Comparison of intermittent or continuous methotrexate plus 6-mercaptopurine in regimens for standard-risk acute lymphoblastic leukemia in childhood (JCCLSG-S811). The Japanese Children's Cancer and Leukemia Study Group

From 1981 to 1983, 131 previously untreated patients with acute lymphoblastic leukemia (ALL) standard-risk group were entered to the protocol JCCLSG-S811. Of 119 eligible patients, 115 (96.6%) attained complete remission by treatment with prednisone (PRD) plus vincristine (VCR) or vindesine (VDS). After preventive central nervous system (CNS) therapy including 18 Gy cranial irradiation and three doses of intrathecal methotrexate (MTX), the patients were assigned randomly to the two maintenance chemotherapies, Regimen A and Regimen B. Regimen A (intermittent regimen) consisted of PRD (120 mg/m2/day by mouth for 5 days) plus 6-mercaptopurine (6MP) (175 mg/m2/day by mouth for 5 days) plus VCR (2.0 mg/m2 intravenously) alternating biweekly with MTX (225 mg/m2 intravenously). Regimen B (continuous regimen) consisted of 6MP (50 mg/m2/day by mouth) plus MTX (20 mg/m2/week by mouth) combined with pulses of PRD and VCR (the same dosages as Regimen A) every 4 weeks. As the late intensification therapy (LIT), five courses of high-dose MTX (2000 mg/m2 per dose per week intravenously for three doses every 12 weeks) with leucovorin rescue were administered to all patients who were in continuous complete remission (CCR) for more than 2 years. Sixty and 55 patients, respectively, were registered in Regimen A and B. The CCR rates in Regimen A and B were 75.1% +/- 5.8% (mean +/- 1 SE) and 49.7% +/- 7.3% (P less than 0.01) at 4 years, and 72.1% +/- 6.3% and 49.7% +/- 7.3% (P less than 0.05) at 5 years, respectively. In Regimen B, CNS and testicular relapses increased after 3 years of CCR. In addition, the patients in Regimen B had a much higher incidence of infections than Regimen A. The LIT did not seem to have important effects on the duration of CCR. From these data we conclude that the intermittent cyclic regimen of 6MP and MTX may be more effective as compared to the continuous administration of these drugs in the maintenance chemotherapy.

Late asthmatic response to Ascaris antigen challenge in dogs treated with metyrapone

We developed an experimental dog preparation that shows a biphasic bronchoconstriction after allergen exposure. After anesthetization, the dogs were intubated with endotracheal tubes and manually ventilated. Respiratory resistance (Rrs) was measured by the forced oscillation method at 3 Hz. Ascaris suum, diluted from 10(-5) to 10(-2) of the extract, was inhaled during tidal breathing for 5 min. One hour before antigen challenge, 10 dogs received 70 mg/kg of metyrapone (cortisol synthesis inhibitor), and 2 h after antigen challenge 35 mg/kg of metyrapone were injected intravenously. In another 10 dogs, metyrapone was not administered. After the maximal increase in Rrs had been assessed (immediate asthmatic response), Rrs increased again 4 to 6 h after antigen challenge in 8 of the 10 dogs treated with metyrapone (late asthmatic response, 443 +/- 282% mean +/- SD of initial Rrs), which was significantly higher than Rrs 6 h after antigen challenge (124 +/- 41%) in dogs without metyrapone (p less than 0.01). In another 5 dogs, ragweed challenge with metyrapone caused no change in Rrs. Bronchoalveolar lavage at the time of the late response revealed a significant correlation between late asthmatic response and neutrophil accumulation (p less than 0.01) in all dogs. We conclude that cortisol depletion augments the occurrence of the late response. The present dog model may be a useful tool for study of the late response in bronchial asthma.

Effect of a previous voluntary deep breath on laryngeal resistance in normal and asthmatic subjects

We studied changes in both laryngeal resistance (Rla) and respiratory resistance (Rrs) after a voluntary deep breath in 7 normal and 20 asthmatic subjects. Rla was measured using a low-frequency sound method (Sekizawa et al. J. Appl. Physiol. 55: 591-597, 1983) and Rrs by forced oscillation at 3 Hz. In normal subjects, both Rla and Rrs significantly decreased after a voluntary deep breath (0.05 less than P less than 0.01). During methacholine provocation in the normal subjects, a voluntary deep breath significantly decreased Rrs (0.05 less than P less than 0.01, but Rla was significantly increased (0.05 less than P less than 0.01). In 10 asthmatic subjects in remission, a voluntary deep breath significantly increased Rrs (0.05 less than P less than 0.01) but significantly decreased Rla (0.05 less than P less than 0.01). In another 10 asthmatic subjects during spontaneous mild attacks, a voluntary deep breath significantly increased both Rrs and Rla (0.05 less than P less than 0.01). The present study showed that without obvious bronchoconstriction, Rla decreased after a voluntary deep breath in both normal and asthmatic subjects but, with bronchoconstriction, Rla increased in both groups. Subtraction of the change in Rla from Rrs gives the change in Rrs below the larynx (Rlow). Rlow changed little or decreased in normal subjects and increased in asthmatic subjects, irrespective of base-line bronchomotor tone. These results suggest that airway response below the larynx after a voluntary deep breath differentiates patients with bronchial asthma from normal subjects.

