An evaluation of various indices of body weight change and their relationship with coronary risk factors

OBJECTIVE

To compare interrelationships between different indices and their relationship with cardiovascular disease risk factors.

METHOD

Longitudinal comparison among weight change indices in the observation of a fixed population from age 21-40.

SUBJECTS

215 non-obese blue-collar workers in a steel company.

MEASUREMENTS

Systolic blood pressure, diastolic blood pressure, serum cholesterol, serum uric acid, past history of illness, present illness, body mass index (BMI: weight/height2 (kg/m2)), indices of weight change (the intrapersonal standard deviation of BMI (ISD), the coefficient of variation of BMI (CV), the root mean square error of variation (RMSE) around the slope of BMI vs age, weight change categories (cycler, weight gainer, no changer, etc.), and number of weight cycles (NWC: one cycle is defined as 5% weight loss and 5% weight gain)). Indices were calculated using yearly and five-yearly measurements of weight for analyses.

RESULTS

The average RMSE distinguished large cyclers from other weight change categories, while ISD and CV did not. The correlation between ISD and CV was strong and significant. That between RMSE and ISD (or CV) was moderate and significant. Among the weight change categories, no weight change group included many actual weight cyclers. As for the relationship with coronary risk factors, no significant change in risk was noted in cyclers as determined by NWC or weight change category. The top one third of ISD and the top one third of CV was related with elevated risk of "any risk factor,' but at a lower level of significance.

CONCLUSION

ISD and CV reflect almost the same aspects of weight change, but the other indices reflect different aspects. When investigating the relationship between coronary risk factors and weight variability (especially, weight cycling) among young adult non-obese men, it is preferable to use weight change patterns such as NWC and weight change categories, or RMSE in conjunction with or in place of CV (or ISD).

Detection of genes regulating beta-lactamase production in Enterococcus faecalis and Staphylococcus aureus

Four beta-lactamase-producing clinical isolates (WH245, WH257, CH570, and DEL) of Enterococcus faecalis were examined for the presence of the staphylococcal beta-lactamase regulatory genes (blaR1 and blaI) by PCR using six primer pairs. All isolates produced small amounts of beta-lactamase constitutively. In WH245, CH570, and DEL, the corresponding regions of the regulatory genes have lost sequences of various lengths. However, the regulatory genes in WH257 appeared to be the same as those in staphylococcal plasmid pI258. The beta-lactamase genes could be transferred to enterococcal and staphylococcal recipients from WH257 and DEL by conjugation or transformation with selection for gentamicin resistance. After transformation, the expression of beta-lactamase from DEL was still constitutive, whereas the gene from WH257 showed inducible expression in Staphylococcus aureus. The gene coding for inducible beta-lactamase production from pI258 showed constitutive expression in E. faecalis. These findings suggest that constitutive beta-lactamase production in E. faecalis is due not only to the absence of functional regulatory genes but to some other factor(s) as well.

Detection of tet(K) and tet(M) in Staphylococcus aureus of Asian countries by the polymerase chain reaction

This study describes the use of the polymerase chain reaction (PCR) to detect the tet(K) and tet(M) tetracycline resistance genes in Staphylococcus aureus. Primers based on the DNA sequence of the tet(K) and tet(M) genes from S. aureus were used as primers in the PCR assay to detect the presence of genes for resistance to tetracycline and minocycline. Two-hundred and fifteen isolates of S. aureus from Asian countries as Japan, Indonesia, China, Korea and Thailand were examined, and the results confirm that tet(K) specifies resistance to tetracycline but not to minocycline and tet(M) specifies resistance to both tetracycline and minocycline. We observed two different types of clinical isolates of S. aureus strains resistant to minocycline and tetracycline: the first carried only the tet(M) gene, while the second carried both the tet(M) and the tet(K) genes. Almost all of the clinical isolates of S. aureus resistant to minocycline and tetracycline from Indonesia, China and Thailand carried both tet(M) and tet(K) genes, while most of clinical isolates of S. aureuss from Japan and Korea carried only tet(M) gene.

