[Prognosis of incidental (stage A) prostatic cancer]

Incidentally discovered prostatic cancer can pursue a benign clinical course or it can rapidly progress. For the purpose of this study, we summarized pathological and clinical results of 107 (5.3%) stage A prostatic cancer patients in 2008 transurethral resection of the prostate for clinically diagnosed benign prostatic hyperplasia. For each patient, 3.9 slides, 13.6 tissue chips per slide and 52.5 tissue chips per patient (from 16 to 140 chips) were examined microscopically. The survival rates of patient with well, moderately and poorly differentiated groups were 62, 37 and 12% at 10 years, and those with Gleason score 2 to 4, 5 to 7 and 8 to 10 group were 63, 42 and 0% respectively. The survival rates in stage A1 (well differentiated or Gleason score 4 or less in less than 5% of the tissue removed during transurethral resection of the prostate) and stage A2 (anything other than stage A1) were 63 and 41% at 10 years, respectively. And cancer specific survival rates in stage A1 and stage A2 were 96% and 64% at 10 years, respectively. The number of cancer specific death were 1 in 30 (3.3%) in stage A1 group and 14 in 77 (18.2%) in stage A2 group. Our results indicated that tumors with low potential for aggressive behavior had a volume extent of less than 5% and a well differentiated group. Aggressive treatments should be recommended to all patients who were diagnosed stage A2 prostatic cancer.

Detection of precore/core-mutant hepatitis B virus genome in patients with acute or fulminant hepatitis without serological markers for recent HBV infection

To confirm the possibility that some hepatitis B virus (HBV) variants do not induce HB s antigen (HBsAg), anti-HB core antibody (anti-HBc) and anti-HBc IgM in a transient infection, polymerase chain reaction (PCR) was performed in 20 patients with acute hepatitis and 7 patients with fulminant hepatitis. Patients were diagnosed with non-A, non-B hepatitis by serological markers at admission. PCR successfully amplified the precore/core gene in 5 (25%) of the patients with acute hepatitis and 2 (29%) of the patients with fulminant hepatitis. Subsequent sequencing revealed frequent mutations including precore-defects in the precore/core gene.

Phorbol ester stimulates the activity of a protein tyrosine phosphatase containing SH2 domains (PTP1C) in HL-60 leukemia cells by increasing gene expression

The affinity-purified antibody to a protein tyrosine phosphatase (PTP) containing two src homology 2 domains (PTP1C) was generated. The antibody recognized two types of PTP1C (PTP1C-alpha and -beta) of which the molecular sizes were 66 (alpha) and 62 kDa (beta), respectively, and these two types were expressed differentially in various cell types. The immune complex phosphatase assay using the antibody demonstrated that 12-O-tetradecanoylphorbol-13-acetate (TPA) and a vitamin D metabolite increased the PTP activity of immunoprecipitated PTP1C to 230 and 150% of control, respectively. By contrast, neither dimethyl sulfoxide nor retinoic acid significantly affected the PTP activity of PTP1C in HL-60 cells. The time course increment by TPA of PTP1C activity was closely correlated with that of the acquisition by HL-60 cells of a macrophage-like phenotype. In addition, TPA increased the amount of PTP1C detected by immunoblotting and immunoprecipitation and raised the level of expression of PTP1C mRNA in HL-60 cells. The increase of PTP1C mRNA induced by TPA treatment was inhibited by cycloheximide, suggesting that new protein synthesis is required for the increase by TPA of PTP1C mRNA expression. Furthermore, TPA increased the rate of transcription of the PTP1C gene without affecting the stability of PTP1C mRNA. These results suggest that (i) two subtypes of PTP1C may exist and function in various cell types, and (ii) TPA stimulates the PTP activity of PTP1C by increasing the transcription rate of PTP1C gene expression. The possible role of PTP1C in the macrophage differentiation will be also discussed.

