A case of severe non-cardiogenic pulmonary edema in a woman treated with atosiban for preterm labor.

BACKGROUND: A 27-year-old primigravid woman with a triamniotic pregnancy presented with preterm labor at 29 weeks of gestation and acute severe pulmonary edema after treatment with atosiban. CASE REPORT: The severe symptoms and hypoxemia of the patient led to emergency hysterotomy and intensive care unit hospitalization. CONCLUSIONS: This clinical case prompted us to review the existing literature to examine studies on differential diagnoses in pregnant women with acute dyspnea. The possible pathophysiological mechanisms of this condition and the management of acute pulmonary edema are worth discussing.

Bioactivity of Essential Oil of Zingiber purpureum Rhizomes and Its Main Compounds against Two Stored Product Insects.

The insecticidal and repellent activities of the essential oil extracted from Zingiber purpureum Roscoe rhizomes were evaluated against Tribolium castaneum (Herbst) and Lasioderma serricorne (L.) adults. During our screening program for agrochemicals from Chinese medicinal herbs and wild plants, the essential oil of Z. purpureum rhizomes was found to possess strong contact toxicity against T. castaneum and L. serricorne adults, with LD50 values of 39.0 and 16.3 µg per adult, respectively, and also showed strong fumigant toxicity against the two grain storage insects with LC50 values of 13.6 and 9.3 mg/liter of air, respectively. The essential oil obtained by hydrodistillation was investigated by gas chromatography-mass spectrometry. The main components of the essential oil were identified to be sabinene (48.1%), terpinen-4-ol (25.1%), and γ-terpinene (6.7%), followed by α-terpinene (4.3%), ß-thujene (3.4%), and α-phellandrene (2.7%). Sabinene, terpinen-4-ol, and γ-terpinene were separated and purified by silica gel column chromatography and preparative thin-layer chromatography. Terpinen-4-ol showed the strongest contact toxicity against T. castaneum and L. serricorne (LD50=19.7 and 5.4 µg per adult, respectively) and also the strongest fumigant toxicity against T. castaneum and L. serricorne (LC50=3.7 and 1.3 mg/liter of air, respectively). Otherwise, sabinene and terpinen-4-ol were strongly repellent against T. castaneum as well as the essential oil, while γ-terpinene exhibited weaker repellency against T. castaneum compared with the positive control, DEET (N, N-diethyl-3-methylbenzamide). Moreover, only the essential oil exhibited strong repellency against L. serricorne, the three compounds exhibited weaker repellency against L. serricorne relative to DEET.

Two new pregnane glycosides from soft coral Cladiella krempfi.

Two new pregnane-type steroidal glycosides, pregna-5,20-dien-3-O-alpha-fucopyranoside (1) and pregna-20-en-3-O-alpha-fucopyranoiside (2), along with two known pregnane derivatives, were isolated from the soft coral Cladiella krempfi. Their structures were determined by spectroscopic data analysis.

Glucocorticoids negatively regulate the transcription of KC, the mouse homolog of MGSA/GRO.

The KC gene is a member of the small inducible gene family of regulated chemokines. It encodes a growth factor and chemoattractant that appears to mediate inflammatory and immune responses in vitro and in vivo. We now show that the transcriptional induction of KC by serum is inhibited by glucocorticoids. The effect of glucocorticoids is dose-dependent, requires one hour of exposure, is reversed by the protein synthesis inhibitors puromycin and cycloheximide and acts at the transcriptional level. The results support the hypothesis that the major anti-inflammatory action of glucocorticoids may be to inhibit the induction of immediate-early genes that encode cytokines involved in intercellular communication.

Role of serine/threonine protein kinases in the induction of JE, a platelet-derived growth factor inducible gene.

