Glutathione peroxidase and glutathione S-transferase, class alpha, in rat intestine. Immunohistochemical and immunoblotting studies on changes in expression of these antilipoperoxidative enzymes during normal development

Glutathione peroxidase (GSH-PO) and glutathione S-transferase (GST), class alpha, showing GSH-PO-like enzymatic activity, were localized immunohistochemically in frozen sections of rat intestine in order to elucidate changes in the expression of these antilipoperoxidative enzymes during normal development. The direct immunoperoxidase method was performed using specific rabbit antibodies (Fab fragments) against the enzymes purified from rat liver. Immunoreactive GSH-PO and GST-alpha were demonstrated in the intestinal villous epithelial cells. In the duodenum, GSH-PO was positive during the period from 19 days of gestation to 1 week after birth, while GST-alpha was negative during this period. Two weeks after birth, positivity for GST-alpha appeared, and GSH-PO became undetectable. In the ileum, both of the enzymes were observed until 2 weeks of age, but after weaning their expression disappeared. These immunohistochemical findings were confirmed by immunoblot analysis using intestinal tissue extracts. To evaluate environmental effects on the expression of these enzymes, germ-free animals, common bile duct-ligated rats, and Hank's solution-fed infant rats were prepared. No remarkable alterations in the immunohistochemical localization pattern were observed. Since the switching of enzyme expression around the time of weaning was not influenced by these experimentally induced environmental conditions, it appears that these enzymatic changes are genetically predetermined.

[A case report of coronary artery bypass grafting surgery with aprotinin in a patient undergoing chronic haemodialysis]

A 61-year-old patient who was receiving haemodialysis because of chronic renal failure developed unstable angina pectoris with three vessel disease. We performed successful coronary artery bypass grafting, using aprotinin to reduce blood loss. Blood loss during the operation was 750 ml, and during a 6 hour period after the operation it was 150 ml. This amount seemed to be small. No adverse clinical effects attributable to aprotinin were seen, and urine volume and plasma creatinine were not different before and after the operation. In summary, aprotinin is useful adjunct to open heart surgery in chronic haemodialysis patients.

[Dor operation combined with redo coronary artery bypass grafting; report of two successful cases]

Case 1. A 69-year-old male, who had undergone coronary artery bypass grafting with saphenous vein graft for acute myocardial infarction 16 years previously, was admitted into our hospital for heart failure and recurrent angina. Coronary angiography showed occlusion of the graft and 75% stenosis in the proximal circumflex artery. Left ventriculography showed end-diastolic volume of 216 ml and ejection fraction of 24%. Dor operation combined with redo coronary artery bypass grafting was performed. Postoperatively, the ejection fraction improved to 53% and the cardiac index improved from 1.8 to 2.2 l/min/m2. Case 2. A 67-year-old male, who had undergone double coronary artery bypass grafting using saphenous vein grafts for acute myocardial infarction 8 years previously, was admitted into our hospital for heart failure and recurrent angina. Coronary angiography showed occlusion of the 2 grafts and 99% stenosis of the proximal left anterior descending artery. Although the left ventricle was slightly dilated, echocardiography demonstrated a thrombus in the left ventricle. Dor operation was performed concomitantly with removing of the thrombus and redo coronary artery bypass grafting. Postoperatively, the ejection fraction improved to 68% and the cardiac index improved from 1.6 to 2.3 l/min/m2. When the patients underwent coronary artery bypass surgery with saphenous vein grafts for acute myocardial infarction, they could be susceptible to left ventricular asynergy and graft failure on the long run. Therefore, the patients who need redo coronary revascularization may be potential candidates for Dor operation, and they require close examination regarding the myocardial viability, volume and shape of the left ventricle.

[Treatment with interferon-alpha 2a in a patient with chronic inflammatory demyelinating polyneuropathy]

We report an adult patient with refractory chronic inflammatory demyelinating polyneuropathy (CIDP) who resisted conventional immunological therapies but could be successfully treated with interferon (IFN)-alpha 2a. A 56-year-old man was admitted to our hospital with progressive distal dominant muscle weakness and sensory disturbance of all extremities. He was diagnosed as CIDP based on laboratory examinations which revealed conduction block on peripheral nerve conduction studies and demyelinating findings on sural nerve biopsy. He was given several immunological treatments, including immunoadsorption therapy (IAT), oral corticosteroid, immunosuppressive agents such as cyclophosphamide and mizoribine, but without satisfactory efficacy although transient improvement of muscle weakness was observed for two weeks after IAT. A session of IAT every four weeks was therefore continued to maintain his symptoms for nine months. He was then treated with IFN-alpha 2a intramuscular injections every other day. Four weeks after starting of IFN-alpha 2a therapy, the worsening of his symptoms stopped and his muscle strength improved gradually to normal level without IAT, suggesting that IFN-alpha 2a may be effective in some patients with refractory CIDP. Further studies are needed to confirm the efficacy of IFN-alpha 2a for CIDP.

