Cementless total hip replacement does not change bone mineral density of the lumbar spine, DEXA measurements in 50 patients

We measured the lumbar spine mineral density with the dual-energy x-ray absorptiometry method, 8 days, 3 and 6 months after total hip replacement in 50 patients and found no statistical differences over time.

Determination of periprosthetic bone density with the DEXA method after implantation of custom-made uncemented femoral stems

Implantation of a total hip replacement leads to resorption of bone, especially in the upper femoral shaft and this depends mainly on the design of the stem, and also on the survival time of the implant. Density of the periprosthetic bone was examined with the DEXA method in both femurs in 27 patients at a mean of 21 months after implantation of uncemented custom-made femoral stems. A loss of bone density between 5% and 21% was found which was independent of the survival time of the implant. The maximum decrease was at the upper medial part of the calcar. The negligible loss of bone density, compared to other reports, favours the use of a computer tomography assisted custom-made femoral stem.

Antiphospholipid antibodies (aPL) increase the potential monocyte procoagulant activity in patients with systemic lupus erythematosus

Lupus anticoagulant (LA) and anticardiolipin antibodies (aCL) are frequently detected in sera from patients affected by systemic lupus erythematosus (SLE). However, the role of antiphospholipid antibodies (aPL) in thrombus formation has not been defined as yet. Twenty-two patients affected by SLE, all fulfilling the 1982 ARA revised criteria, and twenty healthy subjects were investigated for the presence of LA, aCL and other aPLs. Monocyte procoagulant activity-PCA (Tissue Factor production) was evaluated by one stage plasma recalcification time. In all patients the plasma levels of F1 + 2 and of plasminogen activator inhibitor (PAI) were also determined. Monocyte PCA was significantly higher in SLE patients with LA and/or aCL in comparison to SLE patients without LA and/or aCL (p < 0.01) and to controls (p < 0.05). However, no connection was observed between PCA expression by mononuclear cells and LA or aCL levels. No differences in F1 + 2 and PAI plasma levels were found between SLE patients with or without aPL and controls. In our SLE patients LA and/or aCL positivity appears strictly related to an increased monocyte activation that could play an important role in the occurrence of thrombotic events.

n-3 PUFA supplementation, monocyte PCA expression and interleukin-6 production

n-3 polyunsaturated fatty acids (PUFA) can affect several monocyte functions and the biochemistry of blood cells, thus possibly influencing the initiation of thrombosis, inflammatory disease and atherosclerosis. In this study, we have investigated the effect of dietary supplementation with n-3 PUFA ethyl esters on procoagulant activity (PCA) and interleukin-6 (IL-6) production by human mononuclear cells. Nine healthy volunteers received 4 g/d of n-3 PUFA ethyl esters (4 x 1 g capsules with at least 85% eicosapentaenoic + docosahexaenoic acid ethyl esters) for 18 weeks. Before and at the end of the treatment, mononuclear cells were obtained from peripheral citrated blood by Ficoll-Hypaque density gradient centrifugation. Cellular suspensions (10(7) cells/ml) were incubated at 37 degrees C for 4 h in the absence and presence of lipopolysaccharide (10 micrograms/ml); PCA was determined by one-stage clotting assay and IL-6 concentrations were assayed in supernatants by specific ELISA. After 18-week treatment, both unstimulated and stimulated monocyte PCA were significantly reduced by 66% and 63%, respectively (P < 0.01). Similarly, a significant inhibitory effect by n-3 PUFA treatment on basal and LPS-stimulated IL-6 monocyte production was observed (50% and 46%, respectively, P < 0.05). These data indicate that 18-week n-3 PUFA supplementation may influence monocyte activities, which play a specific role in atherosclerosis and its thrombotic complications.

[Strength of muscles surrounding the hip joint and gait in patients following implantation of a cementless hip endoprosthesis]

There are only a few studies which could support conclusions concerning the strength of the muscles surrounding the hip joint and especially concerning the strength relationships following implantation of endoprotheses. The aim of this study was to examine the pre- and postoperative course of strength deficits in this musculature compared to clinical parameters and the uninvolved side. Fifty-eight patients between 30 and 67 years of age, in whom individual total hip protheses were implanted were clinically examined prior, 9 weeks and 6 months after surgery. Moreover, the maximum isometric strength of abductors, flexors, and rotator muscles as well as maximum isokinetic strength of the extensors and flexor musculature at 60% and 120%/s were measured. The flexor and extensor musculature already showed a clear increase in maximum strength after 9 weeks and 6 months (90-124%). By contrast, the isometric strengths of the rotators increased only slightly, the abductor strength decreased after 6 weeks to below the preoperative baseline level and attained this level again only after 6 months. The clinical parameters Trendelenburg sign, limping and walking capacity were clearly improved after 6 months, but no correlation to the abductor strength could be demonstrated. It is concluded that limp-free gait can be attained even without maximum strength increase in the abductors, which are important for fluid gait, at least for short distances. The importance of regular training of the rotator and abductor musculature in coxarthrosis is emphasized to delay limitation of movement and decreased strength in the sense of capsule pattern.

