[Perioperative management of a child with congenital nephrogenic diabetes insipidus]

The key point in perioperative management of a patient with congenital nephrogenic diabetes insipidus is fluid and electrolytes management. Since the urine of these patients consists mainly of solute free water, replacement fluids should be fluids which provide free water. A 2-year-old girl with congenital nephrogenic diabetes insipidus was scheduled for dental extraction. Her daily fluid intake was 10 liter. She had a history of recurrent fever, polyuria and polydipsia since 2 months of age. Her previous perioperative course for gastric volvulus at another hospital was complicated with postoperative hyponatremia and convulsion. A venous line was secured the day before surgery and 5% dextrose in water was infused at a rate of 12 ml.kg-1.hr-1. Intraoperative infusion was mainly with 5% dextrose in water combined with maintenance fluid. Five hours after surgery oral intake was started. Her intraoperative electrolytes levels were low (Na 133 mEq.l-1, K 2.8 mEq.l-1), but otherwise her perioperative course was uneventful.

Genomic structure and transcriptional regulation of human Galbeta1,3GalNAc alpha2,3-sialyltransferase (hST3Gal I) gene

Previous studies have shown that hST3Gal I mRNA is overexpressed in colorectal cancer tissues and primary breast carcinoma compared with nonmalignant or benign tissue, suggesting that the transcriptional regulation of hST3Gal I gene is altered during malignant transformation. We report transcriptional regulation of the hST3Gal I gene in colon adenocarcinoma and leukemia cell lines. To determine the genomic structure of the 5'-untranslated region, we cloned and identified the 5'-untranslated region of hST3Gal I from a human genome library. The 5'-untranslated region was found to be divided into three exons, namely, exons Y, X, and C1. The transcription initiation sites map at -1035 bp from the translation initiation site. Our results indicate that the transcriptional regulation of hST3Gal I depends on the pI promoter that exists 5'-upstream of exon Y in these cell lines. The results of luciferase assay suggest that the nt -304 to -145 region is important for transcriptional activity of hST3Gal I gene in both cell lines. The nt -304 to -145 region contains two sequences similar to the Sp1 recognition elements (GC-box) and one USF binding site. The results of site-directed mutagenesis indicated that the Sp1 binding sites and USF binding site of the pI promoter are involved in the transcription of hST3Gal I mRNA. However, the triple mutant of these sites still exhibits about 50% transcriptional activity, suggesting that there are other transcription factors involved in the transcription of hST3Gal I mRNA. These results suggest that these factors may play a critical role in the up-regulation of the hST3Gal I gene during malignant transformation.

[Anesthetic management for the correction of pectus excavatum using pectus bar under video-assistance]

We report anesthetic management for a child undergoing Nuss operation, a minimally invasive operation which requires neither cartilage incision nor its resection for correction of pectus excavatum. The patient was a 7-year-old boy with the funnel index 5 and the mediastinal shift to the left. General anesthesia with endotracheal intubation was induced and maintained with nitrous oxide, sevoflurane and fentanyl. Thoracic epidural anesthesia was used with 0.125% bupivacaine to supplement analgesia. When the curved bar was passed under the sternum with the aid of an endoscope, sinus tachycardia occurred and continued for 5 minutes but subsided without medication. Otherwise operative course was uneventful with negligible blood loss. After surgery, the patient was kept at bed rest for 2 days, receiving epidural patient-controlled analgesia combined with sedation with midazolam with good results. He was allowed to sit 3 days, to walk 5 days and discharged 10 days postoperatively.

[A questionnaire-based survey on the Internet concerning optimal timing for knee surgery in a patient with rheumatoid arthritis]

To investigate the differences between orthopedists and internists in indications for surgical management in patients with rheumatoid arthritis (RA), a questionnaire-based survey was performed on the Internet with the presentation of a case of progressive RA along with serial X-ray films of the knee. Ninety-three doctors (43 orthopedists and 50 internists, average age: 49.2 years) answered the questionnaire. Most of the doctors who viewed the X-ray film showing Larsen's grade IV chose that as the optimal time for total knee arthroplasty. No difference was noted in their choice between orthopedists and internists. Opinions varied widely, however, among younger doctors, but there was agreement among older doctors, suggesting the effect of the study and experience. On the other hand, some doctors recommended arthroscopic synovectomy for knees in the earlier stages of RA, but others did not recommend the arthroscopic surgery itself. Although this new methodology might include possible biases, we believe it should be considered in the research of rheumatology.

Remnant-like particle cholesterol, triglycerides, and insulin resistance in nonobese Japanese type 2 diabetic patients

OBJECTIVE

The aim of the study was to investigate the relationships between remnant-like particle (RLP) cholesterol, triglycerides, and insulin resistance in nonobese Japanese type 2 diabetic patients.

RESEARCH DESIGN AND METHODS

A total of 86 nonobese Japanese type 2 diabetic patients (72 men and 14 women, aged 40-83 years, BMI 20.1-26.6 kg/m2) were studied. BMI, HbA1c levels, and fasting concentrations of plasma glucose, serum lipids (RLP cholesterol, total cholesterol, HDL cholesterol, and triglycerides), and serum insulin were measured. Insulin resistance was estimated by the homeostasis model assessment (HOMA-IR). The subjects were divided into two groups according to the value of HOMA-IR. Values >2.5 were indicative of the insulin-resistant state, and values <2.5 were indicative of the insulin-sensitive state.

RESULTS

The insulin-resistant group had significantly higher RLP cholesterol and triglyceride levels and lower HDL cholesterol levels compared with the insulin-sensitive group. Univariate regression analysis showed that insulin resistance was positively correlated with BMI (r = 0.254, P = 0.019), HbA1c levels (r = 0.278, P = 0.011), RLP cholesterol levels (r = 0.315, P = 0.004), and triglyceride levels (r = 0.332, P = 0.002) and was negatively correlated with HDL cholesterol levels (r = -0.301, P = 0.006) in our diabetic patients. Multiple regression analysis showed that insulin resistance was independently associated with serum triglyceride levels, which explained 13.5% of the variability of insulin resistance in our nonobese Japanese type 2 diabetic patients.

