[An AHP analysis on factors associated with the career choice of medical students of UOEH]

In order to clarify factors associated with the career choice of medical students of UOEH, an AHP (Analytic Hierarchy Process) analysis was employed for 4th year medical students in 1994 (86 students). As factors associated with career choice, the following three factors were evaluated as important in the following order; 'work worth engaging in', 'income', and 'identity as a medical doctor'. For these three major factors, the surgeon was evaluated as the most favorable, followed by the physician, the clinician of other sectors (ORL, ophthalmology, etc), the occupational physician, researcher, and medical doctors in the administration. When comparing students who wanted to be clinicians and those who wanted to be occupational physicians, the latter group attached more importance to 'stability' and 'scholarship'. Finally, the present AHP analyses clarified that students prefer to become clinicians regardless of their expressed preference for a future career. This fact has created for us an educational problem to be discussed in future curriculum meetings of UOEH.

Cytokine mRNA expression profiles in rats infected with the intestinal nematode Nippostrongylus brasiliensis

Although the immune responses to intestinal nematode infection have been well studied and have been shown to be strongly driven by Th2-associated cytokines in mice, such information has been limited with respect to rats. We investigated changes in levels of the mRNAs encoding interleukin-2 (IL-2), IL-3, IL-4, IL-5, IL-10, and gamma interferon in the mesenteric lymph nodes of rats infected with Nippostrongylus brasiliensis by reverse transcription-PCR in comparison with immunoglobulin E (IgE)/IgG2a antibody, eosinophil, basophil, and mucosal mast cell responses. In the two rat strains used, Brown Norway and Fischer-344, which show different responses to allergens, serum IgE increased to much higher levels in the former than in the latter 2 weeks after infection. Intestinal mastocytosis was observed much earlier and more intensely in Brown Norway rats than in Fischer-344 rats, but the degrees of peripheral eosinophilia and basophilia did not differ between the two strains. In both strains, IL-3, IL-4, and IL-5 mRNA expression increased and peaked around 7 to 14 days after infection, while expression of IL-2, IL-10, and gamma interferon mRNAs did not change notably throughout the experimental period. The highest IL-4 mRNA expression was observed slightly earlier in Brown Norway than in Fischer-344 rats, but levels of IL-3 and IL-5 mRNAs peaked synchronously in both strains. The amounts of mRNAs encoding these three cytokines were always higher in Brown Norway than in Fischer-344 rats. It is suggested that in rats, Th2 or Th2-like cells are also induced after nematode infection, and IgE elevation is mainly related to increased IL-4 gene expression.

[Nineteen multiple primary cancer cases of 100 patients undergoing lung cancer resection]

In our department, half of 100 consecutive lung cancer resection cases were over the age of 70 years. In the same 100 patients, nineteen cases had multiple primary cancers. Sixteen cases had double, two cases had triple, one case had quadruple primary cancers. The incidence rate of multiple primary cancers involving the lung was 19%. This incidence of 19% is higher than the others ever reported in Japan. It was concluded, when lung cancer patients were elder, that there was increasment in the frequency of multiple cancer cases involving lung, and there was a high possibility of the occurrence of 2nd and 3rd primary cancers.

Role of basic fibroblast growth factor in the regulation of rat basilar artery tone in vivo

Using the cranial window method, we investigated the effect of basic fibroblast growth factor (bFGF) on the diameter of the rat basilar artery in vivo. bFGF (5-200 ng/ml) caused significant vasodilation in a dose-dependent manner with the maximal effect (119% of baseline diameter) at 200 ng/ml. Vasodilation was not observed when the basilar artery was treated with heat-inactivated bFGF or bFGF preincubated with bFGF-neutralizing monoclonal antibody. Moreover, bFGF-induced vasodilation was suppressed significantly by coadministration of the nitric oxide (NO) synthase inhibitor, NG-nitro-L-arginine methyl ester (L-NAME). In contrast, NG-nitro-D-arginine methyl ester (D-NAME), which is the isomer of L-NAME, exerted no influence on bFGF-induced vasodilation. These findings suggest that the dilatation by bFGF of the rat basilar artery is mediated by NO, and that bFGF plays an important role in the regulation not only of the anterior circulation as previously described but also of the posterior circulation in the brain.

