Artificial insemination using cryopreserved sperm in the silkworm, Bombyx mori

We report in this paper that female moths artificially inseminated with cryopreserved sperm (-196 degrees C) could oviposit eggs when the sperm was preserved for 356days, and that the fertilization rate and the number of eggs laid were almost equivalent to those obtained in normally mated moths. The optimal cooling rate for sperm freezing was 5-65 degrees C/min for maintaining a high fertility of sperm. The simple and reliable method of cryopreservation was to put the semen first in a deep freezer at -80 degrees C and thereafter put them in liquid nitrogen. When female moths of 'white 2' egg-color mutant strain were inseminated with a mixture of frozen-thawed sperm from males of normal-colored egg strain and non-frozen sperm from males of the 'white 2', female moths deposited a majority of 'white 2' eggs and a very small number of eggs of normal color. The result shows that there was a competitive fertilization of sperm between the two strains of the silkworm, and that sperm fertility was reduced to a considerable extent by freezing at -196 degrees C. These results may contribute not only to basic studies on fertilization in Lepidoptera but also to the development of long-term preservation procedure of genetic resources by using cryopreserved sperm of Bombyx mori.

Biomechanical study of the development of scoliosis, using a thoracolumbar spine model

A thoracolumbar spine model was made using synthetic resin vertebrae and silicon discs. The model was fixed to a metal frame and spinal deformation caused by loading was determined relative to three-dimensional coordinates set in the frame. A three-dimensional evaluation of the development of spinal deformity was performed by applying rotational, lordotic, and lateral flexional forces in various orders to the model. The most severe scoliosis occurred when loading was done in the order of rotational force, lordotic force, and lateral flexional force.

[Regional differences of in vivo proton MR spectroscopy in developing human brain]

The purpose of this study was to clarify regional differences in proton MR spectroscopy (1H-MRS) in the developing human brain. Proton MR spectra were obtained from 24 infants aged 0 to 24 months old. Proton MR spectroscopy was performed on a 1.5 Tesla clinical MR unit using a 3D-chemical shift imaging sequence (3D-CSI). MR spectra obtained from voxels in frontal white matter and those in parietal white matter were compared. The NAA/Cho ratios of the frontal region were lower than those of the parietal region at birth but increased rapidly during the first six months of life. The rate of increase was reduced in the second year of life. In contrast, NAA/Cho ratios in paracentral areas were already high at birth but increased slowly through the first two years of life. Cho/Cr ratios of the frontal region were stable during the first year of life and started to decrease in the second year of life. In the parietal region, Cho/Cr ratios were decreased throughout infancy. Regional differences in 1H-MRS spectra were apparent during infancy, and these differences were suggested to reflect regional differences in the maturation of the developing human brain.

[A cost-effectiveness analysis of a pre-visit testing system for new outpatients in primary care medicine]

We evaluated cost-effectiveness parameters of common diagnostic test panels advocated by the Japan Society of Clinical Pathology in order to determine the validity of pre-visit testing of these test panels for new outpatients with some defined symptoms. The "Essential Laboratory Tests(ELT) (2)" panel was universally applied to 540 new outpatients who visited the Comprehensive Medicine Clinics in the National Defense Medical College and its affiliated hospital. A "useful result(UR)", the unit of usefulness of the ELT, was assigned by assessing the impact of its results on physician's diagnosis- or decision-making. Patients were classified into 7 major symptom groups according to their chief complaint, and clinical effectiveness(UR/patient), economic efficiency(cost/UR) and cost-effectiveness(delta cost/delta UR) were analyzed in each patient group. Clinical effectiveness ranged from 1.38(renal/urinary tract symptoms) to 0.27 UR/patient(neurological symptoms) with a cost disparity from yen 1,222 to yen 5,946/UR between these patient groups. Substantial decreases in clinical effectiveness were demonstrated in all patient groups with the ELT(1)-testing alone in a simulation study; however, cost-effectiveness parameters still remain in excellent values in the renal/urinary tract symptom and infection/inflammation-related symptom groups(1.13 and 0.77 UR/patient at a cost of yen 836 and yen 1,181/UR, respectively). The addition of some ELT(2)-specific test items such as AST, ALT to the ELT(1) baseline panel improved clinical effectiveness of the ELT(1) in lassitude/exhaustive symptom group at a minimal cost increment. This study verified the validity of the ELT(1) as a panel for pre-visit testing in patients with renal/urinary tract symptoms and infection/inflammation-related symptoms, but not in those with other symptoms.

[Revolution of the health care delivery system and its impacts on laboratory testing in the United States]

Failure to slow the exponential growth of total health care expenditures in the United States through the government policies resulted in a rapid and progressive penetration of managed care organizations(MCOs) in the early 1990s. Diagnostic testing is viewed as a "commodity" rather than a medical service under the managed care environment. Traditional hospital-based laboratories are placed in a downward spiral with the advent of managed care era. A massive reduction of in-house testing resulted from shorter lengths of patients' hospital stay and a marked decrease in admission under the dominance of managed care urges them to develop strategies for restoring tests deprived by the managed care-associated new businesses: consolidation and networking, participation in the outreach-testing market, and point-of-care/satellite laboratory testing in non-traditional, ambulatory settings are major strategies for survival of hospital laboratories. A number of physicians' office laboratories(POLs) have been closed owing to regulatory restrictions imposed by the Clinical Laboratory Improvement Amendments of 1988(CLIA '88), and to the expanded penetration of MCOs which limit reimbursement to a very few in-house procedures. It seems likely that POLs and hospital laboratories continue to reduce test volumes, while commercial reference laboratories(CRLs) gain more tests through contracting with MCOs. In the current stream of managed care dominance in the United States, clinical laboratories are changing their basic operation focus and mission in response to the aggressively changing landscape. Traditional laboratories which are unwilling to adapt themselves to the new environment will not survive in this country.

Competitive reverse transcription-polymerase chain reaction assay for quantification of human multidrug resistance 1 (MDR1) gene expression in fresh leukemic cells

We have analyzed MDR1 gene expression in 69 clinical samples obtained from 64 patients with leukemic hematologic malignancies by using a competitive reverse transcription-polymerase chain reaction assay with a heterologous competitor RNA. To exclude a false-positive result caused by concomitant normal lymphocytes that physiologically express MDR1, in samples we determined a cut-off value of 8 amol MDR1 transcript per microgram of RNA by simultaneous measurement of rhodamine 123 dye efflux either in lymphocyte or gated leukemic cell populations. Consequently, 23 of 69 samples were concluded to be MDR1-positive in leukemic cells per se. The MDR1 expression rate was significantly correlated with factors such as a history of preceding chemotherapy, elder age of the patient, and certain disease types (eg, leukemia progressed from myelodysplastic syndrome). Moreover, the complete response rate after chemotherapy was significantly higher in MDR1-negative patients than in MDR1-positive patients (52% vs 17%, respectively; P = .01). The assay established will enable the quantification of MDR1 gene expression in blood samples from patients with leukemic hematologic malignancies and will be applicable to clinical laboratories as a routine test.

Serum concentrations of advanced glycation endproducts are associated with the development of atherosclerosis as well as diabetic microangiopathy in patients with type 2 diabetes

We measured serum concentrations of advanced glycation endproducts (AGEs) in patients with type 2 diabetes, to elucidate the mechanisms underlying the elevated serum concentrations of AGEs and to clarify the relationship between serum AGE concentrations and the development of microangiopathy and macroangiopathy. Serum AGEs were significantly higher in diabetic patients than in age-matched control subjects (p < 0.0001). In diabetic patients, serum AGEs were positively correlated with HbAlc (r = 0.47, p < 0.0001), urinary albumin excretion (UAE) (r = 0.42, p < 0.0001), diabetes duration (r = 0.31, p = 0.0030), and fasting plasma glucose (r = 0.34, p = 0.0010). Multiple regression analysis disclosed that only the HbAlc and UAE levels independently correlated with serum AGE levels. Serum AGEs in diabetic patients with progressive retinopathy and overt nephropathy were significantly higher than in those with less severe retinopathy and nephropathy. Serum AGEs were significantly higher in the diabetic patients with coronary heart disease (CHD) than in those without CHD. These results suggest that the HbAlc and UAE levels are independent risk factors for increased serum AGE concentrations in type 2 diabetic patients, and that higher serum AGE concentrations are associated with increased severity of diabetic retinopathy and nephropathy. Serum AGE concentrations may be a useful marker not only for the severity of diabetic microangiopathy but also for the development of CHD in patients with type 2 diabetes mellitus.

