Enhanced tumor growth and invasiveness in vivo by a carboxyl-terminal fragment of alpha1-proteinase inhibitor generated by matrix metalloproteinases: a possible modulatory role in natural killer cytotoxicity

Matrix metalloproteinases (MMPs) are believed to contribute to the complex process of cancer progression. They also exhibit an alpha1-proteinase inhibitor (alphaPI)-degrading activity generating a carboxyl-terminal fragment of approximately 5 kd (alphaPI-C). This study reports that overexpression of alphaPI-C in S2-020, a cloned subline derived from the human pancreas adenocarcinoma cell line SUIT-2, potentiates the growth capability of the cells in nude mice. After stable transfection of a vector containing a chimeric cDNA encoding a signal peptide sequence of tissue inhibitor of metalloproteinase-1 followed by cDNA for alphaPI-C into S2-020 cells, three clones that stably secrete alphaPI-C were obtained. The ectopic expression of alphaPI-C did not alter in vitro cellular growth. However, subcutaneous injection of the alphaPI-C-secreting clones resulted in tumors that were 1.5 to 3-fold larger than those of control clones with an increased tendency to invasiveness and lymph node metastasis. These effects could be a result of modulation of natural killer (NK) cell-mediated control of tumor growth in nude mice, as the growth advantage of alphaPI-C-secreting clones was not observed in NK-depleted mice, and alphaPI-C-secreting clones showed decreased NK sensitivity in vitro. In addition, production of alphaPI and generation of the cleaved form of alphaPI by MMP were observed in various human tumor cell lines and in a highly metastatic subline of SUIT-2 in vitro. These results provide experimental evidence that the alphaPI-degrading activity of MMPs may play a role in tumor progression not only via the inactivation of alphaPI but also via the generation of alphaPI-C.

[A case report of infective endocarditis with total rupture of the posterior papillary muscle after aortic valve replacement]

We reported a case with severe mitral regurgitation caused by total rupture of the posterior papillary muscle two days after aortic valve replacement. A 62-year-old man was transferred to our hospital with high fever and dyspnea with severe aortic regurgitation caused by infective endocarditis. The left heart failure occurred suddenly two days after the initial operation. Echocardiogram revealed massive mitral regurgitation and rupture of the posterior papillary muscle. He underwent emergent mitral valve replacement. Histological examination of the papillary muscle showed typical ischemic necrosis without inflammation. The postoperative course was uneventful. We suggested the papillary muscle rupture in this case may be due to coronary artery emboli occurred in association with infective endocarditis.

Amelioration by cyclosporin A of brain damage in transient forebrain ischemia in the rat

The immunosuppressant drug cyclosporin A (CsA) is considered to be inherently protective in conditions of ischemia, e.g. in hepatic and cardiac tissue. However, investigations of effects of CsA on neuronal tissue have been contradictory, probably because the blood-brain barrier (BBB) is virtually impermeable to CsA. In the present study, we exploited the finding that the insertion of a syringe needle into brain parenchyma obviously disrupts the BBB and allows influx of CsA, and explored whether CsA, given as intraperitoneal injections daily for 1 week before and 1 week after forebrain ischemia of 7 or 10 min duration, ameliorates the damage incurred to the hippocampal CA 1 sector. In other experiments, the needle insertion and the first i.p. injection of CsA were made 30 min after the start of recirculation, with continued daily administration of CsA during the postinsult week. In animals which were injected with CsA in daily doses of 10 mg kg-1, but in which no needle was inserted, the drug failed to ameliorate CA1 damage, whether the ischemia had a duration of 7 or 10 min. Likewise, needle insertion had no effect on CA1 damage if CsA was not administered. In contrast, when CsA was given to animals with a needle insertion, CA1 damage was dramatically ameliorated, whether treatment was initiated 1 week before ischemia, or 30 min after the start of recirculation. The effect of CsA seemed larger than that of any other drug proposed to have an anti-ischemic effect in forebrain/global ischemia. Injection of tritiated CsA in one animal with BBB disruption lead to detectable radioactivity throughout the ventricular system, suggesting a generalised increase of the entry of CsA across the BBB. The results demonstrate that immunosuppressants of the type represented by CsA markedly ameliorate delayed neuronal damage after transient forebrain ischemia, provided that they can pass the BBB. It is discussed whether the effect of the drug is one involving calcineurin, a protein phosphatase, or if CsA counteracts a permeability transition of the inner mitochondrial membrane, assumed to occur in response to adverse conditions, e.g. gradual accumulation of Ca2+ in the mitochondria in the postischemic period.

Expression cloning and characterization of a transporter for large neutral amino acids activated by the heavy chain of 4F2 antigen (CD98)

A cDNA was isolated from rat C6 glioma cells by expression cloning which encodes a novel Na+-independent neutral amino acid transporter designated LAT1. For functional expression in Xenopus oocytes, LAT1 required the heavy chain of 4F2 cell surface antigen (CD98), a type II membrane glycoprotein. When co-expressed with 4F2 heavy chain, LAT1 transported neutral amino acids with branched or aromatic side chains and did not accept basic amino acids or acidic amino acids. The transport via LAT1 was Na+-independent and sensitive to a system L-specific inhibitor 2-aminobicyclo-(2,2,1)-heptane-2-carboxylic acid. These functional properties correspond to those of the classically characterized amino acid transport system L, a major nutrient transporter. In in vitro translation, LAT1 was shown to be a nonglycosylated membrane protein consistent with the property of 4F2 light chain, suggesting LAT1 is at least one of the proteins formerly referred to as 4F2 light chain. LAT1 exhibits relatively low but significant amino acid sequence similarity to mammalian cationic amino acid transporters and amino acid permeases of bacteria and yeasts, indicating LAT1 is a new member of the APC superfamily. Because of highly regulated nature and high level of expression in tumor cell lines, LAT1 is thought to be up-regulated to support the high protein synthesis for cell growth and cell activation. The cloning of LAT1 is expected to facilitate the research on the protein-protein interaction in the transporter field and to provide a clue to the search for still unidentified transporters.

Evaluation of hepatocyte growth factor activator inhibitor expression in normal and malignant colonic mucosa

Gene expression of hepatocyte growth factor activator inhibitor (HAI), a recently identified Kunitz-type serine proteinase inhibitor, was analyzed in a series of human colorectal carcinoma cell lines and in human colorectal tissues. All of the 14 cell lines derived from adenocarcinoma of the colorectum expressed HAI in vitro, whereas a colon carcinoma cell line of neuroendocrine origin did not. In vivo, HAI was consistently expressed in the normal colorectal mucosa. Although the expression of HAI mRNA was conserved in adenocarcinoma tissues of the colorectum, the levels of expression were decreased in the adenocarcinoma tissues compared to the normal counterparts. There was a tendency towards an inverse correlation, albeit not well defined, between the amounts of HAI mRNA and the tumor progression. Immunohistochemical study indicated that HAI protein is present predominantly on the surface of epithelial cells of the colon and the immunoreactivity was decreased in the adenocarcinoma cells.

[Spontaneous splenic rupture after mitral valve replacement for infective endocarditis]

We report a successful treatment of massive bleeding due to spontaneous splenic rupture after mitral valve replacement. A 61-year-old man was admitted to our hospital for intermittent high fever. An echocardiogram demonstrated a large vegetation on the posterior cusp of the mitral valve and mitral regurgitation of moderate degree. Staphylococcus epidermidis was cultured from his arterial blood. He underwent a mitral valve replacement after 3 weeks of antimicrobiological therapy with penicillin G crystalline and minocycline hydrochloeide. The patient fell into hemorrhagic shock on postoperative day 11 after complaining dull pain on his left upper abdomen for 3 days. A computed tomography demonstrated a splenic rupture and massive hematoma in the retroperitoneum. A splenic arterial embolization was done before splenectomy. The blood and clot of 2800 g were sucked from peritoneal and retroperitoneal cavities. There were no mycotic aneurysms nor abscess but the torn capsule on the swelled and partially necrotic spleen. The patient discharged uneventfully on postoperative day 43. Infective endocarditis frequently causes splenic infarction but rarely splenic rupture. Anticoagulation therapy after mitral valve replacement might have emphasized the bleeding in the patient.

