The all-inside meniscal suture technique using new instruments

The all-inside meniscal suture was performed by using new arthroscopic instruments with a soft and fine (4-0 gauge) polyfilament thread that yielded relatively small knots so as to be innocuous to articular cartilage. No neurovascular injury, infection, or any other complication had occurred intraoperatively and postoperatively in this technique.

Comparison of the human genomic structure of the Runt domain-encoding PEBP2/CBFalpha gene family

We cloned the human cDNA corresponding to the cDNA (PEBP2alphaB-451) encoding the mouse polyomavirus enhancer-binding protein 2alphaB-451, representing a major splice variant from acute myeloid leukemia gene 1 (AML1). Genomic DNA clones of AML1 were also isolated and the exon/intron structure was determined. Furthermore, we determined and compared the genomic structures of three mammalian Runt domain-containing genes, PEBP2alphaA,AML/PEBE2alphaB and PEBP2alphaC.

The cDNA cloning of the hamster homologue of the human L6 gene

The cDNA cloning and sequencing of a Syrian hamster gene that produces a surface antigen on cells transformed by the SV40 or BK virus are described. Sequence analysis showed that this gene is a member of the transmembrane 4 superfamily (TM4SF) and encodes the Syrian hamster counterpart of the human and the murine L6 antigens. The amino-acid sequences are highly conserved, being 71% identical among three species.

Enhanced anticancer effect of vincristine with methionine infusion after methionine-depleting total parenteral nutrition in tumor-bearing rats

Methionine-depleting total parenteral nutrition (Met(-) TPN), in which an amino acid solution devoid of L-methionine and L-cysteine is infused, is thought to reduce tumor cell growth through acting as a partial late S-G2 (i.e., late-S and G2 phases) blocker. The antitumor effect of vincristine (VCR), which acts on mitotic phase cells, was examined with methionine infusion immediately after Met(-) TPN in Yoshida sarcoma (YS)-bearing rats. Rats were given Met(-) TPN for 8 days immediately after inoculation with YS cells (days 0 to 8), which was followed by methionine-containing (Met(+)) regular TPN for 3 days (days 9-11) along with intraperitoneal administration of 0.05 mg/kg/day VCR. All rats were then fed solid food and water ad libitum until they died, with 0.1 mg/kg VCR administration on days 12 and 13. As controls, a Met(-) TPN only group, Met(+) TPN groups with and without VCR, and freely fed groups with and without VCR were studied. The progression of YS was markedly suppressed by Met(-) TPN with VCR. The median survival time in days was 25 days, significantly longer (P<0.001) (generalized Wilcoxon's tests) by 11 to 14 days than that of any of the other groups. In conclusion, VCR appears to have greater efficacy as an anticancer agent when administered together with methionine after Met(-) TPN.

Esophageal carcinoma and coexisting hepatocellular carcinoma resected simultaneously

We have experience with two cases in which esophageal carcinoma and coexisting hepatocellular carcinoma were resected simultaneously. One patient had advanced esophageal carcinoma located in the thoracic esophagus and solitary hepatoma in the posterior segment of the liver with normal liver function. The other patient had superficial esophageal carcinoma in the thoracic esophagus and solitary hepatoma in the posterior segment of the liver with impaired liver function. Subtotal resection of the esophagus and posterior segmentectomy of the liver were performed simultaneously in both patients. In the patient with impaired liver function, postoperative management of respiration and bleeding was difficult, and intensive care was needed. Mediastinal lymph node resection was modified. Postoperative course was considered to have a close relationship to liver function. Thus, close evaluation of liver function is important to decide suitable treatment of patients with primary hepatocellular carcinoma and coexisting malignant neoplasms. With close evaluation of liver function and intensive postoperative care, simultaneous resection of esophageal carcinoma and hepatocellular carcinoma is not impossible or difficult.

Prostate-specific antigen activates single-chain urokinase-type plasminogen activator

Prostate-specific antigen (PSA) increases in the plasma of patients with prostate cancer, and has therefore been used as a reliable tumor marker. It has been demonstrated that prostate cancer cells over-express urokinase-type plasminogen activator (uPA), which plays an important role in tumor invasion and metastasis. We found that PSA converts the single-chain proform of urokinase-type plasminogen activator (scuPA) to an active 2-chain form. The active 2-chain uPA generated from scuPA by PSA was measured by hydrolyzation of S-2444, a synthetic substrate for uPA. PSA activated scuPA time- and dose-dependently. SDS-PAGE analysis revealed that, after incubation with PSA, the intensity of the 55-kDa band of scuPA decreased concomitantly with increases in the intensity of the 2 bands at 33 kDa and 22 kDa. Amino-acid-sequence analysis indicated that PSA cleaved Lys158-Ile159, which corresponds with the site cleaved by plasmin. PSA did not enhance or impair the activity of the 2-chain form of uPA. These findings imply that PSA could be an initiator of the protease cascade involved in prostate-cancer invasion and metastasis.

