Intrapartum tocolysis has no effect on fetal lactate concentration

OBJECTIVE

To assess the fetal metabolic effects of intrapartum maternal tocolysis with terbutaline in the presence of fetal heart rate abnormalities, with a special emphasis on lactate concentration, in view of its potential use as a marker of fetal condition.

DESIGN

Descriptive study.

SETTING

Two labour wards, National University Hospital, Singapore, and Ostersund Hospital, Sweden.

METHODS

Eight parturients with abnormal intrapartum fetal heart rate recordings were given bolus i.v. injection of 0.25 mg terbutaline and monitored both before and 20 minutes after treatment.

RESULTS

Maternal venous glucose increased from 5.0 (0.9) (mean (SD)) to 5.6 (1.2) mmol/l (p=0.002) and fetal scalp blood glucose rose from 4.1 (1.8) to 4.7 (1.4) mmol/l (p=0.009) 20 minutes after the injection. No significant change was found in maternal or fetal lactate concentrations.

CONCLUSION

Terbutaline tocolysis for "intrauterine resuscitation" does not affect fetal lactate concentration 20 minutes after treatment.

Transfection of interleukin-8 increases angiogenesis and tumorigenesis of human gastric carcinoma cells in nude mice

The growth and spread of tumour cells depends on adequate vasculature. We have previously reported that the expression of interleukin-8 (IL-8) directly correlates with the vascularity of human gastric carcinomas. To provide evidence for a causal role of IL-8 in angiogenesis and tumorigenicity of human gastric cancer, we used the lipofectin method to stably transfect the human TMK-1 gastric carcinoma cells (low endogenous IL-8) with an IL-8 expression vector or control vector. Transfection with IL-8 did not affect the proliferation of cultured cells, yet the culture supernatants of the transfected (but not control) cells stimulated proliferation of human umbilical vein endothelial cells. The IL-8-transfected and control cells were injected into the gastric wall of nude mice. IL-8-transfected cells produced rapidly growing, highly vascular neoplasms as compared to control cells. These results provide direct evidence for the role of IL-8 in the angiogenesis and tumorigenicity of human gastric carcinomas.

Expression of p27Kip1, cyclin E and E2F-1 in primary and metastatic tumors of gastric carcinoma

The cell cycle is controlled by positive and negative regulators. Gene abnormalities and aberrant expressions of various cyclins/CDKs and CDK inhibitors may play a pivotal role in stomach carcinogenesis. To clarify the role of cyclin E, CDK inhibitor p27Kip1 and their target molecule, E2F-1 in tumor metastasis, we examined immunohistochemically the expression of cyclin E, p27Kip1 and E2F-1 in 23 gastric carcinomas and metastatic tumors of the lymph node. Most of gastric carcinomas with lymph node metastasis showed reduced p27Kip1 expression. p27Kip1 was negative in 39% (9/23) of primary tumors, while it was so in 52% (12/23) of lymph node metastases. By comparison of p27Kip1 expression in primary and metastatic tumors in individual cases, metastatic tumor cells in the lymph nodes were expressed at weaker levels than in those in primary tumors in 43% (10/23) of the cases. On the other hand, over 70% (17/23) and 50% (12/23) of the cases expressed cyclin E and E2F-1 at nearly the same levels in both primary tumor and lymph node metastasis, respectively. These results suggest that tumor cells with reduced p27Kip1 expression may selectively metastasize to lymph node or distant organs.

Expression of cell-cycle-regulating transcription factor E2F-1 in colorectal carcinomas

The expression of E2F-1 in human colorectal carcinomas was examined immunohistochemically, and the correlation of E2F-1 expression with clinicopathological findings and with the expression of p27(Kip1) was analyzed to elucidate the role of E2F-1 in the development and progression of colorectal carcinomas. In nonneoplastic mucosa, a small number of epithelial cells in the proliferative zone were weakly positive for E2F-1. Weak expression of E2F-1 was detected in many adenoma cells. Most of the colorectal carcinomas expressed E2F-1 at various levels, and strong expression of E2F-1 was detected in 56% (49/88) of the cases. There was no correlation between the expression of E2F-1 and any clinicopathological parameters such as tumor stage, depth of tumor invasion and lymph node metastasis. Reduced expression of p27(Kip1) was confirmed to be significantly correlated with deep tumor invasion and presence of metastasis. No correlation was evident between overexpression of E2F-1 and reduced p27(Kip1) expression.

