Remarkable elevation of interleukin 6 and interleukin 8 levels in the bone marrow serum of patients with rheumatoid arthritis

OBJECTIVE

Characteristic cellular changes have previously been reported in the bone marrow of patients with rheumatoid arthritis (RA). We investigated the levels of various cytokines in RA bone marrow.

METHODS

We studied 25 patients with RA (22 women and 3 men) and 10 trauma patients (7 women and 3 men) as non-RA controls. Twelve kinds of cytokines [interleukin (IL)-1 alpha, IL-1 beta, IL-2, IL-3, IL-4, IL-6, IL-7, IL-8, granulocyte colony stimulating factor, granulocyte/macrophage colony stimulating factor, tumor necrosis factor (TNF)-alpha, and TNF-beta] were assayed by ELISA in iliac bone marrow serum (BMS), tibial BMS, and peripheral blood serum.

RESULTS

Markedly elevated levels of IL-6 and IL-8 were detected in iliac BMS, and much lower levels were found in tibial bone marrow and peripheral blood serum. The levels of IL-6 and IL-8 in iliac BMS showed a close relationship to the extent of synovial proliferation.

CONCLUSION

Iliac bone marrow may be an important site for the production or accumulation of IL-6 and IL-8 in RA, and these cytokines may influence synovial proliferation in patients with polyarthritis.

[Effect of nasal-CPAP and hypercapnia on human abdominal muscles]

The effect of nasal continuous positive airway pressure (nasal-CPAP) and hypercapnia on abdominal muscles was investigated in 10 healthy volunteers in the supine position. Pairs of fine wire electrodes were inserted into the rectus abdominis, external oblique, internal oblique and transversus abdominis under direct vision provided by high resolution ultrasound echography. Ultrasound provided clear visualization of the individual muscle layers and the guide needle for electrode insertion. Monitoring end tidal CO2 (ETCO2), 1) nasal-CPAP of 15 cmH2O was applied, 2) CO2 was then added to the inspiratory limb of the nasal-CPAP system, and 3) CO2 rebreathing was also performed without nasal-CPAP. Electromyograms (EMG) were sampled and integrated. Peak values of integrated EMG were measured under the following three conditions, normocapnia, 7% ETCO2, and 9% ETCO2, with and without nasal-CPAP. In each abdominal muscle, the percentage of patients with expiratory EMG activity increased with increasing ETCO2, regardless of nasal-CPAP. Among the four muscles, the transversus abdominis was recruited most frequently, the rectus abdominis least frequently. The EMG from each muscle was activated by nasal-CPAP of 15 cmH2O under each of the three conditions. We conclude that in humans 1) nasal-CPAP and hypercapnia synergistically activate abdominal muscles, 2) the transversus abdominis is the primary expiratory muscle, and 3) the rectus abdominis is an accessory expiratory muscle.

Ependymomas in children: histologic and DNA-flow cytometric study

Ependymoma, a common neoplasm in the central nervous system of children, expresses great variability of morphological appearances. Correlation with clinical behavior has been controversial in previous studies. In order to explore the potential value of DNA-flow cytometric analysis in predicting the clinical course of ependymomas in children, we studied 22 patients with this tumor, selected from two large pediatric institutions. In addition, a number of histologic features were reviewed, such as necrosis, mitoses, endothelial proliferation, cellularity, and pleomorphism. DNA analyses of paraffin-embedded tissue from these tumors showed 9 of 17 (53%) with DNA indexes less than 1.16 and 8 of 17 (47%) with DNA indexes above 1.16. Ten of 17 (59%) patients died, 2 (12%) were lost for follow-up, and 5 (29%) are alive. No statistical correlation was found between DNA index, outcome, and histology. In spite of the small sample size, our findings appear to support the general impression that ependymomas are morphologically highly variable tumors of potential aggressiveness without valuable prognostic histologic markers.

