The influence of peri-operative blood transfusion during radical hysterectomy on the prognosis of uterine cervical cancer

To evaluate the clinical implications of peri-operative transfusion in the surgical treatment of uterine cervical cancer, a detailed analysis of the cumulative survival rate was performed using clinical data from 145 patients with FIGO stage Ib cervical cancer of the squamous cell type acquired between 1982 and 1989 at the Center for Adult Diseases. The cumulative survival rate was statistically analyzed using the Kaplan Meier method. Of the 145 patients with stage Ib cancer, 103 were considered to have undergone complete excision and received no further treatment post-operatively, and 42 were considered to have undergone incomplete excision because of the involvement of lymph nodes or the lymphovascular space. Of the 79 patients in the former group who received peri-operative transfusion, 69 received less than seven units (1400 mL) and 10 received more than eight units (1600 mL). The cumulative 5-year survival rate was 100% in the 24 patients who received no transfusions, 91.7% in those who received less than 1400 mL, and 90.0% in those who received more than 1600 mL. Similarly, of the 42 patients in the incomplete excision group, nine did not receive any peri-operative transfusion, 27 received less than 1400 mL, and six received more than 1600 mL. The 5-year survival rate in these groups was 88.9, 77.8 and 50.0%, respectively. The survival rate of our patients with stage Ib cervical cancer without peri-operative transfusion was significantly higher than that of those with transfusion, regardless of post-operative irradiation therapy status, indicating that peri-operative transfusion has an adverse influence on the prognosis in cervical cancer.

Phosphorylation-dependent control of structures of intermediate filaments: a novel approach using site- and phosphorylation state-specific antibodies

Site-specific phosphorylation of intermediate filament (IF) proteins on serine and threonine residues leads to dynamic alterations in filament structure. Site- and phosphorylation state-specific antibodies for IF proteins can visualize spatial and temporal distribution of site-specific IF protein phosphorylations in the cell. These antibodies are also useful to identity IF kinases involved in cellular events, including cell signaling and cell cycle.

Myosin binding subunit of smooth muscle myosin phosphatase at the cell-cell adhesion sites in MDCK cells

We examined the intracellular localization of the myosin binding subunit (MBS) of smooth muscle myosin phosphatase. In MDCK cells in a confluent monolayer of polarized epithelial sheet, MBS was concentrated to the cell-cell adhesion sites. Double-immunofluorescence analysis with anti-MBS and anti-beta-catenin antibodies showed that MBS was mainly localized at the adherens junction. Furthermore, MBS was translocated reversibly between the cytosol and the cell-cell adhesion sites during the formation and disappearance of cell-cell contacts. These data suggest that MBS may play an important role in the regulation of the cell-cell adhesion.

Biochemical and cellular effects of roscovitine, a potent and selective inhibitor of the cyclin-dependent kinases cdc2, cdk2 and cdk5

Cyclin-dependent kinases (cdk) play an essential role in the intracellular control of the cell division cycle (cdc). These kinases and their regulators are frequently deregulated in human tumours. Enzymatic screening has recently led to the discovery of specific inhibitors of cyclin-dependent kinases, such as butyrolactone I, flavopiridol and the purine olomoucine. Among a series of C2, N6, N9-substituted adenines tested on purified cdc2/cyclin B, 2-(1-ethyl-2-hydroxyethylamino)-6-benzylamino-9-isopropylpurine (roscovitine) displays high efficiency and high selectivity towards some cyclin-dependent kinases. The kinase specificity of roscovitine was investigated with 25 highly purified kinases (including protein kinase A, G and C isoforms, myosin light-chain kinase, casein kinase 2, insulin receptor tyrosine kinase, c-src, v-abl). Most kinases are not significantly inhibited by roscovitine. cdc2/cyclin B, cdk2/cyclin A, cdk2/cyclin E and cdk5/p35 only are substantially inhibited (IC50 values of 0.65, 0.7, 0.7 and 0.2 microM, respectively). cdk4/cyclin D1 and cdk6/cyclin D2 are very poorly inhibited by roscovitine (IC50 > 100 microM). Extracellular regulated kinases erk1 and erk2 are inhibited with an IC50 of 34 microM and 14 microM, respectively. Roscovitine reversibly arrests starfish oocytes and sea urchin embryos in late prophase. Roscovitine inhibits in vitro M-phase-promoting factor activity and in vitro DNA synthesis in Xenopus egg extracts. It blocks progesterone-induced oocyte maturation of Xenopus oocytes and in vivo phosphorylation of the elongation factor eEF-1. Roscovitine inhibits the proliferation of mammalian cell lines with an average IC50 of 16 microM. In the presence of roscovitine L1210 cells arrest in G1 and accumulate in G2. In vivo phosphorylation of vimentin on Ser55 by cdc2/cyclin B is inhibited by roscovitine. Through its unique selectivity for some cyclin-dependent kinases, roscovitine provides a useful antimitotic reagent for cell cycle studies and may prove interesting to control cells with deregulated cdc2, cdk2 or cdk5 kinase activities.

