In vivo quantification of leukocyte behavior in the retina during endotoxin-induced uveitis

PURPOSE

The interaction between leukocytes and vascular endothelial cells plays an important role in various inflammatory disorders. This study evaluated leukocyte behavior in the retina during endotoxin-induced uveitis (EIU) in vivo.

METHODS

EIU was induced in female Lewis rats by footpad injection of lipopolysaccharide (LPS). The time-course changes of retinal leukocyte behavior were followed at 1.5, 3, 4.5, 6, 12, 24, 48, 72, and 120 hours after LPS treatment using acridine orange digital fluorography, consisting of high-resolution images from a scanning laser ophthalmoscope and a fluorescent nuclear dye of acridine orange.

RESULTS

Major retinal vessels were significantly dilated (P < 0.05) at 4.5 hours after LPS injection. The vasodilation, marked in veins, became maximum at 24 hours and subsided at 72 hours. Leukocytes were observed rolling along the walls of major veins at 4.5 hours. The number of rolling leukocytes gradually increased and reached a peak level of 33.8 +/- 3.4 cells/minute per major vein at 12 hours. Leukocyte rolling was still observed at 72 hours. No rolling of leukocytes was observed along the arterial walls throughout any experiments. The velocities of rolling leukocytes were determined at 6, 12, 24, and 48 hours. The leukocyte rolling velocity at 6 hours was significantly slower (33.3 +/- 2.8 microns/second, P < 0.05) than at the other three times (average, 46.6 microns/second). Cellular infiltration into the vitreous cavity was detected at 24 hours and reached its maximum at 48 hours.

CONCLUSIONS

This study demonstrates that it is possible to evaluate EIU by investigating retinal leukocyte behavior and that vasodilation of major retinal vessels and leukocyte-endothelial interactions precede inflammatory cell emigration into the vitreous. This method may be useful to quantify the severity of inflammation in EIU.

[Clinical significance of serum surfactant proteins A and D in idiopathic interstitial pneumonia]

Pulmonary surfactant is synthesized and secreted by alveolar type II cells. The major components of surfactant are phospholipids and four distinct surfactant-specific proteins: SP-A, SP-B, SP-C, and SP-D. The concentrations of SP-D and SP-A were measured in sera of patients with idiopathic interstitial pneumonia (IIP), by enzyme-linked immunosorbent assay with monoclonal antibodies against human SP-D and SP-A. The concentrations of SP-D and SP-A in samples from the patients were, respectively, 5.7 and 2.8 times higher than those in samples from healthy volunteers; 86.2% and 71.4% of the patients had concentrations of SP-D and SP-A, respectively, that were more than 2 standard deviations greater than the mean of the control values. Moreover, the serum SP-D and SP-A concentrations appeared to reflect the disease activity of IIP. There was a negative significant correlation between the concentrations of SP-A in serum and in bronchoalveolar lavage fluid. These results suggest that SP-D and SP-A, which are primarily secreted from alveolar type II cells into the alveolar lumen, can enter the bloodstream easily due to injury at the alveolar-capillary membrane. We conclude that measurement of SP-D and SP-A in sera can provide an easily identifiable and useful clinical marker for the diagnosis of IIP, and can be used to predict the disease activity of IIP.

Prevention by the new Ca2+ channel antagonist, AJ-3941, of loss of endothelium-dependent relaxation after subarachnoid hemorrhage in rats

