Factors affecting motivation for receiving a booster dose of the COVID-19 vaccine among Japanese university students and staff: a cross-sectional questionnaire survey

Understanding the factors that influence people's decisions regarding vaccination is essential to promote vaccination. We aimed to clarify the motivations for receiving booster vaccines. We conducted a paper-based questionnaire distributed during January-February 2022 involving students and faculty staff who received the first COVID-19 vaccination at the mass vaccination program during June-September 2021 at Keio University. A total of 1725 participants were enrolled, and all completed the survey. Among these, 64.9% reported a significant adverse event (AEs) affecting daily life after the second vaccine. "Fear of severe COVID-19 illness" (72.6%) was the most common reason for getting vaccinated, followed by "concern of infecting others" (68.4%) and "fear of COVID-19 infection itself" (68.3%). Television emerged as the most influential source of information (80%), followed by university information (50.2%) and social networking sites (42.8%). Multivariate analysis revealed "fear of severe COVID-19 illness", "fear of COVID-19 infection itself", and "trust in the efficacy and safety of the vaccines in general" were significantly correlated with willingness to receive paid vaccinations. The severity of AEs and source of information were not related to participants' willingness to receive booster vaccinations. Participants with positive reasons for vaccination were more likely to accept a third dose.

SARS-CoV-2 Infection among Medical Institution Faculty and Healthcare Workers in Tokyo, Japan

Objective To consider effective measures against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in medical institutions, this study estimated the SARS-CoV-2 infection rate among healthcare workers (HCWs) in Tokyo, Japan, and determined the specific findings for mild coronavirus disease 2019 (COVID-19) cases. Methods This study analyzed the results of serologic tests to detect immunoglobulin G antibodies against SARS-CoV-2 and evaluated the demographic and clinical characteristics of the faculty and HCWs at a Tokyo medical institution in August 2020. The demographic and clinical characteristics of participants with antibody-positive results were compared to those of participants with antibody-negative results. Materials This study recruited 2,341 faculty and HCWs at a Tokyo medical institution, 21 of whom had a COVID-19 history. Results Of the 2,320 participants without a COVID-19 history, 20 (0.862%) had positive serologic test results. A fever and dysgeusia or dysosmia occurred with greater frequency among the participants with positive test results than in those with negative results [odds ratio (OR), 5.475; 95% confidence interval (CI), 1.960-15.293 and OR, 24.158; 95% CI, 2.693-216.720, respectively]. No significant difference was observed in the positivity rate between HCWs providing medical care for COVID-19 patients using adequate protection and other HCWs (OR, 2.514; 95% CI, 0.959-6.588). Conclusion To reduce the risk of COVID-19 spread in medical institutions, faculty and HCWs should follow standard and necessary transmission-based precautions, and those with a fever and dysgeusia or dysosmia should excuse themselves from work as soon as possible.

Fabrication of size-controlled polyimide nanoparticles

Polyimide particles were fabricated through the two-steps imidization of poly(amic acid) particles prepared by using reprecipitation method. PAA and PI nanoparticles were all spherical, and the changes of particle size, its distribution, and morphology were not observed before and after the imidization. The preparation of PI nanoparticles size-controlled between ca. 20-500 nm was also achieved by changing the experimental conditions, temperature of the poor solvent, the composition of two kind of poor solvent, and PAA-NMP solution concentration.

Early experience with low-prime (99 ml) extracorporeal membrane oxygenation support in children

Quick setup is mandatory for cardiopulmonary resuscitation using an extracorporeal membrane oxygenation (ECMO) assist device. Our conventional ECMO circuit for pediatric patients consists of a centrifugal pump (CX-HP) and membrane oxygenator (CX10H). Because of the large priming volume (260 ml), the circuit had to be primed with donor blood and required 30 minutes for setup. We started to use a low-prime ECMO with small centrifugal pump (HPM-15) and membrane oxygenator (MENOX Alpha Cube) for induction of ECMO beginning in 2000. The priming volume of this low-prime circuit is only 99 ml. The circuit can be primed without donor blood, even in the small patient, and requires only 10 minutes to set up. We review our experiences with cardiopulmonary resuscitation for sudden cardiopulmonary collapse in pediatric patients, including postcardiotomy patients. From 1997 to 2000, 23 patients underwent ECMO support with a conventional circuit (group A). From 2000 to 2004, we used low-prime circuit for induction of ECMO in 12 patients (group B). After the induction of ECMO with low-prime circuit, ECMO was converted to conventional heparin-bonded circuit for the longer support. The results suggested that the quick induction of ECMO with low-prime circuit has significant advantages in cardiopulmonary support in pediatric patients.

Postductal origin of the left carotid, left subclavian, and aberrant retroesophageal right innominate arteries in truncus arteriosus with interrupted aortic arch

A neonate presented to the C.S. Mott Children's Hospital at the University of Michigan with truncus arteriosus and interrupted left aortic arch, with associated postductal origin of the left carotid, left subclavian, and aberrant retroesophageal right innominate arteries. In addition, the patient was diagnosed with DiGeorge syndrome. This unique anomaly has not been previously reported. The anatomy, pathophysiology, embryology, and successful surgical management of this anomaly are reviewed in this report.

Blends of aliphatic polyesters. VI. Lipase-catalyzed hydrolysis and visualized phase structure of biodegradable blends from poly(epsilon-caprolactone) and poly(L-lactide)

Phase-separated biodegradable polymer blends were prepared from poly(epsilon-caprolactone) (PCL) and poly(L-lactide) (PLLA), and Rhizopus arrhizus lipase-catalyzed hydrolysis and phase structure of the blend films were investigated. Gravimetry revealed that the lipase-catalyzed hydrolysis of PCL in PCL- and PLLA-rich phases is disturbed by the presence of PLLA. Polarimetry confirmed the occurrence of a predominant hydrolysis of PCL and subsequent removal of the hydrolyzed water-soluble PCL oligomers in the blend films. Gravimetry and gel permeation chromatography of the non-blended PLLA film indicated that R. arrhizus lipase has no catalytic effect on the hydrolysis of PLLA. The phase structure of the blend films could be visualized by selective enzymatic removal of one component and subsequent scanning electron microscopic observation.

Results of hyperamplification of centrosomes in naturally developing tumors of dogs

OBJECTIVE

To evaluate results of centrosome hyperamplification in naturally developing tumors of dogs.

SAMPLE POPULATION

Tumor specimens from 9 dogs with tumors (rhabdomyosarcoma, osteosarcoma, chondrosarcoma, myxosarcoma, and mammary gland tumor) and 2 canine osteosarcoma cell lines.

