Granulocyte collection by polymorphonuclear cell-targeting apheresis with medium-molecular-weight hydroxyethyl starch

Granulocyte transfusion (GTX) is a therapeutic option for patients with prolonged neutropenia suffering from severe infections. Efficient granulocyte collection by apheresis from donors requires clear separation of granulocytes from red blood cells (RBCs), and infusion of high-molecular-weight (MW) hydroxyethyl starch (HES) facilitates RBC sedimentation. Recent research has shown that apheresis with medium-MW HES may prevent adverse effects of high-MW HES on donors, but the rationale for collection with medium-MW HES has yet to be evaluated. To validate the use of medium-MW HES, we first performed experiments with whole blood samples to determine how efficiently high-, medium- and low-MW HES separated granulocytes from RBCs, and found that medium-MW HES was just as efficient as high-MW HES. We also reviewed clinical data of granulocyte apheresis at our institution to evaluate granulocyte yields. Retrospective analysis of granulocyte collection revealed that apheresis with medium-MW HES yielded sufficient granulocytes for GTX and that donor anemia reduced collection efficiency. These results collectively may help us to establish a safer method for apheresis targeting polymorphonuclear granulocytes as an alternative to high-MW HES.

Optimization of lymphapheresis for manufacturing autologous CAR-T cells

Collection of CD3+ lymphocytes via lymphapheresis is essential for manufacturing autologous chimeric antigen receptor (CAR) T cells. Optimization of timing and procedures for lymphapheresis for each patient is critical because patients often have progressive diseases and receive medications that could reduce T cell counts. We conducted a retrospective study of clinical data from 28 patients who underwent lymphapheresis for CD19-directed CAR-T therapy with tisagenlecleucel to identify factors that could affect CD3+ lymphocyte yields. The numbers of CD3+ cells in peripheral blood were significantly correlated with CD3+ cell yields (correlation coefficient r = 0.84), which enabled us to estimate the volume of blood to process before apheresis. We also found that small cell ratio (SCR) at the apheresis site precisely reflected the proportion of lymphocytes, especially in patients without circulating blasts (coefficient of determination: r² = 0.9). We were able to predict the CD3+ cell yield and prevent excessive apheresis by measuring pre-apheresis circulating CD3+ cell counts and monitoring SCR. Collectively, these results will help us to establish a strategy for optimization of lymphapheresis procedures for CAR-T cell production on a patient-by-patient basis.

A Novel Hematopoietic Progenitor Cell Mobilization Regimen Comprising Bortezomib, G-CSF, and Preemptive Plerixafor for Multiple Myeloma

Adequate hematopoietic progenitor cell collection is critical for autologous peripheral blood stem cell transplantation. Conventionally, patients with multiple myeloma are treated with high-dose cyclophosphamide and granulocyte colony-stimulating factor (G-CSF) or G-CSF alone to mobilize their peripheral blood stem cells. However, some patients exhibit insufficient stem cell recruitment in response to these regimens. Recently, plerixafor has been approved for coverage by insurance in Japan. Combination treatment with plerixafor and G-CSF is now a standard procedure. In addition, treatment with bortezomib and G-CSF results in efficient stem cell recruitment. On the basis of the results from mouse studies, we hypothesized that combination treatment with bortezomib ensures efficient mobilization and mediates in vivo purging of malignant cells. Therefore, we administered a regimen of bortezomib, G-CSF, and preemptive plerixafor to 10 patients with multiple myeloma, and analyzed its efficacy and safety. The median patient age was 68 years. We collected CD34-positive cells (median: 4.9×10⁶/kg) in a single session of apheresis from all patients. We observed no obvious myeloma cell contamination in the collected product or serious toxicity during treatment and collection. After collection, we performed autologous peripheral blood stem cell transplantation and confirmed engraftment in all patients (median: day 10). We found that the regimen is safe and reliably facilitated the collection of sufficient autologous peripheral blood stem cells by apheresis from all patients in a single day. Despite the small patient group size, we conclude that the regimen is promising for safe and efficient collection of peripheral blood stem cells for autologous transplantation in patients with multiple myeloma.

Subacute Methotrexate Encephalopathy Mimicking Ischemic Stroke With Dynamic Changes on Magnetic Resonance Imaging

We report a 35-year-old woman who suddenly developed left hemiparesis and dysarthria at 13days after treatment with intrathecal and intravenous methotrexate for intravascular large B cell lymphoma with possible central nervous system infiltration. Seven hours after onset, she developed further right hemiparesis and aphasia. However, the majority of neurologic symptoms disappeared spontaneously and completely by 34hours. We also recorded the dynamic progression and regression of abnormal signals in the bilateral corona radiata on diffusion-weighted imaging, in parallel with neurologic symptoms. The rapid reversal of MR abnormalities and neurologic symptoms allowed us to diagnose methotrexate encephalopathy, and exclude intravascular large B cell lymphoma recurrence and regular brain infarction. The case provides new data on the dynamic changes of abnormal signals on magnetic resonance imaging in methotrexate encephalopathy over a short recovery time.

