IgA Vasculitis Developed as an Adverse Effect of Tofacitinib Taken for Rheumatoid Arthritis

Tofacitinib is a new small-molecule inhibitor of the JAK/STAT signaling pathway used to treat rheumatoid arthritis. We herein report a case of IgA vasculitis apparently caused by tofacitinib. A 67-year-old woman with rheumatoid arthritis developed IgA vasculitis after taking tofacitinib for 6 months. She presented with proteinuria and purpura of the lower extremities. Biopsy specimens from her skin and kidney were compatible with IgA vasculitis. Following termination of tofacitinib, the patient completely recovered from the IgA vasculitis. Drug-induced IgA vasculitis has been previously described for anti-tumor necrosis factor-(TNF)α therapies, but this is the first report of this adverse effect with anti-JAK therapy.

Influence of micrometastasis on N stage in gastric cancer and clinical application

In order to evaluate the real extent of lymph node metastasis (LNM) in gastric cancer, an immunohistochemical (IHC) analysis was performed. We examined 11173 lymph nodes removed from 355 patients with all stages of gastric carcinoma. Tissue preparations were stained with cytokeratin 18, monoclonal antibody against cytokeratin. Micrometastases were found in 2.5% of the lymph nodes and in 31.3% of patients. The incidence of the patients with LNM increased to 9.1% in T(1m) (n = 99), 31.6% in T(1sm) (n = 95, 23.1% in sm1, 34.8% in sm2), 66.7% in T2 (n = 108, 48.8% in mp, 76.5% in ss), 88.1% in T3 (n = 42), and 90.9% in T4 (n = 11) lesions. Upstage was identified in 8.5% of patients: 6.7% in T1 (4.0% in m, 7.7% in sm1, 10.1% in sm2), 14.8% in T2 (20% in mp, 11.8% in ss), 2.4% in T3, and 0% in T4. Factors related to LNM were: tumor size and lymphatic invasion in mucosal lesions; only lymphatic invasion in submucosal lesions; size and depth of tumor, and lymphatic invasion in T2 lesions. In conclusion, the incidence of micrometastasis in regional lymph nodes was higher than we imagined in T1 lesions, more than D1 lymphadenectomy for sm1 and selected cases of mucosal cancer, and D2 lymphadenectomy for sm2 are necessary.

Antitumor effect of bcl-2 antisense phosphorothioate oligodeoxynucleotides on human renal-cell carcinoma cells in vitro and in mice

BACKGROUND AND PURPOSE

Programmed cell death is a genetically regulated pathway that is altered in many cancers. This process is, in part, regulated by the bcl-2 oncogene. Antisense oligodeoxynucleotides (ODNs) targeted to specific oncogenes have been used with some therapeutic success in animal models of leukemia and melanoma cells and human Hodgkin's lymphoma. We evaluated the effects of antisense ODNs targeted to the bcl-2 oncogene on the proliferation of human renal-cell carcinoma (RCC) cells in vitro and on the growth of human RCC xenografts in BALBc nude (nu/nu) mice.

MATERIALS AND METHODS

Expression bcl-2 mRNA in five RCC cell lines (ACHN, Caki-1, RCZ, RCW, and OS-RC-2) was analyzed by reverse transcriptase-polymerase chain reaction. The effects of phosphorothioated ODNs containing human bcl-2 sense and bcl-2 antisense sequences that were transfected with Lipofectin on the proliferation and viability of cultures of established human RCC cell lines were determined by MTS assay. The expression of Bcl-2 protein in ACHN tumor cells following antisense bcl-2 (AS2) ODN treatment was evaluated by Western blot analysis, and the extent of apoptosis in these cells was determined by fluorescence-activated cell sorter (FACS) analysis. The antitumor activity in ACHN xenografts in nu/nu mice was monitored by measuring differences in tumor weight in treated and control mice.

RESULTS

Expression of bcl-2 mRNA was detected in all five RCC lines. Treatment with antisense bcl-2 ODNs inhibited the growth of all tested RCC cells and decreased Bcl-2 protein expression in ACHN cells. The AS2 antisense ODN complementary to the coding region of bcl-2 mRNA showed a superior antiproliferative effect compared with AS1 ODN complementary to the translation initiation region. Inhibition by antisense bcl-2 ODNs of ACHN cells was dose dependent. The FACS analysis revealed that growth inhibition was associated with the induction of programmed cell death. In vivo, AS2 ODN antitumor activity was noted in locally injected groups.

CONCLUSIONS

Treatment of human RCC with antisense ODNs targeted to bcl-2 inhibits growth and is associated with the induction of programmed cell death. These results suggest therapeutic use of antisense bcl2 in the treatment of RCC.

[Anthropometric study on normal human auricle in Japan]

OBJECTIVE

Japanese people are physically larger and live longer than in the past. In light of these changes, we studied anthropometric auricular morphology in Japanese people in all age groups.

METHODS

Subjects were 1,958 healthy Japanese people with no ear disease, 966 males aged 0-94 years and 992 females aged 0-99 years. They were classified at 5-year intervals into 18 age groups, and each group consisted of 50-72 persons. Bilateral size of auricles (ear length, ear width, length of ear attachment, auricular cartilage length, and auricular lobe length) were measured in the usual manner. All measurements were made with calipers by a single observer.

RESULTS

Larger values were obtained in males than in females in almost all age groups. Rapid growth was observed until late teenage, and significant growth continued thereafter until advanced age. Auricular size was found to be greater than that in Japanese people in the past.

CONCLUSIONS

In addition to changes in auricular size believed attributable to growth until late teenage, age-associated changes appear to continue during adulthood.

