Biohybrid catalysts for sequential one-pot reactions based on an engineered transmembrane protein

A two-step one pot reaction sequence consisting of artificial metalloprotein olefin metathesis and hydrogenation was performed yielding 1,2-diphenylethane derivatives.

Formate complexes of titanium(iv) supported by a triamido-amine ligand

The terminal formate complex [(OCHO)Ti(N₃N)] (3) containing the trianionic triamido-amine ligand (Me₃SiNCH₂CH₂)₃N^3- (N₃N) was prepared via salt metathesis of [ClTi(N₃N)] (1) with sodium formate or alternatively by treatment of the alkyl complex [ⁿBuTi(N₃N)] (2) with ammonium formate [HNEt₃][OCHO]. Deprotonation of 3 with potassium hexamethyldisilazide gave a polymeric helical chain of the oxo complex {K[OTi(N₃N)]}_n (4). Reaction of 2 with the trityl salt [Ph₃C][B(3,5-Cl₂C₆H₃)₄] or the Brønsted acid [HNEt₃][B(C₆F₅)₄] gave [(Et₂O)Ti(N₃N)][BR₄] (6[BR₄]·Et₂O) with R = 3,5-Cl₂C₆H₃ or C₆F₅. The diethyl ether ligand was easily replaced by other L-type donor ligands such as tetrahydrofuran, pyridine, and 4-dimethylaminopyridine to give 6[BR₄]·L with L = thf, py, and dmap. Reaction of 6[BR₄]·Et₂O with a stoichiometric amount of CO₂ gave the dimeric, dicationic bis(carbamate)-bridged complexes [Ti{N(CH₂CH₂NSiMe₃)₂(CH₂CH₂NSiMe₃(μ-CO₂-ηO:ηO'))}]₂[BR₄]₂ (7[BR₄]₂) through insertion of one CO₂ into one of the titanium-amido bonds. Addition of pyridine to 7[B(C₆F₅)₄]₂ formed the monomeric carbamate complex [(py)Ti{((O₂C-κ²O,O')NSiMe₃CH₂CH₂)N(CH₂CH₂NSiMe₃)₂}][B(C₆F₅)₄] (8[B(C₆F₅)₄]·py). The cationic formate-bridged species [(Ti(N₃N))₂(μ-OCHO-ηO:ηO')][BR₄] (10[BR₄]) readily formed when the terminal formate complex 3 was reacted with the cationic 6[BR₄]. The reactivity of triamido-amine stabilized titanium(iv) complexes is shown to differ considerably from that of related titanium tris(anilide) complexes.

1,4-Dihydropyridyl complexes of magnesium: synthesis by pyridine insertion into the magnesium–silicon bond of triphenylsilyls and catalytic pyridine hydrofunctionalization

Magnesium triphenylsilyl complexes [Mg(SiPh₃)₂(THF)₂] and [(Me₃TACD)Mg(SiPh₃)] ((Me₃TACD)H = 1,4,7-trimethyl-1,4,7,10-tetraazacyclododecane) serve as precursors for 1,4-dihydropyridyl complexes of magnesium which are active in the hydroboration of pyridine.

Cyclotrimerization of phenylacetylene catalyzed by a cobalt half-sandwich complex embedded in an engineered variant of transmembrane protein FhuA

An (η⁵-cyclopentadienyl)cobalt(i) complex was covalently incorporated in an engineered variant of the β-barrel protein FhuA. The new biohydrid catalyst cyclotrimerized phenylacetylene to give regioisomeric triphenylbenzenes.

Molecular magnesium hydrides supported by an anionic triazacyclononane-type ligand

A dimeric magnesium hydride supported by a monoanionic TACN-type ligand is formed by an unusual rearrangement of an unstable mononuclear complex with a terminal Mg–H bond.

Metatheases: artificial metalloproteins for olefin metathesis

Recent advance in the design of artificial metalloproteins for olefin metathesis is presented.

Formation of α-[KSiH3] by hydrogenolysis of potassium triphenylsilyl

Molecular potassium silyl [K(Me₆TREN)SiPh₃] was used as precursor for the synthesis of the hydrogen storage material α-[KSiH₃] under mild conditions. Facilitated by the neutral amine ligand Me₆TREN, the hydrogenolysis proceeded selectively across the Si–C_Phbond.

The Endoscopic Surgical Skill Qualification System for gastric surgery in Japan

INTRODUCTION

Laparoscopic surgery has been increasing in popularity in recent years. In 2004, the Japan Society for Endoscopic Surgery developed its Endoscopic Surgical Skill Qualification System (ESSQS) to assess surgeons.

METHODS

To earn the ESSQS accreditation, applicants must submit an unedited operative video in which they perform either a distal gastrectomy or pylorus-preserving gastrectomy with lymph node dissection for gastric cancer. The videos are assessed by two separate judges based on detailed criteria for common and procedure-specific technical-grade slips. Common criteria from all fields of gastrointestinal and general surgery are used to evaluate the basic laparoscopic surgical skills and autonomy of the operator. The target organ determines the procedure-specific criteria are set to assess whether or not adequate oncological clearance has been achieved.

