The herbal medicine Dai-Kenchu-Tou stimulates upper gut motility through cholinergic and 5-hydroxytryptamine 3 receptors in conscious dogs

BACKGROUND

The herbal medicine Dai-Kenchu-To, composed of zanthoxylum fruit, ginseng root, and dried ginger rhizome, is clinically effective for uncomplicated postoperative adhesive intestinal obstruction. We investigated the effect of Dai-Kenchu-To and each ingredient on upper gastrointestinal motility and its mechanism of action.

METHODS

Five mongrel dogs were equipped with 4-strain gauge-force transducers on the gastric body, antrum, duodenum, and jejunum to measure contractile activity of the circular muscle. Dai-Kenchu-To (1.5 g) or the separate ingredients zanthoxylum fruit, ginseng root, or dried ginger rhizome (1.0 g each) were administered by bolus into the gastric lumen. The effect of atropine, hexamethonium, phentolamine, propranolol, and ondansetron on intragastric Dai-Kenchu-To-induced contractions was studied.

RESULTS

Intragastric Dai-Kenchu-To induced phasic contractions in the antrum, duodenum, and jejunum. Zanthoxylum fruit elicited phasic contractions mainly in the duodenum and jejunum, whereas dried ginger rhizome induced phasic contractions in the antrum. Ginseng root had no effect. Phasic contractions induced by intragastric Dai-Kenchu-To were inhibited by atropine and hexamethonium at all sites, although ondansetron inhibited these contractions in the antrum and duodenum.

CONCLUSIONS

Intragastric Dai-Kenchu-To stimulates upper gastrointestinal motility through cholinergic and 5-hydroxytryptamine 3 receptors.

Motor dynamics encoding in cat cerebellar flocculus middle zone during optokinetic eye movements

We investigated the relationship between eye movement and simple-spike (SS) frequency of Purkinje cells in the cerebellar flocculus middle zone during the optokinetic response (OKR) in alert cats. The OKR was elicited by a sequence of a constant-speed visual pattern movement in one direction for 1 s and then in the opposite direction for 1 s. Quick-phase-free trials were selected. Sixty-six cells had direction-selective complex spike (CS) activity that was modulated during horizontal (preferring contraversive) but not vertical stimuli. The SS activity was modulated during horizontal OKR, preferring ipsiversive stimuli. Forty-one cells had well-modulated activity and were suitable for the regression model. In these cells, an inverse dynamics approach was applied, and the time course of the SS rate was reconstructed, with mean coefficient of determination 0.76, by a linear weighted superposition of the eye acceleration (mean coefficient, 0.056 spikes/s per deg/s(2)), velocity (5.10 spikes/s per deg/s), position (-2.40 spikes/s per deg), and constant (mean 34.3 spikes/s) terms, using a time delay (mean 11 ms) from the unit response to the eye response. The velocity and acceleration terms contributed to the increase in the reconstructed SS rates during ipsilateral movements, whereas the position term contributed during contralateral movements. The standard regression coefficient analyses revealed that the contribution of the velocity term (mean coefficient 0.81) was predominant over the acceleration (0.03) and position (-0.17) terms. Forward selection analysis revealed three cell types: Velocity-Position-Acceleration type (n = 27): velocity, position, and acceleration terms are significant (P < 0.05); Velocity-Position type (n = 12): velocity and position terms are significant; and Velocity-Acceleration type (n = 2): velocity and acceleration terms are significant. Using the set of coefficients obtained by regression of the response to a 5 deg/s stimulus velocity, the SS rates during higher (10, 20, and 40 deg/s) stimulus velocities were successfully reconstructed, suggesting generality of the model. The eye-position information encoded in the SS firing during the OKR was relative but not absolute in the sense that the magnitude of the position shift from the initial eye position (0 deg/s velocity) contributed to firing rate changes, but the initial eye position did not. It is concluded that 1) the SS firing frequency in the cat middle zone encodes the velocity and acceleration information for counteracting the viscosity and inertia forces respectively, during short-duration horizontal OKR and 2) the apparent position information encoded in the SS firing is not appropriate for counteracting the elastic force during the OKR.

