Synthesis and antitumor activity of 4-phenyl-1-arylsulfonyl imidazolidinones

Novel 1-(1-benzoylindoline-5-sulfonyl)-4-phenyl-4,5-dihydroimidazolon es 3 synthesized show highly potent and broad cytotoxicities. Among them compound 3b (DW2143) exhibits much more potent cytotoxicities than doxorubicin and highly effective antitumor activities against murine (3LL, Colon 26) and human xenograft (NCI-H23, SW620) tumor models.

Inhibition of fos-jun-DNA complex formation by dihydroguaiaretic acid and in vitro cytotoxic effects on cancer cells

The effect of dihydroguaiaretic acid (DHGA), isolated from the aryls of Myristica fragrans, on the transcription factor (fos-jun dimer) action was investigated via in vitro assay. DHGA showed an inhibitory effect against the complex formation of the fos-jun dimer and the DNA consensus sequence with an IC50 value of 0.21 micromol. Nordihydroguaiaretic acid (NDGA) and curcumin also inhibited fos-jun dimer action showing IC50 values of 7.9 and 6.9 nmol, respectively. DHGA and NDGA suppressed leukemia, lung cancer and colon cancer in an in vitro bioassay. The in vitro experiment suggested that inhibition of fos-jun-DNA complex formation could be due to the direct interference of fos-jun dimer binding onto the DNA consensus sequence by NDGA and curcumin.

Suppression of inflammatory responses by surfactin, a selective inhibitor of platelet cytosolic phospholipase A2

Surfactin inhibits platelet and spleen cytosolic 100 kDa phospholipase A2 (PLA2). In contrast, this same compound enhances rat platelet group II PLA2 activity by approximately 2-fold and slightly increases group I PLA2 activity from porcine pancreas and Naja naja venom in vitro. Surfactin does not affect a Ca2+ -independent PLA2 partially purified from bovine brain. Thus, this compound inhibits selectively the cytosolic form of PLA2. Based on in vitro studies utilizing preincubation of surfactin with the enzyme, dialysis, and increased concentrations of substrates, the inhibitory effect of surfactin appears to be due to a direct interaction with the enzyme. Linear regression analysis of the linear portion of a concentration-response curve reveals an IC50 of 8.5 microM. To further determine the inhibitory pattern, a Dixon plot was constructed to show that the inhibition by surfactin is competitive, but not uncompetitive, with an inhibition constant of Ki = 4.7 microM in 50 mM Tris-HCl buffer, pH 8.0, at 37 degrees. Surfactin blocked non-stimulated and calcium ionophore A23187-stimulated release of arachidonic acid from monkey kidney CV-1 cells, which contain a cytosolic 100 kDa PLA2 as the major activity, as shown in an anionic exchange DEAE-5PW high performance liquid chromatography profile and western blotting analysis. Surfactin ameliorated inflammation induced by several chemicals. That is, it exhibited in vivo anti-inflammatory activity in several tested inflammatory reactions including 12-O-tetradecanoylphorbol-13-acetate (TPA)-induced mouse ear edema, carrageenan-induced rat paw edema, and acetic acid-induced mouse writhing. These results demonstrate that surfactin is a selective inhibitor for cytosolic PLA2 and a putative anti-inflammatory agent through the inhibitory effect produced by direct interaction with cytosolic PLA2, and that inhibition of cytosolic PLA2 activity may suppress inflammatory responses.

Toxicities of 166Holmium-chitosan in mice

166Holmium (166Ho) is a radionuclide of rare earth chemical and is known to have antitumor activity. Several chemicals were complexed with 166Ho to facilitate the transport of this radionuclide to the site of action. In this study, 166Ho was complexed to chitosan (Chit) which decreases the distribution of Ho into other tissues when applied intrahepatically. To investigate the single dose toxicity, mice were administered intravenously with 1 mCi/kg body weight of 166Ho-Chit (DW-166HC), Chit or nothing. Organ weights, hematological and histopathological studies were performed in 6 animals per group at 1, 3 and 14 days after administration. In 166Ho-Chit treated animals, a slight decrease of erythrocyte number was observed at day 14 and increases of relative liver and lung weights were found at day 3. Although marked multiple necrotic foci in the white pulp and depletion of marginal zone in the spleen were noted at day 1, these findings were decreased in severity and fully recovered at day 3 and day 14, respectively. Slightly decreased kidney weights were observed both in Chit and in 166Ho-Chit treated groups without histological alterations. Thus it is suggested that most effects of 166Ho-Chit observed at an early stage after administration are limited to rapidly dividing cells and reversible within 14 days.

Triprimer-PCR method: rapid and reliable detection of transgenes in transgenic rice plants

We designed a triprimer-PCR system for detection of transgenes and applied for analysis of two different kinds of transgenic rice plants, which were previously transformed with the plasmids pBY605RR or pARP7 containing a maize ribosome-inactivating protein gene, Zmcrip3a, and a herbicide-resistant gene, bar. Genomic Southern-blot analysis demonstrated that the transgenes were stably inherited to their R1 progenies without changes in configuration. The resulting data were used as a reference for triprimer-PCR analysis. The triprimer-PCR system uses an endogenous gene as an internal standard which shares an identical priming site for one primer with a transgene while each of the other two primers is specific to either the transgene or the endogenous gene. Triprimer-PCR analysis was carried out on genomic DNA isolated from 24 different progenies of the pBY605RR- and the pARP7-transformed lines that contain different copy numbers of transgenes. The RbcS:Zmcrip3a junction region of the pBY605RR integrated in rice chromosomes, together with the endogenous RbcS, was efficiently amplified, producing 440 and 250 bp expected PCR products. Also, the Act1:Zmcrip3a junction region of the transgene pARP7 with the endogenous Act1 was similarly amplified, producing 540 and 340 bp expected PCR products. The two PCR products in each set of experiments were observed consistently and independently of copy numbers or rearrangements of the transgene. Thus, the triprimer-PCR strategy may provide a rapid and reliable method for confirming transformation or analyzing segregation of transgenes at the molecular level.

