Intra- and inter-investigator reliabilities of oral moisture measured using an oral moisture-checking device

BACKGROUND

Oral mucosal moisture determined using oral moisture-checking devices is used as a mouth dryness evaluation method. Such devices are capable of evaluating the state of mouth dryness in a simple manner and have applicability in a wide range of subjects; however, their intra- and inter-investigator reliabilities have not yet been clarified.

OBJECTIVE

This study aims to investigate the intra- and inter-investigator reliabilities of measuring oral moisture using an oral moisture-checking device for a wide range of age groups.

METHODS

Intra- and inter-investigator reliabilities were investigated in 28 young subjects and 19 older subjects aged ≥65 years. Three trained investigators independently measured oral mucosal moisture values using an oral moisture-checking device. Intra-investigator reliability was assessed using the coefficient of variation (CV) and intraclass correlation coefficient (ICC) (1.1), and inter-investigator reliability was assessed using ICC (2.1).

RESULTS

Mean CV was 0.015 and 0.016, mean ICC (1.1) was 0.806 and 0.877, and ICC (2.1) was 0.873 and 0.829 in the young and older subjects, respectively.

CONCLUSION

In young subjects, the mean values of ICC (1.1) and ICC (2.1) of the oral moisture-checking device were 0.806 and 0.873, respectively, whereas in older subjects, these values were 0.877 and 0.829, respectively. Thus, this confirms that the examination of oral mucosal moisture using the oral moisture-checking device has sufficient intra- and inter-investigator reliabilities for a wide range of age groups.

The geomorphology, color, and thermal properties of Ryugu: Implications for parent-body processes

The near-Earth carbonaceous asteroid 162173 Ryugu is thought to have been produced from a parent body that contained water ice and organic molecules. The Hayabusa2 spacecraft has obtained global multicolor images of Ryugu. Geomorphological features present include a circum-equatorial ridge, east-west dichotomy, high boulder abundances across the entire surface, and impact craters. Age estimates from the craters indicate a resurfacing age of [Formula: see text] years for the top 1-meter layer. Ryugu is among the darkest known bodies in the Solar System. The high abundance and spectral properties of boulders are consistent with moderately dehydrated materials, analogous to thermally metamorphosed meteorites found on Earth. The general uniformity in color across Ryugu's surface supports partial dehydration due to internal heating of the asteroid's parent body.

Abstract P3-05-17: The numbers of Foxp3 positive cells in simultaneous bilateral breast cancer

Background

Evasion of the immune system is one of the hallmarks of malignant tumors, and recently blocking of such evasion has been used in clinical practice for the treatment of some types of cancers. Recruitment of regulatory T cells (Tregs), which express the specific marker Foxp3, is an established mechanism of escaping from the immune system. In breast cancer, it has been reported that the number of Tregs differs widely among breast cancer subtypes, and that patients who have many Tregs around the tumor tend to have a poor prognosis. However, the factors that are important for the recruitment of Tregs are not well known. Thus, factors that depend on the host (e.g., age or comorbidity), on the tumor (e.g., subtype, grade, or stage), or on measurement error might be the cause of the observed differences in the number of Tregs. In this study, we investigated the numbers of Tregs in simultaneous bilateral breast cancer patients in order to determine the factors that influence the recruitment of Tregs, while excluding differences in individuals as much as possible.

Material and methods

Patients who had breast cancer in both breasts and who underwent simultaneous surgery between January 2005 and September 2015 at two institutions were enrolled in this study. Patients who underwent primary systemic therapy who were diagnosed with ductal carcinoma in situ, or who were stage IV were excluded. The average numbers of Foxp3-positive (Foxp3+cells) were determined from scores of five high-power fields (HPFs). The association between the difference in Foxp3+ cell number between each breast in a single individual and clinicopathological features was examined.

Results

Seventy patients were included in this study. Their ages ranged from 39-85 (median 54) years old. Ninety five percent of the tumors were invasive ductal carcinoma non-special type. Eighty eight (62.9%), 43 (30.7%), and 9 (6.4%) of the tumors were T1, T2, and ≥T3, respectively, and 102 (72.9%) of the tumors were node-negative. Regarding nuclear grade (NG), 104 (74.3%), 21 (22.1%), and 7 (5%) of the tumors were NG1, 2, and 3, respectively. As for subtype, 124 (88.6%), 9 (6.4%), and 7 (5%) were ER-positive and HER2-negative(ER+/HER2-), ER-positive or negative and HER2-negative(ER±/HER2+), and ER-negative and HER2-negative(ER-/HER2-), respectively. The numbers of Foxp3+ cells ranged from 0 to 39.8 (median 3.3)/HPF, and difference in Foxp3+ cell number between each breast in a single individual ranged from 0 to 34 (median 3.9)/HPF.

Differences in tumor size and node status in individuals did not impact on the number of Foxp3+ cells. However, the number of Foxp3+ cells in tumors that were NG3 (P=0.00098) or ER±/HER2+ or ER-/HER2- type (P=0.00586) were statistically significantly increased compared with tumors that were NG1/2 or ER+/HER2- type in the same host.

Furthermore, the difference of Foxp3+ cells between each tumor in a single individual were quite small regarding tumor size and node status in 53 patients who had similar NG and subtype tumors in both breasts.

Conclusions

The number of Foxp3+ cells showed no relationship with tumor size, or lymph node status in simultaneous bilateral breast cancer patients. High NG, ER±/HER2+ or ER-/HER2- type of the tumor were involved with enhancement of the recruitment of Tregs.

Citation Format: Goto R, Hirota Y, Aruga T, Horiguchi S, Tazawa S, Nakamura S, Takimoto M. The numbers of Foxp3 positive cells in simultaneous bilateral breast cancer [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P3-05-17.

Isolation of novel mycobacteria contaminating an aquarium fish tank in a Japanese university hospital

AIMS

To better understand nontuberculous mycobacteria (NTM) contamination in a hospital setting, six freshwater fish gut homogenates and water in an aquarium fish tank placed on the reception counter of a nursing station were cultured for mycobacteria.

METHODS AND RESULTS

By direct sequencing of 16s rRNA, rpoB and hsp65, scotochromogenic and nonchromogenic Mycobacterium szulgai isolates containing hsp65 type II (GenBank accession nos. FJ384762 and FJ384764, respectively), Mycobacterium gordonae isolates containing rpoB clusters B and E (GenBank accession no. FJ384766), and Mycobacterium kansasii isolates containing hsp65 type VI were collected from the gut homogenates and water from the fish tank. However, no isolates were obtained from the tap water used to refill the fish tank. A randomly amplified polymorphic DNA (RAPD) analysis using a 10-mer primer (5'-TGGTCGCGGC) showed that some NTM from the fish tank water were identical to those obtained from the gut homogenates.

CONCLUSIONS

Fish and water in the tank were contaminated by the novel NTM.

SIGNIFICANCE AND IMPACT OF THE STUDY

These findings could help to elucidate infection routes and contamination sources of novel NTM from water sources.

