[Evaluation of urinary NMP22 (nuclear matrix protein 22) as a diagnostic marker for urothelial cancer--screening for urothelial cancer in patients with microscopic hematuria. NMP Study Group]

This study was undertaken to determine the clinical usefulness of NMP22 (Nuclear Matrix Protein 22) as a urinary marker for the screening of urothelial cancer in patients with microscopic hematuria, especially in comparison with that of voided urine cytology. Urinary NMP22 values were determined for 183 patients with microscopic hematuria by use of a UNMP22 Test kit, which is based on an enzyme-linked immunosorbent assay. All patients were entered in this study before cystoscopy was performed, and were evaluated for NMP22 values and voided urine cytology simultaneously from the same urine samples. Of the 183 patients with microscopic hematuria, 14 cases of urothelial cancer were detected. For the other cases, 65 were of benign diseases and 104 were designated NED (No Evidence of Disease). The median NMP22 values for urothelial cancer, benign diseases, and NED were 26.5 U/ml (95% CI: 18.5-228.2; 4.9 U/ml (95% CI: 3.6-8.3), and 5.9 U/ml (95% CI: 4.8-6.5), respectively. The urinary NMP22 value for urothelial cancer was significantly higher than for benign diseases and NED. When the cut-off value of urinary NMP22 was set at 12 U/ml, the positive rate of NMP22 for urothelial cancer was 85.7%, significantly higher than the 50% positive rate by voided urine cytology. This study indicates that urinary NMP22 is a useful tool for the screening of urothelial cancer in patients with microscopic hematuria.

Kinetics of respiratory depression in rats induced by buprenorphine and its metabolite, norbuprenorphine

The respiratory depression induced by buprenorphine and its active metabolite, norbuprenorphine (NBN), was evaluated in rats by measurement of changes in respiratory rate and arterial pCO2 levels. After i.v. bolus administration of buprenorphine no effects were noted over the dose range 0.008 to 3 mg/kg; by contrast, the respiratory rate after rapid i.v. administration of NBN decreased in a dose-dependent fashion within the dose range of 1 to 3 mg/kg, and the arterial pCO2 levels also varied in relation to the change in respiratory rate. The minimum respiratory rate was observed 15 min after NBN administration. Judging by the respiratory depressive effect after i.v. infusion, NBN was approximately 10 times more potent than the parent drug. In spite of the similarity of NBN concentrations in the brain after i.a. and after i.v. administration of NBN (3 mg/kg), neither the respiratory rate nor the arterial pCO2 levels after i.a. administration changed compared with the control levels. Moreover, the NBN concentration in the lungs after i.v. administration was approximately 4-fold higher than that after i.a. administration. NBN-induced depression was rapidly reduced after i.v. administration of naloxone and beta-funaltrexamine, but ICI 174864 was without effect. These results suggest that the respiratory depression induced by NBN may be mediated by opioid mu receptors in the lung rather than in the brain.

[Radiological diagnosis of viral encephalitis]

Most of viral encephalitis may demonstrate no specific change on CT and MR images. Brain swelling, edema, abnormal density (CT) and abnormal intensity (MR) can be detected in herpes simplex encephalitis and enterovirus encephalitis (coxsackie, echo, polio). The common finding on CT and MRI in patients with HIV encephalopathy are atrophy, leukomalacia. Progressive multifocal leukoencephalopathy (PML) shows multifocal oval or round white matter T2-hyperintensities on MR images. Subacute sclerosing panencephalitis (SSPE) may present slight changes in the subcortical and periventricular white matter, as well as basal ganglia. Progressive disorder makes widespread T1-low, T2-high intensity area and atrophy. MRI of acute disseminated encephalomyelitis (ADEM) shows multifocal subcortical hyper intense foci on T2-weighted studies. The deep white matter, brainstem, thalamus and cerebellum can be affected. Most of ADEM lesions resolve. Imaging findings of acute lymphocytic meningitis by echovirus and coxsackievirus are usually normal.

