72-kDa stress protein (hsp72) induced by administration of dimethylarsinic acid to mice accumulates in alveolar flat cells of lung, a target organ for arsenic carcinogenesis

Our previous studies have demonstrated that the oral administration of dimethylarsinic acid (DMA), a main metabolite of inorganic arsenics in mammals, in mice causes DNA damage in the lung as well as the promotion and progression of lung- and skin-tumorigenesis. Moreover, we indicated that 72-kDa stress protein (Hsp72) was induced in cultured human pulmonary (L-132) cells by exposure to DMA and was accumulated specifically in the cell nuclei. The present in vivo study reveals the induction of Hsp72 by intraperitoneal administration of DMA to A/J mice used previously as an animal model of dimethylarsenic-induced lung tumorigenesis. The Hsp72 was observed in the lung, a target organ for arsenic carcinogenesis in human, and in the kidney as well, but not in the liver and spleen. By immunohistochemical analysis, the Hsp72 in lungs was exhibited to exist in the nuclei of alveolar flat cells, including capillary endothelial cells, which were previously found to increase the clumping of heterochromatin, an early morphological change in the developmental process of pulmonary carcinomas, after administration of DMA to mice. These in vivo observations suggest that the increase and accumulation of Hsp72 by administration of DMA to mice may occur specifically in target organs for arsenic carcinogenesis.

Oncostatin M is produced during pregnancy by decidual cells and stimulates the release of HCG

Oncostatin M (OSM) is a member of the interleukin-6 superfamily and a multifunctional cytokine that effects the growth and differentiation of many different cell types. OSM concentrations in the sera of pregnant women were found to be significantly higher than those of non-pregnant women. Western blot analysis revealed that the OSM protein was present in the decidua and chorionic tissue in each trimester. Throughout pregnancy, the amount of the OSM protein in the decidua was larger than that in the chorionic tissue. Immunohistochemistry using an anti-OSM monoclonal antibody demonstrated that OSM was mainly localized in the decidual glands and stroma. OSM transcripts in the decidua and the chorionic tissue were detected during each trimester by reverse transcription-polymerase chain reaction (RT-PCR). The regulation of human chorionic gonadotrophin (HCG) release by the placenta in first trimester stimulated with recombinant OSM was also investigated. Stimulation of the placenta by OSM augmented HCG release in a time- and dose-dependent manner. HCG release induced by recombinant human OSM was completely blocked by antibodies against OSM and the signal transducer, gp130, but only partially inhibited by antibodies against the leukaemia inhibiting factor (LIF) receptor. These results suggest that OSM molecules produced by decidual glands and stromal cells during pregnancy have an important role in placental endocrine function.

A patient of hypogonadotropic hypogonadism accompanied by growth hormone deficiency and decreased bone mineral density who attained normal growth

We present here a rare case of hypopituitarism accompanied by growth hormone (GH) deficiency and hypogonadotropic hypogonadism, in which the patient attained normal height but was of eunuchoid appearance. A 23-year-old man who had not reached puberty was referred to Saitama Medical School for hormonal evaluation. Basal hormonal data and hormone-stimulating tests revealed impaired secretion of GH, gonadotropins and adrenocorticotropic hormone (ACTH). Serum levels of testosterone, estrone, estradiol and estriol were all below the detectable ranges. The patient's plasma ACTH responded to corticotropin releasing hormone, but not to insulin-induced hypoglycemia. Serum GH showed a minimal response to GH-releasing hormone, but was unresponsive to insulin-induced hypoglycemia. Serum luteinizing hormone and follicle stimulating hormone did not respond to luteinizing hormone-releasing hormone. The results were compatible with a diagnosis of hypothalamic hypopituitarism. Magnetic resonance images of the brain showed a small anterior pituitary, an ectopic posterior lobe and transection of the pituitary stalk. Although the patient showed signs of hypopituitarism, he finally attained normal height, possibly because of failed epiphyseal maturation. His bone mineral density was markedly reduced to 0.647 g/cm2 in the lumbar spine; this level was 61.7% of the average level of healthy young males. Our findings were compatible with a recently advocated view that estrogen is important in promoting epiphyseal fusion and in determining bone density in males as well as females.

