Retinal detachment associated with atopic dermatitis

BACKGROUND

Retinal detachment associated with atopic dermatitis, one of the most common forms of dermatitis in Japan, has markedly increased in Japan in the past 10 years. To clarify pathogenic mechanisms of retinal detachment in such cases, we retrospectively studied clinical characteristics of retinal detachment associated with atopic dermatitis.

METHODS

We examined the records of 80 patients (89 eyes) who had retinal detachment associated with atopic dermatitis. The patients were classified into three groups according to lens status: group A, eyes with clear lenses (40 eyes); group B, eyes with cataract (38 eyes), and group C, aphakic or pseudophakic eyes (11 eyes).

RESULTS

No significant differences were noted in the ratio of males to females, age distribution, refractive error, or characteristic of retinal detachment among the three groups. The types of retinal breaks, however, were different in eyes with and without lens changes. While atrophic holes were dominant in group A, retinal dialysis was mainly seen in groups B and C.

CONCLUSION

These findings suggested that anterior vitreoretinal traction may play an important role in the pathogenesis of retinal breaks in eyes with atopic cataract and that the same pathological process may affect the formation of cataract and tractional retinal breaks in patients with atopic dermatitis.

Predicting the need for hospital admission in patients with acute bronchial asthma

Historical data, physical findings, pulmonary function, arterial blood gases, and subjective degree of dyspnea rated on a modified Borg scale were correlated with eventual requirement of hospitalization in 83 episodes of acute asthma attacks of 70 adult patients. Among the pretreatment data, only pulse rate remained significant by a multivariate analysis to predict hospitalization. For patients who had apparently been successfully treated in the emergency room and discharged home, residual degree of subjective dyspnea was the only significant variable chosen by a linear discriminant function to predict the eventual need for hospitalization, with a sensitivity of 75% and a specificity of 78%. We concluded that careful clinical evaluation still remains the best available diagnostic tool in the care of acute asthma.

Human REG family genes are tandemly ordered in a 95-kilobase region of chromosome 2p12

Reg, first isolated from a rat regenerating islet cDNA library, is expressed in regenerating islet beta-cells. Recently, it has been revealed that Reg and Reg-related genes constitute a multigene family, the Reg family. In human, the four REG family genes, i.e., REG 1 alpha, REG 1 beta, REG-related sequence (RS) and HIP/PAP, have so far been isolated. In this study, we analyzed YAC clones containing the four genes and performed two-color FISH to determine the map order of the genes. The human REG family genes are tandemly ordered in the 95-kbp DNA region of chromosome 2p12 as follows: 2cen-HIP/PAP-RS-REG I alpha-REG I beta-ptel.

Requirement of calmodulin-dependent protein kinase II in cyclic ADP-ribose-mediated intracellular Ca2+ mobilization

Cyclic ADP-ribose (cADPR) is generated in pancreatic islets by glucose stimulation, serving as a second messenger for Ca2+ mobilization from the endoplasmic reticulum for insulin secretion (Takasawa, S., Nata, K., Yonekura, H., and Okamoto, H. (1993) Science 259, 370-373). In the present study, we observed that the addition of calmodulin (CaM) to rat islet microsomes sensitized and activated the cADPR-mediated Ca2+ release. Inhibitors for CaM-dependent protein kinase II (CaM kinase II) completely abolished the glucose-induced insulin secretion as well as the cADPR-mediated and CaM-activated Ca2+ mobilization. Western blot analysis revealed that the microsomes contain the alpha isoform of CaM kinase II but do not contain CaM. When the active 30-kDa chymotryptic fragment of CaM kinase II was added to the microsomes, fully activated cADPR-mediated Ca2+ release was observed in the absence of CaM. These results along with available evidence strongly suggest that CaM kinase II is required to phosphorylate and activate the ryanodine-like receptor, a Ca2+ channel for cADPR as an endogenous activator, for the cADPR-mediated Ca2+ release.

