[The clinical characters and treatment of lung cancer in youth]

From January 1970 to December 1990, 67 patients with lung cancer aged younger than 40 years, were treated in the PUMC Hospital. There were 43.3% with SCLC and 37.3% with adenocarcinoma. Twenty-eight patients underwent resection of the lung. Thirty-five cases received chemotherapy or radiotherapy only. The clinical and pathological characteristics of lung cancer in youth, and the influence of surgical and non=surgical treatments to the patients with lung cancer are discussed. The authors consider that the bronchoscopic and sputum smear examinations are very helpful for diagnosing lung cancer in the early stage. Postoperative adjuvant chemo- and radio-therapy is suggested because of the high incidence of SCLC and adenocarcinoma in the young patients with lung cancer.

[Analysis of the influence factors on the resection and prognosis of thymic tumors]

One hundred eleven thymic tumors were intervened surgically, including 92 thymoma, 8 thymic carcinoid, and 10 thymic carcinoma. In this series 50.9% of the cases were complicated with various syndrome, 44.5% with myasthenia gravis (MG), more frequently in the epithelial cell type. Pure red cell aplasia often associated with the spindle-cell thymoma. Of the thymic carcinoid 50% had ectopic ACTH syndrome. Resection rate correlated with the size and invasion of the tumor. There were significant difference in resection rate among thymoma, thymic carcinoid, and thymic carcinoma. The degree of invasion undoubtedly influenced on resection. The 3-, 5-, and 10-year survival rates of the thymoma were 82.7%, 68.1% and 40.0% respectively. The prognosis depended on the pathological classification and the severity of neighbouring invasion, but MG had no significant effect on prognosis. Recurrence and metastasis of the tumor remained to be the main cause of late death.

Characterization of the lanthanide ion-binding properties of calcineurin-B using laser-induced luminescence spectroscopy

Calcineurin (CaN) is a Ca2+/calmodulin-dependent protein phosphatase found in brain and other tissues. It is a heterodimer consisting of a catalytic subunit (CaN-A) and a Ca(2+)-binding regulatory subunit (CaN-B). The primary structure of CaN-B indicates that it, like calmodulin, is an EF-hand protein and binds four Ca2+ ions. Eu3+, due to its favorable spectroscopic and chemical properties, has been substituted for Ca2+ in CaN-B to determine the metal ion-binding properties of this "calmodulin-like" protein. Excitation of the 7F0-->5D0 transition of Eu3+ results in a spectrum similar to that of calmodulin, consisting of three peaks. Analysis of the spectral titration curves reveals four Eu(3+)-binding sites in CaN-B. The affinities vary: sites I and II have dissociation constants of 1.0 +/- 0.2 and 1.6 +/- 0.4 microM, respectively; the values for sites III and IV are Kd = 140 +/- 20 and Kd = 20 +/- 10 nM, respectively. Binding of Tb3+ is slightly weaker. Tb3+ luminescence, sensitized by tyrosine, reveals that for lanthanides the highest affinity sites lie in the C-terminal domain. Energy transfer distance measurements between Eu3+ and Nd3+ in sites III and IV reveal a separation of 10.5 +/- 0.5 A, which suggests that these sites are arranged in a typical EF-hand pair. This information indicates that the overall structure of CaN-B is similar to the dumbbell-shaped proteins troponin-C and calmodulin, but is more like TnC in its metal-binding properties.

The effect of ultraviolet-B irradiation on the cell shedding rate of the corneal epithelium

In this study cell shedding rates of the corneal epithelium were determined in vitro following a single suprathreshold dose of ultraviolet-B irradiation. Rabbit corneas were excised and superfused in pairs. The epithelial and endothelial surfaces were bathed with solutions containing essential ions and adjusted to appropriate pH and osmolality. One cornea in each pair was irradiated, while the other cornea served as a control. Shed cells were periodically collected from the corneal surface and the shedding rate determined by counting the number of cells in a 50 min time period. Following a latent period of about 3 h, the epithelial shedding rate accelerated, and remained elevated for at least 8 h after irradiation. This result suggests that suprathreshold doses of ultraviolet-B irradiation disrupt the normal orderly cell shedding process and homeostatic equilibrium of the corneal epithelium. The elevated cell shedding rate exposes subsurface nerve endings and causes the characteristic pain of photokeratitis.

Posttranscriptional mRNA processing as a mechanism for regulation of human A1 adenosine receptor expression

The human A1 adenosine receptor gene contains six exons with exons 1, 2, 3, 4, and part of 5 representing 5' untranslated regions. Reverse transcription-PCR with exon-specific primers showed two distinct transcripts containing either exons 3, 5, and 6 or exons 4, 5, and 6, with exons 3 and 4 being mutually exclusive. No mature mRNAs containing exons 1 and 2 have been detected. All human tissues that express any A1 receptors contain mRNA with exons 4, 5, and 6. Tissues which express high levels of A1 receptors contain mRNA with exons 3, 5, and 6. Exon 4 contains two upstream ATG codons whereas exon 3 contains none. COS cells transfected with expression vectors containing exon 4 (exons 1-6, 3-6, or Ex4-6) express much lower levels of A1 receptors than vectors without exon 4 (exons 3, 5, and 6). Mutation of upstream ATG codons in exon 4 leads to 3- to 7-fold increased A1 receptor expression, up to the level seen with the construct containing exons 3, 5, and 6. Thus, in human tissues "basal" levels of A1 receptors can be expressed by use of mRNA containing exons 4, 5, and 6, but when high levels are needed, alternative transcripts with exons 3, 5, and 6 are produced.