Comparative analysis of expression of hepatocyte growth factor and its receptor, c-met, in gliomas, meningiomas and schwannomas in humans

Expression of hepatocyte growth factor (HGF) and c-met, a proto-oncogene that encodes a receptor for HGF, was examined in 45 cases of human primary intracranial tumors by means of RT-PCR. In gliomas, HGF and c-met mRNAs were preferentially expressed in high-grade tumors. Co-expression of both genes was observed in glioblastomas (6/15) and in one anaplastic astrocytoma (1/5) but not in low-grade astrocytomas (0/3). By contrast, the c-met gene was consistently expressed in meningiomas (12/14) and schwannomas (8/8). The presence of c-Met protein was confirmed in the tumor cells of glioblastoma, meningioma and schwannoma by immunohistochemical staining. Moreover, all of the schwannoma cases co-expressed the HGF gene. These observations suggest that HGF/c-met expression is somehow related to the disease progression in gliomas, whereas c-Met protein might have an important fundamental biological role in meningioma and schwannoma. Moreover, since all of the schwannoma cases concomitantly expressed the ligand (HGF) and the receptor (c-met) genes, HGF may act in an autocrine fashion in schwannoma.

Diagnostic and biological significance of sideroblastic erythropoiesis in the myelodysplastic syndromes

We retrospectively reviewed clinical and hematologic features of nine patients with acquired idiopathic sideroblastic anemia (AISA). Seven of them had ringed sideroblasts (RS) more than 15% of marrow nucleated cells. RS persisted in the marrow even in the remaining two patients who had a relatively low marrow erythroblasts despite RS ranging from 1/4 to half of the marrow erythroid series. However, RS declined in proportion in another two patients of the nine whose disease progressed to refractory anemia with excess of blasts (RAEB), although a high proportion of RS reappeared in one patient at the time of relapse following allogeneic marrow transplantation. A similar decline of RS concomitant with disease progression was also seen in seven additional patients with RAEB or RAEB in transformation (RAEB-t) with sideroblastic erythropoiesis. Cytogenetic abnormalities, although rare initially, became detectable either at the time of disease progression or at the worsening of anemia in AISA. These observations suggest that the majority of AISA fall in the category of myelodysplasia, and that a progressive decline in RS is part of the natural history of myelodysplasia. Closer follow-up of the proportion of RS in patients with AISA is warranted to better understand its biologic significance.

Characterization of the Hyphal Swelling Group of Pythium: DNA Polymorphisms and Cultural and Morphological Characteristics

The hyphal swelling (HS) group of Pythium species and P. ultimum were studied for cultural and morphological characteristics, restriction fragment length polymorphisms of the amplified internal transcribed spacer (ITS) region in nuclear rDNA, and random amplified polymorphic DNA (RAPD) analysis of genome DNA. The shape of sporangia was spherical to subspherical or lemoniform and averaged 18.1-23.0 μm. All isolates could grow at 5 to 35°C, and the rate at the optimal temperature, 30°C, was 29-34 mm/24 h. The size of the ITS region amplified by polymerase chain reaction and the banding patterns after digestion with the restriction enzymes showed no variation between the HS group and P. ultimum. No difference in banding patterns was shown between the HS group and P. ultimum by RAPD analysis with each of three primers. Isolates examined were from Japan, and results should be confirmed from other regions.

Aortic valve replacement through the transected aorta in a patient with aortic stenosis and a calcified ascending aorta

This report describes a surgical approach of aortic valve replacement in a patient with a calcified ascending aorta, calcified aortic valve stenosis and coronary artery disease. The aortic valve was replaced with a 19 mm St. Jude Medical prosthetic valve through the transected aorta while the distal ascending aorta was cross-clamped at a narrow but not calcified band approximately 4.5 cm distal to the aortic anulus. These procedures were successfully done and no neurological deficit was found after surgery. The aortic valve replacement through the transected aorta may be one of the alternatives in selected patients with porcelain aortas and calcified aortic valves.

Hyperglycemia and hypercapnia suppress BDNF gene expression in vulnerable regions after transient forebrain ischemia in the rat

Preischemic hyperglycemia or superimposed hypercapnia exaggerates brain damage caused by transient forebrain ischemia. Because high regional levels of brain-derived neurotrophic factor (BDNF) protein correlate with resistance to ischemic damage, we studied the expression of BDNF mRNA using in situ hybridization in rats subjected to 10 minutes of forebrain ischemia under normoglycemic, hyperglycemic, or hypercapnic conditions. Compared with normoglycemic animals, the increase of BDNF mRNA using in situ hybridization in rats subjected to 10 minutes of forebrain ischemia under normoglycemic, or hypercapnic conditions. Compared with normoglycemic animals, the increase of BDNF mRNA in dentate granule cells was attenuated and that in CA3 pyramidal neurons completely prevented in hyperglycemic rats. No ischemia-induced increases of BDNF mRNA levels in the hippocampal formation were detected in hypercapnic animals. Hyperglycemic and hypercapnic rats showed transiently decreased expression of BDNF mRNA levels in the cingulate cortex, which was not observed in normoglycemic animals. The results suggest that suppression of the BDNF gene might contribute to the increased vulnerability of the CA3 region and cingulate cortex in hyperglycemic and hypercapnic animals.

[A Rastelli operation with a reconstruction of the central pulmonary artery for a pulmonary atresia with an absent left pulmonary artery]

A Rastelli procedure was successfully performed on a 6-year-old girl with an absence of the intrapericardial pulmonary artery and the left pulmonary artery (PA), following a right B-T shunt. The central PA was reconstructed with an 18 mm diameter xenopericardial roll behind the ascending aorta and the superior vena cava. After intracardial repair, the Rastelli operation was performed using an 18 mm diameter composite graft which consisted of a valved xenopericardial roll and a knitted Dacron graft. Since the size of the right PA was large enough to undergo this surgical procedure (the preoperative right PA index was 300 mm2/m2), the postoperative peak systolic pressure ratio of the right ventricle to the left ventricle declined from 1.0 to 0.64. Although the patient showed slight signs of right ventricular failure on the operative day, the postoperative course was uneventful.

Expression of intestinal trefoil factor mRNA is downregulated during progression of colorectal carcinomas

AIMS

Intestinal trefoil factor is a mucosa associated trefoil peptide expressed predominantly in the goblet cells of the small and large intestine. The aim of this work was to investigate the expression of the intestinal trefoil factor gene in human colorectal cancers.

METHODS

The expression of intestinal trefoil factor mRNA was examined by northern blot analysis in 27 cases of surgically resected primary colorectal carcinoma of various stages.

RESULTS

Although intestinal trefoil factor mRNA was expressed consistently in the tumours, the levels of expression varied considerably among the cases examined. The levels of expression were low in advanced stage tumours (Dukes's B, C, and D) compared with early stage tumours (Dukes's A) (p < 0.05). In addition, there was a tendency towards a positive correlation, albeit not well defined, between the amounts of intestinal trefoil factor mRNA and the histological differentiation of tumours.

CONCLUSIONS

Intestinal trefoil factor mRNA was expressed consistently in the cases of colorectal carcinoma studied and expression was inversely associated with tumour progression.