Differentiation of Rickettsia japonica by restriction endonuclease fragment length polymorphism using products of polymerase chain reaction amplification with Rickettsia rickettsii 190-kilodalton surface antigen gene primers

Restriction fragment length polymorphism of polymerase chain reaction (PCR) amplification products differentiated Rickettsia japonica, a causative agent of Oriental spotted fever, from other spotted fever group (SFG) rickettsiae. Primer pair Rr190. 70p and Rr190. 602n of R. rickettsii 190-kDa antigen gene sequence primed genomic DNAs obtained from R. japonica, type strain YH and strains NT, NK, YKI, and TKN. The products were cleaved by PstI but not by AfaI restriction endonuclease. The PstI digestion pattern of PCR-products amplified from all strains of R. japonica was identical and easily differentiated from that of other SFG rickettsiae. The present study demonstrated a genotypic difference between R. japonica and other pathogenic SFG rickettsiae.

A large deletion in the connection subdomain of murine leukemia virus reverse transcriptase or replacement of the RNase H domain with Escherichia coli RNase H results in altered polymerase and RNase H activities

The functional relationship between the polymerase and RNase H domains of reverse transcriptase (RT) was investigated by studying the activities of AKR murine leukemia virus (MuLV) enzymes. In addition to the wild type, an RNase H-minus RT missing the entire RNase H domain and two other mutants having abnormal polymerase:RNase H ratios were expressed. These mutants include (i) a chimeric protein in which the MuLV RNase H domain was replaced by the entire Escherichia coli RNase H sequence and (ii) an RT with a 126 amino acid deletion in a region analogous to the "connection" subdomain in the p66 subunit of human immunodeficiency virus type 1 RT (Kohlstaedt, L. A., Wang, J., Friedman, J. M., Rice, P. A., & Steitz, T. A. (1992) Science 256, 1783-1790). With the wild-type RT, the major RNase H cleavage reaction was coordinated with DNA synthesis and occurred at a position corresponding to 15 nucleotides from the 3'-terminus of the DNA primer. Additional cleavages closer to the 5'-end of the RNA were explained in terms of a model relating binding of the RNA.DNA hybrid substrate and enzyme structure. The chimeric RT behaved like E. coli RNase H, exhibited 300-fold higher RNase H activity than wild-type RT, and was limited in its ability to synthesize DNA. Qualitative and quantitative changes in the polymerase and RNase H activities of the deletion mutant were also observed. The RNase H domain appeared to function independently of the polymerase domain, supporting the idea that the proper spatial relationship between the two active centers was disrupted by the mutation. Taken together, our results indicate that alteration of the normal polymerase:RNase H ratio can have profound effects on both polymerase and RNase H cleavage activities, as expected for an enzyme with two interdependent domains.

A study on cerebral nicotine receptor distribution, blood flow, oxygen consumption, and other metabolic activities--a study on the effects of smoking on carotid and cerebral artery blood flow

We investigated middle cerebral artery flow velocity (MCA-FV) by a noninvasive method to determine whether or not smoking causes an increase in cerebral blood flow (CBF). Furthermore we determined sequentially the changes in CBF caused by smoking in order to evaluate changes in responses at different times in daily activities and the effect from meals. The subjects were 25 healthy individuals ranging in age from 20 to 36 yr. MCA-FV was measured by a transcranial Doppler system. They smoked a filtered cigarette for 5 min at 1 P.M., 3 P.M., 6 P.M., 8 P.M., 10 P.M., 8 A.M., and 11 A.M. Results (1) Smoking caused increases in both common carotid artery flow volume and MCA-FV, and the percentage increase of these parameters showed a good correlation (r = 0.809). (2) MCA-FV increased significantly during the first (by 6.6%) and second halves (by 5.4%) of the smoking period. (3) The change in MCA-FV after meals was slight. (4) Smoking tended to increase MCA-FV during each smoking session but the changes were not significant. The pulsatility index reduced significantly during almost every smoking session. These results lead to the conclusion that smoking reduces vascular resistance in cerebral arteries and increases CBF.

