Percutaneous transluminal angioplasty of the right coronary artery having an anomalous origin: two cases report

Percutaneous transluminal coronary angioplasty was performed on 2 patients, each having an anomalous origin of the right coronary artery with anterior-superior orientation. Each patient had experienced post-infarction angina after an inferior wall myocardial infarction without antecedent thrombolytic therapy. The procedures were successfully performed with appropriate selection and manipulation of the guiding catheter. Our findings indicate that the Amplatz left catheter is the guiding catheter of choice in catheterizing a right coronary artery of anomalous origin with anterior-superior orientation.

Sequence variations between two Epstein-Barr virus LMP 1 variants have no effect on the activation of NF-kappaB activity

Previously, we reported that the LMP 1 gene of Epstein-Barr virus (EBV) derived from nasopharyngeal carcinoma (NPC) tissues (i.e., NLMP 1 gene) was able to transform BALB/c3T3 cells. On the other hand, LMP 1 gene of B95-8 strain (i.e., BLMP 1 gene) was not able to transform these cells (Chen et aL, 1992). Further studies indicated that a 10-amino-acid deletion in the carboxyl terminus of NLMP 1 played an important role in transformation (Li et al., 1996). In this study, we tested if this 10-amino-acid deletion affected the induction of NF-kappaB activity by LMP 1. The long terminal repeat of the human immunodeficiency virus type 1 (HIV-1 LTR) contained two copies of NF-kappaB sites and was used to construct the Luc gene-based reporter plasmid, p kappaB-Luc. Plasmid p kappaB-Luc was co-transfected with plasmids containing the NLMP 1 gene, BLMP 1 gene, and their chimeric or deletion constructs, respectively, into C-33A and BALB/c3T3 cells. The activation was then measured by the luciferase activity. Results showed that the full-length proteins induced a similar level of NF-kappaB activity, the two 3' mutants (R15delta and D4delta) still induced a relatively high level of activity, and the two 5' deletion mutants (delta3058 and delta3243) of NLMP 1 gene did not show any significant activation in C-33A cells. However, none of these LMP 1 proteins induced NF-kappaB activity in BALB/c3T3 cells. Using subcellular fractionation analysis and an immunocytostaining method, the truncated proteins of delta3058 and delta3243 were detected in the cytoplasm of the cells whereas the full-length NLMP 1 protein was located at the cytoplasmic membrane. Stable BALB/c3T3 cell clones that expressed both truncated proteins were established and then their ability to induce tumors in nude mice was examined. Data showed that both truncated NLMP 1 proteins still maintained partial transformation activity. Our results suggested that there was no direct correlation between NF-kappaB activation and transformation activity of LMP 1 in BALB/c3T3 cell transformation and that the amino-terminal membrane-spanning domain was important for maintaining both functions of LMP 1.

Expression of a streptomycete leaderless mRNA encoding chloramphenicol acetyltransferase in Escherichia coli

The chloramphenicol acetyltransferase (cat) gene from Streptomyces acrimycini encodes a leaderless mRNA. Expression of the cat coding sequence as a leaderless mRNA from a modified lac promoter resulted in chloramphenicol resistance in Escherichia coli. Transcript mapping with nuclease S1 confirmed that the 5' end of the cat message initiated at the A of the AUG translational start codon. Site-directed mutagenesis of the lac promoter or the cat start codon abolished chloramphenicol resistance, indicating that E. coli initiated translation at the 5' terminal AUG of the cat leaderless mRNA. Addition of 5'-AUGC-3' to the 5' end of the cat mRNA resulted in translation occurring also from the reading frame defined by the added AUG triplet, suggesting that a 5'-terminal start codon is an important recognition feature for initiation and establishing reading frame during translation of leaderless mRNA. Addition of an untranslated leader and Shine-Dalgarno sequence to the cat coding sequence increased cat expression in a cat:lacZ fusion; however, the level of expression was significantly lower than when a fragment of the bacteriophage lambda cI gene, also encoding a leaderless mRNA, was fused to lacZ. These results indicate that in the absence of an untranslated leader and Shine-Dalgarno sequence, the streptomycete cat mRNA is translated by E. coli; however, the cat translation signals, or other features of the cat mRNA, provide for only a low level of expression in E. coli.

