Q fever pneumonia in children in Japan

The prevalence of Q fever pneumonia among children with atypical pneumonia from whom only an acute-phase serum sample was available was traced by using an indirect immunofluorescence (IF) test, nested PCR, and isolation. Twenty (34.5%) of 58 sera were found to have both polyvalent and immunoglobulin M antibodies to the phase II antigen of Coxiella burnetii by the IF test. Q fever pneumonia was present in 23 (39.7%) of 58 patients as determined by both the nested PCR and isolation and in 20 patients as determined by the IF test. The sensitivities for nested PCR and isolation were 100%, and that for the IF test was 87%. Our results indicate that nested PCR was faster and more sensitive than isolation and the IF test in the diagnosis of acute Q fever when a single acute-phase serum was available. These findings suggest that C. burnetii is an important cause of atypical pneumonia in children in Japan.

Early gastric lymphoma: a clinicopathologic study of ten patients, literature review, and comparison with early gastric adenocarcinoma

BACKGROUND

Improved diagnostic techniques have increased early detection of gastric lymphoma as well as the early detection of adenocarcinoma. However, clinicopathologic features of early gastric lymphoma are presently undefined.

METHODS

Clinicopathologic features of 10 patients with early gastric lymphoma were compared with the same features of 180 patients with early gastric adenocarcinoma. In addition, 46 articles were reviewed to evaluate clinicopathologic differences.

RESULTS

Early gastric lymphoma was found in 29.2% of the patients who underwent surgery for gastric lymphoma. Early gastric lymphoma was associated with lymph node involvement in 29.9% of the patients, superficial spreading tumors in 48.6%, and multifocal lesions in 40%. These rates are greater than those in patients with adenocarcinomas (P < 0.05%). The survival rate was identical in both groups. Early gastric lymphoma may develop into large, multifocal tumors, accompanied by lymph node involvement.

CONCLUSIONS

Surgical treatment with a wide resection of the stomach and extensive lymph node dissection is necessary for early gastric lymphomas.

Lung cancer producing interleukin-6

A patient with complaints of high fever and left shoulder pain was found to have a large mass in the left upper lobe on chest roentgenogram. Laboratory evaluation revealed marked thrombocytosis, hypoalbuminemia, and increased serum concentrations of CRP, fibrinogen and interleukin-6 (IL-6). A transcutaneous biopsy specimen revealed large cell carcinoma. Tumor production of IL-6 was confirmed by immunohistochemical staining with an anti-human IL-6 monoclonal antibody (MH60).

Clinicopathological characteristics of gastric cancer in the elderly

The clinicopathological features of 380 elderly patients 70 years of age or older with gastric cancer were reviewed retrospectively from hospital records between 1969 and 1993. They were then compared with 1134 middle-aged patients between 40 and 69 years. The elderly constituted 18.4% of all gastric cancer patients 20 years ago but now comprise 24.4% of all patients in the most recent decade, despite the overall decrease in the rate of gastric cancer. The distinguishing histological features of gastric cancer in the elderly were an intestinal type of cancer, expansive tumour growth and synchronous multiplicity of the lesions. Elderly patients had a similar rate of tumour extension but had poorer survival as compared with the middle-aged patients. Post-operative death within 30 days after surgery was also higher in the elderly than in the middle-aged patients.

[Evaluation of coronary arterial remodeling using intravascular ultrasound imaging]

Previous pathological studies demonstrated that the atherosclerotic coronary artery enlarges in response to developing atherosclerotic plaque. To clarify this phenomenon of coronary arterial remodeling, 24 segments of the left anterior descending artery were studied with intravascular ultrasound imaging. The luminal area and vessel area (area bounded by the echolucent zone) were measured by planimetry, and the percentage plaque area was calculated. Vessel area was correlated with plaque area (y = 12.3 + 0.72, r = 0.54, p < 0.001). When the 24 coronary segments were divided into two categories according to the percentage plaque area, there was no correlation between plaque area and lumen area in the coronary segment with less than 40% plaque area (n = 14, r = 0.20, p = NS) or less than 30% plaque area (n = 9, r = 0.18, p = NS). However, there was a correlation between plaque area and lumen area in the coronary segments with greater than 40% plaque area (n = 10, y = 22.1-0.27x, r = -0.82, p < 0.01). The correlation was somewhat better in cases with greater than 30% plaque area (n = 15, y = 22.5-0.28x, r = -0.89, p < 0.0001). Intravascular ultrasound imaging demonstrates the phenomenon of coronary arterial remodeling in vivo, which indicates that human coronary artery enlarges in response to increasing plaque area until the plaque occupies 30% of the vessel area. However, if the plaque occupies more than 30%, an increase in plaque area leads to a decrease in lumen area. Therefore, the phenomenon of coronary arterial remodeling is a compensatory mechanism to prevent luminal narrowing in the early stage of human coronary atherosclerosis.

