Volume supplementation with iso-sodium solution prevents hypernatremia after head injury

OBJECTIVE

To evaluate our developed volume supplement protocol in preventing hypernatremia after head injury.

METHODS

Iso-sodium solution was infused to keep the 8-hour water balance positive in 20 head-injured patients with hypotonic urine.

RESULTS

Serum sodium concentrations moved to within a normal range in 6 patients and were temporarily increased in 12 patients. Seven of the 12 showed a negative cumulative water balance and slightly low creatinine clearance. Mean arterial pressure in the other five patients was lower after supplementation and was positively related to sodium excretion. Hypernatremia could not be prevented in the other two patients and they did not survive. Creatinine clearance was below 40 mL/min/m2 in these two patients before supplementation.

CONCLUSION

Our protocol worked effectively in patients in whom renal function was preserved. Decreased creatinine clearance because of preexisting dehydration and lower arterial pressure disturbed increase in urinary sodium excretion and temporarily aggravated the hypernatremia.

Inhibition of experimental vasospasm by pretreatment with ultraviolet light irradiation in a rat femoral artery model

OBJECTIVE

Chronic cerebral vasospasm is resistant to conventional treatments despite recent advances in treatment modalities. We studied the preventive effect of ultraviolet (UV) irradiation on development of vasospasm and its mechanism in a rat femoral artery model.

METHODS

The rat femoral artery model for vasospasm was used in this investigation (n = 108). The femoral arteries were divided into four groups: empty and no irradiation (control), UV irradiation (UV group), blood placement (VS group), and blood placement after UV irradiation (VS + UV group). Luminal area was measured, and smooth muscle cell counts in the medial layer of the vessel wall were obtained. An immunohistochemical study was performed with cross sections of fixed femoral arteries at 12 hours and 1, 3, 5, 7, and 49 days after blood placement. The rings of femoral arteries on Day 7 were subjected to pharmacological study.

RESULTS

Pretreatment with UV irradiation (VS + UV group) resulted not only in significant inhibition of chronic vasospasm but also in a significant decrease in smooth muscle cells compared with the VS group on Days 5 and 7. The UV-treated arteries (UV and VS + UV groups) exhibited a significant number of Bax- and Bcl-2-positive cells on Days 5 and 7, but few CPP-32 positive cells were observed at the same time points. In the pharmacological study, contractile response to KCI or phenylephrine was reduced significantly in the UV-treated arteries.

CONCLUSION

These results imply that UV irradiation prevents chronic vasospasm and suggest that UV-induced cell death plays an important role in the preventive effect without causing complications during the chronic period.

Dose-dependent conjugation of sulfobromophthalein and hepatic transit time in bile fistula rats: role of the microtubule-dependent vesicle pathway

Sulfobromophthalein (BSP) is selectively taken up by the liver and secreted into the bile as unconjugated and conjugated forms. Our previous study demonstrated that unconjugated BSP, but not conjugated BSP, caused the dissociation of biliary lipid secretion from that of bile acids, suggesting that the hepatic BSP conjugation rate partly regulated biliary lipid secretion. To evaluate the mechanisms through which biliary lipid secretion is regulated by exogenous organic anions, we intravenously administered BSP to male Sprague-Dawley rats at various doses either continuously or as a bolus. Then the relationship of the dose of BSP to its conjugation rate, hepatic transit time, and biliary lipid secretion was determined. BSP decreased biliary secretion of cholesterol and phospholipids in a dose-dependent manner without affecting bile acid secretion. In contrast, the proportion of conjugated BSP in bile was associated with the dose. Although the serum clearance of BSP after bolus infusion was constant regardless of the dose administered (50 or 200 nmol/100 g), BSP secretion was delayed with increasing doses: unconjugated BSP was secreted predominantly in the early phase (0-15 min after bolus injection), and conjugated BSP was the predominant form in the late phase (15-30 min). Pretreatment with colchicine reduced the conjugation rate and hepatic transit time of BSP, suggesting that the microtubule-dependent vesicle pathway plays a role in biliary excretion and conjugation of BSP. We conclude that biliary lipid secretion is influenced by organic anions with an affinity for bile acids such as BSP and that this effect is dependent upon the hepatic metabolic rate, i.e., conjugation rate. The hepatic transit time also plays a key role in this process by influencing metabolism.

Endovascular treatment for vertebral dissecting aneurysm presenting with subarachnoid hemorrhage

We report results and problems of the endovascular treatment in 12 cases of intradural vertebral dissecting aneurysm presenting with subarachnoid hemorrhage. There were four complications related to interventional procedure and conventional angiography. In three patients (25%), VDAs ruptured immediately after injection of contrast media or hypertension during the interventional procedure, which caused respiratory arrest. In a case of bilateral VA dissection (8%), after proximal VA occlusion had been performed for unilateral VDA, contralateral dissection extended to the basilar artery resulting in brain stem infarct. We suggest that the incidence of rebleeding of VDA during angiography and embolization is higher than that of usual saccular aneurysms. Careful injection of contrast media and strict blood pressure control seems to be more important to prevent rebleeding in VDAs than intracranial saccular aneurysms. Since unilateral VA occlusion may extend contralateral dissection in a case of bilateral VA dissection, it is necessary to check contralateral VA dissection before VA occlusion.