Contaminated oral intubation equipment associated with an outbreak of carbapenem-resistant pseudomonas in an intensive care unit

Twenty intensive care patients were diagnosed as infected or colonized by Pseudomonas aeruginosa within a one-month period; a rate three to four times higher than the typical background frequency of this infection in the intensive care unit (ICU). Patients with positive respiratory specimens were mechanically ventilated, which included re-used disinfected bite blocks during intubation. Fourteen specimens from 20 positive patients originated in the respiratory tract. Seven clonal variants were isolated and identified as originating from the same strain by pulsed-field analysis. These isolates were also matched to the strain detected on the re-used bite blocks, which had been disinfected with 140ppm sodium hydrochloride. Notably, Staphylococcus aureus was also detected on bite blocks sterilized with ethylene dioxide, indicating incomplete disinfection. In immunocompromised patients, re-use of bite blocks during intubation must be prohibited. Single-use kits or intubation without the use of bite blocks is recommended.

Fatty acid metabolism assessed by 125I-iodophenyl 9-methylpentadecanoic acid (9MPA) and expression of fatty acid utilization enzymes in volume-overloaded hearts

BACKGROUND

The peroxisome proliferator-activated receptor (PPAR) alpha is a member of the nuclear receptor superfamily and regulates gene expression of fatty acid utilization enzymes. In cardiac hypertrophy and heart failure by pressure-overload, myocardial energy utilization reverts to the fetal pattern, and metabolic substrate switches from fatty acid to glucose. However, myocardial metabolism in volume-overloaded hearts has not been rigorously studied. The aim of the present study was to examine fatty acid metabolism and protein expressions of PPARalpha and fatty acid oxidation enzymes in volume-overloaded rabbit hearts.

METHODS

Volume-overload was induced by carotid-jugular shunt formation. Sham-operated rabbits were used as control. Chronic volume-overload increased left ventricular weight and ventricular cavity size, and relative wall thickness was decreased, indicating eccentric cardiac hypertrophy. (125)I-iodophenyl 9-methylpentadecanoic acid (9MPA) was intravenously administered, and animals were sacrificed at 5 min after injection. The 9MPA was rapidly metabolized to iodophenyl-3-methylnonanoic acid (3MNA) by beta-oxidation. Lipid extraction from the myocardium was performed by the Folch method, and radioactivity distribution of metabolites was assayed by thin-layer chromatography. The protein was extracted from the left ventricular myocardium, and levels of PPARalpha and fatty acid oxidation enzymes were examined by Western blotting.

RESULTS

Myocardial distribution of 9MPA tended to be more heterogeneous in shunt than in sham rabbits (P = 0.06). In volume-overloaded hearts by shunt, the conversion from 9MPA to 3MNA by beta-oxidation was faster than the sham-control hearts (P < 0.05). However, protein levels of PPARalpha and fatty acid utilization enzymes were unchanged in shunt rabbits compared with sham rabbits.

CONCLUSIONS

These data suggest that myocardial fatty acid metabolism is enhanced in eccentric cardiac hypertrophy by volume-overload without changes in protein expressions of PPARalpha and fatty acid utilization enzymes. Our data may provide a novel insight into the subcellular mechanisms for the pathological process of cardiac remodelling in response to mechanical stimuli.

Cine viewing of abdominal CT

A few studies have been reported that CT cine viewing on the CRT is superior to film-based viewing of CT images (Seltzer et al., Radiology 197 (1994) 119; Bonaldi et al., Am. J. Roentgenol. 170 (1998) 373; Tillich et al., Am. J. Roentgenol. 169 (1997) 1611). The purpose of our study is to know how to use cine viewing of abdominal CT. Thirty CT studies on the abdomen with both precontrast and postcontrast images were examined. The suitable rate of cine viewing ranged from 1 to 6 frames per second according to the size, the contrast and the complexity of the anatomical structures, and the slice thickness. For small or complex structures, checking each image might be required to know the full detail of them. Positional sorting among multiphase images, which is followed by consecutive display of a precontrast image, postcontrast early and late phase images at one position and so on, is useful to see the dynamic pattern of enhancement of the anatomical structures. However, there was no significant difference between cine viewing and film-based viewing concerning both the detectability of the anatomical structures and the conspicuity of enhancement of the liver and the pancreas, so that cine viewing might be an alternative to film-based viewing for CT diagnosis of the abdomen.

[Evaluation of rapidly growing Mycobacteria isolates in a general hospital: reports from the hospital microbiology laboratory]

Forty isolates of rapidly growing Mycobacteria, Mycobacterium fortuitum group including M. fortuitum and M. peregrinum and M. chelonae group including M. chelonae subsp. chelonae and M. chelonae subsp. abscessus at Showa University Fujigaoka Hospital collected between February 1981 and December 1997 were investigated in this study. These isolates were from the patients who were not infected with HIV. The average age of fourteen patients, from whom M. fortuitum group was isolated, was 58 years, ranging from 17 to 80 years old. One patient (71-year-old) with chronic myelogenous leukemia and another (64-year-old) with chronic diabetes mellitus were diagnosed with skin abscesses of M. fortuitum group, which were located on the right site of the neck and in the scar after injecting insulin (injection abscess), respectively. The average age of twenty-six patients, from whom M. chelonae group was isolated, was 57 years, ranging from 32 to 84 years old. One patient (75-year-old) with articular rheumatism was diagnosed with a lung infection of mixed M. chelonae group and Pseudomonas aeruginosa, and another (74-year-old) with diabetes mellitus and kidney failure was strongly suspected of a lung infection. The isolates of the two mycobacteria from the remaining patients were due to colonization, while these patients had the following underlying diseases contributing to infections: pulmonary emphysema; diabetes mellitus; leukemia; collagen diseases; lung cancer; chronic kidney diseases; systemic lupus erythematosus; carcinomatous pleurisy; bronchiectasis; post-tuberculosis. Most isolates of the two mycobacteria were separated from the specimens of patients' respiratory tracts, but since M. chelonae group was a contaminant in the tap-water for diluting concentrated chlorhexidine, the organism happened to be isolated with the mucous membranes of the 6 patients' colons that were picked up while using the washed fiber-scope. These findings suggest that M. fortuitum and M. chelonae groups, in spite of the fact that they rarely cause infection, have a significant risk of infecting aged patients in general hospitals with various underlying diseases attributable to infections. As only a few colonies were isolated from patients' specimens in the majority of cases, it took time to carry out these clinical examinations, and to improve this "laboratory's delay", it is needed to make faster report to clinicians.

KRH-594, a new angiotensin AT1 receptor antagonist, prevents end-organ damage in stroke-prone spontaneously hypertensive/Izm rats

1. In the present study, we examined whether KRH-594, a new angiotensin AT1 receptor antagonist, would stop the progression of renal failure and end-organ damage and improve the survival rate in salt-loaded stroke-prone spontaneously hypertensive rats (SHRSP/Izm). 2. Oral administration of KRH-594 (3 and 10 mg/kg per day) for 11 weeks significantly reduced systolic blood pressure, urinary total protein, blood urea nitrogen, serum creatinine and urinary N-acetyl glucosaminidase and increased creatinine clearance in SHRSP/Izm. 3. In a histological study, KRH-594 (3 and 10 mg/kg per day) significantly improved the glomerulosclerosis, basophilic change and hyalin cast of tubules, proliferation of afferent arterioles and interlobular artery wall scores of the kidney and the cardiac fibrosis scores of the heart in SHRSP/Izm. KRH-594 (3 and 10 mg/kg per day) also significantly inhibited cardiac hypertrophy. 4. KRH-594 (3 and 10 mg/kg per day) prevented death in SHRSP/Izm during the examination period. 5. These results suggest that KRH-594 improves hypertensive complications, such as renal failure, cardiac hypertrophy and thickening of the artery wall, and prevents death in salt-loaded SHRSP/Izm.