Prognostic evaluation of preoperative combined treatment for advanced cancer in the lower rectum with radiation, intraluminal hyperthermia, and 5-fluorouracil suppository

BACKGROUND

Since 1977, we have studied preoperative treatments using 5-fluorouracil (5-FU) suppositories alone or in combination with radiation to reduce local recurrence and improve survival of patients with rectal cancer.

PATIENTS AND METHODS

We developed a novel preoperative therapy combining radiation, intraluminal hyperthermia, and 5-FU suppositories. Thirty-five patients with rectal cancer underwent surgery after this treatment, and 41 patients underwent surgery without pretreatment.

RESULTS

The patients who underwent preoperative combination treatment showed significant tumor reduction; 2 achieved microscopically complete regression. In comparison with the patients who underwent surgery without pretreatment, the preoperative treatment group had a 16.7% lower local recurrence rate (10.4% versus 27.1%) and an improved survival rate (81.8% versus 67.6%).

CONCLUSIONS

Preoperative combination therapy is a promising modality for the patients with respectable advanced cancer in the lower rectum.

A research to develop a predicting system of mammalian subacute toxicity. II. Single dose detailed toxicity studies

"Single dose detailed toxicity study" in rats was conducted with 6 chemical substances to establish a predicting system of subacute toxicity of non-congeneric industrial chemicals. In the detailed examinations, new and previously reported biological parameters were developed and utilized for the establishment and confirmation of the correlations for both qualitative and quantitative prediction of target organs and effects in repeated dose toxicity studies of non-congeners; the new parameters were concerned with liver, kidneys and blood and the established relating equations for prediction had a correlation coefficient of 0.83 (liver), 0.49 (kidneys) and 0.94 (blood), while the old parameters effectively confirmed the previous correlations. The serial changes in the study gave a biological explanation to the established relationships between acute and subacute toxicities in terms of extrapolation.

Epitope of 24G7 anti-bilirubin monoclonal antibody

We examined an antigenic epitope recognized by an anti-bilirubin monoclonal antibody designated 24G7 (Shimizu, S., Izumi, Y., Yamazaki, M., Shimizu, K., Yamaguchi, T., and Nakajima, H. (1988) Biochim. Biophys. Acta 967, 255-260). The reactivity of bilirubin-IX alpha, its analogues (III alpha, XIII alpha, and mesobilirubin-IX alpha) and related azo compounds, with 24G7 was compared by means of an enzyme-linked immunosorbent assay (ELISA). The order of reactivity was as follows: (a) aniline azopigment > ethyl anthranilate azopigment > sulfanilic acid azopigment, (b) bilirubin-XIII alpha > bilirubin-IX alpha > bilirubin-III alpha, (c) bilirubin-IX alpha = mesobilirubin-IX alpha. These findings indicated that the epitope is present in (a) the dipyrrolic moiety of the endovinyl (correspond to N-21 and N-22 of bilirubin), or exovinyl types (N-23 and N-24); (b) the dipyrrolic moiety of the endovinyl type, which contains (c) a methyl group (C-2) but not a vinyl group (C-3) in the dipyrrolic moiety of endovinyl type. Therefore, we concluded that the epitope was the region containing the oxo group at C-1, the methyl group at C-2, C-(4,5,6,9), and the N-21 and -22 of bilirubin-IX alpha.

Expression of variant CD44-messenger RNA in colorectal adenocarcinomas and adenomatous polyps in humans

BACKGROUND & AIMS

Recent studies have shown that some variant forms of CD44, a transmembrane glycoprotein expressed on various cell surfaces, might be involved in tumor progression or tumor metastasis. The aim of this study was to analyze the expression of CD44-messenger RNA (mRNA) in colorectal cancer and colorectal adenoma to further elucidate the role of CD44 in colorectal tumorigenesis.

METHODS

The expression of CD44-mRNA was examined in 90 specimens from 44 patients with colorectal cancer or colorectal adenomatous polyps and in the peripheral blood leukocytes from 7 healthy volunteers by reverse transcription-polymerase chain reaction and Southern blot hybridization.

RESULTS

Strong expression of the epithelial form and variant forms containing exons 11 or 12 of the CD44 gene, which conferred metastatic behavior to rat cells, was detected in primary and metastatic tumor tissues, whereas it was very weak or not detectable in normal colonic mucosae, normal liver tissue, or peripheral blood leukocytes. However, adenomatous colorectal polyps also showed as strong an expression of epithelial and variant forms of CD44 as primary and metastatic tumor tissues.

