Metal-ion stoichiometry of the HIV-1 RT ribonuclease H domain: evidence for two mutually exclusive sites leads to new mechanistic insights on metal-mediated hydrolysis in nucleic acid biochemistry

Crystallographic studies of the Mn(2+)-doped RNase H domain of human immunodeficiency virus type 1 reverse transcriptase (HIV-1 RT) have revealed two bound Mn2+ separated by approximately 4A and surrounded by a cluster of four conserved carboxylates. Escherichia coli RNase H is structurally similar to the RNase H domain of HIV-1 RT, but requires one divalent metal cation for its activity, implying either that the HIV-1 RT RNase H domain contrasts in its ability to bind two divalent metal ions, or that the crystallographic data reflect specific use of Mn2+ and/ or the doping technique employed. Metal binding stoichiometry has been determined for Mn2+ and the biologically more relevant Mg2+ cation by solution calorimetric studies of native and recombinant p66/p51 HIV-1 RT. Three Mn2+ ions bind to HIV-1 RT apo-enzyme: one at the DNA polymerase and two at the RNase H catalytic center, the latter being consistent with crystallographic results. However, only one Mg2+ ion is bound in the RNase H catalytic center. Several mechanistic implications arise from these results, including the possibility of mutually exclusive Mg2+ binding sites that might be occupied according to the specific reaction being catalyzed by the multifunctional RNase H domain. The occurrence of distinct binding stoichiometries for Mg2+ and Mn2+ to multifunctional enzymes has previously been reported.

Humoral human xenoreactivity against isolated pig pancreatic islets

It is widely believed that the hyperacute rejection of vascularized xenografts in the pig-to-human combination is triggered by the binding of human preformed natural antibodies (PNAbs) to the Galalpha.(1,3)Gal epitope in pig endothelium and the subsequent activation of complement. However, it remains poorly defined whether xenogeneic pig pancreatic islets are damaged by antibody and complement-mediated mechanisms. We examined the expression of Galalpha(1,3)Gal on isolated adult pig islets and the presence of PNAbs in normal human sera directed against islets, using immunofluorescence staining and confocal laser scanning microscopy. The pig islets were not stained with Galalpha(1,3)Gal-specific lectin GSIB4, however, the exocrine cells reacted strongly with GSIB4, indicating that the Galalpha(1,3)Gal epitope was highly expressed on exocrine cells, but not on islets. Human sera showed weak reactivity of IgM and IgG class PNAbs to the islets, but strong reactivity to the exocrine cells. Furthermore, we investigated the cytotoxic effect of human serum on pig islets using an in vitro model of pig-to-human islet transplantation. The incubation of pig islets with normal human sera for 45 min resulted in less than 10% specific lysis despite the binding of PNAbs, whereas exposure of porcine aortic endothelial cells to the same human sera caused 56% complement-mediated lysis, determined using a MTT cytotoxic assay. These results support the view that pig islets might not undergo early antibody and complement-mediated rejection in humans.

Rumors of disease in the global village: outbreak verification

Emerging infectious diseases and the growth of information technology have produced new demands and possibilities for disease surveillance and response. Increasing numbers of outbreak reports must be assessed rapidly so that control efforts can be initiated and unsubstantiated reports can be identified to protect countries from unnecessary economic damage. The World Health Organization has set up a process for timely outbreak verification to convert large amounts of data into accurate information for suitable action. We describe the context and processes of outbreak verification and information dissemination.

Direct and rapid detection by PCR of Erysipelothrix sp. DNAs prepared from bacterial strains and animal tissues

A PCR method for rapid screening of Erysipelothrix spp. in the slaughterhouse was carried out by using four species-specific sets of oligonucleotide primers after initial amplification with the primer set MO101-MO102, which amplifies the 16S rRNA sequences of all four Erysipelothrix species. The DNA sequences coding for the rRNA gene cluster, including 16S rRNA, 23S rRNA, and the noncoding region downstream of 5S rRNA, were determined in order to design primers for the species-specific PCR detection system. The homology among the 4.5-kb DNA sequences of the rRNA genes of Erysipelothrix rhusiopathiae serovar 2 (DNA Data Bank of Japan accession no. AB019247), E. tonsillarum serovar 7 (accession no. AB019248), E. rhusiopathiae serovar 13 (accession no. AB019249), and E. rhusiopathiae serovar 18 (accession no. AB019250) ranged from 96.0 to 98.4%. The PCR amplifications were specific and were able to distinguish the DNAs from each of the four Erysipelothrix species. The results of PCR tests performed directly with tissue specimens from diseased animals were compared with the results of cultivation tests, and the PCR tests were completed within 5 h. The test with this species-specific system based on PCR amplification with the DNA sequences coding for the rRNA gene cluster was an accurate, easy-to-read screening method for rapid diagnosis of Erysipelothrix sp. infection in the slaughterhouse.

Influence of highly curved DNA segments on in vivo topology of plasmids

Recombinant plasmids carrying a highly curved DNA structure are sometimes unstable in Escherichia coli. In order to know the underlying mechanism, several plasmids carrying one or two highly bent DNA segment(s) from the human adenovirus type 2 (Ad2) enhancer and/or origin region of phage lambda replication were systematically constructed and propagated in E. coli. The highly bent DNA segments disturbed the action of DNA topoisomerases: i.e. they were shown to be able to produce an anomalously wide spectrum of linking number topoisomers that tails toward lower supercoiling with a little of the DNA actually positively supercoiled. Furthermore, bent DNA caused multimeric plasmid formation. The linking number topoisomers and multimers seemed to be intermediate topological states of the bent DNA-containing plasmids that would lead to the deletion occurring in them. The nucleotide sequence of a deletion product of a bent DNA-containing plasmid showed that the putative source of the severe topological constraint was entirely eliminated from the plasmid.

