PCF1 and PCF2 specifically bind to cis elements in the rice proliferating cell nuclear antigen gene

We have previously defined the promoter elements, sites IIa and IIb, in the rice proliferating cell nuclear antigen (PCNA) gene that are essential for meristematic tissue-specific expression. In this study, we isolated and characterized cDNAs encoding proteins that specifically bind to sites IIa and IIb. The two DNA binding proteins, designated PCF1 and PCF2, share > 70% homology in common conserved sequences at the N-terminal regions. The conserved regions are responsible for DNA binding and homodimer and heterodimer formation, and they contain a putative basic helix-loop-helix (bHLH) motif. The structure and DNA binding specificity of the bHLH motif are distinguishable from those of other known bHLH proteins that bind to the E-box. The motif is > 70% homologous to several expressed sequence tags from Arabidopsis and rice, suggesting that PCF1 and PCF2 are members of a novel family of proteins that are conserved in monocotyledons and dicotyledons. A supershift assay using an anti-PCF2 antibody showed the involvement of PCF2 in site IIa (site IIb) binding activities in rice nuclear extracts, particularly in meristematic tissues. PCF1 and PCF2 were also more likely to form heterodimers than homodimers. Our results suggest that PCF1 and PCF2 are involved in meristematic tissue-specific expression of the rice PCNA gene through binding to sites IIa and IIb and formation of homodimers or heterodimers.

Treatment of full-thickness macular holes with autologous serum

A total of 28 patients (29 eyes) with stage 2-4 idiopathic full-thickness macular holes were treated with the use of autologous serum. Autologous serum (20-30 microL) was placed over each macular hole followed by injection of 16% perfluoropropane gas. Postoperatively, 28 eyes (97%) had flattening of the macular hole, and the hole could not be detected in 27 eyes (93%). Twenty-two eyes (76%) showed visual acuity improvement by at least two lines or more. Preoperative factors such as good visual acuity, earlier stage, and younger age were correlated with postoperative good visual acuity. These results suggest that autologous serum is beneficial in the treatment of full-thickness macular holes.

PCF1 and PCF2 specifically bind to cis elements in the rice proliferating cell nuclear antigen gene

We have previously defined the promoter elements, sites IIa and IIb, in the rice proliferating cell nuclear antigen (PCNA) gene that are essential for meristematic tissue-specific expression. In this study, we isolated and characterized cDNAs encoding proteins that specifically bind to sites IIa and IIb. The two DNA binding proteins, designated PCF1 and PCF2, share > 70% homology in common conserved sequences at the N-terminal regions. The conserved regions are responsible for DNA binding and homodimer and heterodimer formation, and they contain a putative basic helix-loop-helix (bHLH) motif. The structure and DNA binding specificity of the bHLH motif are distinguishable from those of other known bHLH proteins that bind to the E-box. The motif is > 70% homologous to several expressed sequence tags from Arabidopsis and rice, suggesting that PCF1 and PCF2 are members of a novel family of proteins that are conserved in monocotyledons and dicotyledons. A supershift assay using an anti-PCF2 antibody showed the involvement of PCF2 in site IIa (site IIb) binding activities in rice nuclear extracts, particularly in meristematic tissues. PCF1 and PCF2 were also more likely to form heterodimers than homodimers. Our results suggest that PCF1 and PCF2 are involved in meristematic tissue-specific expression of the rice PCNA gene through binding to sites IIa and IIb and formation of homodimers or heterodimers.

Aldosterone-producing adrenal cortical cancer: a case report and analysis of steroidogenic enzymes in the tumor

A case of hyperaldosteronism caused by adrenal cortical cancer observed in a 32-year-old man was reported. The patient showed marked hypertension and hypokalemia, but neither obesity nor hyperglycemia was observed. Endocrine studies revealed hyperaldosteronism and concurrent excessive secretion of cortisol, but diurnal rhythms of plasma ACTH and cortisol were normal. Imaging studies revealed a large left adrenal mass, and the positive accumulation of radiolabelled material by adrenal scintigraphy was observed both in the tumor and the contralateral adrenal gland. The removed tumor was predominantly composed of dark compact cells with marked nuclear pleomorphism, and mitotic figures and sinusoidal invasion were also observed. The analysis of steroidogenic enzyme activities revealed that the activity of aldosterone-synthesizing enzyme (P-450aldo) which was usually undetectable in normal adrenal tissues and adenomas other than aldosterone-producing adenoma (APA) was detectable as one-third of that of APA. Although activities of other enzymes were reduced, the expression of P-450aldo activity was considered to be the specific character of this cancer.