Immunohistochemical detection of human telomerase reverse transcriptase in normal mucosa and precancerous lesions of the stomach

Telomerase activity confers cell immortality through stabilization of the chromosome, participating in the development of a majority of human cancers. Human telomerase reverse transcriptase (TERT) has been identified as a catalytic subunit of telomerase, and is overexpressed in most gastric carcinomas. We immunohistochemically examined the expression of TERT in normal gastric mucosa and candidate precancerous lesions such as intestinal metaplasia and adenoma. In non-neoplastic gastric mucosa including intestinal metaplasia and normal fundic mucosa, weak but significant expression of TERT was detected in nuclei of epithelial cells located in the lower two-thirds of the glands (wider than the proliferative zone). The telomerase activity was found in a half of gastric adenomas, whose levels of the activity were about 10% of those in gastric carcinomas. TERT protein was expressed in the nuclei of the adenoma cells at moderate levels, that were not necessarily comparable with the telomerase activities. These findings overall suggest that TERT expression may be one of the prerequisites for telomerase activation in an early stage of stomach carcinogenesis.

Expression of the E2F family in human gastrointestinal carcinomas

The E2F family of transcription factors plays a key role in the control of cell-cycle progression. Some family members may act as oncogenes, others as tumor-suppressor genes. The genetic changes and the expression of E2F-1 and -3 were examined in human gastric and colorectal carcinomas by Southern, Northern and Western blots. Gene amplification of E2F-1 was detected in 4% (1/23) of gastric carcinomas and 25% (3/12) of the colorectal carcinomas. Increased expression of E2F-1 mRNA was observed in 40% (12/30) of the gastric carcinomas and in 60% (3/5) of the colorectal carcinomas in comparison with the corresponding non-neoplastic mucosa. Over-expression of E2F-1 protein was confirmed in many of the gastric carcinomas. In contrast, expression levels of E2F-3 mRNA were lower in 70% (21/30) of the gastric carcinomas and in 20% (1/5) of the colorectal carcinomas than in their corresponding normal counterparts, while gross alteration of the E2F-3 gene was not detected. These results suggest that gene amplification and anomalous expression of the E2F gene may permit development of gastrointestinal carcinomas.

Expression of the E2F family in human gastrointestinal carcinomas

The E2F family of transcription factors plays a key role in the control of cell-cycle progression. Some family members may act as oncogenes, others as tumor-suppressor genes. The genetic changes and the expression of E2F-1 and -3 were examined in human gastric and colorectal carcinomas by Southern, Northern and Western blots. Gene amplification of E2F-1 was detected in 4% (1/23) of gastric carcinomas and 25% (3/12) of the colorectal carcinomas. Increased expression of E2F-1 mRNA was observed in 40% (12/30) of the gastric carcinomas and in 60% (3/5) of the colorectal carcinomas in comparison with the corresponding non-neoplastic mucosa. Over-expression of E2F-1 protein was confirmed in many of the gastric carcinomas. In contrast, expression levels of E2F-3 mRNA were lower in 70% (21/30) of the gastric carcinomas and in 20% (1/5) of the colorectal carcinomas than in their corresponding normal counterparts, while gross alteration of the E2F-3 gene was not detected. These results suggest that gene amplification and anomalous expression of the E2F gene may permit development of gastrointestinal carcinomas.