Transfer of the E6 and E7 genes of human papillomavirus type 18 into human epithelial cells via recombinant retrovirus infection

A retroviral vector carrying the E6 and E7 genes of HPV type 18 was transfected into a packaging cell line, Ampho psi 2. Thirteen recombinant viruses carrying the E6 and E7 genes were obtained. The titers of these recombinant viruses were estimated by infecting BALB/c3T3 cells and then counting the number of G418r colonies. Presence of HPV E6/E7 genes was confirmed by the PCR method and sequence-specific primers. The expression of E7 gene was examined by RT-PCR method. Results showed that the titers were ranged between 0.2 and 1.2 x 10(3) CFU/ml and the E7 transcripts were detected in all 13 cell clones. These E6 and E7-containing cell clones were able to grow in soft agar, indicating the E6/E7 delivered by the recombinant retroviruses retained their transformation function. These recombinant viruses were then used to infect human NPC cell lines, NPC-TW076 and -TW039 and cell clones resistant to G418 were obtained. Using Western blot analysis and HPV type 18 E6-specific monoclonal antibody, HPV-CIP5, these cells were shown to contain a protein with a molecular mass of 18 kDa. Our data indicated that the HPV E6/E7-containing recombinant retroviruses were capable of infecting human cell lines. The potential of using these recombinant retroviruses to immortalize human primary epithelial cells was discussed.

Multidrug-resistant gene expression in small-cell lung cancer

The development of drug resistance can contribute to treatment failure in small-cell lung cancer (SCLC). In this report, we investigate p-glycoprotein-mediated multidrug resistance (MDR) in these patients. Tumor tissue was obtained prior to treatment and at relapse if possible, short-term culture was carried out, and these tumor cells were analyzed for MDR gene expression by slot blot and reverse transcriptase polymerase chain reaction (RT-PCR) and northern blot analysis. Three cell lines were also established from short-term cultures. Twenty-four patients with MDR(-) and seven with MDR +(++) were available for survival analysis. Median survival for MDR (-) patients was 10 months, whereas for MDR +(++) patients it was 2 months. This was statistically significance (p < 0.0007). The presence of MDR1 gene expression also correlated with the lack of response to chemotherapy (p < 0.001). Increased MDR1 gene expression is usually present in patients with more tumor burden at initial diagnosis. Furthermore, loss of MDR1 gene expression can occur in intrinsically MDR(+) SCLC cells after multiple passages in drug-free media. We concluded that increased MDR1 gene expression is present in a small number of SCLC both before and after chemotherapy and usually signifies poor survival and no response to chemotherapy.

Transradial coronary angiography and angioplasty in Chinese patients

Radial artery punctures for diagnostic coronary angiography or coronary balloon angioplasty were performed in 211 patients with a success rate of 98% (207 patients). In the four failed transradial accesses, the procedure was accomplished via the transfemoral route. Major local vascular complications included one arteriovenous fistula, one pseudo-aneurysm, and one ischemic contracture of the right hand. Reduced radial pulses were noted in 25 (12%) patients at follow-up without ischemic manifestations. Transradial diagnostic coronary angiography was successfully completed in 184 (98%) of 187 patients. The technical success for balloon angioplasty was obtained in 73 (97%) of 75 patients. Clinical success was observed in 68 (91%) patients; balloon angioplasty resulted in one nonfatal myocardial infarction and four late deaths (3 cardiac and 1 stroke). We believe that transradial catheterization for diagnostic coronary angiography and balloon angioplasty in our relatively small built Chinese population is a safe and practical alternative approach.

Inguinal hernia in children: US versus exploratory surgery and intraoperative contralateral laparoscopy

PURPOSE

To analyze the value of ultrasound (US) in the preoperative recognition of clinically apparent and inapparent inguinal hernias (or patent processus vaginalis).

MATERIALS AND METHODS

Two hundred sixty children (197 boys, 63 girls), in whom a clinical diagnosis of inguinal hernia (226 unilateral hernias, 34 bilateral hernias) had been made, underwent US examination with a 7.0-MHz linear-array transducer. The contralateral internal inguinal ring was evaluated by means of intraoperative laparoscopy in 141 patients. The 197 boys were grouped together by age (< 12 months, 12-24 months, 24-48 months, 48-72 months, and > 72 months).

RESULTS

In the 260 patients who underwent inguinal herniorrhaphy, 246 hernias (95%) were correctly diagnosed at US based on criteria of an internal inguinal ring width greater than 4 mm in diameter or the presence of fluid or organs in the inguinal canal at rest or during straining. A total of 473 hernias were confirmed surgically and 459 (97%) hernias were correctly detected at US. A statistically significant difference in the mean width of the internal inguinal ring of the five age groups was found between patients at rest and during straining (P < .05) in US measurement of the 197 surgically proved cases in boys.

CONCLUSION

US is a noninvasive, readily available, and highly accurate (95%) method for evaluating the presence of inguinal hernia in children at risk, especially when the clinical findings are equivocal or normal. US can provide an objective measure in determining the advisability of exploratory inguinal surgery in such cases.

