[Efficacy of cibenzoline in the termination and long-term prevention of paroxysmal atrial fibrillation: analysis based on the time of onset]

OBJECTIVES

The efficacy of cibenzoline was assessed in the termination and long-term prevention of paroxysmal atrial fibrillation in relation to the time of onset in a series of patients with paroxysmal atrial fibrillation.

METHODS

Study of the termination included 92 patients (63 males, 29 females, mean age 64 +/- 12 years) and study of long-term prevention included 106 patients (77 males, 29 females, mean age 64 +/- 11 years; mean follow-up 32.7 +/- 18.8 months). Paroxysmal atrial fibrillation was classified into 3 types based on the time of onset: day type (AM 7:00-PM 5:00), night type (PM 5:00-AM 7:00) and mixed type (anytime). Successful termination was defined as pharmacological cardioversion within 30 min of the intravenous administration of 70 mg cibenzoline and efficacy of long-term prevention was presented as the event-free ratio of patients after oral administration of 300 mg/day cibenzoline.

RESULTS

Successful pharmacological termination was achieved in 66.7% of the day type (n = 24), 70.0% of the night type (n = 48), and 41.6% of the mixed type (n = 20). There was a significantly higher success in the day type (p < 0.05), and tendency to success in the night type (p = 0.079) compared to the mixed type. The event-free ratios at 1, 3, 6, 12, 24 months after oral administration were 84.6%, 76.9%, 73.1%, 65.4%, 61.5% in the day type (n = 26), 92.0%, 80.0%, 80.0%, 72.0%, 60.0% in the night type (n = 25), and 81.8%, 61.8%, 47.3%, 30.9%, 23.6% in the mixed type (n = 55), respectively. Significantly higher success was achieved at 24 months in the day type and the night type compared to the mixed type (p < 0.05).

CONCLUSIONS

Termination and long-term prevention of paroxysmal atrial fibrillation by cibenzoline has a high degree of efficacy in patients with both day and night onset of paroxysmal atrial fibrillation.

A sandwich enzyme-linked immunosorbent assay for human serum paraoxonase concentration

Serum paraoxonase (PON) is associated with plasma high density lipoproteins, and prevents the oxidative modification of low density lipoproteins. We have developed a sensitive sandwich enzyme-linked immunosorbent assay (ELISA), using two monoclonal antibodies against PON, to measure serum PON concentration. The concentration of PON in healthy Japanese subjects was 59.3 +/- 1.3 microgram/mL (mean +/- SEM; n = 87). Serum PON concentrations in relation to the PON 192 genetic polymorphism were: 69.5 +/- 2.9 microgram/mL in the QQ genotype; 63.0 +/- 1.9 microgram/mL in the QR genotype; and 52.8 +/- 1.7 microgram/mL in the RR genotype. Concentrations were significantly lower in the RR than in the QQ genotype (P < 0.01). Serum paraoxonase specific activity was higher in RR than in QQ subjects (18.6 +/- 0.40 vs. 2. 56 +/- 0.05 nmol/min/microgram, P < 0.01), but arylesterase specific activity was unrelated to genotype. PON concentration was positively associated (P < 0.001) with both serum arylesterase activity and, after adjusting for the effect of the position 192 polymorphism, with serum paraoxonase activity. Subjects with angiographically verified coronary heart disease had significantly lower PON concentrations than the healthy controls (52.0 +/- 2.3 microgram/mL; n = 35, P < 0.01). This association was independent of the position 192 genotype. Our new ELISA should be of value for epidemiologic and clinical studies of serum PON concentration. immunosorbent assay for human serum paraoxonase concentration.