Clinical results and complications of endovascular treatment for intracranial aneurysms

SUMMARY

Thirty-two patients with intracranial aneurysm were treated via the endovascular approach and clinical results and complications were accessed. The aneurysms were on the anterior circulation, posterior circulation and feeding artery of AVM in 17, 12 and three patients respectively. In 17 (anterior circulation aneurysm), 12 patients underwent parent artery occlusion. There were two complications: cerebral embolism due to premature detachment of balloons and cerebral infarct due to parent artery occlusion. In 12 (posterior circuration aneurysm), four patients had complications: three infarcts due to parent artery occlusion and one aneurysmal bleeding at the interventional procedure. Coil compactions occurred in four cases. There were no complications in cases associated with AVM. Use of detachable balloons for intra-aneurysmal occlusion and intra-aneurysmal embolisation for partially thrombosed giant aneurysm tends to result in ischemic lesions where patient outcome is poor. We must pay attention to avoid these complications even though intra-aneurysmal embolisation using microcoils is currently performed safely.

Competitive uptake of porphyrin and LDL via the LDL receptor in glioma cell lines: flow cytometric analysis

We examined the simultaneous uptake of porphyrin and (LDL) by four established cell lines of glioma and normal fibroblasts using flow cytometry (FCM). The results indicated porphyrin and LDL showed competitive conjugation with the LDL receptor. These results support the theory of the porphyrin uptake via the LDL receptor.

Preparation and characterization of SNO-PEG-hemoglobin as a candidate for oxygen transporting material

Acellular hemoglobin (Hb) derivates developed as oxygen carriers are known to cause hypertensive reactions due to their nitric oxide (NO) scavenging action. To modulate this undesired activity, we have developed a new Hb derivative, s-nitrosylated polyethylene glycol (PEG)-modified hemoglobin (SNO-PEG-Hb), which can deliver oxygen and NO. After human Hb was modified with PEG to increase its molecular weight, the free sulfhydryl groups of Hb were s-nitrosylated with s-nitrosoglutathione. Administration of unmodified Hb into anesthetized rats caused a hypertensive reaction, while s-nitrosylated Hb derivatives such as SNO-Hb and SNO-PEG-Hb did not raise blood pressure. The plasma half-lives of heme and NO bound to SNO-PEG-Hb were 11.5 and 2.4 hours respectively, indicating that the s-nitrosylated Hb derivative may act as a slow-releasing agent for NO. Based on these findings, SNO-PEG-Hb is a useful candidate for a blood substitute and tool for oxygen therapeutics.

Review: prediction of in vivo fates of proteins in the era of genomics and proteomics

Even after a nascent protein emerges from the ribosome, its fate is still controlled by its own amino acid sequence information. Namely, it may be co-/posttranslationally modified (e.g., phosphorylated, N-/O-glycosylated, and lipidated); it may be inserted into the membrane, translocated to an organelle, or secreted to the outside milieu; it may be processed for maturation or selective degradation; finally, its fragment may be presented on the cell surface as an antigen. Here, prediction methods of such protein fates from their amino acid sequences are reviewed. In many cases, artificial neural network techniques have been effectively used. The prediction of in vivo fates of proteins will be useful for characterizing newly identified candidate genes in a genome or for interpreting multiple spots in proteome analyses.

Billroth I gastrectomy using a circular stapler to treat gastric cancer

We describe herein our technique of performing gastrectomy followed by side-to-end gastroduodenostomy. Because the clamp is removed at the resection line of the greater curvature, there is no need to perform an additional gastrotomy for insertion of the instrument. This feature differentiates our technique from previous methods of anastomosis using the circular stapler. We believe that our technique is superior in simplicity and security to the traditional hand-sewn anastomosis. Moreover, it allows for a shorter operative time. This technique is recommended for practical surgery over conventional techniques.

Assessment of prediction accuracy of protein function from protein--protein interaction data

Functional prediction of open reading frames coded in the genome is one of the most important tasks in yeast genomics. Among a number of large-scale experiments for assigning certain functional classes to proteins, experiments determining protein-protein interaction are especially important because interacting proteins usually have the same function. Thus, it seems possible to predict the function of a protein when the function of its interacting partner is known. However, in vitro experiments often suffer from artifacts and a protein can often have multiple binding partners with different functions. We developed an objective prediction method that can systematically include the information of indirect interaction. Our method can predict the subcellular localization, the cellular role and the biochemical function of yeast proteins with accuracies of 72.7%, 63.6% and 52.7%, respectively. The prediction accuracy rises for proteins with more than three binding partners and thus we present the open prediction results for 16 such proteins.

Unilateral spatial neglect associated with chronic subdural haematoma: a case report

A 69-year-old right-handed man who exhibited unilateral spatial neglect in association with a chronic subdural haematoma, presented with mild left arm and leg weakness first noted 4 weeks prior to admission. Neurologic examination on admission revealed a mild left hemiparesis, including the face. Neuropsychologic examination revealed left unilateral spatial neglect, but no language disturbance. Minimal support was necessary to maintain activities of daily living. Computed tomography revealed a large right temporoparietal, extraaxial hypodense fluid collection containing scattered hypodense foci. The haematoma was evacuated via a right parietal burr hole. Following surgery, the patient dramatically improved neurologically and neuropsychologically, as well as in independent performance of daily activities. It is suggested that the improvement in ADL provides a behavioural correlate of improvement in the latter, represented a behavioural correlate of improved cerebral function, and that either direct compression by the chronic subdural haematoma or an interhemispheric pressure difference had caused unilateral spatial neglect. Such neglect is an unusual consequence of chronic subdural haematoma.

