The advantage of primary resection and anastomosis with intraoperative bowel irrigation for obstructing left-sided colorectal carcinoma

Of a total 712 patients with left-sided colorectal cancer, 79 (11%) required emergency surgery due to severe obstruction by tumors. Of these 79 patients, 55 underwent tumor resection and anastomosis. Primary resection and anastomosis with intraoperative bowel irrigation was performed in 44 patients (primary group), while staged resection and anastomosis was performed in only 11 (staged group). In comparing the two groups, there was no significant difference in the rates of curative resection, being 76% versus 90%. However, the primary group demonstrated significantly lower rates of postoperative wound infection (P < 0.001), anastomotic dehiscence (P not equal to 0.05), and postoperative mortality, at 2% versus 18% (P < 0.05). The cumulative survival curve was also better in the primary group (P < 0.05). These favorable results of the primary group were confirmed by analyses which established that no bias of therapeutic backgrounds existed in either of the two groups. Thus, it was concluded that for left-sided obstructing colorectal carcinoma, intraoperative bowel irrigation, followed by primary resection and anastomosis, produces more advantageous results.

Knee articular cartilage injury in leg lengthening. Histological studies in rabbits

The effect of lengthening the tibia, by callotasis on the articular cartilage in the knee, was investigated histologically in 18 rabbits. The distraction rate was 1 mm per day. On the right tibia, the distraction frequency was in 2 steps (0.5mm/12 hours), while on the left it was in 120 steps (0.0083 mm/12 minutes). The 18 animals were divided into 3 subgroups based on length gain. Cartilage and subchondral bone samples were examined by light and fluorescent microscopy. The incidence of cartilage degeneration on the 2-step side was 2/5, 5/6, and 6/7 at 10, 20, and 30 percent length increases. On the 120-step side it was 0/5, 1/6, and 1/7 at the same length increases. The intensity of tetracycline fluorescence of the subchondral plate on the 2-step side was higher than that on the 120-step side, showing 1.7, 2.0, and 2.3-fold increases at 10, 20, and 30 percent length increases. Our study suggests that increasing the frequency of distraction in callotasis can help to prevent damage to articular cartilage in adjacent joints.

Purification, characterization and molecular cloning of an acidic amino acid-specific proteinase from Streptomyces fradiae ATCC 14544

We have isolated a novel acidic amino-acid-specific proteinase from Streptomyces fradiae ATCC 14544, using benzyloxycarbonyl-L-Phe-L-Leu-L-Glu-p-nitroanilide (Z-Phe-Leu-Glu-pNA) as a substrate. A proteinase, which we propose to call SFase, was purified from the culture filtrate by salting out, repeated S-Sepharose chromatography, and affinity chromatography (CH-Sepharose-Phe-Leu-D-Glu-OMe). The purified enzyme showed a single band having an apparent molecular weight of 19,000 on sodium dodecyl sulfate polyacrylamide gel electrophoresis. When synthetic peptides were used as substrates, SFase showed high specificity for Z-Phe-Leu-Glu-pNA. Comparison with nitroanilides of glutamic acid and aspartic acid as substrates revealed that the reactivity was about 10-fold higher for a glutamyl bond than an aspartyl bond. SFase selectively hydrolyzed the -Glu-Ala-bond of two glutamyl bonds in the oxidized insulin B-chain within the initial reaction time until the starting material was completely digested. Diisopropylfluorophosphate and benzyloxycarbonyl-Phe-Leu-Glu chloromethylketone completely inhibited SFase, while metalloproteinase inhibitors, such as EDTA and o-phenanthrolin, did not inhibit the enzyme. The findings indicate that SFase can be classified as a serine proteinase, and is highly specific for a glutamyl bond in comparison with an aspartyl bond. To elucidate the complete primary structure and precursor of SFase, its gene was cloned from genomic DNA of the producing strain, and the nucleotide sequence was determined. Consideration of the N- and C-terminal amino-acid sequences of the mature protein of SFase indicates that it consists of 187 amino acids, which follows a prepropeptide of 170 residues. In comparison with the acidic amino-acid-specific proteinase from Streptomyces griseus (Svendsen, I., Jensen, M.R. and Breddam, K. (1991) FEBS Lett. 292, 165-167), SFase had 82% homology in the amino acid sequence. The processing site for maturation of SFase was a unique sequence (-Glu-Val-), so that the propeptide could be released by cleavage of the peptide bond between Glu and Val.

Steroid-related bilateral osteonecrosis of the patella

We present a case of bilateral osteonecrosis of the patella in a patient during steroid therapy and demonstrate the radiological, arthroscopic, and histological features. Osteonecrosis of the patella should be considered as a possible cause of knee pain in patients receiving steroid therapy.

