OBJECTIVE: CD40 and the TNFR belong to the NGF/TNFR supergene family. Ligation of CD40 on B cells induces activation ignals leading to proliferation, Ig isotype class switching, germinal center formation but also induces Fas antigen expression.In addition,CD40 ligation induces pro-inflammatory cytokines including TNF-alpha and LT-alpha gene transcription by human B cell.TNF-alpha is a pleiotropic cytokine and also induces Fas antigen expression on various cells. Lately it has been known that TNF-alpha plays an important role in the pathogenesis of chronic inflammatory diseases,including rheumatoid arthritis,or chronic inflammatory bowel diseases.However there have been occurrence of autoantibodies,or autoimmune disease such as lupus after use of anti TNF-alpha blocking agents. In this report,we tested the relationship and biological significance of CD40 ligation and TNFR signaling with respect to Fas antigen expression on human B cells. METHODS: Ramos Burkitt's lymphoma B cell was used as a prototype of ger-minal center B lymphocyte,and R2G6 cell was utilized as a model of activated germinal center B cell.CD40 lgation was performed by the coculture with CD40 ligand bearing L-293 cells,or anti-CD40 monoclonal antibody,whereas control was obtained with CD-8-L-293 cells or control antibody.Expression of Fas antigen was determined with flow cytometer.Apoptosis assay was conducted by two ways.Alamar blue reduction assay after sIgM cross linking or anti-Fas anti-body,in the presence or absence of CD40 ligation or TNF-alpha .In addition,DNA content assay was utilized to make sure the proportion of apoptotic Ramos B cells by various treatments. RESULTS: 1)CD40 and TNF-alpha induced Fas antigen expression on Ramos B cell line cells and rendered them susceptible to Fas-mediated apoptosis.2)CD40 and TNFR signaling upregulate Fas antigen independently.3)Both TNFR and CD40 signaling rescue sIgM crosslink induced apoptosis of Ramos B cell line cells,only CD40,but not TNFR,signaling rescues Ramos cells from Fas-mediated apoptosis. CONCLUSION: Taken together,these results demonstrate that B cell signaling via two distinct members of the NGF/TNFR superfamily,CD40 and TNFR, independently engage the Fas pathway and provide mechanisms for eliminating B cells.Acting alone,both signals will ready B cells for Fas-mediated apoptosis. In concert with sIg signaling,the rescue effect provided uniquely by CD40 ligation assures the selective survival of only those B cells which have bound antigen and presented it to antigen-specific T(h) cells .
Antigens, CD95* ; Apoptosis ; Autoimmune Diseases ; B-Lymphocytes ; Burkitt Lymphoma ; CD40 Ligand ; Cell Line ; Coculture Techniques ; Cytokines ; Germinal Center ; Humans* ; Immunoglobulin Class Switching ; Ligation ; Receptors, Tumor Necrosis Factor* ; Tumor Necrosis Factor-alpha*

OBJECTIVES: Chronic pain is one of the most common experiences of humans and a typical psychophysiological disorder. The aim of this study was to measure the psychophysiological responses in chronic pain patients using a biofeedback system, and to compare them with the results from normal healthy subjects. METHODS: Forty two patients with chronic pain (17 males and 25 females, average age 44.67+/-11.10 years) and 42 normal healthy controls (17 males and 25 females, average age 45.17+/-10.46 years) participated in this study. Electromyography (EMG), skin conductance (SC), and skin temperature (ST) were recorded using biofeedback system during the 3 phases (baseline, stress, and recovery) of stress reactivity test, and average values of them were calculated. Difference of values between two groups in each corresponding phase was analyzed with independent t-test, and change of values across phases of stress reactivity test was analyzed with paired t-test (all two-tailed, p<0.05). RESULTS: Compared to normal controls, chronic pain patients had higher value of EMG (baseline : 8.10+/-5.97 micronV vs 4.72+/-1.52 micronV, t=-3.56, p<0.01 ; stress : 11.25+/-6.89 micronV vs 8.49+/-4.78 micronV, t=-2.13, p<0.05 ; recovery : 7.12+/-3.77 micronV vs 4.78+/-1.59 micronV, t= -3.70, p<0.01) and SC (baseline : 1.06+/-1.0 micronS vs 0.42+/-0.29 micronS, t=-4.0. p<0.01 ; stress : 1.87+/-2.05 micronS vs 1.03+/-0.86 micronS, t=-2.47, p<0.05 ; recovery : 1.74+/-1.77 micronS vs 0.64+/-0.59 micronS, t=-3.8, p<0.01) in all the 3 phases. But, skin temperature comparison did not reveal significant differences in all the 3 phases between two groups. CONCLUSION: Psychophysiological responses of chronic pain patients in stress reactivity test were different from those of normal healthy controls. These results suggest that sympathetic nervous system is more activated in chronic pain patients.
Biofeedback, Psychology ; Chronic Pain ; Electromyography ; Female ; Humans ; Male ; Psychophysiologic Disorders ; Psychophysiology ; Skin ; Skin Temperature ; Sympathetic Nervous System