Molecular characteristic-based epidemiology of hepatitis B, C, and E viruses and GB virus C/hepatitis G virus in Myanmar

We carried out a molecular characteristic-based epidemiological survey of various hepatitis viruses, including hepatitis B virus (HBV), hepatitis C virus (HCV), hepatitis E virus (HEV), and GB virus C (GBV-C)/hepatitis G virus (HGV), in Myanmar. The study population of 403 subjects consisted of 213 healthy individuals residing in the city of Yangon, Myanmar, and the surrounding suburbs and 190 liver disease patients (155 virus-related liver disease patients and 35 nonviral disease patients). The infection rates of the viruses among the 213 healthy subjects were as follows: 8% for HBV (16 patients), 2% for HCV (4 patients), and 8% for GBV-C/HGV (17 patients). In contrast, for 155 patients with acute hepatitis, chronic hepatitis, liver cirrhosis, or hepatocellular carcinoma, the infection rates were 30% for HBV (46 patients), 27% for HCV (41 patients), and 11% for GBV-C/HGV (17 patients). In the nonviral liver disease group of 35 patients with alcoholic liver disease, fatty liver, liver abscess, and biliary disease, the infection rates were 6% for HBV (2 patients), 20% for HCV (7 patients), and 26% for GBV-C/HGV (9 patients). The most common viral genotypes were type C of HBV (77%), type 3b of HCV (67%), and type 2 of GBV-C/HGV (67%). Moreover, testing for HEV among 371 subjects resulted in the detection of anti-HEV immunoglobulin G (IgG) in 117 patients (32%). The age prevalence of anti-HEV IgG was 3% for patients younger than 20 years and 30% or more for patients 20 years of age or older. Furthermore, a high prevalence of anti-HEV IgG (24%) was also found in swine living together with humans in Yangon. These results suggest that these hepatitis virus infections are widespread in Myanmar and have led to a high incidence of acute and chronic liver disease patients in the region.

Expression of c-fos, heat shock protein 70, neurotrophins, and cyclooxygenase-2 mRNA in response to focal cerebral ischemia/reperfusion in rats and their modification by magnesium sulfate

The marginal area surrounding a region of ischemic brain tissue, designated as the penumbra, is of interest as a potential area for the rescue of neurons from cell death. Despite its clinical importance, relatively little is known about the molecular events leading to changes in brain cells in the penumbra following ischemia. In the first part of this study, we used in situ hybridization to investigate the temporal and spatial expression of c-fos, heat shock protein 70 (HSP70), neurotrophins and inducible cyclooxygenase-2 (COX-2) in the rat brain following a 2-h occlusion of the middle cerebral artery (MCA) with reperfusion. In the penumbra and surrounding cortex, upregulation of c-fos, brain-derived neurotrophic factor (BDNF), and COX-2 mRNAs was observed, while expression of HSP70 mRNA was restricted to the penumbra. This spatial discrepancy of mRNA expression suggests that different mechanisms are involved in the regulation of c-fos/BDNF/COX-2 and HSP70 expression. Intravenous infusion of magnesium sulfate (25 mg/kg) decreased both the infarct volume and upregulation of these mRNAs, suggesting its therapeutic potential.

ORI-GENE: gene classification based on the evolutionary tree

MOTIVATION

Genome projects have produced large amounts of data on the sequences of new genes whose functions are as yet unknown. The functions of new genes are usually inferred by comparing their sequences with those of known genes, but evaluation of the sequence homology of individual genes does not make the most of the available sequence information. Therefore, new methods and tools for extracting more biological information from homology searches would be advantageous.

RESULTS

We have developed a computational tool, ORI-GENE, to analyze the results of sequence homology searches from the perspective of the evolution of selected sets of new genes. ORI-GENE has a graphical interface and accomplishes two important tasks: first, based on the output of homology searches, it identifies species with similar genes and displays their pattern of distribution on the phylogenetic tree. This function enables one to infer the way in which a given gene may have propagated among species over time. Second, from the distribution patterns, it predicts the point at which a given gene may have been first acquired (i.e. its 'origin'), then classifies the gene on that basis. Because it makes use of available evolutionary information to show the way in which genes cluster among species, ORI-GENE should be an effective tool for the screening and classification of new genes revealed by genome analysis.

AVAILABILITY

ORI-GENE is retrievable via the Internet at: http://www.rtc.riken.go.jp/jouhou/ORI-GENE.

Pre-emptive therapy against cytomegalovirus (CMV) disease guided by CMV antigenemia assay after allogeneic hematopoietic stem cell transplantation: a single-center experience in Japan

From April 1998 to March 2000, a cytomegalovirus (CMV) antigenemia-guided pre-emptive approach for CMV disease was evaluated in 77 adult patients who received allogeneic hematopoietic stem cell transplantation at the National Cancer Center Hospital. A CMV antigenemia assay was performed at least once a week after engraftment. High-level antigenemia was defined as a positive result with 10 or more positive cells per 50 000 cells and low-level antigenemia was defined as less than 10 positive cells. Among the 74 patients with initial engraftment, 51 developed positive antigenemia. Transplantation from alternative donors and the development of grade II-IV GVHD were independent risk factors for positive antigenemia. Ganciclovir was administered as pre-emptive therapy in 39 patients in a risk-adapted manner. None of the nine low-risk patients with low-level antigenemia as their initial positive result developed high-level antigenemia even though ganciclovir was withheld. Only one patient developed early CMV disease (hepatitis) during the study period. CMV antigenemia resolved in all but two cases, in whom ganciclovir was replaced with foscarnet. In eight patients, however, the neutrophil count decreased to 0.5 x 10(9)/l or less after starting ganciclovir, including three with documented infections and two with subsequent secondary graft failure. The total amount of ganciclovir and possibly the duration of high-dose ganciclovir might affect the incidence of neutropenia. We concluded that antigenemia-guided pre-emptive therapy with a decreased dose of ganciclovir and response-oriented dose adjustment might be appropriate to decrease the toxicity of ganciclovir without increasing the risk of CMV disease.