Circulating soluble Fas concentration in breast cancer patients

Fas/Fas ligand (FasL) system, a major regulator of apoptosis, is involved in cancer cell death induced by the immune system and anticancer drugs. Fas is a cell-surface receptor that exists in two forms, transmembrane and soluble. The former induces apoptosis by ligation of FasL or agonistic anti-Fas antibody, whereas the latter inhibits Fas-mediated apoptosis by neutralizing its ligand. In this study, we examined circulating soluble Fas (sFas) concentration in 118 healthy people, 162 primary and 71 recurrent breast cancer patients by ELISA. In the healthy group, men showed higher sFas concentrations than women (P<0.001). In both sexes, sFas levels increased with age, and the age-matched cutoff value was determined. The median sFas concentration in primary and recurrent cancer patients was 0.815 and 1.510 ng/ml, both of which were higher than in normal female controls (0.580 ng/ml; P = 0.024 and P<0.001, respectively). Among primary cancer patients, although no significant correlation was found between sFas concentration and clinical parameters other than menopausal status, high-sFas patients had a worse prognosis than low-sFas patients for both overall and disease-free survival (P = 0.013 and P = 0.032, respectively). The multivariate analysis confirmed that circulating sFas concentration was an independent prognostic indicator (P = 0.020 for overall survival, P = 0.025 for disease-free survival). We looked at the recurrent cancer patients, and sFas levels were higher in patients with liver metastasis compared with those with other recurrent sites (P = 0.010), and high-sFas patients showed a worse prognosis than low-sFas patients (P = 0.037). Our data demonstrate that, compared with healthy female controls, breast cancer patients, especially those with liver metastases, have higher circulating sFas levels. sFas may be useful once these results are confirmed by larger studies.

Budd-Chiari syndrome complicated by hepatocellular carcinoma with no evidence of infection with hepatitis virus: a case report

Hepatocellular carcinoma occurs in patients with Budd-Chiari syndrome. However, the etiology of hepatocellular carcinoma accompanied with Budd-Chiari syndrome has not been elucidated. We report a case of Budd-Chiari syndrome with membranous obstruction of the inferior vena cava complicated by hepatocellular carcinoma in an 80 year-old man. There was no evidence of co-infection with hepatitis A, B, C, D, E, and G virus. Histologically, the non-cancerous liver tissue showed chronic venous congestion with no evidence of hepatitis virus-associated liver cirrhosis. This case suggests that chronic venous congestion of the liver may be one of the pathologic conditions that occurs in hepatocellular carcinoma.

Experimental study of bone formation from autogenous periosteal graft following insulin-like growth factor I administration

The present study evaluates the effect of insulin-like growth factor I (IGF-I) administration on bone formation following grafted periosteum. Twenty-four Japanese white rabbits were randomly assigned into one IGF-I administered group (1 mg for 14 days) and a second control group. Grafted periosteum taken from the tibia was placed under the submandibular muscles. At 14, 21, and 28 days following the operation, the grafted periosteum was extirpated and examined. Throughout all stages of the experiment, active bone formation was confirmed histologically and radiographically in both control and experimental groups. In addition, a micro-CT scan was used to observe three-dimensional micro structures in newly formed bone and to measure the trabecular bone thickness as a marker of bone development. As a result, a significant increase in bone formation in the IGF-I group was observed when compared with the findings in the control group. Trabecular bone thickness in the IGF-I group was significantly greater when compared with the control group at 14 days and 21 days following grafting (P < 0.01). At 28 days following grafting, there were no significant differences, suggesting that administration of IGF-I may play an important role in inducing bone formation from grafted periosteum in the early stages.

Integrin alpha6beta1 plays a significant role in the attachment of hepatoma cells to laminin

BACKGROUND/AIMS

Tumor invasion and metastasis consist of a series of complex events. During this process, the ability of tumor cells to adhere to laminin, a major component of basement membranes, is required at various steps. The expression of laminin-binding integrins and the extent of tumor metastasis and progression appear to be related. In hepatocellular carcinoma, increased expression of laminin-binding integrins is observed. However, little is known concerning the possible functional interactions between laminin-binding integrins and laminin. Therefore, we investigated the participation of laminin-binding integrins in the attachment of hepatoma cells to laminin.