AJ-3941 ((+/-)-(E)-1-(3-fluoro-6,11-dihydrodibenz[b,e]-oxepine-11-yl ) -4-(3-phenyl-2-propenyl)-piperazine dimaleate; CAS No. 143110-70-7), a cerebrovascular-selective Ca2+ channel antagonist having anti-lipid peroxidative action, was reported to prevent cerebral vasospasm following subarachnoid hemorrhage in rats. The present study was undertaken to determine whether AJ-3941 protects the impairment of cerebroarterial endothelium-dependent relaxation which is concomitantly induced with cerebral vasospasm. Subarachnoid hemorrhage biphasically suppressed the response to acetylcholine in rat basilar artery, at 0.5 h (n = 4; P < 0.06) and 1 day (n = 5; P < 0.05) after subarachnoid hemorrhage. The reduction of the responses was correlated significantly to the degree of vasospasm determined angiographically. This reduction was accompanied by a 49% increase of arterial lipid peroxide contents. Endothelium-independent relaxation in subarachnoid hemorrhage rats was preserved in response to 3-morpholinosydnonimine, sodium nitroprusside and papaverine. AJ-3941 prevented (n = 6-8, P < 0.05) the suppression of the acetylcholine-induced response and the increase in lipid peroxide content in subarachnoid hemorrhage rats. These results suggest that AJ-3941 could exert its vasospasmolytic effect by preserving endothelial function through its anti-lipid peroxidative action, in addition to its inhibition of vasospasmogen-induced vasoconstriction related to intracellular Ca2+ mobilization.

Monoclonal antibody, KK1, recognizes human retinal astrocytes and distinguishes a subtype of astrocytes in mouse brain

Astrocytes exhibit a diverse morphology and numerous functions in the central nervous system as well as in the retina. In order to obtain markers for the analysis of astrocytes, we prepared monoclonal antibodies that recognized antigens specific to astrocytes. Monoclonal antibody (mAb), designated KK1, reacted with the processes of astrocytes in the nerve fiber layer and the ganglion cell layer in the human retina as detected by indirect immunofluorescence. Normal Müller cells, whose processes are localized vertically in retina, were not labeled by KK1 mAb. In mouse brain, KK1 mAb reacted specifically with astrocytes in the white matter, but not with those in the gray matter. Studies employing a high-resolution confocal laser scanning microscope and double-labeling with KK1 mAb and commercially available anti-glial fibrillary acidic protein (GFAP) mAb (GA5) revealed that KK1 mAb visualized the processes that were not recognized by anti-GFAP mAb (GA5) in both human retina and mouse brain. In cultured mouse astrocytes, KK1 mAb reacted only with anti-GFAP mAb (GA5)-positive cells, but a small percentage of anti-GFAP mAb (GA5)-positive cells were labeled with KK1 mAb. In addition, the subcellular distribution of the KK1 antigen in cultured astrocytes apparently differed from that of GFAP labeled by anti-GFAP mAb (GA5). The antigen that was purified from the normal mouse brain by KK1 mAb-conjugated beads reacted with anti-GFAP mAb(GA5) in immunoblotting. No reactivity of KK1 mAb was observed in immunohistochemical analysis in GFAP -/- mutant mouse brain. These results demonstrate that KK1 mAb specifically recognized an epitope of GFAP that did not react with other anti-GFAP mAb (GA5). Retinal astrocytes and a subtype of astrocytes in the white matter of mouse brain shared the epitope that was recognized by KK1 mAb. KK1 mAb might be a powerful tool to investigate a subtype of astrocytes.

Inducible nitric oxide synthase in retinal ischemia-reperfusion injury

The purpose of this study was to determine whether inducible nitric oxide synthase (iNOS) was implicated in the pathogenesis of retinal ischemia-reperfusion injury. Semi-quantitative reverse transcription-polymerase chain reaction showed that the level of iNOS mRNA expression was markedly increased in rat retina following transient ischemia, with peak expression at 12 hr after reperfusion (15.7-fold increase over pre-ischemic levels). In situ hybridization showed that iNOS mRNA was expressed by resident retinal cells, most likely glial cells in the innermost retina, and also by the neutrophils that had infiltrated the retina. Intraperitoneal administration of NG-(1-iminoethyl)-L-ornithine (L-NIO), an inhibitor of iNOS, significantly increased the rate of b-wave recovery compared to that of control animals. The values (mean +/- S.E.M.) were 55.0 +/- 4.4% versus 40.1 +/- 5.1% (P < 0.05) at 1 day and 68.6 +/- 6.6% versus 45.8 +/- 3.5% (P < 0.05) at 3 days. This study shows that iNOS mRNA is highly expressed by non-neuronal cells of the inner retina during reperfusion following transient retinal ischemia. It also shows that L-NIO treatment provides some protection against ischemia-reperfusion injury. We suggest that nitric oxide produced by iNOS may mediate retinal ischemia-reperfusion injury.