Safety and effectiveness of exercise training in patients with silent myocardial ischemia

The effectiveness of exercise training in patients with silent myocardial ischemia was examined. Forty patients with coronary heart disease (mean age 55 +/- 8 years) were recruited for a 12-week exercise training program. All patients underwent treadmill exercise stress testing, exercise thallium-201 single photon emission computed tomography and left heart catheterization. They were divided into three groups based on the symptoms and the results of exercise thallium scintigraphy, i.e., painful myocardial ischemia (PMI group), silent myocardial ischemia (SMI group), and non-myocardial ischemia (NMI group). Normalized treadmill time was longer in the SMI group (108 +/- 24%) than in the PMI group (86 +/- 14%, p < 0.05). All 40 patients, 14 from the PMI group, 16 from the SMI group and 10 from the NMI group, completed the whole exercise training program. A significant prolongation of treadmill time was attained in all three groups after exercise training [PMI group: from 494 +/- 105 to 632 +/- 78 sec (p < 0.05), SMI group: from 609 +/- 147 to 746 +/- 137 sec (p < 0.05), NMI group: from 572 +/- 112 to 739 +/- 13 sec (p < 0.05)]. The improvement of myocardial ischemia following exercise training was similar in the SMI and PMI groups. No adverse effects were detected throughout the program. The exercise training program adopted in this study proved safe and effective in patients with silent myocardial ischemia.

Effects of ganglioside GD1a on the fluidity and phase transition of phosphatidylcholine model membrane immobilized on porous cellulose acetate filter

The thermotropic effect of ganglioside GD1a on the phosphatidylcholine membrane immobilized on the porous cellulose acetate filter was investigated by ESR spin-labeling and DSC. The spin-labeled GD1a having 12-DOXYL-stearic acid instead of the long acyl chain of the ceramide portion (GD1a*) was incorporated into the model membrane. An ESR examination of the membrane showed that GD1a* undergoes an anisotropic rotation in the wide range of temperature -30-70 degrees C. By monitoring the overall splitting (2T parallel) of spin-labeled phosphatidylcholine (PC*), the model membranes were found to show decreased fluidity in accordance with the GD1a content. The phase transition temperature (Tm) of distealoylphosphatidylcholine (DSPC) model membranes could be estimated by the measurement of ESR and DSC. The effects of GD1a were found to be more significant in broadening the phase transition rather than in elevating the Tm of DSPC model membranes.

An effective tool to detect lesions causing unstable angina with multivessel disease: iodine-123-betamethyl-p-iodophenyl-pentadecanoic acid single photon emission computed tomography

Radiolabeled fatty acids such as iodine-123-betamethyl-p-iodophenyl-pentadecanoic acid (BMIPP) have unique metabolic properties suggesting potential use as myocardial perfusion tracers. The uptakes of BMIPP and thallium 201 were compared using single photon emission computed tomography (SPECT) in 24 patients displaying unstable angina with multivessel disease at a mean of 3.4 days after admission. Coronary angiography was performed within a week. Uptake was considered normal if the activity was greater than 80% of the normal area, mildly reduced if 50% to 79%, and severely reduced if less than 50%. The regional activities in four quardrants in short-axis slices were measured from basal, mid and apical sets. We attempted to identify the causative lesion on dual SPECT imaging. We planned the following management of each patient based on the results of the dual SPECT study. BMIPP activity imaging found 4 segments (1.4%) with severe decrease, 70 (24.3%) with mild decrease, and 214 (74.3%) with normal uptake. In contrast, T1 activity imaging showed normal uptake in 68 of 74 abnormal BMIPP activity segments. Furthermore, all segments with abnormal BMIPP uptake were matched with locations of coronary artery stenosis by coronary angiography. Accordingly, coronary revascularization (percutaneous transluminal coronary angioplasty, coronary artery bypass grafting) was performed based on BMIPP SPECT. Reductions in BMIPP activity were common in patients with unstable angina with multivessel disease. BMIPP SPECT is an excellent tool for detecting the causative lesion in unstable angina. The subsequent intervention could be performed with less risk based on the strategy of dilating the only causative lesion which was detected by the BMIPP SPECT in patients with multivessel disease displaying unstable angina.