CONCLUSIONS

These results indicate that 1) nonobese Japanese type 2 diabetic patients with insulin resistance are characterized by high RLP cholesterol and triglyceride levels, and low HDL cholesterol levels; and 2) the level of serum triglycerides is an independent predictor of insulin resistance in these patients.

[Perioperative management of two neonates with severe Ebstein's anomaly with pulmonary atresia]

Ebstein's anomaly appearing during the neonatal period carries a high mortality rate. We report the perioperative management of two neonates with severe Ebstein's anomaly associated with pulmonary atresia. Their chest radiography revealed massive cardiomegaly, with cardiothoracic ratio of 90% and 100%, respectively. Their tracheas were intubated immediately after birth because of severe respiratory distress. The babies were laid in the prone position and one of them was managed with high frequency oscillatory ventilation (HFO) for prevention of pulmonary barotrauma and extensive atelectasis in the preoperative period. On the 4th and 3rd day after birth, respectively, they underwent Starnes procedure which consists of closure of tricuspid valve, enlargement of atrial septal defect, reduction of right atrium and creation of aortopulmonary shunt reported to be a useful palliative treatment for critically ill neonates with Ebstein's anomaly. Case 1 baby could not be weaned from cardiopulmonary bypass because of low cardiac output. Case 2 could not be weaned from extracorporeal membrane oxygenation due to hypoxia. We consider, however, treatment of respiratory failure and lung protection after birth are important for the prognosis. Perioperative use of HFO may be advantageous for the neonate with severe Ebstein's anomaly with pulmonary atresia.

Plasma concentrations of tumor necrosis factor-alpha (TNF-alpha) and soluble TNF receptors in patients with bulimia nervosa

BACKGROUND

Tumor necrosis factor-alpha (TNF-alpha) is a cytokine with numerous immunological and metabolic activities. In addition, TNF-alpha can stimulate a variety of physiological, neuroendocrine and behavioural responses of the central nervous system. In experimental animals, TNF-alpha induces changes in physiological and behavioural parameters which have also been observed in eating disorders. The biological activities of TNF-alpha are mediated by two structurally related, but functionally distinct receptors, TNF-RI and TNF-RII. Since injection of TNF-alpha results in increased shedding of TNF-alpha receptors, it is likely that TNF-alpha release is reflected by soluble TNF-receptors (sTNF-Rs) levels.

AIMS

We studied plasma concentrations of TNF-alpha and two sTNF-Rs (sTNF-RI and sTNF-RII) in female patients with bulimia nervosa.

DESIGN AND PATIENTS

Twenty female patients with bulimia nervosa (BN) and 20 age-matched normal women (N) were studied.

MEASUREMENTS

Plasma TNF-alpha concentrations were measured by enzyme immunoassay kit and plasma concentrations of sTNF-RI and sTNF-RII were measured by enzyme-linked immunosorbent assay.

RESULTS

Plasma TNF-alpha concentrations in BN were significantly higher than those in N (4.7+/- 0.5 ng/l vs. 1.6+/-0.1 ng/l; P<0.01). Although no significant difference was observed in plasma sTNF-RI concentrations between the two groups, plasma sTNF-RII concentrations in BN were significantly higher than those in N (2080.0+/-107.5 ng/l vs. 1569.5 +/-84.0 ng/l; P<0.01). Plasma TNF-alpha concentrations were significantly related to plasma sTNF-RI concentrations (r = 0.511, P<0.05) and to plasma sTNF-RII concentrations (r = 0.532, P<0.05) in bulimic patients. However, plasma TNF-alpha concentrations were not related to body fat mass or to bulimic behaviours in these patients.

CONCLUSIONS

Our present findings suggest that the adipose tissue may not be the immediate source of TNF-alpha in bulimic patients but the increase in plasma TNF-alpha in these patients may be derived from the central nervous system sources. The elevated sTNF-RII may reflect different shedding kinetics compared with sTNF-RI in bulimic patients.

Immunohistochemistry of advanced glycation end products in neurofilamentous axonal spheroids induced by beta-beta'-iminodipropionitrile in lower motor neurons of rat

Chronic parenteral administration of beta-beta'-iminodipropionitrile (IDPN) in adult female rats induces large neurofilament-rich axonal spheroids (AXS) in spinal motor neurons closely resembling those AXS in early phases of amyotrophic lateral sclerosis. Immunohistochemistry of advanced glycosylation end-products (AGEs) in axonal spheroids was performed in the present study. Anti-AGE and anti-neurofilament antibodies strongly co-labeled IDPN-induced axonal spheroids, whereas motor neuron soma showed little AGE immunoreactivity. In an attempt to modify and intensify glycosylation, another group of IDPN rats was made hyperglycemic with streptozotocin after IDPN intoxication. These hyperglycemic rats showed AXS with striking AGE immunoreactivity. An additional group of rats made hyperglycemic before IDPN intoxication showed markedly diminished AXS formation, with a few small AGE-positive AXS in anterior horns. Findings suggest that AGEs are involved in neurofilament crosslinking as well as disassembly of neurofilament induced by IDPN with or without hyperglycemia. Hyperglycemia did not intensify neurofilament aggregation. Additional immunohistochemistry revealed not only aberrant phosphorylation, but also intense local production of Cu/Zn superoxide dismutase and nitrotyrosine in axonal spheroids, probably secondary to superoxide generation as a consequence of AGE production at neurofilament protein, impeding its assembly as hypothesized in motoneuron diseases.

A hamster model of equine herpesvirus 9 induced encephalitis

An acute and lethal infection of equine herpesvirus 9 (EHV-9), a new type of equine herpesvirus, was established in Syrian hamsters by intranasal inoculation. Clinical symptoms included the loss of body weight, nasal and ocular discharges and apparent neurological symptoms. Both LD50 and ID50 were equal at 33 plaque forming units. Histological and immunohistochemical examination demonstrated that the virus replicated in the olfactory mucosal cells and in the neurons of the olfactory bulbs, cerebrum and mesencephalon. The induction of encephalitis by intranasal but not by other routes of inoculation (i.v., i.p., i.m.) indicated that EHV-9 entered the brain via the olfactory nerve and then spread trans-synaptically to connecting neurons along the olfactory tract. This animal model should be useful for studying the pathogenesis and neurovirulence of this newly discovered neurotropic virus as well as other neurotropic herpesviruses.