1H, 13C, 15N nuclear magnetic resonance backbone assignments and secondary structure of human calcineurin B

The calmodulin- and calcium-stimulated protein phosphatase calcineurin, PP2B, consists of two subunits: calcineurin B, which binds Ca2+, and calcineurin A, which contains the catalytic site and a calmodulin binding site. Heteronuclear 3D and 4D NMR experiments were carried out on a recombinant human calcineurin B which is a 170-residue protein of molecular mass 19.3 kDa, uniformly labeled with 15N and 13C. The nondenaturing detergent CHAPS was used to obtain a monomeric form of calcineurin B. Three-dimensional triple resonance experiments yielded complete sequential assignment of the backbone nuclei (1H, 13C, and 15N). This assignment was verified by a 4D HN(COCA)NH experiment carried out with 50% randomly deuteriated and uniformly 15N- and 13C-enriched calcineurin B. The secondary structure of calcineurin B has been determined on the basis of the 13C alpha and 13C beta secondary chemical shifts, J(HNH alpha) couplings, and NOE connectivities obtained from 3D 15N-separated and 4D 13C/15N-separated NOESY spectra. Calcineurin B has eight helices distributed in four EF-hand, helix-loop-helix [Kretsinger, R. H. (1980) CRC Crit. Rev. Biochem. 8, 119-174] calcium binding domains. The secondary structure of calcineurin B is highly homologous to that of calmodulin. In comparison to calmodulin, helices B and C are shorter while helix G is considerably longer. As was observed for calmodulin in solution, calcineurin B does not have a single long central helix; rather, helices D and E are separated by a six-residue sequence in a flexible nonhelical conformation.

Influence of alloferin on neuromuscular function in myasthenia patients undergoing thymectomy

Myasthenia gravis patients are hypersensitive to nondepolarizing relaxants, such as alcuronium, an intermediate-long nondepolarizing agent. This study observed the effects of alcuronium treatment in myasthenia gravis patients as compared with non-MG patients during operation. Ten MG patients (Ossermann class I-IV, scheduled for thymectomy) and 10 non-MG patients (ASA class I-II, scheduled for operation) were selected. An induction dose of alcuronium 0.2 mg/kg and thiopental 4-6 mg/kg was given, followed by intubation and ventilation with 50% nitrous oxide in oxygen and 0.5-1.5% ethrane. Neuromuscular transmission was monitored using an accelerograph and degrees of neuromuscular function at different depths were recorded. There were statistically significant differences between the two groups. The effect of alloferin in the MG group was quicker and deeper. This study also found a relation between MG class and the recovery of respiration: Respiratory recovery was quicker in classes I-II than in classes III-IV.

Characterization of the human A1 adenosine receptor gene. Evidence for alternative splicing

To approach transcriptional and translational regulation of adenosine receptors, we have isolated cDNA and genomic clones of the human A1 adenosine receptor (A1AR). The cDNA, when inserted into the pCMV5 expression vector and transfected into COS-7 or CHO cells, leads to the expression of a functional A1AR that displayed all the appropriate pharmacologic properties. The human A1AR gene consists of at least six exons and five introns. A single intron interrupts the coding sequence, while the remaining introns are within the 5'-untranslated region. Comparison of our cDNA with one by Libert et al. (Libert, F., Van Sande, J., Lefort, A., Czernilofsky, A., Dumont, J. E., Vasart, G., Ensinger, H. A., and Mendla, K. D. (1992) Biochem. Biophys. Res. Commun. 187, 919-926) reveals that exon 4 in the 5'-untranslated region was completely missing from their sequence. Study of mRNAs from a range of human tissues by reverse transcription-polymerase chain reaction using a variety of primers revealed clear evidence for alternative splicing. Transcripts containing exons 4, 5, and 6 were found in all tissues expressing A1AR, while a separate transcript with exons 3, 5, and 6 was seen only in selected tissues. No transcript contains both exons 3 and 4. No evidence for expression of exons 1 and 2 could be discerned. Exon 4 contains two AUG initiation codons with reasonable Kozak consensus, suggesting the possibility of translational regulation. Exon 3 contains no AUG initiation codons.

Effect of albendazole on Ancylostoma caninum larvae migrating in the muscles of mice

When mice inoculated with 1,000 third-stage larvae of Ancylostoma caninum for 1 week were treated intragastrically (ig) with albendazole (Alb) 75, 150 or 300 mg/kg.d for 3 days, the mean larva numbers collected from the muscles of each group were 2.7 +/- 1.7, 2.0 +/- 1.5 and 1.0 +/- 1.0, respectively, being much less than that 205 +/- 68 of the control group. In mice treated ig with Alb 150 mg/kg.d for 3 days, the concentrations of Alb and its effective metabolite, albendazole sulfoxide (AlbSO), were determined in plasma and the muscles at different intervals after the last medication using high performance liquid chromatography. The results showed that only low concentrations of Alb were detected in both plasma and the muscles. However, higher concentrations of AlbSO were found not only in the plasma (5.4-10.5 micrograms/ml), but also in the muscles (2.2-4.6 micrograms/g). The higher contents of AlbSO in the muscles would be helpful for killing the Ancylostoma larvae migrating in the muscles of mice.