High-power fourth- and fifth-harmonic generation of a Nd:YAG laser by means of a CsLiB(6)O(10)

High pulse energies of nanosecond-level fourth- and fifth-harmonic (4omega and 5omega) generation of a Nd:YAG laser have been obtained with a CsLiB(6)O(10) (CLBO) nonlinear crystal. 500 mJ of 4omega output with a conversion efficiency of 50% from the second-harmonic input was generated. 5omega output at 213 nm of as high as 230 mJ was obtained by sum-frequency generation of the 266- and 1064-nm beams, corresponding to a 10.4% conversion efficiency of the initial fundamental input energy. The characteristics of the CLBO crystal that permit this effective frequency conversion are discussed.

[A specific disorder in Kanji writing in a learning disabled child with a visual cognition disorder--a cognitive-neuropsychological and electrophysiological analysis]

We reported a learning disabled child with a specific disorder involving Kanji writing. The patient was a 13-year-old boy. Although he manifested generally normal intellectual ability and his performance on WISC-R indicated that VIQ was 101 and PIQ 84, he could only write approximately 20% of Kanji, which he learned at age 6 to 7. On cognitive-psychological tests, he showed a visual cognition disorder that was different from that in a previously reported case during information processing. Electrophysiologically, he showed a disorder in visual task-relevant potentials. The mechanism underlying this patient appears to be a retrieval disorder for complex graphic forms in addition to a visual cognition disorder because of two reasons. One is that he could distinguish Kanji from similar graphic forms. The other is that he could read Kanji aloud.

Visualization of protein kinase activities in single cells by antibodies against phosphorylated vimentin and GFAP

Vimentin and glial fibrillary acidic protein (GFAP) are intermediate filament proteins expressed in the cytoplasm of various types of cells. The head domains of these proteins are phosphorylated by various protein kinases. Site- and phosphorylation-specific antibodies which recognize a phosphorylated serine/threonine residue in the head domains and its flanking sequence provide a useful tool to monitor and visualize protein kinase activities in single cells.

Facile reaction of gangliosides with hydroxyl radical

The reactivity of gangliosides with superoxide anion (O2(•-)) and hydroxyl radical (HO(•)) was evaluated by ESR spin-trapping using 5,5-dimethyl-1-pyrroline-N-oxide under physiological conditions (1/15 M phosphate buffer, pH 7.4). Gangliosides proved to react with HO(•) but not with O2(•-). The second order rate constants for various gangliosides with HO(•) ranged from 5 × 10(9) M(-1)s(-1) to 16 × 10(9) M(-1)s(-1). The rate constant for tetrasialoganglioside, GQ1b, was about three times higher than that of monosialoganglioside, GM1. The reactivity of gangliosides and asialo-GM1 with HO(•) was in the order: GQ1b >GT1b >GD1a >GD1b = GM1 ≫ asialo-GM1. The observed high reactivity of gangliosides probably involves the sialyl residues, since sialic acid was shown to be more reactive with HO(•) than d-glucose under the same conditions.