Analysis by limited proteolysis of domain organization and GSH-site arrangement of bacterial glutathione transferase B1-1

Limited proteolysis method has been used to study the structure-function relationship of bacterial glutathione transferase (GSTB1-1). In absence of three-dimensional structural data of prokaryote GST, the results represent the first information concerning the G-site and domains organization of GSTB1-1. The tryptic cleavages occur mainly at the peptide bonds Lys35-Lys36 and Phe43-Leu44, generating two major molecular species of 20-kDa, 3-kDa and traces of 10-kDa. 1-chloro-2,4-dinitrobenzene favoured the proteolysis of the 20-kDa fragment markedly enhancing the production of the 10-kDa peptide by cleaving the chemical bonds Lys87-Ala88 and Arg91-Tyr92. The tryptic cleavage sites of GSTB1-1 was found to be located close to those previously found for the mammalian GSTP1-1 isozyme. It was concluded that despite their low sequence homology (18%), GSTB1-1 and GSTP1-1 displayed similar structural features in their G-site regions and probably a common organization in structural domains.

Beta-endorphins ACTH and cortisol in CSF and plasma of HIV infected patients

Interactions between HPA (Hypothalamic-pituitary-axis) and immune system seem to involve the EPO (endogenous opioid peptides) system, as shown by some recent findings. Possible relationships between beta-endorphin (beta-End) synthesis and severity rate of immunodeficiency have been studied in 48 HIV Ab positive patients, at different stages of infection. A statistically significant decrease in the beta-End synthesis was observed in these patients, as compared to a control group of 19 healthy subjects, but this decrease was not related to the CD4+T lymphocytes number. Plasmatic levels modifications of HPA-related peptides were not observed in the IVC1 CDC group.

High incidence of BK virus large-T-antigen-coding sequences in normal human tissues and tumors of different histotypes

T-antigen (TAg) coding sequences specific for BK virus (BKV) were detected, by PCR amplification followed by Southern-blot hybridization, in a high percentage of human tumors and tumor-cell lines, as well as in normal tissues, by analysis of 189 specimens. Specifically, the BKV early region was detected in 85% of brain tumors and in all normal brain tissues, in 78% of osteosarcomas, in 38% of Ewing's tumors, in 40% of normal bone specimens and in 71% of normal peripheral blood cell samples. Wilms' tumor tissues used as a control were all negative for BKV sequences. RT-PCR analysis indicated that TAg coding sequences were expressed in specimens carrying BKV early region, ranging from 64% of the osteosarcomas to 100% of glioblastomas, Ewing's tumors, peripheral blood cells and normal bone. Moreover, DNA sequencing performed in 12 different positive samples revealed that the amplified PCR products are identical to the early-region sequence of wild-type BKV. The role of BKV TAg and its possible mechanism of action in human tumorigenesis are discussed.

A new interface chamber for the study of mammalian nervous tissue slices

We describe a new interface-type chamber for electrophysiological studies in mammalian brain slices. Thermoregulation of the inner recording chamber is achieved using the Peltier effect and a feedback control unit. Between 15 and 40 degrees C, and for perfusion rates from 1 to 5 ml/min, the temperature can be maintained within +/- 0.1 degrees C of the command value; it can also be rapidly and reliably changed. An external bath, heated by a coiled resistor, generates a humidified, oxygenated atmosphere diffusing above the slices. Survival of neuronal tissue is excellent and stable intracellular recordings can be obtained using either sharp or patch-clamp micropipettes. Perfusion solutions can be readily exchanged, rendering this chamber suitable for the study of bath-applied neuroactive compounds.

Interleukin-6 and acute-phase proteins in head and neck cancer

The acute-phase response is the answer of the organism to a disturbance of its homeostasis and is characterized by dramatic changes in the concentration of some plasma proteins defined as acute-phase proteins. In recent years several data have shown that interleukin-6 (IL-6) is the major inducer of acute-phase protein synthesis in human hepatocytes. Recently, we demonstrated higher IL-6 serum levels in head and neck cancer (HNC) patients than in healthy subjects. In the present study we examined the relationship between levels of IL-6 and of several acute-phase proteins, including C-reactive protein (CRP), alpha 1-antitrypsin (ATT), alpha 1-acid glycoprotein (AAG), haptoglobin (HPT) and fibrinogen. Eighteen patients were studied and had squamous cell carcinoma of the larynx (n = 9), oral cavity (n = 4), oropharynx (n = 3) and hypopharynx (n = 2). Proteins were measured at three time points before and three time points after surgery. Significant (P < 0.0001) relationships were found between IL-6 and CRP (r = 0.69), and fibrinogen (r = 0.51), whereas no correlation was found with AAT (r = 0.13, P = 0.56), AAG (r = 0.38; P = 0.07) and HPT (r = 0.16; P = 0.46). These data strongly suggest that IL-6 may play a key role in acute-phase protein synthesis in HNC and in regulation of the complex host response to malignancies.