Translation of vph mRNA in Streptomyces lividans and Escherichia coli after removal of the 5' untranslated leader

The Streptomyces vinaceus viomycin phosphotransferase (vph) mRNA contains an untranslated leader with a conventional Shine-Dalgarno homology. The vph leader was removed by ligation of the vph coding sequence to the transcriptional start site of a Streptomyces or an Escherichia coli promoter, such that transcription would initiate at the first position of the vph start codon. Analysis of mRNA demonstrated that transcription initiated primarily at the A of the vph AUG translational start codon in both Streptomyces lividans and E. coli; cells expressing the unleadered vph mRNA were resistant to viomycin indicating that the Shine-Dalgarno sequence, or other features contained within the leader, was not necessary for vph translation. Addition of four nucleotides (5'-AUGC-3') onto the 5' end of the unleadered vph mRNA resulted in translation initiation from the vph start codon and the AUG triplet contained within the added sequence. Translational fusions of vph sequence to a Tn5 neo reporter gene indicated that the first 16 codons of vph coding sequence were sufficient to specify the translational start site and reading frame for expression of neomycin resistance in both E. coli and S. lividans.

Post-transcriptional regulation of H-ferritin gene expression in human monocytic THP-1 cells by protein kinase C

The mRNA coding for H-ferritin was highly induced in human monocytic THP-1 cells following treatment with phorbol 12-myristate 13-acetate (PMA). The induction was detected at 3 h, reached maximal levels at 12 h, and was sustained for up to 48 h subsequent to PMA exposure. PMA-induced up-regulation of H-ferritin gene expression was also observed in other leukaemic cell lines, HL60 and U937, but not in non-leukaemic cell types, including human fibroblasts, endothelial cells and smooth muscle cells. The effect of PMA could be completely blocked by the protein kinase C inhibitor, H-7. Furthermore, treatment of THP-1 cells with bacterial phospholipase C also produced a marked increase in expression of H-ferritin mRNA, suggesting the activation of protein kinase C was responsible for the accumulation of mRNA. Nuclear run-off experiments demonstrated that PMA did not increase the transcriptional rate of the H-ferritin gene. In contrast, the half-life of the H-ferritin mRNA measured in the presence of actinomycin D was greatly prolonged in PMA-treated cells. The induction of H-ferritin mRNA by PMA required no protein synthesis. Conversely, treatment of THP-J cells with protein synthesis inhibitor, cycloheximide, resulted in a 4-5-fold increase in H-ferritin mRNA. The increase in the stability of the H-ferritin mRNA was also observed in cells treated with cycloheximide. Taken together, these results suggest that the stability of H-ferritin mRNA in THP-1 is subjected to regulation via a protein kinase C-mediated phosphorylation on existing putative protein factor(s).

Concurrent 5-fluorouracil, daily low-dose cisplatin, and radiotherapy in stage IIIB cervical cancer. A phase II prospective study

Between June 1987 and May 1991, 30 patients with Stage IIIB cervical cancers were treated using synchronous radiotherapy, 5-fluorouracil (5-FU), and daily low-dose cisplatin. External radiotherapy (3,600-3,960 cGy) was given to the whole pelvis in 4 weeks. Two courses of intracavitary brachytherapy were given 2 weeks later. Parametrial boost was then given. Continuous infusion of 5-FU 750 mg/m2 was given for 5 days during the first and third week of pelvic irradiation. Cisplatin (6 mg/m2) was given 30 min before every irradiation in the second and fourth week. The complete response rate was 87%. The 3-year local control rate was 77%. The 3-year overall and disease-free survival rate was 66% and 56%, respectively. Distant metastases were the major causes of treatment failure. Toxicities were acceptable. Our preliminary results indicate that this synchronous combination treatment is feasible. Further follow-up is required to determine whether this regimen has a genuine favorable impact on survival and chronic toxicity.

Utility of 10 MHz ultrasound catheters in the intraaortic assessment of coronary artery ostial stenoses

Our preliminary observations show that intraaortic intravascular ultrasound using 10 MHz transducer catheters is safe and feasible in the assessment of coronary ostial lesions. This imaging modality is potentially useful in decision making regarding the choice of coronary intervention.

Usefulness of intracardiac echocardiography in complex transseptal catheterization during percutaneous transvenous mitral commissurotomy

OBJECTIVE

To examine the utility of intracardiac echocardiography in guiding complex transseptal catheterization of patients undergoing percutaneous transvenous mitral commissurotomy.

DESIGN

We assessed this procedure in high-risk patients in whom transseptal catheterization is technically complex and more demanding.

MATERIAL AND METHODS

Fifteen patients with mitral stenosis were studied. Twelve patients had giant left atria (70 mm or more), two had atrial septal aneurysms, and one had severe kyphoscoliosis. A newly developed 8-F 10-MHz intracardiac transducer catheter was placed in the right atrium through an 8-F Mullins sheath inserted from the left femoral vein. Echocardiographic images were used to confirm the septal position of the Brockenbrough needle tip before septal punctures.

RESULTS

Transseptal puncture was successful and uncomplicated in all 15 patients. Use of intracardiac echocardiography eliminated the need for atrial angiography. Before transseptal puncture, the needle tip was identified to be in contact with the atrial septum, as an echogenic point with its acoustic shadow and septal indentation. In addition, in the two patients with aneurysms, puncture of the thin-walled aneurysms was avoided.