CONCLUSIONS

These results suggest that variant forms of CD44-mRNA might be expressed in an early stage of colorectal carcinogenesis.

The effects of cardiac infarction on realistic three-dimensional left ventricular blood ejection

The effect of cardiac infarction on the flow patterns in cardiac left ventricular ejection was studied using a realistic model which was made from the profile of the left ventricle of a dog heart in diastole. A coordinate measuring machine was used to measure the left ventricular coordinates, and these were input into a three-dimensional flow simulation package. The left ventricular wall motion was described by having the walls moved towards the center of the aortic outlet, and in the case of infarcted tissue, the ventricular wall movement was diminished to simulate infarction flow behavior. The final ventricular volume varied from 25 percent to 54.1 percent of the initial volume in cases without and with infarction, respectively. The maximum blood ejection velocities and ventricular pressure decreased significantly in the presence of infarction. Infarcted areas showed complex blood flow vortex formation not present in the healthy ventricles. The computational technique presented here predicts infarction flow effects which could be observed with measurement techniques such as ultrasound and magnetic resonance imaging, allowing a finer detail of understanding than using either simulation or experimental measurements alone.

Applicability of monoclonal antibody Fab fragments as a carrier of neocarzinostatin in targeting chemotherapy

Two types of fragments of MAb A7 were produced to improve the efficacy and safety in targeting chemotherapy with neocarzinostatin. In this study, 125I-labeled F(ab')2 and Fab fragments of MAb A7 and 125I-labeled MAb A7 were injected intravenously into mice with pancreatic carcinoma xenografts, and the accumulation of each antibody in the tumors was compared. A greater amount of the 125I-labeled Fab fragments of MAb A7 localized in the tumor 2 h following the injection than was observed with the other probes. Relatively less 125I-labeled MAb A7 localized in the tumor 2 h following the injection than was observed with the other two probes. Moreover, reaction of rabbit antimouse IgC with the Fc portion, which is the most immunopotent region of the Fab and F(ab')2 fragments of MAb A7 and MAb A7, was determined by ELISA; the weakest reaction was observed with the Fab fragments of MAb A7. These results suggest that the Fab fragments of MAb A7 may be more suitable carriers of an anticancer drug that is inactivated rapidly in the blood, such as NCS, in targeting chemotherapy than either intact MAb A7 or the F(ab')2 fragments of MAb A7.

IL-6 mRNA synthesis by peripheral blood mononuclear cells (PBMC) in patients with chronic renal failure

We measured levels of IL-6 mRNA in PBMC obtained from patients with chronic renal failure, using polymerase chain reaction (PCR). PBMC were isolated from 45 patients on haemodialysis (HD) at the start of HD. PBMC were also isolated from 35 patients on HD at the end of HD, 23 patients on continuous ambulatory peritoneal dialysis (CAPD), 24 undialysed patients with chronic renal failure (CRF), and 19 healthy controls. Total RNA was extracted from PBMC with RNA zol and reverse transcribed into cDNA. To prepare samples containing identical amounts of beta-actin cDNA, we performed competitive PCR by co-amplifying serial dilutions of mutant templates containing a single point mutation which generated a unique Eco RI site. Next, to measure IL-6 cDNA semiquantitatively in the samples containing identical amounts of beta-actin (100 pg), we performed PCR amplification using 2 fg of the IL-6 mutant template containing a unique Eco RI site. Higher levels of IL-6 mRNA in the PBMC were observed in the HD patients than in the CAPD patients and healthy controls. The levels of IL-6 mRNA in the PBMC at the end of HD were not significantly higher than those at the start of HD. These results suggest that the dialysis session itself did not significantly affect IL-6 mRNA levels in the PBMC, but that chronic stimulation by maintenance HD may be associated with higher levels of IL-6 mRNA observed in HD patients.

Effects of calyculin A and FK506 on the O2- generation of rat peritoneal macrophages

To investigate the role of phosphatase in O2- generation, the effects of the potent phosphoprotein phosphatase inhibitors, Calyculin A and FK506, were analyzed during phagocytosis using rat peritoneal macrophages. O2- generation was continuously measured after addition of opsonized zymosan (op. ZY) or IgG-coated zymosan (IgG-ZY). The rate of O2- generation was directly proportional to the number of macrophages, up to 1-2 x 10(6) cells/ml. It was found that the rate and duration of O2- generation were markedly inhibited by Calyculin A. The addition of 100 nM of Calyculin A reduced O2- generation to about one-tenth of the control value. In contrast, FK506 did not inhibit O2- generation, suggesting that calcium calmodulin phosphatase is not involved in the activation of NADPH oxidase. This result indicates that the process of dephosphorylation might involve activation of NADPH oxidase as a control mechanism in phagocytosis by rat peritoneal macrophages. Furthermore, since Calyculin A is an inhibitor of phosphatase 1 and 2A, it is suggested that dephosphorylation may be evoked by these phosphatases.