Dichain structure of botulinum neurotoxin: identification of cleavage sites in types C, D, and F neurotoxin molecules

Botulinum neurotoxin (NT) is synthesized by Clostridium botulinum as about a 150-kDa single-chain polypeptide. Posttranslational modification by bacterial or exogenous proteases yielded dichain structure which formed a disulfide loop connecting a 50-kDa light chain (Lc) and 100-kDa heavy chain (Hc). We determined amino acid sequences around cleavage sites in the loop region of botulinum NTs produced by type C strain Stockholm, type D strain CB16, and type F strain Oslo by analysis of the C-terminal sequence of Lc and the N-terminal sequence of Hc. Cleavage was found at one or two sites at Arg444/Ser445 and Lys449/Thr450 for type C, and Lys442/Asn443 and Arg445/Asp446 for type D, respectively. In culture fluid of mildly proteolytic strains of type C and D, therefore, NT exists as a mixture of at least three forms of nicked dichain molecules. The NT of type F proteolytic strain Oslo showed the Arg435 as a C-terminal residue of Lc and Ala440 as an N-terminal residue of Hc, indicating that the bacterial protease cuts twice (Arg435/Lys436 and Lys439/Ala440), with excision of four amino acid residues. The location of cleavage and number of amino acid residue excisions in the loop region could be explained by the degree of exposure of amino acid residues on the surface of the molecule, which was predicted as surface probability from the amino acid sequence. In addition, the observed correlation may also be adapted to the cleavage sites of the other botulinum toxin types, A, B, E, and G.

Molecular composition of progenitor toxin produced by Clostridium botulinum type C strain 6813

The molecular composition of the purified progenitor toxin produced by a Clostridium botulinum type C strain 6813 (C-6813) was analyzed. The strain produced two types of progenitor toxins (M and L). Purified L toxin is formed by conjugation of the M toxin (composed of a neurotoxin and a non-toxic nonhemagglutinin) with additional hemagglutinin (HA) components. The dual cleavage sites at loop region of the dichain structure neurotoxin were identified between Arg444-Ser445 and Lys449-Thr450 by the analyses of C-terminal of the light chain and N-terminal of the heavy chain. Analysis of partial amino acid sequences of fragments generated by limited proteolysis of the neurotoxin has shown to that the neurotoxin protein produced by C-6813 was a hybrid molecule composed of type C and D neurotoxins as previously reported. HA components consist of a mixture of several subcomponents with molecular weights of 70-, 55-, 33-, 26 through 21- and 17-kDa. The N-terminal amino acid sequences of 70-, 55-, and 26 through 21-kDa proteins indicated that the 70-kDa protein was intact HA-70 gene product, and other 55- and 26 through 21-kDa proteins were derived from the 70-kDa protein by modification with proteolysis after translation of HA-70 gene. Furthermore, several amino acid differences were exhibited in the amino acid sequence as compared with the deduced sequence from the nucleotide sequence of the HA-70 gene which was common among type C (strains C-St and C-468) and D progenitor toxins (strains D-CB16 and D-1873).

Anabolic effect of aminoterminally truncated fibroblast growth factor 4 (FGF4) on bone

Fibroblast growth factor 4 (FGF4), a member of the FGF family, plays several important roles in bone development during embryogenesis. Systemic administration of FGF4 increases bone mass in rats, which suggests the potential therapeutic usefulness of this growth factor in treatment for osteopenia and in bone regeneration. We investigated the length of FGF4 required to exert its anabolic effects, because this information may be useful in developing new molecules to mimic the effects of FGF4. Because the active site of FGF family molecules is in the carboxylterminal region, we produced aminoterminally truncated recombinant human FGF4s (rhFGF4s) of different sizes. Human FGF4 cDNA containing almost the full length of the coding region (573 bp, 191 amino acid residues) was inserted into pUC18 vector and then deleted from the 5' end using the ExoIII system. Each of the deleted FGF4 cDNAs was subcloned into a pET29(+) expression vector. Differently sized recombinant proteins were expressed in the BL21(DE3)pLysS Escherichia coli strain and then purified. The growth-stimulative effects on NIH3T3 cells of each recombinant protein were examined by means of MTT colorimetric assay. Full-length and the shortened recombinant proteins, which stimulated NIH3T3 cell growth, were then subcutaneously administered into male ddY mice (6 weeks old) every day for 2 weeks. Bone mineral density (BMD) was measured using dual-energy X-ray absorptiometry (DEXA) and peripheral quantitative computed tomography (pQCT). The rhFGF4 of 134 amino acid residues, the region homologous to other members of the FGF family, exerted a growth-stimulative effect on NIH3T3 cells comparable to the full-length version of FGF4; however, the shortest version, with 111 amino acid residues, showed a limited growth-stimulative effect. Systemic administration of the rhFGF4 of 134 amino acid residues increased the bone mineral density (BMD) of femurs at a dose of 0.1 mg/kg, which was comparable to that of the full-length rhFGF4. DEXA analysis, pQCT analysis, soft X-ray photos, and contact microradiographs revealed an increase in femoral trabecular bone in FGF4-treated animals; an increase in bone formation was also evident upon histomorphometric analysis. These results indicate that the region of FGF4 that is homologous to other FGF family members provides a sufficient anabolic effect in bone and that this recombinant protein is potentially useful as a therapeutic agent in bone.

Detection and nucleotide sequence analysis of human caliciviruses (HuCVs) from samples in non-bacterial gastroenteritis outbreaks in Hokkaido, Japan

Samples of feces and vomit collected from patients during 13 non-bacterial gastroenteritis outbreaks which occurred in Hokkaido between 1995 and 1998 were examined by electron microscopy (EM) and reverse-transcription polymerase chain reaction (RT-PCR) for evidence of infection with human caliciviruses (HuCVs). In 6 food-borne outbreaks, oysters were the probable source of infection, while the origin of HuCVs was not found out for the other 7 outbreaks. One-hundred-eleven of 214 stool, vomit and oyster specimens examined gave positive results by RT-PCR, while HuCVs were detected by EM in 36 of 121 stool specimens examined. We determined the nucleotide sequences of 470-bp or 373-bp PCR products amplified from the RNA polymerase region of the HuCV genomes with primer sets MR3/4 and Yuri22F/R, respectively. The sequences of different strains revealed great heterogenicity, with a range of 60 to 100% homology among strains. In a few cases, a mixed genotype was found in the same patient or same outbreak by means of nested PCR and cloning of PCR products into an appropriate vector. Of the 19 different strains found, 4 strains could be classified as Norwalk virus (genogroup 1) and the other 15 strains as Snow Mountain agent (genogroup 2) based on genotyping with homology analysis. Furthermore, the strains belonging to genogroup 2 could be classified into 4 subgroups with more than 93% homology in amino acids among strains in the subgroup.