Momordins inhibit both AP-1 function and cell proliferation

The activation of Jun/Fos is a crucial factor in transmitting the tumor promoting signal from the extracellular environment to nuclear transcription machinery. One of the final steps in signal transduction is the binding of Jun/Fos to the AP-1 site in order to express gene transcription. Utilizing this concept, we screened about 100 extracts of natural plants to search for a Jun-Fos function inhibitor. The methanol extract of Ampelopsis radix reduced Jun/Foc retardation remarkably. The active principles of the extract were isolated and purified by repeated column chromatography and their structures were identified as oleanolic acid glycosides known as momordin I, Id, and Ie. These compounds reduced the Jun/Fos-DNA interaction and their activities were quantitated with liquid scintillation counting of corresponding bands. Among them, momordin I had the strongest inhibitory activity, with an IC50 value of 22.8 micrograms/ml. The methanol extract and momordin I, Id and Ie also showed cell cytotoxicity against human cancer cell lines. As expected from a gel shift assay, momordin I showed the strongest cytotoxicity and its IC50 value was from 7.280 micrograms/ml to 16.05 micrograms/ml depending on the cell line. With these data, it may be concluded that the mechanism of anticancer activity of momordin I comes from its inhibitory effect on the protein-DNA interaction. The in vivo test was done only with the methanol extract. The extract showed measurable anticancer activity against murine colon cancer. The wet tumor weight reduction rate was 17.73% at 90 mg/kg dose. We suggest that the Jun/Fos-DNA interaction results in cell cytotoxicity.

2-(1-Naphthyloxy)ethylamines with enhanced affinity for human 5-HT1D beta (h5-HT1B) serotonin receptors

Although the beta-adrenergic antagonist propranolol (1) binds at rodent 5-HT1B serotonin receptors, it displays low affinity (Ki > 10,000 nM) for its species homologue 5-HT1D beta (i.e., h5-HT1B) receptors. The structure of propranolol was systematically modified in an attempt to enhance its affinity for the latter population of receptors. Removal of the alkyl hydroxyl group, shortening of the O-alkyl chain from three to two methylene groups, and variation of the terminal amine substituent resulted in compounds, such as N-monomethyl-2-(1-naphthyloxy)-ethylamine (11; Ki = 26 nM), that display significantly higher h5-HT1B affinity than propranolol. Compound 11 was shown to bind equally well at human 5-HT1D alpha (h5-HT1D) receptors (Ki = 34 nM) and was further demonstrated to possess h5-HT1B agonist character in an adenylate cyclase assay. It would appear that such (aryloxy)alkylamines may represent a novel class of 5-HT1D receptor agonists.

Functional significance of the TATA element major groove in transcription initiation by RNA polymerase II

The binding of TFIID to the TATA element initiates assembly of a preinitiation complex and thus represents one of the most important steps for transcriptional regulation. The fact that the TATA binding protein (TBP), a subunit of TFIID, exclusively contacts the minor groove of the TATA element led us to ask whether the major groove of the TATA element plays any role in transcription initiation or its regulation. Our results show that modifications of the major groove of the TATA element in the adenovirus major late promoter have no effect on TFIID binding affinity or on transcription in a cell-free system reconstituted with purified factors. However, major groove modifications do decrease the levels of both basal and activator-mediated transcription in unfractionated nuclear extracts, indicating that the intact structure of the major groove of the TATA element is functionally important for transcription initiation in a more physiological context.

Epidural infusion of bupivacaine 0.0625% plus fentanyl 3.3 micrograms/ml provides better postoperative analgesia than patient-controlled analgesia with intravenous morphine after gynaecological laparotomy

One hundred and twenty women undergoing gynaecological abdominal operations were randomized to receive either epidural bupivacaine 0.0625% + fentanyl 3.3 micrograms/ml infusion (Group EPI, n = 57), or patient-controlled intravenous morphine analgesia (Group PCA, n = 54) for postoperative pain relief. The groups were comparable in demographic data, types and duration of operation. Group EPI achieved significantly lower verbal rating scale of pain (VRS) at rest at 0, 4, 12, 16, 20, 28 and 40th postoperative hours. The VRS during cough were also significantly lower in Group EPI at 0, 4, 8, 12, 28 and 36th postoperative hours. None of the patients had respiratory depression or hypotension. Nausea/vomiting occurred in 52.6%/33.3% of patients in Group EPI and 52.7%/37.0% in Group PCA. Most patients (84.2% in Group EPI and 72.2% in Group PCA) rated their pain management as "good". We conclude that epidural infusion of bupivacaine 0.0625% and fentanyl 3.3 micrograms/ml provide better analgesia than patient-controlled intravenous morphine after gynaecological laparotomy.

Spatial vision thresholds in the near absence of attention

It is well known that attention increases the discriminability of some types of spatial information. To ascertain more specifically which types of spatial information benefit from attention, we have measured spatial vision thresholds both in the presence and in the near absence of attention. To obtain near absence of attention, we induce subjects to focus attention elsewhere in the display by means of a suitably demanding concurrent visual task. We measure contrast and orientation thresholds for sine-wave gratings, as well uni- and bidirectional offset thresholds for vernier targets. The results suggest that attention selectively lowers some thresholds but not others: orientation thresholds are far more affected than contrast thresholds, and bidirectional vernier thresholds are far more affected than unidirectional thresholds.

