Coexistence of ovarian cancer and peritoneal tuberculosis: a case report

Peritoneal tuberculosis (TB) is known to mimic advanced ovarian cancer. In this case report, we describe a unique case of ovarian cancer (endometrioid carcinoma grade 3) at the International Federation of Gynecology and Obstetrics (FIGO) stage IC1 with pulmonary and peritoneal TB, which was suspected preoperatively to be a coexistence of advanced ovarian cancer and pulmonary TB. A 68-year-old woman presented with a prominent abdominal mass and fever. Laboratory investigations, imaging, and sputum analysis indicated a probable diagnosis of ovarian cancer at FIGO stage IIIC, characterized by peritoneal dissemination and para-aortic lymph node metastasis, which was further complicated by coexisting pulmonary TB. Surgical management included total abdominal hysterectomy, bilateral salpingo-oophorectomy, and partial omentectomy. Intraoperatively, the tumor was localized to the right ovary with significant peritoneal thickening and adhesions indicative of peritoneal TB. The surgery was completed without apparent complications. Postoperative histopathological evaluation confirmed grade 3 endometrioid carcinoma in the right ovary along with evidence of peritoneal TB. Given the extent of adhesions attributed to TB, lymph node dissection for staging was deemed challenging and was thus not pursued. Initiation of anti-TB treatment on postoperative day 2 resulted in marked regression of the preoperatively identified pulmonary nodules and para-aortic lymph node enlargement, suggesting their inflammatory origin from TB. Although postoperative chemotherapy is typically advocated for patients with stage IC1 endometrioid carcinoma grade 3, the patient opted against it. Consequently, no adjuvant therapy was administered and the patient remained under close observation.

Successful fertility preservation in stage II endometrial carcinoma with long-term progestin therapy: A case report

Progestin therapy is a fertility-sparing treatment option for well-differentiated stage IA endometrioid carcinomas without myometrial invasion. Here, we present a case of successful pregnancy and live birth following long-term progestin therapy in a patient with stage II well-differentiated endometrioid carcinoma. A 30-year-old nulliparous woman with an unremarkable medical history presented with abnormal uterine bleeding. A 45 mm mass was identified in the lower uterine segment. An endometrial biopsy revealed grade 1 endometrioid carcinoma, leading to a diagnosis of stage II uterine corpus cancer based on hysteroscopic findings. The patient refused surgical treatment and underwent oocyte retrieval and cryopreservation at another hospital. A subsequent endometrial biopsy revealed a marked reduction in the Ki-67 index from approximately 60 % to less than 10 %, suggesting the possibility of a hormone-sensitive tumor. The patient persistently refused surgery. Therefore, progestin therapy with medroxyprogesterone acetate (MPA) at a dose of 400 mg/day was initiated as a temporary measure until the patient would accept surgery. The tumor gradually reduced in size and eventually disappeared after 9 months. The MPA therapy was discontinued uneventfully after 20 months. Sixteen months after the discontinuation of MPA therapy, atypical endometrial hyperplasia was detected, and a second round of MPA therapy was initiated. Progestin retreatment was successful and was discontinued at 6 months. Four years after the initial treatment, the patient achieved pregnancy through timed intercourse and delivered a healthy baby at 38 weeks of gestation.

Vaginal malignant peripheral nerve sheath tumor treated with complete surgical resection and postoperative radiation therapy

Malignant peripheral nerve sheath tumors (MPNSTs) are neoplasms originating from or differentiating into nerve sheaths of peripheral nerves. Vaginal origin is rare, with only six vaginal primary cases reported to date. A 55-year-old woman presented to our hospital with a 7 cm vulvar mass. Tumor biopsy results were suspicious of sarcoma, and pelvic magnetic resonance imaging and hysterofiberscopy showed that the tumor originated from the lower vagina. The mass was transvaginally excised, and histological examination confirmed the diagnosis of a vaginal MPNST with negative surgical margins. The patient underwent radiotherapy because the risk of recurrence was high, owing to the large tumor size and high mitotic index. The patient remained recurrence-free for 1 year after the primary treatment. This is the first case of a high-risk vaginal MPNST that avoided early disease recurrence with additional radiotherapy after complete tumor resection.

Multidirectional Traction Method Using SURGICEL NU-KNIT and Surgical Suture in Robot-assisted Laparoscopic Surgery for Endometrial Cancer

OBJECTIVE

To describe a novel approach to robot-assisted laparoscopic total hysterectomy (RH) for endometrial cancer that minimizes cancer sell spillage and develops a stable surgical field.

DESIGN

Demonstration of the multidirectional traction method with narrated video footage.