[Three-dimensional architecture of the intrinsic tongue muscles using a modified alkaline maceration method]

The three-dimensional architecture of the intrinsic tongue muscle fibers using the anterior part of the rabbit tongue was studied by scanning electron microscopy with a modified chemical-maceration method. The tongue tissues fixed with 10% formalin solution were treated with 1% OsO4 solution at 5 minutes for hardening of the specimen surface. Subsequently, they were immersed in 6N-NaOH solution for 30 minutes at 60 degrees C for the removal of connective tissues followed by dissection of muscle fibers under a binocular microscope to clarify the structure of the intrinsic tongue muscles. The specimens were treated with tannic acid and OsO4 (conductive staining method; Murakami, 1974), and observed with a SEM. Muscular fiber bundles of the transverse and vertical muscles of the tongue changed their direction at the alignment on the sites where the bundles enter the longitudinal muscles from the innermost surface to form monolayers of muscular bundles extending anteroposteriorly. These muscular bundles formed tunnel-like structures each of which covered a longitudinal muscle bundle. It was considered that these tunnel-like structures support the contraction of the longitudinal muscles as the "muscular sheath".

[Chest radiograph of atypical pneumonia: comparison among Chlamydia pneumoniae. Pneumonia, ornithosis, and Mycoplasma pneumoniae pneumonia]

No report has been found comparing Chlamydia pneumoniae (C. pneumoniae) pneumonia radiographically with other atypical pneumonias, Chlamydia psittaci (C. psittaci) pneumonia and Mycoplasma pneumoniae (M. pneumoniae) pneumonia. We described the chest radiographs of three kinds of pneumonia cases: 46 cases of C. pneumoniae pneumonia, 39 cases of C. psittaci pneumonia, and 131 cases of M. pneumoniae pneumonia. Radiographic shadows were categorized into main shadows and sub-shadows. The main shadows are classified from the viewpoint of the characteristics; air space consolidation(AS), ground-glass opacity(GG), reticular shadow(RS), bronchopneumonia(BP), and small nodular shadows (SN). The size, the site, and the number of the main shadows were also analyzed. In comparison among the three pneumonias, BP was the most frequent in M. pneumoniae pneumonia (0.40/case). AS predominated in C. pneumoniae pneumonia (0.67/case), and GG in C. psittaci pneumonia (0.62/case). The number of main shadows was equal, about 1.4/case in three pneumonias. Large shadows were less frequent in M. pneumoniae pneumonia than C. pneumoniae pneumonia (p = 0.02) and C. psittaci pneumonia (p = 0.01). Main shadows were more frequent in the outer zone in M. pneumoniae pneumonia than C. psittaci pneumonia (p = 0.01), and in the middle zone in C. psittaci pneumonia than in M. pneumoniae pneumonia (p = 0.02). Cases with bilateral main shadows were less common in M. pneumoniae pneumonia (9%) than C. pneumoniae pneumonia(33%, p = 0.001) and C. psittaci pneumonia(30%, p = 0.005). Thickening of bronchovascular bundles as a sub-shadow was most frequently noted in M. pneumoniae pneumonia. Some differences among the three atypical pneumonias were seen in the chest radiograph. However, no specific findings of C. pneumoniae pneumonia were shown radiographically in this study.

[Portal and pulmonary hypertension in a patient with MCTD]

A 42-year-old woman with mixed connective tissue disease (MCTD) died due to the rupture of esophageal varices. The autopsy revealed fresh thrombi in the main trunk of the portal vein. Microscopic examination disclosed wide-spread periportal fibrosis and stenosis of peripheral portal veins without remodeling of hepatic lobular architecture, which was compatible to idiopathic portal hypertension (IPH). Anti-phospholipid antibody was negative. Accordingly it is likely that portal vein thrombosis developed secondary to IPH. In the literature 6 (37.5%) of 16 collagen vascular disease patients with IPH died, and three of them were due to rupture of esophageal varices. Therefore IPH should be considered to be one of the most important complications affecting its grave prognosis in patients with collagen vascular disease. The patient also had had pulmonary hypertension (PH) when the diagnosis of portal hypertension was made. In the literature we found 5 collagen vascular disease patients with both PH and IPH like this case. The most outstanding common clinical feature among these 6 patients was Raynaud's phenomenon associated with positive anti-RNP antibody. Moreover 5 of 6 cases including this case simultaneously developed both PH and IPH. The clinical course of these patients suggests there may be a common pathogenetic factor for these two lesions. A possible candidate involved in the pathogenesis of PH and IPH may be endothelin, one of the vasoactive substances, since its receptor is said to be expressed abundantly in pulmonary and portal vasculatures. However, further investigation is necessary to elucidate the mechanism of PH and IPH in collagen vascular diseases.

Sickness absence due to mental disorders in Japanese workforce

This study was conducted to elucidate sickness absence due to mental disorders in Japanese companies. Data on sickness absence taken for seven consecutive days or more at eight companies (total number of employees: 44,816) was used for the analysis. Diagnosis of mental disorders was based on medical certificates prepared by physicians. The frequency of absence due to all diseases and mental disorders was 3.0% and 0.3%, respectively. The proportion of frequency absence due to mental disorders compared to that for all diseases was 9.4%. Figures for absence prevalence were almost the same as those for frequency absence. The average length of absence due to mental disorders and non-mental disorders was 119.5 days and 47.3 days, respectively. Rate of absence days due to mental disorders compared to that for all diseases was 21.0%. Percent of sickness absenteeism was 0.4%. In one company, the proportion of frequency absence and rate of absence days due to mental disorders compared to those for all diseases had an increasing tendency over the last six years.

[Method of preventing hepatic artery occlusion during continuous intrahepatic arterial infusion chemotherapy of 5-FU]

A randomized clinical trial of combined use of steroids, which have a vascular endothelium-protecting action, was performed to develop a method to prevent hepatic artery occlusion during continuous intrahepatic arterial infusion chemotherapy with 5-FU. The steroid used was dexamethasone palmitate (Limethason), which has a high rate of uptake by endothelial cells. The 24 patients with advanced colorectal cancer were divided into 2 groups randomly and both were treated with 5-FU 250 mg/day by continuous hepatic arterial infusion for three weeks. The weekly dose was 5-FU 7 V (1,750 mg) adjusted to 50 ml with physiological saline in Group A and 5-FU 7 V (1,750 mg) adjusted to 50 ml with Limethason 1 A (4.0 mg of dexamethasone palmitate) in Group B. The reservoir was replaced every week. No changes in the mixture (appearance, pH, granule diameter, dexamethasone palmitate content) were observed up to one week. Hepatic arterial stenosis was observed in 8 cases in Group A (67%), but was not observed in any of the cases in Group B. The above results indicated that Limethason has a preventive effect against hepatic artery occlusion.