Compatibility of vancomycin hydrochloride and famotidine 5% dextrose injection

The compatibility of vancomycin hydrochloride and famotidine in 5% dextrose injection stored at two temperatures was studied. Vancomycin hydrochloride and famotidine were reconstituted and diluted with 5% dextrose injection to form an admixture with a famotidine concentration of 0.2 mg/mL and a vancomycin concentration of 5 mg/mL. The admixture was stored in 100-mL vented intravenous containers in the dark at 4 and 25 deg C; three containers were stored at each temperature. A 2-mL sample was taken from each container after six and 12 hours and 1, 3, 5, 7, 10, 12, and 14 days of storage and visually inspected, tested for pH and assayed by a developed stability-indicating high performance liquid chromatographic method. Triplicate samples were prepared for each storage condition. No color change, precipitation or cloudiness was observed in any sample at any time during the study. Vancomycin 5 mg/mL and famotidine 0.2 mg/mL in admixtures in 5% dextrose injections are stable for 14 days at 4 and 25 deg C.

CCAAT binding NF-Y-TBP interactions: NF-YB and NF-YC require short domains adjacent to their histone fold motifs for association with TBP basic residues

Both the TATA and CCAAT boxes are widespread promoter elements and their binding proteins, TBP and NF-Y, are extremely conserved in evolution. NF-Y is composed of three subunits, NF-YA, NF-YB and NF-YC, all necessary for DNA binding. NF-YB and NF-YC contain a putative histone-like motif, a domain also present in TBP-associated factors (TAFIIs) and in the subunits of the transcriptional repressor NC2. Immunopurification of holo-TFIID with anti-TBP and anti-TAFII100 antibodies indicates that a fraction of NF-YB associates with TFIID in the absence of NF-YA. Sedimentation velocity centrifugation experiments confirm that two pools of NF-YB, and most likely NF-YC, exist: one associated with NF-YA and binding to the CCAAT box; another involved in high molecular weight complexes. We started to dissect NF-Y-TFIID interactions by showing that: (i) NF-YB and NF-YC interact with TBP in solution, both separately and once bound to each other; (ii) short stretches of both NF-YB and NF-YC located within the evolutionary conserved domains, adjacent to the putative histone fold motifs, are necessary for TBP binding; (iii) TBP single amino acid mutants in the HS2 helix, previously shown to be defective in NC2 binding, are also unable to bind NF-YB and NF-YC.

DNA analysis by flow cytometry in early gastric cancer

OBJECTIVES

Flow cytometric analysis of a paraffin-embedded block of tissue provides rapid and accurate means of analyzing the DNA content of a tumor. The aim of this study was to clarify the clinical significance of flow cytometric findings in early gastric cancer(EGC). Thus we conducted this study to investigate whether DNA contents of tumor cells can correlate with known prognostic indices in patients with EGC.

METHODS

The flow cytometric DNA analysis was performed with paraffin-embedded specimens from tumors of 107 patients with EGC. Flow cytometric analysis was performed using a FACScan (Becton Dickinson). In constructing the histogram, 30,000 cells were scanned from each section and results were scored. The S-phase fraction was obtained according to the CellFit cell cycle analysis (Becton Dikinson). Frequencies of aneuploidy in tumors with various clinical and pathologic parameters were compared using the chi-square test. Mean SPF/PI valuse were compared by the student t-test.

RESULTS

Diploidy pattern was observed in 80 (75%) cases while aneuploidy was seen in 27(25%) cases. Aneuploidy was more frequently detected in tumors with submucosal involvement (32.7%) and lymph node (+) group (30.8%) than in the mucosal tumor (17.3%) and lymph node (-) group (24.5%), but the differences were not significant. Frequency of aneuploidy was not affected by either the histologic type or morphologic classification. On the other hand, high proliferative activities (SPF/PI) significantly correlated with the submucosal tumor invasion (66.7% vs. 45%; p < 0.05) and lymph node metastasis (28.6% vs. 7.5%; p < 0.05).

CONCLUSION

Tumor aggressiveness is not directly related to DNA aneuploidy but proliferative activities are responsible for the aggressive nature of early gastric cancer. The results of this study show that DNA analysis by flow cytometry in considered to be one method of determining the biological activity of gastric cancer cells.

The autoimmunity-inducing xenobiotic mercury interacts with the autoantigen fibrillarin and modifies its molecular and antigenic properties

The heavy metal mercury elicits a genetically restricted, anti-nucleolar autoantibody response that targets fibrillarin, a 34-kDa protein component of many small nucleolar ribonucleoprotein particles. The mechanisms by which a toxin such as mercury elicits an autoantibody response that predominantly targets a single intracellular protein autoantigen remain uncertain, but may be prefaced by mercury gaining access to the intracellular environment. Mercury-induced cell death was associated with loss of fibrillarin antigenicity and modification of the molecular properties of fibrillarin as revealed by aberrant migration under nonreducing conditions in SDS-PAGE. Addition of mercury to isolated nuclei also resulted in aberrant migration of fibrillarin, but not other nuclear autoantigens. The sensitivity of the HgCl2-induced modification of fibrillarin to 2-ME, iodoacetamide, and hydrogen peroxide suggested interaction of mercury with the two cysteines in the fibrillarin sequence. This was confirmed by mutation of the cysteines to alanines, which abolished the aberrant migration of fibrillarin in the presence of HgCl2. The modification of the molecular structure of fibrillarin by mercury reduced immunoprecipitation by anti-fibrillarin autoantibodies, pointing to unmodified fibrillarin as the B cell Ag and implicating mercury-modified fibrillarin as the source of T cell antigenicity. These observations demonstrate for the first time that an environmental toxin can alter the physicochemical properties of an autoantigen and may help to explain the antigenic specificity of mercury-induced murine autoimmunity.

