[Transfer of genes to human airway epithelial cells in vitro via DNA virus vectors]

Transfer of genes via DNA virus vectors to human airway epithelial cells is not fully understood. We tested the effects of multiplicities of infection (moi) and incubation time on the efficiency of gene transfer by adenovirus vectors and AAV vectors in cultures of human airway epithelial cells. The cells were exposed to Ad-CMV-lacZ or AAV-CMV-LacZ for 1 to 48 hours at different moi from 0.1 to 100. Efficiency of transduction was assessed as the percentage of cells that expressed LacZ, and was measured by using X-gal staining. A dose-dependent relationship was found between vector moi and the percentage of cells that expressed LacZ. For both vectors, gene expression was greater when incubation time was longer (up to 12 hours), which suggests that the uptake of vectors into the cells is not selective. Efficiency of transduction did not differ between adenovirus and AAV vectors at the same moi. These results suggest that (1) gene transfer via DNA virus vectors increases in a moi-dependent fashion, and that (2) gene expression of the DNA virus vector may be increased by prolonged exposure of the vector to human airway epithelial cells.

[Required manpower for health care and nursing services for the aged at home public health nurses, visiting nurses, dental hygienists, dietitians, physical therapists, and occupational therapists]

The purpose of this study was to estimate the manpower required for the health care and nursing services for the aged at home. For prefectural health care and welfare planning for the aged, data such as the proportion of the aged who need help, service demand, and required frequency of services were obtained. The means and "mean +/- 2 x standard deviations" were calculated to obtain various parameters. Calculated figures were those which can be obtained with some effort. The results are as follows (middle level estimation (low level estimation-high level estimation)): requirements are 1.9 (0.61-5.7) public health nurses, 2.6 (0.63-14) visiting nurses, 0.20 (0.084-0.42) dental hygienists, 0.35 (0.17-0.66) dietitians, and 0.25 (0.014-1.27) physical and occupational therapists per population 10,000. For the national total, requirements are 23 (7.3-67) thousand public health nurses, 31 (7.5-160) thousand visiting nurses, 2.4 (1.0-5.0) thousand dental hygienists, 3.9 (2.0-7.8) thousand dietitians, and 3.0 (0.17-15) thousand physical and occupational therapists. By population sizes, for example in the municipalities which has 10-30 thousand people, required are 4.2 (1.7-11) public health nurses, 5.3 (1.3-27) visiting nurses, 0.4 (0.2-0.8) dental hygienists, 0.5 (0.3-0.9) dietitians, and 0.5 (0.0-2.5) physical and occupational therapists. Comparison of the present numbers with estimated manpower needs show that, the present number of public health personnel is almost the same as the low level estimation. But the present numbers of other manpower is lower than the low level estimation. Considering other services such as maternal and child health, it seems that the municipalities which has 10+ thousand population should employ full-time dietitians and dental hygienists. For policy making in a municipality, the policies of other municipalities should be considered. Because it is based on means for municipalities, the results of this study should be useful for application by other municipalities.

[Hyperventilation syndrome in a very old woman]

A 92-year-old woman was admitted to our hospital due to hypertension, nausea, pain in the anterior part of the chest, epigastralgia, and tachypnea. During the initial examination of the patient in the emergency ward, she was very excited, howled, and both her hands were numb. Arterial blood gas analysis revealed a marked alkalemia (pH greater than 7.55) and hypocapnia (Pco2 24.1 mmHg). After paper bag re-breathing, the pH and Pco2 were within normal limits. Because there was no lesion in the lungs or the brain that would account for hyperventilation and convulsions, the attack was considered to be a manifestation of hyperventilation syndrome should be carefully considered in the differential diagnosis of disturbance of consciousness even in elderly patients.

[Atherosclerosis regression in the elderly--correlation between centrally depressed lesions and risk factors]