Defibrotide reduces monocyte PAI-2 and procoagulant activity

Defibrotide is a polydeoxyribonucleotide-derived anti-ischemic drug with multiple sites of action involving both plasmatic and cellular targets. This agent has been demonstrated to produce profibrinolytic, cytoprotective, and vaso-facilatory actions. Since monocytes are increased in the mediation of some of the pathophysiologic responses seen in ischemic disorders, the functional properties of these cells were investigated in experimental conditions to evaluate their behavior during resting and stimulated states. Defibrotide was supplemented in these systems to determine its modulatory action. In this investigation Defibrotide was found to decrease the PAI-1 levels and may indicate that this may be the mechanism for its profibrinolytic actions. Defibrotide was also found to reduce the procoagulant activity of monocytes in these experimental settings. Both PAI and procoagulant factors play an important role in the pathophysiology of inflammation, DIC, and ischemia. Defibrotide induced reduction of these two factors represents the mechanism whereby this agent produces its therapeutic action.

Effects of substance P on cardiovascular regulation in the rabbit

The effect of substance P on blood pressure and aortic reflex was investigated in rabbits. Microinjections of substance P and Sar9, Met(O2)11-SP (a selective NK1-receptor agonist) into the floor of the fourth ventricle led to a dose-dependent increase of blood pressure and a sharp enhancement of the baroreflex. These effects were abolished by pretreatment with SR 140333 (a selective NK1-receptor antagonist). Intraventricular injection of the antagonist alone significantly decreased the amplitude of the aortic reflex. After bivagotomy, the amplitude of the parasympathetic component of the baroreflex decreased dramatically and substance P injections were no longer effective. Our results demonstrate that substance P activation of NK1 receptors plays a major role in the modulation of the parasympathetic component of the baroceptor reflex.

Possible involvement of tumour cell membrane gangliosides in platelet-tumour cell interactions

The possible correlation(s) between platelet proaggregating activity, and sialic acid content and ganglioside expression of six human colorectal tumour cell lines (CBS, GEO, HT-29, WiDr, MIP and DLD-1) was evaluated. The three cell lines (HT-29, WiDr and DLD-1) capable of inducing remarkable in vitro platelet aggregation, had significantly higher amounts of lipid-bound sialic acid than those cell lines characterised by a lower platelet proaggregating activity (GEO, CBS and MIP). High performance thin-layer chromatography demonstrated the presence of one band comigrating with GM3 in all cell lines, while GD1a and GT1b comigrating gangliosides were present only in HT-29, WiDr and DLD-1 cells. Finally, an increased platelet pro-aggregating activity of GEO and CBS cell lines was observed after the incorporation of exogenous gangliosides. The present data support the hypothesis that lipid-bound sialic acid may be involved in platelet-tumour cell interactions.

Evaluation of the potential role of class II histocompatibility antigen HLA-DR in platelet/tumor cell interaction

It has been reported that HLA-DR is a potent inducer of thrombin generation. Human colorectal cells (GEO, WiDr, DLD-1, and MIP) that lack the constitutive expression of HLA-DR cause platelet aggregation through a thrombin-dependent mechanism. Treatment with recombinant human gamma-interferon induced the expression of HLA-DR in the GEO, WiDr, and DLD-1 cells, whereas the MIP cell line remained HLA-DR negative. The concurrent analysis of tumor cell/platelet interaction after gamma-interferon treatment showed a decrease in platelet proaggregating activity of either the responsive GEO (highly expressing HLA-DR) or the unresponsive MIP (HLA-DR negative) cells. Furthermore, the DLD-1 (moderately expressing HLA-DR) cells showed an increase of proaggregating activity after gamma-interferon treatment, whereas WiDr (highly expressing HLA-DR) cells did not modify their activity. These results suggest a lack of a role of HLA-DR in the in vitro platelet proaggregating activity of human colorectal tumor cells.

The role of extraplatelet thromboxane A2 in unstable angina investigated with a dual thromboxane A2 inhibitor: importance of activated monocytes

BACKGROUND

The role of thromboxane A2 (TxA2) in unstable angina has not yet been defined. TxA2 receptor antagonists may be of value in studying this role.

METHODS

To investigate whether TxA2 has a pathogenetic effect on the occurrence of myocardial ischemia and from what source TxA2 originates, we studied TxA2 formation by unstimulated monocytes from patients with unstable angina (n = 40), stable effort angina (n = 20), and controls (n = 20). We also compared the effects of picotamide (1200 mg/day), a TxA2-synthase inhibitor and TxA2-receptor antagonist, with those of aspirin (325 mg/day) on myocardial ischemia and TxA2 formation by monocytes and platelets. The double-blind randomized study was performed on patients with unstable angina on continuous Holter monitoring.

RESULTS

In the presence of autologous lymphocytes, unstimulated monocytes from patients with unstable angina formed significantly (P < 0.001) more TxA2 than those from controls or from patients with effort angina. Although TxA2 formation by circulating monocytes and platelets was inhibited to a greater degree by aspirin than by picotamide (88 +/- 6 and 98 +/- 2%, respectively, versus 65 +/- 2 and 74 +/- 1%, P < 0.001), aspirin failed to affect the occurrence of myocardial ischemia whereas picotamide significantly (P < 0.001) reduced the number of anginal attacks (84.8%), silent ischemic episodes (64.2%), and overall duration of ischemia (69.8%), in comparison to the run-in period.