IL-18 induction of IgE: dependence on CD4+ T cells, IL-4 and STAT6

Overproduction of immunoglobulin E (IgE) and T helper cell type 2 (TH2) cytokines, including interleukin 4 (IL-4), IL-5 and IL-13, can result in allergic disorders. Although it is known that IL-4 is critical to the polarization of naïve CD4+ T cells to a TH2 phenotype, both in vitro and in many in vivo systems, other factors that regulate in vivo IL-4 production and TH2 commitment are poorly understood. IL-18, an IL-1-like cytokine that requires cleavage with caspase-1 to become active, was found to increase IgE production in a CD4+ T cells-, IL-4- and STAT6-dependent fashion. IL-18 and T cell receptor-mediated stimulation could induce naïve CD4+ T cells to develop into IL-4-producing cells in vitro. Thus, caspase-1 and IL-18 may be critical in regulation of IgE production in vivo, providing a potential therapeutic target for allergic disorders.

Skin-specific caspase-1-transgenic mice show cutaneous apoptosis and pre-endotoxin shock condition with a high serum level of IL-18

To study the pathophysiological roles of overexpressed caspase-1 (CASP1), originally designated as IL-1 beta-converting enzyme, we generated transgenic mice in which human CASP1 is overexpressed in their keratinocytes. The transgenic mice spontaneously developed recalcitrant dermatitis and skin ulcers, characterized by the presence of massive keratinocyte apoptosis. The skin of the mice contained the active form of human CASP1 and expressed mRNA for caspase-activated DNase, an effector endonuclease responsible for DNA fragmentation. Their skin and sera showed elevated levels of mature IL-18 and IL-1 beta, but not of IFN-gamma. The plasma from these animals induced IFN-gamma production by IL-18-responsive NK cells. Administration of heat-killed Propionibacterium acnes, a potent in vivo type 1 cell inducer, caused IFN-gamma-mediated lethal liver injury in the transgenic mice, which was completely inhibited by treatment with neutralizing anti-IL-18 Ab. These results indicated that in vivo overexpression of CASP1 caused spontaneous apoptotic tissue injury and rendered mice highly susceptible to exogenous type 1 cell-inducing condition in collaboration with endogenously accumulated proinflammatory cytokines.

A case of acute graft-versus-host disease following autologous peripheral blood stem cell transplantation

A 42-year-old woman developed severe erythema with exfoliative scaling on the bilateral palms and soles and erosive dermatitis on the axillae and groin eight days after an autologous peripheral blood stem cell transplantation for the treatment of non-Hodgkin's lymphoma. She also developed exanthema; however she did not show intestinal, hepatic, or renal involvement. The skin biopsy revealed characteristic apoptotic cell death of the epidermis with eosinophilic necrosis, and she was diagnosed with acute graft-versus-host disease (GVHD). The cutaneous lesions responded to topical corticosteroid treatments and improved within a month without systemic immunosuppressing therapies. The cutaneous GVH reaction did not recur. However, she was treated with an intermittent thrombocyte transfusion because of persistent thrombocytopenia. On day 130, she developed intestinal pneumonia and died due to respiratory dysfunction. Unlike an allo-bone marrow graft, GVHD after an autologous stem cell transplantation is not common. Even for an autologous transplantation, GVH may develop with less characteristic clinical manifestations.

H-reflex and motor evoked potential changes during head down bed rest

The purpose of the present study was to investigate effect of un-loading lower limb on H-reflex and motor evoked potentials (MEPs) induced by transcranial magnetic stimulation (TMS) during bed rest.

Significance of human testicular mast cells and their subtypes in male infertility

The mast cell populations in the human testis were examined using immunohistochemical techniques in five fertile volunteers and 12 patients with obstructive azoospermia, seven patients with idiopathic azoospermia, and 30 patients with varicocele. The number of mast cells per seminiferous tubular section was significantly increased (P < 0.05) in the men with idiopathic azoospermia. In the normal testes, mast cells containing only tryptase were the predominant subtype. In the patient groups, the predominant subtype of mast cell was shifted to that containing both tryptase and chymase. The average number of mast cells containing both tryptase and chymase per seminiferous tubular section was significantly increased (P < 0.05) compared with the controls in patients with obstructive azoospermia, idiopathic azoospermia, and varicocele. The number of mast cells containing only tryptase was not increased in infertile men. The selective expansion of the mast cell population containing both tryptase and chymase may be related to spermatogenetic disorders and testicular fibrosis.