Cross-sectional study on the relationship between smoking or smoking cessation and trait anxiety

OBJECTIVE

The relationships between trait anxiety, or anxiety proneness, and smoking and between trait anxiety and smoking cessation, among an adult population were investigated.

METHODS

The subjects were 2,669 male Japanese personnel working for a Japanese government agency. Participants completed a self-administered questionnaire on smoking and smoking cessation status and other habits. Trait anxiety was evaluated with the trait anxiety part of the standardized Japanese version of the Spielberger State-Trait Anxiety Inventory. Trait anxiety is regarded as the long-term, more endogenous general type of anxiety. Odds ratios of the single 2 x 2 table were calculated and a logistic regression analysis was used to adjust for age.

RESULTS

After adjusting for age, high trait anxiety did not increase the risk of smoking and was not related to success in abstaining from smoking. More subjects with high trait anxiety had planned to stop smoking (adjusted odds ratio: 1.39, P = 0.01) but did not actually succeed in doing so.

CONCLUSION

The present study did not support the hypothesis that high trait anxiety increased the risk of having a smoking habit and that high trait anxiety increased the chance of abstaining from smoking. However, the study did show that high trait anxiety was related to the planning of smoking cessation, but not to actually giving up the smoking habit.

Common diagnostic test panels for clinical evaluation of new primary care outpatients in Japan: a cost-effectiveness evaluation

BACKGROUND

The Japan Society of Clinical Pathology (JSCP) has developed a guideline for common diagnostic test utilization in new primary care outpatients. To determine the scientific and economic validity of the JSCP panel testing system, we analyzed cost-effectiveness parameters of test panels advocated.

METHODS

The "Essential Laboratory Tests" panel (2) [ELT(2) panel], a package of common diagnostic tests added to the ELT(1) baseline health-status screening panel, was applied to 540 new outpatients who visited the Comprehensive Medicine Clinics in an academic medical center during 1991 to 1997. A "useful result" (UR) of testing was defined as a finding that contributed to a change in a physician's diagnosis- or decision-making, relating to a "tentative initial diagnosis" (TID) obtained from history and physical examination alone.

RESULTS

Clinical usefulness was demonstrated in 259 patients with ELT(2), in whom 398 URs were generated. Clinical effectiveness (UR/TID) ranged from 1.65 (hematological) to 0.088 (neurological disease), with a cost disparity from yen1251 ( approximately $10) to yen23 037 ( approximately $200) per UR. A total of 1137 tests generated URs. We further assessed the clinical effectiveness and economic efficiency (cost/UR) of ELT(1) and restructured panels. Use of the ELT(1) alone generated 244 URs in 167 patients. The poor efficiency of the ELT(1) panel was markedly improved with the addition of certain ELT(2)-specific tests in liver/pancreatobiliary, metabolic/endocrine, and cardiovascular disease groups.

CONCLUSIONS

A wide disparity in the utility of ELT panels in different patient groups does not support the JSCP recommendation of their routine use for new outpatients. Selective test combinations should be used in selected patient groups.

A possible role of immunoglobulin E in patients with hyperthyroid Graves' disease

To investigate the possible participation of immunoglobulin E (IgE) in the autoimmune process of Graves' disease, incidence of elevation of serum IgE level, TSH receptor antibody (TRAb), and thyroid status were studied in 66 patients with hyperthyroid Graves' disease, 54 patients with Hashimoto's thyroiditis, 19 patients with bronchial asthma, and 15 patients with pollen allergy. In hyperthyroid Graves' patients, elevation of serum IgE levels (> or = 170 U/mL) was found in 19 of 66 patients (29%), 11 of whom had hereditary and/or allergic conditions. Elevations of serum IgE levels were found in 63% of patients with bronchial asthma and in 40% of patients with pollen allergy. Mean values of serum IgE were the same in patients with hyperthyroid Graves' disease and with bronchial asthma. During methimazole treatment TRAb decreased without fluctuation of IgE levels in both groups. The decrease in TRAb was significantly greater in patients with normal IgE than in patients with IgE elevation. After prednisone administration, reduction in TRAb was greater in patients with normal IgE than that in patients with IgE elevation. High incidence of IgE elevation in hyperthyroid Graves' disease and slower reduction in TRAb in association with IgE elevation suggest a difference in the autoimmune processes in Graves' disease with and without elevation of IgE.

Thyroid hormone modulates insulin-like growth factor-I(IGF-I) and IGF-binding protein-3, without mediation by growth hormone, in patients with autoimmune thyroid diseases

The expression and synthesis of insulin-like growth factor-1 (IGF-I) and IGF-binding protein-3 (IGFBP-3) are regulated by various hormones and nutritional conditions. We evaluated the effects of thyroid hormones on serum levels of IGF-I and IGFBP-3 levels in patients with autoimmune thyroid diseases including 54 patients with Graves' disease and 17 patients with Hashimoto's thyroiditis, and in 32 healthy age-matched control subjects. Patients were subdivided into hyperthyroid, euthyroid and hypothyroid groups that were untreated, or were treated with methylmercaptoimidazole (MMI) or L-thyroxine (L-T4). Serum levels of growth hormone (GH), IGF-I and IGFBP-3 were determined by radioimmunoassay. Serum GH levels did not differ significantly between the hyperthyroid and the age-matched euthyroid patients with Graves' disease. The serum levels of IGF-I and IGFBP-3 showed a significant positive correlation in the patients (R=0.616, P<0.001). The levels of both IGF-I and IFGBP-3 were significantly higher in the hyperthyroid patients with Graves' disease or in those with Hashimoto's thyroiditis induced by excess L-T4 administration than in control subjects. Patients with hypothyroid Graves' disease induced by the excess administration of MMI showed significantly lower IGFBP-3 levels as compared to those in healthy controls (P<0.05). Levels of IGFBP-3, but not IGF-I levels, showed a significant positive correlation with the levels of free T4 and free T3. In Graves' disease, levels of TPOAb, but not of TRAb, showed a significant positive correlation with IGFBP-3. We conclude that in patients with autoimmune thyroid diseases, thyroid hormone modulates the synthesis and/or the secretion of IGF-I and IGFBP-3, and this function is not mediated by GH.

Association between alcohol intake and subjective health: the Sotetsu Study

Subjective health and alcohol intake are important predictors of mortality. There have been few epidemiological studies, however, of the relationship between alcohol consumption and subjective health among the Japanese. The purpose of this study is to investigate the association between alcohol consumption and subjective health. The study subjects were 2,020 Japanese male employees, who were free from serious disease conditions. The data on subjective health and alcohol consumption were obtained by means of self-reported questionnaire. The subjects who responded "poor health" in the answer to the question about the subjective health status were considered to be in ill-health. Ethanol intake per day was calculated by multiplying the frequency of drinking by the ethanol intake per drinking occasion and summing up for each alcoholic beverage. Age, smoking status, physical activity, and sleeping hours were treated as confounding factors. As a result, subjects who consumed 25-36 or 49 g ethanol or more per day had a significantly lower risk of self-rated ill-health compared with those who had never drunk, and a significantly inverse trend was found independent of age, smoking status, physical activity, and sleeping hours. In conclusion, moderate drinkers have a lower risk of self-rated ill-health among Japanese male employees investigated.

[Anti-thyroid peroxidase antibody]

Anti-thyroid peroxidase antibody(TPOAb) in patients with autoimmune thyroid diseases was identified with anti-microsomal antibody. Highly sensitive assays of TPOAb using radioimmunoassays and enzyme immunoassays have been developed following a hemagglutination assay technique. TPOAb is present in the serum of almost all patients with Hashimoto's thyroiditis, in more than 70% of those with Graves' disease, and, to a variable degree, in patients with nonthyroid autoimmune diseases and some normal subjects. There is a good correlation between the degree of lymphocytic infiltration of the thyroid gland and the titer of TPOAb. Postpartum thyroiditis, usually a transient disorder, occurs with high frequency in women who have TPOAb. TPOAb, in addition to anti-thyroglobulin antibody, was a clinically useful marker for defining autoimmune thyroid diseases and for detecting an underlying autoimmune process in the thyroid, however, its biological importance remains to be clarified at the present time.