RESULTS

Between 2004 and 2009, 154 (44.6%) out of 345 applicant surgeons assessed under the ESSQS for gastric surgery have been accredited. Interrater agreement was acceptable and ranged between 0.21 and 0.59.

CONCLUSION

The ESSQS system may facilitate improvement in surgical technique and the standardization of laparoscopic surgery in Japan.

Safe anastomosis in laparoscopic low anterior resection for rectal cancer

INTRODUCTION

In laparoscopic rectal surgery, there are some limitations on a surgeon's ability to maneuver, especially in transection of the lower rectum. To achieve minimally invasive surgery, safe anastomosis, including proper rectal transaction, is necessary.

METHODS

To overcome the difficulty in lower rectal resection, we followed a series of steps. First, we completely mobilized the rectum to the pelvic bottom, just above the anal canal, making the lower rectum mobile and allowing for an easy rectal transection. To secure the transaction, the mesorectum around the transection must be properly divided. We recommend placing the lower right quadrant port as caudal as possible to properly staple the rectum. We found a 60 mm compression-type stapler most suitable for rectal transection. To wash and flatten the rectum, a detachable intestinal clip is quite useful because of its flexibility. Finally, in addition to conventional abdominal drains around the anastomotic site, we employed transanal tube to actively decompress rectal pressure inside the anastomotic site.

RESULTS

Between August 2009 and July 2010, 101 patients underwent laparoscopic low anterior resection using this technique. Most patients, 98.0% (99/101), underwent lower rectum transection using a single-fire cartridge. The anastomotic leakage rate was only 1.0% (1/101) in total and 1.3% (1/78), when not including patients with diverting stoma.

CONCLUSION

We have to follow up with more patients to conclude whether our technique is effective in the long term. However, this step-by-step technique could lead to safe anastomosis in laparoscopic low anterior resection for rectal cancer.

Impact of single-port cholecystectomy on postoperative pain

BACKGROUND

This study compared postoperative pain following four-port laparoscopic cholecystectomy (LC) and single-port cholecystectomy (SPC).

METHOD

This prospective, quasi-randomized, single-centre trial focusing on postoperative pain included 49 patients undergoing elective surgery with either a conventional LC, or SPC using a surgical glove port. Postoperative pain was evaluated using a visual analogue scale (VAS) and postoperative analgesic use as primary outcome measures. Total duration of operation, length of hospital stay, blood test results on the day after surgery and total port cost were secondary outcome measures.

RESULTS

Twenty-five LCs and 24 SPCs were undertaken. The VAS score on day 1 after surgery was significantly less in the SPC group than in the LC group: median (range) 24 (12-38) versus 45 (33-57) mm (P = 0·002). Significantly fewer patients in the SPC group required analgesia (9 of 24 versus 19 of 25 in the LC group; P = 0·007). There were no significant differences in total duration of operation, length of hospital stay, and blood test results on the day after surgery.

CONCLUSION

Single-port surgery using a surgical glove port reduces postoperative pain compared with conventional LC.

Cell wall fraction of Enterococcus hirae ameliorates TNF-alpha-induced barrier impairment in the human epithelial tight junction

AIMS

The evaluation of the effects of Enterococcus hirae, an intestinal bacterium in the adjacent mucosa (mucosal bacterium), on tumour necrosis factor-alpha (TNF-alpha)-induced barrier impairment in human epithelial Caco-2 cells.

METHODS AND RESULTS

The filter-grown Caco-2 monolayers were used as an intestinal epithelial model system. In Caco-2 cells, heat-killed E. hirae ATCC 9790(T) suppressed the TNF-alpha-induced barrier impairment and increase in interleukin-8 (IL-8) secretion, but lipase- and mutanolysin-treated E. hirae ATCC 9790(T) did not have these effects. It was demonstrated that lipoteichoic acid (LTA) from E. hirae ATCC 9790(T) is responsible for Caco-2 cells' recovery from TNF-alpha-induced impairments. In addition, Caco-2 cells had the same response to Toll-like receptor 2 (TLR2) ligand, Pam(3)Cys-Ser-(Lys)(4) as they did to LTA. Increased expression of zonula occludens-1 was observed by the addition of E. hirae ATCC 9790(T) to TNF-alpha-treated Caco-2 cells, and decreased expression of myosin light chain kinase was observed by the addition of LTA and Pam(3)Cys-Ser-(Lys)(4); this, in turn, led to barrier enforcement.

CONCLUSIONS

Enterococcus hirae ATCC 9790(T) cell wall fractions, such as LTA, protect against intestinal impairment by regulation of epithelial tight junction via TLR2 signalling.

SIGNIFICANCE AND IMPACT OF THE STUDY

Enterococcus hirae could be useful in the treatment of inflammatory bowel disease, as well as other intestinal disorders.