Preliminary report on cardiovascular responses to urapidil during intubation and extubation

Urapidil (Ebrantil), a new antihypertensive agent with central and peripheral sites of action, has proven effective in the management of both chronic and acute hypertension. This study investigates its effects on cardiovascular responses during intubation and extubation under general anesthesia. Thirty normotensive patients (ASA I-II) were randomized into control (I, without urapidil, n = 10); lower dose (II, 0.4 mg/kg, n = 10); and higher dose (III, 0.6 mg/kg, n = 10) groups. A significant fall of blood pressure was observed in all patients within 1 min after urapidil administration (P < 0.05), and the magnitude of the decrease was related to blood pressure before treatment. However, no transient drop of blood pressure to hypotensive values was observed. The results suggest that urapidil could be used under general anesthesia in patients to control fluctuating blood pressure during intubation and extubation. The increased heart rate (P < 0.05) seen for several minutes after urapidil administration may have been due to the patients' hypovolemic state.

Total gastrectomy via thoracotomy for cancer of the cardia or fundus of the stomach (report of 90 cases)

From 1978 through 1990, 90 total gastrectomies with esophagojejunostomy via thoracotomy were performed for the treatment of cancer of the cardia or fundus of the stomach in our hospital. Eighty-five patients were in TNM-stage III and five in stage IV. The 30-day postresectional mortality was 1.1%, and the 5-year survival rate was 13.8%. 14CO2 breathing test and clinical evaluation of 34 postoperative patients (not included in the 90 patients) showed that total gastrectomy may decrease the incidence of positive residual cancer along the incision lines, and may help to avoid small stomach syndrome. There was no statistical difference in postoperative fat absorption between patients treated by ordinary proximal subtotal gastrectomy and those receiving total gastrectomy via thoracotomy.

Hepatitis B virus infection in Honolulu students

OBJECTIVES

To determine hepatitis B virus (HBV) carrier and infection rates and HBV epidemiology in Honolulu students.

DESIGN

Cross-sectional survey.

SETTING

Honolulu public elementary, intermediate, and high schools.

PATIENTS

A volunteer sample of 4936 students from 43 Honolulu schools.

MAIN OUTCOME MEASURES

HBV carrier rate (presence of hepatitis B surface antigen) and infection rate (presence of either hepatitis B surface antigen, antibody to hepatitis B surface antigen, antibody to hepatitis B core antigen, or any combinations of these) by school grade, ethnicity, and place of birth.

RESULTS

Eighty-three (1.68%) students were identified as HBV carriers, and a total of 353 (7.15%) students had serologic evidence of infection. Infection rates increased from elementary school age to high school age, more so in Asian/Pacific Island-born students. The prevalence of infection was higher in Asian/Pacific Island-born students than in those born in the United States. The majority of infected Hawaiian-born students were first-generation Asian/Pacific Island Americans.

CONCLUSIONS

Horizontal transmission of HBV occurs in Honolulu school-age children. HBV immunization of all infants in Hawaii, not just those born to carrier mothers, is necessary to reduce HBV transmission in Hawaii.

Long survival with giant cell myocarditis

Several aspects of giant cell myocarditis remain controversial, including the natural history of the disease and the nature of the giant cells. We have observed three patients who had long survival with chronic active giant cell myocarditis. The first patient was a 59-yr-old female who had a 10-yr history of complete heart block which was found at autopsy to have been caused by giant cell myocarditis. The second patient is a 36-yr-old female who received a heart transplant 5 yr after a biopsy proven episode of active myocarditis, and examination of the explanted heart revealed giant cell myocarditis. The third patient was a 41-yr-old male who received a heart transplant 2 yr after developing progressive heart failure, and the explanted heart had giant cell myocarditis. On immunohistochemical study of the three hearts, the giant cells stained with the macrophage markers lysozyme and KP-1 (CD-68). Staining of the same cells with desmin and actin was focally positive in a punctate pattern, correlating with the ultrastructural presence of myofibrils within giant cell phagolysosomes. The associated lymphocytic infiltrate stained primarily for the T-cell markers CD-3, CD-45RO, and CD-43 whereas only a few of the lymphocytes stained with the B-cell marker CD-20. The long histories of cardiac dysfunction in the three patients show that giant cell myocarditis may have a protracted course. The morphologic studies show that the giant cells are of histiocytic origin but can contain phagocytosed components of myocytes, observations that may account for the controversy surrounding the nature of the giant cells in giant cell myocarditis.

[Bronchial disruption due to blunt chest trauma--a report of 6 cases]

Six cases with bronchial disruption due to blunt chest trauma are reported. Clinical symptoms were dyspnea in 5 patients, hemopneumothorax in 3 cases, and hemoptysis and subcutaneous emphysema in 4 cases each. Pneumothorax was not found on immediate radiological examination in 3 patients. Bronchial disruption was defined by exploratory thoracotomy in one case three days after trauma. In the remaining 5 cases, the diagnosis was demonstrated by lipiodol bronchography and fibrobronchoscopy 70 days to 6 years later. End-to-end anastomosis of the bronchus was performed in 5 patients, whereas right middle and lower lobectomy was done in one case. Five patients with bronchial repair suffered transient atelectasis of the lung, which reexpanded in 4 to 10 days.

Misdiagnosis of lung cancer in patients under age 40--a clinical analysis of 47 cases

Diagnosis of lung cancer in 47 patients aged younger than 40 years was delayed as a result of misdiagnosis, accounting for 70.1% of all cases of lung cancer in those aged less than 40 years treated in PUMC Hospital in the same period. Pulmonary tuberculosis and tuberculous pleurisy were diagnosed in 26 cases (55.3%). Pulmonary inflammation was suspected in 24 cases (51.1%). The delay in diagnosis was one to three months in 28 cases and longer than 3 months in 19 cases. Twenty-eight (59.6%) of the 47 patients underwent surgery, including exploratory thoracotomy (21.4%) and pneumonectomy (40.9%). The five-year survival rates in the resectable group and in the non-surgical group were 31.6% and 5.3%, respectively. We recommend that accessory examinations should be performed wherever possible in younger patients with suggestive pulmonary nodules in order to collect sufficient evidence to confirm or rule out the diagnosis of lung cancer and thereby reduce the rate of misdiagnosis in such younger people.