PROCEDURE

3 antibodies for centrosome proteins (ie, anti-gamma-tubulin, anti-BRCA1, and anti-pericentrin) were used for immunohistochemical analysis. Double immunostaining for centrosomes was used to confirm the specificity of these antibodies for centrosomes. Mutational analysis of the canine p53 gene was carried out by polymerase chain reaction-single-strand conformation polymorphism analysis, and expression of canine MDM2 protein was evaluated by use of immunohistochemical analysis, using anti-MDM2 antibody.

RESULTS

Immunohistochemical analysis of dog osteosarcoma cell lines with apparent aneuploidy revealed frequent hyperamplification of centrosomes in the osteosarcoma cell lines. Similar hyperamplified centrosomes were detected in the tumor tissues from all of the 9 tumors. The frequency of cells with hyperamplified centrosomes (3 to 20/cell) in each tumor tissue ranged from 9.50 to 48.1%, whereas centrosome hyperamplification was not observed in normal lymph nodes from these dogs. In 8 of the 9 tumors, mutation of p53 gene or overexpression of MDM2, or both, was detected.

CONCLUSIONS AND CLINICAL RELEVANCE

Various types of naturally developing tumors in dogs often have hyperamplification of centrosomes associated with chromosome instability. Hyperamplification of centrosomes is a novel tumor marker for use in cytologic and histologic examinations of clinical specimens obtained from dogs.

Molecular cloning of feline interferon-gamma-inducing factor (interleukin-18) and its expression in various tissues

Interleukin-18 (IL-18) is a cytokine with potent interferon-gamma-inducing activity, and plays an important biologic role in the enhancement of the activity of natural killer cells and cytotoxic T-lymphocytes. In this study, feline IL-18 cDNA was cloned and characterized to establish a basis for the prospective cytokine therapy in small animal practice. The nucleotide sequence of feline IL-18 cDNA obtained in this study was 712bp long and contained its entire open reading frame encoding 192 amino acid residues. The predicted amino acid sequence of feline IL-18 cDNA showed 77.2, 84.8, 60.2 and 62.6% similarity with those of human, dog, rat and mouse counterparts, respectively. The feline IL-18 cDNA included a putative cleavage site of IL-1beta-converting enzyme (ICE) and IL-1 signature-like sequences identified in human and mouse IL-18 cDNAs. Expression of IL-18 mRNA was detected in various tissues including spleen, liver and cerebrum in the cat.

Aberrations of the p53 tumor suppressor gene in various tumors in dogs

OBJECTIVE

To evaluate aberrations of the p53 tumor suppressor gene in naturally developing tumors in dogs.

SAMPLE POPULATION

Tumor specimens from 15 dogs with various tumors, including malignant lymphoma (7 dogs), monocytic leukemia (1), mammary gland adenoma (1), mammary gland benign mixed tumor (1), rhabdomyosarcoma (1), colon cancer (1), and osteosarcoma (3).

PROCEDURE

Aberrations of the p53 gene in these tumor tissues were examined by reverse transcriptase-polymerase chain reaction and single-strand conformation polymorphism analysis, using 3 fragments that covered the entire open reading frame of the canine p53 gene, followed by nucleotide sequencing of the abnormal bands.

RESULTS

Point mutations, deletions, and insertions resulting in a number of amino acid substitutions of wild-type p53 were detected in 7 of the 15 tumor specimens from dogs with malignant lymphoma, monocytic leukemia, rhabdomyosarcoma, colon cancer, and osteosarcoma. Of these 7 dogs, 2 had aberrations of the p53 gene on both alleles, whereas 5 had aberrations of the p53 gene on 1 allele and concurrently lacked the wild-type p53 transcript. Many of the aberrations of the p53 gene detected in these tumors were located in the transactivation, DNA binding, and oligomerization domains.

CONCLUSIONS AND CLINICAL RELEVANCE

Various naturally developing tumors in dogs often have inactivation of the p53 tumor suppressor gene, which may be 1 of the multiple step-wise genetic changes during tumorigenesis. This study indicates that p53 gene can be a target for gene therapy for tumors in dogs.

Molecular cloning of feline hepatocyte growth factor (HGF) cDNA

Hepatocyte growth factor (HGF) is a pleiotropic cytokine responsible for regeneration, development and maintenance of various organs, and growth, invasion and metastasis of tumor cells. A full-length feline HGF cDNA was cloned and sequenced by RT-PCR from cat liver. Feline HGF consists of 728 amino acid and contains alpha- and beta-chains encoded in a single open reading frame. The predicted amino acid sequence of feline HGF showed 93.2, 93.3 and 93.3% homology with those of human, mouse and rat HGF, respectively. The putative proteolytic processing site, all cysteine residues, and four potential glycosylation sites are conserved in all species. Therefore, feline HGF is expected to have a similar three-dimensional structure to human, mouse and rat HGF.

Ventricular outflow tracts after Kawashima intraventricular rerouting for double outlet right ventricle with subpulmonary ventricular septal defect

OBJECTIVE

To determine whether or not the ventricular outflow tracts can be efficiently constructed in patients with double outlet right ventricle with subpulmonary ventricular septal defect by the Kawashima intraventricular rerouting in which the morphologically right ventricular outlet is divided into two, one for the systemic and the other for the pulmonary circulations.

METHODS

The intraventricular rerouting procedure was carried out in nine patients with this particular malformation. Age at repair ranged from 35 days to 3 years old. The distance between the attachments of the tricuspid and the pulmonary valves was 10 mm or greater in all except one patient in whom the measured value was 3 mm. Resecting subaortic musculature appropriately, a tailored patch, either oval-shaped (in seven) or heart-shaped (in two), was placed to construct an unobstructed channel for the left ventricular outflow tract with its diameter greater than that of the anticipated normal aortic orifice at the time of repair. For an unobstructed channel to the pulmonary arteries, enlargement of the right ventricular outflow tract was carried out using a patch in six.

RESULTS

All patients survived the operative procedure. On postoperative catheterization, mean pulmonary arterial pressure was 15 +/- 8 mmHg, and cardiac index was calculated as 3.3 +/- 0.6 l/min per m2. It proved that the constructed left ventricular outflow tract can become larger in the longer term. Pressure gradient across the left ventricular outflow tract was greater than 20 mmHg in two patients in the intermediate term. One of these two underwent reoperation for the obstruction 10 years after the initial repair. It was suspected that use of a heart-shaped internal conduit, which seems to result from inadequate conal resection, was one of the possible causes of such obstruction in the longer term. Pressure gradient of 47 mmHg was seen across the right ventricular outflow tract in one patient, although this patient has undergone no reoperation. Enlargement of the right ventricular outflow tract could minimize postoperative obstruction for the pulmonary pathway.

CONCLUSIONS

The intraventricular rerouting remains one of the attractive surgical options for repair in this particular setting, in terms of successful construction of the ventricular outflow tracts.