The mature size of rat 4-aminobutyrate aminotransferase is different in liver and brain

The amino acid sequence predicted from a rat liver cDNA library indicated that the precursor of beta-AlaAT I (4-aminobutyrate aminotransferase, beta-alanine-oxoglutarate aminotransferase) consists of a mature enzyme of 466 amino acid residues and a 34-amino acid terminal segment, with amino acids attributed to the leader peptide. However, the mass of beta-AlaAT I from rat brain was larger than that from rat liver and kidney, as assessed by Western-blot analysis, mass spectroscopy and N-terminal sequencing. The mature form of beta-AlaAT I from the brain had an ISQAAAK- peptide on the N-terminus of the liver mature beta-AlaAT I. Brain beta-AlaAT I was cleaved to liver beta-AlaAT I when incubated with fresh mitochondrial extract from rat liver. These results imply that mature rat liver beta-AlaAT I is proteolytically cleaved in two steps. The first cleavage of the motif XRX( downward arrow)XS is performed by a mitochondrial processing peptidase, yielding an intermediate-sized protein which is the mature brain beta-AlaAT I. The second cleavage, which generates the mature liver beta-AlaAT I, is also carried out by a mitochondrial endopeptidase. The second peptidase is active in liver but lacking in brain.

Proportion of reflux esophagitis in 6010 Japanese adults: prospective evaluation by endoscopy

Compared with findings in Western countries, the prevalence of reflux esophagitis in Oriental countries is estimated to be low. In this prospective study, we aimed to examine the proportion of reflux esophagitis in Japanese adults, as evaluated by endoscopy. Endoscopists were prospectively directed to grade esophageal mucosal breaks with esophagitis according to the Los Angeles Classification of Esophagitis in all subjects that underwent endoscopic examination. In total, 6010 subjects underwent endoscopic examination for evaluation of esophagitis grading from December 1996 to February 1998. The subjects included 4394 outpatients who were not receiving medication for gastrointestinal disease and 1616 subjects who visited the hospital for routine physical examinations. The overall proportion of esophagitis was 16.3%. Most of the subjects with esophagitis were classified as having grade A or B (proportion of grades A and B, 9.6% and 4.6%, respectively). The age-related proportion of esophagitis and of severe esophagitis (i.e., grades C and D) increased in females aged over 70 and in males aged over 80. Increased body mass index (partly due to decreased height caused by osteoporosis), and/or hiatal herniation, were related to the proportion of esophagitis in females aged over 70. These data indicated that reflux esophagitis is a common disease in Japan. However, severe esophagitis (grades C and D) is not common.

A dual topoisomerase inhibitor, TAS-103, induces apoptosis in human cancer cells

TAS-103 (6-[[2-(dimethylamino)ethyl]amino]-3-hydroxy-7H-indeno[2,1-c] quinolin-7-one dihydrochloride), a dual topoisomerase (topo) inhibitor, was developed as an anticancer agent by targeting topo I and topo II and has previously been shown to be effective against lung tumors. In this study, we investigated the cytotoxic activity of TAS-103 in various human cancer cell lines (including gastric, colon, squamous, lung, and breast cancer cells) and the induction of apoptosis by TAS-103. We next established stable transfectants of Bcl-2 in the gastric cancer cell line AZ521 and found that Bcl-2 blocked TAS-103-induced apoptosis. In addition, we demonstrated that the activities of ICE-like and CPP32-like proteases are involved in the signal transduction pathway of TAS-103-induced apoptosis. In summary, TAS-103 is a novel type of anticancer agent with a unique mechanism and could be useful as a lead compound for development of new drugs.

Study of mandibular movements in mandibulectomy patients--border movements and functional movements during mastication, deglutition and speech

In mandibulectomy patients who have not undergone surgical reconstruction, the remaining mandibular segment is unstable and often deviated. Its movements have low reproducibility during mastication, deglutition and speech. The purpose of this study was to clarify three-dimensionally the differences in mandibular movements for each of these oral functions in mandibulectomy patients with and without mandibular continuity. Four mandibulectomy subjects (Group I) without mandibular continuity and three subjects (Group II) with mandibular continuity were selected. Their mandibular movements were recorded using a jaw movement tracking device with six degrees of freedom. Each movement was assessed graphically at the virtual incisor point and the rotational angles of the mandible in the frontal, sagittal and horizontal plane were analyzed. The findings were as follows; 1. In Group I, the border movements at the virtual incisor point exhibited an irregular and asymmetric envelope deviated to the resected side in the frontal plane, whereas Group II exhibited a smooth and symmetric envelope. 2. In Group I, the rotational angles in the frontal plane during border movements and mastication, in all planes during speech, and in the frontal and horizontal plane during deglutition were significantly larger than in Group II. A comparison among border and all functional movements in mandibulectomy patients revealed characteristic movements in the rotation of the mandible in the frontal plane. It is suggested that the rotational angle of the mandible is a useful parameter for assessment of mandibular movements in mandibulectomy patients.

Evaluation of obturator prostheses using vibration analysis

Obturator prostheses have been extensively used in the functional rehabilitation of maxillectomy patients. The purpose of this study was to evaluate in vitro the vibration movements of three types of obturator prostheses. Three types of bulbs were used: the solid type, the buccal flange type, and the hollow type. Modal analysis was performed to identify the better form. The three types of obturator prostheses were excited by a shaker, and the frequency response functions were recorded on an FFT analyzer to identify their modal shapes. In addition, transient response simulations were carried out, and decay rates of the resultant transient response waves were compared to evaluate the energy absorption after the obturator prosthesis had experienced an impact. The results showed that the modal shapes were closely similar, while the amplitudes at the rests and clasps of the hollow type bulb were the smallest. In the transient response simulation, the decay rates of the hollow type were significantly the highest (p < 0.01). In this study, modal analysis demonstrated that the hollow type obturator prosthesis showed the steepest vibration decay slope, indicating that it might be the best among the three types of bulbs for use in clinical treatments.

