Powered Orthosis for Lower Limbs -Its Structure and Control-

This paper describes a powered orthosis for lower limbs which restores the gait of locomotion of disabled persons, such as paraplegics, with its structure and control as well as its clinical experiments. The powered orthosis supports the patient's weight, and it has four electrohydraulic digital actuators to motorize hip and knee joints, as well as sensors to detect joint angles and plantar contacts. Each joint angle is controlled by a microcomputer such that an appropriate gait pattern is restored for a stable, powered level walk. This second prototype of the powered orthosis has been designed and developed for testing on patients in order to determine its effectiveness. For the control of this orthosis, the gait pattern is generated by a 16-bit master microcomputer using the preprogrammed pattern which is synthesized with 20 parameters; six 8-bit slave microcomputers measure and control joint angles. A new type of digital actuator was developed specifically for this purpose. In addition, a desktop microcomputer is used for the change of parameters as well as for the dialogue with the master computer. The orthosis weighs only 19.5kg, and the hydraulic power unit 68kg. Clinical experiments of this prototype are conducted on two paraplegics. A powered walk of 6.0 sec/step is realized for the first time, and then 4.5 sec/step for approximately 10 meters.

Successful treatment of adult T-cell leukemia/lymphoma with MACOP-B, M-FEPA and VEPP-B combination chemotherapy

A 45-year-old man was referred to our department in March of 1989. Physical examination showed erythroderma, palmo-plantar hyperkeratosis, generalized lymphadenopathy, hepatosplenomegaly, and leukemic manifestation. The lymphocyte count in the peripheral blood before treatment was 1.7 x 10(4) cells/mm3. Atypical lymphocytes such as flower cells and lobulated cells were seen in the peripheral blood. A sample excised from a lymph node showed immunoblastic, pleomorphic T cells by a modified classification scheme of the Working Formulation. A high level of serum LDH was detected (2.1 times the upper normal limit). Anti HTLV-1 antibody was also detected in the serum. The atypical lymphocytes were positive for CD3, CD4, CD5, CD7 and HLA-DR, and negative for CD8. Thus, the clinical, pathologic and immunologic features were those of typical acute-type ATL. The patient was treated with VEPA-M for three months starting in March of 1989. Because of poor response, the patient was then treated with MACOP-B, M-FEPA, and VEPP-B for about one year from June of 1989 and has been free of disease up to the time of writing, March of 1993.

[History of the term "tan" (phlegm) (I) - Studies of the term "tan" described in classical Chinese translations of Buddhist literature]

We traced the origin of the term "tan" (phlegm) in Chinese traditional medicine. This term itself is not found in early works but is represented by the terms of tuo (saliva) and xian (drivel). However, in the theory of tri-dosa of Indian traditional medicine, phlegm is an important element. Our studies of classical Chinese translations of Buddhist literature showed that the concept of tan in Buddhist medicine was introduced into China through Buddhism.

Arrest of cell cycle progression of HeLa cells in the early G1 phase in K(+)-depleted conditions and its recovery upon addition of insulin and LDL

Cell cycle progression of synchronized HeLa cells was studied by measuring labeling of the nuclei with [3H]thymidine. The progression was arrested in a chemically defined medium in which K+ was replaced by Rb+ (Rb-CDM) but was restored upon addition of insulin and/or low density lipoprotein (LDL). Cells started DNA synthesis 12 hr after addition of insulin and/or LDL, regardless of the time of arrest, suggesting their arrest early in the G1 phase. After incubation of cells in Rb-CDM containing insulin or LDL singly for 3, 6, or 9 hr, replacement of the medium by that without an addition resulted in marked delay in entry of cells into the S phase, but in its replacement by medium containing both agents, the delay was insignificant. Synthesis of bulk protein, estimated as increase in the cell volume, was not strongly inhibited. From these results we conclude that cell cycle progression of HeLa cells in K(+)-depleted CDM is arrested early in the G1 phase and that the arrest is due to lack of some protein(s) required for entry into the S phase that is synthesized in the early G1 phase.

Autonomic hyperreflexia in pure progressive autonomic failure: a case report

A 60-year-old woman suffered from recurrent episodes of fever, hypertension, facial flushing, vomiting, stridor, slowly progressive symptoms of hypohidrosis, and orthostatic hypotension. The episodes were synchronous with elevated catecholamine concentration in plasma and urine. This is an example of paroxysmal autonomic hyperreflexia in a setting of pure progressive autonomic failure.