The role of the body mass index and triglyceride levels in identifying insulin-sensitive and insulin-resistant variants in Japanese non-insulin-dependent diabetic patients

Using the minimal model approach shown by Bergman, our group had previously shown 2 variants among non-obese mildly diabetic patients, one with normal insulin sensitivity and the other with insulin resistance. The present study examines whether these 2 variants exist in the ordinary Japanese non-insulin-dependent diabetes mellitus (NIDDM) population and compares the clinical profile between the 2 discrete forms of NIDDM. In addition, we investigated the factors responsible for insulin resistance observed in Japanese NIDDM populations. One hundred eleven untreated Japanese NIDDM subjects (fasting glucose < 10 mmol/L) were assessed for insulin action (homeostasis model assessment [HOMA-IR] = fasting serum insulin (microU/mL) x fasting plasma glucose (mmol/L)/22.5) and the fasting lipid profile. Sixty percent of these patients had normal insulin sensitivity (HOMA-IR < 2.5). The insulin-resistant patients had higher serum cholesterol (188.1 +/- 5.2 v 182.2 +/- 3.9 mg/dL, P> .05) and low-density lipoprotein (LDL) cholesterol (501.2 +/- 16.7 v 469.4 +/- 14.8 mg/dL, P > .05) than the insulin-sensitive patients, but the difference was not statistically significant. In contrast, the former group had a significantly higher body mass index ([BMI] 26.6 +/- 0.8 v 21.7 +/- 0.4 kg/m2, P < .0001) and higher serum triglycerides (181.0 +/- 16.4 (range, 79 to 545) v 95.1 +/- 4.1 (range, 36 to 204) mg/dL, P < .0001) and lower high-density lipoprotein (HDL) cholesterol (47.2 +/- 1.7 v 58.2 +/- 2.5 mg/dL, P < .005) than the latter group. HOMA-IR was related to the BMI. Fifteen of 17 (88%) NIDDM patients with a BMI greater than 27.0 were insulin-resistant, whereas 35 of 38 (92%) NIDDM patients with a BMI less than 21.5 were insulin-sensitive. In the midrange BMI (21.5 to 27.0 kg/m2), patients were equally likely to be insulin-resistant or insulin-sensitive. Analysis of the midrange BMI group showed that HOMA-IR was associated with serum triglycerides (P < .0001) but not with the BMI. These data suggest the following conclusions: (1) Japanese NIDDM patients can be classified into 2 populations, one with normal insulin sensitivity and the other with insulin resistance; (2) NIDDM patients with normal insulin action have a low cardiovascular disease risk factor, whereas those with insulin resistance have a markedly increased cardiovascular disease risk factor; and (3) the BMI and serum triglyceride level per se are associated with insulin action in Japanese NIDDM populations.

Direct measurement of mammographic x-ray spectra using a CdZnTe detector

Our purpose is to directly measure mammographic x-ray spectra with collimators and a low-efficiency CdZnTe detector developed recently and to find out the best fit response function of CdZnTe detector to correct the measured spectra. Photon spectra (target Mo or Rh) produced by a mammographic x-ray unit at 25-32 kV and 240 mAs (= 3 times of 80 mAs) and transmitted through 0.03 mm Mo or 0.025 mm Rh filter and object (0.1 mm Al to 0.8 mm Al phantoms) have been analyzed. Since detected spectra were distorted by the response of CdZnTe detector and did not present the true photon spectra, the correction was applied by the stripping procedure. The response function of detector used in this procedure has been determined by the evaluation of interactions (K-escape, coherent scattering, and Compton scattering processes) and incomplete charge collection calculated using the Monte Carlo method. We have used Kalpha1, Kalpha2, Kbeta1, Kbeta2 radiations of Cd, Zn, and Te, respectively and have used the weight function for the incomplete charge collection and have considered Compton scattering. The Monte Carlo simulations were continued by changing the important factors (mean path length of hole lambda(h), dead layer of the CZT crystal and weight factor Wq) of incomplete charge collection until the best fit response function was found out. Corrected photon spectra were compared with the mammographic x-ray spectral data of Bureau of Radiological Health (BRH) measured using a Ge detector. Attenuation curves of aluminum for 25-32 kV were calculated from the corrected photon spectra and compared with the attenuation curves measured using an ionization chamber. These results obtained using the CdZnTe detector agreed with the mammographic x-ray spectral data of BRH and attenuation curves obtained by the ionization chamber.

[Cesarean section in a pregnant patient with placenta percreta involving the urinary bladder]

Placenta percreta involving adjacent structures is serious complication of pregnancy with a high mortality rate. A 32-year-old woman, gravida 4, para 3, who had previously undergone a cesarean section, was admitted to our hospital at 31 weeks' gestation for placenta previa. At 33 weeks' gestation, the diagnosis of placenta percreta with involvement of the urinary bladder was made by ultrasonography and magnetic resonance imaging. At 34 weeks' gestation, an elective cesarean section was scheduled. Anesthesia was maintained with sevoflurane in oxygen before delivery, and with nitrous oxide in oxygen, fentanyl and midazolam after delivery. During the operation, attempts to remove the placenta resulted in massive hemorrhage. Blood loss for the procedure was 13,800 g. Because of the extreme hemorrhage, we encountered hemorrhagic shock and postoperative complications despite the preoperative preparation. In case of placenta percreta, it is essential to prepare adequate volume of blood for transfusion at the start of surgery and secure large bore intravenous lines. A rapid transfusion device may be recommended. Regarding the anesthetic management, general anesthesia is preferable in consideration of the risk of hemorrhagic shock and the length of operation time. Furthermore, we need team approach and preoperative management to prevent the uncontrolled hemorrhage in such a severe case.