CONCLUSION

Intracardiac echocardiography facilitates safe complex transseptal catheterization in patients with mitral stenosis and giant left atria, atrial septal aneurysms, or severe kyphoscoliosis.

A general purpose fuzzy controller for monotone functions

In this work, a general purpose fuzzy controller is proposed to handle the class of monotonic functions. A set of rules on the selection of fuzzy subsets and decision tables based on the mean-of-inversion (MOI) defuzzification method for guaranteed convergence and accuracy is given and proved. Unlike the mean-of-maximum (MOM) and the center-of-area (COA) methods, the MOI method defuzzifies each fired rule separately instead of superimposing fired rules before defuzzification.

Atrial septal motion in effusive--constrictive pericarditis: transesophageal echocardiographic study and hemodynamic correlation

Transesophageal echocardiography was performed in 7 patients with effusive-constrictive pericarditis to analyze atrial septal motion(ASM). In 3 patients, the ASM was found to be normal with atrial septum (AS) moving toward the right atrium from ventricular mid-systole to early-diastole and toward the left atrium from mid-diastole to early-systole. Respiration had little effect on the ASM. In 2 patients, a brisk inversion of ASM toward the left atrium at ventricular early-to-mid systole was noted during inspiration. In the other 2 patients, a sustained ASM toward the left atrium during ventricular systole was found. In 4 of these 7 patients, hemodynamic studies were performed simultaneously with the transesophageal echocardiography. The ASM reflected the pressure gradient between the left atrium (as measured by pulmonary arterial wedge pressure) and the right atrium. The augmented ASM toward the left atrium occurred as left atrial pressure decreased markedly during inspiration. In conclusion, the ASM in patients with effusive-constrictive pericarditis showed 3 patterns: normal, sustained systolic motion toward the left atrium and a brisk systolic displacement toward the left atrium during inspiration. The ASM reflects changes in the interatrial pressure gradient.

Digital radiographic images will benefit endodontic services

Future assurances for endodontic services and assessments of traumatized teeth will depend in part on significant improvements to the quality of dental radiographs. Whereas digital images offer many potential sensor, display and archival advantages over film-based radiographs, the marginal image improvements from intraoral sensors primarily benefit patient education. Precisely digitized conventional radiographs are more likely to yield quantum image resolution improvements, although neither dentists nor patients will benefit until cost-effective digitizing systems have been developed for the dental office.

Human papillomavirus type 18 DNA in gestational trophoblastic tissues and choriocarcinomas

The objectives of our study were to better understand carcinogenesis of gestational trophoblastic tumors and to investigate the possible presence of human papillomavirus types 16 and 18 DNA sequences in these tumors. Amplification-based DNA methodology was used on 11 hydatidiform moles, 5 invasive moles, 8 choriocarcinomas and 9 normal early placental tissues. Human papillomavirus type 16 DNA was not found in any of these tissues. Although human papillomavirus type 18 DNA was also not found in the 9 normal placentas and 5 invasive moles, it was present in 2 of the 11 (18%) hydatidiform moles and in 4 of the 8 (50%) choriocarcinomas.

Study on in vivo release of levonorgestrel-containing silicon capsule

The in vivo release rate of levonorgestrel-containing silicon capsule (in vitro releasing rate: 6 micrograms/d) placed in rabbits was determined. The results showed that the average release per year was 8.32 micrograms with r being 0.96000. The release pattern of the levonorgestrel-containing silicon capsule system was proved to be zero-order release. Our study provided some experimental data for clinical use of the system for birth control.

Twice-per-day fractionated high versus continuous low dose rate intracavitary therapy in the radical treatment of cervical cancer: a nonrandomized comparison of treatment results

PURPOSE

To compare the efficacy of two twice-per-day fractionated high dose rate (HDR) brachytherapies with a historical control group treated with low dose rate (LDR) brachytherapy for cervical cancer patients.

METHODS AND MATERIALS

From 1985 to 1988, 92 patients with cancer of the cervic were treated by remote-controlled, HDR brachytherapy, six fractions of 7 Gy per fraction (42 Gy) at point A (HDR-6). Fifty-seven patients were treated with four fractions of 8 Gy per fraction (32 Gy) at point A (HDR-4). A twice-per-day program was used for all HDR patients by two split courses. As a historical control, treatment results of 259 patients treated with LDR brachytherapy (40 Gy in two split courses) were compared with those of the two HDR regimens. All patients received whole pelvic external irradiation, 36-45 Gy (mostly 40 Gy) before brachytherapy.

RESULTS

Five-year local control rates were not significantly different for the three groups (HDR-6 = 82.0%, HDR-4 = 85.5%, and LDR = 89.5%, respectively). Five-year survival rates were also comparable (67.7%, 77.9%, and 74.1%, respectively). However, late complications were lower in HDR-4 than HDR-6 (11.0% vs. 25.6%).

