Adverse Local Tissue Reaction and Late-Onset Eosinophilic Gastroenteritis After Primary Total Hip Arthroplasty: A Case Report

CASE

A 67-year-old woman suffered from chronic diarrhea at 10 years after right total hip arthroplasty. She also had a pseudotumor caused by an adverse local tissue reaction (ALTR) in her right pelvis. We performed revision arthroplasty, in part because we suspected the diarrhea may have been associated with the intrapelvic pseudotumor. She was later diagnosed with eosinophilic gastroenteritis (EGE).

CONCLUSION

Although these two diseases were thought be be related through a similar immune reaction, our patient's clinical course suggests that the ALTR and EGE were independent events.

Immobilizing Bactericides on Dental Resins via Electron Beam Irradiation

Polymerizable bactericides, such as quaternary ammonium compound-based monomers, have been intensively studied as candidates for immobilizing antibacterial components on dental resin. However, they predominantly exhibit a bacteriostatic behavior, rather than bactericidal, as the immobilized components are left with insufficient molecular movement to disrupt the bacterial surface structure through contact-mediated action. In this study, we developed a novel strategy to increase the density of the immobilized bactericide and enhance its antibacterial/antibiofilm properties by combining a surface-grafting technique with electron beam irradiation. A solution of the quaternary ammonium compound-based monomer, 12-methacryloyloxydodecylpyridinium bromide (MDPB), was coated on polymethyl methacrylate (PMMA) resin specimens at the concentrations of 30, 50, and 80 wt%. The coated resins were subsequently exposed to 10 MeV of electron beam irradiation at 50 and 100 kGy, followed by thermal stabilization at 60 °C. The antibacterial effect was evaluated by inoculating a Streptococcus mutans suspension on the coated PMMA resin samples, which exhibited bactericidal effects even after 28 d of aging (P < 0.05, Tukey's honestly significant difference test). Transmission electron microscopy and bacteriolytic activity evaluation revealed that the S. mutans cells had sustained membrane depolarization. Furthermore, the antibiofilm effects against S. mutans and bacteria collected from human saliva were assessed. The thickness and the percentage of membrane-intact cells of the S. mutans and multispecies biofilms formed on the MDPB-immobilized surfaces were significantly lower than the uncoated PMMA specimens, even after 28-d aging (P < 0.05, Tukey's honestly significant difference test). Thus, the immobilization of antibacterial MDPB via electron beam irradiation induced rapid membrane depolarization, increasing membrane permeability and eventually causing cell death. Our strategy substantially enhances the antibacterial properties of the resinous materials and inhibits biofilm formation, therefore demonstrating significant potential for preventing infectious diseases in the oral environment.

Carnitine insufficiency is associated with fatigue during lenvatinib treatment in patients with hepatocellular carcinoma

Background

Fatigue is a common adverse event during lenvatinib treatment in patients with hepatocellular carcinoma. One mechanism contributing to development of fatigue might involve abnormal adenosine triphosphate synthesis that is caused by carnitine deficiency. To address this possibility, we examined the relationship between carnitine levels and fatigue during lenvatinib treatment.

Methods

This prospective study evaluated 20 patients with hepatocellular carcinoma who underwent lenvatinib treatment. Both blood and urine samples were collected from the patients before starting lenvatinib therapy (day 0), and on days 3, 7, 14, and 28 thereafter. Plasma and urine concentrations of free and acyl carnitine (AC) were assessed at each time point. The changes in daily fatigue were evaluated using the Brief Fatigue Inventory (BFI).

Results

Plasma levels of free carnitine (FC) at days 3 and 7 were significantly higher compared with baseline (p = 0.005, p = 0.005, respectively). The urine FC level at day 3 was significantly higher compared with baseline (p = 0.030) and that of day 7 tended to be higher compared with baseline (p = 0.057). The plasma AC concentration at days 14 and 28 was significantly higher compared with that of baseline (p = 0.002, p = 0.005, respectively). The plasma AC-to-FC (AC/FC) ratio on days 14 and 28 was significantly higher compared with baseline (p = 0.001, p = 0.003, respectively). There were significant correlations between the plasma AC/FC ratio and the change in the BFI score at days 14 and 28 (r = 0.461, p = 0.041; r = 0.770, p = 0.002, respectively).

Conclusions

Longitudinal assessments of carnitine and fatigue in patients with hepatocellular carcinoma suggest that lenvatinib affects the carnitine system in patients undergoing lenvatinib therapy and that carnitine insufficiency increases fatigue. The occurrence of carnitine insufficiency may be a common cause of fatigue during the treatment.

Rifaximin prevents ethanol-induced liver injury in obese KK-Ay mice through modulation of small intestinal microbiota signature

Exacerbation of alcoholic hepatitis (AH) with comorbid metabolic syndrome is an emerging clinical problem, where microbiota plays a profound role in the pathogenesis. Here, we investigated the effect of rifaximin (RFX) on liver injury following chronic-binge ethanol (EtOH) administration in KK-A^y mice, a rodent model of metabolic syndrome. Female, 8-wk-old KK-A^y mice were fed Lieber-DeCarli diet (5% EtOH) for 10 days, following a single EtOH gavage (4 g/kg body wt). Some mice were given RFX (0.1 g/L, in liquid diet) orally. Small intestinal contents were collected from mice without binge. Intestinal microbiota was quantified using aerobic and anaerobic culturing techniques and further analyzed by 16S rRNA sequencing in detail. EtOH feeding/binge caused hepatic steatosis, oxidative stress, and induction of inflammatory cytokines in KK-A^y mice, which were markedly prevented by RFX treatment. Hepatic mRNA levels for cluster of differentiation 14, Toll-like receptor (TLR) 4, TLR2, and NADPH oxidase 2 were increased following EtOH feeding/binge, and administration of RFX completely suppressed their increase. The net amount of small intestinal bacteria was increased over threefold after chronic EtOH feeding as expected; however, RFX did not prevent this net increase. Intriguingly, the profile of small intestinal microbiota was dramatically changed following EtOH feeding in the order level, where the Erysipelotrichales predominated in the relative abundance. In sharp contrast, RFX drastically blunted the EtOH-induced increases in the Erysipelotrichales almost completely, with increased proportion of the Bacteroidales. In conclusion, RFX prevents AH through modulation of small intestinal microbiota/innate immune responses in obese KK-A^y mice.NEW & NOTEWORTHY Here we demonstrated that rifaximin (RFX) prevents chronic-binge ethanol (EtOH)-induced steatohepatitis in KK-A^y mice. Chronic EtOH feeding caused small intestinal bacterial overgrowth, with drastic alteration in the microbiota profile predominating the order Erysipelotrichales. RFX minimized this EtOH induction in Erysipelotrichales with substitutive increases in Bacteroidales. RFX also prevented EtOH-induced increases in portal lipopolysaccharide, and hepatic cluster of differentiation 14, toll-like receptor (TLR) 2, and TLR4 mRNA levels, suggesting the potential involvement of microbiota-related innate immune responses.