Effects of a newly developed fat emulsion containing eicosapentaenoic acid and docosahexaenoic acid on fatty acid profiles in rats

A new fat emulsion of symmetrical triacylglycerols, containing only eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) was developed. The effects of this preparation on serum and liver fatty acid composition were investigated. Male Sprague-Dawley rats were fed a fat-free oral diet for 2 wk and were then divided into two groups. Seven rats were infused for 7 d with 1 mL of the new fat emulsion, which accounted for 1% of total caloric intake. The other 7 rats received saline. Both groups of rats received a fat-free diet during the infusion. EPA and DHA decreased to one third to one fifth of normal value after 2 wk on a fat-free diet. EPA and DHA of serum and liver remained at a low level in the control group throughout the study. But in the rats administered with the new fat emulsion, EPA and DHA increased rapidly and exceeded normal values in both serum and liver after 7 d of infusion. Decreased arachidonic acid with increased 20:3n-9 resulted in the rise of the triene/tetraene (T/T) ratio to greater than 0.4, indicating an n-6 essential fatty acid deficiency in the control rats. In the group administered the new fat emulsion, however, 20:3n-9 and total content of monounsaturated fatty acids decreased significantly, and the T/T ratio was less than than 0.4 in both serum and liver. In conclusion, the intravenous use of a newly developed fat emulsion containing EPA and DHA is useful in improving the EPA and DHA status of serum and liver without any harmful effects. Beneficial effects are expected in the modulation of inflammatory and stress response.

[N-3 polyunsaturated fatty acids in surgical nutrition]

Recent surgical nutrition includes the management of mediator to induce the stress response and immune function. N-3 polyunsaturated fatty acid (n-3 PUFA) were reported to increase the survival rate, and to improve the nutritional and immune status of septic or burned animals. N-3 PUFA also inhibited the proliferation and metastasis of cancer, and improved the cancer cachexia. N-3 PUFA decreased the production of cytokine and eicosanoid originated from n-6 PUFA, and reduced the inflammatory and stress response. Cell-mediated immunity was suppressed with the reduction of cytokine. But in the stressed state, N-3 PUFA ameliorated the stress induced immunosuppression. Alteration of transcription of cytokine mRNA, changes of membrane fluidity, and reduced expression of adhesion molecule were proposed to interpret these effects. In conclusion, n-3 PUFA can be applied for the surgical patients, especially for the critically ill patients.

A new pseudo-peptide of Arg-Gly-Asp (RGD) with inhibitory effect on tumor metastasis and enzymatic degradation of extracellular matrix

A series of pseudo-peptide analogs of the Arg-Gly-Asp (RGD) sequence of fibronectin have been synthesized, and their anti-metastatic effects in mice and inhibitory effects on tumor cell invasion in vitro have been examined. The partially modified retro pseudo-peptide of RGD, Rrev-COCH2CO-D (FC-63), was more effective in inhibiting tumor metastasis than the original RGDS peptide. Replacement of the malonyl moiety of FC-63 with a carboxyethylene linkage (Rrev-COCH2CH2-D, FC-303 ) achieved more potent inhibition of lung metastasis of melanoma cells than FC-63. Among the analogs, FC-336, a p-xylylendiamine derivative having two FC-303 moieties, showed the most potent inhibitory effect on experimental lung metastasis produced by i.v. co-injection with B16-BL6 melanoma or colon 26 M3.1 cells in a dose-dependent manner. Multiple administrations of FC-336 after tumor inoculation also showed efficient therapeutic potency against spontaneous lung metastasis of B16-BL6 melanoma in mice. Furthermore, FC-336 effectively inhibited the invasion, migration and adhesion of tumor cells in vitro, but its inhibitory effects were not more than those of RGDS peptide. Zymography analysis revealed that FC-336 inhibited the degradation of gelatin substrate by matrix metalloproteinases (MMPs) produced by tumor cells, while the RGDS peptide did not affect the enzymatic degradation. These findings indicate that the pseudo-peptides of the RGD sequence, possessing the inhibitory property of the degradation by MMPs differently from original RGD-containing peptides, may be advantageous and useful in preventing tumor metastasis.

FP-21399 blocks HIV envelope protein-mediated membrane fusion and concentrates in lymph nodes

The identification of fusin and other chemokine receptors as coreceptors for HIV-1 has renewed the interest in agents that may prevent viral entry. Polyanionic compounds such as dextran sulfate, curdian sulfate, and suramin act on the V3 loop of the viral envelope and may prevent its interaction with fusin. These agents show activity against a wide range of HIV-1 strains, but have undesirable circulating half-life, bioavailability, and toxicity. We have developed a small molecule inhibitor of HIV-1 that has several advantages over these other agents. FP-21399 is a novel compound of the bis(disulfonaphthalene) dimethoxybenzene class that blocks entry of HIV into CD4+ cells and blocks fusion of infected and noninfected CD4+ cells. This compound only weakly inhibits binding of CD4 and gp120, at concentrations much greater than are required to block viral entry. Furthermore, FP-21399 can block the interaction between gp120 and antibodies directed against the V3 loop, but does not block binding of antibodies directed against the V4 loop. Animal studies demonstrate that FP-21399 is concentrated in lymph nodes, making it a promising compound for anti-HIV therapy. In SCID mice reconstituted with human immune cells, maintenance of HIV-1 infection was blocked by a 5-day treatment with low doses of FP-21399, suggesting that lymph node accumulation may contribute to antiviral activity. Finally, attempts to generate drug-resistant virus in cell culture resulted in only weakly resistant variants with IC90 values that are much lower than concentrations of FP-21399 found in lymph nodes.

