Morphological features of the cervical ligament

PURPOSE

The purpose of this study was to clarify the morphological characteristics of the cervical ligament (CL).

METHODS

This study examined 80 legs from 40 Japanese cadavers. The CL was classified by the number of fiber bundles. The morphological features measured were fiber bundle length, width, thickness, and angle with the sagittal plane.

RESULTS

The CL was classified as follows: Type I, the CL is a single fiber; Type II, the CL consists of a superficial fiber and an inferior fiber; and Type III, the CL consists of a superficial fiber, intermediate fiber, and inferior fiber. Type I was seen in 15 feet, Type II in 57 feet, and Type III in 8 feet. In comparisons of morphological features within each type, significant differences were seen in fiber bundle length, width, and angle between superior fiber bundles and inferior fiber bundles of Type II and Type III. In comparison among types, the total fiber bundle width was significantly wider in Type II and Type III than in Type I, and the angle was significantly smaller in Type III than in Type I.

CONCLUSION

The results of this study suggested that each type may have different sub-talar joint control functions.

Serum modified HDL was associated with cardiovascular disease in a Japanese community-based cohort

Background

Previous studies have shown that high density lipoprotein (HDL) is protective against cardiovascular disease (CVD). However, recent studies suggested that function of HDL was more important than HDL cholesterol levels. The present study aimed to clarify the relationship between modified HDL levels and CVD incidence.

Methods

LOX-1 (lectin-like oxidized LDL receptor) is the receptor that mediates modified LDL (low density lipoprotein) activity; however, some lipoproteins with apolipoprotein A1 (Apo A-1) are also bonded to LOX-1. In this study, serum LOX-1 ligand containing Apo A-1 was defined as modified HDL, which were measured by our new development method. We conducted a nested case-control study in a Japanese cohort study, involving 11,002 community dwellers. During 4.0 years follow-up, we observed 127 new CVD onsets. For each CVD case, age and sex matched three controls were randomly selected (N = 381). Serum samples collected at baseline survey stored at − 80 °C were used for the measurement of modified HDL. We estimated multivariable-adjusted odds ratio (OR) and 95% confidence interval (CI) for the association between modified HDL levels and CVD by conditional logistic regression.

Results

Modified HDL levels were associated with increased risk of CVD (OR for one unit increase of log transformed modified HDL, 2.05: 95% CI, 1.16-3.62) after adjustment for body mass index, hypertension, diabetes, LDL cholesterol, HDL cholesterol, lipid lowering agents, chronic kidney disease, smoking and alcohol drinking. The magnitude of OR was almost equivalent to those of hypertension and diabetes, which were 2.33 (95% CI, 1.37-3.98) and 2.61 (95% CI, 1.48-4.59), respectively. On the other hands, other lipids markers showed relatively weak associations with CVD.

Conclusions

Serum modified HDL, i.e., LOX-1 ligand containing Apo A-1, might be a novel predictive marker for CVD in apparently healthy individuals.

Key messages

Recent epidemiologic studies suggested that function of high-density lipoprotein (HDL) was more important than HDL cholesterol level itself to predict cardiovascular disease. Modified HDL measured by a novel cell-free, non-fluorescent method as LOX-1 ligand containing Apo A-1, was a predictive marker for CVD after adjusting for other traditional risk factors.

Morphological features of the posterior intermalleolar ligament

PURPOSE

In the present study, the posterior intermalleolar ligament (PIML) was classified by type using large-scale cadavers to provide basic information to help elucidate the mechanism of ankle joint posterior impingement syndrome.

METHODS

This investigation examined 100 legs from 49 Japanese cadavers (mean age at death, 79 ± 11 years; 58 sides from men, 42 from women). In the classification method, an absent PIML was classified as Type I, a PIML with one fiber bundle (attachment to one place) was Type II, a PIML with two fiber bundles (attachment to two places) was Type III, and a PIML with three fiber bundles (attachment to three or more places) was Type IV. Furthermore, according to other adhering tissues, they were further subdivided and classified by type.

RESULTS

There were various types of PIML: 19 (19%) Type I; 24 (24%) Type II; 23 (23%) Type III; and 34 (34%) Type IV. A PIML was present in 81 legs (81%). There were no significant differences between men and women and between left and right sides.

CONCLUSIONS

The complex relationships of the PIML with the surrounding ligaments and tissues are considered to be among the factors that make interpretation of imaging findings difficult.

Short-chain fatty acids induce tissue plasminogen activator in airway epithelial cells via GPR41&43

BACKGROUND

Chronic rhinosinusitis (CRS) is a heterogeneous chronic inflammatory disease generally divided based on the presence or absence of nasal polyps (NPs). One of the features of NPs is excessive fibrin deposition, which is associated with down-regulation of tissue plasminogen activator (t-PA) in NPs. As t-PA is expressed in epithelial cells, and epithelium is readily accessible to topical therapies, identifying compounds that can mediate the induction of t-PA would be a potential new strategy for the treatment of NPs.

OBJECTIVE

The objective of this study was to determine whether short-chain fatty acids (SCFAs) can induce t-PA in airway epithelial cells via their known receptors GPR41 and GPR43.

METHODS

We performed immunohistochemistry (IHC) to determine whether receptors for SCFAs, known as G protein-coupled receptor 41/free fatty acid receptor 3 (GPR41/FFAR3) and GPR43/FFAR2, are expressed in nasal tissue. Primary normal human bronchial epithelial (NHBE) cells were stimulated with different concentrations of SCFAs to test induction of t-PA, which was analysed by expression of mRNA and protein. Mediation of responses by SCFA receptors was evaluated by specific receptor gene silencing with siRNA.

