMC). This activity itself failed to stimulate in vitro granulocyte-macrophage colony (CFU-GM) formation but could increase the number of colonies induced by colony-stimulating factors (CSFs). CPA was produced by the adherent stromal cells but not by the nonadherent cells. No CPA could be detected in cultures of pure marrow fibroblasts, nor was it secreted by the stromal cells following macrophage depletion. In contrast, a large amount of CPA was found in cultures of isolated macrophages, suggesting that marrow macrophages may be the main cell source of CPA. Although colony formation was augmented by adding CPA in combination with various CSFs, the colony type induced by CPA plus CSF was no different from that of CSF alone. Preincubation of bone marrow (BM) cells with CPA at 37 degrees C for 24 hours before using in clonal culture assay resulted in a marked colony enhancement. Furthermore, colony formation by 5-fluorouracil (5-FU)-treated marrow cells could be induced by granulocyte-macrophage (GM)-CSF plus CPA but not by GM-CSF alone. These results suggest that CPA may act on early developing hematopoietic stem cells to induce them to differentiate into more mature myeloid progenitor cells capable of responding to CSF stimulation. CPA was nondialyzable and stable under heat (56 degrees C for 30 minutes) and freeze/thawing (3 times). Its activity was acid-labile (pH 2.0) but relatively alkaline-resistant (pH 11.0). When treated with enzymes, CPA was sensitive to trypsin and bacterial protease but not to neuraminidase. In addition, the activity of CPA could be abrogated by anti-CPA antiserum but remained unchanged after treatment with antibodies to other murine hematopoietic synergizing/stimulating factors, including interleukin-1 (IL-1), IL-3, IL-4, IL-6, and stem cell factor (SCF).

Effect of lipopolysaccharide on the production of colony-stimulating factors by the stromal cells in long-term bone marrow culture.

The production of colony-stimulating factors (CSFs) by murine bone marrow stromal cells was studied with Dexter long-term bone marrow culture (LTBMC). For induction of CSF release, various concentrations (0.5-40.0 microgram/ml) of bacterial lipopolysaccharide (LPS) were added to nonrecharged 3-week-old LTBMCs consisting of an intact or macrophage-depleted adherent cell layer. The depletion of monocytes/macrophages from freshly prepared bone marrow cell suspension was performed by carbonyl-iron incorporation before establishment of LTBMC. The supernatants (Sup) of normal LTBMCs contained a low level of macrophage colony-stimulating factor (M-CSF) that was produced by the adherent cells but not by the nonadherent cell elements. No colony inhibitor was found in the Sup of LTBMCs, whereas a colony-promoting activity (CPA) was detected in medium conditioned by the adherent marrow cells (AC-CM). CPA could enhance the colony formation of myeloid progenitor cells when used in combination with recombinant murine granulocyte-macrophage colony-stimulating factor (GM-CSF). The production of CSFs peaked at about 24 h after refeeding, but it then declined to only half the optimal activity at the end of the week. Addition of LPS to the intact LTBMC invariably increased the production of a GM-CSF-like cytokine. The release of this cytokine was dose dependent and peaked at a dosage of 20 micrograms/ml of LPS at 24 h after treatment. In contrast, macrophage-depleted marrow-adherent cells failed to respond to LPS for CSF secretion. These results suggest that LPS can stimulate marrow macrophages to directly release CSF or to potentiate the production of CSF by other stromal cells.

Production of hematopoietic regulatory cytokines by peripheral blood mononuclear cells in patients with aplastic anemia.