The CT findings of pulmonary sarcoidosis

We analyzed the CT findings in 35 patients with pulmonary sarcoidosis. Twenty-seven patients had biopsy-proven sarcoidosis; in eight patients the diagnosis was made clinically. In all the 35 patients, 10-mm collimation scans were available. In seven patients, high-resolution CT was also obtained. Twenty-eight patients had lymphadenopathy associated with pulmonary infiltration, two patients had pulmonary infiltration without lymphadenpathy, five patients had lymphadenopathy alone. The most frequent parenchymal features on CT were small nodules (100%) and irregularly thickened bronchovascular bundle (90%). Other frequent CT findings were pleural or subpleural thickening (83%), septal lines (73%) and ground-glass attenuation (63%). In all cases, small nodules were associated with other lesions. The authors conclude that in patients with sarcoidosis, CT is a valuable technique to visualize the findings in the pulmonary parenchyma characteristic enough to allow confident diagnosis. While high-resolution CT is superior in the assessment of linear opacities and cysts, conventional CT is superior in demonstrating small nodular opacities. We believe that both should be combined in the examination of patients with sarcoidosis.

Antimetastatic activities of synthetic Arg-Gly-Asp-Ser (RGDS) and Arg-Leu-Asp-Ser (RLDS) peptide analogues and their inhibitory mechanisms

We have investigated the inhibitory effect of the N-terminal modified Arg-Gly-Asp-Ser (RGDS) analogues, AcDRGDS and AcDRLDS, on tumor cell adhesion to the components of extracellular matrix and basement membrane, and also tested the antimetastatic effect of their conjugates with trimesic acid, Ar(DRGDS)3 and Ar(DRLDS)3. AcDRGDS significantly inhibited tumor cell adhesion to fibronectin, vitronectin and RGDS substrates, but not to CS1 substrate which is a ligand for the alpha 4 beta 1 tumor surface integrin receptor. In contrast, AcDRLDS variant peptide significantly inhibited tumor cell adhesion to laminin, in addition to RGDS-mediated adhesion to fibronectin and vitronectin. AcDRLDS also inhibited tumor cell adhesion to CS1 as well as the RGDS sequence within the fibronectin molecule in a concentration-dependent manner, although the inhibitory effect was less than that of the CS1 (EILDV) peptide. Ar(DRLDS)3 inhibited the laminin- and fibronectin-mediated invasion and migration of tumor cells, whereas Ar(DRGDS)3 selectively inhibited fibronectin-mediated invasion and migration. Ar(DRGDS)3 and Ar(DRLDS)3 were much more effective in inhibiting experimental lung or liver metastases of various types of murine and human tumors than the original RGDS-containing peptides or Ar(COONa)3. Multiple administrations of Ar(DRGDS)3 or Ar(DRLDS)3 potently inhibited spontaneous lung metastasis produced by intra-footpad injection of B16-BL6 cells without affecting the primary tumor size at the time of surgical excision, as compared with RGDS peptide or untreated control. Thus, Ar(DRGDS)3 and Ar(DRLDS)3 substantially increased the exhibiting any antimetastatic effect of the peptides without direct cytotoxicity.

Studies on the development of the articular part of the temporal bone with special reference to the postglenoid process

The development and significance of the postglenoid process on the articular surface of the temporal bone were studied using 217 Indian skulls, which were divided by their level of tooth eruption into 6 developmental stages; preeruption period (Stage I), initial stage (m1 eruption) of the deciduous dentition period (Stage II), middle stage (m2 eruption) of the deciduous dentition period (Stage III), late state (eruption of 20 deciduous teeth) of the deciduous dentition period (Stage IV), mixed dentition period (Stage V), and permanent dentition period (Stage VI). Each skull was mounted on a Kraniophor in such a way that the auriculoorbital (Frankfurt) plane was positioned vertical to the horizontal plane and photographed at a focal distance of 40 cm. Using the Frankfurt plane as a base line, the vertical distances to the lowest point of the postglenoid process (a-A), to the deepest point of the mandibular fossa (b-B), and to the mid-point of the articular tubercle (c-C) were measured. The distances from various points of the mandibular fossa to the articular surface of the temporal bone were measured at the level of the Frankfurt plane. The results may be summarized as follows: The length of the postglenoid process as measured from the Frankfurt plane was 0.58 mm at Stage I and 0.75 mm at Stage II. It increased by 0.6-1.0 mm at each developmental stage. By Stage VI, it had increased to 3.85 mm (six- to seven-fold increase from the initial value). The anteroposterior width of the postglenoid process remained almost unchanged throughout the developmental stages. The growth of the articular structures of the temporal bone from the preeruption to deciduous dentition period increased 73% in the total anteroposterior dimension (5.22 mm) and 44% in the total vertical dimension (3.32 mm). The vertical dimension of the mandibular fossa began to rapidly increase following the eruption of the deciduous first molars.

[Clinical significance of anti-cardiolipin antibody in patients with systemic lupus erythematosus (SLE)]

Anti-cardiolipin antibody (aCL) in SLE patients reacts with cardiolipin/beta 2-GP1 complex. In order to disclose clinical significance of aCL in patients with SLE, aCL was determined by newly-developed anti-CL.beta 2-GP1 kit [Yamasa] EIA in 58 patients with SLE and the relationship between clinical manifestation of SLE and the presence of aCL was examined. Anti-cardiolipin antibody was positive in 20 patients (34.5%). In 20 SLE patients with positive aCL, livedo reticularis in 7, retinal vein thrombosis in 3, thrombophlebitis in 3 and other vasculo-occlusive episodes were observed as a characteristic clinical features of positive aCL. In contrast, a SLE patient complicated by ileal perforation due to necrotizing angiitis had negative aCL. Other clinical and laboratory features associated with aCL include recurrent fetal loss and thrombocytopenia.

