Molecular Cloning, Nucleotide Sequence, and Expression of the Structural Gene for Alkaline Serine Protease from AlkaliphilicBacillussp. 221

The gene encoding an alkaline serine protease from alkaliphilic Bacillus sp. 221 was cloned in Escherichia coli and expressed in Bacillus subtilis. An open reading frame of 1,140 bases, identified as the protease gene was preceded by a putative Shine-Dalgarno sequence (AGGAGG) with a spacing of 7 bases. The deduced amino acid sequence had a pre-pro-peptide of 111 residues followed by the mature protease comprising 269 residues. The alkaline protease from alkaliphilic Bacillus sp. 221 had higher homology to the protease from alkaliphilic bacilli (82.1% and 99.6%) than to those from neutrophilic bacilli (60.6-61.7%). Also Bacillus sp. 221 protease and other protease from alkaliphilic bacilli shared common amino acid changes and 4 amino acid deletions that seemed to be related to characteristics of the enzyme of alkaliphilic bacilli when compared to the proteases from neutrophilic bacilli.

Overexpression of melanoma-associated antigen D4 is an independent prognostic factor in squamous cell carcinoma of the esophagus

To pursue an urgently needed treatment target for esophageal cancer (EC), we investigated the function of the recently discovered melanoma-associated antigen (MAGE)-D4 in squamous cell EC. MAGE-D4 messenger RNA (mRNA) expression was analyzed in nine EC cell lines using quantitative reverse transcription polymerase chain reaction. In 65 surgical specimens of squamous cell EC with no prior neoadjuvant therapy, MAGE-D4 mRNA expression in EC tissues and corresponding normal tissues was analyzed and compared, and evaluated in terms of clinicopathological factors. In representative cases, MAGE-D4 protein distribution was analyzed immunohistochemically. The heterogeneity of MAGE-D4 mRNA expression was confirmed in EC cell lines by quantitative reverse transcription polymerase chain reaction. In surgical specimens, MAGE-D4 mRNA expression was significantly higher in EC tissues than in corresponding normal tissues (P < 0.001). Patients with the highest MAGE-D4 mRNA expression in EC tissues (top quartile, n = 17) had significantly shorter overall survival than patients with low expression (2-year survival: 44% and 73%, respectively, P = 0.006). Univariate analysis identified age (≥65 years), lymphatic involvement, and high MAGE-D4 mRNA expression as significant prognostic factors; high MAGE-D4 mRNA expression was also an independent prognostic factor in multivariable analysis (hazard ratio: 2.194; P = 0.039) and was significantly associated with Brinkman index (P = 0.008) and preoperative carcinoembryonic antigen level (P = 0.002). Immunohistochemical MAGE-D4b expression was consistent with MAGE-D4 mRNA profiling. Our results suggest that MAGE-D4 overexpression influences tumor progression, and MADE-D4 can be a prognostic marker and a potential molecular target in squamous cell EC.

Long-term prognosis of patients with major depression and silent cerebral infarction

OBJECTIVE

Many studies have examined the effects of cerebrovascular changes on treatment response in geriatric depression. However, few such studies have examined the relationship between cerebrovascular changes and long-term prognosis. We examined the effects of cerebrovascular changes on the course of geriatric depressive symptoms, dementia rates, and mortality over a follow-up period of approximately 10 years.

METHOD

Participants were 84 patients with major depression (age of onset over 50 years); patients suffering from strokes, neurological disorders, and other psychiatric disorders were excluded. Magnetic resonance imaging findings were used to classify all patients into silent cerebral infarction (SCI)-positive (n = 37) or SCI-negative groups (n = 47). Prognoses were ascertained using a review of clinical charts and mailed questionnaires.

RESULTS

Only 5% of patients with SCI were able to maintain remission whereas 36% of patients without SCI were able to do so. Total duration of depressive episodes was significantly longer in the SCI-positive group than in the SCI-negative group. SCI was also associated with a higher risk of dementia.