Development of a Cavity Disinfectant Containing Antibacterial Monomer MDPB

An experimental cavity disinfectant (ACC) that is intended to be used for various direct and indirect restorations was prepared by adding an antibacterial monomer 12-methacryloyloxydodecylpyridinum bromide (MDPB) at 5% into 80% ethanol. The antibacterial effectiveness of ACC and its influences on the bonding abilities of resin cements were investigated. To examine the antibacterial activity of unpolymerized MDPB, the minimum inhibitory and bactericidal concentrations (MIC and MBC) were determined for Streptococcus mutans, Lactobacillus casei, Actinomyces naeslundii, Parvimonas micra, Enterococcus faecalis, Fusobacterium nucleatum, and Porphyromonas gingivalis. Antibacterial activities of ACC and the commercial cavity disinfectant containing 2% chlorhexidine and ethanol (CPS) were evaluated by agar disk diffusion tests through 7 bacterial species and by MIC and MBC measurement for S. mutans. The effects of ACC and CPS to kill bacteria in dentinal tubules were compared with an S. mutans–infected dentin model. Shear bond strength tests were used to examine the influences of ACC on the dentin-bonding abilities of a self-adhesive resin cement and a dual-cure resin cement used with a primer. Unpolymerized MDPB showed strong antibacterial activity against 7 oral bacteria. ACC produced inhibition zones against all bacterial species similar to CPS. For ACC and CPS, the MIC value for S. mutans was identical, and the MBC was similar with only a 1-step dilution difference (1:2). Treatment of infected dentin with ACC resulted in significantly greater bactericidal effects than CPS ( P < 0.05, analysis of variance and Tukey’s honest significant difference test). ACC showed no negative influences on the bonding abilities to dentin for both resin cements, while CPS reduced the bond strength of the self-adhesive resin cement ( P < 0.05). This study clarified that the experimental cavity disinfectant containing 5% MDPB is more effective in vitro than the commercially available chlorhexidine solution to eradicate bacteria in dentin, without causing any adverse influences on the bonding abilities of resinous luting cements.

Development of an antibacterial root canal filling system containing MDPB

An antibacterial monomer 12-methacryloyloxydodecylpyridinum bromide (MDPB)-containing experimental, chemically cured primer was prepared to develop a new resin-based root canal filling system. This study investigated the antibacterial effects of the MDPB-containing primer (experimental primer [EP]) against Enterococcus faecalis and assessed the in vitro bonding and sealing abilities of the filling system, consisting of EP and a Bis-GMA-based sealer resin. Antibacterial effects of EP were evaluated by contact with planktonic or adherent bacteria for 30 or 60 sec, and the viable bacterial number was counted. The antibacterial effects against E. faecalis in dentinal tubules were also assessed, according to a root canal infection model. Bonding and sealing abilities of the experimental filling system were examined by microtensile bond strength tests and leakage tests based on fluid filtration methods. Significantly greater reduction in viable bacteria in planktonic and adherent form was obtained by short-period contact with EP compared with the control primer (without MDPB) or with the proprietary (Epiphany) primer (p < .05). Significantly greater bactericidal effects of the EP inside the dentinal tubule of root, as opposed to the control primer or Epiphany primer, were confirmed according to a root canal infection model (p < .05), and 100% killing of E. faecalis could be obtained by the application of EP after irrigation with a 5% sodium hypochlorite solution. The experimental endodontic filling system demonstrated significantly greater bond strength to root dentin than Epiphany sealer system (Epiphany primer and Epiphany Root Canal Sealant; p < .05), showing formation of resin tags and a hybridized layer. Leakage tests clarified that the experimental system provided excellent sealing. This study confirmed that the MDPB-containing experimental antibacterial primer has the ability to effectively disinfect the root canal. Additionally, the experimental root canal filling system employing this primer and the Bis-GMA-based sealer resin is useful for achieving good sealing, suggesting its possible benefit for successful endodontic treatments.

[Pleuroperitoneal communication at the beginning of continuous ambulatory peritoneal dialysis; report of a case]

A 46-years-old woman admitted for induction of continuous ambulatory peritoneal dialysis (CAPD). When peritoneal functional test was performed, dyspnea was occurred. Chest X-ray and chest computed tomography (CT) scan revealed massive right hydrothorax. Technetium-99m macroaggregated albumin scintigraphy showed communication between abdominal cavity and thoracic cavity. The thoracoscopic diaphragmal repair was performed. After CAPD was started, right hydrothorax occurred again. Re-repair of the diaphragm was performed in small thoracotomy and small hole was revealed. The hole was sutured and diaphragm was coverd by fibrin glue and polyglycolacid (PGA) felt all over. Since then, CAPD was continued successfully. Thoracoscopic surgery is less invasive and appropriate therapy for this case. It is important that the diaphragm will be covered all over by fibrin glue and PGA sheet because even pin-hole makes recurrence. For detect of the communicative portion, use of indigocarmin and examination of glucose concentration in the pleural effusion were effective.