Cloning and expression of mouse deafness dystonia peptide 1 cDNA

Complementary DNA of mouse deafness dystonia peptide 1 (DDP1) was isolated from adipocyte cDNA library and expressed in mammalian cells. The sequence shares homology of 92 and 97% on the nucleic acid and the amino acid levels with human DDP1. In comparison to mouse Bruton's tyrosine kinase (Btk) locus, the coding region spans 2 exons and the splice point is the same as human DDP1. Northern blot analysis suggests that mouse DDP1 expresses ubiquitously. In vitro transcription/translation study showed that the cDNA of mouse DDP1 codes about 11 kDa peptide. DDP1 tagged with FLAG localized in mitochondria and cytoplasm of COS7 cells. P19 embryonal carcinoma cells transfected with anti sense DDP1 cDNA were frequently dead after subculture and all the survivals expressed endogenous DDP1 mRNA. Therefore, mouse DDP1 may play an important role to survive in contrast to Tim8p, a yeast homologue, which was unnecessary in yeast.

KRH-594, a new angiotensin AT1 receptor antagonist, ameliorates nephropathy and hyperlipidaemia in diabetic spontaneously hypertensive rats

1. We examined whether KRH-594, a new angiotensin AT1 receptor antagonist, ameliorates the progression of diabetic nephropathy and hyperlipidaemia in streptozotocin (STZ)-induced diabetic unilateral nephrectomized spontaneously hypertensive rats (DM-1K-SHR) or not. 2. The oral administration of KRH-594 (3 and 10 mg/kg per day) and candesartan cilexetil (1 mg/kg per day) for 16 weeks significantly reduced systolic blood pressure, urinary albumin and urinary total protein in DM-1K-SHR. 3. In a histological study, KRH-594 (3 and 10mg/kg per day) and candesartan cilexetil (0.3 and 1 mg/kg per day) dose-dependently improved glomerulosclerosis and the hyalin cast of tubules in DM-1K-SHR kidneys. Both KRH-594 (10 mg/kg per day) and candesartan cilexetil (0.3 and 1 mg/kg per day) dose-dependently inhibited cardiac hypertrophy. 4. KRH-594 (3 and 10 mg/kg per day), but not candesartan cilexetil, dose-dependently reduced the levels of triglyceride, total cholesterol and phospholipids in DM-1K-SHR. 5. These results suggest that KRH-594 improves diabetic complications, such as nephropathy and hyperlipidaemia, with hypertension.

Heterogeneous cardiac sympathetic innervation in heart failure after myocardial infarction of rats

We examined cardiac neuronal function and beta-receptor with a dual-tracer method of [(131)I]meta-iodobenzylguanidine (MIBG) and [(125)I]iodocyanopindolol (ICYP) in rat heart failure after myocardial infarction (MI). In rats with MI, left ventricular (LV) systolic function decreased, and LV dimension and right ventricular (RV) mass increased gradually. MIBG accumulations of the noninfarcted LV (remote region) and RV decreased by 15% at 1 wk compared with sham-operated rats, and these accumulations were restored by 71% and 56%, respectively, at 24 wk compared with age-matched sham rats despite sustained depletion of myocardial norepinephrine contents in these regions. ICYP accumulation of the remote region and of the RV did not decrease at any stages. Myocardial MIBG distribution was heterogeneous at 1 wk when it was lower in the peri-infarcted region than in the remote region, associated with reduced ICYP accumulation in the peri-infarcted region. The heterogeneous distribution of both isotopes disappeared at 12 wk. Thus cardiac sympathetic neuronal alteration was coupled with downregulation of beta-receptors in rat heart failure after MI. The abnormal adrenergic signaling occurred heterogeneously in terms of ventricular distribution and time course after MI.

Effect of ozagrel on locomotor and motor coordination after transient cerebral ischemia in experimental animal models

The effect of ozagrel, a selective thromboxane A(2) (TXA(2)) synthetase inhibitor, on the obstruction after cerebral ischemia-reperfusion was studied in experimental animal models. The reduced spontaneously locomotor activity and the obstruction of motor coordination were improved by the administration of ozagrel in the conscious cerebral ischemia-reperfusion mouse model. Ozagrel suppressed the decrease in specific gravity of the brain tissue induced by the occlusion-reperfusion in the conscious cerebral ischemia-reperfusion SHR model, and recovered the postischemic decrease in cortical PO(2) after middle cerebral artery occlusion-reperfusion in cats. The level of TXB(2), a metabolite of TXA(2), in the brain increased after the cerebral ischemia-reperfusion, and ozagrel prevented this increase. Additionally, ozagrel also increased the level of 6-keto-PGF(1alpha), a metabolite of prostaglandin I(2) (PGI(2)), in the brain tissue after cerebral ischemia-reperfusion, and the administration of PGI(2) improved the reduced spontaneous locomotor activity in the conscious cerebral ischemia-reperfusion mouse model. Our data suggest that ozagrel suppressed the obstruction following cerebral ischemia-reperfusion by preserving the cerebral blood flow via preventing the increase in TXA(2) and causing an increase in the PGI(2) level.

Tranilast inhibits the proliferation of human coronary smooth muscle cell through the activation of p21waf1

Restenosis after percutaneous transluminal coronary angioplasty (PTCA) occurs due to vascular smooth muscle cell proliferation and migration. Recently, tranilast, an anti-allergic drug, has been used for the prevention of restenosis after PTCA. To determine the molecular mechanism involved, the effect of tranilast on the proliferation of human coronary smooth muscle cells (SMCs) was investigated. Tranilast arrested the proliferation of human coronary SMCs at the G0/G1 phase of the cell cycle. In association with this inhibitory effect, tranilast increased p21waf1 and p53 tumor suppressor factor, and decreased cyclin-dependent kinase 2 (CDK2) activity. These results suggest that tranilast inhibits the proliferation of human coronary SMCs during restenosis after PTCA via an induction of p21waf1 and p53. Tranilast may thus allow us to prevent restenosis after PTCA by interfering with this mechanism.

Washout of I-123 meta-iodobenzylguanidine for assessing cardiac sympathetic activity with progression of hypertension in Dahl salt-sensitive rats

BACKGROUND

To evaluate cardiac sympathetic activity, a simple method should be developed to replace such complex methods as the spillover rate of tritiated norepinephrine (3H-norepinephrine) or microneurography of sympathetic nerve activity. The goal of this study is to evaluate cardiac sympathetic activities by analyzing the washout of I-123 meta-iodobenzylguanidine (123I-MIBG), a radiolabeled norepinephrine analogue, in Dahl salt-sensitive (DS) rats as it relates to the progression of hypertension.