Virtual CT colectomy by three-dimensional imaging using multidetector-row CT for laparoscopic colorectal surgery

Laparoscopic colorectal surgery has been attracting attention for its capacity to improve the quality of life (QOL) of patients. However, there are disadvantages to this approach, namely, it is difficult to obtain an image of the entire view of the operative field, and organs and lesions cannot be manipulated directly by the surgeon during surgery. For this reason, it takes a relatively large amount of time to ligate vessel, which can vary between patients. Furthermore, vessels and organs can be damaged during lymph nodes dissection under laparoscopic guidance, leading to heavy bleeding that prevents the surgeon from having access to a good view of the operative field. Then, to assess preoperatively the vascular anatomy, we carried out multiphase, contrast-enhanced examinations using multidetector-row CT (MDCT) on patients with colorectal cancer, and prepared the fused image of 3D images of arteries, veins, the colorectum, organs, and tumor. We called the utilization of 3D imaging virtual CT colectomy, which contributed to rapid and safe manipulation of the origins of the arteries and the veins, as well as lymph nodes dissection, without incurring injury to the involved arteries and veins.

Correlations of hemoglobin index (IHb) of gastric mucosa with Helicobacter pylori (H. pylori) infection and inflammation of gastric mucosa

BACKGROUND

Helicobacter pylori (H. pylori) infection causes various gastric diseases, among them H. pylori-associated gastritis characterized by diffuse redness of the gastric mucosa. The haemoglobin index (IHb) of the fundic mucosa is an objective parameter of the extent of mucosal redness, but it is unclear whether or not IHb can be used as a diagnostic marker for H. pylori infection. The purpose of this investigation was to evaluate the correlations between IHb of the fundic mucosa and H. pylori infection, inflammatory cell infiltration, and inflammatory mediator production.

METHODS

IHb of the fundic mucosa was measured in 108 patients with various gastric diseases (group 1), and values were compared between H. pylori-positive and H. pylori-negative patients. Fifteen patients with H. pylori infection from group 1 underwent H. pylori eradication therapy and IHb was measured before and after treatment. Both IHb and inflammatory cell infiltration were assessed in 61 patients (group 2). In 31 patients from group 2, the expression of interleukin (IL)-8 and inducible nitric oxide synthase (iNOS) messenger RNA (mRNA) was assayed in gastric biopsy specimens by the reverse transcription-polymerase chain reaction (RT-PCR).

RESULTS

IHb levels were significantly higher in H. pylori-positive patients than in H. pylori-negative patients (P < 0.001). IHb was decreased at one month after the eradication of H. pylori (P < 0.001). IHb was higher in patients with infiltration by both mononuclear cells and neutrophils (P < 0.001). There was a significant correlation between the IHb level and the expression of IL-8 mRNA (P < 0.001), as well as between IHb and iNOS mRNA expression (P < 0.05).

CONCLUSIONS

There were significant correlations between IHb of the gastric mucosa and H. pylori infection, inflammatory cell infiltration, and IL-8/iNOS mRNA expression, suggesting that IHb is a reliable marker of H. pylori infection for use during follow-up endoscopy after H. pylori eradication therapy.

Laparoscopic approach for early gastric cancer within a paraesophageal hiatal hernia

We present a case of early gastric cancer located in gastric volvulus associated with paraesophageal hiatal hernia. Two lesions of EGC were diagnosed in the distal third of the stomach, most of which had herniated into the left chest through a large hiatal defect in an organoaxial fashion. Routinely, laparoscopic-assisted distal gastrectomy (LADG) is our preferred approach for EGC, and the presence of hiatal hernia in this case did not alter our approach. Laparoscopic repair of hiatal hernia was performed successfully followed by LADG. A review of the literature supports a minimally invasive approach for both procedures and shows it to be safe, effective, and technically feasible. Further, LADG is shown to be oncologically adequate in terms of tumor margins and lymph node dissection, but its relevance to long-term disease-free survival still needs to be studied in well-designed prospective trials.

Recombinant monoclonal thyrotropin-stimulation blocking antibody (TSBAb) established from peripheral lymphocytes of a hypothyroid patient with primary myxedema

Anti-TSH receptor antibodies (TRAbs) have been known to be involved in Graves' disease and primary hypothyroidism. We previously isolated and reconstituted immunoglobulin (Ig) genes of Epstein-Barr virus-transformed B cell clones producing monoclonal TRAbs obtained from Graves' patients. In the present study, we performed a similar experiment using a B cell clone, 32A-5, derived from a patient with primary hypothyroidism. The variable region genes of Ig heavy (H) and light (L) chains were isolated and sequenced from the 32A-5 clone. A significant number of somatic mutations were found in variable regions of H and L chain gene segments. Each pair of H and L chain cDNAs was ligated into an expression vector for IgG1 production and stably introduced into myeloma cells. The transfectants were injected ip into BALB/c mice to yield ample volume of the antibody for following applications. Interactions of recombinant 32A-5 with Graves' sera with varying thyroid-stimulating antibody (TSAb) activities were studied. The recombinant antibody tended to suppress TSAb activities in 10 of 15 Graves' sera, in which four were significantly inhibited. In summary, this is the first study to analyze human monoclonal TSH-stimulation blocking antibodies (TSBAb) at the molecular level. Use of human recombinant monoclonal TSBAb may be an analytical tool for molecular-basis etiology and an alternative therapeutic path for Graves' disease.