CONCLUSIONS

These results indicate that TxA2 formed by monocytes contributes to the pathogenesis of myocardial ischemia in unstable angina. TxA2 formation occurs mainly in extravascular spaces, probably within the coronary vascular wall. Picotamide appears to control myocardial ischemia effectively in patients with unstable angina.

Isokinetic force-velocity curves in patients following implantation of an individual total hip prosthesis

There are only a few studies which could support conclusions concerning the strength of the muscles surrounding the hip joint and especially concerning the strength relationships following implantation of endoprostheses. The aim of this study was to examine the post-operative course of strength deficits in this musculature compared to clinical parameters. Fifty-eight patients between 30 and 67 years of age, in whom individual total hip prostheses were implanted, were clinically examined prior, 9 weeks and 6 months after surgery. Moreover, the maximum isometric strengths of abductors, flexors, and rotator muscles as well as maximum isokinetic strengths of the extensors and flexor musculature at 60 degrees/s and 120 degrees/s were measured. The flexor and extensor musculature already showed a clear increase in maximum strength after 9 weeks and 6 months. By contrast, the isometric strengths of the rotators increased only slightly, the abductor strength decreased after 9 weeks to below the preoperative baseline level and attained this level again only after 6 months. The clinical parameters Trendelenburg sign, limping, and walking capacity were clearly improved after 6 months, but no correlation to the abductor strength could be demonstrated. It is concluded that limp-free gait can be attained even without maximum strength increase in the abductors, which are important for fluid gait, at least for short distances. The importance of regular training of the rotator and abductor musculature in coxarthrosis is emphasized to delay limitation of movement and decreased strength in the sense of a capsule pattern.

Variations of adenine nucleotide levels in normal and pathologic human erythrocytes exposed to oxidative stress

Normal human erythrocytes suspended in isotonic saline at 0.5 haematocrit displayed, after 30 min exposure to 1 mM tert-butylhydroperoxide at 37 degrees C, a marked increase of NADPH, while the concentration of the other adenine nucleotides was almost unchanged. Hereditary Spherocytosis and glucose-6-phosphate dehydrogenase-deficient red blood cells exhibited, under basal conditions, higher levels of most of the nucleotides assayed and significant amounts of hypoxanthine. Treatment with tert-butylhydroperoxide caused, in glucose-6-phosphate dehydrogenase-deficient erythrocytes, a pronounced decrease of ADP and of AMP levels, a substantial invariance of other adenine nucleotides and a considerable raise of hypoxanthine. On the contrary, Hereditary Spherocytosis erythrocytes exhibited, after oxidative stress, increased levels of ADP and of AMP, a slight decrease of ATP and an accumulation of hypoxanthine similar to that found in enzyme-deficient red cells. In both the pathologic erythrocytes the addition of phosphate during the oxidative treatment resulted in a lower formation of hypoxanthine, while the presence of 10 mM glucose, fully prevented its appearance.

Investigation of intra-domain and inter-domain interactions of glutathione transferase P1-1 by limited chymotryptic cleavage

Limited proteolysis of glutathione transferase P1-1 (GSTP1-1) by chymotrypsin performed at 20 degrees and 30 degrees C mainly generates two complementary peptides of 17 kDa and 6 kDa molecular mass with concomitant loss of catalytic capacity. Sequence analysis of these peptides showed that the peptide bond between Tyr47 and Gly48 was cleaved. The analysis of the recently resolved three-dimensional structure of GSTP1-1 [Reinemer, P., Dirr, H. W., Ladenstein, R., Huber, R., Lo Bello, M., Federici, G. & Parker, M. W. (1992) J. Mol. Biol. 227, 214-226] suggests that the proteolytically cleaved bond results located in a portion of the polypeptide chain lining the G-site which has been demonstrated to be part of an exposed and flexible region of the N-terminal domain (structural elements alpha B1 and alpha B2) [Aceto, A., Caccuri, A. M., Sacchetta, P., Bucciarelli, T., Dragani, B., Rosato, N., Federici, G. & Di Ilio, C. (1992) Biochem. J. 285, 241-245]. The fragments which are generated by proteolysis at 20 degrees C, remain linked by noncovalent interaction in a complex (nicked GSTP1-1) which is dissociated by incubation at higher temperatures. As shown by circular dichroic analysis, although inactive, nicked GSTP1-1 retains an overall secondary structure closely resembling that of the parent enzyme. However, the fluorescence data of the nicked GSTP1-1 indicate that the Trp38, which is near the chymotrypsin-cleavable bond, becomes exposed in a more polar environment. This indicates that, in the nicked enzyme, the polypeptide portion containing the structural elements alpha B1 and alpha B2 has more freedom of fluctuation. The fact that this polypeptide chain portion contains two essential amino acid residues of the G-site (Trp38 and Lys42) might account for the loss of ability to bind glutathione by the nicked enzyme which is consequently catalytically inactive. Proteolysis performed at 30 degrees C generated a homodimeric 17-kDa fragment. The structural analysis of this fragment suggests that the GSTP1-1 alpha C helix, which is located in the domain I and is thought to be involved in the inter-domain interaction, could exert a critical role in maintaining the native folding of domain II.