Effect of antisense human telomerase RNA transfection on the growth of human gastric cancer cell lines

The majority of gastric cancers express high levels of human telomerase template RNA (hTR) that is essential for cellular survival. In this study, we examined whether antisense hTR (ahTR) had a growth inhibitory effect on three gastric cancer cell lines, MKN-1, MKN-28, and TMK-1, through transfection via an ahTR expression vector. Both the ahTR transfected MKN-1 and TMK-1 cells changed morphologically into multinucleate giant cells, and subsequently underwent cell death. Conversely, the ahTR transfected MKN-28 cells survived over 50 PDs in spite of telomere shortening. Surprisingly, high levels of telomerase activity were observed in the telomere-reduced cells. Furthermore, the expression of mRNAs for p21/Waf1/Cip1/Sdi1, IRF-1 and IFN inducible 6-16 was higher in the telomere-reduced cells than in the parental cells. These results suggest overall that the ahTR expression may bring about telomere shorting, leading to cell death or cellular senescence in gastric cancer cells.

Chitin-graft-poly(2-methyl-2-oxazoline) enhanced solubility and activity of catalase in organic solvent

Catalase from bovine liver was lyophilized from an aqueous solution containing chitin-graft-poly(2-methyl-2-oxazoline) (3), which was synthesized by the reaction of 52% deacetylated chitin (1) with living poly(2-methyl-2-oxazoline) (2). The rate of consumption of H2O2 in chloroform catalyzed by the lyophilized catalase with 3 was enhanced more than 10 times that by catalase without 3. The dispersibility and solubility of lyophilized catalase with 3 in chloroform were improved in comparison with catalase itself.

Lactate, lactate/pyruvate ratio and catecholamine interrelations in cord blood at delivery in complicated pregnancies

The interrelationships between lactate, lactate/pyruvate (L/P) ratio and catecholamines (CA) in cord artery and vein blood were studied in 56 pregnancies who had complications in the antenatal period or during labour. This group of babies had higher CA levels and were more acidaemic than fetuses after normal pregnancies and labour. There were stronger correlations between lactate and noradrenaline (NA) (R = 0.56, P < 0.001), adrenaline (A) (R = 0.41, P = 0.002) and dopamine (DA) (R = 0.42, P = 0.001) in cord artery blood, than previously reported for normal deliveries. Correlations between L/P ratio and CAs were also significant, although weaker. Multiple regression analysis, using cord artery lactate as the dependent variable, revealed significant correlations for pH (P = 0.01) and pyruvate (P < 0.001) but not for the CAs. The subgroups with high lactate (> 75th centile) had significantly higher NA (P = 0.007) and DA (P < 0.001) in cord artery and NA (P < 0.001) and A (P < 0.001) in cord vein blood, as compared with the subgroup who had lower lactate concentrations. We conclude that fetal hypoxia induces fetal CA production as well as anaerobic metabolism with lactate production. However, the adrenergic stimulation seems not to contribute significantly to the fetal lactate production.

Correlation between history of contact with people living with HIV/AIDS (PWAs) and tolerant attitudes toward HIV/AIDS and PWAs in rural Thailand

This study examines the hypothesis that people who have more contact with PWAs (people living with AIDS) are more tolerant than those who have no contact with them. Four provinces with different incidence of AIDS in 4 different regions of Thailand were selected. Structured questionnaire interviews were conducted with village people, asking about their history of contact with PWAs, and knowledge and attitudes toward HIV/AIDS and PWAs (n = 434). An 'Attitude Score', which indicates an accepting attitude (or tolerance) toward HIV/AIDS and PWAs, was developed using the results of the questionnaire on attitudes. Six factors: sex, education, age, province, knowledge, and history of contact with PWAs were positively correlated with the Attitude Score. After a multiple regression analysis, contact with PWAs was significantly associated with Attitude Score. This study is one of the first analytical studies conducted in a non-Western country to show that people's tolerant attitudes towards HIV/AIDS and PWAs are positively related to their history of contact with HIV/AIDS and PWAs. This findings should have important implications for future educational programmes and preventative intervention.

