[Evaluation of combination chemotherapy for advanced gastric carcinoma as a neoadjuvant chemotherapy with CDDP, MMC, etoposide and 5'-DFUR]

Seven cases of nonresectable gastric carcinoma with lymph node metastasis were treated with combination chemotherapy [CDDP 75 mg/m2 i.v. day 1 (A method: Ccr > or = 50 ml/min) or 20 mg/m2 i.v. day 1, 2, 4, 5 (B method: Ccr < 50 ml/min), MMC 10 mg/m2 i.v. day 1, etoposide 50 mg/body i.v. day 3, 4, 5, 5'-DFUR 2,100 mg/body po 4 day/week] every 4 weeks as a neoadjuvant chemotherapy. After treatment, the size of the primary tumor was reduced in four of seven cases. The lymph nodes disappeared in one case and were reduced in size in four cases. Metastatic liver tumors were found in four cases. They disappeared in one case and the size was reduced in one of seven cases. One patient with renal dysfunction was treated with B method. However, renal dysfunction did not become worse. Five patients were operated after chemotherapy. Absolute curative resection was performed in three of them. The total rate of curative resection was 43% (3/7). Four patients were alive for 19 months after operation. The main side effects of this therapy were nausea, anorexia and bone marrow suppression, which, were found in all patients. These results suggest that this combination chemotherapy is as effective as neoadjuvant chemotherapy for advanced gastric carcinoma.

Correlation of asymmetry of visual field loss with optic disc topography in normal-tension glaucoma

OBJECTIVE

To compare the differences in optic disc configuration with different stages of visual field loss in normal-tension glaucoma.

DESIGN

Interocular pairwise comparisons.

SETTING

Glaucoma clinic of a teaching hospital.

PATIENTS

Thirteen patients with normal-tension glaucoma and asymmetric visual field loss of at least 2.5 dB in the mean defect of the visual field indexes.

INTERVENTIONS

Areas under the optic disc profiles mapped from values for radial sections of the optic disc measured at intervals of 30 degrees and expressed as percentages of the area of a rectangle were obtained from stereophotographs with a computerized image analysis system. Visual fields were tested with automated perimetry (OCTOPUS), using program G1.

MAIN OUTCOME MEASURE

Correlation analyses between the interocular differences in the areas under the optic disc profile and the interocular differences in the visual field indexes.

RESULTS

The correlation coefficients between the interocular differences in mean defect and those of the area under the optic disc profile in the superior to temporal sections ranged from -.71 to -.61 (.007 < P < .028). The interocular differences in loss variance correlated with the differences in the area under the optic disc profile in the superior section (r = -.61, P = .0252).

CONCLUSION

The differences in visual field loss between the two eyes in normal-tension glaucoma appear mainly to reflect morphometric changes in the superior half of the optic disc.

[Primary culture of bovine adrenocortical cells]

The isolated bovine adrenocortical cells are prepared aseptically by the use of collagenase and deoxyribonuclease. The isolated cells are suspended in Ham F-10 medium containing 5% fetal calf serum, 10% newborn calf serum, 2.5% horse serum and antibiotics. The seeded cells are cultured at 37 degrees C in a humidified atmosphere of 5% CO2 in air. Steroidogenic activity for ACTH reached the maximum in the 2- to 3-day primary cultured cells; the maximum response to ACTH in these cells is more intense than that in freshly isolated bovine adrenocortical cells. The primary cultured cells have prostaglandin, muscarinic, ATP and beta-adrenergic receptors that are linked to steroidogenesis in addition to ACTH and aldosterone receptors. Thus primary cultured bovine adrenocortical cells are a useful tool to study these receptors and the intracellular events that are associated with the receptors. We also demonstrated that the fura 2 loaded primary cultured monolayer cells on glass cover slips provide us much more information than suspended cells in the study of intracellular Ca2+ mobilization in adrenocortical cells.