[Optimal temperature of cardiac myocytes preservation under severely hypoxic status--experimental study of the isolated cardiac myocytes]

Purpose of the present study was to evaluate functional and biochemical effects of hypoxia and hypothermia on cardiac myocytes, in order to identify the optimal temperature of cardiac myocyte preservation. Cardiac myocytes isolated from the neonatal rat ventricles (1.5 x 10(6) myocytes/culture flask) were incubated under the severely hypoxic conditions (partial pressure of oxygen was 20 mmHg) for 24 hours at 4 degrees C, 10 degrees C, 15 degrees C, 20 degrees C, 25 degrees C, and 37 degrees C. After each hypoxic incubation, CPK and LDH were measured in the incubation media. The myocytes were then cultured for additional 24 hours at 37 degrees C to evaluate the recovery of the myocyte beating rate. In 4 degrees C and 37 degrees C groups, the myocyte beating rate recovery was markedly low as 0.0% and 34.5% of the control, compared to the beating rate pr or to hypoxia, respectively (p < 0.001). Release of CPK and LDH (mIU/flask) was significantly higher in 4 degrees C (CPK: 197.1, LDH: 1395) and 37 degrees C (CPK: 138.6, LDH: 1201) groups, respectively (p < 0.001). CPK and LDH levels did not significantly increase among four (10 degrees C, 15 degrees C, 20 degrees C, and 25 degrees C) groups. In order to further confirm the optimal temperature, hypoxic incubation time was prolonged to 48 hours in 10 degrees C, 15 degrees C, 20 degrees C, and 25 degrees C groups. In 20 degrees C group, the myocyte beating rate recovery was highest to be 83.7% among the groups (p < 0.001 vs 10 degrees C, 25 degrees C, p < 0.05 vs 15 degrees C). Release of CPK, 33.1 mIU/flask, was lowest in 20 degrees C group (p < 0.001 vs 10 degrees C, p < 0.05 vs 15 degrees C). Release of LDH, 550.3 mIU/flask, was lowest in 20 degrees C group (p < 0.001 vs 10 degrees C, 25 degrees C, p < 0.05 vs 15 degrees C). Thus, cellular damage was lesser in 20 degrees C group both functionally and biochemically than the other temperature groups. These results suggested that 20 degrees C appears to be an optimal temperature for severely hypoxic preservation of the cardiac myocyte. This cell culture system may provide a useful and simple method for evaluation of the direct effects of hypoxia and hypothermia on cardiac myocytes in vitro.

Analysis of tissue factor and tissue factor pathway inhibitor expression in human colorectal carcinoma cell lines and metastatic sublines to the liver

To investigate the expression of tissue factor (TF) and tissue factor pathway inhibitor (TFPI) in human colorectal carcinomas, Northern blot analysis was performed in a series of human colorectal carcinoma cell lines and in normal or tumoral colorectal tissues. Of 16 human colorectal carcinoma cell lines examined, most expressed TF mRNA, though the levels of expression varied significantly. Considerably higher expression was observed in the cell line CaR-1, while lines established from metastatic lesions tended to express abundant TF mRNA. By contrast, TFPI mRNA levels were low in these high TF-expressing cell lines. TFPI was expressed abundantly in WiDr and in a few other cell lines which expressed a very low level of TF mRNA. Immunocytochemically, both proteins were stained predominantly on the cell surface; however, diffuse cytoplasmic staining for TF also was observed in CaR-1 cells. In addition, the cell surface TF activity was significantly higher in CaR-1 cells than in WiDr cells, confirming the results of mRNA analysis. The level of TF mRNA in colorectal carcinoma tissue in vivo and its ratio to the normal counterpart also varied significantly among the cases. To search for a possible role of TF/TFPI in metastasis of colorectal carcinoma cells, the expression of these genes was compared between a rectal adenocarcinoma cell line, RCM-1, and its highly metastatic subline, RCM-1 L-10. Compared with the parent line, RCM-1 L-10 expressed 7.5-fold higher levels of TF mRNA, whereas TFPI expression was not altered significantly or even decreased slightly. The higher cellular TF activity was confirmed in the metastatic subline in comparison with the parent line.

[A survey on sexual awareness and behaviour of residents of a provincial city]

For better understanding of the sexual behaviours that are high-risk in terms of HIV infection, a random sample of 200 people aged above 20 and below 60 years, from a population of 23,700, was selected in the provincial city of Nagano and surveyed by visitation. The responses of 156 people (a rate of response of 78%) were collected and the results were statistically analyzed. The methods employed in conducting a survey on sexual behaviour were also evaluated. The number of sexual partners is an indicator of high-risk sexual behaviour for HIV infection. The data reveals that 65.3% of the men and 37% of the women had two or more partners in the past, with 37.5% of the men and 12.5% of the women having two or more partners in the last 5 years, and 19.1% of the men and 4.2% of the women having two or more partners in the last year, revealing that a higher percentage of men than women have multiple partners. Comparison by age group reveals that young men and women in their 20s have the highest percentage of multiple partners. For both men and women first sexual intercourse before the age of 18, for men self-employment, being a craftsmen or in agriculture, and for women, higher education, were all factors in having greater numbers of partners. In conducting a survey on sexual behaviour the following should be kept in mind. 1) The psychological background of the respondent; Sex counseling skills are required on the part of the interviewer when taking a survey on sex since it is a very private and personal topic for people. Respondents have a tendency to be those who are open-minded about sex and are active in life, and these factors can exaggerate the survey results. 2) Conduct of a survey on sexual behaviour; The survey should be taken only after the purpose of the survey has been fully explained to the respondents and trust has been established. In principle, therefore, mailing of a letter of request and the actual questions should not be the method utilized prior to the collection of responses.

Amelioration by cyclosporin A of brain damage following 5 or 10 min of ischemia in rats subjected to preischemic hyperglycemia

It has recently been shown that the immunosuppressant cyclosporin A (CsA) dramatically ameliorates the selective neuronal necrosis which results from 10 min of forebrain ischemia in rats. Since CsA is a virtually specific blocker of the mitochondrial permeability transition (MPT) pore which is assembled under adverse conditions, such as mitochondrial calcium accumulation and oxidative stress, the results suggest that the delayed neuronal death is due to an MPT. In the present study we explored whether CsA can also ameliorate the aggravated brain damage which is observed in hyperglycemic subjects, and which encompasses rapidly evolving neuronal lesions, edema, and postischemic seizures. Anaesthetised rats with a plasma glucose concentration of approximately 13 mM were subjected to 10 min of forebrain ischemia, and allowed a recovery period of 7 days. In these animals, CsA prevented seizure from occurring and virtually eliminated neuronal necrosis. In order to allow even higher plasma glucose values (approximately 20 mM) to be studied, with long-term recovery, the duration of ischemia had to be reduced to 5 min. Again, CsA suppressed seizure activity and reduced neuronal damage. However, the effects were not as marked or consistent as in the 10 min group, suggesting that excessive tissue acidosis recruits mechanisms of damage which are not sensitive to CsA.

Mode of disease progression in primary myelodysplastic syndromes: a Japanese co-operative study. The Refractory Anemia Study Group of The Ministry of Health and Welfare, Japan

Chronological changes in hematological findings were analyzed in 225 patients with myelodysplastic syndromes (MDS). They were diagnosed between 1990 and 1992. Their hematological findings, i.e. hemoglobin levels, leukocyte and platelet counts, proportions of peripheral blood (PB) blasts and monocytes, and proportion of blasts in bone marrow (BM), were recorded for up to 42 months after diagnosis, when available. BM was examined regularly in only a few patients. Therefore, it was impractical to use the French-American-British Cooperative Group criteria for subtype classification during the disease course. Thus, we used the percentage of PB blasts as the only indicator of stage evolution. We classified the disease into four stages: stage 1, less than 1% PB blasts; stage 2, 1-5% PB blasts; stage 3, 5-30% PB blasts; and stage 4, 30% or more PB blasts. There were 171 patients initially in stage 1, 37 initially in stage 2, and 17 initially in stage 3. Less than half (45%) of the patients initially in stage 1 progressed to stage 2, while 91% of the patients initially in stage 2 and all of the patients initially in stage 3 showed stage evolution. Eight variables, i.e. BM blasts 5% or more, male sex, karyotypic abnormalities, micromegakaryocytes, mononuclear large megakaryocytes, platelet counts 50 x 10(9)/l or higher, abnormal nucleus of granulocytes, and abnormal granules of granulocytes, were found to be significant risk factors for evolution from stage 1 to 2. Evolution from stage 1 to a higher stage within 15 months of diagnosis was associated with impending poor prognosis in most patients. However, of the 67 patients initially in stage 1 who died, 30 did not show stage evolution. Evolution from stage 2 to a higher stage and from stage 3 to stage 4 was also associated with impending poor prognosis. Higher levels of cytopenia were not associated with poorer prognosis in the stage 1 patients. In conclusion, our grading system proved to be useful in evaluating the chronological changes in MDS patients.