Eight-year trend of new patients at Clinic for Disabled Patients, University Hospital, Faculty of Dentistry, Tokyo Medical and Dental University

The trend of new patients was investigated at the Clinic for Disabled Patients, University Hospital, Faculty of Dentistry, Tokyo Medical and Dental University for eight years from 1989 to 1996. The purpose of this study was to explore the future role of this specialized clinic. The study revealed the following information: 1. A total of 1,388 new patients, corresponding to 173.5 new patients per year on average, visited the clinic. 2. The percentage of patients aged 30 or more increased. As a result, the mean patient age rose from 40.4 in 1989 to 47.6 in 1996. 3. Referrals accounted for more than 80% of new patients. Medical doctors referred more patients to our clinic than dentists did. 4. While the percentage of disabled patients tended to decrease, the percentage of medically compromised patients increased. 5. The predominant complaint was dental caries. Patients with cardiovascular diseases also complained of gingival bleeding and ill-fitting dentures. The growing percentage of medically compromised patients and the increasing mean age of patients over the eight-year period seems to reflect advances in medical science and the aging society. These tendencies could be more remarkable in the future. Therefore, much closer cooperation between dentists and medical doctors will be required.

Effects of cyclic loading on the strength of all-ceramic materials

PURPOSE

To investigate the effects of fatigue on the strength of materials used in all-ceramic crowns, the biaxial flexural strength of all-ceramic restorative materials was measured with precracked and laminated specimens after cyclic loading.

MATERIALS AND METHODS

Two types of all-ceramic systems were used to prepare specimens: a glass-infiltrated alumina core system (In-Ceram) and a leucite-reinforced feldspathic porcelain system (IPS-Empress). Monolayer and laminated disks with a diameter of about 11.75 mm and a thickness of 1.20 +/- 0.05 mm were prepared. The biaxial flexural strength of the specimens that were polished and/or created with a precrack was measured. Their strength was also measured following cyclic loading. A cyclic load that was 60% of the mean breaking load of the specimens (before cyclic loading) was applied to specimens for 10(5) cycles in 37 degrees C water.

RESULTS

Although 20% to 30% of the polished specimen samples fractured during cyclic loading, the biaxial flexural strength of specimens that survived the cyclic loading was nearly the same as that of specimens not subjected to the cyclic loading. The strength of the alumina system decreased with the introduction of precracks, and nearly all specimens fractured during cyclic loading. The strength of the leucite system, however, did not decrease with the presence of precracks, and no fractures were observed on these specimens during cyclic loading.

CONCLUSION

These results suggest that although the alumina system has high flexural strength, it is more sensitive to flaws and susceptible to fatigue fracture. The effect of fatigue on the leucite system appears to be low.

In vivo gene transfer to mouse spermatogenic cells by deoxyribonucleic acid injection into seminiferous tubules and subsequent electroporation

An in vivo gene transfer technique for living mouse testes was used to develop a novel transient expression assay system for transcriptional regulatory elements of spermatogenic specific genes. The combination of DNA injection into seminiferous tubules and subsequent in vivo electroporation resulted in an efficient and convenient assay system for gene expression during spermatogenesis. The transfer of the firefly luciferase reporting gene driven by the Protamine-1 (Prm-1) enhancer region revealed a significant increase in the activity of the reporter enzyme. Histochemical studies of the transfer of the lacZ gene driven by the Prm-1 enhancer showed specific lacZ expression only in haploid spermatid cells in adult testes, corresponding with the expression pattern of endogenous Prm-1. We were able to detect long-lasting transgene expression in the transfected spermatogenic cells. A group of spermatogenic differentiating cells maintained the transfected lacZ expression after more than 2 mo of transfection, suggesting that spermatogenic stem cells and/or spermatogonia could also incorporate foreign DNA and that the transgene could be transmitted to the progenitor cells derived from a transfected proliferating germ cell.

Molecular composition of the 16S toxin produced by a Clostridium botulinum type D strain, 1873

The 16S toxin was purified from a Clostridium botulinum type D strain 1873 (D-1873). Furthermore, the entire nucleotide sequences of the genes coding for the 16S toxin were determined. It became clear that the purified D-1873 16S toxin consists of neurotoxin, nontoxic nonhemagglutinin (NTNH), and hemagglutinin (HA), and that HA consists of four subcomponents, HA1, HA2, HA3a, and HA3b, the same as type D strain CB16 (D-CB16) 16S toxin. The nucleotide sequences of the nontoxic components of these two strains were also found to be identical except for several bases. However, the culture supernatant and the purified 16S toxin of D-1873 showed little HA activity, unlike D-CB16, though the fractions successively eluted after the D-1873 16S toxin peak from an SP-Toyopearl 650S column showed a low level of HA activity. The main difference between D-1873 and D-CB16 HA molecules was the mobility of the HA1 on sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE). Therefore it was presumed that the loss of HA activity of D-1873 16S toxin might be caused by the differences of processing HA after the translation.

Expression of cell adhesion molecule CD44 and sialyl Lewis A in gastric carcinoma and colorectal carcinoma in association with hepatic metastasis

To clarify the role of the expression of adhesive molecules [CD44 (standard form) and sialyl Lewis A (sialyl Lea)] on hepatic metastasis, 108 advanced gastric carcinomas and 94 advanced colorectal carcinomas were investigated immunohistochemically. Multivariate analysis demonstrated that CD44 expression and lymph node metastasis in gastric cancer and CD44 and sialyl Lea expression in colorectal cancer were significantly related to hepatic metastasis. The incidence of hepatic metastasis was highest in patients with the expression of both CD44 and sialyl Lea. The expression of CD44 standard form as well as sialyl Lea may have a major role as adhesion molecules in the process of hepatic metastasis.