Atherosclerotic plaque with central depression (depressed lesion) may indicate regression of atherosclerosis in the aorta. Aortic depressed lesions have a solitary elevated area of plaque with a sharply-bordered roung depression in its center and no area ulceration. This may be interpretable as a sign of regression of atherosclerosis. To clarify the pathogenesis of depressed lesion, we studied clinical risk factors such as hypercholesterolemia in patients with depressed lesions that were confirmed at autopsy. The patients were divided into 3 groups according to their total cholesterol level at autopsy: a high-risk group (> or = 220 mg/dl), a moderate-risk group (180-220 mg/dl), and a low-risk group (< or = 180 mg/dl). Depressed lesions were found in 16.4% of those in the high-risk group, in 14.6% of those in the moderate-risk group and in 69.0% of those in the low-risk group. Severe aortic atherosclerosis was found in 69.8% of the patients; 50.9% of those with severe disease were in the-low risk group. Depressed lesions were also found in those with low levels of low-density lipoprotein cholesterol (< or = 140 mg/dl), 58.8% of whom were found to have severe atherosclerosis. There was no relationship between total cholesterol level and the presence of depressed lesions. However, a clinical prevention trial may result in sufficient control of ahterosclerosis among those in the high-risk group and may also lead to regression of aortic lesions.

[Dapsone (4,4'-diaminodiphenyl sulfone) resolved severe leukocytopenia and thrombocytopenia in a patient with systemic lupus erythematosus]

A 47 year old woman was presented in June, 1994 with a ten years history of systemic lupus erythematosus. Since six months before first visit to our hospital, she had experienced general malaise, myalgia and persistent low grade fever. Among this period, titers of anti DNA antibody in her blood were gradually increased. She had been treated with the prednisolone which was step-wisely increased up to 15 mg/day, but her symptoms had been worsened. On admission, physical examination showed low grade fever and erythema on her both hands. Investigations showed her white blood cell count 1400/microliter, platelet 90000/microliter, positive test result for ANA, anti DNA antibody and anti Sm antibody, low serum concentrations of complements, and persistent proteinuria. She was treated with 60 mg/day of oral prednisolone. Though her symptoms and immunological abnormalities were gradually improved, her platelet count and white blood cell count were gradually decreased to 50000/microliter and 1400/microliter in August, respectively. Platelet associated IgG was increased (102.9 ng/10(7) cells). In spite of the various trials of treatment, such as plasmapheresis, high-dose intravenous gammaglobulin, and cyclophosphamide, the white blood cell and platelet number could not be raised. Finally, the administration of 75 mg/day of dapsone brought a significant rise in both blood cell counts. Thus being certainly effective against leukocytopenia and thrombocytopenia, dapsone should be considered an one of the beneficial therapeutic procedures for refractory autoimmune leukocytopenia and thrombocytopenia in SLE patients.

Purification and Properties of Flavin- and Molybdenum-Containing Aldehyde Oxidase from Coleoptiles of Maize

Aldehyde oxidase (AO; EC 1.2.3.1) that could oxidize indole-3-acetaldehyde into indole-3-acetic acid was purified approximately 2000-fold from coleoptiles of 3-d-old maize (Zea mays L.) seedlings. The apparent molecular mass of the native enzyme was about 300 kD as estimated by gel-filtration column chromatography. Sodium dodecyl sulfate-polyacrylamide gel electrophoresis revealed that the enzyme was composed of 150-kD subunits. It contained flavin adenine dinucleotide, iron, and molybdenum as prosthetic groups and had absorption peaks in the visible region (300-600 nm). To our knowledge, this is the first demonstration of the presence of flavin adenine dinucleotide and metals in plant AO. Other aromatic aldehydes such as indole-3-aldehyde and benzaldehyde also served as good substrates, but N-methylnicotinamide, a good substrate for animal AO, was not oxidized. 2-Mercaptoethanol, p-chloromercu-ribenzoate, and iodoacetate partially inhibited the activity, but well-known inhibitors of animal AO, such as menadione and estradiol, caused no reduction in activity. These results indicate that, although maize AO is similar to animal enzymes in molecular mass and cofactor components, it differs in substrate specificity and susceptibility to inhibitors. Immunoblotting analysis with mouse polyclonal antibodies raised against the purified maize AO showed that the enzyme was relatively rich in the apical region of maize coleoptiles. The possible role of this enzyme is discussed in relation to phytohormone biosynthesis in plants.

Behçet's disease induced by interferon therapy for chronic myelogenous leukemia

A 59-year-old Japanese woman, diagnosed with mixed connective tissue disease (MCTD) and chronic myelogenous leukemia (CML), developed several characteristic features of Behçet's disease (BD) after receiving alpha-interferon (IFN-alpha). She displayed recurrent oral aphtha, genital ulceration, erythema nodosum at the bilateral arm, and low grade fever. The skin of the femur where the IFN-alpha was injected showed modular acneiform changes. Skin biopsy revealed perivascular infiltration. The symptoms compatible with BD improved after discontinuation of IFN-alpha and the introduction of prednisolone and azathioprine. This is the first description of BD induced by IFN-alpha.