Invasion of brain by neurovirulent influenza A virus after intranasal inoculation

We examined the immunohistochemical localization of neurovirulent influenza A virus (WSN and R404BP) in the brains and lungs of C3H/HeN and A2G mice 3 days after intranasal inoculation, as well as in A2G mice 3 days after intracerebral inoculation. The invasion of brain by R404BP virus was greater than that of WSN in both mouse strains. The areas of infection were less extensive in Mx gene(+) A2G mice than in the Mx gene(-) C3H/HeN mice, which is consistent with previous reports. Major involvement was seen in various catecholaminergic neurons, capillaries, meninges and ependymal areas. Olfactory and trigeminal nerves were not positive for the WSN antigen. These results show that, in the early phase of infection, influenza A virus invades, probably through hematogenous spread, and particularly affects catecholaminergic neurons.

Analysis of the mouse transcriptome based on functional annotation of 60,770 full-length cDNAs

Only a small proportion of the mouse genome is transcribed into mature messenger RNA transcripts. There is an international collaborative effort to identify all full-length mRNA transcripts from the mouse, and to ensure that each is represented in a physical collection of clones. Here we report the manual annotation of 60,770 full-length mouse complementary DNA sequences. These are clustered into 33,409 'transcriptional units', contributing 90.1% of a newly established mouse transcriptome database. Of these transcriptional units, 4,258 are new protein-coding and 11,665 are new non-coding messages, indicating that non-coding RNA is a major component of the transcriptome. 41% of all transcriptional units showed evidence of alternative splicing. In protein-coding transcripts, 79% of splice variations altered the protein product. Whole-transcriptome analyses resulted in the identification of 2,431 sense-antisense pairs. The present work, completely supported by physical clones, provides the most comprehensive survey of a mammalian transcriptome so far, and is a valuable resource for functional genomics.

Immunocytochemical studies of major gap junction proteins in rat salivary glands

We examined protein components of the gap junctions between acinar cells of the parotid, sublingual and submandibular glands of the rat, using type-specific antibodies directed against major gap junction proteins, connexin32 (Cx32) and connexin26 (Cx26). Double-immunofluorescence microscopy revealed that fluorescent spots of both connexins in the parotid and sublingual glands were distributed between the apposed regions of acinar cells. They appeared together, or were co-localized. The intensity of the Cx26-associated fluorescent signals was relatively weak in the submandibular glands compared with the other glands and was absent from some acini. When present, these spots were always co-localized with Cx32 immunoreactive positive spots. The results suggest that Cx32 and Cx26 in rat salivary glands are colocalized within the same gap junctional plaques when simultaneously expressed by the same acinar cells.

Increased expression of angiotensin-converting enzyme in retinas of diabetic rats

PURPOSE

The aim of this study was to examine the localization and the changes in the amount of angiotensin-converting enzyme (ACE) and the relationship between the renin-angiotensin (RA) system and vascular endothelial growth factor (VEGF)/VEGF-receptor system in the retinas of diabetic rats.

METHODS

Immunohistochemical localization of ACE, VEGF, and VEGF-receptor fetal liver kinase-1 (Flk-1) was examined in cryosections of the retinas of streptozotocin-injected diabetic rats. A semi-quantitative comparison of diabetic rats with age-matched controls was also performed by counting the ACE- or Flk-1-positive vessels per microscopic field.

RESULTS

ACE immunoreactivity was localized in the retinal vessel walls, and the percentages of ACE-positive vessels were significantly increased in the retinas of diabetic rats maintained 3 to 5 months. Both VEGF and Flk-1 signals increased simultaneously with the increment of ACE immunoreactivity.

CONCLUSIONS

ACE, expressed in the retinal vessel walls, increases simultaneously with the increment of both VEGF and Flk-1 in the retinas of diabetic rats, suggesting that upregulation of ACE might play some role in the progression of diabetic retinopathy through the VEGF/VEGF receptor system.