SETTING

Many reports have indicated that RH for endometrial cancer has the same or superior short-term results compared with conventional laparoscopic hysterectomy (LH), and the long-term prognosis is the same [1,2]. However, there are no randomized controlled trials of RH versus LH, and some previous reports [3] have suggested that RH has a worse prognosis than LH, so the long-term prognosis should be considered with caution. Factors that may affect the long-term prognosis include the use of uterine manipulators [4] and compression of the uterine body with robotic forceps without tactile sensation [3]. However, to the best of our knowledge, no surgical technique capable of avoiding these factors has been established yet. Herein, we report a multidirectional traction method using SURGICEL NU-KNIT (Ethicon; Johnson & Johnson Medical Ltd., Tokyo, Japan), a local hemostatic agent, and surgical sutures.

INTERVENTION

Cut 2-0 Prolene (Ethicon; Johnson & Johnson Medical Ltd., Tokyo, Japan) with straight needles (ST-70) thread to 35 cm, stick a 1 × 2 cm piece of SURGICEL NU-KNIT, and make knots Fig. 1. This implement is used to puncture the incisional margins of the peritoneum and then the abdominal wall to bring the thread to the surface of the body, where it is grasped with forceps and fixed. By repeating this operation, multidirectional traction can be obtained Fig. 2. A manipulating suture is also attached to the uterus to minimize the compression of the uterine body with robotic forceps.

CONCLUSION

The multidirectional traction method allows for reproducible stable surgical field development and minimizes cancer cell spillage by reducing uterine grasping by robotic forceps without the use of uterine manipulators.

The impact of assisted reproductive technology on the risk of postpartum hemorrhage: Difference by the mode of delivery and embryo transfer

AIM

The frequency of postpartum hemorrhage (PPH) is increasing in developed countries, and some reports suggest that assisted reproductive technology (ART) increases various perinatal complications, including PPH. We investigated whether the effect of ART pregnancies on the incidence of PPH is modified by the mode of delivery.

METHODS

A retrospective cohort study was performed. We analyzed the medical records of 2914 pregnant women, including 411 pregnancies achieved by ART, which were delivered in our hospital from 2017 to 2020. PPH was defined as hemorrhage exceeding the 90th percentile of blood loss per the mode of delivery and number of fetuses. Multivariable logistic regression analysis was used to assess the association between ART and PPH. Propensity score-matched analyses were used to assess the difference in the incidence of PPH by the mode of delivery.

RESULTS

As previously reported, multivariable logistic regression analysis showed that ART pregnancy is an independent risk factor for PPH. Propensity score-matched analysis for with and without ART showed a 3.39-fold higher incidence of PPH for ART pregnancy in the vaginal delivery group (p < 0.001).

CONCLUSIONS

The effect of ART pregnancies on the incidence of PPH differed depending on the mode of delivery. Only in vaginal delivery, ART pregnancy increased the incidence of PPH.

Exploring Attractiveness of the Basic Sciences for Female Physicians

In Japan, traditional gender roles of women, especially the role of motherhood, may cause early career resignations in female physicians and a shortage of female researchers. Besides this gender issue, a general physician shortage is affecting basic science fields. Our previous study suggested that female physicians could be good candidates for the basic sciences because such work offers good work-life balance. However, the attractiveness for female physicians of working in the basic sciences, including work-life balance, is not known. In a 2012 nationwide cross-sectional questionnaire survey, female physicians holding tenured positions in the basic sciences at Japan's medical schools were asked an open-ended question about positive aspects of basic sciences that clinical medicine lacks, and we analyzed 58 respondents' comments. Qualitative analysis using the Kawakita Jiro method revealed four positive aspects: research attractiveness, priority on research productivity, a healthy work-life balance, and exemption from clinical duties. The most consistent positive aspect was research attractiveness, which was heightened by medical knowledge and clinical experience. The other aspects were double-edged swords; for example, while the priority on research productivity resulted in less gender segregation, it sometimes created tough competition, and while exemption from clinical duties contributed to a healthy work-life balance, it sometimes lowered motivation as a physician and provided unstable income. Overall, if female physicians lack an intrinsic interest in research and seek good work-life balance, they may drop out of research fields. Respecting and cultivating students' research interest is critical to alleviating the physician shortage in the basic sciences.

A case of laparoscopy-assisted vaginal cuff suturing for vaginal cuff dehiscence after total laparoscopic hysterectomy

INTRODUCTION

Vaginal cuff dehiscence after hysterectomy is a rare complication and occurs in less than 1% of patients. It can present with serious complications, such as bowel evisceration and peritonitis.