A 13-Mer peptide of a brain injury-derived protein supports neuronal survival and rescues neurons from injury caused by glutamate

Neuronal survival is mediated by several kinds of proteins. Among these, neurotrophic factors play important roles in the nervous system by supporting neuronal activity and survival. It has been suggested recently that certain factors promote neuronal survival in the case of brain injury. To examine this possibility, we purified a novel neurotrophic factor from Gelfoam that was implanted at the site of injury caused in neonatal rats. During amino acid sequence analysis, we found that a fragmental peptide of this neurotrophic protein consisting of 13 amino acids showed neurotrophic activity. This 13-mer peptide promoted survival of septal cholinergic and mesencephalic dopaminergic neurons in culture and rescued hippocampal neurons from injury caused by glutamate in culture. This peptide rescued neurons from cell death caused by glutamate, even when added 4.5 h after glutamate exposure.

Enhancement of plasma fibrinolysis in vitro by jararhagin, the main haemorrhagic metalloproteinase in Bothrops jararaca venom

Jararhagin, a haemorrhagic metalloproteinase from Bothrops jararaca venom, plays an important role in systemic as well as local haemorrhage. In this study, the effect of jararhagin on the fibrinolytic system was investigated. The fibrinolytic activity of various kinds of animal plasmas was measured by the fibrin plate method. No activity was detected in plasma alone. However, after mixing plasma with jararhagin, strong fibrinolytic activity was recorded in guinea-pig, horse, dog, rabbit and human plasmas. The mechanism of the increase of firbinolytic activity by jararhagin was studied further in guinea-pig plasma. Fibrin-zymographic studies indicated that jararhagin increased tissue-type plasminogen activator (tPA) activity by the dissociation of a complex of tPA with type 1 plasminogen activator inhibitor (PAI-1). alpha 2-Plasmin inhibitor (alpha 2-PI) activity in the plasma was measured using a synthetic chromogenic substrate method after incubation with jararhagin. The alpha 2-PI activity in the plasma decreased in both time-dependent and dose-dependent manners. These in vitro results suggest that, in some animal plasmas, jararhagin increases plasma fibrinolytic activity by causing dissociation of the tPA/PAI-1 complex and by the inactivation of alpha 2-PI. It is possible that this direct action of jararhagin on the enhancement of plasma fibrinolytic activity may contribute to the aetiology of systemic haemorrhage frequently observed in human victims of B. jararaca envenoming.

The effect of high-energy shock wave therapy combined with cisplatin on mouse hepatoma

It is well documented that high-energy shock waves (HESW) can produce antitumor effects in vivo and in vitro. Furthermore, because HESW can be focused on a limited area, this therapy is considered applicable to the treatment of localized cancer. In this study, we investigated the effects of HESW therapy combined with cisplatin (CDDP) on MH134 hepatoma in a mouse model. Tumor growth was inhibited by 1 mg/kg CDDP treatment in combination with 2,000 HESW administration, but not by 1 mg/kg CDDP treatment only. Moreover, the CDDP concentration in the tumor increased after HESW administration. The active oxygen induced by HESW was then investigated by the electron spin resonance system, and it was found that HESW generated hydroxy-radicals. As oxygen radicals have been reported to change cell membrane potential, it is supposed that active oxygen induced by HESW changes cell membrane permeability, and that CDDP is concentrated in the tumor. Therefore, the combined therapy with HESW and CDDP showed synergistic inhibitory effects on tumor growth.

Interleukin 10 cooperates with interleukin 4 to suppress inflammatory cytokine production by freshly prepared adherent rheumatoid synovial cells

OBJECTIVE

Inflammatory cytokines have been implicated as important mediators of inflammation in rheumatoid arthritis (RA). We investigated whether interleukin 4 (IL-4) and interleukin 10 (IL-10) suppress the production of inflammatory cytokines by freshly prepared adherent rheumatoid synovial cells.

METHODS

Adherent synovial cells were obtained from the rheumatoid synovium by collagenase digestion. The levels of IL-1 beta, tumor necrosis factor-alpha (TNF-alpha), IL-6, and IL-8 in culture supernatants were measured by ELISA. The gene expression of IL-6 and IL-8 were determined by Northern blot analysis.