Inhibitory effect of leminoprazole on acid secretion in parietal cells isolated from guinea pig gastric mucosa

Isolated guinea pig parietal cells, the function of which is similar to that of human parietal cells, were used in this study. The accumulation of 14C-aminopyrine (14C-AP) was measured to study the inhibitory mechanism of leminoprazole in cells. Stimulation by 10 microM histamine, 0.1 mM carbachol, 1 microM gastrin or 1 mM db-cAMP brought about satisfactory incorporation of 14C-AP, and leminoprazole concentration-dependently inhibited acid secretion induced by these stimulants. At 10(-5) M, almost 100% inhibition was observed. The IC50 values of leminoprazole obtained from its inhibitory action on histamine, carbachol, gastrin and db-cAMP-stimulated acid secretion were 4.0 x 10(-7) M, 3.5 x 10(-7) M, 2.5 x 10(-7) M and 5.6 x 10(-7) M, respectively. Thus the extent of inhibition was the same for the responses to all the secretagogues. These results indicate that the site of action of leminoprazole is intracellular and distal from cAMP (intracellular second messenger), but not at the receptor sites. The results also strongly suggest that the inhibitory action of leminoprazole on H+,K(+)-ATPase may contribute to the inhibitory effect of this drug on gastric acid secretion.

Grades of exophthalmos and thyrotropin-binding inhibitory immunoglobulin in patients with myasthenia gravis

Exophthalmos and thyrotropin-inhibitory immunoglobulin (TBII) were examined in myasthenia gravis (MG) patients with normal thyroid function. Exophthalmos was found in 7 of 31 (22.6%) MG patients, and TBII was detected in 4 of 21 (19.0%) MG patients. The grades of exophthalmos did not decrease after extraocular muscle weakness was improved by treatment. Patients with MG whose diplopia was Tensilon unresponsive were only found among those with exophthalmos. TBII was more frequently detected in MG patients with exophthalmos than in those without. The present study revealed that exophthalmos is not rare in MG patients, even if they do not show any signs of Graves' disease other than exophthalmos and their thyroid functions are within the normal limit. The presence of TBII in MG patients may relate to the development of exophthalmos, and exophthalmos itself might enhance ocular symptoms of MG.

[The influence of serum separators on biochemical values in experimental animals]

The influence of three serum separators, A, B and C, on biochemical values was examined. With A or B, changes in the values of ChE, LAP, UN, K, P, Cl and Ca in rat serum; ChE, UN, Cl and Ca in dog serum; and K and P in monkey serum took place over a period of 20 min after blood collection. Therefore, the biochemical values of whole blood were considered to be stable after 20 min. Thus, biochemical tests were conducted on serum from the three serum separators after allowing the blood to stand 20 min. The values obtained for each separator were not markedly different from those of the control. These results suggest that a serum separator is useful for separation of serum of experimental animals under the proper conditions.

Lipoprotein(a) levels in the nephrotic syndrome

We investigated serum lipoprotein(a) [Lp(a)] levels in 20 patients with the nephrotic syndrome. Lp(a) levels in the nephrotic syndrome patients were significantly higher than those in a control group (30.4 +/- 22.5 vs 10.4 +/- 17.7 mg/dl). Overall, the serum Lp(a) and lipid levels showed no relationship, but on an individual basis the serum Lp(a) level varied with the serum levels of total cholesterol and low density lipoprotein cholesterol in the nephrotic syndrome patients. Our findings suggest that a decrease in serum albumin led to increased hepatic Lp(a) synthesis. It is well known that thrombotic disease supervenes on hypercoagulability in the nephrotic syndrome, so the determination of Lp(a) levels in these patients may provide information which is useful for preventing thrombotic complications.

[A descriptive study of the defining characteristics of nursing diagnosis: sexual dysfunction]

The defining characteristics of the nursing diagnosis "Sexual Dysfunction" were gathered from NAAM assessment records. From this population 96 records with the defining characteristics of Sexual Dysfunction were selected. The 9 defining characteristics proposed by The North American Nursing Diagnosis Association were used as a framework for the data collection tool. The 3 most frequently defining characteristics were absence of sexual desire (71.9%), vaginal discharge (64.5%), and pain (44.8%). The authors concluded that 6 defining characteristics have not appeared; absence of sexual desire and vaginal discharge can be considered as minor characteristics. The authors recommend the implementation of other studies to clarify the subjective defining characteristics.