PGE2 protects isolated cells against injury through multiple mechanisms

In order to clarify how PGE2 regulates gastric mucosal integrity, we examined the effects of PGE2 on ethanol-caused injury of isolated gastric chief cells, cultured gastric mucous cells from guinea pigs and Balb/c 3T3 fibroblasts. Pretreatment of these cells with PGE2 reduced ethanol-caused injury of the cells. Furthermore, pretreatment of gastric mucous cells with indomethacin enhanced ethanol-caused injury, suggesting that endogenous PGE2 may be involved in the cell protection. PGE2 stimulated an increase in diacylglycerol (DG) accumulation in chief cells and treatment of chief cells with synthetic DG reduced the injury of the cells. However, DG accumulation was not observed in gastric mucous cells treated with PGE2. Therefore PGE2 may protect the cells from injury through a variety of mechanisms. In addition, PGE2 enhanced the survival of the quiescent fibroblasts cultured in the absence of serum, while PGE2 had no survival enhancing effect on gastric mucous cells. These results suggest that the mechanism by which PGE2 preserves the cell viability may depend on not only cell types used but also how the cells are injured.

Thrombopoietic effects of interleukin-6 in long-term administration in mice

To further investigate the thrombopoietic and adverse effects of interleukin-6 (IL-6), 2 or 10 micrograms/day of recombinant human (rh) IL-6 was administered intraperitoneally (i.p.) to mice for up to 30 days. IL-6 increased platelet count, which plateaued at a level 30 to 40% higher than control after 5 days of treatment. This cytokine also maintained the high platelet count for the duration of treatment. The count exceeded normal levels 7 days after cessation of the 30-day treatment. IL-6 also induced a remarkable increase in the size but not the frequency of megakaryocytes in bone marrow sections. The number of bone marrow colony-forming units megakaryocyte (CFU-MK) and colony-forming units granulocyte-macrophage (CFU-GM) was not augmented by the administration of IL-6 in this protocol, while spleen progenitors were significantly stimulated. Small but significant increases did occur in the number of bone marrow megakaryocytes and CFU-MK, and in the proportion of CFU-MK in the DNA synthetic phase in mice treated with 10 micrograms/day of IL-6 for 30 days. Electron microscopic examination of bone marrow demonstrated that IL-6 remarkably developed the distribution of the demarcation membrane system (DMS) in mice treated for 30 days, with little change in mice treated for 5 days. The administration of 2 micrograms/day for 30 days induced a 2.2-fold increase in fibrinogen. No changes were observed in the hepatic or renal functions. Histologic and immunofluorescence studies on the kidneys revealed no significant changes compared with controls, indicating that proliferation of the glomerular mesangium did not occur. No neutralizing antibodies were detected in mice treated for 30 days. We conclude that the long-term administration of IL-6 in mice stimulates megakaryocyte maturation and platelet production with few adverse effects, and that this cytokine may be a candidate for the treatment of thrombocytopenia in humans.

[Clinical analysis in 2266 cases of transurethral resection of the prostate]

During the past 20 years from August 1971 to July 1991, 3215 cases of transurethral resection were performed at Kitasato University Hospital, and consisted of 2008 benign prostatic hyperplasias, 692 bladder tumors, 258 prostate cancers, 167 bladder neck contractures, 38 urethral strictures, 20 chronic prostatities and 32 various urologic diseases. On 2266 transurethral resections of the prostate including 2008 benign prostatic hyperplasias, and 258 prostate cancers analysis was conducted. Patient age ranged from 44 to 97 (mean, 70.1). Resected tissue varied from 1 to 177 (mean, 26.9) grams. The time required for resection was from 9 to 245 (mean, 73.0) minutes. The volume of irrigation fluid was from 4 to 92 (mean, 25.0) liters. The duration of catheter placement after operation was 3 to 44 (mean, 4.1) days and hospitalization, 10 to 81 (mean, 12.1) days. The number of complications and blood transfusions were 308 (13.6%) and 381 (16.8%) respectively. Resected amount of tissue, volume of irrigation fluid, duration of catheter placement and frequency of complication in the benign prostatic hyperplasia group exceeded those in prostate cancer group. The length of hospitalization and blood transfusion rates were higher in the prostate cancer group. The rate or frequency of each item increased with the operating time and amount of resected tissue. Today, 60 minutes of operating time as a limiting factor of transurethral resection is not considered a important factor. Based on the results of the 2266 TURP cases, an attempt will be made to establish safer methods of treatment.