PRESENTATION OF CASE

A 51-year-old multigravida Korean woman underwent total laparoscopic hysterectomy for leiomyoma. Six months later, she reported lower abdominal pain and vaginal bleeding. Physical examination revealed rebound tenderness in the lower abdomen, and pelvic examination showed a small amount of vaginal bleeding with an evisceration of the small intestine through the vagina that exhibited healthy peristalsis. The eviscerated bowel, which seemed to be a part of the ileum, was carefully manually reduced transvaginally into the abdominal cavity. Laparoscopic observation revealed adhesions between the omentum, small intestine, and the peritoneum. Specifically, the small intestine was adhered around the vaginal cuff. An abdominal abscess was found in the left lower abdominal cavity. An adhesiotomy was performed and the abdominal abscess was removed and irrigated. Complete separation of the anterior and posterior vaginal cuff edges was obtained. The vaginal cuff was closed with interrupted 0-polydioxanone absorbable sutures without bowel injury. A 6-month follow-up examination revealed complete healing of the vaginal cuff.

DISCUSSION

In this case, we were able to make use of both laparoscopic and transvaginal methods to perform a successful repair with a minimally invasive and safe technique.

CONCLUSION

Laparoscopically assisted vaginal cuff suturing for vaginal cuff dehiscence after total laparoscopic hysterectomy was found to be effective, safe, and minimally invasive.

Successful delivery after abdominal radical trachelectomy followed by adjuvant chemotherapy for advanced invasive uterine cervical cancer: a case report and literature review

Uterine cervical cancer is increasingly prevalent among young Japanese women who are eager to preserve their fertility, and abdominal radical trachelectomy (ART) is often performed in patients with early-stage invasive lesions. Herein we present details of a 27-year-old woman with stage IB1 cervical cancer. Although the patient received ART, histopathological findings revealed a parametrial invasion. Hence, 3 courses of adjuvant chemotherapy with paclitaxel and carboplatin (TC) were administered, and the patient conceived spontaneously 44 months later. Rupture of the membrane occurred at 32 weeks and 4 days, and a 1822 g female baby was delivered by emergency cesarean section. The patient is alive without disease and her child is growing favorably. This case demonstrates the balance between preservation of fertility and curative adjuvant chemotherapy after ART.

[A Clinical Comparison of Continuous Sciatic Nerve Block and Epidural Anesthesia for Postoperative Pain Control in Patients with Fracture of the Foot]

BACKGROUND

Epidural analgesia provides good pain relief for patients with fracture of the foot Ultrasound-guided peripheral nerve block offers safety and efficacy without affecting the leg.

METHODS

We compared the continuous sciatic nerve block with the continuous epidural anesthesia regarding postoperative pain after the open reduction and internal fixation (ORIF) of the ankle fracture or calcaneal bone fracture.

RESULTS

Fifteen patients were included in the epidural group (group E), and 17 patients in the sciatic nerve block group (group S). The postoperative pain scores were significantly lower in group S 3 hours and 12 hours after the procedure, and tended to be lower in other periods. Perioperative periods were uneventful in both groups.

CONCLUSIONS

Continuous sciatic nerve block developed good postoperative analgesia in ORIF of ankle fracture or calcaneal bone fracture compared with continuous epidural anesthesia.

[Suspected case of peripartum cardiomyopathy during perioperative period--a case report]

A 31-year-old primigravida was admitted for control of twin gestation and delivery. At 36-week gestation, an emergent cesarean section was performed under combined spinal-epidural anesthesia because of progression of PIH. Anesthetic course was uneventful until the operation was finished. An hour later, systolic blood pressure started to decline to reach about 70 mmHg and Sp(O2) about 80%. Pleural effusion was observed in the chest X-ray on post-operative day 1. Echocardiography showed akinesis of the antero-septal wall with ejection fraction (EF) of 47%. Peripartum cardiomyopathy (PPCM) was strongly suspected. HELLP syndrome and DIC were also combined with PPCM, so intensive care was given to her from the 1st POD. Symptoms of heart failure were alleviated by furosemide and carperitide by the 12th POD. The EF increased to 58% on the 11th POD.

Durability of resin-dentin bonds

PURPOSE

The purpose of this study was to determine if the durability of resin-dentin bonds could be evaluated more quickly if the bond specimen was divided into 1 x 1 x 8 mm beams incubated at 37 degrees C for a 90-day period.

MATERIALS AND METHODS

Extracted human third molars were prepared for bonding by removing the occlusal surface near the dento-enamel junction (superficial dentin group) or near the pulp (deep dentin group). The teeth were bonded either with MacBond, One Step or Clearfil Liner Bond 2, and then builtup to form a flat resin composite crown. After 24 hours in water, each buildup was vertically divided into slabs 1 mm thick, the top half of which was resin, with the bottom half as dentin. Each slab was then vertically sectioned at 1-mm increments to create 1 x 1 x 8-mm beams of resin-bonded dentin. They were incubated for 1 day or 90 days at 37 degrees C, followed by measurement of the tensile bond strengths. The results were analyzed by the Least-Squares Means method at the 95% confidence level.