Different activation of vascular mitogen-activated protein kinases in spontaneously and DOCA-salt hypertensive rats

Regulation mechanisms of the activity of vascular mitogen-activated protein (MAP) kinases, enzymes believed to be involved in the pathway for cell proliferation, may be altered in hypertension. To examine whether vascular MAP kinase activation mechanisms are altered in hypertension, we measured the activity of MAP kinases in rat aorta strips from spontaneously hypertensive rats (SHR) and from deoxycorticosterone acetate (DOCA)-salt hypertensive rats, and examined whether vascular angiotensin and endothelin systems are responsible for the alteration of MAP kinase activation in these hypertensive models. Endothelium-denuded aorta strips were incubated at 37 degrees C in medium. MAP kinase activity after incubation was increased in rat aorta strips. The MAP kinase activation was greater in 9- and 15-week-old SHR aorta strips than in age-matched Wistar Kyoto rats (WKY) aorta strips. Similarly, MAP kinase activation was enhanced in aorta strips from DOCA-salt hypertensive rats. In aorta strips from these kinds of rats, the angiotensin receptor antagonist, losartan, and the endothelin receptor antagonist, cyclo (D-alpha-aspartyl-L-prolyl-D-valyl-L-leucyl-D-tryptophyl) (BQ123), inhibited the MAP kinase activation. The losartan-induced, but not BQ123-induced, inhibition of MAP kinase activation was enhanced in 15-week-old SHR aorta strips, whereas the BQ123-induced, but not losartan-induced, inhibition of MAP kinase activation was enhanced in DOCA-salt hypertensive rat aorta strips. Angiotensin II-induced MAP kinase activation was enhanced in 15-week-old SHR aorta strips, whereas it was depressed in DOCA-salt hypertensive rat aorta strips. These results indicate that MAP kinase activation function is enhanced in aorta strips from both kinds of hypertensive rats. It appears that the enhancement of MAP kinase activation results partly from enhanced vascular angiotensin system in SHR and from enhanced vascular endothelin system in DOCA-salt hypertensive rats.

Pentagalloylglucose, an antisecretory component of Paeoniae radix, inhibits gastric H+, K(+)-ATPase

We purified a compound with strong inhibitory effect on H+, K(+)-ATPase from Paeoniae radix, which has been used in Japan for the treatment of gastritis and peptic ulcers. The compound was identified as 1,2,3,4,6,-penta-o-galloyl-beta-D-glucose by proton nuclear magnetic resonance, carbon-13 nuclear magnetic resonance, and fast atomic bombardment mass spectrometry. The IC50 of the compound for H+, K(+)-ATPase was 166 nmol/l. Kinetic analyses indicated that the inhibition of the enzyme by pentagalloylglucose was noncompetitive with respect to K+. Pentagalloylglucose had relatively weak inhibitory effects for Mg(+)-ATPase (IC50: > 10 mumol/l) and Na+, K(+)-ATPase (IC50: 2.7 mumol/l). Pentagalloylglucose also inhibited the accumulation of [14C]aminopyrine in parietal cells that had been isolated from guinea pig stomach and stimulated by 10 mumol/l histamine (IC50: 7.8 mumol/l) and 1 mmol/l dbc-AMP (IC50: 10 mumol/l). These results suggest that pentagalloylglucose is a potent inhibitor of H+, K(+)-ATPase and may be responsible for inhibition of acid secretion by Paeoniae radix.

[Incidence proportion estimation, prevalence and effective visiting nurse care of pressure ulcers]

PURPOSE

The purpose of this study are as follows: 1. To determine incidence proportion estimations and prevalence of pressure ulcers in home care settings. 2. To clarify the effective nursing care for prevention and treatments of pressure ulcers at visiting nursing service stations. 3. To show whether demographic characteristics are factors in pressure ulcer development.

METHODS

This research is a part of the series of studies on prevalence of pressure ulcers in 934 visiting nursing service stations on October 1995 in Japan. This was followed in November 1, 1996 to October 31, 1997, by another investigation for incidence proportion estimation and prevalence of pressure ulcers and their relationship to nursing care facilities, in which questionnaires were mailed to 620 facilities that participated in the first research. Responses from 294 (47.4%) facilities and 1,208 subjects were received. We analyzed the responses from 215 facilities (73.1%) and 864 subjects to the two types of questionnaires.