Use of expanded polytetrafluoroethylene sutures as artificial tendinous cords in children with congenital mitral regurgitation

OBJECTIVE

To determine the efficacy in the intermediate term of artificial cords inserted in children with congenital mitral regurgitation.

METHODS

We reconstructed the tendinous cords using expanded polytetrafluoroethylene (ePTFE) sutures in 11 children with severe mitral regurgitation. In these patients, the aortic (anterior) leaflet of the mitral valve had been markedly prolapsed, the tendinous cords being partially lacking in seven, and elongated in the remaining four. In addition, one of the papillary muscles was hypoplastic in five and absent in three. The number of artificial cords constructed varied from two to six. Conventional annuloplasty was performed in all to plicate the dilated annular attachment of the valve. Ventricular septal defect was present in four patients, and other associated malformations in another two. Age at operation ranged from 9 months to 9 years old, with a mean of 4.5 years.

RESULTS

All patients survived the operation. No reoperation has been needed thus far. No complications were encountered related to the use of the prosthetic materials or anticoagulation. As judged by echocardiography, regurgitation became trivial or slight immediately after the repair. In two patients, however, regurgitation recurred within 1 year of the operation. Coaptation between the leaflets was maintained by a compensatory growth at the site of attachment of the artificial cords. Catheterization demonstrated significant improvements in the end-diastolic volume of the left ventricle.

CONCLUSION

Expanded polytetrafluoroethylene sutures can be used as artificial cords when attempting to repair the malformed mitral valve in children, providing excellent results in the short- and the intermediate-term after the surgical procedure.

[Long-term results of aortic root replacements with pulmonary autografts (Ross procedure) in five cases]

Aortic root replacement with a pulmonary autograft (the Ross Procedure) has been successfully performed in our hospital since November, 1992. The long-term results of five of the earliest cases are reported in this paper (2-3 year follow-up). The patients' ages were two months to eighteen years old. Four of the patients suffered from aortic valve stenosis, and one suffered from aortic regurgitation. Severe left ventricular failure was recognized in three cases. However, the patients recovered from surgery smoothly and without significant aortic regurgitation and left ventricular outflow tract gradients. A serious concern exist as to whether the implanted autograft in 2 months old infant would grow. In this patient, postoperative cardiac catheterization was performed after sixty days, one year, and two years. The diameter of the anulus of the pulmonary autograft enlarged from 12 mm to 18 mm over the period of two years. Compared with the calculated aortic valvular diameter from a standardized body surface area, these diameters were equivalent to 150%-162% of the standardized size at each age. The implanted pulmonary autograft has subsequently enlarged gradually and proportionally. Its function as an aortic valve was maintained even after significant enlargement of the aortic anulus to 18 mm. We therefore conclude that the Ross procedure can be recommended because of the apparent ability the pulmonary autograft to grow over time.

Establishment of total cavopulmonary connection without use of cardiopulmonary bypass

OBJECTIVE

To minimize deleterious postoperative influences of cardiopulmonary bypass on the pulmonary circulation immediately after the Fontan type procedure, total cavopulmonary connection was achieved without use of cardiopulmonary bypass.

METHODS

Since April 1996, 15 patients including five patients with visceral heterotaxy, in whom no intracardiac procedure was needed, have undergone this operative maneuver. Age at operation ranged from 1.2 to 44.6 years. Construction of a systemic to pulmonary shunt had been previously employed in seven patients, banding of the pulmonary trunk in two patients, and the Norwood procedure in one patient. The superior caval vein was initially anastomosed to the pulmonary arteries in bidirectional fashion under temporary bypass from the superior caval vein to the atrium. The channel for draining the inferior caval vein was subsequently constructed with the aid of temporary bypass from the inferior caval vein to the atrium, using a Goretex tube in ten patients, using a pedicled autologous pericardial roll in four patients, and directly anastomosing the pulmonary trunk to the orifice of the inferior caval vein in one patient. In patients with visceral heterotaxy and an independent hepatic venous drainage, redirection of the blood flow via the caval vein as well as the hepatic vein could be successfully achieved by placing dual temporary bypasses into these veins.

RESULTS

Postoperative courses were excellent in all patients. Superior caval venous pressure was 11 +/- 2 mmHg at 12 h after the operation. No blood transfusion was needed in nine patients(60%).

CONCLUSION

This alternative operative procedure is undoubtedly attractive when establishing the Fontan circulation in patients undergoing no intracardiac maneuvers.

Artificial chordae for mitral valve reconstruction in children

BACKGROUND

Congenital mitral regurgitation continues to present a challenge for cardiac surgeons because of the diversity of the anatomy of the congenitally malformed mitral valve. We undertook aggressive repair of the mitral valve with artificial chordae for reconstruction of the prolapsed anterior leaflet in some children. The short-term results are reported herein.

METHODS

Three patients with isolated congenital mitral regurgitation underwent mitral valve repair with use of expanded polytetrafluoroethylene sutures as artificial chordae.

RESULTS

There have been no late deaths and no valve-related complications. Serial follow-up echocardiographic examinations have not revealed any increase in the severity of mitral regurgitation with continuing patient growth up to 39 months after the operation.

CONCLUSIONS

When combined with other conservative methods of mitral valve repair, chordal replacement with expanded polytetrafluoroethylene sutures in children undergoing mitral valve reconstruction produces good short-term results. We believe that it delays and possibly prevents the need for a mechanical prosthesis with its associated complications in this young patient population.

Pulmonary circulation after biventricular repair in patients with major systemic-to-pulmonary collateral arteries

OBJECTIVE

To determine factors affecting postoperative pulmonary circulation in patients with major systemic-to-pulmonary collateral arteries.

METHODS

A total of 48 patients underwent biventricular repair subsequent to unifocalization at ages in the range 1-34 years. The preparative procedures consisted of ligation of the collateral arteries in 6, plasty to the pulmonary arteries using no artificial materials in 12 and extensive reconstruction using heterologous pericardial tubes in 30. The number of the pulmonary vascular segments unifocalized was 9-18 (16 +/- 3). The amount of flow draining via residual minute systemic-to-pulmonary collaterals measured at the time of repair was 4-58% (24 +/- 16%) of the total perfusion by the cardiopulmonary bypass machine.

RESULTS

This value was 40 +/- 16% in 5 patients dying in the short term after repair. The number of segments was nine or ten after unifocalization in 2 of these. Another 4 patients died in the longer term, 3 of these with CATCH 22 syndrome dying because of pulmonary hypertension. Postoperative catheterization demonstrated mean pulmonary arterial pressures in the range 8-40 (21 +/- 9) mmHg and pulmonary resistance in the range 1.7-10 (5.0 +/- 2.1) units/m2. Pulmonary resistance was correlated statistically to age at repair (r = 0.77), the number of pulmonary vascular segments (r = -0.41) and to percent collateral flow (r = 0.48). The use of a heterologous pericardial tube for unifocalization was also related probably to higher pulmonary resistance.