[Activities of antimicrobial agents against 5,180 clinical isolates obtained from 26 medical institutions during 1998 in Japan. Levofloxacin--Surveillance Group]

The surveillance study was conducted to determine the antimicrobial activity of fluoroquinolones (ofloxacin, levofloxacin, ciprofloxacin, tosufloxacin) and other 20 antimicrobial agents against 5,180 clinical isolates obtained from 26 medical institutions during 1998 in Japan. The resistance to fluoroquinolones was remarkable in Enterococci, methicillin-resistant staphylococci and Pseudomonas aeruginosa from UTI. However, many of the common pathogens such as Streptococcus pneumoniae including penicillin-resistant isolates, methicillin-susceptible Stahylococcus aureus, Moraxella catarrhalis, the family of Enterobacteriaceae, Haemophilus influenzae including ampicillin-resistant isolates have been kept to be susceptible to fluoroquinolones. About 90% of P. aeruginosa isolates from RTI were susceptible to fluoroquinolones. In conclusion, the results from this surveillance study suggest that fluoroquinolones are useful in the treatment of various bacterial infections including respiratory infections.

[Gamma knife radiosurgery for skull base meningiomas: the treatment results and patient satisfaction expressed in answers to a questionnaire]

Skull base meningiomas can be treated by radiosurgery with low morbidity. We evaluated the effectiveness of gamma knife radiosurgery for skull base meningiomas. We also evaluated patient satisfaction through answers to a questionnaire. We treated 77 patients of skull base meningiomas using gamma knife radiosurgery from January 1994 to June 1998. Among these patients, 73 patients were able to be followed up from 6 to 60 months (average 25 months). The diagnosis was made by operations on 39 patients (53%), and on magnetic resonance imagings in 34 patients (47%). 21 patients (28.7%) had residual tumors after operations and 18 patients (24.3%) had recurrence after operations. 40% of neurological deficits occurred after previous operations and 20% of the patients were asymptomatic. The locations of the tumors were mainly the cavernous sinus region in 35 patients and the petroclival region in 20 patients. The tumor sizes were 8.6 to 58.3 mm (average 24.7 mm) and five cases of tumors with a mean diameter above 40 mm were treated by two-staged radiosurgery. Treatment volume was 0.3 to 31 ml (average 9.8 ml). The treatment dose was 8 to 16 Gy (average 11.2 Gy) at the tumor margin. The tumor decreased in size in 50 patients (68%) and was unchanged in 20 patients (28%) and we were able to achieve 96% tumor growth control. The clinical symptoms improved in 22 patients (30.1%) and were unchanged in 47 patients (64.4%) and only 4 patients (5.5%) showed deterioration. 50 patients (68%) felt clinical improvement and only 3 patients (4%) sensed deterioration. 58 patients (79%) were able to continue their previous work. Gamma knife radiosurgery has a very low morbidity rate and enables good tumor control, and patients with skull base meningiomas express satisfaction with the treatment results.

Primary intracranial germinoma in the medulla oblongata

BACKGROUND

Primary intracranial germ cell tumor in the medulla oblongata is very rare; only five cases, including our case, have been reported.

CASE REPORT

Our patient, an 18-year-old woman, was diagnosed with a primary intracranial germinoma in the medulla oblongata by an open biopsy. She was treated successfully with chemotherapy and radiosurgery.

CONCLUSION

All five tumors in this site were histologically diagnosed as germinomas. The finding of female predominance in germ cell tumors in this region is shown.

The role of orally administered dimethylarsinic acid, a main metabolite of inorganic arsenics, in the promotion and progression of UVB-induced skin tumorigenesis in hairless mice

The effect of dimethylarsinic acid (DMA) on skin tumorigenesis by UVB irradiation was examined. Hairless mice (Hos: HR-1) irradiated with UVB at a dose of 2 kJ/m(2) twice weekly, were fed with drinking water containing 1000 ppm DMA, a main metabolite of inorganic arsenics, produced more skin tumors than DMA-untreated mice. Histopathological examination revealed that the mouse malignant tumors with severe atypism appeared only in the treatment group of UVB plus 1000 ppm DMA. These positive results point out the importance of dimethylated metabolites of inorganic arsenic in the process of skin carcinogenesis.

A case of renin-producing adrenocortical cancer

Here we report a case of a renin-producing adrenocortical carcinoma. A 57-year-old woman was referred to our hospital complaining of thirst and generalized muscle weakness. She was diagnosed as being hypertensive and diabetic with associated hypokalemia and she had a hard elastic mass with a diameter of 10 cm on the left side of her neck. An abdominal computed tomography scan revealed a suprarenal mass on the left side (8.5 x 8 x 6.5 cm). Endocrinological examination demonstrated a marked elevation in the patient's serum glucocorticoid and sex steroid hormones as well as plasma renin activity. Histological examination of a sample taken from the neck mass revealed a metastasis from an adrenal carcinoma, which was stained positively with antibodies against cytochrome P450 and renin, establishing the diagnosis of a renin-producing adrenocortical carcinoma. Trilostane was effective in reducing serum cortisol levels, but mitotane was ineffective.