Prediction of co-regulated genes in Bacillus subtilis on the basis of upstream elements conserved across three closely related species

BACKGROUND

Identification of co-regulated genes is essential for elucidating transcriptional regulatory networks and the function of uncharacterized genes. Although co-regulated genes should have at least one common sequence element, it is generally difficult to identify these genes from the presence of this element because it is very easily obscured by noise. To overcome this problem, we used conserved information from three closely related species: Bacillus subtilis, B. halodurans and B. stearothermophilus.

RESULTS

Even though such species have a limited number of clearly orthologous genes, we obtained 1,884 phylogenetically conserved elements from the upstream intergenic regions of 1,568 B. subtilis genes. Similarity between these elements was used to cluster these genes. No other a priori knowledge on genes and elements was used. We could identify some genes known or suggested to be regulated by a common transcription factor as well as genes regulated by a common attenuation effector.

CONCLUSIONS

We confirmed that our method generates relatively few false positives in clusters with higher scores and that general elements such as -35/-10 boxes and Shine-Dalgarno sequence are not major obstacles. Moreover, we identified some plausible additional members of groups of known co-regulated genes. Thus, our approach is promising for exploring potentially co-regulated genes.

[Simultaneous carotid and coronary artery surgery in asymptomatic carotid artery stenosis--report of three cases]

Some patients with coronary artery disease are diagnosed as having additional carotid artery disease. This subset of patients has been identified as a high-risk group for cardiac and cerebral complications following surgical intervention. Three patients who underwent combined CEA/CABG for coexistent asymptomatic carotid occlusive disease are reported. Case 1: A 69-year-old female who suffered chest pain on exertion. Her coronary angiogram showed severe stenosis of three vessels. Her carotid angiogram showed 98% stenosis of the right internal carotid artery and poor collateral circulation. The severe stenosis of her carotid artery was considered as a risk factor for perioperative cerebral stroke. Intraoperatively, CEA preceded the CABG. Postoperative course was uneventful. Case 2: A 64-year-old male. Intermittent claudication was his initial symptom. His coronary angiogram showed stenosis in three vessels and carotid angiogram showed 75% stenosis in the right carotid artery. Simultaneous CABG and CEA was performed. His postoperative course was uneventful. Case 3: A 62-year-old male whose ECG indicated ischemic heart disease, although he had no symptoms. His coronary angiogram showed stenosis in three vessels, and 80% stenosis of his right carotid artery was observed by carotid angiogram. He underwent simultaneous surgery, and had an uneventful postoperative course. It has been reported that 1.5-8.7% of CABG patients have severe carotid artery stenosis, and perioperative cerebral stroke occurs in 0.9-16%. Simultaneous surgery was successful in our three patients who had asymptomatic carotid artery stenosis. Using this surgical approach for critical coexistent disease may minimize the incidence of perioperative cerebrovascular complications in patients undergoing CABG.

DBTBS: a database of Bacillus subtilis promoters and transcription factors

With the completion of the determination of its entire genome sequence, one of the next major targets of Bacillus subtilis genomics is to clarify the whole gene regulatory network. To this end, the results of systematic experiments should be compared with the rich source of individual experimental results accumulated so far. Thus, we constructed a database of the upstream regulatory information of B.subtilis (DBTBS). The current version was constructed by surveying 291 references and contains information on 90 binding factors and 403 promoters. For each promoter, all of its known cis-elements are listed according to their positions, while these cis-elements are aligned to illustrate their consensus sequence for each transcription factor. All probable transcription factors coded in the genome were classified with the Pfam motifs. Using this database, we compared the character of B.subtilis promoters with that of Escherichia coli promoters. Our database is accessible at http://elmo.ims.u-tokyo.ac.jp/dbtbs/.

Attenuation of hypothermia-induced platelet activation and platelet adhesion to artificial surfaces in vitro by modification of hemoglobin to carry S-nitric oxide and polyethylene glycol

Hypothermic cardiopulmonary bypass alters platelet function and hypothermia is associated with postoperative myocardial ischemia. Thrombogenic surfaces such as extracorporeal circuits, vascular graft materials, and components of atherosclerotic plaque induce activation of platelets. The effects of human hemoglobin (Hb) covalently modified to carry S-nitric oxide (NO) functional groups (SNO-Hb), polyethylene glycol (PEG-Hb), and SNO-PEG-Hb on platelet activation were studied. Platelet activation was assessed by cytometric analysis of GPIIb-IIIa activation and P-selectin expression at hypothermic condition (22 degrees C) after stimulation with Hb derivatives. Platelet adhesion and aggregation were measured in a parallel glass plate chamber coated with unmodified Hb, SNO-Hb, PEG-Hb, SNO-PEG-Hb, and collagen. Platelet binding of antibodies to GPIIb-IIIa and P-selectin was significantly enhanced by hypothermic condition and by unmodified Hb. There was significantly less platelet binding of antibodies to GPIIb-IIIa and P-selectin with SNO-Hb, PEG-Hb, and SNO-PEG-Hb compared with unmodified Hb. There was significantly less platelet attachment, adhesion, and aggregation on the SNO-Hb, PEG-Hb and SNO-PEG-Hb coated surfaces compared with unmodified Hb-coated and -uncoated surfaces. SNO-Hb, PEG-Hb, and SNO-PEG-Hb induced less platelet activation at hypothermic temperature, and induced less platelet adhesion and aggregation on thrombogenic surfaces compared with unmodified Hb. The inhibitory effect may be derived from antiadhesive properties of Hb, antiplatelet actions of NO, and molecular barrier action of PEG.

