An alpha-chain TCR CDR3 peptide can enhance EAE induced by myelin basic protein or proteolipid protein

Regulation of experimental autoimmune encephalomyelitis (EAE) can be induced by anti-idiotype immunity against T cell receptor (TCR) fragments associated with major histocompatibility complex (MHC) molecules. However, we have recently found that preimmunization with an alpha-chain TCR CDR3 peptide (LYFCAARSNYQL) derived from myelin basic protein (MBP)-specific clones did not suppress but rather augmented the severity of EAE induced by MBP-specific T cells in SJL/J mice. To test whether CDR3 vaccination could control only a highly restricted T cell population, we studied the effect of the peptide against EAE induced by T cells specific for different Ag/MHC ligands and autoimmune diseases affecting non-neural tissues. In contrast to expectations, the peptide was found to augment not only EAE induced by MBP-specific T cells, but also proteolipid protein (PLP)-specific T cell- or PLP peptide-induced EAE in SJL/J mice, and MBP-induced EAE and adjuvant arthritis (AA) in rats. The CDR3 peptide was neither inhibitory nor supportive for Ag-induced activation of an encephalitogenic clone in vitro. In addition, the peptide treatment neither inhibited the induction of Ag-specific T cells nor altered the APC function of spleen cells. These findings, on the one hand, confirm previous results showing TCR peptide-induced enhancement of the disease and, on the other hand, indicate that the TCR CDR3 peptide may control T cells with broader Ag/MHC specificities than could be expected. Structural similarity among TCR idiotypes of autoimmune T cells may partly account for these results.

[Clinical experience of the Er: YAG laser for apicoectomy]

Recently, the Er: YAG laser has attracted attention because of its possibility of cutting hard tissue with extremely small thermal injuries. In this paper, eight cases (thirteen teeth) of apicoectomy using Er: YAG laser are reported. All procedures were performed without using air turbin or electric drill. The advantages of Er: YAG laser application include: absence of uncomfortable vibration: less chance for contamination of the surgical site: and reduced risk of trauma of adjacent tissue compared with ordinary methods.

Application of non-radioactive europium (Eu3+) release assay to a measurement of human natural killer activity of healthy and patient populations

Europium (Eu3+) release assay is a non-radioactive method for a measurement of cytotoxicity of lymphocytes and has several advantages compared with a conventional 51Cr release assay. However, the Eu3+ release assay has not been applied to a natural killer (NK) activity measurement of a large number of the human population mainly due to a lack of comparability with the 51Cr release assay. With some modifications of the procedures and careful manipulation of cells, constant and reproducible results were obtained by the Eu3+ release assay. NK activity of several individuals was measured by the Eu3+ release assay and was compared with data obtained by 51Cr release assay performed simultaneously. The obtained values by the two methods were almost identical. We applied the Eu3+ method to measure NK activity of a large number of individuals, including 68 apparently healthy donors and 36 autoimmune and 21 cancer patients. Some of these diseases are known to show abnormal NK activity. The obtained cytotoxicities were mostly consistent with the previously reported data obtained by the 51Cr release assay. These results indicated that the Eu3+ release assay could be used as an alternative method for a measurement of human NK activity of mass population including patients.

[Study on the positive rate of infectious diseases in in-patients at the department of oral surgery]

The positive rate of infectious diseases (syphilis, hepatitis B and C) in in-patients at the department of oral surgery was investigated for five years. Each positive rate of them was 2.4% for STS, (1.3% for TPHA), 0.6% for HBs antigen, 3.2% for HCV antibody, respectively. These results suggest that it is important to perform universal precaution in the treatment room.

[Serum levels of remnant-like particles-cholesterol (RLP-C) in patients on hemodialysis]

Serum remnant-like particles-cholesterol (RLP-C), an atherosclerosis risk factor that strongly reflects disorders of chyromicron and VLDL metabolism and contains high levels of TG, was measured in patients on hemodialysis and CAPD. The purpose of this study was to determine the serum levels of RLP-C in 30 outpatients on hemodialysis (18 males, 12 females) and 84 patients on CAPD (53 males, 31 females). The serum RLP-C level was 8.1 +/- 13 mg/dl in CAPD patients and 2.7 +/- 0.2 mg/dl in hemodialysis patients (p < 0.001). Patients who used dialysate containing over 150 g of glucose per day, showed higher levels of serum RLP-C than CAPD patients whose glucose consumption was under 150 g (10.4 +/- 2.4 mg/dl vs. 5.5 +/- 0.6 mg/dl, p < 0.01). There was no statistical relationship between age, sex, dialysis duration and serum RLP-C in CAPD and hemodialysis patients. Serum level of RLP-C was positively correlated with serum triglyceride, total cholesterol, apolipoprotein B and VLDL, and was negatively correlated with apoA-I/apoB in the dialysis patients. It appears that RLP-C, which is one of the risk factors of atherosclerosis, might reflect a disorder of triglyceride metabolism in patients on dialysis, especially on CAPD.