Variable expression of the folylpolyglutamate synthetase gene at the level of mRNA transcription in human leukemia cell lines sensitive, or made resistant, to various antifolate drugs

We investigated the expression of the folylpolyglutamate synthetase (FPGS) gene at the mRNA level in MOLT-3 and K562 human leukemia cell lines sensitive, or made resistant, to methotrexate (MTX) and/or trimetrexate (TMQ), or raltitrexed (ZD1694). Northern blot analysis demonstrated approximately 3-fold higher FPGS mRNA expression in K562 cells than that in MOLT-3 cells, being consistent with graded polyglutamation capacities of these cell lines. A slight increase in the expression of the FPGS gene was observed in the TMQ-resistant MOLT-3 cells (MOLT-3/TMQ800); moreover, sequential development of MTX resistance in the TMQ-resistant cells (MOLT-3/TMQ800-MTX10,000) resulted in a further enhancement of FPGS mRNA expression despite of decreased polyglutamation capacity in this subline. Another MTX-resistant subline with impaired reduced folate carrier (MOLT-3/MTX10,000) also showed overexpression of FPGS mRNA. Conversely, both raltitrexed-resistant sublines (MOLT-3/ZD1694 x C and K562/ZD1694 x C) displayed a moderately decreased expression of FPGS mRNA. These findings did not correspond to the virtual absence of ZD1694 polyglutamates inside the former cells nor to possibly intact polyglutamation capacity in the latter cells. These results indicate that FPGS mRNA expression may predict cellular ability to produce polyglutamate metabolites of antifolate drugs in the sensitive cells, but does not necessarily reflect FPGS function at the enzyme level in the antifolate-resistant tumor cells.

Microsatellite instability and clonal heterogeneity of MDR1 messenger RNA expression in trimetrexate-resistant human leukemia MOLT-3 cells developed in thymidine

Various gene alterations are involved in the drug resistance of leukemia cells. To understand the mechanism that underlies the emergence of cells with such gene alterations in human leukemia, we performed clonal analysis of the gene expression of mutant dihydrofolate reductase (DHFR) and mdr1 in trimetrexate-resistant human leukemia MOLT-3 cells. Trimetrexate-resistant (70- and 60-fold) sublines were developed in the presence or absence of an exogenous supply of thymidine (MOLT-3/TMQ70/Th+, MOLT-3/TMQ60/Th-, respectively). Ten clonal lines were isolated by methyl cellulose cloning from each of the 2 trimetrexate-resistant MOLT-3 sublines. All the clonal lines from the 2 sublines expressed mutated DHFR mRNA, with a base change (T --> C) at the second position of codon 31, as well as the wild-type mRNA, in accordance with cross-resistance to methotrexate. On the other hand, mdr1 mRNA expression was demonstrated by reverse-transcription polymerase chain reaction only in clonal lines from MOLT-3/TMQ70/Th+ cells. mdr1 mRNA expression in clonal lines from MOLT-3/TMQ70/Th+ cells and subclonal lines subsequently obtained from the 3 clonal lines with different mdr1 mRNA expression levels was heterogeneous, and its high expression levels were correlated with acquisition of the multidrug resistance (MDR) phenotype. Polymerase chain reaction-based assay for separate microsatellites, mfd27 and mfd41, demonstrated genomic instability among clonal and subclonal lines of MOLT-3. The clonal analysis of polymorphic microsatellites also suggested that emergence of MDR in trimetrexate-resistant MOLT-3 cells in thymidine was not only heterogeneous but also progressively expanding among clones. Genomic instability may play a role in the establishment and clonal evolution of drug resistance in leukemia cells.

Retrovirus-mediated transfer of anti-MDR1 hammerhead ribozymes into multidrug-resistant human leukemia cells: screening for effective target sites

One of the underlying mechanisms of multidrug resistance (MDR) is cellular over-production of P-glycoprotein (P-gp), which acts as a drug efflux pump. P-gp is encoded by a small group of related genes termed MDR; only MDR1 is known to confer drug resistance. To overcome P-gp-mediated drug resistance, we have developed two anti-MDR1 hammerhead ribozymes driven by the beta-actin promoter. Upon transduction of the ribozymes into MDR cells, vincristine resistance was decreased. These two ribozymes were constructed, which showed different cleavage activities. In this study, to determine suitable target sites for the anti-MDR1 ribozyme, the exon 1b-intron 1 boundary, the translation-initiation site, the intron 1-exon 2 boundary and the exon 2-intron 2 boundary, codons 179 and 196 of the MDR1 gene were selected as candidates. To improve the ribozyme activity, a retroviral vector containing RNA polymerase III promoter was used. Stable retrovirus producer cells were generated by transfecting the retroviral vector plasmids carrying the ribozyme into the packaging cell line. Retroviral vector transduction of human leukemia cell lines expressing MDR1 was accomplished by co-culturing these with virus producer cells. Stably transduced cells were selected by G418 and pooled to determine the efficacy of each ribozyme. These ribozyme-transduced cells became vincristine-sensitive concomitant with the decreases in MDR1 expression, P-gp amount and drug efflux pump function. Among the ribozymes tested, the anti-MDR1 ribozyme against the translation-initiation site exhibited the strongest efficacy. This retrovirus-mediated transfer of anti-MDR1 ribozyme may be applicable to the treatment of MDR cells as a specific means to reverse resistance.

Inhibitory effect of Epstein-Barr virus activation by Citrus fruits, a cancer chemopreventor

To search useful compounds in Citrus fruit for cancer chemoprevention, we carried out a primary screening of extracts of fruit peels and seeds from 78 species of the genus Citrus and those from two Fortunella and one Poncirus species, which were closely related to the genus Citrus. These Citrus extracts inhibited the Epstein-Barr virus early antigen (EBV-EA) activation induced by 12-O-tetradecanoylphorbol 13-acetate (TPA) as a useful screening method for anti-tumor promoters. Our results indicated that Citrus containing substances may be inhibit susceptibility factors involved in the events leading to the development of cancer.

Artificial insemination using trypsin-treated sperm in the silkworm, Bombyx mori

A new method was developed for artificial insemination of the silkworm. Virgin females artificially inseminated by this method oviposited fertilized eggs at a rate almost similar to that of females mated with males. Using inactive sperm collected from the seminal vesicles, we confirmed the previous finding by Omura, S., 1936a, Artificial insemination of Bombyx mori, Journal of Faculty of Agriculture, Hokkaido Imperial University 38, 135-150, and Omura, S., 1938, Studies of the reproductive system of the male of Bombyx mori II, Post-testicular organs and post-testicular behaviour of the spermatozoa, Journal of Faculty of Agriculture, Hokkaido Imperial University 40, 129-170, that the sperm of B. mori requires the secretion of the glandula prostatica for activation. Sperm also could be activated by trypsin. At an optimal concentration, 0.3 &mgr;g trypsin/ml in 50% semen solution, the fertilization rate as well as the number of eggs oviposited was almost equivalent to that obtained in normally mated moths. These results may contribute not only to basic studies on fertilization and reproduction in Lepidoptera but also to the development of long-term preservation of genetic resources by using cryopreserved sperm of B. mori and other Lepidoptera insects.

The antiproliferative effect of acridone alkaloids on several cancer cell lines

Fifteen acridone alkaloids were examined for their antiproliferative activity toward monolayers and suspension of several types of cancer and normal human cell lines. As a result, atalaphyllidine (9), 5-hydroxy-N-methylseverifoline (11), atalaphyllinine (12), and des-N-methylnoracronycine (13) showed potent antiproliferative activity against tumor cell lines, whereas they have weak cytotoxicity on normal human cell lines. The structure-activity relationship established from the results revealed that a secondary amine, hydroxyl groups at C-1 and C-5, and a prenyl group at C-2 played an important role for antiproliferative activities of the tetracyclic acridones.