Prostaglandin F2 alpha promotes the inhibitory action of endothelin-1 on the bovine luteal function in vitro

Prostaglandin F2 alpha (PGF2 alpha) is a primary luteolysin in the cow. Although the mechanisms involved in luteolysis are thought to be a complex of its direct action on luteal cells and indirect effect on luteal blood flow, the detailed mechanisms remain to be elucidated. This study focuses on the possible interaction of endothelial cells-derived endothelin-1 (ET-1) with PGF2 alpha in the rapid suppression of progesterone release from the bovine corpus luteum (CL). In in vitro microdialysis system (MDS) of CL, PGF2 alpha acutely stimulated the release of progesterone and oxytocin during infusion and ET-1 release after infusion. Moreover, PGF2 alpha induced slight decrease of progesterone release during the last period of the experiment (8-11 h after PGF2 alpha exposure). Two 1 h-perfusions of ET-1 at 3 h intervals induced only a slight decrease of progesterone release after the second perfusion. This treatment also affected the oxytocin release; the first ET-1 perfusion produced an acute stimulation, whereas the second ET-1 perfusion inhibited the release to below 50%. When the CL pieces were pre-perfused with PGF2 alpha for 2 h, the two consecutive perfusion of ET-1 at 3 h intervals induced drastic decrease in progesterone and oxytocin release only after the second ET-1 perfusion. Thus, a pre-exposure with PGF2 alpha clearly potentiated the inhibiting activity of ET-1 in the progesterone release. These results suggest a physiological impact of PGF2 alpha and ET-1 in the rapid cascade of functional luteolysis in vivo, and a possible interaction between endothelial cells and luteal cells.

Clinical evaluation of nuclear matrix protein 22 (NMP22) in urine as a novel marker for urothelial cancer

OBJECTIVES

This study was undertaken to determine the clinical usefulness of nuclear matrix protein 22 (NMP22) as a novel urine marker for urothelial cancer, particularly, to substitute for voided-urine cytology.

METHODS

NMP22 values were determined for 280 patients and 20 healthy volunteers by NMP22 Test Kit based on an enzyme-linked immunosorbent assay.

RESULTS

When the cut-off value was set at 10 U/ml, the positive rate of urinary NMP22 for urothelial cancer was 80.9% (38/47), whereas that for posttreatment cases and benign diseases was 35.7% (74/207). When urinary NMP22 and voided-urine cytology were compared, the test for urinary NMP22 showed higher sensitivity than cytology in patients with urothelial cancer. When urinary NMP22 values were determined pre- and postoperatively in patients with urothelial cancer, the postoperative value decreased in all patients, and were below the cut-off value in all except one patient.

CONCLUSIONS

Urinary NMP22 is a useful diagnostic marker as a substitute for voided-urine cytology for the surveillance of urothelial cancer.

Synthesis and phospholipase A2 inhibitory activity of thielocin B3 derivatives

We prepared several types of derivatives of thielocin B3, a very potent naturally occurring inhibitor for human nonpancreatic secretory PLA2 (sPLA2-II), and conducted a structure-activity relationship study to identify potent sPLA2-II inhibitors with the aim of developing antiinflammatory drugs. The total number of aromatic rings is critical for sPLA2-II inhibition, and the best result was obtained in the case of six rings. The structure of the central part of the inhibitors was not specific, and potent inhibitors were found among the sulfide, sulfone, ether, methylene, and amino derivatives. Although a diester of the terminal carboxylic acid lost its inhibitory activity, having both of the carboxylic acids was not necessary for expression of activity, as illustrated by a glycine derivative with the benzyl ester group 36. Among the newly synthesized derivatives, 18, 20, 29, and 36 showed very potent human sPLA2-II inhibitory activity comparable to that of natural thielocin B3. Their IC50 values are in the range 0.069-0.14 microM, and they are a class of compounds showing the most potent sPLA2-II inhibition to date.

Immunohistochemically-determined changes in the distribution of insulin-like growth factor-I (IGF-I) and epidermal growth factor (EGF) in the bovine endometrium during the estrous cycle