[Studies on the intracellular pharmacodynamic properties of proton pump inhibitors and the inhibitory mechanism of acid secretion]

In recent studies, proton pump inhibitors, such as omeprazole, were found to be transformed into sulfenamide derivatives in the acid space of isolated parietal cells. It is considered that these sulfenamide derivatives mainly inhibit H+, K(+)-ATPase activity. To clarify the inhibitory mechanism of proton pump inhibitors, we studied the effect on acid secretion of the isolated parietal cells. Proton pump inhibitors inhibited histamine-, carbachol- and gastrin-stimulated 14C-aminopyrine accumulation. Db-cAMP stimulation was also inhibited by these inhibitors. Consequently, it is believed that the origin of H+, K(+)-ATPase was located in the final stage of the acid production.

Ultrastructure of thyroid C cells in sheep treated with vitamin D3

Ultrastructural observation was performed in C cells of sheep injected intramuscularly with a dose of 2 million IU of vitamin D3 daily for 10 days, 20 days and 30 days, respectively. After treatment with vitamin D3, hyperplasia and hypertrophy of C cells were noticed mainly at the periphery of the thyroid follicles. Most of hypertrophied C cells degranulated conspicuously and contained many prosecretory granules near the well developed Golgi apparatus which were in the actively secreting and packaging phase of their secretory cycle. The other C cells had prominent lamellar arrays of rough-endoplasmic reticulum and aggregations of free ribosomes in the cytoplasm which were interpreted to be in the actively synthesizing phase of their secretory cycle. Atrophic C cells which contained degenerative organelles in the cytoplasm were occasionally observed among the hypertrophied C cells. The present ultrastructural findings clarified that C cells synthesize and secrete calcitonin continuously due to prolonged hypercalcemia induced by long-term administration of excessive doses of vitamin D3 in sheep.

[Prognosis of life in polymyositis/dermatomyositis]

Although substantial patients are dead in the course of PM/DM, little papers have precisely investigated the cause of death and factors which may relate to death in PM/DM. The purpose of the present study is to evaluate the prognosis for life, causes of death and risk factors for life in PM/DM. Clinical records of 76 adult PM/DM patients were retrospectively reviewed. Seven patients died of associated malignancy. Five-year survival rate was 69.7% in PM/DM patients without malignancy. During the last 24 years, there was no significant change in survival rate. Among causes of death in 19 cases without malignancy, 7 cases died of respiratory failure and 7 patients died of cardiac involvement. There seems to be two types of pulmonary involvement causing respiratory failure; i.e. acute interstitial pneumonitis and chronic interstitial pneumonitis. In the former cases, the courses were very rapid, and patients died during 4 months after appearance of the first symptom. Risk factors were chosen by comparing clinical manifestation in dead patients with those in control subject. Control subjects were selected from non-dead patients by matching with sex, age, and duration after start of the first therapy. Acute onset disease, fever, arthritis, hypergammaglobulinemia, elevated ESR (greater than or equal to 30 mm/hr), lung fibrosis, and heart involvement are risk factors for life.

Extracellular ATP stimulates interleukin-dependent cultured mast cells and eosinophils through calcium mobilization

We examined the effect of ATP and related nucleotides on the changes in intracellular calcium ([Ca2+]i) in murine bone marrow-derived mast cells (BMMC) and human cord blood-derived eosinophils (EO) cultured in the presence of interleukins. ATP, ADP and AMP released a substantial amount of histamine and leukotriene C4 from BMMC, and EO showed locomotive activity in response to ATP, ADP and GTP. These reactions were accompanied with an increase in [Ca2+]i in BMMC and in EO. The rise in [Ca2+]i in BMMC induced by ATP or antigen at optimal concentrations was inclined to be persisting. On the other hand, these nucleotides induced a rapid and transient rise in [Ca2+]i in EO. Purified human peripheral EO also exhibited locomotive activity and an increase in [Ca2+]i in response to ATP. These results indicate that extracellular ATP activates interleukin-dependent cultured mast cells and EO through Ca2+ mobilization, and suggest that ATP, which is known to be released from activated platelets or autonomic nerves, may stimulate in vivo counterparts of these cultured inflammatory cells.