[Novel method for lower-half body perfusion at circulatory arrest]

It is generally accepted that patients with thoracic aortic aneurysma (TAA) require surgical reconstruction in the open distal anastomosis method. However, the optimal treatment of those with TAA remains controversial, as some of the postoperative complications are spinal-cord injury, rhabdomyolysis, MNMS and so forth caused by ischemia of lower-half body. Therefore the new Y connector with a one-way valve is useful for open distal anastomosis to avoid ischemia of the lower-half body. Through the branch of the Y connector between the femoral artery cannula and the arterial line, the occlusion balloon catheter is inserted and inflated at the descending aorta for perfusion of lower-half body. This procedure is safer and faster to perform than the conventional methodology in which a puncture is inserted, and a balloon catheter may be used only on the side of blood supply, thus making it possible to minimize the aggression of the patient.

Involvement of Fas ligand and Fas-mediated pathway in the cytotoxicity of human natural killer cells

The cytotoxicity of NK cells has been thought to be mediated mainly by the perforin-dependent pathway. We investigated the involvement of Fas-mediated pathway in the killing activity of purified human CD3-, CD16+ NK cells. Fas ligand mRNA was expressed in freshly isolated NK cells. Apoptosis, which was identified by the fragmented chromatin in individual cells, was induced in the cells that expressed high levels of Fas via direct NK-to-target cell interaction or Ab-dependent cell-mediated cytotoxicity, even in Ca(2+)-free medium, in which perforin pores are known not to be formed. Apoptosis in both the presence and absence of external Ca2+ was inhibited by Fab of an anti-Fas mAb. Transfection of the Fas gene in target cells facilitated the induction of apoptosis, compared with the parental cell line. The function of the Fas-mediated pathway in the coexistence of the perforin-dependent pathway was examined in 10 cell lines expressing different levels of Fas by Ca2+ imaging and morphologic observation of single cells. With a certain boundary level, low or high levels of Fas expression in target cells were correlated to a great degree with either acute necrosis due to severe membrane damage after NK-target cell contact or apoptosis at a later period, respectively. We concluded that Fas ligand/Fas interaction is present and plays a significant role in the human NK cell-induced apoptosis.

Chitinous component of the cell wall of Fusarium oxysporum, its structure deduced from chitosanase digestion

The cell of Fusarium oxysporum was digested with commercial Bacillus chitosanase. The chitosanase produced low molecular weight heterooligosaccharides consisting of GlcN and GlcNAc from the cell wall. A main component of the digestion products was identified as 2-amino-2-deoxy-beta-D-glucopyranosyl- (1-->4)-2-acetamido-2-deoxy-D-glucopyranose. The chitosanase appeared to be more effective than Streptomyces griseus chitinase for cell wall digestion. Moreover, maltose was unexpectedly found in the digestion products, indicating that the cell wall contains alpha-1,4-linked glucan chain as a polysaccharide component.

Use of intravascular ultrasound for in vivo assessment of changes in intimal thickness of angiographically normal saphenous vein grafts one year after aortocoronary bypass surgery

OBJECTIVE

To use intravascular ultrasound in vivo to evaluate changes in the intimal thickness of angiographically normal saphenous vein grafts one year after implantation.