RESULTS

Prevalence of pressure ulcers was found to be 8.0% (95% CI: 7.5-8.6) on July 1, 1997 and incidence proportion estimation was 3.7% (95% CI: 3.3-4.1) from November 1, 1996 to October 31, 1997 for the 10,750 clients in 215 facilities. The number of prescriptions for turning of client sleep position (p = 0.044), and having a standard care assessment procedure (p = 0.015) were significantly higher for no-present pressure ulcer than in facilities with under 5% having present pressure ulcers and facilities with over 5% having present pressure ulcers. Subtracting the prevalence point in 1997 from 1995, the utilization of a primary nursing care plan (p = 0.021), and the number of part-time nurses (p = 0.008) were significantly higher in the groups that had a decrease or no-change compared to the increased groups. 45.6% of the ulcers identified were situated on the sacrum/buttocks and 39.4% of the ulcers were grade 2. The mean total score on the Braden Scale was 12.7. A score of 18 may be considered as the cut-off point in home care settings.

DISCUSSION

Prevalence of pressure ulcers was found to be 8.0% and incidence proportion estimation was 3.7%. The present findings concerning incidence proportion estimation and prevalence of pressure ulcers and the practice of nursing care in visiting nursing service stations suggests possibility for improving outcomes for clients with pressure ulcers and for those at risk factors of developing them.

Diffuse pachygyria with cerebellar hypoplasia: a milder form of microlissencephaly or a new genetic syndrome?

We report on 2 families with diffuse pachygyria and cerebellar hypoplasia, who presented hypotonia, ataxia, seizures, and developmental delay since infancy. Computed tomography (CT) and magnetic resonance imaging (MRI) revealed decreased gyral formation in the cerebral cortex and marked hypoplasia in the cerebellum. Cerebellar hypoplasia is often associated with type 2 lissencephaly; however, our cases showed no polymicrogyria, and their clinical findings were quite mild compared with those of microlissencephaly. Their characteristic phenotype suggested a new genetic syndrome, which was possibly inherited as an autosomal recessive trait.

[A review of methodology on community health nursing diagnosis]

PURPOSE

To develop a systematic method and model for community health nursing diagnosis to be used in teaching and in community practices.

METHOD

From searching the databases of Medline (from Jan. 1966 to May 1997) and the Japana Centra Revuo Medicina (from Jan. 1987 to Jan. 1997), literature on community diagnosis, community health nursing, diagnosis, assessment and analysis were classified into keywords, purposes, subjects, health problems and methods.

RESULTS

1. As an explanation of the process of nursing diagnosis the community-as-partner model (Anderson and McFarlane; 1995) is useful for understanding the target community and the use of the community health nursing diagnosis process. 2. The methodology of the community health nursing diagnosis is based on three strategies of public health diagnosis. The method of interview surveys was strengthened by incorporating the ethnographic method. 3. Several case studies in the partnership between communities and universities in USA were introduced.

CONCLUSION

Changes in community health policy require that public health nurses develop specialized and comprehensive practices in their communities. The authors presented the model of the community health nursing diagnosis process and proposed a partnership between communities and universities. The construction of community health nursing diagnosis process in this paper is based on the public health diagnosis framework consisting of three strategies, to which analysis of existing data, a social survey utilized in epidemiological community diagnosis, and free interviewing from ethnographic methods are incorporated. Developing this systematic diagnosis process of facilitates the search for potential or actual community health problems or concerns, the practice of applying data from surveys and the discussion of concrete strategies toward problem solving. It is useful for educational and research processes and in practice in the community.

Optic nerve blindness due to paranasal sinus disease

Patients with total blindness caused by paranasal sinus disease have rarely been reported. We retrospectively studied the prognosis of patients who had optic nerve blindness due to paranasal sinus disease. During the past 10 years, we identified 17 patients with optic nerve disease and posterior paranasal sinus disease. Seven of the 17 patients with optic nerve disease and paranasal sinus disease had no light perception. Five of these 7 patients with paranasal sinus disease had a final visual acuity of 20/200 or better. Two patients showed dramatic visual improvement after endonasal surgery. Because immediate surgery to correct paranasal sinus disease is required in affected patients, computed tomography should be done at the patient's first visit.