Platelet-derived growth factor (PDGF) and serum both stimulate the transcription of the mouse early response gene, JE. JE and its human homolog, macrophage chemotactic protein-1 (MCP-1), encode potent monocyte chemotactic factors. JE/MCP-1 is a member of the chemokine superfamily of small inducible genes whose products are multifaceted mediators of inflammatory and immune responses. We now report evidence that the serine/threonine kinase inhibitors H7 and H8 but not HA1004, W-7, and ML-7 inhibit the transcriptional induction of the JE gene by serum whereas the phosphatase inhibitor, okadaic acid, increases JE expression. Downregulation of protein kinase C by prior exposure to TPA does not inhibit the induction of JE by serum, nor does it affect the inhibition of JE induction by H7. These results suggest that one or more serine/threonine kinases may be important in the signal transduction mechanism that leads to the induction of the JE gene.

Glucocorticoids inhibit the transcriptional induction of JE, a platelet-derived growth factor-inducible gene.

Macrophages and monocytes have essential roles in normal wound healing, in the immune response, and in the pathogenesis of atherosclerosis. Platelet-derived growth factor (PDGF) stimulates the transcription of the early response gene, JE, and its human homolog, macrophage chemotactic protein-1 (MCP-1) in fibroblasts. JE/MCP-1 encodes a cytokine which is a member of a superfamily of small inducible genes that include platelet factor 4, beta-thromboglobulin, 310-C/NAP-1/IL-8, IP-10, KC/gro/MGSA, and others which may play important roles in the inflammatory and immune response. We now report that glucocorticoids inhibit the transcriptional induction of the JE gene by PDGF and serum in a dose-dependent manner. The glucocorticoid response followed the expected anti-inflammatory rank order of potency and was not due to a shift in the time course of induction. Nonsteroidal anti-inflammatory agents were ineffective in reducing JE mRNA levels. Dexamethasone inhibited the accumulation of JE transcripts induced by PDGF, 12-O-tetradecanoylphorbol-13-acetate, and double-stranded synthetic RNA. Nuclear runoff assays demonstrated that the negative regulation occurred by decreasing the transcriptional induction of the JE gene. No effects on JE message stability could be detected in the presence of dexamethasone. The protein synthesis inhibitors cycloheximide and puromycin reversed the glucocorticoid-mediated inhibition and suggested that new protein synthesis was necessary. These results suggest that the transcriptional inhibition of glucocorticoids is mediated by the expression of a labile transcriptional repressor for the JE gene.

PDGF and the small inducible gene (SIG) family: roles in the inflammatory response.

A growing body of evidence suggests that cells responding to an initial growth, inflammatory or immune signal can respond by inducing the transcription of selective members of the SIG family. This family of related inducible cytokines are involved in the amplification, propagation and coordination of intercellular communication among cell types involved in the immune and inflammatory responses. The principal anti-inflammatory action of glucocorticoids may involve the transcriptional and translational inhibition of cytokines such as JE and other members of the SIG family to effectively disrupt the normal lines of intercellular communication which normally coordinates the immune and inflammatory response. The identification of new members of the family and the discovery of the functions of the known members will lead to a clearer understanding of the complicated processes which lead to normal and pathological immune and inflammatory responses.

[Primary studies on transesophageal atrial activation mapping].

A method of transesophageal atrial activation sequence determination was created by using simultaneous recording with two unipolar esophageal leads and V1, as well as by the bipolar esophageal lead. Based on the assumption that the peak of P wave in the uni-polar esophageal lead (PE) reflects roughly the activation time of the left posterior atrium wall, and so as to the peak of P wave in V1 (PV1) for the right anterior atrium wall, four items were used as indicators of atrial activation sequence: 1. PV1-PE interval; 2. PEp-PED interval (measured from the peak of P wave in the proximal to that in the distal esophageal lead); 3. Morphology of the bipolar esophageal P wave (PEB); 4. PEp-PED-PV1 sequence; In 190 cases having undergone transesophageal atrial pacing with sinus rhythm, PV1-PE measurement was 28.0 +/- 13.9 ms and PEp-PED was 3 +/- 12 ms. During atrioventricular reciprocating tachycardia in 17 cases with type-A preexcitation and 18 cases with left-sided concealed accessory pathway, PV1-PE was -63.3 +/- 19.0 and -63.7 +/- 27.5 ms, with PEp-PED -17.1 +/- 22.0 and 16.4 +/- 16.7 ms respectively. Transesophageal atrial activation sequence determination is helpful in raising the diagnostic accuracy for arrhythmia.