The autoimmunity-inducing xenobiotic mercury interacts with the autoantigen fibrillarin and modifies its molecular and antigenic properties

The heavy metal mercury elicits a genetically restricted, anti-nucleolar autoantibody response that targets fibrillarin, a 34-kDa protein component of many small nucleolar ribonucleoprotein particles. The mechanisms by which a toxin such as mercury elicits an autoantibody response that predominantly targets a single intracellular protein autoantigen remain uncertain, but may be prefaced by mercury gaining access to the intracellular environment. Mercury-induced cell death was associated with loss of fibrillarin antigenicity and modification of the molecular properties of fibrillarin as revealed by aberrant migration under nonreducing conditions in SDS-PAGE. Addition of mercury to isolated nuclei also resulted in aberrant migration of fibrillarin, but not other nuclear autoantigens. The sensitivity of the HgCl2-induced modification of fibrillarin to 2-ME, iodoacetamide, and hydrogen peroxide suggested interaction of mercury with the two cysteines in the fibrillarin sequence. This was confirmed by mutation of the cysteines to alanines, which abolished the aberrant migration of fibrillarin in the presence of HgCl2. The modification of the molecular structure of fibrillarin by mercury reduced immunoprecipitation by anti-fibrillarin autoantibodies, pointing to unmodified fibrillarin as the B cell Ag and implicating mercury-modified fibrillarin as the source of T cell antigenicity. These observations demonstrate for the first time that an environmental toxin can alter the physicochemical properties of an autoantigen and may help to explain the antigenic specificity of mercury-induced murine autoimmunity.

Guillain-Barré like syndrome associated with acute renal failure and thrombocytopenia following acute viral hepatitis A

We reported a 43-year-old woman who showed a Guillain-Barré like syndrome associated with acute renal failure (ARF) and thrombocytopenia following acute viral hepatitis A(HA). The clinical feature was acute progressive and of ascending symmetric paraparesis which developed 5 days after gastrointestinal infection. Neurologic examination showed flaccid paraparesis, areflexia in all extremities and limitation on the straight leg raising test. Laboratory examinations showed the evidences of ARF, thrombocytopenia and HA. EMG findings suggested a polyradiculopathy. Renal biopsy showed the findings of acute interstitial nephritis, acute tubular necrosis and IgA deposition nephropathy. She was treated by plasmapheresis and platelet transfusion, then showed a rapid improvement, and has been well without further complication after discharge.

In-vitro and in-vivo activities of DW-116, a new fluoroquinolone

DW-116 is a novel fluoroquinolone that was two- to four-fold more active than rufloxacin and less active than sparfloxacin, ciprofloxacin and ofloxacin against Gram-positive bacteria in vitro. Against Gram-positive and Gram-negative bacteria, the in-vivo activity of DW-116 was similar or slightly greater than that of rufloxacin and less than that of sparfloxacin, ciprofloxacin and ofloxacin. ED50 (50% effective dose) values for DW-116 did not correlate with in-vitro MICs.

Fauna and geographical distribution of house dust mites in Korea

During the period of 1933-1994, house dusts were collected from 65 homes at 10 different localities by operating electric vacuum cleaners. House dust mites were isolated from 10 g dust by applying the modified wet sieving method. Total 7,257 mites were collected and 23 species were identified. Among them. Dermatophagoides farinae (DF) was predominant (65.3% of the total), followed by D. pteronyssinus (DP) (20.6%) and Tyrophagus putrescentiae (TP) (6.5%). Rhizoglyphus robini. Sancassania phyllophagianus, Cheyletus traussarti and Scheloribates latipes were the first findings from Korea. DF was predominant in Seoul (66.8%). Kwangju (63.6%), inland of Pusan (79.6%), Inchon (96.5%). Taejon (83.9%), Chonju (87.15) and Chongju (95.2%), whereas DP was predominant in Yongkwang-ub (72.5%) and Yongdo (island) of Pusan (64.9%), and TP in Chunchon (38.2%). The localities where DP and TP were predominant showed higher relative humidity in air (> 73% RH). Among 62 study homes, DF, DP and TP were found in 24.6% of the homes, co-habitat of two species in 48.1% and one species in 27.3%. DF was predominant in 63.5% of the homes studied. DP in 29.6% and TP in 6.9%. In 10 g of the house dust, less than 99 mites were found in 49 homes (70.0%), 100-499 mites in 11 homes (15.7%). 500-999 mites in 3 homes (4.3%) and more than 1,000 mites in 2 homes (2.9%). No mite was found in 5 homes (7.1%). In order to evaluate environmental factors affecting the population density of house dust mites, house type, age of house construction, size of the house, number of the family and frequency of the cleaning were compared with the number of mites, and none of the above factors were statistically correlated with the mite density.

Long-term outcome when major complications follow coronary artery bypass graft surgery. Recovery after complicated coronary artery bypass graft surgery

OBJECTIVE

To determine whether information available 1 week after surgery correlates with long-term function in patients who suffer major complications after coronary artery bypass graft (CABG) surgery.

DESIGN

An inception cohort study.

SETTING

A 526-bed community teaching hospital.

PATIENTS

All 67 patients who required at least 7 days of CT-ICU care following 2,751 consecutive CABG operations.

MAIN OUTCOMES

Hospital survival, long-term survival, and functional ability at long-term follow-up.

RESULTS

Forty-three patients survived hospitalization (64%), while 24 died 37 +/- 45 days (range, 7 to 190 days) after surgery. When 42 patients were surveyed 22 +/- 9 months after surgery, 21 of the survivors enjoyed excellent, independent function, 7 were moderately impaired but living at home, 6 were institutionalized with severe limitations, and 8 had died. Patients with very severe cardiac or neurologic dysfunction 1 week after surgery had an extremely poor outcome. When mechanical ventilation was required for causes other than primary failure of the respiratory system, long-term function and hospital survival were poor. Twelve of 14 patients with pulmonary complications survived hospitalization, and all 12 were alive at long-term follow-up.