Tc-99m tetrofosmin myocardial perfusion SPECT after dipyridamole combined with low-level exercise in the diagnosis of coronary artery disease

Tc-99m tetrofosmin is a lipophilic, cationic perfusion imaging agent that changes to Tl-201 in detecting coronary artery disease during exercise testing. The purpose of this study is to evaluate the usefulness of Tc-99m tetrofosmin dipyridamole stress imaging combined with low level exercise for the detection of coronary artery disease. We examined 42 patients and 10 normal volunteers who also underwent coronary angiography. A one-day protocol was used: in the stress study, 296 MBq of tetrofosmin was injected and in the rest study 888 MBq was injected. After intravenous administration of dipyridamole (0.142 mg/kg/min for 4 minutes), the patient was exercised on a bicycle ergometer for 3 min (25 Watts). Tetrofosmin was injected 2 minutes after dipyridamole infusion during the exercise. Single photon emission computed tomographic images were obtained 30 minutes after the tracer injection. Images were interpreted as abnormal in 36 of 42 patients with coronary artery disease, and normal in all of 10 normal volunteers. The overall sensitivity of detection of coronary artery disease was 83.3% and the normalcy rate was 100%. The diagnostic values for the detection of significant stenosis in the three major arteries were: LAD sensitivity 83%, specificity 92%; LCX sensitivity 47%, specificity 91%; RCA sensitivity 75%, specificity 83%. Of the 66 arteries with more than 50% stenosis, 48 arteries were correctly identified. Of the 36 with more than 70% stenosis, 31 were identified. Scintigraphic evidence of multivessel disease was found in only 9 patients (50%). A protocol of Tc-99m tetrofosmin SPECT combined with low level exercise after dipyridamole is therefore useful for the detection of the coronary artery disease.

Blink reflex in cerebral palsy: evaluation of late components in patients with normal auditory brainstem responses

The electrically elicited blink reflex was examined and evaluated quantitatively in 60 controls and seven patients with cerebral palsy due to perinatal asphyxia who exhibited normal auditory brainstem responses. In the controls, the early component (R1) latency changed slightly from infancy to adulthood, and the late component (R2 and R2') latencies decreased to adult values by 4 to 6 years of age. The electromyographic activity of R2 and R2' increased later and became mature in the young adolescent period. Prolonged R2 latency and decreased R2 amplitude were observed more frequently than R1 abnormalities in the patients. The electromyographic activity of R2 in the patients was lower than that in control subjects more than 13 years old. Almost all patients showed bilateral cerebral atrophy and dilated lateral ventricles, but only one patient exhibited distinct pontine atrophy on cranial computed tomographic scan. These electrophysiologic abnormalities suggest that decreased excitability of interneurons of the reflex arc was present in the patients, particularly in older ones. The blink reflex test seems to be more sensitive than the auditory brainstem response for detecting brainstem dysfunction in patients with cerebral palsy due to neonatal asphyxia.

Keratin 8 phosphorylation in vitro by cAMP-dependent protein kinase occurs within the amino- and carboxyl-terminal end domains

We reported earlier that phosphorylation in vitro of keratin filaments reconstituted from rat type I keratin 18 and type II keratin 8 by cAPM-dependent protein kinase induces disassembly of the keratin filament structure. Keratin 8 rather than keratin 18 was the major target of the kinase. We have now identified the sites on rat keratin 8 for cAMP-dependent protein kinase. Sequential analysis of the purified phosphoropeptides, together with the known primary sequence, revealed that four major sites, Ser-12, Ser-23, Ser-36, and Ser-50, and three minor sites, Ser-8, Ser-33, Ser-42, are located in the amino-terminal head domain, while three minor sites, Ser-416, Ser-423 and Ser-425 locate in the carboxyl-terminal tail domain.

Mitosis-specific phosphorylation of vimentin by protein kinase C coupled with reorganization of intracellular membranes

Using two types of anti-phosphopeptide antibodies which specifically recognize vimentin phosphorylated by protein kinase C (PKC) at two distinct PKC sites, we found that PKC acted as a mitotic vimentin kinase. Temporal change of vimentin phosphorylation by PKC differed form changes by cdc2 kinase. The mitosis-specific vimentin phosphorylation by PKC was dramatically enhanced by treatment with a PKC activator, 12-O-tetradecanoylphorbol-13-acetate (TPA), while no phosphorylation of vimentin by PKC was observed in interphase cells treated with TPA. By contrast, the disruption of subcellular compartmentalization of interphase cells led to vimentin phosphorylation by PKC. Cytoplasmic and nuclear membranes are fragmented and dispersed in the cytoplasm and some bind to vimentin during mitosis. Thus, targeting of activated PKC, coupled with the reorganization of intracellular membranes which contain phospholipids essential for activation, leads to the mitosis-specific phosphorylation of vimentin. We propose that during mitosis, PKC may phosphorylate an additional subset of proteins not phosphorylated in interphase.