Anatomical location of enterochromaffin-like (ECL) cells, parietal cells, and chief cells in the stomach demonstrated by immunocytochemistry and electron microscopy

Enterochromaffin-like (ECL) cells are included in the endocrine cells present in the gastric oxyntic mucosa, and have been attracting attention as histamine-secreting cells contributing to gastric secretion. However, the anatomical location of ECL cells in relation to parietal cells and chief cells has not yet been sufficiently investigated. To elucidate this location of ECL cells, we performed an immunocytochemical study using anti-histamine antibody and electron microscopic examination of guinea pig gastric mucosa. ECL cells were located near the basement membranes in the gastric oxyntic region, and were in contact with both chief cells and parietal cells in the same glandular epithelium. The ratio of ECL cells in contact with chief cells was clearly greater than that in contact with parietal cells. An omega-shaped morphology, indicating emiocytosis, was found in ECL cells by electron microscopy. These findings suggest that ECL cells have a paracrine effect on chief cells and parietal cells, and may have an important physiological role in pepsinogen secretion.

Vascular mitogen-activated protein kinase activity is enhanced via angiotensin system in spontaneously hypertensive rats

The vascular structural remodeling function may be altered in genetically hypertensive animals, spontaneously hypertensive rats (SHR). To examine this possibility, we measured the activity of mitogen-activated protein (MAP) kinases, enzymes believed to be involved in the pathway for cell proliferation, in rat aorta strips, and examined whether the endothelium removal-induced MAP kinase activation function is altered in SHR and whether vascular angiotensin and endothelin systems are responsible for the alteration of MAP kinase activation in SHR. Male 4-week-old SHR and age-matched Wistar Kyoto rats (WKY) supplied by Charles River Japan were used. Endothelium-denuded aorta strips were incubated at 37 degrees C in medium. MAP kinase activity after incubation was time-dependently increased in strips from SHR and WKY. MAP kinase activation was greater in SHR than in WKY aorta strips. Similarly, MAP kinase activation was enhanced in aorta strips from 4-week-old SHR and stroke prone SHR supplied by the Diseases Model Cooperative Research Association (Kyoto, Japan). In aorta strips from SHR and WKY, the angiotensin receptor antagonist, losartan, and the endothelin receptor antagonist, cyclo (D-alpha-aspartyl-L-prolyl-D-valyl-L-leucyl-D-tryptophyl)(BQ123), caused concentration-dependent inhibition of MAP kinase activation. The losartan-induced but not BQ123-induced inhibition of MAP kinase activation was greater in SHR than in WKY aorta strips. Angiotensin II caused a concentration-dependent increase in MAP kinase activity and the angiotensin II-induced MAP kinase activation was greater in SHR than in WKY aorta strips. These results indicate that endothelium removal-induced MAP kinase activation is enhanced in aorta strips from young SHR, suggesting that vascular structural remodeling function may be enhanced in SHR. It appears that the enhancement of MAP kinase activation results, at least in part, from enhanced function of vascular angiotensin system in SHR.

[Systemic sclerosis: different subsets and disease remitting drugs]

Systemic sclerosis(scleroderma) is a generalized disorder of connective tissue characterized clinically by thickening and fibrosis of the skin and distinctive forms of involvement of internal organs notably the heart, lungs, kidneys and the gastrointestinal tract. Systemic sclerosis is a complicated disease with wide variation of manifestations and outcomes. It ranged from a disease which is extremely mild hardly effecting someone's life to one that is very severe causing an early demise. We describe different subsets of this complicated disease which allows physicians to have better understanding of its prognosis and outcome. Serum autoantibodies are useful in predicting prognosis, since they have association with serious visceral disease. Recently, laboratory studies are helpful both in identifying organ system abnormalities and the scleroderma specific autoantibodies. These autoantibodies are potentially very important in identifying subsets of patients. Using physical and serologic findings, the physician can determine the specific problems which are need to be addressed and treated.