[The TNM classification of cancer--from the viewpoint of pathology]

The 5th international TNM classification (proposed in 1997) is an anatomical classification of cancers used all over the world. In Japan, various kinds of Japanese classification of cancers have widely been accepted since 1962. Researchers may be confounded at international cancer conferences because of some differences in these classification. We here summarize the history and criteria of the present TNM classification and describe the concept of new N factors additional and in the 5th edition. In the Japanese versions of cancer classification, the concepts of H and P factors should be reconsidered. The importance of the cytologic diagnosis in ascites is discussed and pathological grades of differentiation into the new cancer staging are introduced.

Gait analysis before or after varus osteotomy of the femur for hip osteoarthritis

SUMMARY OF BACKGROUND

Intertrochanteric varus osteotomy of the femur for hip osteoarthritis is expected to bring improved congruity and increased weight-bearing surface area of the hip joint. Before surgery, we usually make a tracing on a paper using an anteroposterior roentgenogram of the hip to simulate the operating procedures and obtain better conditions in the hip. Nevertheless, there have been some cases in which this procedure does not provide satisfactory postoperative results in terms of relief of pain or locomotion, with long-term limp due to weakness of the hip abductor muscle group and shortening of the leg.

OBJECTIVES

To confirm if the improved congruity and increased covering of the weight-bearing surface area obtained by varus osteotomy can be actually reproduced during walking, and to evaluate the kinetic mechanism of the effects of this procedure using gait analysis.

METHODS

We measured the strength ratio of the hip abductor muscles as the percent of the opposite side, and analyzed the pelvic movement and data of dynamic electromyography (EMG) recorded during locomotion in 24 female patients who underwent unilateral intertrochanteric varus osteotomy of the femur for hip osteoarthritis, 30 non-surgically-treated female patients with hip osteoarthritis, and 54 healthy women. In the operated patients, the roentgenograms obtained during one-legged stance on the affected side disclosed that 10 were positive for Trendelenburg's phenomenon (T(+) group) and 14 were negative for Trendelenburg's phenomenon (T(-) group). All subjects walked with bare feet at a comfortable pace on a walkway containing a force plate. Photo switches were placed in a walkway to measure the gait velocity and to determine the stance phase time of one gait cycle. Frontal and sagittal trajectories of body surface markers for computerized joint-angle motion analysis were acquired using the Quick-MAG system. EMG data for the gluteus maximus, gluteus medius, tensor fascia latae, and lateral hamstrings recorded using surface electrodes were integrated to quantify as the percent of maximum voluntary contraction (% MVC).

RESULTS

This study disclosed that the stance phase time was shorter and the strength ratio of the hip abductor muscles was lower in the operated patients than those in the other 2 groups, and the change of the pelvic obliquity was smaller and the % MVC of the gluteus medius and tensor fascia latae were greater than those in the normal subjects. The change of the pelvic tilt showed the same pattern with those of the pelvic obliquity. The T(+) group showed decreased strength ratio of the hip abductor muscles and increased % MVC for the gluteus medius and the tensor fascia latae compared to the T(-) group, but the changes of both the pelvic obliquity and pelvic tilt did not significantly differ in the 2 groups.

CONCLUSION

This study showed the postoperative reappearance of the simulated conditions in the hip before varus osteotomy of the femur, providing evidence that the pelvis was horizontally maintained during walking due to decreased stance phase time and increased performance of the hip abductor muscles after this procedure.