Suppression of electrophoretic anomaly of bent DNA segments by the structural property that causes rapid migration

Intrinsic DNA curvature is speculated to be a common feature of all satellite DNA sequences and may aid in the tight winding of DNA in constitutive heterochromatin. Several satellite DNAs, however, show unusually rapid migration in non-denaturing polyacrylamide gels, which is just the opposite behavior of that shown by curved DNA structures. Employing bovine satellite I DNA monomer, we attempted to understand the molecular mechanism of 'rapid migration'. The phenomenon of rapid migration was temperature-dependent and to a small extent polyacrylamide-concentration-dependent. Physiological or near-physiological concentrations of Mg2+and Ca2+ions bent the rapid migrating DNA segment. Predominance of purine-purine base stacking over purine-pyrimidine in nucleotide sequence was strongly indicated to be the cause of the rapid migration. Furthermore, they seemed to be implicated in the formation of induced DNA bend. We also found that the satellite I monomer contains an intrinsic DNA curvature as do many other satellites. Heretofore, the rapid migration property has concealed the presence of curvature.

Repeat hepatectomy for recurrent colorectal metastases

Recurrence rates after hepatic resection in patients with colorectal metastases are reported to range from 47% to 80%. Hepatic recurrence is seen in 35% to 50% of patients. Aggressive surgical resection appears to be a worthwhile treatment in patients with recurrent hepatic metastases to promote longer patient survival because surgical resection remains the only curative therapy available. This is a retrospective review of our experience with 15 patients undergoing repeat hepatic resection culled from 67 patients undergoing initial hepatectomy for metastatic colorectal cancer. Of 67 patients who underwent hepatectomy for colorectal hepatic metastases, 33 developed hepatic recurrence at a median interval of 23 months (range 1-176 months) after the first hepatectomy. The second hepatectomy was performed in 15 patients 5 to 29 months after the first hepatectomy, with no mortality. The mean operating time and blood loss at the second hepatectomy were similar to those at the first hepatectomy. The mean hospital stay at the second hepatectomy was significantly shorter than that at the first hepatectomy. The cumulative survival rate for the 15 patients was 42.4% at 3 years and 21.2% at 5 years, respectively, which compared favorably with the survival rate of the 67 patients who underwent initial hepatectomy. Patients who underwent the second hepatectomy had significantly higher survival rates from the first hepatectomy than the 18 patients with unresectable hepatic recurrence. Repeat hepatectomy can be performed safely and provides long-term survival rates similar to those of first hepatectomies. In appropriately selected patients, repeat hepatectomy for colorectal metastases is a worthwhile treatment.

Serum interleukin-6, interleukin-8, hepatocyte growth factor, and nitric oxide changes during thoracic surgery

Thoracic surgery creates a different environment from abdominal surgery in respect to the surgical procedure with pulmonary collapse under unilateral ventilation. Definitive evidence whether surgical trauma during thoracotomy is involved in postoperative pulmonary infections has not been clearly demonstrated. The objectives of this study were to evaluate the influence of surgical trauma during thoracotomy on postoperative infections and to investigate the clinical significance of postoperative humoral mediators in pulmonary infections after surgery. We measured serum interleukin-6 (IL-6), IL-8, hepatocyte growth factor (HGF), and nitric oxide (NO) levels in 27 patients undergoing thoracic surgery; the measurements were before and during thoracotomy, 60 minutes after reinflation, and after surgery. The patients were divided into three groups: lobectomy patients (group A), and esophagectomy patients without (group B) or with (group C) postoperative infections. The serum IL-6 and IL-8 levels in group C were markedly elevated 60 minutes after reinflation and were significantly higher than those in group A. The serum IL-8 levels during that period in group C were significantly higher than those in group B. The postoperative serum IL-6, IL-8, HGF, and NO levels were significantly higher in group c than in group B. Taken together, intraoperative hypercytokinemia, especially IL-8, following the thoracic procedure and subsequent reinflation preceded the clinical onset of postoperative infections. Hence postoperative serum IL-6, IL-8, and HGF levels may be useful predictors of infection after esophagectomy.

Clinical features of paradiverticulitis

Colonic diverticula have been generally accepted as a source of massive hemorrhaging. Little is known, however, about fecal occult blood loss from colonic diverticula and diverticulosis. We retrospectively investigated the possibility of minor bleeding in 737 diverticula cases diagnosed from April 1989 to May 1994. Thirty-seven cases (5%) of diverticula are explained as the sources of positive occult blood testing ascertained clearly by colonoscopy. These divide into three types: (1) from intradiverticular bleeding (intradiverticulitis), (2) from peridiverticular bleeding (peridiverticulitis), and (3) from interdiverticular colonic mucosal erosion (interdiverticulitis). These findings account for the occult blood loss that we call paradiverticulitis. The two-year prospective study found 67 cases (11.3%) of paradiverticulitis in 595 diverticula cases. We concluded that paradiverticulitis is one of the causes of positive occult blood tests.

Deoxyribonuclease secreted from an insectivorous plant Drosera adelae

A deoxyribonuclease that is secreted from an insectivorous plant Drosera adelae was partially purified by column chromatography. The enzyme acted as an endonuclease on double-stranded DNA and generated oligonucleotides with 3' hydroxyl and 5' phosphate ends. The activity of the enzyme was high in the range from pH 3.5 to 5.0. The enzyme seemed to require divalent cations for maximum activity.

Characterization of DNA fragments that show anomalously rapid migration in non-denaturing polyacrylamide gels

Several DNA fragments that show anomalously rapid migration in nondenaturing polyacrylamide gels have been cloned from digests of bovine genomic DNA. Electrophoretic behaviors of these fragments were analyzed in detail under various conditions. The results indicated that these fragments may adopt non-B DNA conformation.

Mobility of the obturator prosthesis in hemimaxillectomy edentulous patients

In edentulous patients with maxillary defects, it is difficult to obtain sufficient retention, support, and stability of the obturator prosthesis, in addition, its mobility during various functions is considered to be large. A thorough understanding of the mobility of the obturator prosthesis is important to achieve successful results in the patient's oral rehabilitation. In this study, the ranges of movement of the obturator prostheses in three hemimaxillectomy edentulous patients were compared during tapping, chewing (biscuit), and opening and clenching jaw movements by simultaneously conducting three-dimensional measurements of three points that were established on the central incisor and the right and left first molars of the obturator prosthesis with a jaw movement tracking device having six degrees of freedom. This study indicates that the range of movement of the obturator prosthesis varied extensively from individual to individual. The ranges of movement were larger than those of normal complete dentures and differed considerably from each other when categorized according to the three functions and three measuring points in the patients.