RESULTS

MacBond gave the highest (p < 0.05) 1-day bond strengths to superficial dentin, but significantly lower bond strengths were measured in deep dentin. There were no significant differences in the bond strengths of either One Step or Clearfil Liner Bond 2 to superficial vs deep dentin at 1 day, but at 90 days their bond strengths to deep dentin had fallen significantly (p < 0.05). Prepolymerized cylinders of resin composite bonded together with One Step showed little variation in bond strength over the 90-day experiment. SEM examination of the failed bonds showed increased porosity in intertubular dentin over time.

CONCLUSION

The results indicate that division of large specimens into many small beams accelerated the deterioration of bond strength in deep dentin in all three bonding systems and in both superficial and deep dentin in the MacBond treated specimens. This method seems promising for studying the durability of resin-dentin bonds.

Fracture aspects of resin-dentin bonding in non-trimming microtensile test

Comparative studies on resin-dentin bond strength and failure mode were performed between the conventional tensile test and the microtensile test with non-trimming small specimens, 1 x 1 mm in cross-section, for two brands of dentin bonding systems. The fracture surface of the conventional large specimen showed a catastrophic cohesive failure in dentin at its center and a lesser adhesive failure, suggesting that the whole failure was due to the development of some major cracks. The non-trimming microtensile test showed significantly larger average bond strength with markedly larger standard deviation and significantly larger fraction of adhesive failure than the conventional test. Some small specimens were extremely strong and some were weak according to the heterogeneous distribution of tight bonding and defective or deficient bonding over the whole dentin surface. These results suggest that the non-trimming microtensile test may potentially provide more realistic aspects of resin-dentin bonding than the conventional bulk specimen.

Wearing behaviors of a hybrid composite resin for crown and bridge

The wearing behaviors of a hybrid composite resin for crown and bridge (ES) were examined using a two-body impacting-sliding wear test with a porcelain (PO), Au-Ag-Pd alloy (PD), direct restorative composite resin (CR) and tooth enamel (TO). Although PO was the hardest of all, it showed the largest wear together with ES in the combination of ES-PO, which was probably initiated from the superficial destruction by their impact. The wear in ES-PD was the second largest. It was noted in this combination that the surface of ES was partially contaminated by scraped thin layers of PD to a degree distinguished by the naked eye. The mutual wears of the components were relatively low in the combination of ES with CR, TO or ES itself. It is suggested from these findings that the hybrid composite resin may be useful as an alternative to porcelain for posterior crown and bridge unless it opposes porcelain or alloys.

A pivotal role for DNase I-sensitive regions 3b and/or 4 in the induction of somatic hypermutation of IgH genes

Chimeric mice were prepared from embryonic stem cells transfected with IgH genes as transgenes and RAG-2-deficient blastocysts for the purpose of identifying the cis-acting elements responsible for the induction of somatic hypermutation. Among the three transgene constructs used, the V(H) promoter, the rearranged V(H)-D-J(H), an intron enhancer/matrix attachment region, and human Cmu were common to all, but the 3'-untranslated region in each construct was different. After immunization of mice with a T cell-dependent Ag, the distribution and frequency of hypermutation in transgenes were analyzed. The transgene lacking the 3' untranslated region showed a marginal degree of hypermutation. Addition of the 3' enhancer resulted in a slight increase in the number of mutations. However, the transgene containing DNase I-sensitive regions 3b and 4 in addition to the 3' enhancer showed more than a 10-fold increase in hypermutation, reaching levels comparable to those observed in endogenous V(H)186.2 genes of C57BL/6 mice.

Application of electrolyzed acid water to sterilization of denture base part 1. Examination of sterilization effects on resin plate

Bactericidal activities of electrolyzed strong and weak acid waters for acrylic denture base resin were evaluated in order to discuss the applicability of these waters for sterilization of denture base. Only 1-minute immersion in the electrolyzed strong or weak acid water could completely eliminate the attached bacteria, Staphylococcus aureus 209P, on the resin plate. When the resin was relined with tissue conditioner, 5-minute immersion or 1- to 2-minute ultrasonic cleaning reduced the number of the bacteria from 10(5)/cm2 level to 10(1)/cm2 and no surviving bacteria could be detected after 10-minute treatment. These findings suggest that both the electrolyzed strong and weak acid waters are well applicable to the disinfectant for acrylic denture base showing excellent bactericidal activities in a significantly shorter treatment as compared with the conventional denture cleaning.

Utility of Ni-Ti shape memory orthodontic wire

The characteristic temperature dependence of recovery force was evaluated for a Cu-containing Ni-Ti shape memory wire with the nominal Af point being 40 degrees C. It exerted mild recovery force within the range of the proposed optimum force at the usual oral temperature. Larger forces were generated when it was heated to temperatures above Af: 40, 50 or 60 degrees C. By subsequently cooling to temperatures below Af, the force decreased again, and vice versa. The excellent reversibility, reproducibility and durability of the recovery force were also confirmed. These results indicate that the shape memory wire may be a reasonable material for a new concept of intermittent orthodontic treatment, in which mild force will be applied to the tooth for most of the daily hours and the tooth movement will be intermittently accelerated by larger forces generated only when the patient has hot foods or drinks.