Induction of HIV-1 Nef-specific cytotoxic T lymphocytes by Nef-expressing DNA vaccine

Recently, some individuals who have remained seronegative despite definite exposure to HIV-1 have been reported. Among these individuals, an unusually high frequency of HIV-1 Nef-specific cytotoxic T lymphocytes was observed. Direct injection of plasmid DNA encoding foreign antigen can elicit both cell-mediated immunity and antibody responses (DNA vaccine). We constructed an HIV-1 Nef-expressing plasmid, and we induced HIV-1 Nef-specific cytotoxic T lymphocytes. This is the first report of inducing HIV-1 Nef-specific cytotoxic T lymphocytes by DNA vaccine.

Pure red cell aplasia after major ABO-incompatible bone marrow transplantation: two case reports of treatment with recombinant human erythropoietin

A 34-year-old man with acute myelocytic leukemia (AML: MO) and a 32-year-old woman with AML: M2 developed pure red cell aplasia (PRCA) after receiving a major ABO incompatible bone marrow transplant (BMT). The first patient responded to recombinant human erythropoietin (rhEPO) therapy, while the second did not. The second patient also received methylprednisolone (m-PSL) but developed reticulocytosis and hemolysis after the administration of m-PSL. Plasmapheresis was then performed and the patient promptly recovered from hemolysis and PRCA. We conclude that close attention must be paid when treating PRCA following major ABO-incompatible BMT with rhEPO and m-PSL, as there is always the potential for massive hemolysis.

Role of superoxide anions in airway hyperresponsiveness induced by cigarette smoke in conscious guinea pigs

To investigate the involvement of superoxide in airway hyperresponsiveness and bronchoconstriction induced by cigarette smoke (CS), we evaluated the effects of superoxide dismutase (SOD), a scavenger of superoxide anion, and apocynin, an inhibitor of superoxide anion-generating NADPH oxidase in phagocytes, on the airway responses induced by CS in conscious guinea pigs. Airway responsiveness was assessed by PC200Mch, the concentration required to produce a doubling in the baseline specific airway resistance (sRaw) to an inhaled methacholine aerosol, in nonanesthetized spontaneously breathing animals. Before being exposed to ten puffs of CS, animals inhaled either SOD (5,000 units/ml or 25,000 units/ml) or vehicle. Although SOD did not affect PC200Mch in the air control group, this agent significantly reduced the CS-induced airway hyperresponsiveness. Repeated administration of apocynin (12 mg/kg for 4 days) did not affect PC200Mch after exposure to CS. These data suggest that the superoxide from CS was involved in the airway hyperresponsiveness induced by CS, whereas phagocytic reactive oxygen species were not. The data also suggest a potential therapeutic role for antioxidants in airway hyperresponsiveness.

A human T-cell lymphotropic virus type-I carrier with chronic renal failure, aplastic anemia, myelopathy, uveitis, Sjögren's syndrome and panniculitis

A 53-year-old female infected with human T lymphotropic virus type-I (HTLV-I) suffered from chronic renal failure, aplastic anemia, myelopathy, uveitis, Sjögren's syndrome and Weber-Christian disease. Although HTLV-I antibody was negative in cerebrospinal fluid, she was diagnosed as HTLV-I associated myelopathy/tropical spastic paraparesis (HAM/TSP) based on clinical and histological findings. Though to date there is no direct evidence, other complications have also been reported to be HTLV-I related diseases. This case provided the unique opportunity to observe various HTLV-I related diseases.