An alternative-exon database and its statistical analysis

We compiled a comprehensive database of alternative exons from the literature and analyzed them statistically. Most alternative exons are cassette exons and are expressed in more than two tissues. Of all exons whose expression was reported to be specific for a certain tissue, the majority were expressed in the brain. Whereas the length of constitutive exons follows a normal distribution, the distribution of alternative exons is skewed toward smaller ones. Furthermore, alternative-exon splice sites deviate more from the consensus: their 3' splice sites are characterized by a higher purine content in the polypyrimidine stretch, and their 5' splice sites deviate from the consensus sequence mostly at the +4 and +5 positions. Furthermore, for exons expressed in a single tissue, adenosine is more frequently used at the -3 position of the 3' splice site. In addition to the known AC-rich and purine-rich exonic sequence elements, sequence comparison using a Gibbs algorithm identified several motifs in exons surrounded by weak splice sites and in tissue-specific exons. Together, these data indicate a combinatorial effect of weak splice sites, atypical nucleotide usage at certain positions, and functional enhancers as an important contribution to alternative-exon regulation.

Endovascular Surgery for Internal Carotid Stenoses. Results of PTA vs. Stenting

SUMMARY

This paper will overview our results of endovascular therapy (PTA or stenting) for cervical ICA stenosis and discuss the advantages and disadvantages of each treatment. 60 cases with 62 lesions were treated with PTA 68 times, while 36 cases with 37 lesions were treated with stenting 37 times. A total of 99 lesions were treated with PTA or stenting 105 times. In the PTA group arterial stenosis improved from 76.4% to 21%. In the stent group the stenosis improved from 82.3% to 8.3%. The morbidity rate was 2/60 (3.3%) in PTA group, although two cases had minor neurological deficits, while in stent treated group, morbidity rate was 1/36 (2.8%), although it showed one major neurological deficit. Mortality was 0% in each group. The restenosis rate in PTA group was 15/58 (26%), while it was 0/20 (0%) in stent treated group. Stenting brings significant reduction of stenosis and reduces the rate of restenosis compared to PTA. However, stenting has its own disadvantages such as hypotension and distal kinks when deployed in tortuous ICA stenosis.

The strategy for internal carotid stenosis with thrombus

SUMMARY

We report 3 cases of internal carotid artery (ICA) stenosis with thrombus. The initial symptom is transient ischemic attack (TIA) in 1 case, and cerebral infarction due to artery-to-artery embolism in 2 cases.We started anticoagulation and antiplatelet therapy after the angiography on admission in all cases. Carotid endarterectomy (CEA) was performed in 1 case after confirming the disappearance of the thrombus 1 month after the initial attack, although small cerebral embolic infarction happened during this period. In the other cases, percutaneous transluminal angioplasty (PTA) and stenting was performed using the protective technique about 2 weeks after the initial attack without embolic complication. Postoperative angiography showed sufficient dilatation. It seemed that PTA/stenting using the protection system was one of the alternatives for ICA stenosis with thrombus.

International harmonization of bioequivalence studies and issues shared in common

In the course of a review of the current health insurance system in Japan, promotion of the use of generic products of lower price is expected in direction for minifying the drug costs which occupy about 20% thereof. However, the use of generic products has not increased so much as expected. One of the reasons to explain the fact might be that concerns exist about switchability from an innovator product to a generic product or among generic products because of bias in bioequivalence. Namely, hesitation about the difference in quality between generic products and innovator products, particularly in bioequivalence due to differences in the manufacturing process and pharmaceutical technology, exists among professionals in medical practice. The bioequivalence study to guarantee that a generic product is bioequivalent to an innovator product in terms of effectiveness and safety is most important in assuring the quality of generic products. There are various specifications and study methods to prove bioequivalence which differ slightly from one to another in different countries. We have investigated bioequivalence studies which are conducted in the major countries. Consequently, we clarified that bioequivalence studies are in international harmonization in terms of the major portions thereof. However, different conditions, e.g., selection of subjects, food effect, application of multiple dose study, and in vitro dissolution study, are still employed for the studies. Therefore, we consider that these differences constitute the topics to be reviewed in future.

New bioequivalence studies: individual bioequivalence and population bioequivalence

The bioequivalence study which is currently conducted in different countries is the so-called average bioequivalence approach; this approach has been indicated to be insufficient for assessing switchability between two formulations (i.e., from the reference formulation to the test formulation). In the U.S., therefore, the population bioequivalence approach and the individual bioequivalence approach were recently proposed as the studies which would replace the current average bioequivalence approach. The average bioequivalence approach compares only the mean parameters of the test and reference formulations in the subject groups which received them. In contrast, the population bioequivalence approach guarantees prescribability by assessing the total variances of bioavailability values of the test and reference formulations in addition to the average bioequivalence. The individual bioequivalence approach guarantees switchability from the reference formulation to the test formulation by assessing the intrasubject variance and subject-by-formulation interaction in addition to the average bioequivalence. We introduce the individual bioequivalence approach and the population bioequivalence approach in comparison with the current average bioequivalence approach and have discussed the characteristics and issues of each of these three bioequivalence approaches.

Structuring WAN and LAN for EPR use in community health care

After describing determinants for the creation of a successfully used community health care network, our new project of making a mechanism fostering steady development of WAN and LAN among community is presented. Most of the difficulties that inhibit the sound development of community health care system are solved.

Stereoscopic display of a three-dimensional image of the larynx using high-speed helical scanning

To evaluate the usefulness of stereoscopic images of larynges using helical CT in stereo mode, a retrospective review of the characteristics of stereoscopic viewing of larynges was made. The subjects were 3 patients with laryngeal cancer, 1 patient with laryngeal leiomyosarcoma and 1 patient with an advanced tongue carcinoma whose formalin-fixed larynx was extirpated. The larynges were scanned by high-speed helical CT using 1- to 2-mm slices. The reproduction of stereographic images was performed by the manipulation and rotation of three-dimensional structures around the y-axis on the computer display. The three-dimensional images of the complex structures, such as the arytenoid cartilage, aryepiglottic fold and pyriform sinus, were better observed by binocular images (stereograms) than by monocular images. Stereoscopic views of the larynx are useful in producing three-dimensional images of the unseen inner surface of the human body.