Histological difference between complete responders and non-responders to interferon therapy of the livers of patients with chronic hepatitis C

Liver histology was compared in patients with chronic hepatitis C to note the differences between responders and non-responders to interferon treatment. Fifty-eight patients were administered interferon in varying doses and over various periods, and were then followed up for 1 year. According to the improvement status of serum alanine aminotransferase (ALT) levels during this period, the patients were classified into complete responders who showed complete normalization of ALT; partial responders who exhibited a significant decrease, but not complete normalization of ALT; and non-responders who did not reveal any significant decrease of ALT. Before application of the interferon treatment, liver biopsies were analyzed in four parameters and given scores from 0 to 5 for three groups in cord with no prior knowledge of the efficacy. The parameters included necroinflammation, fibrosis/lobular distortion, portal lymphocytic reaction and portal (or fibrous septal) outline destruction. Results indicated that there were no significant differences in the score of necroinflammation and portal lymphocytic reaction between the complete responder group and the non-responder group. In contrast, the complete responder group exhibited weaker fibrosis/lobular distortion and less portal outline destruction than the non-responder group. The partial responder group was more akin to the former group in these parameters. Thus, it is safe to conclude that liver histology may predict the efficacy of interferon treatment.

Use of a dual chamber pacemaker with a novel fallback algorithm as an effective treatment for sick sinus syndrome associated with transient supraventricular tachyarrhythmia

A dual chamber pacemaker having a fallback (FB) mode was utilized in nine patients with sick sinus syndrome (SSS) associated with transient supraventricular tachyarrhythmia (atrial fibrillation [Af] in three patients, atrial flutter [AF] in two, and paroxysmal atrial tachyarrhythmia [PAT] in four). Various degrees of abnormality of atrioventricular (AV) conduction were observed at the time of pacemaker implantation in five patients. In this pacemaker, a DDD mode was active during sinus rhythm, but the mode changed, through a given cycle of high rate tracking at an upper rate limit (URL), to VDI only during intrinsic atrial rate increases that were either normally or abnormally above the URL. The VDI mode automatically returned to DDD when the atrial rate fell below the URL. At follow-up periods of 7-12 months, this pacemaker appeared to be especially effective in those SSS patients with transient Af or AF. In the SSS patients with PAT, however, the FB mode was not active because the PAT rhythm was conducted to the ventricle without block (1:1 conduction) and thus the given cycles of ventricular tracking at the URL did not occur. From the repetitive FB starting tests that were performed during an Af period in one patient with transient Af, a 2:1 point setting of a given URL plus 30-50 ppm was required to quickly start the FB algorithm. Moreover, an atrial sensitivity setting that was less than half of the P wave amplitude was desirable.(ABSTRACT TRUNCATED AT 250 WORDS)

[Pre-operative, operative and postoperative complications in 2266 cases of transurethral resection of the prostate]

Pre-operative and operative complications in 2266 patients having undergone transurethral resection of prostate (TURP) for the past 20 years at Kitasato University Hospital were analyzed. They consisted of 2008 benign prostatic hyperplasia and 258 prostate cancer patients. Seven hundred and fifty four patients showed some of physical disorders prior to TUR:hypertension in 147 cases, diabetes mallitus in 87, ischemic heart disease in 46, chronic obstructive lung disease in 41 and others. Operative and postoperative complications of TURP were seen in 308 cases (13.6%). Perforation of the prostatic capsule was seen in 100 cases (4.4%) and bladder perforation into intraperitoneal cavity in 6 cases (0.3%). Transurethral fulgulation for postoperative hemorrhage was conducted on 79 cases (3.5%). Hyponatremia lower than 130 mEq/L was noted in 14 cases (0.6%). Severe urinary tract infection leading to bacteremia was observed in 9 cases (0.4%). Postoperative epididymitis was evident in 20 cases (0.8%). There was postoperative urinary incontinence in 19 cases, 3 of which was treated with Teflon-paste injection successfully. One patient had to undergo AMS-800 artificial sphincter implantation. The number of postoperative urethral stricture patients requiring urethral dilatation or internal urethrotomy was 12 (0.5%) and postoperative bladder neck contracture was seen in 20 cases (0.9%). One patient (0.04%) who developed DIC after profuse postoperative hemorrhage died on the 37th postoperative day. The efficiency of TURP depends not so much on the skill of cutting as on the speed and accuracy of orientation and haemostasis. The quick recognition of anatomical landmarks will assure effective and safe resection.