A common-source outbreak of fulminant hepatitis B in hemodialysis patients induced by precore mutant

From September 9 to October 3, 1994, five patients on maintenance hemodialysis in a dialysis unit in Tokyo contracted hepatitis B virus (HBV) infection successively, and four of them died of fulminant hepatitis. The unit treated 181 patients three times a week on eight shifts, and all five afflicted patients were on the same shift along with 27 other patients. HBV DNA clones from the hepatitis patients had a point mutation converting codon 28 in the precore region to a stop codon, which aborts the synthesis and secretion of hepatitis B e antigen, and showed a sequence similarity of > 99.5% within 645 base pairs covering the X gene and precore region. There were two HBV carriers with antibody to hepatitis B e antigen who were receiving hemodialysis on the same shift. HBV DNA clones from one of them had the stop codon 28 in the precore region, and a sequence similarity of > 99.7% to those from the five patients. Based on these results, it was deduced that the fulminant HBV strain was transmitted from the carrier to five patients, and resulted in the death of four. The outbreak indicates that immunocompromised hosts like hemodialysis patients can develop fulminant hepatitis B if and when they are infected with extremely virulent HBV strains.

HLA B44-restricted cytotoxic T lymphocyte responses to the peptides of HCV nucleoprotein residues 81-100 in patients with chronic hepatitis C

Human leukocyte antigen B44-restricted cytotoxic T lymphocytes (CTLs) recognize an epitope in hepatitis C virus (HCV) nucleoprotein residues 81-100. CTLs that recognize two wild-type peptides 81-100 of HCV genotypes 1b/II and 2a/III were generated from peripheral blood lymphocytes of each of three patients studied. Although CTLs that recognize a wild-type peptide 81-100 of HCV genotypes 1a/I and 2b/IV were not generated from any patient, CTLs that recognize peptide 81-100 of a rare HCV isolate of type 1a/I were generated from two patients. The results suggest that HLA B44-restricted CTLs recognize most, if not all, HCV isolates of types 1b/II and 2a/III and rare variants of type 1a/I and that the wild-type HCV isolates of genotypes 1a/I and 2b/IV may be less immunogenic for HLA B44-restricted CTLs.

A minimal and optimal cytotoxic T cell epitope within hepatitis C virus nucleoprotein

Amino acid residues 81-100 of the hepatitis C virus (HCV) nucleoprotein contain a cytotoxic T cell epitope that is recognized by cytotoxic T lymphocytes (CTLs) in association with human leukocyte antigen B44. With panels of truncated and overlapping peptides, the minimal and optimal epitope recognized by CTLs was shown to be a 9-mer peptide (residues 88-96). The peptide can stimulate effectively CTLs that are able to recognize endogenously synthesized and processed HCV nucleoprotein.

[Surgery of thoracoabdominal aortic aneurysm associated with coronary artery disease]

A 67-year-old man underwent combined surgery for thoracoabdominal aortic aneurysm and coronary artery disease. Preoperative computed tomographic scan and aortography showed a large aneurysm in diameter of 7 cm locating from lower half of the descending thoracic aorta to just above the celiac artery. Coronary arteriography revealed severe stenosis (99%) of the proximal left anterior descending artery (LAD). The patient was operated on in October 1994, via a thoracoabdominal approach by entering the thorax in the 8th intercostal space and the retroperitoneal space through a paramedian incision after division of the costal arch. An additional standard thoracotomy was performed in the 5th intercostal space, through which a left internal thoracic artery (LITA) was mobilized. After the proximal descending thoracic aorta as well as the right femoral artery was cannulated for arterial perfusion, and the main pulmonary artery as well as the right femoral vein for venous return, total cardiopulmonary bypass was established and a LITA graft was anastomosed to the LAD under cardioplegic arrest. Thereafter the aneurysm was replaced with an 18 mm dacron prosthesis while the LITA graft and coronary arteries were reperfused and cardiac beating was resumed. His postoperative course was uncomplicated. Postoperative angiography demonstrated satisfactory repair of the aorta and a fully patent LITA graft.