Factors affecting gallstone recurrence after successful extracorporeal shock wave lithotripsy

Ninety-six patients treated successively for symptomatic cholelithiasis with extracorporeal shock wave lithotripsy (ESWL) and oral bile acid therapy consisting of ursodeoxycholic acid in daily dosages of 600 mg were prospectively followed for gallstone recurrence for a median of 13 months. Ultrasonography was performed to detect stone recurrence at 3, 6, and 12 months, and then yearly after the termination of therapy. Recurrent stones were found in 17 patients (18%). The cumulative probability of gallstone recurrence was 15.8% at 12 months, 26.1% at 24 months, and 30.7% at 36 months. The probability of stone recurrence over the entire period of observation was not dependent on stone number, whereas the median interval to detection of recurrence was significantly shorter in the patients with multiple stones (2 months) than in those with solitary stones (8 months) (p < 0.05). The rate of impaired gallbladder contractility was higher in patients with recurrence (8/15, 53.3%) when compared with those with no recurrence (15/72, 20.8%) (p < 0.01). Neither age, gender, or stone characteristics predicted stone recurrence. Only one patient with a recurrence reported biliary pain. Of the 15 patients with recurrent stones who opted for further nonsurgical treatment, complete stone disappearance was achieved in 10. Impaired gallbladder function may predict gallstone recurrence after ESWL.

Cycloprodigiosin hydrochloride, H(+)/CL(-) symporter, induces apoptosis and differentiation in HL-60 cells

Cycloprodigiosin hydrochloride (cPrG * HCl), a novel H(+)/Cl(-) symporter, induces acidification of the cytosol and leads to apoptosis in rat and human liver cancer cells. In the present study, the effect of cPrG * HCl on a promyelocytic leukemia cell line (HL-60) was examined. cPrG * HCl lowered intracellular pH and induced apoptosis through up-regulation of Fas ligand, activation of stress-activated protein kinase (SAPK/JNK) and caspase. Apoptosis induced by cPrG * HCl was strongly suppressed when a cell-permeable weak base, imidazole, was present, indicating that cytosol acidification introduced by cPrG * HCl triggered caspase activation, leading to apoptosis. Concomitantly, cell differentiation into monocyte was also induced by cPrG * HCl both morphologically and functionally. However, the cPrG * HCl-induced differentiation was not suppressed by addition of imidazole, indicating that the differentiation process is unrelated to cytosol acidification. Further, the differentiation induced by cPrG * HCl was blocked by tyrosine kinase inhibitors (lavendustin A and HMA) but unaffected by the inhibitors of A-kinase (H-89) or C-kinase (H-7). Taken together, these findings suggest that cPrG * HCl, through apoptosis and differentiation induction, may be useful in leukemia treatment.

Fetal striatal transplants reinstate the electrophysiological response of pallidal neurons to systemic apomorphine challenge in rats with excitotoxic striatal lesions

Previous studies with single-unit recording and 2-[14C]deoxyglucose quantitative autoradiography have shown that systemic administration of apomorphine increases the functional activity of pallidal neurons, and that the enhancement in the globus pallidus (GP) activity is abolished by striatal lesions. The present study employing electrophysiological techniques tested whether embryonic striatal tissue implanted in the excitotoxically damaged striatum of rats may affect the lesion-induced alteration in the neuronal response of GP to apomorphine. Systemically administered apomorphine significantly increased spontaneously firing rates of GP cells. The blockade of dopamine receptors with haloperidol reversed the increased rate to baseline levels. Quinolinate-induced striatal lesions attenuated the rate-increasing effect of apomorphine. Embryonic striatal grafts placed in the lesioned striatum restored the response of GP cells to systemic apomorphine. The graft-mediated restoration of the GP neuron response to apomorphine were accompanied by an improvement in the motor asymmetry induced by this drug. Considering previous anatomical data to demonstrate extensive innervation of the GP by embryonic striatal grafts, the present results suggest that the grafts reconstruct the functional striatopallidal pathway which is capable of transmitting apomorphine-induced changes in the neuronal activity.

[Rapid development of multiple meniscal signs complicating invasive pulmonary aspergillosis in a patient receiving chemotherapy for acute leukemia]

This report describes the rapid development of multiple meniscal signs complicating invasive pulmonary aspergillosis in a 53-year-old man receiving chemotherapy for acute leukemia. While undergoing first induction therapy for AML, he developed chest pain, and multiple bilateral infiltrations were seen in chest roentgenograms. Administration of antibiotics, antifungal agents, steroid pulse therapy and G-CSF was begun. Pulmonary cavities with meniscal signs developed. The next day, pneumothorax and hemothorax were noted. Although drainage and mechanical ventilation were performed, the patient died after massive hemoptysis. Invasive pulmonary aspergillosis was diagnosed at autopsy.

Protective effect of melatonin on methylmercury-Induced mortality in mice

Effect of melatonin on the mortality in methylmercury chloride (MMC)-intoxicated mice was evaluated. Mice were given MMC in the diet (40 mg Hg/g) with or without melatonin in drinking water (20 mg/ml) for 5 weeks. In the control group, given MMC alone, 4 of 10 mice began to show neurological signs (e.g., abnormal righting reflex, staggering gaitfallen and posture on its side) concomitant with loss of body weight 4-7 days before death. This group also showed 60% of survival rate on the 35th day. However, the treated group, concomitantly given melatonin, showed a 100% of survival rate on the 35th day, although 1 of 10 mice began to show the neurological signs on the 33rd day. The level of thiobarbituric acid reactive substance in the brain, as an indication of oxidative damage, showed a significant decrease in the treated group compared with the control group. Thus, the 100% survival rate in the treated group may be partly due to antioxidative effect of melatonin on the MMC induced neurotoxicity.

