[Anesthesia for a patient with cardiac sarcoidosis]

Anesthesia for a 49-year-old man with cardiac sarcoidosis is reported. Preoperative cardiac examination showed left ventricular dysfunction (ejection fraction = 27%) and myocardial conduction defects. In addition, his previous history included atrial fibrillation and cerebral infarction. Transesophageal echocardiography showed thrombus in the left appendage. Anesthesia was induced with fentanyl and diazepam and maintained with fentanyl and isoflurane. Perioperative hemodynamic monitoring included direct arterial pressure, central venous and pulmonary artery pressure and continuous cardiac output. In addition, transesophageal echocardiography was useful for watching thrombus in the left appendage. His hemodynamic condition was stable and no neurological complication was noted after anesthesia.

[A case of multiple sclerosis with recurrent episodes of psychiatric symptoms]

We reported a 19-year-old woman with multiple sclerosis (MS) with recurrent episodes of psychiatric symptoms at the age of 10 and 19, as the first and 11th relapse, respectively. Her first episode of MS resembled acute encephalitis at the age of 9 and she relapsed 12 times. The psychiatric symptoms were not mood disorders but altered states of consciousness, such as the delirous state. She was treated with high doses of intravenous methylpredonisolone and her symptoms were almost resolved, but her anxiety neurosis remained. Her MRI showed demyelination in the white matter of the frontal lobe and the hippocampus, which suggested that psychiatric symptoms of MS would be related to the frontal lobe lesion.

Changes in muscle size, architecture, and neural activation after 20 days of bed rest with and without resistance exercise

Nine healthy men carried out head-down bed rest (BR) for 20 days. five subjects (TR) performed isometric, bilateral leg extension exercise every day, while the other four (NT) did not. Before and after BR, maximal isometric knee extension force was measured. Neural activation was assessed using a supramaximal twitch interpolated over voluntary contraction. From a series cross-sectional magnetic resonance imaging scans of the thigh, physiological cross-sectional areas (PCSA) of the quadriceps muscles were estimated (uncorrected PCSA, volume/estimated fibre length). Decrease in mean muscle force after BR was greater in NT [-10.9 (SD 6.9)%, P < 0.05] than in TR [0.5 (SD 7.9)%, not significant]. Neural activation did not differ between the two groups before BR, but after BR NT showed smaller activation levels. Pennation angles of the vastus lateralis muscle, determined by ultrasonography, showed no significant changes in either group. The PCSA decreased in NT by -7.8 (SD 0.8)% (P < 0.05) while in TR PCSA showed only an insignificant tendency to decrease [-3.8 (SD 3.8)%]. Changes in force were related more to changes in neural activation levels than to those in PCSA. The results suggest that reduction of muscle strength by BR is affected by a decreased ability to activate motor units, and that the exercise used in the present experiment is effective as a countermeasure.

Congenital giant aneurysm of the left atrial appendage mimicking pericardial absence case report

A 25-year-old man was found to have an abnormal cardiac contour on a chest radiograph, and was referred. Transesophageal echocardiography suggested herniation of the left atrial appendage (LAA) through a gap in the pericardium, and magnetic resonance imaging indicated congenital partial absence of the pericardium. Cardiac dysfunction was caused by compression from the enlarged left atrium and thrombi were thought to be present in the appendage, so surgery was performed. The intraoperative diagnosis was congenital LAA aneurysm. Although distinguishing between congenital LAA aneurysm and congenital absence of the pericardium is reported to be possible with magnetic resonance imaging, we were unable to so in this case.

A calcium-activated cation current by an alternatively spliced form of Trp3 in the heart

To investigate a cDNA encoding cation current, we isolated an alternatively spliced form of a rat Trp3, designated Trp3sv. Trp3sv encodes 736 amino acids with a unique N terminus and six transmembrane segments. Expression of the cRNA in Xenopus oocytes was successfully performed. The cation selective current appeared after the addition of ionomycin or induced by prolonged depolarization but not by hyperpolarization. This induction was not observed by a treatment with thapsigargin, phorbol ester, or ATP. Na(+), K(+), tetraethylammonium, and divalent cations were permeable, while N-methylglucamine and chloride were nominally impermeable ions. The currents were not inhibited by flufenamate ruthenium red but nonspecifically by 2 mm Gd(3+). Northern as well as Western blot suggested lower levels of the expression observed in some organs, while reverse transcriptase-polymerase chain reaction suggested that it widely spread among various organs. Therefore, we may conclude that N-terminal spliced valiant of Trp3, Trp3sv, encodes a calcium-activated cation channel in various organs.

[Rethinking the Sapir-Whorf hypothesis: role of language in shaping thought]

Traditionally, the issue of the relationship between language and thought has been framed as the Sapir-Whorf hypothesis, in which crosslinguistic-crosscultural universality or diversity of thought has been the center of the debate. The long-lasting debate revolving around the hypothesis has not yielded a clear, satisfactory conclusion. This unsatisfactory result seems to be largely attributed to the fact that (a) the term "thought" has been so vaguely defined, and that (b) the interpretation of the Sapir-Whorf hypothesis itself has been quite diverse among researchers. In this paper, I argue that the question we should ask is not whether thought is universal or different across different language groups. Instead, we should ask more specific (and realistic) questions, taking it for granted that our thought is constrained by innate language-independent cognitive faculties but at the same time a large part of our thought is shaped by language. The questions we should ask are: in what cognitive domains (e.g., spatial cognition, ontological knowledge, categorization of natural objects etc.), at what specific level (e.g., perception, memory, knowledge representation, on-line information processing) and in what degree (a) our thought is influenced by the specific structure of the given language (or is immune to it) and (b) our thought is shaped by language learning (or constrained by language-independent innate cognitive structure). In order to reevaluate the Sapir-Whorf hypothesis in this new perspective, I reviewed literature mainly focusing on three distinctive cognitive domains: ontological knowledge with respect to individuation, categorization of natural objects, and spatial cognition.

