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C C Liu

Publications and source records attributed to C C Liu.

At least 127 records · Page 7Linked to original sources

The role of labetalol and propofol in the management of HELLP syndrome--a case report.

The acronym HELLP describes a syndrome of (H) hemolysis, (EL) elevated liver enzymes, and (LP) low platelets, which symptomatically defines a unique group of preeclamptic/eclamptic women. Pregnancies complicated by this syndrome are associated with poor maternal and fetal outcome. This poses a considerable challenge to the anesthesiologists as many of these patients require emergent Cesarean section. We reported a 30-year-old woman with gestation of 32 wk who sustained Cesarean section under the impression of pregnancy with HELLP syndrome. General anesthesia was performed for this patient. The preoperative evaluation, general management, and intraoperative monitoring system were described. The individual role and use of labetalol and propofol were also discussed in this report.

Adult↗

Conscious sedation by low dose propofol infusion during spinal anesthesia for cesarean section.

BACKGROUND: A simple sedative technique without inducing oversedation or amnesia for birth experience would be necessary for patients undergoing Cesarean section receiving regional anesthesia. Clinical effects and dose requirement of intravenous propofol infusion were evaluated for this purpose. METHODS: Forty-five parturients under adequate spinal anesthesia were randomly assigned to three groups and propofol was given after the clamping of the umbilical cord. The loading doses and initial infusion rates for group A, B, C were 0.3, 0.4, 0.5 mg/kg and 3, 4, 5 mg/kg/h, respectively. RESULTS: Oversedation was not found and verbal contact was maintained in patients of group A and B. Two patients in group C were oversedated. Cardiovascular and respiratory function remained stable in all three groups. The incidences of complete amnesia for the experience of baby shown and intraoperative nausea/ vomiting were low. Most patients were satisfied with the sedation technique. CONCLUSIONS: Intravenous infusion of propofol with a rate of 3-4 mg/kg/h after 0.3-0.4 mg/kg bolus injection is a sale, simple and satisfactory intraoperative postdelivery sedation technique in elective patients undergoing Cesarean section under spinal anesthesia.

Adult↗

Morphologic and functional characterization of perforin-deficient lymphokine-activated killer cells.

Mice deficient in perforin, a key mediator of lymphocyte-mediated cytolysis, have recently been generated using the gene knockout technique. CTL and NK cells derived from these mice have been shown to be defective in the granule-dependent cytolytic pathway. To investigate whether the granule-formation process has been altered in these perforin-deficient cytotoxic cells, rendering them defective in using the other granule mediators, we have examined in the present study the morphologic and functional characteristics of perforin-deficient LAK cells. Perforin-deficient LAK cells, similar to wild-type LAK cells, were shown to contain a large number of granules in their cytoplasm. By electron microscopy, the morphology of the granules present in these two cell populations appeared indistinguishable. The complete depletion of perforin in LAK cells derived from perforin gene-knockout mice was further confirmed by immunoelectron microscopy using anti-perforin antiserum. The expression of other cytolytic mediators, present either within the granules (granzymes A and B) or elsewhere (Fas ligand), appeared to be unperturbed, as investigated using the reverse transcription-PCR technique. Like the CTL and NK cells isolated from perforin-deficient mice, perforin-deficient LAK cells could lyse only target cells that express high levels of Fas molecule. Furthermore, these perforin-deficient LAK cells, similar to wild-type LAK cells and a CTL clone, were resistant to perforin-mediated cytolysis.

Animals↗

Bcl-2 blocks degranulation but not fas-based cell-mediated cytotoxicity.