CONCLUSION

More than half of patients requiring 7 days or more of ICU treatment after CABG surgery survive, and many enjoy excellent long-term function. However, those with very severe cardiac or neurologic dysfunction 1 week after surgery have little chance for independent recovery.

Characterization of endothelin-induced nociception in mice: evidence for a mechanistically distinct analgesic model

The behavioral response elicited in mice by an i.p. injection of endothelin-1 (ET-1) (0.1 mg/kg) was differentiated from that elicited by standard agents such as acetylcholine (ACh) (5.5 mg/kg) or phenyl-p-quinone (PpQ) (1.25 mg/kg). First, there was lack of two-way "cross-tolerance' between test paradigms. That is, at equieffective doses, a 60-min prior i.p. injection of ET-1 blocked the behavioral response to a subsequent i.p. injection of ET-1 or PpQ, but not of ACh, whereas a 60-min prior injection of ACh or of PpQ had no effect on a subsequent i.p. injection of ACh, PpQ or ET-1. Second, differential antagonism of ET-1-, ACh- or PpQ-induced responses was observed in an examination of 36 test compounds. For example, cyclo-oxygenase inhibitors such as indomethacin and ibuprofen did not block the ET-1-induced response at > 10 times the doses that blocked ACh- or PpQ-induced responses, whereas other compounds (such as certain benzodiazepines) inhibited ET-1-induced, but not ACh- or PpQ-induced, responses. These findings suggest that ET-1 produces a novel nociceptive stimulus, mechanistically distinct from ACh and PpQ. Hence, the ET-1-induced behavioral response in mice serves as a rapid and convenient measure of in vivo endothelin activity. In addition, this test might be a model for clinical pains not adequately treated by present analgesic agents or adequately tested by preclinical antinociceptive screens using ACh or PpQ. As such, it is a potentially valuable model for the identification of novel analgesic and other agents.

Endoscopic mucosectomy using an esophageal variceal ligation device for minute gastric cancer

We present here a modified technique for endoscopic mucosal resection using the technique of esophageal variceal ligation for minute gastric cancer. This method of endoscopic mucosal resection requires only the commonly-used one-channel endoscope, an esophageal variceal ligation device, and some clinical experience with the ligation of esophageal varices and snare polypectomy. It can therefore be considered technically simple and safe. We treated four patients with minute gastric cancer using this endoscopic mucosal resection technique. All tumors were completely resected without major complications. Resected specimens were 1.0-1.5 cm in diameter, sufficient for histopathological evaluation, and curative resection was achieved in all patients.

Differential expression of D-type G1 cyclins during mouse development and liver regeneration in vivo

D-type G1 cyclins are the primary cell cycle regulators of G1/S transition in eukaryotic cells, and are differentially expressed in a variety of cell lines in vitro. Little is known, however, about the expression patterns of D-type G1 cyclins in normal mouse in vivo. Thus, in the present study, tissue-specific expressions of cyclin D1 and D3 genes were examined in several tissues derived from adult male mice, and stage-specific expression of cyclin genes was studied in brain, liver, and kidney of developing mice from embryonic day 13 to postnatal day 11. Cell cycle-dependent expression of cyclins was also examined in regenerating livers following partial hepatectomy. Our results indicate that (1) cyclins D1 and D3 are expressed in a tissue-specific manner, with cyclin D1 being highly expressed in kidney and D3 in thymus; (2) cyclin D3 mRNA is abundantly expressed in young proliferating tissues and is gradually reduced during development, whereas cyclin D1 mRNA fluctuates during development; and (3) compensatory regeneration of liver induces cyclin D1 gene expression 12 hr after partial hepatectomy, and cyclin D3 gene expression from 36 to 42 hr (at the time of G1/S transition). In conclusion, this study indicates that cyclin D1 and D3 genes are differentially expressed in vivo in a tissue-specific, developmental stage-dependent, and cell cycle-dependent manner.

Transgenic mouse blastocysts that overexpress metallothionein-I resist cadmium toxicity in vitro

The role of metallothionein with regard to cadmium toxicity in vitro was investigated using preimplantation mouse blastocysts derived from a transgenic strain that constitutively overexpresses metallothionein-I transgenes (MT-I*). Northern blot and in situ hybridization revealed high levels of MT-I mRNA in transgenic blastocysts when compared with control blastocysts, and reverse transcriptase-polymerase chain reaction-amplified MT-I mRNA was almost exclusively MT-I*. Moreover, pulse-labeling experiments showed that the relative rate of synthesis of MT was 9-fold higher in transgenic blastocysts. Cadmium (Cd2+) toxicity was assessed after incubating blastocysts for 4 hr in Whitten's medium containing 50 microM Cd2+. Embryos that displayed abnormal morphology were judged "sensitive". Transgenic blastocysts were more resistant to cadmium-induced morphological changes than were control blastocysts. "Sensitive" and "resistant" blastocysts were individually genotyped by polymerase chain reaction, or they were transferred to foster mothers, and embryonic development to midterm was monitored. Of the blastocysts derived from mating heterozygous transgenic males with control females, 56% were transgenic before incubation with Cd2+, whereas 95% of the blastocysts that retained normal morphology after incubation were transgenic. Moreover, after Cd2+ exposure, transgenic blastocysts with normal morphology were nine times more likely to develop to midterm than were control blastocysts with normal morphology. Blastocysts with abnormal morphology failed to develop to midterm. These studies indicate that MT plays a central role in protection from Cd2+ toxicity within the physiological context of the developing mouse embryo.