Relation between the serum level of C-peptide and risk factors for coronary heart disease and diabetic microangiopathy in patients with type-2 diabetes mellitus

Syndrome X is used to describe a constellation of factors that lead to coronary heart disease (CHD): hypertension, hyperinsulinemia, impaired glucose tolerance, and an abnormality in lipid metabolism. We investigated the relationship between serum levels of C-peptide immunoreactivity (CPR) and diabetic complications in 256 patients with type-2 diabetes mellitus. The serum level of CPR was measured by radioimmunoassay (RIA). Diabetic patients were divided into 3 groups according to the serum level of CPR as follows: low CPR (n = 19, <0.7 ng/ml), normal CPR (n = 174, 0.7 to 2.2 ng/ml) and high CPR (n = 63, >2.2 ng/ml). The body mass index (BMI) and the serum level of triglycerides were significantly higher in the high CPR group (P < 0.05, respectively) compared with normal CPR group. The prevalence of hypertension was significantly higher in the high CPR group than in the other 2 groups (low CPR: 16%, normal CPR: 28%, high CPR: 38%). The frequency of the number of patients receiving insulin therapy was greater in the low CPR group than in the other 2 groups, (low CPR: 58%, normal CPR: 15%, high CPR: 11%). The serum CPR level was significantly lower in patients with than without proliferative retinopathy or macroalbuminuria. Our conclusion is that the present data suggest that an increased serum level of CPR is associated with obesity, elevated serum triglycerides, and hypertension in patients with type-2 diabetes mellitus. A low CPR level leading to hyperglycemia is associated with the progression of diabetic microangiopathies, such as retinopathy and nephropathy.

[CT diagnosis of hyperdense intracranial neoplasms: review of the literature]

In contrast to typical astrocytic tumors that show hypodense areas on computed tomographic images, some intracranial tumors show hyperdense areas on CT images. The major reasons for hyperdensity on CT images are hypercellular lesions, intratumoral calcification, and intratumoral hemorrhage. Malignant lymphomas, germinomas, and medulloblastomas show homogeneous hyperdensity on CT images because of their hypercellularity. Tumorous lesions such as subependymal giant cell astrocytomas, oligodendrogliomas, ependymomas, central neurocytomas, craniopharyngiomas, and meningiomas often present with hyperdense calcified lesions on CT images. Intratumoral hemorrhage also causes hyperdensity on CT images, and is often associated with metastatic brain tumors, glioblastomas, pituitary adenomas, and rarely with any of the other intracranial tumors. Although magnetic resonance imaging is now the major diagnostic tool for diseases of the central nervous system, the first imaging studies for patients with neurologic symptoms are still CT scans. Hyperdense areas on CT images are a clue to making an accurate diagnosis of intracranial neoplasms.

Acridones as inducers of HL-60 cell differentiation

Fifteen acridone alkaloids were examined for their activity of induction of human promyelocytic leukemia cell (HL-60) differentiation. HL-60 cells were differentiated into mature monocyte/macrophage by atalaphyllidine (9), atalaphyllinine (12), and des-N-methylnoracronycine (13). The activities of NBT reduction, nonspecific esterase, and phagocytosis, were induced by 2.5 microM of 9, 12, and 13. After a 4-day treatment, 9, 12, and 13 at 10 microM inhibited clonal proliferation of HL-60 cells by 28, 96, and 63%, respectively. The structure-activity relationship established from the results revealed that hydroxyl group at C-1 and prenyl group at C-2 had an important role.

Does psychological stress improve physical performance?

The purpose of this study is to determine whether psychological stress enhances physical performance and how personality traits affect it. The annual physical test was chosen as the psychological stressor. Ninety three students ran 50 meters as part of the test and one week after that as a control. The pulse rate and time were measured and pulse rate was used as an indicator of psychological stress. All students took the anxiety-trait scale test of the State-Trait Anxiety Inventory. The pulse rate was higher and the time record was better in the annual physical test compared with that of control. When we categorized the subjects by the anxiety-trait scale test, only the high anxiety-trait students could run faster when faced with higher stress. In conclusion, psychological stress can enhance the physical performance of certain students. It is possible that psychological stress and personality traits interact and both of them affect physical performance.

The protective effect of good physical fitness when young on the risk of impaired glucose tolerance when old

BACKGROUND

The role of physical activity or fitness on preventing impaired glucose tolerance (IGT) has not been widely investigated. The present case-control study examined the relationship between the occurrence of IGT in men in their 50s and the level of their physical fitness while in their 30s.

METHODS

The subjects consisted of 38 male Japan Self-Defense Forces officials in their 50s who had IGT, as diagnosed by the 75-g oral glucose tolerance test, and 60 control individuals. Nine diabetics were included in the IGT cases. As an indicator of physical fitness between the ages of 30 and 39 years, we selected the best time recorded for each individual during that decade of life for the 1,500-m physical fitness test run. We calculated the odds ratio for IGT in relation to selected risk factors (including physical fitness), and a logistic regression analysis was used to adjust for possible confounding variables.

RESULTS

The odds ratio (95% confidence interval, P value) for IGT with physical fitness in their 30s was 0.25 (0.11-0.58, P < 0.05). With adjustment for a parental history of diabetes and body mass index in both their 30s and their 50s, the odds ratio was 0.31 (0.11-0.86, P < 0.05).

CONCLUSIONS

We concluded that the occurrence of IGT, including diabetes, in men in their 50s can be reduced by maintaining a high level of physical fitness while in their 30s.

The effects of a fixed-fee reimbursement system introduced by the Federal Government on laboratory testing in the United States

Rapid growth of health care expenditures during the 1970s in the United States led to implementation of a prospective payment system (PPS) based on diagnosis-related groups (DRG) for Medicare inpatient reimbursement in 1983. With the introduction of DRG/PPS, hospitals encouraged earlier discharges and discouraged admission of patients who may require expensive services. Patient care has moved into more outpatient and non-hospital settings which have been less regulated and paid on a cost-reimbursement basis. The change of reimbursement system has converted hospital laboratories from "profit center" under the fee-for-service reimbursement practice to possible "cost center" at least for inpatient laboratory services with the advent of DRG/PPS. Hospitals have reduced laboratory operating expenses by constraining laboratory growth and development. Laboratory testing in non-hospital settings such as physicians' office laboratories, which were exempt from license and quality control by governmental regulations, has increased exponentially since implementation of DRG/PPS. To improve the quality of laboratory testing in such unregulated laboratories, the federal government has promulgated the Clinical Laboratory Improvement Amendments of 1988 (CLIA '88), requiring on-site survey and license under CLIA '88 for all laboratories in the United States regardless of the size, complexity, or location of laboratory. Implementation of DRG/PPS resulted in a temporary success in reducing Medicare Part A budget growth, but had only a small impact to slow the actual growth of total national health care expenditures or laboratory-related expenditures. Nevertheless, the change of reimbursement practice has created a large incentive to reduce unnecessary resource utilization, and cost-effective laboratory testing has become an essential concept during the DRG/PPS era.

A rare case of a thyrotropin-secreting pituitary tumor which responded to methimazole

A 52-year-old Japanese male complained of palpitations and excessive sweating. He showed evidence of hyperthyroidism, but without suppression of the serum thyroid-stimulating hormone (TSH). On admission, the serum level of the alpha-subunit of TSH was elevated, but tests for thyroid autoantibodies were negative. The TSH response to thyrotropin-releasing hormone (TRH) was blunted. Imaging studies revealed a pituitary tumor 2 cm in diameter. Administration of methimazole lowered the serum levels of thyroid hormones, and elevated the serum level of TSH. These findings led to the diagnosis of a thyrotropin-secreting pituitary tumor. Immunohistochemical analysis and electron microscopic findings verified the diagnosis.