DESIGN

Fifteen saphenous vein grafts in 12 patients were examined one month and 12 months after aortocoronary bypass graft surgery with intravascular ultrasound using a 30 MHz transducer. None of the grafts examined showed any angiographic abnormalities. The intimal thickness and intimal area of the graft in the proximal portion were measured on intravascular ultrasound images obtained one month and 12 months after operation.

SETTING

General hospital.

PATIENTS

Twelve patients who underwent aortocoronary bypass graft surgery.

RESULTS

The ultrasound images showed a thin-walled graft with a thin intima one month after operation (mean (SD)) (0.31 (0.09) mm). The intimal thickness of the graft increased significantly to 0.65 (0.08) mm (P < 0.001) 12 months after operation. The intimal area of the graft was 0.90 (0.80) mm2 one month after operation. 12 months after operation the intimal area had increased significantly to 5.26 (1.38) mm2 (P < 0.001).

CONCLUSION

Intravascular ultrasound in vivo showed that one year after implantation angiographically normal saphenous vein grafts had a thicker intima than one month after implantation.

Visualization of leukocyte dynamics in the choroid with indocyanine green

PURPOSE

To report a method to evaluate leukocyte dynamics in the choroidal circulation with indocyanine green (ICG) angiography.

METHODS

Nonpigmented and pigmented rats were administered ICG solution intravenously. The fundus image was obtained with a scanning laser ophthalmoscope and recorded on magnetic tapes at a video rate (30 frames/second). The images were analyzed with a personal computer-based image analysis system.

RESULTS

On ICG angiography, hyperfluorescent dots were seen moving along the choroidal vessels and in the retinal vessels several minutes after injection. These fluorescent dots were thought to be circulating leukocytes stained with ICG. The micrographs of blood smears after ICG injection showed intense fluorescence of leukocytes. Computer-assisted image analysis allowed tracing of these fluorescent dots using a frame-by frame method.

CONCLUSIONS

Results of this study indicated that ICG can be used for vital staining of leukocytes and that it is possible to evaluate leukocyte movement in the choroidal circulation in vivo in rats.

Effect of prior O2 breathing on ventilatory response to sustained isocapnic hypoxia in adult humans

Sixteen healthy volunteers breathed 100% O2 or room air for 10 min in random order, then their ventilatory response to sustained normocapnic hypoxia (80% arterial O2 saturation, as measured with a pulse oximeter) was studied for 20 min. In addition, to detect agents possibly responsible for the respiratory changes, blood plasma of 10 of the 16 subjects was chemically analyzed. 1) Preliminary O2 breathing uniformly and substantially augmented hypoxic ventilatory responses. 2) However, the profile of ventilatory response in terms of relative magnitude, i.e., biphasic hypoxic ventilatory depression, remained nearly unchanged. 3) Augmented ventilatory increment by prior O2 breathing was significantly correlated with increment in the plasma glutamine level. We conclude that preliminary O2 administration enhances hypoxic ventilatory response without affecting the biphasic response pattern and speculate that the excitatory amino acid neurotransmitter glutamate, possibly derived from augmented glutamine, may, at least in part, play a role in this ventilatory enhancement.

Scintigraphic detection of regional disruption of the adrenergic nervous system in sarcoid heart disease

The presence of defects on resting thallium (201Tl) myocardial scintigraphy has been previously demonstrated in myocardial sarcoidosis. To examine cardiac sympathetic nerve activity in patients with cardiac sarcoidosis, we performed 201Tl and I-123 MIBG (meta-iodobenzylguanidine) myocardial scintigraphy in patients with sarcoidosis. Sixteen patients with sarcoidosis were classified into 2 groups according to the presence or absence of defects on 201Tl scintigraphy. Myocardial images by both 201Tl and I-123 MIBG were then divided into 20 segments and scored using a 6-point scoring system. Defect Score was defined as a the sum of significant scores in each image. The mean Defect Score in I-123 MIBG images was higher in the 201Tl defect group (44.3 +/- 13.3) than in both the normal 201Tl group (25.1 +/- 10.5) and the control group (22.7 +/- 11.4). Moreover, the locations of defects on I-123 MIBG scans were consistent with those on 201Tl scans. This study suggests that cardiac adrenergic function may be impaired in cardiac sarcoidosis, and I-123 MIBG scintigraphy may be more sensitive in detecting cardiac sarcoidosis than 201Tl scintigraphy, although the clinical significance of these findings requires further study.