Purification, characterization, cloning, and expression of a glutamic acid-specific protease from Bacillus licheniformis ATCC 14580

A glutamic acid-specific protease has been purified to homogeneity from Bacillus licheniformis ATCC 14580 utilizing Phe-Leu-D-Glu-OMe-Sepharose affinity chromatography and crystallized. The molecular weight of the protease was estimated to be approximately 25,000 by SDS-polyacrylamide gel electrophoresis. This protease, which we propose to call BLase (glutamic acid-specific protease from B. licheniformis ATCC 14580), was characterized enzymatically. Using human parathyroid hormone (13-34) and p-nitroanilides of peptidyl glutamic acid and aspartic acid, we found a marked difference between BLase and V8 protease, EC 3.4.21.9, although both proteases showed higher reactivity for glutamyl bonds than for aspartyl bonds. Diisopropyl fluorophosphate and benzyloxycarbonyl Leu-Glu chloromethyl ketone completely inhibited BLase, whereas EDTA reversibly inactivated the enzyme. The findings clearly indicate that BLase can be classified as a serine protease. To elucidate the complete primary structure and precursor of BLase, its gene was cloned from the genomic DNA of B. licheniformis ATCC 14580, and the nucleotide sequence was determined. Taking the amino-terminal amino acid sequence of the purified BLase into consideration, the clones encode a mature peptide of 222 amino acids, which follows a prepropeptide of 94 residues. The recombinant BLase was expressed in Bacillus subtilis and purified to homogeneity. Its key physical and chemical characteristics were the same as those of the wild-type enzyme. BLase was confirmed to be a protease specific for glutamic acid, and the primary structure deduced from the cDNA sequence was found to be identical with that of a glutamic acid-specific endopeptidase isolated from Alcalase (Svendsen, I., and Breddam, K. (1992) Eur. J. Biochem. 204, 165-171), being different from V8 protease and the Glu-specific protease of Streptomyces griseus which consist of 268 and 188 amino acids, respectively.

Characterization of recombinant human and rat pancreatic phospholipases A2 secreted from Saccharomyces cerevisiae: difference in proteolytic processing

An expression plasmid for human pancreatic phospholipase A2 in Saccharomyces cerevisiae was constructed by insertion of cDNA encoding its preprophospholipase A2 into a yeast expression vector pAM82. The resulting product secreted in the yeast culture medium was mainly prophospholipase A2, which was the same as the natural proenzyme in all aspects examined, including the higher order structure. However, when the rat preprophospholipase A2 cDNA was manipulated in the same manner, the active phospholipase A2 of the intact mature form was secreted with the proenzyme being hardly detected in the medium. This unexpected favorable result would occur due to cleavage of rat phospholipase A2 pro-peptide by a trypsin-like proteinase in S. cerevisiae. Based on this finding, we constructed a plasmid carrying the sequence coding for the prepro-peptide of rat pancreatic phospholipase A2 behind the PHO5 promoter in the pAM82 vector, which leads to the secretion of heterologous proteins as their mature form. The use of this plasmid led to secretion of biologically active human pancreatic secretory trypsin inhibitor and a glutamic acid-specific endopeptidase from Staphylococcus aureus ATCC 12600, which are eukaryote and prokaryote proteins, respectively, in the culture medium of S. cerevisiae.

Secretory expression of a glutamic-acid-specific endopeptidase (SPase) from Staphylococcus aureus ATCC12600 in Bacillus subtilis

In order to obtain a large quantity of glutamic-acid-specific endopeptidase of Staphylococcus aureus ATCC12600 (SPase) without cultivating its pathogenic host bacterium, expression plasmids enabling secretion of SPase from Bacillus subtilis were constructed by inserting the SPase gene into B. subtilis-Escherichia coli shuttle vectors. B. subtilis harbouring a simple recombinant plasmid containing the coding and the 5'-flanking regions of SPase in the shuttle vector pHY300PLK secreted 22 mg/l of SPase into the medium. As this level was lower than that of the natural strain (45 mg/l), we tried to increase the expression level by constructing a series of hybrid plasmids with the following features: (1) the terminator sequence of the alkaline protease gene from B. subtilis, (2) the promoter and the leader sequences of the alpha-amylase gene or of alkaline protease gene from B. amyloliquefaciens, (3) the vector pHY300PLK and the fused vector of pHY300PLK and pUB110. By using a variety of hybrid plasmids, the resulting transformants secreted SPase at levels of 33-120 mg/l. The recombinant SPase isolated from the medium was indistinguishable from the natural one with respect to its behaviour on sodium dodecyl sulphate-polyacrylamide gel electrophoresis and Western blotting as well as its enzyme activity.

A supernumerary muscle between the adductors brevis and minimus in humans

In order to elucidate the nerve supply of a supernumerary muscle observed between the adductors brevis and minimus in humans and to investigate its true nature and mechanism of formation, 100 body halves from 50 adult Japanese cadavers were subjected to gross anatomical examination. A supernumerary muscle was noted in 33 (33.0%) out of the 100 thighs. In each of these thighs, it arose from the upper part of the inferior ramus of the pubis and ran obliquely downwards and laterally. It was inserted into the anterior surface of the insertion aponeurosis of the adductor minimus (17/33 thighs, 51.5%), the upper part of the pectineal line (9/33 thighs, 27.3%), or the posterior side of the base of the lesser trochanter (7/33 thighs, 21.2%). It was supplied, from its posterior aspect, by a filament from the twig originating from the posterior branch of the obturator nerve and being distributed to the superficial fasciculus of the obturator externus (18/33 thighs, 54.5%) or by a twig directly originating from the posterior branch (15/33 thighs, 45.5%). The obturator nerve received fibers from L1234 (4/33 thighs), L234 (25/33 thighs), L2345 (2/33 thighs) or L34 (2/33 thighs) and, moreover, its posterior branch ran through (25/33 thighs, 75.8%) or over (8/33 thighs, 24.3%) the obturator externus to emerge into the thigh. Based on the topographical-anatomical relationships of this muscle to its nerve supply, it seems probable that it is formed by separation from the superficial layer of the obturator externus and changes into an independent structure during the process of ontogeny. Furthermore, from a statistical standpoint, the segmental composition or course of the obturator nerve is not related to either the formation or incidence of this muscle.