Identification of an ethanol-soluble protein as beta-amylase and its purification from soybean seeds

In the 60% ethanol extract of soybean seeds, a prominent protein band was visible after polyacrylamide gel electrophoresis, which had a molecular weight of about 55 x 10(3) M(r). This protein was purified to homogeneity by buffered ethanol extraction and preparatory gel electrophoresis. Since the N-terminus was apparently blocked, the protein was cleaved with cyanogen bromide and the largest fragment was isolated and a partial sequence determined. The sequence of the 27 N-terminal amino acid residues matched a published soybean beta-amylase peptide sequence. In addition, the purified protein had a high specific activity for beta-amylase and was not a glycoprotein. Furthermore, the partial sequence (106 nucleotides) of a cDNA clone, isolated from a soybean seed cDNA library by antibody screening, matched the cDNA sequence of soybean beta-amylase except for one base. Therefore, the ethanol-soluble protein was identified as beta-amylase. The enzyme was purified to homogeneity using a two-step purification procedure with a yield of over 50%.

Serum tumor necrosis factor (TNF) in the pathogenesis of clinical hepatic failure of HCV and/or HBV infection

Serum TNF and IL-6 levels were measured in 48 patients with liver disease positive for anti-HCV only or concurrent HBV infection. High serum TNF levels were observed in patients with liver disease positive for anti-HCV and/or HBV infection (P < 0.001). Serum TNF levels varied with the severity of liver disease. Serum TNF levels of anti-HCV positive patients with hepatic failure were higher than those with CAH (P < 0.01). Serum TNF levels of patients infected with HCV or concurrent HBV were also significantly higher than those with HBV infection alone (P < 0.001). However, no difference in serum IL-6 levels was observed in either group of patients. Serum TNF in the deceased patients with hepatic failure induced by HBV and HCV infection was higher than in those who survived (P < 0.05), and it also seemed significantly different in patients with and without multiple organ failure (P < 0.05). In vitro, HSS showed marked inhibitory activity on TNF production from PBM induced by endotoxin, but had no significant effect on the TNF cytotoxicity of L929 cells. It seems that high serum TNF level is an important mediator in the pathogenesis of liver necrosis and failure of microcirculation in HCV and/or HBV infection. These observations favor the attempt to treat hepatic failure with HSS or anti-TNF. Encouraging results were achieved using HSS in the treatment of subacute liver necrosis in our institute.(ABSTRACT TRUNCATED AT 250 WORDS)

Apoxesis of primary tracheal tumor. A clinical analysis of 23 cases

During a 17-year period, 23 patients with primary tracheal tumors underwent surgical treatment in the Department of Thoracic Surgery, PUMC Hospital (11 cases of benign tumor of the trachea, 12 cases of low malignancies). Fourteen times of apoxesis were performed in 11 patients with benign tumors who were followed up for an average of 6.3 years. Fifteen operations were performed in 12 cases including local resection of the tracheal wall and tumor in 4, and curettage of tumor plus electric cauterization on the basis in 10. Eight of 9 patients with adenoid cystic carcinoma received postoperative adjuvant irradiation, with a 5-year postoperative survival rate of 75% (6/8) and 3 cases survived over ten years. The desirability of apoxesis and local resection of tracheal tumor is discussed. The authors suggest that these two surgical patterns can be regarded as a simple and effective treatment for patients with primary tracheal tumors.

[Evaluation of local resection for primary tracheal tumor: a clinical analysis of 23 cases]

During a 17 year period, 23 patients with primary tracheal tumor underwent surgery in the PUMC Hospital. Of them, 11 cases were benign tumors and 12 had low malignancies. 11 patients with benign tumors received 14 times of apoxesis of the tumor. 12 cases with low malignancies underwent 15 times of operations including local resection of the tracheal wall and tumor in 4 cases, and tumor apoxesis as well as electrocautery on the basis in 10 cases. Eight of 9 patients with adenoid cystic carcinoma were treated postoperatively with irradiation. Eleven cases with benign tumors were followed up for an average 6.3 of years. Nine cases with adenoid cystic carcinoma were followed up for an average 7.6 of years and 5 year survival rate was 75% (6/8). Among them 3 cases survived longer than 10 years. The authors consider that the local resection and tumor apoxesis can yet be regarded as a simple and effective way of surgical treatment for primary tracheal tumor.

Thymic carcinoid tumor--a report of 7 cases

The thymic carcinoid tumor is a rare neoplasm which is often clinically misdiagnosed as thymoma. But the two differ in origin, biological behavior, accompanying syndromes, pathological features, and prognosis. The characteristics of the thymic carcinoid tumor are: difficulty in diagnosis, high malignancy, frequent recurrence and extrathoracic metastasis over a prolonged period postoperatively. Complete surgical resection of original and recurrent tumors is the important treatment. Microscopic, electron microscopic and immunohistochemical examinations may be required in making an accurate pathological diagnosis. This paper reports 7 cases of thymic carcinoid tumor.