Expression and transcriptional regulation of the human alpha1, 3-fucosyltransferase 4 (FUT4) gene in myeloid and colon adenocarcinoma cell lines

In fucosyltransferase genes, mRNA expression is regulated in a cell-type-specific manner. The expression level of human fucosyltransferase 4 (FUT4) mRNA is high in both colon adenocarcinoma and myeloid cell lines. We will demonstrate here cell-specific expression and transcriptional regulation of the FUT4 gene. FUT4 has two different transcription initiation sites that respectively produce long- and short-form mRNAs. To determine the major FUT4 transcript in colon adenocarcinoma and myeloid cell lines, we analyzed the transcriptional starting sites of the FUT4 gene in myeloid and colon adenocarcinoma cell lines, using 5'-RACE, RT-PCR, and luciferase analysis. The results suggested that the expression level of short-form mRNA is higher than the long-form transcript in the colon adenocarcinoma cell lines and that the expression level of long-form mRNA is higher than the short-form transcript in the myeloid cell lines. Using a luciferase assay, we identified a functional DNA portion within FUT4 genomic DNA that confers a colon adenocarcinoma cell line-specific enhancer, located in nucleotide number (nt) -256 to -44, and a myeloid cell line-specific enhancer, located in nt -686 to -582. The present results suggest that these elements play a critical role in the colon adenocarcinoma and leukemia cell-specific transcriptional regulation of the FUT4 gene.

Transcriptional regulation of human beta-galactoside alpha2, 6-sialyltransferase (hST6Gal I) gene during differentiation of the HL-60 cell line

We have previously shown that the expression of beta-galactoside alpha2,6-sialyltransferase (hST6Gal I) mRNA decreases during HL-60 differentiation induced with dimethyl sulfoxide (DMSO) and that transcriptional regulation depends on the P3 promoter that exists 5'-upstream of exon Y (A. Taniguchi et al., FEBS Lett.,441, 191-194, 1998). The regulation of hST6Gal I may be important for the expression of sialyl-Le(x)in HL-60 cells. In the present report, we studied the transcriptional regulation of hST6Gal I gene during DMSO-induced differentiation of HL-60 cells. To elucidate the molecular basis of hST6Gal I gene expression, the genomic region containing the P3 promoter of hST6Gal I was isolated and functionally characterized. Using a luciferase assay, we identified a functional DNA portion that confers an enhancer, located at nucleotide number (nt) -317 to -174 within the P3 promoter of hST6Gal I genomic DNA. This element contains two sequences similar to Sp1 (GC-box) and one sequence similar to Oct-1 recognition motifs (octamer sequence). Site-directed mutagenesis of Sp1 and Oct-1 sites showed that two Sp1 motifs and one Oct-1 motif are essential for transcriptional activity in HL-60 cells. Enhancer activity is suppressed during HL-60 cell differentiation induced with DMSO. These results suggest that GC-box and octamer sequence may play a critical role in the transcriptional regulation of the hST6Gal I gene during HL-60 cell differentiation.

Sleep apnea syndrome in patients with pulmonary thromboembolism

Seven patients (one man and six women) with a diagnosis of pulmonary thromboembolism (PTE) were examined by polysomnography in order to clarify the relationship between sleep-related breathing disorders and PTE. In the chronic stage of PTE, sleep apnea syndrome (SAS) was recognized in two patients (a man and a woman) among the subjects. Four of the five patients without SAS showed nocturnal hypoxemia. The female predominance was different from ordinary SAS without the disease background of PTE even though PTE is accompanied by hypoxemia and pulmonary hypertension like SAS. A pathophysiological relationship between PTE and SAS was not found in this study.

Decrease in cell surface sialic acid in etoposide-treated Jurkat cells and the role of cell surface sialidase

The present study investigated the mechanism underlying alterations of cell surface sugar chains of Jurkat cells by inducing apoptosis with etoposide, an inhibitor of topoisomerase II. Within 3 h of etoposide treatment, flowcytometric analysis revealed a decrease in Maackia amurensis agglutinin recognized alpha2,3-linked sialic acid moieties and an increase in Ricinus communis agglutinin recognized galactose. The results suggested that asialo-sugar chains on glycoconjugates were rapidly induced on the etoposide-treated cell surface. To clarify the desialylation mechanism, we studied alpha2,3-sialyltransferase mRNA expression and the activity of sialidase on the cell surface during etoposide-induced apoptosis. The expression of hST3Gal III and hST3Gal IV mRNAs were down-regulated and sialidase activity on the cell surface increased threefold within 2 h of etoposide treatment. Moreover, the decrease in alpha2,3-linked sialic acid levels was significantly suppressed in the presence of 2,3-dehydro-2-deoxy-N-acetylneuraminic acid, an inhibitor of sialidase. These results suggested that activation or exposure of sialidase on the cell surface was induced by etoposide treatment and was the main cause of the decrease in sialic acids.

Serum matrix metalloproteinase 3 as a predictor of the degree of joint destruction during the six months after measurement, in patients with early rheumatoid arthritis

OBJECTIVE

To evaluate whether matrix metalloproteinase 3 (MMP-3), a proteinase that is expressed in rheumatoid synovial tissue and shows potent activity in degrading the proteoglycan of cartilage, plays a pivotal role in the joint destruction seen in early rheumatoid arthritis (RA).

METHODS

In a prospective study of patients with early RA, the relationship between the serum concentration of MMP-3, as determined by a sandwich enzyme immunoassay system, and the progression of joint destruction in patients with early RA, as measured by the Larsen radiologic score, was investigated.

RESULTS

Serum MMP-3 levels were elevated in the RA patients compared with healthy controls, not only in the late stage, but also in the early stage of the disease in patients whose duration of RA was <4 months. The serum MMP-3 level at entry into the study had a strong correlation with the Larsen score at 6 months and 12 months after entry (r = 0.58 and r = 0.49, respectively). Similarly, the serum MMP-3 level at 12 months and 24 months after entry showed a positive association with the Larsen score in the subsequent 6-12 months. Suppression of the serum MMP-3 level in the first year led to a decline in joint damage in the second year.

CONCLUSION

The serum concentration of MMP-3 is a useful marker for predicting bone damage in the early stage of RA, and the suppression of MMP-3 production may be an effective therapeutic approach for patients with early RA.