Involvement of Fas ligand and Fas-mediated pathway in the cytotoxicity of human natural killer cells

The cytotoxicity of NK cells has been thought to be mediated mainly by the perforin-dependent pathway. We investigated the involvement of Fas-mediated pathway in the killing activity of purified human CD3-, CD16+ NK cells. Fas ligand mRNA was expressed in freshly isolated NK cells. Apoptosis, which was identified by the fragmented chromatin in individual cells, was induced in the cells that expressed high levels of Fas via direct NK-to-target cell interaction or Ab-dependent cell-mediated cytotoxicity, even in Ca(2+)-free medium, in which perforin pores are known not to be formed. Apoptosis in both the presence and absence of external Ca2+ was inhibited by Fab of an anti-Fas mAb. Transfection of the Fas gene in target cells facilitated the induction of apoptosis, compared with the parental cell line. The function of the Fas-mediated pathway in the coexistence of the perforin-dependent pathway was examined in 10 cell lines expressing different levels of Fas by Ca2+ imaging and morphologic observation of single cells. With a certain boundary level, low or high levels of Fas expression in target cells were correlated to a great degree with either acute necrosis due to severe membrane damage after NK-target cell contact or apoptosis at a later period, respectively. We concluded that Fas ligand/Fas interaction is present and plays a significant role in the human NK cell-induced apoptosis.

Acetylcholine releases of mesopontine PGO-on cells in the lateral geniculate nucleus in sleep-waking cycle and serotonergic regulation

1. Five adult cats were prepared with standard sleep-recording electrodes, microinjection cannulae in the bilateral mesopontine tegmentum X area and cannulae for microdialysis probes in the LGN. 2. Dialysates were collected at 5 min intervals during SWS, REM sleep and wakefulness, and during pre- and post-stimulation periods of 5MeODMT microinjection in the bilateral mesopontine tegmentum of freely moving cats. 3. A REM sleep-specific increase of ACh release was observed in the LGN, but not out of the LGN. 4. ACh release was depressed up to 33% by bilateral 5MeODMT microinjection in the mesopontine tegmentum where the microinjection of carbachol also depressed ACh in the LGN probably by stimulating the auto receptor. 5. Our observations indicate that PGO-on neurons of mesopontine tegmentum release more ACh in the LGN during REM sleep by burst discharge than during wakefulness and SWS, and that presumptive cholinergic PGO-on cells are regulated by serotonergic inputs.

Cephalometric comparison of craniofacial morphology between primary bone grafted and nongrafted complete unilateral cleft lip and palate adults

The effect of primary bone grafts on craniofacial growth was evaluated in adult patients with complete unilateral cleft lip and palate (UCLP). The subjects were 18 UCLP patients with primary bone grafts and a control group of 36 UCLP patients without bone grafts. The former received primary transplantation of autogenous rib bone simultaneously with primary cheiloplasty by the same surgeon between 1963 and 1969. Frontal and lateral cephalograms taken after 16 years of age were traced. Skeletal landmarks were identified on them, and their x,y-coordinates were digitized. The effects of gender and/or primary bone graft on the craniofacial morphology were tested by ANOVA using 21 angles, 8 breadths, 13 distances, and 2 ratios. Nasal cavity breadth was wider in the primary bone grafted group. However, the anterior maxilla in that group was more upward and retruded than that in the nongrafted group. The primary bone grafted group was divided into two subgroups based on the overjet of the incisors: group N = normal overjet; group C = anterior cross-bite. There was no difference in the maxilla between groups N and C. However, the mandible in group C was more anterior and superior than in group N. In conclusion, primary bone graft may impede maxillary horizontal and vertical growth to a certain degree, and severe anterior cross-bite in primary bone grafted subjects may be brought about by mandibular closure.