[Thymic carcinoid tumor with Cushing syndrome]

A case of a 71-year-old male with ectopic adrenocorticotropic polypeptide (ACTH)-producing thymic carcinoid tumor presenting Cushing's syndrome was reported. This patient had symptoms of fatigue and a polyposia for 2 years before a mediastinal tumor was detected. Chest computed tomography (CT) scan demonstrated an anterior mediastinal mass, and serum ACTH and cortisol level revealed very high. Secretion of cortisol was not inhibited in an 8-mg dexamethazone suppression test. We diagnosed ectopic ACTH-producing tumor, and performed complete excision of the thymus including thymic tumor. Histologically, the tumor demonstrated typical carcinoid with the positivity of ACTH immunostaining. After the operation, ACTH and cortisol levels were reduced and the clinical symptoms were improved rapidly. We have concluded that it is important to control serum perioperative cortisol level for the prevension of morbidity.

Neuronal specificity of alpha-synuclein toxicity and effect of Parkin co-expression in primates

Recombinant adeno-associated viral (rAAV) vector-mediated overexpression of alpha-synuclein (alphaSyn) protein has been shown to cause neurodegeneration of the nigrostriatal dopaminergic pathway in rodents and primates. Using serotype-2 rAAV vectors, we recently reported the protective effect of Parkin on alphaSyn-induced nigral dopaminergic neurodegeneration in a rat model. Here we investigated the neuronal specificity of alphaSyn toxicity and the effect of Parkin co-expression in a primate model. We used another serotype (type-1) of AAV vector that was confirmed to deliver genes of interest anterogradely and retrogradely to neurons in rats. The serotype-1 rAAV (rAAV1) carrying alphaSyn cDNA (rAAV1-alphaSyn), and a cocktail of rAAV1-alphaSyn and rAAV1 carrying parkin cDNA (rAAV1-parkin) were unilaterally injected into the striatum of macaque monkeys, resulting in protein expression in striatonigral GABAergic and nigrostriatal dopaminergic neurons. Injection of rAAV1-alphaSyn alone decreased tyrosine hydroxylase immunoreactivity in the striatum compared with the contralateral side injected with a cocktail of rAAV1-alphaSyn and rAAV1-parkin. Immunostaining of striatonigral GABAergic neurons was similar on both sides. Overexpression of Parkin in GABAergic neurons was associated with less accumulation of alphaSyn protein and/or phosphorylation at Ser129 residue. Our results suggest that the toxicity of accumulated alphaSyn is not induced in non-dopaminergic neurons and that the alphaSyn-ablating effect of Parkin is exerted in virtually all neurons in primates.

The ATM-dependent DNA damage signaling pathway

Many of the insights that we have gained into the mechanisms involved in cellular DNA damage response pathways have come from studies of human cancer susceptibility syndromes that are altered in DNA damage responses. ATM, the gene mutated in the disorder, ataxia-telangiectasia, is a protein kinase that is a central mediator of responses to DNA double-strand breaks in cells. Recent studies have elucidated the mechanism by which DNA damage activates the ATM kinase and initiates these critical cellular signaling pathways. The SMC1 protein appears to be a particularly important target of the ATM kinase, playing critical roles in controlling DNA replication forks and DNA repair after the damage. A major role for the NBS1 and BRCA1 proteins appears to be in the recruitment of an activated ATM kinase molecule to the sites of DNA breaks so that ATM can phosphorylate SMC1. Generation of mice and cells that are unable to phosphorylate SMC1 demonstrated the importance of SMC1 phosphorylation in the DNA-damage-induced S-phase checkpoint, in determining rates of repair of chromosomal breaks, and in determining cell survival after DNA damage. Focusing on ATM and SMC1, the molecular controls of these pathways is discussed.

Phase II trial of docetaxel in advanced or metastatic endometrial cancer: a Japanese Cooperative Study

The purpose of this study was to determine whether docetaxel has antitumour activity in patients with advanced or recurrent endometrial carcinoma. Chemotherapy-naïve or previously treated patients (one regimen) with histopathologically documented endometrial carcinoma and Eastern Cooperative Oncology Group performance status ⩽2 entered the study. Docetaxel 70 mg m⁻² was administered intravenously on day 1 of a 3-week cycle up to a maximum of six cycles. If patients responded well to docetaxel, additional cycles were administered until progressive disease or unacceptable toxicity occurred. Of 33 patients with a median age of 59 years (range, 39–74 years) who entered the study, 14 patients (42%) had received one prior chemotherapy regimen. In all, 32 patients were evaluable for efficacy, yielding an overall response rate of 31% (95% confidence interval, 16.1–50.0%); complete response and partial response (PR) were 3 and 28%, respectively. Of 13 pretreated patients, three (23%) had a PR. The median duration of response was 1.8 months. The median time to progression was 3.9 months. The predominant toxicity was grade 3–4 neutropenia, occurring in 94% of the patients, although febrile neutropenia arose in 9% of the patients. Oedema was mild and infrequent. Docetaxel has antitumour activity in patients with advanced or recurrent endometrial carcinoma, including those previously treated with chemotherapy; however, the effect was transient and accompanied by pronounced neutropenia in most patients.

Inhibitory effect of hexamethylene bisacetamide on replication of human cytomegalovirus

The effect of hexamethylane bisacetamide (HMBA), a hybrid polar compound, on gene expression and replication of human cytomegalovirus (HCMV) was studied. When HCMV-infected human thyroid papillary carcinoma (TPC-1) and human embryonic lung (HEL) fibroblast cells were maintained with medium containing 2.5 and 5 mM HMBA for 10 days, there was a greater than 2- to 3-log reduction in virus yield compared to that in untreated cells. Infection of TPC-1 cells with HCMV resulted in an establishment of persistent infection and the cells continuously produced virus with titer of over 10(5) PFU/ml, whereas HMBA prevented the infected cells from entering into the persistent infection. Moreover, treatment of the persistently infected cultures with HMBA reduced production of infectious HCMV more efficiently than did ganciclovir, and eventually ceased HCMV production. Western blotting analysis revealed that HMBA blocks accumulation of the immediate early 2 (IE2) protein in TPC-1 cells and delays synthesis of this protein in HEL cells, but has little effect on the level of the IE1 protein during the early times after infection. Synthesis of the viral early and late proteins in both cells was also substantially blocked by HMBA. The results indicate that the inhibition or the delay of the critical IE2 protein synthesis in the presence of HMBA would actually be a process that fails to proceed beyond the IE stages in HCMV replication cycle.