Case reports of epulis treated by CO2 laser without anesthesia

This study reports seven cases of epulis excised by the CO2 laser without anesthesia. The laser was used in a continuous wave mode at power setting of 2-4 W. All lesions were excised completely, and no patients felt pain during laser irradiation. The operation was successful without using surgical packs, and there was no postoperative discomfort. There has been no evidence of recurrence after operation.

Adjustment of creatinine-adjusted values in urine to urinary flow rate: a study of eleven heavy metals and organic substances

The use of urinary monitoring in medical surveillance programs in industry requires development of an accurate and unbiased index of urinary concentrations of occupational toxins. To examine the effects of urinary flow (UF) rate on the standard creatinine (Cn)-adjusted value and the UF- and Cn-adjusted values according to Greenberg and Levine and to Araki et al. for 11 heavy metals and organic substances, 19 metal-foundry workers aged 34-59 years (mean 48), who had been exposed to lead, zinc, and copper for 2-17 (mean 10) years, were studied during four periods of the day under water-free, water-restrictive and water-loading conditions for 6 days. The blood lead concentrations of the 19 workers ranged from 22 to 59 (mean 38) micrograms/dl. The results indicated that there was no significant UF effect on the UF- and Cn-adjusted values of Araki et al. for all urinary substances except mercury and coproporphyrin. On the other hand, the UF- and Cn-adjusted value of Greenberg and Levine was positively correlated with UF rate for all urinary substances, and the standard Cn-adjusted value was either positively or inversely correlated with UF rate for many urinary substances. Therefore, the UF- and Cn-adjusted value of Araki et al. is considered to be applicable to the measurement of most urinary substances under conditions of wide variation in UF rate.

[Sudden syncope during spinal block under sitting position: a report of three cases]

We reported 3 cases of sudden syncope during saddle block under sitting position. Patients were healthy and had no history of fainting. Syncope occurred following hypotension and bradycardia during difficult lumbar dural punctures under sitting position. Patients were treated successfully by changing position to supine, elevating both legs and giving vasopressors. Neurocardiac syncope due to the activation of afferent cardiac C-fiber has been suggested as a possible explanation in sudden syncope, which follows head-up position or emotional change. The first sign of syncope was hypotension and bradycardia due to cardiac C-fiber reflex. How to prevent this NCS under saddle block are as follows; 1. vigorous search for history of syncope, 2. pay attention to the patients during spinal tap, 3. skillful technique in spinal tap, and 4. proper premedication including anticholinergic agents. Treatments include 1. changing position to supine, 2. elevation of both legs to increase ventricular end-diastolic pressure, and 3. use of vasopressors including phenylephrine.

Angiotensin I-converting enzyme insertion/deletion polymorphism: potential significance in nephrology

Angiotensin I-converting enzyme (ACE) plays a pivotal role in cardiovascular homeostasis and by activating angiotensin I into angiotensin II and inactivating bradykinin. These two peptides play antagonistic roles on the cardiovascular system by regulating vascular tone and vascular smooth muscle cell proliferation. Identification of the ACE gene as a genetic marker for various forms of cardiovascular disease is a recent result of the progress made in molecular biology and genetics. The insertion/deletion (ID) polymorphism of the ACE gene defined by the presence or absence of the 287 base pair Alu sequence situated in intron 16 has been investigated as a possible genetic marker for a variety of cardiovascular disease including myocardial infarction, essential hypertension, cardiomyopathy, and diabetic vascular complications. This paper reviews prior reports and briefly describes our recent study on the association of the ACE I/D polymorphism and antiproteinuric effect of ACE inhibitors in patients with proteinuria.