Expression of CD44 containing variant exon 9 (CD44v9) in gastric adenomas and adenocarcinomas: relation to the proliferation and progression

The expression of CD44 splice variant containing exon 14 (variant exon 9: CD44v9) was examined immunohistochemically in non-neoplastic mucosa, adenoma and adenocarcinoma of the stomach and analyzed the relation with the expression of Ki-67 antigen and p53 protein. In non-neoplastic gastric mucosa, basolateral membrane of the epithelial cells in the pyloric glands showed the expression of CD44v9. The epithelial cells in the intestinal metaplastic mucosa of the stomach sometimes expressed CD44v9. In the neoplastic lesions, the expression of CD44v9 was detected in 20% (34/170) of the adenomas and 28% (132/478) of the adenocarcinomas, respectively. The incidence of CD44v9 expression did not differ among histological type of gastric carcinoma. Twelve per cent of the adenocarcinomas showed strong expression of CD44v9, whereas non of the adenomas did. The incidence of CD44v9 expression was significantly higher in carcinomas invading into muscularis propria or the cases of stages 3 and 4 in comparison with that in carcinomas limited to submucosa or the stages 1 and 2 cases (p<0.05). The incidence of positive cases was higher in carcinomas with lymph node metastasis than those without metastasis (p<0.05). The expression of CD44v9 was significantly correlated with the expression of Ki-67 (p<0.05). It was also correlated with the expression of p53 protein in the tumor cells (p<0.01). These findings overall suggest that the expression of CD44v9 may be associated with the development as well as progression of the gastric carcinomas.

Assessment of psychosocial stressors and maladjustment among foreign students of the University of the Ryukyus

An extensive survey of problems encountered by foreign students of the University of the Ryukyus and the resulting levels of stress was carried out in order to determine the main stressors hindering academic progress and personal adjustment. Subjectively perceived stress levels after arrival in Japan were obtained from 134 subjects through a comprehensive questionnaire for reporting specific stressors. The 30-item General Health Questionnaire (GHQ) was included to assess mental health state. Differences in scores by area of origin were also determined for the total GHQ scores and its sub-scales. The GHQ results showed that regardless of length of time in Japan, more than 60% of the subjects scored within a range usually indicative of a mental health risk. Mean scores by area of origin showed a 50% reduction over time for non-Chinese Asians and North American/Europeans, but only a reduction of 1.1% or less for Chinese, Latin American, Middle/Near Eastern and African subjects. Limitations in achievement of academic goals were reported by the greatest number of students as causing moderate to excessive stress (57.5%); most frequently reported causes were language inadequacy (55.2%), reference materials unavailable (34.3%), unfamiliarity with Japanese study methods (32.1%), and inadequate guidance from teachers/advisors (26.9%). Various social, personal and daily life problems in the non-academic setting were also reported as causing high stress levels. Most of the stressors identified are not considered inevitable and point toward directions to pursue in preventive strategies in mitigating psychological distress and maladjustment of students.

[Application of antisense human telomerase RNA toward cancer therapy]

We overviewed recent results of anti-tumor effects and inhibition of telomerase activity in tumor cells through antisense human telomerase RNA(hTR). By introducing antisense hTR expression construct into tumor cells, reduction of telomeric DNAs and crisis or cellular senescence occurred in several human cancer cell lines. Antisense oligonucleotides to hTR synthesized with peptide nucleic acids and phosphorothioate deoxyribonucleic acids(PS) also inhibited telomerase activity in vitro. Furthermore, PS antisense hTR had significant effect to decrease tumor size and a number of metastatic nodules in a xenograft human cancer-nude mouse model. Taken together, the telomerase inhibitors targeting to hTR are expected to be novel anti-tumor agents.

Lactate compared with pH analysis at fetal scalp blood sampling: a prospective randomised study

OBJECTIVE

Fetal scalp blood sampling is a widely used method for assessing fetal condition in the event of ominous fetal heart rate patterns. The purpose of this randomised trial was to compare the value of fetal scalp blood lactate and pH management in cases of abnormal intrapartum fetal heart rate tracings.

METHODS

Of 341 cases of ominous fetal heart rate patterns, 169 were randomly assigned to pH analysis, and 172 to lactate measurements. Lactate was measured using a lactate card requiring 5 microL of blood and yielding the result within 60 seconds. pH analysis was performed with an ABL 510 acid-base analyser requiring 35 microL of blood and yielding the results within 47 seconds.