[A case of Cushing's syndrome due to bilateral multiple adrenal adenomas]

We report a case of Cushing's syndrome due to bilateral adrenal adenomas. A 45-year-old woman was found to have Cushing's syndrome during the course of treatment for diabetes mellitus. The diagnosis of Cushing's syndrome was based on the absence of a diurnal rhythm in plasma cortisol and failure to suppress plasma cortisol by 1 or 4 mg of dexamethasone. The plasma level of adrenocorticotropic hormone (ACTH) was below the normal range, and plasma cortisol responded normally to rapid ACTH injection. Abdominal computed tomography revealed bilateral adrenal tumors. Bilateral uptake of radiocholesterol by the adrenal cortex was observed in adrenal scintigraphy. Bilateral adrenalectomy was performed. Microscopic examination and analysis of steroid contents by high performance liquid chromatography showed that the tumor was cortisol-producting adenoma.

[Adjuvant tamoxifen duration: more large-scale randomized evidence is needed]

The Early Breast Cancer Trialists' Collaborative Group (EBCTCG) overview of worldwide evidence has demonstrated that a few years of adjuvant tamoxifen produces a moderate but definite benefit in long-term survival. However, there is major uncertainty regarding the optimal duration of tamoxifen treatment and in particular, as to whether, after a few years on tamoxifen, most women should stop or should continue for several years longer. ATLAS (Adjuvant Tamoxifen: Longer Against Shorter) is a large international randomized trial designed to assess reliably the balance of benefits and risks of prolonging tamoxifen duration by an additional five years in women who have already had some years of adjuvant tamoxifen and for whom there is uncertainty about whether to stop, or to continue for longer. It is important that most of the clinicians are aware of the uncertainties regarding the optimal duration of tamoxifen and should consider entering their patients into ATLAS, which has the potential to provide reliable evidence to answer this question that affects the management of many hundreds of thousands of women worldwide and thereby may contribute to the further downward trend in breast cancer mortality which is already being seen.

Photorefractive Keratectomy for Myopia and Photoastigmatic Keratectomy for Astigmatism

BACKGROUND

We conducted a clinical trial to evaluate the efficacy and safety of excimer laser photorefractive keratectomy (PRK) and photoastigmatic refractive keratectomy (PARK) using the Nidek EC-5000 excimer laser.

METHODS

A total of 67 eyes from 47 patients whose average age was 35 years were enrolled in the study. The mean spherical equivalent of the manifest refraction before surgery was -7.50 diopters (D). Patients were followed for at least 6 months. One year after surgery, uncorrected visual acuity improved in 98% of the eyes, while spectacle-corrected visual acuity had not deteriorated in any patient. The achieved corrections were within +/-1.00 D of attempted correction in 72.5% of eyes. Predictability was poor in eyes in which the correction was more than 10.00 D. Subepithelial haze occurred in all eyes to minimal extent, and disappeared gradually.

CONCLUSION

Photorefractive keratectomy and photoastigmatic refractive keratectomy, performed with the Nidek EC-5000 excimer laser, is a reliable and adequately safe procedure to correct myopia of a limited range.

Human urinary macrophage colony-stimulating factor reduces the incidence and duration of febrile neutropenia and shortens the period required to finish three courses of intensive consolidation therapy in acute myeloid leukemia: a double-blind controlled study

PURPOSE

To determine whether macrophage colony-stimulating factor (M-CSF) reduces the incidence and duration of febrile neutropenia during three courses of intensive consolidation therapy and whether it shortens time to complete consolidation therapy.

PATIENTS AND METHODS

In 198 adult patients with acute myeloid leukemia (AML) in complete remission (CR), M-CSF (8 x 10(6) U/d) or placebo was administered from 1 day after the end of each consolidation chemotherapy for 14 days.