[MR imaging for breast cancer]

The potential role of magnetic resonance (MR) imaging in the diagnosis of breast disease has been investigated since the late 1970s. Conventional MR imaging has not been reliable for diagnosis of breast masses, and so contrast MRI using Gd-DTPA has been performed. In particular the gradient echo (GRE) technique combined with administration Gd-DTPA (i.e., dynamic MRI) improves detection and tissue characterization of breast masses. In recent studies, breast MR imaging has shown up to 100% sensitivity in the detection of breast cancer. On the other hand, its specificity varies between 37% and 98% because of the fact that may benign lesions are also enhanced with many contrast media, similar to breast cancer. To improve the specificity of MR imaging, MR-guiding localization and fine needle aspiration biopsy for breast masses will be necessary. Recently breast conserving therapy has been widely accepted in our country, so we deduce that MRI is useful method for detecting multifocal or multicentric breast cancer.

Fibroblasts synthesize kininogen in response to inflammatory mediators

Mouse fibroblasts in vitro secret kininogen (KGN). Rat fibroblasts also synthesized and secreted T-KGN in vitro. KGN production by these fibroblasts is greatly stimulated by dibutyryl cAMP, prostaglandin E2 and tumor necrosis factor. Human fibroblast WI-38 cells also express the L-KGN gene, which was stimulated by dibutyryl cAMP and prostaglandin E2. These results demonstrate that fibroblasts express the KGN gene, and suggest that the expression is regulated by inflammatory mediators. RT-PCR, using specific primers for the T-KGN and L-KGN genes, reveals that the rat hind-paw express both T- and L-KGN mRNAs, and the expression of both KGN mRNAs was increased in the hind-paw 24 h after inducing inflammation by injecting Freund's complete adjuvant into the paw. Thus, it is suggested that local connective tissues express the KGN gene, and that the expression is enhanced under pathological conditions, such as inflammation.

[Assessment of cochlear functions of patients with acoustic neuromas]

Electrocochleographic cochlear microphonics (ECochG-CM) and Evoked Otoacoustic Emissions (EOAE) were recorded for 17 patients with acoustic neuromas to assess their cochlear functions. ECochG-CM was recorded by a transtympanic needle electrode technique. The acoustic stimuli of EOAE were short tone bursts and thresholds of detection of the slow components were determined. In 13 of the 17 patients, elevated detection thresholds of ECochG-CM and/or abnormal interaural differences in detection thresholds of the slow components of EOAE were observed. The patients with hearing loss and an elevated thresholds of CM were believed to have cochlear impairments. Those with hearing loss and a relatively low detection threshold of CM were thought to have cochlear nerve damage and a smaller degree of cochlear impairment. The correlation of ECochG-CM and EAOE was 0.799. Both ECochG-CM and EOAE were useful in evaluating the cochlear functions of patients with acoustic neuromas. Although EOAE was easier to apply clinically, ECochG was indispensable when detailed examinations of cochlear functions were necessary.

A long-range physical map of human chromosome 21q22.1 band from the YAC continuum

The human Chromosome (Chr) 21q22.1 region contains several genes for cytokines and neurotransmitters and the gene for superoxide dismutase (mutant forms of which can cause familial amyotrophic lateral sclerosis). A region of approximately 5.8 Mb encompassing D21S82 and the glycinamide ribonucleotide transformylase (GART) loci was covered by overlapping YAC clones, which were contiguously ordered by clone walking with sequence-tagged site (STSs). A total of 76 markers, including 29 YAC end-specific STSs, were unambiguously ordered in this 5.8-Mb region, and the average interval between markers was 76 kb. Restriction maps of the YAC clones with rare-cutting enzymes were simultaneously prepared, and the restriction sites were aligned to obtain a consensus restriction map of the proximal region of the 21q22.1 band. The restriction map made from 44 overlapping YACs contains 54 physically assigned STSs. By integrating the consensus map of the adjacent 1.8-Mb region, we obtained a fine physical map spanning 6.5 Mb of human Chr 21q22.1. This map contains 24 precisely positioned end-specific STSs and 12 NotI-linking markers. More than 39 potential CpG islands were identified in this region and were found to be unevenly distributed. This physical map and the YACs should be useful as a reference map and as a resource for further structural analysis of the Giemsa-negative band (R-band) of Chr 21q22.1.