The aim of this study was to measure the level of cytokines produced by peripheral blood mononuclear cells (PBMNC) in patients with aplastic anemia (AA) and determine their effect on normal bone marrow (BM) colony growth. Thirty-five patients with AA and 21 normal controls were enrolled in the study. Medium conditioned by PBMNC of AA patients in the presence of phytohemagglutinin (PHA) was found to be suppressive to the clonal growth of normal BM cells. Thus, we further determined the presence in the PBMNC conditioned medium (CM) of inhibitory cytokines (macrophage inflammatory protein-1 alpha [MIP-1 alpha], transforming growth factor-beta 2 [TGF-beta 2], interferon-gamma [IFN-gamma], and tumor necrosis factor-alpha [TNF-alpha]) and stimulatory cytokines (granulocyte-macrophage colony-stimulatory factor [GM-CSF], interleukin-3 [IL-3], and stem cell factor [SCF]). The results show no significant difference between AA patients and normal controls in the spontaneous production of all cytokines by PBMNC. After PHA stimulation, the production of MIP-1 alpha, IFN-gamma, TNF-alpha, and GM-CSF significantly increased in the cultures of AA patients (p = 0.0009, 0.0002, 0.0022, and 0.0156, respectively). However, both TGF-beta 2 and SCF were undetectable in most of the tested samples. IL-3 was measured in the conditioned medium only after PHA stimulation, but without significant difference between the two groups (p = 0.67). Furthermore, the myelopoietic suppressing effect of AA-PBMNC CM could be significantly blocked by pretreatment with specific antibodies to the corresponding inhibitory cytokines (MIP-1 alpha, IFN-gamma, and TNF-alpha). After antibody neutralization, an apparent change occurred in the clonal growth of normal BM cells incubated with AA-PBMNC CM, resulting in colony enhancement of 205, 131, and 237% by anti-MIP-1 alpha, anti-IFN-gamma, and anti-TNF-alpha, respectively. These results suggest that overproduction of inhibitory cytokines, rather than underproduction of stimulating cytokines, may play a role in the progression of at least some patients with AA.

Regulation of HIV-1 LTR trans-activating activities in two different human hepatocellular carcinoma cell lines.

The regulation of trans-activating activities of two human hepatocellular carcinoma cell (HCC) lines, HEP-G2 and SK-HEP-1, was investigated. These cells were transfected with the wild-type and a nested series of its 5'-deletion mutants of the long terminal (LTR) repeat derived from HIV-1, which were ligated with the chloramphenicol acetyl transferase gene. These two HCC cell lines exhibited different biological characteristics, reflecting their status of differentiation. Both cell lines showed moderate degrees of constitutive (basal) trans-activating activities. While HEP-G2 cells, which are well differentiated, showed marked degrees of enhancement of trans-activation after treatment with 12-O-tetradecanoylphorbol-13-acetate, SK-HEP-1 cells, which are poorly differentiated, showed only moderate or low degrees of enhancement. These two cell lines up-regulated their trans-activating activities in response to the deletion of some regions of positive and negative regulatory elements, suggesting that they produce trans-acting factors that are quantitatively different from each other, and often employ different sets of positive and negative regulatory elements for trans-activation.

Cytokine regulation of HIV-1 LTR transactivation in human hepatocellular carcinoma cell lines.

Human hepatocellular carcinoma (HCC) cell lines, HEP-G2, J5, and SK-HEP-1, which differ in their differentiation status, were compared for their trans-activating activities after treatment with cytokines or 12-O-tetradecanoylphorbol-13-acetate (TPA). These cells were transfected with a long terminal repeat (LTR) which was derived from human immunodeficiency virus type 1 (HIV-1) and ligated to chloramphenicol acetyl transferase (CAT) gene. After treatment with interleukin-1 alpha (IL-1 alpha), interleukin-6 (IL-6), interferon-gamma (IFN-gamma), or TPA, they exhibited various degrees of enhancement of transactivation. The well differentiated HEP-G2 cells exhibited the highest degree of enhancement with these agents, while the poorly differentiated SK-HEP-1 cells showed no enhancement with cytokines and slight enhancement with TPA. The J5 cells, which were intermediate in their status of differentiation, showed a moderate degree of enhancement with cytokines and TPA. These results suggest that HCC cells at different stages of differentiation may produce different levels of cellular transacting factors activated by each of these agents. To map the cytokine response elements (CREs) in the HIV-1-LTR, HEP-G2 cells were transfected with nested series of 5' deletion mutants of HIV-1-LTR and treated with each of these cytokines. It was found that not only the degrees but also the patterns of enhancement varied depending upon the presence of positive or negative regulatory sequences in HIV-1-LTR, and that the NF-kappa B sequence played an important role, either by itself or in conjunction with the 5'-proximal response elements (REs) to interact with cellular trans-activating factors elicited by the cascade of transduction responses to cytokines. Despite the presence of promoters including kappa B and IFN-gamma RE as well as IL-6RE sequence in HIV-1-LTR-transfected cells, the poorly differentiated SK-HEP-1 cells showed no enhancement of transactivation by these cytokines, suggesting the lack of receptors or activity of some signal transduction factors which are present in well differentiated HEP-G2 and moderately differentiated J5 cells.