Synergistic action of cholera toxin B subunit (and Escherichia coli heat-labile toxin B subunit) and a trace amount of cholera whole toxin as an adjuvant for nasal influenza vaccine

Cholera toxin B subunit (CTB) and Escherichia coli heat-labile toxin (LTB) (2 micrograms), each supplemented with a trace amount of cholera toxin (CT) (0.02-20 ng), were examined for the adjuvant effect on antibody (Ab) response against influenza inactivated HA (haemagglutinin) vaccine in Balb/c mice. Each mouse received a primary intranasal (i.n.) inoculation of the vaccine (1.5 micrograms) and the CT-containing CTB and in 4 weeks a second i.n. inoculation of the vaccine alone. The primary inoculation of the vaccine with CTB alone did not induce either anti-HA IgA or IgG Ab response, or haemagglutination-inhibition Ab responses in the serum. The vaccine with less than 2 ng of CT also failed to induce Ab response. On the other hand, the vaccine with CT-containing CTB induced a high Ab response, which increased depending on the CT dose. Moreover, the second vaccine induced a response more than ten times higher than the primary one and the response increased depending on the CT dose. Similar enhancement was found in the local anti-HA IgA Ab response in the nasal wash. Such synergistic effects were observed also between LTB and CT. The amount of Ab produced by the synergism was considered to be enough to protect against virus infection. These results suggest that CTB (or LTB) containing a trace amount of CT (about 0.1%) can be used practically as a potent adjuvant for nasal vaccination of humans against influenza.

[A case of aspirin-induced asthma which developed due to rubbing a lotion containing a non-steroidal anti-inflammatory drug, ketoprofen, on the skin]

A forty-year-old woman was admitted to our hospital because of a severe attack of bronchial asthma. The asthmatic attack developed 3 hours after her rubbing a large amount of a lotion containing a non-steroidal anti-inflammatory drug (NSAID), ketoprofen, over her skin. The patient had a past history of asthmatic attack induced by another NSAID (Sedes-G) given per os. The previous asthmatic attack developed about 3 hours after her rubbing the lotion containing the NSAID over her skin. The relatively long interval between the per cutaneous NSAID administration and the onset of the asthmatic attack indicates that the time delay is dependent on the absorption route of the administered NSAID. The severity of the attack is considered to be related to the amount of NSAID absorbed.

MR of pediatric intracranial meningiomas

PURPOSE

To assess MR and pathologic characteristics of childhood intracranial meningiomas, comparing the radiographic findings with those observed in adult intracranial meningiomas.

METHODS

Clinical records, MR and CT scans, and histology of eight children with intracranial meningiomas presenting for a period of 7.5 years were retrospectively reviewed.

RESULTS

Boys equaled girls but predominated from ages 4 to 11 years. The ages ranged from 4 to 18 years. Two patients had radiation-induced meningiomas. Two children had multiple lesions; neither had neurofibromatosis. All solitary lesions were supratentorial. Other characteristics included: dural-based attachment (n = 6); large size (> 5 cm) (n = 4); cystic components (n = 3); and intraventricular location (n = 1). Histologic subtypes were: meningothelial (n = 4); transitional (n = 3); and fibroblastic (n = 1). Preoperative diagnoses of meningiomas were made in six cases based on overall imaging characteristics.

CONCLUSIONS

Diagnosis of childhood intracranial meningiomas does not differ from that of adults radiographically, with the exception of larger tumor sizes.

Focal segmental glomerular sclerosis, a type of intractable chronic glomerulonephritis, is a stem cell disorder

The etiopathogenesis of focal and segmental glomerular sclerosis (FGS) remains unknown. Using a new animal model for FGS (FGS mouse), we demonstrate here that bone marrow transplantation from normal mice to FGS mice with a high grade of proteinuria (+ + +) ameliorates FGS, and that the transplantation of bone marrow cells or purified hemopoietic stem cells (HSCs) from FGS mice induces FGS in normal mice. These findings strongly suggest that FGS is a stem cell disorder; the abnormalities may be genetically programmed at the level of HSCs.

