Structuring WAN and LAN for EPR use in community health care

After describing determinants for the creation of a successfully used community health care network, our new project of making a mechanism fostering steady development of WAN and LAN among community is presented. Most of the difficulties that inhibit the sound development of community health care system are solved.

Highest microvessel count as a long-term prognostic factor in Japanese breast cancer patients

The aim of this study was to determine whether microvessel density (MVD) could add useful information in predicting the prognosis of breast cancer patients. In our study, MVD was calculated by counting microvessels per x200 field in the highest neovascularized area of the tumor (highest microvessel count, HMC). HMC significantly increased according to the increased number of positive nodes. Higher HMC significantly correlated with worse relapse-free survival (RFS) of patients with negative node, one to three positive nodes in the axilla or with stage I and II tumors. HMC, however, was not predictive for RFS of patients with four or more positive nodes or with stage III tumors. Multivariate analysis revealed that HMC was second only to nodal status and tumor size as being predictive for RFS. These results suggest that HMC could be used in selection of patients with early-stage breast cancer who are at high risk for having occult metastasis.

[Effectiveness of retrograde tepid blood cardioplegia in valve surgery combined with coronary artery bypass grafting]

The purpose of this study was to evaluate the usefulness of continuous retrograde continuous tepid blood cardioplegia (CTBC) in 8 patients underwent multivalve surgery combined with coronary artery bypass grafting (CABG) (Group 1), in comparison with antegrade CTBC in 10 patients with single valve replacement (Group 2). Aortic crossclamp time in Group 1 (187.9 +/- 55.2 minutes) was significantly longer than that (94.1 +/- 27.4) in Group 2 (p < 0.005). There was no hospital death in both groups. Spontaneous recovery rate of the heart beat following aortic declamping was 75% in Group 1, 90% in Group 2 (ns). Postoperative max CK-MB was 87.9 +/- 43.1 IU/l in Group 1, 74.8 +/- 27.0 IU/l in Group 2 (ns). During the early postoperative period, LVSWI significantly increased in both groups, whereas RVSWI showed no significant increase in both groups. Accordingly, in Group 1 in spite of longer aortic crossclamp time comparing Group 2, myocardial protection was considered to be satisfactory. In conclusion, retrograde CTBC is useful as an intraoperative myocardial protection in multivalve surgery combined with CABG which must need much longer aortic cross clamp time.

[Epidemiological analysis of influenza B virus belonging to B/Victoria/2/87 lineage isolated in off-season of 1998 and late epidemic season in Shizuoka Prefecture]

In Shizuoka Prefecture, influenza B viruses belonging to B/Victoria/2/87 lineage caused an outbreak among school children in the off-season of 1998, and the same B viruses were mainly isolated during the following epidemic. Low titer of HI antibody among children for influenza B virus belonging to the same lineage was a recognized factor in the causation of the distinctive epidemic. The herald virus strains seemed to be antigenically similar to the late epidemic virus strains, but the former strains were not genetically close to the latter. This indicates that the herald viruses are not always the parental viruses for the following influenza season.

[The effect of combination chemotherapy to adapted to chronotherapy with 5-fluorouracil, leucovorin, mitomycin C and cisplatin in patients with gastric or colorectal cancer]

We performed combination chemotherapy adapted to chronotherapy with 5-fluorouracil, leucovorin, mitomycin C and cisplatin in 11 patients with gastric cancer and 7 with colorectal cancer. Treatment consisted of a 5-day course of continuous arterial or intravenous infusion of 5-FU (500 mg/body/day), arterial or intravenous infusion of leucovorin (20 mg/body/day) at 6:00 p.m. on days 1-5, arterial or intravenous infusion of mitomycin C (2 mg/body) at 9:00 a. m. on day 5, and arterial or intravenous infusion of cisplatin (20-80 mg/body) at 6:00 p.m. on day 5. The effective rate against gastric cancer was 73%; however, the effective rate against colorectal cancer was 29%. During and after this therapy, there was only a little appetite loss, nausea and stomatitis.