The aims of this study were to investigate whether there are cell-specific distributions of insulin-like growth factor I (IGF-I) and epidermal growth factor (EGF) in the endometrium, and to determine whether or not the expression of these factors varies with the stage of the estrous cycle. Fifty-four endometrial biopsy specimens were collected from normal cycle Holstein-Friesian heifers. The endometrial specimens were divided into nine groups (at least five different animals per group) corresponding to the following days of the cycle: days 20-0, 1-3, 4-5, 6-7, 8-10, 11-13, 14-15, 16-17, and 18-19 (day 0 = estrus). IGF-I and EGF were localized by immunohistochemistry in the intact heifer endometrium throughout the estrous cycle. Throughout the estrous cycle, IGF-I was localized in the luminal epithelium and stroma with a little staining in the glandular epithelium (P < 0.01). In the luminal epithelium, the number of IGF-I-positive cells increased on days 1-3, 6-7, 11-13, and 16-17. In the stroma, the number of IGF-I-positive cells increased on days 8-10 and 20-3. The number of positively stained cells in the glandular epithelium increased around the estrous period. EGF stained intensely in the stroma but very little in the luminal and glandular epithelia (P < 0.01). In the stroma, three peaks in the number of EGF-positive cells were observed: on days 1-3, 6-7, and 11-13. These results demonstrate cyclical changes in the endometrial cell types localization of IGF-I and EGF.

[Usefulness of contrast-enhanced CT of the peritoneum to evaluate efficacy of neoadjuvant chemotherapy for peritoneal dissemination in an advanced gastric cancer case]

We performed contrast-enhanced CT before and after chemotherapy in a patient with advanced gastric cancer to assess the efficacy of neoadjuvant chemotherapy for peritoneal dissemination. The patient was preoperatively given combined chemotherapy with UFT and CDDP. Hepatic metastatic and peritoneal disseminated foci were markedly reduced on CT. Thus CT proved to be useful for assessing peritoneal dissemination and the efficacy of neoadjuvant chemotherapy.

Potent inhibitors of secretory phospholipase A2: synthesis and inhibitory activities of indolizine and indene derivatives

Phospholipase A2 is an enzyme which hydrolyzes the sn-2 position of certain cellular phospholipids. The liberated lysophospholipid and arachidonic acid are precursors in the biosynthesis of various biologically active products. As human nonpancreatic sPLA2 is present in high levels in the blood of patients in several pathological conditions, the potent sPLA2 inhibitors have been suggested to be useful drugs. Here we describe the synthesis, structure-activity relationship, and inhibitory activities of indolizine and indene derivatives. 1-(Carbamoylmethyl)indolizine derivatives and 1-oxamoylindolizine derivatives exhibited very potent inhibitory activity. The former was unstable to air oxidation, but the latter exhibited an improvement both in stability and in potency. Some compounds approached the stoichiometric limit of the chromogenic assay.

Comparison of bovine uterine horns for progesterone and oxytocin levels with bilateral corpus luteum

Bovine uterine horns with both ovaries containing a corpus luteum (CL) were compared for progesterone (P4) and oxytocin (OT) concentrations during the luteal phase of the estrous cycle. Uterine tissue samples from five Holstein cows with bilateral CL obtained from the slaughterhouse were used for this study. No significant difference was observed in P4 and OT levels in the right and left horns with corpora lutea in both ovaries. The data clearly indicate that both sides of the uterine horn having a functional CL are exposed to similar levels of P4 and OT, supporting the hypothesis that luteal products are delivered locally to the uterus. Key words: Progesterone, oxytocin, uterine horn, bilateral, corpus luteum, cow

Oxamflatin: a novel compound which reverses malignant phenotype to normal one via induction of JunD

In the course of screening for inhibitors of tumorigenic phenotype of K-ras-transformed NIH3T3 cells (DT cells), we found a novel compound, oxamflatin, an aromatic sulfonamide hydroxamate derivative, which induces flat phenotype in these cells and suppresses their anchorage-independent growth. In contrast to DT cells, in v-raf-transformed NIH3T3 cells, no change in their morphology and no specific inhibition of their anchorage-independent growth was observed. Interestingly, oxamflatin was effective to NIH3T3 cells transformed by constitutively activated mutant of MEK, indicating the possibility that oncogene-induced morphological change is not necessarily induced by common signaling pathway such as MAP kinase cascade. In oxamflatin-treated DT cells, the expression of transcription factor junD was highly augmented, resulting in trans-activation of fibronectin gene by junD via cyclic AMP responsive element in its promoter. This behavior of junD was confirmed to correlate well with partial blocking of malignant phenotype in DT cells. Thus, oxamflatin can be categorized as the first reagent which induces genes whose products can interfere with oncogene-dependent transformation.

