A new regulatory element that augments the Tax-dependent enhancer of human T-cell leukemia virus type 1 and cloning of cDNAs encoding its binding proteins

The Tax protein of human T-cell leukemia virus type 1 (HTLV-1) trans activates the 21-bp enhancer of HTLV-1. A sequence of more than two copies of the 21-bp enhancer is efficiently activated by Tax, but one copy is not activated extensively. Another sequence (TRE-2, positions -163 to -117) adjacent to the 21-bp enhancer in the long terminal repeat of HTLV-1 can enhance a single copy of the 21-bp enhancer activity in trans activation by Tax. This sequence contains motifs related to the Ets- and NF-kappa B-binding sequences, but mutations at these sites indicated that neither is responsive to cooperation with the 21-bp enhancer. A deletion mutation of TRE-2 identified 25 bases at positions -158 to -134 (TRE-2S) as an essential sequence, and TRE-2S was sufficient to give maximum cooperation with one copy of the 21-bp enhancer in trans activation by Tax protein. Using TRE-2S as a probe, we screened a cDNA library of HUT102 cells by the Southwestern (DNA-protein) procedure and isolated two cDNA clones, THP-1 and -2. These two clones encode TRE-2S-binding proteins, and they differ by only an extra 17 amino acids in THP-2. Both THP proteins contain five zinc finger motifs which are strikingly similar to those of the GLI family, an amplified gene product in glyoma cells. The binding site of THP-1 and -2 was GAACCACCCA in TRE-2S, which is highly homologous to the GLI-binding site. These results suggest that binding of THP to TRE-2S may be involved in cooperation with one copy of the 21-bp enhancer in responding to Tax trans activation.

[Clinical usefulness of measurement of erythropoietin in blood]

Blood erythropoietin (EPO) concentration was measured by radioimmunoassay in 513 patients with various diseases. Untreated polycythemia vera showed lower EPO concentration than normal. Aplastic anemia (AA) revealed the highest EPO level among all anemic diseases in relation to hematocrit value. EPO level of AA patients who underwent bone marrow transplantation was as low as normal subjects even when the anemia has not fully recovered. Paroxysmal nocturnal hemoglobinuria (PNH) showed unusually high EPO concentration among hemolytic anemias. In normal subjects, blood EPO concentration showed a diurnal rhythm that was higher at night than during the daytime. These findings suggest the diagnostic usefulness of measurement of EPO in blood diseases.

[Comparison of endoscopic therapy and conventional surgery for the treatment of early gastric cancer in elderly patients]

The first choice for the treatment of gastric cancer is surgery. Presently, endoscopic therapy offers the possibility of cure for some types of early gastric cancer, especially among aged or poor surgical risk patients and has obtained excellent results. During the past 13 years and 6 months from April 1978 to September 1991, 55 lesions in 52 patients aged over 75 years old were treated by endoscopic therapy. During this same period, 57 patients aged over 75 years old were surgically treated for early gastric cancer. In this study we evaluated the efficacy of endoscopic therapy for the treatment of early gastric cancer, and furthermore we compared endoscopic therapy with surgery in relation to prognosis, complications and quality of life. The analysis of endoscopic treatment showed that in 72.7% of our cases local cure was obtained. Generally, early gastric cancers less than 20 mm, of well differentiated type, restricted to the mucosa and without ulceration are suitable for endoscopic therapy. Local cure could be achieved in more than 90% of these cases. Among the 52 patients treated by endoscopic therapy, there were residual lesions after treatment in in 4 patients. They died of advanced disease or metastatic liver tumor. These patients were poor surgical risks and for this reason surgery was contraindicated. Analysis by the Kaplan-Meier method showed that in comparison with conventional surgery, endoscopic therapy showed better results in the first two years of follow up and almost the same results after three years.(ABSTRACT TRUNCATED AT 250 WORDS)

[Determination of the standard level of serum erythropoietin in relation to hemoglobin concentration]

Serum erythropoietin (EP) concentration was measured by the recombinant EP-based radioimmunoassay and was examined to standardize the hemoglobin (Hb) related level of 144 normal control and 56 patients with iron deficiency anemia and hemolytic anemia excluding paroxysmal nocturnal hemoglobinuria. The standardization was achieved by logarithmic regression of the EP titier on Hb either by the two-phase linear form or by the third degree sigmoid form at a 95% confidence limit for each regression. The third degree regression was found to be preferable from the view point of both statistics and the negative feedback mechanism. The average and scattering of the deviation from the standard level thus determined of the disease groups indicated that the EP level is: (1) 12 fold higher than the standard level in 42 aplastic anemias (the most in excess and a few in standard). (2) three fold higher than that in 27 myelodysplastic syndromes (relatively higher dispersed state). (3) 29% of the standard level in 33 anemias associated with chronic renal failure (deficient state). (4) 105% of the extrapolated standard level in 22 polycythemia veras (standard state). The standardization of Hb-related Ep titer may provide new pathophysiological approaches in a variety of hematopoietic disorders.