[Comparative study of risk criteria for germ cell tumor]

The development of cisplatin-based chemotherapy has achieved a high cure rate in patients with advanced germ cell tumors (GCT) and it is more important to predict the prognosis of each patient before treatment and select the most suitable regimen of therapy. To date, 4 risk criteria for GCT are presented. From November, 1985 to April, 1991 our treatment protocol for GCT consisted of VAB-6 (vinblastine, actinomycin D, bleomycin, cisplatinum) or PVeBV (vinblastine, etoposide, bleomycin, high-dose cisplatin) as the induction chemotherapy and VIP (etoposide, ifosfamide, cisplatin) as the salvage chemotherapy. In total, 12 patients were entered on this protocol. They were divided into 2 groups based on the actual clinical course. Those who achieved complete remission within 3 cycles of chemotherapy were divided into "good response group" and others were into "poor response group". These results were compared with those classified by the 4 risk criteria. As a result of our study "The Indiana Staging System" seemed to be the most useful.

Synthesis and biological activities of cyclopropenone antibiotic penitricin and congeners

A number of derivatives of the cyclopropenone antibiotic penitricin have been synthesized by the reaction of metalated cyclopropenone acetals with electrophiles. Studies on the antimicrobial structure-activity relationships indicated that the penitricin skeleton, hydroxymethylcyclopropenone, is indispensable for antimicrobial activity. These compounds were also found to display cytotoxic activity.

Purification, characterization and gene cloning of a novel glutamic acid-specific endopeptidase from Staphylococcus aureus ATCC 12600

Twenty strains of Staphylococcus aureus from ATCC type cultures and strains found in clinical studies were cultivated, and their endopeptidase activity specific for glutamic acid was surveyed using benzyloxycarbonyl-Phe-Leu-Glu-p-nitroanilide (Z-Phe-Leu-Glu-pNA) as a substrate. The activity was found in two of the strains, ATCC 12600 and ATCC 25923. A glutamic acid-specific proteinase, which we propose to call SPase, was purified from the culture filtrate of S. aureus strain ATCC 12600 by a series of column chromatographies on DEAE-Sepharose twice and on Sephacryl S-200. A single band was observed on sodium dodecyl sulfate polyacrylamide gel electrophoresis (SDS-PAGE) of the purified SPase. The molecular weight of the proteinase was estimated to be 34000 by SDS-PAGE. When synthetic peptides and oxidized insulin B-chain were used as substrates, SPase showed the same substrate specificity as V8 proteinase, EC 3.4.21.9, which specifically cleaves peptide bonds on the C-terminal side of glutamic acid and aspartic acid. Examination with p-nitroanilides of glutamic acid and aspartic acid as substrates, however, revealed that both proteinases are highly specific for a glutamyl bond in comparison with an aspartyl bond. To elucidate the complete primary structure of SPase, its gene was cloned from genomic DNA of S. aureus ATCC 12600, and the nucleotide sequence was determined. Taking the amino acid sequence of SPase from the NH2-terminus to the 27th residue into consideration, the clones encode a mature peptide of 289 amino acids, which follows a prepropeptide of 68 residues. SPase was confirmed to be a novel endopeptidase specific for glutamic acid, being different from V8 proteinase which consists of 268 amino acids.

[Detection of methicillin-resistant Staphylococcus aureus by polymerase chain reaction]

The low-affinity penicillin-binding protein (PBP 2') is associated with methicillin-resistance of Staphylococcus aureus and its structural gene (mecA) not present in methicillin-susceptible S. aureus could be detected by the polymerase chain reaction (PCR) method, in which a 533 bp region of mecA was amplified and detected by agarose gel electrophoresis. Survey for the mecA gene in 210 clinical isolates of S. aureus revealed that, while there was a gross correlation between the presence of the mecA gene and the resistance level to beta-lactams, three strains of mecA (+) tested showed beta-lactam susceptibility similar to those of mecA (-) strains. These three strains did not produce a detectable amount of PBP 2' constitutively nor inducibly, which was the cause of their high susceptibility to beta-lactams. One of them yielded a typical methicillin-resistant variant at a low frequency with a concomitant recovery of PBP 2' production when the bacterial cells of high density were spread onto an agar plate containing 10 micrograms/ml of oxacillin. These findings suggested that typical methicillin resistant S. aureus occurred during chemotherapy with beta-lactam antibiotics even when resistant strains could not be detected by the susceptibility test and thus all mecA (+) strains including those with high susceptibility should be precisely detected.