Involvement of superoxide anions in ozone-induced airway hyperresponsiveness in unanesthetized guinea pigs

To evaluate the involvement of superoxide in ozone (O(3))-induced airway hyperresponsiveness, we studied the effects of superoxide dismutase (SOD), a scavenger of superoxide anion, and apocynin, an inhibitor of superoxide anion-generating NADPH oxidase in phagocytes, on the airway responses induced by O(3) in unanesthetized guinea pigs. Airway responsiveness was measured by PC(200)Mch, the concentration required to produce a doubling in the baseline specific airway resistance to an inhaled methacholine aerosol, in spontaneously breathing animals. Before exposure to 3 ppm O(3) for 30 min, animals inhaled either SOD (5000 U/ml) or vehicle for 5 min. Although SOD did not affect PC(200)Mch in the air control group, this agent reduced the O(3)-induced airway hyperresponsiveness. Repeated administration of apocynin (12 mg/kg for 4 days) also attenuated the O(3)-induced airway hyperresponsiveness. These data suggest that superoxide may be involved in the pathogenesis of O(3)-induced airway hyperresponsiveness, possibly through the stimulation of superoxide anions release from bronchoalveolar phagocytes. The data also suggest a potential therapeutic role for antioxidants in oxidant injury by air pollutants.

Characterization and epitope mapping of several new anti-P-glycoprotein monoclonal antibodies

Monoclonal antibodies (MAbs) were raised against partially purified Class I P-glycoprotein from multidrug-resistant Chinese hamster ovary CHRB30 cells. Fifteen stable monoclonal hybridoma cell lines were established, and the secreted antibodies were classified into 8 groups on the basis of banding pattern on immunoblots of P-glycoprotein digested with cyanogen bromide or partially digested with proteases. One representative of each group was tested further for several activities. Six of the 8 recognized human P-glycoprotein in the multidrug-resistant SKVLBI cell line. None of the antibodies recognized P-glycoprotein in unfixed cells, suggesting that all recognize cytoplasmic epitopes or extracellular epitopes not accessible in native P-glycoprotein. All 8 antibodies were able to immunoprecipitate P-glycoprotein from non-denaturing detergent solution. The linear epitopes of the antibodies were mapped to 11-27 amino acids. Two of the antibodies had epitopes in the linker region, 3 in the N-terminal nucleotide binding domain, 2 in the C-terminal nucleotide binding domain and 1 in the predicted cytoplasmic loop between predicted transmembrane helices 8 and 9. These antibodies, with known epitopes, could have uses for P-glycoprotein detection, structure/function studies, purification and quantitation.

DNA topoisomerase II inhibitors enhance random integration of transfected vectors into human chromosomes

To study the involvement of DNA topoisomerase (topo) II on nonhomologous (illegitimate) recombination, we examined the effect of topo II inhibitors on random integration of exogenous vectors into human chromosomes. We transfected human cell lines PA1, HeLa and EJ-1 with linearized plasmid pSV2neo by electroporation, treated with topo II inhibitors and determined the frequency of Geneticin-resistant (G418r) colonies. We found that three topo II inhibitors, etoposide (VP-16), ICRF-193 and amsacrine (m-AMSA), greatly enhanced the frequency of G418r colonies. These effects were maximally expressed by as little as 12 hrs treatment with the drugs. Similar enhancements were found with different vectors (closed-circular and linear), different cell types, or by different transfection methods (calcium precipitation and lipofection). In contrast, the inhibitor treatments did not affect the transient expression of chloramphenicol acetyltransferase and beta-galactosidase activity following transfection with pSV2CAT and pCH110, respectively. Southern blot analysis revealed that the integration pattern of transfected pSV2neo into PA1 chromosomes was random and not characteristic for each inhibitor. These results suggest that topo II inhibitors directly act at a nonhomologous recombination reaction, promoting the integration process of transfected vectors into human chromosomes. We discuss the enhancement mechanism with a special emphasis on DNA strand breaks induced by the inhibitors.

A bibliometric study of the trend in articles related to epidemiology published in occupational health journals

OBJECTIVES

To study the role assumed by epidemiology in occupational health literature and characterise its change over the years.

METHODS

A bibliometric study was conducted with a MEDLINE search to evaluate 9024 articles published in eight representative occupational health journals for the period 1980-93. Articles related to epidemiology were found by descriptors indexed in the articles and their numbers and proportions among all published articles was tabulated for the study period.

RESULTS

The proportion of source items indexed by epidemiology as a descriptor increased over threefold from 7.9% (42/534) in 1980 to over 25% after 1990. Epidemiology was indexed most frequently as a subheading associated with other descriptors-for example, occupational diseases-epidemiology. Cohort studies had the largest increase in the descriptors that indicated epidemiological type of studies during the period studied.