Mutations in the transcriptional regulatory region of the precore and core/pregenome of a hepatitis B virus with defective HBeAg production

Termination mutations in the precore open reading frame of hepatitis B virus (HBV) variants with defective hepatitis B e antigen (HBeAg) production have been demonstrated in both infected patients who have seroconverted to anti-HBe and those with fulminant hepatitis B. A donated plasma sample was found to be positive for the hepatitis B surface antigen, but negative for both HBeAg and anti-HBe. The HBV DNA titer in the plasma was estimated to be 32 pg/ml, and circulating virus-like particles were observed by electron microscopy. The entire nucleotide sequence of the virus was determined and at least 7 nucleotides were found to be unique when compared with previously reported sequences. These nucleotides created no termination codon in the precore/core, pol, preS/S and HBx open reading frames. The deduced amino acid substitutions were 28 Arg--Gln, 94 His--Tyr, 131 Val--Ile and 132 Phe--Tyr of HBx and 715 Met--Val and 789 Asp--Asn of pol. Furthermore, the precore and core/pregenome promoter contained altered 1764 A, 1766 T and 1768 A. Therefore, mutations in regions other than the precore open reading frame can cause defective HBeAg production.

Ultrasound vasography evaluation of radial arterial grafts used for coronary arterial bypass surgery

OBJECTIVES

For coronary bypass surgery, radial arteries are often used as bypass grafts. Some of these arteries however, have arteriosclerotic lesions. We attempted to evaluate the relationship between arteriosclerosis and vasodilation.

METHODS

Prior to bypass surgery, 20 patients underwent ultrasound vasography to determine the condition of their radial and brachial arteries. Flow-mediated dilation, which is the same as endothelium-dependent vasodilation, was measured in the brachial artery of the nondominant arm by reactive hyperemia after 5-minute forearm ischemia. Vasodilation after application of a sublingual glyceryl trinitrate spray was also measured.

RESULTS

During surgery, 4 of 20 radial arteries demonstrated calcification, and 3 of the 4 could be used by removing the calcified part. However, the other artery, which had extensive calcification that could not be detected by ultrasound vasography, was discarded. The amount of vasodilation seen after the administration of sublingual glyceryl trinitrate had no correlation with calcified grafts. Calcified radial arteries demonstrated significantly poor brachial artery vasodilation by an endothelial-dependent vasodilation test.

CONCLUSIONS

Calcification in radial arteries can thus only be evaluated by flow-mediated dilation.

Arsenic trioxide induces down-regulation of gp46 via protein oxidation: proteomics analysis of oxidative modified proteins in As2O3-treated HTLV-1-infected cells

Adult T-cell leukemia (ATL) is a severe chemotherapy-resistant malignancy associated with prolonged infection by the human T cell-lymphotropic virus 1 (HTLV-1) retrovirus. Epidemiology studies strongly indicate that an increase in HTLV-1 virus load is an important factor during the onset of ATL. Therefore, inhibition of the growth/transmission of HTLV-1 infected cells is a promising strategy in preventing the disease. In our previous study, we revealed that arsenic trioxide (As2O3), a drug used to treat acute promyelocytic leukemia (APL), exerts an inhibitory effect on syncytium formation between HTLV-1 infected cells and HeLa cells via suppression of HTLV-1 envelope protein gp46 expression at low concentrations. In this study, we analyze the mechanism of action of As2O3 using a proteomics approach. Our results suggest that down-regulation of gp46 might be related to As2O3-induced oxidation of the 71-kDa heat shock cognate protein (HSC70) and the 78-kDa glucose-regulated protein (BiP/GRP78). We postulate that AS2O3 exerts an inhibitory effect on HTLV-1 virus transmission via down-regulation of gp46-production, which might be caused by oxidative modification of various proteins such as chaperones.

Progesterone receptor membrane component 2 expression leads to erlotinib resistance in lung adenocarcinoma cells

Epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs) provide a favorable treatment outcome in patients with EGFR mutation-positive non-small cell lung cancer. However, most of such patients become resistant to EGFR-TKIs within a year. Thus, clarifying the mechanism of acquired resistance to EGFR-TKIs has been a research focus. Here, we demonstrated that the expression of progesterone receptor membrane component 2 (PGRMC2) was upregulated in an erlotinib-resistant cell line, PC9/ER, compared with the parental PC9 lung cancer cells. Our previous study showed that PGRMC1 is responsible for acquired resistance to erlotinib; however, PGRMC2 has not been discussed yet. Thus, the aim of this study was to determine the role of PGRMC2 in acquired resistance to erlotinib. Transfection with PGRMC2 siRNA significantly enhanced the sensitivity to erlotinib in PC9/ER cells. Furthermore, knockdown of PGRMC2 reduced the expression of p21, which is known as cell-cycle inhibitor and antiproliferative effector. These results suggest that PGRMC2 partially contributes to erlotinib resistance in PC9/ER cells, and that investigation into the effect of PGRMC2 on apoptosis and the cell cycle are warranted.