Glutathione transferase isoenzymes in olfactory and respiratory epithelium of cattle

Glutathione transferase (GST) was investigated in the olfactory and respiratory epithelium of cattle. A significantly more abundant GST in terms of either protein amount or activity was found in the olfactory rather than in the respiratory epithelium. No apparent qualitative differences in the isoelectric focusing, sodium dodecyl sulphate-polyacrylamide gel electrophoresis (SDS-PAGE) and HPLC profiles were noted in the reduced glutathione (GSH) affinity purified GST pool of olfactory and respiratory epithelium. Both tissues have at least six GST isoenzymes with isoelectric point values of 4.9 (peak I), 5.3 (peak II), 5.95 (peak III), 6.5 (peak IV), 7.1 (peak V) and 9.3 (peak VI). From both tissues at least seven different GST subunits can be resolved by HPLC analysis. The GST isoenzymes having pI at 5.3 and 9.3 were predominantly expressed in the olfactory than in the respiratory epithelium. These latter forms conjugate GSH efficiently with alkenals and hydroperoxides, respectively. Kinetic, immunological and structural properties, including HPLC analysis and N-terminal region amino acid sequence seem to indicate that the bovine nasal mucosa tissue in addition to a GST subunit which is orthologue to rat subunit 8 (alpha class) express tissues specific subunits.

Interleukin-1 beta and interleukin-6 release by peripheral blood monocytes in head and neck cancer

In patients with advanced head and neck squamous cell carcinoma (HNSC), evidence of cell-mediated immunity and monocyte functional abnormalities has been reported. We studied the production of interleukin 1 beta (IL-1 beta) and interleukin 6 (IL-6) by peripheral blood monocytes from 22 patients with HNSC (12 larynx and ten oral cavity cancers) in comparison with monocyte cytokine production of age-matched healthy subjects. Pure monocytes were incubated with and without lipopolysaccharides (LPS) (10 micrograms ml-1) for 4 h at 37 degrees C and IL-1 beta and IL-6 concentrations were determined in supernatants by specific ELISA. There was no significant difference in IL-1 beta levels in monocyte supernatants from cancer in comparison to control subjects; conversely, a higher IL-6 production by unstimulated and LPS-activated cells from HNSC patients than from controls was found. No relationship was observed between cytokine production and cancer stage. The regression analysis evidenced a significant correlation between IL-1 beta and IL-6 monocyte-release in HNSC patients and in controls, so suggesting a possible autocrine control of IL-6 production by other cytokines.

Induction of fictive locomotion by sulphur-containing amino acids in an in vitro newborn rat preparation

The role of the sulphur-containing amino acids (SAAs) in the initiation of fictive locomotion was tested in an isolated spinal cord preparation from newborn rats. These substances were bath-applied and the fictive locomotion was recorded in the lumbar ventral roots. It emerged from this study that all the compounds tested could trigger an organized pattern (alternating left and right bursts of activity) with a dose-dependent response. However, specific frequency and concentration ranges were observed with each of these SAAs. Moreover, a clear-cut difference between D and L isomers in the ability of the SAAs to induce this activity was observed; the SAAs of the D-forms were found to be generally more potent than those of the L-forms. The effects of the SAAs were found to be mediated by both NMDA and non-NMDA receptors, since they were blocked in a dose-dependent manner by the specific antagonists of these receptors. Moreover, it was observed that beta-p-chlorophenylglutamic acid, an uptake inhibitor of homocysteic acid (HCA), potentiated the effect of exogenously applied HCA, which supports the idea that HCA may act as a transmitter. The sulphuric and non-sulphuric amino acids were also classified in their order of potency. The most potent compound turned out to be D-homocysteine sulphinic acid, while D-cysteine sulphinic acid was the least potent. It also emerged that the maximal frequencies obtained with SAAs and excitatory amino acids were in the same range, which might correspond to the maximal limits of this system.

Immunohistochemistry with antibody to the LA-1 oncogene as a prognostic marker in cervical intraepithelial neoplasia

Previous studies with antibody to a synthetic peptide designated LA-1 identified a 60-kDa protein in cervical intraepithelial neoplasia and invasive cancer tissues. To determine whether these findings are of clinical significance cervical tissues from 223 patients with squamous intraepithelial lesion (SIL) or invasive carcinoma and 39 normal healthy cervical tissues were stained with antibody to LA-1 using the immunoperoxidase assay. Tissues from 52 patients with squamous carcinomas at other sites were used as controls. Staining was respectively observed in 46.4, 56.5, and 64.7% of patients with low-grade SIL, high-grade SIL, and invasive cancer. It was localized in the atypical epithelium involving a progressively larger extent of epithelium as a function of increased pathologic grade. Only 10.3% of the normal cervical tissues stained with anti-LA-1 antibody. Twenty-five patients that were lost to follow-up for 2-5 years after the original diagnosis were studied at the time of diagnosis (1 degree biopsy) and when they returned to the clinic (2 degrees biopsy). In the follow-up series, LA-1 staining was observed in both biopsies from 9/12 patients that progressed to a higher degree of atypia, while 9/11 patients whose lesions remained stationary were LA-1 negative. Our studies suggest that LA-1 might be a useful biological marker of cervical neoplasia.