CONCLUSION

The results of this long-term follow-up study demonstrate that the presence of SCI is associated with a relatively poor prognosis in geriatric depression.

Measurement of serum PDN-21 (Katacalcin) levels by radioimmunoassay in patients with various thyroid diseases

We established a radioimmunoassay (RIA) using anti-PDN-21 antiserum, which was obtained by immunizing rabbits with synthesized PDN-21, and the basic results are described in this report, with discussion of the significance of PDN-21 determination in various thyroid diseases. In this RIA, the double antibody technique was used for B/F separation. This assay yielded excellent standard curves, specificity, recovery and reproducibility showing that the assay is satisfactory from the clinical standpoint. The upper limit of the normal PDN-21 level was 67 pg/ml in 98 healthy persons. Only patients with medullary carcinoma of the thyroid among patients with various thyroid diseases showed specifically positive assay results. The level was 110 to 18,300 pg/ml (mean, 5,940 pg/ml) in 7 patients whose levels were determined preoperatively, and 64 to 140,000 pg/ml (mean, 10,900 pg/ml) in 18 patients whose levels were determined postoperatively. Thus, PDN-21 levels increased very sharply in the settings of recurrence and tumor residue. These results suggest that PDN-21 has the potential to be an extremely sensitive, highly specific marker for medullary carcinoma of the thyroid.

Role of Arginine Residues on the S4 Segment of the Bacillus halodurans Na+ Channel in Voltage-sensing

The one-domain voltage-gated sodium channel of Bacillus halodurans (NaChBac) is composed of six transmembrane segments (S1-S6) comprising a pore-forming region flanked by segments S5 and S6 and a voltage-sensing element composed of segment S4. To investigate the role of the S4 segment in NaChBac channel activation, we used the cysteine mutagenesis approach where the positive charges of single and multiple arginine (R) residues of the S4 segment were replaced by the neutrally charged amino acid cysteine (C). To determine whether it was the arginine residue itself or its positive charge that was involved in channel activation, arginine to lysine (R to K) mutations were constructed. Wild-type (WT) and mutant NaChBac channels were expressed in tsA201 cells and Na+ currents were recorded using the whole-cell configuration of the patch-clamp technique. The current/voltage (I-V) and conductance/voltage (G-V) relationships steady-state inactivation (h(infinity)) and recovery from inactivation were evaluated to determine the effects of the S4 mutations on the biophysical properties of the NaChBac channel. R to C on the S4 segment resulted in a slowing of both activation and inactivation kinetics. Charge neutralization of arginine residues mostly resulted in a shift toward more positive potentials of G-V and h(infinity) curves. The G-V curve shifts were associated with a decrease in slope, which may reflect a decrease in the gating charge involved in channel activation. Single neutralization of R114, R117, or R120 by C resulted in a very slow recovery from inactivation. Double neutralization of R111 and R129 confirmed the role of R111 in activation and suggested that R129 is most probably not part of the voltage sensor. Most of the R to K mutants retained WT-like current kinetics but exhibited an intermediate G-V curve, a steady-state inactivation shifted to more hyperpolarized potentials, and intermediate time constants of recovery from inactivation. This indicates that R, at several positions, plays an important role in channel activation. The data are consistent with the notion that the S4 is most probably the voltage sensor of the NaChBac channel and that both positive charges and the nature of the arginine residues are essential for channel activation.

Radiological and surgical management of thyroid neoplasms

Recent advances in the radiological diagnosis in thyroid neoplasms have been achieved by high-resolution ultrasonography and color-Doppler, and the ultrasound-guided fine-needle aspiration biopsy and ultrasound-guided percutaneous ethanol injection therapy have been developed on the basis of these modalities. Ultrasonography and ultrasound-guided fine-needle aspiration biopsy have made minimally invasive thyroid surgery possible. The surgical procedures are classified into three main categories according to the approach, and each approach has its own advantages and disadvantages. Surgeons have to select the most suitable approach from one of these categories of approaches for each patient with a thyroid neoplasm.