Breeding of the gad-mdx mouse: influence of genetically induced denervation on dystrophic muscle fibers

A new double mutant mouse strain, gad-mdx, was established. The transmission of mdx and gad genes was monitored by determining their chemical markers, creative kinase activity and phosphoglucomutase-1 isoenzyme, respectively, in blood samples. This new strain was characterized by high creatine kinase activity in the plasma, lack of dystrophin in the muscle, and the presence of axonal swellings in the neural tissue. Although the body weight and the limb muscle size of the mutant mice were significantly lower than those of either gad or mdx mice, the clinical signs were not evident until the animals were 80 days old. After that time, the disease followed the course seen in the gad strain, and muscle weakness was exhibited in the advanced stages. Histologic examination revealed that the prevalence of muscle fiber necrosis, a deleterious consequence of the mdx gene, was significantly lower in the double mutant strain than in the mdx strain. These results supported the idea that small-caliber muscle fibers, which are induced by gad gene expression, are resistant to dystrophic necrosis. We believe that this double mutant strain will be valuable for the analysis of neural influence on diseased muscle fibers, and that it will also provide an opportunity for the testing of new therapeutic strategies for human Duchenne muscular dystrophy.

Chronic dynamic exercise improves a functional abnormality of the G stimulatory protein in cardiomyopathic BIO 53.58 Syrian hamsters

BACKGROUND

The effects of chronic exercise training on myocardial contractility and beta-adrenergic signal transduction in hearts with left ventricular dysfunction have not been determined.

METHODS AND RESULTS

Fourteen-week-old cardiomyopathic BIO 53.58 and normal F1B Syrian hamsters underwent 10 weeks of treadmill training and were compared with 24-week-old BIO 53.58 and F1B untrained controls. Left ventricular isovolumic maximum positive dP/dt and peak developed pressure were significantly lower in BIO 53.58 than in F1B controls. Exercise training improved left ventricular contractile indices in BIO 53.58 but not F1B hamsters. The left ventricular beta-adrenergic receptor number (Bmax) was similar in BIO 53.58 and F1B controls. Basal adenylate cyclase activity (ACA) and ACAs stimulated by isoproterenol, 5'-guanylylimidodiphosphate (GppNHp), sodium fluoride, and forskolin were significantly lower in BIO 53.58 than in F1B controls. The functional activity of stimulatory guanine nucleotide-binding protein (Gs), as determined by reconstitution with S49 lymphoma cyc- cell membranes, was significantly lower in BIO 53.58 controls. After 10 weeks of exercise training, Bmax and basal and isoproterenol-stimulated ACAs were unchanged in either BIO 53.58 or F1B hamsters compared with controls. However, in F1B hamsters, training decreased ACAs stimulated by GppNHp, sodium fluoride, and forskolin, with a reduced functional activity of Gs. In contrast, these ACAs increased significantly in association with an enhanced Gs activity in cardiomyopathic BIO 53.58 hamsters after training.

CONCLUSIONS

Chronic exercise training does not change receptor-mediated beta-adrenergic responsiveness in either F1B or BIO 53.58 hamsters. However, exercise training reduces Gs activity in normal F1B hamsters and improves the functional abnormality of Gs in cardiomyopathic BIO 53.58 hamsters. This improvement may potentially contribute to augmented left ventricular contractility in BIO 53.58 after training.

[A clinical study of fulminant Legionnaires' disease]

Seven cases of fulminant Legionnaires' disease treated at Kitasato University Hospital between 1985 and 1992 were reviewed. These patients were male with a mean age of 55.9 years (range, 37-67 yrs), and five were heavy alcohol drinkers. All seven patients required mechanical ventilation. Four patients recovered (group 1) and three expired due to respiratory failure (group 2). The mean interval from initial symptoms to the development of respiratory failure was 8.8 days in group 1 and 6.0 days in group 2, except in the one patient with lung cancer (case 6). The progression of pneumonia was more rapid in group 2. The mean intervals from admission to administration of erythromycin were 1.5 days and 3.5 days, respectively, in groups 1 and 2. In group 1, pulmonary infiltrates and respiratory insufficiency worsened for the first few days after erythromycin administration but improved thereafter. The average duration of ventilatory care in group 1 was 13.3 days. The administration of rifampicin combined with erythromycin may be useful for the treatment of fulminant Legionnaires' disease. When fulminant pneumonia is encountered in a middle-aged or elderly male alcoholic, Legionnaires' disease should be suspected and erythromycin administration with rifampicin should be initiated as early as possible.