Isotope-edited multidimensional NMR of calcineurin B in the presence of the non-deuterated detergent CHAPS

At the concentration needed for NMR, the calcium-saturated form of calcineurin B dissolved in water shows resonance line widths that indicate aggregation of this protein. Although the line width or aggregation state can be influenced to some degree by temperature, pH, and salt concentrations, in the absence of detergent no conditions could be found where the protein behaved as a monomeric unit. In the presence of a 10- to 20-fold molar excess of the zwitterionic detergent 3-[(3-cholamidopropyl)-dimethyl-ammonio]-1-propanesulfonate (CHAPS), resonance line widths were considerably narrower and were compatible with a protein of approximately 25 kDa. The presence of the NMR signals of the non-deuterated CHAPS does not interfere with modern isotope-directed NMR studies as the signals from protons not attached to 15N or 13C are removed by isotope filtering and purge pulses.

A study of the effect of magnetized water on enzyme activities by potentiometric enzyme electrode method

A very promising glutamate decarboxylase electrode, which has linear response range of 5.6 x 10(-5)-1.2 x 10(-2) mol/L. Nernstian slope of 50 mV/decade, detection limit of 3.2 x 10(-5) mol/L and response time less than 3 min, has been designed to observe and evaluate quantitatively the effect of magnetized water on enzyme activities by potentiometric enzyme electrode method. It was found that the activity of glutamate decarboxylase can increase by 30% in magnetized water. The mechanism of increased enzyme activity was discussed in the present paper. Such a new finding will probably lead to some new explanations for the physiological and biological mechanism of the effect of magnetized water on living organisms, thus providing a new approach to the study of the effect of magnetized water.

The effect of multi-glycosides of Tripterygium wilfordii Hook f. (GTW) on the survival time of cardiac allografts in rats

Heterotopic heart transplantation was carried out in rats and the influence of multi-glycosides of Tripterygium wilfordii Hook f. (GTW) and a subtherapeutic dose of cyclosporine A (CsA) on the mean survival time (MST) of the cardiac allografts was investigated. The results showed that the MSTs of cardiac allografts in both the GTW and CsA-treated groups were significantly prolonged (P < 0.01 vs control). The rate of allograft rejection in the drug-treated groups was much lower than that in the control group.

[Effect of compound and minor prescription of heat-nature products radix Aconiti lateralis preparata, rhizoma Zingiberis and cortex Cinnamomi on the sympathetic nervous system, adrenal gland, TSH and LH]

The effect of compound and minor prescriptions of Radix Aconiti Lateralis Preparata, Rhizoma Zingiberis and Cortex Cinnamomi on sympathetic nervous system, adrenal gland, TSH and LH of rats was studied. Results showed that both prescriptions made the heart rate quicken, estrous cycle shorten, improved the adrenal cortex hormone and promote TSH and LH synthesis and secretion. The two Heat-nature products (Radix Aconiti Praeparata and Rhizoma Zingiberis) may be used instead of all the three products to make a Heat Syndrome animal model.

[Hepatocyte stimulatory peptide and its clinical significance in viral hepatitis]

Hepatocyte stimulator peptide (HSP) is a new hepatic stimulator substance. Its monoclonal antibodies have been obtained in our laboratory. In this study, HSP was determined in the sera of 315 subjects including patients with various forms of hepatitis and healthy persons with enzyme-linked immunosorbent assay (sandwich method). It is shown that HSP level in the sera of patients with fulminant hepatitis was high and correlated with the level of tumour necrosis factor (TNF), serum bilirubin (SB) or prothrombin time (PT). It is suggested that level of HSP in the sera of the patients reflected the degree of hepatocyte injury. A formula was recommended to predict the outcome of the patients with fulminant hepatitis.

[Tumor necrosis factor and interleukin 6 in hepatitis C virus infection]

Tumor necrosis factor (TNF) was determined with ELISA in 72 patients with hepatitis C and hepatitis B virus infections. Interleukin 6 (IL-6) was determined at the same time. TNF and IL-6 were significantly increased in patients with hepatitis C virus infections when compared with normal subjects and hepatitis B patients. There was a significant positive correlation between TNF and IL-6. It is suggested that increased TNF and IL-6 may play an important role in pathogenesis of hepatitis C virus infection.

Cloning, expression, and characterization of the unique bovine A1 adenosine receptor. Studies on the ligand binding site by site-directed mutagenesis

The bovine brain A1 adenosine receptor (A1AR) is distinct from other A1ARs in that it displays the unique agonist potency series of N6-R-phenylisopropyladenosine (R-PIA) greater than N6-S-phenylisopropyladenosine (S-PIA) greater than 5'-N-ethylcarboxamidoadenosine and has a 5-10-fold higher affinity for both agonists and antagonists. The cDNA for this receptor has been cloned from a size-selected (2-4-kb) bovine brain library and sequenced. The 2.0-kb cDNA encodes a protein of 326 amino acid residues with a molecular mass of 36,570 daltons. The amino acid sequence fits well into the seven-transmembrane domain motif typical of G protein-coupled receptors. Northern analysis in bovine tissue using the full length cDNA demonstrates mRNAs of 3.4 and 5.7 kb with a tissue distribution consistent with A1AR binding. Subcloning of the cDNA in a pCMV5 expression vector with subsequent transfection into both COS7 and Chinese hamster ovary cells revealed a fully functional A1AR which could inhibit adenylylcyclase and retained the unique pharmacologic properties of the bovine brain A1AR. The A1AR was found to have a single histidine residue in each of transmembrane domains 6 and 7. Histidine residues have been postulated by biochemical studies to be important for ligand binding. Mutation of His-278 to Leu-278 (seventh transmembrane domain) dramatically decreased both agonist and antagonist binding by greater than 90%. In contrast, mutation of His-251 to Leu-251 decreased antagonist affinity and the number of receptors recognized by an antagonist radioligand. In contrast, agonist affinity was not perturbed but the number of receptors detected by an agonist radioligand was also reduced. These data suggest that both histidines are important for both agonist and antagonist binding, but His-278 appears critical for ligand binding to occur.