A study on the basic nature of human biological aging processes based upon a hierarchical factor solution of the age-related physiological variables

The purpose of this study is to determine the laws governing the aging processes based on a hierarchical factor solution of the age-related physiological variables. Healthy individuals (462) who had taken a 2-day health examination were studied. Twenty-seven physiological variables were submitted to hierarchical factor solution. The analysis revealed that there was a fixed pattern in the variations of these 27 physiological variables. In this hierarchical factor solution, three group factors as functioning at different levels of complexity composed of the 16 common factors were extracted. Of these group factors, the first and third group factors can be referred to the aging process. The first group factor, the so-called factor 1 loaded with most of physiological variables, was interpreted as a primary aging factor which presented the primary process of human aging. The third group factor, the so-called factor 6 to 16 loaded only with a few variables related to a single physiological system or organ, were interpreted as system-specific secondary aging factor. These results obtained by the hierarchical factor solution thus seem to support the notion that biological age changes can be viewed as time dependent complex integration of the primary and secondary aging processes.

Identification of methicillin-resistant strains of staphylococci by polymerase chain reaction

A simple and reliable method using a polymerase chain reaction (PCR) was devised to identify methicillin-resistant staphylococci. By using lysates of the strain to be tested as templates and 22-mer oligonucleotides as primers, a 533-bp region of mecA, the structural gene of a low-affinity penicillin-binding protein (PBP 2'), was amplified by PCR and detected by agarose gel electrophoresis. Results obtained by this method were compared with those obtained by broth microdilution MIC determination for 210 and 100 clinical isolates of Staphylococcus aureus and coagulase-negative staphylococci, respectively. Of 99 mecA-negative S. aureus isolates, 100% of the strains were methicillin susceptible and 98% of the strains were oxacillin susceptible. Three strains (3%) of 111 mecA-positive S. aureus isolates exhibited almost the same susceptibility to beta-lactams as the mecA-negative ones and did not produce detectable amounts of PBP 2' despite the presence of the mecA gene. One of them yielded typically methicillin-resistant variants at a low frequency with concomitant recovery of PBP 2' production. The mecA gene was also found in coagulase-negative Staphylococcus epidermidis, Staphylococcus haemolyticus, Staphylococcus sciuri, Staphylococcus saprophyticus, and Staphylococcus caprae and conferred resistance on most of the bacteria.

[Estimation of nuclear volume of nontumorous bladder mucosa in patients with bladder tumor--measurement by vertical section]

The mean nuclear volume (MNV) of non-tumorous bladder mucosa in 27 patients with a bladder tumor was estimated by using a new stereological method, "vertical section". Eighty four specimens were obtained by punch biopsy from preselected sites of urinary bladder. Thirteen specimens (10 patients) out of 84 were histologically diagnosed as carcinoma in situ (CIS). Bladder mucosa of 24 patients with various benign diseases were also measured as normal controls. The MNV of the normal control group was 127.1 +/- 19.6 microns 3 (mean +/- standard error) and that of the specimens diagnosed with CIS was 279.6 +/- 69.0 microns 3. There was no overlap between the two groups. Out of 71 specimens diagnosed as having no malignancy, 30 (42.3%) exhibited significantly increased MNV. Estimation of the MNV of non-tumorous bladder mucosa may be useful for standardization of CIS. Further studies are needed to investigate the role of the increased MNV in histologically normal mucosa in the course of a bladder tumor.

Structure of (+/-)-(2S,1'S)-2-[hydroxy(phenyl)methyl]-2-methylcyclohexanone, C14H1802

Mr = 281.30, monoclinic, P2(1)/n, a = 10.966 (4), b = 7.170 (3), c = 15.976 (4) A, beta = 93.14 (2) degrees, V = 1254.3 (9) A3, Z = 4, Dx = 1.16 g cm-3, lambda (Mo K alpha) = 0.71069 A, mu = 0.706 cm-1, F(000) = 472, T = 295 K, final R = 0.057 for 1212 unique observed reflections. The compound was prepared by reaction of the trichlorotitanium-delta 1(2)-enolate of 2-methylcyclohexanone with benzaldehyde.

[201Tl-reverse redistribution in a case with stunned myocardium]

A 58-year-old man was admitted to our hospital because of chest pain. Electrocardiogram showed giant negative T waves in leads I, II, III, aVl, aVf and V2 through V6. Echocardiogram showed anterior wall motion abnormality. Rest-redistribution thallium scan obtained 3 days after admission revealed reverse redistribution in antero-apical area. Coronary angiogram showed no significant stenotic lesions and left ventriculogram in chronic stage showed improvement of wall motion abnormality. Repeat thallium scan in chronic stage showed disappearance of perfusion defect in apical area. It was difficult to diagnose myocardial viability in our case with stunned myocardium because rest-redistribution thallium scan showed reverse redistribution. As the mechanism of this finding, early coronary recanalization in acute stage of the event was suspected.

Successful reconstruction of completely obstructed right CCA in Takayasu's disease: usefulness of rapid sequence scanning method--case report

The authors describe a case of Takayasu's disease accompanied by complete occlusion of the bilateral subclavian, left vertebral (VA), and right common carotid arteries (CCA) and by severe stenosis of the right VA and left CCA. The patency of the right external and internal carotid arteries was demonstrated preoperatively by rapid sequence computed tomographic scanning. The right CCA was successfully reconstructed with an aorta-CCA bifurcation bypass. Simultaneously, the stenotic left CCA was also reconstructed with an aorta-CCA bypass using a Y-shaped woven Dacron graft.