METHODS AND RESULTS

Dahl salt-resistant (DR) rats and DS rats were fed an 8 % salt diet starting at age 5 weeks. Marked hypertension and cardiac hypertrophy developed in the DS rats, whereas DR rats remained normotensive. Then the time-activity curves of 123I-MIBG from 15 to 200 minutes were obtained from both DS and DR strains at ages 8, 11, and 13 weeks using dynamic scintigraphic analysis. We also examined the nonneuronal washout of 123I-MIBG using dynamic scintigraphic studies in desipramine pretreated normal rats. In the preliminary study with desipramine pretreatment, the majority of the nonneuronal 123I-MIBG washout occurred by 90 minutes after injection. Therefore the late-phase washout in the control rats was found to reflect the neuronal washout. We then applied exponential curve fitting to the time activity curves acquired in the 90- to 200-minute period after 123I-MIBG injection in both DR and DS rats. When we compared the coefficients of these washout curves in the DS and DR rats as an index of cardiac sympathetic activities, the coefficient values remained high during all stages in DS rats, whereas they decreased with age in DR rats.

CONCLUSION

Measurement of late-phase 123I-MIBG washout may be a useful tool for assessing the change in sympathetic activity in the progression of hypertension without the influence of extraneuronal washout of 123I-MIBG and left ventricular hypertrophy.

Angiotensin II type 1 receptor blockade prevents up-regulation of angiotensin II type 1A receptors in rat injured artery

We investigated the effects of the angiotensin II (Ang II) type 1 receptor (AT1) antagonist KRH-594 on levels of the mRNAs for AT1A, AT1B, platelet-derived growth factor-receptor beta (PDGF-Rbeta), and extracellular matrix (ECM)-related genes using the competitive reverse transcription-polymerase chain reaction (RT-PCR) method and on neointimal formation in the balloon-injured rat carotid artery. The mRNA levels for AT1A and PDGF-Rbeta, but not for AT1B, increased from day 3 after injury to day 14. KRH-594 administered orally at 3 and 10 mg/kg/day significantly suppressed these increases. KRH-594 (10 mg/kg/day) also suppressed the injury-induced gene expressions for transforming growth factor-beta1 and fibronectin and reduced collagen alpha1(I) and alpha1(III) mRNA levels for the first 7 days after injury. KRH-594 (10 and 30 mg/kg/day) significantly and dose-dependently reduced the neointimal area in cross sections of the artery 14 days after injury. Another AT1 antagonist, TCV-116 (candesartan cilexetil; 1 and 3 mg/kg/day p.o.), had similar effects on the morphological change and AT1A mRNA level, whereas a smooth muscle relaxant, hydralazine (10 mg/kg/day p.o.), did not. These results indicate that up-regulation of AT1A, PDGF-Rbeta, and ECM-related genes in the balloon-injured carotid artery is in part an AT1-mediated phenomenon and that prevention of receptor up-regulation may contribute to the attenuating effects of AT1 antagonists on neointimal formation after injury.

[Evaluation of Mycobacterium kansasii isolates from a clinical laboratory in a city hospital]

Fifteen isolates of Mycobacterium kansasii in Showa University Fujigaoka Hospital between 1982 and 1995 were investigated. Comparing by gender, 13 were isolated from male patients and only two were isolated from female patients. The average of cases was 48 years old and 14 out of 15 cases (93%) were isolated from respiratory tract specimens. The rate of the smear- and culture-positives was 64%, which was significantly higher than that (26%) of M. avium complex (p < 0.01 by chi 2 test). All 4 isolates were susceptible to rifampicin (10 micrograms/ml) by drug susceptibility testing using Ogawa egg medium, and only 1 was resistant to ethambutol (2.5 micrograms/ml). Seven out of 10 patients whose medical record was available were diagnosed as pulmonary infection with M. kansasii. Two out of 4 patients with primary infection type had underlying diseases such as diabetes mellitus and leukemia, while the remaining two patients did not have any underlying disease. Two out of 3 patients with secondary infection type had a medical history of tuberculosis and the remaining 1 patient had infected pulmonary cyst. Such as Pseudomonas aeruginosa, Enterobacter aerogenes and Flavobacterium spp., and Branhamella catarrhalis, associated with M. kansasii, bacteria more than 10(7) cfu/ml were isolated from the sputa of 3 patients with leukemia, infected pulmonary cyst and post-tuberculosis, respectively. M. kansasii, Stenotrophomonas maltophilia (10(7) cfu/ml) and Candida albicans were detected from the sputum of 1 patient with nephrosis, for which steroid (predonin) and antibiotics (piperacillin and latamoxef) were administrated, however, this patient was not diagnosed as a case of M. kansasii infection. These findings suggest the fact that M. kansasii inhabits among compromised hosts of a city hospital.

[Can 99mTc-mercaptoacetyltriglycine (99mTc-MAG3) evaluate the renal function without blood sampling?: consensus report from multicenter study]

A multicenter study was undertaken in Japan to evaluate the correlation between the percentage of renal uptake of 99mTc-mercaptoacetyltriglycine (99mTc-MAG3) estimated by the count-based gamma camera method and the blood clearance of 99mTc-MAG3. Twenty four centers were enrolled and 172 cases were finally analyzed in this study. The renal clearance of 99mTc-MAG3 (TER) was obtained by using a single blood sample taken at 44 min after injection. Comparison of TER and renal uptake provided a coefficient of correlation of 0.874; suggesting that sufficiently accurate quantification of renal function could be obtained from the renal uptake estimate by the gamma camera method. This study also showed that the comparison of renal function might be feasible among patients under the same protocols, although precise and careful consideration is required in each center.

Effects of the new angiotensin receptor antagonist dipotassium (Z)-2-[[5-ethyl-3-[2'-(1H-tetrazol-5-yl)biphenyl-4-yl] methyl-1,3,4-thiadiazoline-2-ylidene]aminocarbonyl]-1-cy clopentencarbox ylate on experimental cardiac hypertrophy and acute left ventricular failure

The cardiovascular effects of dipotassium (Z)-2-[[5-ethyl-3-[2'-(1H-tetrazol-5-yl)biphenyl-4-yl] methyl-1,3,4-thiadiazoline-2-ylidene]aminocarbonyl]-1-cyc lopentencarboxylate CAS 169328-25-0, KRH-594), a new angiotensin II type 1 (AT1) receptor antagonist, on pressure-overload cardiac hypertrophy in rats and on acute left ventricular failure in dogs were investigated. In rats with a 2-week abdominal aorta constriction, left ventricular weight (LVW) and systolic blood pressure (SBP) were significantly greater than in sham-operated rats. Oral administration of KRH-594 (10 or 30 mg/kg/day for 2 weeks) reduced the increases in both LVW and SBP. Another AT1 receptor antagonist, candesartan cilexetil (1 or 3 mg/kg/day for 2 weeks), also prevented this type of cardiac hypertrophy. In anesthetized dogs with a 60-min coronary ligation, left ventricular end-diastolic pressure (LVEDP) and total peripheral resistance (TPR) were raised, whereas the maximum first derivative of left ventricular pressure and cardiac output were both decreased. Intravenous administration of KRH-594 (3 mg/kg) significantly attenuated the increases in both LVEDP and TPR after coronary ligation. These results suggest that KRH-594, by reducing the cardiac afterload, may ameliorate pressure-overload cardiac hypertrophy in rats and produce an improvement in the hemodynamic status of dogs with acute left ventricular failure.