Studies on ras oncogene activation in endometrial carcinoma

The frequency of K-ras point mutation(PM) at codon 12 was studied in 45 patients with endometrial carcinoma. In vitro amplification of target sequences of DNA extracted from endometrial cancer tissues by polymerase chain reaction and dot blotting with oligonucleotide hybridization were performed. Ten of 45 endometrial carcinomas disclosed K-ras PM at codon 12 (22.2%). Transition from GGT to GAT was most frequent in PM(41.7%). Simultaneously, double PM (GAT/GCT) were also detected in 2 cases. No relationship appeared to be present between PM and clinical prognosis such as clinical stage, histological type, histological grade of differentiation, depth of myometrial invasion, and ascitic cytology. The positive rates of lymph node metastasis tended to be higher in the group with positive PM than in the group without PM. K-ras and C-myc gene amplifications were found in 2 (5.1%) and 3 (7.7%) of 39 cases, respectively. No PM of H-ras at codons 12 and 61 was detected. Our results showed that the PM of K-ras gene at codon 12 was a fairly common event in genetic abnormality and suggested it would have some role in the progression of carcinogenesis in endometrial carcinoma.

Varicella-zoster virus infection in immunocompromised patients

The prophylactic effect of acyclovir (ACV) on varicella-zoster virus (VZV) infection in leukaemia patients who have undergone bone marrow transplantation (BMT) was reviewed. The benefits of the use of the laminar air flow (LAF) room in the prevention of nosocomial VZV infections in the haematological ward are also discussed. Since 1986 ACV has been administered to BMT patients to prevent herpes simplex virus (HSV) infections. Of 98 patients with leukaemia who underwent BMT, 73 received ACV (200 mg five times daily) and 25 were not given ACV. In the untreated group, 9 patients (36.0%) developed VZV infection by day 67 (median) and 3 patients died due to disseminated VZV infection. In the ACV-treated group, 18 patients (24.6%) developed VZV infection by day 150 (median) and there were no deaths. From July to December 1989, nine cases of VZV infections (eight patients and one nurse) were reported in the haematological ward of the hospital. All cases originated in the conventionally ventilated areas of the ward while no VZV infections were reported in the 14 patients who occupied the LAF rooms during the same period.

[Clinical effects of cefodizime in severe infections complicated with hematological diseases. Hanshin Infection Study Group]

One hundred thirty-eight patients with severe infections accompanying hematological diseases were treated with cefodizime (CDZM). CDZM was administered by intravenous injection at daily doses ranging from 2 g to 8 g for about 3 to 18 days. Clinical efficacies of CDZM were excellent in 30 cases, good in 37 cases, fair in 1 case and poor in 53 cases. The efficacy rate was 55.4%. The efficacy rate was 56.4% in patients from whom causative organisms were not identified. The efficacy rate against Gram-negative bacteria (66.7%) was higher than that against Gram-positive bacteria (28.6%). No significant differences in the efficacy rates were found among groups of patients with different initial neutrophil counts (less than 100, 100-499, and over 500/microliters). Skin eruption caused by CDZM was observed in 2 patients (1.5%). Hepatic disorders, renal dysfunction and urinary test abnormality (protein and urobilinogen) were observed in 7 (5.0%), 1 (0.7%) and 1 (0.7%), respectively. Therefore, CDZM was considered to be a clinically useful antibiotic for severe infections complicated with hematological diseases.