[Relapsing polychondritis in a patient with myelodysplastic syndrome]

Relapsing polychondritis is a rare disorder of uncertain origin characterized by recurrent inflammation of cartilage. A case of myelodysplastic syndrome (MDS) associated with relapsing polychondritis is reported. A 60-year-old man who had been diagnosed as MDS was admitted because of pain and swelling in the bilateral preauricular regions and cheek. A diagnosis of relapsing polychondritis was made by coexistence of auricular chondritis, arthropathy, ocular inflammation and audio-vestibular disturbance. He also developed ocular palsies and optic neuritis. He was treated with prednisolone, azathioprine, dapsone, and then with steroid pulse therapy. Moreover, plasmapheresis and high dose gamma-globulin therapy were undertaken. However, all these treatments were unsuccessful and he died of respiratory failure.

Biological age versus physical fitness age in women

The purpose of this study was to determine whether adult women who are in a state of high physical fitness are in a good state biologically, in terms of biological and physical fitness ages as estimated by statistical means. The subjects were 65 healthy Japanese women (aged 20-64 years). Biological and physical fitness ages were estimated from the data for 18 physiological function tests and 5 physical fitness tests, respectively, by a principal component model. The correlation coefficient between biological and physical fitness ages was 0.70 (P less than 0.01), which was generally regarded as a high correlation. Therefore, those who were in a state of high physical fitness were considered to be in good biological condition. This result is in good agreement with the results (r = 0.72) from adult men, on whom we reported previously. A statistical analysis to ascertain the relative importance of each contributory variable associated with the variance in biological age suggested that routine clinical evaluation of blood pressure and lipid metabolism might play an important role in determining not only the presence and severity of vascular disease but also the rate of biological aging in women.

Transfection of cDNA with G----T point mutation at the cleavage site of insulin receptors to COS 7 cells

To study whether the G----T point mutation of insulin proreceptors at the cleavage site which changed -Arg-Lys-Arg-Arg- to -Arg-Lys-Arg-Ser- caused unprocessed insulin receptors with decreased insulin binding affinity, we performed transfection of cDNA with the mutation in COS 7 cells and examined the expressed insulin receptors. After site-directed mutagenesis, an expression vector pGEM3SV was used to make a plasmid which contained full-length HIRcDNA behind SV40 early promoter. Transfection of normal HIR cDNA produced normal insulin receptors on the plasma membranes in COS 7 cells. However, transfection of cDNA with the mutation resulted in the presence of 210K proreceptors in the plasma membranes with decreased insulin binding ability (35% of normal). These results suggest that the mutation, not the defect of converting enzyme, was the cause for unprocessed insulin proreceptors in the patients with insulin resistance.

[The present aspect of tuberculous pleurisy--report of the 29th series (A) of CSUCT--Cooperative Study Unit of Chemotherapy of Tuberculosis (CSUCT) of the National Sanatoria in Japan]

CSUCT carried out 9-21 month's follow up of 273 patients with exudative tuberculous pleurisy who were admitted to 39 national sanatoria in 1985, and were treated for the first time. The background factors of the patients at the time of admission were as follows: the average age, 47.2; male/female ratio 3:1; idiopathic pleurisy 163 cases and secondary pleurisy 110 cases. Distribution of maximal temperature on admission; 37.0 degrees C or less 24.4%; 37.1-38.0 degrees C 37.8%; 38.1-39.0 degrees C 28.5%; higher than 39.0 degrees C 9.3%. Younger patients tended to show higher temperature than the older. The positivity of tuberculin reaction was 84.3%, and among them 34% were strongly positive (greater than or equal to 20 mm). There was no correlation between the volume of pleural effusion and the intensity of tuberculin reaction. In patients more than 60 years of ages, the positivity was low (76.0%). The erythrocyte sedimentation rate (after 1 hour) was 63.6 +/- 31.6 mm.

CLINICAL SYMPTOMS

cough in 72%; sputum in 48.5%; chest pain in 57.5%; tubercle bacilli in sputum in 11.6%. We compared idiopathic pleurisy (I) and secondary pleurisy (S) and total cases of pleurisy (T) regarding several factors; average age (I: 46.7, S: 48.0, T: 47.2); peak season of incidence (I: Feb. Mar. S: Mar. April, T: Feb. Mar. April); the period of hospitalisation (I: 4.07 months, S: 5.80 months, T: 4.77 months); the positive rate of tubercle bacilli in the pleural effusion (I: 9.0%, S: 12.9%, T: 10.5%); %VC (mean value) on admission (I: 71.4%, S: 69.8%, T: 70.7 +/- 17.0%); %VC after treatment (I: 79.0%, S: 79.7%, T: 79.4 +/- 17.9%), and we found no significant difference in the above factors between I. and S. In 49 patients who were treated by chemotherapy with steroids, %VC before treatment was 68.9% (mean value), and that after treatment was 81.2% (mean value), however, there was no significant difference between the %VC of these patients and that of total patients. Recent chemotherapy (SM or EB + INH + RFP) greatly contributed to improve clinical symptoms by accelerating the absorption of pleural effusion and in minimizing the formation of pleural thickening. Previously, we experienced often deterioration of tuberculous lesions in relation to the use of steroids. By the use of recent intensified chemotherapy, the harmful side effects of steroids became almost insignificant, and at the same time, treatment with steroids is needed only in a few cases.