[Rerupture mechanism of ruptured intracranial dissecting aneurysm in the vertebral artery following proximal occlusion]

Proximal occlusion is commonly employed to prevent rebleeding of intracranial dissecting aneurysms of the vertebral artery (VA), but rebleeding sometimes occurs. To determine the cause of such rebleeding we reviewed nine cases, including eight reported in the literature and one treated at our hospital. We classified the techniques used to proximally occlude the VA into two types. In Type I, occlusion is performed immediately proximal to the aneurysm so that there are no perforating arteries or the posterior inferior cerebellar artery (PICA) between the clip and the aneurysm. In Type II, occlusion is performed proximal to the PICA so postoperative retrograde flow persists from the contralateral VA through the aneurysm into the ipsilateral PICA. Among the four Type I cases reviewed, it was found that the interval between occlusion and rebleeding was very short: three developed rebleeding within four hours of occlusion, and the fourth showed rebleeding on the fourth day. In the five Type II patients, rebleeding occurred more than four days (mean 15.2 days) after occlusion. It is thought that in Type I occlusion, retrograde flow into the aneurysm immediately after occlusion may raise the intraaneurysmal pressure enough to cause rerupture within just a few hours of occlusion. In Type II occlusion, postoperative retrograde flow through the aneurysm into the ipsilateral PICA exists, so the intraaneurysmal pressure is not likely to rise as rapidly, with the result that rebleeding occurred after more than four days probably due to recurrence of dissection. The short interval between proximal occlusion and rebleeding, especially in Type I cases, suggests that postoperative angiography is only of limited usefulness in evaluating the possibility of rebleeding. The mortality rate reported for cases with reruptured vertebral dissecting aneurysms after proximal occlusion is very high (55.6%). These data indicate that surgical trapping or endovascular intraluminal occlusion, which is difficult to perform in some patients, should be considered the most suitable procedure from the view point of preventing postoperative rebleeding.

Concentrations of serum granulocyte-colony-stimulating factor in normal pregnancy and preeclampsia

OBJECTIVE

In order to elucidate the potential role of granulocyte-colony-stimulating factor (G-CSF) during the course of normal pregnancy and preeclampsia, we measured the serum concentrations of G-CSF in both normal pregnant women and preeclamptic patients.

METHODS

Sera of 10 nonpregnant women, 34 normal pregnant women (n = 10, first trimester; n = 10, second trimester; n = 14, third trimester), 10 postpartum women, 10 mild preeclamptic patients, and 10 severe preeclamptic patients were collected. The serum concentrations of G-CSF were measured by enzyme immunoassay.

RESULTS

The serum level of G-CSF in normal pregnant women (third trimester: 38.3 +/- 15.3 pg/mL; mean +/- SD) was significantly increased when compared with the levels observed in nonpregnant women (20.3 +/- 10.1 pg/mL, p < 0.05), which was similar to the G-CSF concentrations in postpartum subjects (20.7 +/- 9.1 pg/mL). The mild and severe preeclamptic patients showed significantly higher levels of G-CSF (56.9 +/- 18.8 pg/mL, p < 0.05; 73.2 +/- 30.4 pg/mL, p < 0.0001, respectively) than those noted in the third trimester women. The preeclamptic patients who presented with edema had greater (p < 0.01) serum levels of G-CSF (75.5 +/- 25.0 pg/mL) compared with nonedematous patients (44.7 +/- 14.9 pg/mL). The serum levels of G-CSF significantly correlated with both weight gain (p < 0.05), diastolic blood pressure (p < 0.01), and systolic blood pressure (p < 0.01), but not with white blood cell counts.

CONCLUSION

Serum concentrations of G-CSF are increased in normal and, even more so, in preeclamptic pregnancies. Because there was no relationship between serum G-CSF concentration and the number of leukocytes, G-CSF might act not to promote the physiological leukocytosis of pregnancy, but to stimulate the function of leukocytes such as phagocytosis. Moreover, it might be that G-CSF plays important roles in the activation of granulocytes or vascular endothelial injury, which are considered to be important pathological conditions in the development of preeclampsia.