The ability of bcl-2 in target cells to block cell-mediated cytotoxicity by allospecific CTL was tested. The blocking effect was variable. Because killing by CTL involves two different pathways, degranulation (perforin plus granzymes) and fas, we examined the effect of bcl-2 on these pathways independently. Bcl-2 in target cells blocked apoptotic cell death induced either by cytotoxic granule extracts or by CTL killing under conditions in which the fas pathway is blocked. On the other hand, bcl-2 had no effect on target cell-killing either by Fas-specific mAb or by CTL capable of killing only via the fas pathway. These data suggest bcl-2 may block apoptotic lysis induced by perforin plus granzymes, but not apoptotic lysis induced via the fas pathway. Thus, any analysis of the effect of bcl-2 on apoptotic cell death in target cells killed by CTL must take into account the relative contributions of the degranulation vs fas pathways.

Animals↗

Amylin increases bone volume but cannot ameliorate diabetic osteopenia.

Amylin is normally secreted in a regulated fashion by the pancreatic beta-cells in parallel with insulin and has been reported to have bone-conserving properties. Type I diabetes mellitus results in a low-turnover osteopenia in the presence of decreased amylin, which is in contrast to type II diabetes where less bone loss, in the presence of high amylin levels, occurs. We investigated the effects of amylin on bone mineral metabolism in normal and diabetic (streptozotocin-induced) rats, in order to ascertain whether amylin would modify the streptozotocin-induced diabetic osteopenia. Ten-week-old male Sprague-Dawley rats were randomized as follows: group A (n = 18) received normal saline; group B (n = 18) received amylin; group C, diabetic rats (n = 23), received normal saline; and group D, diabetic rats (n = 23), received amylin. Amylin (100 pmol/100 g b.w.) was administered by a daily subcutaneous injection. Double calcein-labeled tibiae were removed for histomorphometric analysis followed sacrifice on day 19. Results showed no difference in blood ionized calcium between groups. Blood glucose remained above 600 mg/dl in the diabetic animals and was not affected by the administration of amylin. Serum osteocalcin, insulin-like growth factor-1 (IGF-1), parathyroid hormone (PTH), and 1,25 dihydroxyvitamin D [1,25(OH)2D] were significantly lower in the diabetic rats compared with control group A by day 19. Amylin produced higher levels of serum osteocalcin in group B on day 9 (P < 0.05) compared with controls but returned to control values (group A) by day 19; no such change occurred in the diabetic group.(ABSTRACT TRUNCATED AT 250 WORDS)

Amyloid↗

Perforin: structure and function.

Perforin is a cytolytic mediator produced by killer lymphocytes, and is stored in and released by cytoplasmic granules. The protein is partially homologous to the terminal components of the membrane attack complex of complement and produces pores of up to 20 nm in diameter on target membranes. Its genomic and protein structures have recently been unraveled, and its function elucidated through the availability of genetically engineered, perforin-deficient mice. Here Chau-Ching Liu, Craig M. Walsh and John Ding-E Young briefly outline certain biochemical and molecular features of perforin, and discuss the still-evolving issues concerning the relevance of perforin and Fas in cell killing.

Animals↗

Characterization of the isoforms of the group I allergen of Cynodon dactylon.

BACKGROUND: The group I allergen of Cynodon dactylon, Cyn d I, was found to consist of four to 10 isoforms. METHODS: We studied the isoforms with the use of two-dimensional gel electrophoresis. The antigenic difference of the isoforms was evaluated by radioimmunoprecipitation with monoclonal antibodies (MAbs). The acidic isoforms and the basic and neutral isoforms were further isolated by MAb-affinity chromatography for RAST and competitive RAST. In addition, the N-terminal sequence was evaluated by microsequencing. RESULTS: A total of 11 isoforms were found in Cyn d I in extracts prepared from different sources of Bermuda grass pollen (BGP). They were either acidic (Cyn d I-A, I-B, I-C, I-D, I-E, I-F, I-G, I-H, and I-I), neutral (Cyn d I-X), or basic (Cyn d I-J). Cyn d I-G, with an isoelectric point of approximately 6.4, was constantly present in all the pollen preparations, whereas the content of the basic Cyn d I-J varied from less than 5% to greater than 20%. The molecular weight of the basic and neutral isoforms were slightly lower than those of the acidic isoforms. All isoforms shared a common antigenic determinant(s) recognizable by MAb 4-37, and the basic and neutral isoforms possessed a unique antigenic determinant(s) recognizable by MAb 1-61. RAST showed that both the acidic Cyn d I and the basic and neutral Cyn d I were recognized by human IgE in the pooled sera of persons allergic to BGP. Competitive RAST showed a high crossreactivity between the acidic and the basic and neutral isoforms. A 95% sequence identity also existed between the N-terminal 20 amino acid residues of basic Cyn d I-J and the dominant acidic isoform Cyn d I-G. CONCLUSIONS: The present study disclosed that basic Cyn d I-J is an important allergen and that the content of this isoform varies in different lots of BGP.