RESULTS

The duration and incidence of febrile neutropenia was significantly reduced by 34% (P = .00285) and 17% (P = .02065), respectively, in 88 assessable patients in the M-CSF group compared with those in 94 assessable patients in the placebo group. Patients in the M-CSF group had 565 days and 133 episodes of febrile neutropenia during 7,901 days at risk, while patients in the placebo group had 977 days and 185 episodes during 9,077 days at risk. The median period required to finish the three courses of consolidation therapy was 93 days in the M-CSF group, which was significantly shorter than 110 days in placebo group (P = .0050). In the M-CSF group, the recovery of neutrophils and platelets was significantly faster (P = .0348 and P = 0.0364, respectively), the administration of systemic antimicrobial agents tended to be less (P = .0839), and the frequency of platelet transfusion (P = .0259) and the total volume of transfused platelets (P = .0292) were significantly less. However, there was no significant difference in the disease-free survival.

CONCLUSION

M-CSF significantly reduced the incidence and duration of febrile neutropenia during the intensive consolidation therapy, and shortened the time to complete consolidation chemotherapy in AML.

[The physical, mental and social impacts of telling prostate cancer patients the true diagnosis]

BACKGROUND

Telling cancer patients the true diagnosis is inevitable to acquire informed consent especially in the Western world. In Japan, however, no such consensus has been established yet. We investigated the influence of telling the true diagnosis on QOL of prostate cancer patients.

METHODS

We measured physical, mental and social aspect of prostate cancer outpatients by the General Health Questionnaire (GHQ) and the international Prostate Symptom Score (I-PSS). Using the general linear models we tried to explore which variables would attribute to "severe depression", "anxiety and insomnia" and "social dysfunction".

RESULTS

No significant differences were found in any of the eight variables (age, performance status, clinical stage, I-PSS and Goldberg's four factors of GHQ) among the two groups that were informed the true diagnosis or not. The correlation structures of "severe depression", "somatic symptoms" and I-PSS are significantly different in the two groups. As a result of the analysis by the GLM, "somatic symptoms", I-PSS and clinical stages had main effect on "severe depression". Also, there was an interaction between the effect of telling the true diagnosis and "somatic symptoms".

CONCLUSION

These results suggest that the mental condition of prostate cancer patients remain stable when they are in good physical condition regardless of being informed the true diagnosis or not. However, the patients who weren't told the true diagnosis have a tendency to get depression accompanying deterioration of physical condition. It is therefore considered that telling the true diagnosis makes the patients understand the changes of their physical conditions and help their mind to be stable.

A rare case of Cushing's syndrome due to bilateral adrenocortical adenomas

We report a rare case of Cushing's syndrome due to bilateral adrenocortical adenomas in a 45-year-old female. She suffered from diabetes mellitus and hypertension for a decade, but her appearance was not Cushingoid. The plasma cortisol level in the morning was at the upper limit of the normal range, but did not show a diurnal rhythm or was suppressed by 1 mg of dexamethasone. The plasma level of ACTH was undetectable, and it failed to respond to human CRH (hCRH). Plasma cortisol responded well to synthetic ACTH. The urinary 17-OHCS level was high, and was not suppressed by 4 mg of dexamethasone. While these findings were consistent with a diagnosis of adrenocortical adenoma, computed tomography showed several nodules in both adrenal glands that suggested the presence of huge nodular adrenocortical hyperplasia or bilateral adrenocortical adenomas. Bilateral adrenalectomy demonstrated the presence of three adenomas, two in the right and one in the left adrenal. Analysis of the extract from each adenoma revealed that two of the three produced an excess amount of cortisol. Magnetic resonance imaging (MRI) of the brain suggested the presence of pituitary adenoma. Prior to adrenalectomy, TSH, GH or LH showed a low response to TRH, GHRH or LHRH, respectively. Since normal responses were restored after bilateral adrenalectomy, these abnormalities were attributed to hypercortisolemia.