[The long-term results of the irradiation therapy for the dural arteriovenous malformation]

Although radiotherapy has been used to treat non-neoplastic vascular diseases, it is not widely accepted as a standardized treatment for dural arteriovenous malformations (DAVM). The uncertainties regarding the therapeutic outcome and the benign nature of DAVM are the major factors that limit the indication of radiotherapy. In an attempt to assess the long-term benefits and risks of the treatment, we analyzed 24 patients with DAVM treated with radiotherapy. The cavernous sinuses were involved in 12 and the transversesigmoid sinuses in 12. Doses ranging from 10 to 56 Gy (median 44.9 Gy) were delivered by multiple fractionation. In terms of clinical improvement, complete response was achieved in 19 patients and partial response in five. Four patients had recurrence of symptoms; two patients were reirradiated with the result of good symptomatic relief, one patient was successfully treated with transarterial embolization and the other patient with less disabling symptoms was managed conservatively. No adverse side effects attributed to radiation were encountered during the follow-up period of 0.5-17 years (median 8.5 years). Radiotherapy is a safe and effective method for the treatment of DAVM and is warranted in patients who are unsuitable for transarterial embolization or surgical procedure.

The effect of ultra-low sodium dialysate in CAPD. A kinetic and clinical analysis

In peritoneal dialysis, sodium (Na) passes through the peritoneal membrane to a lesser extent than H2O and thus hypotonic fluid is removed indicating that Na removal is inefficient. Therefore we developed an ultra-low Na dialysate (ULNaD) [Na 98 mmol/liter, osmolality 340 mOsm/kg, glucose (G), 2.48%] to facilitate trans-peritoneal Na removal. The aim of the study was to examine (a) the fluid and Na kinetics of this solution, and (b) the clinical effect in the overhydrated patient. Regarding the former, in six cases, changes in the effluent Na levels during a 240-minute dwell of ULNaD were measured at 60-minute intervals. In eighteen cases, the transperitoneal net-Na removal (Na removal) and drained ultrafiltration (UF) volume after a 240-minute dwell of ULNaD were measured and compared to two types of standard Na dialysate (SNaD) [Na 132 mmol/liter, 1.36% G (348 mOsm/kg) and 2.27% G (396 mOsm/kg)]. The effluent Na levels increased gradually until the end of the dwelling. Drained UF volume of ULNaD (224 +/- 25 ml) was more than 1.36% G SNaD (77 +/- 33 ml, p < 0.01), but it was less than 2.27% G SNaD (341 +/- 32 ml, p < 0.01). However, a significant increase in Na removal by ULNaD (78.1 +/- 5.6 mmol) was found compared with both SNaD solutions (12.6 +/- 6.4 mmol in 1.36% G solution, p < 0.001; 27.8 +/- 5.1 mmol in 2.27% G solution, p < 0.001, respectively). Regarding the latter study aim, in six overhydrated patients with a Na excess, SNaD was replaced with ULNaD once a day for 7 consecutive days. At the end of the study as compared to the pre-values, a significant reduction in body weight (-2.5 +/- 1.0%, p < 0.05) and mean arterial pressure (-12.3 +/- 3.5%, p < 0.001) was observed. An increased drainage of daily UF volume (+86.5 +/- 31.1%, p < 0.05) and a markedly increased daily Na removal (+131.1 +/- 24.2%, p < 0.01) were also observed. The results of this study suggest that ULNaD actually facilitates trans-peritoneal Na removal mainly by diffusion force, and that ULNaD could benefit overhydrated patients with a Na excess.

A low-affinity vasopressin V2-receptor gene in a kindred with X-linked nephrogenic diabetes insipidus

In this study, a mutation in vasopressin Type 2 receptor (V2R) in a patient with hereditary nephrogenic diabetes insipidus (NDI) has been identified and characterized. The sequencing of the V2R gene from the patient revealed that there was a missense mutation (TAT to TGT) resulting in the substitution of 205Tyr for Cys in the putative third extracellular domain. The expression analysis in COS cells showed that the binding affinity of the mutant receptor (KD = 19.8 nM) for arginine vasopressin was much lower than that of the wild-type receptor (KD = 1.8 nM) so that intracellular cAMP production stimulated by arginine vasopressin was impaired in cells with the mutant V2R. From these results, it was concluded that the single amino-acid substitution of V2R is responsible for this familial disease.

Effect of induced hypertension with angiotensin II infusion on biodistribution of 111in-labeled monoclonal antibody

We investigated whether induced hypertension could enhance tumor uptake of monoclonal antibody. 111In-DTPA-A7 (IgG1 against 40kD tumor associated glycoprotein) was injected into colon carcinoma xenografted mice which were subcutaneously implanted with micro-osmotic pump containing angiotensin II (AT-II). Biodistribution was observed in groups of mice infused with AT-II at rate of 0.5 micrograms/kg/min (L) or 1 microgram/kg/min (H) and compared with a group of mice infused with saline (S). Tumor uptake of 111In-A7 in L and H was 1.32 and 1.57 times greater than S at 48 h after intravenous injection of A7. Normal organ uptakes also tended to be increased by AT-II infusion. Further study is needed to get optimum effect of hypertensive treatment on biodistribution of radiolabeled MoAb.