[The long term results of hyperbaric oxygen treatment for macular edema with retinal vein occlusion]

We retrospectively evaluated the effect of hyperbaric oxygen treatment on seventy-nine eyes of seventy cases with cystoid macular edema secondary to retinal vein occlusion. Twenty-three eyes had central retinal vein occlusion (CRVO), and fifty-six eyes had branch retinal vein occlusion (BRVO). Visual acuity improved by two lines or more in 40 eyes (17%) with BRVO, and in 10 eyes (44%) with CRVO immediately after the therapy. Six months or more after treatment, visual improvement persisted in 14 of 30 BRVO eyes (47%), and in only one of 11 CRVO eyes (9%). CRVO showed poor prognosis in the long term compared with BRVO. We speculated that activation of aerobic metabolism might be more important than reduction of vascular hyperpermeability as the therapeutic effect of hyperbaric oxygen, and that hyperbaric oxygen might mainly affect the retinal cells in the marginal zone of the ischemic retina in the macular region.

Change in K+ current of HeLa cells with progression of the cell cycle studied by patch-clamp technique

The K+ channel of HeLa S3 cells in metaphase was analyzed by inside-out and whole cell patch-clamp techniques. The channel had the characteristics of strong inward rectification, small conductance (22 pS at -100 mV), and dependence on intracellular Ca2+. We investigated the cell cycle dependency of the channel, using cells synchronized by harvesting them at the mitotic stage. The cell capacitance increased gradually with increases in the cell volume toward the S phase. The inward K+ currents through the channel at fixed membrane potentials were highest in early G1 and then decreased with time to a minimum in the S phase, increasing again in the M phase. The permeabilities at fixed membrane potentials were also highest in early G1, decreased to minima in the S phase, and increased again toward the next mitosis. In contrast, mean amplitude and the open probability of the single channel at a fixed membrane potential (-60 mV) did not change significantly during the cell cycle. Therefore the capacitance increases with progression of the cell cycle, whereas the permeability decreases from early G1 to an apparent minimum in the S phase. These changes may be caused by cell cycle-dependent changes in the number of channels.

Orally active, nonpeptide vasopressin V1 antagonists. A novel series of 1-(1-substituted 4-piperidyl)-3,4-dihdyro-2(1H)-quinolinone

A series of compounds has been synthesized and demonstrated to be antagonists of V1 receptors both in vitro and in vivo. These compounds are structurally related to the 1-(4-piperidyl)-2(1H)-quinolinones, including OPC-21268, an orally bioavailable AVP V1 antagonist with high V1 specificity. It has been found that the introduction of an acetamide group on the terminal alkoxy chain of 41-44 leads to an increase in oral activity. Certain of these compounds may have efficacy in the study of AVP V1 receptors.

Aerobic responses of mouse macrophages to phagocytosis against Escherichia coli as revealed by microphotometry

Fluorescence of peritoneal macrophages, which ingested E. coli labelled with N-[7-(dimethylamino)-4-methyl-coumarinyl]-maleimide, was measured with a microfluorometer. The cellular contents of protein and formazan of a monotetrazolium produced by succinate dehydrogenase (SD) activity were assayed with a microspectrophotometer. During phagocytosis, protein increased in 30 min., but was balanced later by self-hydrolysis. SD activity was unchanged for 30 min. and then increased until 2 hrs. Upon removal of bacteria, the fluorescence and protein decreased with time, whereas SD activity increased further for 1 hr. before decrease. This indicates a delayed activation of the enzyme. The cellular ATP content was reduced during phagocytosis and restored to the normal level 3 hrs. after removal of bacteria. Both KCN-sensitive and -insensitive oxygen uptakes increased in phagocytosis. Thus, oxidative metabolism of macrophages is stimulated in phagocytosis and the stimulation can be demonstrated in situ by the microphotometric methods.

[Experience with extracorporeal shock wave lithotripsy in children]

Extracorporeal shock wave lithotripsy treatment for calculi of the upper urinary tract was performed on 4 children between 6 and 13 years old. The patients were treated under general anesthesia with Lithostar. Good fragmentation was achieved in all cases. No undue side effects or complications were encountered in the cases. We conclude that extracorporeal shock wave lithotripsy is a safe and effective method of treating renal and ureteral calculi in children.