[Antithymocyte globulin treatment in 11 patients with aplastic anemia]

We report the response to, and toxicity of antithymocyte globulin (ATG) treatment in 11 consecutive patients (7 men and 4 women; median age 46 years) with aplastic anemia (AA). Six of the patients had severe disease and 5 had moderate disease; all were treated within one year from diagnosis. The ATG regimen was the initial treatment for 6 patients, but a sequential treatment for the other 5. Cyclosporin A was administered orally 1-3 weeks after the ATG treatment. All patients were assessed for over 6 months (median, 20.4 months); 8 showed a good response, 1 a minimal response, and 2 no response. Disease severity had no influence on the response. In 1 patient, ATG treatment had to be discontinued because of hepatic toxicity. However, adverse reactions were not severe in the other 10 patients. These findings suggest that ATG treatment is a safe and effective therapy for AA.

Role of phospholipase A2 in cholesterol gallstone formation is associated with biliary phospholipid species selection at the site of hepatic excretion: indirect evidence

Phospholipase A2 plays a role in cholesterol gallstone development by hydrolyzing bile phospholipids into lysolecithin and free fatty acids. Lysolecithin and polyunsaturated free fatty acids are known to stimulate the synthesis and/or secretion of gallbladder mucin via a prostanoid pathway, leading to enhancing cholesterol crystal nucleation and growth, and therefore, the action of phospholipase A2 is associated, in part, with bile phospholipid fatty acid. To clarify this hypothesis, we evaluated the effect on bile lipid metastability in vitro of replacing phospholipids with lysolecithin and various free fatty acids. Supersaturated model biles were created with an identical composition (cholesterol saturation index, 1.8; egg yolk lecithin, 34 mM; taurocholate, 120 mM; cholesterol, 25 mM) except for 5%, 10%, or 20% replacement of egg yolk lecithin with a combination of palmitoyl-lysolecithin and a free fatty acid (palmitate, stearate, oleate, linoleate, or arachidonate), followed by time-sequentially monitoring of vesicles and cholesterol crystals using spectrophotometer and video-enhanced differential contrast microscopy. Replacement with hydrophilic fatty acids (linoleate and arachidonate) reduced vesicle formation and promoted cholesterol crystallization, whereas an enhanced cholesterol-holding capacity was evident after replacement with hydrophobic fatty acids (palmitate and stearate). These results indicate that the effect of phospholipase A2 on bile lithogenecity is modulated by the fatty acid species in bile phospholipids, and therefore, that the role of phospholipase A2 in cholesterol gallstone formation is dependent, in part, on biliary phospholipid species selection at the site of hepatic excretion.

Apraxia and cerebral haemorrhage: the relationship between haematoma volume and prognosis

In this study, we examined twenty-five patients with left putaminal haemorrhage to investigate the relations between ideational apraxia (IA) and intracerebral haemorrhage. Apraxias were determined at 1 and 6 months after the stroke onset. Extension and volume of haematoma were examined with CT scan within 2 days of stroke onset. IA was present in 10 cases at 1 month and disappeared in 6 cases (transient IA) and persisted in 4 cases(persisted IA) at 6 months from the onset. Although the haematoma volume related to the existence of IA, there was no significant difference between transient and persistent IA. All three patients with the haematoma volume larger than 40 ml in the transient IA group were younger than 50 years old. All cases with persistent IA were older than 50 years old. Consequently, the existence of IA seems to be partially dependent on the haematoma volume which may cause the organic damage of subcortical white matter. However, patient's age is also important to determine the prognosis of IA. This maybe related to the nature of the haemorrhage and the mode of the onset. These factors remain to be determined.

Interhemispheric neuroepithelial cyst associated with agenesis of the corpus callosum. A case report and review of the literature

This report describes a neonatal case in whom a large interhemispheric cyst associated with agenesis of the corpus callosum was revealed by fetal ultrasonography and demonstrated by MRI to be multilobulated. Endoscopic fenestration of cysts was initially designed in view of the development of the patient's brain and surgical invasiveness. One year later, when motor paresis of the left arm and progressive enlargement of the cyst on MRI were revealed, open surgery was performed. The histological diagnosis was a neuroepithelial cyst with the feature of choroid plexus epithelia. The clinicopathological features of interhemispheric epithelial cysts associated with agenesis of the corpus callosum are reviewed in the light of differential diagnosis and therapeutic considerations.

Enhancement of hippocampal cholinergic neurotransmission through 5-HT1A receptor-mediated pathways by repeated lithium treatment in rats

Hippocampal cholinergic neuronal activity is reported to be regulated, at least partly, through serotonin1A (5-HT1A) receptors. Chronic lithium treatment has been shown to alter both behavioral and neurochemical responses mediated by postsynaptic 5-HT1A receptors. We investigated whether long-term lithium treatment affects central cholinergic neurotransmission through 5-HT1A receptor-mediated pathways. Changes in acetylcholine (ACh) release induced by 8-hydroxy-2-(di-n-propylamino)tetralin (8-OH-DPAT), a 5-HT1A receptor agonist, in the rat hippocampus were measured using a microdialysis technique and a radioimmunoassay for ACh. Administration of lithium for 21 days resulted in a serum lithium concentration of 1.03 mM and caused little change in density or affinity of [3H]8-OH-DPAT binding sites in the hippocampus. The local application of 8-OH-DPAT into the hippocampus of lithium treated rats increased the ACh efflux in both the absence and the presence of physostigmine, a cholinesterase (ChE) inhibitor, in the perfusion fluid. The basal ACh efflux of lithium treated rats was not different from that of the control rats under normal conditions, but was significantly higher than that of the controls when ChE was inhibited. These results demonstrate that chronic lithium treatment increases spontaneous ACh release in the hippocampus under conditions of ChE inhibition, but not under normal conditions, and enhances cholinergic neurotransmission through 5-HT1A receptor-mediated pathways, and suggest that activation of 5-HT1A receptor function by lithium is related to the enhancement of hippocampal cholinergic neurotransmission.