[A case suspected of early active pulmonary tuberculosis detected by CT with the onset of episcleritis]

A 56-year-old female with the chief complaint of conjunctival injection was referred to our hospital after treatments with oral and topical corticosteroid under the diagnosis of episcleritis without any therapeutic efficacy. Possible causes of the episcleritis such as collagen vascular disease were not found, but a chest CT revealed centrilobular nodules, branching linear lesions and bronchial wall thickening which were not detected in a plain X-ray picture. We suspected pulmonary tuberculosis and tuberculous episcleritis based on these CT findings, strongly positive tuberculine skin test result and a history of contact with a smear positive tuberculosis patient. The pulmonary lesion disappeared and the episcleritis healed after the treatment with systemic antituberculous agents.

Evaluation of left ventricular relaxation using the continuous-wave Doppler velocity profile of aortic regurgitation: noninvasive measurement of left ventricular negative dP/dt and time constant

BACKGROUND

The maximal negative dP/dt [max (-)dP/dt] and time constant (T) are useful indices for evaluating left ventricular (LV) relaxation, but they require invasive procedures.

HYPOTHESIS

The purpose of this study was to obtain max (-)dP/dt and T using the continuous-wave Doppler aortic regurgitation velocity curve (AR-CW) noninvasively. Using the Bernoulli equation, the AR-CW allows accurate determination of the pressure gradients (PG) between the aorta and the left ventricle.

METHODS

In 10 patients with trivial to mild AR, the rising segment of the AR-CW reflecting LV pressure decrease was digitized with the cardiac image analysis system. Transpulmonary contrast-enhanced Doppler echocardiography was used in three patients to obtain intense velocity envelope. The PG curve and the firs derivative curve were reconstructed and the maximal point of the first derivative curve, which is consistent with max(-)dP/dt, was termed as maximal rate of pressure fall (maxRPF). As T (calculated according to the method of Weiss) can be obtained from T=Pm/max(-)dP/dt [Pm: LV pressure at the phase of max(-)dP/dt], we calculated T from Pm/maxRPF (Pm=dicrotic notch pressure-4Vm2) (Vm: AR velocity at the phase of maxRPF).

RESULTS

The Doppler-derived maxRPF and T (TD) approximated the catheter-derived max(-)dP/dt and T (y = 0.85x + 245, r = 0.97, p < 0.001, y = 0.79x + 4, r = 0.87, p < 0.001). In addition, dobutamine echocardiography was performed in nine patients showing increased maxRPF and decreased TD, indicating improvement of LV relaxation.

CONCLUSION

These Doppler-derived new indices are sufficiently useful to evaluate LV relaxation noninvasively.

Predicting risk of embolization during anticoagulation for left atrial thrombus by transesophageal echocardiography: a case report

A 75-year-old woman was admitted with transient left hemiparesis accompanied by diminished level of consciousness in September 1994. Holter electrocardiography showed transient atrial fibrillation, and transesophageal echocardiography (TEE) revealed an atrial septal aneurysm, spontaneous echo contrast, and a thrombus in the left atrial appendage. The patient received anticoagulant treatment with warfarin, and follow-up TEE showed thrombus resolution. However, after the warfarin was discontinued, symptoms recurred in October 1995 and TEE showed a club-like left atrial thrombus (21 x 40 mm) originating in the left atrial appendage and extending to the center of the left atrium. Follow-up TEE after warfarin therapy showed resolution at the neck of the thrombus but the head threatened detachment. The thrombus was subsequently excised surgically. Follow-up TEE was critical for detecting the risk of significant embolization during anticoagulant therapy.