Evidence for the involvement of platelet-derived growth factor in the angiotensin II-induced growth of rat vascular smooth muscle cells

This study examines the possible involvement of endogenous platelet-derived growth factor (PDGF) in the angiotensin II-induced growth of rat aortic smooth muscle cells. In quiescent confluent cells, anti-PDGF-AB neutralizing antibody inhibited angiotensin II-induced DNA synthesis and protein synthesis. PDGF-AA, -AB, and -BB produced concentration-dependent increases in DNA synthesis and protein synthesis. Genistein did not inhibit PDGF-AB-induced [3H]thymidine incorporation and [3H]leucine incorporation. PDGF-AB stimulated mitogen-activated protein (MAP) kinases, and PDGF-induced MAP kinase activation was inhibited by genistein. Angiotensin II induced PDGF-A chain messenger RNA expression, and genistein inhibited angiotensin-induced PDGF gene expression. These findings suggest that endogenous PDGF is, at least in part, involved in angiotensin II-induced cell growth in rat vascular smooth muscle cells. It appears that genistein inhibits angiotensin II-induced DNA synthesis partly by inhibiting PDGF-A gene expression.

Selenoprotein P in human plasma as an extracellular phospholipid hydroperoxide glutathione peroxidase. Isolation and enzymatic characterization of human selenoprotein p

Selenoprotein P is an extracellular protein containing presumably 10 selenocysteines that are encoded by the UGA stop codon in the open reading frame of the mRNA. The function of selenoprotein P is currently unknown, although several indirect lines of evidence suggest that selenoprotein P is a free radical scavenger. We first developed a conventional procedure to isolate selenoprotein P from human plasma. Next, we investigated the reactivities of selenoprotein P against various hydroperoxides in the presence of glutathione. Although selenoprotein P reduces neither hydrogen peroxide nor tertiary butyl hydroperoxide, it does reduce phospholipid hydroperoxide such as 1-palmitoyl-2-(13-hydroperoxy-cis-9, trans-11-octadecadienoyl)-3-phosphatidylcholine hydroperoxide. Kinetic analysis demonstrated a tert-uni ping-pong mechanism, similar to those described for classical glutathione peroxidase and phospholipid hydroperoxide glutathione peroxidase. Not only glutathione, but also dithiothreitol, mercaptoethanol, cysteine, and homocysteine, were effective as reducing substances, as in the case of phospholipid hydroperoxide glutathione peroxidase. These results show that selenoprotein P functions as a phospholipid hydroperoxide glutathione peroxidase in extracellular fluids.

Local renin-angiotensin system and mitogen-activated protein kinase activation in rat aorta

We previously reported that endogenous angiotensin II is released to cause mitogen-activated protein (MAP) kinase stimulation in the media portion of the vasculature. In this study, we examined whether a functional renin-angiotensin system is indeed present within the media of the vasculature. In rat aortic strips, endothelium removal produced an increase of MAP kinase activity. The MAP kinase activation was inhibited either by the renin inhibitor pepstatin A or by the angiotensin-converting enzyme inhibitor captopril. The degree of the inhibition of the MAP kinase activation by pepstatin A, captopril and the angiotensin receptor antagonist losartan was almost the same. Pepstatin A inhibited MAP kinase activation induced by renin but not by angiotensin I and angiotensin II. Captopril inhibited the MAP kinase activation induced by angiotensin I but not by angiotensin II. In nephrectomized rat aortic strips, endothelium removal also produced an increase in MAP kinase activity, but the MAP kinase activation was considerably small and minimally inhibited by losartan. Nephrectomy produced a marked decrease in plasma renin activity. These findings suggest that an apparently fully intact and functional renin-angiotensin system is present in the media of the rat vasculature and this system serves to increase MAP kinase activity. It appears that renin plays the determining role in the regulation of angiotensin generation also in the media and the major source of the renin is renin of kidney origin.

[Effectiveness of day care service for elderly patients with dementia and their caregivers as observed by comparison of days with and without day care services]

PURPOSE

To explore the effectiveness of day care service for the dementia elderly and their caregivers.