Molecular cloning and analysis of the cDNA for an auxin-regulated calmodulin gene

An auxin-regulated calmodulin cDNA (arCaM) were isolated by differential screening from a mung bean (Vigna radiata) cDNA library. The expression of the arCaM transcript in the etiolated mung bean hypocotyl was examined by RNA gel blot analysis. The arCaM transcript was induced depending on indole-3-acetic acid (IAA) concentrations. An increase in level of the arCaM transcript upon treatment of hypocotyl segments with 10 microM IAA was detected after 1 h and a maximum level was detected at 2 h. Induction of the arCaM transcript occurred upon treatment with 10 microM 2,4-dichlorophenoxyacetic acid (2,4-D) or naphthalene-1-acetic acid (NAA) as well as with IAA, while treatment with 10 microM p-chlorophenoxyisobutyric acid (PCIB) as an anti-auxin, prevented the induction. Ethylene did not have any effect. Other stress conditions, such as exposure to salt stress, heavy metal ions and heat shock, also had no effect on the induction. The levels of the arCaM transcript in leaves of light-grown mung bean plants treated with IAA showed steady but small increases with time.

Cloning of a cDNA encoding rat bone marrow stromal cell antigen 1 (BST-1) from the islets of Langerhans

We have isolated the rat bone marrow stromal cell antigen 1-encoding cDNA (BST-1) from a pancreatic islet cDNA library. The cDNA encodes a 319-amino-acid (aa) protein whose aa sequence shows homology with mammalian CD38 (33%), Aplysia ADP-ribosyl cyclases (33%), as well as mouse (86%) and human (72%) BST-1.

Angiotensin-converting enzyme gene polymorphism in Japanese patients with hypertrophic cardiomyopathy

To examine the contribution of the angiotensin-converting enzyme (ACE) gene to hypertrophic cardiomyopathy (HCM), we determined the ACE insertion/deletion (I/D) polymorphism in 80 patients with HCM and 88 of their unaffected siblings and children. Patients were divided into familial or solitary HCM (FHCM or SHCM) groups with or without affected family members. Genotypes were identified by the polymerase chain reaction (PCR) with oligonucleotide primers flanking the polymorphic region in intron 16 of the ACE gene to amplify template DNA prepared from peripheral leukocytes. D-allele frequencies were 0.38 in all subjects, 0.42 in patients with HCM, and 0.35 in relatives (p < 0.05). The probability ratios were 1.98, 1.46, and 2.97 in patients with HCM, FHCM, and SHCM, respectively. The D allele frequency was higher in SHCM than in FHCM (p < 0.05). The findings suggest that HCM, especially in solitary cases, is partially determined by genetic disposition. Findings imply that the ACE D allele is one of the genetic contributing factors associated with cardiac hypertrophy in HCM.

Expression of renin and angiotensin-converting enzyme in human hearts

To understand the significance of the tissue renin-angiotensin system in the heart, we examined the expression of renin and angiotensin-converting enzyme (ACE) in autopsied human hearts. Samples were taken from organs obtained at autopsy from 15 patients without heart disease and 3 patients with heart disease (old myocardial infarctions, acute myocardial infarctions, and hypertrophic cardiomyopathy). We examined the expression of renin and ACE mRNA by using the reverse transcription-polymerase chain reaction (RT-PCR). RT-PCR showed the expression of renin in the right atria in all patients. However, expression of renin mRNA in the left ventricles was not found in any of the 15 hearts without heart disease. In contrast, renin mRNA was detected in the left ventricles in hearts with heart disease. ACE mRNA was detected in both the atria and the ventricles in normal hearts, and its expression did not alter in diseased hearts. These findings suggest that renin mRNA is expressed mainly in the right atria in normal hearts, but that its expression in the left ventricle can be activated in some pathological conditions.

[Removal of infected transvenous electrodes associated with giant vegetations under cardiopulmonary bypass]

A 69-year-old man was admitted because of endocarditis with septicemia following recurrent fever of one year duration. The patient had underwent implantation of DDD pacemaker for complete A-V block 2 years ago. Preoperative echocardiogram demonstrated giant vegetations around the intraatrial and intraventricular electrodes, however no pathogenic organisms were detected by serial blood cultures. Total pacemaker system including infected endocardial electrodes were removed under cardiopulmonary bypass successfully, and new epicardial electrodes were implanted at the same time. The patient was recovered uneventfully.