Regulation of RAG expression in developing lymphocytes

Proper expression of products of the recombination-activating genes (RAGs) is essential for the development of the adaptive immune system. A major advance in the past year toward understanding RAG regulation is the establishment of green fluorescent protein (GFP)-RAG indicator mouse strains. In vivo visualization of RAG expression in single cells has helped to define the cells that express RAGs in secondary lymphoid organs and revealed differential cis requirements for stage- and lineage-specific RAG expression.

Resolution and synthesis of optically active alcohols with immobilized water-soluble proteins from green pea, soybean and buckwheat as new bio-catalysts

Kinetic resolution of racemic alcohols, (+/-)-1-(4-substituted phenyl)ethanol and (+/-)-1-(2-naphthyl)ethanol, was done with immobilized green pea, soybean, or buckwheat proteins. The resolution was done stereoselectively by oxidizing only one enantiomer of a racemic alcohol to leave an optically active alcohol with a high purity. In addition, each protein could be reused consecutively at least three times without any decrease of yield or optical purity.

[Primary pulmonary cryptococcosis with endobronchial lesion]

A 19-year old man was admitted to our hospital with fever and productive cough. Chest X-ray films revealed multiple nodular shadows accompanied by a fusing tendency in the right middle field. A diagnosis of bacterial pneumonia was indicated, and the patient was treated with antibiotics. However, because this failed to resolve the nodular shadows, bronchofibroscopy was performed. Examination with a fiberoptic bronchoscope revealed an elevated lesion in the truncus intermedius. Histopathologic examination of a specimen obtained by transbronchial biopsy revealed cryptococcal organisms with the infiltration of monocytes. These findings yielded a diagnosis of pulmonary cryptococcosis with endobronchial lesion. After 6 months of treatment with fluconazole, the multiple nodular shadows disappeared. Comparison of bronchoscopic findings before and after fluconazole treatment clearly demonstrated the efficacy of the therapy.

Diffuse myocardial infarction caused by isolated bilateral coronary ostial stenoses in a young woman: report of a case

A young Japanese woman who appeared to be free from any coronary risk factors was admitted to a local hospital with chest pain. Serological tests showed no evidence of inflammation; however, an electrocardiogram revealed diffuse myocardial ischemia and a coronary angiogram demonstrated isolated bilateral coronary ostial stenoses. Moreover, her serum creatine phosphokinase level was high. On the day following admission, the patient developed severe cardiogenic shock, and she was transferred to our hospital where emergency coronary artery bypass grafting with the saphenous veins was performed using retrograde tepid blood cardioplegia. Recovery of cardiac function was immediate and her postoperative course was uneventful. We suspect that fibromuscular dysplasia was the most likely cause of the ostial stenoses in this patient.

Resolution and synthesis of (S)-1-(2-naphthyl)ethanol with immobilized pea protein: as a new biocatalyst

(S)-1-(2-Naphthyl)ethanol was yielded by immobilized pea (Pisum sativum L.) protein (IPP) from (R, S) 2-naphthyl ethanol (> 99% ee, yield; about 50%), in which the (R)-enantiomer was selectively oxidized to 2-acetonaphthone. IPP could be reused consecutively at least three times without any decrease of yield and optical purity.

[Effect of combination chemotherapy with multiple drugs (FLMP therapy) based on the circadian rhythms of the human body in advanced recurrent gastric cancer]

Combination chemotherapy with multiple drugs (FLMP therapy), in which the drugs were determined based on biochemical modulation and the dosing schedule was established in accordance with the circadian rhythms of the human body, was performed in cases of advanced recurrent gastric cancer. The drugs were administered according to the following schedule: 500 mg of 5-FU (continuous) on days 1-5 (the dose was increased during the night), 20 mg of LV on days 1-5 (at 6 PM), 2 mg of MMC on day 5 (at 9 AM) and 60-80 mg of CDDP on day 5 (at 6 PM). A five-day course was administered by intravenous drip or hepatic arterial infusion at intervals of 4 weeks. Of 14 patients treated, the effect was estimated to be CR in 3, PR in 6, NC in 3, and PD in 2. The effectiveness rate was 62.3% overall, and the rate by administration route was 6/10 (60.0%) for i.v. and 3/4 (75.0%) for i.a. The side effects were slight. Those of grade 3 or more included anorexia in 5%, nausea and vomiting in 1%, stomatitis in 1% and leukopenia in 1%. This therapy, administered in accordance with the theory of chronotherapy, caused few side effects, and thus is considered a promising treatment for gastric cancer.

