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Biomedical subjects

P Chan

Publications and source records attributed to P Chan.

At least 19 recordsLinked to original sources

Identification and characterization of the complement C5a anaphylatoxin receptor on human astrocytes.

The C fragment C5a exerts its important physiologic and pathologic effects through interaction with a specific C5a receptor (C5aR) which is highly expressed on polymorphonuclear leukocytes and some other leukocytes. The presence of this receptor on epithelia and endothelia has recently been documented, raising the possibility that these other cells might also respond to locally generated C5a. C has been implicated in several brain disorders, notably demyelination and neurodegeneration, and cells within brain can synthesize a complete C system. It is thus of interest to examine the mechanisms by which C damages or activates brain cells. To this end we have examined the expression on human fetal astrocytes and astrocyte-derived cell lines of receptors for C fragments. We here report that human astrocytes and cell lines express a receptor for C5a (48 to 72 x 10(3) copies/cell), which is indistinguishable at the protein or mRNA level from that in leukocytes. The astrocyte C5aR was recognized by five different specific Abs, which revealed by Western blotting a protein of 40 to 45 kDa in primary human astrocytes and astrocyte cell lines. Expression was confirmed by RT-PCR using multiple primers. Neither inflammatory cytokines nor PMA caused up-regulation of the receptor on astrocytes. The receptor was functional in that addition of C5a (1 nM to 100 nM) or, at high doses (100 nM), C5adesArg, triggered a calcium transient in astrocytes. We propose that C5aR expression on astrocytes plays an important role in control of inflammation in brain and may be a central component of C-mediated brain injury.

Amino Acid Sequence

Increased sympathetic nervous system activity in Chinese hypertensive patients with type II diabetes mellitus.

To evaluate the coexistence of sympathetic overactivity and hypertension in type 2 diabetic patients, a population-based study was conducted of newly-diagnosed type 2 diabetic patients recruited from a single community located at northern Taiwan. This study included 2877 (male 1382, female 1495) middle-aged ethnic Chinese adults, aged 45-65 years. Of the 1382 males, 67 had newly-diagnosed type 2 diabetes mellitus, whereas 75 of the 1495 females had type 2 diabetes. The data showed that about 39% of diabetic patients had borderline hypertension (mean blood pressure 141/91 mmHg) whereas the average incidence in non-diabetic subjects was 15.5%. The borderline hypertensive diabetic patients had significantly higher heart rates (mean 78.8 vs. 69.3 beats/min; P < 0.001) than control subjects. However, the cardiac index was similar in both control and diabetic subjects (mean 2.48 vs. 2.53 l/min/m2; P > 0.05). Our data show that sympathetic overactivity and increased incidence of hypertension actually existed in these type 2 diabetic patients of Chinese origin.

Analysis of Variance

The three heavy-chain precursors for the inter-alpha-inhibitor family in mouse: new members of the multicopper oxidase protein group with differential transcription in liver and brain.

The inter-alpha-inhibitor (I alpha I) family is comprised of the plasma protease inhibitors I alpha I, inter-alpha-like inhibitor (I alpha LI), pre-alpha-inhibitor (P alpha I) and bikunin. I alpha I, I alpha LI and P alpha I are distinct assemblies of bikunin with one of three heavy (H) chains designated H1, H2 and H3. These H chains and bikunin are respectively encoded by a set of three H genes and an alpha 1-microglobulin/bikunin precursor (AMBP) gene. All four gene products undergo maturation steps from precursor polypeptides. The full-length cDNAs for the H1-, H2- and H3-chain precursors were cloned from a mouse liver cDNA library and sequenced. Extensive searches of amino acid sequence similarities to other proteins in databanks revealed (i) a highly significant similarity of the C-terminal sequence in the three H-chain precursors to the multicopper-binding domain in the group of multicopper oxidase proteins and (ii) the presence of von Willebrand type-A domains in the mature H chains. Amino acid sequence comparisons between the three mouse H1-, H2- and H3-chain precursors and their human counterparts allowed us to appraise the timing and order of occurrence of the three H-chain genes from a shared ancestor during mammalian evolution. Owing to a multiple alignment of the six mouse and human nucleotide sequences for these H-chain precursors, a reverse transcriptase PCR assay with degenerate oligonucleotides was designed, allowing us to (i) present evidence that no mRNAs for further H genes exist in mouse liver and (ii) demonstrate a previously undescribed transcription of the H2- and H3-chain mRNAs in mouse brain, which contrasts with the expression of all four, H1, H2, H3 and AMBP, mRNAs in liver.