Molecular cloning of human and mouse DJ-1 genes and identification of Sp1-dependent activation of the human DJ-1 promoter

DJ-1 has been identified as a novel oncogene that transforms mouse NIH3T3 cells in cooperation with activated ras. Subsequently, two other groups have identified SP22 or CAP-1, rat homologs of human DJ-1, as a sperm protein targeted by some toxicants leading to male infertility, and another group has also reported that RS, the same as human DJ-1, is a component of an RNA-binding protein complex. To characterize the expression or functional importance of DJ-1, the genomic DNAs of both human and mouse DJ-1 were cloned and characterized. Both genomic DNAs comprise 7 exons spanning about 16-24 kb, in which 2-6 exons encode the DJ-1 protein. The human DJ-1 gene was mapped at chromosome 1p36.2-p36.3, a region that has been shown to be a hot spot of chromosome abnormalities in several tumor cells. To analyze the promoter of the human DJ-1 gene, a series of deletion constructs of the region upstream of exon 2 were linked to the luciferase gene, and their luciferase activities were measured in human HeLa cells. Of the many putative transcription regulatory sequences, the Sp1 site present at -100 from the transcription initiation site contributed to the major promoter activity, and Sp1 was identified as a protein binding to this site by a mobility shift assay using HeLa nuclear extract.

Anomalous DnaA protein binding to the regulatory region of the Escherichia coli aldA gene

A binding site for DnaA protein was identified in the regulatory region of the aldA gene of Escherichia coli. Specific binding was demonstrated by in vitro assays including filter binding as well as mobility shift in a polyacrylamide gel of the DnaA-DNA complex. In cells growing in minimal medium containing glucose, expression of ss-galactosidase activity from an aldA-lacZ fusion gene was suppressed by oversupply of DnaA protein and was enhanced by reducing the free DnaA level. These results suggest that DnaA protein negatively regulates expression of the aldA gene under these conditions. Despite fairly strong binding, the bound DNA fragment had no consensus 9 bp DnaA binding sequence (DnaA box), and anomalous binding to an AT-rich sequence located close to the transcription start site was revealed by a footprinting experiment.

EMB-30: an APC4 homologue required for metaphase-to-anaphase transitions during meiosis and mitosis in Caenorhabditis elegans

Here we show that emb-30 is required for metaphase-to-anaphase transitions during meiosis and mitosis in Caenorhabditis elegans. Germline-specific emb-30 mutant alleles block the meiotic divisions. Mutant oocytes, fertilized by wild-type sperm, set up a meiotic spindle but do not progress to anaphase I. As a result, polar bodies are not produced, pronuclei fail to form, and cytokinesis does not occur. Severe-reduction-of-function emb-30 alleles (class I alleles) result in zygotic sterility and lead to germline and somatic defects that are consistent with an essential role in promoting the metaphase-to-anaphase transition during mitosis. Analysis of the vulval cell lineages in these emb-30(class I) mutant animals suggests that mitosis is lengthened and eventually arrested when maternally contributed emb-30 becomes limiting. By further reducing maternal emb-30 function contributed to class I mutant animals, we show that emb-30 is required for the metaphase-to-anaphase transition in many, if not all, cells. Metaphase arrest in emb-30 mutants is not due to activation of the spindle assembly checkpoint but rather reflects an essential emb-30 requirement for M-phase progression. A reduction in emb-30 activity can suppress the lethality and sterility caused by a null mutation in mdf-1, a component of the spindle assembly checkpoint machinery. This result suggests that delaying anaphase onset can bypass the spindle checkpoint requirement for normal development. Positional cloning established that emb-30 encodes the likely C. elegans orthologue of APC4/Lid1, a component of the anaphase-promoting complex/cyclosome, required for the metaphase-to-anaphase transition. Thus, the anaphase-promoting complex/cyclosome is likely to be required for all metaphase-to-anaphase transitions in a multicellular organism.

Components of the spindle-assembly checkpoint are essential in Caenorhabditis elegans

The spindle-assembly checkpoint ensures that, during mitosis and meiosis, chromosomes do not segregate until they are properly attached to the microtubules of the spindle. Here we show that mdf-1 and mdf-2 are components of the spindle-assembly checkpoint in Caenorhabditis elegans, and are essential for the long-term survival and fertility of this organism. Loss of function of either of these genes leads to the accumulation of a variety of defects, including chromosome abnormalities, X-chromosome non-disjunction or loss, problems in gonad development, and embryonic lethality. Antibodies that recognize the MDF-2 protein localize to nuclei of the cleaving embryo in a cell-cycle-dependent manner. mdf-1, a gene encoding a product that interacts with MDF-2, is required for cell-cycle arrest and proper chromosome segregation in premeiotic germ cells treated with nocodazole, a microtubule-depolymerizing agent. In the absence of mdf gene products, errors in chromosome segregation arise and accumulate, ultimately leading to genetic lethality.

Negative control of replication initiation by a novel chromosomal locus exhibiting exceptional affinity for Escherichia coli DnaA protein

Replication of the Escherichia coli chromosome is initiated at a unique site, oriC. Concurrent initiation occurs at all oriC sites present in a cell once, and only once, per cell cycle. A mechanism to ensure cyclic initiation events was found operating through the chromosomal site, datA, a 1-kb segment located at 94.7 min on the genetic map that titrates exceptionally large amounts of the bacterial initiator protein, DnaA. A strain lacking datA grew normally but exhibited an asynchronous initiation phenotype as a result of extra initiation events. This mutant phenotype was suppressed by DnaA-titrating plasmids. Furthermore, mutations in a 9-bp DnaA-binding sequence (the DnaA box) in datA were enough to induce the mutant phenotype. Thus, datA is a novel chromosomal element that appears to adjust a balance between free and bound DnaA for a single initiation event at a fixed time in the bacterial cell cycle. Titration of DnaA to newly duplicated datA during oriC sequestration, which is mediated by hemimethylated GATC sequences in oriC and the SeqA protein, would contribute to prevention of reinitiations when oriC is desequestered.