Mixed models for bivariate response repeated measures data using Gibbs sampling

Repeated measures data are frequently incomplete, unbalanced and correlated. There has been a great deal of recent interest in mixed effects models for analysing such data. In this paper, we develop bivariate response mixed effects models that are a generalization of linear mixed effects models for a single response variable. We describe their estimation procedures using a Markov chain Monte Carlo method, the Gibbs sampler. We illustrate the methods with analyses of intravenous vitamin D3 administration for secondary hyperparathyroidism in hemodialysis patients. In these data there were two response variables on each individual (PTH and calcium level). This study also suffered from attrition, like many longitudinal studies. While, considering the study design, it was reasonable to assume the drop-out mechanism for the calcium (Ca) level to be 'missing at random', the drop-out mechanism for the PTH level was likely to be non-ignorable. We found that the posterior treatment effects for the PTH level by the single response model were underestimated compared with those obtained by the bivariate response model, while there were little differences in the posterior features for the Ca level under both models.

Soluble intercellular adhesion molecule-1 level in sera is elevated in perennial allergic rhinitis

Soluble intercellular adhesion molecule-1 (sICAM-1) in sera was measured in some allergic disorders, but serum sICAM-1 levels in perennial allergic rhinitis remain to be determined. Our study was aimed at elucidating whether the serum sICAM-1 levels in patients with perennial allergic rhinitis are different from those in nonatopic healthy volunteers and whether immunotherapy can modulate sICAM-1 levels. Serum sICAM-1 was determined in 20 nonallergic volunteers and 137 patients with perennial allergic rhinitis by a sandwich enzyme-linked immunosorbent assay. Our study demonstrated that the level of sICAM-1 in untreated patients is significantly elevated, as compared with nonatopic subjects. Immunotherapy could decrease sICAM-1 in perennial allergic rhinitis, but this suppressive effect became apparent only after many years of immunotherapy. In patients on immunotherapy, a close correlation was observed between sICAM-1 and nasal symptom scores. To take these lines of evidence together, a decrease in sICAM-1 might be related to the working mechanism of immunotherapy, and serum sICAM-1 could be used to monitor the effect of immunotherapy.

Comparison of the Gyro C1E3 and BioMedicus centrifugal pump performances during cardiopulmonary bypass

The compact eccentric inlet port (C1E3) centrifugal blood pump was developed as a cardiopulmonary bypass (CPB) pump. The C1E3 pump incorporated a sealless design with a blood stagnation free structure. The pump impeller was magnetically coupled to the driver magnet in a sealless manner. To develop an atraumatic and antithrombogenic centrifugal pump without a shaft seal junction, a double pivot bearing system was introduced. Recently, a mass production model of the C1E3 was fabricated and evaluated. The ratio of the normalized index of hemolysis (NIH) of the C1E3 was 0.007 g/ 100 L, in comparison to the NIH of the BP-80, 0.018 g/ 100 L, each in a CPB condition of 5 L/min against 325 mm Hg. Both pumps were compared in identical in vitro circuits. To further evaluate the pumps during cardiopulmonary bypass for reliability and function, 6 h of CPB was performed on each of 8 bovines using either the C1E3 or BP-80 centrifugal pump. The BP-80 and C1E3 provided pump flows of 50-60 ml/kg/min without incident. The hemodynamics were stable, and the hematology and biochemistry data were within normal ranges. There were no statistically significant differences between the 2 groups. Concerning the plasma free hemoglobin values, a mass production model of the C1E3 pump had the same hemolysis levels as the BP-80. Our preliminary studies reveal that the C1E3 pump is reliable. Also, the C1E3 will satisfy clinical requirements as a cardiopulmonary bypass pump.

The hemolysis test of the Gyro C1E3 pump in pulsatile mode

While a centrifugal pump is generally used for nonpulsatile blood flow, it can also produce a pulsatile flow by alternating the impeller rotational speed (rpm) periodically. However, there is a concern that this centrifugal pump pulsatile mode may induce added hemolysis as a result of the repeated acceleration and deceleration of rpm. Thus, a hemolysis study of the pulsatile modes of the Gyro C1E3 centrifugal pump (Gyro-P) was conducted. The results were then compared with the nonpulsatile mode of the same pump (Gyro-N) and the nonpulsatile BioMedicus BP-80 (Bio-N) pump. Three different conditions were simulated: left ventricular assist device (LVAD), cardiopulmonary bypass (CPB), and percutaneous cardiopulmonary support (PCPS). The beating rate of the Gyro-P was set at 40 bpm, with repetition of two different impeller speed (the lower being 70% of the higher speed). The 2 impeller speeds were set to obtain the same average flow as that of the nonpulsatile mode. The hemolysis results of the Gyro-P were comparable to or better than those of Bio-N, and no excessive hemolysis was observed, compared to the Gyro-N. In conclusion, The Gyro-P had an excellent hemolytic characteristic and generated no excessive hemolysis in most clinical usage conditions. With the concern of hemolysis eliminated, this pulsatile mode may have various possible mode advantages.