Effect of (+/-)-(E)-1-(3-fluoro-6,11-dihydrodibenz[b,e]-oxepine-11 -yl)-4-(3-phenyl-2-propenyl)-piperazine dimaleate on cerebral vasospasm and impairment of cerebral circulation in subarachnoid hemorrhage model in rats

A subarachnoid hemorrhage (SAH) model in rats was produced by the injection of homologous blood into the cisterna magna. Effects of AJ-3941 ((+/-)-(E)-1-(3-fluoro-6,11 -dihydrodibenz[b,e]-oxepine-11-yl)-4-(3-phenyl-2-propenyl)-p iperazine dimaleate, CAS 143110-70-7) on the development of cerebral vasospasm and the change of regional cerebral blood flow (rCBF) following SAH was investigated in this model. Cerebral vasospasm following SAH showed a biphasic pattern with an early phrase at 10 min and a late phrase on 1 day after blood injection. The physiological parameters (blood pressure, heart rate and blood gas contents) remained stable within the physiological range throughout the course of the experiment. AJ-3941 (0.01 mg/kg i.v. or 0.3 mg/kg p.o.) significantly prevented the development of late phase cerebral vasospasm. Cisternal injection of homologous blood significantly reduced rCBF immediately after the injection and the reduction lasted during the observation period (30 min). Reduction in rCBF after the injection of homologous blood was prevented by AJ-3941 (0.01 mg/kg i.v.). rCBF in AJ-3941-treated rats completely returned to the basal values after 30 min. The present suggest that AJ-3941 may be useful in the prevention of late spasm and in the improvement of cerebral circulation impaired with SAH.

Sleep oxygen desaturation in late sequelae of pulmonary tuberculosis

Thirty-eight patients with late sequelae of pulmonary tuberculosis (TB seq.) were studied to clarify the characteristics of sleep desaturation in comparison with 40 patients with chronic obstructive pulmonary disease (COPD). While awake, the TB seq. group had a lower % VC and a higher PaCO2. In both groups, the sleep lowest SaO2 was positively correlated with the awake SaO2. The regression line between the sleep lowest SaO2 and the awake baseline SaO2 in the TB seq. group was located below that in the COPD group. Awake PaCO2 was negatively related to the sleep lowest SaO2 only in the TB seq. group. These results indicate that the sleep lowest SaO2 values were lower in TB seq. than in COPD patients with the same levels of SaO2 while awake. Sleep studies are necessary to reveal the indication for nocturnal oxygen therapy in TB seq. patients, especially when they are hypercapnic in spite of their good awake oxygenation.

A dnaA box can functionally substitute for the priming signals in the oriV of the broad host-range plasmid RSF1010

The initiation of replication from oriV RSF1010, the replication origin of the broad host-range plasmid RSF1010, depends on RepA (helicase), RepB' (primase), and RepC (initiator protein), encoded by RSF1010 itself, while this initiation event in E. coli is independent of dnaA, dnaB, dnaC, and dnaG [Scherzinger et al. (1984) Proc. Natl. Acad. Sci. USA 81, 654-658; Scholz et al. (1985) in: Plasmids in Bacteria, pp. 243-259, Plenum, New York; Haring and Scherzinger (1989) in: Promiscuous Plasmids of Gram-negative Bacteria, pp. 95-124, Academic Press, London; Scherzinger et al. (1991) Nucl. Acids Res. 19, 1203-1211]. We showed in this work that a newly constructed origin consisting of an oriV RSF1010 and a DnaA protein binding site, the dnaA box, inserted near oriV RSF1010 (oriV RSF1010-dnaA box) could function without RepB' primase, but required RepA and RepC. This oriV RsF1010-dnaA box could not replicate in a dnaA46 strain in which only RepA and RepC were supplied, even at a permissive temperature. These results indicate that an inserted dnaA box can functionally substitute for the RSF1010-specific ssi signals, the RepB' dependent priming signals in oriV RSF1010, and can direct a priming pathway different from the RSF1010-specific one, but related to DnaA protein.