Symptomatic relief for patients with osseous metastasis treated with radiation and methylprednisolone: a prospective randomized study

A multi-institutional prospective study to evaluate the relief of symptoms for patients with osseous metastasis treated with irradiation and methylpredonisolone was performed. A total of 38 patients with osseous metastasis, treated between January 1991 and December 1992, were included in this study. Patients were randomly allocated to one of two treatments: radiation alone (RT alone) (n = 18) or radiation combined with methylpredonisolone (RT + MP) (n = 20). Symptoms were scored by patients themselves using original Quality of Life (QOL) scores. Stratification by urinary hydroxyproline/creatinine ratios (Hypro/Cr) showed no significant differences in QOL scores between RT and RT + MP in the group with good prognosis, which showed a lower Hypro/Cr (< 3.6 mg/g) during treatment. Following treatment, the score for both groups improved. On the other hand, in the group with poor prognosis, with a higher Hypro/Cr (> or = 3.6 mg/g), a significantly greater improvement in QOL scores was observed for the RT + MP group than for the RT alone group (p < 0.05). There was also a marked difference in the RTOG pain scores, evaluated by physicians before treatment and at the end of treatment, between the two treatment groups and the prognostic groups divided according to Hypro/Cr. No correlation was seen at initial presentation between urinary Hypro/Cr and serum tartrate-resistant acid phosphatase (TrACP). In conclusion, the treatment regimen of RT + MP is recommended for patients with osseous metastasis with poor prognosis who show relatively high Hypro/Cr values. Radiotherapy was equally effective in terms of RTOG pain score for both the poor and good prognostic groups. Serum TrACP was not useful for determining the prognosis of our patient groups.

[Perioperative fractionated high dose rate brachytherapy in bone and soft-tissue tumors]

The 13 lesions of 11 patients with bone and soft-tissue tumors (four primary and nine recurrent lesions) were treated with surgery and postoperative fractionated high dose rate (HDR) brachytherapy started on the 6-7th day after surgery. The total dose was 40-50 Gy/7-10 fr/6-7d(bid) at 5 mm from the source. Local control was achieved in eight of 13 lesions (62%). Four of the five uncontrolled lesions had macroscopic residual tumor after the surgery. There was one peripheral nerve damage as a side effect. This study indicates that the use of perioperative fractionated HDR brachytherapy is feasible and well tolerated.

Chemical modification of PA-48153C, a novel immunosuppressant isolated from Streptomyces prunicolor PA-48153

5beta-Methoxy (20), 14-methyl (24), 14,14-dibromo-15-nor (25), 8-O-acyl (26-45), 8-O-alkyl (46), 8-O-alkoxycarbonyl (47, 48), and 8-O-carbamoyl (49) derivatives of PA-48153C, a novel immunosuppressant isolated from fermentation products of Streptomyces prunicolor PA-48153, were prepared. These compounds were found to retain the inhibitory activity on the responses of both T and B cells to mitogens. Among them, the C-8 hexanoate 28 showed potent suppressive effects on mitogen responses with less cytotoxicity to EL4 cells and was selected for in vivo evaluation.

[Local chemotherapy by a sustained-release preparation with fibrin seal against the operative wound in head and neck cancer]

Fibrin seal has been used for hemostasis and sealing in operative field of tumors in the head and neck. The authors applied it for drug preparation and tried a local chemotherapy to treat residual and disseminated tumors of cellular level in the operative wound using 5-FU. The drug release rate in this therapy in vitro study was 50% after 24 hrs. When injected to rats bearing Yoshida sarcoma, it exhibited a marked antitumor effect compared to the control group given 5-FU alone. This therapy is easy to make the dosage adjustment and can apply drugs directly to the tumor residue at the high concentration. It will be clinically a useful adjuvant therapy for radiotherapy, surgery or chemotherapy.

Radiographic changes following radiotherapy in the patients with lung cancer. Is the irradiated area of the mediastinum in the simulation film a significant factor?

BACKGROUND

Radiation induced lung injury is an ominous adverse reaction in the management of thoracic disease by radiation therapy. Although the importance of the area of irradiated lung is well known, the irradiated area of mediastinum is little to be considered in the routine treatment.

PURPOSE

To evaluate the significance of the irradiated area of the mediastinum in the simulation film for radiation induced lung injury.