Metabolic N-demethylation of 1,3-bis[[1-cycloheptyl-3-(p- dimethylaminophenyl)ureido]methyl]benzene dihydrochloride, a novel acyl-coenzyme A:cholesterol acyltransferase inhibitor

The metabolism of 1,3-bis[[1-cycloheptyl-3-(p-dimethylamino- phenyl)ureido]methyl]benzene dihydrochloride (YM17E) in rat liver microsomes was investigated. After incubation of YM17E with rat liver microsomes in the presence of NADPH, a significant amount of YM17E was consumed and several products appeared. The structures of these products were identified by thermospray-linked LC/MS. By comparison of fragmentation patterns between these products and authentic compounds, five metabolites were eventually identified. All five metabolites--termed M1, M2-a, M2-b, M3, and M4--were sequentially formed through N-demethylation. The formation of these metabolites was NADPH-dependent, and was inhibited by SKF-525A, metyrapone, and carbon monoxide, which are inhibitors of cytochrome P-450. These results suggest that N-demethylation of YM17E is one of the main pathways of its biotransformation, and that this metabolism is catalyzed by cytochrome P-450-mediated monooxygenase.

Hepatocellular carcinoma producing universal type of alkaline phosphatase

We report on a 54-year-old man with hepatocellular carcinoma (HCC) associated with a marked elevation of serum alkaline phosphatase (ALP) levels. Serum ALP was biochemically similar to that of universal (liver/bone/kidney) type. The noncarcinomatous area revealed typical micronodular cirrhosis due to excessive alcohol consumption. By histochemical staining, ALP activity was demonstrated diffusely within the cytoplasm of carcinoma cells. Immunohistochemical observation of the carcinoma cells excluded the intestinal or placental type of ALP. Tissue extracts from the carcinomatous area had much higher ALP activities than those from a noncarcinomatous area, which also showed characteristics of the universal type. The present HCC is the first reported to produce and excrete the universal type of ALP.

Simultaneous determination of a new inhibitor of acyl CoA:cholesterol acyltransferase, YM17E, and five metabolites using high-performance liquid chromatography with electrochemical detection

We describe a reversed-phase high-performance liquid chromatographic method for the determination in plasma of YM17E (I), an inhibitor of acyl CoA:cholesterol acyltransferase, and its five metabolites using electrochemical detection. This method enables simultaneous quantification of I and five active metabolites. The plasma sample is extracted by a one-step solid-phase extraction using a SepPak C18 cartridge, with high recovery and reproducibility of the analytes. The method is sensitive and the limits of determination are 0.5 ng/ml for I and 1 ng/ml for metabolites M1, M2-a, M2-b, M3 and M4. This method is applicable to rat, dog and human plasma, and is useful for pharmacokinetic studies.