METHODS

Human hepatoma cell lines (KIM-1, KYN-1, 2) were used. We investigated the expression of integrin alpha1, alpha2, alpha3, alpha6, beta1, and beta4 subunits on hepatoma cells by immunocytochemical and flow cytometric analysis. Participation of these integrin subunits in the attachment of hepatoma cells to laminin was evaluated by an inhibition of cell adhesion assay.

RESULTS

Integrin alpha1, alpha2, alpha3, alpha6 and beta1 subunits were expressed at the marginal areas of hepatoma cells, while the integrin beta4 subunit was scarcely detected. Laminin promoted the attachment of hepatoma cells in a dose-dependent manner. Although anti-integrin alpha1, alpha2, beta3 and beta4 subunit antibodies did not inhibit cell attachment to laminin, anti-integrin alpha6 and beta1 subunit antibodies inhibited the attachment by 50% or more.

CONCLUSIONS

These findings indicate that integrin alpha6beta1 is very important in the attachment of hepatoma cells to laminin, suggesting the participation of this integrin in metastasis and invasion of hepatoma cells.

Structure-activity relationships of RGD mimetics as fibrinogen-receptor antagonists

The activities of a series of RGD mimetics, which contained a variety of cationic structures, for the inhibition of platelet aggregation and fibrinogen-receptor binding were measured. The stability of the coulombic ion-pairing complex of the model compounds with the acetate anion as a model for the receptor was calculated in terms of the ionic interaction energy. The results suggest that stability is one of the significant factors which govern the inhibitory potency of fibrinogen-receptor binding. The distance between cationic and anionic groups might also affect the potency. A compound which contained an amidinophenyl structure as the cationic moiety showed exceptionally high inhibitory activity, suggesting that some other factors, in addition to coulombic interaction and the distance, affect the potency.

Turcot syndrome with colonic obstruction and small intestinal invagination: report of a case

We report herein the case of a 16-year-old boy diagnosed as having Turcot syndrome, otherwise known as glioma-polyposis syndrome. The patient was transferred from the Department of Neurosurgery where he was undergoing investigation of a brain tumor, to the Department of Medicine for investigation of gastrointestinal symptoms. The patient was diagnosed as having Turcot syndrome, and was then transferred to the Department of Surgery for treatment of an obstruction in the sigmoid colon and small intestinal invagination. A subtotal colectomy with side-to-end ileoproctostomy and release of the invaginations was carried out. Multiple polyps were found in the colon, two of which, including a large polyp that obstructed the colonic lumen, were confirmed histologically to be adenocarcinoma. The remaining polyps were adenomas. A biopsy of the brain tumor confirmed a diagnosis of astrocytoma (WHO grade II). This case report describes the characteristic features of Turcot syndrome presented by this patient.

Management of urinary complications in Crohn's disease

Among the 127 patients who underwent surgical treatment for Crohn's disease at Tohoku University Hospital, urinary complications were noted in 13 patients (10.2%), including urolithiasis in 6 patients (4.7%), a ureteral obstruction in 4 (3.1%), and urinary fistula in 3 (2.4%). In patients with urolithiasis, conservative therapy was effective. An ureteral obstruction was detected on the right side in all 4 of these cases because of the inflamed terminal ileum. In 2 of the 4 cases, the symptoms improved by either preoperative total parenteral nutrition or elemental diet therapy. A resection of the inflamed intestine was necessary in all cases. In patients with urinary fistulas, a resection of the inflamed intestine combined with a reconstruction of the urinary tract was carried out after total parenteral nutrition. In conclusion, conservative therapy with preoperative total parenteral nutrition or elemental diet therapy proved to be effective for a ureteral obstruction since it improved the intestinal inflammation. As a definitive treatment, surgery is still necessary for the management of urinary fistulas and ureteral obstruction. Based on our findings, patients with urolithiasis in Crohn's disease should thus be treated conservatively in the same way as patients without Crohn's disease.