Gamma Knife radiosurgery for metastatic brain tumor: the usefulness of repeated Gamma Knife radiosurgery for recurrent cases

Forty-one patients with a total of 193 metastatic brain tumors were treated because of new lesions or in a few cases because of tumor regrowth. The management involved two to four treatments with Gamma Knife radiosurgery (GKRS). The overall median survival was 15 months. The local control rate of tumors was 89% for the first treatment and 93% for repeated treatments. Symptomatic radiation-induced edema appeared in only two cases (4.9%). Patients with metastatic brain tumors who developed new lesions after GKRS were treated with GKRS alone for subsequent lesions. It was possible to control tumors for a long period with minimal side effects. As a result, we were able to maintain the quality of life of these patients, but, the effect of GKRS in controlling tumor regrowth seemed temporary.

Gamma Knife radiosurgery for skull base metastasis and invasion

We treated 18 patients with skull base metastasis or invasion using Gamma Knife radiosurgery. Seven of these patients had invasive nasopharyngeal cancer and 11 had distant metastasis from other cancers. The mean diameter of tumors was 22-46 mm (median 32.1 mm) and the radiation dose to the tumor margin was 12-23 Gy (median 16.2 Gy). The median follow-up period was 10.5 months. Clinical symptoms were improved in 61% of the patients after treatment and tumor control was obtained in 67% of cases at their final followup. Radiation injury occurred in only one patient (6%) who had received previous radiotherapy to the same region. Gamma Knife radiosurgery is a useful therapeutic option for the treatment of skull base metastasis and invasion, either as a secondary treatment for recurrence after previous radiotherapy or as a primary treatment.

Successful manual reduction of locked metacarpophalangeal joints in fingers

BACKGROUND

Many studies on the etiology and operative treatment of locked metacarpophalangeal joints in fingers have been reported, but there have been few investigations on manual reduction. The rate of success of manual reduction in previous reports has been low, and no consensus has been reached with regard to the best method of manual reduction. On the basis of our experience with operative treatment, we devised a safe method of manual reduction.

METHODS

Between January 1987 and December 1995, we reduced a locked metacarpophalangeal joint in twelve female patients; every locked finger was successfully reduced, and complications such as fracture did not occur during manual reduction. The average duration of follow-up was five years and nine months (range, three years and two months to nine years and three months).

RESULTS

Six patients had no recurrence of the locking. Four of the six remaining patients had one or two incidents of locking, had no alteration in the activities of daily living, and did not want operative treatment. The two remaining patients reported that they had incidents of locking several times a day, and they requested operative treatment as they were afraid of additional recurrences. One patient had an open reduction fifteen months after the initial episode of locking, and the other patient elected not to have an operation for personal reasons.

CONCLUSIONS

We believe that our method of manual reduction should be used to treat a locked metacarpophalangeal joint in a finger and that operative treatment should be limited to patients in whom manual reduction is unsuccessful or the reduction is unstable.

Cassiopeia flap: modification of Limberg flap for saving normal skin

Local flaps have the advantages of texture matching and increased flap survival rate. The proper local flap planning for each lesion causes the dermatologist to be reluctant to employ them. We propose a modified local flap, the "Cassiopeia flap", with three simple marking points made on the ends of the diameter and on the equidistant point along the diameter; two points from equilateral triangles form a "W (Cassiopeia)". We applied this modification to ten lesions on the face, scalp, trunk and thigh with excellent results.

The effect of modified ultrafiltration in pediatric open heart surgery

Since 1997 we have performed modified ultrafiltration (MUF) in pediatric open heart operations. To elucidate the clinical effects of MUF, patients under 20 kg in weight who underwent corrective open heart operation since 1997 are divided into 2 cohorts according to the enforcement of MUF (control group versus MUF group) retrospectively. Procedures, age, bodyweight, cardiopulmonary bypass (CPB) time, operation time, amount of donor blood use, postoperative inotrope dose, postoperative intubation time, and postoperative gas exchange capacity of lung expressed with respiratory index (RI) were compared between groups. Furthermore, a multiple linear regression analysis was performed to find independent correlates with postoperative RI. Finally scattergrams of intubation time and RI were drawn against several factors. In univariate analyses, the MUF group had significantly shorter intubation time and better RI. Multivariate analysis revealed that the enforcement of MUF was an independent correlate of postoperative RI. Analyses on the scattergrams revealed that the above mentioned favorable effects of MUF were prominent in the patients younger than 3 years or weighing less than 10 kg. We concluded that MUF had significant effects on pulmonary function preservation in pediatric open heart operations, especially for smaller children.