Lipopolysaccharide and granulocyte colony-stimulating factor delay neutrophil apoptosis and ingestion by guinea pig macrophages

In previous studies, neutrophil-ingesting macrophages were clearly and easily observed in the peritoneal cavity of guinea pigs after intraperitoneal injection of thioglycolate medium, and phagocytosis of neutrophils by macrophages could be detected in in vitro cultures of peritoneal exudate cells. Using an in vitro system, we examined the effect of bacterial lipopolysaccharide and recombinant human granulocyte colony-stimulating factor on the apoptosis (programmed cell death) of neutrophils and their subsequent ingestion by macrophages. Lipopolysaccharide delayed karyopyknosis and apoptosis of neutrophils, as shown by endogenous endonuclease activity and a high proportion of trypan blue-excluding cells, and subsequent ingestion by autologous macrophages. Granulocyte colony-stimulating factor also delayed neutrophil karyopyknosis and ingestion by macrophages. When a thioglycolate medium was coinjected intraperitoneally with lipopolysaccharide into guinea pigs in the in vivo system, delays in neutrophil disappearance and ingestion by macrophages in the peritoneal cavity were also observed. We suggest that bacterial products and cytokines regulate neutrophil apoptosis and subsequent ingestion by macrophages at inflamed sites.

A case of cutaneous B-cell lymphoma with a storiform stromal reaction

A case of cutaneous B-cell lymphoma is described. The patient was treated only by surgical excision of the skin tumors five times during a period of about two years from February of 1984 to October of 1986. After the last surgical excision, a continuous disease-free period was achieved. Biopsy samples showed dense lymphocytic infiltrations with discrete masses in the dermis and subcutis; one of them showed a storiform pattern. At the time, the infiltrating cells were composed of medium and large lymphoid cells and spindle-shaped cells. The medium and large lymphoid cells were positive for CD20, CD22 and HLA-DR and negative for CD3, CD4, CD5, CD8, CD43, and kappa and lambda light chain. The spindle-shaped cells were negative for CD20, CD43, kappa and lambda light chain, lysozyme, and S-100 protein.

Marked reduction of type I keratin (K14) in cisplatin-resistant human lung squamous-carcinoma cell lines

We have established two cisplatin-resistant human lung squamous-carcinoma cell lines, PC10-B3 and PC10-E5, from their original cell line PC10. To discover which proteins are associated with cisplatin resistance, we carried out a two-dimensional gel electrophoresis to analyze differences in protein alteration between PC10, PC10-B3 and PC10-E5. A protein spot M(r) 50 kDa, pI5.3, was reduced markedly and a spot M(r) 50 kDa, pI4.9 was increased when PC10-B3 and PC10-E5 were compared with PC10. A spot M(r) 58 kDa, pI5.8 newly appeared only in PC10-E5. Cell fractionation showed that the M(r) 50 kDa, pI5.3 (p50-5.3) and the M(r) 50 kDa, pI4.9 fell within the nuclear fraction, while the M(r) 58 kDa, pI5.8 was found among the cytosol and microsomal fractions. Microsequencing after in situ digestion of the dramatically reduced spot p50-5.3 revealed that it was identical to 50 kDa, type I keratin (K14). Moreover, a retinoic acid-mediated K14 reduction was concomitant with a 4.0-fold increase in cisplatin resistance in PC10. Our report is the first to suggest the possible association of marked K14 reduction and cisplatin resistance in PC10-B3 and PC10-E5.

Effects of seven months' exposure to a static 0.2 T magnetic field on growth and glycolytic activity of human gingival fibroblasts

Human gingival fibroblasts in confluent cultures were continuously exposed to a static 0.2 T magnetic field for 6 or 8 months. Culture flasks were not changed during the exposure, but culture medium was renewed. After dilution and mixing of the cultures surviving intact, field-exposed and sham-exposed cultures received further field- or sham-exposure on Sm-Co blocks. Rate of cell proliferation, histogram of the nuclear DNA content, rates of lactate production and glucose consumption and the ATP content were determined and cell morphology was investigated by both light- and electron-microscopy. Results show no marked differences between exposed and control cells.