Perinatal cytomegalovirus infection complicated with pneumonitis and adrenalitis in a premature infant.

Cytomegalovirus causes pneumonia, hepatitis, thrombocytopenia, and hemolytic anemia. Cytomegalovirus adrenalitis in premature infants, however, is rare. This report described a premature newborn who had progressively worsening hyperbilirubinemia, pancytopenia, and hepatosplenomegaly at the age of 4 days. The baby's mother had prolonged rupture of amniotic membrane for about 8 weeks. The infant received exchange blood transfusion, empiric antibiotics treatment, and mechanical ventilation. Pneumonia and sepsis developed at the age of 18 days. Serum anticytomegalovirus immunoglobulin M and urine virus culture were positive for cytomegalovirus. The baby died at the age of 22 days. Autopsy showed cytomegalovirus infection complicated with interstitial pneumonitis and pulmonary edema, subacute bronchopulmonary dysplasia with interstitial fibrosis, and adrenalitis. We concluded that the functional status of the adrenal glands in cytomegalovirus-infected premature newborns who have unexplained electrolytes imbalance, fever, diarrhea, weight loss, or hypotension should be closely followed because of the possible involvement of adrenal glands.

Effect of caffeic acid phenethyl ester, an antioxidant from propolis, on inducing apoptosis in human leukemic HL-60 cells.

Caffeic acid phenethyl ester (CAPE) is an active component isolated from propolis. The aim of this study was to investigate the mechanism of CAPE-induced apoptosis in human leukemic HL-60 cells. It was found that CAPE entered HL-60 cells very quickly and then inhibited their survival in a concentration- and time-dependent manner. CAPE induced characteristic DNA fragmentation and morphological changes typical of apoptosis in these cells. Estimation of the apoptotic percentage showed a time-dependent increase after CAPE (6 microg/mL) treatment (up to 66.7 +/- 2.0% at 72 h). Treatment with CAPE caused rapid activation of caspase-3 after 4 h, down-regulation of Bcl-2 expression after 6 h, and up-regulation of Bax expression after 16 h. These results suggest that CAPE is a potent apoptosis-inducing agent; its action is accompanied by activation of caspase-3, down-regulation of Bcl-2, and up-regulation of Bax in human leukemic HL-60 cells.

Cutaneous alternariosis in association with scabies or iatrogenic Cushing's syndrome.

Cutaneous alternariosis is rare. Most infections occur in immunocompromised hosts. We report the first three cases in Taiwan. The patients were elderly farmers residing in Tainan. They developed indolent, erythematous, ulcerated or crusted papules, plaques or pustules over the extensor aspect of the forearms or hands. Pure colonies of Alternaria sp were isolated from biopsy specimens in each case. The diagnosis was confirmed by detecting pleomorphic fungal elements in the dermis within suppurative, granulomatous infiltrates. All three patients were immunocompromised. They showed a negative reaction to an intradermal test of seven common antigens. Cases 2 and 3 had iatrogenic Cushing's syndrome. Cases 1 and 3 had extensive scabies, which in Case 1 was of the Norwegian type. To the best of our knowledge, scabies associated with alternariosis has not been reported previously. The infection showed spontaneous regression in Case 1; in Case 2, it resolved after seven weeks of intralesional amphotericin B at a dose of 1 mg/mL twice a week.