[Acute myelomonocytic leukemia with mastocytosis in bone marrow]

A 22-year-old female was admitted to our hospital because of general fatigue. The lymph nodes, liver and spleen were not palpable. She was without cutaneous lesions. Haematological examinations revealed leukocytes 3,200/microliters with 44% blasts of myelomonocytic origin, and platelets 15,000/microliters. Bone marrow smears were hypercellular marrow with 51% blasts of myelomonocytic origin and focal involvement of mast cells. Serum histamine and vitamin B12 level was high. Mast cells were round with rounded or segmented nuclei. The nucleoli were inconspicuous and the cytoplasm contained a number of metachromatic granules. Cytochemically, mast cells stained positive for alpha-naphthol-AS.D-chloroacetate esterase and acid phosphatase, and negative for peroxidase, Sudan black B and alpha-naphthyl butylate esterase. In toluidine blue staining, mast cells had stained similarly with pH values from 2.5 to 6.5. She was diagnosed as acute myelomonocytic leukemia with benign mastocytosis, and treated with BH.AC-DNP. A complete remission was obtained, but mast cells in the marrow did not decrease. Relationship between leukemia and mastocytosis was not known, but it was suggested that mast cells responded to the proliferation of the leukemic cells.

Thymic stroma-derived T cell growth factor (TSTGF): III. Its ability to promote T cell proliferation without stimulating interleukin 2- or 4-dependent autocrine mechanism

A thymic stroma-derived cell clone, MRL104.8a produced a T cell growth factor designated as thymic stroma-derived T cell growth factor (TSTGF). This factor that is distinct from previously described T cell growth factors such as interleukin (IL) 2 or 4 was capable of promoting the growth of IL2-dependent, antigen-specific helper T cell clones. While such growth promotion was induced without requirement of the relevant antigen and exogenous IL2, we further investigated whether it depended on activation of an IL2- or IL4-dependent autocrine mechanism. Helper T cell clones, 8-E and 8-5, were able to proliferate in response to stimulation with either antigen or TSTGF. 8-E and 8-5 produced IL2 and IL4, respectively, in cultures following antigenic stimulation, whereas neither IL2 nor IL4 activity was detected in cultures during TSTGF-induced proliferation. The proliferation of these helper T cell clones by antigenic stimulation was almost completely inhibited when anti-IL2 receptor or anti-IL4 antibody was added to the cultures. The addition of cyclosporin A (CsA) to cultures of 8-E and 8-5 clones together with antigen also resulted in the complete inhibition of cellular proliferation in association with the suppression of IL2 and IL4 production. In contrast, TSTGF-induced proliferation was not affected by addition of either type of antibody or CsA. These results indicate that TSTGF is a novel T cell growth factor that can exert its own growth-promoting effect without depending on an IL2- or IL4-operating autocrine mechanism.

[Discriminant function analysis for evaluating the status of coronary heart disease risk]

We investigated to discriminate those individuals categorized by 1. obesity, 2. hypercholesterolemia, 3. hypertension, 4. low maximal oxygen uptake, 5. an abnormal electrocardiogram reflecting ischemic patterns, and/or 6. real sedentary life, from relatively healthier individuals without coronary heart disease (CHD) risk factors. One hundred and six Japanese women, aged 30 to 72 years, all of whom were in the postabsorptive state, were recruited in a series of tests for anthropometric and physiologic profiles both during the resting state and during the submaximal-maximal cycling exercise. Subjects were categorized into two groups--those who possessed four or more of the above 1, 2, 3, 4, 5, and 6 (high-CHD-risk group, n = 15) and apparently healthy individuals with a minimum number of risk factors (low-CHD-risk group, n = 83). Analyses of the data revealed that a combination of 8 variables extracted from among original 25 variables accurately classified 13/15 (87%) of high-CHD-risk group and 77/83 (93%) of low-CHD-risk group (mean = 90/98 or 92%) into their respective groups. The 8 variables were double product, Katsura index, waist girth, chest girth, TG, TC, and skinfold thicknesses at the subscapular and abdominal sites. Subsequent t-test identified significant differences between groups not only for VO2max, SBP and TC but also for DBP, LDLC, TG, Hb, HR, and HRmax. Most of these differences were of a much greater magnitude compared to the existing difference in chronological age. These findings suggest the usefulness and importance of anthropometric and blood lipid variables in the explanation of differences in the health status between high-CHD-risk women and their counterparts.

cDNA cloning of Gb, the substrate for botulinum ADP-ribosyltransferase from bovine adrenal gland and its identification as a rho gene product

A 1.5 kilobase cDNA coding for the complete amino acid sequence of Gb, the substrate for ADP-ribosyltransferase in C1 and D botulinum toxins from bovine adrenal gland, has been isolated from a cDNA library of bovine adrenal gland. This cDNA encodes a polypeptide of 21,770 Da consisting of 193 amino acid residues, and the deduced amino acid sequence contains all the partial amino acid sequences reported previously (Narumiya, S., Sekine, A., and Fujiwara, M. (1988) J. Biol. Chem., 263, 17255-17257). Sequence comparison revealed that Gb is identical with the product of human rho clone 12 (rho A). The present results also confirmed our suggestion that the ADP-ribosylation occurs at Asn41 in the putative effector domain of the rho gene product.

cDNA cloning and sequence determination of rat membrane-associated phospholipase A2

Based on the partial amino acid sequences of membrane-associated phospholipase A2 (PLA2M), belonging to group II, purified from rat spleen, the cDNA encoding PLA2M was cloned by a new cloning strategy utilizing enzymatic cDNA amplification. At the N-terminus of the coded 146 residues, which were deduced from the cDNA sequence, the putative signal peptide was found despite the tight adherence of this enzyme to the membrane. The sequence of rat PLA2M exhibits 75% homology with that of human group II PLA2 in the protein-coding region. The result of RNA blot analysis showed that rat ileal mucosa contains the largest amount of the PLA2 transcript among the tissues examined.