The amino acid sequence of glutathione transferase from Proteus mirabilis, a prototype of a new class of enzymes

The complete amino acid sequence of glutathione transferase from Proteus mirabilis was determined. The sequence was reconstructed by analysis of peptides obtained after cleavage by trypsin, Glu-C and Asp-N endoproteinases. The enzyme subunit is composed of 203 amino acid residues corresponding to a molecular mass of 22856 Da. Comparison of this sequence with other known primary structures of the corresponding enzyme from different sources shows a low level of identity (17-26%) with only seven conserved residues in all the sequences considered. This novel glutathione transferase could represent the prototype of a new class, possibly including other bacterial enzymes.

Purification and characterization of the major glutathione transferase from adult toad (Bufo bufo) liver

Five forms of glutathione transferase (GST) were resolved from the cytosol of adult common toad (Bufo bufo) liver by GSH-affinity chromatography followed by isoelectric focusing. The major enzyme (GST-7.64; 55% of total activity bound to the column) has a pI value of 7.64, is composed of two subunits each with a molecular mass of 23 kDa, and has the N-terminal amino acid residue blocked. GST-7.64 has also been characterized with respect to amino acid composition, substrate specificity, inhibition characteristics, c.d. spectra and immunological reactivity. The N-terminal sequence of some peptides obtained after tryptic digestion has also been determined. All together the results obtained suggest that the major toad liver GST is distinct from any known GST, including microbial, plant and mammalian GSTs.

Lupus anticoagulant and monocyte procoagulant activity in polyabortive women

Monocyte stimulation may be induced by various agents. Monocytes generate procoagulant activity (PCA) in response to stimulation; they widely interact with the hemostatic system and participate in thrombin formation. Extensive placental thrombotic infarction has been implicated in fetal death in polyabortive patients with lupus anticoagulant (LA). We investigated 38 polyabortive women: 17 LA negative (LA-) and 18 LA positive (LA+). We compared the results with 25 clinically normal women. After four hours of incubation, the mean value of monocyte PCA in the LA+ women was significantly higher than in either the LA- or the control group (p < 0.0001). The monocyte PCA was out of the range of the controls in 9 of the 18 LA+ women. No correlation was observed between the levels of LA and monocyte PCA (r = 0.02; p = 0.94). No differences were found in monocyte PCA increase when induced by LA-, LA+ or control plasma; in all cases the increase was about five-six fold. Our results indicate that an increased monocyte PCA is present in some LA+ polyabortive women, thus suggesting that monocyte activation might be involved in the formation of thrombotic placental infarction and the consequent fetal loss in some patients. It might also suggest that these patients, in particular, could benefit from corticosteroid treatment, which is known to inhibit the formation of monocyte PCA.

Phonetic rehabilitation after laryngectomy

This work deals with the phonetic rehabilitation of patients after laryngectomy, describing the various types of alaryngeal voice. The rehabilitation was monitored with a computer by means of a specific voice programme which permits the registration, visualization and reproduction of each sound emitted in conjunction with the classification of the principal parameters, thus allowing the patient to check his acoustic feedback.

Purification and characterization of glutathione transferase from psoriatic skin

The glutathione transferases (GSTs) comprise a family of enzymes that catalyze the conjugation of glutathione with certain hydrophobic compounds, bind various hydrophobic compounds, and have selenium-independent glutathione peroxidase activity. Of the four classes of GST, the pi class is the only one present in keratinocytes, and pi-class GST is elevated in psoriatic epidermis. We have purified and characterized GST from psoriatic scales. Immunoreactivity was observed with pi class antisera, and amino terminal sequencing showed identity with GST from human placenta and cultured human keratinocytes. We conclude that the majority of GST activity in psoriatic skin is due to a pi-class isoenzyme, and pi-class GST may represent an index for hyperproliferation.

Transient intermittent lymphocyte activation is responsible for the instability of angina

BACKGROUND

Blood clotting activation is an important component of the inflammatory response; the outbursts of unstable angina are usually associated with increased thrombin formation and coronary mural thrombosis.