Quantitative and morphological changes of Langerhans cells in Bowen's disease from patients with chronic arsenicism.

Langerhans cells (LCs) are considered to be responsible for the immunologic presentation of tumor-associated antigens and play a role in the elimination of neoplastic clones. Ultraviolet light B can cause dysfunction and loss of LCs. Both the number and dendritic morphology of LCs are known to be diminished in squamous cell carcinomas from sun-exposed skin. The effects of arsenics on LCs are unknown. Using an OKT-6 monoclonal antibody to stain intraepithelial LCs, we compared their number and morphology in Bowen's lesions and in the perilesional skin from sun-protected sites in ten patients with chronic arsenicism. There was a significant reduction in the numbers of LCs in the Bowen's lesions as compared to the perilesional skin specimens. Loss of dendrites was observed in all Bowen's lesions and in seven of the perilesional skin specimens. Ultrastructurally, the LCs showed an absence of dendrites, but the Birbeck granules were preserved. Since the specimens were not from sun-exposed skin in our study, the findings may be related to chronic arsenic intoxication. The morphologic alteration of LCs observed in the perilesional skin further suggests an arsenic-related systemic dysfunction of the LCs, which in turn may contribute to the development of skin cancers in these patients.

Pyogenic liver abscess caused by Pseudomonas aeruginosa in a previously healthy child: report of one case.

Pyogenic liver abscess (PLA), a very uncommon liver disease in the normal pediatric group is often associated with immunocompromised conditions. Pseudomonas aeruginosa has long been regarded as a relatively rare pathogen of PLA, especially in patients without underlying problems. A previously healthy one-year-and-seven-month-old boy who had symptoms of fever, vomiting and diarrhea got a liver abscess at right hepatic lobe which was confirmed by abdominal ultrasound and computed tomography (CT) diagnoses. Ultrasound-guided percutaneous aspiration of liver abscess was done soon after the confirmation. The culture result of aspirate grew P. aeruginosa. The patient received a 4-week course of adequate antibiotics treatment after the aforementioned aspiration procedure. In addition, a series of ultrasounds were performed to follow the resolution of abscess during the treatment period. The immune function tests of the patient were within normal ranges. Finally, the lesion resolved completely without leaving any complication.

Cerebral infarction in newborns: report of two cases.

Neonates with cerebral infarction do not present with specific symptoms and the condition is usually insidious, so many atypical cases are not diagnosed properly during the neonatal stage. Normal neurological examination results may be found in newborns who have actually had a cerebral infarction insidiously. We present two newborns with cerebral infarction. One had clinical symptoms of seizures. Brain computed tomography showed a low-attenuated area and magnetic resonance angiography showed a decreased caliber and number of cerebral artery branches. The other had normal neurological examination results. He was referred to our hospital due to cyanosis. Brain sonography revealed a focal hyperechoic area and T2 weighted magnetic resonance image showed an increased signal intensity area. The incidence, etiologies, clinical and radiographic findings are also reviewed.

Subglottic hemangioma associated with cutaneous and cerebellar hemangiomas detected by MRI: report of one case.

Subglottic hemangioma (SGH) is a benign neoplasm that may cause severe and life-threatening respiratory obstruction in infants. However, patients usually present with inspiratory stridor in the first few months of life and may be mistakenly diagnosed as recurrent or persistent croup. Definitive diagnosis is made by image studies, endoscopic examination and biopsy or all. We report a 2-month-old female infant of SGH with initial clinical manifestations of dyspnea and inspiratory stridor co-existing with cutaneous and cerebellar hemangiomas. Clinicians must be alert the possibility of SGH when associated with cutaneous hemangioma. This patient has received oral steroid treatment for more than two months with improvement of the airway obstruction. Although purplish patch lesions over left side of face, eyelid, cheek, and peri-oral regions regressed, the size of the SGH on the followed MRI was slightly enlarged. The diagnosis and various treatments of SGH are discussed and reviewed in this paper.