Alpha-Globulins

Venous hemodynamic abnormalities in patients with leg ulceration.

PURPOSE: Venous ulceration in the leg has been predominantly associated with deep venous insufficiency, although a few reports have implicated the superficial veins. The aim of this study was to identify the distribution of valvular incompetence in patients with active leg ulceration. PATIENTS AND METHODS: Color flow duplex imaging (CFDI) ultrasonography was used to evaluate the entire venous system--superficial, perforator and deep--from groin to ankle in 112 limbs of 94 patients with venous leg ulcers. RESULTS: Seventy two limbs (64%) had multisystem incompetence and 36 (32%) had one system involved only, whereas in 4 limbs (4%) there was no venous incompetence. Deep venous reflux exclusively was present in 7 limbs (6%) and the perforator system alone was involved only in 3 limbs (3%). However, isolated superficial incompetence was seen in 26 extremities (23%) and combination of superficial with perforator system alone in 23 (21%). In addition, reflux overall in the superficial system (alone and in combination with perforator and deep systems) was seen in 94 limbs (84%). The most common pattern (28%) of abnormality was reflux in all systems, superficial, perforator, and deep. CONCLUSIONS: The results of this study show that variable combined patterns account for over two thirds of patients with ulceration. No comprehensive surgical policy for alleviating ulceration can be justified; we suggest that a complete evaluation of all venous systems from groin to ankle with CFDI ultrasonography in patients with venous ulceration is practical on a routine basis and will be particularly valuable before surgery in order to target intervention at specific incompetent sites.

Adolescent

Salmonellosis and mycotic aneurysm of the aorta. A report of 10 cases.

We report a 5 year experience of 10 cases of mycotic aneurysms of the aorta caused by salmonella infection. Of the 10 patients, nine were males and one was female in an age range from 60 to 80 years with a mean of 71 years. The major clinical manifestations were fever, abdominal or back pain, pulsatile abdominal mass and leucocytosis. The diagnosis was based on clinical symptoms and signs and positive blood or tissue cultures. The main confirmatory procedure was computed tomography (CT). Two year survival rate was 20%. Five patients died during hospitalisation, without surgery. Three patients died within 2 months of surgery. The other two patients, treated surgically and by intensive antibiotic therapy, survived. Death resulted usually from recurrent infection and graft leakage. Contrary to previous reports, salmonella mycotic aneurysm is still common in this geographical area and the prognosis is poor.

Aged

Photodynamic therapy in a cell culture model of human intimal hyperplasia.

OBJECTIVE: To investigate the effectiveness of photodynamic therapy (PDT) in eliminating proliferating vascular smooth muscle cells (VSMCs). This may have a potential role in reducing restenosis rates clinically. MATERIALS AND METHODS: Human VSMCs were successfully cultured from 15 long saphenous veins (SV) and seven restenotic lesions (RL) removed during revision coronary and peripheral vein graft surgery. Cultured VSMCs were incubated with photofrin at doses of 0-5 micrograms/ml for 48 h, and then exposed to 4 J/cm2 of polychromatic light. Cell destruction was quantified by a colorimetric assay using 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide. RESULTS: Results are expressed as a mean percentage survival +/- standard error. Cells were minimally affected by either photofrin alone (SV: 95.5% +/- 5.3; RL: 119.8 +/- 4.8) or light alone (SV: 75.38% +/- 3.99; RL: 100.1 +/- 11.0). The combination of 2 micrograms/ml of photofrin and 4 J/cm2 of polychromatic light energy, i.e. PDT, was severely toxic to cells derived from saphenous veins (5.52% +/- 0.85) as well as cells derived from restenotic lesions (9.6 +/- 2.3). These doses are comparable to doses that can be achieved in vivo. CONCLUSION: PDT in the appropriate drug and light doses can eliminate human VSMCs, including those responsible for vascular restenosis.