Cysteine protease of the nematode Nippostrongylus brasiliensis preferentially evokes an IgE/IgG1 antibody response in rats

Some cysteine proteases such as papain and those of mites and schistosomes have potent allergenic properties. To clarify the allergenicity of nematode cysteine proteases, the enzyme was purified from the intestinal nematode Nippostrongylus brasiliensis using cation exchange chromatography and gel filtration chromatography. The purified protease, of 16 kD and pI 8.5, showed maximum enzyme activity at pH 5.5 and substrate preference for Z-Phe-Arg-MCA. The specific inhibitors of cysteine protease leupeptin, iodoacetic acid, and E-64, completely suppressed the activity, indicating that the purified enzyme belongs to the cysteine protease family. Cysteine protease activity was found not only in somatic extract, but also in the excretory-secretory (ES) product of the nematode. When anti-cysteine protease immunoglobulin isotypes were examined in sera from rats infected with N. brasiliensis, a high level of IgG1 and a lower level of IgE antibody were detected. Depletion of IgG antibodies from the sera using protein G affinity columns resulted in a marked increase in reactivity of anti-cysteine protease IgE with the antigen, possibly due to the removal of competing IgG antibodies. In contrast to IgE and IgG1, production of anti-cysteine protease IgG2a was negligible. These results indicate that the nematode cysteine protease preferentially evokes an IgE/IgG1 antibody response.

The association of the platelet count and the peripheral CD8+ cell count in Japanese HIV-infected hemophiliacs

To determine the factors involved in the pathogenesis of thrombocytopenia frequently found in human immuno-deficiency virus (HIV) infection, we studied the clinical and laboratory findings of 35 Japanese HIV-infected hemophiliacs regarding their association with thrombocytopenia. Seventeen HIV-positive patients were thrombocytopenic. They had fewer CD4+ cells and were in more advanced stages of the disease, compared with the 18 patients without thrombocytopenia. We carried out the stepwise regression analysis on 32 patients in the early stage of HIV infection, with the platelet count as the dependent variable, and with the CD8+ cell count, serum cholinesterase, alanine aminotransferase (ALT), CD4+ cell count and white blood cell count as explanatory variables. The CD8+ cell count, serum cholinesterase, and ALT were entered into the regression model as explanatory variables of the platelet count with statistical significance. A positive linear correlation in these 32 patients between the CD8+ cell count and platelet count (r = 0.50, P < 0.01) was noted. We conclude that the decrease of the CD8+ cell count may play a role in the pathogenesis of thrombocytopenia in Japanese hemophiliacs in the early stage of HIV-infection.

[A case of nephrotic syndrome associated with severe interstitial pneumonitis due to cyclophosphamide whose life was saved by steroid pulse therapy]

A 53-year-old man was admitted for treatment of nephrotic syndrome due to membranous nephropathy. Since he did not improve with prednisolone alone, cyclophosphamide was administered concomitantly. However, this induced severe interstitial pneumonitis, which was not cured by discontinuation of the drug, but disappeared completely with six episodes of methylprednisolone pulse therapy. The incidence of cyclophosphamide-induced interstitial pneumonitis is low, but the mortality is high. Since cyclophosphamide is often used for the treatment of nephrotic syndrome, attention should be focused on the incidence of interstitial pneumonitis. Discontinuation of cyclophosphamide and intensive therapy are required when it occurs.

Full-thickness skin grafting of postsurgical oral defects: short- and long-term outcomes

PURPOSE

This study evaluated the use of full-thickness skin grafts (FTSGs) following excision of precancerous and cancerous oral lesions.