Changes in the bioenergetic state of rat hippocampus during 2.5 min of ischemia, and prevention of cell damage by cyclosporin A in hyperglycemic subjects

A recent study from this laboratory has shown that brief transient ischemia (2 min 30 s) in normo- and hyperglycemic rats leads to moderate neuronal necrosis in CA1 cells of the hippocampus, of equal density in the two groups. However, hyperglycemic animals failed to depolarize during the ischemia, nor did they show a decrease in extracellular calcium concentration. The present study was undertaken to study the metabolic correlates to these unexpected findings. Normoglycemic (plasma glucose approximately 6 mM) and hyperglycemic (approximately 20 mM) rats were subjected to ischemic periods of 1 min and 2 min 15 s (2 min 30 s with freezing delay considered), and their brains were frozen in situ. Samples of dorsal hippocampus were dissected at -22 degrees C and extracted for the measurement of phosphocreatine (PCr), creatine, ATP, ADP, AMP, glucose, glycogen, and lactate. Normoglycemic animals showed rapid depletion of PCr, ATP, glucose, and glycogen, and a rise in lactate content to 10-12 mM x kg(-1) during the ischemia. Hyperglycemic animals displayed a more moderate rate of fall of PCr and ATP, with ATP values exceeding 50% of control after 2 min 30 s. Glycogen stores were largely maintained, but degradation of glucose somewhat enhanced the lactic acidosis. The results demonstrate that hyperglycemic rats maintained ATP at levels sufficient to prevent cell depolarization and calcium influx during the ischemic period. However, the metabolic perturbation observed must have been responsible for the delayed neuronal damage. We speculate that lowered ATP, increased inorganic P, and oxidative stress triggered a delayed mitochondrial permeability transition (MPT), which led to delayed neuronal necrosis. This assumption was supported by a second series of experiments in which CA1 damage in hyperglycemic rats was prevented by cyclosporin A, a virtually specific inhibitor of the MPT.

[Clinical evaluation of cefpirome sulfate for severe infections in patients with hematological disorders. Hanshin Study Group of Hematopoietic Disorders and Infections]

We investigated the therapeutic efficacy and safety of cefpirome sulfate (CPR) in treatment of hematopoietic disorder-associated infections. A total of 219 patients were admitted to 12 hospitals of Hanshin Study Group of hematopoietic disorders and infections between April 1994 and March 1996 and were enrolled in this study. Most patients received intravenously infused CPR at a dose of 1 or 2 g twice a day for 3 days or more. Twenty nine patients dropped out or were excluded and remaining 190 patients were adopted for the evaluation. A overall response rate was 58.4% (111/190). Among neutropenic patients, the response rate was 50% (8/16) in patients whose peripheral neutrophil counts (PNC) remained less than 100/microliter throughout the observation period and was 53.7% (22/41) in patients with PNC remained less than 500/microliter. In contrast, in patient whose PNC was below 500 before the treatment but exceeded 501/microliter during of at the end of the treatment, the response rate was as high as 78.4% (29/37). When G-CSF was combined, the response rate became significantly (P < 0.05) higher, 68.5% (50/73), as compared with that, 52.1% (61/117), in patients without it. In cases in which the causative organisms could be identified, the organisms were eliminated in 81.8% (9/11) of the patients infected with Gram-positive bacteria, whereas in 100% (12/12) in those infected with Gram-negative bacteria. Skin eruption developed in 6 patients during the treatment with CPR, and vascular pain and parosmia in one each other. These symptoms subsided soon after discontinuation or even without discontinuation of CPR. Abnormal laboratory findings, mainly liver dysfunction, i.e. elevation of slight degree of serum transaminase levels, were observed. The values, however, turned to normal immediately after the cessation or completion of the treatment. In conclusion, CPR is considered to be an antibiotic of value with high efficacy and safety in treatment of hematopoietic disorder-associated infections.

Modulation of matrix metalloproteinase-7 (matrilysin) secretion in coculture of human colon carcinoma cells with fibroblasts from orthotopic and ectopic organs

Matrix metalloproteinase-7 (MMP-7) is a member of the family of matrix-degrading metalloproteinases that are believed to contribute to the complex process of cancer invasion and metastasis. The secretion level of MMP-7 as assayed by immunoblot analysis was low but distinct in the culture medium of a human colon carcinoma cell line, WIDr, whereas none of the fibroblasts secreted the detectable level of MMP-7. The coculture of WiDr with various human fibroblasts from orthotopic (colon) and ectopic (thyroid, brain, lung, and skin) organs significantly stimulated the secretion of MMP-7 compared with the cultures of individual cells. Reverse transcriptase-polymerase chain reaction analysis and RNA blot analysis suggested that this enhancement occurred at a pretranslational level. The extent of the stimulation was widely varied by the fibroblasts used and was dependent on the cellular ratios and density in the coculture. There may exist a tendency that fibroblasts of orthotopic origin stimulate more extensively than do those of ectopic origin. Moreover, in the coculture of high cell density, normal fibroblasts from the ectopic organs reduced the MMP-7 secretion. The stimulation of MMP-7 secretion may be partially mediated through soluble factor(s); however, direct cell-cell interactions would be required for maximum stimulation. The enhanced MMP-7 secretion was also observed in coculture of colon fibroblasts with other colorectal carcinoma cell lines such as RCM-1 and SW837, which secreted hardly detectable levels of MMP-7 in the individual culture. These results suggest that MMP-7 secretion by colon carcinoma cells is influenced by specific interactions between the carcinoma cells and host fibroblasts.

Clinical importance of interleukin-2 receptor alpha-chain expression in acute leukemia. The Japan Cooperative Group of Leukemia/Lymphoma

To clarify the clinical importance of interleukin-2 (IL-2) receptor (IL-2R) expression in acute leukemia, we examined 517 adult patients with acute leukemia and CML blast crisis (CML-BC). IL-2R alpha was expressed in 42/311 AML, 5/11 acute unclassified leukemia, 24/116 pre-B ALL, 2/32 T-ALL, and 27/47 CML-BC, while IL-2R beta was expressed only in 2 T-ALL. Expression of IL-2R alpha was closely associated with that of different lineage markers, CD11b, CD34, and Ph1+ abnormality. IL-2R alpha(+) non-T leukemic cells did not respond to IL-2. Clinical outcome of IL-2R alpha (+) leukemia showed lower response to conventional chemotherapy and poorer prognosis than IL-2R alpha (-) cases. Serum IL-2R alpha level in IL-2R alpha (+) cases increased at the onset. Our findings indicate the diagnostic importance of IL-2R alpha expression in acute leukemia as a prognostic risk factor with a close relation to the particular cellular characteristics.

cDNA cloning of rat pS2 peptide and expression of trefoil peptides in acetic acid-induced colitis

By using a combination of the methods of reverse transcription-PCR and rapid amplification of cDNA ends, a cDNA for rat pS2 peptide (rpS2) was successfully cloned and sequenced from rat stomach. By RNA blot analysis, the gene was shown to be expressed abundantly in the stomach and only faintly in the duodenum, but not in other tissues including the distal small and large intestines. rpS2 expression was also examined in the rectum during the course of acetic acid-induced colitis; rpS2 mRNA was detected during the acute phase of colitis but not in normal controls or during the recovery phase. On the other hand, expression of rat intestinal trefoil factor (rITF) was down-regulated during the acute phase of colitis and then up-regulated during the recovery phase, whereas rat spasmolytic peptide was not detectable throughout the course of the induced colitis. These results indicate that the patterns and timing of the expression of these trefoil peptides are different from each other. rpS2 may play an important role in the proliferation of intestinal epithelial cells during the acute phase of mucosal ulceration, whereas rITF may be involved in differentiation of the cells, particularly to form goblet cells, during the recovery phase.

Expression of inter-alpha-trypsin inhibitor light chain (bikunin) in human pancreas

Expression of inter-alpha-trypsin inhibitor light chain (ITI-LC, also known as bikunin or urinary trypsin inhibitor) was examined in various human tissues. By reverse-transcription polymerase chain reaction, the mRNA was detected not only in the liver, a known site of ITI-LC production, but also in the kidney, heart, lung, and pancreas. By RNA blot analysis, the mRNA was also detected in the pancreas and liver, but not in the kidney, heart, or lung. The ITI-LC protein was immunohistochemically detected along the surface of pancreatic acinar cells. These results indicate the apparent expression of the gene for ITI-LC in the pancreas. ITI-LC protein on the surface of pancreatic acinar cells may play an important role in preventing autodigestion by exocrine enzymes such as trypsinogen and chymotrypsinogen.