No abstract available.
Lupus Erythematosus, Systemic* ; Polyarteritis Nodosa*

Rheumatoid arthritis is a chronic inflammatory systemic disease of young or middle aged adults, characterized by destructive and proliferative changes in the synovial membrane, periarticular structures, skeletal muscle and perineural sheath. Eventually, the joints are destroyed, ankylosed and deformed. Therfore, the aim of treatment is to keep the inflammatory process at a minimum, thereby preserving the joint motion, maintaining the health of muscle supplying motor power about the joint and preventing secondary joint stiffness and deformity. Surgical treatment in rheumatoid arthritis has progressed and there have been advances in the relief of pain and increase in the range of motion. Among them the results of total knee arthroplasty (TKA) have improved steadily during the past decade due to refinements in design, fixation, and surgical technique. At orthopedic department of seoul national university hospital, we performed 31 total knee replacement in 18 patients who had suffered from rheumatoid arthritis during the period from Aug. 1982 to Dec. 1988. Following results were obtained. 1. Knee score increased from 37.8 to 76.9. 2. Tibio-femoral angle was corrected from 0.9° valgus to 5.3° valgus. 3. Conplications were peroneal nerve palsy in 3 knees, instability in 1 knee, tuberculous arthritis in 1 knee. 4. In 25 out of 31 knees, good functional results were obtained.
Adult ; Arthritis ; Arthritis, Rheumatoid ; Arthroplasty ; Arthroplasty, Replacement, Knee ; Congenital Abnormalities ; Humans ; Joints ; Knee ; Middle Aged ; Muscle, Skeletal ; Orthopedics ; Paralysis ; Peroneal Nerve ; Range of Motion, Articular ; Seoul ; Synovial Membrane

No abstract available.
Pregnancy*

No abstract available.
Antibodies* ; Rheumatic Diseases*

PURPOSE: Application of a laparoscopic technique to common bile duct explorations has been limited due to technical difficulty. With increased experience and technique, laparoscopic surgery has become a possible option for the treatment of common bile duct stones. The purpose of this study was to assess the usefulness of laparoscopic surgery in the treatment of common bile duct stones. METHODS: Between March 1997 and August 1999, 35 patients with choledocholithiasis were treated with laparoscopic common bile duct exploration (4 had a previous biliary operative history). Intraoperative choledochoscopy was used to remove common bile duct stones. The stones were retrieved by using a saline flush, a basket, or a Fogarty catheter. The impacted stones were destroyed using electrohydraulic lithotripsy. RESULTS: Successful laparoscopic stone clearance was achieved in 33 cases (94.3%), and conversion to open surgery occurred in one case (2.9%). The morbidity was 5.7% without mortality. Two cases of retained stone were treated with postoperative choledochoscopic removal via fistula tract and postoperative endoscopic extraction. CONCLUSION: Laparoscopic common bile duct exploration is feasible and safe in most patients. With increased of experience, laparoscopic common bile duct exploration could be used widely.
Catheters ; Choledocholithiasis ; Common Bile Duct* ; Conversion to Open Surgery ; Fistula ; Humans ; Laparoscopy* ; Lithotripsy ; Mortality

We evaluated the in vivo kinetics, distribution, and pharmacology of N-(4-[F] fluorornethylbenzyl)spiperone ([F]FMBS), a newly developed derivative of spiperone, as a potentially more selective #radiotrar.er for the dopamine (DA) Dz receptors. Mice received 1.9-3.7 MBq (1.8-3.6 nmol/kg) of [F]FMBS by tail vein injectivn. The time course and regional distribution of the tracer in brain were assessed. Blocking studies were carried out by intravenously preinjecting DA Dp receptor blockers (spiperone, butaclamol) as well as drugs with high affinity for DA Dr lSCH 23390), DA transporter (GBR 12909), and serotonin Sp (5-HTz) (ketanserin) sites. After injection of the tracer, the radioactivity in striatum increased steadily over time, resulting in a striatal-to-cerebellar ratio of 4.8 at 120 min postinjection. By contrast, the radioactivity in cerebellum, frontal cortex, and remaining cortex washed out rapidly. Preinjection of unlabe1ed FMBS (1 rng/kg) and spiperone (1 mg/kg) reduced [F] FMBS striatal-to-cerebellar ratio by 41Zo and 80Ya, respectively. (+)-Butaclamol(1 mg/kg) blocked 80Yo of the striatal [F]FMBS binding, while (-)-butaclamol (1 rng/kg) did not. Preinjection of SCH 23390 (1 mg/kg) and GBR 12909 (5 mg/kg) had no significant effect. On [""F]FMBS binding. Ketanserin (1 mg/kg), a ligand for the 5-H1g receptors, did not cause significant inhibition either in striatum, in frontal cortex, or the remaining cortex. The results demonstrate that [F]FMEtS labels DA Dz receptors selectively in vivo in the mouse brain. It may hold promise as a selective radiotracer for studying DA Dz receptors in vivo by PET.
Animals ; Brain ; Cerebellum ; Dopamine* ; Ketanserin ; Kinetics ; Mice ; Pharmacology ; Radioactivity ; Receptors, Dopamine D2* ; Serotonin ; Spiperone* ; Veins