Computational analysis of full-length mouse cDNAs compared with human genome sequences

Although the sequencing of the human genome is complete, identification of encoded genes and determination of their structures remain a major challenge. In this report, we introduce a method that effectively uses full-length mouse cDNAs to complement efforts in carrying out these difficult tasks. A total of 61,227 RIKEN mouse cDNAs (21,076 full-length and 40,151 EST sequences containing certain redundancies) were aligned with the draft human sequences. We found 35,141 non-redundant genomic regions that showed a significant alignment with the mouse cDNAs. We analyzed the structures and compositional properties of the regions detected by the full-length cDNAs, including cross-species comparisons, and noted a systematic bias of GENSCAN against exons of small size and/or low GC-content. Of the cDNAs locating the 35,141 genomic regions, 3,217 did not match any sequences of the known human genes or ESTs. Among those 3,217 cDNAs, 1,141 did not show any significant similarity to any protein sequence in the GenBank non-redundant protein database and thus are candidates for novel genes.

[A case of sepsis by Neisseria meningitidis beginning with pneumonia during a trip abroad]

A 62-year-male presented a high fever and a dry cough during a trip to Australia. He was admitted to a hospital as soon as be returned to Japan. The next day after returning to Japan, he was transferred to our hospital with septic shock and loss of consciousness. Neisseria meningitidis was cultured from his blood. N. meningitidis is rare in Japan. However its seems common, in some foreign countries. With these findings, it can be postulated that N. meningitidis might be one of the etiological agents of the imported infectious disease.

Specific detection of circulating tumor cells by reverse transcriptase-polymerase chain reaction of a beta-casein-like protein, preferentially expressed in malignant neoplasms

Beta-casein-like protein (BCLP) is a putative protein on cervical cancer and exhibits immunological characteristics similar to those of bovine beta-casein. We evaluated if BCLP mRNA detection in the blood is useful in gynecologic malignancies. We examined 30 patients with uterine cancer, nine cultured cancer cell lines and 26 healthy women volunteers. From these study populations and samples, total RNA was obtained. Reverse transcriptase-PCR (RT-PCR) of BCLP was performed on each sample. Eighteen (60.0%) patients and 4 (15.4%) volunteers were positive for BCLP mRNA. The RT-PCR reached sensitivity and specificity of 60.0% and 84.6%, respectively. Of eight patients having diagnosed recurrence, 7 (87.5%) were positive for BCLP mRNA. In patients with recurrence, sensitivity and specificity were 87.5% and 50%, respectively. The expression of mRNA showed a correlation with recurrence, but no correlation with metastasis or histological type. BCLP was specifically expressed in cancer cells and might be an aid in clinical diagnosis.

Cloning and characterization of a tumor-associated antigen, beta-casein-like protein

Monoclonal antibody (MAb) 1C5 reacts with 87% of uterine cervical adenocarcinoma and bovine beta -casein, but not with squamous cell carcinoma. To clarify the characteristics of the antigen (beta-casein-like protein; BCLP) recognized by MAb 1C5, molecular cloning was performed using 5' rapid amplification of the cDNA ends (5' RACE) and the oligo-capping method. The protein predicted from the cDNA consisting of 937 nucleotides comprises 222 amino acids. The BCLP gene and deduced amino acid sequences were novel and showed no similarity to known cancer-associated genes in the database. Northern blot analysis showed that a 1.1 kb transcript was ubiquitously expressed in cancer cell lines and was predominantly expressed in uterine cervical adenocarcinoma. To clarify the function of BCLP, BCLP cDNA was transfected into L929 cells, resulting in a significant increase in cell area, a downregulation of cell growth rate and a decrease in cell attachment. We conclude that BCLP might be associated with cell morphology and a regulation of growth pattern of tumor.

Relocalization of apoptosis-inducing factor in photoreceptor apoptosis induced by retinal detachment in vivo

Apoptosis-inducing factor (AIF) is a novel mediator in apoptosis. AIF is a flavoprotein that is normally confined to the mitochondrial intermembrane space, yet translocates to the nucleus in several in vitro models of apoptosis. To investigate the role of AIF in the apoptotic process in vivo, we induced retinal detachment (RD) by subretinal injection of sodium hyaluronate, either in Brown Norway rats or in C3H mice. Apoptotic DNA fragmentation, as determined by terminal nick-end labeling, was most prominent 3 days after RD. The subcellular localization of AIF was examined by immunohistochemistry and immunoelectron microscopy. In normal photoreceptor cells, AIF was present in the mitochondrion-rich inner segment. However, AIF was found in the nucleus after RD. Photoreceptor apoptosis developed similarly in C3H control mice, and in mice bearing the gld or lpr mutations, indicating that cell death occurs independently from the CD95/CD95 ligand system. Both the mitochondrio-nuclear transition of AIF localization and the nuclear DNA fragmentation were inhibited by subretinal application of brain-derived neurotrophic factor. To our knowledge, this is the first description of AIF relocalization occurring in a clinically relevant, in vivo model of apoptosis.

