Gender effect on prognosis of patients receiving long-term home oxygen therapy. The Respiratory Failure Research Group in Japan

Although long-term home oxygen therapy (LTOT) certainly prolongs survival, it is not known whether this advantageous effect is similar for both sexes. In this study, we analyzed sex-related differences in survival based on a very large population that had received LTOT from 1986 to 1993. A total of 9,759 patients with chronic obstructive pulmonary disease (COPD), sequelae of tuberculosis (TBsq), and chronic interstitial pneumonia (IP) were selected in 1,212 medical institutions for analysis of survival rates. The survival rates of both sexes were compared with each other using the Cutler-Ederer Method. Despite higher PaCO2 at the beginning, the survival rate of women was significantly better than that of men in these three disease categories. Cox's proportional hazards analysis further confirmed the gender effect on survival by eliminating the effects of age, PaO2, PaCO2, %VC, and FEV1/FVC. The mean survival periods of the women who died during follow-up periods were also significantly longer than those of men (0.41 yr in COPD, 1.84 yr in TBsq, and 0.78 yr in IP). From these findings, we conclude women have a better prognosis than men when they start receiving LTOT, regardless of the cause of respiratory failure.

[Effects of inhaled oxitropium bromide, an anticholinergic drug, on pulmonary hemodynamics in patients with chronic obstructive pulmonary diseases]

We studied the effects of the inhaled anticholinergic agent oxitropium bromide (Ox) on pulmonary hemodynamics in eleven patients with chronic obstructive pulmonary disease. All the patients underwent right heart catheterization and seven of them underwent an incremental ergometer exercise test while in the supine position. Pulmonary hemodynamics and arterial blood gases were measured at rest and during maximal exercise, before and 30 minutes after inhalation of 2 puffs (200 micrograms) of Ox. Inhalation of Ox did not significantly change pulmonary hemodynamics at rest. The mean pulmonary arterial pressure and the mean pulmonary capillary wedge pressure during exercise decreased significantly (from 40.3 +/- 4.6 to 37.7 +/- 3.9 mmHg, and from 20.4 +/- 3.5 to 17.1 +/- 2.7 mmHg, respectively, mean +/- SE). However, neither cardiac output nor pulmonary vascular resistance changed with inhalation of the drug, at rest or during exercise. We therefore conclude that this commonly used dose of Ox does not directly affect the pulmonary vascular system. The small but significant decreases in pulmonary arterial pressure and pulmonary capillary wedge pressure with Ox may have been indirect effects, caused by bronchodilation.

Use of local cerebral blood flow monitoring to predict brain damage after disturbance to the venous circulation: cortical vein occlusion model by photochemical dye

A rat model of cortical vein occlusion by the photochemical thrombotic technique was used to evaluate whether monitoring the change in the local cerebral blood flow (LCBF) could predict brain damage after cortical vein occlusion. The cortical vein occlusion was attained by using the photochemical thrombotic technique, and the sequential LCBF was measured by using a laser Doppler flowmeter positioned over the middle frontal cortex between two adjacent dorsal veins for 120 minutes after the start of the irradiation to the cortical vein. Rats were assigned to one of three experimental groups. In Group A (n = 10), one dorsal cerebral vein was occluded; in Group B (n = 10), two adjacent dorsal cerebral veins were occluded; and in a sham-operated group (n = 5), the rats also underwent craniotomy and light exposure but received injections of saline rather than the rose bengal dye. After 24 hours, the rats were submitted to perfusion fixation and were examined histopathologically. After irradiation-induced cortical vein occlusion, a gradual and significant decrease of the LCBF was observed in both Group A (significantly different from the LCBF of the sham-operated group after 90 min, P < 0.05, and 120 min, P < 0.01) and Group B (significantly different from the LCBF of the sham-operated group at 30 min, P < 0.05, and at 60, 90, and 120 min, P < 0.01). Significant differences (P < 0.01) in the LCBF were also seen between the two experimental groups at 90 and 120 minutes after the start of the irradiation and the subsequent brain damage.(ABSTRACT TRUNCATED AT 250 WORDS)