Postoperative oblique sagittal MR imaging of microvascular decompression for hemifacial spasm

Pre-operative and postoperative oblique sagittal gradient-echo magnetic resonance (MR) imaging was used to evaluate micro-vascular decompression of the facial nerves in 26 patients with hemifacial spasm. The pre-operative MR images were divided into two groups as follows: 22 images in Group I, clear imaging of a high-intensity line and/or spot at the root exit zone (REZ) of the facial nerve; and 4 in Group II, and unreliable image around the REZ. Surgery found that the causative vessel was the vertebral artery (VA) in 9 cases and the anterior inferior cerebellar artery (AICA) or the posterior inferior cerebellar artery (PICA) in 13 cases in Group I, and the AICA or the PICA in the 4 cases in Group II. Postoperative MR imaging showed clear decompression as the high-intensity line and/or spot completely separated from the REZ by a low- and/or iso- intensity area in 9 cases of VA compression repositioned to the petrous dura matter, in 11 cases of PICA or AICA compression treated by shredded Teflon pledgets in Group I and in 3 cases in Group II. Postoperative MR imaging showed an incomplete separation of any high-intensity line and/or spot in the REZ in 2 cases of PICA or AICA compression in Group I and in one in Group II. The outcome was excellent in 22 of 23 cases with clear decompression, and in 1 of 3 cases of unclear decompression. Hemifacial spasm persisted in 3 cases. Oblique sagittal gradient-echo MR imaging is a useful method for postoperative follow-up which can demonstrate changes around the REZ of the facial nerve if hemifacial spasm recurs.

Serum hyaluronan as a predictor of hepatic regeneration after hepatectomy in humans

BACKGROUND

The capacity for hepatic regeneration after hepatectomy is important for allowing surgeons to determine the appropriate extent of resection. However, conventional preoperative liver function tests are unsatisfactory for estimating the post-operative regenerative capacity of the remnant liver. The aim of this study was to evaluate the relationship between preoperative serum hyaluronan and hepatic regeneration.

METHODS

Preoperative serum hyaluronan levels and the hepatic regeneration rate were estimated in 49 patients using computerized tomographic volumetry. The hepatic fibrotic rate was calculated with non-tumorous tissues stained with Azan-Mallory. Immunolocalization of factor VIII-related antigen (FVIIIAg) was examined as a marker for hepatic sinusoidal capillarization.

RESULTS

The serum hyaluronan level was significantly correlated with the hepatic regeneration rate (P < 0. 001). Patients with serum hyaluronan levels below 200 ng mL-1 exhibited a significant correlation between the hepatic regeneration rate and the hepatic fibrotic rate. However, patients with serum hyaluronan levels above 200 ng mL-1 did not demonstrate a distinct correlation. The hepatic regeneration rate of patients with FVIIIAg in the liver and serum hyaluronan levels above 200 ng mL-1 were very low compared with those without FVIIIAg (P < 0.001). Multiple regression analysis revealed that serum hyaluronan was a significant predictor of post-operative hepatic regeneration among several clinical variables (r = 0.857, R2 = 0.735).

CONCLUSION

It has been suggested that hepatic regeneration is closely related to both hepatic fibrosis and hepatic sinusoidal capillarization. The serum hyaluronan level is regarded as a useful predictor for hepatic regeneration after hepatectomy.

Laparoscopic distal pancreatectomy with preservation of the spleen

We describe a case of chronic pancreatitis treated by laparoscopic distal pancreatectomy with conservation of the spleen involving the resection of the splenic vessels. A proximal ligation of the splenic artery and vein was performed, followed by transection of the body of the pancreas. Retroperitoneum was dissected to the left by mobilizing the stump of the transected pancreas. The entire distal pancreas was freed posteriorly. The distal splenic artery and vein were ligated and divided individually adjacent to the tail of the pancreas at the hilum of the spleen. The points of this operation were to ligate the splenic artery and vein at both sides of the resected pancreas and to save the spleen with the blood supply continuing through the short gastric vessels and the splenocolic ligament. This operation with splenic preservation is more suitable for a patient who is a candidate for laparoscopic distal pancreatectomy, which will minimize the operation time, preserve the useful immunologic role of the spleen, and obtain the intact resected specimen. Furthermore, this procedure is useful in chronic pancreatitis patients because it avoids the difficult dissection of the posterior pancreas off of the splenic vessels.