Formant interaction as a cue to vowel perception: a case report

Accumulating evidence indicates that cerebral processing of consonants and vowels is separable. It has been shown that disordered temporal acuity leads to disturbed consonant perception in cases with pure word deafness. In contrast, there has been no clear explanation of how vowel perception is impaired. We examined a patient with auditory agnosia, who showed a differential ability to identify the five Japanese vowels after bilateral cerebral lesions. He correctly identified the vowel [a] in more than 70% of auditory presentations, whereas he identified [i] in only about 30% of presentations. The difference between the first and second formant frequencies "F2-F1" and an artificially defined value "F1-(F2-F1)" for each vowel correlated significantly with the percentage of correct identifications. These findings support the hypothesis that vowel perception is based on formant interactions.

Brain activation during the fist-edge-palm test: a functional MRI study

The purpose of our study is to clarify, using functional MRI, brain regions activated during the fist-edge-palm task (FEP) compared to relatively simple hand motor tasks using either the right or the left hand in right-handed normal volunteers. The FEP was introduced to detect a disorder of voluntary movement, and it is believed to be closely related to contralateral frontal lobe damage. However, this assumption still remains controversial. Ten subjects participated in this study. Hand motor tasks were as follows: (1) the FEP, in which the subjects were requested to place their hand in three different positions sequentially: a fist resting horizontally, a palm resting vertically, and a palm resting horizontally; (2) a fist-palm task (FP), in which the subjects were asked to clench and unclench their fist alternately; and (3) a control task requiring the subjects to knock lightly with their clenched fist. The contralateral sensomotor and premotor areas were activated in the FP with the right hand and the contralateral sensorimotor, premotor, and supplementary motor areas (SMA) were activated in the FP with the left hand. In the FEP with either hand, bilateral premotor and left parietal areas and ipsilateral cerebellum were also activated as well as contralateral sensorimotor area and SMA. Our results suggest that successful performance of the FEP requires the participation of more brain areas than FP, which may explain why some patients without frontal lobe damage failed to perform the FEP.

[European paintings entitled "Jesus Christ as Pharmacist" in the Middle Ages and later]

Ninety-eight pictures painted in the Middle Ages and later entitled "Christ as Pharmacist" are shown in a little German book (W. H. Hein, Christus als Apotheker, Govi-Verlag, Frankfurt am Main, 1974). In the three paintings shown here, Christ appears as a pharmacist standing behind a pharmacy table used to compound medicine, and he has a medicinal balance in his left hand. The Christian terms, such as faith, love, and hope, and the drug's name are written on each of the drug vase labels. It seems that the purpose of displaying these paintings in a pharmacy was both to propagate Christianity to the poor who bought medicine at their family pharmacy and to win their respect for the pharmacist.

Identification of cariostatic substances in the cacao bean husk: their anti-glucosyltransferase and antibacterial activities

The cacao bean husk has been shown to possess two types of cariostatic substances, one showing anti-glucosyltransferase (GTF) activity and the other antibacterial activity, and to inhibit experimental dental caries in rats infected with mutans streptococci. In the present study, chromatographic purification revealed high-molecular-weight polyphenolic compounds and unsaturated fatty acids as active components. The former, which showed strong anti-GTF activity, were polymeric epicatechins with C-4beta and C-8 intermolecular bonds estimated to be 4636 in molecular weight in an acetylated form. The latter, which showed bactericidal activity against Streptococcus mutans, were determined to be oleic and linoleic acids, and demonstrated a high level of activity at a concentration of 30 microgram/mL. The cariostatic activity of the cacao bean husk is likely caused by these biologically active constituents.

The historical study of an ethics for American pharmacists

The Code of Ethics for pharmacists clarifies the standards of professional conduct. The code should be positively enforced in every country, and must play its role as the conduct standard for pharmacists at all times. American pharmacists did not suddenly become ethical in the 1980s. An appreciation of the importance of professional ethics has a long history starting when the Philadelphia College of Pharmacy adopted a Code of Ethics in 1848. Since the first legislation of the American Pharmacy Code of Ethics as far back as 1852, the code has been revised in 1922, 1952, 1969, 1981 and 1994. The term of between revisions has gotten shorter over the years, reflecting the change in the status and the proficiency of pharmacists in 146 years. Its historical meaning is quite significant.