[A case of bilateral partial anomalous pulmonary venous connections with the right upper pulmonary vein draining to the high superior vena cava]

A 10-year-old girl with bilateral partial anomalous pulmonary venous connections (PAPVC) was referred to us. The right upper pulmonary vein (PV) drained to the high superior vena cava (SVC) and the left upper PV to the left innominate vein. The left upper PV was directly anastomosed to the right atrial appendage. The SVC was divided distal to the orifice of the right upper PV and anastomosed to the right atrial appendage. A Xenomedica patch was placed within the right atrium to divert the pulmonary venous blood from the SVC orifice across the surgically enlarged ASD to the left atrium. The postoperative course was satisfactory without arrhythmia, and cineangiography revealed no obstruction at the SVC and the right upper PV pathways. We thought that this method is advantageous in preserving the sinus node and its feeding artery, as well as being applicable to the PAPVC to the high SVC.

Effects of platelet depletion on PMA-induced acute lung injury in awake sheep

Little is known about the role of circulating platelets in PMA-induced lung injury in vivo. We investigated the effects of platelet depletion (PD) on the injury using seven unanesthetized sheep with lung lymph fistulas and eight other sheep for morphological study. PD diminished a decrease in the lymph to plasma concentration ratio (L/P) after 1 microgram/kg PMA treatment (n = 4) and caused more increases in lung lymph flow, L/P and lung lymph clearance after 5 micrograms/kg PMA treatment (n = 3) than in control sheep. The high dose was lethal to platelet-depleted sheep. However, PD had no effects on pulmonary hemodynamics. Morphologically, alveolar hemorrhages and exudate, and bleb formation of type I epithelial cells were more prominent in the platelet-depleted sheep than in the control sheep. We conclude that circulating platelets have protective effects against PMA-induced lung injury but have little involvement in PMA-induced pulmonary hypertension.

Importance of prevention of intravenous thrombosis and preservation of the venous collateral flow in bridging vein injury during surgery: an experimental study

BACKGROUND

Venous infarction (cerebral edema and/or hemorrhage) may occur several hours after sacrifice of the bridging vein during surgery. However, in our experience, severe venous infarction is often produced by prolonged brain retraction in addition to sacrifice of the vein.

METHODS

The experiment was carried out using 20 adult cats. In five cats, all bridging veins were coagulated near the superior sagittal sinus and 12 hours later the surgical wound was closed (group A). In five other cats, a round plate weighing 45 g was placed on the center of the Sylvian fissure for 12 hours and then the wound was closed (group B). In the remaining 10 cats, both of these interventions were performed (group C). All 20 animals were sacrificed 12 hours after the wound closure.

RESULTS

The degree of Evans-blue dye leakage and brain edema was much more marked in the group C than in groups A and B. The endothelial intactness of the bridging veins studied by staining with a factor VIII-related antigen was much more disturbed in group C than in the other groups.

CONCLUSIONS

The endothelium of the cortical veins is damaged much more by the combination of sacrifice of the vein and brain retraction, and this endothelial damage of the cortical vein leads to extensive venous infarction.

Identification of the Tax interaction region of serum response factor that mediates the aberrant induction of immediate early genes through CArG boxes by HTLV-I Tax