Quantitative analysis of human multidrug resistance 1 (MDR1) gene expression by nonisotopic competitive reverse transcriptase polymerase chain reaction assay

We have established competitive reverse transcriptase polymerase chain reaction (RT-PCR) assay for the quantification of MDR1 mRNA encoding P-glycoprotein (P-gp) by analyzing leukemia sublines of MOLT-3 with various expression of MDR1. The expression was quantified by simultaneous RT-PCR of cellular RNA with decreasing amounts of heterologous competitor RNA, which shares the MDR1 primer sequences with the cellular MDR1 mRNA, but yields a different-sized PCR product. This allows resolution of the amplified cDNA fragments. The amounts of MDR1 mRNA measured by the assay were accurate and reproducible over wide range, and were determined as 31.6, 100, and 316 amol/microgram total RNA in MOLT-3/TMQ70, MOLT-3/ TMQ800, and MOLT-3/VCR1,000, respectively. The relative ratio of MDR1 mRNA measured by the competitive RT-PCR among three sublines was similar to that of MDR1 transcript determined by Northern analysis (1:4:12) and to that of P-gp measured by flow cytometry (FCM) analysis. In mononuclear cells from patients with leukemia, MDR1 mRNA could be sufficiently quantified by the competitive RT-PCR established, while FCM assay could scarcely detet P-gp. This study demonstrated that the competitive RT-PCR assay using heterologous competitor RNA is a rapid, reliable, and non-radioactive procedure and is acceptable for the evaluation of MDR1 expression in clinical samples.

A cross-sectional study on the relationship between depression and left ventricular hypertrophy

BACKGROUND

Despite a large number of studies, the relationship between depression and cardiovascular disease remains ambiguous. This study is the first to investigate the relationship between depression and left ventricular hypertrophy (LVH) as detected by electrocardiogram.

METHODS

The subjects were 346 male Japan Self-Defense Forces personnel ages 49 to 55 years. LVH was assessed by electrocardiogram. Depression was measured by the Self-Rating Depression Scale (SDS). Other selected risk factors were measured. Odds ratios for LVH in relation to selected variables were calculated. A logistic regression analysis was used to adjust for possible confounding variables.

RESULTS

High level of depression (SDS score > or = 34) showed a high risk of LVH occurrence. After adjusting for BMI, systolic blood pressure, and/or diastolic blood pressure, there was a tendency toward a positive association of LVH with high level of depression.

CONCLUSIONS

Our present study demonstrated that depression is closely related to LVH. Since LVH could be a predictor of fatal cardiovascular disease, this is of direct relevance to the prescription of preventive measures.

Epidemiologic study of the relationship between schistosomiasis due to Schistosoma japonicum and liver cancer/cirrhosis

In Yamanashi Prefecture, one of the former areas in Japan endemic for Schistosoma japonicum, there have been no cases of schistosomiasis since 1978. We attempted to find out in this study whether there was still a chronic effect of schistosomiasis, e.g., liver cancer or liver cirrhosis present in this region. The subjects studied were the population in Yamanashi Prefecture from 1973 through 1992. We divided the population into residents in an area endemic for schistosomiasis and those in a nonendemic area. We calculated the standardized mortality ratios (SMRs) for liver cancer and liver cirrhosis in both areas. The schistosome egg-positive rate of liver cancer and liver cirrhosis specimens from the patients in these two endemic areas was also calculated. Male SMRs for liver cancer in the endemic area were 188.5% in 1985 and 188.0% in 1990. Even today, many years after the last case of schistosomiasis, schistosome eggs can be found in the livers of deceased liver cancer and cirrhosis patients. The chronic effect of S. japonicum could contribute to the current high mortality rate for liver cancer in the endemic area, although we need to consider the other etiologic factors of liver cancer, e.g., hepatitis B virus, hepatitis C virus, and alcohol intake.

[Mechanisms of multidrug resistance in tumor cells and analytical methods for its detection]

We reviewed mechanisms of multidrug resistance (MDR) phenotype in tumor cells and evaluated analytical methods for detection of clinical MDR. A well-recognized mechanism of MDR phenotype is the induction and increased expression of P-glycoprotein (P-gp) which is a 170 kDa cellular transmembrane protein encoded by a multidrug-resistance 1 gene (MDR1) and works as a drug efflux pump. Cellular MDR phenotype through P-gp/MDR1 can be detectable at protein level by: (1) using immunohistochemical method, flow cytometric assay and Western blot analysis with monoclonal antibodies against human P-gp, and (2) measuring Rhodamine 123 dye-efflux as a functional assay of P-gp. Molecular knowledge and recent technical progress enable to determine MDR1 gene expression by RT-PCR-based analytical methods as well as conventional quantification methods of gene expression such as Northern blot analysis. In the evaluation of P-gp/MDR1 expression in clinical samples, in which amount of materials was limited, utilization of simple and sensitive methods like competitive RT-PCR assay might be efficacious for its quantitative detection in clinical laboratories. Evidences which showed the positive correlation between the expression of P-gp/MDR1 and clinical resistance or refractoriness of tumor cells to anticancer drugs involved in MDR have been accumulated and support the clinical importance of its detection to circumvent resistance with alternate use of non-MDR drugs.

Power spectral analysis of variations in heart rate in patients with hyperthyroidism or hypothyroidism

Power spectral analysis (PSA) of the variation in heart rate is useful in determining the relative activity of the sympathetic and parasympathetic nerves. In this study, PSA was used to investigate the relationship between abnormalities in autonomic nerve function and the presence of thyroid disorders in patients with autoimmune thyroid diseases. The low frequency (LF) or high frequency (HF) components of R-R variations were determined by PSA. The coefficient of variation of the R-R time intervals (CV(R-R)) was positively correlated with HF in healthy subjects. In untreated hyperthyroid patients with Graves' disease, the CV(R-R) and HF values were significantly lower than in healthy controls. Moreover, the LF/HF ratio in patients with untreated Graves' disease was significantly higher, and the LF/HF ratio in hypothyroid patients with Hashimoto's thyroiditis was significantly lower than in healthy controls. A negative correlation was observed between serum levels of free thyroid hormones (FT4 and FT3) and HF in Graves' disease patients. In some hyperthyroid patients, antithyroid drug therapy or beta-blocker administration gradually restored reduced HF values. Present results suggest that relative vagal nerve activity is reduced in hyperthyroid patients and that this reduction is reversible according to the decrease in serum levels of thyroid hormones.

Molecular characterization of human acute leukemia cell line resistant to ZD9331, a non-polyglutamatable thymidylate synthase inhibitor

ZD9331 is a non-polyglutamatable, potent quinazoline antifolate inhibitor of thymidylate synthase (TS). In an effort to clarify the exact mechanism of resistance to this novel TS inhibitor, we examined the molecular alterations in its target enzyme TS, the transport protein (reduced folate carrier, RFC), and folylpolyglutamate synthetase (FPGS) in a human acute lymphoblastic leukemia cell line, MOLT-3, made resistant to ZD9331. A 310-fold resistant subline was established after 6 months exposure to the drug at concentrations up to 7 microM, and was designated MOLT-3/ ZD9331. MOLT-3/ZD9331 showed crossresistance to CB3717 (4.8-fold), raltitrexed (63-fold) and methotrexate (MTX) (120-fold), but retained sensitivity to trimetrexate (0.88-fold). The resistant cells demonstrated impaired initial cellular uptake and low accumulation of [3H]MTX in accordance with a decreased expression of RFC1, suggesting the downregulation of RFC. However, Southern blot analysis demonstrated no change in gene copy number nor gross rearrangement of RFC1 in the resistant cells. In addition, MOLT-3/ZD9331 showed amplification of the TS gene with a concomitantly increased level in the gene expression. In contrast, the expression of FPGS did not alter. These results demonstrate that continuous exposure of the cells to ZD9331 leads not only to a decreased expression of RFC1 but also to TS gene amplification and overexpression. The resistant mechanisms are likely to be regulated both at a genetic and a transcriptional level for different resistance phenotypes in the ZD9331-resistant MOLT-3 cells.

Power spectral analysis of heart rate variation in diabetic patients with neuropathic foot ulceration

OBJECTIVE

To evaluate the relationship between diabetic autonomic neuropathy and diabetic neuropathic foot ulceration, we used power spectral analysis (PSA) of heart rate variation, which provides the accurate simultaneous quantification of parasympathetic and sympathetic activities, to assess autonomic function in diabetic patients.