Effects of fluoride intake on the mineral content, acid solubility and resorption caused by experimental periodontitis of rat alveolar bone

Adult rats were given either distilled water or drinking water containing 100 parts/10(6) of fluoride. The alveolar bone of rats given fluoride for 90 days showed an increased mineral content and decreased acid solubility compared to the bone of rats given distilled water. Experimental periodontitis was initiated in both groups after 110 days of treatment to cause alveolar bone resorption. Fourteen days later, the rats were killed and it was found that the alveolar bone resorption caused by experimental periodontitis was significantly smaller in the rats given fluoride in their drinking water than in those given distilled water. The findings suggest that fluoride intake might have a protective effect on rapidly progressing alveolar bone resorption.

Effects of Houttuyniae cordata and refinery final molasses on the development of offensive odor in porcine small intestine during storage

Porcine small intestine evolved a specific offensive odor only 0.5 to 1 day after storage at 20 degrees C. We investigated the effects of Houttuyniae cordata (dokudami), refinery final molasses (RFM), green tea, and brown sugar on the evolution of methylmercaptan and ethanol, which were the main components of the volatiles which evolved from porcine small intestine in storage. Furthermore, we determined their antibacterial effect and deodorant activity against methylmercaptan, as possible factors in reducing the offensive odor. Addition of those materials reduced the offensive odor during storage. In particular, dokudami, green tea, and RFM markedly suppressed the evolution of methylmercaptan. RFM was most effective in suppressing the growth of bacteria. Dokudami had the highest deodorant activity, comparable to that of perilla leaves. However, the retardation of methylmercaptan evolution in situ cannot be simply explained by either of deodorant or antibacterial effect. It seems likely that the combined action of both effects affects the evolution of methylmercaptan in situ.

Overexpression of human lipoprotein lipase enhances uptake of lipoproteins containing apolipoprotein B-100 in transfected cells

To investigate the role in lipoprotein metabolism of lipoprotein lipase (LPL) secreted by tissues, we established two cell lines. Fusion plasmids containing either human LPL cDNA or antisense LPL cDNA under control of the cytomegalovirus promoter were transfected into Chinese hamster ovary (CHO) cells, designated as CHO-LPL and CHO-anti-LPL, respectively. CHO-LPL constitutively produced a high level of LPL, whereas CHO-anti-LPL produced a minimal level. When very-low-density lipoprotein (VLDL) was incubated with CHO-LPL, VLDL triglycerides were hydrolyzed, intermediate-density lipoprotein (IDL) was produced, and apolipoprotein E contents increased. CHO-LPL took up and degraded 125I-VLDL at 37 degrees C four times more strongly than did CHO-anti-LPL. Whereas the degradation of apolipoprotein E-deficient VLDL was only 12% that of normal VLDL in CHO-LPL, structural changes of the lipoprotein, including apolipoprotein E expression on the lipoprotein surface, may be important for the cellular uptake of VLDL. Furthermore, we found that binding at 4 degrees C of VLDL and LDL to CHO-LPL was greater than to CHO-anti-LPL, and this binding difference was abolished by washing the cells with heparin. This suggests that cell surface LPL plays a role in the binding of lipoproteins to the cells. We conclude that both the composition of VLDL particles and their cellular binding are influenced by LPL secreted by cells, both of which may enhance the cellular uptake of VLDL.

Serum concentration of 7S collagen and prognosis in patients with the adult respiratory distress syndrome

BACKGROUND--7S collagen, an N-terminal peptide of type IV collagen, is a primary constituent of the basement membrane. To evaluate whether the serum concentration of 7S collagen reflects the severity of inflammatory lung disease, the serum concentration of 7S collagen was measured in patients with adult respiratory distress syndrome (ARDS) and idiopathic pulmonary fibrosis (IPF). METHODS--A radioimmunoassay was used for the measurement of 7S collagen. Gas exchange abnormality was expressed as the arterial oxygen tension (PaO2) divided by the fractional concentration of inspired oxygen (FiO2). RESULTS--The mean (SD) concentration of 7S collagen was 2.7 (0.9) ng/ml in 10 healthy subjects, 5.0 (1.5) ng/ml in 11 patients with IPF, and 14.8 (9.7) ng/ml in 13 patients with ARDS. Significant differences were observed between the patients with ARDS and both healthy subjects and the patients with IPF. In the patients with ARDS serum concentrations of 7S collagen were strongly related to PaO2/FiO2 (r = -0.61). Moreover, the mean (SD) serum concentration of 7S collagen in the eight patients with ARDS who died (19.5 (10.2) ng/ml) was considerably higher than that of the five who survived (7.1 (2.1) ng/ml). CONCLUSION--These results suggest that serum levels of the 7S fragment of type IV collagen may have some prognostic value in ARDS.