Differential expression of major gap junction proteins, connexins 26 and 32, in rat mammary glands during pregnancy and lactation

We examined the expression pattern of two major gap junction proteins, connexin 26 (Cx26) and connexin 32 (Cx32), in rat mammary glands during pregnancy and lactation. Immunohistochemically the two different Cxs were coexpressed in acinar cells and were independently modulated according to the physiological cell activity. Western blot analysis demonstrated that Cx26 gradually increased from early pregnancy, while Cx32 rapidly and dramatically increased at 16 h after parturition, and that both Cxs reached a maximum early in lactation. Increased expression of both Cxs was confirmed by Northern blot analysis showing that their mRNA transcripts were significantly induced on the day of parturition. We also analyzed double-immunofluorescent staining for Cx26 and Cx32 on a confocal laser scanning microscope, in order to examine colocalization of these Cxs in situ. Cx26 immunoreactivity mostly overlapped with Cx32-positive sites in acinar cells of lactating mammary glands, indicating that both Cxs were colocalized together in the same gap junctional plaques in lactation. These results suggest that upregulation of Cx26 and Cx32 in acinar cells at lactating stages, with colocalization in the same gap junctional plaques, may be important for control of secretion by acinar cells in rat mammary glands.

Characterization of silica-supported Ni catalysts effective for methane decomposition by Ni K-edge XAFS

The structural change of Ni species during the methane decomposition into hydrogen and carbon over Ni/SiO2 catalyst was investigated by Ni K-edge XANES/EXAFS. Before the contact of methane with the Ni/SiO2 catalyst, Ni species were present as Ni metal mainly. The structure of the Ni metal did not change appreciably when the Ni/SiO2 was actively decomposing methane. In contrast, the formation of nickel carbide species was observed at the deactivation stage of the catalyst.

Functional annotation of a full-length mouse cDNA collection

The RIKEN Mouse Gene Encyclopaedia Project, a systematic approach to determining the full coding potential of the mouse genome, involves collection and sequencing of full-length complementary DNAs and physical mapping of the corresponding genes to the mouse genome. We organized an international functional annotation meeting (FANTOM) to annotate the first 21,076 cDNAs to be analysed in this project. Here we describe the first RIKEN clone collection, which is one of the largest described for any organism. Analysis of these cDNAs extends known gene families and identifies new ones.

[A case of lateral origin of the left internal mammary artery]

A 66 years old men, with left anterior descending coronary artery (LAD) stenosis and aortic valve stenosis, underwent coronary artery bypass grafting (CABG) to LAD with left internal mammary artery (LIMA) and aortic valve replacement. His postoperative course was uneventful. But, postoperative angiogram showed that his patent LIMA graft was originated from much lateral side of the left subclavian artery. Internal mammary artery is considered the most ideal graft for CABG, but its' anomality is not well known. We present this rare case with the anomalous origin of LIMA.

Surgical management of genital prolapse: is chain cystourethrography useful for evaluating anatomical corrections and urinary symptoms after surgery?

OBJECTIVE

To evaluate the relationship between chain cystourethrography and surgery for genital prolapse and urinary symptoms.

METHODS

A retrospective study of women with genital prolapse was conducted from January 1991 through December 1997. To assess the preoperative and postoperative anatomical situations objectively, chain cystourethrography was performed.

RESULTS

Fifty-seven patients underwent surgical repairs for genital prolapse. All of them recovered from the genital prolapse both subjectively and objectively after surgery. Chain cystourethrography is useful for evaluating postoperative anatomical corrections. However, 6 patients (12%) suffered from a recurrent feeling of genital prolapse, and 14 patients (28%) had urinary symptoms postoperatively.

CONCLUSIONS

Our treatment showed good anatomical corrections based on chain cystourethrography, and there were no prognostic differences among the surgical procedures. However, anatomical correction does not always mean improvement of urinary symptoms. Further studies are needed to clarify what factors contribute to the prognosis in such cases.

[Anesthetic management for a patient with autoimmune hemolytic anemia]

A 69-year-old woman with autoimmune hemolytic anemia (AIHA) received gastric resection and splenectomy under general anesthesia combined with epidural anesthesia. Her blood type had been determined as type A, Rh type CCDee, with anti-e-antibody and anti-pdl-antibody positive as autoantibodies. We applied the technique of hemodilutional autologous transfusion to supplement the blood loss during the operation to prevent hemolysis or occurrence of new antibody after homologous transfusion. We should pay much attention to a patient with AIHA to find signs of peri-operative hemolysis and to give the treatment for hemolysis in early stage. We consider that the hemodilutional autologous transfusion is a useful technique for the anesthetic management of the patient having a rare blood type.