Secoiridoid glycosides from the flower buds of Lonicera japonica

Two secoiridoid glycosides, loniceracetalides A and B, were isolated in very small amounts, together with 10 known iridoid glycosides, from the flower buds of Lonicera japonica. The structures of loniceracetalides A and B were determined by spectroscopic analysis.

[Sensitivity and specificity of rapid diagnosis kit detecting separately influenza A and B viruses]

Sensitivity and specificity of the Directigen Flu A + B kit, a rapid test for influenza virus A and B, were evaluated. This test detects influenza A and B viruses separately by EIA. Reactivity of the kit was tested using a total of 23 isolates: 13 isolates of human influenza virus A (H1N1, H3N2) and 10 isolates of human influenza virus B. All of the isolates were tested positive and no difference in reactivity was found in antigenic variables and subtypes. The kit was only reactive to influenza virus A and B, not reactive to other viruses. Typical influenza A and B strains were tested for detection limit. 7.8 x 10(3) pfu/ml was a detection limit for influenza virus A (H1N1: Beijing/262/95), 4.7 x 10(4) pfu/ml for influenza virus A (H3N2: Kitakyusyu/159/93), and 3.1 x 10(4) pfu/ml for influenza virus B (Guangdong/05/94). The Directigen Flu A + B kit was a easy-to-use, rapid detection device and the kit has sensitivity and specificity equivalent to other diagnostic devices, suggesting the kit are useful in medical institutions.

[Clinical evaluation of rapid diagnostic kit detecting separately influenza A and B viruses]

The Directigen Flu A + B kit, a rapid diagnostic device for influenza virus A and B was evaluated. The nasopharyngeal aspirates were obtained from 239 patients who visited our hospital, between January and March, 2000, presenting flu-like symptoms. Influenza virus AH1: 77 and AH3: 51 were isolated from 128 specimens and none from 111 specimens. Directigen Flu A + B showed 115 specimens positive and 106 specimens negative. The sensitivity and specificity of this kit were 89.8% (115/128) and 95.5% (106/111) compared with viral isolation. Agreement on positive and negative interpretations between Direction Flu A and this kit was 97.9% (234/239). In the evaluation of this kit for influenza B virus, 60 frozen nasopharyngeal aspirates collected from February to April, 1999 were used. The sensitivity and specificity of this kit were 88.9% (16/18) and 88.1% (37/42) compared with viral isolation. Agreement on positive and negative interpretations between FLU OIA and this kit was 91.7% (55/60). The Directigen A + B demonstrated sensitivity and specificity equivalent to the conventional kits in nasopharingeal aspirates. This kit can also differentiate influenza A and B viruses, a feature which is useful for treatment using anti-viral agents such as amantadine and neuraminidase inhibitor. To date, the kit is the most effective tool for the rapid diagnosis of influenza.

Protective effect of phytic acid hydrolysis products on iron-induced lipid peroxidation of liposomal membranes

Beneficial effects of dietary phytic acid (myo-inositol hexaphosphate; IP6) have often been explained by its strong iron ion-chelating ability, which possibly suppresses iron ion-induced oxidative damage in the gastrointestinal tract. Because phytic acid is hydrolyzed during digestion, this work aimed to know whether its hydrolysis products (IP2, IP3, IP4, and IP5) could still prevent iron ion-induced lipid peroxidation. Studies using liposomal membranes demonstrated that hydrolysis products containing three or more phosphate groups are able to inhibit iron ion-induced lipid peroxidation although their effectiveness decreased with dephosphorylation. Similarly, they also prevented iron ion-induced decomposition of phosphatidylcholine hydroperoxide. These results demonstrate that intermediate products of phytic acid hydrolysis still possess iron ion-chelating ability, and thus they can probably prevent iron ion-induced lipid peroxidation in biological systems.

Application of Rh-catalyzed cyclization to the formation of a chiral quaternary carbon

Rh-Catalyzed cyclization was applied to the formation of a chiral quaternary carbon. It has become clear that the Rh-complex can discriminate between isopropenyl and 2-isopentenyl (or isopentyl) substituents, and the cyclization afforded 3,3,4-trisubstituted cyclopentanones with a chiral quaternary carbon in a stereoselective manner. The cyclization of 4-pentenals 6a, b by an achiral neutral Rh(PPh3)3Cl afforded 3,3,4-cis-trisubstituted cyclopentanones (+/-)-7a,b in 86-96%, and the cyclization by a cationic Rh[(R)-BINAP]CIO4 afforded 3,3,4-trans-trisubstituted cyclopentanones (-)-8a, b of 82-86% ee in 88-98% yields. The mechanism of stereoselection by Rh-complexes is also discussed.

Fluctuations of lamellar structure prior to a lamellar-->gyroid transition in a nonionic surfactant system

Fluctuations of lamellar structure prior to a lamellar-->gyroid transition in a nonionic surfactant-water system has been investigated by means of small-angle x-ray scattering (SAXS) and differential scanning calorimeter measurements. For large DeltaT (DeltaT=T-T(LG), where T is the temperature and T(LG) the lamellar-->gyroid transition temperature) in the lamellar phase, the SAXS profiles can be described by a Caille correlation function for undulating lamellar structure. Approaching the temperature to the T(LG), an excess diffuse scattering grows at the lower Q (Q is the magnitude of scattering vector) side of the first lamellar peak. Highly oriented lamellar samples revealed that the excess diffuse scattering arises from in-plane density fluctuations. We attribute this diffuse scattering to the perforation fluctuation layer (PFL) structure and we show that the PFL is an equilibrium structure. At T(LG), the PFL transformed to the gyroid phase through a transient ordered structure having a rhombohedral symmetry.