RESULTS

Immunohistochemistry study revealed that airway epithelial cells expressed GPR41 and GPR43. Acetic acid, propionic acid, butyric acid and valeric acid significantly induced t-PA expression from two- to tenfolds. The strongest inducer of t-PA from NHBE cells was propionic acid; cells stimulated with propionic acid released t-PA into the supernatant in its active form. Gene silencing of GPR41 and GPR43 revealed that induction of t-PA by SCFAs was dependent upon both GPR41 and GPR43.

CONCLUSIONS AND CLINICAL RELEVANCE

Short-chain fatty acids were shown to induce airway epithelial cell expression of t-PA via GPR41 and GPR43. Topical delivery of potent compounds that activate these receptors may have value by reducing fibrin deposition and shrinking nasal polyp growth.

Anatomical study of the inferior patellar pole and patellar tendon

In this study, detailed investigations into the shape of the inferior patellar pole, the site of the patellar tendon attachment, and the length and course of the patellar tendon were performed with the aim of examining the anatomical factors involved in the developmental mechanism of patellar tendinitis. The investigation examined 100 legs from 50 cadavers. The inferior patellar pole was classified into three types: pointed, intermediate, and blunt. The attachment of the patellar tendon to the inferior patellar pole was classified into two types: an anterior and a posterior. The length of the patellar tendon was measured from the tibial tuberosity to the inferior patellar pole. The pointed type was seen in 57% of legs, the intermediate type in 21%, and the blunt type in 22%. Twenty-one legs were the pointed type, as well as the anterior type. The patellar tendon was significantly shorter with the posterior type than with the anterior type. The blunt type also had a significantly shorter patellar tendon than the pointed type. In legs that were both the pointed type and the anterior type, the inferior patellar pole and the proximal posterior surface of the patellar tendon impinged during knee flexion due to the posterior tilt of the patella, suggesting the possibility that this may induce damage. With the posterior type and blunt type, on the other hand, the possibility of strong tensile stress on the tendon fibers of the posterior facet of the inferior patellar pole was suggested.

Gender differences of muscle and crural fascia origins in relation to the occurrence of medial tibial stress syndrome

Although women reportedly have a higher prevalence of medial tibial stress syndrome (MTSS) than men, the possible role of gender-based anatomical differences has not been investigated. The aim of the present study was to investigate the presence of gender-based differences in the range of muscle attachments along the entire medial tibia, the proportion of muscle attachment at the middle and distal thirds of the medial margin of the tibia, the structure of the crural fascia, and chiasm position. The specimens were 100 legs of 55 Japanese cadavers. Statistical analysis was carried out using a chi-square test to compare anatomical features between the sexes. The flexor digitorum longus (FDL) had a higher proportion of attachment to the middle and distal thirds of the medial margin of the tibia than the soleus (SOL; P < 0.001). The proportion of the SOL attachment to the middle and distal thirds of the medial margin of the tibia was 33.3% in men and 72.5% in women (P < 0.001). The soleal aponeurosis was not observed in any specimen. In all specimens the FDL formed the top layer of both chiasms. These results suggest that the higher prevalence of MTSS reported among women may be the result of gender-based anatomical differences.

Novel scoring system and algorithm for classifying chronic rhinosinusitis: the JESREC Study

Background

Chronic rhinosinusitis (CRS) can be classified into CRS with nasal polyps (CRSwNP) and CRS without nasal polyps (CRSsNP). CRSwNP displays more intense eosinophilic infiltration and the presence of Th2 cytokines. Mucosal eosinophilia is associated with more severe symptoms and often requires multiple surgeries because of recurrence; however, even in eosinophilic CRS (ECRS), clinical course is variable. In this study, we wanted to set objective clinical criteria for the diagnosis of refractory CRS.

Methods

This was a retrospective study conducted by 15 institutions participating in the Japanese Epidemiological Survey of Refractory Eosinophilic Chronic Rhinosinusitis (JESREC). We evaluated patients with CRS treated with endoscopic sinus surgery (ESS), and risk of recurrence was estimated using Cox proportional hazard models. Multiple logistic regression models and receiver operating characteristics curves were constructed to create the diagnostic criterion for ECRS.

Results

We analyzed 1716 patients treated with ESS. To diagnose ECRS, the JESREC scoring system assessed unilateral or bilateral disease, the presence of nasal polyps, blood eosinophilia, and dominant shadow of ethmoid sinuses in computed tomography (CT) scans. The cutoff value of the score was 11 points (sensitivity: 83%, specificity: 66%). Blood eosinophilia (>5%), ethmoid sinus disease detected by CT scan, bronchial asthma, aspirin, and nonsteroidal anti‐inflammatory drugs intolerance were associated significantly with recurrence.

Conclusion

We subdivided CRSwNP in non‐ECRS, mild, moderate, and severe ECRS according to our algorithm. This classification was significantly correlated with prognosis. It is notable that this algorithm may give useful information to clinicians in the refractoriness of CRS before ESS or biopsy.

Clinicopathological and immunohistochemical features of extragastrointestinal stromal tumors: report of two cases

CD117 (c-kit proto-oncogene protein product) is expressed in most gastrointestinal stromal tumors (GISTs) and plays a crucial role in the pathogenesis and treatment of this disease. However, the clinicopathological and immunohistochemical features of CD117-positive mesenchymal tumors without connection to the gastrointestinal tract, known as extragastrointestinal stromal tumors (EGISTs), are not well documented because these tumors are rare. We describe the clinicopathological and immunohistochemical features of two cases of EGIST and compare them with those of GIST. Of the 1855 abdominal or esophageal tumors resected during the past 10 years at our hospital, 23 were GISTs and 2 were EGISTs. The clinicopathological or immunohistochemical characteristics do not seem to differ remarkably between EGISTs and GISTs. Although rare, CD117 positivity should be tested in abdominal mesenchymal tumors that have no connection to the gastrointestinal tract. The clinicopathological features of CD117-positive abdominal mesenchymal tumors may not depend on whether the tumor is connected to the gastrointestinal tract.