[Determination of urinary metabolites of organic solvents among chemical industry workers]

With the revision made to the Regulation on the Prevention of Organic Solvent Poisoning in June 30, 1989, analysis of urine must be made for metabolites as a part of the health examination of workers exposed to xylene, N,N-dimethylformamide, styrene, 1,1,1-trichloroethane, tetrachloroethylene, trichloroethylene, toluene, and n-hexane. In accordance with this Regulation, health examinations were conducted at eight factories of five chemical manufactures in 1990. This report presents the results obtained for 1,073 workers as compiled by the Committee of Industrial Health of the Japan Urea and Ammonium Sulfate Industry Association. 1) The results of data analysis have shown that workers whose urine was collected when they had been exposed to an imperceptible degree to organic solvent or who underwent urine collection during an unknown period of time after exposure numbered 615 or 57.3% of all the workers. 2) Workers whose urine was collected within about 5 hours after exposure numbered 458 (42.7%). The metabolite concentrations in these workers were significantly lower than the BEI values. 3) It may be concluded from the results that workers were exposed to organic solvents to an extremely small extent during organic solvent handling operations at chemical industry factories which maintain good control over toxic materials.

Ultrastructural study of rabbit buccal epithelial cells and intercellular junction by scanning and transmission electron microscopy

We observed by scanning and transmission electron microscopy the ultrastructure on the upper and lower surfaces of buccal epithelial superficial layer cells and the arrangement of intercellular junction apparatuses. In the superficial layer cells of the rabbit buccal epithelium, microvillus-like processes were observed on the lower surface and microridges on the upper surface. The distal portion of the microvillus-like process on the lower cell surface formed a wedge-like structure. At the intermicroridge areas on the upper cell surface, wedge-like depressions were observed. These depressions were interdigitated with the wedge-like structures of the microvillus-like processes. From the observation of the serial ultrathin sections, most interdigitation sites have two demosomes per microvillus-like process (89.5%). The desmosomes were located in the distal portion of the microvillus-like processes (99.3%). The wedge-like structures of the microvillus-like processes and wedge-like depressions on the inter-microridge areas seem to increase the junctional surface and enhance cell cohesion against external forces from various directions.

Inhibition of tumor metastasis by Arg-Gly-Asp-Ser (RGDS) peptide conjugated with sulfated chitin derivative, SCM-chitin-RGDS

We have synthesized a new compound in which Arg-Gly-Asp-Ser (RGDS) was conjugated with 6-O-sulfated and 6-O-carboxymethyl-chitin (SCM-chitin), i.e. SCM-chitin-RGDS, and tested the inhibitory effect on lung and liver metastases of three different types of tumors in mice. SCM-chitin-RGDS was more effective for the inhibition of liver metastasis of L5178Y-ML25 lymphoma and lung metastases of colon 26 M3.1 cells than SCM-chitin, RGDS or their mixture. GRGDS peptide, however, required a higher dose (3000 micrograms) to obtain a sufficiently antimetastatic effect. Intermittent i.v. administration of SCM-chitin-RGDS before or after the i.v. inoculation of L5178Y-ML25 cells caused significant inhibition of liver metastasis as compared with the multiple administration of RGDS, SCM-chitin or untreated control. Co-injection of lymphoma cells with SCM-chitin-RGDS or multiple treatment of SCM-chitin-RGDS after tumor inoculation showed significantly enhanced survival rate. SCM-chitin-RGDS also showed the spontaneous lung metastasis produced by intrafootpad injection of B16-BL6 melanoma cells by the multiple i.v. administrations. These results demonstrate that the conjugation of RGDS peptide with SCM-chitin led to augmentation of therapeutic potential to cancer metastasis, thus implying an importance of the conjugation of cell-adhesive RGDS peptide with structurally heparin-like SCM-chitin, which possess binding ability to the heparin-binding domain of fibronectin or laminin and extremely low anticoagulant properties.

Synthetic Arg-Gly-Asp-Ser analogues of the cell recognition site of fibronectin that retain antimetastatic and anti-cell adhesive properties

Synthetic peptide analogues of the Arg-Gly-Asp-Ser (RGDS) sequence of fibronectin in which the amino acid of Gly was substituted with another one, named X, i.e. Arg-X-Asp-Ser (R-X-DS), and N-terminal modified R-X-DS have been synthesized to examine their antimetastatic effects in murine lung or liver metastasis models, as well as the inhibitory effect on tumor cell invasion, migration and adhesion in vitro. R-X-DS [X = Leu (L) or D-Leu (1)], as well as RGDS at a high dose of 3000 micrograms, significantly reduced the number of lung tumor colonies when they were co-injected with B16-BL6 melanoma. At a dose of 1000 micrograms/mouse, N-terminal modified R-X-DS, i.e. acetyl-D-R-X-DS [AcDR-X-DS: X = G, L or I], showed a more potent inhibitory effect on the lung or liver metastasis of B16-BL6 melanoma or L5178Y-ML25 lymphoma cells, respectively, as compared with RGDS or R-X-DS. AcDRLDS and AcDRIDS prevented the invasion of B16-BL6 cells into Matrigel/fibronectin- and Matrigel/laminin- coated filters, haptotactic migration, and the adhesion of the cells to both fibronectin- and laminin-coated substrates, whereas AcDRGDS inhibited only fibronectin-mediated cell functions. The intermittent i.v. administration of a water soluble vinylpolymer [poly(carboxyethylmethacrylamide), poly(CEMA)] containing R-X-DS (X = L or 1) or RGDS, following the subcutaneous inoculation of B16-BL6 cells, significantly inhibited spontaneous Jung metastasis as compared with multiple administrations of RGDS, R-X-DS or the untreated control.(ABSTRACT TRUNCATED AT 250 WORDS)

[An experience of dissecting cerebral aneurysm of the anterior cerebral artery]