Renal lesions of the FGS strain of mice: a spontaneous animal model of progressive glomerulosclerosis

The strain of FGS/Nga mouse is reported to develop proteinuria and progressive glomerulosclerosis. We studied the renal pathology of that strain periodically for 1 year. Focal and segmental glomerulosclerosis was observed 3 months after birth and the lesion progressed to the glomerular obsolescence in a year. Electron microscopic study revealed electron dense deposits (DD) in the mesangium and the splitting of glomerular basement membrane. Studies using immunofluorescence and immunoelectron microscopy revealed that these DD were contained IgA, IgM, C3 and the retroviral envelope antigen (gp70). Clinically, proteinuria began at the age of 3 months and the renal function was decreased on time course. No other organs were involved. We studied the renal lesions of FGS mice by the histological and immunohistochemical methods and concluded that this mouse strain provides the tool for studying the mechanisms of the progression of glomerulosclerosis.

Inhibitory effects of propiverine on rat and guinea-pig urinary bladder muscle

In muscle strips isolated from guinea-pig and rat urinary bladder, propiverine (3-10 microM) inhibited carbachol-induced contractions in the presence of verapamil and Ca(2+)-induced contractions in excess K+ medium containing atropine, suggesting it has both anticholinergic and Ca2+ channel blocking actions. The Ca2+ channel blocking action was also demonstrated by recording inward Ca2+ currents in single cells dispersed from both species. The inhibition of inward currents by propiverine was three times stronger in the rat than the guinea-pig, ID50 being 7 microM for rat and 21 microM for guinea-pig. The recovery of the current after washout was faster than that of mechanical inhibition. It is concluded that propiverine blocks not only muscarinic receptors, but also Ca2+ channels at similar concentrations.

Ischemic preconditioning is associated with a delay in ischemia-induced reduction of beta-adrenergic signal transduction in rabbit hearts

BACKGROUND

It has been reported that the A1-adenosine receptor mediates the cardioprotective effect of ischemic preconditioning. This receptor couples inhibitory guanine nucleotide-binding protein (Gi) and inhibits adenylate cyclase activity. However, the role of adenylate cyclase in preconditioning is unknown.

METHODS AND RESULTS

We compared the effects of ischemia on the sarcolemmal beta-adrenergic receptor density (Bmax), the stimulatory guanine nucleotide-binding protein (Gs) activity as determined by reconstitution with S49 lymphoma cyc- membranes, and baseline and maximally stimulated adenylate cyclase activities (ACAs) in control and preconditioned rabbit hearts. The control population (n = 28) received 0, 10, 20, and 60 minutes of coronary occlusion (n = 6 to 8 per stage), and preconditioned rabbits (n = 24) received two cycles of alternating 5-minute occlusion and reperfusion before sustained ischemia (n = 6 per stage). In control hearts, occlusion induced rapid and progressive reductions in the Bmax, Gs, and ACAs after 10 to 60 minutes of ischemia. Preconditioning did not affect the reduction in Bmax, but it preserved reductions in Gs activity and ACAs after 10 to 20 but not 60 minutes of sustained ischemia. In another study, 18 rabbits were treated with pertussis toxin 48 hours before surgery to block Gi. During treatment, no significant difference was observed in the ischemia-induced reduction in ACAs in the ischemic region between control (n = 8) and preconditioned (n = 10) animals after 20 minutes of ischemia.

CONCLUSIONS

Preconditioning delays ischemia-induced reductions in beta-adrenergic signal transduction. Inhibition of ACA is not the target effect of the A1-adenosine receptor-Gi pathway responsible for the cardioprotective role of preconditioning.

Therapeutic effect of intradermal injections with difucosyl lactosamine (dimeric Lex) on patients with rheumatoid arthritis

As reported by us, a new myeloid cell population with an oncofetal membrane marker, dimeric Lex (di-Lex; III3FucV3 FucnLc6), was found in the epiphyseal bone marrow adjacent to the involved joints of patients with severe rheumatoid arthritis (RA). Patients with RA received intradermal (id) injections of di-Lex incorporated in liposome or of high molecular weight glycoprotein, or tumor associated carbohydrate antigen (TCA), containing the same carbohydrate epitope as di-Lex. The epiphyseal myeloid cells were reduced or sometimes eliminated during id injection. In random trials of id injection, observation under clinical and laboratory conditions showed improvement in 63% (17/27) of the patients treated for 6 months with appropriate doses of di-Lex (III3FucnLc4), and in 72% (31/43) of those treated with an identical protocol for TCA. However, id injection with monomeric Lex had no effect.