FAP associated thyroid carcinoma in mother and her daughter

A 21 year-old Japanese female was referred to the hospital for evaluation of a mass in her neck. Cytologic samples obtained through fine needle aspiration (FNA) material from the mass showed pseudopapillary or sheet-like clusters. The cells had oval nuclei and columnar cytoplasms. Nuclear groove and intranuclear inclusions were scarcely seen. The cells had a cribriform or solid pattern, unlike cells in papillary thyroid carcinoma. This distinct cytological appearance is thought to belong to FAP (familial adenomatous polyposis)-associated thyroid cancer. The patient was diagnosed with FAP associated papillary thyroid carcinoma. FAP was confirmed by colonoscopy. Her mother, 48 years old, also detected an anterior neck swelling at the time of her daughter's admission. At the age of ten, the mother had undergone total colectomy because of FAP. FNA of the mass demonstrated the same cytological appearance as from her daughter's tumor. Total thyroidectomy was performed. Gross and microscopic appearances of the tumor was similar in mother and daughter. We believe it is possible to detect FAP through FNA cytology of thyroid tumors if pathologists are aware of the unique cytohistological features of thyroid tumor cells in FAP.

Total endoscopic parathyroidectomy

During the last five years, minimally invasive procedures have been adopted for the surgical treatment of hyperparathyroidism, because preoperative localization studies such as high-resolution ultrasonography and sestamibi scintigraphy, guidance by intraoperative scans, and the use of quick, intraoperative parathyroid hormone assay have improved. Endoscopic parathyroidectomy was performed by Gagner in 1996, and surgical procedures using endoscopy have been devised. The endoscopic procedures range from the "pure" endoscopic approach characterized by constant gas insufflation to video-assisted gasless techniques. We adopted the "pure" endoscopic approach, because a small incision can be made far from the neck and the cosmetic result is excellent. We report our technique with no scars in the neck region for endoscopic unilateral neck exploration with primary hyperparathyroidism and for endoscopic bilateral neck exploration with renal hyperparathyroidism.

Sentinel lymph node biopsy in patients with thyroid carcinoma

The subject of performing prophylactic or elective modified dissections of the neck in patients with clinically occult lymph nodal metastases from thyroid cancers is controversial since metastases to lymph nodes are associated with high rates of recurrences. Biopsies of sentinel lymph nodes can be performed successfully in patients with thyroid cancers since they can be identified with dyes or 99mTc. Our preliminary findings indicate that biopsies of sentinel lymph nodes can be useful in the treatment of thyroid cancers; however, the clinical significance of identifying metastases in regional lymph nodes by this technique remains to be determined.

Minimally invasive radioguided parathyroidectomy

The recent development of radioguided parathyroidectomy has allowed parathyroidectomy to be quickly performed by a significantly less invasive procedure. Radioguided parathyroidectomy is also likely to decrease operation time, risk of complications, hospital stay, and the overall cost of patient care, result in a smaller scar and rapid, nearly pain-free recovery, and allow local anesthesia. Despite these apparent benefits, a case-control study showed no distinct advantages of employing intraoperative sestamibi identification during parathyroidectomy.

Laparoscopic partial adrenalectomy

Since corticosteroids are indispensable hormones, partial or cortical-sparing adrenalectomies may be adopted for the surgical treatment of adrenal diseases. In this article, we describe the technique and results of these procedures. Laparoscopic partial or cortical-sparing adrenalectomy has been performed in 10 patients. Seven cases had an aldosterone-producing adenoma (APA) and three had a pheochromocytoma. Three cases with an APA and a case with a pheochromocytoma had tumors located far from the adrenal central vein, and the vein could be preserved. Four cases with an APA and two with a pheochromocytoma had tumors located close to the adrenal central vein, and it was necessary to section the central vein to resect them. All endoscopic procedures were performed successfully. There were no postoperative complications. At follow-up, adrenal 131I-adosterol scintigrams showed the preservation of remnant adrenal function in all patients. Laparoscopic partial or cortical-sparing adrenal surgery was safely performed, and adrenal function was preserved irrespective of whether the adrenal central vein could be preserved or not. We consider this to be a useful operative technique for selected cases.