Effect of teeth clenching on isometric and isokinetic strength of ankle plantar flexion

To investigate the effect of voluntary teeth clenching on the isometric and isokinetic exercises of the lower limbs, the association of muscle strength (peak torque, PT) and muscle activities (integrated electromyographic activity per unit of time, iEMG/s) of the three muscles of the triceps surae with teeth clenching during isometric and isokinetic plantar flexion were simultaneously measured for 12 healthy male volunteers using a Cybex 6000 Extremity Testing and Rehabilitation System and a surface EMG analyzing system. The statistical analysis demonstrated that for the isometric exercise, PT and each iEMG/s significantly increased in association with teeth clenching, and a positive correlation existed between the biting force and each variable. In contrast, no association was found with teeth clenching for the isokinetic exercise. In this study, therefore, it was found that the effect of teeth clenching differed between the isometric and isokinetic exercises.

Application of modal analysis to human subjects: comparison of healthy subjects and cleft lip and palate subjects

To evaluate the vibrational characteristics of the maxillary arch, modal analysis was applied to human subjects. Twelve healthy human subjects and 2 cleft lip and palate (CLP) subjects with surgical failure in their cleft area were chosen for this study. The main measurement system was composed of an impact hammer, acceleration sensor, CF-6400 FFT Analyzer, PC-9821Xn personal computer, and Vibrant PC modal analysis software. The measurement points were established on 12 teeth between the upper first molars on both sides of the mouth in healthy subjects, and on 10 teeth in CLP subjects. In all subjects, one distinct resonance peak was observed in each transfer function at each measurement point. All of the transfer functions of a given subject strongly resembled each other in terms of shape. The amplitude and modal shapes of the maxillary arches of all the subjects were obtained by using a curve-fitting function in the software. In the healthy subjects, the maxillary arch expanded outward and shrank inward on vibration with no node after an impact. In the CLP subjects, the phase lag between the large and small segment was distinctly observed after an impact. In this study, the applicability of modal analysis for human subjects was demonstrated.

Evaluation of athletic mouthguard through vibration test on maxillary teeth of human dry skull

The athletic mouthguard has been used for the prevention of orofacial injuries in contact sports. In this research, the effectiveness of a mouthguard was evaluated for its protection of the maxillary teeth of a human dry skull through experimental modal analysis. The upper central incisor was excited by an electrodynamic shaker. The frequency response functions of the upper teeth were then recorded on an FFT analyzer in order to identify modal shapes of the maxillary arch with and without a mouthguard. In addition, transient response simulations were carried out and decay rates of transient response waves were compared. As a result, when the mouthguard was in place, the resonance peaks of the frequency response functions were dampened, and the nodes of the modal shapes for the anterior teeth were indefinite in the frequency domain over 1 kHz. In the transient response simulation, the decay rates of transient response waves when the mouthguard was used were significantly higher than those when the mouthguard was not used (p<0.01). The results suggest that the mouthguard relieves the stress concentrated on the anterior teeth in a frontal collision by absorbing and dispersing some of the shock energy, thus quickly stopping the vibration of the maxillary teeth. These findings support the clinical fact that mouthguards prevent orofacial injuries in sporting activities.

Breast reconstruction after mastectomy without additional scarring: application of endoscopic latissimus dorsi muscle harvest

Breast reconstruction with the latissimus dorsi muscle flap combined with a saline-filled implant was performed. Using an endoscope, additional operative scarring due to muscle harvesting was avoided. The operative techniques were easier than usual endoscopic surgery because most of the procedures were performed under direct vision. The procedures are presented in this article.

Anti-thrombotic effects of CX-397, a recombinant hirudin analog, in a canine model of coronary artery thrombosis

CX-397, a recombinant hirudin analog, is a potent and specific inhibitor of human alpha-thrombin. We conducted a comparative study of CX-397 and heparin in a canine model of left circumflex (LCX) coronary artery thrombosis to evaluate the anti-thrombotic efficacy of CX-397. Administration of drugs (i.v.; bolus + infusion) was commenced 10 min prior to the initiation of LCX coronary artery electrolytic injury (100 microA for 300 min). All saline-treated control animals (7/7) developed thrombotic occlusion during the experimental period, leaving a residual thrombus mass of 15.4 +/- 3.8 mg. Treatment with CX-397 at three incremental dose levels reduced the incidence of occlusion (4/7, 2/5 and 0/7) and decreased thrombus weight (12.6 +/- 2.5 mg, 6.3 +/- 3.0 mg and 2.1 +/- 1.3 mg, respectively) in a dose-dependent manner. At the intermediate dose (15,000 ATU/kg + 15,000 ATU/kg/h) or higher, CX-397 showed significant anti-thrombotic effects (p <0.05 and p <0.01) and suppressed increases in thrombin-antithrombin III complex (TAT) levels (p <0.01 and p <0.001). In the heparin (80 U/kg + 60 U/kg/h)-treated group, the incidence of occlusion (5/7) and thrombus weight (14.1 +/- 6.2 mg) did not differ significantly from the control group. Plasma TAT levels in the heparin group decreased compared with the control group (p <0.01), but was less potent than the intermediate dose CX-397 (p <0.01). The anti-coagulation (activated partial thromboplastin time and activated clotting time) and template bleeding time prolongation effects of heparin were more potent than those of the intermediate dose CX-397 which showed significant anti-thrombotic effects. In conclusion, CX-397 dose-dependently suppressed thrombus formation by inhibition of thrombin activity in a canine coronary artery injury model. The anti-thrombotic efficacy of CX-397 was more potent than that of heparin at equivalent anti-coagulation dosage.