Complete hydatidiform mole coexisting with a live fetus after gamete intrafallopian transfer. A case report

BACKGROUND

Molar pregnancy with a coexisting live fetus is a rare occurrence. We report the only known case with a surviving coexistent fetus after gamete intrafallopian transfer (GIFT).

CASE

After GIFT, a 28-year-old primary infertility patient was diagnosed as having a complete hydatidiform mole coexisting with a live fetus at 13 weeks of gestation. At 36 weeks of gestation, a cesarean section was performed due to elevated serum human chorionic gonadotropin (hCG) levels, and a male infant with a normal appearance and weighing 2,688 g was delivered.

CONCLUSION

If the patient desires to try to carry the fetus to viability after counseling on the possible associated risks of malignancy, it is possible to achieve fetal viability if (1) there is decline in the serum hCG level after it peaks before the second trimester, (2) ultrasound reveals degeneration of the molar part, and (3) there are no complications of pregnancy.

[Anesthetic management in a patient with severe acute pancreatitis during pregnancy]

Continuous epidural anesthesia was used in a 34 year-old pregnant woman with acute pancreatitis related to hypertriglyceridemia. She underwent an emergency cesarean section due to severe pancreatitis under spinal anesthesia. After delivery, extended incision was made to examine the pancreas and to perform drainage. Epidural infusion using 1% mepivacaine and buprenorphine was started to reduce pain and improve microcirculation. After starting epidural infusion with other therapies, clinical feature and data improved. This case suggests that reduction of severe pain and improvement of microcirculation are important in therapies of severe pancreatitis.

[Right phrenic nerve palsy in a patient with ventricular septal perforation after acute myocardial infarction]

A 77-year-old female had acute myocardial infarction and ventricular septal perforation (VSP). An operation was performed 14 days after VSP. During cardiopulmonary bypass, a patch was sutured in place on the left side of the defect under a mild hypothermia with topical cardiac cooling procedure. In the postoperative period, mechanical ventilation was continued with use of pulmonary monitor (CP-100, BICORE). When the patient was weaned of mechanical ventilation, work of breathing increased (WOBp: 1.67 J.l-1) without the change of SaO2, PaO2, PaCO2 and the respiratory state. After extubation, the chest X-ray showed elevated right diaphragmatic level and a diagnosis of unilateral diaphragmatic paralysis was made. Oral intake was started two days after extubation. SpO2 decreased after oral intake, and it was significantly improved by taking a left lateral position. The symptoms disappeared 47 days after the operation. It should be noticed that the rise of endoceliac pressure in the patient who had a unilateral phrenic nerve palsy, affected the SpO2.

Characterization of subclonal cell lines showing high motility derived from an undifferentiated human endometrial cancer cell line

To examine the relationship between the morphology and the motility of cancer cells, we studied the difference between human endometrial undifferentiated cancer cell lines with different motilities, using light and electron microscopy, immunocytochemistry and RT-PCR. In a transplanted tumor of a cell line with high motility, many connective tissues and microvessels were observed and there were few intercellular spaces, which were ultrastructurally full of extracellular matrix. In the high-motility cell line only cytokeratin 19 was observed, and the level of cytokeratin 19 mRNA was elevated. Thus, motility is suggested to be related to the induction of connective tissues and cytoskeleton.

Utility of colorimetric end-tidal carbon dioxide detector for monitoring during prehospital cardiopulmonary resuscitation

The purpose of this study was to evaluate a colorimetric end-tidal CO2 (ETCO2) detector (EASY CAP) as a monitor during prehospital cardiopulmonary resuscitation (CPR) without tracheal intubation. This detector was used for 121 patients during CPR with a laryngeal mask airway or face mask by authorized emergency lifesaving technicians. At 7 to 15 minutes after the initiation of CPR, ETCO was <0.5% in 30 cases (group A), 0.5% to 2.0% in 46 cases (group B) and >2.0% in 45 cases (group C). The rate of return of spontaneous circulation was 17% in group A, 24% in group B, and 48% in group C (groups A v C, P < .01). There was a significant difference in the rate of hospital admission between groups A and C. The ETCO2 value may be useful for monitoring during prehospital CPR with a laryngeal mask airway or face mask.