METHODS

Subjects were sixty caregivers who took care of dementia elderly and were using day care service in two municipalities. The data on caregiving, care burden of caregivers, and time schedule of daily life were obtained from a questionnaire that was distributed at the five day care centers and collected through home visits. The data from a day with day care were compared with data from a day without.

RESULTS & DISCUSSION

1. Caregivers reported that their care burden was reduced on the day with day care, even though their time schedule for the day was not so different from the day without day care. 2. The harder the caregiving became, the more caregivers felt relieved on the day with day care. 3. Obviously, day care would no be expected to have the same effect in situations in which the caregiver is elderly or works outside the home all day.

CONCLUSION

When we think about day care it is important to provide a well adapted home care program which effectively meets the needs of the dementia elderly and their caregivers.

Effects of genistein and staurosporine on angiotensin II-induced DNA synthesis, protein synthesis and mitogen-activated protein kinase activation in vascular smooth muscle cells

This study examines the effects of protein kinase inhibitors and activator on angiotensin II-induced DNA synthesis and protein synthesis of rat aortic smooth muscle cells. In quiescent confluent cells, angiotensin II induced a concentration-dependent increase in thymidine incorporation and leucine incorporation. The tyrosine kinase inhibitor genistein caused an inhibition of the angiotensin II-induced DNA synthesis but not of the agent-induced protein synthesis. The protein kinase C inhibitors staurosporine and calphostin C caused an inhibition of the angiotensin II-induced protein synthesis but not of the agent-induced DNA synthesis. The protein kinase C activator phorbol 12-myristate 13-acetate stimulated protein synthesis. Angiotensin II stimulated mitogen-activated protein (MAP) kinases and the angiotensin II-induced MAP kinase activation was inhibited by genistein but not by staurosporine. These findings suggest that angiotensin II-induced DNA synthesis is at least partly mediated via protein-tyrosine phosphorylation and angiotensin II-induced protein synthesis is at least partly mediated by activation of protein kinase C. It seems likely that MAP kinase activation is involved in DNA synthesis but not in protein synthesis induced by angiotensin II.

Influence of FK506 on experimental atherosclerosis in cholesterol-fed rabbits

To investigate the role of activated T lymphocytes in the formation of atherosclerotic lesions, we studied the influence of FK506, an immunosuppressant, on the development of atherosclerosis in cholesterol-fed rabbits. New Zealand White rabbits fed on a 1.5% cholesterol diet were administered FK506 at 0.05 mg/kg (n = 12), 0.1 mg/kg (n = 12) or isotonic saline (as the control, n = 12) intramuscularly three times a week for 12 weeks. Although FK506 treatment did not affect plasma lipid levels, it caused an increase in the development of atherosclerotic lesions in a dose-dependent manner. Immunohistochemical analysis of the aorta after 8 weeks on the diet revealed that the ratio of T lymphocytes to the total number of cells in the plaques decreased significantly in the FK506 treated rabbits compared to the control rabbits. In culture, FK506 did not affect smooth muscle cell proliferation and cholesteryl ester formation in the macrophages. In contrast, culture medium from lymphocytes stimulated by concanavalin A decreased the accumulation of cholesteryl ester in the macrophages. This effect was inhibited by the culture medium in the presence of FK506. These findings suggest that activated T lymphocytes may inhibit intracellular cholesterol accumulation in atherosclerotic plaque.

Evidence that angiotensin II, endothelins and nitric oxide regulate mitogen-activated protein kinase activity in rat aorta