Blockade of antibody-induced glomerulonephritis with Crry-Ig, a soluble murine complement inhibitor

A recombinant soluble form of the mouse membrane complement inhibitor Crry (complement receptor-related gene y) fused to IgG1 hinge, CH2, and CH3 domains has been created and designated Crry-Ig. Crry has been used because, similar to human soluble CR1, it demonstrates decay-accelerating activity for both the classical and alternative pathways of complement as well as cofactor activity for factor I-mediated cleavage of C3b and C4b. The mouse IgG1 isotype was incorporated because it is a noncomplement-activating isotype and, when fused to Crry, results in a complement inhibitor that should not be recognized as foreign when used chronically in murine models. Crry-Ig demonstrated complement-inhibitory activity in both the fluid phase and on target surfaces. Following in vivo injection, Crry-Ig manifested a two-phase serum elimination profile, a rapid initial loss most likely reflecting tissue redistribution and a second more prolonged decline with a t1/2 of 40 h. Inhibition of complement activation in mice following injection of Crry-Ig was demonstrated by a marked decrease in the ability of serum from treated mice to be activated by zymosan particles in vitro. Finally, in vivo efficacy of Crry-Ig was demonstrated by its ability to substantially diminish renal injury induced by complement-fixing nephrotoxic Ab. The use of Crry-Ig in vivo in murine models of chronic inflammatory and autoimmune disease should allow further insight into the potential therapeutic effects and possible untoward complications of continuous blockade of complement using inhibitors that act on activation products of C4 and C3.

Cross-linking CD21/CD35 or CD19 increases both B7-1 and B7-2 expression on murine splenic B cells

Activation of the complement cascade and ligation of complement C3 receptors on B cells represent an important bridge between innate and Ag-specific acquired immunity. We show here that cross-linking of mouse CD21 (complement receptor type 2, CR2, C3d receptor) and CD35 (complement receptor type 1, CR1, C3b/C4b receptor) or co-cross-linking of CD21/CD35 and surface IgM rapidly up-regulates both B7-1 and B7-2 expression on murine resting splenic B cells. CD21/CD35-mediated up-regulation of both B7-1 and B7-2 expression is observed within 14 h, while other stimuli up-regulate only B7-2 but not B7-1 at this early time point. Consistent with the increase in B7 levels, BALB/c B cells on which surface IgM and CD21/CD35 have been co-cross-linked stimulate C57BL/6 T cells more effectively than controls. This CD21/CD35-enhanced allogeneic MLR is blocked nearly completely by anti-B7-2 mAbs and partially by anti-B7-1 mAbs. In addition, cross-linking of CD19, which is physically associated with CD21/CD35, leads to increased B7-1 and B7-2 expression. These data suggest that CD21/CD35 ligation results in enhanced B cell Ag presentation using costimulatory mechanisms shared with other activators and thus works cooperatively in this process. Rapid up-regulation of B7-1 expression, a unique response to CD21/CD35 and CD19 cross-linking, may be a particularly important effect of C3-containing ligands. We propose that CD21/CD35- and CD19-mediated B7-1 and B7-2 up-regulation is an important mechanism by which complement activation links innate and acquired immunity.

Individual variation of acetohexamide reductase activities in liver microsomes and cytosol of rats

We examined individual variations in acetohexamide reductase activities in liver microsomes and cytosol of rats. Large differences among individuals were observed for acetohexamide reductase activity in liver microsomes of male Fischer-344 (Fischer), Sprague-Dawley (SD) and Wistar rats at 9 weeks of age, except in the Wistar-Imamichi (Wistar-IM) strain. These four strains of female rats did not exhibit any microsomal enzyme activity. Although acetohexamide reductase activities were fully detectable in liver cytosols from all the strains of male and female rats, there was neither strain-related difference nor considerable individual variation in the cytosolic enzyme activity. In liver microsomes of male Fischer rats at 4 weeks of age, acetohexamide reductase activity was not detectable. The microsomal enzyme activity in male Fischer rats markedly increased at 6 weeks of age to approach the levels at 9 and 12 weeks of age, with large individual variations.