Tax of human T-cell leukemia virus type I (HTLV-I) activates transcription at a CArG box of various immediate early genes such as the proto-oncogene c-fos. To do this, Tax does not directly bind to the CArG box, but instead binds to the CArG binding factor SRF. In this study, we investigated the domain of SRF required for the activation by Tax and studied the role of this domain on transcriptional regulation at the CArG box. Using a fusion protein of SRF with a yeast transcription factor GAL4, the 14 amino acid (aa) portion (aa 422-435) of SRF was identified as the domain required for Tax activation [Tax-responsive region of SRF (TRRS)]. By means of a two hybrid system, we showed that TRRS was essential for the interaction of SRF with Tax in vivo. The over-expression of SRF with a deletion of TRRS inhibited the Tax activation at the CArG box. Thus, TRRS is the domain of SRF that is essential for Tax activation at the CArG box. Unlike to Tax activation, TRRS was not required for TPA (12-o-tetradecanoylphobol-13-acetate) induction at the CArG box, but a TRRS deletion enhanced the basal activity at the CArG box both under serum-starved and TPA-stimulated conditions. These results suggest that TRRS negatively regulates the transcriptional activation function of SRF, and consequently contributes to the low basal activity at the CArG box before TPA induction.

Immunoelectron microscopic study of HTLV-II-producing cells with an anti-envelope gp46 monoclonal antibody

We observed expression of envelope gp46 protein on an HTLV-II-producing T-cell line (Mo) cells by an immunoelectron microscopical method using a monoclonal antibody against HTLV-II gp46. gp46 reactivity was observed on virus-like particles, extracellular vesicles, cell membrane, and partially in nuclear membrane and endoplasmic reticulum.

Activation of ornithine decarboxylase in epithelial cells of rat intestine

Intestinal ornithine decarboxylase (ODC) is strongly induced by dietary amino acid and protein feeding. However, the consequence of this induction is unknown. In this study, we analyzed the relationship between intestinal ODC activity and DNA synthesis in villus and crypt cells of rat intestine. Single amino acid diets and protein diets stimulated ODC activity in villus cells, but not in crypt cells. However a 20% casein diet induced ODC activity and increased the putrescine concentration in villus and crypt cells. Administration of alpha-difluoromethylornithine, a suicide inhibitor of ODC, prevented both an increase in putrescine level and DNA synthesis in the crypt cells. Observations suggested that the induction of ODC is necessary to initiate DNA synthesis in rat intestinal epithelium.

Chromosome assignments of genes for human Na(+)-dependent phosphate co-transporters NaPi-3 and NPT-1

Chromosome assignments for the genes encoding human renal high affinity Na/phosphate co-transporters NaPi-3 and NPT-1 were derived by analyzing somatic cell hybrid DNAs. Polymerase chain reaction (PCR), using primers specific for two human Na/Pi co-transporters demonstrated that the genes for NaPi-3 was assigned to human chromosome 5 while that for NPT-1 was assigned to human chromosome 6. Renal phosphate transporter genes may be candidates for causing hereditary hypophosphatemia with hypercalciuria in humans.

Production of functional chick liver HMG 2a protein in Escherichia coli

An efficient Escherichia coli system for the production of a variant form of high-mobility group-2a protein (HMG 2a), having the additional 5 amino acid residues (Ala-Pro-Thr-Leu-Glu) at the NH2-terminal, has been constructed. cDNA encoding HMG 2a was ligated with the Omp A signal peptide sequence and was inserted into an inducible bacterial expression vector pSH-L. After the plasmid introduced into E. coli was expressed by temperature shift, the recombinant product was purified by trichloacetic acid precipitation followed by Bio-Rex 70 column chromatography. The purified product showed the expected NH2-terminal sequence and the superhelical activity of circular DNA similar to the authentic HMG 2a isolated from chick liver.

Serum antibody against Helicobacter pylori assayed by a new capture ELISA

We developed a highly specific detection technique for serum antibody, using a monoclonal antibody to a specific antigen of Helicobacter pylori. A monoclonal antibody preparation that reacted with the 54-kDa molecule of H. pylori antigens was obtained. Using this preparation, an antigen-capture enzyme-linked immunosorbent assay (ELISA) was established by fixation of the monoclonal antibody, followed by reaction with sonicated whole cell antigens. The serum antibody titers of patients with gastritis and peptic ulcers were significantly higher than control titers, and the antibody titer correlated with the histological severity of gastritis. Patients positive for H. pylori by bacterial culture had higher titers than H. pylori-negative patients. Our new ELISA may be useful for the diagnosis of H. pylori infections and for evaluation of the severity of gastric inflammation.