Distal ureteral atresia associated with crossed renal ectopia with fusion: recovery of renal function after release of a 10-year ureteral obstruction

We report on a 10-year-old boy with distal ureteral atresia associated with crossed renal ectopia with fusion. He was admitted with a high fever associated with a urinary tract infection. The diagnosis was established by antegrade and retrograde pyelography. The upper hydronephrotic portion of the kidney, obstructed for 10 years, recovered its function after nephrostomy placement. To our knowledge, this is the first patient whose renal function has recovered despite an ureteral obstruction of 10-years' duration. Therefore, we recommend a transient nephrostomy placement even for far advanced pediatric hydronephrosis, to test for the possibility of functional recovery.

Immunohistochemical study of tumor-infiltrating lymphocytes before and after intravesical bacillus Calmette-Guérin treatment for superficial bladder cancer

BACKGROUND

This study investigated changes in the phenotypic characteristics of tumor-infiltrating lymphocytes during intravesical bacillus Calmette-Guérin (BCG) treatment using an immunohistochemical technique.

METHODS

A total of 16 patients with superficial bladder cancer underwent intravesical BCG treatment for therapeutic purposes. Tissue specimens were obtained from these patients before and after BCG treatment by cold cup biopsies.

RESULTS

The numbers of CD3+ cells, CD4+ cells, CD8+ cells, and CD19+ cells significantly increased after treatment compared with numbers before treatment (P < 0.01). Although gamma/delta T cells were not observed before treatment, they appeared after treatment in 6 patients. In all these patients, the tumors disappeared or their size was reduced by more than 50%, and none of the tumors recurred. The induction of CD25+ cells after treatment was seen in 11 of the 16 patients.

CONCLUSION

gamma/delta T cells may play an important role in the immune response of the host to the tumor in intravesical BCG treatment (although this correlation was statistically insignificant.

Orderly disposition of heterogeneous small subunits in D-ribulose-1,5-bisphosphate carboxylase/oxygenase from spinach

We determined the crystal structure of spinach ribulose-1, 5-bisphosphate carboxylase/oxygenase (Rubisco) by x-ray diffraction at 1.8-A resolution and found that the enzyme contained two kinds of S, SI and SII, present in equal number and disposed in an orderly way within the Rubisco holoenzyme. The electron density maps suggested that leucine was at residue 56 in SI, although histidine was at that position in SII. There were other residue differences. Thus, spinach Rubisco has a L8SI4SII4 subunit structure. The orderly disposition of the heterogeneous small subunits in the Rubisco holoenzyme provides accounts of a multigene family of S in plants.

[Comparative studies on activities of antimicrobial agents against causative organisms isolated from patients with urinary tract infections (1994). III. Secular changes in susceptibility]

Susceptibilities of Enterococcus faecalis, Staphylococcus aureus, Citrobacter spp., Enterobacter spp., Escherichia coli, Klebsiella spp., Proteus mirabilis, Pseudomonas aeruginosa and Serratia spp. isolated from patients with urinary tract infections (UTIs) in 10 hospitals during June 1994 to May 1995 to various antimicrobial agents were compared with those in the same period of previous years according to a classification, uncomplicated UTIs, complicated UTIs without indwelling catheter, and complicated UTIs with indwelling catheter. No remarkable changes were found in susceptibilities of Citrobacter spp., Enterobacter spp. and Serratia spp. The susceptibilities of E. faecalis to amikacin and quinolones were better than those in 1993. As for S. aureus, susceptible strains to all drugs increased in uncomplicated UTIs. Against E. coli in 1993, the antimicrobial activities of piperacillin, cefotiam and aminoglycosides have decreased, however, in 1994, these activities have turned to the better state. As for Klebsiella spp. susceptible strains to ABPC decreased. The susceptibilities of P. mirabilis to all drugs except minocycline were good. Against P. aeruginosa in 1993, the activities of aminoglycosides have decreased, but, in 1994, these activities have turned to the better state. These data should be considered in clinical treatment of various urinary tract infections.

[Comparative studies on activities of antimicrobial agents against causative organisms isolated from patients with urinary tract infections (1994). II. Background of patients]

Clinical background was investigated on 628 bacterial strains isolated from patients with urinary tract infections (UTIs) in 10 hospitals during period from June, 1994 to May, 1995. 1. Distributions of sex, age and urinary tract infections Among over sixties males, the majority was taken by complicated urinary tract infections. Among females, the uncomplicated urinary tract infections was most frequent without a relation of age. As for over 40 females, the increase of complicated UTI was admitted. 2. Distribution of sex, age and pathogens isolated from UTIs In uncomplicated UTIs, Escherichia coli was most frequently isolated without a relation of age, and next Enterococcus faecalis and CNS. In complicated UTIs without indwelling catheter, E. coli, Pseudomonas aeruginosa and E. faecalis were isolated the most frequent. In complicated UTIs with indwelling catheter, P. aeruginosa was most frequently isolated, and next E. faecalis and Staphylococcus aureus. 3. Administration of antimicrobial agents and pathogens isolated from UTIs In uncomplicated UTIs, pathogens, after administration of antibiotics, isolated from patients have obviously decreased from 216 to 32 isolates. And also, pathogens of complicated UTIs without indwelling catheter, have decreased from 127 to 50 isolates. However, in complicated UTIs with indwelling catheter, pathogens after or before administration of antibiotics, were not revealed an obvious change. 4. Pathogens and UTIs with or without factor and operation In uncomplicated UTIs with or without factor and operation, E. coli was mainly detected. In complicated UTIs without indwelling catheter and with factor and operation E. faecalis was mainly detected, and next E. coli, S. aureus and P. aeruginosa. Without factor and operation, E. coli was mainly detected. In complicated UTIs with indwelling catheter and with factor and operation, P. aeruginosa, E. faecalis and S. aureus were mainly detected at 23.5%, 15.0%, 15.0%, respectively. Without factor and operation, Proteus spp. 22%, and next E. faecalis and P. aeruginosa 10% and 12%, were detected, respectively. The distribution of pathogens, in the case of Proteus spp. and P. aeruginosa has been obviously varied by the influence of factor and operation.