[The influence of endoscopic injection sclerotherapy (EIS) on respiro-circulatory condition in patients with portal hypertension--the effect of oxygen administration]

We studied the influence of EIS on the respiro-circulatory condition of patients with portal hypertension. Subjects were fifty patients with portal hypertension who were successfully injected more than 5.0 ml of sclerotant into varices. A prospective randomized controlled trial was proposed to elucidate the effect of prophylactic administration of pure oxygen. Twenty-five patients inhaled pure oxygen (O2), remaining twenty-five patients did not during EIS. Respiro-circulatory function of patients was evaluated by monitoring O2 saturation, pulse rate and blood pressure during EIS. PaO2 was measured before and after EIS in seven patients without O2. EIS by the 5% ethanolamine oleate with iopamidol (EOI) was performed under X-ray monitoring. O2 saturation in patients without O2 inhalation was lowered, whereas that in patients with O2 inhalation was stable during EIS. O2 saturation during injection of EOI and after EIS in patients without O2 inhalation was significantly lower than that in patients with O2 inhalation. Pulse rate was significantly lower and a rise in blood pressure was smaller in patients given O2. No significant differences of PaO2 was noted before and after EIS. In conclusion, the monitoring of O2 saturation, pulse rate and blood pressure is necessary during EIS. Prophylactic administration of pure oxygen may be useful for prevention of hypoxic state and respiro-circulatory stabilization during EIS.

Trabeculotomy ab externo, cataract extraction, and intraocular lens implantation: preliminary report

PURPOSE

To compare the results of a triple procedure using either extracapsular cataract extraction (ECCE) or one of two phacoemulsification techniques combined with trabeculotomy ab externo and intraocular lens (IOL) implantation.

SETTING

Kyoto University Hospital, Kyoto, Japan, and Nagata Eye Hospital, Nara, Japan.

METHODS

In this comparative study, 25 eyes with primary open-angle glaucoma had ECCE combined with trabeculotomy ab externo and IOL implantation and 22 had the same procedure using phacoemulsification instead of ECCE. Of the eyes that had phacoemulsification, 10 had a single-flap and 12 had a double-flap procedure.

RESULTS

All 22 eyes that had phacoemulsification had a postoperative IOP of 21 mm Hg or less, as did all ECCE eyes except 2. Although the self-sealing incision might have caused the higher incidence of IOP spikes in the immediate postoperative period, IOPs in the phacoemulsification groups were lower after 3 months. Results were similar in the single-flap and double-flap phacoemulsification groups. There were no significant complications.

CONCLUSION

Cataract extraction by phacoemulsification or ECCE combined with IOL implantation and trabeculotomy ab externo is a safe, effective treatment for patients with coexisting glaucoma and cataract.

[Prognostic value of serial Doppler echocardiographic follow-up of transmitral flow patterns in patients with congestive heart failure who presented with pulmonary edema]

The predictive value of serial Doppler echocardiographic follow-up of transmitral flow patterns for the prognosis of patients with congestive heart failure who presented with pulmonary edema was evaluated in 80 consecutive patients with decreased left ventricular systolic function (ejection fraction < 40%). Restrictive patterns [peak early diastolic filling velocity (E)/peak late diastolic filling velocity (A) ratio (E/A) > 2 and/or deceleration time for E wave to decline to baseline (DcT) < 150 msec] were observed in 72 patients (90%) on admission. After intensive therapy, DcT showed a nonrestrictive pattern in 38 of 72 patients (53%). The survival rates at 1 year was 50% for the restrictive group, and 97% for the nonrestrictive group. E/A showed a nonrestrictive pattern in 37 of 56 patients (66%). The survival rates at 1 year was 86% for the restrictive group, and 58% for the nonrestrictive group. Serial Doppler echocardiographic follow-up of transmitral flow patterns is useful in predicting the prognosis in patients with congestive heart failure who presented with pulmonary edema.