[History of professionalization of modern clinical pharmacist (1): pharmaceutical practices in hospice before the French Revolution]

The times around the French Revolution, as E. H. Ackerknecht pointed out, were especially epochmaking in that "the clinical medicine" or 'medicine in the hospital' was born and bred through the days by discarding the medicine of court physicians and the metaphysical medicine that had been dominant for centuries until then. This change is, therefore, very important from the viewpoints of sociopolitical, cultural and medical histories. The medicine practised and taught mainly in Paris in those days based politically on the newborn nationalistic centralization; technically on pathologicoanatomy and biostatistics; and conceptually on the modern medical epistemologoy that made it possible to abstract and see a 'disease' from the sick by observation, description and classification of their common signs and symptoms, and then to ignore a suffering specific to each individual patient instead. Thus those who could believe in the être (entity) of a 'disease' the clinical medicine made it 'visible' were trained for medical professionals such as modern physicians, surgeons and clinical pharmacists, which finally realized the professional monopolization of the medicine. The aim of this paper is to report and analyze the historical process how there came out the modern clinical pharmacist who was permitted by the nation as the only occupation to deal in ethical drugs in the hospital, while excluding many other people who had been treating 'traditional medicines' from the modern pharmacies of hospitals.

[Snake as a symbol in medicine and pharmacy - a historical study]

The snake and snake venoms have stimulated the mind and imagination of humankind since the beginning of records about society. No animal has been more worshipped yet more cast out, more loved yet more despised than the snake. The essence of the fascination with fear of the snake lies within the creature's venom. Snakes have been used for worship, magic potions and, medicine, and they have been the symbol of love, health, disease, medicine, pharmacy, immortality, death and even wisdom. In the Sumer civilization (B.C. 2350-2150), designs with 2 snakes appeared. In Greek mythology (B.C. 2000-400), statues of Asclepius (God of Medicine), with "Caduceus" (made of two snakes and a staff), and his daughter Hygeia (God of Health), holding a snake and bowl, were created as symbols for medicine and health, respectively. A kind of Caduceus (1 snake and 1 staff) has been used as a symbol by the World Health Organization (WHO) and a snake and bowl as a symbol of pharmacies in Europe. Snakes have also been worshipped by old Indian peoples involved in Hinduism since 6-4th century B.C. In ancient Egypt, snake designs were used in hieroglyphs. In China, dried bodies of about 30 species of snakes are still using as Chinese medicines. In Japan, a painting of the symbol of "Genbu" (snake with tortoise) was found recently on the north wall of the Takamatsuzuka ancient tomb (7-8th century A.D.), however it is a symbol of a compass direction, and has probably less relation to medicine and pharmacy.

[History of Polish pharmacy]

Doctoral thesis (in French) by Monika Debska-Donnet, entitled "History of pharmacy and pharmaceutical art collections in Poland" which was presented to Paris XI University (Faculty of Pharmaceutical and Biological Sciences) in 1991, was translated into Japanese and summarized. In this report, histories of pharmacy education, pharmacists, community pharmacies, pharmacopoeiae, pharmaceutical industries in Poland were described, and four representative Polish museums of history of pharmacy were also explained.

[History of professionalization of modern clinical pharmacist (2): reformation of medical systems before and after the French Revolution]

Paradoxically the medical reformation at the French Revolution is based on two concepts; one was the free medical and pharmaceutical practices without professional licence and another was the nationalistic centralization. The newborn nationalistically centralized institution was applied simultaneously in the field of politics and modern medicine. The physicians of "Société Royale de Médecine" started to investigate the epidemic diseases all over France in 1778. After the French Revolution, it soon developed into a larger public organization that represented the knowledge of medicine and the collegiate mind of the Société shared among the practicioners.

Reciprocal modulation of alpha(2A)-adrenoceptor and G(alpha o) protein states as determined by carboxy-terminal mutagenesis of a G(alpha o) protein

The C-terminal portion of G(alpha) proteins plays a key role in their selective activation by cognate receptors. alpha(2A)-Adrenoceptors (alpha(2A)-ARs) can differentially inhibit or stimulate adenylyl cyclases by the activation of distinct G(i/o) and G(s) protein families. The implication of the C-terminal portion of G(alpha o) and G(alphas) proteins in their activation by alpha(2A)-ARs was analyzed by constructing mutant G(alpha o) proteins in which each of the last five amino acid positions were exchanged for those corresponding to a G(alphas) protein. Agonist-dependent, pertussis toxin-resistant binding of guanosine 5'-O-(3-[(35)S]thio)triphosphate ([(35)S]GTP gamma S) revealed that the degree of positive efficacy of clonidine was highly dependent on the presence of a G(alpha o) protein-derived Gly amino acid as the -3 residue at the C-terminal portion of the protein. In contrast, antagonist properties for clonidine were observed for those mutants carrying a G(alphas) protein-derived Glu residue at this position. (-)-Epinephrine yielded almost similar maximal [(35)S]GTP gamma S binding responses, but its potency was decreased 22- to 150-fold at the -3 Glu containing mutant G(alpha o) proteins compared with those mutants containing a Gly. A 9- to 39-fold increase in the alpha(2A)-AR agonist equilibrium dissociation constants further reflected changes in the G(alpha) protein-induced alpha(2A)-AR state mediated by the specific Gly to Glu mutation in the C-terminal portion of the G(alpha o) protein. The present data emphasize the unique role of the -3 position at the G(alpha) protein C-terminal portion, independent of its surrounding peptidic environment, in constraining a structure favorable for activated receptor interaction and transmission of the mutation-induced conformational change from the G(alpha o) protein to the alpha(2A)-AR.