Mouse complement receptors type 1 (CR1;CD35) and type 2 (CR2;CD21): expression on normal B cell subpopulations and decreased levels during the development of autoimmunity in MRL/lpr mice

Human complement receptors type 1 (hCR1;CD35) and type 2 (hCR2;CD21) are expressed on B lymphocytes at specific stages during differentiation and activation. These receptors play critical roles in the immune response to T-dependent Ags in addition to germinal center formation. Expression of both hCR2 and hCR1 is decreased on B lymphocytes of patients with systemic lupus erythematosus (SLE). We have studied the expression of mouse CR2 and CR1 on normal populations of mouse B lymphocytes in BALB/c mice. Our results demonstrate that expression of these receptors in the normal state closely parallels that of hCR2. During bone marrow development, expression is first detected on low B220/high IgM cells, demonstrating that complement receptors appear after central tolerance mechanisms are completed. In the splenic microenvironment the highest levels of receptor expression are found on marginal zone B lymphocytes. Mouse CR2 and CR1 are also found on peritoneal B1a and B1b cells in addition to IgA+ Peyer's patch B cells. Activation of splenic B cells under Th2 conditions results in a marked decrease in receptor expression. To determine whether the patterns of receptor expression also parallel those found in human disease, we studied the MRL lpr/lpr (MRL/lpr) model of SLE. Interestingly, we found an early decrease in complement receptor expression that is progressive and first detectable before major clinical manifestations of nephritis. We hypothesize that the early decrease in complement receptor expression such as that demonstrated by MRL/lpr mice plays an important role in the pathogenesis of murine and perhaps human SLE.

Mouse complement receptors type 1 (CR1;CD35) and type 2 (CR2;CD21): expression on normal B cell subpopulations and decreased levels during the development of autoimmunity in MRL/lpr mice

Human complement receptors type 1 (hCR1;CD35) and type 2 (hCR2;CD21) are expressed on B lymphocytes at specific stages during differentiation and activation. These receptors play critical roles in the immune response to T-dependent Ags in addition to germinal center formation. Expression of both hCR2 and hCR1 is decreased on B lymphocytes of patients with systemic lupus erythematosus (SLE). We have studied the expression of mouse CR2 and CR1 on normal populations of mouse B lymphocytes in BALB/c mice. Our results demonstrate that expression of these receptors in the normal state closely parallels that of hCR2. During bone marrow development, expression is first detected on low B220/high IgM cells, demonstrating that complement receptors appear after central tolerance mechanisms are completed. In the splenic microenvironment the highest levels of receptor expression are found on marginal zone B lymphocytes. Mouse CR2 and CR1 are also found on peritoneal B1a and B1b cells in addition to IgA+ Peyer's patch B cells. Activation of splenic B cells under Th2 conditions results in a marked decrease in receptor expression. To determine whether the patterns of receptor expression also parallel those found in human disease, we studied the MRL lpr/lpr (MRL/lpr) model of SLE. Interestingly, we found an early decrease in complement receptor expression that is progressive and first detectable before major clinical manifestations of nephritis. We hypothesize that the early decrease in complement receptor expression such as that demonstrated by MRL/lpr mice plays an important role in the pathogenesis of murine and perhaps human SLE.

Resting B cells from New Zealand Black mice demonstrate a defect in apoptosis induction following surface IgM ligation

New Zealand Black (NZB) mice spontaneously develop autoimmune disease, usually characterized by an autoimmune hemolytic anemia, and NZB genes are essential for a severe systemic lupus-like disease in (NZB x NZW)F1 mice. We have found that resting B cells from NZB mice demonstrate a pronounced defect, compared with five normal strains, in apoptosis induction after cross-linking with anti-IgM Abs. In contrast, spontaneous apoptosis of NZB B cells in culture was similar to normal strains. B cells from young (NZB x SM/J)F1 and (NZB x NZW)F1 mice underwent apoptosis normally, indicating that the NZB defect in apoptosis is a recessive trait. However, older (8-32 wk) predisease (NZB x NZW)F1 mice manifested a similar defect in apoptosis induction. The analysis of NXSM recombinant inbred mice derived from NZB and SM/J, in addition to backcross mice, suggested that the NZB apoptosis defect is a multigenic trait. Interestingly, resting B cells form B6.lpr and B6gld mice underwent apoptosis following anti-IgM treatment at a level similar to that of the C57BL/6 parental strain. Thus, the induced apoptosis of resting B cells and the NZB defect are likely not related to either Fas or Fas ligand. We propose that this phenotypic defect in apoptosis induction, or the biochemical alteration that underlies the defect, may be casually related to autoimmune disease in NZB mice and its contribution to lupus-like disease in (NZB x NZW)F1 mice.

Resting B cells from New Zealand Black mice demonstrate a defect in apoptosis induction following surface IgM ligation

New Zealand Black (NZB) mice spontaneously develop autoimmune disease, usually characterized by an autoimmune hemolytic anemia, and NZB genes are essential for a severe systemic lupus-like disease in (NZB x NZW)F1 mice. We have found that resting B cells from NZB mice demonstrate a pronounced defect, compared with five normal strains, in apoptosis induction after cross-linking with anti-IgM Abs. In contrast, spontaneous apoptosis of NZB B cells in culture was similar to normal strains. B cells from young (NZB x SM/J)F1 and (NZB x NZW)F1 mice underwent apoptosis normally, indicating that the NZB defect in apoptosis is a recessive trait. However, older (8-32 wk) predisease (NZB x NZW)F1 mice manifested a similar defect in apoptosis induction. The analysis of NXSM recombinant inbred mice derived from NZB and SM/J, in addition to backcross mice, suggested that the NZB apoptosis defect is a multigenic trait. Interestingly, resting B cells form B6.lpr and B6gld mice underwent apoptosis following anti-IgM treatment at a level similar to that of the C57BL/6 parental strain. Thus, the induced apoptosis of resting B cells and the NZB defect are likely not related to either Fas or Fas ligand. We propose that this phenotypic defect in apoptosis induction, or the biochemical alteration that underlies the defect, may be casually related to autoimmune disease in NZB mice and its contribution to lupus-like disease in (NZB x NZW)F1 mice.

