Plasma t-PA and PAI-1 antigen concentrations in non-insulin dependent diabetic patients: implication for diabetic retinopathy

Parameters of fibrinolysis, including basal plasma tissue type plasminogen activator (t-PA) and plasminogen activator inhibitor type 1 (PAI-1) antigen levels were studied in 49 non-insulin dependent diabetic patients (23 men, 26 women: ages 51.3 +/- 14.9 years) and 16 age matched non-diabetic subjects (9 men, 7 women ages 49.8 +/- 12.2 years) as a control group. Compared to a control group, the diabetic patients had a significantly higher mean plasma t-PA antigen (4.94 +/- 2.68 vs 3.20 +/- 2.30 ng/ml) and PAI-1 antigen (34.86 +/- 16.71 vs. 17.60 +/- 15.36 ng/ml) levels (P < 0.05). Significant univariate correlations were observed between t-PA and body mass index (BMI) (P = 0.0009, r = 0.7217), and PAI-1 were positively correlated with BMI and FBS (fasting blood sugar) in the total diabetic patients (P = 0.0003, r = 0.7217; P = 0.0477, r = 0.2858, respectively). In diabetic patients with proliferative diabetic retinopathy, both PAI-1 and t-PA antigen levels were significantly lower than those of diabetic patients with negative or background retinopathy (P = < 0.05). There were no significant differences of the plasma t-PA and PAI-1 levels between diabetic patients with micro- and macroproteinuria. This study conducted on non-insulin dependent diabetic patients suggests that they have significantly higher t-PA and PAI-1 antigen levels than do control subjects, and these findings appear to correlate negatively with proliferative retinopathy observed among the patients studied.

Insulin levels and fibrinolytic activity in patients with end-stage renal disease

Considering that PAI-1 is an important factor modulating the systemic fibrinolytic activity, the abnormal insulin metabolism frequently seen in end-stage renal disease (ESRD) may cause decreased fibrinolytic activity in concert with PAI-1. To study this possibility, we measured insulin levels and compared it with the fibrinolytic profiles in ESRD patients. Fasting blood sugar, insulin, and C peptide levels were higher in ESRD patients than in the control group. In the ESRD patients, the insulin levels showed a positive correlation with C peptide (r = 0.612, p = 0.0001), fasting blood sugar (r = 0.334, p = 0.044), and PAI-1 antigen (r = 0.474, p = 0.0001) and a reverse correlation with euglobulin fibrinolytic activity (r = 0.5, p = 0.005), but no correlation with t-PA antigen. The euglobulin fibrinolytic activity showed a reverse correlation with PAI-1 antigen (r = 0.289, p = 0.0144), but no correlation with t-PA antigen. Our results suggest that abnormal insulin metabolism and/or insulin resistance, which occur frequently in ESRD, may play an important role in the decrease in systemic fibrinolytic activity by the regulation of the PAI-1 concentration.

A cytoplasmic protein, NfrC, is required for bacteriophage N4 adsorption

At least four genes are required for irreversible adsorption of bacteriophage N4. nfrA and nfrB have been characterized previously and encode an outer membrane protein and inner membrane protein, respectively. The nfrC gene product is characterized in detail in this study. We have mapped the nfrD locus to min 52 on the Escherichia coli linkage map. Maxicell analysis of nfrC and a null allele (nfrC2) cloned into a high-copy-number plasmid shows its gene product to be 42 kDa in size. We determined the nfrC nucleotide sequence which predicts a gene product of 42 kDa. Western blots (immunoblots) of Escherichia coli proteins after cellular fractionation show NfrC to be a cytoplasmic protein which is required for irreversible bacteriophage N4 adsorption, an event occurring at the cell surface.

Obstructing cancer of the gastric antrum: palliative treatment with covered metallic stents

A new technique, which requires a simple surgical gastrostomy without general anesthesia, is described for placement of covered expandable metallic stents. This technique was performed successfully in a patient with malignant obstruction of the gastric antrum, obviating palliative surgical resection.

Fibrinolytic activity in end-stage renal disease

Recently, we described that in the physiologic state, urokinase concentration is higher in the renal vein than in the renal artery which suggests that the kidney is the essential organ providing urokinase to the systemic circulation. In end-stage renal disease (ESRD) patients, urokinase provided by the kidney may be decreased, and this might be the cause of decreased systemic fibrinolytic activity seen in ESRD. To study this possibility, we measured fibrinolytic profiles including urokinase, tissue plasminogen activator (t-PA) and fibrinolytic activity in the euglobulin fraction of ESRD patients and compared the results with those of two control groups consisting of renal transplantation patients and age- and sex-matched healthy controls. The euglobulin fibrinolytic activity was 92.2 +/- 14.8 BAU in the ESRD group, 108.7 +/- 13.5 BAU in the kidney transplantation (KT) group and 101.5 +/- 8.0 BAU in the healthy control group. Although it was lower in the ESRD than in the KT (p < 0.005) and the healthy control group (p < 0.005), there was no difference between the KT and the healthy control group. t-PA antigen was 1.2 +/- 1.3 ng/ml in the ESRD group, 3.5 +/- 1.7 ng/ml in the KT group and 3.1 +/- 2.1 ng/ml in the healthy control group. It was lower in the ESRD compared to the KT (p < 0.001) and the healthy control group (p < 0.001) but there was no difference between the KT and the healthy control group.(ABSTRACT TRUNCATED AT 250 WORDS)