[Antimicrobial activities of roxithromycin against recently obtained clinical isolates]

The purpose of our investigation was to monitor current trends in the susceptibility patterns of clinical bacterial isolates to roxithromycin (RXM). We measured the MICs of macrolide antibiotics, such as RXM, erythromycin (EM), clarithromycin (CAM), rokitamycin (RKM) and midecamycin (MDM), and other classes of antibacterial compounds against various clinical isolates at seven institutions between October and December in 1994 and 1995. RXM had excellent antibacterial activities for S. pyogenes, S. agalactiae, M. (B.) catarrhalis and methicillin sensitive S. aureus. Against methicillin sensitive S. epidermidis, RXM activity was fairly good but about 20% of the strains had MIC > or = 128 micrograms/ml. The activity against S. pneumoniae was not so potent and similar to activities of EM, CAM, MDM, and clindamycin. The vast majority of methicillin resistant S. aureus and S. epidermidis were also resistant to macrolide antibiotics and other classes of compounds tested. In conclusion, RXM is an unique macrolide antibiotic by retaining potent activity against S. pyogenes, S. agalactiae, S. aureus except MRSA, M. (B.) catarrhalis and M. pneumoniae.

[Epidemiological evaluation of mycobacteria isolates in one city hospital: reports from the hospital microbiology laboratory]

The frequency of mycobacteria isolated from patient's specimens at Showa University Fujigaoka Hospital was investigated. By fitting a polynominal curve (degree = 3) of the annual frequency of culture-positive Mycobacterium tuberculosis (1977 through 1995), it was noted that the frequency had not changed since 1977. The patients in the 40s or older and 60s or older comprised 74 and 38%, respectively. Of 104 patients diagnosed as tuberculosis (between 1993 and 1995), 43 (41%) were compromised hosts with the following underlying diseases: kidney disease; diabetes mellitus; malignant tumor; respiratory disease; Behçet's disease; ophthalmosarcoidosis; multiple arthritis; Hashimoto's disease. This suggested that these compromised hosts are at high risk of onset and relapse of tuberculosis, and occasionally the doctor's or patient's delay was seen during the diagnostic process. By fitting a polynominal curve (degree = 3) of the annual frequency of culture-positive atypical mycobacteria (1977 through 1995), it was noted that the frequency had increased since 1981. The patients in the 40s or older and 60s or older comprised 88 and 60%, respectively. Between 1982 and 1994, we encountered 46 cases of atypical mycobacteriosis of the lung: 37 M. avium complex (MAX) diseases; 7 M. kansasii diseases; one M. chelonae disease; one unidentified disease involving Runyon Group II mycobacterium. Eight involved patients with bronchiectasia (5 cases), diabetes mellitus (2 cases), or leukaemia (one case). Haemophilus influenzae, Pseudomonas aeruginosa, and Moraxella catarrhalis at more than 10(7) CFU per ml of sputum were isolated from 6 patients diagnosed with MAC or M. kansasii lung diseases, suggesting the possibility of mixed infections. M. tuberculosis and atypical mycobacterium (15 cases), and two different atypical mycobacteria (16 cases) were isolated from the same or different specimens of the same patients at the same or different times. However, the pathogenicity of these mycobacteria remained unknown, because atypical mycobacteria are non-pathogenic in many cases. The above findings suggested that the environment fit for the mycobacteria growth in human body has gradually been formed associating with aging, lung-lesion, and decline of immune capacity.

MR imaging of pituitary adenomas with sphenoid sinus invasion: characteristic MR findings indicating fibrosis

We reviewed MR images obtained before and after the injection of Gd-DTPA in six patients with pituitary adenoma extending into the sphenoid sinus, and correlated the imaging and histological findings. The portion of each adenoma involving the sphenoid sinus and sellar floor was less intense on both T1- and T2-weighted spin-echo images and Gd-enhanced images when compared with the sellar/suprasellar solid portion of the adenoma, which showed marked contrast enhancement. Histological examination of adenoma specimens taken from the sphenoid sinus demonstrated abundant collagen fibers between the adenoma cells, whereas tumor tissue from the suprasellar region showed no fibrotic change. We concluded that pituitary adenomas seem to have a tendency to develop fibrosis on extension into the sphenoid sinus.

Radioiodinated diacylglycerol analogue: a potential imaging agent for single-photon emission tomographic investigations of cerebral ischaemia

Phospholipid metabolism is closely related to membrane perturbation in cerebral ischaemia. We investigated in vivo topographical lipid metabolism using an iodine-123-labelled diacylglycerol analogue, (1-(15-(4-iodine-123-iodophenyl)-pentadecanoyl)-2-stearoyl-rac-gly cerol) (123I-labelled DAG), in a middle cerebral artery (MCA) occlusion model with the aim of positive imaging of ischaemic insult. Sprague-Dawley rats underwent coagulation of the MCA to induce permanent occlusion. MCA occlusion times prior to injection of 123I-labelled DAG ranged from 15 min to 14 days. Each rat was injected with 11-37 MBq of 123I-labelled DAG via a tail vein. After 30 min, in vivo autoradiographs were reconstructed. Scanning of the living rat brain in this MCA occlusion model was performed using a gamma camera with a pinhole collimator. Cerebral infarctions were recognized in the frontal cortex, the parietal cortex and the lateral portion of the caudate-putamen by 2,3,5-triphenyltetrazolium hydrochloride staining. In infarcted regions (region 1), 123I-labelled DAG incorporation showed a slight decrease up to 12 h; it then increased up to 6 days and decreased thereafter. In peri-infarcted regions (region 2), the incorporation showed almost no change up to 12 h, then increased up to 5-6 days and decreased thereafter. In other regions (region 3), the incorporation showed no change. Lipid analysis showed that 123I-labelled DAG was metabolized to 15-(4-iodine-123-iodophenyl)-pentadecanoic acid by DAG lipase and to 123I-labelled phosphatidylcholine. Scanning of the ischaemic region showed higher accumulation than on the non-lesioned side. We established a method to visualize ischaemic foci as positive images. The early changes in 123I-labelled DAG incorporation were closely related to DAG lipase, which degraded the accumulated intrinsic DAG, and increased 123I-labelled DAG incorporation in the chronic stage involves several aspects of neural destruction in the process of autolysis. It is concluded that the reported method could have a clinical future.

Effects of low molecular weight heparin on a severely antithrombin III-decreased disseminated intravascular coagulation model in rabbits

The effect of dalteparin, a low molecular weight heparin, on severely antithrombin III (ATIII)-decreased disseminated intravascular coagulation (DIC) model was compared with that of unfractionated heparin (heparin). The DIC model in rabbits was produced by continuous infusion of thrombin in combination with bolus injection of latex. After a 3 hr infusion of thrombin, plasma ATIII activity was lowered to 30% of normal plasma. Platelet number, fibrinogen content and alpha 2 plasmin inhibitor (alpha 2PI) activity were also decreased. Dalteparin (25-100 IU/kg/hr) and heparin (25-100 U/kg/hr) inhibited the decrease in ATIII activity, platelet number and fibrinogen content, and had no effect on alpha 2PI activity. Activated partial thromboplastin time (APTT) was prolonged by heparin (50 and 100 U/kg/hr), but not by dalteparin (25-100 IU/kg/hr). The ratio of anti-factor Xa (F.Xa) activity to anti-thrombin activity for dalteparin (50 IU/kg/hr) was higher than that for heparin (50 U/kg/hr). With the addition of exogenous ATIII, the ratio of anti-F.Xa to anti-thrombin for heparin increased, but that for dalteparin did not change. However, the increased ratio for heparin was still lower than the unchanged ratio for dalteparin. These results suggest that both dalteparin and heparin have the ability to rectify the abnormal parameters of severely ATIII-decreased DIC, and that the effects of dalteparin are mainly involved with anti-F.Xa activity whereas the effects of heparin are via anti-thrombin activity.