Helicobacter pylori infection and gastroduodenal disease: a comparison of endoscopic findings, histology, and urease test data

To determine the prevalence and significance of Helicobacter pylori (H. pylori) infection, biopsies of the antral mucosa were obtained from 139 patients and 43 asymptomatic volunteers. The specimens were examined by hematoxylin-eosin staining and the ureas test. The detection rate of H. pylori by histologic examination was 91.3% in patients with duodenal ulcer, 75.0% in those with combined duodenal and gastric ulcer, 63.6% in those with gastric ulcer, 22.9% in those with gastric carcinoma, 36.4% in those with gastric adenoma, 14.3% in those with gastric hyperplastic polyp, and 51.7% in those with gastritis, and the respective percentages detected by the urease test were 91.3%, 75.0%, 54.5%, 28.6%, 27.3%, 14.3%, and 44.8%. H. pylori was also detected in 10/43 (23.3%) asymptomatic healthy volunteers by histology and the urease test. The prevalence of H. pylori was significantly higher in the patients than in the asymptomatic healthy volunteers (p < 0.05). H. pylori was detected in 62.9% of patients with endoscopic erosive gastritis and in 97.9% of those with histologically proven chronic active gastritis. The urease test was positive in 77/82 patients who were histologically positive for the organism (sensitivity: 93.9%), and it was negative in 98/100 patients who were negative by histology (specificity: 98.0%). Thus, there was over 90% agreement between the urease test and histology. Our investigations showed that H. pylori was closely related to peptic ulcers and antral gastritis, and that the urease test provides a simple, rapid and accurate diagnosis of H. pylori infection.

Marked increase of CD57+CD16- cells in long-term survivors of graft-versus-host disease after allogeneic bone marrow transplantation

We have evaluated long-term serial changes in the immunological state from soon after allogeneic bone marrow transplantation (BMT) In 44, mainly leukemia patients with respect to changes in lymphocyte surface markers. Absolute numbers of cluster designation (CD)2+, CD20+ and human lymphocyte antigen-DR+ (HLA-DR+) cells recovered to within their normal ranges three months, one year and two years, respectively, after BMT. The reversal of the CD4+: CD8+ ratio persisted for five years or more but returned to normal after six years. CD57+CD16- cells were markedly increased from three mo up to a maximum of five years after transplantation; they were increased between three and six months after transplantation irrespective of graft-versus-host disease (GVHD), but changes after one year or more differed among patients without GVHD, with acute GVHD, with acute and chronic GVHD or with chronic GVHD. Absolute numbers of CD57+CD16- cells tended gradually to return to normal after one year or more in the group without GVHD but only after six years in patients in the other three GVHD groups.

Alopecia universalis treated with oral cyclosporine A and prednisolone: immunologic studies

Alopecia universalis is a refractory condition. Although the cause of this disease is unknown, immunologic abnormalities have recently been suspected. Thus, we treated six cases of refractory alopecia universalis with immunotherapy. Oral administration of cyclosporine A (2.5 mg/kg) and prednisolone (5 mg/day) resulted in marked symptomatic improvement. Cyclosporine A did not produce any side effects because the administered dosage was relatively low. At present, more than 6 months after the cessation of treatment, recurrence of alopecia has not been seen. Oral administration of low-dose cyclosporine A and prednisolone is considered to be an effective treatment for this disease. Immunologic examination of peripheral blood demonstrated improvement of immunologic function. In particular, CD8-positive T cells, NK cells, and C3, which had been reduced, were increased. A reduction in active CD4 cells, eosinophils, and circulating immune complexes was observed. Histology with fluorescent antibodies showed T-cell infiltration around the hair matrixes. This phenomenon was no longer observed after treatment. These improvements in immunologic function were seen in parallel with the resolution of the clinical symptoms, indicating that immunologic abnormalities are related to this disease.

Comparative report on endoscopic and surgical treatment for early gastric cancer in elderly patients

Two cases of elderly patients with similar early gastric cancers who were submitted to endoscopic and surgical treatment are presented as examples. Considering older patients as a sole group in the decision-making process we discuss the pros and cons of each therapy supporting efficacy and opposing side effects in order to maintain a reasonable quality of life.

Isolation of genes specifically expressed in flat revertant cells derived from activated ras-transformed NIH 3T3 cells by treatment with azatyrosine

We previously reported that mouse NIH 3T3 cells transformed by transfection of activated human c-Ha-ras become apparently normal upon treatment with the antibiotic azatyrosine. The revertant cells maintain their normal phenotype during prolonged culture in the absence of azatyrosine, although activated p21ras is still expressed. The normal phenotype induced by azatyrosine could be due to activation of expression of some cellular gene(s) in the cells that results in suppression of ras function. To identify the genes with increased expression in the revertant cells, we adopted differential screening of recombinants from a phage cDNA library made from mRNA of the revertant cells, hybridized with 32P-labeled cDNAs made from mRNAs of the ras-transformed NIH 3T3 cells and the revertant cells. Two clones thus isolated were found to be almost identical to the ras recision gene (rrg), which was identified as a tumor-suppressor gene by Contente et al. [Contente, S., Kenyon, K., Rimoldi, D. & Friedman, R. M. (1990) Science 249, 796-798]. Other genes identified were the collagen type III and rhoB genes. Approximately half the clones were found to contain a sequence corresponding to that of the murine retrovirus-like intracisternal A particle. We speculate that azatyrosine activates several cellular genes in the ras-transformed cells and that some of these genes, including rrg, act cooperatively to counteract ras function, resulting in reversion of the ras-transformed cells to the normal phenotype.