[Primary pulmonary chemodectoma. Report of 2 cases and review of the literature]

The authors report two cases of primary pulmonary chemodectoma. The patients were admitted to the PUMC Hospital because of nodular lesion in the lung. The diagnosis was documented by postoperative pathology. Primary pulmonary chemodectoma is rare. Ten cases has been reported in the English literature. The clinical characteristic features is pulmonary single lesion on chest X-ray film. No correct diagnosis was made pre-operatively. A typical histopathological finding is observed. NSE and S-100 proteins is positive with immuno-histological stain. Surgery operation is the only reliable treatment.

[Esophageal diverticulum]

During a 25-year period, nineteen patients with esophageal diverticulum were treated surgically in PUMC Hospital. Of them, eleven cases underwent resection of the diverticulum (10 pulsion type and 1 traction type); and four cases were treated by inversion suturing of the diverticulum (all traction type). The results of follow-up showed that pulsion diverticulum resection was satisfactory, and the resection was better than inversion suturing for traction-type diverticula. In this series, diverticulitis and esophagitis were present in all cases. Carcinoma of the esophagus developed at site near the diverticulum in 4 cases. Pathologic examination demonstrated severe submucosal inflammatory infiltration and epithelial hyperplasia of the esophagus associated with the diverticulum, with these changes being increasingly severe with the precondition of the carcinoma to the diverticulum. Carcinoma of the esophagus as a complication of diverticulum may be associated with chronic diverticulitis and esophagitis.

Esophageal diverticulum associated with carcinoma of the esophagus--a report of four cases

During a 25-year period, four patients with esophageal diverticulum associated with carcinoma of the esophagus underwent surgery. The results were satisfactory. The clinical features included a long history of diverticulum and the presence of a carcinoma of the esophagus in close proximity to the former. Inflammation within the diverticulum and in the mucosa around the diverticulum was noted. The closer the diverticulum to the carcinoma, the more severe the inflammation. Therefore, diverticulitis and esophagitis may be important factors leading to the development of carcinoma of the esophagus, and patients with esophageal diverticulum should be followed up regularly and the diverticulum resected as early as possible if inflammation within the diverticulum or peri-diverticular esophagitis is found.

Prevention of syngeneic graft-versus-host disease by recovery of thymic microenvironment after cyclosporine

Following a course of cyclosporine, syngeneic rat radiation chimeras consistently develop a GVHD-like syndrome. Correlation of the thymic immunopathology with conditions leading to syngeneic graft-versus-host disease (sGVHD) suggested the hypothesis that reconstitution of the normal thymic microenvironment after CsA is necessary for self-tolerance. When thymic regeneration is impaired, as in rats receiving previous mediastinal irradiation, then self-reactive effector cells are not regulated and proceed to damage the target tissues. Alternately, it could be argued that the observed thymic abnormalities are irrelevant to sGVHD. To test the primary hypothesis, post-CsA thymic reconstitution was prevented by total thymectomy in unirradiated rats. These rats consistently developed acute type sGVHD seen at 7 and 21 days post-CsA while rats from the CsA-treated sham thymectomy control group failed to develop sGVHD. Because thymectomy prior to CsA blocks sGVHD, most likely the peripheral effector cells in the post-CsA thymectomy group were derived from the CsA-altered thymus. The absence of sGVHD in the sham group indicates that the thymus led to active regulation of these cells after stopping CsA. If regeneration of the thymus restored only negative selection, then the sham thymectomy group should have also developed sGVHD. Flow cytometry and morphology of the spleen and lymph nodes demonstrated that the thymectomized rats, like CsA-treated radiation chimeras, experienced a significant delay in maturation of T cells following CsA. In contrast to the usual model in radiation chimeras, however, the post-CsA thymectomized rats did not convert to chronic type sGVHD. The importance of an abnormal thymus for this transition was confirmed in syngeneic radiation chimeras. Thymectomy after CsA in these rats also blocked the rapid transition to chronic sGVHD.

A PCR procedure to determine the sequence of large polypeptides by rapid walking through a cDNA library

A procedure that uses the PCR to make rapid successive steps through a random-primed cDNA library has been developed to provide a method for sequencing very long genes that are difficult to obtain as a single clone. In each successive step, the portions of partial clones that extend out from the region of known DNA sequence are amplified by two stages of PCR with nested, outward-directed primers designed approximately 50 bases in from the end of the known sequence, together with a general primer based on the sequence of the vector. This procedure has been used to determine the coding sequence of the cDNA for the beta heavy chain of axonemal dynein from embryos of the sea urchin Tripneustes gratilla. By starting from a single parent clone, whose translated amino acid sequence overlapped the microsequence of a tryptic peptide of the beta heavy chain, and making 3 such walk steps downstream and 14 walk steps upstream, we obtained a sequence of 13,799 base pairs that had an open reading frame of 13,398 base pairs. This sequence encodes a polypeptide with 4466 residues of Mr 511,804 that is believed to correspond to the complete beta heavy chain of ciliary outer arm dynein.