Cell Division

Colour flow duplex scanning in suspected acute deep vein thrombosis; experience with routine use.

OBJECTIVES: To determine the accuracy of colour flow Duplex scanning (CFDS) in the diagnosis of deep vein thrombosis (DVT) and subsequently to investigate its diagnostic value in patients who have normal deep veins despite symptoms. DESIGN: Prospective open clinical study. SETTING: Vascular laboratory and radiology departments of University Hospital. MATERIALS AND METHODS: In the first part 112 limbs in 103 patients, 94 with symptoms of acute DVT and nine with pulmonary embolism (PE) were examined prospectively with CFDS and venography. Subsequently, in the second part, 328 legs in 304 patients were examined by CFDS alone for acute symptoms of DVT or PE. MAIN RESULTS: DVT was detected in 55 limbs by venography: proximal DVT was seen in 23 limbs, distal DVT in 25 limbs and both proximal and distal in seven limbs. CFDS was 100% sensitive and 98.8% specific in detecting proximal DVT whereas its sensitivity and specificity was 87.5% and 98.7% for distal DVT. Positive and negative predictive values were over 95% for both limb segments. The overall accuracy for the proximal DVT was 99.4% and for the distal 93.1%. In the second part, CFDS alone detected DVT in 156 limbs (47.6%); DVT was in the proximal segment in 82, distal segment in 61 and both in 13. In 172 limbs other causes of symptoms were identified in 34 (20%). CONCLUSIONS: We have demonstrated that CFDS is as accurate as venography when used by experienced operators. The average time of examination is 15-20 minutes and compares favourably with venography. Other causes of leg symptoms can also be diagnosed by CFDS in around 20% of patients who are found to have normal veins.

Humans

Inhibition of human vascular smooth muscle cell proliferation by the novel multiple-action antihypertensive agent carvedilol.

We examined the antiproliferative effect of the novel multiple-action antihypertensive agent carvedilol on human vascular smooth muscle cells (VSMC). Carvedilol inhibited the increase in cell number induced by foetal calf serum (FCS) in 86% (18 of 21) of human VSMC grown both from saphenous vein (17.6 +/- 3.5% inhibition, mean +/- SEM, n = 15) and restenotic lesions (31.4 +/- 5.5% inhibition, mean +/- SEM, n = 5). Carvedilol had a greater antiproliferative effect than other beta-adrenoceptor antagonists. In comparison with calcium channel blockers, carvedilol (10 microM) elicited a degree of growth inhibition similar to that of verapamil, but was less effective than the dihydropyridine amlodipine at equimolar concentrations. Although carvedilol had a greater antiproliferative effect on cells derived from restenotic lesions cells than on control saphenous vein cells, the difference was not statistically significant. In the present study, the antiproliferative effect of carvedilol on human VSMC in vitro occurred at concentrations higher than those in plasma. Although this may represent a limitation to the clinical efficacy of carvedilol against proliferation of VSMC associated with hypertension and atherosclerosis, the apparent relative selectivity of carvedilol for restenosis-derived cells is a promising line of investigation.

Antihypertensive Agents

Coagulation activation in type 2 diabetes mellitus: the higher coronary risk of female diabetic patients.