METHODS AND RESULTS

To investigate 1) whether monocyte activation is responsible for the enhanced thrombin formation during bursts of unstable angina and 2) what mechanism(s) might be responsible for monocyte activation, we studied patients with unstable angina (n = 31), stable effort angina (n = 23), left endoventricular thrombosis (n = 8), and control subjects (n = 44), measuring plasma fibrinopeptide A (FPA) levels and the capacity of monocytes to express procoagulant activity (PCA) and of lymphocytes to modulate this expression. Patients with unstable angina and patients with endoventricular thrombosis had significantly (p less than 0.0001) higher FPA plasma levels than patients with effort angina and control subjects. However, only monocytes from unstable angina patients expressed significantly increased PCA characterized as tissue factor-like activity (units/10(5) monocytes, median and range; 120, 1.1-463.2 versus 10.8, 0.8-39.1 in control subjects; p less than 0.0001 versus the other groups). When 14 patients with unstable angina were restudied 8-12 weeks later, they showed neither elevated plasma FPA levels nor monocyte PCA. In unstable angina patients, there was a correlation between FPA and PCA (r = 0.56, p less than 0.001). For expression of PCA by monocytes, both an incubation of at least 2 hours with lymphocytes and direct monocyte-lymphocyte contact were needed. In reconstitution and cross-mixing experiments, only lymphocytes from patients with active unstable angina induced the expression of PCA by monocytes from both control and patient groups.

CONCLUSIONS

The results demonstrate that the increased thrombin formation in unstable angina patients is due to the expression of tissue factor-like activity by activated monocytes. The monocyte activation appears to be a part of a lymphocytic cell-instructed response intermittently triggered by unknown factors.

Monocyte tumor necrosis factor production in head and neck squamous cell carcinoma

Changes in monocyte and macrophage function have been demonstrated in patients with head and neck squamous cell carcinoma. The purpose of this study was to evaluate tumor necrosis factor (TNF) production by activated monocytes from patients with head and neck squamous cell carcinoma and to evaluate its relation to cancer stage, weight loss, and performance status. Monocytes from patients (n = 10) and controls (n = 10) were isolated from peripheral blood mononuclear cells by plastic adherence and incubated with lipopolysaccharide (10 micrograms/mL). The TNF concentration of supernatants was assayed by TNF alpha-specific immunoassay. The TNF production by monocytes from head and neck squamous cell carcinoma patients was significantly higher (P less than .001) than those of controls. No significant relationship was found to cancer stage, weight loss, and performance status. These findings indicate that, in head and neck squamous cell carcinoma patients, an increased TNF production by activated monocytes takes place which does not correlate with cancer stage, cancer-related weight loss, and performance status.

[Stress and nursing. Comparison of the levels of burnout between surgical departments and intensive care units]

Burnout is a state of workers of helping professions that results from a situation of work stress and is characterised by emotional exhaustion, depersonalization and low personal accomplishment. Burnout levels were measured in three nursing staffs: two of them working in intensive care units and one in a surgical department. The results show significant statistical differences between the two staffs of intensive care units. Such differences seem to be connected with the psychological climate evaluated in the units.

Effects of blood transfusion on the immune responsiveness and survival of cancer patients: a prospective study

To evaluate whether blood transfusion exerts an adverse influence on cancer evolution, a prospective clinical and immunologic investigation was carried out on 58 surgical patients with gastric or colorectal adenocarcinoma. None had had previous transfusion; 35 received perioperative transfusion. Among preoperative variables, only red cell count and hemoglobin concentration were significantly reduced in the patients transfused at operation. Other clinical characteristics and immunologic functions (except interferon-gamma release) did not differ significantly from those of untransfused patients. The survival rate of transfused patients, although shorter, was not significantly different from that of untransfused patients. Immunologic tests done after surgery on 30 patients (17 transfused and 13 untransfused) did not show significant differences in the two groups. Significant increases in interleukin-2-stimulated production and immunoglobulin M synthesis were observed in transfused patients after surgery. Patients transfused perioperatively with more than 3 units of blood had some evidence of decreased immune function, but differences were not significant. While shorter survival and some immunologic changes may correlate with the number of transfusions, more patients must be studied to determine whether this relationship will be confirmed.

Investigation on the humoral immune response in patients with gastro-intestinal cancer

The humoral immune reactivity was studied in patients affected by gastro-intestinal cancer. The number of peripheral B lymphocytes, the concentration of serum immunoglobulins (Ig) and of C3 complement factor and the frequency of circulating immuno complexes (CIC) did not significantly differ between patients and age-matched controls, while the C4 factor level was significantly increased. The frequency of serum monoclonal components (M-components) was higher in the patients than in the elderly subjects. Moreover the results concerning the "in vitro" functional response of patient B lymphocytes showed a significant decrease of the proliferative responses to Staphylococcus Aureus Cowan I (SAC) and a significant increase of the IgG and IgM synthesis by peripheral blood mononuclear cells (PBMC) in unstimulated and pokeweed mitogen (PWM) stimulated cultures. The meaning of these results, taken together with those reported by others, is discussed.

Low-dose heparin as an antithrombotic agent

Heparin, after subcutaneous administration, has been found to be able to bind to endothelial receptors both in rabbits and in humans. N-sulphonate 35S-heparin remains bound in rabbits for at least 24 h and is able to enhance the inactivation process of thrombin and factor Xa. Heparin subcutaneously (200 U/kg) injected for 2 weeks resulted in an enhanced inactivation of thrombin and factor Xa by the endothelium. The antithrombin-enhancing activity persists longer than the anti-Xa activity. In man, daily subcutaneous administration of heparin (12,500 U/day) for 2 weeks significantly reduces the increased fibrinopeptide A plasma levels and normalizes the increased 125I-fibrinogen turnover. The present work indicates that heparin administration at a low dose represents a treatment able to remarkably enhance the antithrombotic properties of the vessel wall, independently of the presence of detectable heparin levels in the circulating blood.