Comparison of intermittent injection of nondepolarizing solution with a single flush of UW solution for donor heart preservation

Isolated canine hearts were preserved for 6 h at 5 degrees C followed by normothermic reperfusion for 2 h. The dogs were divided into two groups of nine hearts each; group 1 received a nondepolarizing preservation solution in multidose, and group 2 received a single flush of University of Wisconsin (UW) solution. Serum MB-CK and mitochondrial aspartate aminotransferase (m-AAT) concentrations and calcium overload during reperfusion were lower in group 1 than in group 2. At the end of reperfusion, myocardial ATP and total adenine nucleotide concentrations were higher and mitochondrial morphology appeared more intact in group 1 than in group 2. Left ventricular diastolic function was preserved better in group 1 than in group 2. These results suggest that in 6-h heart preservation, a nondepolarizing solution applied in multidose fashion protects the myocardium from the deleterious effects of hypothermia and cardioplegia better than a single flush of UW solution.

Kinetic study on the effects of intracellular K+ and Na+ on Na+, K+, Cl- cotransport of HeLa cells by Rb+ influx determination

The effects of intracellular K+ and Na+ (K+c, Na+c) on the Na+, K+, Cl- cotransport pathway of HeLa cells were studied by measuring ouabain-insensitive, furosemide-sensitive Rb+ influx (JRb) at various intracellular concentrations of K+ and Na+ ([K+]c, [Na+]c). When [K+]c was increased and [Na+]c was decreased, keeping the sums of their concentrations almost constant, JRb as a function of the extracellular Rb+ or Na+ concentration ([Rb+]e, [Na+]e) was stimulated. However, the apparent K0.5 for Rb+e or Na+e remained unchanged and the ratio of the apparent K0.5 for K+c and the apparent Ki for Na+c was larger than 1. When JRb was increased by hypertonicity by addition of 200 mM mannitol, the apparent maximum JRb increased without change in the apparent K0.5 for Rb+e. These results show that K+c stimulates and Na+c inhibits JRb, without change in the affinities of the pathway for Rb+e and Na+e. The affinity for K+c is slightly lower than that for Na+c. Hypertonicity enhances JRb without any change in the affinity for Rb+e. We derived a kinetic equation for JRb with respect to K+c and Na+c and proposed a general and a special model of the pathway. The special model suggests that, in HeLa cells, JRb takes place when Rb+e binds to the external K+ binding site of the pathway after the binding of K+c to the internal regulatory site.

Adverse effect of antipyretic agent on serum zinc

To study the pathogenesis of the zinc deficiency that is sometimes found postoperatively, the serum concentration of zinc was determined in 35 patients before, during, and after thoracoabdominal surgery. Preoperatively, a serum zinc level below 60 micrograms per 100 ml was recorded in four of 16 patients tested and was associated with severe anorexia. Postoperatively, the serum zinc level was significantly reduced for up to four days, when the patient was unable to eat. After the start of oral feeding, the average serum zinc level returned to normal. The serum zinc level decreased rapidly in two patients after bouts of severe sweating produced by an antipyretic agent (diclofenac). In another patient, the serum zinc level decreased rapidly following the loss of a large volume of intestinal fluid via an intestinal stoma. Factors leading to low serum concentrations of zinc thus include anorexia, operations, antipyretic agents, and the loss of intestinal fluid.

Transforming growth factor-beta protein and mRNA in glomeruli in normal and diseased human kidneys

BACKGROUND

Evidence indicates a key role for transforming growth factor-beta (TGF-beta) in the accumulation of pathologic extracellular matrix in experimental glomerular injury. The aim of this study was to elucidate the expression of TGF-beta and its role in human glomerulonephritis.

EXPERIMENTAL DESIGN

Expression of TGF-beta 1 in normal and diseased human kidneys was examined by immunohistochemical staining with two antibodies (Ab1 and Ab2), and by in situ hybridization with an oligonucleotide probe.