Esophageal strictures: treatment with a new design of modified Gianturco stent. Work in progress

To overcome the drawbacks of the modified Gianturco stent tube with barbs, a new barbless stent tube was constructed. Twenty-two barbless stent tubes 4.5-14.0 cm long were placed with a new introducing tube in 21 patients: 10 stent tubes in 10 patients with recurrent dysphagia after radiation therapy or chemotherapy, 10 in 10 patients with esophageal cancer in whom surgical management was contraindicated, and two in one patient with postoperative benign stricture. No technical failure or procedural complications occurred. After the procedure, all but two patients could ingest most or all foods. In two patients with an esophagorespiratory fistula and one patient with esophageal rupture, the barbless stent tube successfully occluded the fistula and rupture site. The stent tube migrated in one patient. Fifteen patients are surviving, with the stent tubes patent for 3-35 weeks (mean patency, 13 weeks); the six other patients died 7-24 weeks (mean, 16 weeks) after stent placement. It is concluded that barbless stent tubes show promise in the management of dysphagia caused by esophageal strictures.

Plasma t-PA and PAl-1 antigen concentrations in non-insulin dependent diabetic patients: effects of treatment modality on fibrinolysis

Basal plasma tissue type plasminogen activator (t-PA) and plasminogen activator inhibitor type 1 (PAl-1) antigen levels were studied in 49 non-insulin dependent diabetic patients (23 men, 26 women: ages 51.3 +/- 14.9 years) and 16 age matched non-diabetic subjects (9 men, 7 women: ages 49.8 +/- 12.2 years) as a control group. Compared to a control group, the diabetic patients had a significantly higher mean t-PA antigen (5.15 +/- 3.02 vs 3.20 +/- 2.30 ng/ml) and PAl-1 antigen (35.89 +/- 18.59 vs 17.60 +/- 15.36 ng/ml) levels (p < 0.05). Plasma t-PA antigen level was not influenced by each treatment modality. There was a significant decrease of plasma PAl-1 antigen level after Metformin administration compared to that of before Metformin administration (39.74 +/- 19.39 vs 25.14 +/- 16.18 ng/ml) (p < 0.05), and the insulin-treated group showed a tendency for a decrease of plasma PAl-1 antigen levels after insulin administration but this did not reach statistical significance (29.93 +/- 15.37 vs 17.32 +/- 10.60 ng/ml). Sulfonylurea did not change both plasma t-PA and PAl-1 antigen levels. In conclusion, diabetic patients have high t-PA and PAl-1 antigen levels. Biguanide reduced plasma PAl-1 antigen levels, which might play some helpful role in the improvement of chronic complications in NIDDM.

Effect of periodic transfusion on erythropoietin concentration in end stage renal disease

BACKGROUND

It has been reported that a feedback circuit exists between erythropoietin (EPO) concentration and the degree of anemia even in end stage renal disease (ESRD), and growing experience with subcutaneous EPO administration confirms that only slight increases in EPO levels are required to correct renal anemia. Keeping in mind these findings, if a small portion of reserved EPO production could be reactivated in ESRD, it might be biologically significant and vice-versa. From this viewpoint, it is conceivable that periodic long term transfusion might suppress EPO production in ESRD.

METHODS

In order to see whether periodic transfusion influences the EPO concentration in ESRD, a cross-sectional retrospective study was undertaken by reviewing medical records of 28 non-transfusion patients and 22 transfusion patients with ESRD undergoing hemodialysis.

RESULTS

The EPO concentration of the ESRD group (29.1 +/- 8.0 mU/ml) but only about one twentieth of the control group (578.8 +/- 69.1 mU/ml). In ESRD group, It was 27.9 +/- 8.0 mU/ml in transfusion group and 30.6 +/- 7.9 mU/ml in non-transfusion group. EPO concentration at varying hematocrit (Hct) levels did not differ between the non-transfusion group and transfusion group. There was an inverse relationship seen in the non-transfusion group (p < 0.05) but no relationship was seen between the EPO concentrations and varying Hct levels in the transfusion group. The EPO concentration at equal levels of Hct did not differ between the non-transfusion group and transfusion group. The relationship between EPO concentration and the changes in Hct during the observation period did not differ between the non-transfusion group and transfusion group. Both the total amount of transfusion and the frequency of transfusions did not influence EPO concentration.

