High frequency of circulating HBcAg-specific CD8 T cells in hepatitis B infection: a flow cytometric analysis.

Viral antigen-specific T cells are important for virus elimination. We studied the hepatitis B virus (HBV)-specific T cell response using flow cytometry. Three phases of HBV infection were studied: Group A, HBeAg (+) chronic hepatitis; Group B, HBeAb (+) HBV carrier after seroconversion; and Group C, HBsAb (+) phase. Peripheral T cells were incubated with recombinant HB core antigen (HBcAg), and intracytoplasmic cytokines were analysed by flow cytometry. HBcAg-specific CD4 and CD8 T cells were identified in all three groups and the number of IFN-gamma-positive T cells was greater than TNF-alpha-positive T cells. The frequency of IFN-gamma-positive CD4 and CD8 T cells was highest in Group C, compared with Groups A and B. No significant difference in the HBcAg-specific T cell response was observed between Group A and Group B. The HBcAg-specific CD8 T cell response was diminished by CD4 depletion, addition of antibody against human leucocyte antigen (HLA) class I, class II or CD40L. Cytokine-positive CD8 T cells without HBcAg stimulation were present at a high frequency (7 of 13 cases) in Group B, but were rare in other groups. HBcAg-specific T cells can be detected at high frequency by a sensitive flow cytometric analysis, and these cells are important for controlling HBV replication.

Low-dose succinylcholine facilitates laryngeal mask airway insertion during thiopental anaesthesia.

We have assessed the optimal dose of succinylcholine to provide satisfactory conditions for insertion of a laryngeal mask airway (LMA) without causing myalgia during induction of anaesthesia with thiopental. We studied 60 adult patients, allocated randomly to one of three groups: group 1 (n = 20) received normal saline, group 2 (n = 20) received succinylcholine 0.25 mg kg-1 and group 3 (n = 20) received succinylcholine 0.5 mg kg-1. Insertion of the LMA was performed 1 min after administration of succinylcholine or saline. Insertion conditions were significantly better in group 3 compared with groups 1 and 2. The incidence of adverse responses on insertion was significantly higher in groups 1 and 2 than in group 3. Four of 20 patients (20%) in group 3 complained of myalgia, which was higher than that in group 1 (0%) and group 2 (10%), but there were no significant differences between groups on the day of operation. On day 3 after operation, seven patients (35%) in group 3 complained of myalgia, which was significantly higher than that in group 1 (5%) and group 2 (20%). Time from administration of succinylcholine to resumption of spontaneous respiration was significantly longer in groups 2 (194.9 (SD 50.4) s) and 3 (234.2 (34.3) s) than in group 1 (84.7 (32.4) s). There was also a significant difference between groups 3 and 2 for duration of apnoea.

[Effect of continuous infusion of flumazenil on unexpected postoperative resedation by midazolam].

Resedation after general anesthesia induced by midazolam is thought to be not an unusual problem for the anesthetists. We investigated the effect of continuous infusion of flumazenil on the patients who had general anesthesia using midazolam as an induction agent and had flumazenil for prolonged recovery after procedure. Fourteen of 54 patients were judged as prolonged recovery and were given 0.25 mg of flumazenil. Then, they were randomly divided into the following two groups. In the first group, another 0.25 mg of flumazenil was given 2 hours after the first flumazenil. In the second group, 0.25 mg of flumazenil in 250 ml of lactated Ringer's solution was given continuously for 2 hours after the first flumazenil. All the patients were fully awake after the first flumazenil but one case of resedation occurred in the first group and in none of the patients in the second group. We conclude that continuous infusion of 0.25 mg of flumazenil for 2 hours is effective and makes anesthetist free from anxiety of postoperative resedation by midazolam.

[A fundamental study on a bioassay for the antiphlogistic effect of topically applied antiinflammatory agents (author's transl)].

To establish a reliable laboratory assay for quantitating topical anti-inflammatory efficacy, the method of Tonelli et al was modified by employing felt fixed forceps, felt and sharp punch in Wistar rats. Croton oil, applied topically to the rat ear, elicited an acute phlogistic response which was maximal 6 hr after the application. The phlogistic response elicited by a single topical application of croton oil (1, 2, 5 and 10%) was increased in a dose-dependent manner, and croton oil, 5%, induced 63.2% increase of ear weight and was the optimal concentration for the experiment. Using this procedure, the antiphlogistic potencies of two corticoids were assayed under conditions of a blind test. ED50 of betamethasone valerate and diflucortolone valerate was 0.26 mg/ml and 0.0097 mg/ml, respectively, in Wistar rats, and 0.86 mg/ml and 0.016 mg/ml in Sprague Dawley rats, suggesting that diflucortolone valerate has an antiphlogistic potency of 27-56 relative to that seen with betamethasone valerate with minor differences in the strain of the rat. Our method should prove to be a useful assay for rapidly quantitating antiphlogistic activities of topically applied corticoids.