Thrombophilia in diabetic patients is a well-recognized phenomenon which constitutes an additional risk of coronary heart disease. This study included 1980 ethnic Chinese people (835 male, 1145 female); age range: 45 to 69 years, including 280 Type 2 diabetic patients (male 125, female 155). Haemostatic parameters measured were fibrinogen, prothrombin time, activated partial thromboplastin time (APTT), factor VIIc, factor VIIIc, antithrombin III, and plasminogen. Compared with a control group, male diabetic patients showed significantly shorter APTT (25.6 +/- 3.7 vs 27.5 +/- 3.6 s, p < 0.001), and elevated factor VIIIc (171.1 +/- 77.48 vs 131.16 +/- 52.23%, p < 0.0001), whereas female diabetic patients showed significantly shorter APTT (24.9 +/- 4.2 vs 26.5 +/- 3.9 s, p < 0.001) and elevated fibrinogen (10.6 +/- 3.3 vs 9.8 +/- 2.6 mumol 1(-1), p < 0.05), factor VIIc (150.4 +/- 68.7 vs 135.3 +/- 32.3%, p < 0.001), factor VIIIc (190.1 +/- 92.6 vs 141.1 +/- 62.4%, p < 0.0001), and plasminogen (140.3 +/- 41.9 vs 128.4 +/- 38.7%, p < 0.01). This study showed that Chinese diabetic patients had coagulation activation, and that female diabetic patients seemed to constitute a higher risk group for coronary heart disease than males.

Aged

Acute heroin intoxication with complications of acute pulmonary edema, acute renal failure, rhabdomyolysis and lumbosacral plexitis: a case report.

After intravenous injection of heroin, a 27-year-old male with altered mental status and hypotension was seen at the Emergency Service where acute pulmonary edema was noted. The problem was resolved three days later after oxygen therapy had been administered by face mask. Acute renal failure, rhabdomyolysis and monoplegia of the patient's left leg were exhibited during his stay at the Intensive Care Unit. Neurological examination and electro-diagnostic studies (electromyography and nerve conduction velocity) showed left lumbosacral plexitis. Hemodialysis was given. Though the patient's hospital course was uneventful, satisfactory recovery from his left leg weakness, which persisted for one year after hospital discharge, was finally achieved.

Acute Disease

Successful percutaneous transluminal angioplasty in native coarctation of aorta in young adult: a case report.

Coarctation of aorta is a rare cause of secondary hypertension, premature death will occur if no appropriate treatment is given. Before 1980, the only effective treatment was surgery, and recurrent stenosis was frequent. After then several works on percutaneous transluminal angioplasty of this disease were reported, with promising short-term and long-term results, especially in children and young adults. This report concerns a 19-year-old male who had hypertension for four years; the hypertension was caused by coarctation of the aorta, confirmed by cardiac catheterization and angiography. Average blood pressure (BP) of his upper extremities was 200/110 mmHg which dropped to 150/90 mmHg immediately, and still two years, after angioplasty, whereas BP of the lower extremities maintained at about 150/80 mmHg measured by Korotkoff technique. Follow-up transesophageal echocardiography found no coarctation or aneurysm at the dilatation site one year later. Magnetic resonance imaging, performed two years later, showed an almost normal aortic wall at the coaxctation. The postoperative course was uneventful, and patient follow-up at the cardiology clinic has regularly shown an average BP around 150/80 mmHg.

Adult

Effect of calcium channel blockers on the growth of human vascular smooth muscle cells derived from saphenous vein and vascular graft stenoses.

Vascular restenosis after invasive interventions is an important clinical problem for which no preventive pharmacologic therapy exists. Calcium channel blockers have been shown to inhibit myointimal hyperplasia in animal models of restenosis and in some small and flawed clinical coronary restenosis trials. We examined the inhibitory effect of amlodipine, verapamil, and diltiazem on the growth of cultured human vascular smooth muscle cells (VSMC) derived from saphenous vein (n = 20) and graft stenoses (n = 7), in 14-day proliferation assays and [methyl 3H]thymidine uptake studies. Amlodipine and verapamil produced significant inhibition (30%) of VSMC proliferation and DNA synthesis at 10 microM but not at 500 nM-1 microM. To our knowledge, this is the first study to examine the antiproliferative effect of calcium channel blockers in VSMC derived from human graft stenoses. Growth inhibition of VSMC from graft stenoses was not significantly different from that of control saphenous vein-derived cells. We conclude, therefore, that calcium channel blockers inhibit human VSMC proliferation in vitro, regardless of whether the cells were grown from graft stenoses or saphenous vein. However, the concentrations at which these calcium channel blockers elicit antiproliferative effects may not be attainable during therapeutic dosing in humans.