[Neonatal brain injury and evoked potentials]

Marked abnormalities in ABR at discharge from NICU can predict overall prognosis in patients with neonatal asphyxia. However, in patients with neonatal asphyxia as a single risk factor, the incidence of ABR abnormalities was low and ABR was not indicative of their long-term prognosis. Over the past 10 years, we encountered 13 patients with deterioration of ABR and progressive hearing impairment after discharge from NICU. All patients showed severe cardiorespiratory symptoms in the neonatal period. Nine of thirteen patients were diagnosed as persistent neonatal pulmonary hypertension. Multimodal evoked potential studies could predict life expectancy and functional state in patients with severe motor and intellectual impairment. These kind of neurophysiological test can show the patients' functional state at the time of the examination. Discrepancies in evoked potentials and clinical symptoms provide important information regarding the pathophysiology of the patients.

[Auditory perception in patients with multiple and severe handicaps: study of mismatch negativity to speech sounds]

We have found that the mismatch negativity (MMN) of event-related potentials (ERPs) to the tone burst sound is generated passively in some multiple and severe handicapped patients. This study investigated whether 10 patients with severe handicaps, whose auditory perception is hard to be evaluated clinically, exhibited MMN to the speech sound (SS). The stimuli included tone bursts of 700 and 1000 Hz in frequency, and 4 patterns of SS (1 phoneme: [a, ae], [a, o]; and 2 phonemes: [amo, ano], [ao, aka]) presented at an 85: 15 occurrence with 75 dBSPL. In the tone burst paradigm, 7 patients had a definite MMN wave followed by an N1 wave. However, a few patients showed MMN to some patterns of SS. The latency of MMN to SS was almost within normal limits. These results suggest that these patients could discriminate subtle differences of frequency in some speech sounds, although their auditory response to actual speech sounds were poor.

Primary structure of light and heavy chain variable regions of antibodies recognizing phosphorylated vimentins

We determined the primary structure of three types of monoclonal antibodies against phosphorylated vimentin, 4A4, YT33, and MO82, which recognize phosphorylated Ser55, Ser33, and Ser82 on vimentin, respectively. The amino acid sequences between these antibodies and the anti-phosphotyrosine antibodies previously reported, (Asn/Gln)-X-(Gln/Tyr)-Ser-Tyr in the complimentarity determining region (CDR) 3 of the light chain of 4A4 and YT33, Asn-Pro-Asn-(Asn/Ser)-Gly-X-(Ser/Thr)-(Ser/Thr)-Tyr-Asn-Gln-(Arg/Lys)-Ph e-Lys in the heavy chain CDR2 of MO82, and Lys-X-Ser-(Ser/Asn) in the heavy chain CDR3 of YT33 and MO82, were highly conserved. These motifs may play a role in recognizing phosphate groups of phosphoserine and phosphotyrosine.

Detection of protein kinase activity specifically activated at metaphase-anaphase transition

We have previously reported that Ser13 and Ser34 on glial fibrillary acidic protein (GFAP) in the cleavage furrow of glioma cells are phosphorylated during late mitotic phase (Matsuoka, Y., K. Nishizawa, T. Yano, M. Shibata, S. Ando, T. Takahashi, and M. Inagaki. 1992, EMBO (Eur. Mol. Biol. Organ.) J. 11:2895-2902). This observation implies a possibility that there is a protein kinase specifically activated at metaphase-anaphase transition. To further analyze the cell cycle-dependent GFAP phosphorylation, we prepared monoclonal antibodies KT13 and KT34 which recognize the phosphorylation of GFAP at Ser13 and Ser34, respectively. Immunocytochemical studies with KT13 and KT34 revealed that the GFAP phosphorylation in the cleavage furrow during late mitotic phase occurred not only in glioma cells but also in human SW-13 and mouse Ltk- cells in which GFAP was ectopically expressed, thus the phosphorylation can be monitored in a wide range of cell types. Furthermore, we detected kinase activity which phosphorylates GFAP at Ser13 and Ser34 in the lysates of late mitotic cells but not in those of interphase cells or early mitotic cells. These results suggest that there exists a protein kinase which is specifically activated at the transition of metaphase to anaphase not only in GFAP-expressing cells but also in cells without GFAP.