Continued RAG expression in late stages of B cell development and no apparent re-induction after immunization

Models of B-cell development in the immune system suggest that only those immature B cells in the bone marrow that undergo receptor editing express V(D)J-recombination-activating genes (RAGs). Here we investigate the regulation of RAG expression in transgenic mice carrying a bacterial artificial chromosome that encodes a green fluorescent protein reporter instead of RAG2. We find that the reporter is expressed in all immature B cells in the bone marrow and spleen. Endogenous RAG messenger RNA is expressed in immature B cells in bone marrow and spleen and decreases by two orders of magnitude as they acquire higher levels of surface immunoglobulin M (IgM). Once RAG expression is stopped it is not re-induced during immune responses. Our findings may help to reconcile a series of apparently contradictory observations, and suggest a new model for the mechanisms that regulate allelic exclusion, receptor editing and tolerance.

[Emergency coronary artery bypass grafting for left main coronary artery disease]

Emergency coronary artery bypass grafting (CABG) for acute coronary syndrome due to left main coronary artery (LMCA) disease still remains to be a therapeutic challenge. Seventy consecutive patients underwent CABG for LMCA disease were divided into two groups, that is 21 patients with emergency CABG (Group E) and 49 with scheduled CABG (Group S). There were four in-hospital deaths (mortality rate: 19.1%) in Group E and two (4.1%) in Group S. Three of 4 deaths in Group E had cardiogenic shock associated with acute myocardial infarction (AMI) preoperatively, and low output syndrome followed by multiple organ failure postoperatively. All of four deaths cases received intermittent cold GIK cardioplegia as an intraoperative myocardial protection. On the other hand, seven cases, received retrograde continuous warm blood cardioplegia (CWBC), including AMI with shock due to LMCA occlusion and concomitant CABG and valve replacement complicated with aortic regurgitation, all survived operations. In conclusion, retrograde CWBC may be useful as an intraoperative myocardial protection in emergency CABG for AMI with shock due to LMCA occlusion.

Clinical significance of immunohistochemical Bcl-2 expression in invasive breast carcinoma

The immunohistochemical expression of bcl-2 protein, and its correlations with clinicopathological features and prognosis were studied in patients with invasive breast carcinoma. Bcl-2 positive expression significantly correlated with hormone receptor positivity and histological tumor differentiation, and inversely correlated with p53 overaccumulation. No correlation was observed between bcl-2 expression and patient age, menopausal status, tumor size, and lymph node metastasis. Survivals of stage I to III patients who had not received adjuvant hormonal therapy showed no difference between bcl-2-positive and -negative tumors, even if patients were divided as with or without adjuvant chemotherapy, or with or without nodal involvement. In consequence, immunohistochemical bcl-2-positivity correlates with positive hormone receptors and well differentiated phenotypes in invasive breast carcinoma, however, it might not predict response to adjuvant chemotherapy and not be a favorable predictive value in patients treated without adjuvant hormonal therapy.

Effectiveness of continuous warm blood cardioplegia in cardiac valve re-replacement

BACKGROUND AND AIM OF THE STUDY

In order to achieve better operative results, myocardial protection for cardiac valve re-replacement must be further improved. The aim of this study was to compare the efficacy of continuous warm blood cardioplegia (CWBC) with that of intermittent cold potassium cardioplegia (ICPC) in cardiac valve re-replacement.

METHODS

A total of 49 consecutive patients underwent elective cardiac valve re-replacement via sternal re-entry; 27 patients received CWBC and 22 ICPC. During surgery, a narrower dissection of the heart was used in the CWBC group. The myocardial protective effects and operative outcome were analyzed in the two groups.