CONCLUSION

It is essential to accomplish effective unifocalizations followed by earlier definitive repair so as to establish better pulmonary circulation.

Spontaneous degranulation of cultured bone-marrow-derived immature mast cells from X-linked immunodeficient (Xid) mice

IgE-mediated, antigen-dependent stimulation of immature mouse mast cells cultured in IL-3-containing media produces secretion by granule exocytosis. Similar cultured mast cells were derived from X-linked immunodeficient (Xid) mice and examined by electron microscopy. In these cultures, Xid mast cells were also immature. In contrast to cultures obtained from control mice, 10-20% of the immature mast cells of Xid origin were undergoing secretion by granule extrusion in the absence of any secretogogue. Spontaneous secretion may be related to discordered tyrosine kinase function and/or signal transduction pathways in the Xid mouse.

Results of unifocalization for pulmonary atresia, ventricular septal defect and major aortopulmonary collateral arteries: patency of pulmonary vascular segments

Unifocalization, a surgical technique to unifocalize the pulmonary blood supply in patients with pulmonary atresia, ventricular septal defect and major aortopulmonary collateral arteries, is a useful preparative operation to extend the indication for corrective surgery. The preoperative and postoperative pulmonary angiograms of 51 patients (aged 3 months-26 years at first unifocalization, 29 males, 22 females), who underwent a total of 96 unifocalizations from December 1985 to July 1994, were studied to assess the effectiveness of each procedure of unifocalization. The procedures of unifocalization were ligation (9), angioplasty (6), direct anastomosis (25), bridging (6), additional central pulmonary artery creation (9), central pulmonary artery creation (36) and thrombectomy (5). Altogether 125 anastomoses were made, and the patency of 101 (80.2%) anastomoses was confirmed, 24 (19.2%) were shown to be occluded. The patency rate of the anastomoses between xenograft rolls and intrapulmonary arteries was 79.5% (70/88), while that between native central pulmonary arteries and intrapulmonary arteries was 83.8% (31/37; N. S.). The patency rate of the anastomoses involving intrahilar arteries was 88.0% (44/50), while that for the group involving extrahilar arteries only was 71.9% (46/64; P < 0.05). It is concluded that 1) unifocalization with the reconstruction of central pulmonary arteries using a pericardial roll is a useful method for patients with absent or hypoplastic central pulmonary arteries, 2) it is preferable to divide the fissures of lung in anastomosing pulmonary arteries of arborization abnormalities.

Effects of T-helper 2-type cytokines, interleukin-3 (IL-3), IL-4, IL-5, and IL-6 on the survival of cultured human mast cells

Although stem cell factor (SCF) has been identified as a critical cytokine for the development of human mast cells from their progenitors, the effects of other cytokines on human mast cells are less well understood. We examined the effects of several cytokines on the survival of human mast cells of 100% purity generated in suspension cultures of umbilical cord blood mononuclear cells in the presence of 100 ng/mL recombinant human (rh) SCF and interleukin-6 (IL-6). Mast cells suspended in conventional serum-containing medium died over a period of 2 to 6 days after the withdrawal of SCF and IL-6. The cells became pyknotic and underwent DNA fragmentation characteristic of apoptosis. The addition of SCF, IL-3, IL-4, IL-5, or IL-6 to the cultures in both serum-containing and serum-free medium prolonged their survival in a dose-dependent manner. Some other cytokines, such as IL-2, IL-9, IL-10, IL-11, tumor necrosis factor-alpha, transforming growth factor-beta 1, and nerve growth factor, had no survival-promoting effect at 100 ng/mL. Preincubation of mast cells with SCF, IL-4, IL-5, or IL-6 for 24 hours during sensitization with IgE enhanced IgE/anti-IgE antibody-induced histamine release from mast cells, whereas IL-3 showed a negligible effect. Polymerase chain reaction amplification of alpha-chains of IL-3 receptor (R), IL-4 R, IL-5 R, and IL-6 R yielded products of the correct size predicted from the sequence of each receptor. The binding assay using 125I-labeled IL-3 indicated that these mast cells bear receptors for IL-3. These findings suggest that IL-3, Il-4, IL-5, and IL-6, which are mainly produced by T-helper 2 lymphocytes, might regulate the functions of human mast cells in vivo via specific receptors in allergic reactions.

Ultrastructural analysis of the development of human basophils and mast cells in vitro

The ultrastructural analysis of a variety of culture systems of human cord blood mononuclear cells (spanning a 10-year research effort) is reviewed. Human basophils, eosinophils and mast cells reliably developed from their agranular precursors that are present in human cord blood. Suspension cultures and cocultures with fibroblasts were used to examine the effects on differentiation and maturation of full (fibroblast), interleukin-2-depleted (human T cells), and murine inducer T cell culture supernatants, partially purified mouse fibroblast factor(s), recombinant human interleukins 3 and 5, and recombinant human and murine c-kit ligands (stem cell factor, mast cell growth factor). Together, these studies allowed us to define the differentiation and full maturation of the basophil and eosinophil lineages and provided evidence for the induction of a form of secretion (termed piecemeal degranulation) of the basophil and eosinophil lineages in interleukin-3- or -5-supplemented cultures. Mast cells were absent from interleukin-3- or -5-containing cultures. The development of fully mature mast cells occurred regularly in fibroblast-containing cocultures; partially mature mast cells developed in fibroblast culture supernatant-, partially purified mouse fibroblast factor(s)-, and either recombinant human or murine c-kit ligand-supplemented suspension cultures. Small numbers of basophils and eosinophils were present in the suspension cultures that received c-kit ligand in its recombinant or naturally occurring forms. Ultrastructural immunogold analyses confirmed that basophils and eosinophils contained the Charcot-Leyden crystal protein (in different subcellular locations) but that mast cells did not. In both cocultures and suspension cultures, the primary event recorded for mast cells was that of differentiation and maturation, with the ultrastructural correlates of synthetic activity and granule building prevailing. Spontaneous secretory events, recognizable by ultrastructural analysis, were not evident in either mature or partially mature mast cells developing in these cultures.