Inhibition of low density lipoprotein oxidation in vitro by the 6- and 7-hydroxy-metabolites of doxazosin, an alpha 1-adrenergic antihypertensive agent

Antioxidants may be of use in the prevention of coronary artery disease by inhibiting low density lipoprotein (LDL) oxidation, a process that is believed to play an important role in atherogenesis. Because the structures of the 6- and 7-hydroxy-metabolites of doxazosin, an alpha 1-adrenergic-blocking antihypertensive agent, suggest that they might have antioxidant properties, studies were performed to determine whether these metabolites inhibit LDL oxidation. Micromolar concentrations of 6- and 7-hydroxydoxazosin, but not doxazosin itself, inhibited Cu(2+)-mediated oxidative modification of LDL in a dose-dependent fashion, similar to that observed with the lipophilic antioxidant, probucol. LDL modified in the presence of these metabolites was not taken up and degraded by macrophages to the same extent as LDL oxidized in their absence. In contrast to probucol, the antioxidant effect was lost after reisolation of LDL incubated with the metabolites. Whereas probucol, like vitamin E, sequesters with LDL, 3H-labeled 6- and 7-hydroxydoxazosin did not comigrate with lipoproteins on FPLC, but were associated with albumin and occurred free in solution. Thus, these metabolites of doxazosin may exert their antioxidant effect in the aqueous milieu of the lipoprotein, similar to vitamin C, and may be useful for the prevention of atherosclerosis in hypertensive individuals.

Phenytoin, an antiepileptic drug, competitively blocked non-NMDA receptors produced by Xenopus oocytes

The blocking effect of phenytoin (PHT) and other antiepileptic agents on the glutamate receptors was investigated under voltage-clamp conditions using Xenopus oocytes that translated ddY-stock mouse brain mRNA. PHT shifted the concentration-response curve for kainate to right without significant block on the maximum response obtained, indicating that PHT competitively blocks the non-NMDA receptors. An apparent dissociation constant of PHT was 1.9 x 10(-4) M. The block was voltage-independent. Other antiepileptic agents examined hardly blocked the kainate responses except phenobarbital that blocked the responses. The possibility that the competitive block constitutes a part of the antiepileptic action of PHT was discussed.

Mass propagation of shoots of Stevia rebaudiana using a large scale bioreactor

A procedure for the mass propagation of multiple shoots of Stevia rebaudiana is described. Isolated shoot primordia were used as the inoculum to obtain clusters of shoot primordia. Such clusters were grown in a 500 liter bioreactor to obtain shoots. A total of 64.6 Kg of shoots were propagated from 460 g of the inoculated shoot primordia. These shoots were easily acclimatized in soil.

Development of a method for embedded-culture of pig pancreatic islet-like cell clusters in agarose containing maltose-carrying polystyrene (HEVM) and nicotinamide

A method for embedded-culture of islet-like cell clusters (ICCs) from neonatal pig pancreas is described. The procedure is based on a sequential treatment of the pancreas with a proteolytic enzyme and ethylenediaminetetraacetate (EDTA). During the exposure to EDTA-Dispase, small pieces of pancreas were gradually digested, with gentle stirring. Under- and over-digested pancreatic cell clusters were separated from the pancreatic fragments by filtration, and formed whole islet-like cell clusters in RPMI 1640 containing 11.0 mM D-glucose and 10% fetal bovine serum (FBS). The ICCs were embedded in agarose with or without a gel containing a random copolymer hydroxethylmethacrylate-vinylbenzyl maltonamide (HEVM) of hydroxethylmethacrylate-(HEMA)-vinylbenzyl maltonamide (VMA) and nicotinamide. They remained morphologically intact and a physiological response to acute stimulation with glucose was obtained when they were embedded in the agarose containing HEVM and nicotinamide. These findings suggest that ICCs in agarose containing HEVM and nicotinamide could be a useful tool for morphological, biochemical and molecular biological studies, and also as a potential source of material for transplantation.