Characteristics of postischemic seizures in hyperglycemic rats

Normoglycemic animals subjected to 10-20 min of transient ischemia survive without major neurological symptoms, but incur delayed neuronal damage selectively affecting vulnerable neuronal populations. If the animals are hyperglycemic before ischemia is induced, cell damage develops more rapidly, and postischemic seizures appear after a delay of 18-24 h. This study was designed to assess whether the primary insult, i.e., transient ischemia in hyperglycemic animals, triggers early epileptogenic activity which 'matures' into clinical seizures, or if the seizures arise as a result of secondary events occurring after many hours of recirculation. EEG activity during 20-24 h of postischemic recirculation was recorded from electrodes implanted in the neocortex and hippocampus of freely moving rats which had been subjected to 10 min of ischemia under normoglycemic or hyperglycemic conditions. Normoglycemic animals showed a transient postischemic reduction of EEG amplitude and frequency, and sparse and temporary epileptiform activity. In contrast, hyperglycemic animals showed a more pronounced reduction of EEG amplitude and frequency, and early appearing epileptiform activity which was sustained, and ultimately transformed into overt electrographic seizures. The EEG changes were more pronounced in the neocortex than in the hippocampus. The results thus demonstrate that the initial ischemic insult, and not the secondary damage appearing many hours after the initiation of recirculation, triggers epileptiform activity that 'matures' into status epilepticus.

Regional brain-derived neurotrophic factor mRNA and protein levels following transient forebrain ischemia in the rat

Levels of BDNF mRNA and protein were measured in the rat brain using in situ hybridization and a two-site enzyme immunoassay. Under basal conditions, the highest BDNF concentration was found in the dentate gyrus (88 ng/g), while the levels in CA3 (50 ng/g), CA1 (18 ng/g) and parietal cortex (8 ng/g) were markedly lower. Following 10 min of forebrain ischemia, BDNF protein increased transiently in the dentate gyrus (to 124% of control at 6 h after the insult) and CA3 region (to 131% of control, at 1 week after the insult). In CA1 and parietal cortex, BDNF protein decreased to 73-75% of control at 24 h. In contrast, BDNF mRNA expression in dentate granule cells and CA3 pyramidal layer was transiently elevated to 287 and 293% of control, respectively, at 2 h, whereas no change was detected in CA1 or neocortex. The regional BDNF protein levels shown here correlate at least partly with regional differences in cellular resistance to ischemic damage, which is consistent with the hypothesis of a neuroprotective role of BDNF.

Vesnarinone - induced WBC disorders in Japan

Vesnarinone is a new oral inotropic agent that augments myocardial contractility with little effect on heart rate or myocardial oxygen consumption. In Japan, vesnarinone was approved in June 1990 and first marketed in September 1990. Although the efficacy of vesnarinone has been confirmed, WBC disorders, which are principal adverse events associated with the use of vesnarinone, were found after marketing was begun in Japan. This survey was carried out to estimate the incidence of WBC disorders, the predominant periods in which these adverse events develop, and the effects of risk factors in the cohort of patients who have been administered vesnarinone since its market release in Japan. Data were available for 14,921 patients who took vesnarinone at least once during the period from 1 March 1991, through 28 February 1994. Vesnarinone-induced agranulocytosis, which is usually evidenced by a sharp decrease in granulocyte count, was seen in 0.25% of the patients. The cumulative incidence of agranulocytosis was 0.34% at 12 weeks. The predominant period of development was estimated to be the first 4 months after initiation of therapy, with the rate peaking in the second month. The risk of WBC disorders was higher among females.

An electrophysiological demonstration of axonal projections of single ventral inspiratory neurons to the phrenic nucleus of the cat

Axonal branching patterns of single inspiratory (I) neurons of the nucleus retroambigualis (NRA) were studied electrophysiologically in cat phrenic nucleus (C4-C6). Experiments were performed on Nembutal anesthetized, artificially ventilated cats, and extracellular spikes of I neurons were recorded. The cervical spinal gray matter was microstimulated from dorsal to ventral sites at 100 microns intervals with an intensity of 150-250 microA using a glass insulated tungsten microelectrode. The stimulations were made at 1 mm intervals rostrocaudally along the spinal cord, and effective stimulating sites of antidromic activation in axonal collaterals were systematically mapped. I neurons examined (n = 8) descending contralaterally distributed multiple collaterals in the phrenic nucleus. These collaterals were found throughout the rostrocaudal phrenic nucleus. An I neuron (n = 1) descending ipsilaterally also distributed collaterals in the ipsilateral phrenic nucleus. Axonal collaterals in the contralateral phrenic nucleus occupied 44.2% of the total length of the cervical spinal cord examined. To determine the detailed trajectory of collaterals in the cervical gray matter, microstimulation was performed in and around the collateral arborizations at the maximum intensity of 50 microA. The descending stem axons could be localized in the lateral funiculus in four I neurons and in the ventral funiculus in one I neuron. I neurons distributed axonal collaterals within the phrenic nucleus. Some part of the collaterals ran to the medial region of the gray matter, re-crossed the midline under the central canal and reached the phrenic nucleus ipsilateral to the I neuron. Re-crossed collaterals arborized in the phrenic nucleus, but did not extend to the gray matter more lateral than the phrenic nucleus. Rostrocaudal extension of the re-crossed collaterals was found to be narrow.

[A case of pentalogy of Cantrell with tetralogy of Fallot and left ventricular diverticulum]

We report a successful repair of tetralogy of Fallot and left ventricular diverticulum associated with pentaology of Cantrell. The repair consisted of partial infundibular septectomy, closure of ventricular septum, reconstruction of right ventricular outlet using monocuspid transjunctional patch, and resection of left ventricular diverticulum. The infundibulum was extremely elongated, caused by ventricular dextroversion, and the hypoplasia of pulmonary trunk was absent. Therefore, transjunctional patch was longer, even after infundibular septectomy. This report discuss the pathogenesis of these cardiac anomalies and surgical imlication.

[Rastelli operation for congenital heart disease complicated with peripheral pulmonary artery stenosis]

Peripheral pulmonary artery stenosis following the occlusion of ductus arteriosus is not rare in patients with pulmonary atresia. It is also seen after the creation of Blalock-Taussig shunt for various types of cyanotic congenital heart disease. Although pericardial patch enlargement for the pulmonary artery stenosis has been done at corrective surgery, the results were unsatisfactory because of restenosis. So, we proposed and performed a new method of pulmonary artery plasty using large rectangular heterogeneous pericardium, by which pulmonary artery could be widely enlarged from the pulmonary trunk to periphery of the stenosis. A 3-year-old female (case 1) was diagnosed with pulmonary atresia, ventricular septal defect, patent ductus arteriosus and coronary anomaly associated with left pulmonary artery stenosis. She previously received left Blalock-Taussig shunt. Another patient was a 4-year-old male (case 2) diagnosed with double-outlet right ventricle, pulmonary stenosis and patent ductus arteriosus. He also received right Blalock-Taussig shunt and had left pulmonary artery stenosis. Both patients received Rastelli operation with pulmonary artery plasty simultaneously. Rastelli operation was performed using composite graft consisted of valved heterogeneous pericardial roll and knitted Dacron graft. Post operative courses were uneventful and they were doing well one year after operation. We consider that the pulmonary artery plasty with rectangular heterogeneous pericardial patch is an effective surgical procedure to avoid restenosis compared with conventional pericardial patch enlargement or balloon pulmonary artery plasty.