Assessment of adrenergic neuron function altered with progression of heart failure

We used MIBG to evaluate cardiac adrenergic neuron integrity and function in congestive heart failure.

METHODS

Rats were treated with adriamycin (2 mg/kg, s.c.) once a week for 7, 8 and 9 wk. In analyzing cardiac adrenergic neuron function, we assessed alterations of uptake-1, exocytotic release and nonexocytotic metabolic release in relation to progression of heart failure.

RESULTS

LVEF progressively decreased. Cardiac MIBG accumulation (4 hr postinjection) decreased to 53% of control at 7 wk and markedly decreased to 14% of control at 9 wk, accompanied by massive pleural effusions. Reduction of MIBG accumulation in the lung and spleen, which are adrenergic-rich organs similar to the heart, were less pronounced compared to reduction in the heart. There was no difference in cardiac uptake of 3H-norepinephrine between the control and 8-wk groups. Cardiac uptake of 3H-norepinephrine decreased 91.0% in the control and 90.8% in the 8 wk group by pretreatment of desipramine, indicating no difference in the uptake-1 component.

CONCLUSION

Congestive heart failure due to adriamycin cardiomyopathy progressively accelerates exocytotic release of norepinephrine predominantly from cardiac adrenergic neurons, but neuronal uptake function is not disturbed so long as heart failure is not advanced. In the advanced stage, nonexocytotic metabolic release is induced specifically in cardiac adrenergic neurons due to energy depletion and norepinephrine release markedly increases.

Transcriptional regulation of tissue- and urokinase-type plasminogen activator genes by thrombin in human fetal lung fibroblasts

The mechanism of thrombin induction of tissue- and urokinase-type plasminogen activator (t-PA and u-PA) biosynthesis was investigated in cultured human fetal lung fibroblast cells, IMR-90. Northern blot analysis of total RNA from thrombin-treated cells showed marked accumulations of both t-PA and u-PA mRNA during 24 h. Nuclear run-on experiments showed that the transcription rates of both genes were increased in the thrombin-treated cells. These thrombin effects were inhibited by cycloheximide (CHX), an inhibitor of protein biosynthesis. Treatment of IMR-90 cells with CHX alone caused an increase in u-PA mRNA but not in t-PA mRNA. CHX, however, did not affect the transcription rates of both genes in the cells. Thus, on-going protein synthesis is required for increased accumulations of both t-PA and u-PA mRNA by thrombin but not for the constitutive expression of u-PA gene in IMR-90 cells. Therefore, we conclude that the accumulations of t-PA and u-PA mRNA due to thrombin result mainly from increased rates of their gene transcriptions, and that this influence is exerted in part by proteins synthesized by thrombin stimulation. Thrombin also increased plasminogen activator inhibitor type-1 (PAI-1) in the levels of both antigen and mRNA more rapidly than it increased t-PA in IMR-90 cells. In conditioned medium, most of the secreted PAI-1 seemed to form a complex with t-PA. Northern blot analysis using a PAI-2 cDNA probe showed that the levels of PAI-2 mRNA were markedly increased in response to thrombin.(ABSTRACT TRUNCATED AT 250 WORDS)

Gas chromatographic separation of bile acid 3-glucosides and 3-glucuronides without prior deconjugation on a stainless-steel capillary column

A method for the gas chromatographic (GC) separation of the 3-glucoside and 3-glucuronide conjugates of bile acids without the necessity for a hydrolytic step is described. The bile acid glycosides were derivatized to their complete methyl ester trimethylsilyl (Me-TMS) or methyl ester dimethylethylsilyl (Me-DMES) ether derivatives, which in turn were chromatographed on an inert and thermostable stainless-steel capillary column, Ultra ALLOY-1 (HT), coated with a thin film (0.15 micron) of chemically bonded and cross-linked dimethylsiloxane. They exhibited a single peak of the theoretical shape without any accompanying peaks due to thermal decomposition, even at oven temperatures of 320-330 degrees C. Excellent GC separation of isomeric bile acid glycosides was achieved by the combined use of suitable derivatives and column. This method, which does not need the prior deconjugation of the glycosidic moiety, could be usefully applied to biosynthetic and metabolic studies of bile acids in biological materials.

Renal cell carcinoma associated with chronic renal failure: evaluation with sonographic angiography

PURPOSE

To determine the value of sonographic angiography for diagnosis of renal cell carcinoma (RCC) in patients with chronic renal failure (CRF).

MATERIALS AND METHODS

The authors compared findings from sonographic angiography, conventional ultrasound (US), computed tomography (CT), and conventional angiography in 15 patients with CRF in whom RCC was suspected. All of these patients subsequently underwent nephrectomy.

RESULTS

RCC was demonstrated pathologically in 13 patients, whereas two had benign lesions only. Sonographic angiography depicted tumor enhancement in all patients with RCC except one; no enhancement was shown in the two patients with benign lesions. Conventional angiography depicted tumors stained by contrast material in nine of 13 patients with RCC, and CT depicted tumor enhancement in 10 of 13 patients. US was useful for the detection of nodules but did not allow differentiation of malignant from benign lesions.

CONCLUSION

Sonographic angiography has a possible role in the detection of small nodules in patients with CRF.

Analysis of conjugated bile acids in human biological fluids. Synthesis of hyodeoxycholic acid 3- and 6-glycosides and related compounds

The glucuronide, glucoside and N-acetylglucosaminide conjugates of hyodeoxycholic acid were synthesized. In addition, murideoxycholic acid 3-glycosides and some of their C-5 epimeric analogs were also prepared. The principal reactions used are 1) the Koenigs-Knorr condensation reaction of 3-oxo-6 alpha-hydroxy and 6-oxo-3 alpha-hydroxy esters with an appropriate alpha-acetohalosugar catalyzed by cadmium carbonate in benzene under reflux, 2) reduction of the resulting bile acid glycoside methyl ester-acetates with tert-butylamine-borane complex, and 3) subsequent hydrolysis with aqueous lithium hydroxide.