Low-dose tissue plasminogen activator followed by planned rescue angioplasty reduces time to reperfusion for acute myocardial infarction treated at community hospitals

The time from admission to reperfusion in patients with acute myocardial infarction (AMI) was compared according to the type of hospital and treatment strategy. A total of 164 patients with a first AMI within 12h of onset were enrolled at one tertiary emergency center (TEC) and 6 community hospitals (CHs). The subjects were randomly assigned to receive either primary percutaneous transluminal coronary angioplasty (PTCA) (TEC-primary PTCA and CHs-primary PTCA groups) or 800,000 units of intravenous monteplase, half the standard dose of a mutant tissue plasminogen activator (t-PA), followed by rescue PTCA if the Thrombolysis in Myocardial Infarction (TIMI) flow grade was 2 or less (TEC-monteplase and CHs-monteplase groups) on the first coronary angiogram. Sixty minutes after admission, TIMI flow grade 3 rates of the study groups were as follows, in descending order: TEC-monteplase group, CHs-monteplase group, TEC-primary PTCA group, and CHs-primary PTCA group (56%, 41%, 36%, and 8%, respectively; p<0.01). However, there was no significant difference in the final TIMI flow grade 3 rate among the 4 groups. In the CHs, the peak creatine kinase tended to be lower in the monteplase group than in the primary PTCA group. The results suggest that low-dose monteplase followed by rescue PTCA is an effective strategy for promoting early reperfusion in patients with AMI, especially those who are treated at CHs.

The toxR gene of Vibrio (Listonella) anguillarum controls expression of the major outer membrane proteins but not virulence in a natural host model

To examine the hypothesis that the ancestral role of the toxR gene in the family Vibrionaceae is control of the expression of outer membrane protein (OMP)-encoding genes for adaptation to environmental change, we investigated the role of the toxR gene in Vibrio anguillarum, an important fish pathogen. The toxR gene of V. angullarum (Va-toxR) was cloned from strain PT-87050 isolated from diseased ayu (Plecoglossus altivelis), and the sequence was analyzed. The toxR sequence was 63 to 51% identical to those reported for other species of the family Vibrionaceae. Distribution of the Va-toxR gene sequence in V. anguillarum strains of various serotypes was confirmed by using DNA probe and PCR methods. An isogenic toxR mutant of V. anguillarum PT-24, isolated from diseased ayu, was constructed by using an allelic exchange method. The wild-type strain and the toxR mutant did not differ in the ability to produce a protease(s) and a hemolysin(s) or in pathogenicity for ayu when examined by the intramuscular injection and immersion methods. A 35-kDa major OMP was not produced by the toxR mutant. However, a 46-kDa OMP was hardly detected in the wild-type strain but was produced as the major OMP by the toxR mutant. For the toxR mutant, the MICs of two beta-lactam antibiotics were higher and the minimum bactericidal concentration of sodium dodecyl sulfate was lower than for the wild-type strain. Analysis of the N-terminal amino acid sequences of the 35- and 46-kDa OMPs indicated that these proteins are the porin-like OMPs and are related to the toxR-regulated major OMPs of the family Vibrionaceae. The results indicate that the toxR gene is not involved in virulence expression in V. anguillarum PT-24 and that toxR regulation of major OMPs is universal in the family Vibrionaceae. These results support the hypothesis that the ancestral role of the toxR gene is regulation of OMP gene expression and that only in some Vibrio species has ToxR been appropriated for the regulation of a virulence gene(s).

[A patient with recurrent breast cancer whose liver metastasis regressed following combined use of weekly docetaxel and MPA.5'-DFUR]

A 28-year-old woman who was 10 months pregnant was diagnosed with left breast cancer. She received preoperative chemotherapy and underwent mastectomy after parturition. Endocrine therapy and adjuvant CMF and CAF was administered, but a bone metastasis appeared 2 years later and a liver metastasis 3 years later. Weekly docetaxel and MPA plus 5'-DFUR combination therapy were successively and simultaneously administered. The liver tumor regressed, and the survival time was prolonged by 1 year and 6 months. This case suggests that the combined use of both therapies was safe for the patient in serious bad condition and had a strong antitumor effect.

Conflict of intentions due to callosal disconnection

OBJECTIVES

Three patients with callosal syndrome manifested a peculiar symptom in that they were unable to perform intended whole body actions because another intention emerged in competition with the original one. Attempts were made to clarify the symptomatology of this manifestation and its possible mechanism is discussed.