[Comparative studies on activities of antimicrobial agents against causative organisms isolated from patients with urinary tract infections (1994). I. Susceptibility distribution]

The frequencies of isolation and susceptibilities to antimicrobial agents were investigated on 567 bacterial strains isolated from patients with urinary tract infections in 10 hospitals during the period of June 1994 to May 1995. Of the above total bacterial isolates, Gram-positive bacteria accounted for 26.8% and a majority of them were Enterococcus faecalis. Gram-negative bacteria accounted for 73.2% and most of them were Escherichia coli. 1. Enterococcus faecalis. Ampicillin (ABPC) and imipenem (IPM) showed the highest activities against E. faecalis isolated from patients with urinary tract infections. The MIC90s of them were 1 microgram/ml. Vancomycin (VCM) was also active with the MIC90 of 2 micrograms/ml. Piperacillin (PIPC) and biapenem (BIPM) were also active with the MIC90s of 4 micrograms/ml and 8 micrograms/ml, respectively. The others were not so active with the MIC90s of 16 micrograms/ml or above. 2. Staphylococcus aureus including MRSA. VCM showed the highest activities against S. aureus isolated from patients with urinary tract infections. Its MIC90 was 1 microgram/ml against both S. aureus and MRSA. Arbekacin (ABK) was also active with the MIC90 of 2 micrograms/ml. The others except minocycline (MINO) were not so active with the MIC90s of 64 micrograms/ml or above. 3. Staphylococcus epidermidis. MINO showed the strongest activity against S. epidermidis isolated from patients with urinary tract infections. Its MIC90 was 0.25 microgram/ml. ABK was also active with the MIC90 of 1 microgram/ml. Cephems were active with the MIC90s of 2 approximately 16 micrograms/ml, but penicillins and quinolones were not so active with the MIC90s and 64 approximately 128 micrograms/ml. 4. Citrobacter freundii. Gentamicin (GM) showed the highest activities against C. freundii isolated from patients with urinary tract infections. Its MIC90 was 1 microgram/ml. IPM was also active with the MIC90 of 2 micrograms/ml. Cefpirome (CPR) and cefozopran (CZOP) were also active with the MIC90s of 4 micrograms/ml and 8 micrograms/ml. The others were not so active with the MIC90s of 32 micrograms/ml or above. 5. Enterobacter cloacae. IPM showed the highest activities against E. cloacae. Its MIC90 was 0.5 microgram/ml. GM and amikacin (AMK), ciprofloxacin (CPFX) and tosulfloxacin (TFLX) were also active with the MIC90s of 4 micrograms/ml. Penicillins and cephems except latamoxef (LMOX), cefmenoxime (CMX), CPR and CZOP showed lower activities with the MIC90s of 256 micrograms/ml or above. 6. Escherichia coli. Most of antimicrobial agents were active against E. coli. CPR, CZOP, IPM, carumonam (CRMN), CPFX and TFLX showed the highest activities against E. coli. The MIC90s of them were 0.125 microgram/ml or below. Cefotiam (CTM), flomoxef (FMOX) CMX, ceftazidime (CAZ), and LMOX were also active with the MIC90s of 0.25 microgram/ml. Penicillins were not so active with the MIC90s of 128 micrograms/ml or above. 7. Klebsiella pneumoniae. CRMN showed the highest activities against K. pneumoniae. Its MIC90 was < or = 0.125 microgram/ml. CZOP was also active with the MIC90 of 0.25 microgram/ml. Penicillins were not so active with the MIC90s of 128 micrograms/ml or above. 8. Proteus mirabilis. P. mirabilis was susceptible to a majority of drugs. CMX, CAZ, LMOX, CRP, cefpodoxime (CPDX), CRMN, CPFX and TFLX showed the highest activities against P. mirabilis isolated from patients with urinary tract infections. The MIC90s of them were 0.125 microgram/ml or below. MINO was not so active with the MIC90 of 128 micrograms/ml. 9. Pseudomonas aeruginosa. Most of the agents were not so active against P. aeruginosa. IPM showed MIC90 of 8 micrograms/ml. The others were not so active with the MIC90s of 16 micrograms/ml or above. CPFX showed MIC50 of 0.5 microgram/ml.

A novel DnaA protein-binding site at 94.7 min on the Escherichia coli chromosome

There is a DNA sequence which has unusually high affinity for the DnaA protein of Escherichia coli between the glyV and amiB-mutL operons at 94.7 min on the genetic map. Affinity of DnaA protein for DNA was measured in vivo as the activity of beta-galactosidase produced from the lacZ gene on a plasmid fused to the 5'-terminal portion of the mioC gene, which is under the control of the DnaA protein. The chromosomal DNA segment between the two operons, carried on a compatible plasmid, derepressed the beta-galactosidase activity by titrating DnaA protein. Derepression occurred on the chromosomal dnaA gene as well, since it is autoregulated. Hence, as measured by immunoassays, one plasmid molecule carrying the DnaA-binding region titrated 370 dnaA molecules, which is a value eightfold higher than that for a plasmid containing the oriC region. We estimate that about 60% of the total cellular DnaA molecules are bound to this site. Four DnaA-binding sequences (DnaA boxes) and a DnaA-regulated promoter directing transcription of two small genes were present within a 250 bp stretch in this region but additional long DNA regions, including the fifth DnaA box located about 650 bp downstream, were required for maximum binding. A role for the DnaA-binding site in controlling DnaA-protein concentration in the cell cycle is discussed.