Targeted gene transfer to corneal endothelium in vivo by electric pulse

A novel method of in vivo targeted gene transfer to intentionally selected areas of the corneal endothelium was developed. Plasmid DNA with the lacZ gene coding for beta-galactosidase was injected into the anterior chamber of adult Wistar rats, and eight pulses of electricity at intensities ranging from 5 to 40 V/cm were delivered for 50 ms to the cornea with a specially designed electric probe in order to determine the effect of gene transfer on the corneal endothelial cells. Gene expression was visualized by enzymatic color reaction using X-gal in enucleated eyes on days 1, 3, 7, 14 and 21 after gene transfer. The treated eyes were then photographed and the X-gal-positive areas were evaluated by an image analyzer. The ratios of the areas (X-gal-positive area/area of entire corneal endothelium x 100%) were then calculated to determine gene transfection efficiency. The expression of beta-galactosidase was clearly detected in the cytoplasm of the corneal endothelial cells as early as day 1 and lasted until day 21. The most intense gene expression was observed on days 1 and 3 (5.21% on day 1 and 6.45% on day 3). The expression of beta-galactosidase on day 3 was most evident following delivery of 20 V electric pulses (0.09% at 5 V, 0.03% at 10 V, 6.45% at 20 V). beta-Galactosidase expression was limited to the corneal endothelial cells in highly selected areas and no beta-galactosidase expression was detected in any other intra- or axtraocular tissues. In addition, no cell damage was apparent in the cornea and no inflammation was detected in any other intraocular tissues. Thus, low-voltage electric pulses successfully transferred the gene of interest to highly selective areas of the corneal endothelium without inducing any pathological changes. This targeted gene transfer method appears to have great potential for use in gene therapy for ocular diseases.

Retinal functional change caused by adenoviral vector-mediated transfection of LacZ gene

We examined the effect of insertion of an exogenous gene on retinal function to assess the rationale of adenoviral vector-mediated gene transfer for future gene therapy. An adenoviral vector expressing bacterial LacZ (AdCALacZ) was injected into the eyes of adult rats either intravitreally (group A) or subretinally (group B), and the gene expression and retinal function were thus examined at different time points after gene transfer for 3 weeks. X-Gal histostaining showed that neural retinal cells were transfected in group A and that retinal pigment epithelial cells were transfected in group B. The gene transfer was more efficient in group B (54.4% of the fixed retinal area was stained) than in group A (10.4%). The electroretinogram (ERG) revealed retinal dysfunction in the AdCALacZ-transfected rats even at the stage in which the histological damage was not apparent by electron microscopy and immunohistochemical studies for cytokeratin, S-100 protein, and glial fibrillary acidic protein. The ERG change was correlated with the intensity of inflammation, and retinal function recovered to the original level by 3 weeks, along with a diminution of inflammation. Functional changes were more evident in eyes treated with AdCALacZ than in those infected with adenoviral vector with no exogenous gene; however, no histological difference was observed between these groups, indicating that the insertion of exogenous gene itself affects retinal function. The results showed that different kinds of retinal cells could be gene-transferred by an adenoviral vector, depending on the application method. The retinal dysfunction caused by each adenoviral transfection method was caused by inflammation and the insertion of exogenous gene, and this retinal dysfunction was recoverable. In future gene therapy, special attention should be given to the method of exogenous gene insertion in the retina.

Leech extracellular hemoglobin: two globin strains that are akin to vertebrate hemoglobin alpha and beta chains

Leech (Whitmania edentula, Haemadipsa zeylanica var. japonica and Erpobdella lineata) extracellular hemoglobins are basically composed of three constituent subunits, a dimer (D1 and D2 chains) and two monomers (M1 and M2 chains). We isolated these four chains from respective species by a combination of reversed-phase chromatography on a Resource RPC column and gel-filtration on a Superdex 75 column. The apparent molecular masses of the four globin chains were estimated by SDS-PAGE analysis to be 13 kDa (M1), 16 kDa (M2; 19 kDa in its reduced form) and about 27 kDa for the dimer subunit (13 kDa for D1; 15 kDa for D2), regardless of the source. The amino (N)-terminal segments (21-30 residues) from twelve globin chains of the above three species were determined and aligned. It was found that the twelve sequences could be separated into two distinct globin groups A and B. This finding supports the original idea of "two globin strains in annelid hemoglobin", which was proposed without any evidence for leech hemoglobins. Comparing the sequences in the three classes of Annelida, Hirudinea, Oligochaeta and Polychaeta, we found two invariant amino acids, Cys and Trp, which are interposed by eleven amino acid residues. Furthermore, the globin chains belonging to strain A were readily discernible as they had three more invariants, Ser-13, Asp-16 and Trp-28, while the globin chains of strain B had two more invariants, Lys-12 and Arg-27. Consequently, we propose that each of the three classes of Annelida have two distinct groups of globin chains that are akin to vertebrate hemoglobin alpha and beta chains.