METHODS

The three patients are described and previous reports on patients with callosal damage were reviewed. Four additional patients with similar symptoms were found and the clinical features common to all seven patients were examined.

RESULTS

This symptom could not be attributed to unilateral movement disorders such as unilateral apraxia, intermanual conflict, or compulsive manipulation of tools. The manifestations included marked hesitation in initiating actions, interruption of actions, repetitive actions, and performance of unintended actions with difficulty in correcting them. All patients, except one, had a lesion in the posterior half of the body of the corpus callosum, and there was no significant involvement of the cerebral cortex. The symptom became manifest later than 4 weeks after callosal damage. It occurred during spontaneous actions, but not during well automated actions nor when following instructions.

CONCLUSION

This symptom, tentatively named "conflict of intentions", can be regarded as a fragment of diagonistic dyspraxia originally described by Akelaitis, although it can occur independently of intermanual conflict. Normally, the right and left cerebral hemispheres may be complementarily modifying automated whole body actions in order to adapt behaviour to changes of the environment as well as to the intention. Partial callosal disconnection without significant cortical involvement would exaggerate the disparity between the role of each hemisphere through the reorganisation of neural systems after callosal damage. Such double, often contrary, behavioural tendencies may sometimes simultaneously enter the patient's awareness.

Expression of survivin correlates with apoptosis, proliferation, and angiogenesis during human colorectal tumorigenesis

BACKGROUND

To identify the role of survivin, a novel inhibitor of apoptosis (IAP) in colorectal tumorigenesis, the authors investigated tissue expression of survivin in human colorectal tumors including 43 hyperplastic polyps, 171 adenomas with low dysplasia, 42 adenomas with high dysplasia, and 60 carcinomas in adenoma, and examined whether the expression of survivin correlated with tumor cell apoptosis, proliferation, and angiogenesis, which is known to initiate the imbalance between cell proliferation and apoptosis.

METHODS

Immunohistochemical staining for the paraffin sections by using the monoclonal antibodies, survivin, p53, bcl-2, Ki-67, and CD34, was performed by the standard avidin-biotin-peroxidase technique. The apoptotic cells were detected by terminal deoxynucleotidyl transferase-mediated dUTP-biotin nick end labeling method, using an Apop Tag in situ detection kit.

RESULTS

The immunoreactivity of survivin significantly increased in the transition from adenoma with low dysplasia to high dysplasia/carcinoma (P < 0.001). Similar changes in protein expression were observed for p53 but not for bcl-2, which was expressed throughout the colorectal tumorigenesis. This transition was associated with a significant decrease in the apoptotic index (AI) and significant increases in the Ki-67 labeling index (LI) and microvessel density (MVD; P < 0.001 for both). The expression of survivin inversely correlated with AI and was positively correlated with Ki-67 LI and MVD (P < 0.001 for both).

CONCLUSIONS

These results suggest that, like p53, survivin plays an important role in transition from adenoma with low dysplasia to high dysplasia during human colorectal tumorigenesis.

Expression of survivin correlates with apoptosis, proliferation, and angiogenesis during human colorectal tumorigenesis

BACKGROUND

To identify the role of survivin, a novel inhibitor of apoptosis (IAP) in colorectal tumorigenesis, the authors investigated tissue expression of survivin in human colorectal tumors including 43 hyperplastic polyps, 171 adenomas with low dysplasia, 42 adenomas with high dysplasia, and 60 carcinomas in adenoma, and examined whether the expression of survivin correlated with tumor cell apoptosis, proliferation, and angiogenesis, which is known to initiate the imbalance between cell proliferation and apoptosis.

METHODS

Immunohistochemical staining for the paraffin sections by using the monoclonal antibodies, survivin, p53, bcl-2, Ki-67, and CD34, was performed by the standard avidin-biotin-peroxidase technique. The apoptotic cells were detected by terminal deoxynucleotidyl transferase-mediated dUTP-biotin nick end labeling method, using an Apop Tag in situ detection kit.

RESULTS

The immunoreactivity of survivin significantly increased in the transition from adenoma with low dysplasia to high dysplasia/carcinoma (P < 0.001). Similar changes in protein expression were observed for p53 but not for bcl-2, which was expressed throughout the colorectal tumorigenesis. This transition was associated with a significant decrease in the apoptotic index (AI) and significant increases in the Ki-67 labeling index (LI) and microvessel density (MVD; P < 0.001 for both). The expression of survivin inversely correlated with AI and was positively correlated with Ki-67 LI and MVD (P < 0.001 for both).

CONCLUSIONS

These results suggest that, like p53, survivin plays an important role in transition from adenoma with low dysplasia to high dysplasia during human colorectal tumorigenesis.