Pathogenicity of a new neurotropic equine herpesvirus 9 (gazelle herpesvirus 1) in horses

Pathogenicity of equine herpesvirus 9 (EHV-9), a new type of equine herpesvirus isolated from Gazella thomsoni, in horses was investigated by intranasal inoculation of EHV-9 (10(7) pfu) to two conventionally reared 8-months old half-bred weanling horses. Fever higher than 39 degrees C was recorded. Virus was recovered from nasal swabs and peripheral blood mononuclear cells. Both horses developed neutralizing antibody to EHV-9. Perivascular infiltration of mononuclear cells and glial reaction were found in the olfactory and limbic systems. The results suggested that EHV-9 has a pathogenicity in horses.

Down-regulation of human Galbeta1,3GalNAc/Galbeta1,4GlcNAc alpha2,3-sialyltransferase (hST3Gal IV) gene during differentiation of the HL-60 cell line

We studied the regulation of the human Galbeta1, 3GalNAc/Galbeta1,4GlcNAc alpha2,3-sialyltransferase (hST3Gal IV) gene during HL-60 cell differentiation induced by dimethyl sulfoxide (DMSO), all trans-retinoic acid (ATRA), and phorbol myristate acetate (PMA). During differentiation, levels of hST3Gal IV mRNA dramatically decreased after 1 day of stimulation. Reverse-transcription PCR identified two mRNA isoforms, types B1 and BX, in HL-60 cells. The results of luciferase assays showed that the level of B3 promoter activity is high, whereas A1/2 and B2 promoter activities are low in HL-60 cells, suggesting that type B1, BX, and B3 mRNA isoforms are expressed in HL-60 cells. A luciferase assay identified a functional DNA portion within the proximal region of the B3 promoter that confers negative transcriptional regulation on the hST3Gal IV B3 promoter during HL-60 differentiation. These results suggest that this element plays a critical role in down-regulating the B3 promoter activity during HL-60 cell differentiation.

Triplet State of Würster's Blue-Based Di(cation radical)

[reaction: see text] N,N-bis[4-(dimethylamino)phenyl]-N,N'-dimethyl-1,3-benzenediamine was prepared in order to investigate the corresponding Würster blue-based di(cation radical). The generated diradical was found to be a ground-state triplet, and moreover, the observed ESR spectrum had no definite fine structure, suggesting a mixture of some conformers.

[A new bite block also serving as an endotracheal tube holder for infants]

We developed a new type of bite block with a combined function as an endotracheal tube (ETT) holder for infants and small children to prevent airway troubles caused by tube kinking, dislodging, extubation and oral membrane trauma. One mm thick plastic plate sized 3.5 x 2 cm was curved to make an open roll. The outer surface of the roll was covered and glued with soft plastic tube (5.0 mm ID endotracheal tube), cut in 3.5 cm length to give an elastic outer surface for the patient's comfort. The rolled ends were diagonally cut to make an oblique slit of 3 mm width. A t-shaped flange made of soft vinyl plate was fixed at a third of the length of the roll to maintain the block's position relative to the lips and to make the fixation of the tube easier. In practical use, after endotracheal intubation is performed as usual, this bite block is put into the mouth and positioned at the oral angle with the flange on the patient's skin. The ETT is fit into the slit of the roll. The skin-facing surface of the flange is pasted to the skin with the double stick material usually used for colostomy stoma. The ETT and the bite block are fixed en bloc with fixing tapes around the mouth. Our bite block has following advantages over other types of bite blocks and tube holders especially for children; 1) the volume of foreign bodies (ETT and bite block) occupying the oral cavity can be reduced and this attenuates the patient's discomfort, 2) good holding of the ETT can prevent its dislodging and decrease the incidence of accidental extubation and 3) suctioning is easier because of wide oral space. The four sizes of the bite block suitable for 4.0, 4.5, 5.0, 5.5 and 6.0 mm ID ETTs are manufactured. We applied this device to several ICU patients and found its use practical and safe.

[A case of systemic lupus erythematosus complicated by Nocardia farcinica]

We report a patient with systemic lupus erythematosus (SLE) complicated with nocardiosis. This case is very important that the complication of nocardiosis in SLE is very rare and the treatment to both SLE and nocardiosis is very difficult. A twenty-one-year old female was admitted to our hospital because of thoracic empyema and active lupus nephritis. Her medical history revealed that the diagnose of SLE was made when she was 18 with lymphocytopenia, proteinuria, positive antinuclear antibodies, and high titer of antibodies to native DNA. She was treated with prednisolne 60 mg daily and became better. Proteinuria appeared again in September 1995 and she was admitted to the former hospital. Renal biopsy proved diffuse proliferative glomeluronephritis (WHO IVb). She was treated with 1 g per day of methylprednisolone for 3 days and succeeded with 60 mg day of prednisolone. In early November she developed left chest pain and fever and chest X-ray demonstrated left pleural effusion. Antibiotics, antituberculosis, and antifungal therapy failed to subside her pleuritis and it turned to empyema. Then she was transferred to our hospital for further treatment. Nocardia farcinica was detected from the aspirated pleural fluid obtained at the former hospital. Drainage and intrathoracic impenem injection were effective. While long usage of minocycline was continued for the nocardiosis, 500 mg of cyclophosphamide pulse therapy to lupus nephritis was administrated. Two weeks later a new pulmonary lesion with left chest pain and liver abscess developed. Administration of trimethoprim-sulfamethoxazole subsided the nocardiosis. She was discharged with 1 g per day of proteinuria the prescribed 13 mg per day of prednisolone and continuous TMP-SMZ intake for nocardial infection. When immunosuppressive therapy must be given to the immunocompromised host, a more potent therapy must be added to avoid infection.

Epithelial-cell-specific transcriptional regulation of human Galbeta1,3GalNAc/Galbeta1,4GlcNAc alpha2,3-sialyltransferase (hST3Gal IV) gene

The mRNA expression of the sialyltransferase genes is regulated in a cell type specific manner. We show here the epithelium cell-specific transcriptional regulation of the human Galbeta1, 3GalNAc/Galbeta1, 4 GlcNAc alpha2,3-sialyltransferase gene (hST3Gal IV). Using a luciferase assay, we identified a functional DNA portion within hST3Gal IV genomic DNA that confers an epithelial cell line specific enhancer, located in nucleotide number (nt) -520 to -420 within the B3 promoter. This element contains two sequences similar to AP2 recognition motifs. Co-transfection with an AP2 expression vector stimulated the enhancer activity of nt -520 to -420 element eight-fold compared with that using parental vector. Site-directed mutagenesis of AP2 sites showed that two AP2 motifs are essential for enhancer activity in HeLa cells. These results suggest that AP2 plays a critical role in the epithelium-cell specific transcriptional regulation of the hST3Gal IV gene.