RESULTS

Unsuccessful fetal blood sampling procedures (no result or an unreliable result) occurred significantly more often in the pH subgroup than in the lactate subgroup (OR 16.1 with 95% CI 5.8-44.7). In the pH subgroup the failure rate was inversely related to the degree of cervical dilatation. Compared with the pH subgroup, the lactate subgroup was characterised by fewer fetal scalp incisions per blood sampling attempt (median 1.0 [interquartile range (IQR) 1-1] vs 2.0 [IQR 1-2]), and significantly less time required for the sampling procedure (median 120 s [IQR 90-147] vs 230 s [IQR 180-300]). The groups did not differ in mode of delivery, neonatal outcome and umbilical artery acid-base balance and lactate levels.

CONCLUSION

This trial showed the levels of lactate and pH in fetal scalp blood to be comparable in predicting perinatal outcome, but the procedure to measuring lactate was more successful than that for pH. Owing to its simplicity of performance, lactate analysis is an attractive alternative for intrapartum fetal monitoring.

Preventive behaviors against HIV transmission adopted by Japanese commercial sex workers (CSWs)

To assess self-protective behaviors of commercial sex workers (CSWs) against HIV transmission, a consecutive study was conducted at an obstetric-gynecology clinic in the largest "soapland" area in Tokyo. Among 208 CSWs interviewed, only half (107) regularly requested (RR) the clients to use condoms. Sixty-two percent of RR had learned from others ("learners") oral application of condoms while only 39% of NRR (non-regular requesters) did ("non-learners") (p = 0.001). Seventy-six percent of the learners were only "rarely" or "never" detected by the clients regarding condom application compared with only 23% of the non-learners (p< 0.001). While 90% of additionally recruited 40 NRR reported that they would request condom use by a "suspicious" client, none had experienced violence even when the clients found the secretive application. The oral application of condoms appears to be a transferable and potentially effective preventive behavior.

The absence of synergism between the effects of an aldose reductase inhibitor, epalrestat, and a vasodilator, cilostazol, on the nerve conduction slowing and the myelinated fiber atrophy in streptozotocin-induced diabetic rats

The preventive effects of combined or separate treatment for 10 weeks with an aldose reductase inhibitor, epalrestat (50 mg/kg/day), and a vasodilator, cilostazol (30 mg/kg/day), on nerve conduction deficits and morphometric alterations were examined in streptozotocin-induced diabetic rats. The average motor nerve conduction velocities (MNCV) in the tail nerve of the untreated diabetic (DM) group, the group treated with epalrestat (ES), the group treated with cilostazol (CZ), the group with both agents together (ES&CZ), and the normal control group were 34.7, 37.7, 39.3, 39.0 and 42.1 m/s, respectively. All treatments partially but significantly prevented a reduction in MNCV. The MNCV in the ES&CZ group was almost the same as in the CZ group. In a morphometric study of the sural nerve, the DM group showed a reduction in the average diameter of myelinated fiber and in occupancy (percentage of the fascicular area occupied by myelinated fibers), and a shift in the diameter-frequency histogram to smaller diameters. Only the CZ group showed evidence of a partial but significant preventive effect on the decrease in occupancy. In the CS and ES&CZ groups, there was a significant tendency away from the shift of histograms to smaller diameters. The ES&CZ group did not show any fewer morphometric changes than the CZ group. Thus, there was no synergism between the effects of epalrestat and cilostazol on the development of experimental diabetic neuropathy. This finding may provide a useful clue to the mechanisms of action of ES and CZ in diabetic neuropathy.

Growth inhibition of cultured human gastric cancer cells by 9-cis-retinoic acid with induction of cdk inhibitor Waf1/Cip1/Sdi1/p21 protein