PATIENTS AND METHODS

A total of 208 patients with primary lung cancer treated with radiation therapy were analyzed for incidence of radiation induced lung injury. Lung injury was defined as the appearance of an abnormal shadow on the chest radiograph. CT images were used to differentiate recurrence or other conditions. Age, sex, irradiation dose, irradiated lung area, T and N factors of the tumor, irradiated mediastinum area, performance status of patients, location of irradiated fields and use of chemotherapy were analyzed with Cox's multivariate regression model.

RESULTS

The cumulative rate of radiation induced lung injury at 12 months was 85%. Significant factor of radiation induced lung injury was irradiated area of the mediastinum (p = 0.03). Irradiated area of the lung (p = 0.18, n.s.), total tumor dose (p = 0.1, n.s.), use of chemotherapy (p = 0.08, n.s.) and location of irradiated field (p = 0.08, n.s.) may also have an effect on radiation induced lung injury.

CONCLUSION

The irradiated area of the mediastinum is one of the significant factors in radiation induced lung injury.

Comparative analysis of buprenorphine- and norbuprenorphine-induced analgesic effects based on pharmacokinetic-pharmacodynamic modeling

The relationships between plasma or brain concentrations and analgesic effects of both buprenorphine (BN) and an active metabolite, norbuprenorphine (NBN), were investigated in rats. Maximal analgesic effects measured by a tail flick test were obtained at 10 and 30 min after intravenous (i.v.) administration of BN (8 micrograms/kg dose) and NBN (100 micrograms/kg dose), respectively. No correlation was observed between analgesic effect and the early plasma BN or NBN concentrations. However, at latency times, the concentration of BN in the plasma, cerebellum and the rest of the brain (including the brainstem, midbrain and cerebrum) was related in a counterclockwise hysteresis fashion to analgesia. There was no relationship between the estimated specific binding concentration of BN in the brain and the analgesic effects. After i.v. administration of BN or NBN, the analgesic effect of NBN was approximately one-fiftieth that of BN. The n-octanol/water partition coefficient of NBN was one-tenth that of BN. Further, the results of intraventricular administration of each drug suggested that the intrinsic analgesic activity of NBN was one-fourth that of BN. From these findings, we conclude that the remarkably weak pharmacological effect of NBN after i.v. administration may be due not only to the low permeability of NBN into the brain but also to its small intrinsic pharmacological effect.

A case of secondary syphilis with mucous patches on the hard palate

A rare case of secondary syphilis showing mucous patches on the hard palate is reported. A 31-year-old male had two erosive patches which were slightly raised on his hard palate. A linear lesion was also present on the inside of his right alveolar process. Many red-brown macules on his abdomen and bilateral inguinal lymphadenopathy accompanied these symptoms. The serological tests for syphilis were positive: VDRL test 1:512, TPHA test 1:20,480, and IgM-FTA-ABS test 1:40. Immunohistochemical staining with rabbit monoclonal antibody to Treponema pallidum by the biotin-streptoavidin system detected treponemal organisms in the paraffin-embedded specimen from his mucous patch. A diagnosis of secondary syphilis was made, and he was given amoxicillin (AMPC) at 750 mg per day for 4 weeks. His eruptions, including the mucous patch, healed in a week.

Modified ovoid applicator for intracavitary radiation therapy with a Selectron-MDR or microSelectron-HDR

A modified ovoid applicator for intracavitary radiotherapy was developed for Japanese and other Asian women. It has more variations of smaller sized ovoids than the original rigid standard applicator of the Selectron-MDR and microSelectron-HDR. In addition, application of the ovoid pair and tandem flange is easy due to the flat surface of the inner aspect of the ovoid pairs, which prevents slippage of the ovoids and flange. The applicator is described together with source loading and dose distribution.

Modified Inoue applicator for endometrial brachytherapy

The Inoue applicator (3 channels) for endometrial cancer with a microSelectron-HDR was modified to enable both intrauterine and vaginal treatments to be done at the same time. The applicator is described together with a case report.

Cardiac hemangiopericytoma growing in the left atrium

A 49-year-old woman was seen because of exertional dyspnea. Two-dimensional echocardiography revealed the presence of a large mass in the left atrium. An urgent operation was performed because the tumor suddenly stuck in the mitral orifice. The lesion, which occupied the entire left atrium, was resected during cardiopulmonary bypass. Histologic analysis revealed malignant hemangiopericytoma.