Intracranial dissecting aneurysms have been reported occasionally in recent years. However, excluding dissecting aneurysms which extend from the proximal intracranial carotid artery, dissecting aneurysms arising merely in ACA are found only rarely. We are reporting here a case of a 42 year-old gentleman who did not present any particular causative etiology such as trauma or other basic diseases causing arteritis. Our patient is the 8th case, as far as we could find in the literature, in which the dissection of the arterial wall originated at the ACA. The patient was thought to have a tiny saccular aneurysm at the A 1-2 junction of the right ACA associated with vasospasm in the distal ACA on the angiogram. The patient had motor weakness on the left side and headache as well as a low density area in the territory of the ACA on the CT scan. A craniotomy was performed verifying the aneurysm to be dissecting in type without any sign of recent subarachnoid hemorrhage in the surrounding structures. No aggressive surgical treatment such as trapping of the aneurysm was done because the collateral blood circulation in that territory of the distal right ACA seemed to be poor and the patient no longer had neurological deficit at the time of operation. The patient was treated successfully with antiplatelet therapy. On the follow-up angiogram performed 3.5 months after the onset of the illness, we noted the disappearance of the abnormal angiographical findings of the dissecting aneurysm and distal arterial narrowing (pearl and string sign).(ABSTRACT TRUNCATED AT 250 WORDS)

[A case of benign epithelioma of the ciliary body]

A 34-year-old woman showed a partially pigmented, greyish-white mass at a position of 1 o'clock behind the iris of her left eye. The lens equator was compressed and focal opacity had developed. The adjacent ciliary processes and zonules were intact. Photocoagulation was not effective and dense cataract gradually developed, so we performed extracapsular cataract extraction and partial iridocyclectomy. The tumor was nonencapsulated, nodular and myxomatous in appearance, arising from the pars plicata. Histological examinations revealed that the tumor was composed of nonpigmented cells and a small number of pigmented cell clusters. The cells were arranged like cords or gland-like structure with intervening myxomatous, fibrillar, and partially hyalinous interstitium. There was no finding of malignancy. The tumor showed similar microscopic structure and findings of mucous stains of normal ciliary nonpigmented epithelium and internal basement membrane, so a diagnosis of benign epithelioma was made.

Skinfold thickness and cardiovascular risk factors in American and Japanese telephone company executives

Data from a cross-sectional study of cardiovascular disease risk factors in 962 US and 827 Japanese male telephone company executives were used to determine the associations of skinfold thickness measurements (abdominal, subscapular, triceps, ulnar) with blood pressure, blood glucose, serum cholesterol, and serum triglycerides. These associations were assessed within each group of executives and were compared between the groups. Most skinfolds showed association with risk factors in univariate regression. After adjusting for age and body mass index, the abdominal skinfold continued to be significantly associated with blood pressure and triglycerides in both groups, while the subscapular skinfold showed associations only with triglycerides. After adjustment, the peripheral skinfolds showed no association with risk factors in the US men, however, in the Japanese men the ulnar skinfold continued to be associated with blood pressure. These findings suggest that abdominal and ulnar skinfold measurement may be useful in adjusting for the effect of obesity on coronary heart disease risk in epidemiological studies.

[Studies on clinical remission of rheumatoid arthritis]

Clinical remission was observed in 19 out of 276 patients with rheumatoid arthritis. Remission rate was higher in male patients. In order to determine the clinical characteristics of remission cases, comparative study was performed. Although the time between initiation of treatment and clinical remission varied from case to case, the remission was related to early diagnosis and use of immunomodulating drug. No exacerbation was observed in our 19 patients with remission for the periods of 17 observation months. However, serial X-ray examination of hands disclosed that the erosive changes developed even after clinical remission.

Quantum Conversion and Image Detection by a Bacteriorhodopsin-Based Artificial Photoreceptor

A thin film (50 to 500 angstroms thick) comprising fragments of bacteriorhodopsin (bR)-containing purple membrane was formed on an SnO(2) conductive electrode by the Langmuir-Blodgett method. The film was put into contact with a thin, aqueous electrolyte gel to construct an electrochemical sandwich-type photocell with a junction structure SnO(2)/bR/electrolyte/Au electrode. Under visible light irradiation, the bR-based photocell produced an efficient rectified photocurrent that proved to have unique differential responsivity to light intensity, which is characteristic of in vivo biological photoreceptors. An artificial photoreceptor comprising a pixel network of the bR photocell was fabricated in an attempt to study image-detecting and processing abilities of bR.

Further observations on serial serum immunoreactive inhibin levels in the luteal phase and early gestation after ovarian stimulation for in vitro fertilization and embryo transfer

Serum immunoreactive inhibin of the luteal phase was measured by radioimmunoassay in 71 patients in vitro fertilization and embryo transfer (IVF-ET). The correlation between the pregnancy outcome and the serial inhibin pattern from the luteal phase to early gestation was studied. In nonconception cycles (n = 35), serum inhibin concentration rose and reached a peak level around 5 or 6 days after oocyte pick-up (OPU), then fell to the level of the early follicular phase. In conception cycles (n = 22), serum inhibin levels rose again 10-15 days after OPU. Serum inhibin levels were significantly higher from 10 days after OPU in multiple pregnancy (n = 5) than in single pregnancy (n = 17). In viable single pregnancy (n = 17), serum inhibin levels were significantly higher than in non-viable pregnancy (n = 14) from 15 days after OPU. Serum inhibin levels in early gestation correlated well with the pregnancy outcome of IVF-ET. These data suggest that inhibin is an important factor for the diagnosis of pregnancy outcome.

T-lymphocyte-receptor repertoire of infiltrating T lymphocytes into NOD mouse pancreas

This study analyzed T-lymphocyte-receptor V beta genes of infiltrating lymphocytes into the pancreases of 12- to 16-wk-old NOD mice with severe insulitis and 5-wk-old mice with mild insulitis by the quantitative polymerase chain reaction method. The V beta transcripts on infiltrating T lymphocytes into pancreases with severe insulitis in older NOD mice were diverse. In contrast, the V beta 11 gene transcript was predominantly expressed on T lymphocytes in the pancreas in younger NOD mice with mild insulitis, suggesting the possible role of V beta 11+ T lymphocytes in triggering insulitis in this species.