Elevated rates of early discontinuation from pharmacotherapy trials in alcoholics and drug abusers

The failure of subjects to complete clinical trials is a common problem with important implications for the interpretation of study results. Although a substantial literature exists on the high prevalence of premature termination from psychiatric and substance abuse treatment setting, there has been little attention paid to early discontinuation in clinical trials. There is evidence that the presence of substance abuse predicts higher rates of early discontinuation. This, combined with a recent increase in efforts to develop medications for treatment of substance use disorders, led us to conduct a literature review to determine whether pharmacotherapeutic trials for patients with these disorders have higher rates of premature discontinuation than comparable studies of patients with other psychiatric disorders. Of 267 articles that were initially identified, 83 met predetermined criteria for inclusion in the analysis. As hypothesized, after controlling for a number of potential contributing variables, treatment trials with substance abuse patients showed a significantly poorer retention rate than those of patients with other psychiatric diagnoses. The difference in retention rate was also evident when studies specific to alcohol dependence, the largest subgroup of substance use disorders, were evaluated separately. Although the retrospective nature of the study design limits the conclusions that can be drawn, the results suggest that, in pharmacotherapy trials with alcoholics or other substance abuse patients, particular attention should be paid to enhancing treatment retention.

Somatotopic localization of thermal stimuli: I. A comparison of within- versus across-dermatomal separation of innocuous thermal stimuli

Fourteen healthy subjects (4 males, 10 females) were asked to localize a thermal stimulus applied to the left distal forearm. Two temperature-controlled probes (1,2-cm2 area each) were strapped to the forearm, separated by 8 cm. The probes were positioned in one of three ways: (1) longitudinally within the C6 dermatome, (2) longitudinally within the C8 dermatomes, and (3) transversely with one probe within the C6 and one probe within the C8 dermatome. For any given stimulus configuration, cooling stimuli were localized significantly better than warming stimuli. For both warming and cooling, the transdermatomal configuration (transversely separated probes) provided significantly better localization than the intradermatomal configuration (longitudinally separated probes). Thus, the anisotropy that has been described for tactile spatial acuity is also present for thermal localization. These results suggest that cutaneous somatotopic information is integrated similarly for both and thermal stimuli, but differently within versus across dermatomes.

Activation of the complete mouse metallothionein gene locus in the maternal deciduum

The mouse metallothionein (MT) gene family consists of four known members (MT-I through IV) clustered on chromosome 8. Studies reported herein examine the expression and regulation of the MT-III and MT-IV genes in specific cell types in the maternal reproductive tract, developing embryo, and fetus known to express the MT-I and -II genes. MT-III and MT-IV mRNAs were absent from the visceral yolk sac, placenta, and fetal liver, tissues with high levels of MT-I and MT-II mRNAs. In contrast, MT-III and MT-IV mRNAs were both abundant in the maternal deciduum, and in experimentally induced deciduoma on 7 and 8 days postcoitum (1 dpc = vaginal plug), as are MT-I and -II mRNAs. The abundance of each of these MT mRNAs increased coordinately during development of the deciduum (6-8 dpc), and in situ hybridization localized MT-I, MT-III, and MT-IV mRNAs to the secondary decidual zone of the antimesometrial region on 8 dpc, where in some regions all of the cells were apparently positive. Thus, all of the known mouse MT genes are co-expressed in at least some of the cells in the secondary decidual zone. Electrophoretic analysis of decidual MT suggested that the MT-I, -II, and -III isoforms are abundant proteins in the secondary deciduum. Bacterial endotoxin-lipopolysaccharide (LPS) and Zn are powerful inducers of MT-I and MT-II gene expression in many adult organs, whereas these agents apparently have little effect on MT-III and MT-IV gene expression. Neither of these agents significantly effected levels of decidual MT-III or MT-IV mRNAs in vivo or in primary cultures of decidual cells in vitro, and only modest effects of Zn on MT-I mRNA levels were noted. During 2 days of in vitro culture, decidual cell MT-I and MT-III mRNA levels remained elevated while MT-IV mRNA levels decreased. Thus, expression of the mouse MT gene locus in the deciduum appears to be developmentally regulated, and in this tissue, the MT genes are refractory to induction by Zn or inflammation.

Crystal structure of a TFIIB-TBP-TATA-element ternary complex

The crystal structure of the transcription factor IIB (TFIIB)/TATA box-binding protein (TBP)/TATA-element ternary complex is described at 2.7 A resolution. Core TFIIB resembles cyclin A, and recognizes the preformed TBP-DNA complex through protein-protein and protein-DNA interactions. The amino-terminal domain of core TFIIB forms the downstream surface of the ternary complex, where it could fix the transcription start site. The remaining surfaces of TBP and the TFIIB can interact with TBP-associated factors, other class II initiation factors, and transcriptional activators and coactivators.

The development of clinical practice guidelines for treatment of peptic acid diseases in a VA ambulatory care clinic

The costly treatment of peptic acid diseases at a Veterans Affairs ambulatory care clinic prompted the development of clinical practice guidelines (CPGs) for the disorders. A committee consisting of a clinical pharmacist, the chiefs of ambulatory care and medicine, and a gastroenterologist guided the process. A consensus-style conference format involving medical staff and residents, pharmacists, and other health providers was chosen to develop the CPGs. Before the conference each participant received a list of key issues and literature on practice guidelines, and on peptic acid diseases and their treatment. At the conference the participants were divided into four groups; each group discussed specific key issues using a modified nominal group process. Recommendations from each group were made to the entire conference. Final recommendations were compiled into what was adopted and readily received as the CPGs for the institution.

A comparison of antihypertensive effects between two formulations of atenolol: tenolol and tenormin

BACKGROUND

Atenolol is a cardioselective beta-blocker. Tenolol is a new formulation of atenolol, with bioequivalence to the original atenolol (Tenormin). This study was designed to compare the antihypertensive effects between the two formulations of atenolol, Tenolol and Tenormin.

METHODS

Twenty-three patients, with mild to moderate hypertension untreated with any antihypertensive drugs, were recruited. They were randomized to receive two weeks of placebo, four weeks of Tenolol or Tenormin (100 mg once daily) and two weeks of placebo. Then the treatments were crossed over for four more weeks.