[Radiological changes in the femoral side after cementless total hip arthroplasty]

We investigated radiological and functional changes of the femurs with cementless total hip arthroplasty. Our particular attention was paid to the relationship between the thigh pain and the rate, period of its incidence and the progression of radiological changes. The cases studied consisted of 57 female patients with severe coxarthrosis who were implanted with a SUS316-L macroanchoring type of THP (JIAT). Clinical evaluations, radiographic findings in the femoral side, and osteometric observations were carried out periodically in the period before surgery until five years after surgery. The JOA criterion at the time of the final examination was average 91 points. However, we observed a high degree of bone change in the femur on the radiogram. Of 63 hips, there was 71% cortical bone atrophy, a 43% reduction of cortex thickness, 25% cortical bone hypertrophy, 94% endosteal bone bridging in the stem tip, a 64% linear sclerosis of the neighboring stem, and a 37% enlargement of the medullary cavity. Bone atrophy was manifested soon after surgery, and there was 34% recovery. Further, there was no connection between thigh pain and bone changes. We, therefore, concluded that such bone changes as atrophy would not immediately bring about adverse consequences.

[A case of transethmoidal encephalocele]

A case of a 3-year-old boy with transethmoidal encephalocele is presented. The patient was found to have bacterial meningitis, which responded well to an intravenous antibiotics therapy. No physical anomaly was evident on examination but plain skull X-ray film showed cloudiness of the left nasal antrum. Coronal CT scan disclosed a defect in the left cribriform plate and soft tissue mass in the left nasal cavity. MRI showed an anterior basal encephalocele protruding into the nasal cavity. Hypothalamic-pituitary system and the optic nerves appeared normal in the sagittal image. CSF rhinorrhea was confirmed by RI cisternography. An operation was performed transcranially. After a left frontal craniotomy, a unilateral bony defect in the cribriform plate and protrusion of the brain was observed subfrontally. The crista galli was intact. The herniated brain substance was transected and partially removed and the bony defect plugged by temporal muscle and covered by lyofirized dura. Microscopic examination of the herniated brain mass revealed gliosis and capillary proliferation. The patient recovered well and there has been no recurrence of CSF rhinorrhea or meningitis. Basal encephalocele is a very rare congenital anomaly. It is reported to constitute 1 to 10% of all encephaloceles. Incidence is estimated as 1 in every 35,000 to 40,000 live births. The anomaly is classified into two subtypes; transethmoidal (TE) and transsphenoidal (TS).(ABSTRACT TRUNCATED AT 250 WORDS)

Recurrent lupus pneumonitis with pulmonary hemorrhage in systemic lupus erythematosus associated with chronic thyroiditis and antithyroid hormone autoantibodies

We describe a SLE patient with repeated lupus pneumonitis and pulmonary hemorrhage. The hemorrhagic episodes were considered to be related to thrombocytopenia and lupus pneumonitis, which have responded well to treatment with moderate doses of steroids and immunosuppressant. She was also found to be suffering from chronic thyroiditis (hypothyroidism) and was positive for anti-thyroid hormone antibodies, which have not been reported before in the SLE patients with thyroid diseases.

Treatment with low-dose cytosine arabinoside followed by administration of macrophage colony-stimulating factor prolongs the survival of patients with RAEB, RAEB-T, or leukemic phase myelodysplastic syndrome: a pilot study

The treatment of patients with aggressive subclasses of myelodysplastic syndrome (MDS) remains a challenge. In an effort to improve the survival of patients with refractory anemia with excess blasts (RAEB), RAEB in transformation (RAEB-t), or acute myelogenous leukemia transformed from MDS (MDS-AML), we conducted a small trial in which 28 such patients were treated with low-dose cytosine arabinoside (LDAraC) followed by administration of macrophage colony-stimulating factor (M-CSF). The overall rate of response to the treatment was 61%, including 39% with a complete response, which is higher than rates obtained in previous studies in which LDAraC alone was administered to patients with MDS. Median survival was 23.5 months in cases of RAEB, 16.7 months in cases of RAEB-t, and 19.7 months in cases of MDS-AML. The overall survival of the study group appeared to be prolonged in comparison with a historical control group of patients treated with LDAraC alone. It is suggested that M-CSF added to the administration of LDAraC plays an active role in the therapy. No therapy-related death occurred. Some unique actions of M-CSF were suggested in this trial. It is concluded that therapy with LDAraC + M-CSF is a useful treatment option for patients with aggressive subclasses of MDS and MDS-AML to provide better response and survival.