RESEARCH DESIGN AND METHODS

We studied 55 NIDDM patients including 10 diabetic patients without neuropathy, 23 diabetic patients with neuropathy and no history of foot ulceration, and 22 diabetic patients with neuropathic foot ulceration. We performed PSA of 100 R-R intervals at rest and analyzed the results by fast Fourier transformation.

RESULTS

The low frequency (LF) power, which reflects sympathetic activity, and the high frequency (HF) power, which reflects parasympathetic (vagal) activity, were inversely correlated with the duration of diabetes and the fasting plasma glucose (FPG) levels. By multiple regression analysis, the FPG remained with significant influence on both LF and HF powers. The LF and HF powers were positively correlated with motor nerve conduction velocity (MCV) and sensory nerve conduction velocity (SCV) in the upper and lower limbs and the coefficient of variation of R-R intervals. The LF and HF powers were significantly reduced in patients with neuropathy and patients with foot ulceration compared with patients without neuropathy. Although the median MCV and SCV were similar between diabetic patients with neuropathy and patients with foot ulceration, both the LF and HF powers were significantly decreased in patients with foot ulceration compared with patients with neuropathy. There was no difference in the value of the LF:HF ratio, an index of sympathovagal balance, among three subgroups. We observed a positive correlation between LF and HF power in all subjects; however, the LF and HF powers were not correlated in the subgroups of patients with foot ulceration.

CONCLUSIONS

These results showed that diabetic patients with neuropathic foot ulceration have a greater impairment in spectral indexes of autonomic activity obtained by PSA than patients with neuropathy and no history of foot ulceration, whereas no difference was present in nerve conduction velocities.

Vincristine saturation of cellular binding sites and its cytotoxic activity in human lymphoblastic leukemia cells: mechanism of inoculum effect

Vincristine (VCR) is an active agent in the treatment of acute lymphoblastic leukemia (ALL). We evaluated the relationship between the cytotoxic activity of VCR and the degree of VCR saturation of cellular drug binding sites, using the MOLT-3 ALL cell line. When MOLT-3 cells at a density of 1 x 10(6) or 1 x 10(8) cells/mL of pH-controlled medium were exposed to VCR for 1 hr, its cytotoxic activity on cells at high density was 10-fold less than on cells at low density (inoculum effect). The number of VCR binding sites measured by Scatchard analysis was 9.25 x 10(6)/cell. At high cell density, the saturation of VCR binding sites was one log order less than that at low density. Irrespective of cell density, curves of cell-kill versus the degree of VCR saturation of the cellular binding sites overlapped each other. Minimal cytotoxic activity was observed at 0.3% VCR saturation, and nearly maximal cytotoxic activity occurred at about 25% saturation, with the Ic50 at about 4% saturation. These data show that the VCR-induced cell-kill effect is dependent on the degree of saturation of VCR binding sites rather than on the extracellular VCR concentration. The lesser cell-kill on cells at high density can be explained by the lack of drug molecules to sufficiently saturate cellular binding sites. This phenomenon may be responsible, at least in part, for the poor chemotherapeutic outcome of ALL patients with high leukocyte counts at presentation.

[Quantitative analysis of multidrug resistance phenotype in hematological malignancies]

Cells with multidrug resistance (MDR) phenotype express P-glycoprotein (P-gp) on the cell membrane, which functions as a drug-efflux pump. To quantify the expression of the gene encoding P-gp (multidrug resistance 1; MDR1) and assess P-gp function, we developed competitive reverse transcription-polymerase chain reaction (RT-PCR) assay using heterologous competitor RNA and flow cytometric analysis using rhodamine 123 (Rh123; an artificial substrate for P-gp), respectively. First, we adjusted the assays by analyzing leukemia sublines showing various levels of MDR1 expression. The MDR1 expression in leukemia sublines quantified by competitive RT-PCR assay showed linearity over a wide range, and the results were parallel with those of MDR1 expression measured by Northern blot analysis, the P-gp antigen expression measured by flow cytometric analysis using MRK16, P-gp function analysis by Rh123 dye-efflux assay, and MDR phenotype. Then, we applied these assays to leukemic cells from patients with hematological malignancies. All 69 samples from 64 patients were successfully assayed, and the range of MDR1 expression was from 1.6 to 100 amol/microgram RNA. Since subpopulations of normal lymphocytes show a low degree of P-gp function, strict gating of leukemia cells was mandatory for dye-efflux assay of clinical samples. MDR1 expression in normal lymphocytes was below 8 amol/microgram RNA. By comparison to MDR1 expression quantified by competitive RT-PCR assay with P-gp function assessed by Rh123 dye-efflux assay in gated leukemic cells, more than 8 amol/microgram RNA was regarded as positive MDR1 expression in the leukemic cells themselves. These data suggest that these assays are suitable for evaluating P-gp expression and function in clinical samples when the proper cut-off value is used and may provide insights into the contribution of P-gp to drug resistance in hematological malignancies.

Mechanisms of elevation of serum and urinary concentrations of soluble thrombomodulin in diabetic patients: possible application as a marker for vascular endothelial injury

Serum and urinary levels of soluble thrombomodulin (TM) were measured in 71 patients with non-insulin-dependent diabetes mellitus (NIDDM) and 132 age-matched control subjects to elucidate the mechanisms involved in increased TM levels. We compared the TM level with urinary albumin excretion (UAE), creatinine (Cr) clearance, and indices of renal tubular damage such as urinary beta2-microglobulin. Serum TM was significantly higher in diabetic patients versus control subjects (P < .001) regardless of whether the patients had diabetic nephropathy. Urinary TM levels were also higher in diabetic patients than in control subjects (P < .001). Serum TM in diabetic patients was correlated positively with serum Cr and UAE and inversely with the Cr clearance rate (P < .001, respectively). The urinary level of TM in diabetic patients was significantly correlated with 24-hour glucose excretion and the serum level of 1,5-anhydroglucitol (1,5-AG) (P < .001). However, no correlations were found between urinary TM levels and renal function in diabetic patients. There was also no correlation between serum and urinary levels of TM in the patients. These results suggest that although the serum TM level is influenced by an impairment of the renal clearance of TM, this parameter may be a useful marker for vascular endothelial injury in diabetic patients. On the other hand, since the elevated urinary level of TM in the patients paralleled their urinary excretion of glucose, urinary TM levels do not correlate with vascular endothelial injury in diabetic patients.

Variable expression of RFC1 in human leukemia cell lines resistant to antifolates

The resistance to folate-based antifolates is associated with impaired function of the reduced folate carrier (RFC), one of the major routes of folate transport into cancer cells. To clarify the importance of RFC functions in the antifolate resistance, we have examined the expression of RFC1 and its phenotype as a folate transporter in human leukemia cell lines resistant to various antifolates. MOLT-3 cells resistant to ZD9331 (a thymidylate synthase (TS) inhibitor that utilizes the RFC for cell entry) (MOLT-3/ZD9331) showed decreased expression of RFC1 concomitant with diminished cellular uptake of [3H]methotrexate (MTX). K562 cells resistant to raltitrexed (ZD1694, another TS inhibitor that utilizes the RFC for cell entry) (K562/ ZD1694 x C) scarcely expressed RFC1, which is in accordance with the impaired uptake of folate analogs and the high degree of resistance to ZD1694 and MTX. On the other hand, no apparent decrease of RFCI1 expression was found in transport-deficient MTX-resistant MOLT-3 cells (MOLT-3/MTX10000) though its phenotype showed defective transport of MTX or ZD1694. In these cell lines with impaired RFC function, [3H]leucovorin (LV) uptake was only moderately decreased as compared to [3H]MTX or [3H]ZD1694 uptake. These cells grew with a minimal retardation in folate-free medium supplemented with 10 nM LV, suggesting that these cell lines with impaired RFC function had enough folate transporters to transport LV. In contrast to downregulation of RFC, the much greater uptake of [3H]MTX was observed in the MOLT-3/trimetrexate (TMQ)800-MTX10000 in parallel with increased RFC1 expression. These cell lines with the altered expression of RFC1 may serve as models useful for investigating the regulation of RFC1 expression and for understanding the molecular mechanism(s) behind the transport-mediated antifolate resistance.