Detection of the GBV-C hepatitis virus genome in serum from patients with fulminant hepatitis of unknown aetiology

Hepatitis viruses A, B, C, D, and E have not accounted for all cases of hepatitis, hence "non A-E" agent(s) might be implicated. A set of new viruses (GBV-A, -B, and -C) whose genomes have been sequenced, are being investigated as possible causes of non A-E hepatitis. We investigated six cases of fulminant hepatitis of unknown aetiology for the presence of GBV-C genome in their serum, and three showed positive signals by semi-nested PCR using primers derived from the NS3/helicase region. Nucleotide sequence analyses confirmed these signals to be derived from a GBV-C sequence. The results suggest the importance of GBV-C in the aetiology of fulminant hepatitis.

Nicotinamide inhibits IRF-1 mRNA induction and prevents IL-1 beta-induced nitric oxide synthase expression in pancreatic beta cells

Nitric oxide produced by inducible nitric oxide synthase in islets exerts inhibitory and cytotoxic effects on pancreatic beta cells and is therefore thought to be a potent mediator in the pathogenesis of Type I diabetes mellitus. Here, using isolated rat pancreatic islets, we show that high-concentration nicotinamide (20 mM), but not low-concentration nicotinamide (5 mM), attenuates the interleukin-1 beta-evoked inhibition of glucose-induced insulin secretion by preventing the induction of interferon regulatory factor-1, a transcriptional factor which plays an essential role in inducible nitric oxide synthase gene expression, and the interleukin-1 beta-induced nitric oxide formation. High-concentration nicotinamide also restored an interleukin-1 beta-induced decrease in ATP content in pancreatic beta cells, suggesting that interleukin-1 beta-induced nitric oxide inhibits the mitochondrial function. The present results show the molecular basis of the preventive effect of high-dose nicotinamide on Type I diabetes mellitus.

An improved method for large-scale purification of recombinant human glucagon

Glucagon was expressed in Escherichia coli as a fusion protein including the glucagon sequence [Ishizaki et al. (1992), Appl. Microbiol. Biotechnol. 36, 483-486]. The high-level expression of a protein in E. coli often results in an insoluble aggregate called an inclusion body containing a fusion protein. In our previous report [Yoshikawa et al. (1992), J. Protein Chem. 11, 517-525], we solubilized this inclusion body by using guanidinium chloride. However, the existence of denaturant caused problems such as a low proteolytic activity for transforming the fusion protein into glucagon and complicated purification methods. We tried to improve the method to enable large-scale purification. At alkaline pH, the inclusion body could be solubilized to a high concentration and cleaved by amino acid-specific endopeptidases. By utilizing isoelectric precipitations as a new economical purification method for glucagon from intermediates, the glucagon obtained was shown to be over 99.5% pure by analytical RP-HPLC. The yield was almost equal that of our previous method, and the glucagon produced was chemically and biochemically equivalent to natural glucagon.

Atopic retinal detachment. Report of four cases and a review of the literature

Ocular complications of atopic dermatitis include cataract, blepharitis, keratoconjunctivitis, keratoconus, iritis and retinal detachment. The aim of this study was to evaluate the characteristics of retinal detachment in atopic dermatitis patients. We examined four patients with atopic dermatitis and retinal detachment, and performed an extensive review of the literature. There have been about 130 reported cases of retinal detachment in patients with atopic dermatitis from Japan, in comparison with only a few reports from Europe and the U.S.A. An extensive review of the literature revealed that retinal detachment occurs at a young age in atopic dermatitis patients, and that often both eyes are involved. As retinal detachment is not a rare complication of atopic dermatitis, we propose that this type of retinal detachment is designated 'atopic retinal detachment'. Dermatologists should be aware of this potential complication of atopic dermatitis.