[Endobronchial treatments made possible by extracorporeal lung assist in a patient in status asthmaticus refractory to mechanical ventilation]

A 19-year-old endotracheally intubated women was admitted to our hospital in severe status asthmaticus that was not relieved by inhalation of beta 2-agonists or by epinephrine, aminophylline, or corticosteroids. A chest radiography revealed pneumomediastinum and subcutaneous emphysema. Pressure-limited mechanical ventilation at a peak airway pressure of 20--30 cmH2O failed to ventilate the lungs, and caused a left pneumothorax and atelectasis. Extracorporeal lung assist (ECLA) was begun and enabled repeated suctioning through a fiberoptic bronchoscope for more than a minute with no serious complications. During ECLA aerosol therapy with a large dose of a beta 2-agonist (procatherol 0.15 mg) increased the tidal volume with no adverse effects. Atelectatic areas of the lungs re-expanded, pulmonary function improved, and ECLA was stopped 86 hours after it had been started. We suggest that, although it is highly invasive, ECLA can be useful in patients with status asthmaticus refractory to mechanical ventilation, and can allow endobronchial suctioning to be done safely.

Effects of competitive blood flow on arterial graft patency and diameter. Medium-term postoperative follow-up

To identify predictors of arterial graft patency, we followed up 30 internal thoracic arterial grafts and 23 right gastroepiploic arterial grafts in situ with patency documented during postoperative angiography. After 24 months of follow-up on average, repeat angiography detected that one internal thoracic artery and two gastroepiploic arteries were anatomically occluded and that the other three gastroepiploic arteries were nonfunctioning. The logistic regression model identified a relationship between graft patency and competitive flow, which was detected as stenosis in the recipient coronary arteries (coefficients, p < 0.05; model, Hosmer-Lemeshow chi2 statistic 3.59, p = 0.89). The linear regression model demonstrated that changes in graft luminal diameter correlated with competitive flow (p < 0.01), smoking history (p < 0.05), and type of arterial grafts (p < 0.001) (R2 = 0.40, adjusted R2 = 0.36). The findings suggest a temporal relationship between competitive flow and prognosis of arterial graft.

Effects of hyaluronan on cell proliferation and proteoglycan synthesis in rabbit ligamental cells

The effect of hyaluronan (HA) on cell proliferation and synthesis of proteoglycan (PG) in rabbit ligamental cells was examined in vitro. HA promoted the incorporation of 35S-sulfate in a concentration-dependent manner, significantly at 100 micrograms/ml and upward, without effect on cell proliferation. The chromatographic profile of the 35S-labelled materials extracted with 4 M guanidine hydrochloride by Sepharose CL-2B was different in the HA-treated cells as compared with untreated cells. Although the radioactivities of the low-molecular fraction peaked at Kav 0.71 did not change, those of the high-molecular fraction (Kav 0.30-0.50) increased with treatment of HA. Ligamental cells expressed the mRNA of the PG family's versican and aggrecan (large-molecular weight PGs), biglycan and decorin (small-molecular weight PGs) in dot blot analysis. Although the mRNA expression of aggrecan, biglycan and decorin did not change, that of versican increased upon treatment with HA. These findings suggest that HA is involved in promoting production of the large-molecular-weight PG versican, and in facilitating extracellular matrix formation.

Vascular smooth muscle relaxation by alpha-adrenoceptor blocking action of dobutamine in isolated rabbit aorta

We investigated the mechanism of vascular relaxation produced by dobutamine, a positive inotropic agent with beta 1-adrenergic action. Dobutamine concentration-dependently (10 nM-10 microM) relaxed ring segments of rabbit aorta partially precontracted with 1 microM phenylephrine (PE) but did not relax those precontracted with 40 mM K+ or 5 microM prostaglandin F2 alpha (PGF2 alpha). The relaxation was not completely inhibited by pretreatment with 10 microM propranolol. Dobutamine did not significantly increase tissue cyclic AMP levels concomitantly with relaxation as does isoproterenol (ISO) in rabbit aorta. Dobutamine produced a parallel rightward shift in concentration-response curves to PE. The Schild plot analysis resulted in a linear regression of a slope of 1.077 +/- 0.077, which was not significantly different from unity. The pA2 value of dobutamine as compared with PE in rabbit aorta was 6.81 +/- 0.03. Dobutamine causes arterial dilatation mediated not only through a beta-adrenergic action but also through an alpha-adrenergic blocking action in rabbit aorta.