RESULTS

Two ICPC patients died in hospital, one from cerebral bleeding and one from low output syndrome. The rate of spontaneous recovery of the heart-beat after aortic declamping was significantly higher in CWBC patients than in the ICPC group (92.3% versus 13.6%, p < 0.001). Postoperatively, maximum serum creatine kinase-MB levels were significantly lower in CWBC patients than in ICPC patients (25.5 +/- 6.0 versus 81.1 +/- 26.0 IU/l, p < 0.02). Left ventricular stroke work index in the CWBC group showed significantly better recovery in the early postoperative period compared with that in the ICPC group. Extraction of myocardial oxygen (range: 0.33 to 0.35) and lactate (range: -0.02 to 0.14) in CWBC patients was maintained within the normal range immediately after aortic declamping and in the early postoperative period. In contrast, in ICPC patients extraction of myocardial oxygen (range: 0.18 to 0.23) and lactate (range: -0.27 to -0.17) was impaired during the same period. Postoperative (24-h) blood loss was significantly less in CWBC patients than in ICPC patients (p < 0.02).

CONCLUSION

In cardiac valve re-replacement surgery through sternal re-entry, and without wide exposure of the heart, continuous warm blood cardioplegia provides much greater myocardial protection than does intermittent cold potassium cardioplegia.

2-(3-Pyridyl)thiazolidine-4-carboxamide derivatives. III.) Synthesis of metabolites and metabolism of 2-(3-pyridyl)thiazolidine-4-carboxamides YM461 and YM264 as platelet-activating factor (PAF) receptor antagonists

The metabolism of 2-(3-pyridyl)thiazolidine-4-carboxamides YM461 and YM264 was investigated, and their metabolites were compared with separately synthesized materials by measuring 1H-NMR spectra, mass spectra, and HPLC retention times, and evaluated for platelet activating factor (PAF) antagonistic activity. YM461 was metabolized by two different metabolic pathways (cleavage of the thiazolidine ring and oxidation of the benzyl position), whereas YM264 was metabolized by three metabolic pathways. The minor metabolite M7 from YM264 possessed potent PAF antagonistic activity, as strong as YM264 and this existed as an active metabolite. From pharmacokinetics studies, YM264 was almost completely absorbed from the gastrointestinal tract, but readily metabolized in rats. In dogs, pharmacokinetic parameters of YM264 were significantly improved compared to those in rats, and YM264 tended to show better pharmacokinetics than YM461 due to an extension of the half-life period.

Comparison of PCR, (1-->3)-beta-D-glucan and galactomannan assays in sera of rats with experimental invasive aspergillosis

We compared PCR, galactomannan detection assay using a latex agglutination test and (1-->3)-beta-D-glucan detection assay in detecting infection in rats experimentally infected with Aspergillus fumigatus. On day 2 after inoculation, (1-->3)-beta-D-glucan and nested PCR were positive for 80%, while galactomannan detection assay was positive for 60%. In addition, the positive result of nested PCR (87.5%) was higher than those of galactomannan detection assay (75%) and (1-->3)-beta-D-glucan (71.4%) on day 3 after inoculation. The sensitivity of nested PCR was superior to those of galactomannan detection assay and (1-->3)-beta-D-glucan detection assay. The three diagnostic tests were compared with histopathological findings, and the sensitivity of three diagnostic tests was correlated with histopathological changes. In addition, the elevated levels of (1-->3)-beta-D-glucan paralleled the development and progression of pulmonary aspergillosis. Our results indicate that a combination of two or three of these tests seems to provide a rapid diagnosis of invasive aspergillosis and assist in the evaluation of the development and severity of invasive aspergillosis.

Local resection after breast-conserving therapy

We analyzed the results of local re-excision after radiation therapy on seven patients with positive surgical margins at the initial breast-conserving surgery. The age of the patients ranged from 30 to 55 years, and the tumor sizes from 1.1 to 4.7 cm. Both estrogen receptor and progesterone receptor status were positive in two patients, negative in four, and unknown in one. Pathological examination revealed residual carcinoma in one (14.3%) of seven patients. The immunohistochemical results of the initial specimen were estrogen receptor-positive, c-erbB-2-positive, and Bax-negative. We performed local re-excision after radiation therapy and found only one incidence of residual carcinoma in the conserved breast.