Regioselective modification of Lysine's amino groups by proteases

The regioselectivity of six serine proteases for the amino groups of lysine was investigated. alpha-Chymotrypsin showed a preference for the alpha-amino group, although the selectivity can be varied 10-fold depending on the reaction medium. Subtilisin Carlsberg and other bacterial proteases were highly specific for the epsilon-amino group, regardless of the reaction medium: they were used as catalysts for the preparative synthesis of isopeptides in anhydrous tert-amyl alcohol.

Factors associated with high density lipoprotein cholesterol in Japanese and American telephone executives

The association of plasma high density lipoprotein cholesterol (HDL cholesterol) with several factors was examined in a cross-sectional study of Japanese and American telephone executives. Mean HDL cholesterol levels were similar in both groups of men and were negatively associated with body mass index, smoking, and serum uric acid and positively associated with alcohol and exercise. These associations did not differ between the Japanese and the American men. The mean HDL cholesterol level was 4.2 mg/dl lower in the Japanese than in the American men after adjusting for age, body mass index, alcohol, smoking, exercise, and serum uric acid. The difference in HDL cholesterol between Japanese and American men in this study is inconsistent with the much lower coronary heart disease mortality in Japan and with previous comparison studies of these two populations. Most previous studies have not adjusted for important confounders, but the selective nature of our study groups may have also contributed to this inconsistency. These racial differences in HDL cholesterol may also be due to either genetic or unmeasured environmental and cultural differences. Given the similarity in HDL cholesterol levels between these two groups, our results suggest that HDL cholesterol does not play an important role in the lower coronary heart disease mortality in Japanese men.

Symptoms among workers with long-term exposure to methyl bromide. An epidemiological study

Symptoms as an important sign of the effects of methyl bromide were studied in 56 male workers (37 currently exposed and 19 previously exposed) in a methyl bromide factory. The workers were 18 to 62 yr of age (mean age: 41) and were exposed from 1 to 25 yr (mean: 7 yr). They were compared to 56 age-matched referents with a standardized questionnaire. The results of pairwise comparison of the symptoms of the age-matched pairs of exposed and referent subjects showed that the occurrence of dizziness, numbness, paresthesia and weakness of extremities, nightmares, fatigue and dry and scaly skin was statistically significantly higher among the workers than among the referents. When the symptoms during the work shift (acute symptoms) were compared, irritation symptoms such as itching, bullae or reddish swollen hands and runny noses with nasal irritation were reported significantly more often in the exposed groups. The correlation of the symptoms among the exposed workers suggested that chronic symptoms are closely related to acute irritation symptoms and exposure duration. The results suggest that symptom inquiry is useful for detecting the possible effects of exposure to methyl bromide.

[Left ventricular rupture following mitral valvular surgery]

During 10 years from 1979 to 1988, 99 patients underwent mitral valvular surgery in our clinic. Among 99 patients, we have experienced 3 cases of left ventricular rupture (3.0%). One of 3 patients survived after successful surgical repair. In patient 1, who underwent MVR, type I rupture occurred. The tears were immediately sutured on the beating heart. But 4 hours later, he died due to rerupture. The cause of rupture was suggested the high blood pressure following the trouble of respirator. In patient 2, who underwent OMC and AVR, type II rupture occurred. The cause of rupture was suggested to be the intimal injury of left ventricle with sucker or the excessive traction of papillary muscle. Fortunately, the bleeding was stopped after the mattress suture of tear from epicardial side under the beating heart. Subsequent rerupture did not occur and she could discharge from hospital 44 days later. In patient 3, who underwent AVR and MVR, type III rupture occurred. We restarted cardiopulmonary bypass and sutured the tears adding patch closure from the epicardial side on cardiac arrest. But she died two days later due to continuous bleeding. It is suggested that the stent of bioprosthesis injured the endocardium of left ventricle. In patient 1 and 3, we might have to repair the tear after the removal of prosthetic valve.

[Morphological studies on the margo infraorbitalis (on the longitudinal changes of infraorbital suture)]

The purpose of this study was to obtain information on the developmental changes of the infraorbital margin and the form of infraorbital suture. 136 Indian craniums were divided into five developmental groups according to the stage of eruption of the teeth. The anterior view of the skull was observed photographically. The results are summarized as follows: 1. The infraorbital margins were divided into three types according to the shape of the infraorbital suture. Type I: Infraorbital suture was independent. Type II: Infraorbital suture and zygomatico-facial suture coincided. Type III: Infraorbital suture and zygomatico-facial suture were joined. Type I was the basic type of infraorbital suture. 2. The frequency of type I was 90% at the pre-eruption stage, 31.8% at the eruption stage, 41.7% at the deciduous dentition stage, 56.3% at the mixed dentition stage, and 62% at the permanent dentition stage. 3. On the distance between the median line and each point of the infraorbital margin the growth rate is expressed in values relative to a standard that was based on the pre-eruption stage. The growth rate was greatest at the highest point of the superior margin in the infraorbital foramen (1.79 times), the middle rate was at the position of the infraorbital suture (1.72 times) and the smallest rate was 1.63 times at the position of the zygomatico-facial suture. Each measuring point moved towards lateral side.

[Longitudinal changes in amounts of maxillary growth]

The purpose of this study is to investigate postnatal developmental changes in the shape of the maxilla. Normal maxillary form at each development stage and amounts of growth were analyzed by longitudinally measuring 136 Indian skulls. Maxillary growth changes were assumed on the basis of mean values and growth rates of each region measured. Results 1) Vertical growth Vertical growth of the maxilla (N-Pr) at the fifth (permanent-dentition) stage approximately doubled growth in the first (pre-eruption) stage. The corpus of the maxilla and its alveolar process lay beneath the foramen infraorbit. Vertical growth in this region (m-Pr) increases rapidly during the period of eruption of deciduous and permanent teeth. In permanent dentition, the vertical dimensions of the upper (N-m) and lower (m-Pr) parts of the foramen infraorbit were almost the same. 2) Growth in width As the eyes grow, the upper face widens. Resulting development in the tensed zygomatic-maxillary suture at the inferior margin of the orbit expands the upper surface of maxilla. Maxillary width increased by approximately 1.8 times between the first and fifth stages.