Strain- and sex-related differences of acetohexamide reductase activities in liver microsomes and cytosol of rats: the Wistar-Imamichi strain lacks the male-specific microsomal enzyme activity

A marked strain-related difference was observed among acetohexamide reductase activities in liver microsomes of male rats. The microsomal enzyme activities in the Fischer-344 (Fischer), Sprague-Dawley (SD) and Wistar strains were 2.58 +/- 0.50, 1.60 +/- 0.44 and 0.79 +/- 0.41 nmol/min/mg protein, respectively. The microsomal enzyme activities in these rat strains were much higher in males than in females, indicating that the microsomal enzyme is a male-specific enzyme. The Wistar-Imamichi (Wistar-IM) strain was found to lack the male-specific microsomal enzyme activity. In Fischer, SD and Wistar strains of testectomized male rats, the microsomal enzyme activities were significantly increased by the treatment with testosterone. However, testosterone treatment was ineffective on the microsomal enzyme activity in the Wistar-IM strain. These results suggest that Wistar-IM rats has a genetic deficiency of the microsomal enzyme. There was no strain-related difference among the cytosolic enzyme activities in male rats. The cytosolic enzyme activities in Fischer and Wistar rats were higher in females than in males.

Co-ligation of mouse complement receptors 1 and 2 with surface IgM rescues splenic B cells and WEHI-231 cells from anti-surface IgM-induced apoptosis

Recent studies have shown that complement receptors play important roles in both T-dependent and T-independent B lymphocyte responses to low doses of antigen (Ag) in vivo. Complement activation by either the classical or alternative pathway results in the covalent binding of C3 molecules to Ag in forms that ligate complement receptors type 1 (CR1) and 2 (CR2). We hypothesized that C3-bound Ag might cross-link CR2 and/or CR1 with surface (s)IgM and alter the signal that would be transduced through sIgM by Ag binding alone. One result of the altered signal could be the rescue of B lymphocytes from apoptosis that would otherwise be induced by the binding of certain types of Ag alone. We find that co-cross-linking of mouse CR2 and CR1 with sIgM rescues both resting B cells and WEHI-231.7 cells from apoptosis induced by sIgM ligation in a fashion similar to that found using soluble mouse CD40 ligand (mCD40L). Anti-CR2/CR1-mediated rescue requires co-cross-linking of the receptors with sIgM, and has an additive effect on mCD40L-mediated apoptosis rescue. Based on these results, it is likely that the CR2/CR1-derived signal is cooperative with T cell-derived signals such as CD40L and interleukin-4.

Effects of rapid burnout type gypsum-bonded investment on performance of castings. Part 1. Surface aspects and fit of crowns

Rapid burnout type gypsum-bonded investment materials were developed to shorten the time required for dental casting procedures. With these materials, molds can be prepared by rapid heating at 700 degrees C for 30 min from 30 min after the start of mixing. When the investment block was rapidly heated at 700 degrees C, no fractures were observed in the rapid burnout type investments with one exception, while a conventional cristobalite investment broke into pieces shortly after being placed in the furnace. Casting fins were sometimes induced only for the material which showed fracturing on rapid heating. No practical problems were found in the surface roughness of the castings. The 30 min-setting expansion was significantly different among the materials although there were no differences in thermal expansion, and the material showing greater 30 min-setting expansion was efficient to obtain better fit of the crown as in the conventional casting procedures.

Efficacy of gas purging for titanium casting

Oxygen density in the melting atmosphere, oxygen uptake, hardness and castability of pure titanium castings were examined to evaluate the efficacy of gas purging in reducing contamination from the melting atmosphere and mold, using a newly developed titanium casting machine in which the double purging process is systematized. The adoption of a double purging operation resulted in an extremely low oxygen density in the melting atmosphere, followed by extremely low oxygen uptake in the casting when compared with the conventional titanium casting machine. When the purging operation was used, the surface hardness was markedly reduced, although there was no difference in castability. From these results, it was suggested that the newly developed titanium casting machine with the double purging operation could produce better titanium castings with less contamination due to the mold and gas impurities in melting atmosphere.