[Fundamental and clinical studies of flomoxef in the pediatric field]

Fundamental and clinical studies of flomoxef (FMOX, 6315-S) were conducted and the obtained results are summarized as follows. For the pharmacokinetic investigation, FMOX at 10 or 20 mg/kg was administered by intravenous drip infusion over 30 minutes. In the 10 mg/kg group, the maximum blood concentration was reached just after completion of the drip infusion with the mean concentration of 30.3 +/- 4.5 micrograms/ml, and the mean half-life was 0.734 +/- 0.196 hour. The 6-hour urinary excretion rate was 72.3%. In the 20 mg/kg group, which also showed the peak concentration immediately after completion of the drip infusion, the mean peak blood concentration was 54.3 +/- 9.7 micrograms/ml and the mean half-life was 0.628 +/- 0.185 hour. The 6-hour urinary excretion rate was 69.3%. The urinary recovery tended to be lower in children than in adults. Between 10 mg/kg and 20 mg/kg, a definite correlation was observed between dose levels and blood concentrations. In the clinical investigation conducted with a total of 30 patients (22 with respiratory tract infection, 3 with lymphadenitis, 2 each with urinary tract infection and cellulitis, and 1 with acute osteomyelitis), FMOX was found to be excellent in 14 cases, good in 9, fair in 1, poor in 1, and not evaluable in 5. The efficacy rate was, therefore, 92.0%. In the bacteriological evaluation, 8 out of 12 clinically isolated strains were eradicated, 2 unchanged and 2 unknown. The elimination rate was 80.0%. Regarding side effects, no abnormal clinical symptoms were observed. As abnormal laboratory values, eosinophilia, prolongation of APTT, increased platelet count, and a slight elevation of GOT were observed.

Central and peripheral airways as determinants of ventilatory function in patients with chronic bronchitis, emphysema, and bronchial asthma

We studied central and peripheral airways as determinants of ventilatory function in patients with chronic bronchitis (CB), bronchial asthma (BA), and emphysema (CPE), which were identified using the selective alveolobronchogram (SAB) (see reference 14). First, the relationship between SAB and morphologic findings in the airway was examined in 16 autopsy lungs. The irregularity indices of both central (C-II) and peripheral airways (P-II), obtained from SAB, showed a significant correlation with pathologic abnormalities in both airways (p less than 0.01). Second, SAB were obtained in 38 CB, 25 BA, and 62 CPE patients in whom pulmonary function tests were performed. In CB, C-II were significantly correlated with P-II (p less than 0.001). In CB, inspiratory lung resistance (RL) was significantly correlated with P-II (p less than 0.001) and with C-II (p less than 0.01), and FEV/VC% was significantly correlated with P-II (p less than 0.0001) but not with C-II. In BA and CPE, little correlation was observed between any SAB parameter and RL or FEV/VC%. We conclude that the present SAB parameters represent morphometric abnormalities of the central and peripheral airways, and that in CB, peripheral airway abnormalities correlated well with chronic airway obstruction.

Effects of magnesium and sodium ions on the outer membrane permeability of cephalosporins in Escherichia coli

Both Mg2+ and Na+ stimulated the outer membrane permeation of negatively charged cephalosporins in Escherichia coli without any significant alteration of the permeation of a zwitterionic cephalosporin. Such stimulation was not observed in an E. coli mutant lacking porins. The stimulation was caused by the direct interaction between the cations and the porin pores, which resulted in a decrease in cation selectivity of both the Omp F and Omp C porin pores.