CONCLUSION

periodic long term transfusion does not seem to decrease the sensitivity of the EPO producing cell to the degree of anemia in ESRD.

The effect of dilution, pH and ionic strength of plasma on t-PA precipitation in euglobulin fraction

In order to evaluate the influence of dilution, pH and ionic strength on the precipitation of t-PA and PAI-1 during euglobulin precipitation, we measured t-PA Ag, PAI-1 Ag and fibrinolytic activity in the euglobulin fraction made of pooled plasma from liver cirrhosis patients, under various conditions by changing pH, ionic strength and degree of dilution. The precipitation of t-PA Ag in the euglobulin fraction was enhanced by decreasing the ionic strength and greatest at pH 6.0. The fibrinolytic activity in the euglobulin fraction showed consistent changes with t-PA Ag under varying pH and ionic strength. The precipitation of t-PA Ag was not influenced by the dilution factor but the larger the dilution factor, the greater the PAI-1 and the smaller the fibrinolytic activity in the euglobulin fraction. PAI Ag in euglobulin fraction showed consistent changes with t-PA Ag in the euglobulin fraction regardless of the changes in ionic strength and pH. The amount of precipitation of t-PA and PAI-1 was increased by the presence of dextran sulfate, under varying pH, ionic strength and dilution conditions. Our results show that the currently used conditions for standard euglobulin precipitation are the most favorable for t-PA precipitation into the euglobulin fraction. The fibrinolytic activity exerted in the euglobulin fraction seems to depend on the amount of t-PA-PAI-1 complex rather than minimized protease inhibitor in the euglobulin fraction.

Urokinase concentration in the renal artery and vein

To compare the fibrinolytic activity between the renal artery and vein and the systemic circulation, we measured tissue-type plasminogen activator (t-PA), urokinase and total fibrinolytic activity in the blood samples from both the left and right renal artery and vein and the anterior cubital vein of 7 kidney donors. Englobulin fibrinolytic activity was significantly higher in the renal vein [106.6 +/- 5.6 blood activator units (BAU)] than in the renal artery (90.6 +/- 4.1 BAU; p less than 0.001) and cubital vein (94.3 +/- 6.3 BAU, p less than 0.005), but there was no difference between renal artery and cubital vein. t-PA Ag was 2.9 +/- 1.1 ng/ml in the renal vein, 2.6 +/- 1.0 ng/ml in the renal artery and 2.6 +/- 1.1 ng/ml in the cubital vein. There was no difference between renal artery, renal vein and cubital vein. Urokinase was significantly higher in the renal vein (3.3 +/- 0.4 ng/ml) than in the renal artery (2.4 +/- 0.4 ng/ml; p less than 0.001) and cubital vein (2.6 +/- 0.4; p less than 0.005), but there was no difference between the renal artery and cubital vein. In all cases, there was no difference in the fibrin(ogen) degradation product concentration between the renal artery and vein and the cubital vein. These findings suggest that the kidney may be an essential organ for providing urokinase to the systemic circulation.

The urine urokinase concentration in end stage renal disease with acquired renal cyst

To see whether there was any difference in the urine urokinase concentration between acquired cystic kidney disease (ACKD) group and control (non cyst) group in end stage renal disease patients (ESRD), we evaluated fifty ESRD patients who had been maintained on chronic hemodialysis for various period. The urine urokinase concentration was higher in the ACKD group (17.5 +/- 14.7 unit/ml, range 13.5-47.0 unit/ml, n = 9) than the control group (4.1 +/- 3.4 unit/ml, range 0.5-12.0 unit/ml, n = 36) (p less than 0.001), and polycyst group (2.6 +/- 1.8 unit/ml, range 1.0-5.1 unit/ml, n = 5) (p less than 0.01). But there was no difference between the control group and polycyst group. In the control group and the ACKD group, there was a direct relation between the dialysis duration and the urokinase concentration and the longer the dialysis duration, the higher the urine urokinase concentration (r squared = 0.424, p = 0.0001). The hemodialysis duration was longer in the ACKD group (42 +/- 17.0 months) than the control group (20.0 +/- 12.5 months) (p less than 0.005). These findings suggest that urokinase may be responsible for cystogenic degeneration in ESRD.