[Echocardiographic observation of intraoperative circulatory collapse in a patient with hypertrophic obstructive cardiomyopathy]

Two-dimensional Doppler echocardiography was used as an intraoperative cardiac function monitor in anesthetic management of a 79-year-old male with hypertrophic obstructive cardiomyopathy (HOCM) who underwent pulmonary lobectomy for lung cancer. Circulatory collapse occurred after thoracic epidural anesthesia (TEA), and was aggravated with following induction of general anesthesia. The collapse did not improve with phenylephrine nor atropine and necessitated ethylephrine and dopamine. During the above course, left ventricular outflow tract pressure gradient measured with continuous wave Doppler method was almost in proportion to cardiac output measured with thermo-dilution method. This means that TEA and the administration of inotropics did not worsen the left ventricular outflow tract obstruction. Left ventricular filling property estimated by trans-mitral flow velocity spectra improved when hemodynamics was stabilized with continuous infusion of dopamine, while it had been impaired during preoperative period and at the beginning of anesthesia. Our observation suggests that TEA for HOCM patient is a relative indication because it may exert negative inotropic effect, and that careful titration with inotropics is not contraindicated when undesired cardiac depression is proved by echocardiography.

Bronchoplastic procedures for tuberculous bronchial stenosis

Thirty-six patients underwent tracheobronchoplastic procedures for treatment of tuberculous tracheobronchial stenosis. The modes of operations were left upper sleeve lobectomy in 13 patients, sleeve resection of the left main bronchus in 12 patients (two underwent concomitant left upper lobectomy), right upper sleeve lobectomy in five patients, sleeve resection of the right intermediate bronchus in two patients, right sleeve superior segmentectomy of the lower lobe in one patient, sleeve resection of the trachea with concomitant left pneumonectomy in one patient, carinal resection with right upper sleeve lobectomy and middle lobectomy in one patient, and dilatation of the left main bronchus with a free skin graft reinforced with a steel wire in one patient. One patient died of pulmonary edema of unknown cause on the first postoperative day. Anastomotic stenosis occurred in seven patients. One of these patients underwent reoperation and six underwent endoscopic dilatation. One patient died in the hospital of massive bleeding during endoscopic dilatation 4 months after operation. Slight to moderate stenosis resulted in the remaining patients. Although there are some complications, we believe bronchoplastic operation is worthwhile for restoring pulmonary function in patients with tuberculous tracheobronchial stenosis.

Oxidation of low density lipoprotein by thiols: superoxide-dependent and -independent mechanisms

Oxidatively damaged low density lipoprotein (LDL) may cause macrophages to accumulate cholesterol in an unregulated manner, initiating the development of atherosclerotic lesions. Cultured smooth muscle cells oxidize LDL by a superoxide (O2.-)-dependent mechanism that requires L-cystine and redox-active transition metal ions in the incubation medium. To test the hypothesis that cellular reduction of L-cystine to a thiol might be involved, we exposed LDL to L-cysteine, glutathione, and D,L-homocysteine. In a cell-free system each thiol modified LDL by a pathway that required either Cu2+ or Fe3+. Thiol- and Cu(2+)-modified LDL underwent lipid peroxidation and exhibited a number of properties of cell-modified LDL, including increased mobility on agarose gel electrophoresis and fragmentation of apolipoprotein B-100. Superoxide dismutase inhibited modification of LDL by L-cysteine/Cu2+, whereas catalase and mannitol were without effect. In striking contrast, superoxide dismutase had little effect on oxidation of LDL by Cu2+ and either homocysteine or glutathione. Moreover, only L-cysteine/Cu(2+)-modified 125I-labeled LDL was degraded more rapidly than 125I-labeled LDL by human monocyte-derived macrophages: superoxide dismutase in the reaction mixture blocked the facilitated uptake of L-cysteine/Cu(2+)-modified 125I-labeled LDL, suggesting involvement of O2.-. These results indicate that LDL oxidation by L-cysteine and Cu2+ requires O2.- but not H2O2 or hydroxyl radical. The reaction may involve the metal ion-dependent formation of L-cystine radical anion which is oxidized by oxygen, yielding O2.- and the disulfide. LDL modified by L-cysteine and smooth muscle cells exhibit similar physical and biological properties, indicating that thiol-dependent generation of O2.- may be the oxidative mechanism in both systems. Thiols also promote lipid peroxidation by O2(.-)-independent reactions but human macrophages fail to rapidly degrade these oxidized LDLs.