Early peak creatine kinase activity is not always a marker of successful reperfusion with myocardial salvage in patients with reperfused anterior acute myocardial infarction

BACKGROUND

Although early peak creatine kinase activity (peak CK) is considered a reliable marker of coronary reperfusion in patients with acute myocardial infarction (AMI), whether early peak CK indicates good myocardial salvage is unclear. Moreover, some patients have late peak CK despite successful reperfusion, and its clinical implication remains to be elucidated.

METHODS AND RESULTS

We examined the association of the time to peak CK with predischarge left ventricular function in 124 patients with a first AMI who had successful reperfusion within 6 hours from symptom onset. Patients were classified according to the time from reperfusion to peak CK: group A, 61 patients with peak CK < 6 hours; group B, 42 with peak CK from 6 to 12 hours; and group C, 21 with peak CK > 12 hours. There were no differences among the 3 groups in age, sex, method of reperfusion, time from symptom onset to reperfusion, collateral circulation, or the extent of risk area estimated by number of leads with ST-segment elevation. Left ventricular ejection fraction measured by predischarge left ventriculography was lowest in group A, followed by group B, and highest in group C (median values, 43%, 52%, and 60%, P < .01). Left ventricular dysfunction (left ventricular ejection fraction < or = 40%) occurred in 26 (43%) patients in group A, 8 (19%) in group B, and none in group C (P < .01).

CONCLUSIONS

We conclude that compared with early peak CK, late peak CK consistently reflects good myocardial salvage in patients with anterior AMI who had successful reperfusion within 6 hours from symptom onset.

Neuroanatomical discrimination between manipulating and maintaining processes involved in verbal working memory; a functional MRI study

We used functional magnetic resonance imaging (fMRI) to investigate neural correlates of processes concerning store and manipulation in verbal working memory. We prepared a revised lag 1 digit span, digit span and a simple number detection task. Specific activities in association with manipulating process were identified in the right middle (BA 9/46) and left precentral gyrus (BA 6). Activated areas specific to maintaining process were detected in the right middle (right BA 11/10) and medial (BA 6) frontal gyri, the right inferior parietal lobule (BA 40), and the left middle (BA 9) and inferior frontal gyri (BA 44). The process-nonspecific activated areas common to two processes were identified in the right inferior frontal gyrus (BA 47) and the left superior parietal lobule (BA 7). Using the signal percent change of each subject, we calculated the correlation coefficients among each activated area. The results of this analysis showed that two processes of verbal working memory were clearly discriminated. The two essential processes of manipulation and maintenance in working memory seem to activate process-specific and overlapping (process-nonspecific) areas, but the patterns of combination were definitely different.

[Efficacy of low-dose mutant tissue-type plasminogen activator followed by planned rescue percutaneous transluminal coronary angioplasty as reperfusion therapy for acute myocardial infarction]

OBJECTIVES

The efficacy of injection of a low-dose mutant tissue-type plasminogen activator (mt-PA), monteplase, followed by planned rescue percutaneous transluminal coronary angioplasty (PTCA) was compared with that of primary PTCA.

METHODS

A total of 164 patients with acute myocardial infarction within 12 hr from onset were randomly assigned to a treatment with 80 x 10(4) U bolus of monteplase (Group M) or no administration (Group P) by the envelope method, followed by immediate angiography with angioplasty in patients with Thombolysis in Myocardial Infarction (TIMI) flow grade 0, 1 or 2.

RESULTS

There were no differences in baseline characteristics between the two groups. Initial angiography showed a higher reperfusion rate (TIMI 2 + 3: 21% + 38% vs 13% + 9%, p < 0.001) and the median time to TIMI 3 was shorter (63 vs 78 min, p < 0.005) in Group M than in Group P, but the final TIMI 3 rate was similar (93% vs 96%). Peak creatine kinase was lower, and predischarge left ventricular ejection fraction measured in 70% of all patients was higher (59 +/- 9% vs 54 +/- 14%, p = 0.02) in Group M than in Group P. Recurrent ischemia with ST elevation occurred in three patients in Group M, but death, re-acute myocardial infarction or stroke did not occur in either group and the rate of bleeding complication was similar (4.9% vs 3.7%). PTCA was performed less frequently in Group M, but medical expenses were comparable in both groups.

CONCLUSIONS

Low-dose mt-PA followed by rescue PTCA is effective for early recanalization and preservation of left ventricular function without increases in bleeding complications or medical expenses. These results suggest that low-dose mt-PA should be given to all patients with acute myocardial infarction who are scheduled to undergo primary PTCA.

Judging semantic and episodic incongruity: a magnetoencephalographic study

Evoked magnetic fields over the entire head were measured during a semantic judgment task, in which conditions of the pre-test learning session were manipulated. Subjects learnt related and unrelated category-noun pairs, and were then asked to judge the relationship between category and noun. Unrelated pairs evoked activation around 400 ms in the left temporal area. In addition, newly presented related pairs, of which the categories were used to learn unrelated pairs, also evoked similar activities. Our findings suggest that these activities are not only related to the semantic incongruity between a pair of words as in previous studies, but also to the episodic incongruity between the learning and measurement sessions.