PURPOSE: N-(3-[18F]Fluoroporpy)-2beta- carbomethoxy-3beta-(4-iodophenyl) nortropane ([18F]FP-CIT) has been shown to be very useful for imaging the dopamine transporter. However, synthesis of this radiotracer is some what troublesome. In this study, we used a new method for the preparation of [18F]FP-CIT to increase radiochemical yield and effective specific activity. MATERIALS AND METHODS: [18F]FP-CIT was prepared by N-alkylation of nor-beta-CIT (2 mg) with 3-bromo-l-[18F]fluoropropane in the presence of Et3N (5-6 drops of DMF/CH3CN, 140 degree C, 20 min). 3-Bromo-l-[18F]fluoropropane was synthesized from 5 microliter of 3-bromo-l-trifluoromethanesulfonyloxypropane (3-bromopropyl -l-triflate) and nBu4N18F at 80 degree C. The final compound was purified by reverse phase HPLC and formulated in 13% ethanol in saline. RESULTS: 3-Bromo-l-[18F]fluoropropane was obtained from 3-bromopropyl-l-triflate and nBu4N18F in 77-80% yield. N-Alkylation of nor-beta-CIT with 3-bromo-l-[18F]fluoropropane was carried out at 140 degree C using acetonitrile containing a small volume of DMF as the solvents. The overall yield of [18F]FP-CIT was 5-10% (decay-corrected) with a radiochemical purity higher than 99% and effective specific activity higher than the one reported in the literature based on their HPLC data. The final [18F]FP-CIT solution had the optimal pH (7.0) and it was pyrogen-free. CONCLUSION:: In this study, 3-bromopropyl-l-triflate was used as the precursor for the [18F]fluorination reaction and new conditions were developed for purification of [18F]FP-CIT by HPLC. We established this new method for the preparation of [18F]FP-CIT, which gave high effective specific activity and relatively good yield.
Chromatography, High Pressure Liquid ; Dopamine Plasma Membrane Transport Proteins* ; Dopamine* ; Ethanol ; Hydrogen-Ion Concentration ; Positron-Emission Tomography ; Solvents

BACKGROUND: Various studies on the prediction of common bile duct (CBD) stones through preoperative or operative cholangiography have been reported. When CBD stones were suspected due to preoperative screening factors, endoscopic retrograde cholangiopancreatography was done as a first choice and operative cholangiography could be omitted. We want to know the indications of selective cholangiography and the significance of routine operative cholangiography during a simple cholecystectomy. METHODS: The cases of 134 patients who received on open cholecystectomy between Jan. 1995 and Sept. 1997 were reviewed. Twenty-even (27) cases of a choledocholithotomy without cholangiography were discarded from this study. Our cases were divided into two groups: group I included 9 patients who had CBD Stones, which was pathologicaly confirmed by operative cholangiography, and group II included 98 patients who had no CBD Stones, which pathologicaly confirme by operative cholangiography. The predictability of pathologic CBD. was calculated by the factors as the total bilirubin, alkaline phosphatase, AST, ALT, GGT, CBD. diameter by sonography. According to the number of positive screening factors, 3 grades of scoring were imposed in each case. Grade I was the case where 0- screening factor was positive, grade II was the case where 2 screening factors were positive, and grade III was the case where 3 or more screening factors were positive. RESULTS: Eighty-ive (85) cases were grade I, 6 cases were grade II, and 16 cases were grade III. In grade I, only one case had asymptomatic CBD stones, and the negative predictability was 98.8%. In grade II, there were no CBD lesions, and the negative predictability was 100%. In grade III, there were 8 cases of pathologic CBD lesions, and the negative predictability was 50%. CONCLUSIONS: Precise prediction of CBD lesions before a cholecystectomy is of value in deciding whether or not to perform an operative cholangiography. In our study, we graded the patients according to 5 non-nvasive screening factors. In grade I cases, the negative predictability of 98.8% was acceptable for omitting the operative cholangiography. In grade II cases, the negative predictability was 100%, but in these cases, there was the possibility of pathologic CBD Stones. Hence, in these cases, an operative cholangiography may be done, depending on the surgeon's decision. In grade III cases, an operative cholangiography or a preoperative ERCP. is mandatory.
Alkaline Phosphatase ; Bilirubin ; Cholangiography* ; Cholangiopancreatography, Endoscopic Retrograde ; Cholecystectomy ; Common Bile Duct ; Humans ; Mass Screening