A new modification of anaesthesia mask for fibreoptic intubation in children

We made a paediatric anaesthesia mask suitable for fibreoptic intubation by modifying a commercially available disposable mask with a ventilation port (Vent port) on a side. We added a large fibreoptic port (FO port, 22 mm in ID) in the middle of the mask to allow the passage of all sizes of paediatric tracheal tubes. This FO port was covered with an elastic rubber membrane to allow air-tight fibrescopic manipulation Fibreoptic intubation was performed safely through the FO port under continuous manual ventilation with anaesthetic gases via a Vent port connected to the breathing circuit. We succeeded in tracheal intubation in several infants and children with difficult airway in less than ten min, mainly via the nasotracheal route. This fibreoptic mask provides a safer technique for fibreoptic intubation in patients with difficult airways, especially in infants and small children.

Plasma concentrations of tumor necrosis factor-alpha (TNF-alpha) and soluble TNF receptors in patients with anorexia nervosa

Tumor necrosis factor-alpha (TNF-alpha) is a cytokine with numerous immunological and metabolic activities. To study the role of TNF-alpha on the pathophysiology of anorexia nervosa and its complications, plasma concentrations of TNF-alpha, 2 soluble TNF receptors (sTNF-RI and sTNF-RII), and leptin were measured in 20 female patients with anorexia nervosa (AN) and 20 age-matched normal women (N). Plasma TNF-alpha concentrations in AN were significantly higher than those in N (4.1 +/- 0.6 pg/mL vs. 1.6 +/- 0.1 pg/mL; P < 0.01). Although no significant difference was observed in plasma sTNF-RI concentrations between the two groups, plasma sTNF-RII concentrations in AN were significantly higher than those in N (2094.0 +/- 138.5 pg/mL vs. 1569.5 +/- 84.0 pg/mL; P < 0.01). Plasma concentrations of TNF-alpha and sTNF-RII after treatment of 8 anorectic patients were not different from those before treatment, although body fat mass and plasma leptin concentrations significantly increased after treatment. Plasma TNF-alpha concentrations were not related to body fat mass in anorectic patients. These results suggest that the adipose tissue may not be the immediate source of TNF-alpha in anorectic patients and that TNF-alpha may contribute to the pathophysiology of immunological and metabolic abnormalities in anorexia nervosa.

Human mannose-binding lectin preferentially binds to human colon adenocarcinoma cell lines expressing high amount of Lewis A and Lewis B antigens

The binding of human mannose-binding lectin (MBL) to human colon adenocarcinoma cell lines and leukemia cell lines was analyzed by flow cytometry using specific antibodies against MBL. MBL binding was observed in 3 of 7 colon adenocarcinoma cell lines (Colo205, Colo201 and DLD-1), but not in any of 3 leukemia cell lines tested. The binding of MBL to these cell lines was sugar-specific and calcium-dependent, since it was almost completely inhibited in the presence of 10 mM EDTA or 50 mM mannose. The MBL binding to Colo205 cells was more strongly reduced by the pretreatment of the cells with an O-linked glycosylation inhibitor, benzyl-2-acetamide-2-deoxy-alpha-galactopyranoside (Bz-alpha-GalNAc), rather than an N-linked glycosylation inhibitor, tunicamycin. The degree of MBL binding was well correlated with the expression of Lewis A and Lewis B antigens on these cell lines. Moreover, MBL binding to Colo205 cells was inhibited by anti-Lewis A and anti-Lewis B antibodies. These results suggest that MBL could bind to some human colon adenocarcinoma cell lines through their Lewis A and Lewis B moieties.

Differentiation elicits negative regulation of human beta-galactoside alpha2,6-sialyltransferase at the mRNA level in the HL-60 cell line

We studied the regulation of the beta-galactoside alpha2,6-sialyltransferase (hST6Gal I) gene during HL-60 cell differentiation induced with dimethyl sulfoxide (DMSO), all transretinoic acid (ATRA), and phorbol myristate acetate (PMA). During HL-60 cell line differentiation, cell surface levels of alpha2,6-sialic acids expression decreased, as measured by flow cytometric analysis using Sambucus nigra agglutinin (SNA). Activities of hST6Gal I and levels of hST6Gal I mRNA dramatically decreased after 1 day of stimulation. Using reverse transcription polymerase chain reaction (PT-PCR), we found the major hST6Gal I mRNA isoform in HL-60 cells contains 5'-untranslated exons Y and Z. These results suggest that the expression of cell surface alpha2,6-sialic acids is controlled at the mRNA level, which is regulated by a promoter located 5'-upstream of exon Y.

[Perinatal and perianesthetic management of the sacrococcygeal teratoma in a neonate]

We report perinatal and perianesthetic management of a female infant with sacrococcygeal teratoma who underwent fetal bladder puncture and postnatal tumor resection. At 33 weeks' gestation, fetal ultrasonography revealed an intrapelvic mass, oligohydramnios and the dilatation of the bladder. At 34 weeks' gestation, bladder puncture was performed in utero to relieve urinary obstruction by the mass. And it served to reserve the renal function but caused remarkable ascites at birth due to urine leakage to the peritoneum through the puncture site. After the delivery by cesarean section, the patient underwent the tumor extirpation at 2 days of life. The operation and anesthesia proceeded uneventfully. In previous reports, several mortalities due to exsanguinating hemorrhage during surgery have been reported. In addition, sacrococcygeal teratoma is occasionally accompanied by coagulopathy and high output cardiac failure caused by arteriovenous fistulae. Therefore it is important for good patient outcomes to evaluate preoperatively the risks mentioned above.