Monitoring and antibacterial treatment for postoperative bacterial overgrowth in Crohn's disease

PURPOSE

Bacterial overgrowth sometimes complicates the clinical course of Crohn's disease and may lead to inappropriate treatment. To clarify the effect of antibiotic therapy, we monitored the hydrogen concentration in expiratory breath after fasting.

METHODS

We evaluated 18 patients (15 males; median age, 32.7; range, 22.3-60 years) for postoperative bacterial overgrowth symptoms and for intestinal dilation by plain abdominal x-ray. Five patients had ileitis and 13 patients had ileocolitis. Various intestinal resections were performed in all, and strictureplasties were done at the same time in 13 patients. The median postoperative period was 10.2 (range, 1.2-102) months. Nine patients, who had symptoms such as bloating, nausea, vomiting, or pain, were classified as the symptomatic group, whereas nine other patients, who had no symptoms, were classified as the symptom-free group. Sixteen patients who had undergone intestinal resections for noninflammatory bowel disease served as the control group. After overnight fasting, hydrogen concentration in end-expiration, breath was measured with gas chromatography. At the same time clinical examinations of white blood cell count, hemoglobin, total protein, serum albumin, iron, sialic acid, and C-reactive protein in the peripheral blood were performed. To assess the effect of antibacterial treatment, changes in symptoms were assessed in eight patients who received antibacterial treatment. Hydrogen concentration was measured repeatedly before and after treatment in six patients.

RESULTS

The symptomatic group had an expiratory hydrogen concentration level significantly higher (median, 40; range, 20-139 ppm) than the control group (median, 3; range, 1-6 ppm) and the symptom-free group (median, 4; range, 1-10 ppm). After the antibiotic treatment the symptoms were improved in all of the patients, and the hydrogen concentration level was significantly reduced (median, 4.5; range, 2-13 ppm).

CONCLUSIONS

Antibacterial treatment was useful in the postoperative patients whose assessments were complicated by bacterial overgrowth. Using a hydrogen breath test, bacterial overgrowth was effectively monitored and managed, effecting a change in clinical symptoms.

JE-2147: a dipeptide protease inhibitor (PI) that potently inhibits multi-PI-resistant HIV-1

We designed, synthesized, and identified JE-2147, an allophenylnorstatine-containing dipeptide HIV protease inhibitor (PI), which is potent against a wide spectrum of HIV-1, HIV-2, simian immunodeficiency virus, and various clinical HIV-1 strains in vitro. Drug-resistant clinical HIV-1 strains, isolated from seven patients who had failed 9-11 different anti-HIV therapeutics after 32-83 months, had a variety of drug-resistance-related amino acid substitutions and were highly and invariably resistant to all of the currently available anti-HIV agents. JE-2147 was, however, extremely potent against all such drug-resistant strains, with IC(50) values ranging from 13-41 nM (<2-fold changes in IC(50) compared with that of wild-type HIV-1). The emergence of JE-2147-resistant HIV-1 variants in vitro was substantially delayed compared with that of HIV-1 resistant to another allophenylnorstatine-containing compound, KNI-272, and other related PIs. Structural analysis revealed that the presence of a flexible P2' moiety is important for the potency of JE-2147 toward wild-type and mutant viruses. These data suggest that the use of flexible components may open a new avenue for designing PIs that resist the emergence of PI-resistant HIV-1. Further development of JE-2147 for treating patients harboring multi-PI-resistant HIV-1 is warranted.

Lack of repetition priming effect on visual event-related potentials in schizophrenia

BACKGROUND

The present study was designed to assess, using event-related potentials, whether aberrant semantic processing reported in schizophrenia results from primary semantic overactivation or contextual dysregulation.

METHODS

The visual event-related brain potentials were compared between 9 schizophrenic subjects and 16 normal control subjects performing two kinds of semantic categorization tasks with different nontarget stimuli: 1) nontargets comprising words, pseudowords, and unpronounceable foreign letters and 2) nontargets comprising initial presenting words, immediate repetition words, and delayed repetition words.