CONCLUSION

Epidemiology is assuming increasing importance in occupational health literature. This was shown quantitatively and qualitatively by the use of descriptors in the MEDLINE database.

Identification of a novel binding site to the integrin alphaIIbbeta3 located in the C-terminal heparin-binding domain of human plasma fibronectin

Fibronectin has been shown to bind to integrin alphaIIbbeta3 in Arg-Gly-Asp (RGD)-dependent and -independent manners. A recent study has indicated that a 29-kDa dispase-digestive fragment from the C-terminal heparin-binding domain of human plasma fibronectin (lacking RGD sequence) inhibits binding of fibronectin to thrombin-stimulated platelets and ADP-induced aggregation (Tanabe, J. , Fujita, H., Iwamatsu, A., Mohri, H., and Ohkubo, T.(1993) J. Biol. Chem. 268, 27143-27147). We provide here the evidence that a peptide corresponding to residues from Ala1704 to Glu1718 (designated F1) from this fragment inhibited binding of 125I-labeled 29-kDa fragment of fibronectin to thrombin-stimulated platelets and ADP-induced aggregation. The F1 peptide bound directly to alphaIIbbeta3 integrin receptor. These results indicate that a novel binding site in the C-terminal heparin-binding region of fibronectin is localized within the residues from Ala1704 to Glu1718. Binding of 125I-labeled 29-kDa fragment of fibronectin to thrombin-stimulated platelets was not inhibited by RGDS peptide and the 12-residue peptide from the cell-binding domain of fibronectin, suggesting that binding site in the C-terminal heparin-binding domain may be different from those of RGDS and the 12-residue peptide. This additional alphaIIbbeta3-binding domain(s) in fibronectin may also play some role for prevention of thrombus formation by direct interaction with alphaIIbbeta3.

[Pancytopenia and Pneumocystis carinii pneumonia associated with low dose methotrexate pulse therapy for rheumatoid arthritis--case report and review of literature]

Low-dose weekly pulse MTX therapy is effective for rheumatoid arthritis (RA) and is used for patients with RA who are unresponsive to conventional disease-modifying antirheumatic drugs (DMARDs). We used MTX to a 62-year-old man with RA who had received DMARDs for 5 years. MTX was effective for RA but after 12 weeks MTX therapy started, he complicated pancytopenia and developed Pneumocystis carinii pneumonia. We reviewed all RA patients reported in Japan and in the world from 1965, complicated with Pancytopenia (37 cases) and Pneumocystis carinii pneumonia (13 cases) after MTX therapy. Results were as following; (1) MTX should not be used with TMP-SMX. and risk factors for pancytopenia were (2) age over 60 years old (3) renal hypofunction (4) use of NSAID.

Estimation of the optimal cut off point in a new immunological faecal occult blood test in a corporate colorectal cancer screening programme

OBJECTIVE

To estimate the optimal cut off point in a new immunological method (OC-Hemodia) for faecal occult blood testing (FOBT).

SETTING

A corporate colorectal cancer screening programme in Japan. METHOD - The screening programme targeted colorectal cancer and adenomatous polyps > or = 10 mm, and was conducted on 27 860 participants (age > or = 40 ) during 1991-92. The follow up consisted of diagnostic management by total colonoscopy on positive screened subjects exceeding the manufacturer recommended cut off level of 50 ng/ml faecal haemoglobin, and the identification of false negative cases by health insurance claims. The optimal cut off point was estimated by the positive predictive value, receiver operating characteristic (ROC) curve, and a cost effectiveness analysis. In this study evaluation was carried out only for cancer as the target disease.

RESULTS

- At the current cut off level of 50 ng/ml the sensitivity and specificity were 86.5% and 94.9%. When the optimal cut off point was estimated the highest positive predictive value was obtained at 250-350 ng/ml. The ROC curve showed that the sum of sensitivity and specificity is maximised at 50 ng/ml, but evaluation of the ratio, change in sensitivity/change in false positive rate, pointed to higher optimal cut off points, showing marked changes occurring at about 200 ng/ml. The average cost per case was lowest at 250-300 ng/ml. Overall, the optimal cut off point was estimated to be about 200 ng/ml, at which the sensitivity and specificity of the test would be 77.5% and 98.9%, respectively.