Metastatic cardiac papillary carcinoma originating from the thyroid in both ventricles with a mobile right ventricular pedunculated tumor

A 62-year-old man with a history of surgical therapy for papillary thyroid carcinoma was admitted because of chest pain, dyspnea on effort, pretibial edema, and slight fever. An electrocardiogram showed ST segment elevation in the precordial leads and low voltage in the limb leads. A large solid mass was demonstrated in both ventricles, with pericardial effusion, by echocardiography, thoracic computed tomography scan, transesophageal echocardiography, and angiography. A punch biopsy of the tumor revealed metastatic papillary carcinoma. During radiation therapy, the patient suddenly died of ventricular fibrillation. At autopsy, the tumor occupied almost the entire right ventricular cavity, expanding toward the main trunk of the pulmonary artery with a mobile peduncle and it had infiltrated the left ventricular wall through the interventricular septum. Microscopic examination confirmed metastatic papillary thyroid carcinoma. Only 2 other cases of cardiac metastases of papillary thyroid carcinoma have been reported and this case is the first report of metastases in both ventricles with a mobile right ventricular pedunculated tumor.

Effect of protamine on cation-selective permeability in hamster medullary thick ascending limb of Henle's loop

To estimate the contribution of the paracellular shunt pathway to cation-selective permeability in the hamster medullary thick ascending limb of Henle's loop, we observed the effect of protamine, a selective blocker of paracellular conductance, on salt-diffusion voltage (dVT) in the isolated nephron segment perfused in vitro. When 300 microg/ml protamine was added to the lumen, the lumen-positive dVT generated upon reduction of the lumen NaCl concentration was decreased from 5.1 +/- 0.9 to 0.8 +/- 0.8 mV and the calculated Na+/Cl- permeability ratio was decreased from 1.40 +/- 0.14 to 0.86 +/- 0.08. Although the effect of protamine persisted after removal of the agent from the lumen, addition of 30 U/ml heparin, which neutralizes protamine, returned the dVT toward the control level. This effect was almost the same when the orientation of the imposed NaCl gradient was reversed. Protamine exhibited a similar effect on dVT in the presence of ouabain added to the bath. Protamine was without effect from the bath. Protamine did not affect the basel VT perfused with the control solution. Increased VT by decreasing perfusion pressure was inhibited by adding protamine from the lumen. These observations suggest that the paracellular pathway contributes to the cation selectivity of the medullary thick ascending limb. The cation selectivity of the paracellular shunt pathway may mainly account for the changes in VT which are either dependent on the luminal flow rate or transmural NaCl concentration gradient, while it may not contribute to the basal level of VT.

Successful conservative treatment of endometrial carcinoma permitting subsequent pregnancy: report of two cases

Two women with endometrial carcinoma who wished to preserve their childbearing ability received conservative treatment by medroxyprogesterone acetate (MPA, 600 mg/day for 22 weeks and 29 weeks, respectively). Following regression of endometrial lesions, their infertility was treated by inducing ovulation. Intact pregnancy was diagnosed 13 months and 11 months after completion of the MPA treatment, respectively. One patient had a twin pregnancy and delivered two infants at 35 weeks of gestational age. The other patient delivered a full-term baby. They had no evidence of recurrence 60 months and 31 months after the conservative treatment, respectively. We believe this conservative treatment with progestin may be safely performed for young patients with endometrial cancer who wish to preserve their fertility.

Recombinant adenoviral mediated CD39 gene transfer prolongs cardiac xenograft survival

BACKGROUND

Extracellular ATP and ADP may be important mediators of vascular inflammation and thrombosis. Nucleoside triphosphate diphosphohydrolase (NTPDase or CD39) is a vascular ectoenzyme that hydrolyses ATP and ADP; however, this activity is lost during reperfusion injury. We show that the supplementation of NTPDase activity within xenograft vasculature using CD39 recombinant adenoviruses (AdCD39) has protective effects in vivo.

METHODS

Recombinant adenoviruses containing human CD39 or beta-galactosidase (Adbeta-gal) encoding genes were constructed. Hartley guinea pig coronary arteries were perfused ex vivo with University of Wisconsin solution containing 10(9) plaque-forming units of the recombinant adenovirus. Infected grafts were then implanted in the abdomen of complement depleted Lewis rats.

RESULTS

NTPDase activities decreased in all grafts within the first 24 hr and subsequently recovered only in those hearts infected with AdCD39. Immunohistological examination of AdCD39-infected grafts confirmed successful CD39 gene transfer into the endocardium and macrovasculature. Expression of CD39 modestly prolonged graft survival (90.2+/-5.4 hr, mean+/-SD, n=5) when compared with Adbeta-gal-infected grafts (67.4+/-5.4 hr, P<0.005) and perfusion controls (66.4+/-5.2 hr; P<0.005).

CONCLUSIONS

Recombinant adenoviral infection can induce expression of CD39 within cardiac xenografts and provide survival benefits in vivo. Our data show that ex vivo infection by recombinant adenovirus vectors can result in vascular expression of a potential therapeutic agent.

[Investigation of a new HIV-1 p24 antigen detection kit based on the enzyme-linked fluorescent immunoassay]

We investigated the performance of the new p24 antigen detection kit (VIDAS HIV p24) with the conventional antigen kit (HIV-1 Ag monoclonal; Abbott). The new kit is an enzyme-linked fluorescent immunoassay (ELFA) and all of the assay steps are performed automatically by the VIDAS instrument within 100 minutes. With the seven HIV-1 seroconversion panels, three seroconversions were detected on an average of 6.8 days earlier with ELFA than the conventional EIA kit. ELFA showed negative results for all of the 11 false positive samples by the combined (p24, anti-HIV) detection kit (VIDAS HIV DUO). The results obtained suggest that ELFA are very useful for an earlier diagnosis of HIV infection and re-test for false positive samples by other HIV diagnosis kits.