Purification and characterization of beta-N-acetylglucosaminidase from Alteromonas sp. strain O-7

beta-N-Acetylglucosaminidase (EC 3.2.1.30) was purified from the outer membrane of a marine bacterium, Alteromonas sp. strain O-7. The enzyme (GlcNAcase A) was purified by successive column chromatographies. The purified enzyme was found to be homogeneous on sodium dodecyl sulfate polyacrylamide gel electrophoresis. The molecular mass and pI of GlcNAcase A were 92kDa and 4.9, respectively. The optimum pH and temperature were 6.0-7.0 and 45 degrees C, respectively. GlcNAcase A was stable up to 40 degrees C at pH 7.0, and hydrolyzed N-acetylchitooligosaccharides from dimer to hexamer. The amino-terminal 16 amino acid residues of GlcNAcase A were sequenced.

Dependency on the rate of change in PaO2 of the ventilatory response to progressive hypoxia

The biphasic nature of the ventilatory response to sustained hypoxia (< 1 h) is thought to occur as a result of combined effects of stimulation and depression with hypoxia. If the depressant effect of hypoxia on ventilation occurs later than the stimulatory effect, the magnitude of the ventilatory response to progressive hypoxia may be different according to the time required for a given fall in PaO2 during the test. In this study, we measured, in 10 healthy adult volunteers, ventilatory responses to isocapnic progressive hypoxia (HVR) using three different protocols (4 min, 6 min, and 15 min for SaO2 to decrease from the baseline to 80%) with or without pretreatment using theophylline (300 mg twice a day), an adenosine receptor antagonist, in a 2-d, single-blind crossover design. The slope values of HVR with the placebo were 0.31 +/- 0.04 (SE) (L/min/% fall of SaO2) in the 4-min protocol, 0.26 +/- 0.04 in the 6-min protocol, and 0.18 +/- 0.04 in the 15-min protocol. The HVR for the 15-min protocol was significantly lower than that for the 4-min or 6-min protocol. The HVR with theophylline was 0.46 +/- 0.08 for the 4-min protocol, 0.54 +/- 0.09 for the 6-min protocol, and 0.66 +/- 0.11 for the 15-min protocol, among which there were no significant differences. The dependency of HVR on the rate of change in PaO2, that was seen with a placebo run, disappeared after pretreatment with theophylline.(ABSTRACT TRUNCATED AT 250 WORDS)

Indocyanine green videoangiographic findings in choroidal metastatic tumor

BACKGROUND

Indocyanine green videoangiography (ICGV) has recently advanced and become widely available as a clinical tool. We tested the efficacy of ICGV in evaluating metastatic choroidal tumors.

METHODS

ICGV using Topcon 50-IA was performed in five patients with clinically diagnosed choroidal metastatic tumors. The findings were compared with those of conventional fluorescein angiography (FAG).

RESULTS

Compared with FAG, ICGV demonstrated more smooth and regular hypofluorescent lesions, precisely indicating the exact size of the tumor. In all cases, no tumor vessels were found. The choroidal vascular integrity around the tumors was observed. FAG, however, was more sensitive in detecting the tumor development than ICGV when the extent of the hypofluorescent lesion could be seen clearly in the early phase. FAG provided more information regarding retinal pigment epithelial dysfunction in the outer blood retinal barrier overlying the tumor.

CONCLUSION

Since ICGV enables visualization of tumors through the retina, it is very useful, particularly in cases of associated secondary retinal detachment around the tumors. ICGV combined with FAG provides more precise assessment of the tumors themselves and their response to treatment than FAG alone.