CONCLUSION

The optimal cut off point of the new immunological method of FOBT was estimated to be about 200 ng/ml, a value which, more than the current cut off value, favours specificity over sensitivity.

Expression of an epithelial membrane glycoprotein by neurons arising from the human olfactory plate through development

Human terminal-vomeronasal neural crest cells began to express a 34,000 molecular weight epithelial membrane glycoprotein, which was detected by the mouse monoclonal antibody Ber-EP4 soon after their migration into the olfactory plate. Expression of this antigen continued in neurons arising from these cells, which were olfactory sensory neurons and luteinizing hormone-releasing hormone-producing neurons migrating into the brains of the embryos of approximately 44-52 postovulatory days. Ber-EP4 immunoreactivity appeared over the entire surface membranes of these neurons, including their processes, not only in their extracerebral portions, but also within the brain parenchyma from 48 to 53 postovulatory days. Ber-EP4 immunoreactivity of these migrating neurons became weaker as they matured into luteinizing hormone-releasing hormone-producing neurons and disappeared from the postnatal hypothalamic neurons; however, it remained in the primary sensory nerve fibers throughout postnatal life. Except for the neurons arising from the olfactory plate, no other human neurons express this epithelial antigen during the course of development. The mechanism and significance of the expression of this antigen in mature sensory neurons remains unclear, but the intramucosal location and morphological kinship of these neurons to epithelial cells may be related to this phenomenon. The results of the present study indicate that neurons arising from the olfactory plate are distinct from other neurons by having a 34,000 molecular weight epithelial membrane glycoprotein that can be detected by the mouse monoclonal antibody, Ber-EP4, during the embryonic stage. This antigen disappears from the luteinizing hormone-releasing hormone-producing neurons concomitant with maturation, but is preserved in the olfactory primary sensory nerve throughout postnatal life.

[Successful therapy with cyclosporine in a case with interstitial pneumonitis associated with polymyositis]

We describe a case of interstitial pneumonitis associated with polymyositis who responded well to cyclosporine therapy. In October, 1993, a 49-year-old female was admitted to our hospital because of fever, muscle weakness and progressive dyspnea. Interstitial pneumonitis with polymyositis was diagnosed and daily oral steroid therapy was started. As the therapy was ineffective, pulse intravenous steroid therapies followed by oral cyclophosphamide and steroid therapy was given. Whereas serum levels of muscle enzymes decreased, she became progressively hypoxemic. No effect was observed in series of therapy including additional pulse steroid therapy, pulse intravenous cyclophosphamide therapy, oral azathioprine and oral bethametazone therapy. In April, 1994, oral cyclosporine was started. After daily oral cyclosporine was combined with steroid, her symptoms, chest X-ray, chest CT and pulmonary function tests significantly improved. Her disease became stable and there was no signs of recurrence since then. It is suggested that cyclosporine is useful for the treatment of progressive interstitial pneumonitis associated with polymyositis.

Lymphoproliferative disorder of granular lymphocytes (natural killer cell type) with interstitial pneumonia in a patient with familial pancytopenia

A 50-year-old woman is presented here with natural killer (NK) cell type lymphoproliferative disorder of granular lymphocytes. She was admitted to the hospital because of dyspnea on exertion. Chest X-ray revealed bilateral reticular shadows. Open lung biopsy demonstrated usual interstitial pneumonia (UIP). Her white blood cell count was 3,900/mm3, of which 55% was large granular lymphocytes (LGLs). The LGLs were CD3- CD16+CD56+, and the clonality of them was not confirmed. Despite steroid therapy, she died from exacerbation of UIP complicated with opportunistic infection. The patient, her father and son had pancytopenia. Congenital immunological abnormality might cause both large granular lymphocytosis and UIP.