Hypoxic injury of immature cardiac myocytes under various hypothermic conditions using an in vitro cell-culture model

The purpose of this study was to evaluate the functional and biochemical effects in immature cardiac myocytes under hypoxic and hypothermic conditions. Cardiac myocytes were isolated from neonatal rat ventricles and cultured for 4 days, after which 12.5 x 10(5) myocytes/flask were incubated under 3% hypoxic conditions at 4 degrees C, 10 degrees C, 15 degrees C, 20 degrees C, 25 degrees C, and 37 degrees C for 6, 12, and 24 h. After each hypoxic incubation, creatine kinase (CK) and lactate dehydrogenase (LDH) were measured in the incubation medium. The myocytes were then cultured for an additional 24 h at 37 degrees C to evaluate the recovery of the myocyte beating rate. In the 4 degrees C and 37 degrees C groups, the myocyte beating rate recovery markedly decreased with increasing incubation times from 78.1% and 97.2% at 6 h to 0.0% and 38.4% of the control, which was the beating rate prior to hypoxic incubation, at 24 h, respectively. However, in the 10 degrees C, 15 degrees C, and 25 degrees C groups, this value decreased significantly only at 24 h. In the 20 degrees C group, beating rate completely recovered in 24 h. A marked increase was found in the release of CK and LDH in the 4 degrees C group from 28.5 mIU/flask and 232.9 mIU/flask at 6 h to 83.7 mIU/flask and 640.7 mIU/flask at 24 h, respectively. However, in the 25 degrees C and 37 degrees C groups, this release was significantly increased only at 24 h.(ABSTRACT TRUNCATED AT 250 WORDS)

[Limited skin incision and partial median sternotomy for the repair of atrial septal defects in children]

Eight patients underwent the repair of atrial septal defect using the limited skin incision and partial median sternotomy. The average length of skin incision was 55% of the longitudinal size of the sternum. Our approach did not prolong the operation time and decreased the bloodloss. Moreover, postoperative events, such as hematoma, sternal instability, and wound infection, were not observed, and the cosmetic result was excellent. We think this method is safe and effective especially for children with atrial septal defect.

Clinical characteristics of Japanese patients with primary myelodysplastic syndromes: a co-operative study based on 838 cases. Anemia Study Group of the Ministry of Health and Welfare

The characteristics of Japanese (JPN) patients with myelodysplastic syndromes (MDS) were investigated in 838 retrospectively collected cases. The median age of the JPN patients was 60 years, about 10 years younger than that in most of the reports based on Western patients. Median survivals were 65 months for refractory anemia (RA), 58 months for RA with ring sideroblasts (RARS), 16 months for RA with an excess of blasts (RAEB), 10 months for RAEB in transformation (RAEBT), and 20 months for chronic myelomonocytic leukemia (CMML). Cumulative leukemia-free rates at final observation were 73% for RA, 79% for RARS, 24% for RAEB, 20% for RAEBT, and 53% for CMML. When low-risk (RA and RARS) patients were divided into two groups, those 40 years of age and older, and those under 40, the cumulative leukemia-free rate was 94% for the younger patients (n = 101), compared with 66% for the older patients (n = 318). The prognostic factors for survival were different from those in Western reports, i.e., variables representing quantitative abnormalities (hemoglobin levels, granulocyte, and platelet counts) were not major prognostic factors, while variables representing qualitative abnormalities (morphological abnormalities in granulocytic and megakaryocytic series cells) were highly significant. Two scoring systems for overall survival and for leukemic transformation were developed, based on multivariate prognostic factor analysis. Neither system included variables representing the degree of cytopenia. Whatever the reason for the different prognostic factors in JPN and Western MDS patients, the use of a scoring system based on Western patients for clinical decision-making in a JPN patient could be misleading, and vice versa.

Long-term hypothermic preservation of cardiac myocytes isolated from the neonatal rat ventricle: a comparison of various crystalloid solutions

In this study, the functional and biochemical effects of crystalloid solutions on immature cardiac myocytes incubated under hypothermic conditions were evaluated. Cardiac myocytes were isolated from neonatal rat ventricles and cultured for 4 days, following which 12.5 x 10(5) myocytes per flask were incubated at 4 degrees C for 3, 6, 12, and 18 h in five types of crystalloid solutions: lactated Ringer's (LR), St. Thomas' Hospital (ST), University of Wisconsin (UW), 5% glucose-based potassium (GK), and normal saline (NS). The levels of creatine phosphokinase (CPK) and lactate dehydrogenase (LDH) in the solutions were measured after each hypothermic incubation, following which the myocytes were cultured for an additional 24 h at 37 degrees C to evaluate the recovery of the myocyte beating rate. In the LR, UW, and NS groups, the recovery ratios of the myocyte beating rate were over 95% of the control (the beating rate prior to hypothermic incubation) at 3 h, but decreased to 20.3, 15.1, and 0%, respectively, at 18 h. The ST and GK groups had significantly lower recovery ratios than the other three groups (72.9% and 63.4%, respectively) at 3 h. The release of CPK and LDH in the LR, UW, and NS groups was significantly suppressed compared to the ST and GK groups, with the greatest suppression observed in the LR group. Moreover, the ST and GK groups had the highest CPK and LDH levels, respectively. Thus, LR solution had the least cytotoxic effects, indicating that it could be the most suitable basic solution of the various cardioplegic or preservation solutions during the neonatal period.

In vitro evaluation of nicorandil, diltiazem, and prostaglandin E1 on hypothermic injury to immature myocytes

The purpose of the present study was to evaluate the functional and biochemical effects of nicorandil (NRD), diltiazem (DTZ), or prostaglandin E1 (PGE) on cardiac myocytes incubated under hypothermic conditions. Cardiac myocytes were isolated from neonatal rat ventricles and cultured for 4 days with MCDB 107 medium. Myocytes (12.5 x 10(5) myocytes/flask) were then incubated at 4 degrees C for 24 hr in media containing various concentrations of NRD, DTZ, or PGE. After hypothermic incubation, creatine phosphokinase (CPK) and lactate dehydrogenase (LDH) were measured. The myocytes were then cultured for an additional 24 hr at 37 degrees C to evaluate the recovery of myocyte beating rate. In the nicorandil groups, 10(-4) M NRD showed significantly increased beating rate recovery compared to control (44.2% vs 24.6%, respectively, as a percentage of control, i.e., beating rate prior to hypothermic incubation). Treatment with 10(-6) M diltiazem showed no beneficial effects (10(-6) M: 25.2%; control: 29.8%); however, beating was not observed at 10(-4) or 10(-5) M. There were no significant changes among the PGE groups. The release of CPK and LDH was significantly suppressed with 10(-4) M NRD (10(-4) M: 24.1, 257.2 MIU/flask; control: 125.4, 459.5 mIU/flask, respectively). However, 10(-4) M DTZ showed significantly increased CPK and LDH levels compared to the control (10(-4) M: 203.3, 883.4 mIU/flask; control: 112.3, 457.4 mIU/flask, respectively). There were no significant differences for CPK and LDH levels among the PGE groups. In conclusion, nicorandil has protective characteristics for immature myocytes that may be suitable for cardiac preservation in the neonatal period.

[Effects of combined aprotinin and prostagrandin E1 therapy on aortic arch replacement]

This study was undertaken to compare the effects of combined aprotinin and prostaglandin E1 therapy on aortic arch replacement. Twenty patients were divided into 2 groups with (group A; n = 10) or without (group B; n = 10) the treatment (200 KIU of aprotinin and 0.01-0.02 microgram/kg/min of prostaglandin E1 during cardiopulmonary bypass (CPB) and the first postoperative day. Preoperative evaluation of respiratory function and all parameters related to CPB procedure were revealed to be equal between the groups. Postoperative A-a DO2 and respiratory index (RI) as functional parameters of oxygenation capacity, dosage of dopamine were monitored at 0, 3, 6, 12, 18 and 24 hr after termination of CPB and at extubation period. Serum creatinine, platelet numbers and blood coagulation function (PT, APTT) were also assayed postoperatively. The recovery of respiratory and cardiac function were superior in group A with treatment, but renal and blood coagulation function showed no difference in the groups. We suggest the combined therapy with aprotinin and prostaglandin E1 for aortic arch replacement may emerge as a valuable treatment to save postoperative respiratory and cardiac function.