RESULTS

Freshly prepared rheumatoid synovial cells spontaneously produced large amounts of IL-6 and IL-8. However, the amounts of IL-1 beta and TNF-alpha produced were approximately 1000-fold less than those of IL-6 and IL-8. IL-4 alone inhibited the production of IL-1 beta, IL-6, and IL-8 by 32, 35, and 50%, respectively. IL-10 alone was less potent than IL-4 in suppressing these cytokines. Of note, the combination of IL-4 and IL-10 cooperatively exerted potent suppressive effects on the production of IL-1 beta, IL-6, and IL-8 by 74.3, 69, and 77%, respectively. The suppressive effects of the combination of IL-4 and IL-10 on IL-6 and IL-8 were also observed at the levels of mRNA.

CONCLUSION

These results suggest that combination of IL-4 and IL-10 may be capable of suppressing the production of inflammatory cytokines at rheumatoid inflammatory joints.

[Complications in the intraperitoneal chemotherapy with the implantable intraperitoneal port and the strategy for the prevention of the complication]

Fifty-four patients with gastrointestinal carcinomas were treated with intraperitoneal chemotherapy through devices, and an implantable port system which had been used subcutaneously. The complications of the implantable ports were analysed in this study. There were 1 bowel perforation, 2 cases of retention of ascites, 2 infections, 2 inflow obstructions and 8 cases of pain, especially in the perineal or lower abdominal area. The number of patients requiring removal of the device due to complications were 7; 1 perforation, 2 ascites, 2 infections and 2 for pain. The strategy for reducing the complications due to the device were analysed as follows. A soft catheter should be selected. The catheter in the abdominal cavity should not be long, not as long as the tip of catheter touch the bottom of pelvic organs. Due care for kinking of the catheter should be taken in the implanting procedure. Antibiotics should be applied in and around the port. Steroids should be added to the solution for intraperitoneal chemotherapy.

[Intraperitoneal infusion therapy of MTX and 5-FU for advanced gastric cancer and its peritoneal metastasis]

We administered methotrexate (MTX) and 5-fluorouracil (5-FU) into the peritoneal cavity as chemotherapy after operation for advanced gastric cancer from a port implanted subcutaneously during the operation, every or every other week. It has been said that MTX tends to be kept in the peritoneal cavity, so the kinetics of MTX is important when it was administered there in. We investigated the concentrations of MTX in the peritoneal cavity and serum with infusion into the peritoneal cavity (IP), and compared it with intraarterial (IA) and intravenous (IV) administration. The results were the lower serum concentration of MTX in IP than in both IA and IV at 1-2 hours after infusion, but thereafter it was the same level in each group. The intraperitoneal concentration of MTX was lower than the detectable level at 24-48 hours after infusion. On the other hand, we investigated the side effects of this therapy, and only one of 20 cases given therapy many times had nausea and vomiting. So the intraperitoneal infusion therapy of MTX and 5-FU seemed to be safe.

Enhancement of the antitumor effect by combined use of high-energy shock waves and ATX-70

The antitumor effects of high-energy shock waves (HESW) in combination with ATX-70 [a gallium-porphyrin complex, 2,4-bis(1-decyloxyethyl)-Ga(III)-1,3,5,8-tetramethylporphyrin++ +-6, 7-dipropionyl diaspartic acid [sequence: see text] were investigated. In vitro, the cell damage to mouse MH134 hepatoma after HESW treatment was enhanced by adding ATX-70. In vivo, HESW and ATX-70 combination therapy inhibited cell growth. However, neither HESW treatment alone nor ATX-70 treatment alone inhibited cell growth. These results imply that the antitumor effects of HESW and ATX-70 combined therapy are caused by activation of ATX-70 by HESW.

Characterization and transfusion of in vitro cultivated hematopoietic progenitor cells