Different regulation of plasminogen activator inhibitor 2 gene expression by phorbol ester and cAMP in human myeloid leukemia cell line PL-21

Previous studies have shown that protein kinase C (PKC) activators and dibutyryl cyclic AMP (Bt2cAMP) synergistically increase the antigen level of plasminogen activator inhibitor type-2 (PAI-2) in a human myeloid leukemia cell line PL-21. To clarify the mechanism, PAI-2 gene expression induced by phorbol myristate acetate (PMA), a PKC activator, and Bt2cAMP was investigated by Northern blot hybridization using a PAI-2 cDNA probe cloned from a human placental library. The level of PAI-2 mRNA was markedly increased in response to PMA and reached a maximum 5-9 h after stimulation. Nuclear run-on assay revealed an increase in PAI-2 gene transcription in PMA-treated cells. The induction was inhibited by inhibiting de novo protein synthesis with cycloheximide (CHX). cAMP also increased PAI-2 mRNA level in a dose-dependent manner. The increase began within 2 hours and, contrary to the case of PMA, the mRNA levels were maintained. Moreover, cAMP-induced increase in PAI-2 mRNA was not inhibited by CHX, rather enhanced. PMA and cAMP synergistically induced PAI-2 gene expression, which was completely inhibited by CHX. The cells pretreated with PMA for 24 h did not any more respond to stimulation with PMA but responded to cAMP and PAI-2 mRNA level was increased. The apparent half-life of constitutive level PAI-2 mRNA in PL-21 cells, determined by actinomycin-D-decay experiments, was approximately 2 h. Those induced by PMA and cAMP were approximately 5 h and 2 h, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Heparin stimulates the proliferation of bovine aortic endothelial cells probably through activation of endogenous basic fibroblast growth factor

We investigated the effect of heparin on the proliferation of cultured bovine aortic endothelial (BAE) cells. Heparin increased DNA synthesis in BAE cells in a concentration-dependent manner. The DNA synthesis increased by 2 to 2.5-fold with 1 mg/ml of heparin after 48 h incubation without serum and exogenous fibroblast (heparin-binding) growth factors. The stimulating effect of heparin decreased with the diminishing number of monosaccharide units which constitute heparin. By the addition of a neutralizing antibody to basic fibroblast growth factor (bFGF), the stimulating effect of heparin decreased, whereas an antibody to acidic fibroblast growth factor (aFGF) had no effect. The culture medium conditioned by heparin-treated BAE cells stimulated DNA synthesis in Balb/3T3 fibroblasts that proliferate in response to bFGF. The mitogenic activity of the conditioned medium was suppressed by the antibody to bFGF. However, heparin did not increase bFGF mRNA level in BAE cells. These results suggest that heparin stimulates the proliferation of BAE cells by the activation of endogenous bFGF, but not by the induction of its synthesis.

Antithrombin III producing hepatocellular carcinoma

A case of primary hepatocellular carcinoma with an abnormal increase in the antigenic quantity and activity of Antithrombin III (AT-III) is reported. The patient was a 53-year-old man. The liver was palpated for a five fingerbreadths, but no jaundice or ascites was noted. Computed tomogram (CT) revealed the presence of many nodules of various sizes in the right hepatic lobe. Both viral markers of HBV and HCV were negative. For tumor markers, PIVKA-II was high (27.7 AU/ml) but AFP was normal. Among coagulation and fibrinolytic factors, the activity and antigenic levels of AT-III were abnormally high (290% and 81.6 mg/dl). An US guided needle biopsy of the tumor revealed hepatocellular carcinoma, Edmondson I. The cellularity was high and the tumor cells were small, well differentiated. The tumor cells were positively stained in immunohistochemical staining using the anti-AT-III antibody. It was believed that AT-III produced by the tumor cells was responsible for this exaggerated level.

Thrombin regulation of tissue-type plasminogen activator synthesis in cultured human fetal lung fibroblasts

We examined the effects of thrombin on tissue-type plasminogen activator (t-PA) release and t-PA mRNA levels in cultured human fetal lung fibroblast cells, IMR-90. The secretion of t-PA was increased by thrombin in a dose- and time-dependent manner, but it was not affected by inactivated thrombin with diisopropylfluorophosphate (DFP). Both antithrombin III (ATIII) and heparin cofactor II (HCII), plasma inhibitors to thrombin, inhibited thrombin-induced t-PA release. The thrombin-induced t-PA secretion was preceded by an increase of the steady state level of t-PA-specific mRNA in the cells, suggesting that thrombin activates t-PA gene expression. The t-PA mRNA expression induced by thrombin was completely blocked by pretreatment of the cells with an inhibitor of translation, cycloheximide (CHX). These results suggest that the effect of thrombin on t-PA expression is mediated through its proteolytic activity and the biosynthesis of transcription factor(s).

[Postoperative evaluation of renal cell carcinoma in the abdominal computed tomography]

Two hundred one abdominal CT scans were performed in 93 patients who had undergone previous nephrectomy for renal cell carcinoma. Three had local recurrence and nine had metastatic lesions. Local recurrence and metastatic lesions were detected from 7 months to 6 years and 4 months after nephrectomy (median 2 years and 9 months). Local recurrent lesions were detected as masses in the vacant renal fossa. Metastatic lesions of the abdomen were seen in adrenal gland, liver, contralateral kidney, bone, etc. Administration of oral contrast material was useful to differentiate these recurrent lesions from intestine. It was important to fully understand the anatomical change after nephrectomy, and US might be especially helpful for evaluating the liver and contralateral kidney.

Plasma GH response to the sequential 3 day administrations of GHRH followed by arginine infusion in patients with idiopathic GH deficiency and normal short children

To study the site of lesions in idiopathic growth hormone (GH) deficiency (IGHD), growth hormone releasing hormone (GHRH) was administered sequentially for 3 days to 19 patients with IGHD, 3 patients with GH deficiency (GHD) secondary to hypothalamic tumors, and 7 normal short children (NSC). GHRH (100 micrograms) was injected as a bolus on days 1 and 3, and was infused over 60 min on day 2. Of 19 patients with IGHD, 6 showed an improved GH response (group A), 5 a decreased response (group B) and the remaining 8 an unchanged response (group C) to sequential administration of GHRH. The response was unchanged in patients with secondary GHD or NSC. There was no significant correlation between the patterns of GH response and the findings on pituitary MR images or the delivery state at birth in IGHD patients. Ten patients with IGHD (4 of group A; 3 each of groups B & C) and 2 NSC showed much greater GH responses to arginine (0.5 g/kg i.v. for 30 min) injected with preceding GHRH than to arginine injected without preceding GHRH. These results indicate that hypothalamic lesions were primarily responsible for GH deficiency in about 60% of the patients with IGHD (groups A and B), and group C might have more severe hypothalamo-pituitary damages than the other groups. Hypothalamic somatostatin neurons seems to be functioning to a degree even in severe IGHD patients.

[Effect of tranilast, an anti-allergic drug, on the human keloid tissues]

We studied the inhibitory effects of tranilast, an anti-allergic drug, on the human keloid tissues implanted into the dorsal skin of athymic nude mice and on the growth of keloid fibroblast in vitro. In the keloid tissue-implanted model, tranilast (50-200 mg/kg, p.o.) decreased the weight of the keloid tissue as triamcinolone (25 mg/kg, p.o.) did. Tranilast (200 mg/kg, p.o.) reduced the hydroxyproline content of implanted tissues. Tranilast (3-300 microM) also inhibited the collagen synthesis by keloid fibroblast in vitro. Only a high concentration of tranilast (300 microM) suppressed the glycosaminoglycan synthesis and cell proliferation of keloid fibroblasts. Moreover, tranilast scarcely affected the fibronectin production. Triamcinolone (10 microM) also inhibited glycosaminoglycan synthesis and cell proliferation. These results suggest that the inhibitory effect of tranilast on the keloid tissues is related to its inhibition of the collagen synthesis of fibroblasts. Tranilast would be useful as a therapeutic drug for the treatment of keloids.