Treatment of small cell lung cancer

During a 28-year period, 110 patients with small cell lung cancer were treated at our hospital. Fifty-nine patients received surgery, and 58 patients (including 7 cases after exploratory thoracotomy) received chemotherapy and/or radiotherapy. The 5-year survival rate of the surgically treated group was 17%, while none in the non-surgical group survived for more than 5 years.

Midazolam as a main anesthesia induction agent--a comparison with thiopental and diazepam

A clinical randomized investigation was undertaken to determine the value of midazolam as a narcotic adjuvant for anesthetic induction. Thirty ASA I-II adult patients undergoing selective surgery were allocated randomly into two groups to receive one of the following agents: midazolam 0.3 mg/kg, thiopental 5 mg/kg, or diazepam 0.4 mg/kg. The induction time as measured from the onset of injection to loss of the eyelash reflex was shortest in the case of thiopental; while a lower frequency of apnea, lesser suppression of circulation, and lack of venous irritation were points favoring midazolam. However, further study is needed to clarify the moderate cardiovascular response seen during intubation in some cases as well as to elucidate any patient population differences.

[A study of protein engineering for human cardionatrin. II. Construction of two new human cardionatrin analog genes, RH-2 & RH-3 by intragenic recombination in vitro]

Two new analog genes of the alpha-human atrial natriuretic polypeptide (alpha-hANP) were constructed by accurate intragenic recombination of analog RH-1 gene with ANP gene in vitro, both of which had been synthesized and reported. One recombined analog gene, RH-2, was designed to contain an equivalent of the alpha-hANP gene, capping the peptidase inhibitor SQ20881 sequence at its 5'end. The other analog gene, RH-3, was designed to contain an equivalent of the alpha-hANP gene, wedging in two proline codons CCG & CCG at the 3' end. The recombinants bearing the genes, bacteriophage RH-2/M13mp18 & RH-3/M13mp18, were identified by DNA domain combination analysis--in situ hybridization and dot blotting with three probes matching three specific DNA domains, and by restriction analysis. The DNA sequences of RH-2 and RH-3 were confirmed by the dideoxynucleotide chain termination method.

[The report of 2 cases of thyroid cancer with intratracheal growth]

From 1961-1987, 28 patients were operated upon for tracheal tumor, including 2 cases of thyroid cancer with intratracheal growth. Operative findings showed that in these cases a small intraluminal cancer mass and large extraluminal cancer mass were fixed together. Intratracheal growth was secondary to extratracheal thyroid cancer. Evidence of cancer from aberrant intratracheal thyroid tissues was not found. Differential diagnosis of tracheal tumor from thyroid cancer with intratracheal growth is difficult. Palliative resection with post-operative irradiation was used in these two cases because of the generally poor condition of the patients.

Pleural plaques do not predict asbestosis: high-resolution computed tomography and pathology study

Pleural plaques can be caused by asbestos exposure, but their predictive value in diagnosing pulmonary asbestosis is uncertain. Similarly, although high-resolution computed tomography (HRCT) can accurately detect parenchymal lung lesions, its ability to detect asbestosis is unknown. In a test of the predictive value of pleural plaques and HRCT, lungs of 29 autopsied patients with bilateral parietal pleural plaques were compared with lungs from 29 age- and sex-matched controls without pleural plaques. Significantly more of the patients with pleural plaques had histories of asbestos exposure (P less than 0.01). One lung from each patient was inflation fixed and air dried. HRCT of the lungs did not show significantly more thickening, lines, or densities in patients with pleural plaques than did controls; and HRCT did not predict a significantly greater likelihood of asbestos-related parenchymal disease in the study group. Gross and histologic examinations showed no significant intergroup differences in the frequency or severity of several forms of emphysema and fibrosis. Average asbestos fiber counts were not significantly higher in the lungs with pleural plaques. We conclude that pleural plaques do not predict asbestosis, and that high-resolution computed tomography accurately detects interstitial and parenchymal lung disease but cannot reliably diagnose asbestosis.

Accelerated arteriosclerosis in heart transplant recipients is associated with a T-lymphocyte-mediated endothelialitis

Accelerated arteriosclerosis has emerged as a major life-threatening complication in long-term survivors of heart transplantation. It has been proposed that accelerated arteriosclerosis is an immune-mediated complication of rejection. We observed a striking endothelialitis in the coronary arteries of two explanted hearts obtained from patients with severe transplant-related accelerated arteriosclerosis. This finding prompted us to review the pathologic changes in the coronary arteries of 23 autopsied patients who had received heart transplants. The infiltrate in these vessels was characterized using immunohistochemical stains for lymphocytes (CD45), macrophages (MAC-387), T lymphocytes (CD45RO), B lymphocytes (L-26), and smooth muscle cells (actin). In addition, a full panel of monoclonal antibodies was used on the fresh-frozen tissue available from one of the two explanted hearts. Ten of the eleven recipients with accelerated arteriosclerosis had a moderate to marked lymphocytic endothelialitis compared to 3 of 14 without transplant-related arteriosclerosis (P less than 0.005). Immunohistochemical staining of the paraffin-embedded material demonstrated that most of the lymphocytes in the subendothelial space of these vessels were T lymphocytes and that this infiltrate was associated with an accumulation of macrophages and a proliferation of smooth muscle cells in the intima. In the explanted heart from which fresh-frozen tissue was available for more detailed cell typing, the T cells marked predominantly as cytotoxic T lymphocytes (CD8+, CD2+). These results suggest that accelerated arteriosclerosis may be mediated, in part, by a cytotoxic T-lymphocyte-directed endothelialitis.