Electrophysiologic characteristics of the Ca-permeable channels, ECaC and CaT, in the kidney

To investigate the molecular mechanism of Ca transport in the kidney, we have isolated Ca-permeable channels, rECaC (rat ECaC) and mCaT (mouse CaT1), from rodent kidney, which are recently reported as Ca-transporting proteins. RT-PCR suggested the presence of CaT1 in medullary tubules. It showed 67% homology with rECaC constructing a family. Whole cellular currents in Chinese hamster ovary (CHO) cells were measured by patch clamp. Expression of both proteins exhibited a similar large cation current, a high permeability to Ca, a time-dependent rapid inactivation, and a "run-down." When the pipet contained EGTA, the inactivation and the run-down did not occur. Addition of db-cAMP activated and following rp-cAMPS recovered the mCaT-induced current significantly, whereas no influence was observed in the rECaC-induced one. We conclude that ECaC and CaT are a molecular family of ion channel with similar characteristics, contributing Ca transport in the kidney.

Habitual snoring in an outpatient population in Japan

In order to investigate the occurrence and history of sleep problems in Japan, the 11-Centre Collaborative Study on Sleep Problems (COSP) project was carried out. Complaints of snoring are examined, and its prevalence, risk factors and screening reliability are discussed. The subjects who participated in the study were 6445 new outpatients from a general hospital. They were asked to answer a sleep questionnaire that consisted of 34 items with seven demographic items; each item was composed of four grades of frequency. In order to offset possible seasonal variations in sleep habits, data were collected across four seasons. Sleep patterns, insomnia, hypersomnia, parasomnia and circadian rhythm sleep disorders were covered. Habitual snoring was seen in 16.0% of males and 6.5% of females. Male predominance was noted. From these data, the relationship between habitual snoring and sleep complaints was statistically analyzed. Habitual snorers (HS) were observed to wake up more frequently during sleep (17.8% of males, 21.5% of females) than were non-habitual snorers (NHS; 6.6% of males, 9.7% of females). Mid-sleep awakening of HS was also more frequent than it was for NHS; however, there were no differences in difficulty in falling asleep and early morning awakening. Body mass index, cigarette smoking and alcohol consumption were also correlated with habitual snoring.

Precursor genes of future pandemic influenza viruses are perpetuated in ducks nesting in Siberia

Influenza A viruses of different subtypes were isolated from fecal samples of ducks in their nesting areas in Siberia in summer from 1996 to 1998. Phylogenetic analysis of the NP genes of the isolates in Siberia and those in Hokkaido, Japan on their flyway of migration from Siberia to the south in autumn revealed that they belong to the Eurasian lineage of avian influenza viruses. It is noted that the genes of the isolates in Siberia are closely related to those of H5N1 influenza virus strains isolated from chickens and humans in Hong Kong in 1997 as well as to those of isolates from domestic birds in southern China. The results indicate that influenza viruses perpetuated in ducks nesting in Siberia should have contributed genes in the emergence of the H5N1 virus in Hong Kong. Vaccine prepared from avirulent A/duck/Hokkaido/4/96 (H5N3) influenza virus was potent enough to protect mice from challenge with lethal dose of the pathogenic H5N1 virus [19]. Intensive surveillance study of aquatic birds especially in Siberia is, therefore, stressed to provide information on the future pandemic influenza virus strains and for vaccine preparation.

Inhibition of HIV-1 infection by an intramolecular antisense peptide to T20 in gp160

Antisense amino acids are amino acids which can be translated from the corresponding anti-codons of a sense amino acid. Antisense peptides encoded by the noncoding DNA strand have a tendency to interact with each other. We have demonstrated that antisense peptide sequences are present intramolecularly, and these may contribute to the folding and maintenance of the tertiary structure of a protein. T20 is a synthetic peptide with an amino acid sequence in the gp41 of HIV-1 and has been demonstrated to be a potent inhibitor of HIV-1 infection. We searched for intramolecular peptide sequences which are antisense to portions of T20. A synthetic peptide (TA-1L) consisting of amino acids 84 to 97 of gp160, which contains an antisense peptide sequence (TA-1) to T20, was shown to inhibit HIV-1(IIIB) infection of MT-4 cells. Interaction of these antisense peptides could be involved in sustaining HIV-1 infectivity. The TA-1L site, which exists in the C1 domain of gp160, is highly homologous among strains of HIV-1, especially at TA-1 and in the amino acids flanking the C terminus. Although the TA-1 sites of 18 out of 30 HIV-1 strains were antisense to the T20 region, those of the remaining 12 strains, including HIV-1(MN), were not. However, TA-1L inhibited infection by HIV-1(MN), which has no antisense peptide in T20 corresponding to TA-1, although the inhibitory effect was weaker. TA-1L may thus also interfere with the gp160 interaction with CD4, which has an antisense sequence to TA-1.

Lipopolysaccharide-induced HIV-1 expression in transgenic mice is mediated by tumor necrosis factor-alpha and interleukin-1, but not by interferon-gamma nor interleukin-6

BACKGROUND

As serum HIV-1 load correlates well with the prognosis of the disease, it is suggested that the viral load is one of the major determinants of the disease progression of AIDS. Accordingly, HIV-1 activation mechanisms were extensively studied in vitro, and involvement of cytokines including tumor necrosis factor (TNF)-alpha, interleukin (IL)-1, IL-6 and interferon (IFN)-gamma has been suggested in this process. However, so far the roles of these cytokines in the HIV-1 expression in vivo have not been well elucidated because of the lack of appropriate animal disease models.