[A case of sho-saiko-to-induced pneumonitis, diagnosed by lymphocyte stimulation test using bronchoalveolar lavage fluid]

A 66-year-old Japanese man was admitted to our hospital with fever, cough and dyspnea. He had been taking Sho-Saiko-to, a traditional Chinese medicine, for twenty days. On admission, chest X-ray examination revealed a reticular pattern in the bilateral lungs, and respiratory failure was evident. Serum levels of CRP and LDH were elevated. A differential cell count of the bronchoalveolar lavage fluid (BALF) showed that lymphocytes and eosinophils were increased. Alveolitis with lymphocyte and plasma cell infiltration was observed in a pathological specimen obtained by transbronchial lung biopsy. After all drugs had been discontinued, PaO2, serum CRP and serum LDH improved, and the reticular pattern in the bilateral lungs gradually resolved without administration of corticosteroids or antibiotics. A lymphocyte stimulation test for Sho-Saiko-to using BALF gave a positive result, although LST using blood gave a doubtful reaction. The diagnosis of Sho-Saiko-to-induced pneumonitis was made from the clinical course, laboratory findings, BALF cell analysis, pathological findings and LST using BALF. Only 13 cases of pneumonitis due to administration of traditional Chinese medical drugs have been reported. This case suggests that LST using BALF is useful for the diagnosis of drug-induced pneumonitis.

Effects of cromakalim on the electrical slow wave in the circular muscle of guinea-pig gastric antrum

1. In circular muscle strips of the antrum of guinea-pig stomach, the effects of cromakalim were studied on mechanical activity and intracellular membrane potential. 2. Cromakalim inhibited mechanical activity at concentrations higher than 1 microM, accompanied by membrane hyperpolarization and a decrease in membrane resistance. The hyperpolarization was markedly potentiated in K(+)-free solution and was still observed in the absence of Na+. 3. Slow wave electrical activity was relatively resistant to cromakalim. Changes in its amplitude and frequency were not consistent but blockade of slow waves was never observed. In many preparations cromakalim induced spike-like potentials at the top of slow waves, or when spike-like potentials already existed they were potentiated. However, mechanical activity was always inhibited. 4. Inhibition by cromakalim of the phasic contractions associated with the slow waves, could not be reversed by increasing the external K+ concentration (12-30 mM). 5. The results suggest that in guinea-pig stomach muscle mechanical suppression by cromakalim does not simply result from membrane hyperpolarization or from inhibition of slow waves. A clear dissociation was found between the mechanical and electrical activities. Slow waves, particularly their frequency, are relatively insensitive to membrane hyperpolarization.

The clinical and radiological evaluation of primary brain neoplasms in children, Part II: Radiological evaluation

Data collected over the past 8 years on the radiological appearance of common pediatric primary brain neoplasms are presented. An emphasis is placed on the newer radiological imaging modality of magnetic resonance imaging (MRI). Part I of this article emphasized the clinical evaluation of these brain neoplasms. Three hundred eighty-five children with known brain neoplasms ranging in age from newborn to 18 years were evaluated with one or all of the following radiological modalities: MRI, computed tomography (CT), water-soluble myelography (WSM), WSM with CT, and angiography. Contrast-enhanced MRI and CT scans both were accurate in delineating these brain neoplasms although MRI provided better resolution and delineation than CT. Angiography provided information on the vascularity of the neoplasms and their relationship to prominent arterial and venous structures. Water-soluble myelography with CT and gadolinium-enhanced MRI of the spine were equally accurate in demonstrating metastatic spread to the spinal canal and spinal cord. Magnetic resonance imaging with gadolinium was more accurate than CT with contrast in demonstrating recurrent or residual neoplasm at the operative site and metastatic spread to the brain. Magnetic resonance imaging with gadolinium is the best radiological modality to fully evaluate pediatric brain neoplasms.