Platelet-derived endothelial cell growth factor/thymidine phosphorylase expression in macrophages correlates with tumor angiogenesis and prognosis in invasive breast cancer

Expression of platelet-derived endothelial cell growth factor/thymidine phosphorylase (PD-ECGF/TP), an angiogenic factor, was immunohistochemically analyzed in 117 specimens of invasive breast carcinoma (IBC). PD-ECGF/TP expression was observed in cancer cells and/or stromal cells; most of these stromal cells were activated macrophages. Therefore, we assessed the PD-ECGF/TP expression separately in cancer cells and stromal cells. Sixty-one (52.1%) cases were classified as PD-ECGF/TP-positive in cancer cells and 44 (37.6%) were classified as positive in stromal cells. The PD-ECGF/TP expression in cancer cells did not correlate with any prognostic factors. However, its expression in stromal cells positively correlated with both tumor size and microvessel count, and inversely correlated with estrogen receptor status. Relapse-free survival and overall survival (OS) were significantly worse in patients with PD-ECGF/TP-positive stromal cells than in patients with negative cells. A multivariate analysis using the Cox proportional hazards model showed that the PD-ECGF/TP expression in stromal cells independently predicted OS as well as nodal status and tumor size. In conclusion, PD-ECGF/TP expression in stromal cells correlates with tumor angiogenesis and can be used to predict the prognosis of patients with IBC.

2-(3-Pyridyl)thiazolidine-4-carboxamide derivatives. II. Structure-activity relationships and active configuration of 2-(3-pyridyl)thiazolidine-4-carboxamides as platelet-activating factor receptor antagonists

Conversion of the 2-(3-pyridyl)thiazolidine part of 1-(3-phenylpropyl)-4-[2-(3-pyridyl)thiazolidine-4-carbonyl]piperazine (YM461), which is a potent platelet-activating factor (PAF) antagonist, to other rings was performed, and PAF antagonistic activities evaluated. The 2-(3-pyridyl)thiazolidine skeleton, which exists as a mixture of cis and trans diastereomers, played an important role in the potency of PAF antagonism. In this study, new effective skeletons were not uncovered, however, 2-(4-pyridyl)thiazolidine-4-carboxamides (1n and 1z) showed potent PAF antagonistic activities equal to the 3-pyridyl derivatives. From the results obtained for 1a, 1a(S), 1g and 1i, a cis-(2R,4R)-2-(3-pyridyl)thiazolidine-4-carboxamide was assumed to be the active configuration for PAF antagonism.

Detection of Norwalk-like virus genes in the caecum contents of pigs

Norwalk-like virus genes were detected by RT-PCR in the caecum contents of pigs. Positive PCR products were produced from four out of 1,117 samples by nested PCR using human SRSV primers. Nucleotide sequences between 4,561 and 4,852 numbered according to the Norwalk virus genomic RNA in the RNA polymerase region were determined. Between the Norwalk virus sequence and the sequences detected in pigs, there was 58.2% to 59.9% sequence homology. The swine sequences were located on genogroup II of human SRSVs, but formed a subgroup in the phylogenetic tree of caliciviruses.

Purification and characterization of sialidase from porcine liver

Sialidase [E.C.3.2.1.18] has previously been purified from porcine liver by procedures including extraction, ammonium sulfate precipitation, concanavalin A-Sepharose adsorption, activation, CM-Sepharose ion exchange chromatography, and HPLC on a Shim pack Diol 300 column. Two sialidase preparations, sialidase I and II, were obtained by CM-Sepharose column chromatography and were eluted with pH 4.5 and 5.0 buffers, respectively. The two enzyme preparations showed the same optimum pH, pH stability, and specificities for natural substrates. The two final preparations contained beta-galactosidase activity and showed three protein components of 64, 30, and 21 kDa with sodium dodecyl sulfate-polyacrylamide gel electrophoresis, which are derived from the beta-galactosidase multimer. The anti-beta-galactosidase multimer antiserum was able to precipitate sialidase activity. It is likely that porcine liver sialidase exists as a multienzyme complex with beta-galactosidase and carboxypeptidase (protective protein).