OBJECTIVE

To elucidate the roles of cytokines in HIV-1 activation in vivo.

DESIGN AND METHODS

Transgenic mice carrying a defective HIV-1 genome were used as a model for HIV-1 carriers. In order to examine the possible involvement of cytokines in HIV-1 expression, TNF-alpha-, IL-1-, IL-6- and IFN-gamma-deficient HIV-1 transgenic mice, were produced and HIV-1 expression was analyzed after activation with bacterial lipopolysaccharides (LPS).

RESULTS

HIV-1 expression in the transgenic mouse spleen was activated 10- to 20-fold by LPS, and the serum p24 Gag protein levels reached 400 pg/ml, which is nearly equal to the levels that occur in AIDS patients. However, this augmentation was suppressed by 60% in TNF-alpha-deficient mice and by 40% in IL-1alpha/beta-deficient mice. In contrast, no suppression was observed in either IL-6-, IFN-gamma-, IL-1alpha, or IL-1beta-deficient mice.

CONCLUSIONS

Results suggest that TNF-alpha and IL-1 play important roles in HIV-1 gene activation and selective suppression of these cytokines could improve clinical prognosis and potentially slow progression of the disease.

CD39 modulates endothelial cell activation and apoptosis

BACKGROUND

CD39 is the dominant vascular nucleoside triphosphate diphosphohydrolase (NTPDase) that exerts major effects on platelet reactivity by the regulated hydrolysis of extracellular adenine nucleotides. The effects of NTPDases on endothelial cell (EC) activation and apoptosis remain unexplored.

MATERIAL AND METHODS

Recombinant replication-deficient adenoviruses were constructed with human CD39 cDNA (rAdCD39) or the bacterial beta-galactosidase (rAdbetagal).

RESULTS

Intact human umbilical vein EC cultures infected with rAdCD39 had substantial and stable increases in NTPDase biochemical activity (14.50 +/- 3.50 Pi nmole/well/min), when contrasted with noninfected cells (0.95 +/- 0.002) and rAdbetagal infected cells (1.01 +/- 0.02; p<0.005). Increased NTPDase activity efficiently inhibited immediate type 2Y purinergic receptor (P2Y)-mediated EC activation responses viz. von Willebrand factor secretion in response to extracellular ATP. In addition, CD39 up-regulation blocked ATP-induced translocation of the transcription nuclear factor (NF)-kappaB to the cell nucleus, and abrogated transcription of mRNA encoding E-selectin, and consequent protein synthesis. CD39 also decreased the extent of apoptosis triggered by putative type-2X purinergic (P2X7) receptors in response to high concentrations of extracellular ATP in vitro.

CONCLUSION

These properties of CD39 indicate primary vascular protective effects with potential therapeutic applications.

Cellular localization of aquaporin 7 in the rat kidney

The cDNA for the seventh mammalian aquaporin (AQP7) was isolated from rat testis, and its expression was demonstrated at the tail of late spermatids [Ishibashi et al: J Biol Chem 1997;272:20782-20786]. AQP7 is also expressed in the kidney. The localization of AQP7 in the kidney is unknown. We examined the cellular localization of AQP7 in the kidney with Northern blot, reverse transcribed PCR, Western blot and immunohistochemistry in the rat kidney. In Northern blot, AQP7 was expressed in the cortex and the outer medulla but absent in the inner medulla of the kidney. Reverse transcribed PCR of rat nephron segments revealed the selective expression of AQP7 at the proximal straight tubules (PST). Western blot of the membrane fraction of outer medulla revealed a single band of approximately 33 kDa. Immunohistochemistry of the rat kidney showed the selective expression of AQP7 at the brush border membranes of PST (S3 segment). AQP7 is now shown to be localized selectively at the brush border membranes of PST in the rat kidney. The result suggests that AQP7 may function as a pathway for transcellular water transport in PST in concert with more widely expressed AQP1 in proximal tubules. Alternatively, as AQP7 transports urea as well as water, AQP7 may function as a passive urea secretory pathway in this segment and may play a role in the formation and/or maintenance of the medullary urea concentration gradient.

Spontaneous rupture of bladder diverticulum after postoperative radiotherapy for carcinoma of the uterine cervix: a case report

We present a case of spontaneous rupture of bladder diverticulum three years after postoperative whole pelvic irradiation (50.4 Gy) for carcinoma of the uterine cervix. The patient had suffered from a neurogenic bladder after hysterectomy, but excretory urography revealed no abnormalities. Bladder diverticulum was found two years later. Spontaneous rupture of the urinary bladder is one of the late complications associated with radiotherapy, although it is very rare. Postoperative neurogenic bladder may also be associated with rupture. We should be aware of this rare complication in patients who receive pelvic irradiation.

[Anesthetic management of heart transplantation]

We anesthetized a 47-yr-old man with end-stage hypertrophic cardiomyopathy for heart transplantation. This is the first case of heart transplantation from a patient with brain death, since the organ transplantation law had become valid in Japan. Anesthesia was induced and maintained with fentanyl and diazepam. Aseptic technique was used in inserting and securing all catheters. The patient was assisted by left ventricular assist system, and hemodynamic suppression at anesthetic induction was trivial. Since complete AV block was present at the termination of cardiopulmonary bypass (CPB), VVI pacing and infusion of isoproterenol were started. In addition, nitroglycerin was given for pulmonary vasodilation. The cardiovascular support used for weaning from CPB included dobutamine, isoprote-renol, dopamine and milrinone. Following weaning from CPB sinus rhythm appeared spontaneously and function of the transplanted heart was satisfactory. When the patient was transported to ICU reduction in doses of catecholamines was possible, and dopamine and milrinone were infused. The patient was extubated 10 hours after admission to ICU.