Heparin, monocytes, and procoagulant activity

Monocytes are able to specifically bind heparin rapidly, reversibly, and saturably with 5.5 +/- 2.6 x 10(6) binding sites per monocyte and a dissociation constant of 330 +/- 221 nmol/l. Moreover, at least 40-50% of the cell-bound heparin can be internalized. Heparin binding by monocytes is affected by cell stimulation with an increase of the availability of binding sites after challenge with calcium ionophore, lipopolysaccharide, and interleukin 2. The interaction of heparin with monocytes reversibly decreases the expression of tissue factor on the cellular surface, so hampering the cellular procoagulant potential.

Functional analysis of lymphocytes from two patients affected by common variable immunodeficiency (CVI)

Two patients affected by severe hypogammaglobulinemia classified as CVI were studied. Both patients showed an increase in peripheral T cells and a normal or elevated number of surface immunoglobulin-bearing cells (sIg+); the T cell subsets showed a decrease of CD4 and an increment of CD8 cells with an inversion of the CD4/CD8 ratio. Patient peripheral blood mononuclear cells (PBMC) did not proliferate after Staphylococcus aureus Cowan I (SAC) activation. Moreover, patient PBMC were not able to differentiate into plaque - forming cells (PFC) either spontaneously or after pokeweed mitogen (PWM) stimulation. The immunoglobulin synthesis from patient PBMC stimulated in vitro by PWM was very little as compared to controls. When isolated patient B cells were cultured in the presence of exogenous B cell growth factor (BCGF) and BCGF plus anti-mu and anti-delta antibodies, no proliferation was observed. Taken together the results concerning B cell function of our CVI patients indicate the presence of an intrinsic defect of B cells. These cells are normal in number, but they are not able to leave the resting state, enter the activation state, proliferate and differentiate into Ig secreting cells. Moreover the alteration of the T cell subset proportions seems to suggest an impaired cooperation between B and T cells.

The primary structure of rabbit liver mitochondrial serine hydroxymethyltransferase

The complete amino acid sequence of mitochondrial serine hydroxymethyltransferase from rabbit liver was determined. The sequence was obtained from analysis of peptides isolated from chymotryptic, cyanogen bromide, and limited acid cleavages of the protein. The enzyme consists of four identical subunits, each of 475 residues, i.e. 8 residues shorter than the subunit of the corresponding cytosolic isoenzyme. The sequences of the two rabbit proteins are easily aligned, provided a gap of 5 residues near the amino terminus and a gap of 3 residues near the carboxyl terminus are included in the mitochondrial sequence. The overall degree of identity between the two isoenzymes is 61.9%, whereas the structural identity of each eukaryotic isoenzyme with the corresponding Escherichia coli enzyme is about 40%. The rabbit isoenzymes are about 70 residues longer than the E. coli enzyme, with one-half of these residues accounted for by insertions in both isoenzymes near their carboxyl terminus. Predictions of secondary structure and calculations of hydropathy profiles are also presented, suggesting an even more extensive degree of identity in the three-dimensional folding of the three proteins, in accord with the known similarity of their catalytic properties. Evidence was obtained for the existence of additional molecular forms of the mitochondrial protein, differing in the absence of some amino acid residues at the amino terminus of the polypeptide chain.

Benzylhydrazine as a pseudo-substrate of bovine serum amine oxidase

Bovine serum amine oxidase is inhibited by benzylhydrazine (BHy), but recovers full activity after a few hours incubation [Hucko-Haas & Reed (1970) Biochem. Biophys. Res. Commun. 38, 396-400]. The first phase of the process, requiring about 15 min, was found to consist of a mechanism-based hydrazine-transfer reaction leading to formation of the hydrazine-bound enzyme, benzaldehyde and H2O2. At variance with the enzymic process, the reaction with O2 preceded the benzaldehyde release. Two reaction intermediates could be characterized by optical spectroscopy and were assigned as the azo derivative and the benzaldehyde hydrazone, the latter one probably being involved in the reaction with O2. No reduction of Cu was detected at any stage. The hydrazine adduct could also be obtained by stoichiometric reaction of hydrazine with the native enzyme. The decay of this species occurred in about 8 h and was not studied in detail. The Cu-binding inhibitor NN-diethyldithiocarbamate affected the BHy reaction by stabilizing the benzaldehyde hydrazone form as against the azo derivative and the reaction with O2. However, under these same conditions the initial spectroscopic properties of the diethyldithiocarbamate adduct were recovered if the oxidase was left overnight. The reaction with O2 was abolished only upon removal of at least one Cu atom from the enzyme. On the basis of the failure to detect any change of Cu redox state and the enzyme behaviour in the presence of inhibitors, a reaction mechanism involving the formation of a hydroperoxy intermediate, as in the FAD-containing enzymes, is tentatively proposed.