Clinical characteristics of patients with the initial diagnosis of NIDDM with positivity for antibodies to glutamic acid decarboxylase

The measurement of islet cell antibodies (ICA) and antibodies to glutamic acid decarboxylase (GAD-Ab) is clinically useful in evaluating patients with insulin-dependent diabetes mellitus (IDDM). Our objective was to correlate the clinical characteristics of patients with non-insulin-dependent diabetes mellitus (NIDDM) who exhibited positivity for GAD-Ab vs. patients who were negative for this enzyme. The serum level of GAD-Ab was measured by radiobinding assay (RBA) using pig brain GAD. The prevalence of GAD-Ab in the 181 patients was low; the 8 involved subjects (4.4%) were all females. The NIDDM patients who were GAD-Ab-positive were significantly younger, experienced diabetes onset at an early age, had a shorter duration of diabetes, a shorter interval between diabetes onset to initiation of insulin therapy, a lower body mass index (BMI), a lower serum C-peptide value, and required a higher dose of insulin. A higher proportion of the GAD-Ab-positive patients was receiving insulin therapy.

CONCLUSIONS

Clinical characteristics of patients with NIDDM who were positive for GAD-Ab differed significantly from those of the patients negative for GAD-Ab. The profile of the GAD-Ab-positive patients with NIDDM resembled that of those with IDDM.

Cellular and molecular mechanisms of resistance to antifolate drugs: new analogues and approaches to overcome the resistance

A number of antifolate drugs, which inhibit the key enzymes in the 'thymidylate cycle', dihydrofolate reductase (DHFR) and thymidylate synthase (TS), have been developed as part of the search for analogues with superior antitumor efficacy to a 'classical' antifolate, methotrexate (MTX), and those which are active against the MTX-resistant tumor cells. Recent development of newer classes of antifolate drugs is based on the extensive understanding of the relationship between chemical structures and biological properties and of analogue interactions with target enzymes, transport proteins and folate metabolizing enzyme, folylpolyglutamate synthetase (FPGS). Tumor cells may develop resistance to an antifolate drug by virtue of, (1) amplified activity in its target enzyme, (2) impaired function of drug transport protein, e.g. reduced folate carrier (RFC), (3) induction of mutated target enzyme with low affinity for antifolate(s), and (4) defective polyglutamation of drug(s) in the cells. Recent studies have elucidated in part the molecular events involved in the resistance to antifolates. These include amplification and/or mutation of the gene encoding a target enzyme, reduced or altered gene expression of the RFC, and mutated expression of the FPGS gene. To overcome or circumvent the resistance mechanisms, new antifolates with diverse structures and different biological properties have been designed and developed for clinical use. Trimetrexate (TMQ), a lipophilic DHFR inhibitor which is not a substrate for RFC and FPGS, could overcome the MTX-resistance through impaired RFC and diminished polyglutamation, and partially through amplified DHFR. Selective inhibitors of TS with a folate structure such as raltitrexed could circumvent the resistance by virtue of DHFR overproduction, and this class of compounds which have higher substrate activities for FPGS than MTX may be of value for the treatment of myeloid leukemias in addition to lymphocytic malignancies resistant to conventional chemotherapy. Several strategies to overcome antifolate resistance by using gene therapy are currently under investigation.

Activation of protein kinase C by tyrosine phosphorylation in response to H2O2

Protein kinase C (PKC) isoforms, alpha, betaI, and gamma of cPKC subgroup, delta and epsilon of nPKC subgroup, and zeta of aPKC subgroup, were tyrosine phosphorylated in COS-7 cells in response to H2O2. These isoforms isolated from the H2O2-treated cells showed enhanced enzyme activity to various extents. The enzymes, PKC alpha and delta, recovered from the cells were independent of lipid cofactors for their catalytic activity. Analysis of mutated molecules of PKC delta showed that tyrosine residues, which are conserved in the catalytic domain of the PKC family, are critical for PKC activation induced by H2O2. These results suggest that PKC isoforms can be activated through tyrosine phosphorylation in a manner unrelated to receptor-coupled hydrolysis of inositol phospholipids.

Alterations in serum levels of 1 alpha,25(OH)2 D3 and osteocalcin in patients with early diabetic nephropathy

Serum levels of markers for bone remodeling and diabetic metabolic markers were measured in subjects with non-insulin-dependent diabetes mellitus (NIDDM) to investigate the relationship between early diabetic nephropathy and calcium/bone metabolism. 1 alpha,25(OH)2 D3 (Vit D), osteocalcin (OC), intact parathyroid hormone (PTH) and urine albumin excretion (UAE) were measured in all subjects. Serum levels of Vit D and OC were significantly decreased in diabetic subjects compared to age-matched, non-diabetic controls. In diabetic patients, a significant positive correlation was observed between intact PTH and OC. No significant correlation was found between levels of Vit D and OC. In early diabetic nephropathy without increased serum creatinine, Vit D decreased and OC increased with increasing UAE. Levels of hemoglobin Alc (HbAlc) and fructosamine (FRA) were not correlated with levels of Vit D or OC. Levels of Vit D were decreased and levels of OC were increased in diabetic subjects with proliferative retinopathy or with micro- or macro-albuminuria.

CONCLUSIONS

Results of the present study indicate that changes in bone remodeling markers such as Vit D and OC levels are present in the early stages of diabetic nephropathy, and that circulating intact PTH is important in restoring the reduced OC levels in diabetic patients, probably as a reflection of bone remodeling.

[Flow cytometric analysis of P-glycoprotein function by rhodamine 123 dye-efflux assay in human leukemia cells]

Cells with multidrug resistance(MDR) phenotype express P-glycoprotein(P-gp) on cell membrane, which works as a drug-efflux pump with low selectivity. P-gp function can be determined microfluorometrically using the fluorescent dye rhodamine 123(Rh123), which is an artificial substrate for P-gp. In this study, we assessed P-gp function in human leukemia sublines of MOLT-3 with various magnitude of MDR phenotype using the Rh123-efflux assay. The MDR cells efficiently pumped out Rh123 outside cells in parallel with the magnitude of resistance to vincristine, while the parent MOLT-3 cells scarcely showed dye efflux. The P-gp function determined by the dye efflux assay was correlated with the degree of cell surface expression of P-gp measured by indirect flow cytometric analysis using MRK16 anti-P-gp antibody and with the amount of MDR1 mRNA (encoding P-gp) quantified by Northern blot analysis and by competitive reverse transcription-polymerase chain reaction (RT-PCR) assay. In the evaluation of 28 clinical samples obtained from patients with leukemias, 9 cases exhibited positive results Rh123-efflux. A good correlation of Rh123-efflux with MDR1 expression measured by competitive RT-PCR was observed in these samples. Since subpopulations of normal lymphocytes show low degree of P-gp function, the strict gating of leukemia cells was mandatory in the dye-efflux assay in clinical samples. Although leukemia cells could not be distinguished from normal lymphocytes in the conventional scattergram in some cases, additional staining of the former cells with specific monoclonal antibody such as CD34(labelled with PE-Cy5, a dye without interference with Rh123 fluorescence emission) enabled a selective analysis of a particular subpopulation. The Rh123 dye-efflux assay is a simple and sensitive method for the determination of P-gp expression and its function, and is particularly suitable for the analyses in the clinical laboratory.