Ultrastructural localization of major basic protein in the human eosinophil lineage in vitro

We examined the ultrastructural localization of (a) a secondary granule matrix protein--eosinophil peroxidase (EPO)--by cytochemistry, (b) a secondary granule core protein (major basic protein, MBP) by immunogold labeling, and (c) a primary granule protein (the Charcot-Leyden crystal protein, CLC protein) by immunogold labeling in eosinophilic myelocytes (EMs) and mature, activated eosinophils that differentiated from umbilical cord blood progenitors cultured in the presence of recombinant human interleukin-5 (rhIL-5). These studies provide the first substructural localization of MBP to condensing cores of immature secondary granules of EMs, as well as identification of unicompartmental, MBP-rich secondary granules that are devoid of matrix compartments and EPO content and are not primary granules by virtue of their lack of CLC protein. These granules occur in quantity in IL-5-activated mature human eosinophils, which have previously been shown to actively transport EPO from the matrix compartments of their secondary granules to the extracellular milieu in smooth membrane-bound cytoplasmic vesicles, a secretory process termed piecemeal degranulation, whereby eosinophils progressively empty cytoplasmic granules of their contents in the absence of classical granule extrusion.

Interleukin-4 inhibits the expression of Kit and tryptase during stem cell factor-dependent development of human mast cells from fetal liver cells

Although interleukin-4 (IL-4) in mice is known to augment the proliferation of mast cells and to modulate the expression of certain mast cell protease transcripts, its effect on human mast cells is less well understood. The current study examined the effects of recombinant human IL-4 (rhuIL-4) on stem cell factor (SCF)-dependent fetal liver-derived human mast cells in liquid culture. In no case did rhuIL-4 augment proliferation of mast cells. rhuIL-4 selectively inhibited certain aspects of the development of mast cells in cultures of fetal liver cells with rhuSCF. These include lower numbers and percentages of cells expressing tryptase and surface Kit, smaller cells, and lower contents of cells for tryptase, histamine, and Kit. Development of metachromasia was not attenuated. The downregulation of Kit, the surface receptor for SCF, is probably a critical factor, because cells lacking this molecule would not be able to respond to SCF. In contrast to mast cell progenitors, mast cells already developed in vitro from fetal liver cells are relatively resistant to rhuIL-4, but are still dependent for survival on the presence of rhuSCF.

[Inhaled nitric oxide after Fontan type operation]

The indication of Fontan type operation has been extending, but some cases on the boundary of the indication resulted in low cardiac output syndrome (LOS) postoperatively. Recently the inhalation of nitric oxide (NO) has been revealed to produce selective pulmonary vasodilatation, and it has come to be applied in the clinical setting. We experienced a case of 6-year-old boy with complex cardiac anomaly in whom the inhalation of nitric oxide was remarkably effective for the LOS caused by increased pulmonary vascular resistance after Fontan type operation. In the case various conventional treatments failed to improve his LOS during the weaning from a respirator on the second postoperative day. After the initiation of the inhalation of nitric oxide at a concentration of 6ppm, a rapid decreasing of pulmonary artery pressure concomitant with an improvement of hemodynamics were obtained. We concluded that the inhalation of nitric oxide is an effective strategy for the increased pulmonary resistance after Fontan type operation.

Stimulation of partial development of human mast cells by supernatant fluid from mouse fibroblast cultures

Fibroblasts have been implicated as culture-competent cells for the mast cell lineage in several species. In man, fibroblast monolayers sustain the ultrastructural phenotype and function of isolated human lung mast cells and permit the differentiation and full maturation of human mast cells from their agranular precursors in cord blood cells. We examined whether development and maturation of the mast cell lineage in man can be achieved by a supply of the soluble products present in fibroblast culture supernatants. Suspension cultures of cord blood cells were supplemented with culture supernatants derived from two different murine fibroblast lines; controls were not supplemented. The cultures were sampled for light and electron microscopy at 6, 7 and 8 weeks. Human mast cells developed in quantity when cultures were supplemented with the supernatants from BALB/c 3T3 fibroblasts, in reduced numbers when supplemented with Swiss Albino 3T3 fibroblast supernatants, and not at all in culture media alone. By ultrastructural criteria, the newly developed mast cells did not achieve full maturity; they did continue to synthesize new granules and to undergo intragranular maturational events. Small numbers of mature basophils persisted in suspension cultures, and many were undergoing piecemeal degranulation. Other cell lineages noted included eosinophils, neutrophils, macrophages and endothelial cells. We conclude that a factor(s) of fibroblast origin permits the differentiation and partial maturation of human mast cells from their agranular precursors in cord blood, but that fibroblasts must be physically present for complete maturation of these lineages to occur.

Characterization of cell phenotype by a novel cDNA library subtraction system: expression of CD8 alpha in a mast cell-derived interleukin-4-dependent cell line

We have established a unique variant cell line, MC/9.IL-4, which continuously proliferates in the presence of interleukin-4 (IL-4), from a murine interleukin-3 (IL-3)-dependent mast cell line, MC/9 (referred to as MC/9.IL-3). Compared with MC/9.IL-3 cells, MC/9.IL-4 cells are smaller, lack cytoplasmic granules and metachromasia, carry a very small amount of histamine, and express fewer high-affinity IgE receptors (IgERs) and IL-3 receptors. To further characterize MC/9.IL-4, we developed a novel method to enrich cell type-specific cDNAs by cDNA library subtraction and applied it for MC/9.IL-3 versus MC/9.IL-4. Sequence analysis of cDNA clones isolated by this technique showed that MC/9.IL-4 cells specifically express CD8 alpha and expression of mast cell-specific proteases and major histocompatibility complex class II (MHCII) is considerably decreased. It was also noted that responsiveness to the IL-3-agonistic antibody F9 and expression of the transcription factor GATA-2 is diminished in MC/9.IL-4, indicating that MC/9.IL-4 have lost major characteristics of the bone marrow-derived cultured mast cells. Because other T-cell marker antigens, CD8 beta, CD4, Thy-1, were not detected on MC/9.IL-4 cells, MC/9.IL-4 cells may represent an unknown class of hematopoietic cells that express CD8 alpha. This cell line will be useful in studies of IL-4-mediated signal transduction, as well as transcriptional regulation of mast cell characteristic genes. This study also demonstrates the effective use of the cDNA library subtraction strategy to characterize unknown types of hematopoietic cells at the molecular level.