Detection of interleukin-1 activity in human bladder cancer cell lines

Detection of interleukin (IL)-1 activity was studied in two human bladder cancer cell lines, T24 and EJ1, and one rat bladder carcinoma cell line, 804G. Significantly high proliferation of mouse thymocytes in the assay of IL-1 activity was observed in the conditioned medium (CM) of T24 cells, indicating that the cells released IL-1-like activity. Enzyme-linked immunosorbent assay (ELISA) and Northern blot analysis showed the presence of both IL-1 alpha and IL-1 beta in the CM of T24 cells and expression of mRNAs of both cytokines in the cells. Interleukin-1 activity in EJ1 cells, which produced a little activity, was induced by E. coli lipopolysaccharide (LPS) while it was not induced in T24 by either LPS or other test substances. Conditioned medium of T24 increased proliferation of both T24 and EJ1 in cell-growth assay. Further investigation of the mode of action and role of cytokines, especially those from tumor cells themselves, is necessary in relation to BCG or photodynamic therapy.

Two cases of inflammatory skin metastasis from transitional cell carcinoma of the urinary bladder

Two rare cases of inflammatory skin metastasis from transitional cell carcinoma of the urinary bladder were reported.

[Serum concentration of type IV collagen in urological cancer--comparison with serum concentration of laminin]

In recent years, it has become clear that various extracellular substrates play an important role in the process of invasion and metastasis of malignant tumors. In a previous study, we reported that the serum concentration of laminin in renal cell carcinoma and prostate cancer is elevated, and furthermore, is remarkably high in patients with metastasis. However, in bladder cancer, this level is elevated only in those with metastasis, indicating that the serum concentration of laminin is useful as a marker for metastasis or clinical progression of the malignant tumor. In the present study, we measured the serum concentration of type IV collagen 7S-domain, which, as laminin constructs the basement membrane, and compared the result with the serum concentration of laminin, to evaluate the clinical significance of the findings. The serum concentration of type IV collagen 7S-domain was not elevated significantly in any tumor type, although the serum concentration of laminin was elevated in patients with renal cell carcinoma, prostate cancer and bladder cancer with metastasis. There were no significant differences in the serum concentration of type IV collagen 7S-domain in any group with metastasis.

Calcium supplementation in osteoporosis

Although calcium is the most abundant inorganic constituent of the bone, indispensable for the maintenance of its physical strength, the role of calcium nutrition in the development of osteoporosis and the preventive and therapeutic significance of calcium supplementation in osteoporosis have been matters of intense controversy. The wide difference in the baseline nutritional intake of calcium among different groups and the variation in age of the patients studied may have been contributory factors. Emphasis has so far been placed on the rapid bone loss in the immediate postmenopausal period predominantly influenced by estrogen deficiency which has overshadowed the effect of calcium. The strong dependence of the effect of calcium preparation used tends to be forgotten. In the present study employing oyster shell electrolysate as the calcium source in patients with a mean age of approximately 80 years, bone mineral density was kept significantly higher than in age-matched, non-supplemented patients over a period of 2 years. In separate experimental studies, rats maintained on 2% calcium showed higher bone mineral content and lived longer than did controls maintained on 1% calcium. Age-associated deterioration of renal function and hyperlipidemia were also prevented by calcium supplementation.

In vitro adherence of Staphylococcus saprophyticus, Staphylococcus epidermidis, Staphylococcus haemolyticus, and Staphylococcus aureus to human ureter

Staphylococcus saprophyticus adhered to human ureteral epithelium in vitro. The levels of adherence, which were determined quantitatively with the scanning electron microscope, correlated well with bacterial hemagglutinating activities with sheep erythrocytes (r = 0.9459, P < 0.01). Transmission electron microscopy revealed that the adhering bacteria and the hemagglutinating bacteria possessed similar pili-like structures on their cell surfaces. Staphylococcus epidermidis, Staphylococcus haemolyticus, and Staphylococcus aureus did not adhere to the epithelium. Only S. aureus adhered markedly to the connective tissue of the ureter, and adhesion of this organism was direct via its cell wall. This adherence test system clearly showed up differences in the abilities of these staphylococcal species to adhere to the urinary tract.

[Intralesional and transarterial administration of interferon for renal cell carcinoma]

Topical administration of interferon for locally recurrent renal cell carcinoma in 2 cases was reported. Case 1: a 56-year-old woman had undergone radical nephrectomy for left renal cell carcinoma. She had a locally recurrent tumor adjacent to spleen 26 months after the surgery. She received 3 million units of interferon alpha every day intralesionally for almost 3 years without any distant metastasis. Case 2: a 59-year-old man had undergone left radical nephrectomy for renal cell carcinoma. He had recurrent tumor contiguous to spleen 24 months after nephrectomy. With Seldinger method a catheter was indwelled selectively in splenic artery. Two million units of interferon gamma was administered through the catheter, twice a week for 4 weeks, and once a week in subsequent course. The tumor showed necrosis on CT film. He died of DIC 5 months after the initiation of intraarterial administration of interferon gamma. Topical use of interferon showed some favorable effects in both cases even after the failure of systemic administration. Further investigation is warranted to demonstrate the advantage of topical use of interferon over systemic administration.

Papillary renal cell carcinoma. Report of two cases

Papillary renal cell carcinoma is an uncommon variant of renal cell carcinoma which has unique features including hypovascularity or avascularity, extensive stromal macrophage infiltration and better prognosis than that for nonpapillary renal cell carcinoma. Two cases of papillary renal cell carcinoma presenting hypovascular or avascular angiology are presented. Histologically, the two tumors had a purely papillary structure. Papillae were lined by a layer of epithelial cells which lacked prominent cellular atypia, and there were numerous macrophages in the stroma. In addition, in one patient, extensive calcification of the tumor capsule was present. Furthermore, our experience in the present study with imprint cytology indicates that it offers corroborative information for the intraoperative diagnosis made on the basis of frozen section examination.

Binding sites for P and/or type 1-piliated Escherichia coli in human ureter

Adherence sites for uropathogenic Escherichia coli in the excised human ureter were studied by using scanning electron microscopy. P-piliated E. coli adhered to younger epithelial cells which had microvilli on their surfaces, but did not to mature epithelial cells which had microfolds on their surfaces. This adherence was D-mannose resistant and alpha-D-Galactopyranosyl-(1----4)- beta-D-Galactopyranoside sensitive. Type-1 piliated E. coli adhered to both types of epithelial cells, but it was prevented by D-mannose. Entrapment of adherent type 1-piliated E. coli was observed only on the epithelial cells with microfolds. This model system allowed quantitative estimates of bacterial adherence to the luminal surface of the human ureteral mucosa in vitro, and demonstrated different manners of adherence of P and type 1-piliated E. coli.