Serpin=serine protease-like complexes within neurofilament conglomerates of motoneurons in amyotrophic lateral sclerosis

Neurofilamentous conglomerates (NfCg), as axonal spheroids or conglomerates in motoneurons, are the histopathologic hallmarks for early stages of amyotrophic lateral sclerosis (ALS). We hypothesize that NfCg may be formed by post-translational modifications of altered Nf proteins that include: (1) hyperphosphorylation, (2) glycosylation (or glycoxidation), (3) nitration, (4) ubiquitination and/or (5) crosslinking by the Ca++-dependent transglutaminase (TGase). These, as well as other changes, are predicted to be initiated or accentuated by oxidative damage. The damaged Nf proteins then activate cascades of intracellular protein degradation which include ATP-dependent ubiquitin/proteasome proteolysis. Other proteolytic systems, either Ca++-dependent or independent, may also be activated, such as serine and cysteine protease systems. These enzymes, either lysosomal or non-lysosomal may also participate in the degradation of damaged Nf proteins being balanced by their cognate inhibitors. Protein complexes formed by these protease=inhibitor systems, along with damaged Nf proteins, may accumulate within the cell bodies as neuronal inclusions, since a number of intracellular inclusions are found in motor neurons in ALS. In the current study, we investigated the involvement of serine proteases and their serpins in NfCg formation. Pairs of three serine proteases (trypsin, chymotrypsin and thrombin) and their cognate serpins (alpha1-anti-trypsin, alpha1-anti-chymotrypsin, and protease nexin I) were probed in motoneurons with their antibodies for both NfCg and inclusions. Positive immunoreactivities for all serine proteases and their cognate serpins support the contention that the imbalance of serine proteases and internalized serpins may have a role in formation of NfCg and inclusions, and hence, the pathogenesis of ALS.

Acute sympathetic hyperfunction in overlapping syndromes of systemic lupus erythematosus and polymyositis

A 20-year-old woman with arthralgia, serositis, thrombocytopenia, proteinuria, muscle weakness, elevated creatinine kinase, and positive anti-Sm antibody was diagnosed as having polymyositis and systemic lupus erythematosus (SLE). She had persistent high temperature, sinus tachycardia, hyperhidrosis, mydriasis, visual disturbance, hallucination, and loss of consciousness. Levels of plasma adrenaline, noradrenaline, and dopamine and cerebrospinal fluid interleukin (IL)-6 and IL-8 were all high. A diagnosis of sympathetic hyperfunction accompanied by central nervous system (CNS) involvement in SLE was made parenteral. Pulse administration of high dose corticosteroid therapy was effective. This is the first reported case of a connective tissue disease with CNS involvement manifesting as sympathetic hyperfunction with high plasma catecholamine levels.

[Lupus cystitis and peritonitis successfully treated with intravenous cyclophosphamide pulse therapy: a case report]

The patient, a 35-year-old woman, had been diagnosed as SLE since she developed butterfly rash, arthritis and hair loss with positive antinuclear antibody, anti-DNA antibody, and LE cells in 1989, and treated with daily 20 mg prednisolone (PSL). She had been suffering from nausea, vomiting and waterly diarrhea since 1992. In June 1995, she noted pollakisuria and sense of residual urine, followed by dysuria and nocturia in October. She was admitted to our hospital in January 1996 with progressive gastrointestinal and urinary symptoms. Computerized tomography (CT) depicted thickening of the wall of intestine and bladder, diminished volume of bladder, and bilateral hydronephrosis and hydroureter. Biopsy of the bladder revealed erosion of mucosa and moderate infiltration with inflammatory cells. The diagnosis of lupus cystitis and peritonitis was made and she was initially given intravenous methylprednisolon pulse therapy (500 mg/day) for 3 days, and then switched to 100 mg of daily intravenous PSL. She responded partially to this regimen, but gradually developed gastrointestinal and urinary symptoms again when PSL was tapered down to 70 mg/day. Therefore, monthly intravenous cyclophosuphamide pulse therapy was started. With this therapy, her bladder and bowel symptoms improved, and then the thickness of her bladder and intestinal wall, and the bladder volume normalized. Five months after institution of therapy, PSL was successfully tapered down to 30 mg/day and she was discharged. Intravenous cyclophosphamidepulse therapy is a choice of treatment for steroid-resistant lupus cystitis and peritonitis.

Intravenous glucose tolerance test-derived glucose effectiveness in strength-trained humans

The effect of long-term strenuous resistance training on glucose effectiveness (SG) was examined by comparing 11 strength-trained and 20 sedentary males by a minimal model approach. Lean body mass (LBM) was measured by hydrostatic weighing. The LBM in strength-trained subjects (65.7 +/- 3.1 kg) was significantly larger than in sedentary subjects (56.6 +/- 1.2 kg, P < .01). The glucose disappearance constant ([KG] 3.07% +/- 0.45% min(-1)) and insulin sensitivity ([SI] 17.5 +/- 2.0 x 10(-5) x min(-1) x pmol/L(-1)) in strength-trained subjects were significantly higher than in sedentary subjects (2.06% +/- 0.14% x min(-1) and 10.3 +/- 1.2 x 10(-5) x min(-1) x pmol/L(-1), P < .05). SG in strength-trained subjects (0.024 +/- 0.003 min(-1)) was significantly higher than in sedentary subjects (0.018 +/- 0.001 min(-1), P < .05). These results thus suggest that the improved glucose tolerance in strength-trained subjects was due to increased SG and SI.

Advanced glycation endproducts in neurofilament conglomeration of motoneurons in familial and sporadic amyotrophic lateral sclerosis

BACKGROUND

Massive neurofilament conglomeration in motor neurons has been described to occur in the early stages of both familial and sporadic amyotrophic lateral sclerosis (ALS). Previously, neurofilament conglomerates were immunolabeled for both superoxide dismutase (SOD1) and nitrotyrosine, suggesting the potential for oxidative nitration damage to neurofilament protein by peroxynitrite. Long-lived neurofilaments may also undergo modification by advanced glycation endproducts (AGEs) with concomitant generation of free radicals, including superoxide. This radical species may then react with nitric oxide to form the potent oxidant, peroxynitrite, which in turn can nitrate neurofilament protein. Such a glycated and nitrated neurofilament protein may become resistant to proteolytic systems, forming high-molecular-weight protein complexes and cytotoxic, neuronal inclusions.