Changes in the phosphorylation states of connexin43 in myoepithelial cells of lactating rat mammary glands

Using specific antibodies and cDNA probe, we examined the expression pattern of a major gap junction protein, connexin43 (Cx43), in rat mammary glands during pregnancy and lactation. Double immuno-fluorescence revealed that the labeling of Cx43 was superimposed in the alpha-smooth muscle actin-positive cells, suggesting that myoepithelial cell were interconnected by gap junctions formed of Cx43. Just after delivery, the Cx43-labeled plaques were enlarged and increased in intensity. Northern and Western blot analyses confirmed the dramatic induction of Cx43 at both mRNA and protein levels on the day of parturition. Cx43 mRNA transcript immediately declined, while the increase of Cx43 protein continued for a few days. During pregnancy, immunoblots showed two bands of almost equal amounts at 43 and 45 kDa. Following delivery, the 45-kDa band gradually increased in intensity with a concomitant decrease of the 43-kDa band. From the sixth day of lactation, Cx43 was always detected as a single band at 45 kDa. Alkaline phosphatase treatment of immunoprecipitated Cx43 revealed that both bands represented phosphorylated forms, thus indicating that Cx43 was naturally phosphorylated and that it altered its phosphorylation states during lactation stages. These results suggest that the induction of Cx43 with the changes in the phosphorylation states plays an important role in the lactating function of myoepithelial cells in rat mammary glands. This is the first report on the changes of Cx43 phosphorylation states during physiological stages in vivo.

Immunohistochemistry of a cytoplasmic dynein (MAP 1C)-like molecule in rodent and human brain tissue: an example of molecular mimicry between cytoplasmic dynein and influenza A virus

Immunohistochemistry with an antibody to influenza A/Aichi/2/68 (H3N2) virus was performed using normal mouse, rat and human brain tissues. Dot-like or filamentous structures in the neuronal cytoplasm were clearly stained. Axons were also stained, but weakly. Lewy bodies in Parkinson's disease substantia nigra were also positive. Immunoscreening of the antibody using mouse brain cDNA revealed that this antibody recognized the heavy chain of cytoplasmic dynein. Immunoblot analysis also showed that the reactive molecule was the same size as cytoplasmic dynein (microtubule-associated protein 1 C). This is an example of molecular mimicry between cytoplasmic dynein and influenza A virus, and the antibody appears to be useful for the localization on cytoplasmic dynein in the central nervous system.

Associated movement as a sequel to thoracotomy: aberrant regeneration to the latissimus dorsi muscle

We describe two patients with unusual associated movements as a sequel to thoracotomy. The two patients developed involuntary twitchings of the latissimus dorsi, which were induced by contractions of the adjacent muscles, the serratus anterior muscle in patient 1 and the external intercostal muscle in patient 2, after lobectomy for lung cancer. Electrophysiological and radiological studies showed that aberrant regeneration from the adjacent nerves to the denervated latissimus dorsi could be responsible for the associated movements.

Microglial localization of alpha-interferon receptor in human brain tissues

The localization of the alpha-interferon receptor (alpha-IFNR) was examined in human brain tissues from neurologically normal, Alzheimer's disease (AD) and cerebral infarction cases, using one antibody (IFNaR3) which preferentially recognizes alpha 2-IFN receptor and a second antibody (anti-p40) which recognizes the soluble alpha-IFN alpha/beta receptor. In all cases, microglial cells were stained with the antibodies. In infarct brains, macrophages were intensely labeled for alpha-IFNR. The anti-p40 antibody also showed capillary staining which might be due to residual blood plasma. On Western blots, IFNaR3 recognized only a 210 kDa alpha-IFN/receptor complex, indicating its localization in microglial cells. The anti-p40 antibody recognized this complex as well as four other major materials of lower molecular weight. These results suggest that alpha-IFNR protein is constitutively expressed in microglial cells.

[Type and screen system for efficient use of blood on elective surgery]

For the efficient use of blood resources, we have adopted the Type and Screen system (T & S) and Maximum Surgical Blood Order Schedule (MSBOS) for elective operations. To evaluate the usefulness of these systems, we analyzed the crossmatched to transfused blood ratio (C/T ratio) for the period of one year before and after the adoption of the systems. C/T ratio were 4.65 and 2.38 respectively and crossmatched blood units decreased from 3799 to 2511 units. These results show the usefulness of these systems in perioperative blood transfusion system. It is possible to make use of blood more efficiently by further detailed re-evaluation of both T & S and MSBOS systems.