RESULTS

At two weeks five patients were excluded because their blood pressures (BP) were below 160/90 mmHg. The baseline BPs for the patients receiving Tenormin (162 +/- 18/97 +/- 8 mmHg) and Tenolol (164 +/- 17/97 +/- 9 mmHg) were not distinct. After two weeks of treatment with Tenormin or Tenolol, systolic BPs decreased by 12 +/- 11 mmHg and 13 +/- 14 mmHg, respectively (p < 0.01 for both formulations). Similarly the diastolic BPs decreased significantly (p < 0.01) by 7 +/- 9 mmHg and 7 +/- 10 mmHg, respectively. The hypotensive effects persisted at four weeks of treatment for both formulations. Reductions in systolic and diastolic BPs by treatment with Tenormin and Tenolol were not significantly different by two-way ANOVA analysis. There were no side effects in any patient throughout the study.

CONCLUSIONS

The results indicate that the generic formulation of atenolol (Tenolol) has comparable antihypertensive effects as the original formulation (Tenormin).

Analysis of thymidine kinase gene expression in preimplantation mouse embryos

Thymidine kinase (TK) activity was examined during the development of preimplantation mouse embryos. TK activity was increased approximately 20-fold from day 2 embryos (2-cell) to day 5 embryos (late blastocyst). TK activity did not change along with the progression into S-phase of the first and the second cell cycles but increased sharply at S-phase of the third cell cycle. Analysis of TK mRNA with a reverse transcription-polymerase chain reaction (RT-PCR) method showed that the level of TK mRNA was low in ovulated eggs and 1-cell embryos and was hardly detectable in day 2 embryos (2-cell), but sharply increased in day 3 embryos (mixture of 5- to 8-cell and morula). The functional role of 5'-flanking sequence of TK gene was also investigated in preimplantation embryos after microinjection with the DNA construct of 5'-flanking sequence of TK (2.4 kb) linked to bacterial lacZ gene (TK2.5lacZ) into the pronucleus of 1-cell and subsequently by histochemical staining with X-gal. beta-Galactosidase activity was first detected in day 3 embryos (8-cell), and 30% of embryos were stained with X-gal in day 4 and day 5 embryos, respectively. These results show that an increase in TK activity occurred after 2-cell stage, and this increase was primarily due to the embryonic activation of TK gene expression. Also, it appears that the 5'-flanking sequence of TK may directly regulate the TK gene expression at the transcriptional level during preimplantation murine development.

Withdrawing care. Experience in a medical intensive care unit

OBJECTIVE

To describe the process and outcomes of withdrawing life-sustaining interventions in a medical intensive care unit (MICU).

DESIGN

Retrospective case series.

SETTING

Medical intensive care unit in a community teaching hospital.

PATIENTS

Consecutive series of 28 patients in whom mechanical ventilation, dialysis, and/or vasopressors were withdrawn. We distinguished physiological, neurological, and functional rationales for care withdrawal.

MAIN OUTCOME MEASURES

Duration of discussions, MICU length of stay, and hospital survival.

RESULTS

Mean +/- SD Acute Physiology and Chronic Health Evaluation (APACHE II) score was 27.1 +/- 7.3 on MICU admission, and average +/- SD predicted hospital mortality was 61% +/- 22%. Discussions leading to withdrawal of care occurred over an average +/- SD of 5.2 +/- 5.5 days, with decisions achieved soonest in cases with poor neurological prognosis. Average +/- SD MICU length of stay was 1.4 +/- 1.8 days following a decision to withdraw MICU care, and only four patients received more than 48 hours of additional MICU care. Four patients were discharged alive from the hospital.

CONCLUSIONS

Patients and their surrogates willingly considered outcomes in addition to mortality when considering withdrawal of life-sustaining interventions. Finding an accommodation between physician judgments and patient preferences took time and effort but was an effective means of limiting ineffective life-sustaining efforts. Withdrawing futile or unwanted care was not always fatal.

Recurrent acoustic neuroma presenting as central alveolar hypoventilation

Centrally mediated hypoventilation causes respiratory failure without respiratory distress. We present a case of recurrent acoustic neuroma at the cerebellopontine angle causing acute and chronic respiratory failure. Tumor resection eliminated recurrence of respiratory failure.

Adult presentation of congenital cystic adenomatoid malformation of the lung: a case report

Adult presentation of congenital cystic adenomatoid malformation(CCAM) of the lung is so rare that only 5 cases have been reported in the literature to date. We report the case of a 19-year-old female with CCAM in the left lower lobe. Computed tomography showed a multilobulated cystic lesion with multiple air-fluid levels and also showed focal enhancement of the solid component in the eccentrical portion of the lesion. Thoracic aortogram and selected bronchial arteriograms show a slightly enlarged and tortuous bronchial artery feeding the multilobulated cystic lesion. We present the clinical and radiological features of our case with a brief review of the literature.

Botulinum a toxin treatment of hemifacial spasm and blepharospasm

We studied the effects of botulinum A toxin in 101 patients with hemifacial spasm and 11 patients with blepharospasm in an open trial and double blind manner. All patients in the open trial and 6 patients in the double blind trial improved after the first injection of botulinum toxin. There was no improvement with placebo. The peak effect ranged from one to 6 days after injection and mean peak effect was 3.6 days in blepharospasm, and 4 days in hemifacial spasm. Of 144 treatments, 98.6% had excellent results, (below grade I). The duration of beneficial effect ranged 11 to 40 weeks (mean 16.5 weeks) in hemifacial spasm and 9 to 30 weeks (mean 14.2 weeks) in blepharospasm. Complications were encountered in 63.4% in hemifacial spasm and 72.7% in blepharospasm. The common side effects were dry eyes, mouth droop, ptosis and lid edema in order of frequency. These side effects were mild and resolved spontaneously in 1 to 3 weeks. Botulinum A toxin therapy is effective and convenient, and the treatment of choice for patients with hemifacial spasm and blepharospasm.