A Case of Postoperative Recurrence of Fibrolamellar Hepatocellular Carcinoma with Increased Vitamin B12 Binding Capacity in a Young Japanese Female

A 17-year-old Japanese female underwent major hepatic resection for a huge fibrolamellar hepatocellular carcinoma that was compressing the inferior vena cava. The tumor was not exposed at the surgical margin but was very close to it. A recurrent lesion at the surgical margin of the liver and a lymph node metastasis were discovered 9 months postoperatively together with a marked elevation of vitamin B12 binding capacity. These lesions were resected, and vitamin B12 binding capacity decreased thereafter. Peritoneal dissemination was detected by CT 16 months postoperatively, together with recurrent elevation of vitamin B12 binding capacity. Several types of chemotherapy, including intraperitoneal injection of epirubicin, were applied and improved the patient's quality of life somewhat, but the patient died of recurrent disease 34 months after the initial hepatic resection. This is the first report in Japan of fibrolamellar hepatocellular carcinoma with increased vitamin B12 binding capacity as a useful marker. Fibrolamellar hepatocellular carcinomas, if resected, have a better prognosis than ordinary hepatocellular carcinoma in Japan, as well as in Western countries. An aggressive strategy should be chosen, which consists mainly of precise surgical resection and postoperative multimodality therapy, including chemotherapy.

Interleukin-1 upregulates anaphylatoxin receptors on mononuclear cells

BACKGROUND

The anaphylatoxins, C3a and C5a, that are generated during trauma, major surgery, or infection are potent proinflammatory mediators that increase interleukin (IL-1) cytokine synthesis. We investigated the effects of IL-1 on anaphylatoxin receptor expression in monocytes.

METHODS

A human monocytic cell line, MONO-MAC-6, was used. C3a and C5a binding sites were assayed by competitive binding. Levels of messenger RNA for the C3a and C5a receptors were analyzed by reverse transcriptase-polymerase chain reaction. Changes of free cytosolic Ca(2+) concentration ([Ca(2+)]i) in response to C3a and C5a were measured.

RESULTS

Basal MONO-MAC-6 cell sites for C3a and C5a binding were 10900 C3aR/cell (K(d)=2.0 nmol/L), 8700 C5aR/cell (K(d)=0.9 nmol/L). IL-1alpha increased sites for both C3a (61% increase; P <.01) and C5a (71% increase; P <.001). Levels of C3aR and C5aR messenger RNA also increased in IL-1alpha-stimulated cells. Receptors were coupled to functional responses, which were demonstrated by C3a- or C5a-induced [Ca(2+)]i increases. IL-1 receptor antagonist blocked the effects of IL-1alpha upregulation of anaphylatoxin receptors.

CONCLUSION

These results suggest that there is an additional link between IL-1 and anaphylatoxins to amplify proinflammatory effects through monocytes and macrophages. Although C3a and C5a can increase the monocyte production of IL-1, IL-1 increases monocyte expression of receptors for these anaphylatoxins, which further amplifies inflammation.

New transhepatic biliary drainage procedures for safe intubation and early extubation

BACKGROUND/AIMS

The conventional transhepatic biliary drainage method requires a long period of tube placement and a technically difficult intubation.

METHODOLOGY

New transhepatic biliary drainage methods were applied in cases undergoing an open choledochotomy. The drainage tube was placed transhepatically using a newly developed, rigid and J-shaped needle (J-Needle) with a vertical, ventral and rotating penetration at the proximal hepatic duct. The tube was then introduced directly to the extraperitoneal space by attaching the parietal peritoneum to the liver surface without tube-fixation (extraperitoneal transhepatic tube method).

RESULTS

These procedures were applied in 50 patients. The J-Needle was easily and safely inserted without any complications. In the 39 analyzed cases, the patients were safely extubated on postoperative day 7 and discharged around postoperative day 10.

CONCLUSIONS

The combination of the J-Needle and the extraperitoneal transhepatic tube method is useful for safe transhepatic biliary intubation and early extubation, enabling a shorter hospital stay for patients requiring biliary surgery.

A novel approach to the prevention of postoperative delirium in the elderly after gastrointestinal surgery

PURPOSE

Postoperative delirium (POD) is known to be one of the most critical complications of major operative procedures in elderly patients. Since disorders of the sleep-wake cycle have been reported to be one of the key factors in POD, we attempted to clarify the effectiveness of improving sleep-wake cycle disorders with medication after surgery to prevent POD, by conducting a prospective randomized study of 42 elderly patients who underwent resection of either gastric or colon cancer through an open laparotomy.

METHODS

The delirium-free protocol (DFP) group was given an intramuscular injection of diazepam at 20:00 h each night, as well as a continuous intravenous infusion of flunitrazepam and pethidine administered over 8 h, for the first three nights postoperatively. Two patients were excluded because of failure to complete the DFP.

RESULTS

The incidence of POD was 7/20 (35.0%) in the non-DFP group and 1/20 (5.0%) in the DFP group, this difference being significant (P = 0.023). Morning lethargy produced by the DFP was observed in 40% of the DFP group; however, no other side effects were seen.

CONCLUSIONS

These findings indicate that DFP treatment is effective for controlling POD in elderly patients after general surgery and does not appear to be associated with severe complications or side effects. To our knowledge, this is the first report proposing artificial control of the sleep-awake rhythm by medication as a means of preventing POD in elderly patients.