Our study is to show the safety of transfusion and the number, phenotype, and proliferative potential of in vitro cultivated autologous hematopoietic peripheral blood progenitor/stem cells (PBPCs). An in vitro long-term liquid culture using PBPC suspension from consenting patients with metastatic breast cancer was established. The medium was supplemented with a variety of hematopoietic growth factors. The mononuclear cells (MNCs), their viability, CD34+ subsets, clonogenic cells, and neutrophil function were measured prior to, during, and after liquid culture for 14 days. The total cell number increased during incubation in vitro from 2.5 x 10(8) to 5 x 10(9). The clonogenic and CD34+ cells increased during the first week 6- and 3.5-fold, respectively, and were almost undetectable after 2 weeks. Maturation into the myeloid cell series was demonstrated by standard cytology and increase of CD33+ and CD38+ cell numbers. On average, 1.5 x 10(9) cells were transfused to consenting patients with metastatic breast cancer after high-dose chemotherapy and PBPC transplantation at nadir of WBC < or = 0.1/nL. One hour later, the mean WBC was measurable at 0.3/nL. Subsequently, WBC counts dropped to 0.2/nL and 0.1/nL at 6 and 24 h post transfusion. No side effects and complications were observed. In summary, an in vitro expansion can produce a > or = 20-fold increase of maturing PBPCs for an effective and safe autologous transfusion. This unique approach, when refined, could lead to a safer post-transplant period and a decrease of complications due to neutropenic fever.

Positive and negative regulation of granulocyte-macrophage colony-stimulating factor promoter activity by AML1-related transcription factor, PEBP2

The granulocyte-macrophage colony-stimulating factor (GM-CSF) gene promoter contains a consensus sequence for the polyomavirus enhancer binding-protein 2 (PEBP2) transcription factor, which consists of alpha and beta subunits. There are at least two genes, alpha A and alpha B, encoding the alpha subunit. alpha B is the mouse homologue of human AML1 gene detected at the breakpoints of t(8;21) and t(3;21) myeloid leukemias. We examined alpha A1 (an alpha A-gene product) and alpha B1 and alpha B2 (two alpha B-encoded isomers) for their effects on the GM-CSF promoter. PEBP2 alpha A1, alpha B1, and alpha B2 proteins bound the PEBP2 site within the mouse GM-CSF promoter. PEBP2 alpha A1 and alpha B1 enhanced the expression of the GM-CSF promoter-driven reporter plasmid in unstimulated and 12-O-tetradecanoylphorbol 13-acetate/phytohemagglutinin-stimulated human Jurkat T cells. In contrast, the promoter activity was suppressed by alpha B2. Coexpression of alpha B1 and alpha B2 showed that the promoter activity could be determined by the alpha B1/alpha B2 ratio. Jurkat cell extract contained PEBP2 site-binding protein(s) that cross-reacted with antimouse alpha A1 antibodies. Northern blot analysis indicated the expression of human PEBP2 alpha A, alpha B (AML1), and beta genes in Jurkat cells. Although further studies are required to determine the precise role of PEBP2 in the GM-CSF promoter activity, the present findings suggested the importance of the relative ratio of different PEBP2 isoforms in regulating the levels of the promoter activity.

[Clinical evaluation of anticancer effect of methionine-depleting total parenteral nutrition with 5-fluorouracil and/or mitomycin C]

Methionine-depleting total parenteral nutrition (Met-deplete TPN), infusing AO-90 amino acid solution (lacking both L-methionine and L-cysteine) as a sole nitrogen source, showed synergistic effects with several antineoplastics including 5-fluorouracil (5-FU). In the recent multi-center, randomized, controlled study, advanced gastric cancer patients were randomly allocated to RT group and Control group. RT group received AO-90 amino acid solution, while Control group infused Amiparen (commercial methionine and cysteine containing amino acid solution) as protein source for 14 days' TPN with 5-FU and mitomycin C (MMC). The over all clinical response rate (PR+CR) in RT and Control groups were 26.3% and 8.1%, respectively, with significant statistical difference in both values at p = 0.015. Fourteen advanced gastric cancer patients allocated to RT and Control group randomly and received each amino acid as protein source for 7 days TPN with 5-FU administration. All cases were performed gastrectomy without waiting period, and resected material was examined the histological response. In the 7 cases of RT group, grade 2 was seen in 4 cases, grade 1-b in 1, grade 1-a in 1 and grade 0 in 1. In the 7 of Control, 3 cases were grade 1-a and the remaining 4 were grade 0. There were significant differences in both degree and incidence of the histological response at p = 0.016. A stage IV gastric cancer patient with marked liver metastasis received 2 times RT therapy with 5-FU and MMC for 14 days and undertaken gastrectomy after 22 day, waiting period. Resected gastric cancer showed grade 2 to 3 histological response, and the liver metastasis showed marked effect as PR to CR.