Control of larynx during loaded breathing in normal subjects

We examined laryngeal resistance (Rla) in six normal subjects in control and four kinds of loaded breathing: hypercapnia, chest strapping, added external resistance, and inhaled methacholine. Rla was measured with a low-frequency sound methed (Sekizawa et al., J. Appl. Physiol. 55: 591-597, 1983). In control and the four kinds of loaded breathing, changes in Rla were tightly coupled with ventilation and Rla decreased during inspiration and increased during expiration. Hypercapnia and chest strapping significantly decreased Rla in both inspiration and expiration in all subjects. Added external resistance decreased inspiratory Rla in all subjects, but decreased expiratory Rla in three subjects, did not change it in two subjects, and increased it in one subject. Inhaled methacholine increased Rla in both inspiration and expiration in all subjects. The present study suggests that although laryngeal movement is tightly coupled with ventilation, laryngeal aperture may be determined by the complex competition of dilating and constricting mechanisms associated with the activity of the respiratory center and neural reflexes from the airway.

Effect of hypoxia on bronchial reactivity in dogs

The effect of hypoxia on bronchial reactivity was studied in six anesthetized dogs. Bronchial reactivity was obtained by inhalation of histamine aerosol in stepwise incremental concentrations during fixed tidal volume breathing. Two kinds of hypoxia were induced by inspiration of nitrogen until the end-tidal oxygen concentration (FETO2) reached 15% (mild) and 10% (severe hypoxia). Pulmonary resistance (RL) was measured by the 3 HZ forced oscillation technique in the open chest condition. Before histamine challenge, hypoxia did not increase RL in any of the dogs with mild hypoxia (FETO2 15%) and increased it in one dog with severe hypoxia (FETO2 10%). There was synergy between hypoxia and inhaled histamine in all dogs with both mild and severe hypoxia. The magnitude of synergy was significantly higher in severe than in mild hypoxia (p less than 0.05). With vagi cut, hypoxia did not increase RL compared with normoxia at any histamine concentration. It is suggested that hypoxia enhanced bronchial reactivity through the vagal nerves.

Prognostic factors in children with acute lymphoblastic leukemia. Part II: Multivariate analysis. Children's Cancer and Leukemia Study Group

The pretreatment characteristics of 158 children with previously untreated acute lymphoblastic leukemia diagnosed April 1972 to June 1978 were analyzed for their ability to predict prognosis. The children were treated according to therapeutic protocols 721, 745 and 765, by members of the Japanese Children's Cancer and Leukemia Study Group. Multivariate analysis was performed to determined the relationship between the characteristics and duration of survival of the patients. The following characteristics were analyzed: initial white blood cell (WBC) count, age at diagnosis, initial hemoglobin level, initial platelet count, sex, organomegaly, and treatment regimen that was provided. By using multivariate techniques, factors were found which the independently and significantly predict the length of survival. These factors were initial WBC count (r0 = 0.2908), age at diagnosis (r0 = 0.2982), and treatment regimen (r0 = 0.2488). Using the major prognostic factors of age at diagnosis and initial WBC count, a formula to predict the survival time was established. According to the initial WBC count and age at diagnosis, we classified all cases of childhood ALL as standard risk and high risk.

Prognostic factors in children with acute lymphoblastic leukemia. Part I: Univariate analysis. Children's Cancer and Leukemia Study Group

The pretreatment characteristics of 158 children with previously untreated acute lymphoblastic leukemia diagnosed April 1972 to June 1978 were analyzed for their ability to predict prognosis. The children were treated according to therapeutic protocols 721, 745 and 765, by members of the Japanese Children's Cancer and Leukemia Study Group. A univariate analysis was performed to determine the relationship between the characteristics and the duration of the patients' survival. The following characteristics were analyzed: initial white blood cell (WBC) count, age at diagnosis, initial hemoglobin level, initial platelet count, sex, organomegaly, and treatment regimen that was provided. Favorable prognosis was exhibited only by those patients with initial WBC counts of less than 50,000/mm3, with age at onset between 2 and 6 years, without splenomegaly, and with hemoglobin levels between 5 and 10 g/dl. The most significant contributions among the various individual prognostic factors were initial WBC count (p less than 0.001) and the age at diagnosis (p less than 0.01).