MATERIALS AND METHODS

Fourteen oral lesions, including five leukoplakias, one carcinoma in situ, two verrucous carcinomas, and six squamous cell carcinomas with varying grade of keratinization and invasion were skin grafted after excision. The size of the graft ranged from 16 x 22 mm to 40 x 50 mm, and the fixation period was 8 to 13 days. The grafts were evaluated for necrosis as a short-term result and shrinkage and recurrence of the lesion as long-term results.

RESULTS

Three cases with more than moderate necrosis of the grafted skin were observed (21.4%). Shrinkage was observed in 23% of the 14 skin grafts and tumor recurrence was observed in three FTSGs (2 patients).

CONCLUSIONS

The results suggest that the paucity of the blood supply in the grafted bed, and the uneven pressure and immobilization of the grafted skin, influence the success of the procedure, and that proper case selection is necessary.

Suppression of HIV replication in human monocyte-derived macrophages induced by granulocyte/macrophage colony-stimulating factor

Susceptibility to HIV infection was examined in macrophages differentiated from human monocytes by macrophage colony-stimulating factor (M-CSF) or granulocyte/macrophage colony-stimulating factor (GM-CSF). The replication of macrophage-tropic human immunodeficiency virus type-1 (HIV-1), which was determined by reverse transcriptase (RT) activity, was significantly suppressed in macrophages induced by GM-CSF (GM-type macrophages) but not in those induced by M-CSF (M-type macrophages). Multinucleated giant cells were formed only in M-type macrophages after HIV infection. However, the expression of CD4 molecules on the surface of both types of macrophages was similar and the proviral DNA was detectable in cell lysates of both macrophages, although the amount of proviral DNA in M-type macrophages was higher than that in GM-type macrophages. Many steps have been defined in HIV infection and replication, such as adsorption of HIV to the cell surface, internalization of the viral core into the cytoplasm, uncoating of viral RNA, reverse transcription and integration of proviral DNA into cellular DNA, transcription and translation of proviral DNA, assembly of viral components, and budding of virus particles. Our findings suggested that the suppression of HIV-1 replication in macrophages induced by GM-CSF is mainly due to a disturbance at certain steps of replication after synthesis of the proviral DNA. Thus, the suppression of HIV replication in GM-type macrophages may provide a model of the latency of HIV infection in vivo.

Effects of ALDH2, CYP1A1, and CYP2E1 genetic polymorphisms and smoking and drinking habits on toluene metabolism in humans

In this study, we evaluated the effects of ALDH2, CYP1A1, and CYP2E1 genetic polymorphisms and smoking and drinking habits on the toluene metabolism. The study subjects were 92 male workers who handle toluene in a printing factory, an electrical parts factory, and a painting workplace in Japan. Their exposure levels to toluene were monitored using the diffusion-type sampler. Benzyl alcohol concentrations in their blood and hippuric acid (HA) and creatinine concentrations in their urine at the end of a workshift were determined. The genotype of ALDH2 was classified into the homozygous genotype of a normal ALDH2 gene (NN), the homozygous genotype of an inactive ALDH2 gene (DD), and the heterozygous genotype of normal and inactive ALDH2 genes (ND). The genetic polymorphism of CYP1A1 and CYP2E1 were also determined by restriction fragment length polymorphism (RFLP). A strong correlation between the personal exposure level and the urinary HA concentration was observed. Regression lines were calculated after being divided by the five factors, i.e., ALDH2, CYP1A1, CYP2E1, smoking, and drinking. The HA formation from toluene was significantly (p < 0.001) different among the genotypes of ALDH2. The slopes of the regression lines decreased from NN to ND to DD in this order. The benzyl alcohol concentration in the blood of the DD group was significantly higher than that found in the NN and ND groups. This result demonstrates that ALDH2 polymorphism affects the oxidation of benzyl alcohol to benzoic acid. The toluene metabolism was also affected by CYP1A1 polymorphism. The slope for the Ile/Ile (the predominant homozygous allele) group was significantly lower than that for the Ile/Val (the heterozygous allele) and Val/Val (the rare homozygous allele) group after correction for creatinine. A drinking habit significantly (p < 0.05) reduced urinary HA concentration in the NN group. A smoking habit also significantly (p < 0.05) reduced urinary uncorrected HA concentration in both the NN and ND groups. In a multiple regression analysis, ALDH2 and the drinking habit were significantly (p < 0.01) associated with HA excretion after toluene exposure with and without correction for creatinine, and the corrected HA concentration was also significantly (p < 0.01) increased in the Ile/Val and Val/Val group of CYP1A1. The smoking habit reduced the corrected HA concentration (p < 0.05); however, the polymorphism in the 5'-flanking region of CYP2E1 did not affect HA appearance in urine.