CONCLUSIONS

Both 5-year local control and survival rates were comparable among the three groups. However, HDR-4, which was more biologically equivalent to our LDR regimen, showed fewer complications compared to HDR-6. In addition, our twice-per-day schedule shortened the hospital stay.

Villous adenoma of ampulla of Vater: a case report

A 56-year-old female patient presented with pain and tenderness over the epigastric region. Endoscopy showed a polypoid mass at the ampulla of Vater. Endoscopic biopsy showed villous adenoma with moderate cellular atypia. Wide excision of the tumor was performed. After resection, histological examination confirmed the tumor to be a villous adenoma of ampulla of Vater. This is a rare neoplasm with an incidence of 0.04-0.12% in postmortem series. A few cases have been reported in the literature, but only two documented in the Chinese literature to date. Wide excision has had good results and should be regarded as the treatment of choice for benign lesions.

Functional characterization of the promoter region of the platelet-activating factor receptor gene. Identification of an initiator element essential for gene expression in myeloid cells

To understand the molecular mechanisms that direct the expression of the gene encoding the platelet-activating factor (PAF) receptor, the 5'-flanking region of the human PAF receptor gene was cloned, and its promoter activity in myeloid cell lines was characterized. By the 5'-rapid amplification of cDNA ends method and primer extension, the transcription initiation site was mapped to an adenosine residue 137 bases upstream of the ATG translation initiation codon. The promoter region lacks a typical TATA or CCAAT box. However, the sequence encompassing the transcription initiation site shows high homology to the initiator (Inr) sequence. Transfection of promonocytic U937 cells with recombinant plasmids containing a series of truncated segments of the 5'-flanking region linked to the luciferase reporter gene revealed that the sequence from nucleotides -44 to +27 relative to the transcription initiation site was sufficient to promote a high level of gene expression. The promoter activity was much lower in nonexpressing HeLa cells and promyelocytic HL-60 cells, which express relatively low levels of the PAF receptor. Gel mobility shift analysis demonstrated the binding of nuclear factors extracted from myelocytic cells to the -16/+18 sequence containing the Inr element. No binding activity was detected using the nuclear extracts from the nonmyelocytic HeLa cells. The DNA-protein complexes were sequence-specific since the binding was not significantly affected by the mutated Inr sequences or the Inr sequence of the terminal deoxynucleotidyltransferase gene. Furthermore, point mutations in the Inr element significantly reduced promoter activity in both U937 and THP-1 cell lines. When Me2SO or retinoic acid was used to induce granulocytic differentiation of HL-60 cells, a distinct Inr-protein complex was induced concurrently, but the complex was not observed in 12-O-tetradecanoylphorbol-13-acetate-induced monocytic differentiated HL-60 cells or Me2SO-induced differentiated U937 cells, indicating that the inducible Inr binding activity is granulocyte-specific. These results suggest that distinct nuclear factors interact with the unique Inr element and play a role in the transcriptional regulation of the PAF receptor in various myeloid cells.

Relationship of multidrug resistance to rhodamine-123 selectivity between carcinoma and normal epithelial cells: taxol and vinblastine modulate drug efflux

Preferential retention and cytotoxicity of Rhodamine-123 (Rho-123) was originally reported in a number of carcinoma cell types isolated from a variety of tissues as compared to normal epithelial cells from a limited number of other tissues. In the present study, we have examined Rho-123 selectivity in normal and tumor cell lines isolated from the same tissue source, i.e., human breast. We found that: (a) in matched pairs of normal and carcinoma breast cells, Rho-123 displays no preferential retention in either cell type; (b) there is no preferential toxicity in carcinoma as compared to normal breast cells; in fact, one of the carcinoma cell lines (MDA-MB231) shows moderate resistance to this dye; (c) all of the human breast cell lines do not express P-glycoprotein-mediated multidrug resistance; (d) the normal monkey kidney epithelial cell line CV-1, which was originally used as a model to demonstrate the relative resistance of normal epithelial cells to this drug, is found to express high levels of the mdr-1 gene, is resistant to other multidrug-resistant drugs (taxol and vinblastine), and its resistance to Rho-123 as well as decreased Rho-123 retention can be reversed by verapamil; and (e) taxol and vinblastine are found to block increased Rho-123 efflux in CV-1 cells. Thus, overall the data suggest that preferential retention and cytotoxicity of Rho-123 in carcinoma versus normal epithelial cells is related to the differential expression of the mdr-1 gene.

When will excellent radiographic images be available to the general dental office?

Dental radiography is a highly regarded diagnostic practice. More than 25% of all radiographs are taken for dental purposes, so their improvement will benefit many patients. Although recent advances in materials and processing have contributed to incremental improvements in film-based diagnoses, computer-based enhancement of digitized conventional radiographic images is likely to yield more significant benefits. However, until cost-effective digitizing systems have been developed for the general dental office, the benefits derived from precise radiographic diagnoses and associated improvements in the standards of care will continue to elude both dentist and public.