The relation between pituitary magnetic resonance imaging findings and GH, TSH, PRL dynamics in patients with idiopathic GH deficiency

The relation between pituitary magnetic resonance imaging (MRI) findings and anterior pituitary function was studied in 36 patients with classic idiopathic GH deficiency. These patients were divided into three groups based on MRI findings which were compared with those of 14 normal short children; i.e. normal stalk (N = 6), narrowed stalk (N = 20), and transected stalk (N = 10). The transected and narrowed stalk groups showed significantly delayed TSH responses to TRH compared with the normal stalk group and with the normal short children. Further, the mean maximal TSH increment in the narrowed and transected stalk group was slightly greater than that in normal short children. In contrast, there were no differences in basal plasma GH and PRL levels and their responses to GHRH and TRH among the three groups. When the patients were divided into normal anterior pituitary and atrophic pituitary groups regardless of stalk changes or when they were divided into groups of stalk changes (narrowing and transection) with and without pituitary atrophy, no differences in GH, TSH and PRL dynamics between the groups were observed. These results indicate that pituitary thyrotrope functions, but not somatotrope and lactotrope functions, in patients with idiopathic GH deficiency are more closely correlated to stalk changes than to anterior pituitary changes observed on MRI.

[CT after transsphenoidal surgery]

Two hundred and ten CT studies of 95 patients after transsphenoidal surgery were reviewed. Spheno-ethmoid opacification, intrasellar hematoma and gas bubbles were noted within 2 weeks after surgery. Bone defect of the sellar floor and bone stent were seen on coronal scans in most cases. The packing material frequently disappeared on follow-up studies. Hormonal assessment of the functioning tumor, according to which the effect of treatment was evaluated, was correlated with CT findings. Because differentiation between postoperative changes and residual mass was difficult, there was no definite CT criteria to indicate residual functioning tumor except upward convexity of the diaphragma sellae on CT more than 3 months after surgery. Initial follow up CT study is recommended to be performed at about 3 months after surgery, at which time the immediate postoperative inflammatory changes have been disappeared. The incidence of recurrence was 3/47 (6%), which was shown on follow-up CT from 4 to 10 years after surgery. Therefore subsequent CT study should be done in every year or two, taking the clinical symptoms and hormonal data into consideration.

Identification of a membrane protein responsible for ribosome binding in rough microsomal membranes

A membrane protein fraction was obtained from rat liver rough microsomes by affinity chromatography on a concanavalin A-Sepharose column and then a chelating-Sepharose column. This protein fraction comprised about 2% of the total membrane proteins of rough microsomes and the ribosome-binding activity of ribosome-stripped rough microsomes was predominantly found in this protein fraction, as determined with a liposome assay system. To identify the essential components responsible for the ribosome binding, two approaches were employed. Trypsin treatment of liposomes reconstituted with this protein fraction resulted in the loss of the ribosome-binding activity in parallel with the loss of a dominant band, estimated Mr 34,000, in SDS-polyacrylamide gels. Next, the direct interaction between the binding sites on the membrane of reconstituted liposomes and 60S ribosomal subunits was investigated by photocrosslinking using sulfosuccinimidyl 2-(m-azido-o-nitrobenzamido)-ethyl-1,3'-dithiopropionate (SAND). The photocrosslinked complex was formed between 60S ribosomal subunits pretreated with SAND and binding-site proteins on the membrane of the liposomes. Then, after the liposomes were solubilized, the complex was isolated by sucrose gradient centrifugation of the binding mixture. The crosslinked proteins were released from 60S ribosomal subunits by cleavage of of crosslinks with beta-ME and analyzed by SDS-polyacrylamide gel electrophoresis and 125I-autoradiography. The 34-kDa protein (p34) was the predominant component that crosslinked to the 60S ribosomal subunits and was found in proportion to the amount of 60S ribosomal subunits added to the system. The p34 was distinguishable by immunoblot analysis from urate oxidase, which is the 34-kDa protein of peroxisomal cores contaminating rough microsomes. These results suggest that the present p34 is a likely candidate molecule for the ribosome-binding activity of rough microsomes.

[Four cases of airway infections caused by MRSA (methicillin resistant Staphylococcus aureus)]

Currently, infections caused by MRSA (methicillin-resistant Staphylococcus aureus) pose a great problem clinically. We present 4 patients with MRSA infections experienced by us. In these patients the infection was localized in the trachea and main bronchus. The first patient was a 62-year-old man. After undergoing operation for early gastric cancer, he had septic shock and was admitted to our center. The second was a 60-year-old man. After he underwent operation for advanced gastric carcinoma at another hospital septicemia developed due to suture failure and he was admitted to our center. The third was a 38-year-old woman who was admitted to our center because of grades II degrees-III degrees burns on 75 to 80% of her body surface area. The fourth was a 60-year-old man who was admitted to our center because of rupture of an aneurysm of the abdominal aorta. It is assumed that MRSA has quite different characteristics from the usual MSSA (methicillin-sensitive Staphylococcus aureus) in that it produces a new penicillin-bound protein (PBP-2') within cells. Thus, from the fiberoptic bronchoscopy findings of our own cases it is considered that there may be cases in which the observed lesion is localized in the central airway alone, without involvement of the segmental bronchi. We believe it necessary to take some prompt measures under a suspicion of airway infection caused by MRSA in the following cases: (1) compromised hosts under tracheal intubation, (2) patients who are under treatment with second or third generation cephalosporins, and (3) patients with production of bloody sputum, and (4) endotoxin-positive patients.

The combination therapy with bromocriptine and cyproheptadine in patients with acromegaly

The therapeutic efficacy of the combination of cyproheptadine and bromocriptine was studied in 15 patients with active acromegaly showing incomplete GH suppression in response to bromocriptine therapy alone. The mean basal plasma GH was 31.3 +/- 5.5 micrograms/L, and it decreased to 19.0 +/- 3.9 micrograms/L during the single bromocriptine therapy (10 to 20 mg for 2 to 21 months). When cyproheptadine (12 to 16 mg for 8 to 52 months) was added to bromocriptine therapy, plasma GH decreased further (9.4 +/- 3.0 micrograms/L: vs pretreatment, P less than 0.001; vs bromocriptine treatment, P less than 0.005), and GH normalization was obtained in 8 patients. The plasma somatomedin-C levels in these 8 patients (0.3-1.8 U/ml) were within the normal range during the combination therapy. Plasma GH responses to TRH or GHRH were markedly suppressed in 6 patients during the combination therapy compared to pretreatment or during bromocriptine treatment. In addition, a clear reduction in the tumor size was observed in 4 of 7 previously untreated patients during the combination therapy. In conclusion, cyproheptadine has therapeutic efficacy in acromegalic patients who showed incomplete GH suppression in response to treatment with bromocriptine alone. Following the cyproheptadine and bromocriptine combination therapy tumor shrinkage was observed in some patients.