[Multidisciplinary treatment for a patient with recurrent thymoma associated with myasthenia gravis (MG), pure red cell aplasia (PRCA), and hypogammaglobulinemia]

The patient is 62-year-old female. When she was 43 years old, MG occurred. At age of 49 years thymoma was found and complete thymectomy (stage III) and postsurgical irradiation were performed. At age of 57 years pleural dissemination of the thymoma was found. Chemotherapy was effective but did not obtain total tumor cell kill. Though chemotherapy has been repeated for each tumor regrowth, the regimen used at first recurrence became ineffective and the interval between tumor regrowth became shorter. This year, when she is 62 years old, PRCA and hypogammaglobulinemia were accompanied with the forth tumor regrowth.

Expression of platelet-derived growth factor beta receptor on human monocyte-derived macrophages and effects of platelet-derived growth factor BB dimer on the cellular function

Platelet-derived growth factor (PDGF) plays an important role in the process of atherosclerosis which is characterized by the presence of macrophage-derived foam cells. In the present study, the induction of the mRNA of PDGF-beta receptor was demonstrated during cell differentiation of human monocyte-macrophages, whereas no mRNA was detected in the cells during the early days of culture. Flow cytometry analysis using antibodies specific for PDGF-beta receptor and CD14 showed the presence of both PDGF-beta receptor and CD14 on human monocyte-derived macrophages, whereas no PDGF-beta receptor was detected on human monocytes 4 h after cell adhesion to a culture dish. In the binding assay of PDGF-BB on human monocyte-derived macrophages, a saturable and high affinity binding site with Kd of 27.5 pM and Bmax of 23.3 fmol/mg of cell protein was demonstrated. When human monocytes were cultured in the presence of the protein kinase C inhibitor staurosporine, PDGF-beta receptor induction was inhibited, and tetradecanoylphorbol acetate enhanced PDGF-beta receptor expression in human monocyte-derived macrophages, indicating that PDGF-beta receptor expression is associated with maturation and differentiation of monocyte-macrophages through the activation of protein kinase C. In response to PDGF-BB homodimer, PDGF-beta receptor was phosphorylated, and thymidine uptake and inositol trisphosphate production were stimulated in monocyte-derived macrophages. Furthermore, PDGF-BB suppressed the production of macrophages colony-stimulating factor in macrophages. The expression of PDGF-beta receptor on human monocyte-derived macrophages suggests that PDGF influences the process of atherosclerosis by regulating the function of macrophages as well as smooth muscle cells in the vascular wall.

Transmigration routes and a delayed systemic hypotension in rats after intraperitoneal injection of endotoxin from Escherichia coli