Geographic differences in seasonal variation of mean birth weight in Japan

Seasonal variation of mean birth weight (MBW), mean gestational period (MGP), and MBW at 40 weeks of gestation (MBW40) in the 15 different prefectures of Japan were analyzed using vital statistics from 1974 to 1983. MBW generally shows a bimodal pattern with two peaks in spring and autumn and two troughs in summer and winter. Seasonality exhibits a general geographic trend: The autumn peak loses its height and the spring peak increases its amplitude as one moves from north to south. This trend suggests that environmental factors are associated with the creation of seasonality in MBW. For MGP the pattern is relatively unimodal with a deep trough in winter; however, a late summer small dip is observed in most cases. According to an analysis of coincidence between the two time series (MBW and MGP) and correlation analysis, the seasonal variation in birth weight basically depends on the gestational period. For MBW40, which represents the fetal growth rate, the seasonality shows a pattern similar to that of MBW. A statistically significant coincidence and a correlation are observed between the time series of MBW and MBW40. These results suggest that the two processes of fetal growth (gestational period and fetal growth rate) are associated with the creation of seasonality in MBW.

Evidence for multiple activators for stress-activated protein kinase/c-Jun amino-terminal kinases. Existence of novel activators

Stress-activated protein kinases (SAPKs) or c-Jun amino-terminal kinases (JNKs), which belong to a subgroup of the mitogen-activated protein kinase (MAPK) superfamily, are activated in response to a variety of stresses in mammalian cells. An activity to activate a recombinant rat SAPK alpha was detected in extracts obtained from rat fibroblastic 3Y1 cells exposed to hyperosmolar media and was resolved into unadsorbed and adsorbed fractions on Q-Sepharose chromatography. The adsorbed activity was identified as XMEK2/SEK1/MKK4 by using several anti-XMEK2 antibodies. Thus, a 45-kDa protein that was recognized specifically by these anti-XMEK2 antibodies co-eluted with the SAPK alpha activating activity during chromatography on Q-Sepharose and Superose 6, and the activity could be immunoprecipitated by the antibodies from these fractions. The unadsorbed activity, whose level was much greater than that of the adsorbed activity, did not contain XMEK2/SEK1/MKK4 and was also activated in a time-dependent manner by osmotic shock. This activity was further resolved into several peaks during chromatography on heparin-Sepharose and hydroxylapatite. Most of these peaks eluted separately from major peaks of a kinase activity toward p38/MPK2, another subgroup of the MAPK superfamily, whereas the activated XMEK2/SEK1/MKK4 could phosphorylate p38/MPK2 efficiently. These results indicate the existence of multiple activators for SAPK/JNK; one is XMEK2/SEK1/MKK4, and the others are previously undescribed factors.

[The state of environmental problems in Vietnam]

Following the introduction of a market economy, Vietnam has been faced with a variety of environmental problems. The following eight problems deserve special attention; 1) deforestation, 2) decrease of agricultural land resources, 3) irrational use of water resources, 4) over exploitation of fishery resources, 5) irrational use of mineral resources, 6) loss of genetic resources, 7) environmental pollution, 8) environmental damage due to war. In order to solve these problems, the Vietnamese government established an integrated strategy, the "National Environmental Protection Research Program: NEPRP". However, because of shortages in human resources, adequate technology, and financial resources, it is very difficult for the Vietnamese government to fully implement this program. As the realization of a sound economic development in the Indochina area is very important from the international political point of view, strong expectations exist that developed countries, including Japan, will actively contribute to the solution of these environmental problems in Vietnam.