Perianal mucinous carcinoma successfully treated with a combination of external beam radiotherapy and high dose rate interstitial brachytherapy

The case of an 84-year-old man with perianal mucinous carcinoma is presented. The tumour was 6 cm in diameter and extended into the surrounding tissues. Taking the patient's advanced age and disease into account, rectosigmoidectomy and colostomy were carried out without resection of most of the tumour. Radiotherapy consisted of pre-operative external beam radiotherapy (EBRT) of 40 Gy in 20 fractions, post-operative EBRT of 24 Gy in 12 fractions, and high dose rate interstitial brachytherapy of 12 Gy in a single fraction. The patient tolerated the entire course of radiotherapy well. The patient is doing well without regrowth or complications 7 years after radiotherapy. To our knowledge, there have been no reports on the successful outcome of radiotherapy for perianal mucinous carcinoma. This case suggests that a combination of EBRT plus interstitial brachytherapy boost may play a role in the definitive treatment of perianal mucinous carcinoma.

Molecular cloning of a novel form (two-repeat) protein related to voltage-gated sodium and calcium channels

Voltage-gated Ca and Na channels share similar structure: four homologous domains (I-IV), each with six transmembrane segments (S1-S6). They may be formed by two rounds of duplication of a single channel domain similar to voltage-activated potassium channels. However, the channels with the intermediate structure, namely, two-domain channels have not yet been identified. We report here the cloning of a novel protein from rat kidney that contains two domains (I-II), each with S1-S6 segments that are found in voltage-gated Ca and Na channels. Because of unusual structure, the protein was named two-pore channel 1 (TPC1). TPC1 encodes 819 amino acids with two conserved positively charged voltage sensor segments (S4) but the pore segments are not conserved. Northern blot analysis showed that TPC1 mRNA (5 kb) was expressed widely. It was expressed at relatively high level in kidney, liver, and lung. Immunohistochemistry of kidney revealed that TPC1 was expressed at inner medullary collecting ducts. In expression studies, no functional currents could be detected in CHO cells and Xenopus oocytes. Based on its primary structure, we propose that TPC1 might be a predecessor of the conventional four repeat voltage-gated Ca and Na channels and will give insights into the evolution of ion channels.

CD39 modulates IL-1 release from activated endothelial cells

The activation of endothelial cells (EC) and monocyte-macrophages (M&phi;) by lipopolysaccharide (LPS) is considered an important element of the vascular injury observed in endotoxemia. Interleukin-1 (IL-1) beta release from M&phi; in response to LPS, appears to be mediated by the autocrine/paracrine release of ATP via P2X7 receptor activation. In EC, similar nucleotide-mediated signaling pathways may be influenced by high levels of expression of CD39, the vascular nucleoside triphosphate diphosphohydrolase (NTPDase; ENTPD I). To determine whether CD39 modulates ATP-mediated release of IL-1 from EC, we stimulated human EC with LPS and measured levels of ATP secretion and IL-1 release. LPS triggered ATP secretion from EC that was soon followed by IL-1alpha release. Overexpression of CD39 following infection with recombinant CD39 adenoviral vectors (AdCD39) abrogated the initial phase of ATP secretion and inhibited IL-1alpha release; comparable results were obtained with soluble NTPDase. These data demonstrate that CD39/NTPDase modulates IL-1alpha release from LPS stimulated human EC.

[HIV-1 (human immunodeficiency virus type 1) mutant strain associated with zidovudine resistance detected from a Japanese patient with primary HIV-1 infection]

Sequences of HIV-1 pol gene were determined by direct sequencing from a Japanese patient with primary HIV-1 infection. The patient did not receive antiretroviral therapies. However we observed a HIV-1 mutant strain associated with zidovudine (ZDV) resistance. The patient had both the codon 70 and the codon 215 amino acid substitutions in the RT region. Our data indicated that the patient was infected with a HIV-1 mutant strain associated with ZDV resistance and this is the first report in Japan.

Cyclic AMP stimulates the gene expression of a non-selective cation channel, mNSC1, in pancreatic beta-cell line, MIN6

Mouse non-selective cation channel 1 (mNSC 1) cDNA from mouse pancreatic beta-cell line, MIN6, have recently been cloned. Since the number of non-selective cation channel in pancreatic duct cells has been reported to increase 9-fold in 5 h incubation with cAMP, the effect of cAMP on the gene expression of mNSC1 in MIN6 cells was examined. Dibutyryl cAMP (db-cAMP) was shown to increase the level of the mRNA by reverse transcription-polymerase chain reaction (RT-PCR). The copy number of the mRNA was increased 4-fold in 6 h incubation with db-cAMP by competitive PCR. Western blot analysis also indicated a 4-fold increase in the quantity of the newly synthesized protein in 9 h incubation with db-cAMP. Experiments with 5'-flanking region and with a transcriptional inhibitor suggested that db-cAMP affected transcription, and protected the mRNA from its degradation as well. It is concluded that the expression of mNSC1 is indeed increased by cAMP in the pancreatic beta-cells.