Characterization of cytochrome b(5) in the ascidian Polyandrocarpa misakiensis and budding-specific expression

A cDNA for cytochrome b(5) was cloned from a cDNA library of buds of the ascidian, Polyandrocarpa misakiensis, by a hybridization method involving a digoxigenin-labeled cDNA probe of human soluble cytochrome b(5). The nucleotide sequence of the cDNA for the ascidian cytochrome b(5) (Pmb5) consisted of about 1,800 base pairs including 5'- and 3'-noncoding regions, and a coding sequence of 405 base pairs. The amino acid sequence of 135 residues deduced from the coding nucleotide sequence exhibited 54% identity and 76% similarity to chicken cytochrome b(5). A highly conserved amino acid sequence was observed in the amino-terminal domain of 96 residues containing two heme-binding histidine residues. The putative soluble form of the recombinant Pmb5 expressed in Escherichia coli was purified to homogeneity by column chromatographies on an anion-exchanger and gel filtration. The purified Pmb5 showed the typical absorption spectrum of cytochrome b(5) with an asymmetric peak at 556 nm and a shoulder at 560 nm upon reduction with NADH and NADH-cytochrome b(5) reductase. The low temperature spectrum of the dithionite-reduced form of the protein contained the split peaks at 551 and 555 nm, this spectrum being very similar to that of mammalian liver cytochrome b(5). Expression of Pmb5 in the ascidian was examined immunohistochemically with a monoclonal antibody against the Pmb5. Apparently high level expression of Pmb5 was found in the developing buds, but the levels of cytochrome b(5) in the parents and juvenile adults were very low. This is the first report on the characterization of Pmb5, and the increased expression of Pmb5 in the ascidian.

Conventional tumor markers are prognostic indicators in patients with head and neck squamous cell carcinoma

We tested for squamous cell carcinoma-related antigen (SCC), carcinoembryonic antigen (CEA), ferritin, immunosuppressive acid protein (IAP) and sialic acid in the serum from 247 patients with head and neck squamous cell carcinoma prior to therapy. Significant correlations were found between IAP and tumor size, lymph node metastasis, and clinical stage (P<0.0001, P<0.001, and P<0.0001). Also, sialic acid and SCC were also correlated with tumor size, lymph node metastasis, and clinical stage. Moreover IAP, sialic acid and SCC were strongly associated with survival rate (P<0.0001, P = 0.0230 and P = 0.0159). A multivariate Cox proportional hazard model demonstrated that being positive for IAP was an independent predictor for patients with H&NSCC (P = 0.0115). The results indicate that IAP, sialic acid and SCC are useful as prognostic factors.

Obstructive jaundice caused by a huge liver cyst riding on the hilum: report of a case

A 71-year-old man presented to our hospital with obstructive jaundice, found to be caused by a huge liver cyst which was centrally located and riding on the hilum. Percutaneous transhepatic cyst drainage was performed, following which obstruction of the bile duct was relieved and the jaundice subsided. As jaundice recurred after removal of the drainage tube, the patient underwent deroofing, since when he has remained well. Only 13 cases of liver cysts producing obstructive jaundice have been reported in the English literature, most of which were characteristically enormous, located centrally, and riding on the hilum. Liver cysts possessing such features are likely to cause obstructive jaundice by compressing the hepatic hilum. Cyst drainage is helpful for ameliorating the jaundice and making an accurate diagnosis; however, subsequent deroofing or injection therapy is necessary to prevent recurrence.

Both C3a and C3a(desArg) regulate interleukin-6 synthesis in human peripheral blood mononuclear cells

Synthesis of complement components is part of the acute-phase response. Interleukin-6 (IL-6) is a critical mediator of the acute-phase response during infections and injuries. Plasma levels of C3a and IL-6 have been proposed as prognostic indicators in sepsis and trauma. The effects of C3a and C3a(des)Arg on IL-6 gene expression and protein production in human peripheral blood mononuclear cells (PBMC) were investigated. Neither C3a nor C3a(des)Arg alone induced detectable IL-6 protein or mRNA levels. However, C3a and C3a(des)Arg affected endotoxin-induced IL-6 synthesis in a dose-dependent manner. In nonadherent PBMC, C3a or C3a(des)Arg suppressed, while in adherent PBMC, C3a or C3a(des)Arg enhanced IL-6 protein and mRNA levels. These results suggest that C3a and C3a(des)Arg may provide a control mechanism of acute-phase responses by enhancing IL-6 synthesis in adherent monocytes at local inflammatory sites and by inhibiting IL-6 synthesis in circulating monocytes.

Anti-interleukin-8 monoclonal antibody reduces free radical production and improves hemodynamics and survival rate in endotoxic shock in rabbits

BACKGROUND

Although high levels of interleukin-8 (IL-8) have been found in patients with sepsis and a monoclonal antibody (MoAb) against IL-8 has been successfully used in some animal models of inflammation, no specific therapeutic agent against IL-8 has been tested for the treatment of sepsis. We studied the effects of a MoAb against IL-8 in the treatment of endotoxic shock with a prospective randomized rabbit endotoxic shock model.

METHODS

Twenty New Zealand white rabbits were anesthetized and divided into four groups: normal, anti-IL-8, control-Ab, and lipopolysaccharide (LPS). Anti-IL-8 and control-Ab groups received a MoAb (immunoglobulin G, 3 mg/kg) 5 minutes before the LPS injection. All groups, except the normal group, received a continuous 20-minute infusion of LPS (500 micrograms/kg). The normal group received NaCl (0.9%) rather than LPS.