[Asynergia in cerebellar ataxia--the significance of impairment of elbow fixation in forearm pronation-supination test]

Patients with cerebellar ataxia often show swing of the upper arms or the elbows in forearm pronation-supination test (FPS test). Eleven healthy volunteers and sixteen patients with cerebellar ataxia were examined. We observed FPS test of the subject with their shoulder and elbow joints being flexed at a right angle respectively in sitting position, and recorded them by VTR. We noticed following four points in FPS movement: 1) velocity and regularity, 2) amplitude, 3) finger posture, 4) state of elbow fixation. We recorded surface EMG of the upper arm-fixing muscles (deltoid, pectoralis major, infraspinatus) and the forearm-moving muscles (biceps brachii, pronator teres). In controls, FPS movements were regular and speedy. The upper arm was so well fixed that the elbow did not swing. Continuous discharges were recorded from upper arm-fixing muscles when the upper arm was lifting. Reciprocal grouping discharges were recorded during FPS movements from upper arm-fixing muscles so that they were suppressing the swing of the elbow. In ataxic patients, FPS movements were dysrhythmic and slow. The elbow swung during FPS test. We observed internal rotation and abduction of the shoulder when forearm pronated, and outer rotation and adduction of the shoulder when forearm supinated. Reciprocal grouping discharges that were reverse of normal ones were recorded from upper arm-fixing muscles so that they were aggravating the swing of the elbow. Synergia is an ability to accomplish the various muscle contractions coordinately when making up a certain action. Asynergia is one of the characteristic features of disturbance of the association of muscle contractions of the upper arm and the forearm. FPS test is easy and useful to detect asynergia of the upper extremity in cerebellar ataxia.

[Severe theophylline toxicity in a pregnant asthmatic patient]

A 32 year old pregnant woman who had taken large doses of theophylline for asthmatic attack was brought to our emergency medical center with convulsion and respiratory disturbance. Serum theophylline concentration was 52 micrograms.dl-1 on admission. We intubated the patient to control convulsion and respiration and performed cesarean section. Serum theophylline concentration of the newborn was almost at the same level as that of her mother. Baby was placed on ventilator for several days and discharged without trouble. We must consider the pregnancy as a major risk factor of theophylline toxicity.

[A case report: partial anomalous pulmonary venous return of the left lung communicating with the left atrium through the aberrant vein]

A rare case with partial anomalous pulmonary venous return was presented. The left superior pulmonary vein was drained into the left innominate vein via a common vertical vein and it also communicated with the left atrium via a small aberrant vein. All the other pulmonary veins were normally drained into the left atrium. The surgical repair was performed through the midline sternotomy. The junction of the vertical vein and the left innominate vein was ligated with slight elevation of the pressure in the left pulmonary vein. Under the cardiopulmonary bypass, the secundum atrial septal defect was closed by direct sutures. The postoperative course was uneventful and there was no pulmonary congestion in the left upper lung field.

Comparative study of magnetic resonance and CT scan imaging in cases of severe head injury

The distribution, frequency, and appearance of head injuries were evaluated with MRI and CT in a prospective study of 155 patients with acute (n = 124) and chronic (n = 31) head injuries. MRI was significantly more sensitive than CT in the detection of intraaxial injury at any stage. In severe cases, central structure lesions were detected in approximately 80% of patients. Severity on admission was compatible with MR findings. However it was difficult to decide on neurobehavioural prognosis from initial MRI findings only.

["Acro-erythro-cyanosis"--peculiar vasomotor symptoms due to cervical hernial myelopathy]

Two cases of cervical myelopathy, which exhibited peculiar vasomotor symptoms ("acro-erythro-cyanosis") on distal regions of the four limbs are reported. Continuous reddening, swelling and skin temperature increase were observed on both hands and feet in case 1, a-44-year-old man, and on both hands in case 2, a-47-year-old man. Cold stimulation resulted in cyanosis and decrease of skin temperature on the affected regions paroxysmally. The condition of skin at room temperature may be caused by arteriectasia of arterioles due to hypotonia of vasomotor fibers, and this was similar to erythromelalgia. On the other hand, cold stimulation may have led to this condition, where the contraction of skin arterioles due to hypertonia of vasomotor fibers was added to the dilation of venule, and this was similar to acrocyanosis. Consequently, we provisionally named the vasomotor symptoms in the present cases as "acro-erythro-cyanosis". The other neurological signs were as follows. Case 1: mild weakness in right upper and lower limbs and left small hand muscles, mild superficial and deep sensory disturbance on bilateral palms and soles and decrease of vibration on bilateral lumbar regions and thereunder. Case 2: mild weakness of right small hand muscles, superficial sensory disturbance on distal regions of bilateral upper and lower limbs and a decrease of joint position sense on right hand. Myelography and metrizamide CT myelography revealed a high-degree deformity of the spinal cord due to the herniated disks between C4 and C5 in case 1 and between C3 and C4 in case 2.(ABSTRACT TRUNCATED AT 250 WORDS)