Immunotherapy affects the seasonal increase in specific IgE and interleukin-4 in serum of patients with seasonal allergic rhinitis

This study was designed to determine seasonal changes in cytokines, soluble CD23 and specific IgE in the serum of patients with seasonal allergic rhinitis, and the effect of immunotherapy on these seasonal changes. Fifty-four patients with seasonal allergic rhinitis caused by Japanese ceder pollens were divided into a medication group and an immunotherapy group. The patients of the medication group were treated with non-sedating antihistamines alone during the pollen season. The patients of the immunotherapy group had been treated for variable periods (mean, 5.0 +/- 3.2 years) with immunotherapy using japanese cedar pollen antigens. Serum samples were collected before and during the pollen season from each patient, to determine specific IgE, interleukin-4 (IL-4), interferon-gamma (IFN-gamma) and soluble CD23 levels in serum. A significant increase in specific IgE and IL-4 and a significant decrease in IFN-gamma were observed during the pollen season in the medication group. In contrast, in the immunotherapy group, none of specific IgE, IL-4 and IFN-gamma was significantly changed following natural exposure to pollens. However, these effects were not significant in patients undergoing immunotherapy for 3 or fewer years. Seasonal rates of increase in specific IgE and IL-4 differed significantly between good responders and poor responders to immunotherapy, but seasonal rates of decrease in IFN-gamma did not. A seasonal rate of increase in soluble CD23 was significantly correlated with a seasonal rate of increase in specific IgE, in both the medication and the immunotherapy groups. The seasonal rate of increase in soluble CD23 was significantly smaller in the good responders than in the poor responders to immunotherapy. In conclusion, pollen immunotherapy reduces the seasonal increase in specific IgE, IL-4 and soluble CD23 in serum, and in addition switches the seasonal preferential activation of Th-2 cells to reciprocal activation of Th-1 cells with treatment over several years. It is likely that the mechanisms responsible for the clinically beneficial effects of immunotherapy principally involve the modulation of Th-2 rather than Th-1 cytokines.

Flow visualization studies to improve the spiral pump design

The spiral pump (SP) uses centrifugal and axial pumping principles simultaneously, through a conical shaped impeller with threads in its surface. Flow visualization studies were performed in critical areas of the SP. A closed circuit loop was filled with glycerin-water solution (40%). Amberlite particles (80 mesh) were illuminated by a planar helium-neon laser light (7 mW). The particle velocities were recorded with Kodak (TMAX-400) black and white film, and the flow behavior was studied with a micro video camera and color video printer. The flow visualization studies showed no turbulence or stagnant areas in the inlet and outlet ports of the SP. When using the impeller with one lead, at the top of the threads some recirculation appeared when the total pressure head increased. Two new impellers were made. One of them had the same conical shape with a thread having 2 leads. The second had a thread with 2 leads, but it also had a bigger cone angle. These modifications improved the pump hydrodynamic performance, decreasing the recirculation in pumping conditions that require pressures over 200 mm Hg.

Differential pattern of the circadian rhythm of serum melatonin in young and elderly healthy subjects

The daily profile of serum level of melatonin was studied in 10 young and 13 elderly subjects. All of the subjects were physically and psychiatrically healthy and did not have any clinical symptoms related to rhythm disturbance. Blood samples were taken every 3 h for 1 day and serum melatonin levels were determined by RIA. All except for 1 of the elderly subjects exhibited a clear circadian rhythm of serum melatonin level with a nocturnal peak. In both subject groups, the melatonin rhythm showed significant diurnal variation. There was no significant difference in the total melatonin level per day between young and elderly groups, suggesting that there was no influence of aging on daily total melatonin secretion. However, there was a marked difference in the features of the melatonin rhythm between the two groups, i.e., a rapid decline of the melatonin level from the nocturnal peak in the elderly group, suggesting that the off-set time of melatonin secretion advances with aging. Our findings suggest that the pattern of melatonin rhythm alters significantly without clear clinical symptoms in the process of senescence.