RESULTS

Staining with Ab1, which mainly recognizes mature TGF-beta 1 and the latency-associated peptide (LAP) of natural TGF-beta 1, was linearly positive along the glomerular basement membrane (GBM) and weakly so in the mesangium of normal tissues and those of various glomerular diseases which were pretreated with acid-urea to unmask a hidden epitope. Ab2, which reacts mainly with TGF-beta-LAP, bound to the mesangium and sclerotic areas of the tissues untreated with acid-urea. Immunoelectron microscopy showed that Ab1 was localized to the GBM and the mesangial matrix, and that Ab2 was distributed in subepithelial, or mesangial/paramesangial electron-dense deposits. The presence of mature TGF-beta 1 and TGF-beta-LAP in normal kidneys was confirmed by immunoblotting using guanidine-extracted fractions of glomeruli and GBM isolated from normal human kidneys. Mesangial staining of TGF-beta 1 with Ab2 was significantly correlated with the mesangial matrix increase in mesangial proliferative types of nephritis. In situ hybridization revealed TGF-beta 1 mRNA expression in glomerular cells. Cells with positive mRNA signals were evident in glomeruli that were increased in both mesangial cells and TGF-beta 1 protein expression. The glomerular cells with positive signals were numerous, compared with the number of infiltrating monocyte-macrophages identified with a monoclonal antibody.

CONCLUSIONS

These results indicate that mature TGF-beta and TGF-beta-LAP are localized in association with the matrix components of GBM or mesangium, and with immune deposits in human glomeruli. Glomerular expression of TGF-beta is enhanced in human glomerular diseases, and may contribute to the mesangial matrix increase.

Release of tumor necrosis factor-alpha from human alveolar macrophages is decreased in smokers

It is known that smoking affects the development and maintenance of certain types of granulomatous lung diseases. To explore this mechanism(s), we measured tumor necrosis factor (TNF)-alpha concentrations in the culture supernatants of lipopolysaccharide (LPS)-stimulated alveolar macrophages (AMs) in 13 healthy nonsmokers, 13 healthy smokers, 13 nonsmoking sarcoid patients, and 16 smoking sarcoid patients. We found that the capacity of smokers' AMs to release TNF-alpha was significantly decreased both in the normal and sarcoid groups. We also confirmed the previous observation that there was an exaggerated TNF release in patients with pulmonary sarcoidosis. These results indicate a significant role of TNF-alpha in the pathogenetic mechanisms of pulmonary sarcoidosis and suggest the possible involvement of TNF in the mechanisms by which smoking modulates local immune phenomena.

A case of cutaneous B-cell lymphoma treated successfully with MACOP-B

A case of cutaneous B-cell lymphoma successfully treated by MACOP-B therapy is described. The patient was a 43-year-old man with reddish tumors measuring 3 to 7 cm in diameter on the right cheek and the post-auricles. Histopathologically, massive infiltrations of medium-sized atypical lymphoid cells were found in the reticular dermis and subcutis. A clear zone beneath the epidermis was also detected. The atypical lymphoid cells were positive for CD19, CD20, CD22 and HLA-DR but negative for CD3, CD4, CD5, CD10, CD43, CD45RO and CDw75. The patient was treated successfully with the MACOP-B protocol from March of 1990 to May of 1990. Since April of 1990, he has been free of disease.

Perfusion pressure control by adenosine triphosphate given during cardiopulmonary bypass

Administration of exogenous adenosine triphosphate (ATP) as a vasodilator during cardiopulmonary bypass was assessed in consecutive adult patients (n = 24) who demonstrated a high arterial perfusion pressure (mean, > 90 mm Hg). The action of ATP was characterized by rapid induction and stabilization of the blood pressure level. The dose of ATP ranged from 0.68 to 2.68 mg/min. Within 1 minute after the administration, there was a significant reduction in the perfusion pressure from 102 +/- 18 mm Hg (mean +/- standard deviation) to 72 +/- 19 mm Hg. The ATP was then able to maintain the desired pressure of 69 +/- 12 mm Hg at 5 minutes, 67 +/- 12 mm Hg at 10 minutes, and consistent values thereafter. After the ATP administration was discontinued, there was a prompt recovery of pressure without bradyarrhythmia. The frequency and amount of inotropes used were consistent with the control group (n = 26). Although the administration of ATP reduced the increase in serum catecholamine concentration, there were no significant changes in other vasoactive mediators (eicosanoid, angiotensin II, endothelin) between the two groups during cardiopulmonary bypass. There was neither an accumulation of metabolic products (uric acid, phosphate) nor a decrease in the level of divalent cation (Ca2+), which is observed when the cations combine with phosphates or adenosine nucleotides. This study confirmed the efficacy and safety of ATP infusion during cardiopulmonary bypass.