Changes in the distribution of nerve conduction velocities in diabetics

To examine which of the faster or slower large myelinated nerve fibers (alpha fiber group) are affected earlier by diabetes mellitus (DM), the distribution of nerve conduction velocities (DCV) and conventional sensory nerve conduction velocities (SCV) in the median nerve were measured in 10 male DM patients aged 35-58 (mean 50) years. The patients had suffered from DM for 0-30 (mean 11) years; their fasting blood sugar (FBS) levels were 105-363 (mean 219) mg/100 ml. The DCV was expressed by the conduction velocities below which 10, 20, ......, 80 and 90% of active fibers lie (V10, V20, ......, V80 and V90 velocities, respectively). In DM patients, the V30 to V90 velocities of the DCV as well as the SCV were significantly smaller than those of age-matched male controls. The results of multiple regression analysis indicated that FBS was inversely related to V50 to V90 velocities; duration of the disease was also significantly related to V80 and V90 velocities. These data suggest that faster nerve fibers are more susceptible to DM than slower fibers are; changes in conduction velocities of the faster fibers are closely associated with FBS and duration of DM.

201Tl and 99Tcm-human serum albumin for assessment of the effect of hypertensive treatment with angiotensin II infusion on tumour circulation

The biodistribution of 201Tl and of 99Tcm-human serum albumin (99Tcm-HSA) was observed in tumour-bearing mice to investigate if tissue blood circulation could be evaluated in groups of mice infused with angiotensin II at a rate of 0.5 micrograms kg-1 min-1 (L) or 1 microgram kg-1 min-1 (H). Ten minutes after tracer injection, tumour uptake of 201Tl in the angiotensin II infused group showed a 2.20- and a 3.18-fold increase in the L and H groups, respectively, when compared to a group of mice infused with saline (P = 0.0478 and 0.0029, respectively). The effect of angiotensin II infusion on 201Tl uptake was minimal in normal organs. Decreased normal organ uptake of simultaneously injected 99Tcm-HSA in the L and H groups indicated the contraction of normal organ vessels, while increased tumour uptake of the tracer indicated mechanical dilatation of tumour vessels. We conclude that the effect of angiotensin II or other vasoactive agents can be non-invasively assessed by 201Tl and 99Tcm-HSA scintigraphy.

Displacement of the endotracheal tube caused by change of head position in pediatric anesthesia: evaluation by fiberoptic bronchoscopy

Displacement of the endotracheal tube (ETT) caused by flexion and extension of the neck and the placement of a tongue depressor was investigated in 10 small children between the ages of 16 and 19 mo by means of a fiberoptic bronchoscope. The ETT tip moved a mean distance of 0.9 cm toward the carina with flexion and 1.7 cm toward the vocal cords with extension of the neck. After the placement of a tongue depressor, the ETT tip, which had once moved toward the vocal cords with neck extension, was displaced a mean distance of 1.2 cm toward the carina. Our results demonstrate that endobronchial intubation and accidental extubation could occur after significant changes of the head position and careless placement of a tongue depressor in small children.

Scintigraphic study of malignant melanoma with 123I-iodoamphetamine

N-isopropyl-p-I-123-iodoamphetamine (123I-IMP) is extracted by the brain in proportion to regional blood flow. It is particularly useful in the clinical assessment of various pathological conditions related to altered cerebral flow. Moreover, it has been reported that 123I-IMP is avidly incorporated into melanin and melanotic melanoma. We evaluated 123I-IMP scintigraphy using either planar or single photon emission tomography (SPET) studies in 10 patients with malignant melanoma. The patients were classified into two groups according to the tumour site: Group A, six patients with primary or metastatic cutaneous malignant melanoma of the extremity with planar scintigraphy; Group B, four patients with primary malignant melanoma of other organs with planar scintigraphy and SPET. In Group A, tumour uptake was demonstrated in four of six patients; in Group B, three of four patients had tumour accumulation on SPET and planar scintigraphy. SPET revealed the exact tumour localization, even in the case of a tumour located in the lung. These results suggest that planar scintigraphy using 123I-IMP is useful in the detection of malignant melanoma. Furthermore, more clear tumour localization is possible with SPET, even in the case of a tumour located in the lung.