A guideline for reporting results of statistical analysis in Japanese Journal of Clinical Oncology

The paper gives guidelines to authors on the use of statistics, including statistical considerations when designing studies. Information on this article plus a list of other recommended books is available on the World Wide Web (http:/(/)wwwinfo.ncc.go.jp/jjco/) in Japanese as well as English.

Nitric oxide inhibits neutrophil adhesion to cytokine-activated cardiac myocytes

Neutrophils play important roles in myocardial injury in which an inflammatory reaction ensues. We investigated the role of nitric oxide (NO) in neutrophil adhesion to cardiac myocytes. Isolated adult rat myocytes were coincubated with human neutrophils, and the number of neutrophils adherent to myocytes was microscopically counted. The adhesion increased up to 2.4-fold when both myocytes and neutrophils were activated by interleukin-1 beta (IL-1 beta) and platelet-activating factor (PAF), respectively. The NO donors, S-nitroso-N-acetylpenicillamine (SNAP) and sodium nitroprusside (SNP), inhibited the adhesion by 50% when administered to neutrophils before activation. However, when activated neutrophils were added to myocytes that had been incubated with NO donors during IL-1 beta stimulation, the inhibition of adhesion was not observed. Pretreatment of neutrophils with SNAP or 8-bromoguanosine 3',5'-cyclic monophosphate did not reduce PAF-induced CD11b/CD18 expression determined by flow cytometry, nor did simultaneous treatment of myocytes with IL-1 beta and SNAP decrease IL-1 beta-induced intercellular adhesion molecule-1 expression determined by immunofluorescence staining and enzyme-linked immunosorbent assay. Thus NO inhibits neutrophil-myocyte adhesion, mainly acting on neutrophils without quantitatively affecting the upregulation of CD11b/CD18.

Phase I study of cladribine (2-chlorodeoxyadenosine) in lymphoid malignancies. Cladribine Study Group

Cladribine (2-chlorodeoxyadenosine;) is a purine analogue with clinical activity against hairy cell leukemia, chronic lymphocytic leukemia and indolent lymphoma. To clarify the toxicity profiles of cladribine, we conducted a phase I and pharmacological study of cladribine with a schedule of seven-day continuous intravenous infusion every 28 days up to a maximum of three cycles. We enrolled 10 previously-treated patients with various lymphoid malignancies. No dose-limiting toxicity (grade 4 hematologic and/or grade 3 or more non-hematologic) was observed in the three patients who received 0.06 mg/kg/day (Level 1). Of the seven patients who received 0.09 mg/kg/day (Level 2), one patient developed grade 4 hypoxemia and grade 4 thrombocytopenia, and another developed grade 4 neutropenia. Of the seven patients treated at Level 2, one with cutaneous T-cell lymphoma attained complete remission, and one with mantle cell lymphoma, one with chronic lymphocytic leukemia and one with adult T-cell leukemia-lymphoma attained partial remission. A pharmacokinetic analysis of the seven patients without leukemic cells showed that their area under the concentration versus time curves of plasma cladribine increased dose-dependently from 2661.3 +/- 300.4 nM x h at Level 1 (n = 3) to 3411.3 +/- 341.0 nM x h at Level 2 (n = 4) (P = 0.034). We conclude that the recommended phase II dose of cladribine (0.09 mg/kg/day as a seven-day continuous i.v. infusion) in Caucasian patients can be safely administered to Japanese patients. The encouraging results prompted us to plan subsequent phase II studies of cladribine against adult T-cell leukemia-lymphoma, hairy cell leukemia and indolent lymphoma.