[Analysis of factors associated with medical expenditure for the elderly in Fukuoka]

Based on "the Report of National Health Insurance Plan in Fukuoka", "the Report of Health Services for the Elderly in Fukuoka", and "the Health Statistics of Fukuoka" of 1987 and 1991, factors associated with medical expenditures for the elderly were examined. According to the result of correlation analyses, the general medical examination participation rate under the Health Service Law for the Elderly showed a statistically significant negative correlation with the in-patient medical expenditures as well as the out-patient medical expenditures for the elderly. The analysis concerning the three components of medical expenditure has clarified that this negative correlation is mainly explained by the low utilization of medical services among communities with a high general medical examination participation rate under the Law. This fact suggests that the general medical examination service might have a complementary effect against receiving care in medical facilities. However, there exists a possibility that the negative correlation observed in this study might be explained by the existence of "the third factor" intervening the pathway. In order to clarify the mechanism of relation observed, a micro-level analysis should be required.

The association between parents' unemployment and birthweight in Japan

The association between birthweight and parents' occupations was examined with the 1985 Japanese Vital Statistics, which recorded 1,419,465 live births delivered in Japan from April 1985 through March 1986. The mean birthweights [MBWs] were significantly different according to the paternal occupation as well as the maternal occupation after adjusting for the infants' sex and parity. The MBWs of children of unemployed fathers were significantly lighter than those of offspring of employed fathers. This was due to both retarded intrauterine growth and a shortened gestational period. By contrast, the MBWs were not affected by the unemployment of mothers. The possible reasons for the decreased MBW in the case of unemployed fathers were economical problems due to unemployment, less favorable characteristics of demography and obstetrics, and psycho-social stress among the wives of the unemployed.

Activation of protein kinase cascades by osmotic shock

Osmotic shock induces a variety of biochemical and physiological responses in vertebrate cells. By analyzing extracts obtained from rat 3Y1 fibroblastic cells exposed to hyper-osmolar media, we have found that mitogen-activated protein kinases (MAPKs) and stress-activated protein kinases (SAPKs, also known as JNKs) are both activated in response to osmotic shock. MAPKK1 (MEK1) was also activated markedly. Furthermore, Raf-1 and MEKK were activated strikingly by the osmotic shock. Activation of Raf-1 and MEKK in response to osmotic shock was detected also in PC12 cells, in which MEKK activation by the osmotic shock was much stronger than that by epidermal growth factor. Activation of SAPKs in PC12 cells by the osmotic shock was also more marked than that by epidermal growth factor. The activated MEKK phosphorylated not only MAPKKs but also XMEK2, which is distantly related to MAPKK. Recombinant wild-type XMEK2, but not kinase-negative XMEK2, was able to phosphorylate and activate recombinant SAPK alpha in vitro. In addition, this activity of XMEK2 was activated by the activated MEKK. These results suggest that the MAPK cascade consisting of Raf-1, MAPKK, and MAPK and the SAPK cascade consisting of MEKK, XMEK2, and SAPK are both activated in response to osmotic shock. Finally, it was found that XMEK2 is a good substrate for SAPK.

Ciliary neurotrophic factor prevents ischemia-induced learning disability and neuronal loss in gerbils

Ciliary neurotrophic factor (CNTF) has been shown to have potent neurotrophic activity on peripheral and central neurons in vitro and in vivo. However, it remains to be determined whether or not CNTF rescues hippocampal CA1 neurons from lethal ischemia and prevents ischemia-induced learning disability. In the present in vivo study, we infused CNTF continuously for 7 days into the lateral ventricle of gerbil starting 2 h before 3-min forebrain ischemia. CNTF infusion prevented the occurrence of ischemia-induced learning disability in a dose-dependent manner as revealed by the step-down passive avoidance task. Subsequent light and electron microscopic examinations showed that pyramidal neurons in the CA1 region of the hippocampus as well as synapses within the strata moleculare, lacunosum/radiatum and oriens of the region were significantly more numerous in gerbils infused with CNTF than in those receiving vehicle infusion. These findings suggest that CNTF has a trophic effect on ischemic hippocampal neurons.