Amlodipine

Aging and the nigrostriatal dopamine system: a non-human primate study.

The present study examined neurochemical, morphological and functional markers of the nigrostriatal dopamine system in young, intermediate-aged and old squirrel monkeys. Striking reductions in motoric activity were observed with advancing age. significant age-related loss of dopamine occurred in the substantia nigra (70%) and the putamen (30%) but not in the caudate. There was a strong correlation between the reductions in motoric activity and the loss of putamen dopamine. However, nigrostriatal dopamine loss did not appear to be the consequence of age-related loss of dopaminergic nigral neurons since the number of tyrosine immunoreactive cells was not significantly different among the three age groups. These results suggest that the aging squirrel monkey demonstrates the age-related loss of nigrostriatal dopamine thought to occur in humans and identify this non-human primate as a useful model to further investigate the underlying mechanism(s) and functional consequences of age-related decline of the nigrostriatal dopamine system. In addition, the selective loss of dopamine in the putamen but not the caudate parallels the regional vulnerability observed in Parkinson's disease, an age-related neurodegenerative disorder, raising the possibility of a relationship between normal aging and the development of this disease. Finally, because the number of tyrosine hydroxylase (TH) positive cells remains constant with age, these results raise the possibility that therapeutic strategies aimed at increasing dopamine concentrations may benefit elderly individuals.

3,4-Dihydroxyphenylacetic Acid

Developmentally regulated transcription of the four liver-specific genes for inter-alpha-inhibitor family in mouse.

The inter-alpha-inhibitor family is composed of the plasma-protease inhibitors inter-alpha-inhibitor, pre-alpha-inhibitor and bikunin. Inter-alpha-inhibitor and pre-alpha-inhibitor are distinct assemblies of bikunin with distinct sets from three heavy (H) chains designated H1, H2 and H3. These H chains are encoded by a set of three evolutionarily related H genes, and bikunin by an alpha-1-microglobulin/bikunin precursor gene (AMBP). This precursor is cleaved to yield bikunin, a member of the Kunitz-type protease-inhibitor superfamily, and alpha-1-microglobulin, which belongs to the lipocalin superfamily. Northern-blot experiments with RNAs obtained from various tissues in fetal and in adult mice indicated that the transcription of the four AMBP and H genes is liver-restricted, although there is expression of H3 in brain. An analysis of the H1, H2, H3 and AMBP transcripts, as well as of transcripts for other control genes, in liver during development showed a progressive increase in the amounts of the H1, H2, H3 and AMBP RNAs, which all peak transiently at day 5 after birth. This was shown by a nuclear run-on experiment to originate from a change in transcription rate. The transient and postnatal increase in transcription could be explained neither by the liver-restricted expression nor by a common origin of these four genes, nor by a perinatal requirement for many lipocalins or protease inhibitors. This suggests that all four genes are perinatally triggered at the level of similar elements in their transcriptional regulatory regions, a conclusion strengthened by the weak expression of the four genes that is seen in a mutant mouse strain (albino) that is deficient in some liver-specific transcription factors.

Aging

Mouse alpha-1-microglobulin/bikunin precursor: cDNA analysis, gene evolution and physical assignment of the gene next to the orosomucoid locus.

alpha-1-Microglobulin (A1m) is a member of the lipocalin superfamily whereas bikunin is a Kunitz-type proteinase inhibitor. A1m and bikunin originate from a shared precursor. A comparison of mammalian cDNAs for the precursor indicates a highly conserved amino acid sequence along with muridae-specific deletions in both A1m and bikunin. In rodents, the gene for this precursor is less than 300 kb apart from the orosomucoid gene, another lipocalin gene. This precursor likely results from the assembly of two lipocalin and Kunitz-type genes, between 270 and 80 million years ago.

Alpha-Globulins