Antitumour effects and pharmacokinetics of combination of vinblastine with a staurosporine derivative, NA-382, in P388/ADR-bearing mice

The effects of a staurosporine derivative, N-ethoxycarbonyl-7-oxostaurosporine (NA-382), on the pharmacokinetics of vinblastine were evaluated, compared with those of verapamil, in multidrug-resistant P388/ADR-bearing mice. At first, the in-vitro experiments indicated that NA-382 permeated into the cells better and were more effective in combined cytotoxicity with vinblastine and on accumulation of vinblastine than with verapamil in P388/ADR cells. In combined intraperitoneal injection with vinblastine (200 micrograms kg-1) into P388/ADR-bearing mice, NA-382 in a suspension form (10 mg kg-1) prolonged the life-span of the mice near to that of P388/S-bearing mice treated with vinblastine alone, but verapamil even at the maximum tolerated dosage (30 mg kg-1) barely affected the in-vivo antitumour effect of vinblastine. When simultaneously administered with vinblastine to P388/ADR-bearing mice, NA-382 maintained significantly higher vinblastine levels in the tumour cells for 24 h and gave a larger area under the time-intracellular vinblastine concentration curve (0 to 24 h) than those receiving vinblastine alone, with long retention of the agent in ascitic fluid. Verapamil increased the cellular vinblastine content for only 6 h, accompanying a rapid elimination of the agent from the ascitic fluid. This study indicates that NA-382 is more effective against multidrug-resistance than verapamil, and its suspension is also advantageous for cancer chemotherapy of multidrug-resistant tumours.

Brain distribution characteristics of xanthine derivatives and relation to their locomotor activity in mice

The relationship between the brain distribution and motor activity in mice of the xanthines, theophylline, enprofylline, 1-methyl-3-propylxanthine (MPX) and oxpentifylline was investigated. Their plasma protein binding and hydrophobicity were also examined. When these xanthines were administered orally, enprofylline and oxpentifylline had no effect on motor activity. While theophylline increased motor activity over 10 mg kg-1, MPX caused a decrease in such activity over 10 mg kg-1. The protein-binding behaviour varied among these xanthines and was closely related to their hydrophobicity, which is represented as a logarithmic partition coefficient (log PC). MPX had the highest hydrophobicity, while oxpentifylline had the lowest. Brain distribution characteristics varied among these xanthines, with the rank order of their brain penetration ratio, calculated as the ratio of brain to unbound plasma concentrations, being theophylline > oxpentifylline > MPX > enprofylline. The inhibition constants (Ki) for adenosine A1 receptors and cyclic 3',5'-adenosine monophosphate (cAMP)-phosphodiesterase (PDE) of these xanthines were 44.6 and 134, > 1000 and 112, 26.4 and 49, and > 1000 and 111 microM for theophylline, enprofylline, MPX, and oxpentifylline, respectively. These findings suggest that the lack of effects of enprofylline and oxpentifylline on motor activity is probably due to their low brain penetration ratio or low adenosine A1 affinity in comparison with theophylline. The decrease in the motor activity by MPX may be, in part, mediated by cAMP or adenosine.

[Effect of supplemental oxygen on exercise performance in patients with chronic obstructive pulmonary disease and an arterial oxygen tension over 60 Torr]

The effects of supplemental oxygen on exercise tolerance and exercise-induced dyspnea in patients with chronic obstructive pulmonary disease (COPD) and an arterial oxygen tension (PaO2) over 60 Torr were studied. Twenty two men who met the criteria stated above underwent three 6-minute walk tests while breathing room air, compressed air, or supplemental oxygen, in a double-blind randomized crossover fashion. The distance walked in 6 minutes was recorded, and the degree of dyspnea during exercise was quantified on a visual analog scale with a questionnaire that had eight descriptors of dyspnea sensations. The distances walked were: 535 +/- 27 (SE) for room air, 545 +/- 27 for compressed air, and 563 +/- 23 m for O2. These data indicate a significant placebo effect and an effect of supplemental oxygen. The data regarding dyspnea also indicated both a significant placebo effect and an effect of supplemental oxygen, but the descriptors for the placebo effect differed from those for the effect of supplemental oxygen. Patients in whom arterial desaturation (below 88%) developed during exercise with compressed air benefited from supplemental oxygen: they walked significantly farther and their dyspnea scores for two of the eight descriptors were significantly lower. However, patients in whom arterial desaturation (below 88%) did not develop during exercise with compressed air did not benefit from supplemental oxygen. Nonetheless, the degree of dyspnea during exercise with compressed air could not be used to predict the beneficial effect of supplemental oxygen.