Circulating HBsAg/IgG complexes in idiopathic chronic glomerulonephritis

We measured HBsAg/IgG complexes (CX) quantitatively by ELISA from HBsAg positive serum of 35 liver disease patients, 15 patients with glomerular diseases (8 membranous glomerulonephritis (MGN) 7 membranoproliferative glomerulonephritis (MPGN), and 50 healthy carriers of HBsAg. HbsAg/IgG CX was detected in 26 out of 35 liver disease patients (74.3%), 5 out of 50 healthy carriers (10%), and one of both 8 MGN patients (12.5%) and 7 MPGN patients (14.3%). HBsAg/IgG CX was big in size and wide spread in the liver disease groups but negligible in the healthy carrier group (41 +/- 2.6 ng/ml, n = 5) and MGN (50 ng/ml, n = 1) and MPGN (42 ng/ml, n = 1) group. In the liver disease group, no one suffered from glomerulopathy even with a wide spectrum of HBsAg/IgG CX. These results suggest that HBsAg/IgG CX in plasma is non causative of MGN and MPGN.

Urinary plasminogen activator activity in progressive renal failure

The purpose of this study was to discover how functional nephrons produce the plasminogen activator as renal function progresses to renal failure. Urine Plasminogen activator (U-PA) activity was measured by the fibrin plate method in 73 patients with various degrees of renal function deterioration from various underlying diseases and in one healthy individual in order to evaluate the plasminogen activator activity of remnant nephrons. The plasminogen activator activity of the 12 consecutive urine samples from the healthy individual showed that is varied according to the time of day, but there was no circadian rhythm. The urine plasminogen activator activity correlated with the osmolality (r = 0.51, P less than 0.001) and creatinine (r = 0.56, P less than 0.001) of the urine, suggesting that it is concentrated at distal nephrons. The fractional sodium excretion rate (FeNa) increased abruptly when GFR decreased below 25 L/day. This pattern was very similar with the relation between total U-PA activity/GFR and GFR. The correlation between total U-PA activity and FeNa was not significant, but there was a significant direct correlation between total U-PA activity/GFR and FeNa (r = 0.775, P less than 0.0001). There was no relationship between the 24-hour urine protein and total U-PA activity or total U-PA activity/GFR.(ABSTRACT TRUNCATED AT 250 WORDS)

[Qualitative identification of tongxiening granules]

According to the physical and chemical properties of effective constituents in Tongxiening granules, experiments were conducted on physical, chemical and TLC identifications of this preparation. Reliable data may provide a basis for the establishment of its quality standards.

[Exploration on baking conditions for Atractylodes macrocephala Kloidz in qiweibaizhusan bags]

This paper is concerned with a comprehensive study on the conditions required for baking pieces and grains of Atractylodes macrocephala Kloidz. through the determination of the relative content of atractylone and moisture content in the rhizome. Optimum roasting temperature and time before pulverizing have been determined, thus providing reliable basis for devising the suitable technological process.

Early gastric cancer in Korea

We reviewed the 639 cases of early gastric cancer from nation-wide 16 medical centers. The proportion of early gastric cancer among surgically resected gastric carcinoma comprised 6 to 12 percent. Male to female ratio was 1.7 to 1 with male preponderance. Mean ages of the early gastric cancer was 49.0 years and most prevalent ages was 5th decade. Macroscopically type IIc was most prevalent, reaching 59.9 percent. Depressed type lesions was more frequent than elevated type lesions by four folds. The size of lesions less than 4 cm accounted for more than 80 percent. Most frequent site of lesions were lower third by the CMA classification and lesser curvature transectionally. Lymph node metastasis was observed in 10.9 percent of all cases and it was more frequent in large tumor size more than 4 cm, elevated type, and undifferentiated carcinoma. 5-year survival rate was 91.6 percent. Gastrofiberscopic examination was superior to that of radiological examination in the diagnosis of early gastric cancer.

Clinical features of Crohn's disease in Korea

Crohn's disease is a rare disease in Korea, and only 45 cases have been reported during the period of 34 years from 1952 to 1985. The male to female ratio was about 1.3 to 1 with a slight preponderance of males. The age at diagnosis ranged from 8 to 72 (mean 35.5) years, and the peak incidence occurred in the 3rd, 4th and 5th decades and declined thereafter. More than two thirds of the cases had a grossly demonstrable lesion involving the small bowel, including the terminal ileum. The proportion of patients with macroscopic disease continued to the large bowel alone was only 15%. Abdominal pain was common, presenting in 89% of the patients, while such symptoms as fever, hematochezia and diarrhea were not common. Abdominal mass was palpable in more than half the cases, which made it difficult to differentiate Crohn's disease from cancer of the colon, especially in cases with a predominant infiltration of the bowel wall and a secondary ulcer formation. That is one of the reasons why most cases in Korea have been reported by surgeons. A wide variety of complications were present, of which small bowel obstruction was the most common. Other complications were free perforation, malnutrition, fistula formation, hemorrhage and abscess formation, in decreasing order. The incidence of symptomatic perianal disease was only 11%, and this might be due to the small proportion of the disease confined to large bowel. Extraintestinal manifestations were also rare, and only three patients presented symptoms of arthritis. Other systemic features such as liver disease, skin lesion, eye complications were absent.