Biochemical profile of YM992, a novel selective serotonin reuptake inhibitor with 5-HT2A receptor antagonistic activity

YM992, (S)-2-[[(7-fluoro-4-indanyl)oxy]methyl]morpholine monohydrochloride, exhibited the biochemical profile of a selective serotonin (5-HT) reuptake inhibitor (SSRI) with 5-HT2A receptor antagonistic activity. YM922 showed the same high affinity as fluoxetine against the 5-HT reuptake site (Ki = 21 nM) and a similar affinity to that of crazodone against the 5-HT2A receptor (Ki = 86 nM). In other receptor binding studies, an affinity for the adrenergic alpha 1 receptor (Ki = 200 nM) and 5-HT2C receptor (Ki = 680 nM) was observed. In a monoamine uptake study, YM992 showed a selective 5-HT uptake inhibition (IC50 = 0.15 microM), but only very weakly inhibited both noradrenaline (NA) and dopamine (DA) uptake (IC50 = 3.1 microM (NA), > 10 microM (DA)). YM992 was also found to potently inhibit the aggregation of human platelets (IC50 = 1.9 microM), revealing antagonistic activity for the 5-HT2A receptor in vitro. Enhanced serotonergic neurotransmission, in particular that mediated by the 5-HT1A receptor, has recently been reported to be important in the long-term treatment of depressive disorders with antidepressants. In addition, some 5-HT1A receptor-mediated responses are known to be potentiated by co-administration of 5-HT2A receptor antagonists. Thus, YM992, having both selective 5-HT reuptake inhibition and 5-HT2A antagonistic activity, might show potent therapeutic activity as a novel antidepressant in comparison with conventional SSRIs.

[Depression of cellular immunity after aortic arch replacement]

Multiple organ failure due to infection is now one of the most serious postoperative complications following aortic arch replacement. We therefore evaluated the postoperative changes of cellular immunity using four parameters, 1) peripheral lymphocyte subsets 2) mitogen responsiveness 3) the activity of natural killer (NK) cells 4) interleukin-2 (IL-2) production. Patients were divided into two groups: group A (n = 5) with aortic arch replacement and group B (n = 10) with coronary artery bypass grafting. All variables were measured the day before, the day after, 3 days after, 7 days after, and 14 days after surgery. CD3 positive cells in group A were significantly lower than in group B throughout the postoperative course. CD4 positive cells in group A were significantly lower than in group B on the day after 3 days after the operation. IL-2 production in group A was markedly depressed the day after (all patients 0.8 U) and 3 days after (1.5 +/- 1.6 U) as compared to the preoperative level (7.7 +/- 4.4 U) and the levels on the same days in group B. The activity of NK cells in group A was significantly impaired the day after (10.6 +/- 6.7%) and 3 days after (10.0 +/- 6.7%) as compared to the preoperative level (28.6 +/- 16.7%) and the levels on the same days in group B. IL-2 production in group A was significantly correlated to CD3 and CD4 positive lymphocyte levels. These results clearly showed that patients who underwent aortic arch surgery suffered functional depression of cellular immunity, in particular IL-2 production and the activity of NK cells. These depressions may be a result of massive blood transfusion, tissue trauma under hypothermic cardiopulmonary bypass.

Release of spectrin-containing vesicles from human erythrocyte ghosts by dimyristoylphosphatidylcholine

Membrane vesicles, which were released from human erythrocyte ghosts by dimyristoylphosphatidylcholine (DMPC), showed a protein composition similar to that of the erythrocyte membrane, despite a reduction of in spectrin content. The spectrin content of vesicles decreased with increasing hemoglobin concentration within ghost membranes, but increased upon exposure of hemoglobin-free ghosts to a pressure of 100 MPa. The ESR spectra of spin-labeled membrane proteins showed that membrane proteins in ghosts became unfolded at high pressure. Furthermore, spectrin-poor and protein 4.1-rich vesicles were released by DMPC from diamide-treated ghosts in which spectrin was cross-linked and stabilized. Taking into account that the spectrin tetramer is stabilized by hemoglobin [Liu and Palek (1984) J. Biol. Chem. 259, 11556-11562], these results suggest that the spectrin content of DMPC-induced vesicles from erythrocyte ghosts increases with increasing instability of the cytoskeletal network in parent cells.