[Aniline-induced methemoglobinemia monitored by pulse oximetry]

A case of aniline-induced methemoglobinemia is reported. When the pulse oximeter reading (SpO2) was 80%, the oxygen saturation measured by a co-oximeter (SaO2) was 61.2%, the oxygen saturation calculated from PaO2 values was 98.9% and methemoglobin level was 38.8%. After methylene blue injection, methemoglobin level decreased gradually. With a decrease of methemoglobin level, SpO2 approached SaO2. If disparity between SpO2 and the oxygen saturation calculated from PaO2 values is noted, the presence of methemoglobinemia must be suspected. In clinical situations, the pulse oximeter permits the continuous noninvasive monitoring of oxygen saturation. It is necessary, however, to consider the potential errors in pulse oximetry.

The clinical and radiological evaluation of primary brain tumors in children, Part I: Clinical evaluation

In Part I of this article, we present our data collected over the past 8 years on the clinical evaluations of pediatric brain tumors with an emphasis placed on the more common neoplasms. Our data consists of 385 children ranging in age from newborn to 18 years. The majority of children presented with signs of raised intracranial pressure (including nausea, vomiting, and headaches), seizures or other focal neurologic deficits. Five percent of our children presented to outlying hospitals with symptoms that retrospectively turned out to be due to brain neoplasms but were misdiagnosed as "gastroenteritis," "viral upper respiratory tract infection," or even viral meningitis. These delays in diagnosis can cause serious negative outcomes for these patients and can be avoided through more careful neurologic and ophthalmologic examination at the time of first presentation. Central nervous system neoplasms are not uncommon in children and any child presenting with nausea, vomiting, and headaches should raise the suspicion of a primary brain tumor and should receive both a thorough neurologic exam and screening for papilledema. If papilledema is present, these children should be referred for proper neuroradiologic evaluation (which will be addressed in Part II.

Profile of prostatic-specific antigen in prostatic carcinomas

Prostatic carcinomas (PCs) may be divided into two distinct categories: latent PCs, found mostly at autopsy, and clinical cases, which present with signs and symptoms. These two categories correspond fairly well to histologic grading of PCs and immunoperoxidase staining for prostatic specific antigen (PSA). The objective of this study was to find quantitative and qualitative differences if any, of PSA in PCs, corresponding to Gleason's histologic grade. By radiometric assay of PSA in tissue cytosol, PCs especially those of high histologic grade, were found to have lower PSA concentrations than normal and glandular hyperplastic prostatic tissue. Western blotting of cytosol was performed to detect differences between immunoreactive PSA of PCs compared with noncancerous tissue using both polyclonal and monoclonal antibodies against PSA. Western blotting with anti-PSA revealed some different bands between cancerous and noncancerous cytosols. Western blotting of cancerous and noncancerous cytosols was also performed using anti-prostatic acid phosphatase and anti-beta micro-seminoprotein. Reduced PSA concentration and different immunoblotting pattern of PSA were found to be characteristic for PCs, especially in carcinomas with grades higher than 7, which usually present with more aggressive invasion and metastases.

Effects of magnesium on isolated canine coronary arterial tension

The effects of magnesium on the tension of isolated canine coronary arterial strips were studied. In the solution containing K+ of 20 mEq.l(-1), Ca2+ of 4 mEq.l(-1), and Na+ of 127 mEq.l(-1), the tension was 811 +/- 111 mg with Mg2+ of 1 mEq.l(-1), 494 +/- 135 mg with Mg2+ of 10 mEq.l(-1), 272 +/- 126 mg with Mg2+ of 20 mEq.l(-1), -52 +/- 63 mg with Mg2+ of 30 mEq.l(-1), -69 +/- 80 mg with Mg2+ of 40 mEq.l(-1). In the solution containing K+ of 20 mEq.l(-1), Na+ of 12 mEq.l(-1) and Ca2+ of 0 mEq.l(-1), the tension was 102 +/- 22 mg with Mg2+ of 1 mEq.l(-1), 3 +/- 35 mg with Mg2+ of 10 mEq.l(-1), -49 +/- 33 mg with Mg2+ of 20 mEq.l(-1), -59 +/- 49 mg with Mg2+ of 30 mEq.l(-1), -65 +/- 54 mg with Mg2+ of 40 mEq.l(-1). The data demonstrated that Mg2+ above 30 mEq.l(-1) inhibited the increase in tension caused by Ca2+ and Mg2+ above 20 mEq.l(-1) inhibited the increase in tension caused by low Na+ concentration.