[Combined surgery for coronary artery disease and thoracic aortic disease]

Combined surgery in 6 cases who had coronary artery disease and thoracic aortic disease simultaneously was analyzed. Case # 1 had ascending aortic replacement under deep hypothermic circulatory arrest because of iatrogenic aortic dissection caused by aortic clamp during the routine coronary artery bypass grafting (CABG). Case # 2 had DeBakey type II chronic dissection. Case # 3 had type I aortic dissection 4 years after the initial CABG. Both case # 2 and # 3 had ascending aortic replacement under retrograde cerebral perfusion along with CABG. Transverse aortic replacement was performed in case # 4, # 5 and # 6 under selective cerebral perfusion along with CABG. Case # 4 was associated with ascending-transverse aortic aneurysm. Case # 5 had aortitis syndrome complicated with severe coronary ostial stenosis and cervical branch stenosis. Case # 6 also had aortitis syndrome, severe coronary ostial stenosis, heavily calcified ascending-transverse aorta, and mitral and aortic regurgitation. This case had mitral and aortic valve replacement additionally. Case # 2 died of low cardiac output syndrome and multi-organ failure postoperatively. Case # 4 did not recover from profound shock that followed the preoperative acute myocardial infarction. The problems of low cardiac output syndrome caused by long interval of ischemic cardiac arrest, and also the problems of proximal anastomotic site of saphenous vein grafts were discussed.

[Postoperative evaluation of presealed vascular prostheses in surgical treatment of the thoracic aorta]

Two kinds of presealed vascular prostheses were started to use for the thoracic aortic surgery at May 1991. The Gelseal graft was implanted in 13 patients and the Hemashield graft in 31 patients. Each cases was performed enhanced computed tomographic scan periodically to determine the extent of postoperative dilatation of both grafts. These showed that the Gelseal graft is significant more dilated than the Hemashield graft (51.2 +/- 8.1% vs 10.2 +/- 5.8%: p < 0.001). The dilatation was almost completed within one month and no addition later on both grafts. Because of more dilatation and possibility of serous discharge, the Gelseal graft is not good prosthesis for the patients who require postoperative anticoagulant therapy. If the Gelseal graft is used, smaller size should be selected for its dilatation. As the result of this study, the Hemashield graft is more suitable for thoracic aortic lesions than the Gelseal graft.

Antitumor activity of tumor necrosis factor alpha conjugated with divinyl ether and maleic anhydride copolymer on solid tumors in mice

The purpose of this study is to further explore the usefulness of conjugation with functional polymeric modifiers for clinical application of bioactive proteins and to increase the therapeutic efficacy of tumor necrosis factor alpha (TNF-alpha) by conjugation in vivo. We synthesized TNF-alpha conjugated with the copolymer of divinyl ether and maleic anhydride (DIVEMA), which has intrinsic antitumor activity as a synthetic biological response modifier. The synthesis of DIVEMA-TNF-alpha could be controlled by the addition of 2,3-dimethylmaleic anhydride (DMMAn), which binds to or separates from amino groups when the pH is changed. The specific activity of DIVEMA-TNF-alpha (+) synthesized with DMMAn was hardly decreased in vitro. However, DIVEMA-TNF-alpha (-), which is conjugated without blocking by DMMAn, had a markedly diminished specific activity. DIVEMA-TNF-alpha (+) caused a dramatic hemorrhagic necrotic effect on the tumor when compared to native TNF-alpha 24 h after i.v. injection into mice bearing Sarcoma-180 solid tumors. In addition, DIVEMA-TNF-alpha (+) at a dose of only 100 Japan reference units per mouse revealed a dramatic antitumor effect that is approximately 100 times greater than native TNF-alpha and that could induce complete regression in all five mice bearing Meth-A solid tumors without any apparent side effects. Because neither DIVEMA alone nor a mixture of TNF-alpha and DIVEMA caused antitumor activity with i.v. administration, the increase in antitumor potency of TNF-alpha may be caused by the covalent conjugation with DIVEMA. DIVEMA-TNF-alpha at low dose revealed dramatic antitumor potency. Because TNF-alpha injected in vivo is extremely low-dose, concentration of intrinsic TNF-alpha in vivo is not influenced. Therefore, the cytokine network in vivo is not destroyed. These results suggest that DIVEMA is a useful polymeric modifier for conjugation of TNF-alpha to increase its antitumor activity.