In vitro evaluation of phosphate, bicarbonate, and Hepes buffered storage solutions on hypothermic injury to immature myocytes

In this study we evaluated cardiac myocyte viability and function under hypothermic conditions using three types of buffer solutions: phosphate buffer solution (PBS), Krebs-Henseleit bicarbonate buffer solution (KHB), and Hepes buffered minimum salt solution (MSS). As a control, normal saline solution (NSS) was used. Cardiac myocytes were isolated from neonatal rat ventricles. Myocytes (12.5 x 10(5) myocytes/culture flask) were then incubated at 4 degrees C for 6, 12, 18, and 24 hours in various buffer solutions. After each incubation time, CPK and LDH were measured. The myocytes were then incubated for an additional 24 hours at 37 degrees C to evaluate the recovery of the myocyte beating rate. Group MSS had a significantly better beating rate recovery than group NSS (control) after 18 hours (MSS, 32.7%, NSS, 0.0% of control; i.e., beating rate prior to hypothermic incubation). In contrast, group KHB showed a significantly lower recovery ratio than group NSS at 12 hours (41.0%, 78.8%, respectively), and the lowest recovery was observed in group PBS beginning at 6 hours of hypothermic incubation (27.6%). Group MSS significantly suppressed the release of CPK and LDH compared to group NSS at 24 hours (MSS, 246.7 and 440.2 mIU/flask; NSS, 369.7 and 821.3 mIU/flask, respectively). In contrast, groups PBS and KHB showed significantly increased CPK and LDH levels compared to group NSS after 12 hours (PBS, 388.6 and 721.4 mIU/flask; KHB, 340.5 and 540.5 mIU/flask; NSS, 91.5 and 222.7 mIU/flask, respectively). In conclusion, Hepes buffer has cytoprotective characteristics that may be suitable for long-term hypothermic preservation of immature myocardium compared to phosphate or bicarbonate buffer.

[Tetralogy of Fallot with absent pulmonary valve: a successful case by total corrective surgery in 25 days old infant]

A 25 days old neonate of tetralogy of Fallot with absent pulmonary valve underwent total corrective surgery which consisted of VSD patch closure, resection of anterior wall of both pulmonary arteries and right ventricular outflow tract reconstruction using a monocuspid equine pericardial patch. Postoperatively, the right pulmonary artery diameter decreased from 17.8 mm (307%N) to 7.5 mm (129%N) and the left pulmonary artery diameter from 16.9 mm (338%N) to 8.3 mm (166%N). The patient was weaned from the ventilator 2 days after operation, whose post-operative course was uneventful. Total corrective surgery may provide a great success to symptomatic patients during the neonatal period.

Possible deleterious effects of glucose on immature myocytes under hypothermic conditions

The purpose of the present study was to evaluate the functional and biochemical effects of glucose-based solutions in combination with potassium or insulin (or both) on immature myocytes under hypothermic conditions. Myocytes were isolated from neonatal rat ventricles and cultured for 4 days with MCDB 107 (University of Colorado solution). Initially, myocytes (12.5 x 10(5) myocytes/flask) were incubated at 4 degrees C for 6 hours in 5% glucose solution containing various potassium concentrations ranging from 0 to 80 mEq/L to evaluate the protective effects. Next, myocytes were incubated at 4 degrees C for 3, 6, 12, 18, and 24 hours in three types of solutions: normal saline solution (control), glucose-potassium solution, and glucose-insulin-potassium solution (glucose: 50 g/L; NaHCO3, 20 mEq; potassium, 20 mEq; insulin, 20 IU/L). After each incubation, creatine kinase and lactate dehydrogenase levels were measured in the incubation solutions. The myocytes then were cultured for an additional 24 hours at 37 degrees C to evaluate the recovery of myocyte beating rate. The 20-mEq potassium treatment showed significantly better beating rate recovery and lower enzymal release than the glucose-only control. The saline solution showed the best protection of all three solutions, both functionally and biochemically, by 12 hours. The greatest damage was observed with glucose-potassium solution, beginning at 3 hours of hypothermic incubation. Although potassium and insulin have additional protective effects on hypothermic preservation, the high concentration of glucose has noxious characteristics for immature myocytes that may not be suitable for cardiac preservation in the neonatal period.

Preischemic hyperglycemia leads to delayed postischemic hyperthermia

BACKGROUND AND PURPOSE

Temperature alterations are known to influence the outcome of transient ischemia, even when instituted in the postischemic period. Since preischemic hyperglycemia aggravates ischemic brain damage, the question of whether hyperglycemic animals become hyperthermic arose. To explore this possibility, we measured body temperature telemetrically in normoglycemic and hyperglycemic rats subjected to 10 minutes of forebrain ischemia at a body (and brain) temperature of 37 degrees C.

METHODS

Isoflurane-anesthetized animals were subjected to 10 minutes of forebrain ischemia under normoglycemic or hyperglycemic conditions. Temperature changes after ischemia were measured by means of a telemetric temperature coil.

RESULTS

In normoglycemic animals, temperature decreased to 35.6 +/- 1.1 degrees C (mean +/- SD) during the first 4 hours of recovery, after which it gradually increased to normal values (38 degrees C). Hyperglycemic animals behaved differently in that they remained normothermic for approximately 10 hours during recovery and later became hyperthermic, with core temperatures rising above 39 degrees C. The rise in temperature was not due to the osmotic load of the glucose administered because infusion of mannitol, which gave a comparable increase in plasma osmolality, failed to cause delayed postischemic hyperthermia. Excessive hypercapnia during ischemia in normoglycemic animals, which produces cerebral acidosis of a magnitude similar to that of hyperglycemia and is known to aggravate ischemic lesions, likewise failed to induce hyperthermia. When post-ischemic seizures ensued in hyperglycemic subjects, temperature was 39.8 +/- 0.6 degrees C. Animals with seizures invariably died. To evaluate the influence of postischemic hyperthermia on the outcome, an additional series of experiments was performed in which delayed hyperthermia was avoided by gentle cooling (n = 6) or by acetaminophen administration (n = 5). Although these procedures prevented delayed hyperthermia, they neither blocked seizure induction nor affected the fatal outcome. Postischemic seizures developed when the core temperatures of animals were 37.9 +/- 0.1 degrees C and 37.8 +/- 0.2 degrees C in the cooled and acetaminophen-treated groups, respectively.

CONCLUSIONS

The results suggest that both delayed hyperthermia and delayed seizures in hyperglycemic animals are caused by the aggravated damage incurred by these animals during or immediately after the ischemic insult.

Cytoprotective effects of nicorandil on hypothermic injury to immature cardiac myocytes--comparison with nitroglycerin, diltiazem and prostaglandin E1

The purpose of this study was to evaluate the functional and biochemical effects of nicorandil (NRD), nitroglycerin (NTG), diltiazem (DTZ) and prostaglandin E1 (PGE) on cardiac myocytes incubated under hypothermic conditions. Cardiac myocytes were isolated from neonatal rat ventricles and cultured for 4 days with MCDB 107 medium. Myocytes (12.5 x 10(5) myocytes/flask) were then incubated at 4 degrees C for 24 h in media containing various concentrations of NRD, NTG, DTZ or PGE. After hypothermic incubation, creatine kinase (CK) and lactate dehydrogenase (LDH) were measured. The myocytes were cultured for an additional 24 h at 37 degrees C to evaluate the recovery of myocyte beating rate. In the nicorandil groups, 10(-4) M NRD showed a significantly increased beating rate recovery compared to the control (44% vs 25% respectively, as a percentage of the baseline values; i.e., beating rate prior to hypothermic incubation). Although treatment with 10(-6) M diltiazem showed no beneficial effects (10(-6) M; 25%, control; 30%), beating was not observed at all with 10(-4) M or 10(-5) M DTZ. There were no significant changes among the NTG and PGE groups. The release of CK and LDH was significantly suppressed with 10(-4) M NRD (10(-4) M: 24.1 mIU/flask, 257.2; control: 125.4, 459.5, respectively). In contrast, 10(-4) M DTZ showed significantly increased CK and LDH levels compared to its respective control (10(-4) M: 203.3 mIU/flask, 883.4; control: 112.3, 457.4, respectively). There were no significant differences in CK and LDH levels among the NTG and PGE groups.(ABSTRACT TRUNCATED AT 250 WORDS)

[Cytoprotective effects of nicorandil on immature myocytes under hypothermic conditions]

We evaluated the functional and biochemical effects of nicorandil on cardiac myocytes incubated under hypothermic conditions. Cardiac myocytes were isolated from neonatal rat ventricles and cultured for 4 days. Myocytes (12.5 x 10(5) myocytes/flask) were then incubated at 4 degrees C for 24 hrs in media with nicorandil as follows: O M nicorandil (group C: control), 10(-5)M (group N 1), 5 x 10(-5)M (group N 2), 10(-4)M (group N 3). After hypothermic incubation, CPK and LDH were measured. The myocytes were then cultured for 24 hrs at 37 degrees C to evaluate the recovery of myocyte beating rate. For the beating rate, group N 3 showed a significantly increased recovery compared to the control (N 3: 44.2, p < 0.02, C: 24.6 percent of control; ie, beating rate prior to hypothermic incubation). The release of CPK and LDH was significantly suppressed in group N 3 compared to the control (N 3: 24.1, p < 0.005, 247.2, p < 0.01; C: 125.4 mIU/flask, 459.5 mIU/flask, respectively). Thus, nicorandil has cytoprotective effects on immature myocytes under hypothermic conditions.