Abnormal accumulation of porphyrin derivatives in the kidneys of Long-Evans Cinnamon rats, as evidenced by microspectrophotometry

In the study described here we have revealed an abnormal accumulation of porphyrin derivatives in the kidneys of Long-Evans Cinnamon (LEC) rats, an animal model for human Wilson's disease. In addition, we have confirmed that the derivatives emitted red-orange light in renal sections under UV excitation. This renal red-orange emission has previously been identified as luminescence from cuprous metallothioneins [Cu(I)-MTs], which also accumulate in both the kidneys and liver of LEC rats. In this study, we measured the emission spectra of the luminescence in the kidneys using microspectrophotometry. The spectra of the renal red-orange emission resembled those of porphyrin derivatives rather than those of Cu(I)-MTs. We then extracted these derivatives from the kidneys. An abundance of porphyrin derivatives was established. A significant increase in the levels of the derivatives in the liver and urine of the LEC rats was also confirmed. These results provide evidence of a heme-metabolism abnormality in LEC rats.

Comparison of hemodynamic changes in two veno-venous bypass techniques modified at the portal cannulation site

Veno-venous bypass under total vascular exclusion is a useful technique to permit safer resection of hepatic malignancy. We describe here a retrospective study of two modified venous bypass techniques as alternatives to the conventional end-on portal cannulation technique. Portal decompression via inferior mesenteric vein access was performed in eight patients (group A), and portal decompression via a passive shunt between a branch of the mesenteric vein and the right saphenous vein was performed in a second group (group B; n = 8). Both techniques were used in hepatic resection for malignancy under total vascular exclusion. To assess the efficacy of these bypass techniques, we compared the hemodynamic changes in the two groups. There were no differences in the bypass flow between the two groups. Neither group showed any significant changes in hemodynamic parameters (including mean arterial pressure, cardiac index, systemic vascular resistance index, and pulmonary artery pressure) between the pre-bypass and bypass phases. The heart rate in the bypass phase was significantly increased compared to that in the pre-bypass phase in both groups. All hemodynamic parameters in each phase were similar in the two groups. We conclude that both techniques maintained adequate venous return and stabilized the hemodynamic changes during hepatic resection under total vascular exclusion, and that either technique can be selected according to the intraoperative situation.

Effects of adrenalectomy and glucocorticoid receptor antagonist, RU38486, on pituitary growth hormone-releasing hormone receptor gene expression in rats

We examined the effects of adrenalectomy and a glucocorticoid receptor antagonist, RU38486, on pituitary GH-releasing hormone (GRH) receptor gene expression in rats. GRH receptor mRNA levels were significantly decreased in adrenalectomized rats and replacement of dexamethasone reversed the decrease to normal. GH secretion was inhibited by adrenalectomy, whereas dexamethasone replacement failed to restore the impaired GH secretion. A high dose of RU38486 had an agonistic effect on GRH receptor mRNA levels. These results suggest that endogenous glucocorticoid is necessary for normal expression of pituitary GRH receptor mRNA in rats.

Hyperthermo-chemo-hypoxic isolated liver perfusion for hepatic metastases: a possible adjuvant approach

As a possible intraoperative adjuvant approach to treating hepatic metastases we developed a method of hyperthermo-chemo-hypoxic isolated liver perfusion in combination with hepatic resection. This method was applied to 11 patients with colorectal hepatic metastases between 1992 and 1995. One patient died on postoperative day 14 of hepatic failure (9% mortality), the cause of which was live temperature that reached 42.9 degree C, which seems to be the maximum limit for thermal toxic effect on the human liver. The other 10 patients tolerated the perfusion well, with mild hepatic and non systemic toxicity after minor or even major hepatic resection; the serum aminotransferase and total bilirubin levels returned to normal levels by postoperative day 14. Only one of eight patients (13%) for whom cytotoxic drugs were added to the perfusate (mitomycin C 10 micrograms/ml or cisplatin 2 micrograms/ml) had hepatic recurrence by 19 months after the perfusion (mean follow-up 25.8 months; median 23 months; range 8-57 months). Two patients were alive with no evidence of disease at 13 and 57 months, respectively after the perfusion; the other five patients had postperfusion extrahepatic recurrences (median: 19 months; range 7-20 months). In contrast, hepatic metastases recurred 7 and 20 months after the perfusion, respectively, in the two patients not given a cytotoxic drug.

Endoscope-assisted transaxillary removal of glandular tissue in gynecomastia

Gynecomastia is a condition commonly associated with puberty. An endoscope-assisted transaxillary procedure was used to treat a patient with this condition. An endoscope system was inserted into a 4-cm skin incision in the axilla, and the glands and adjacent fat were removed en bloc. The resulting scar in the axilla was small and inconspicuous, and the postoperative breast contour satisfied the patient. The endoscopic system provided a useful transaxillary approach. These results show that this method appears to be the most suitable one for surgical management of gynecomastia.

Direct detection by PCR of Escherichia coli O157 and enteropathogens in patients with bloody diarrhea

Direct detection of Escherichia coli O157 and foodborne pathogens associated with bloody diarrhea were achieved using polymerase chain reaction (PCR) after the preparation of DNA from stool specimens using the microspin technique. PCR was compared with cultivation and toxin production tests with respect to the efficiency of detection of each pathogen; E. coli O157, Vibrio parahaemolyticus, Salmonella serovar Enteritidis and Campylobacter jejuni. Detection of some or all of the above pathogens in clinical stool specimens was achieved using PCR. The minimum number of cells required for the detection of the above pathogens by PCR was 10(1) CFUs/0.5 g of stool sample. PCR was completed within 6 hr. The above pathogens were also detected in cultivation and toxin production tests. Partial purification of the template DNA using the microspin technique was essential for the elimination of PCR inhibitors from the DNA samples. This PCR method is an accurate, easy-to-read screening method for the detection of Shiga-like toxin producing E. coli O157 and enteropathogens associated with bloody diarrhea in stool specimens.