RESULTS

The 7-day survival rates were 100% for normal group, 80% for anti-IL-8 group, 40% for control-Ab group, and 0% for LPS group. Compared with the LPS group, anti-IL-8 rabbits had a smaller decrease in mean arterial blood pressure (p < 0.05) and increased urinary volume (p < 0.05). Anti-IL-8 rabbits had lower plasmatic levels of IL-1 beta, less free radical production (p < 0.05), and a higher survival rate (p < 0.01).

CONCLUSIONS

IL-8 plays a significant role in endotoxic shock, and IL-8 blockage results in attenuation of the hypotensive and tachypneic effects of LPS, reduced free radical production, and an increased survival rate after lethal endotoxic shock.

A new biologic role for C3a and C3a desArg: regulation of TNF-alpha and IL-1 beta synthesis

The complement activation products C3a and C3a desArg are generated in the course of trauma, infection, tissue injury, and ischemia. We have investigated the effects of C3a and C3a desArg on gene expression and protein synthesis of TNF-alpha and IL-1 beta in PBMC. Neither C3a nor C3a desArg alone induced detectable protein or mRNA levels for TNF-alpha and IL-1 beta. C3a modulated LPS-induced TNF-alpha and IL-1 beta synthesis. In nonadherent PBMC, C3a suppressed LPS-induced synthesis of TNF-alpha (20-71% decrease by 0.2-10 microgram/ml of C3a, p less than 0.01) and IL-1 beta (19-57% decrease by 0.5-10 microgram/ml of C3a, p less than 0.01), independently of endogenous production of PGE2. C3a also suppressed LPS-induced mRNA levels for TNF-alpha and IL-1 beta. In contrast, in adherent PBMC, C3a at 5 to 20 microgram/ml enhanced LPS-induced TNF-alpha (75-188% increase, p less than 0.001) and IL-1 beta (119-274% increase, p less than 0.001) synthesis. C3a enhanced TNF-alpha and IL-1 beta mRNA levels in LPS-stimulated adherent cells. Furthermore, C3a desArg shared with C3a the ability to modulate LPS-induced mRNA and protein synthesis for TNF-alpha and IL-1 beta. These results suggest that C3a, thought to be proinflammatory, and C3a desArg, thought to be biologically inactive, are modulators of inflammation. Both C3a and C3a desArg may enhance cytokine synthesis by adherent monocytes at local inflammatory sites, while inhibiting the systemic synthesis of proinflammatory cytokines by circulating cells.

A new biologic role for C3a and C3a desArg: regulation of TNF-alpha and IL-1 beta synthesis

The complement activation products C3a and C3a desArg are generated in the course of trauma, infection, tissue injury, and ischemia. We have investigated the effects of C3a and C3a desArg on gene expression and protein synthesis of TNF-alpha and IL-1 beta in PBMC. Neither C3a nor C3a desArg alone induced detectable protein or mRNA levels for TNF-alpha and IL-1 beta. C3a modulated LPS-induced TNF-alpha and IL-1 beta synthesis. In nonadherent PBMC, C3a suppressed LPS-induced synthesis of TNF-alpha (20-71% decrease by 0.2-10 microgram/ml of C3a, p less than 0.01) and IL-1 beta (19-57% decrease by 0.5-10 microgram/ml of C3a, p less than 0.01), independently of endogenous production of PGE2. C3a also suppressed LPS-induced mRNA levels for TNF-alpha and IL-1 beta. In contrast, in adherent PBMC, C3a at 5 to 20 microgram/ml enhanced LPS-induced TNF-alpha (75-188% increase, p less than 0.001) and IL-1 beta (119-274% increase, p less than 0.001) synthesis. C3a enhanced TNF-alpha and IL-1 beta mRNA levels in LPS-stimulated adherent cells. Furthermore, C3a desArg shared with C3a the ability to modulate LPS-induced mRNA and protein synthesis for TNF-alpha and IL-1 beta. These results suggest that C3a, thought to be proinflammatory, and C3a desArg, thought to be biologically inactive, are modulators of inflammation. Both C3a and C3a desArg may enhance cytokine synthesis by adherent monocytes at local inflammatory sites, while inhibiting the systemic synthesis of proinflammatory cytokines by circulating cells.

[Antibiotic resistance of clinical isolates Streptococcus pneumoniae]

Streptococcus pneumoniae is a major pathogenic organism of community-acquired bacterial pneumonia as well as otitis media and bacterial meningitis. Recently penicillin- or multiply resistant pneumococci have been isolated worldwide. In this study we examined the susceptibility tests of 11 antibiotics with the total of 63 clinically isolated pneumococci, using a broth microdilution method. Most of pneumococci were isolated from respiratory specimens. According to NCCLS standard, all these pneumococci were classified as follows: PCG-susceptible S. pneumoniae (PSSP, MIC < or = 0.06 micrograms/ml), PCG-intermediately resistant S. pneumoniae (PISP, 0.12 < or = MIC < or = 1.0 micrograms/ml), and PCG-highly resistant S. pneumoniae (PRSP, MIC > or = 2.0 micrograms/ml) were 45 (71.4%), 14 (22.2%) and 4 isolates (6.4%), respectively. Forty-four percent of isolates from children under 10 years and 29% from outpatients were PISP or PRSP. Resistance to erythromycin (EM) clindamycin (CLDM) or minocycline (MINO) was significantly recognized, but not correlated with that to PCG. On the other hand, the resistance to beta-lactam antibiotics were correlated with that to PCG. Seventeen isolates (27%) were resistant to two or more antibiotics among PCG, EM, MINO, ofloxacin (OFLX), and sulfamethoxazole-trimethoprim (ST). In pneumococcal infection, we always have to pay a careful attention to susceptibility test before we choose antibiotics.