[Remission of a non-haemophilic patient with acquired factor VIII inhibitor treated with infusion of factor VIII and corticosteroid]

A 61-years old woman who had been healthy without history of abnormal bleeding, developed widely spread ecchymosis and intramuscular bleeding in March, 1987. She was hospitalized for this hemorrhagic diathesis in May, 1987 and the following laboratory data were revealed: activated partial thromboplastin time (APTT), 76.7 seconds; factor VIII procoagulant activity, 2%; factor VIII inhibitor, 27 Bethesda units/ml. The inhibitor was an immunoglobulin of IgG type. Her clinical data of the blood were normal, and tests for antibodies, such as RA test, LE test and thyroid test were negative. Physical examination revealed ecchymosis over her right arm and swelling and pain in the right arm. She was first treated with a large dose of factor VIII concentrates, but the effect was insufficient. Then prednisolone was given, which resulted in decreasing of the inhibitor and improvement of the coagulation profiles. This treatment appeared to offer effective control on severe hemorrhage in patients with factor VIII inhibitors.

Presence of pancreatic-type phospholipase A2 mRNA in rat gastric mucosa and lung

The content of mRNA for a pancreatic-type phospholipase A2 present in rat gastric mucosa was much greater than that in pancreas. In lung the mRNA for this pancreatic-type phospholipase A2 was also detected, but less than in pancreas. Nucleotide sequence analysis showed that these pancreatic-type phospholipase A2 cDNAs derived from rat gastric mucosa and lung were completely identical to that from rat pancreas (Ohara et al. (1986) J. Biochem. 99, 733-739). This demonstrates that the pancreatic-type phospholipase A2 present in gastric mucosa and lung does not originate from pancreas.

Biological age versus physical fitness age

A population of healthy middle-aged (n = 69) and elderly men (n = 12), who participated in a health promotion program, was studied to determine whether really physically fit individuals are in good biological condition, and also whether improvement of physical fitness in the middle-aged and the elderly reduces their "rate of aging". Biological and physical fitness ages of the individuals studied were estimated from the data for 18 physiological function tests and 5 physical fitness tests, respectively, by a principal component model. The correlation coefficient between the estimated biological and physical fitness ages was 0.72 (p less than 0.01). Detailed analyses of the relationship between the estimated biological and physical fitness ages revealed that those who manifested a higher ("older") physical fitness age did not necessarily have a higher biological age, but those who manifested a lower ("younger") physical fitness age were also found to have a lower biological age. These results suggested that there were considerable individual variations in the relationship between biological condition and physical fitness among individuals with an old physical fitness age, but those who were in a state of high physical fitness maintained a relatively good biological condition. The data regarding the elderly men who had maintained a regular exercise program indicated that their estimated biological ages were considerably younger than the expected values. This might suggest that in older individuals regular physical activity may provide physiological improvements which in turn might reduce "the rate of aging".

Assessment of biological age by principal component analysis

A method of assessing biological age by the application of principal component analysis is reported. Healthy individuals (462) randomly selected from about 6000 men who had taken a 2-day health examination were studied. Out of the 30 physiological variables examined in routine check-ups, 11 variables were selected as suitable for the assessment of biological age based on the results of factor analysis and the physiological meaning of each test. This variable set was then submitted to principal component analysis, and the 1st principal component obtained from this analysis was used as an equation for assessing one's biological age. However, the biological age calculated from this equation is expressed as a score, so the estimated score was transformed to years (biological age) using the T-score idea. The biological age estimated by this method is practically useful and theoretically valid in contrast with the multiple regression model, because this approach eliminates and overcomes the following 2 big problems of the multiple regression model: (1) the distortion of the individual biological age at the regression edges; and (2) a theoretical contradiction in that a perfect model will merely be predicting the subject's chronological age, not his biological age.

Insulin resistance by unprocessed insulin proreceptors point mutation at the cleavage site

Failure to cleave the interconnecting site between alpha- and beta-subunit produced insulin proreceptors in the plasma membranes which had markedly low affinity to insulin, leading to extreme insulin resistance in a patient. We performed cDNA sequence analysis of the cleavage site of the insulin proreceptor from the patient. Polymerase chain reaction was used to obtain large amount of cDNA coding for the region including the interconnecting site. A thermostable DNA polymerase, Taq polymerase, successfully produced enough amount of cDNA of the region to be sequenced. The results showed AGG (Arg) to AGT (Ser) point mutation, resulting in the change of interconnecting sequence of the two subunits from -Arg-Lys-Arg-Arg- to -Arg-Lys-Arg-Ser-. These results suggest that the tertial structure change of the cleavage site leads to production of unprocessed insulin proreceptors.