Cytotoxicity of trimetrexate against antifolate-resistant human T-cell leukemia cell lines developed in oxidized or reduced folate

Cytotoxicity of trimetrexate (TMQ), a lipophilic dihydrofolate reductase inhibitor, was examined in antifolate-resistant human T-cell leukemia cell lines developed in oxidized or reduced folate. An approximately 60-fold methotrexate (MTX)-resistant subline was developed in oxidized folate (pteroylglutamic acid: PGA) (CCRF-CEM/MTX60-PGA) from human T-cell leukemia cell line CCRF-CEM; this line exhibited impaired membrane transport of the drug. Further enhancement of MTX resistance resulted in selection of an approximately 5000-fold MTX-resistant subline (CCRF-CEM/ MTX5000-PGA), which showed increased dihydrofolate reductase activity due to gene amplification in addition to further impairment of MTX transport. An approximately 140-fold MTX-resistant subline, and then a 1500-fold MTX-resistant subline were developed in reduced folate (10 nM leucovorin) (CCRF-CEM/MTX140-LV and CCRF-CEM/MTX1500-LV); they exhibited increased dihydrofolate reductase due to gene amplification accompanied by increased intracellular drug accumulation of MTX. While CCRF-CEM/MTX140-LV and CCRF-CEM/MTX1500-LV cells showed cross-resistance to TMQ, CCRF-CEM/MTX60-PGA and CCRF-CEM/MTX5000-PGA cells were at least as sensitive to TMQ as the parent cells. TMQ was more potent against approximately 200-fold N10-propargyl-5,8-dideazafolic-acid (CB3717)-resistant human T-cell leukemia MOLT-3 sublines developed in PGA (MOLT-3/CB3717(200)-PGA) or leucovorin (MOLT-3/CB3717(200)-LV), as compared to the parent cells; MOLT-3/CB3717(200)-PGA and MOLT-3/CB3717(200)-LV cells were resistant to CB3717 by virtue of impaired transport, only the former possessing gene amplification of thymidylate synthase. The cytotoxicity of TMQ in both MOLT-3/CB3717(200)-PGA and MOLT-3/CB3717(200)-LV cells was reduced by addition of leucovorin in a dose-dependent manner, suggesting intracellular folate deficiency as a cause of TMQ sensitivity. These results demonstrate that TMQ overcomes transport-impaired antifolate resistance, irrespective of gene amplification of dihydrofolate reductase or thymidylate synthase. Types of folate used during the development of antifolate resistance seem to be important in relation to the mechanism of TMQ responsiveness as well as that of antifolate resistance.

Evaluation of skin vasomotor reflexes in response to deep inspiration in diabetic patients by laser Doppler flowmetry. A new approach to the diagnosis of diabetic peripheral autonomic neuropathy

OBJECTIVE

To evaluate the peripheral sympathetic function in feet of NIDDM patients by means of laser Doppler flowmetry.

RESEARCH DESIGN AND METHODS

After deep inspiration, we measured the vasoconstrictor response in the feet of 51 patients with NIDDM, as compared with those of 20 healthy control subjects, using laser Doppler flowmetry. Subjects whose skin temperature was < 32 degrees C were excluded from our study because a skin temperature of approximately 34 degrees C is the optimal temperature for the evaluation of skin vasomotor reflexes in response to a deep inspiration by laser Doppler flowmetry.

RESULTS

The vasoconstrictor response to deep inspiration in the big toe was significantly decreased in NIDDM patients compared with healthy subjects (26.8 +/- 2.0 vs. 48.3 +/- 18.5%, P < 0.0001). In NIDDM patients, the vasoconstrictor response was positively correlated with the duration of diabetes, the median motor and sensory nerve conduction velocities, the coefficient of variation of the R-R interval at rest, and the postural fall in systolic blood pressure. The vasoconstriction was inversely correlated with the vibratory perception threshold.

CONCLUSIONS

Vasomotor reflexes in the lower limbs were markedly impaired in NIDDM patients. The measurement of vasoconstrictor responses to deep inspiration by using laser Doppler flowmetry is a novel and useful method for detecting peripheral sympathetic failure in diabetic patients.

Activation of protein kinase B (Akt/RAC-protein kinase) by cellular stress and its association with heat shock protein Hsp27

Protein kinase B (PKB, also named as Akt or RAC-protein kinase), that is activated by cellular stress such as heat shock and hyperosmotic treatment, was revealed to be activated by oxidative stress and by chemical stressors of CdCl2 and NaAsO2 by measuring the activity of the enzyme immunoprecipitated from the transfected COS-7 cells. Upon stress treatment, a 30-kDa phosphoprotein was co-immunoprecipitated with PKB from the cells metabolic labeled with [32P]orthophosphate. The phosphoprotein was identified as Hsp27, a small heat shock protein, by immunoblot analysis and co-immunoprecipitation. The association of Hsp27 was specific to PKB as the heat shock protein was not co-immunoprecipitated with other protein kinases such as protein kinase C and PKN. When the cells were treated with H2O2, PKB was activated gradually and the association of Hsp27 with PKB increased concurrently with the enhancement of PKB activity. In heat-shocked cells, activation of PKB and the association of Hsp27 were detected immediately after the treatment, and the association of the heat shock protein decreased while PKB kept stimulated activity when the cells were further incubated at 37 degrees C. These results suggest that Hsp27 is involved in the activation process of PKB in the signal transduction pathway of various forms of stress.

Evaluation of microangiopathy of the skin in patients with non-insulin-dependent diabetes mellitus by laser Doppler flowmetry; microvasodilatory responses to beraprost sodium

To determine the relationship of skin microangiopathy and other diabetic microvascular complications, we measured changes in skin blood flow after the administration of the prostacyclin (PGI2) analogue, beraprost sodium (BPS), in 82 patients with non-insulin-dependent diabetes mellitus and 20 healthy subjects. The diabetic patients had various degrees of retinopathy and nephropathy. Using laser Doppler flowmetry we measured skin blood flow at the dorsum of the right big toe at various times after the administration of 40 micrograms BPS and calculated the blood flow change (delta flux = peak flux--basal flux). We also determined the ankle pressure index (API), an ankle/brachial systolic pressure ratio. The basal blood flow was higher in healthy subjects than in diabetic patients (P < 0.001). BPS significantly increased blood flow in both diabetic patients and healthy subjects (P < 0.001). In all 102 subjects delta flux was positively correlated with the API (R = 0.40, P < 0.001). Despite no differences in API among the diabetic retinopathy and nephropathy subgroups, the delta flux in diabetic patients with progressive retinopathy and macroalbuminuria was significantly lower than in healthy subjects or in diabetic patients with less severe retinopathy and nephropathy (P < 0.05). The results suggested that BPS increases skin blood flow and the flow increase induced by BPS is related partly to the levels of API. The effect of BPS on skin blood flow decreased with an increases in the severity of retinopathy and nephropathy. Diabetic skin microangiopathy appears to coexist with other microvascular diabetic complications and may be proportional to their severity.

[Assessment of the guidelines for efficacious utilization of laboratory tests in primary care medicine]

The Japan Society of Clinical Pathology has proposed guidelines for efficacious utilization of laboratory tests in primary care medicine. In a series of our studies, attempts were made to assess the usefulness of the "Essential laboratory tests" which are common laboratory tests to be applied for new outpatients regardless of the clinics and disease categories. We looked the individual test item again in the aspect of diagnostic efficiency for the next version of the guideline. An analysis of 1026 new outpatients in Comprehensive Medicine, National Defense Medical College, demonstrated the usefulness of the "Essential laboratory tests" not only for the establishment of more accurate initial diagnosis but also for the screening of the occult diseases unrelated to the patient's chief complaints. Another clinical study with 520 new outpatients established diagnostic efficiency of the individual test item by calculating diagnostic sensitivity, specificity and positive predictive value. There were test items such as urine urobilinogen to be taken away from the guideline because of its extremely low sensitivity, and such as random blood glucose and serum cholinesterase to be added for the screening of urine-glucose negative diabetes mellitus and possible fatty liver, respectively. There have been some controversies in the selection of inflammation markers such as erythrocyte sedimentation rate or serum sialic acid; the former revealed higher diagnostic sensitivity but had lower specificity in infectious or inflammatory diseases than the latter.

Stiff-man syndrome associated with antecedent myasthenia gravis and organ-specific autoimmunopathy

We describe a case of stiff-man syndrome accompanied by diabetes mellitus, Hashimoto's thyroiditis and the antecedent myasthenia gravis. The diagnosis of stiff-man syndrome was made based on not only clinical findings and the characteristic electromyographic pattern but also the presence of antibodies to glutamic acid decarboxylase in the serum and cerebrospinal fluid. Stiff-man syndrome is known to be associated with organ-specific autoimmunopathy including insulin-dependent diabetes mellitus. The present case is the first one that stiff-man syndrome was preceded by myasthenia gravis of organ-specific autoimmunopathy. Stiff-man syndrome in the present case probably represents the one of fully expressed manifestations from the broad spectrum of organ-specific autoimmunopathy caused by the loss of self-tolerance.