Allergens↗

Human cytochrome P450 mono-oxygenase system is suppressed by propofol.

We have studied the effect of propofol on the cytochrome P450-dependent mono-oxygenase system in human liver microsomes by assaying mono-oxygenase activities toward specific cytochrome P450 isoform test substrates, aniline, 7-ethoxycoumarin, benzphetamine and benzo(a) pyrene. Propofol inhibited benzo(a)pyrene hydroxylation to a greater extent than the oxidative metabolism of the other test substrates, even at 0.05 mmol litre-1. The degrees of inhibition of benzphetamine N-demethylation and 7-ethoxy-coumarin O-de-ethylation were similar, while aniline hydroxylation was least affected by propofol. Spectral analysis showed that propofol competed with carbon monoxide for binding to the haem moiety of haemoprotein in the P450 enzyme. The variable inhibition observed may be caused by the differential binding of propofol to P450 isoforms. Propofol 0.05-1.0 mmol litre-1 exhibited a concentration-dependent inhibitory effect on human cytochrome P450 2E1, 2B1 and 1A1. These inhibitory actions of propofol on human liver microsomal enzymes in vitro suggest that potential drug interactions may exist between propofol and other drugs administered clinically.

Aniline Compounds↗

Difference between in vivo and in vitro effects of propofol on defluorination and metabolic activities of hamster hepatic cytochrome P450-dependent mono-oxygenases.

We have compared the in vivo and in vitro effects of propofol on cytochrome P450-dependent monooxygenase activities in hamster liver microsomes. Propofol (Diprivan) 10 mg/100 g body weight was injected i.p. twice a day for 2 weeks to induce cytochrome P450 enzymes. Liver microsomes were prepared by differential centrifugation. Metabolism of the cytochrome P450-dependent mono-oxygenase system was evaluated by measuring aniline hydroxylation, benzphetamine demethylation and benzo(a)pyrene hydroxylation. Defluorination of enflurane was assayed by detecting free fluoride metabolites. At similar concentrations as in the in vivo group, propofol in vitro exhibited concentration-dependent inhibition of metabolism of benzphetamine and benzo(a)pyrene. Aniline hydroxylation and defluorination of enflurane were inhibited to 78% of control with propofol 0.25 mmol litre-1. In propofol-treated hamsters, there was only minimal inhibitory or inductive effects on either mono-oxygenase activities or capacity for defluorination. This difference between the in vitro and in vivo effects of propofol on cytochrome P450 mono-oxygenase activities emphasizes the need for care when comparing in vitro and clinical data.

Anesthetics, Intravenous↗

Propofol concentration monitoring in plasma or whole blood by gas chromatography and high-performance liquid chromatography.

We compared the measurement of propofol concentrations in plasma or whole blood by high-performance liquid chromatography (HPLC) to that of gas chromatography (GC). Blood samples were collected from patients who had received bolus injection or continuous infusion of propofol. The results showed that the two methods correlated well both in plasma and whole blood samples. However, significant biphasic differences of propofol concentrations between plasma and whole blood specimens were observed in the bolus injection group. Differences were larger in the infusion group. This discrepancy in concentrations resulted from the infusion or clearance of propofol, and the lag of redistribution across blood cell membranes. In conclusion, monitoring of propofol concentrations by the methods of GC and HPLC gives equivalent results. For propofol concentration monitoring, plasma samples are preferred, but immediate centrifugation is needed.