Cytokine gene expression in human cardiac allograft recipients

The long-term success of heart transplantation for end-stage heart disease has been hindered by the problems associated with acute and chronic graft rejection, opportunistic infections and potentially fatal complications of intensive immunosuppression. A more complete understanding of the biology of transplant rejection should provide the basis for the development of improved methods for controlling and monitoring rejection. Cytokines, the soluble factors which regulate the immune response, are central to the rejection process. The objective of this study was to analyse cytokine mRNA transcripts in 99 biopsy samples and 89 blood samples from 65 and 35 Stanford Medical Center cardiac transplant recipients, respectively, gathered between January 1990 and January 1992. Following RNA extraction and conversion to cDNA, samples were amplified with cytokine-specific primers for interleukins (IL) 1 to 8, TNF-beta (tumour necrosis factor-beta) and IFN-gamma (interferon-gamma) and were analysed by gel electrophoresis and Southern blot hybridization. Our results demonstrate that despite chronic immunosuppressive therapy, the peripheral blood of transplant recipients expressed a higher combined percentage of different cytokine transcripts than did peripheral blood obtained from normal volunteers. In transplant patients, detection of cytokine transcripts for IL-1 alpha, IL-1 beta and IL-2 increased with time after transplantation. Intragraft IL-7 gene expression was significantly increased in biopsies diagnosed with mild (grade 1) rejection when compared to those with no evidence of rejection or with moderate to severe rejection. Implications of these results in light of possible mechanisms of rejection and of new approaches to immunotherapy are discussed.

Clinical evaluation of a renal mass diagnostic expert system

In this paper, we describe our clinical evaluation of the diagnostic accuracy of the renal mass diagnostic system (RMDS) and of seven physicians. To investigate the value of intravenous urography (IVU) and/or retrograde urography (RU) in diagnosing renal parenchymal tumors and tumors of the renal pelvis, RMDS and the seven physicians were tested with and without the information regarding IVU/RU at two different times. From this study we believe that RMDS can help residents in making more accurate presurgical renal mass diagnosis, and may eliminate the need for IVU/RU in the diagnosing process for a specific group of patients.

Two multidrug-resistant Friend leukemic cell lines selected with different drugs exhibit overproduction of different P-glycoproteins

Two Friend leukemic multidrug-resistance (MDR) cell lines were established by exposure to stepwise increased concentrations of rhodamine-123 (RHO) (cell line RR-30) or Adriamycin (ADR) (cell line ARN-15). RR-30 displays preferential resistance to RHO, whereas ARN-15 is more resistant to ADR. The levels of resistance to other MDR drugs and reversibility by verapamil between these two MDR cell lines were somewhat different. Southern blot, RNase protection, and Western blot analysis using gene-specific probes demonstrated that RR-30 and ARN-15 cells preferentially amplified the mdr1 and mdr3 genes, respectively, leading to overexpression of the corresponding P-glycoproteins (p-gp). Our results suggest that members of the mdr gene family can be amplified independently by using different selecting agents, which could be responsible for the differences in the sensitivities to these selecting agents as well as to these MDR drugs.

Cytokine gene expression in human lung transplant recipients

The polymerase chain reaction was used to evaluate cytokine gene expression in bronchoalveolar lavage (BAL) cells and peripheral blood leukocytes in 31 human lung transplant recipients. All patients were maintained on a triple immunosuppression regimen consisting of CsA, AZA, and prednisone. Posttransplant survival ranged from 0.5 to 100.5 months (mean = 16.3 months). Cytokines IL-1 alpha, IL-2, IL-4, IL-5, IL-6, IL-7, IL-8, TNF-beta, and IFN-gamma were studied. In BAL, transcripts for IL-1 alpha, IL-7, IL-8, and TNF-beta were found in over 60% of samples and those for IL-5, IL-6, and IFN-gamma in 40-50%, while IL-2 and IL-4 mRNA were rarely found (< 20%). Considerable variation in the frequency of cytokine gene expression between BAL and peripheral blood was observed. When analyzed for the presence of acute pulmonary allograft rejection (without infection), transcripts for IL-4 and IL-6 in BAL demonstrated the greatest increase in frequency compared with nil rejection (P = 0.07 and P = 0.17, respectively). Pulmonary infection (without rejection) was associated with a modest increase in the expression of genes for IL-1 alpha and IFN-gamma (> 10%). Transcripts for IL-4 were not found in association with pulmonary infection, suggesting that this cytokine may be useful as a discriminatory rejection marker.