Morphological changes in gastric carcinoma with progression

By combining morphological two indices, namely, (1) the degree of differentiation of glandular tubules (well or poor) and (2) the amount of intracellular mucus (rich or poor), we previously classified histological types of gastric carcinoma into four types. Using this histological classification, we studied the morphological changes of gastric carcinoma according to extra-gastric invasion in 200 autopsy and 200 resected cases. In cases in which the predominant histological type in the lamina propria was "tubular differentiation--well, mucus in cytoplasm--poor," there was a greater incidence of co-existence with other histological types. In many of these cases, the predominant histological findings changed to "tubular differentiation--poor" in the subserosa, followed by direct invasion into neighboring extra-gastric tissues. In all cases in which the predominant histological type in the lamina propria was "tubular differentiation--poor," the predominant histological type in the subserosa was also "tubular differentiation--poor." To understand the mode of extension of gastric carcinoma in relation to the histological type, we must consider not only the characteristics of the predominant histological types of carcinoma but also those of co-existing types, especially in cases of "tubular differentiation--well, mucus in cytoplasm--poor."

Hydroxyapatite-clay bone fixation for loaded implants

A clay containing hydroxyapatite (HA clay), which was made by mixing HA granules (range of sizes: 0.1-0.3 mm) and a saline solution of sodium alginate, was inserted into the medullary canal of an osteotomized rabbit's tibia with a Ti-6Al-4V titanium alloy implant. Each implant had a conical portion for bearing load. The shear strength of the bone-implant interface for the implant with HA clay was significantly greater than that for the implant without HA clay 3 months postoperatively (P < .02), while there was no significant difference between the two strengths 1 week postoperatively. Under microscopic observation, the percentage of area of newly developed bone was also significantly greater for the implant with HA clay than for the implant without HA clay 3 months postoperatively (P < .04). This study suggests that HA clay encouraged adequate bone fixation of the loaded implant in 3 months, while the clay was not effective for immediate fixation.

Synergistic effect of methionine-depleting total parenteral nutrition with 5-fluorouracil on human gastric cancer: a randomized, prospective clinical trial

Methionine-depleting total parenteral nutrition (Met-depleting TPN), infusing AO-90 amino acid solution (lacking both L-methionine and L-cysteine) as a sole nitrogen source, showed synergistic effects with 5-fluorouracil (5-FU) in tumor-bearing rats and in clinical trials with gastrointestinal tract cancers. In this study, the effect of Met-depleting TPN with 5-FU upon thymidylate synthase (TS) activity was examined, and the histological effect of this treatment on human gastric cancer was evaluated. Fourteen preoperative advanced gastric cancer patients were divided randomly into two groups. Seven cases were given Met-depleting TPN for 7 days before surgery with continuous intravenous administration of 5-FU (500 mg/body per day; total 4.0 g/body) (AO-90 group). The other 7 received conventional L-methionine-containing TPN with 5-FU (control group). All patients underwent gastrectomy without complications due to these treatments. Resected materials were examined for TS kinetics, and the anti-cancer effect was also assessed histopathologically. The specimens in the AO-90 group showed marked degeneration of cancer, while almost no effect was seen in the control group. The free TS activity of carcinoma tissue in the AO-90 group was decreased and the TS inhibition rate was increased in comparison with the control group (P = 0.0165 and P = 0.0243, respectively). Met-depleting TPN appears to play a role as a biomodulator of 5-FU in human gastric cancer.

Detection of K-ras mutations in DNAs isolated from feces of patients with colorectal tumors by mutant-allele-specific amplification (MASA)

K-ras mutations are found in approximately half of all colorectal tumors examined. To explore the possibility of detecting mutated K-ras rapidly and efficiently in DNAs isolated from fecal material, we applied the mutant allele specific amplification (MASA)-PCR method to DNA from feces of patients with colorectal tumors. Among 55 colorectal adenocarcinomas or adenomas examined, 19 were found to carry K-ras mutations in codons 12 or 13. We were able to PCR-amplify DNAs isolated from feces of 15 of these 19 patients, but in only three of the fecal samples, we were able to detect the K-ras mutations corresponding to tumor DNA by MASA and ethidiumbromide staining of the gel. The carcinomas in these three cases were more than 40 mm x 40 mm in size and located in the sigmoid colon or rectum. However, we identified the K-ras mutations in fecal DNAs of additional seven patients by MASA when the gels were blotted and probed with a radio-labeled oligonucleotide; the tumors in those patients had arisen in the distal half of the colon and the smallest of these tumors was only 7 mm x 5 mm. No K-ras mutations were detectable in feces of the remaining five cases, whose tumors were relatively small and/or located in the proximal region. The results suggested that the MASA-PCR system has potential for development as a simple, rapid and noninvasive method for diagnosing the presence of colorectal tumors that carry mutant K-ras alleles, particularly tumors located in the distal colon.