Adult↗

Lack of effect of flumazenil on the reversal of propofol anaesthesia.

Propofol, like the benzodiazepines, activates the GABAA receptor-chloride ionophore complex; they potentiate one another. Since neither pharmacodynamic nor pharmacokinetic data concerning drug interaction between flumazenil and propofol is available, and especially considering the relationship of binding sites, flumazenil, the antagonist of benzodiazepines, was investigated to determine its effect upon recovery from propofol anaesthesia. Forty women receiving dilatation and curettage procedures were included in this double-blind test. After 50 micrograms fentanyl, propofol 2 mg.kg-1 was injected for induction and followed by infusion at the rate of 15 mg.kg-1.hr-1. After the operation, patients were given normal saline (Group A) or flumazenil 10 micrograms.kg-1 (Group B) randomly. Recovery time in Group A was 15.2 +/- 5.1 min and Group B 15.8 +/- 4.8 min. Propofol concentrations at the end of infusion were 4.17 +/- 1.33 micrograms.ml-1 (Group A) and 4.03 +/- 1.45 micrograms.ml-1 (Group B); these then declined to 1.22 +/- 0.17 micrograms.ml-1 (Group A) and 1.18 +/- 0.15 micrograms.ml-1 (Group B) when patients were able to open their eyes on command. No significant differences were found between the groups based on propofol concentrations and recovery time, nor did haemodynamic changes differ between them after administration of reversal agents. It was concluded that flumazenil 10 micrograms.kg-1 does not influence recovery from propofol anaesthesia.

Adult↗

Perforin and lymphocyte-mediated cytolysis.

We have discussed in the previous sections the recent progress made toward elucidating the regulatory mechanism of perforin gene transcription and the domain structure of the perforin molecule. It appears that the expression of perforin is, at least partially, controlled at the transcription level through the interaction between killer cell-specific cis- and trans- acting factors. One of such cognate pairs, NF-P motif (an EBS-homologous motif) and NF-P2 (a killer cell-specific DNA-binding protein), has been described. The regulatory mechanism of gene transcription, however, is likely to involve multiple factors which act in a coordinated fashion to bring about the most efficient expression of perforin limited strictly to activated killer lymphocytes. Through studies using synthetic peptides and recombinant perforins, it has been suggested that the N-terminal region of the perforin molecule is an important, though not the only, domain responsible for the lytic activity. Further studies are warranted to elucidate the role(s) of other potential amphiphilic structures located in the central portion of the perforin molecule in the overall pore-forming activity. The molecular basis underlying the resistance of killer lymphocytes to perforin-mediated lysis still remains an open question. Preliminary results, however, suggest that the surface protein(s) restricted to killer cells may account for their self-protection against perforin. Based on recent studies using perforin-deficient mice, the involvement of perforin in lymphocyte-mediated cytolysis both in vivo and in vitro has been confirmed. Two functional roles, a direct (lytic) and an indirect (endocytosis enhancer; conduit), both of which may contribute critically to the cell-killing event can be attributed to perforin. The fact that lymphocytes may also employ perforin-independent killing mechanism(s), e.g. Fas-dependent pathway, is beyond the scope of this review. There is, nevertheless, no doubt that these alternative cytolytic mechanisms may also play important roles in immune effector and/or regulatory responses associated with killer lymphocytes. Obviously, we are still a long way from concluding on the functional relevance of each individual cytolytic mechanism seen in different physiopathological situations. Suffice it to say, however, that a wealth of information on lymphocyte-mediated killing has already emerged through the multidisciplinary efforts conducted in our and other laboratories that promise to further dissect this complicated event in the years to come.