Using ILIAD system shell to create an expert system for differential diagnosis of renal masses

Differential diagnosis of renal masses is an important and difficult process. A renal mass diagnostic system (RMDS) developed by using the ILIAD expert system shell has been created for diagnostic consultations and patient simulations. Seventy-two cases of renal mass have been tested on this system and the diagnostic accuracy was compared to that of residents. The overall diagnostic accuracy (75%) for renal masses is significantly better than second-year urological residents (60%) and not worse than urological chief residents (71%). The expert system also displays the cost of the diagnostic procedures so that the user can choose the most cost-effective diagnostic process. We conclude that this powerful renal mass diagnosis system developed by using ILIAD system shell can be used as a teaching, self-training and clinical tool for urological residents.

Long-term outcome of acupuncture in women with frequency, urgency and dysuria

Urodynamic measurements including cystometry, anal sphincter electromyography, urethral pressure profilometry and uroflowmetry were carried out on 21 female patients before acupuncture and at 1 and 3 years during follow-up. Follow-up ranged from 60 to 72 months (average 66.2 months). There was no significant difference in all urodynamic measurements before acupuncture and at the 1 year or 3 years follow-up. During follow-up, acupuncture at the Sp-6 point was performed in patients who had recurrence of symptoms of frequency, urgency and dysuria. The number of acupuncture treatments ranged from 2 to 8 times, with an average number of 4.8 times. A decrease of acupuncture treatments after 30 months was noted on 8 patients, but it was not statistically significant. We concluded that the long-term outcome of acupuncture at the Sp-6 point for women with frequency, urgency and dysuria was positive, but that the effect was temporary and repeated acupuncture was necessary to maintain beneficial effects.

Purification and properties of chitinase from cabbage

Chitinase has been purified from the extract of cabbage through successive steps of ammonium sulfate fractionation, chromatofocusing and Sephadex G-75 gel filtration. By these steps, the purity of the enzyme increased by 93.3 fold and the recovery of the enzyme activity was 20%. The purified enzyme had an optimal pH of 5.0, an optimal temperature between 40 to 50 degrees C and a Km of 76 microM for hydrolysis of ethylene glycol chitin. The molecular weight of the enzyme determined from filtration through Sephadex G-75 was 30,000 daltons. Heavy metal ions, Hg2+ (0.5 mM) and Ag+(2.5 mM) significantly inhibited the activity of the enzyme. NBSI1 (1.0 mM), DNFB (0.5 mM) and PMSF (0.5 mM) completely inhibited the activity of the enzyme. The enzyme also showed muramidase activity for hydrolysis of Micrococcus lysodeikticus cell wall. The presence of chitinase in cabbage may function as a defense enzyme against potential pathogens.

Cytokine gene expression in rejecting cardiac allografts

Heart transplantation is now a viable therapeutic option for patients with certain end-stage cardiac diseases. However, episodes of rejection, opportunistic infection, and life-threatening side effects of generalized immunosuppression remain very real problems for these patients. A better understanding of the molecular mechanisms underlying rejection may provide the basis for the development of more specific, less toxic immunosuppressive therapies. While cytokines have long been implicated in the pathogenesis of rejection, the precise role of each cytokine in this process has yet to be defined. We report here the application of the polymerase chain reaction (PCR) to the detection of cytokine mRNA in biopsies obtained from heterotopic abdominal cardiac allografts in cynomolgus monkeys. With the exception of IL-6 and IL-8, cytokine transcripts were undetectable in samples obtained from the donor heart pretransplant. In contrast, IFN-gamma transcripts were detected in all transplants two days after surgery before evidence of rejection was demonstrable by histopathologic analysis. IL-1 beta, IL-2, and IL-6 transcripts were detected when minimal rejection was noted. At later times, IL-1 alpha, IL-1 beta, IL-2, IL-6, IL-8, TNF-beta, and IFN-gamma transcripts were detectable. Further characterization of the spectrum of cytokines expressed at various stages of rejection may lead to insights into the biology of transplant rejection and to the development of more specific and potent reagents to diagnose and/or treat rejection.

Xanthogranulomatous pyelonephritis: experience in 36 cases

A retrospective study of 36 patients with xanthogranulomatous pyelonephritis who underwent nephrectomy at our hospital was performed. The disease occurred most frequently in middle-aged women with a history of recurrent urinary tract disorder. There were 2 cases of focal xanthogranulomatous pyelonephritis, 2 associated with emphysematous pyelonephritis, 2 that manifested as fistula formation between the colon or skin, and 1 with deep sinus formation into the hip joint that presented as septic arthritis. Flank pain and fever were the most frequent complaints. Escherichia coli (67%) and Proteus mirabilis (26%) were the most common organisms isolated from the voided urine, kidney and blood stream. Cephalothin plus gentamicin or tobramycin were the drugs of choice before surgical intervention.