Acute effect of cadmium-metallothionein on glucose and amino acid transport across the apical membrane of the rabbit proximal tubule perfused in vitro

Acute as well as chronic exposure of cadmium (Cd) leads to proximal tubule injury. The exact cellular mechanism of this disorder and whether there is a contribution of cadmium-metallothionein (Cd-MT), a binding protein of Cd, remain unclear. We perfused isolated S2 segments of rabbit nephron, and the deflections of transmural voltage (DeltaV(t)) and apical membrane voltage (DeltaV(a)) on elimination of glucose or alanine from the perfusate were measured for the parameters of activity of Na(+)-glucose and Na(+)-amino acid cotransporters. The effects of Cd-MT or CdCl(2) to either bath or lumen for 10 min on these parameters were examined. We also measured the lumen-to-bath [(14)C]glucose flux. Addition of Cd-MT to lumen suppressed glucose- or alanine-dependent DeltaV(t) and DeltaV(a), as well as baseline V(t) and basolateral membrane voltage (V(b)), at approximately 10 min. [(14)C]glucose flux was inhibited by Cd-MT to lumen. The effects of Cd-MT to bath and CdCl(2) to either lumen or bath were 100-fold less potent than that of Cd-MT to lumen. Luminal Cd-MT immediately suppressed the glucose-dependent DeltaV(a), whereas the baseline V(a) and V(t) were unchanged. The early effect of luminal Cd-MT was simulated by addition of 10(-4) M phloretin. Addition of 10(-4) M ouabain to the bath simulated the later effect of Cd-MT. The protection of SH group by dithiothreitol prevented the early effect of Cd-MT, but not the later effect. We concluded that Cd-MT initially acts directly on Na(+)-glucose and Na(+)-amino acid cotransporters from the lumen by attacking SH group, followed by the later inhibition of Na(+)-K(+)-ATPase after entering the cell from the apical membrane.

Absorption of calcium, magnesium, phosphorus, iron and zinc in growing male rats fed diets containing either phytate-free soybean protein or soybean protein isolate or casein

The effect of dietary phytate-free soybean protein (PFS) on intestinal mineral absorption and retention was examined in growing male rats using a three-day mineral balance technique. The rats were fed diets containing PFS, soybean protein isolate (SPI) or casein at a 20% level for 5 wk. Total calcium (Ca), magnesium (Mg), phosphorus (P), iron (Fe) and zinc (Zn) contents in diets were adjusted to 0.35, 0.05, 0.7, 0.0035 and 0.003%, respectively, by supplementation of the diet with their salts. Mineral absorption and retention ratios in rats fed the PFS diet were significantly higher than those in rats fed either the SPI or casein diet. These results suggest that PFS may be a promising dietary protein source for improving the mineral bioavailability in humans.

Palmitoylation targets CD39/endothelial ATP diphosphohydrolase to caveolae

Ectonucleotidases influence purinergic receptor function by the hydrolysis of extracellular nucleotides. CD39 is an integral membrane protein that is a prototype member of the nucleoside 5'-triphosphate diphosphohydrolase family. The native CD39 protein has two intracytoplasmic and two transmembrane domains. There is a large extracellular domain that undergoes extensive glycosylation and can be post-translationally modified by limited proteolysis. We have identified a potential thioester linkage site for S-acylation within the N-terminal region of CD39 and demonstrate that this region undergoes palmitoylation in a constitutive manner. The covalent lipid modification of this region of the protein appears to be important both in plasma membrane association and in targeting CD39 to caveolae. These specialized plasmalemmal domains are enriched in G protein-coupled receptors and appear to integrate cellular activation events. We suggest that palmitoylation could modulate the function of CD39 in regulating cellular signal transduction pathways.

Optical coherence tomography of orange-red subretinal lesions in eyes with idiopathic polypoidal choroidal vasculopathy

PURPOSE

To study the cross-section images of orange-red lesions in eyes with idiopathic polypoidal choroidal vasculopathy and compare their protrusions quantitatively with those of serous retinal pigment epithelium detachment.

METHODS

Optical coherent tomography images scanning remarkable orange-red lesions in eyes with idiopathic polypoidal choroidal vasculopathy and serous retinal pigment epithelium detachment in age-related macular degeneration or central serous chorioretinopathy were prospectively recorded. The correlation between the base diameter and the height of the lesions was analyzed.

RESULTS

Optical coherence tomography images show prominent anterior protrusion of the orange-red lesions. The ratio of the height to the base diameter of the orange-red lesions in eyes with idiopathic polypoidal choroidal vasculopathy is 0.32+/-0.05, and it is significantly larger than lesions in eyes with serous retinal pigment epithelium detachment (0.18+/-0.05, P< .001).

CONCLUSION

The orange-red lesions in eyes with idiopathic polypoidal choroidal vasculopathy have a more sharply peaked shape than serous retinal pigment epithelium detachment as a subretinal structure, suggesting polypoidal vascular lesions in eyes with idiopathic polypoidal choroidal vasculopathy are situated beneath the Bruch membrane and covered anteriorly with both the retinal pigment epithelium and the Bruch membrane.

[Evaluation of the rapid detection test for influenza A and B viruses using neuraminidase activity]

The ZstatFlu test (ZymeTx, USA) is a rapid detection kit for influenza A and B viruses. This test is based upon the reaction between viral neuraminidase from influenza viruses and a chromogenic substrate. The clinical performance of the ZstatFlu test was determined by comparison with viral isolation in cell culture. A total of 176 respiratory specimens from 172 pediatric patients with influenza like illnesses during the 1998/99 season were tested. Influenza viruses were recovered from 97 specimens (type A: 6, type B: 91) in cell culture. ZstatFlu demonstrated 67.4% sensitivity (29/43) and 62.7% specificity (37/59) for throat swabs. Of the 22 ZstatFlu-positive, culture-negative throat swabs tested by RT-PCR, 18 were positive by RT-PCR. ZstatFlu showed 48.1% sensitivity (26/54) and 90.0% specificity (18/20) for nasopharyngeal aspirates. Of the two ZstatFlu-positive, culture-negative nasopharyngeal aspirates tested by HI titer of paired sera, one showed a 4-fold increase of HI titer. Nasopharyngeal aspirates therefore showed lower sensitivity than throat swabs at this test, different from EIA test kits such as Directigen FluA or FLU OIA. Overall, only 5 specimens were false positive by the ZstatFlu test. Therefore, this test demonstrated high specificity and positive predictive value. In conclusion, the ZstatFlu test is useful for the rapid detection of influenza A and B viruses to identify patients who need antiviral treatment.