[Graduated psychosomatic treatment and quality of life in asthmatics]

We investigated the quality of life (QOL) in 72 patients with bronchial asthma who are under our gradational psychosomatic treatment (GPT) by means of an 11-item questionnaire. The results were summarized as follows: 1) Ninety-two percent of the subjects showed a good understanding of mind-body relations and modified their stressful adaptive patterns. 2) Asthmatic symptoms improved in 86 percent of the subjects. Other symptoms also improved in 72 percent of the subjects. 3) In 81 percent of the subjects, their daily life improved. Furthermore 96 percent of the subjects obtained some advantages through GPT. 4) There were various improvements in psychological states, personal relations and life style in most of the subjects. 5) The attitudes of their families toward the patients improved in 46 percent of the subjects, however 71 percent of the families developed a better understanding of the cause of asthma from the psychosomatic point of view. 6) Most of the subjects with moderate or severe symptoms were considered to have reduced the grade of severity of their symptoms from the doctor's standpoint.

Effects of the biopsychosocial approach (BPSA) on exercise-induced asthma (EIA)

The Biopsychosocial Approach (BPSA) is a treatment program for allergic patients which includes therapy for psychological, behavioral and social factors as well as for physical problems, following basic principles of psychoneuroimmunology. BPSA was applied to patients with bronchial asthma and favorable results were obtained. The mechanism of the therapeutic effects of BPSA included normalization of the patient's autonomic nervous function, levels of blood histamine, and circadian rhythm of lymphocyte activity. BPSA was also used in patients with exercise induced asthma (EIA) and the same parameters were evaluated. Results showed that patients with EIA recovered physiological homeostasis after BPSA therapy normalized blood levels of histamine and substance P (SP), skin reactions to histamine and SP, and autonomic nervous function. We conclude that BPSA is effective for treating patients with EIA.

Long-term follow-up investigation of the effects of the biopsychosocial approach (BPSA) to bronchial asthma

The recent rapid increase in the number of allergic patients is becoming a social problem. Studies of the causes of this phenomenon involve various fields, with much attention focused on finding new antigens in food, air, articles encountered in daily living, etc. Recent studies of psychoneuroimmunology (PNI) also suggest a strong influence of emotions on allergic reactions. The number of allergic patients is increasing in all civilized countries without exception, and the stress prevalent in modern civilized society is related to this increase. Modern allergology does not yet have sufficient countermeasures for such stress states. We applied a biopsychosocial approach (BPSA) to treatment programs for allergic disease, incorporating treatment of physical and psychosocial problems en bloc. We studied the long-term effects of BPSA therapy on 82 patients who were treated for more than 3 months in the hospital and were examined 2 to 3 years after discharge. Results showed that more than 80% of patients maintained improvement and 45% of those with intractable asthma were able to withdraw from steroid hormones. BPSA achieved better results than those with standard medication administered only to the body. Improvements after treatment included physical changes, normalization of MV (microvibration) type, decreased levels of plasma histamine, and normal circadian rhythms of lymphocyte subsets. These changes reflect part of the physical mechanisms by which BPSA improves asthma symptoms. From a psychological view point, the patients' feelings, personal relations, behavior, etc. were changed after BPSA, allowing a new life style and improved QOL. It is important for asthma patients to maintain good overall condition over long periods. After BPSA, 80% of our patients were able to do so. It is difficult for the therapist to approach asthma from different aspects at once, including biological, psychological, and social, so we developed a five-stage program of BPSA therapy and found that this obtained favorable results.