Renal osteodystrophy

The term "renal osteodystrophy" is used to include skeletal disorders of patients with chronic renal failure: osteitis fibrosa, osteomalacia, osteosclerosis, osteoporosis and the frequently associated extraskeletal calcifications. It is the chronic glomerular disease with phosphate retention and resultant hyperphosphatemia on one hand and deficient 1,25 (OH)2 D3 and resultant hypocalcemia on the other to induce secondary hyperparathyroidism. The three most common causes of chronic renal failure in our patients are chronic glomerulonephritis, diabetic nephropathy, hypertensive nephropathy in decreasing frequency, polycystic renal disease occurs in five patients. Other miscellaneous causes include nephrotic syndrome, chronic pyelonephritis, systemic lupus erythematosus, periarteritis nodosa, interstitial nephritis and renal stones. The bone changes are similar in primary and secondary hyperparathyroidism and the incidence of brown tumor is about 3% in the former and 1.5 to 1.7% in the latter. We present one among the 94 dialyzed patients who has long-standing severe chronic renal failure from polycystic kidney disease and develops brown tumor in the mid ulna after 7 years on maintenance hemodialysis. The incidence of brown tumor in our series is about 1.1%. Because of increased longevity of the dialyzed patients, brown tumor from secondary hyperparathyroidism is now more commonly observed. Hyperphosphatemia with serum calcium-phosphate products exceeding plasma solubility of 60 to 75 mg/dl may induce soft tissue and vascular calcification. This explains the much higher incidence of soft tissue calcification in secondary than primary hyperparathyroidism; two of our patients with generalized Monckeberg's type arterial calcification and multiple periarticular calcifications in five patients have been observed.(ABSTRACT TRUNCATED AT 250 WORDS)

Murine memory B cells are multi-isotype expressors

Flow cytometric analyses of the surface immunoglobulins of murine memory B cells revealed the existence of populations expressing multiple isotypes, including an IgM+/IgG+ population that could be stimulated in vitro with antigen to secrete both IgM and IgG. Female BALB/c mice were immunized with R-phycoerythrin (RPE), a fluorescent photosynthetic accessory protein from red algae. Pooled splenocytes from these mice at different stages of immunization were stained with RPE as well as with allophycocyanin- and fluorescein-conjugated anti-isotype antibodies and analysed on a two-laser FACS. RPE-binding cell sub-populations were defined and selectively sorted to verify their phenotype and to demonstrate that the various subpopulations (IgM+/IgG+, IgM+/IgG-, IgM-/IgG+) had different isotype-secretion patterns when challenged with RPE in vitro. These results re-affirm the notion that a transcriptional processing mechanism may be responsible for the simultaneous expression of multiple isotypes in memory cells.

Radiation alone in the treatment of cancer of the uterine cervix: analysis of pelvic failure and dose response relationship

This retrospective analysis involves 569 patients with invasive cancer of the uterine cervix treated with irradiation alone between 1969 and 1980. Treatment consisted of external and intracavitary irradiation and treatment policy remained consistent throughout the study interval. In early stage disease (FIGO IA, IB, and IIA), pelvic failure was 4.6%, 11.2%, and 8.2%, respectively. In late stage disease (FIGO IIB, III, and IVA), pelvic failure was 30.1%, 52.3%, and 69.2%, respectively. Further analysis revealed that total dose at point A is well correlated with pelvic control. An aggressive treatment is crucial in late stage disease in determining the probability of pelvic tumor control and survival. Methods of dose prescription, dose-response relationships, treatment philosophy and its therapeutic implications are discussed.

[Transforming potential of DNA from solid tumor of human gastric carcinoma]

The NIH-3T3 and Rat-1 recipient cells were transfected with DNA from solid tumor or metastatic tissue of 8 gastric carcinoma patients by the method of calcium phosphate precipitation or G418 co-transfection. Seven of them were shown to have transforming potential. After the third round of transfection, a series of transformants were obtained which showed malignant phenotype, growth ability in soft agar culture, tumorigenicity in nude mice and retaining of human Alu repeat sequence. Through Southern hybridization of DNA from the secondary transformant, H-ras oncogene was demonstrated with the same length as in the human cells.

Correlation between lipid fluidity and tryptic susceptibility of Ca2+-ATPase in sarcoplasmic reticulum membranes

Lipid fluidity in native and denatured sarcoplasmic reticulum membranes and extracted lipids was monitored between -30 and 30 degrees C using trans-parinaric acid as a fluorescent probe. In addition to a large increase in fluidity between -30 and 0 degree C in each system, a phase change centered near 10 degrees C was observed in the extracted lipids but not in either the native or denatured membranes. A significant change in fluorescence intensity near 15 degrees C was observed in native sarcoplasmic reticulum membranes, however, when trans-parinaric acid was excited by energy transfer from tryptophan residues of the membrane protein. When Ca2+-ATPase was subjected to proteolytic cleavage by trypsin as a function of temperature, a change in susceptibility was detected at about 15-20 degrees C in the native membranes but not in a solubilized preparation. It is proposed that one or more structural changes in the microenvironment of Ca2+-ATPase in the native membrane occur between 15 and 20 degrees C which may be related to the change in apparent activation energy which is observed for this enzyme.