RESULTS

Schizophrenic subjects showed no evidence suggestive of a greater negative potential associated with words and pseudowords, but they did show a lack of amplitude change associated with immediately repeated words relative to that in control subjects.

CONCLUSIONS

These results suggest that aberrant semantic activation in schizophrenia results mainly from a failure to utilize information from preceding words or context, and could explain the increased N400 to the congruent or related words recently reported in this disease.

Presence of defensin in epithelial Langerhans cells adjacent to oral carcinomas and precancerous lesions

We aimed to immunohistochemically study the localization of defensin (HNPs), a family of peptides with antimicrobial and cytotoxic activity, in oral tumor tissue. Therefore, tissue sections were embedded in paraffin, and defensin was immunostained by the streptavidin-biotin coupled peroxidase method. Langerhans cells were confirmed by indirect immunostaining with anti-S-100 protein polyclonal antibody. Melanocytes were stained with Fontana-Masson's stain. Neutrophils and intimal cells were stained by anti-defensin antibody. Langerhans cells in normal epithelium or dysplasic epithelium adjacent to squamous cell carcinoma and precancerous lesion were also stained. Defensins (HNPs) are nonspecific peptides that occur in neutrophils and protect against bacteria, fungi, and tumor cells. Since defensins are also found in epithelial Langerhans cells adjacent to tumor tissue, these peptides most likely have a role in tumor immunity.

Sialylated MUC1 mucin expression in normal pancreas, benign pancreatic lesions, and pancreatic ductal adenocarcinoma

BACKGROUND/AIMS

Pancreatic cancer has the poorest prognosis of all gastrointestinal cancers. Because sialylated mucin influences the biologic behavior of carcinoma cells, we investigated sialylated MUC1 mucin expression in patients with pancreatic ductal adenocarcinoma.

METHODOLOGY

The expression of sialylated MUC1 mucin was examined in 55 pancreatic ductal adenocarcinomas, 2 normal pancreas specimens, 3 chronic pancreatitis specimens, 1 ductal hyperplasia of the pancreas, 3 mucinous cystadenomas, and 2 liver metastases from pancreatic ductal adenocarcinoma. Expression was assessed by immunohistochemistry with a new monoclonal antibody (mAb) (MY.1E12).

RESULTS

Sialylated MUC1 mucin was expressed in the cancer cell membrane in all the ductal carcinomas. The reaction product was seen at the apical aspect of cells when these were in tubule formation. This pattern was also detected in mucinous cystadenomas. However, it was seen diffusely in the cell membrane in single cancer cells or small clusters of cells without tubule formation and in metastatic liver tumors. Namely, invading or metastatic cancer cells expressed this type of mucin throughout the entire cell membrane. The expression of sialylated MUC1 mucin was not observed in specimens from normal pancreas, chronic pancreatitis, or ductal hyperplasia of the pancreas. In normal pancreas and these lesions, expression of sialylated Mession of sialylated MUC1 was limited to acini and secreted mucin.

CONCLUSIONS

Sialylated MUC1 mucin, which is expressed throughout the cancer cell membrane, may be a factor in the metastatic potential of pancreatic ductal adenocarcinoma.

Palmaz-Schatz stent for hepatic artery stenosis during hepatic arterial infusion chemotherapy

Hepatic arterial infusion chemotherapy using an implantable port system was performed on a 40 year-old man with advanced hepatocellular carcinoma. When the in-dwelling catheter was inserted into the common hepatic artery (CHA), intimal dissection occurred as a result of the catheterization causing severe stenosis. On day 55 after intimal dissection, an in-dwelling Palmaz-Schatz stent was inserted after percutaneous transluminal angioplasty (PTA). CHA blood flow was shown to have improved on Digital subtraction angiography (DSA) and Doppler ultrasound after the in-dwelling Palmaz-Schatz stent. Thus a partial response was shown. The DSA from the implantable port system showed adequate patency 6 months after. This is the first report describing the usefulness of a Palmaz-Schatz stent for the severe stenosis of the CHA caused by the technique of catheterization.