Osteoporosis-like changes in Walker carcinoma 256-bearing rats, not accompanied with hypercalcemia or parathyroid hormone-related protein production

Walker carcinoma 256 (W256) was reported to induce hypercalcemia dependent on bone metastasis and/or parathyroid hormone-related protein (PTHrP) in the rat, providing a model of the humoral hypercalcemia of malignancy. In this study, after the subcutaneous inoculation of cells of the W256/S line, which is maintained in this laboratory, into young female Wistar Imamichi rats (6 weeks old), serum calcium and phosphorus levels changed only within the control range, whereas serum alkaline phosphatase activity and urinary calcium level significantly increased and urinary phosphorus decreased during the tumor growth, resulting in hypercalciuria and hypophosphaturia. W256/S did not express PTHrP-mRNA, whereas LLC-W256 cells did express it. Serum PTHrP level was not changed in W256/S-bearing rats. Osteoporosis-like changes, bone weight loss, low contents of bone calcium and phosphorus, and a decrease in the bone mineral density (BMD), were observed in the femur 14 days after the tumor inoculation. There was a pronounced decrease in the serum 17 beta-estradiol level during the tumor growth. The reduction of BMD of femurs in W256/S-bearing rats was significantly inhibited by treatment with salmon calcitonin or 17 beta-estradiol. On the basis of these results, W256/S carcinoma-bearing rats seem to be a useful model for osteoporosis of hypoovarianism.

Effect of octreotide on ventilation and dyspnea sensation in a patient with cirrhotic hypoxemia

We examined the long-term effects of octreotide, a somatostatin analogue, on ventilation in a case of cirrhotic hypoxemia. After daily administration of octreotide for one month, the dyspnea on exertion was notably ameliorated, although pulmonary gas exchange was only slightly improved. The octreotide therapy reduced the hypoxic ventilatory drive, which may be one reason for the relief of the dyspnea sensation.

Human androgen-induced growth factor in prostate and breast cancer cells: its molecular cloning and growth properties

Androgen-induced growth factor (AIGF) has hormone-regulated properties in the mouse Shionogi carcinoma cell line. To investigate whether or not it is involved in growth of human hormone-responsive cancers, we isolated the human AIGF gene from a placental genomic library. Genomic analyses suggested that the AIGF gene was about 6.5 kilobases in length containing five exons. The deduced amino acid sequence of human AIGF was completely identical with that of the mouse. RT-PCR analyses showed that prostate and breast cancer cell lines, LNCaP, PC-3, and MCF-7, slightly expressed the AIGF gene. Recombinant AIGF enhanced the growth of the human prostate cancer LNCaP cells, and it also markedly stimulated the growth of fibroblasts. These in vitro findings suggest that AIGF might be a possible autocrine or paracrine factor in hormone-responsive cancers.

Regulation and localization of midkine in rat ovary

In a previous experiment, it was shown that midkine (MK) was quite abundant in the follicular fluid; the concentration of MK in bovine follicular fluid was estimated to be 125 micrograms/l. To investigate the regulation of MK production in the ovary, we examined the effect of pregnant mare's serum gonadotropin (PMSG) and PMSG-hCG treatment on the expression of MK in rat ovary. The mRNA of midkine (MK) was increased by PMSG injection and decreased by PMSG and hCG injection; the profile of change of mRNA of MK was similar to that of FSH receptor. Using in situ hybridization, we observed that the MK mRNA localized to granulosa cells. These results suggest that the granulosa cells produce MK under the control of gonadotropin.