Chemiluminescence by polymorphonuclear leukocytes adhering to surfaces

Stimulation of the plasma membranes of granulocytes results in an oxidative metabolic response. This response can be measured by measuring the reduction of oxidizable substrates, such as Nitro Blue Tetrazolium, as well as by measuring the energy released as light (chemiluminescence). While investigating the oxidative response of human granulocytes, we observed a marked variation in the chemiluminescence response when leukocytes were suspended in a balanced salt solution without gelatin or any other protein. We performed systematic study to investigate the role of protein in suspensions of human polymorphonuclear leukocytes. Final results were identical with human serum, albumin, fetal calf serum, and gelatin; gelatin was used as the protein source in most experiments. Polymorphonuclear leukocytes suspended in Hanks balanced salt solution without gelatin decreased in numbers during incubation at room temperature (approximately 50 percent after 60 min). Cell structures were observed on the walls of the tubes containing leukocyte suspensions without gelatin. Numbers of polymorphonuclear leukocytes were stable in suspensions containing gelatin. A chemiluminescence response which peaked at approximately 10 min and was sustained for at least 30 min was observed in suspensions of polymorphonuclear leukocytes without gelatin. This surface attachment-stimulated chemiluminescence occurred in the absence of either soluble or particulate stimuli. Chemiluminescence was inhibited by either superoxide dismutase or sodium azide and did not occur with suspensions of granulocytes from patients with chronic granulomatous disease. We postulate that both superoxide- and myeloperoxidase-dependent oxidative metabolic reactions are induced during the adherence of polymorphonuclear leukocytes to surfaces. Gelatin or other proteins in leukocyte suspending media are necessary when assays are performed to evaluate the metabolic responses of these cells to particulate or soluble stimuli.

Polarographic micromethods for the rapid assay of phagocytosis-connected oxygen consumption by leukocytes in diluted peripheral blood

Simple and quantitative micromethods were devised for the detection of phagocytosis-connected oxygen consumption by leukocytes in diluted peripheral blood. A 20 microliter volume of heparinized peripheral blood was diluted with 180 microliter of HEPES-saline buffer and treated with CO; the mixture was put in an assay well (CO micromethod) or equilibrated with air by stirring it in the well for 2 min (air micromethod). The well was revised to be suitable for the micromethods. Oxygen concentration of the blood was monitored by a Clark-type electrode fitted to the well. The phagocytosis-connected oxygen consumption by leukocytes was induced by the addition of opsonized zymosan to the blood. Both methods were ascertained to give essentially the same activity. The mean specific activity (nmol/min/10(5) cells) of oxygen consumption by phagocytizing leukocytes was 0.65 +/- 0.20 in blood from healthy adults (n = 21). No increase in oxygen consumption by leukocytes was induced in blood from patients with CGD during phagocytosis. The activities of blood from mothers of boys with CGD were 0.29 and 0.74, the latter of which did not necessarily indicate a carrier status.

Precooling of a superconducting magnet using a cryocooler and thermal switches

A simple precooling system for a superconducting magnet is developed using a Cryomech GB02 cryocooler and gas filled thermal switches. A superconducting magnet (NbTi wire, 7 T of maximum field, 5.6 kg of weight) is precooled to 16 K in about 70 h without any manual control. Heat transfer rate of each thermal switch (H2 or N2 gas filled at 1.3 MPa at room temperature) is about 3x10(-1) W/K during the ON state, and 5x10(-3) W/K during the OFF state.

Histological and fine structural studies on pigmented neuroectodermal tumor of infancy

Pigmented neuroectodermal tumor of infancy originating from the anterior maxilla in a two-month-old male has been studied by light and electron microscopy. The tumor is characterized histologically by two types of neoplastic cells embedded in considerable amounts of fibrous stromal tissue. The first type of cell is cuboidal to columnar in shape with an epithelial appearance having abundant cytoplasm; either scanty or a heavy accumulation of melanin pigment is observed in the cytoplasm. These cells are aligned along the cleft-like space or arranged in small ductal structures. Electron microscopy shows the characteristic features of melanocytic cells having a varying degree of asynchronous maturation of melanosomes. The second type of cells is small and round in shape and has a hyperchromatic nucleus and scanty cytoplasm, resembling neuroblastic cells or lymphocytes. Electron microscopy reveals cytoplasmic processes resembling immature neuritis which protrude into the intracellular space; a small number of secretory granules having a central core surrounded by a single limiting membrane are observed in the cytoplasm and cytoplasmic processes.

Characterization of pyruvate kinase from the liver of a patient with aberrant erythrocyte pyruvate kinase, PK Nagasaki

The characterization of the L-type PK were made of PK extracted from the liver of a patient with congenital hemolytic anemia associated with an erythrocyte PK variant, PK Nagasaki. The L-type PK of PK Nagasaki showed the following parameters: slow migration on electrophoresis, high Km for PEP without F-1,6-P2, less activation by F-1,6-P2, normal Km for ADP, high utilization of UDP, acidic pH optimum, and instability to urea and heat. These tests served to differentiate this L-type PK variant from the other variants previously reported. At the same time, both the Km for PEP with F-1,6-P2 saturation and the electrophoretic mobility of L-type PK were found to be different from those of the erythrocyte PK and PK Nagasaki. Though the liver cell, with regard to L-type PK, has only the less functional and less stable mutant L-type PK there is no evidence of liver dysfunction or damage, although there is chronic hemolytic anemia.