Human eosinophils in vitro. An ultrastructural morphology primer

An ultrastructural morphological primer of human eosinophils is presented. Mature and immature eosinophils, obtained from peripheral blood and bone marrow, as well as activated tissue eosinophils are all used to illustrate the various morphologies assumed by eosinophils in vivo. The various ultrastructural changes expressed by this cell lineage in vivo reflect the impact of differentiation, maturation, activation, secretion, and cell injury on morphology. Nearly all of the changes described in vivo are also evident in eosinophils arising in in vitro systems. We review published studies of these culture systems, which have been supplemented with various conditioned media containing naturally occurring growth factor(s) that are permissive (or not permissive) for eosinophils or with the recombinant growth factors, IL-5 or IL-3. These studies were helpful in the recognition of eosinophil-promoting, -sustaining and -activating properties of human IL-3 and IL-5. Moreover, mature and immature eosinophils were shown to release a granule matrix protein--eosinophil peroxidase (EPO)--by its transport in small cytoplasmic vesicles, a process termed piecemeal degranulation (PMD), accounting for the gradual emptying of granule contents in the absence of granule fusions to the plasma membrane. Also presented are eosinophil morphologies that occur in vitro in suspension cultures of human cord blood supplemented with the c-kit ligand from various sources. The wide variety of eosinophil subcellular changes in the c-kit ligand-supplemented cultures, like the changes of which eosinophils are capable in vivo, reflects the processes of differentiation, maturation, activation, secretion and cell injury. Presentation of this ultrastructural morphological primer of human eosinophils in vitro should enable investigators to recognize eosinophils in all of their diverse morphologic forms in cultures that contain differentiating and functioning members of other lineages, also present in c-kit ligand-supplemented cultures. These lineages include mast cells, basophils, neutrophils, monocytes, macrophages, megakaryocytes, and endothelial cells.

Charcot-Leyden crystal protein distribution in basophils and its absence in mast cells that differentiate from human umbilical cord blood precursor cells cultured in murine fibroblast culture supernatants or in recombinant human c-kit ligand

Suspension cultures of human umbilical cord blood mononuclear cells supplemented with c-kit ligand-containing additives give rise to a mixture of cells belonging to several lineages. Among those that differentiate in quantity are mature basophils, immature mast cells, and neutrophilic myelocytes. We used an ultrastructural immunogold method to detect the Charcot-Leyden crystal (CLC) protein, an eosinophil- and basophil-specific protein, to study cells that were obtained at sequential times from 3 to 14 weeks in culture. Basophils (and eosinophils, which were present in smaller numbers) labeled for the CLC protein; mast cells did not. The labeled basophil subcellular sites included formed intragranular, cytoplasmic and nuclear CLCs, cytoplasmic particle-filled and homogeneously dense granules, cytoplasm, nucleus, plasma membrane, and cytoplasmic and Golgi area vesicles. Individual basophil ultrastructural phenotypes similar to those associated with stimulated release and recovery reactions showed the expected variations in the gold-labeled subcellular compartments. Macrophages also were labeled for CLC protein within endocytotic-lysosomal structures; neutrophilic myelocytes did not contain CLC protein. On the basis of findings reported here, the combined ultrastructural morphology and immunogold phenotyping of cells differentiating in c-kit ligand-supplemented cultures allows accurate lineage assignment of the developing cells.

Vesicular transport of peroxidase in human eosinophilic myelocytes

We performed ultrastructural cytochemistry to detect peroxidase in developmentally arrested human eosinophilic myelocytes. Human umbilical cord blood mononuclear cells were cultured for 21 days in the presence of murine-derived conditioned media, resulting in the development of eosinophilic myelocytes. Unlike normally developing eosinophilic myelocytes, which contain peroxidase in synthetic organelles (i.e. cisterns surrounding the nucleus and bounded by the rough endoplasmic reticulum and Golgi structures) and in immature and mature granules, the developmentally arrested cells showed ultrastructural evidence of decreased synthesis and secretory transport of peroxidase. Thus, peroxidase was generally absent in the perinuclear and rough endoplasmic cisterns, in Golgi structures, in immature granules and in the matrix compartment of most mature granules. Rather, biocompartmental specific granules displayed empty, peroxidase-negative matrix and central, peroxidase-negative core material. Peroxidase was present in perigranular vesicles, some of which were attached to granules. Such peroxidase-loaded transport vesicles are similar to those that effect piecemeal degranulation of mature human eosinophils cultured in rhIL-5-containing media [1]. These findings establish vesicle-mediated piecemeal degranulation in the secretory repertoire of immature human eosinophils and suggest the possibility that eosinophilic myelocytes may participate in vivo in important physiological and/or pathological events that require selective secretion from the specific granule matrix compartment.

C-kit ligand induction of immature neutrophils in cultures of human umbilical cord blood

Human cord blood cells cultured in suspension with soluble c-kit ligand produce immature mast cells from their agranular precursors; cocultures of cord blood and mouse 3T3 fibroblasts produce fully mature human mast cells. We noted cells of the neutrophil lineage in the c-kit ligand-supplemented suspension cultures. Similar cultures were prepared from individual cord bloods with several sources of the c-kit ligand, including mouse fibroblast conditioned media, a partially purified mouse 3T3 fibroblast factor(s), recombinant human stem cell factor, recombinant murine mast cell growth factor, and were sampled sequentially for routine and cytochemical ultrastructural studies. These studies show that peroxidase-positive azurophilic granule-containing neutrophilic myelocytes develop in quantity from their agranular precursors in cord blood when the c-kit ligand is present, but little to no maturation to mature neutrophils with specific granules occurs. Specific granules were also absent in the neutrophil precursors. The effect of c-kit ligand in vitro on two cell lineages in man is similar--i.e., it permits the development of immature cells to differentiate from their agranular precursors in cord blood, but complete maturation to fully mature mast cells or neutrophils does not occur.

Development of human mast cells from their progenitors

Two types of human mast cells, which are morphologically similar to skin mast cells and lung mast cells, respectively, can be developed from pluripotent stem cells under different culture conditions. The major growth factor for mast-cell development is c-kit ligand, which induces mastocytosis in vivo. However, this cytokine is not sufficient for full maturation of the cells.

Ultrastructural morphology of immature mast cells in sequential suspension cultures of human cord blood cells supplemented with c-kit ligand; distinction from mature basophilic leukocytes undergoing secretion in the same cultures

The ability to culture human mast cells and, thus, to determine their ontogeny and possible relationships to other lineages has been facilitated by new studies using cocultures of cord blood cells with mouse fibroblasts and recombinant human or murine c-kit ligand-supplemented suspension cultures of cord blood cells. In this study, we examined c-kit ligand-supplemented cord blood cell suspension cultures designed so that the effects of growth factor source, individual cord sample, and culture time (3-17 weeks) on the developing mast cell lineage could be individually evaluated. We found that human mast cells, basophils, neutrophils, eosinophils, macrophages, megakaryocytes, and endothelial cells were present in these cultures. The numbers of mast cells and their granules increased with culture time; mature basophils, present in quantity in 3-week cultures, decreased in number and released granule contents with increased culture times. The mast cell lineage developed similarly, regardless of which factor preparation was added to cultures, but considerable variability existed among individual donors from whom cord bloods were obtained. Unlike the mature, crystal-containing mast cells that regularly developed in fibroblast cord blood cocultures (Furitsu et al. [1989] Proc. Natl. Acad. Sci. USA 86, 10039-10043), human mast cells failed to attain full maturity in the suspension cultures examined here, regardless of individual cord sample, added growth factor, or culture time. Furthermore, unlike cells of the basophil lineage in which granule content release was regularly observed, morphologic evidence of secretion from human mast cells was absent. Instead, these cells were actively undergoing granule building as determined by the increasing numbers of granules and filling of these containers over culture time. Crystal granules never developed, even at the maximum culture time of 17 weeks. We conclude that fibroblasts are necessary and sufficient for the differentiation and maturation of human mast cells in vitro from their agranular precursors in cord blood but that soluble c-kit ligand is not.