Intraoperative quick parathyroid hormone assay in the surgical management of hyperparathyroidism

Intraoperative quick parathyroid hormone (QPTH) assay is claimed to prevent failure during parathyroidectomy for hyperparathyroidism. The causes of operative failure have included multiglandular disease, ectopic parathyroid glands, supernumerary parathyroid glands, errors in frozen section evaluations, and missed diagnosis. A QPTH assay has been recognized as a useful method of determining whether hyperfunctioning tissues have been completely excised. However, an intraoperative QPTH assay may fail to detect the presence of double parathyroid adenomas. Use of this assay in conjunction with preoperative and intraoperative localization studies has led to the advocacy of more directed cervical procedures, such as limited, video-assisted, and endoscopic parathyroidectomy.

Total endoscopic thyroidectomy: axillary or anterior chest approach

We have developed endoscopic thyroidectomy by an anterior chest approach and an axillary approach. In this study, we evaluate the efficacy of these two types of endoscopic procedures and conventional open surgery. The degree of surgical invasiveness and the nature of patients' complaints after surgery were compared using the results of the operation and a questionnaire. The mean operating time for the endoscopic procedure was significantly longer than that for open surgery; however, there was no difference in postoperative pain in the three groups. Three months after surgery, the incidence of discomfort while swallowing in open surgery was higher than that in endoscopic surgery. All the patients who were treated using the axillary approach were satisfied with the cosmetic results. However, five patients (25%) who were treated using the anterior chest approach and 15 patients (75%; P < 0.01) who underwent open surgery complained abut the cosmetic results. The incidence of postoperative complaints after endoscopic surgery is significantly lower than that after open surgery. Patients who were treated using the axillary approach can obtain superior cosmetic results, compared with those who received other procedures.

Multicentre study comparing aggressive behaviour of familial non-medullary thyroid carcinoma and sporadic thyroid cancer

Background

Familial non-medullary thyroid cancer represents about 5 per cent of all thyroid cancers of follicular cell origin. Whether familial non-medullary thyroid cancer is more aggressive than sporadic thyroid cancer is controversial.

Methods

Each patient with familial non-medullary thyroid cancer was matched with three controls for age, sex and tumour node metastasis (TNM) stage of disease. Possible prognostic factors were compared in relation to recurrence, metastases and mortality rate in both groups. Univariate analysis was performed using contingency table analysis and McNemar's χ2 test for paired measurements. Multivariate analysis was used to evaluate factors significant in univariate analysis.

Results

Forty-eight cases (ten men) and 144 matched controls (30 men) were analysed with a mean follow-up of 102 and 94 months respectively. The mean age was 39 years for cases and 46 years for controls. Some 29 per cent of the cases and 12 per cent of the controls had history of prior or coexistent benign thyroid disease (P &lt; 0·05). Ninety-four per cent of cases and 90 per cent of controls had papillary cancers; the remainder were Hurthle cell cancers. Based on TNM staging, there were 66 per cent stage I, 21 per cent stage II and 13 per cent stage III tumours in the familial non-medullary thyroid cancer group; the distribution was similar in the control group. Modified radical neck dissection was performed in 42 per cent of cases and 22 per cent of controls. Multifocal or bilateral disease was seen in 75 per cent of cases and 41 per cent of controls (P &lt; 0·05); 35 per cent of cases and 16 per cent of controls had at least one recurrence (P &lt; 0·05). Ten per cent of cases and 2 per cent of controls developed distant metastases (P &lt; 0·05). Six per cent of cases but no controls died from thyroid cancer (P &lt; 0·05). In patients with familial non-medullary thyroid cancer aged over 45 years (n = 14), distant metastases affected four, of whom three died. In multivariate analysis, age was the only significant variable that affected the disease outcome (P &lt; 0·01).