Amiodarone pulmonary toxicity: CT findings in symptomatic patients

The computed tomographic (CT) chest scans of 11 patients who developed respiratory or constitutional symptoms while receiving amiodarone therapy were reviewed. CT findings indicative of significant amiodarone exposure included (a) high-attenuation parenchymal-pleural lesions in eight of the 11 patients (73%), and (b) increased liver and/or spleen attenuation in 10 of the 11 patients (91%). Nonspecific pulmonary infiltrates were identified in nine of the 11 patients (82%). Four patients had interstitial infiltrates, four had mixed alveolar and interstitial disease, and one had a conglomerate mass. CT findings of high-attenuation parenchymal-pleural abnormalities are thought to be related to the iodinated chemistry of the drug and its prolonged half-life within the lung. These unique properties of the drug and the use of CT to discriminate attenuation levels provide a means of identifying patients with significant pulmonary accumulation of amiodarone.

Three-dimensional CT-volumetric reconstruction and display of the bronchial tree

We applied a refined version of our volumetric rendering technique for three-dimensional (3-D) computed tomographic (CT) imaging to display the cadaveric lung and the major components of the bronchial tree. We report details of the technical aspects of 3-D imaging of the lung, and four representative case studies of lung specimens from our initial experience.

Hemorrhagic infarction of hilar lymph nodes associated with combined heart-lung transplantation

The histologic changes in lymph nodes transplanted during combined heart-lung transplantation were examined. We studied at autopsy nine patients who had received a total of 10 heart-lung transplants. Hemorrhagic infarction of hilar nodes was found in eight of the 10 transplanted lungs. Pulmonary parenchymal pathologic changes associated with lymph node infarction included acute rejection (two cases), chronic rejection with bronchiolitis obliterans (two cases), and pneumonia (four cases). In one of the transplants without lymph node infarction there was chronic rejection with bronchiolitis obliterans and in another there was evidence of bronchopneumonia. The hemorrhagic lymph node infarction seen in the recipients of combined heart-lung transplant's may be directly attributable to the interruption of bronchial arteries and veins by the surgical procedure. At present the possible contribution of node infarction to postoperative morbidity or mortality is unknown.

Inflation-fixed lungs: pathologic-radiologic (CT) correlation of lung transplantation

Pulmonary infections and lung rejection are the two major complications of lung transplantation. Although the therapies for these two processes differ greatly, they often cannot be differentiated using standard radiography. We applied high resolution CT (HRCT) to seven lung specimens that were obtained from patients who had received a heart-lung transplant. The lungs were fixed by a method that allows for direct one-to-one pathologic-radiologic correlation. We found: (a) that in contrast to the extensive changes present microscopically, acute lung allograft rejection was characterized by only minor changes on HRCT; (b) that bronchiolitis obliterans, the hallmark of chronic lung allograft rejection, was not reliably identifiable on HRCT; (c) that bronchiectasis with associated peribronchial inflammation and fibrosis, a common finding in lung allograft rejection, was identifiable on HRCT, but that the HRCT appearance of this lesion was not specific for rejection; and (d) that pulmonary infections were often identifiable as a mixed airway-interstitial process on HRCT.

[A study of protein engineering for human cardionatrin. I. Synthesis, cloning and expression of a gene analog of human atrial natriuretic polypeptide in E. coli]

An analog of the alpha-human atrial natriuretic polypeptide (alpha-hANP) gene, articulated with a peptidase inhibitor SQ20881 at its N-terminal and two prolines at the C-terminal was expressed in E. coli by cloning the reconstituted plasmid pRHL-1 in vivo. This gene analog, RH-1, comprising 154 base pairs in total, was designed to contain an equivalent of the alpha-hANP gene, capping the peptidase inhibitor SQ20881 at its 5' end with a glutamic acid codon GAA to facilitate enzymatic cleavage of the expressed end product by endoproteinase Glu-C, wedging in two proline codons CCG & CCG before the double terminal codons TGA TAG at the 3' end to retard hydrolysis of the expressed product by exopeptidase, and adding 3 restriction sites to both ends. Synthesis of the RH-1 gene was effected enzymatically by joining in predicted order the ten segments of oligodeoxynucleotides which had been chemically synthesized by the solid-phase phosphite-triester method. The synthetic gene was cloned into vector M13mp18. Phage bearing the gene analog was identified by dot blotting and restriction endonuclease mapping. Nucleotide sequence of the gene was determined by the dideoxynucleotide chain termination method.(ABSTRACT TRUNCATED AT 250 WORDS)

CT of inflation-fixed lungs: wedge-shaped density and vascular sign in the diagnosis of infarction

To evaluate the role of high resolution CT (HRCT) in the diagnosis of pulmonary infarcts, we selected 83 postmortem lung specimens with subpleural densities from a collection of 180 lungs that had been prepared by a method which allows for a direct radiologic-pathologic correlation. Twelve of the lungs had pulmonary infarcts and 71 lungs had other disorders that had produced a subpleural shadow on HRCT. Lungs were evaluated for the presence of wedge-shaped pleural-based densities and for the presence of an associated vascular sign. There was no significant difference in the incidence of wedge-shaped densities on HRCT between lungs with pulmonary infarcts and lungs with pulmonary hemorrhage, pneumonia, tumor, or edema (p greater than 0.05). A vascular sign associated with a subpleural density was, however, more common (p less than 0.01) in lungs with pulmonary infarcts. We suggest that the vascular sign associated with a wedge-shaped density may be of importance in diagnosing pulmonary infarcts by HRCT.