Structural aberrations of metaphase derivative chromosomes from reciprocal translocations as revealed by scanning electron microscopy

Metaphase chromosomes from three reciprocal translocation carriers were examined by scanning electron microscopy. A gap was detected in one of the two derivative chromosomes in each carrier. The position of each gap was identical with that of the respective breakpoint of the derivative chromosome to which the longer chromosome fragment was translocated. The gap length resembled a midsize G-band. Our observations suggest that derivative chromosomes of reciprocal translocations involve aberrations of a high-ordered structure of chromatid fibers at the translocation sites.

Familial pericentric inversion incidentally detected at prenatal diagnosis

A case of familial heterozygous pericentric inversion of chromosome 1 [inv(1)(p13q23)] is presented. The inversion was incidentally detected in a fetus whose mother received prenatal chromosomal diagnosis due to her age (40 years old), and thereafter the same inversion was detected in the father whose phenotype was normal. No abnormalities were found in the phenotype of the newborn carrier. Semen analysis of the father revealed normal findings. The couple had no history of spontaneous abortion.

[Risk of chromosomally unbalanced progeny in prenatal diagnoses of reciprocal translocation carrier]

To obtain new criteria for presuming the existence of chromosomally unbalanced progeny in reciprocal translocation carrier couples, the obstetrical histories of 57 couples were analysed. The chromosomally unbalanced progeny who had been prenatally or postnatally diagnosed were mainly partial trisomies. In contrast with partial trisomies, there were only a few cases of partial monosomies and there were only two cases of chromosomal imbalance derived from 3:1 segregation in gametogenesis. Moreover, the percentage of haploid autosome length (%HAL) of the maternal carriers whose progeny had suffered from chromosomal imbalance was significantly smaller than those of the maternal carriers who had not had progeny with chromosomal imbalance. Based on these results, the following criteria were obtained: 1) Partial trisomies tend to be maintained in pregnancy but partial monosomies do not; Most chromosomally unbalanced zygotes which were induced by 3:1 segregated gametes tend to be spontaneously selected in early pregnancy; 3) When interchanged segments of chromosomes are small in maternal reciprocal translocation carriers, chromosomally unbalanced fetuses tend to be maintained in pregnancy.

Paracentric inversion of chromosome 14: a case report

A new case of familial heterozygous paracentric inversion in the long arm of chromosome 14 [inv(14)(q22q32)] is presented. The rearrangement was first ascertained in a fetus examined due to advanced maternal age, and then detected in the father. The phenotypes of the newborn and the father were completely normal. The parents had no history of spontaneous abortion. With reference to previous reports, the risk of clinical abnormalities are discussed for both de novo and familial paracentric inversions of chromosome 14.

Western blot analysis of glycoproteins bearing Lewis(a) and sialyl-Lewis(a) antigens in human colorectal mucosa

Glycoproteins (GPs) bearing Lewis(a) and sialyl-Lewis(a) antigens (Le(a), sialyl-Le(a)) derived from human colorectal carcinomas and their surrounding non-neoplastic mucosa (normal mucosa) were analyzed using Western blotting. GPs bearing Le(a) were detected mainly as segmental bands of M(r) 310, 220, 160, and 80 kDa in 80% of the normal mucosa, but these GPs were detected predominantly as broad bands ranging from high to low molecular weight (MW) in 71% of the carcinoma tissues. GPs bearing sialyl-Le(a) were detected only in 23% of the normal mucosa and limited on huge MW bands, i.e., more than 400 kDa, whereas these GPs were detected predominantly as broad bands in 49% of the carcinoma tissues. In the cases with lymph node metastasis, the MW of GPs bearing sialyl-Le(a) varied over a wide range and were detected as broad bands, compared with the cases without metastasis. In conclusion, the MW of GPs bearing Le(a) and sialyl-Le(a) in normal colorectal mucosa was different from that in colorectal carcinomas. That is, the MWs of GPs bearing Le(a) varied more in carcinoma tissues, and the GPs bearing sialyl-Le(a) from carcinoma tissues had lower MWs than those from normal mucosa. It was, furthermore, suggested that the increased expression of lower MW GPs bearing sialyl-Le(a) are associated with an increased metastatic potential of the tumor cells.

Sister chromatid exchanges in mouse after exposure to pulse-wave ultrasound in utero

The induction of sister chromatid exchanges (SCEs) was investigated in mice after a ten min exposure, in vivo, to 2 MHz focused, pulse-wave ultrasound with a pulse repetition rate of 1000 Hz, pulse duration of 10 microseconds. The bone marrow cells of the pregnant female mice and the fetal liver cells were analyzed. The cell cycle specific metaphase patterns were additionally evaluated. In the bone marrow cells, the mean frequencies of SCEs were 2.77 in control, 3.56 in the cells exposed to ultrasound at 586.2 mW/cm2 (spatial average temporal average, SATA); in the fetal liver cells, 2.64 in control, 3.84 in the cells exposed. The frequencies of SCEs significantly were increased by the treatment. Faster cell kinetics was observed in fetal liver cells than bone marrow cells of pregnant female. But there was no cell-growth inhibitory effect of ultrasound on both bone marrow and fetal liver cells. In fetal liver cells, the critical acoustic power was 160.0-278.9 mW/cm2 (SATA).

A case of a female infant with simultaneous occurrence of de novo terminal deletions on chromosome 14q and 20p

This is a case report on an infant with de novo terminal deletions on the long arm of chromosome 14 and on the short arm of chromosome 20 [46, XX, del(14)(q32)del(20)(p11)]. Examination revealed that the infant had a peculiar face, a cleft and high palate, abnormal dentition, butterfly-like vertebral defects, finger anomalies, a simian line on the left hand, talipes equinovarus, deep plantar furrows, abnormally high values of alkali phosphatase and lactate dehydrogenase, mild anemia and psychomotor retardation. Comparing the present case with previously reported cases of a single deletion on chromosome 14q or chromosome 20p, the infant showed some symptomatic and dysmorphic features of both deletions.