Amino Acid Sequence↗

The effect of medroxyprogesterone acetate on bone metabolism in the oophorectomized, tamoxifen-treated rat.

Tamoxifen (TAM) is used primarily in the management of breast cancer, and it also has bone-sparing effects similar to estrogen. In breast cancer patients TAM may have a potential role in the prevention and management of osteoporosis. TAM therapy is associated with uterine hyperplasia, and medroxyprogesterone acetate (MPA) added to the regimen provides protection against this. Due to the potential combined use of MPA and TAM in the clinical setting, this study was conducted to assess whether MPA acted synergistically, dampened, or enhanced the TAM effect on bone. Seventy-five female rats (60 oophorectomized; Ox), were randomized into five groups and received either TAM (0.1 mg/kg.day) and/or MPA (0.3 mg/kg.day) therapy over 28 days as follows: 1) sham; 2) Ox; 3) Ox plus TAM; 4) Ox plus MPA; and 5) Ox plus TAM plus MPA. Blood was sampled on days 0, 14, and 28 for measurement of ionized calcium, PTH, 1,25-dihydroxyvitamin D, osteocalcin, and insulin-like growth factor 1. TAM-treated rats showed a reduction in body weight serum osteocalcin, PTH, and insulin-like growth factor 1. Histomorphometric analysis of the proximal tibia showed less cancellous bone volume in Ox rats, and the effect was attenuated by TAM. MPA alone had no significant effect on cancellous bone volume. All the bone formation parameters evaluated (bone formation rate, mineral apposition rate, percent calcein-labeled surface, and number of osteoblasts) were higher in Ox rats compared with sham-operated rats and were lower in TAM-treated rats compared with Ox rats. These parameters were not changed by MPA, alone or in combination with TAM. The number of osteoclasts was higher in Ox rats compared with sham-operated rats and was reduced by TAM. MPA therapy alone or in combination with TAM did not affect number of osteoclasts. These results suggest that MPA neither dampened nor enhanced the effect of TAM on bone.

Animals↗

Actinobacillus actinomycetemcomitans pneumonia with chest wall and subphrenic abscess.

A 14-year-old girl had progressive dyspnea and right lower chest pain for about 1 1/2 months and a weight loss of 3 kg in 2 months. Chest X-ray revealed right pleural effusion and a round infiltration over the right lower chest, initially suspected to be malignant. Image study revealed consolidation in the right middle and lower lobes with abscess-like lesions around the right lower pleura and transdiaphrenic involvement to the subphrenic region. The lesion had also invaded the intercostal muscle. The pleural abscess was obtained by fiberoptic thoracoscopy, and culture of the pus grew typical colonies of Actinobacillus actinomycetemcomitans. After the causative microorganism had been identified, cefoxitin was given for 2 weeks followed by oral amoxicillin (250 mg/6 h) for a total period of 3 months. Follow-up chest X-ray revealed resolution of the lung lesions and the patient recovered gradually without any sequelae.

Abscess↗

[Cytochrome P450-dependent monooxygenase system and anesthetics].

The cytochrome P450-dependent monooxygenases constitute the primary enzyme system responsible for the oxidative metabolism of a variety of xenobiotics and endogenous compounds including drugs, carcinogens, fatty acids and hormones. The monooxygenase system consists of multiple forms of P450 enzymes, NADPH-cytochrome reductase and phospholipids. The level sof P450s and associated monooxygenase activities are subject to be regulated by many environmental, physiological, and pathological factors. Inhalation and intravenous anesthetics are all metabolized through these biotransformation enzymes. The pharmacokinetic properties as well as the toxicity of the anesthetics are closely related to the inducing or inhibitory status of the monooxygenase isozymes. To understand the role of cytochrome P450-monooxygenases in drug metabolism is essential for us to handle the drug-to-drug interactions and adverse effects.

Anesthetics↗