An in vitro evaluation of prostaglandin E1 and I2 on hypothermic injury to immature myocytes

The purpose of this study was to evaluate the functional and biochemical effects of Prostaglandin E1 (PGE1) and prostaglandin I2 (PGI2) on cardiac myocytes incubated under hypothermic conditions. Cardiac myocytes were isolated from neonatal rat ventricles and cultured for 4 days with MCDB 107 medium. Following this, 12.5 x 10(5) myocytes/flask were incubated at 4 degrees C for 24 h in media with PGE1, at concentrations of 0 M (group E0), 10(-9) M (group E1), 10(-8) M (group E2), 10(-7) M (group E3), or 10(-6) M (group E4); or with PGI2 at concentrations of 0 M PGI (group I0), 10(-9) M (group I1), 10(-8) M (group 12), 10(-7) M (group I3), or 10(-6) M (group I4). After hypothermic incubation, creatine phosphokinase (CPK) and lactate dehydrogenase (LDH) were measured, and the myocytes were then cultured for 24 h at 37 degrees C to evaluate the recovery of the myocyte beating rate. Of the PGI2 groups, only group I2 recovered significantly more than the control group (group I0), at 47.9 +/- 28.5% (mean +/- SD) of the control, being the beating rate prior to hypothermic incubation, whereas it was 18.1 +/- 9.7% in group I0 (P < 0.025); however, there were no significant differences among the PGE1 groups. Moreover, the release of CPK and LDH was significantly suppressed in group 12 compared to the control, being 57.7 +/- 27.6 mIU/flask (P < 0.05) and 275.1 +/- 83.0 mIU/flask (P < 0.025), respectively, in group I2, and 96.8 +/- 38.3 mIU/flask and 439.6 +/- 147.1 mIU/flask in group I0. Again, no significant differences were observed among the PGE1 groups. In conclusion, PGI2 was found to have a direct cytoprotective effect on immature myocytes which suggests that PGI2 may promote cardiac preservation in the neonatal period.

Infection in myelodysplastic syndromes before evolution into acute non-lymphoblastic leukemia

The frequencies, kinds, pathogens, and risk factors of infections in the myelodysplastic syndromes (MDS) were analysed in 430 cases. The overall tendency was for one infectious episode per 1023.5 patient days. The frequency of infectious episodes was highest just after diagnosis of MDS when more than 4 episodes per 1000 patient days occurred. Thereafter, the rate declined rapidly to about 0.3 episodes per 1000 patient days within 4 years. The most frequent infection was that of the respiratory tract followed by sepsis and fever of unknown origin (FUO). Among the types of infection resulting in death, sepsis and FUO comprised the highest proportion (40%) followed by respiratory tract infections (39%). The most frequent pathogen observed was Staphylococcus bacteria. The significant multivariate risk factors for fatal infections were subtype, hemoglobin, dependence on red blood cell transfusion, age, and sex. A staging system was created using these five simple variables at diagnosis.

Axon branching of medullary expiratory neurons in the lumbar and the sacral spinal cord of the cat

Intraspinal axon collaterals of expiratory (E) neurons in the caudal nucleus retroambigualis extending their desending spinal axons to the lower lumbar (L6-L7) and the sacral (S1-S3) segments were investigated in anesthetized cats. To search for axon collaterals of single E neurons in the lumbar segments, the spinal gray matter was microstimulated from the dorsal to the ventral sites at 100 microns intervals with an intensity of 150-250 microA at 1 mm intervals rostrocaudally along the spinal cord, and effective stimulating sites of antidromic activation in axon collaterals were systematically mapped. In addition, the detailed trajectory of collaterals in the upper lumbar (L1-L3), the middle lumbar (L4-L5), and the sacral (S1-S3) spinal cord was examined by microstimulation at a matrix of points 100-200 microns apart with a maximum stimulus intensity of 50 microA. The trajectory of axon collaterals was reconstructed on the basis of the location of low-threshold foci and the latency of antidromic spikes. Virtually all E neurons examined had 1-7 collaterals at widely separated segments of the lumbar cord. Many axon collaterals were found in the upper lumbar spinal cord as compared to the middle and the lower lumbar spinal cord. The locations of axon collaterals in the upper lumbar spinal cord overlapped with those of abdominal motoneurons. Axon collaterals in the sacral gray matter were found in 3 of 9 E neurons. Axon collaterals were found within the nucleus of Onuf, in the region dorsal to the nucleus of Onuf, and in the intermediate region. The functional significance of the divergent distribution of multiple axon collaterals of single E neurons in different spinal levels of the lumbar and the sacral spinal cord is discussed in relation to the respiratory function of E neurons and other spinal motor activities.

[Clinical efficacy of arbekacin on MRSA infections with hematopoietic disorders. The Hanshin Study Group of Hematopoietic Disorders and Infections]

Arbekacin (ABK) was administered to 17 patients with MRSA infections that complicated underlying hematopoietic disorders, and the efficacy and safety were evaluated. The underlying diseases included acute myelocytic leukemia (8 cases), acute lymphocytic leukemia (1) myelodysplastic syndrome (3), chronic myelocytic leukemia (1), non-Hodgkin's lymphoma (2), Hodgkin's disease (1) and adult T cell leukemia (1). The infections consisted of septicemia (5 cases), pneumonia (4), upper respiratory tract infections (6) and urinary tract infections (2). ABK was administered by i.v. drip infusion in daily doses of 150-200 mg, given in two divided dosages. The therapeutic efficacies were: excellent in 2 (2 septicemias), good in 7 (1 septicemia, 4 upper respiratory infections, 2 urinary tract infections), fair in 2 (septicemia and pneumonia) and poor in 6 (1 septicemia, 3 pneumonias, 2 upper respiratory infections). As a side effect, reversible renal dysfunction was detected in four cases. Causative bacteria were isolated from six cases. They were all coagulase type II and MIC's of ABK were from 0.25 microgram/ml to 4.0 micrograms/ml. Arbekacin therapy was found to be effective even in patients with hematopoietic disorders accompanied by MRSA infections.

[Palliative surgery of congenital heart disease in early infancy]

A total of 38 patients aged under 3 months with congenital heart disease (CHD) underwent palliative surgery between April, 1988 and March, 1993. The mean age at operation was 28.0 (range 1 to 87) days. Palliative procedures were: pulmonary artery banding (PAB) in 14 patients (IAA complex: 4, CoA complex: 6, AVSD: 2, TA: 2), Blalock-Taussig shunt (BTS) in 12 (TOF: 2, TGA: 1, AVSD: 1, PA-IVS: 3, PA-VSD: 3, PA-SV: 1, PA-AVSD: 1), Brock operation in 6 (PPS: 2, PA-IVS: 3, PA-SV: 1), Blalock-Hanlon operation (BH) with PAB in 2 (MA-SV: 2) and Norwood operation (NRD) in 4 (HLHS: 4). PAB of IAA or CoA complex was performed just after the repair of IAA or CoA. Overall operative mortality was 23% (PAB: 14.3, BTS: 8.3, Brock: 33.3, NRD: 100%). One week after PAB, pulmonary artery pressure (PAP) decreased significantly compared to the intraoperative PAP value after PAB (43.1 +/- 16.2, 32.3 +/- 9.0 mmHg, p < 0.05, respectively). Pulmonary artery index (PAI), which is an index of pulmonary artery growth, after BTS increased significantly compared to the preoperative value (mean follow-up interval: 22.1 months) (379.5 +/- 101.4, 159.3 +/- 51.2, p < 0.001, respectively). During Brock operation, balloon catheter was used in order to dilate pulmonary valve. One year after Brock operation, mean pressure gradient through the pulmonary valve 22.6 mmHg. Two-staged corrections of CHD will be performed both safely and successfully by effective palliations at the first stages in early infancy.