The outcome of pregnancy and prenatal chromosomal diagnosis of fetuses in couples including a translocation carrier

In order to evaluate the relation between chromosomal translocation and the outcome of pregnancy, 50 couples were examined. Subjects consisted of 35 couples that included a reciprocal translocation carrier; 13 included a Robertsonian translocation carrier and 2 included a carrier of a mosaic reciprocal translocation. The reasons for performing chromosomal examinations were mainly infertility and abnormality of neonates. The rates of miscarriages and neonatal abnormalities in prior pregnancies were significantly higher than the birth rate of morphologically normal newborns. The presence of a translocation is closely related to reproductive failure because of the chromosomal imbalance. However, prenatal chromosomal examination after the 15th gestational week in subsequent pregnancies revealed that almost half of the fetuses showed normal karyotypes and only 12.8 per cent of the fetuses showed a chromosomal imbalance. Many chromosomally imbalanced fetuses are spontaneously aborted before amniocentesis. The risk of chromosomal imbalance is relatively low in prenatal diagnosis, but partial trisomies of small rearrangements tend to be preserved.

Pericentric inversion of chromosome 9 in prenatal diagnosis and infertility

In order to evaluate the relation between pericentric inversion of chromosome 9 (inv(9)) and clinical problems, the characteristics of inv(9) were investigated on the basis of chromosomal analyses of fetuses and infertile couples. The incidence of such inversion in fetuses with parents having an offspring who suffered from various clinical problems was significantly higher than the basic incidence obtained in fetuses karyotyped by reason of advanced maternal age. In the chromosomal examination of the parents whose fetuses were diagnosed as inv(9), it was revealed that either parent might be the carrier. Furthermore, in the inv(9) carrying fetuses, the number of females was significantly greater than that of males. Analysis of infertile couples revealed that the incidence of such inversion in males was significantly higher than the basic incidence mentioned above. Moreover, infertile couples with an inv(9) carrier showed a significantly higher incidence of intrauterine fetal death, compared with infertile couples with a translocation carrier or those in which the etiology was unknown. These results indicate that inv(9) may often cause clinical problems in offspring of the carrier and infertility with unknown mechanisms related to sex.

[Immunological mechanism of pregnancy and miscarriage--a study with a murine spontaneous miscarriage model]

In order to investigate the immunological mechanisms of pregnancy, fluorocytometric and immunohistochemical analysis of the cells was performed in the placenta and spleen of a murine spontaneous miscarriage model (CBA/J x DBA/2) and control (CBA/J x BALB/c). There was a significant difference between the miscarriage rate for the miscarriage model and that for the control, even though H-2 in these two group is matched. The analysis also was performed in a miscarriage model immunized with male splenocytes. Moreover, the effect of gamma-interferon, a potentiator of NK cell activity, on pregnancy was examined. Interferon treatment increased the miscarriage rate. In pregnancy, the number of splenocyte positive Asialo-GM1 or LFA-1 decreased and the intensity of these antigens decreased, as well. Interleukin-2R positive cell increased in number as well as intensity. In the miscarriage model group successfully treated by immunization, the number of Asialo-GM1 positive cells and L3T4 positive cells decreased, whereas they increased in the unsuccessfully treated group. Asialo-GM1 positive cells in the placenta of successful pregnancy decreased in number, and those in miscarried pregnancy increased. In conclusion, the success of the immunization treatment for habitual abortion depends on how to suppress NK cell activity in a linkage with the helper T-cell.

[Incidence of fetal chromosomal aberration in prenatal cytogenetic examination]

One thousand forty-seven fetal samples were obtained from women who received the prenatal cytogenetic examination for different reasons. In this study, the incidence of fetal chromosomal aberration related to each reason was analyzed. The incidence of de novo chromosomal aberration in the fetuses of the higher maternal age group was 1.5% (8/525: 4 cases of 21-trisomy, 2 cases of 18-trisomy and 2 cases of 47,XXY). The incidence in the group of women who had borne (a) chromosomally abnormal child(ren) was 0.5% (1/202). There was no repeat of 21-trisomy, 18-trisomy or 13-trisomy in this study. The incidence in the group of women who had ultrasonographic abnormalities was 16.9% (26/154). In this study, abnormal amniotic fluid volume, intrauterine growth retardation, malformation, hydrops fetalis, intestinal obstruction, omphalocele, single cord artery and cerebellar hypoplasia were related to chromosomal aberrations. The incidence in the group of women whose husband or herself was cytogenetically abnormal was 40.0% (26/65). This high value indicated that parental translocation and inversion are easily transmitted to their offspring.

Effects of a medicinal herbal liqueur, "yomeishu", on post-operative gynecological patients

We administered 20 ml of Yomeishu (YMS) twice a day before meals for 12 weeks to 50 post-operative patients in gynecology and then inquired into their subjective 20 symptoms (sense of fatigue, insomnia, headache and heavy headedness, appetite, stomach-ache, abdominal inflation, vertigo, lumbago, etc.) The YMS group showed a significant improvement on 14 items compared with the control group. On the whole, a great improvement was observed in the YMS group with serious subjective symptoms as well, and there were significant differences for general condition, sense of fatigue, and coldness in extremities.