MATERIALS AND METHODS

Paraffin sections containing both neurofilament conglomerates and neuronal inclusions were obtained from patients with sporadic (n = 5) and familial (n = 2) ALS and were probed with specific antibodies directed against the AGEs cypentodine/piperidine-enolone, arginine-lysine imidazole, pentosidine, and pyrraline.

RESULTS

Neurofilament conglomerates, but not neuronal inclusions, were intensely immunolabeled with each of the anti-AGE antibodies tested. The immunoreactivity was selective for neurofilament conglomerates and suggested that AGEs may form inter- or intramolecular cross-links in neurofilament proteins.

CONCLUSIONS

These data support the hypothesis that AGE formation affects neurofilament proteins in vivo and is associated with the concomitant induction of SODI and protein nitration in neurofilament conglomerates. AGE formation in neurofilament protein may not only cause covalent cross-linking but also generate superoxide and block nitric oxide-mediated responses, thereby perpetuating neuronal toxicity in patients with ALS.

Establishment of ameloblastoma cell line, AM-1

Ameloblastomas are slowly growing, locally invasive neoplasms with a potentially destructive behaviour. The molecular mechanisms that regulate the cell growth and invasion of ameloblastoma cells are unknown. Because ameloblastoma cells placed in culture have a very limited lifespan, the establishment of immortalized clones of ameloblastoma cells would aid its study. We produced an immortalized ameloblastoma cell line (AM-1) using human papillomavirus type-16. This cell line maintains epithelial cell morphology and expresses cytokeratins K8, K14, K18, K19. Furthermore, bcl-2 protein, which prevents apoptosis, is expressed. We investigated the behaviour of these cells on a collagen matrix in vitro. These cells grew in a monolayer over foci of collagen degradation and could invade the collagen gel at such sites. Since the behavior of cell line AM-1 mimics the behavior of ameloblastoma in vivo, it may be a valuable model for the study of these neoplasms.

Ligand-dependent and -independent interactions with the transforming growth factor type II and I receptor subunits reside in the aminoterminal portion of the ectodomain of the type III subunit

The type III receptor for transforming growth factor beta (TGFbeta), which exhibits no kinase activity, binds TGFbeta1 and TGFbeta2 and is involved in assembly and activity of the multi-subunit TGFbeta signal transduction complex. Recently we showed that TGFbeta receptor type III (TbetaRIII) can participate in a complex composed of the dimeric TGFbeta ligand and a type III, II, and I receptor subunit. The interaction of the TbetaRIII subunit with TbetaRII is TGFbeta-dependent, whereas interaction with TbetaRI is TGFbeta-independent. Here we use coexpression of the three types of TGFbeta receptors in baculoviral-infected insect cells to determine which parts of the unglycosylated TbetaRIII receptor participate in the binding of TGFbeta, the TGFbeta-dependent interaction with TbetaRII and the TGFbeta-independent interaction with TbetaRI. The results suggest that the first 500 amino acid residues in the aminoterminal portion of TbetaRIII exhibit all three properties.

Down-regulation of human sialyltransferase gene expression during in vitro human keratinocyte cell line differentiation

Sialic acids play important roles in biological processes, such as cell-cell communication and cell-matrix interaction. Histochemical analysis using PNA and LFA lectin has shown that the expression of alpha 2,3-sialic acid linked to Gal beta 1,3GalNAc is high in basal cells and decreases following further keratinocyte differentiation. In the present study, we used an in vitro keratinocyte cell line differentiation model to study expression of alpha 2,3-sialic acid linked to Gal beta 1,3 GalNAc. Treatment of the human papillomavirus type 16-immortalized human keratinocyte (PHK16) cell line with high concentrations (1.0 mM) of Ca2+ resulted in PHK16 cell differentiation and redistribution of PNA binding glycoproteins. The synthesis of alpha 2,3-sialic acid linked to Gal beta 1,3GalNAc is mediated by three beta-galactoside alpha 2,3-sialytransferases, which are the gene products of hST30, hST30/N and hST3 Gal II. Ca2+ treatment of PHK16 cells decreased the mRNA expression of hST30/N, whereas the mRNA of hST30 and hST3Gal II was not detected by Northern blot analysis, suggesting that the hST30/N gene is responsible for sialic acid down regulation during keratinocyte differentiation. In order to examine transcriptional regulation of the hST30/N gene, we first determined the transcriptional starting sites of the hST30/N gene in PHK 16 using 5'-RACE analysis. Two kinds of type B isoforms, types B3 and BX, were identified. Type BX is a novel isoform related to the type B form, but which differs upstream of the B3 exon. The results of Northern blot analysis using a type BX-specific probe suggest that the B3 promoter may be regulated by Ca2+. Using a luciferase assay, we identified a functional DNA portion within hST30/N genomic DNA that confers negative transcriptional regulation on the hST30/N B3 promoter during Ca2+ stimulated human keratinocyte differentiation. This element contains some putative transcriptional factor binding sequence motifs such as AP2.

Middle cerebral artery blood flow velocity during laparoscopic surgery in head-down position

Laparoscopic surgery using intraperitoneal CO2 insufflation has become popular in many fields of surgical procedures. In this study, the authors examined the effects of intraperitoneal CO2 insufflation on the middle cerebral artery blood flow velocity (MCABFV) of patients in the head-down position. Fourteen patients undergoing laparoscopic surgery in the head-down position were studied. The MCABFV was measured at the following times: before CO2 insufflation and 15, 30, and 45 min after insufflation. The MCABFV increased significantly (61.4 +/- 14.5, 71.1 +/- 25.5, and 67.2 +/- 18.9 cm/s at 15, 30, and 45 min after insufflation, respectively) as compared with control (49.8 +/- 13.5 cm/s) following the CO2 insufflation. A positive correlation was observed between blood flow velocity and PaCO2 (y = 1.718 + 2.102x; r = 0.669). Our results suggest that the cerebral BFV is increased by intraperitoneal CO2 insufflation during laparoscopic surgery.