[A case of constrictive pericarditis following graft replacement of the descending aorta under left ventricular bypass using a centrifugal pump]

We experienced a case of constrictive pericarditis following replacement of the descending aorta. It has been pointed out that constrictive pericarditis can be developed following LV bypass using centrifugal pump due to the cardiotomy. But no actual case has reported so far. The case was a 61-year-old man for whom graft replacement of the descending aorta through left thoracotomy was performed. Fever and heart failure was elicited 3 weeks after the operation, and he was diagnosed as constrictive pericarditis by chest CT and echocardiography. The reoperation was performed 39 days after the graft replacement. Anterior wall of the both ventricle and postero-lateral wall of the left ventricle were strongly adhered to the pericardium. The adhesion was entirely dissected and the thickened pericardium was resected. The post-operative course was uneventful and the patient was discharged 42 days after the reoperation.

Drug dissolution from indomethacin-starch hybrid powders prepared by the dry impact blending method

Indomethacin was hybridized with potato starch using a dry impact blending method. Resultant hybrid powders were investigated by scanning electron microscopy and X-ray powder diffraction. Amorphous indomethacin spread over the starch surface in a layer immediately after being hybridized, and then gradually reverted to fine crystalline particles adhering firmly to the starch surface. Indomethacin dissolution from the hybrid powder was compared with those from physical mixtures and granules taken from a commercially available capsule. Indomethacin dissolution from powder and capsule dosage forms, even in an acidic medium, was drastically accelerated by the hybridization.

[Report of a case of angiodysplasia of the sigmoid colon associated with aortic stenosis]

Partial sigmoidectomy and then after 84 days aortic valve replacement were performed as a staged operation on a patient with Heyde syndrome, consisting of aortic stenosis and angiodysplasia of the sigmoid colon. An emergent sigmoidectomy was performed because of continuous bleeding from angiodysplasia of the sigmoid colon. Postoperative arteriography showed the persistence of angiodysplasia. Endoscopic examination of the residual angiodysplasia was performed before and after valve replacement and there was no morphological change.

Phenotypic characterization of stem cell factor-dependent human foetal liver-derived mast cells

Human foetal liver cells are an enriched source of mast cell progenitors that complete their differentiation and mature in response to stem cell factor, the ligand for Kit, in liquid culture. These mast cells are Kit+, metachromatic with toluidine blue+, tryptase+, histamine+ and show ultrastructure features of mast cells. Using a panel of monoclonal antibodies (mAb) against different cell-surface antigens (33 mAb were used), the cell-surface phenotype of human stem cell factor-dependent foetal liver-derived mast cells was examined by flow cytometry. Consistent with previous reports on tissue-derived mast cells, those derived from foetal liver in vitro expressed HLA class I, CD9, CD29, CD33, CD43, CD45 and Kit. Unlike mast cells dispersed from tissue, a high expression of CD13 was found. Also, these in vitro-derived mast cells express little, if any, high-affinity IgE receptor. However, small amounts of mRNA for the alpha-chain in foetal liver-derived mast cells compared to KU812 cells (a human basophil-like cell line) could be detected by Northern blotting. Full expression of Fc epsilon RI may require additional growth factor(s).

[Experience with radical operation for lower thoracic esophageal cancer through left diagonal thoraco-laparotomy and right posterolateral thoracotomy]

Two cases were reported in which subtotal thoracic esophagectomy, total gastrectomy, splenectomy and distal pancreatectomy was performed for the lower thoracic esophageal cancer through right diagonal thoraco-laparotomy and left posterolateral thoracotomy. Reconstruction was done with the intrathoracic esophagojejunostomy. Extubation could be done on the 1st postoperative day, and postoperative course was uneventful. It was thought that the approach with left diagonal thoraco-laparotomy and right posterolateral thoracotomy was useful for the easy and complete lymph node dissection from the middle mediastinum to the intra-abdominal cavity.

[The effectiveness of preservation of hepatic arterial blood flow by modified Appleby procedure with reconstruction of the hepatic artery--serial changes in postoperative liver function]

We investigated whether modified Appleby procedure with reconstruction of the hepatic artery can avoid complications due to a decrease in heptic arterial flow which has been comprehended in conventional Appleby's operation. The postoperative liver function of 17 patients undergoing modified Appleby's procedure was compared with that of 16 patients undergoing total gastrectomy and distal pancreato-splenectomy (control group). (1) Anticoagulant therapy was not required during and after operation. The common hepatic arterial flow after vascular anastomosis was 396 +/- 101 ml/min. Postoperative celiac arteriography revealed good patency of anastomosis. (2) There were no significant differences between the modified Appleby group and the control group in any of the blood levels of GOT, GPT total bilirubin and alkaline phosphatase at any point until the fourth postoperative week. In none of the patients in the modified Appleby group, the blood levels of GOT and GPT exceeded 250 IU/l. (3) In the modified Appleby group, ICG-R15 was 4 +/- 1% before operation and 6 +/- 3% at the first postoperative month. These results suggested that modified Appleby procedure enabled us to perform resection according to Appleby's operation safely, without need for preoperative or intraoperative examination about the retrograde blood flow mediated by the gastrodudenal artery.

Human and murine recombinant c-kit ligands support the development of human mast cells from umbilical cord blood cells: ultrastructural identification

The recently identified ligand for c-kit, a protooncogene encoded by the W locus in mice, is a member of the tyrosine kinase receptor family with growth factor activity for mouse mast cells. Mature human mast cells regularly develop from agranular precursors in cord blood in long-term cocultures of cord blood and murine fibroblasts. Since the c-kit ligand is a product of murine fibroblasts, we examined the growth effect of recombinant human c-kit ligand (stem cell factor), of recombinant murine c-kit ligand (mast cell growth factor), and of a partially purified fraction derived from mouse fibroblast culture supernatant on the mast cell lineage of humans by electron microscopy in 8-week cultures of cord blood cells. We found that immature mast cells which developed in cultures containing the recombinant ligand for c-kit of human or murine origin as well as the naturally occurring c-kit ligand in 3T3 fibroblast supernatants were identical. Thus, each of these sources of the c-kit ligand exerted identical effects on the ontogeny of human mast cells as they develop from their agranular precursors in cord blood. Full maturity of factor-supported mast cells did not occur.