Significant correlation between symptom score and IgG4 antibody titer following long-term immunotherapy for perennial allergic rhinitis

Although there is evidence of some measure of clinical benefit as well as immunologic change during the early phase of immunotherapy, a sustained clinical response is only possible with prolonged therapy. Immunotherapy has to be administered for about 3 to 5 years for such sustained clinical efficacy. This study aimed at investigating the dynamics of IgE and IgG4 antibodies after more than 5 years of immunotherapy, to examine the statistical correlation between these antibodies and symptom scores. Our study demonstrated that the allergen-specific IgE antibody level significantly decreases and the IgG4 antibody level significantly increases following immunotherapy. However, the percent decrease in IgE antibodies did not correlate with the percent decrease in symptom scores. On the other hand, the percent increase in IgG4 antibodies correlated with the percent decrease in symptom scores. We infer that an elevation of IgG4 antibodies is not simply an epiphenomenon unrelated to the underlying working mechanism of clinically successful immunotherapy, but probably makes an active contribution to symptom relief.

[Treatment of full-thickness macular holes with autologous serum]

A total of 29 eyes in 28 patients with stage 2 to 4 idiopathic full-thickness macular hole were treated with autologous serum. Autologous serum (20-30 microliters) was placed over the macular hole followed by injection of 16% perfluoropropane gas. Postoperatively, twenty-eight eyes (97%) had flattening of the macular hole, and the hole was invisible in 27 eyes (93%). Twenty-two eyes (76%) showed visual improvement of at least two lines or more. Preoperative factors such as good visual acuity, earlier stage, and younger age were correlated with postoperative good visual acuity. These results suggest the benefit of autologous serum in the treatment of full-thickness macular holes.

A mutation of the beta 3-adrenergic receptor is associated with visceral obesity but decreased serum triglyceride

The Trp64Arg mutation of the beta 3-adrenergic receptor (beta 3AR) is prevalent in several ethnic groups and is associated with weight gain, and some features of syndrome X such as insulin resistance and dyslipidaemia. Nevertheless, it is not known at present whether this mutation is associated with visceral obesity, which is an important risk factor for the development of hypertension, dyslipidaemia, insulin resistance, non-insulin-dependent diabetes mellitus, and atherosclerosis. To investigate whether this mutation may contribute to visceral obesity, we studied the relationships between beta 3AR genotypes and clinical phenotypes. The Trp64Arg allele of beta 3AR was examined in 278 Japanese men with respect to variables relating to visceral obesity assessed by computerised tomography. To detect the Trp64Arg mutation, polymerase chain reaction-restriction fragment length polymorphism analysis using Bst NI digestion was performed. This mutation was more frequently observed in subjects with higher body mass index (BMI) (p = 0.02). Moreover, in 120 subjects with a moderate degree of obesity (22 < or = BMI < 26.4 kg/m2), the mutation (homozygotes and heterozygotes) was associated with visceral obesity (higher ratio of visceral to subcutaneous fat area; V/S) (p = 0.03). Furthermore, the Trp64Arg allele was more frequent in subjects with lower serum triglyceride levels (p = 0.02) and the Trp64Arg homozygotes, but not heterozygotes, exhibited lower triglyceride levels. Thus, this mutation appears to be associated with visceral obesity but with lower serum triglyceride. It is suggested that those with the mutation may describe a subset of subjects characterized by decreased lipolysis in visceral adipose tissue.

The effect of immunotherapy on the serum levels of eosinophil cationic protein in seasonal allergic rhinitis

The role of serum eosinophil cationic protein levels in allergic rhinitis is controversial. It is also unclear whether with immunotherapy it is possible to reduce these serum levels in allergic diseases. We studied serum eosinophil cationic protein levels in patients with cedar-induced allergic rhinitis and compared them with non-atopic controls. The second aim of this study was to elucidate whether immunotherapy is capable of decreasing the seasonal elevation in serum eosinophil cationic protein levels in seasonal allergic rhinitis. The serum eosinophil cationic protein levels of the untreated patient group were significantly higher than those of the non-atopic controls. The levels in patients who received immunotherapy for 2 yr were also significantly higher than those of the non-atopic controls. However, the levels were not different between the patients undergoing immunotherapy for over 3 yr and the non-atopic controls. The serum levels of the 31 patients treated with immunotherapy correlated with the duration of immunotherapy. In conclusion, the serum eosinophil cationic protein levels are higher in untreated patients with seasonal allergic rhinitis and this seasonal activation in circulating eosiohophils decreases gradually during immunotherapy, but this inhibitory effect becomes apparent only after a number of years of immunotherapy. This prevention of seasonal eosinophil activation is one of the mechanisms responsible for the clinical effect of immunotherapy.