[Detubularized right-hemicolonic continent urinary reservoir with plicated terminal ileum]

A continent urinary reservoir which consists of 1) detubularized caecum, ascending colon and the right half of transverse colon. 2) anastomosis of ureter and ascending colon with antireflex technique, and 3) plicated terminal ileal segment for continence and catheter insertion was created in 12 patients after radical cystectomy for urothelioma. Our method to create a continent urinary reservoir is simple and technically easy. It can, therefore, provide patients' satisfaction with low incidence of complication. However, such continent urinary reservoir diversion should be performed only for carefully selected patients, taking into consideration the physical status and the character and social status of the patient. This is because some patients who have had such surgery may change their mind to keep a balloon catheter to avoid the intermittent self-catheterization every 3 to 4 hours after surgery.

[Serum concentration of laminin in transitional cell carcinoma]

The concentration of laminin in the serum was determined for 45 patients with urinary tract transitional cell carcinoma, and the clinical significance of the findings was considered. The difference between the serum laminin concentrations in the control group and the transitional cell carcinoma patient group was not statistically significant, but the serum laminin level was highest in the transitional cell carcinoma patients with metastatic foci. In many of the patients who had metastatic foci and showed clearly progressive disease, the serum laminin concentration was found to increase with the passage of time. When the transitional cell carcinoma tissues were stained by the fluorescent antibody technique, there was little distribution of laminin in the tumor tissues, contrary to our earlier-reported findings regarding the staining of laminin in renal cell carcinoma tissues. In renal cell carcinoma patients, the serum concentration of laminin had been found to be high even when there were no metastatic foci, and consideration of this fact strongly suggests the possibility that the mechanism for laminin synthesis in urinary tract transitional cell carcinoma is different from that in renal cell carcinoma. It was surmised that the serum laminin concentration has potential for use as a diagnostic indicator of metastasis in patients with urinary tract transitional cell carcinoma.

[Clinical application of Sonolith 2000 type B on extracorporeal shock wave lithotripsy for upper urinary tract calculi]

This report describes the results of clinical trials of the second generation extracorporeal shock wave lithotriptor (Sonolith 2000 Type B) in patients with upper urinary tract stones. The studies were carried out on 101 cases at the Departments of Urology, Juntendo University School of Medicine, Kanto Teishin Hospital and General Daiyukai Hospital from Nov. 1987 to Jun. 1988. The location of stones were renal calyx and pelvis in 84 cases, ureteropelvic junction in 7 cases and upper ureter in 12 cases (2 of them had multiple stones at different levels). The average number of treatment per a patient was 1.25, and that of shock waves delivered per treatment was 1798. Ultrasound localization has been effective in all cases. The rate of destruction of the stones was 100% in the kidney, 66.7% in the upper ureter, with an overall average of 95.0%. On the X-ray film obtained six weeks after ESWL treatment, the stone free rate was 53.5%, and the effectiveness rate was 89.1%, including the cases of stone free and cases with fragments smaller than 5 mm. No serious adverse effect was observed, although there were mild transient hematuria in all cases and pyrexia (more than 38.0 degrees C) in 7 cases (6.9%). The procedure was performed safely in the majority of patients without anesthesia. In 10 cases, we applied anesthesia (epidural anesthesia in 3 cases, and local anesthesia in 7 cases) for the prevention of pain. It is concluded that ESWL treatment using Sonolith 2000 Type B is as effective as other types of shock wave lithotriptor previously applied to urolithiasis without serious clinical complication.

In vitro adherence of type 1-fimbriated uropathogenic Escherichia coli to human ureteral mucosa

Type 1-fimbriated Escherichia coli isolated from patients with urinary tract infections adhered in vitro to the epithelial cell surface of an excised human ureter. The bacteria also adhered to a mucous coating and to Formalin-fixed human ureteral mucosa. D-Mannose strongly inhibited such adherence. The bacteria in their nonfimbriated phase lacked the ability to adhere. We concluded that type 1 fimbriae play a role, at least in part, in upper urinary tract infections in humans.

[Serum concentration of laminin in renal cell carcinoma]

Serum concentration of laminin was measured radioimmunologically in 19 patients with renal cell carcinoma and 71 normal controls. The serum laminin levels of renal cell carcinoma patients were significantly higher than those of normal controls. After nephrectomy the elevated serum levels of laminin showed marked decreases in most of the patients without metastasis. By the immunofluorescent technique with LAM-1, a monoclonal antibody which is specific to laminin A and B chains , strong fluorescence was found in the extracellular matrix in renal cancer tissue. Taken all these facts together, renal cell carcinoma may be a laminin synthetic tumor. The average serum laminin level of the patients with a disseminated disease were significantly higher than that of the patients with a localized disease. The elevated serum level of laminin may play an important role in the process of tumor metastasis. Furthermore, our data suggest that elevated laminin levels may predict the subsequent course of a tumor condition. The monitoring of serum laminin level may be valuable for following-up of the course of renal cell carcinoma.

[Fast neutron radiotherapy of prostate cancer]

Between 1976 and 1987, sixty eight patients suffering from prostate cancer were treated with fast neutron radiotherapy at the NIRS hospital in Chiba, Japan. Tumor doses of TDF 100 were administered to the prostate gland, the regional lymphnodes, and the true pelvis, using the two opposing fields by fast neutron alone or with a boost. The overall local or regional tumor recurrence rate was found to be 10% and local control seemed to correlate with the histological differentiation of the cancer tissue, though there was no definite correlation with hormone treatment. A relatively high incidence of grade 3 and 4 radiation complications were observed, 21% for grade 3 and 7% for grade 4, due to subcutaneous fat necrosis caused by an inferior dose distribution of the fast neutron machine. The 5-year survival rate was seen to be 52% in total and 70% for patients in stage C. The modality of radiotherapy for prostate cancer is discussed.