Conclusion

Familial non-medullary thyroid cancer is more aggressive than sporadic thyroid cancer and is associated with increased recurrence, metastasis and death, especially in patients over 45 years of age.

Overexpression of haem oxygenase 1 protects allogeneic thyroid grafts from rejection in naive mice

Background

Endocrine allografts are an option for the treatment of endocrine failure. This study examined whether anti-CD4 monoclonal antibody (mAb) could induce survival of allogeneic thyroid grafts and investigated the mechanisms involved in graft survival.

Methods and Results

One lobe of thyroid was transplanted under the kidney capsule and graft survival was examined histologically. C57BL/10 (H2b) thyroids were rejected in naive CBA (H2k) mice within 14 days after transplantation. When mice were treated with a depleting anti-CD4 mAb (YTA 3·1; 100 μg on day −1, 0 and 3), all C57BL/10 thyroid grafts survived for over 30 days. In order to determine if donor-specific tolerance had been induced, mice with the surviving C57BL/10 thyroid grafts were transplanted with second C57BL/10 or Balb/c (H2d) thyroids under the left kidney capsule at 30 days. Interestingly, all of the second grafts were rejected in the left kidney capsule but the first C57BL/10 thyroid grafts continued to survive in the right kidney capsule for a further 30 days. These findings suggest that grafts themselves were modified under anti-CD4 mAb treatment. To confirm this hypothesis, C57BL/10 thyroid grafts in mice treated with anti-CD4 mAb were resected and retransplanted into naive mice 30 days after transplantation. All of the grafts survived when retransplanted to naive mice and this was found to correlate with overexpression of haem oxygenase 1 in the thyroid grafts. In an attempt to demonstrate the pivotal role of haem oxygenase 1 on graft survival, an inhibitor of haem oxygenase 1 (zinc protoporphyrin) or control compound (copper protoporphyrin) that did not inhibit the enzyme was injected intraperitoneally (30 mmol l−1 every day) after transplantation of C57BL/10 thyroid grafts into the primary CBA recipients treated with anti-CD4 mAb. The grafts in mice treated with zinc protoporphyrin but not copper protoporphyrin were rejected when retransplanted to naive recipients.

Conclusion

Overexpression of haem oxygenase 1 protects allogeneic thyroid grafts from rejection in recipients treated with anti-CD4 mAb. This observation may be applied for clinical endocrine grafts using gene transfer of haem oxygenase 1.

Comparative study of thyroidectomies. Endoscopic surgery versus conventional open surgery

BACKGROUND

We have performed endoscopic thyroidectomy by an anterior chest approach and by an axillary approach. In this study, we evaluate the efficacy of these two types of endoscopic procedures and conventional open surgery.

METHODS

Each procedure was performed in 15 patients. The degree of surgical invasiveness and the nature of patients' complaints after surgery were compared using results of the operation and a questionnaire.

RESULTS

Although the mean operating time for the endoscopic procedure was significantly longer than for open surgery, there was no postoperative pain difference in the three groups. Three months after surgery, the incidence of swallowing discomfort was higher in the open surgery group than in endoscopic surgery group. All of the patients treated using the axillary approach were satisfied with the cosmetic results. However, three patients (20%) treated using the anterior chest approach and 11 patients (73%; p < 0.01) who underwent open surgery complained about the cosmetic results.

CONCLUSIONS

The incidence of postoperative complaints after endoscopic surgery is significantly lower than after open surgery. Patients treated using the axillary approach can obtain cosmetic results superior to those achieved with other procedures.