[Early phase II study of MST-16 (sobuzoxane) on malignant lymphoma]

Early phase II study of MST-16[4,4-(1,2-ethanediyl) bis (1-isobutoxycarbonyloxy-methyl-2, 6-piperazinedione], a derivative of ICRF-154, on malignant lymphoma was conducted by multi-institutional cooperative group. MST-16 was administered orally at doses of 1,600 mg/body/day for 5 days or 1,200 mg/body/day for 10-14 days, mainly. The number of registered and evaluated patients were 29 and 28, respectively (Hodgkin's disease 3 patients and non-Hodgkin lymphoma 25). Twenty-seven of 28 patients had received prior chemotherapy and/or radiation therapy. Of 28 evaluable patients, overall response rate (CR + PR) was 32.1%. In high-dose administration group, the response rate was not significantly high. The response rate seemed to be high in patients who were treated repeatedly (number of courses greater than 3). Major side effects observed were myelosuppression and gastro-intestinal disorders which were reversible in a rest period. Myelosuppression seemed to be severe in high-dose administration group. This study indicated that MST-16 was a useful agent against malignant lymphoma including primary resistant or relapsed patients, and that the recommended regimen for a late phase II study was considered to be 1,600-2,400 mg/body/day for 5-7 days repeatedly with a pause of several days. Furthermore, the study should be considered at the dose of 3,200 mg/body because half cases administered at this dose showed some response.

[Psychosomatic study of inhalation therapy in patients with bronchial asthma. II. Relationship between subjective self assessment of dyspnea and peak expiratory flow rates]

The degree of dyspnea when using metered-dose inhalers (MDIs), and the relationship between subjective self assessments and objective peak expiratory flow rates were examined by means of visual analogue scales and mini wright peak flow meters in 16 subjects with asthma. Three subjects who were neurotic in character were found to have a poor perception of the degree of airway obstruction after inhalation compared with objective changes in their condition. Two subjects, one neurotic and one alexithymic, assessed the degree of dyspnea to be worse after inhalation, when objectively there were few changes. However, one neurotic subject perceived an improvement in his condition when, in fact, there was little change. Furthermore, some severe cases used MDIs in the rogressive state of airway obstruction. In conclusion, we must pay attention to patients' characters when determining treatment in order to prevent overuse of MDIs or delays in treatments including the use of MDIs.

Psychosomatic approach to patients with gynecologic cancer

In patients with terminal cancer, there is a need for a psychosomatic approach in which both the patient's psychological state, including QOL, and physical condition are considered. We studied patients with gynecologic cancer with the following practical objectives: 1. To evaluate the effect of a psychosomatic approach to patients with terminal gynecologic cancer; 2. Using psychological tests and interviews, to clarify the character tendencies of cancer patients, which are often reported in other countries; and 3. To discuss the benefits in the patient's attitude toward living with cancer. In case studies, separation anxiety of terminal cancer patients is increased due to impending death, and often patients cannot deal with these feelings. When the medical staff accepts these emotions, the patients' feelings even in the face of death often change to positive feelings of gratitude to the people around them. All of the results of psychological testing showed model answers, close to the mean of the normal range. This suggests that the patients were suppressing emotions behind their standard responses. Patients with uterine cancer showed a type C or cancer character, while those with ovarian cancer showed type A or heart disease character. Results indicated different attitudes between patients with uterine cancer and those with ovarian cancer. Cancer patients with a vigorous attitude (high POMS-V score pattern behavior) tended to have a good prognosis. This investigation represents a pilot study of a psychosomatic approach to cancer patients. However, recent psychoneuroimmunologic studies have reported the influence of emotion on cancer. Further studies of this kind are needed.

[Psychosomatic study of inhalation therapy in patients with bronchial asthma. I. Evaluation by questionnaire]

We investigated the use of metered-dose beta agonist inhalers (MDIs) by means of 17-item questionnaires from the standpoint of psychosomatic medicine in 56 subjects with bronchial asthma. The results can be summarized as follows: 1) Many asthmatics with neurotic characters used MDIs frequently; Thirteen percent of them suffered adverse effects. The number of times the inhalers were used increased in proportion to the severity and the duration of illness. Fifteen percent of the subjects used MDIs frequently because of anxiety. 2) Fifty percent of the subjects, most of them had neurotic or alexithymic characters, used MDIs without suffering from dyspnea or wheezes; the subjects who used MDIs because of anxiety increased in proportion to the duration of illness. 3) Seventy eight percent of the subjects were anxious about asthmatic attack when they did not carry any MDI; sixty two percent of the subjects, most of them had neurotic or alexithymic characters, actually experienced asthmatic attack. 4) Seventy three percent of the subjects used MDIs secretly; sixty percent of the subjects did not like to inhale in the presence of others. 5) There were some subjects who acted incorrectly on or after asthmatic attack when MDIs were not effective.