Influence of aging on acetohexamide reductase activities in liver microsomes and cytosol of male rats

The influence of aging on the reductase activity of acetohexamide, an oral antidiabetic drug with a ketone group, was examined in liver microsomes and cytosol of male rats. Acetohexamide reductase activities in liver microsomes of male rats at 26 and 31 months of age were much lower than that in liver microsomes of male rats at 9 weeks of age. Testectomy markedly decreased acetohexamide reductase activity in liver microsomes of the 9-week old rats and the decreased enzyme activity was significantly increased by testosterone administration. These results indicate, at least in part, that aging decreases the enzyme activity by decreasing the secretion of testosterone from the testes. On the other hand, aging (26 months of age) did not affect acetohexamide reductase activity in liver cytosol of male rats, although the enzyme activity at 31 months of age was slightly but significantly lower than that in liver cytosol of male rats at 9 weeks of age. Testectomy or testosterone administration had no effect on the enzyme activity in liver cytosol of 9-week old male rats.

Combined testosterone treatment in pubertal and adult periods induces male-specific acetohexamide reductase activity in liver microsomes of female rats

The influence of testosterone treatment on acetohexamide reductase activities in liver microsomes and cytosol of female rats was examined. Acetohexamide reductase activity in liver microsomes was much lower in female rats than in male rats. Combined testosterone treatment in pubertal and adult periods induced male-specific acetohexamide reductase activity in liver microsomes of female rats. However, testosterone treatment only during puberty or during adulthood was without effect. Testosterone secreted from the testes during puberty appeared to have a significant effect similar to neonatal imprinting in the induction of acetohexamide reductase activity in liver microsomes of female rats. The combined testosterone treatment, or testosterone treatment only during puberty or during adulthood had no effect on acetohexamide reductase activity in liver cytosol of female rats.

YACs and the C. elegans genome

During the past decade, it has become apparent that it is within our grasp to understand fully the development and functioning of complex organisms. It is widely accepted that this undertaking must include the elucidation of the genetic blueprint - the genome sequence - of a number of model organisms. As a prelude to the determination of these sequences, clone-based physical maps of the genomes of a number of multicellular animals and plants are being constructed. Yeast artificial chromosome (YAC) vectors, by virtue of their relatively unbiased cloning capabilities and capacity to carry large inserts, have come to play a central role in the construction of these maps. The application of YACs to the physical map of the Caenorhabditis elegans genome has enabled cosmid clone 'islands' to be linked together in an efficient manner. The long-range continuity has improved the linkage between the genetic and physical maps, greatly increasing its utility. Since the genome can be represented by a relatively small number of YACs, it has been possible to make replica filters of genomically ordered YACs available to the community at large.

[Changes in retention strength of luting cements by repeated loading]

The retention of crowns cemented on abutment tooth model was examined for three types of luting cements when compressive loads of 2.5 to 10.0 kg were repeatedly applied to the occlusal plane. The chamfer type Ni-Cr alloy crown and abutment tooth model were prepared, and their surfaces to be cemented were sandblasted with glass beads. Loads were applied 7,200 times a day for 1, 3, or 7-day period after cementing. The polycarboxylate and zinc phosphate cements showed higher crown retentions than glass ionomer cements. Although retention strength of glass ionomer cements was significantly increased by storing the cemented specimen in water for 7 days, repeated loading tended to decrease retention. In polycarboxylate cements and one brand of zinc phosphate cement employed, retention strengths were decreased when stored in water over 3 days. However, their highest levels were maintained or even positively impacted by repeated loading for 7 days.

Analysis of abutment tooth movement utilizing mandibular kinesiography (MKG). Part 2. Effects of clasp design in unilateral free-end denture

The three-dimensional dynamic movement of the abutment tooth was successfully analyzed on a simulation model utilizing the mandibular kinesiography. When the unilateral free-end denture retained by the RPA, RPI or Aker's clasp was subjected to various directions of loads, the abutment tooth was inclined mainly by the sliding displacement of the denture over the alveolar ridge and the lever action around the denture. The Aker's clasp assembly induced the largest tooth movement. The RPA clasp generally exhibited similar tendencies to the Aker's clasp, showing a larger tooth inclination in the disto-buccal direction. The RPI clasp seemed to be preferable for protecting the periodontal tissues from damage associated with unfavorable tooth movements since it induced less distal tooth inclination.

Reproducibility of the vertical dimension of occlusion with an improved measuring gauge

An improved gauge using an eyeglass frame, the TOM gauge, was devised. The reproducibility of the record of vertical dimension with this gauge was evaluated through repeated measurements on subjects having a definite centric stop with the natural dentition. Because of the stabilization provided by the frame and the reference point on the apex nasi, the TOM gauge showed excellent reproducibility of the record compared with the conventional gauges. The TOM gauge can be expected to significantly reduce the risk of errors in measuring the vertical dimension of occlusion especially in complete denture fabrication.