[Surgical management of coarctation of the aorta in early infants]

Thirteen infants under three months old were repaired aortic coarctation between 1980 and 1988. The mean age at operation was 2 +/- 0.8 months, the mean weight was 3.7 +/- 0.6 kg. Patients were simple coarctation in 1, coarctation with VSD in 7, and coarctation with complex heart disease in 5. As the operative method, the prosthetic patch plasty was done in 11 patients, end to end anastomosis in 1 patient and remaining one was primary VSD closure and secondary coarctation repair (patch plasty). Three patients died perioperatively, the overall early mortality rate was 23%. Since the introduction of PGE1 therapy in 1985, operative mortality rate of the operation (patch aortoplasty) was improved dramatically. Two of 10 patients died from LOS after the secondary operation (one was TGA and another was congenital MS with VSD). Eight patients are alive and clinical course after operation had been good. The measurement of arm-leg pressure difference didn't reveal significant residual gradient. Postoperative isthmus index was 90 +/- 13% in follow up measurement. Recoarctation has not been occurred in patients undergoing operations with patch plasty. Postoperative hypoplastic arch index was 93 +/- 19% in 1 to 2 years after operation compared with 70 +/- 16% of the preoperation. Therefore, it is concluded that prosthetic patch aortoplasty and end to end anastomosis of the aorta are both available as reasonable and/or adequate operation for the early infants with coarctation.

Prognostic significance of pancreatic tumor regression after intraoperative radiotherapy

Tumor volume measurement using tumor-margin clipping radiography was performed for estimating tumor regression of eight pancreatic adenocarcinomas treated with intraoperative electron irradiation. Half of the tumors regressed exponentially from the first day of treatment, but the other half increased slightly within the first week, after which volume reduction occurred. The volume-halving time was calculated from the regression curve. A wide distribution of volume-halving times as well as initial tumor volumes was seen in all patients. No correlation was found between these variables, but the former correlated well with survival time (r2 = 0.80). This well-known technique may offer a chance to foresee the prognosis of the disease by determining the volume-halving time.

Response of pancreatic tumor to intraoperative radiotherapy: medical imaging and pathologic system approach

For analyzing the local reaction of pancreatic carcinoma to electron intraoperative radiotherapy, successive computed tomography scanning for tumor volumetry was employed, together with surgical clip localization for tumor area using orthogonal x-rays. Soon after radiotherapy the tumor volume and clipped tumor region began to decrease. After a certain interval, computed tomography volumetry revealed that the irradiated tumor had started to increase in size again, whereas the clipped area had not. Autopsies demonstrated that the increase related chiefly to cancer regrowth outside the primary radiation field.

Evaluation of N-isopropyl-[125I]p-iodoamphetamine affinity sites in rat brain by autoradiography

Affinity sites of N-isopropyl-[125I]p-iodoamphetamine (IMP) were studied in rat brain employing in vitro technique of receptor autoradiography. High degrees of IMP accumulation were observed in almost regions of white matter and some of gray matter. Phenethylamine, glutamic acid and serotonin suppressed IMP accumulation in all brain regions, in cerebral cortex and in hypothalamus, respectively. These results indicated that IMP was accumulated mainly due to its physicochemical property of lipophilicity and might have some interactions with neurotransmitter receptors.

Computed tomography in the assessment of pancreatic tumor response after intraoperative radiation therapy

Computed tomography was used in 7 patients given intraoperative electron beam therapy for advanced carcinoma of the pancreas. The local tumor response was studied quantitatively by defining the tumor contour in consecutive CT scans and then estimating the tumor volume. The maximum diameters of the tumor in 3 planes (X, Y and Z) were also estimated. There was evidence of initial tumor regression in all patients during the first few months after the treatment. No specific behaviour of the diameters in the X, Y and Z planes could be detected. Later on, regrowth of the tumor could sometimes be observed, preferably in one of the 3 planes. On the whole, CT was found to be a useful tool for assessing tumor response to this form of therapy.

[Aortocaval fistula secondary to rupture of abdominal aortic aneurysm; report of two cases]

Two cases of aortocaval fistula secondary to rupture of abdominal aortic aneurysm were presented. First case was 70 year old man who was admitted with pulsating abdominal mass. Prior to admission, he had been suffering from congestive heart failure. On physical examination, a pulsating mass, remarkable thrill and continuous bruit were recognized on his abdomen. Aortography showed abdominal aortic aneurysm and aortocaval fistula. The fistula (5mm X 3mm) was repaired within the aneurysm controlling the bleeding from the fistula by the direct digital compression. Aortic reconstruction was done with woven dacron bifurcation graft. Postoperative course was uneventful. Second case was 68 year old man who was admitted with the sudden onset of severe back pain. On admission, his physical status was already deteriorated. Diagnosis was made easily by the physical examination. Immediately after aortography, cardiac arrest occurred suddenly. After resuscitation, he was operated in the same manner of the first case. Large fistula (2 cm X 1cm) was noted. This patient died of renal failure and cerebral damage on 30th post operative day. Problems of pre- and post-operative patient management and surgical therapy for aortocaval fistula secondary to rupture of abdominal aortic aneurysm were discussed.

[Results of phase III study of lentinan]

A follow-up survey of survivals (Oct. 1 '80 to May 1, '84) in a randomized controlled study (Aug. '79 to Sept. 30' 80) of lentinan in combination administration with chemotherapeutic agents such as 5FU + mitomycin C or tegafur on patients with advanced or recurrent gastrointestinal cancer has shown that lentinan has been effective in such cases with regard to the following facts: 1) A life span prolongation effect at the end-point has been observed with statistical significance in lentinan treated patients as was found in the phase III study. 2) Using the life table analysis method, a higher rate of survival has been observed in the lentinan treated group, especially in combination with tegafur for gastric cancer, clearly showing such high survival rates as 12.97% (P less than 0.05) at two years after, and 9.51% (P less than 0.05) and 3.81%, at three and four years after respectively, and for colorectal cancer, 9.10% and 4.55% at two years and three years after, respectively.