Comparison of neurobehavioral changes in three inbred strains of mice prenatally exposed to methylmercury

Pregnant mice of three inbred strains (BALB/c, C57BL/6J, C57BL/6Cr) were orally given methylmercury (MMC; 3 x 3 mg/kg body weight) or the equivalent volume of phosphate-buffered saline during days 12-14 of gestation and allowed to deliver. The behaviors of their male offspring were evaluated in an open field and their home cage and in a Morris water maze. In the open field test, the BALB/c and C57BL/6Cr MMC groups exhibited less total locomotor activity than did their respective control groups. However, there was no significant difference observed between the MMC and control C57BL/6J strain. In the BALB/c strain, the MMC group exhibited significantly more central locomotion and significantly less peripheral locomotion than did the control group. These results indicated that the prenatal exposure to MMC caused decreases in open-field activity in the C57BL/6Cr and BALB/c strains, concomitantly with a change in emotional status in BALB/c strain. For spontaneous activity in their home cage, all groups moved more actively in the dark phase than in the light phase except BALB/c MMC group. The BALB/c MMC group moved in the light phase as much as in the dark phase, indicating a disturbance of nocturnal rhythm of spontaneous activity. In the Morris water maze, the C57BL/6Cr and C57BL/6J control groups perform very well over the 5 consecutive days. The prenatal exposure to MMC caused significantly prolonged latency in the C57BL/6Cr and C57BL/6J, but not in BALB/c strain. This result indicated that the prenatal exposure to MMC impaired the performance in the Morris water maze differently among the strains. This study provides a basis for evaluating strain-specific neurobehavioral changes when the widely used three inbred strains of mice are chronically exposed to MMC.

Formation Process of MCM-41 Precursor and Porous Texture of MCM-41

The formation process of the MCM-41 precursors (silicate/surfactant complex) was investigated on the basis of the pH titration curves of Na(4)SiO(4) in the presence of [C(16)H(33)N(CH(3))(3)]Cl. Measurements of the pH titration curves were carried out using the computer-controlled gravimetric titrator constructed in our laboratory. The white precipitate (MCM-41 precursor) was abruptly formed at pH 11.1 (298 K) and at pH 9.9 (343 K). Formation of the MCM-41 precursor can be explained by coagulation of the rod-like micelle colloids whose surface is covered by the condensed silicate anions of (HSiO(3))(n)(n-). The porous texture of the MCM-41 samples whose precursors were synthesized under different conditions was analyzed on the basis of the adsorption isotherms of nitrogen at 77 K. It has been shown that the MCM-41 sample whose precursor was prepared at pH 9.9 and 343 K shows one sharp peak (r(p) = 1.65 nm) in the pore size distribution curve, but the MCM-41 samples whose precursors were prepared at pH 6.5-5.0 and 343 K give two peaks (r(p) = 1.66 nm and r(p) = 2.12-2.36 nm). The appearance of the second peak (r(p) = 2.12-2.36 nm) has been considered to be in connection with the destruction of the MCM-41 precursor into small fragments in acidic medium. Copyright 2000 Academic Press.

Promotion of survival and regeneration of nigral dopamine neurons in a rat model of Parkinson's disease after implantation of embryonal carcinoma-derived neurons genetically engineered to produce glial cell line-derived neurotrophic factor

OBJECT

The P19 embryonal carcinoma-derived cell line consists of undifferentiated multipotential cells, which irreversibly differentiate into mature neurons after exposure to retinoic acid (RA). In the present study, the authors genetically engineered P19 cells to produce glial cell line-derived neurotrophic factor (GDNF), and grafted the cells in a rat model that had been rendered parkinsonian.

METHODS

Undifferentiated P19 cells were grown in vitro and transduced with GDNF complementary DNA. The level of GDNF released from the transduced cells was measured using an enzyme-linked immunosorbent assay, and its neurotrophic activities were assessed by testing the effects on rat embryonic dopamine (DA) neurons in culture. After having been exposed to RA for 48 hours and allowed to differentiate into postmitotic neurons, the GDNF gene-transduced cells were implanted into the midbrain of immunosuppressed rats. A unilateral nigrostriatal lesion was then induced by intrastriatal infusions of 6-hydroxydopamine. Immunohistochemical analyses performed 4 weeks postgrafting revealed that the GDNF-producing cells expressed several neuronal markers without evidence of overgrowth. The grafts expressed GDNF protein and prevented the death of nigral DA neurons. Furthermore, the GDNF-producing cells implanted 4 weeks after nigrostriatal lesions restored the expression of tyrosine hydroxylase in injured DA neurons and induced their dendritic sprouting.

CONCLUSIONS

The results indicate that the P19 cell line transduced with the GDNF gene can stably secrete functional levels of GDNF, even after being converted to postmitotic neurons. Because it is has been established that GDNF exerts trophic effects on DA neurons, the means currently used to deliver GDNF into the brain could be a viable strategy to prevent the death of nigral DA neurons in cases of Parkinson's disease.