Mechanical properties of artificial teeth

In selecting the teeth for fabrication of complete or partial dentures, each patient's anatomic and physiologic requirements and the properties of the artificial teeth themselves should be taken into consideration. The purpose of this study was to evaluate the mechanical properties of the artificial teeth by the static compression test and the impact test. Specimens were the lower first molar porcelain and resin teeth (Livdent FB-20 teeth by G. C. Co., Tokyo, Japan). All were of the same shape. In the static compression test, the fracture load and deformation of the artificial teeth were measured with an Instron-type universal testing machine at a cross-head speed of 1.0 mm/min. Elastic modulus, ultimate strength and absorbed energy were calculated. In the impact test, the acceleration of a falling impactor was measured with a drop impact apparatus. The load applied to the specimen was equivalent to 300N. Absorbed energy and deformation were calculated. The resin teeth showed a lower elastic modulus, higher fracture toughness and shock-absorbing ability than the porcelain teeth. Resin teeth should be selected when the first requisite is high shock-absorbing ability, and porcelain teeth should be selected when the first requisite is high masticating efficiency.

An epidemic outbreak of hepatitis E in Yangon of Myanmar: antibody assay and animal transmission of the virus

An epidemic outbreak of hepatitis E occurred in an army recruit camp of Yangon, Myanmar, in October 1989. One hundred and eleven patients among 600 residents were hospitalized. As high as 83.7% of these patients were positive for the acute phase antibody against hepatitis E virus by an enzyme-linked immunosorbent assay developed in our laboratory. Also, 30.6% of 49 symptom-free residents examined were positive for the antibody. We prepared a stool extract from six patients and inoculated it into 10 rhesus monkeys for a series of three sub-passages. All of them developed acute biochemical hepatitis along with an elevation of antibody levels. A rechallenge with viruses of the present outbreak failed to provoke hepatitis in two monkeys that had previously recovered from acute hepatitis caused by an isolate of sporadic hepatitis E of the same area. Similarly, the rechallenge of the sporadic strain did not induce hepatitis in two monkeys that had been previously infected with the epidemic virus. These data suggested that the subjects would obtain neutralizing antibodies against the hepatitis E virus once infected, and many adult inhabitants of the endemic area had no protective antibodies and were still susceptible to hepatitis E infection.

In vivo release of water-soluble drugs from stabilized water-in-oil-in-water (W/O/W) type multiple emulsions following intravenous administrations using rats

The in vivo release of four water-soluble drugs, cefadroxil, cephradine, antipyrine and 4-aminoantipyrine, from a stabilizing water-in-oil-in-water (W/O/W) type multiple emulsion was studied using rats. The W/O/W type multiple emulsion used in this study could be stabilized for 30 d after preparation at room temperature and also for 24 h in pH 7.4 isotonic phosphate buffer or in rat plasma at 37 degrees C. The cefadroxil and cephradine concentrations in rat plasma following intravenous administrations of their W/O/W type multiple emulsions containing drugs were considerably prolonged compared with those of respective aqueous solutions. Sustained-releasing properties of cefadroxil and cephradine from W/O/W type multiple emulsions could be explained by the mechanism underlying the long residence time of W/O/W type multiple emulsions and delay-release of drugs from the W/O/W type multiple emulsions circulated with rat blood stream. However, antipyrine and 4-aminoantipyrine decreased rapidly following W/O/W type multiple emulsions and these plasma profiles coincided precisely with those following intravenous administration of the aqueous solutions of drugs. These in vivo releasing data correlated with in vitro drug release observation stated in the previous papers.

[A new cell line derived from a nude mouse resembling human large cell lung cancer]

Tumor cells derived from a metastatic mediastinal lymph node of a thirty six year old man with large cell lung cancer were transplanted into the subcapsule of the kidney of a nude mouse. The growing tumor was transplanted into a nude mouse twice and, thereafter, cultured in vitro. After the twelfth passage in vitro, the cell (NUTIY) was transplanted into subcutaneous tissue of a nude mouse and formed a rapidly growing tumor, showing the histological pattern similar to the large cell lung cancer of the patient. However, the chromosomal analysis revealed only murine chromosomes for NUTIY and any transfected human genes were not found in the genes of NUTIY by means of Alu probe. H-ras oncogene of NUTIY was amplified 4 folds, but that of the primary lung cancer and the metastatic lymph node of the patient was on a level with normal cells. NUTIY might be a cancer cell which a murine cell had been transformed into by some carcinogen in vitro.