An intraperitoneal injection of endotoxin (ETX; 3 mg/kg) to rats caused gradual decrease in the systemic arterial blood pressure for up to 3 hr, together with decrease in heart rate, increase in hematocrit, and changes in the core temperature (an initial increase and a subsequent decrease). Pretreatment of rats with indomethacin (10 mg/kg, p.o.) prevented the decrease in the systemic blood pressure and the changes in other three parameters. The intraperitoneal injection of ETX also induced a gradual increase in exudation of plasma for up to 3 hr, with increased levels of prostaglandin (PG) E2 and 6-keto-PGF1 alpha in the peritoneal exudate. Indomethacin inhibited the exudation of plasma. The levels of ETX in the arterial and portal venous plasmas began to increase 5 min after the intraperitoneal injection of ETX, and reached levels on the order of micrograms per milliliter plasma 10-20 min after the injection. The levels of ETX in the right and left thoracic lymph nodes, but not in the mesenteric lymph nodes, increased in parallel with those in the systemic arterial plasma. In conclusion, the delayed hypotension may be attributable to the mesenteric vasodilatation induced by PGs generated in the peritoneal cavity, and the ETX injected entered the systemic circulation mainly through lymphatic vessels, but in the initial stage, a part of ETX may be transmigrated into portal vein through damaged intestine.

Bone morphogenetic protein-induced muscle- and synovium-derived cartilage differentiation in vitro

Muscle- and synovium-derived mesenchymal-type cells differentiated into cartilage in response to a coating of partially purified rabbit bone morphogenetic protein (BMP) on a substratum of plastic. Observed by means of phase contrast microscopy, light microscope histochemistry, and electron microscopy, the sequence of events on a BMP-coated plastic substratum is the same as that observed on a substratum of bone matrix. The plastic eliminates the possibility of any endogenous allogeneic matrix-derived BMP contaminating the system. The differentiation of cartilage from synoviocytes and subsynovial cells resembles the pathologic process occurring in human chondromatosis.

Scintigraphic study on the distribution of radiolabeled cis-diamminedichloroplatinum (II) in the tumor-bearing rabbit: a comparison between intra-arterial injection with lipiodol and intravenous injection

To compare the distribution of cis-diamminedichloroplatinum (II) (CDDP) on scintigraphic images between intra-arterial injection with lipiodol and intravenous injection, we obtained serial scintigraphic images using radiolabeled CDDP (Pt-195m CDDP), which had a high specific activity (7.4 x 10(6) Bq [200 microCi]/mg-CDDP), in the rabbit VX-2 tumor system. A dose of 9.25 x 10(6) Bq (250 microCi) of Pt-195m CDDP was injected at one shot via an ear vein, while 7.4 x 10(6) Bq (200 microCi of Pt-195m CDDP mixed with 1 ml of lipiodol was injected at one shot via a saphenous artery. Mean pixel count, which was corrected for the total dose injected, in the arterially injected tumor always exceeded than that in the intravenously injected tumor. Pt-195m CDDP uptake by the rabbit tumor at 2 hr was 7.8% of the total injected dose with intravenous injection and 16.0% with intra-arterial injection. These data suggest that intra-arterial injection with lipiodol is a more useful method to increase CDDP uptake by tumors than intra-venous injection.

Mutations of the p53 gene are involved in Ewing's sarcomas but not in neuroblastomas

We have investigated the frequency of p53 gene mutations in Ewing's sarcoma (ES) and neuroblastoma (NB) by using polymerase chain reaction-single strand conformation polymorphism analysis for genomic DNA or complementary DNA generated from total RNA. Mutations of the p53 gene were found in six of seven ES cell lines: a missense mutation of TGC (Cys)-->TAC (Try) at codon 141 in one, a missense mutation of CGT (Arg)-->TGT (Cys) at codon 273 in one, a missense mutation of TGC (Cys)-->TTC (Phe) at codon 176 in three, and one base deletion of CGC-->CG at codon 283 in one. Further analysis of 14 ES and related primary tumors showed mutations of the p53 gene in only two: one base insertion of CCG-->CCCG at codon 152 in one and a missense mutation of GGC (Gly)-->GTC (Val) at codon 154 in the other. Both of the two tumors were obtained from patients with an advanced stage disease. Three of the eight ESs with mutations of the p53 gene showed the same missense mutation at codon 176, suggesting the mutational hot spot of the p53 gene in ESs. In contrast to ES, none of 6 NB cell lines or 48 NB tumors including advanced-stage ones with or without N-myc amplification showed any aberration of the p53 gene. Our findings suggest that mutations of the p53 gene in ES might represent late genetic events related to tumor progression, and that aberrations of the p53 gene might not be involved in the development or the progression of NB.