The effect of 9-cis-retinoic acid (9-cis-RA) on the growth of eight gastric cancer cell lines was related to their transcription levels of mRNAs for retinoid receptors. Northern blot analysis showed that seven (TMK-1, MKN-1, -28, -45, -74, HSC-39, KATO-III) out of eight gastric cancer cell lines synthesized mRNAs for retinoic acid receptors (RARs) and retinoid X receptor-alpha (RXR-alpha). MKN-7 cells did not transcribe either RARs or RXR-alpha at the mRNA level although they appeared to have no alterations at the gene level. The growth of all of the cell lines except for MKN-7 cells was inhibited by 1 x 10(-6) M 9-cis-RA. Cell cycle distribution analysis revealed that G0-G1 arrest was not induced by exposure to 9-cis-RA in the sensitive TMK-1 and KATO-III cells or the resistant MKN-7 cells. Interestingly, 9-cis-RA temporarily increased the amount of the cyclin dependent kinase (cdk) inhibitor, Waf1/Cip1/Sdi1/p21 protein, and also reduced the amount of cdk-7, epidermal growth factor receptor (EGFR) and cyclin D1 proteins, followed by reduction in phosphorylation of the product of the retinoblastoma tumor suppressor gene (Rb) in the sensitive TMK-1 cells, but not in the resistant MKN-7 cells. These results suggest that 9-cis-RA has a cytostatic effect on gastric cancer cells that synthesize the receptor molecules through cell cycle regulatory machinery.

Growth inhibitory effect of interferon-beta is associated with the induction of cyclin-dependent kinase inhibitor p27Kip1 in a human gastric carcinoma cell line

The effect of IFN-beta on cell growth and the mechanism of growth modulation was examined in human gastric carcinoma cell lines. IFN-beta inhibited the cell growth of TMK-1 cells, whereas it did not affect the growth of the other three cell lines (MKN-7, -28, and -45). The number of apoptotic cells in IFN-beta-treated TMK-1 cells was 2-fold the number of those in control TMK-1 cells, whereas the induction of apoptosis was not observed in IFN-beta-treated MKN-28 cells. IFN-beta enhanced the expression of cyclin-dependent kinase inhibitor p27Kip1 at mRNA and protein levels. The increased p27Kip1 bound preferentially to CDK6. The phosphorylation level of retinoblastoma protein in TMK-1 cells was reduced by IFN-beta treatment. IFN-beta did not affect the expression of cell cycle regulators in MKN-28 cells. These results suggest that the induction of p27Kip1 by IFN-beta might confer inhibition of cell growth, leading to subsequent apoptosis in TMK-1 cells.

Longitudinal change in youth suicide mortality in Okinawa after World War II: a comparative study with mainland Japan

Okinawa prefecture has a unique socio-cultural status in Japan including the experience of having been occupied by the USA from the end of World War II to 1972. In this study, the longitudinal change in youth suicide mortality for those aged 10-29 years in Okinawa (1960-90) was compared with that for the same sex-age groups in mainland Japan (1950-90). In contrast with mainland Japan, no dramatic change in the youth suicide mortality was observed in Okinawa in the 1960s. The rise and fall of teenage suicide mortality in Okinawa during the 1970-80s might be associated with 'reversion anxiety', rather than with the traumatic experience of World War II itself. This seems to be inconsistent with previous speculation regarding the change in youth suicide mortality in mainland Japan. The suicide mortality for men aged 20-29 in Okinawa was significantly higher than that for the same sex-age group in mainland Japan through the observed period. The possible effects of the USA occupation, economic anomie or migration on the suicide in Okinawa should be further examined.

[Percutaneous endoscopic gastrostomy in patients with swallowing difficulties--home care and long-term result]

We studied the possibility of home care of patients who are unable to swallow. Postsurgical complications during the short term (within a week), medium term (within a month) and long term (more than a month) were recorded along with survival time. We also retrospectively studied the number of patients who were discharged after percutaneous endoscopic gastrostomy from November 1989 to March 1995. The percentage of patients with short-term postsurgical complications was 12.1%. Vomiting was the most frequent complication during the medium term and the long term. The weekly rate of complication development (total complications number/total survival time) was highest in the short term and decreased year by year. It was lower in those who were discharged from the hospital than in those who were not discharged. The average survival time was 460.2 days (544.7 days: home care group, 419.0 days: hospital group). The one-year survival rate was 58%, and the two-year survival rate was 36%. One third (32.8%) of patients were cared for at home after gastrostomy (average duration of care at home: 338.5 days) and the average duration of care at home as a percentage of survival time was 58.8%. We conclude that Percutaneous endoscopic gastrostomy can improve the quality of life of patients who are unable to swallow, and may allow them to be cared for at home.