[Hepatic arterial infusion chemotherapy using totally implantable reservoir in liver metastases in colorectal cancer]

Hepatic arterial infusion chemotherapy using totally implantable reservoir was performed for the treatment of liver metastases of colo-rectal cancers, and the therapeutic effects, side effects and complications were evaluated. Reservoir catheters were implanted into hepatic artery via gastroduodenal artery during operation. Mitomycin C (MMC), adriamycin (ADM), and 5-fluorouracil (5-FU) were used as chemotherapeutic agents. Eleven cases of H1 (metastases in one lobe only), 7 cases of H2 (a few scattered metastases in both lobes) and 12 cases of H3 (multiple metastases in both lobes) were treated intermittently with one-shot administration of MMC or ADM (A-group). Ten cases (H1: 1, H2: 2, H3: 7) were treated with intermittent one-shot administration of MMC or ADM following two-week continuous infusion of 5-FU through infusion pump after operation (B-group). In 5 of 10 cases of B-group, serum CEA level fell below the preoperative level, and the tumor size regressed in 3 of those 5 cases which were evaluated on the basis of CT scan. But no remarkable change in CEA level or tumor size on CT scan was seen in A-group. No particular side effect such as leucopenia, liver dysfunction or gastroduodenal symptom was noted except one case developing multiple gastric ulcers and pancreatitis in B-group. Five cases (25%) showed obstruction of catheter and 3 cases (14%) evidence leakage of chemotherapeutic agents in A-group. Three cases (30%) in agents in A-group. Three cases (30%) in B-group displayed obstruction of gastroduodenal artery beyond the tip of catheter. Median survival time of both groups (A, B) was 6 months and 12 months, respectively. The treatment seemed effective for the improvement of serum CEA level and tumor size, and there was a tendency toward prolongation of survival time in B-group.

[Screening for chromosomal anomalies with maternal serum alpha-fetoprotein]

Between July 1, 1986 and January 31, 1988, genetic amniocentesis was performed on 205 patients. The maternal serum alpha-fetoprotein (AFP) and amniotic fluid AFP levels were measured by enzyme immunoassay. Gestational dates were confirmed by sonography, and AFP results were expressed as multiples of the median (MOM). The median of maternal serum AFP from 15 to 17 weeks of gestation was 43.4, 62.6 and 72.5 ng/ml. Three fetuses with chromosomal anomalies were diagnosed; trisomy 21, 4p trisomy, and trisomy 18 (trisomy 18 was in one fetus of a twin pregnancy; the other fetus was normal). Maternal serum AFP levels were, 0.41, 0.49 and 1.30 MOM. Maternal serum AFP less than 0.5 MOM in normal pregnancies was 1/205 (0.5%) and less than 0.6 MOM was 9/205 (4.4%). There was no relationship between maternal serum AFP and amniotic fluid AFP levels. Our results are in agreement with the majority of the results in the literature, showing that maternal serum AFP levels are lower in association with autosomal trisomy fetuses.

[Transcatheter arterial chemoembolization and selective hepatic arterial infusion using totally implantable reservoir]

Transcatheter arterial chemoembolization (TAE) and hepatic arterial infusion using totally implantable reservoir were performed for the treatment of liver metastasis of colo-rectal cancers, and their therapeutic effects, side effects and complications were evaluated. Eleven cases of H1 (metastasis in one lobe only), 7 cases of H2 (a few scattered metastases in both lobes), 12 cases of H3 (numerous metastases in both lobes) were entered into the study and underwent TAE 45 times. Gel foam, Ivaron and Lipiodol were used as embolic materials in combination with chemotherapeutic agents such as mitomycin C and adriamycin. Serum CEA level was decreased less than 50% of pre-TAE level 20 out of 32 (61%). The tumor size was regressed in 25% of TAE cases which were evaluated on the basis of CT scan. Abdominal symptoms including abdominal pain, nausea and vomiting and fever, leukocytosis, elevated GOT, LDH and bilirubin level were seen after TAE therapy. Median survival of H1, H2 and H3 cases were 21 months, 8 months and 4.5 months, respectively. Another 21 cases (H1, 5 cases: H2, 3 cases: H3, 13 cases) of liver metastasis of colo-rectal cancers were treated with selective hepatic arterial infusion therapy using totally implantable reservoir. Reservoir catheters were implanted into hepatic artery via gastroduodenal artery under direct vision at laparotomy. Mitomycin C, adriamycin and fluorouracil (5-FU) were used as chemotherapeutic agents. No particular side effect such as leukopenia or liver dysfunction was noted. Median survival of H1, H2 and H3 cases treated with arterial infusion were 4 months, 9 months and 9 months, respectively. Median survival of TAE cases and arterial infusion cases was 10 and 6 months, respectively. Thus, the survival rate of cases treated with TAE was better than that of cases treated with arterial infusion.

Prenatal diagnosis of partial trisomy 22 derived from a maternal t(11; 22) (q23; q11)

A fetus with partial trisomy 22 was detected by amniocentesis in a pregnant woman with balanced translocation, 46, XX, t(11; 22) (q23; q11). The aborted fetus had multiple congenital anomalies consisting of microcephaly, cleft lip and palate. The extra acrocentric chromosome was identified as der (22), t(11; 22) (q23; q11). The aborted fetus is compared with other trisomic cases described in literatures, and perinatal diagnosis of this case was discussed.

Legibility study of multiplexed twisted nematic LCDs based on colorimetry and matching tests

The effect of driving waveform, reflective vs backlit transmissive mode, and contrast polarity, on the legibility of a multiplexed twisted nematic (TN) LCD were investigated. The backlit transmissive mode with a white display pattern on dark background (W/B contrast) resulted in superior display legibility, while the reflective mode TN LCD with a dark display pattern on white background (B/W contrast) resulted in the second best legibility. The maximum legibility was obtained at a lower operating voltage for the LCD with W/B contrast compared with the B/W contrast; we believe this can be attributed to the nonlinear response of the human eye.