ADP-ribosylation in adrenal glands: purification and characterization of mono-ADP-ribosyltransferases and ADP-ribosylhydrolase affecting cytoskeletal actin

Mono-ADP-ribosylation in mammals is poorly understood. In this study, we purified four mono-ADP-ribosyltransferases and one ADP-ribosylhydrolase from rat adrenal medulla. The four purified mono-ADP-ribosyltransferases had molecular weights of 69,000 by gel filtration, pH optima of 8.0, and Kms for their action on NAD of about 20 microM. The four enzymes ADP-ribosylated to the alpha-subunit of heteromeric GTP-binding proteins. After tryptic digestion of alkylated actin mono-ADP-ribosylated by the purified mono-ADP-ribosyltransferases or botulinum C2 toxin, the two radioactive peptide patterns were identical. The purified ADP-ribosylhydrolase with mono-ADP-ribosylated actin as the substrate had a molecular weight of 61,000 on gel filtration, a pH optimum of 7.5, and a Km for mono-ADP-ribosylated actin of about 7 microM. The enzyme released ADP-ribose from ADP-ribosylated actin and the alpha-subunit of hetromeric GTP-binding proteins. Actin monomers mono-ADP-ribosylated by the four mono-ADP-ribosyltransferases did not form actin filaments after the addition of Mg2+. After release of ADP-ribose by ADP-ribosylhydrolase, actin filaments formed on the addition of Mg2+, suggesting that the polymerization and depolymerization of cytoplasmic actin the adrenal chromaffin cells may be regulated by mono-ADP-ribosylation.

The effect of ultrasonic irrigation before and after citric acid treatment on collagen fibril exposure: an in vitro SEM study

The surface characteristics of periodontally diseased human teeth after two treatments were compared both before and after partial demineralization with citric acid. Thirteen teeth were obtained from patients with advanced periodontal disease. Three teeth were selected for control groups and 10 were used for experimental groups. All diseased root surfaces were identified and outlined. The roots were cut longitudinally into two sections. They were then scaled and root planed and the paired sections were separately classified into two control or two experimental groups. Three sections in control group 1 were rinsed by syringe with saline solution. The three sections in control group 2 were treated with ultrasonic irrigation. The 10 sections in experimental group 1 were rinsed by syringe with saline solution before and after citric acid application; the 10 sections in experimental group 2 were irrigated ultrasonically before and after citric acid application. The concentration of the citric acid was 25% (pH 1.62) and the immersion time was 3 minutes. The root samples were examined by scanning electron microscope. A significant amount of grinding debris covered on all the root surfaces in control group 1, whereas smear was removed in control group 2. The features of root surfaces of the two experimental groups differed considerably. All specimens in experimental group 2 exhibited collagen fibrils exposed as a consequence of citric acid etching. On the other hand, the smear layer was not thoroughly removed from the root surface in experimental group 1, which meant that few collagen fibrils were exposed after partial demineralization. From these results, ultrasonic irrigation before and after citric acid application improves exposure of collagen fibrils, which may be desirable for clinical success in periodontal regenerative therapy.

Biodegradation of glutaraldehyde-tanned human umbilical vein grafts

A retrospective analysis of the long-term behavior of 111 glutaraldehyde-tanned human umbilical vein (HUV) grafts implanted between September 1977 and December 1993 was conducted. A total of 81 patients, with a mean age of 68.7 years, received the grafts and were followed up for between 1 and 131 months. The 5-year primary cumulative patency rate for above-knee femoropopliteal bypass was 83.1%, whereas that of other bypasses was 60.9%. An aneurysm of the graft was defined as a physically apparent localized dilatation, with diffuse ectasia being excluded. There were 11 aneurysms found in 9 grafts, 2 of which arose at the factory-made suture lines. The accumulated incidence of aneurysms had reached 21.9% by the 6th year. One aneurysm compressed the graft and resulted in limb-threatening ischemia and another resulted in frank rupture. Moreover, reinforcement of the mesh could not prevent aneurysm development, the repair of which is mandatory due to the risk of rupture and acute thrombosis. The HUV grafts showed an acceptable patency rate in the above-knee location, but the incidence of aneurysm formation after 5 years was abnormally high. Thus, both the risks and benefits of HUV grafts must be taken into account when considering their clinical application.