Temporal changes of mRNA expression of matrix proteins and parathyroid hormone and parathyroid hormone-related protein (PTH/PTHrP) receptor in bone development

Expression of parathyroid hormone and parathyroid hormone-related protein (PTH/PTHrP) receptor is one of the osteoblastic phenotypes; however, it has not been clear whether this phenotype expression is a marker of immature or mature osteoblasts. We examined the temporal expression pattern of PTH/PTHrP receptor in bone development in vivo and in vitro compared with the expression of other osteoblastic phenotypes: osteopontin (OPN), bone sialoprotein (BSP) and osteocalcin (OC), alkaline phosphatase (ALP), and mineralization. Total RNA was extracted from rat calvariae, and cell culture of rat bone marrow at different developmental stages and then Northern blot hybridization were performed. Mineralization was detected with contact microradiography (CMR) in calvaria or with Alizarin Red S staining in bone marrow cell culture. Both in calvaria and in marrow cell culture, extensive expression of OPN, BSP, type I collagen (COL I), and ALP coincided with the onset of mineralization, and OC expression was observed after mineralized tissue formation. Notably, PTH/PTHrP receptor was expressed at an early developmental stage (prenatal day 14 in calvaria, day 5 in culture) when mineralized tissue was not formed and other osteoblastic phenotypes were scarcely detected. Further study in cell culture revealed that the fold increase in cyclic adenosine monophosphate (cAMP) in response to PTH was elevated with the advance in the culture stage. These results indicate that mRNA expression of PTH/PTHrP receptor could be the early differentiation marker in osteoblastic lineage and that the levels of cAMP production in response to PTH represent the stage of osteoblastic differentiation.

Effects of short- and long-term dexamethasone treatment on growth and growth hormone (GH)-releasing hormone (GRH)-GH-insulin-like growth factor-I axis in conscious rats

Although the inhibitory effects of a chronic excess of glucocorticoids (GC) on body growth and GH secretion are well established, the mechanisms involved remain unclear. In this study, we examined the chronic effects of a high dose of dexamethasone (DEX) on spontaneous GH secretion and insulin-like growth factor (IGF)-I in conscious rats. The animals were given daily i.p. injections of DEX (200 microg/day) for either one or four weeks. Body growth assessed by tibia length and serum IGF-I levels was significantly inhibited 1 week after treatment. By contrast, spontaneous GH secretion was not altered 1 week after the treatment. Neither hypothalamic GRH and somtatostain mRNA levels nor GH responses to GRH from single somatotropes were affected 1 week after the treatment. Four weeks after DEX treatment, body growth of the rats was noticeably suppressed. Interestingly, spontaneous GH secretion, hypothalamic GRH mRNA levels and GH responses to GRH were all inhibited 4 weeks after treatment. Pituitary GRH receptor mRNA levels were not altered 1 week after treatment, but increased after 4 weeks. These results indicate that a high dose of DEX initially impairs IGF-I production and subsequently inhibits spontaneous GH secretion in rats. Inhibition of spontaneous GH secretion resulting from chronic GC excess is due, at least in part, to the impairment of hypothalamic GRH synthesis and pituitary GH responsiveness. An increase in the pituitary GRH receptor may be caused by decreased GRH secretion.

Effects of dopaminergic agents on reversal of reserpine-induced impairment in conditioned avoidance response in rats

Male Slc:Wistar, Std:Wistar, and Slc:F344/N rats had good acquisition of the conditioned avoidance response (CAR), while that of the male Slc:Wistar/ST, Jcl:Wistar, and Crj:Wistar rats was bad. Reserpine-induced impairment (RII) in CAR was observed 2-72 h after administration of dopaminergic (DAergic) agents in male Slc:Wistar rats. Amitriptyline (5-80 mg/kg, P.O.), imipramine, desipramine, cis-dosulepine, and trans-dosulepine at dose of 40 mg/kg, P.O. showed no antagonism against RII in CAR 20-23 h after reserpine injection (1 mg/kg, S.C.). However, the atypical antidepressive agents sibutramine (5-10 mg/kg, P.O.), bupropion (40 mg/kg, P.O.), and nomifensine (10-40 mg/kg, P.O.) exhibited antagonism against RII in CAR. The calcium channel antagonists flunarizine, nimodipine, and KP-840 at dose of 10 and 100 mg/kg, P.O., the cerebral improving agent indeloxazine (20-80 mg/kg, P.O.), the anticholinergic agent atropine (5-40 mg/kg, P.O.), 5-hydroxy-L-tryptophan (5-HTP) (40 mg/kg, I.P.), a precursor of 5-hydroxytryptamine (5-HT), and (+/-)-threo-dihydroxyphenylserine [(+/-)-threo-DOPS] (20-200 mg/kg P.O.), a norepinephrine (NE) precursor, showed no antagonism against RII in CAR. The DAergic agents methamphetamine (5 mg/kg, P.O.) and amantadine (50-250 mg/kg, P.O.), L-DOPA (200 mg/kg, P.O.), and the DAergic D1/D2 receptor agonist apomorphine (0.1-1 mg/kg, S.C.) showed marked antagonism against RII in CAR. Although the DAergic D1-receptor agonist KF-38393 (0.3-30 mg/kg, I.P.) and the DAergic D2-receptor agonist quinpirole (0.3-10 mg/kg, I.P.) induced only a weak recovery of RII in CAR when they were administered alone, in contrast to a potent synergistic recovery of RII in CAR, which was observed when SKF-38393 (1 mg/kg, I.P.) and quinpirole (1 mg/kg, I.P.) were administered together. These results suggest that the DAergic nervous system rather than the adrenergic or 5-HT nervous system is involved in RII in CAR, and that both the DAergic D1- and D2-mediated nervous systems play important roles in this process.

Prosthodontic treatment for patients with large mandibular defects; porous hydroxyapatite grafts

It is difficult for both prosthodontists and their patients with large marginal defects to achieve a satisfactory prosthodontic result, because retention, support, and stability of the prosthesis are limited and recovery of esthetics is unsatisfactory owing to large mandibular defects. Alveolar ridge augmentation therapy is performed to compensate for such problems. We have experienced a good prognosis of prosthodontic treatment for over 10 years in two patients with large marginal defects of the partially edentulous mandible, who had undergone grafting of porous hydroxyapatite blocks to their bone defects. It has been reported that porous hydroxyapatite blocks are unsuitable for edentulous patients, because the mucosa covering the hydroxyapatite block is too thin and delicate to support dentures. We, therefore, designed the denture to prevent concentration of occlusal stress on the mucosa. In both of these two cases, we achieved recovery of occlusal function and esthetics by affixing denture to the large marginally resected defect augmented with a graft of porous hydroxyapatite block.