Meta-analysis on brain representation of experimental dental pain.

Functional magnetic resonance imaging (fMRI) has been widely used for investigating the brain representation associated with dental pain evoked by pulpal electrical stimulation. However, because of the heterogeneity of experimental designs and the small sample size of individual studies, the common brain representation regarding dental pain has remained elusive. We used imaging meta-analysis to investigate six dental pain-related fMRI studies (n = 87) and tested 3 hypotheses: (1) Dental pain is associated with the 'core' pain-related network; (2) pain-related brain activation is somatotopically organized in the somatosensory cortex; and (3) dental pain is associated with the cognitive-affective network related to pain. Qualitative and quantitative meta-analyses revealed: (1) common activation of the core pain-related network, including the somatosensory cortex, the insula, and the cingulate cortex; (2) inconsistency in somatotopically organized activation of the primary somatosensory cortex; and (3) common activation in the dorsolateral prefrontal cortex, suggesting a role of re-appraisal and coping in the experience of dental pain. In conclusion, fMRI combined with pulpal stimulation can effectively evoke activity in the pain-related network. The dental pain-related brain representation disclosed the mechanisms of how sensory and cognitive-affective factors shape dental pain, which will help in the development of more effective customized methods for central pain control.

Pain catastrophizing is associated with dental pain in a stressful context.

Pain is associated with anxiety in a dental setting. It has remained unclear how cognitive-affective factors modulate pain and anxiety in a stressful context, such as receiving dental procedures. We hypothesized that both the situational factor (unpredictability about painful stimuli) and the trait factor (pain catastrophizing, i.e., the tendency to interpret pain in negative orientation) account for dental pain. Fifteen healthy participants were recruited to perform an associative learning task. They were asked to learn the pairing between visual cues and the intensity of incoming painful stimuli delivered at the right upper central incisor. Brain activation associated with pain was recorded by functional magnetic resonance imaging (fMRI). The participants reported increased anxiety and pain in the stressful context, where stimuli intensity was not predicted by the preceding cue. The score of the Pain Catastrophizing Scale was positively correlated with the increased pain modulated by unpredictability. Brain activation at the right posterior hippocampus, a region critically related to associative learning of aversive stimuli and context, was correlated with the individual catastrophizing level. Our findings suggest that both the situational factor (unpredictability) and the trait factor (catastrophizing) influence dental pain, highlighting the role of cognitive-affective factors in pain control of dental patients.

Profiles of circulating endothelial cells and serum cytokines during adjuvant chemoradiation in rectal cancer patients.

INTRODUCTION: This research aimed to demonstrate the correlation of circulating endothelial cells (CECs) count and serum cytokine levels with side effects and prognosis in rectal cancer patients receiving adjuvant chemoradiation. METHODS: Eleven patients received proctectomy, chemoradiotherapy and follow-up for 4 years. Fifty-five blood samples were taken before radiation and during the course. The quantities of CECs were estimated by flow cytometry, and serological factors were measured by ELISA. RESULTS: The CEC level in patients without tumor recurrence was significantly lower than in patients with tumor recurrence (p < 0.01). The IL-6 and TGF-ß1 levels exhibited a similar profile (p < 0.01). For morbidity, the mean CEC level in patients with grade 3 diarrhea was significantly greater than patients with grades 1 (p < 0.001) and 2 diarrhea (p < 0.005). CONCLUSIONS: Levels of CECs, serum IL-6, TGF-ß1 and TNF-α during post-operative chemoradiation in rectal cancer patients might be candidate biomarkers for prognosis and morbidity (NCT00325871).