Molecular heterogeneity among primary motoneurons and within myotomes revealed by the differential mRNA expression of novel islet-1 homologs in embryonic zebrafish

Zebrafish embryos have three or four identifiable primary motoneurons per hemisegment. We previously reported that, while several ventral cells initially express the zebrafish Islet-1 (Isl-1) gene, a member of the LIM/homeobox gene family, the expression of this gene becomes restricted to a single or a pair of cells slightly anterior to each segment border by 16 hr after fertilization. Double staining by in situ hybridization and immunohistochemistry strongly suggested that these cells were mainly rostral primary motoneurons. Here, we have isolated two novel zebrafish cDNA clones for more Isl-1 family genes, termed zfIsl-2 and zfIsl-3. zfIsl-2 mRNA starts to be expressed in the ventral midsegmental cells per hemisegment around 15 hr. Double labeling experiments have shown that these midsegmental cells are the caudal primary motoneuron (CaP) and its variant equivalence pair. Our results revealed the heterogeneity in the expressed genes among primary motoneurons before the fates of the primary motoneurons are irreversibly determined, and further suggest the involvement of the Isl-1 and zfIsl-2 genes in the determination of cellular identities by primary motoneurons in embryonic zebrafish. zfIsl-3 mRNA is not expressed in motoneurons but is expressed at 17 hr, mainly in the ventral myotomes. This suggests that zfIsl-3 may be involved in the regional specification of the myotome and also in target recognition by CaP. zfIsl-2 is also expressed throughout the developing eye and tectal region of the midbrain, the target for the retinal axons. In the ventral spinal cord of the spadetail mutant embryo, which has defects in the somites, the cells expressing zfIsl-2 mRNA significantly decreased in number in contrast to the increase in cells expressing Isl-1 mRNA, suggesting the influence of the somites on the expression of both genes.

A case of autoimmune bullous dermatosis with features of pemphigus vulgaris and bullous pemphigoid

Pleomorphic blisters, including tense bullae and annularly arranged vesicles around the erythema as well as erosive eruptions in the oral cavity, appeared on a 61-year-old woman 5 years after surgery for cholangiocellular carcinoma. A biopsy specimen from the oral cavity showed intraepidermal blisters, and those from skin lesions showed subepidermal blisters with infiltrates of eosinophils and neutrophils. The early-stage vesicles showed infiltrates along the epidermal-dermal junction, where electron microscopy disclosed disruption of the lamina densa, basal cells remaining on the dermis, and acantholytic keratinocytes among the infiltrates, but there was no cleavage of the epidermal-dermal junction at the lamina lucida. Direct immunofluorescence studies showed immune deposition at the intercellular space (ICS) and along the basement membrane zone (BMZ). Indirect immunofluorescence studies confirmed coexistence of IgG class anti-ICS and anti-BMZ antibodies. Although this case showed immunohistochemical features of bullous pemphigoid, the presence of suprabasal cleavage in the oral mucosa, acantholytic cells in the blister cavity, the deposition of IgG at the ICS of the perilesional epidermis, and circulating anti-ICS antibodies strongly suggested that this case was primarily pemphigus. The strong inflammation along the epidermal-dermal junction due to unknown factors may have modified the clinical appearance and the histopathology.

Measurement of serum PSP/reg-protein concentration in various diseases with a newly developed enzyme-linked immunosorbent assay

An enzyme-linked immunosorbent assay, based on two monoclonal antibodies (Hreg1-1 and Hreg101-1) specific for pancreatic stone protein (PSP)/reg-protein, was developed to determine the concentration of this protein in serum from individuals with various diseases. The serum concentration of PSP/reg-protein was significantly higher in patients with various pancreatic diseases than in normal controls, and was also significantly higher in patients with acute pancreatitis or chronic relapsing pancreatitis than in patients with chronic pancreatitis. Furthermore, the serum PSP/reg-protein concentration was also significantly increased in liver cirrhosis, choledocholithiasis, and various cancers of the digestive system, and was extremely high in all patients tested with chronic renal failure. A significant correlation was apparent between the serum concentration of PSP/reg-protein and elastase-I in 68 patients with chronic pancreatitis or pancreatic cancer. Whereas only 7 of these patients showed a normal serum PSP/reg-protein concentration and a significantly increased elastase-I concentration, 15 of these patients showed a significantly increased serum PSP/reg-protein concentration and a normal serum elastase-I concentration. These results indicate that the serum PSP/reg-protein concentration may reflect pancreatic damage, especially in acute pancreatitis, and may be a sensitive a marker for such damage as elastase-1, although false positivity was apparent in renal failure and in some patients with hepatic dysfunction or digestive system malignancies.