Potential RNA polymerase II-induced interactions of transcription factor TFIIB

The ubiquitous transcription factor TFIIB is required for initiation by RNA polymerase II and serves as a target of some regulatory factors. The carboxy-terminal portion of TFIIB contains a large imperfect direct repeat reminiscent of the structural organization of the TATA-binding component (TBP) of TFIID, as well as sequence homology to conserved regions of bacterial sigma factors. The present study shows that the carboxy-terminal portion of TFIIB, like that of TBP, is folded into a compact protease-resistant core. The TFIIB core, unlike the TBP core, is inactive in transcription but retains structural features that enable it to form a complex with promoter-bound TFIID. The protease-susceptible amino terminus appears to contain components responsible for direct interaction with RNA polymerase II (in association with TFIIF) either on the promoter (in association with TFIID) or independently. In addition, core TFIIB (but not intact TFIIB) extends the footprint of TBP on promoter DNA, suggesting that TFIIB has a cryptic DNA-binding potential. These results are consistent with a model in which TFIIB, in a manner functionally analogous to that of bacterial sigma factors, undergoes an RNA polymerase II-dependent conformational change with resultant DNA interactions during the pathway leading to a functional preinitiation complex.

Respiratory failure in the elderly. Analysis of outcome after treatment with mechanical ventilation

BACKGROUND

Concerns about rendering futile care, the financial costs of mechanical ventilation, and aging of the population make it important to analyze the benefit of aggressive therapy for respiratory failure in the elderly.

METHODS

This study is a retrospective review of 1860 patients treated with mechanical ventilation in the medical intensive care unit for more than 3 hours between 1974 and 1985. Patients were assigned to one of nine diagnostic groups, and 10 premorbid chronic illnesses or organ system dysfunctions were recorded. Survival to discharge was determined for all patients, and the duration of survival after discharge was determined for patients aged 80 years and older. Two hundred eighty-two patients aged 80 years and older were compared with 1578 patients less than 80 years of age.

RESULTS

Fifteen percent of patients treated with mechanical ventilation were 80 years of age or older. Forty-four percent of patients younger than 80 years, and 30.9% of patients aged 80 years and older survived to discharge. Patients aged 80 years or older with preexisting renal disease, liver disease, cancer, systemic illness, or chronic gastrointestinal disease with malnutrition had only a 7% survival compared with 29% for younger patients. For patients without these premorbid conditions (80% of both the younger and older groups) survival among the elderly was better, even though it was still poorer than for younger patients (38% vs 49%). Elderly patients requiring more than 15 days of mechanical ventilation had a 9% survival compared with 36% for younger patients.

CONCLUSIONS

A subgroup of patients 80 years of age or older can be identified whose chance for survival from respiratory failure is so poor that withholding or withdrawing treatment with mechanical ventilation may be appropriate. For the majority of elderly patients, short-term survival is nearly as good as in younger patients. Further studies are needed that assess long-term survival and functional recovery after treatment for respiratory failure so that elderly patients and their physicians can better decide whether or not to choose treatment with mechanical ventilation.

Effect of age and preoperative airway obstruction on lung function after coronary artery bypass grafting

To determine whether age or obstructive lung disease affects pulmonary function changes caused by uncomplicated coronary artery bypass grafting, we measured pulmonary function before operation and then 3 or 4 days, 7 days, and 17 +/- 2.2 weeks after operation in elderly patients (age, 74.8 +/- 3.3 years) and patients with obstructive lung disease (ratio of forced expiratory volume in 1 second to forced vital capacity, 0.60 +/- 8.8) and compared the results with those of a "normal" group. In all three groups a severe restrictive defect developed on day 3 (vital capacity, 61% +/- 20% of the preoperative value). Vital capacity recovered to 76.4% +/- 18.5% of the preoperative value on day 7. Three months after coronary artery bypass grafting, lung function had recovered to preoperative baseline (p > 0.2). The percent change from baseline in vital capacity, forced expiratory volume in 1 second, total lung capacity, and diffusing capacity for carbon monoxide was the same in all three groups throughout the study. A severe, reversible restrictive pulmonary function change follows coronary artery bypass grafting. This change is not affected by age or preexisting moderately severe obstructive lung disease.

Effect of recombinant human erythropoietin on muscle energy metabolism in patients with end-stage renal disease: a 31P-nuclear magnetic resonance spectroscopic study

To evaluate the effects of recombinant human erythropoietin (r-HuEPO) on muscle energy metabolism in patients with end-stage renal disease (ESRD), 10 patients receiving maintenance hemodialysis were given r-HuEPO (3,000 U three times a week for 8 weeks). Intracellular phosphocreatine to inorganic phosphate ratios and pH were measured with 31P-nuclear magnetic resonance spectroscopy before and after all-out handgrip exercise, before treatment and at 4 and 8 weeks after r-HuEPO treatment. The same measurements, from 14 normal individuals also were studied for comparison. The hematocrit increased significantly with r-HuEPO treatment, although the dose of r-HuEPO did not correct it to the normal level. The exercise capacity improved significantly. Intracellular pH was not different between the ESRD patients and controls or between before and after r-HuEPO treatment. The phosphocreatine to inorganic phosphate ratio at the resting state improved significantly with r-HuEPO treatment, reaching the same level as the normal subjects even before the low hematocrit normalized. The measurements immediately after exercise were the lowest levels obtained (the nadir state) and were not different between groups. In the state of maximum recovery, a pattern was noted that was similar to that found in the resting state. These results showed that r-HuEPO treatment improved the phosphorylation potential during the resting state and the maximum phosphorylation potential during the postexercise recovery phase, and suggest that the treatment improved the rate of oxidative phosphorylation in ESRD patients receiving hemodialysis.