We measured the activity of mitogen-activated protein (MAP) kinases, enzymes believed to be involved in the pathway for cell proliferation, in rat aortic strips with or without endothelium, and examined effects of angiotensin receptor antagonists, endothelin receptor antagonists and nitric oxide (NO)-related agents. Endothelium removal produced an activation of MAP kinase activity in the strips, whereas the enzyme activity was not affected in the adventitia. The MAP kinase activation was inhibited by either the angiotensin AT1 receptor antagonist losartan or the endothelin ETA receptor antagonist BQ 123. The combination of both antagonists caused an additive inhibition. The angiotensin AT2 receptor antagonist PD 123,319 and the endothelin ETB receptor antagonist BQ 788 did not affect the MAP kinase activation. The NO synthase inhibitor NG-nitro-L-arginine methyl ester (L-NAME) caused an activation of MAP kinase in the endothelium-intact aorta and the MAP kinase activation was inhibited by losartan or BQ123. The NO releaser nitroprusside inhibited the MAP kinase activation induced by endothelium removal or angiotensin II. These results suggest that even in isolated arteries, NO of endothelial origin tonically exert MAP kinase-inhibiting effects and endogenous angiotensin II and endothelins in the media are tonically released to cause MAP kinase-stimulating effects in medial smooth muscle.

Agonist-induced sequestration, recycling, and resensitization of platelet-activating factor receptor. Role of cytoplasmic tail phosphorylation in each process

Agonist-induced sequestration, recycling, and resensitization of platelet-activating factor (PAF) receptor were characterized in transfected Chinese hamster ovary cells. Exposure of the cells to PAF led to rapid sequestration of the receptors into the intracellular compartment and desensitization of the response to PAF. The sequestration was inhibited by pretreatments that perturbed the clathrin-mediated pathway. Subsequent removal of PAF by washing with receptor antagonists led to rapid recycling of the sequestered receptors to the cell surface accompanied by resensitization to PAF. To evaluate the potential role of phosphorylation in the receptor cytoplasmic tail during these processes, mutant receptors in which the tails were truncated or substituted, so as to lack serine/threonine residues, were created. PAF phosphorylated the wild-type receptor rapidly and strongly, but the mutants did not. The maximal extent of sequestration of each mutant was lower than that of the wild-type, and one of the substituted mutants showed no sequestration. Furthermore, the sequestration-defective mutant showed evidence of desensitization after agonist stimulation but not resensitization after agonist removal. Thus, agonist-induced phosphorylation of the cytoplasmic tail facilitates but is not essential for receptor sequestration, and sequestration/recycling appears important in receptor resensitization.

[A case of advanced gastric cancer with carcinomatosa peritonitis effectively treated by 5-FU and low-dose CDDP therapy]

A 66-year-old woman was admitted to our clinic for appetite loss and abdominal distension in August 1995. Endoscopic study revealed an advanced gastric cancer in the upper body of her stomach. Abdominal CT study revealed massive ascites and para-aortic lymph nodal involvement. Cytological study of the ascites revealed class V. She was diagnosed to be in the terminal stage of gastric cancer with carcinomatosa peritonitis. Combination chemotherapy with 5-fluorouracil (5-FU) and low-dose cisplatin (CDDP) was given by continuous intravenous injection of 5-FU 500 mg/day, and intermittent intravenous injection of CDDP 30 mg/week was performed for reduction of the ascites and her complaint. Endoscopic study 6 weeks after starting chemotherapy could not find crater of the gastric cancer but only a shallow ulcerative lesion. The biopsy specimen of that lesion was group III. No ascites and over 50% reduction of the para-aortic lymph node were found by the abdominal CT study. This state persisted over 4 weeks. No myelo-suppression, renal dysfunction or any severe side effect were observed during chemotherapy. Her performance status improved from 3 to 1.

[Regression of atherosclerosis and centrally depressed lesions in rabbit aortas]

Atherosclerotic plaque with central depression (depressed lesion) has been hypothesized to be a morphological feature of atherosclerosis regression. We tested this hypothesis in New Zealand white rabbits. After the animals were fed a diet containing 1% cholesterol for three months, they were changed to a normal diet for 6 to 9 months. Several aortas had centrally depressed lesions similar to those found in elderly people, and the animals had low serum cholesterol levels. Immunohistochemical study showed that the depressed lesions contained more smooth muscle cells and collagen type IV, and fewer macrophage-derived foam cells than did common atherosclerotic elevated lesions found in rabbits. We know of no other report of depressed lesions in rabbits with atherosclerosis. Thus we believe that the centrally depressed lesion is a histological characteristic of regression of atherosclerosis.