[Clinical application of digital TV tomosynthesis to disorders of the wrist and their post-operative evaluation]

The clinical utility of digital TV tomosynthesis was assessed in 13 patients with chronic disorders of the wrist and the first carpometacarpal joints, and a post-operative evaluation was carried out. The disorders included nonunion of the scaphoid in five patients, Kienböck's disease in four, subluxation of the distal radioulnar joint in two, and osteoarthrosis of the first carpometacarpal joint in two. The total time needed to obtain two sets of tomographs of a wrist by digital TV tomosynthesis was about 10 minutes, or approximately one third of the time required with conventional methods. The total radiation exposure in obtaining all tomographs of one direction with digital TV tomosynthesis was less than that in obtaining only one tomograph with conventional methods. Digital TV tomosynthetic images were judged superior to conventional tomographs by four orthopedic surgeons and four radiologists, because tomographic blur was reduced in part by a spatial frequency filter processing. Clinically, digital TV tomosynthesis was very helpful in evaluating nonunion of the scaphoid and Kienböck's disease, especially in their post-operative conditions with metallic fixative devices. Digital TV tomosynthesis was found to be a fast, feasible and inexpensive method with low radiation exposure for evaluating disorders of the wrist.

Effect of dietary NaCl on tyrosine hydroxylase in the superior cervical ganglia of Dahl rats

To investigate the involvement of peripheral catecholamines in the development of Dahl-Iwai salt-sensitive (DIS/Eis) hypertension, we performed immunohistochemical staining of tyrosine hydroxylase (TH) in the superior cervical ganglia (SCG) of DIS/Eis rats and Dahl-Iwai salt-resistant (DIR/Eis) rats, and in situ hybridization histochemistry for demonstration of TH mRNA localization in the SCG of these rats. DIS/Eis and DIR/Eis rats were fed on a high (8%) salt diet or on a low (0.3%) salt diet for 4 weeks. Nerve cells in the SCG of DIS/Eis high salt rats exhibited more intense TH-immunoreactivity (P < 0.01) and hybridization signals (P < 0.01) than those of the other experimental groups. These findings suggest that activation of peripheral sympathetic nerves may account for hypertension in DIS/Eis rats on a high salt diet.

Morphological changes of neuromuscular junctions in the dystrophic (dy) mouse: a scanning and transmission electron microscopic study

Neuromuscular junctions in the extensor digitorum longus muscle of control and dystrophic (dy) mice at stages ranging from 30 to 120 postnatal days were examined by scanning and transmission electron microscopy (SEM and TEM). In control mice, the neuromuscular junctions consisted of thin ramifying nerve endings and of complex labyrinthine gutters with a great number of slit-like junctional folds. The subneural apparatuses of dy mice on the 30th and the 60th postnatal days were composed of undeveloped gutters or a number of cup-like depressions containing a few pit-like or slit-like junctional folds. In dystrophic neuromuscular junctions on the 120th postnatal day, subneural apparatuses were classified into two types: one had a cluster of continuous cup-like depressions with or without slit-like junctional folds, and the other consisted of discrete depressions containing slit-like junctional folds. Moreover, a small number of dystrophic muscle fibers were endowed with two subneural apparatuses which were 20 to 30 microns away from each other. Small round pits (0.5-1.0 microns in diameter) in some cup-like depressions were occasionally protruded by short processes of terminal axons. The present findings suggest that the age-dependent postsynaptic structural changes of dystrophic dy mice induce a complex morphological reorganization of presynaptic nerve endings. This might help the nerve endings compensate for the functional deterioration of dystrophic muscle fibers.