[Activation sequence of the left atrium studied by esophageal leads].

The intracardiac electrogram recorded in upper, middle and lower right atrium showed a positive, biphasic and negative P wave, respectively. This concept has been widely used in positioning the electrode in transesophageal atrial pacing (TEAP). However, in examination of the P wave figure in the unipolar lead along the esophagus by each two cm distance in 100 normal adults, we found that 32 subjects did not fulfill the above-mentioned criteria partially or completely. In order to study the underlying mechanism of such phenomenon, 190 patients undergone TEAP were examined by simultaneous recording of 2 unipolar esophageal leads (interelectrode distance 2-3 cm) with surface ECG. The patients were classified into 3 groups according to the morphology relation between the upper and lower esophageal P waves: Group A consisting of 155 cases (81.6%) in which the fashion of P wave changes was consistent with the usual criteria; Group B 17 cases (8.9%) was not consistent with the criteria; Group C 18 cases (9.5%) was in a reversed manner. The PEP-PED interval (measured from the peak of P wave in proximal esophageal lead to that in distal esophageal lead) was used as an indicator of left atrium activation sequence in vertical direction. Its value in these three groups was 6.3 +/- 10.1, -6.8 +/- 6.9 and -15.7 +/- 7.3 ms, respectively (P less than 0.001), suggesting in the latter two groups the left atrium activation was directed upward.(ABSTRACT TRUNCATED AT 250 WORDS)

Epstein-Barr virus DNA in nasopharyngeal biopsies.

The Epstein-Barr virus (EBV) has been closely associated with the undifferentiated form of nasopharyngeal carcinoma (NPC), which is particularly common in the high risk area in southeast China. We have examined 37 nasopharyngeal biopsies from patients within this high risk area, including 31 cases of undifferentiated NPC and 6 cases of patients with nasopharyngitis, for the presence of EBV DNA. We found that 26 of 31 biopsies from NPC patients were EBV DNA positive; 3 of the 6 biopsies from patients diagnosed with nasopharyngitis were also EBV DNA positive. Southern blot analysis of the DNAs obtained from the EBV genome positive biopsies, digested with EcoRI, showed that all preparations from the NPC tumors had only one band corresponding to the EcoRI A fragment when a BamHI W fragment was used as a probe. However, one tumor had an additional band with a molecular weight larger than EcoRI A. The presence of this novel band could indicate the integration of viral DNA into host cellular DNA. DNA from the same biopsies were restricted with BamHI and PstI restriction enzymes. The data obtained from these experiments suggest that the EBV genomes in both the NPC tumor biopsies and biopsies from nasopharyngitis patients obtained from an endemic area in South China may be similar to each other and to the B95-8 EBV isolate with respect to the BamHI Y region of the EBV genome. The data also demonstrate that infection of normal nasopharyngeal epithelial cells with EBV takes place in patients with nasopharyngitis.

Closed chest catheter ablation of an accessory pathway in a patient with permanent junctional reciprocating tachycardia.

This report describes a 23 year old woman with a lifelong history of permanent junctional reciprocating tachycardia refractory to conventional antiarrhythmic medications who was successfully treated with closed chest, transvenous selective ablation of a posteroseptal bypass tract. Two 100 J (stored) direct-current shocks were delivered to the region of the os of the coronary sinus using a quadripolar catheter positioned in the coronary sinus. At a 2 month follow-up interval, the patient is asymptomatic without recurrence of the tachycardia. It is concluded that in patients with permanent junctional reciprocating tachycardia, selective catheter ablation of a posteroseptal accessory pathway is a feasible alternative to a difficult pharmacologic regimen or to ablative surgery.