Metabolic expression of intrinsic developmental programs for dentine and enamel biomineralization in serumless, chemically-defined, organotypic culture

Biomineralization was investigated using embryonic mouse mandibular first molars (M1) cultured in the presence or absence of fetal calf serum. Metabolic features including cell division and Ca2+ and phosphate incorporation into dentine and enamel extracellular matrices were analyzed. The relative timing and magnitude of DNA synthesis for serumless cultures was comparable to in vivo controls. Isotopic calcium and phosphate incorporation into the mineral phase of dentine and enamel matrices, in the absence of serum, fluctuated during development. Molar tooth morphogenesis, cytodifferentiation, and extracellular matrix formation approximated late crown-stage development in serumless cultures. Von Kossa histochemical staining indicated calcium phosphate salt formation in serumless cultures. Analysis of anhydrous fixation-prepared enamel and dentine representing serumless cultured explants indicated that crystal size and orientation were comparable to in vivo enamel and dentine. In contrast, serum-supplemented cultures showed atypical crystal size and orientation. Calcium/phosphorous (Ca/P) ratio values for serumless cultures after 21 days showed Ca/P enamel values of 2.03 (SD +/- 0.04, p less than 0.025) and dentine values of 1.89 (SD +/- 0.01, p less than 0.025). Electron diffraction patterns of enamel and dentine formed in serumless cultures were principally those of highly-ordered crystalline hydroxyapatite. Our results suggest that tissue-specific dentine and enamel biomineralization is regulated by endogenous factors intrinsic to the developmental program of embryonic tooth organs during serumless culture.

Ultrastructural analysis of enamel formation during in vitro development using chemically-defined medium

To test the hypothesis that enamel biomineralization is regulated by sequential expression of an intrinsic genetic program, we designed experiments to determine if a serumless, chemically-defined medium is permissive for position-dependent ameloblast differentiation and subsequent enamel tissue-specific biomineralization in vitro. In the absence of serum or other exogenous growth factors, Swiss Webster strain mouse embryonic (15- and 16-days gestation) mandibular first molar tooth organs (cap stage) developed within 21 days in vitro into well-defined molar tooth organs expressing dentine and enamel biomineralization. Analysis of data obtained from von Kossa histochemistry for calcium salt formation, as well as ultrastructural information obtained from x-ray microanalysis, electron diffraction, transmission electron microscopy and scanning electron microscopy documented tissue-specific patterns of calcium hydroxyapatite formation in the absence of serum within organotypic cultures in vitro. An as yet unknown intrinsic genetic program regulates enamel formation in vitro.

Arterial pulse wave velocity, Fourier pulsatility index, and blood lipid profiles

Increased arterial pulse wave velocity (PWV) and decreased Doppler-shifted Fourier pulsatility index (PI) have been utilized clinically to diagnose the presence and severity of peripheral vascular disease. We have examined the relationships between these two diagnostic indices and several lipoprotein atherogenic risk factors, e.g., serum total cholesterol (TC), triglyceride (TG), high-density lipoprotein-cholesterol (HDL-C), and low-density lipo-protein-cholesterol (LDL-C) among 74 healthy male volunteers, aged 20 to 56 yr. The Doppler signal from the radial artery was digitized and processed with the Hamming window and 512-point fast Fourier transform to obtain frequency power spectra and PI index by a desktop computer. PWV was determined on the computer by dividing the distance between two pressure transducers placed over the radial and carotid arteries by the transit time difference between the maximal first derivatives (dP/dt) of the recorded arterial pulse waves. The results indicated that PI was inversely related to TC, LDL-C, and TG (r = -0.50, -0.41, -0.54, respectively, P less than 0.001), but evidenced a positive relationship with the HDL-C/TC ratio (r = 0.69, P less than 0.001). PWV was also significantly correlated to TC (r = 0.40) and TG (r = 0.42), but was inversely associated with the HDL-C/TC ratio (r = -0.45, P less than 0.001). These findings are consistent with the current theory relating lipids to the pathology of atherosclerosis.

Gas exchange parameters, muscle blood flow and electromechanical properties of the plantar flexors

Sixteen men were tested to determine VO2max (ml X kg-1 X min-1), anaerobic threshold VO2 (ATVO2) and oxygen kinetics (time constant, T.C.) during running on a treadmill. For measuring maximal calf blood flow (maxBF, ml X 100 ml-1 X min-1), venous occlusion plethysmography was employed immediately following a combination of arterial occlusion and toe raising exercise to exhaustion. In addition, supramaximal electrical stimulations were given to determine maximal calf twitch force (Fmax, N), maximal rate of twitch force development (dF/dt) and relaxation (R X dF/dt, N X ms-1) and electro-mechanical delay time (EMD, ms). Results demonstrated that VO2max, ATVO2 and maxBF were all inversely related to T.C. (p less than 0.05). MaxBF and ATVO2 showed the highest correlation (r = 0.89, p less than 0.01). Stepwise multiple linear regression analyses revealed that variance in VO2max (60%) and ATVO2 (84%) could be accounted for by the combined effects of the following peripheral factors: VO2max = 51,25-3.24(dF/dt) + 0.14(maxBF), and ATVO2 = 11.68 + 0.42(maxBF) - 0.2(Fmax). These findings, together with the results of cluster analysis, suggest a tight link between ATVO2 and peripheral blood flow capacity. On the other hand, a moderate correlation (r = 0.64, p less than 0.01) between VO2max and maxBF might be due in part to individual differences in oxygen extraction-utilization capacity during heavy exercise above anaerobic threshold.