Protective effect of basic fibroblast growth factor-heparin and neurotoxic effect of platelet factor 4 on ischemic neuronal loss and learning disability in gerbils

Platelet factor 4, which has a potent affinity for heparin, has been shown to inhibit the binding of basic fibroblast growth factor to the cell surface receptor and to counteract the biological activities of basic fibroblast growth factor in certain peripheral tissues. In the present in vitro [125I]basic fibroblast growth factor binding experiments, platelet factor 4 consistently inhibited the binding of iodinated basic fibroblast growth factor to cell membranes of the gerbil hippocampus. To investigate the in vivo function of endogenous basic fibroblast growth factor and/or basic fibroblast growth factor receptor possibly activated in the ischemic gerbil brain, we infused platelet factor 4 continuously into the left lateral ventricle with an osmotic minipump. When platelet factor 4 infusion was started within three days after a 3-min ischemic insult, it significantly enhanced ischemia-induced learning disability and ischemic neuronal loss in the CA1 region of the hippocampus, as demonstrated by the results of the step-down passive avoidance task and by subsequent histological examinations. Infusion of platelet factor 4 into the cerebral ventricle of intact gerbils did not affect learning ability or CA1 neuron number. Basic fibroblast growth factor-neutralizing antibody, when infused continuously in the cerebral ventricle, also exhibited a neurotoxic effect in ischemic but not intact gerbils. Basic fibroblast growth factor co-infused with heparin, but not basic fibroblast growth factor alone, rescued a significant number of ischemic neurons which were destined to degenerate without the infusion of heparinized basic fibroblast growth factor, and it prevented ischemia-induced learning disability.(ABSTRACT TRUNCATED AT 250 WORDS)

Purification and characterization of REKS from Xenopus eggs. Identification of REKS as a Ras-dependent mitogen-activated protein kinase kinase kinase

We have previously identified a protein factor, named REKS (Ras-dependent Extracellular signal-regulated kinase/Mitogen-activated protein kinase kinase (MEK) Stimulator), which is necessary for Ras-dependent MEK activation. In this study, we attempted to highly purify and characterize REKS. We have highly purified REKS by successive column chromatographies using a cell-free assay system in which REKS activates recombinant extracellular signal-regulated kinase 2 through recombinant MEK in a guanosine 5'-O-(thiotriphosphate) (GTP gamma S)-Ki-Ras-dependent manner. REKS formed a stable complex with GTP gamma S-Ras; REKS was coimmunoprecipitated with GTP gamma S-Ki-Ras or GTP gamma S-Ha-Ras, but not with GDP-Ki-Ras or GDP-Ha-Ras by an anti-Ras antibody. REKS was absorbed to a GTP gamma S-glutathione S-transferase (GST)-Ha-Ras-coupled glutathione-agarose column but not to a GDP-GST-Ha-Ras-coupled glutathione-agarose column and was coeluted with GTP gamma S-GST-Ha-Ras by reduced glutathione. The minimum molecular mass of REKS was estimated to be about 98 kDa on SDS-polyacrylamide gel electrophoresis. REKS phosphorylated this 98-kDa protein as well as recombinant MEK. REKS was not recognized by any of the anti-c-Raf-1, anti-Mos, and anti-mSte11 antibodies. These results indicate that REKS is a Ras-dependent MEK kinase.

Conservative treatment of thoracic outlet syndrome using an orthosis

We describe a strapping device for elevation of the shoulder in patients with thoracic outlet syndrome (TOS). The device was used by 86 patients with TOS whose symptoms had been alleviated by passively raising the shoulder. Symptoms of TOS were classified as proximal, including pain in the shoulder girdle, and distal, in which there were neurological deficits related to the brachial plexus. The device was more effective in patients with distal symptoms: pain disappeared or improved in 67% of patients; numbness in 85%; sensory disturbance in 84%; and motor disturbance in 80%. However, proximal symptoms were relieved in only 65% of the patients. The ability to perform activities of daily living was rated as excellent in 33% of patients, good in 44%, fair in 12%, and poor in 9%. The shoulder orthosis described in this report can counterbalance downward traction on the brachial plexus and reduce the tension on it, thereby relieving symptoms of TOS.