Characterization of mouse DAF on transfectant cells using monoclonal antibodies which recognize different epitopes

Several membrane proteins prevent host cells from homologous complement attack. In humans, one such protein, decay-accelerating factor (DAF), exists as two isoforms, a GPI anchored form and a secreted form, which are generated by alternative splicing. DAF in mouse is also expressed as two isoforms, a GPI anchored form (GPI-DAF) and a transmembrane form (TM-DAF), which are produced from two separate genes. In this study, we transfected cDNA of mouse GPI-DAF or TM-DAF into Chinese hamster ovary (CHO) cells. Both isoforms of DAF on CHO cells were shown to regulate mouse complement C3 deposition mediated by the classical and alternative pathways and the inhibitory activity of both isoforms was species restricted. The two mouse DAF isoforms were effective against rat complement but not against human and guinea pig complement. Furthermore, we produced hamster mAbs to mouse DAF using GPI-DAF transfectant cells and established seven unique mAbs (RIKO-1-7). Western blotting analysis using RIKO-3, which reacts with both GPI-DAF and TM-DAF, and RIKO-4, which is an anti-GPI-DAF specific mAb, indicated that GPI-DAF was expressed on erythrocytes, spleen and testis, and that TM-DAF was expressed only in testis.

[Evaluation of an optical immunoassay test for rapid detection of influenza A and B viral antigen]

An optical immunoassay test, FLU OIA (BIOSTAR, USA), was evaluated for the diagnosis of influenza viral infection. The reactivity of the FLU OIA test was evaluated using 42 influenza strains (25 human influenza A, 12 human influenza B, 2 swine influenza A and 3 avian influenza A strains). The FLU OIA test showed positive results for all influenza strains. There was no evidence that cross-reactivity occurred with non-influenza viruses. The detection limit of the FLU OIA test was found to be 3.0-6.5 x 10(4) pfu/assay for human influenza A and B strains. The sensitivity and specificity of the FLU OIA test compared to isolation in cell culture was 89.7% and 76.0% for testing of 54 nasopharyngeal aspirate specimens. The FLU OIA test is rapid and easy for the detection of influenza A and B viral antigen and provide a valuable tool for the rapid diagnosis of influenza viral infection.

Peripheral arterial coil embolization for hepatic arteriovenous malformation in Osler-Weber-Rendu disease; useful for controlling high output heart failure, but harmful to the liver

A 55-year-old Japanese housewife, who had Osler-Weber-Rendu disease, was admitted to our hospital because of frequent epistaxis and worsening exertional dyspnea. The computed tomography and hepatic arteriography revealed large hepatic arteriovenous malformation, which was considered to be the leading cause of her high output heart failure. Two series of hepatic arterial coil embolization procedures were performed to reduce hepatic shunt flow. They temporarily improved her cardiac condition, but gradually induced progressive hepatic failure due to intrahepatic cholangitis. Hepatic dysfunction restricted her quality of life and lead to a fatal clinical course one year after the second coil embolization.

[Kinetic analysis of anti-HIV titer in early stage of HIV infection--a new testing strategy to differentiate early HIV infection individuals from false positive cases]

We analyzed the anti-HIV antibody titer by particle agglutination (PA) on 11 HIV seroconversion panels. PA titer increased very rapidly and the titer went up to 1,000 or more within 18.2 days after seroconversion. The results suggest that one to two weeks of duration will be enough to differentiate persons at the early stage of HIV infection from individuals with HIV screening test initially reactive but false positive. In Japan, HIV prevalence is very low and the majority of the HIV screening test-positive (reactive) cases turned out to be false positive. This HIV testing strategy (one to two weeks interval bleeding) will be very practical and useful to differentiate early stage of HIV infection cases from the majority of false positive cases.

Optical coherence tomography of successfully repaired idiopathic macular holes

PURPOSE

To present the cross-sectional retinal imaging results of optical coherence tomography in eyes with successfully repaired idiopathic macular hole and their relevance to visual recovery.

METHODS

We studied 33 eyes with successful repair of an idiopathic macular hole through vitrectomy and fluid-gas exchange from 32 patients (11 men and 21 women) with ages ranging from 48 to 78 years, with a median age of 66 years. Preoperative conditions in eyes with primary surgery disclosed nine eyes with stage 2, 14 eyes with stage 3, and four eyes with stage 4 macular hole. An additional six eyes underwent a second surgery because the previous surgery was unsuccessful. Measurement of best-corrected visual acuity, slit-lamp biomicroscopy with fundus contact lens, fundus photographs, and optical coherence tomographic examination were performed between 6 and 9 months after surgery in 29 eyes and between 15 and 36 months after surgery in four eyes.

RESULTS

Optical coherence tomographic images of the repaired macular holes were categorized into three patterns. U-type (normal foveal contour; 13 eyes) showed mildly to moderately backscattering layers with a smooth circular surface covering retinal pigment epithelium and choriocapillaris layers. In eyes with V-type (steep foveal contour; 13 eyes), the retinal pigment epithelium and choriocapillaris layers were covered with moderately backscattering layers with a notch. W-type (foveal defect of neurosensory retina; seven eyes) showed abruptly or gradually terminating sensory retinal layers to expose the surface of the retinal pigment epithelium and choriocapillaris layers. Postoperative acuity was well correlated with these patterns of optical coherence tomographic images.

CONCLUSION

Assessment of successfully repaired idiopathic macular holes with optical coherence tomographic images provides a useful correlation with postoperative visual recovery.