Serial changes in renal function during laparoscopic cholecystectomy

Intraoperative serial changes in systemic hemodynamic parameters and in the results of renal function tests were studied in 7 patients who underwent laparoscopic cholecystectomy (LAP) in which intra-abdominal pressure was maintained at 12 mm Hg, and in 7 patients who underwent minilaparotomy cholecystectomy (MINI). No significant changes were observed in the parameters in the MINI group during the operation. However, urine output, effective renal plasma flow and glomerular filtration rate in the LAP group were decreased 60 min after initiation of pneumoperitoneum.

Ultrastructural morphology of human mast cell progenitors in sequential cocultures of cord blood cells and fibroblasts

The ontogeny of human mast cells (HMCs) is not known, but agranular precursors committed to HMC development are present in cord blood mononuclear cells. Individual cord bloods were cocultured with murine fibroblasts and prepared for light microscopy, immunofluorescent determination of tryptase and electron microscopy after sequential times in culture. Mast cells and their progenitors were identified and quantitated during their evolution from agranular precursors in human cord blood. Each of these methods revealed similar numbers of HMC progenitors. The earliest, visible granule contents were particulate; later, scrolls superimposed on particulate materials were noted. HMC progenitors did not contain crystal granules, but fully mature HMCs present in long-term cocultures did. The developmental sequence for the evolution of the HMC lineage in vitro, made available by this new culture system, is identical to that described for the development of HMCs in vivo in sequentially examined samples of human fetal tissues.

Recombinant human stem cell factor stimulates differentiation of mast cells from dispersed human fetal liver cells

We have previously shown the development in vitro of tryptase+ human mast cells from fetal liver cells cocultured with murine 3T3 fibroblasts. In this study, recombinant human stem cell factor (rhuSCF), the ligand for the c-kit proto-oncogene product called Kit, stimulated the growth and differentiation primarily of mast cells from dispersed fetal liver cells, whereas recombinant human interleukin-3 (rhuIL-3) stimulated the differentiation of basophils along with other cell types. Cultures of fetal liver cells were initiated and maintained in the presence of rhuSCF or rhuIL-3 for up to 6 weeks. Metachromatic cells in cytospins were identified as mast cells primarily on the basis of tryptase expression, and as MCT or MCTC by immunohistochemistry using monoclonal antibodies against tryptase and chymase, whereas basophils were metachromatic, polymorphonuclear, and lacked these proteases. Levels of tryptase and histamine were measured by radioimmunoassay, tryptase and chymase activities by peptide hydrolysis, and cell surface Kit by flow cytometry with the monoclonal antibody YB5.B8. The predominant presence of mast cells occurred only in the cultures supplemented with rhuSCF. The percentage and total number of mast cells increased over time with increasing concentrations of rhuSCF and reached a plateau at 55 ng/mL. At this concentration of rhuSCF, mast cells first appeared by day 7; by day 42, 106% of the starting number of cells were present and 85% of these were tryptase+, 31% being weakly chymase+. These mast cells appeared immature by ultrastructural criteria; most cells were mononuclear, but some had nuclei with deeply divided lobes. DNA synthesis in tryptase+ mast cells at days 21 and 28 of culture with rhuSCF was demonstrated by incorporation of bromodeoxyuridine. Calculated levels of histamine (1.2 pg/mast cell) and tryptase (0.9 pg/mast cell) were similar to those determined previously in coculture experiments with murine 3T3 fibroblasts. Chymase activity was undetectable in most cell extracts. On day 0, 4% to 20% of fetal liver cells expressed cell surface Kit. In the presence of rhuSCF, the percentages and total numbers of Kit+ cells and the apparent concentration of Kit per cell increased along with the number of tryptase+ cells. In the presence of rhuIL-3, toluidine blue+, tryptase- cells first and maximally appeared at day 14 (11% +/- 2.5%). The percentage of these toluidine blue+ cells then declined to about 6% by days 21 and 35, while the total number of positive cells declined over 10-fold. Kit+ cells in the presence of rhuIL-3 declined from 9% on day 3 to 2% on day 35.(ABSTRACT TRUNCATED AT 400 WORDS)

Hemodynamic changes during laparoscopic cholecystectomy in patients with heart disease

Changes in the hemodynamics and urine output were investigated in 19 patients undergoing laparoscopic cholecystectomy, five of whom had heart disease with the New York Heart Association classification I (n = 1) and II (n = 4). Systemic blood pressure, central venous pressure, pulmonary capillary wedge pressure and cardiac output did not significantly change during the procedure including the establishment of pneumoperitoneum. Urine output 30-60 min after starting the pneumoperitoneum was significantly lower in the patients with heart disease compared to the values before and in the initial phase (0-30 min), and also to the values before and during the procedure in the control group. One patient suffered temporary cardiac decompensation following laparoscopic cholecystectomy which prolonged his hospital stay to seven days. The remaining four patients with heart disease could be discharged on the third or fourth day postoperatively. It is concluded that laparoscopic cholecystectomy is feasible in patients with heart disease but attention should be paid to the possibility of oliguria during prolonged pneumoperitoneum.

[A five-year-survival case in which complete response was recognized after combined chemotherapy using 5-fluorouracil, adriamycin and mitomycin C (FAM) for unresectable gastric cancer]

FAM (5-fluorouracil, adriamycin, mitomycin C) therapy was performed on a 65-year-old man with unresectable gastric cancer. Cancer cells have not been recognized by endoscopic biopsy after the patient's complete response. He is alive without metastasis of recurrence for five years.

Association of protein-tyrosine kinase with phospholipase C-gamma 1 in bone marrow-derived mouse mast cells

Bone marrow-derived mouse mast cells contain phospholipase C-gamma 1 (PLC-gamma 1), which is phosphorylated at tyrosine residues upon cross-linking of cell-bound IgE antibodies with multivalent antigen. It was found that immune complexes formed from digitonin lysates of the mast cells by monoclonal anti-PLC-gamma 1 antibodies contained protein-tyrosine kinase (PTK), which phosphorylated PLC-gamma 1 in vitro. The tyrosine kinase activity coprecipitated with PLC-gamma 1-anti-PLC-gamma 1 complexes markedly increased when the cell lysates were obtained immediately after antigen challenge. The results indicate that PTK is associated with PLC-gamma 1 in the mast cells and that the kinase is activated upon cross-linking of Fc epsilon RI. Neither beta nor gamma subunit of Fc epsilon RI nor src family PTK was coprecipitated with the PLC-gamma 1-anti-PLC-gamma 1 complexes. In situ denaturation/renaturation experiments, which detect autophosphorylated kinases, indicated that the PTK associated with PLC-gamma 1 was a 44-kDa protein.