[Cervical pyogenic spondylodiscitis: 4 cases report and a review of the literature]

We report 4 cases of cervical spondylodiscitis presenting neurological and/or neuroradiological abnormalities. Such a lesion is rare in the cervical spine of adults, but should be suspected when the patient has radiculopathy and/or myelopathy associated with inflammatory signs. We discussed the clinical characteristics and the procedures of the diagnosis and treatment of cervical spondylodiscitis. Early and definitive diagnosis can be achieved by cervical X-ray, MR imaging and biopsy. It is very important to evaluate the pyogen for the lesion by needle biopsy. When the patient has the compression of the spinal cord and/or nerve roots and the neurological findings of radiculopathy and/or myelopathy, surgical exploration and decompression of the spinal cord and/or nerve roots should be carried out as soon as possible. Anterior debridement and fusion should be performed using the effective antibiotics. We were able to achieve good prognosis by treatment following this procedure of diagnosis in the four cases of cervical spondylodiscitis mentioned.

[Adenocarcinoma of the ileal segment with transitional cell carcinoma of the bladder following ileocytoplasty: a case report]

A 67 year-old woman visited our hospital complaining of pollakisuria. She had undergone left nephrectomy and augmentation ileocystoplasty for tuberculous bladder atrophy 40 years previously. She underwent a total cystectomy and tubeless ureterocutaneostomy with a preoperative diagnosis of muscle-invading transitional cell carcinoma of the bladder. The pathological diagnosis was adenocarcinoma of the ileal segment and transitional cell carcinoma of the original bladder. This is the first case report of adenocarcinoma of the ileal segment and transitional cell carcinoma of the original bladder among 22 patients suffering from bladder cancer after ileocystoplasty.

Elevated risk of tuberculosis by occupation with special reference to health care workers

We conducted a study to evaluate tuberculosis (TB) risk in Japan by work performed, either paid or unpaid. We collated information on sex, age, employment category, occupation, and family history from 1120 registration cards of new TB cases at two wards in Nagoya City over seven years (1989-1995). We used census data and data from the Survey of Physicians, Dentists and Pharmacists conducted in 1990 to estimate the population at risk by employment category and occupation. Elevated TB incidence rates were observed for female nurses (SIR: 3.81; 95% CI: 1.97-6.65), clinical laboratory technicians (SIR: 25.00; 6.81-63.99), and males without a paid job (SIR: 1.35; 1.20-1.53). A work environment conducive to transmission may have increased the TB risk in female nurses and clinical laboratory technicians. Male jobless people and institutionalized elderly residents may have enhanced the TB risk for males without a paid job.

[Proceeding of the workshop "What an ideal clinical microbiological laboratory should be". The 33rd in-service training course for medical technologists of university hospitals in 1999]

In the workshop of the 33rd in-service training course for University Hospital Medical Technologists in 1999(sponsorship: the ministry of Education), all groups of participants were charged with discussing an ideal clinical microbiology laboratory. In conclusion, the successful operation of the ideal system of clinical microbiology should require a high level of competence in every staff member of the hospital. It must not be focused solely on the sophistication of laboratory methods. We must modify our behavior effectively and establish a good collaborative partnership with physicians and other health care professionals.

Effectiveness of cancer vaccine therapy using cells transduced with the interleukin-12 gene combined with systemic interleukin-18 administration

We introduced the interleukin-12 (IL-12) gene into mouse renal cell carcinoma (RenCa) cells to develop a tumor vaccine and to examine mechanisms of tumor rejection. IL-12-secreting RenCa (RenCa/IL-12) cells were completely rejected when implanted into syngeneic BALB/c but not athymic nude mice, suggesting that T cells were involved in this antitumor effect. Depletion of natural killer (NK) cells in nude mice did not affect the tumor growth of RenCa/IL-12. The simultaneous injection of mitomycin C-treated RenCa/IL-12 inhibited the tumor growth of parental RenCa injected at a distant site, whereas injection of mitomycin C-treated parental RenCa did not. The antitumor effect of RenCa/IL-12 as a cancer vaccine was induced by CD8+ T cells and NK cells and was inhibited by CD4+ T cells. Although the systemic administration of recombinant IL-18 (rIL-18) alone did not inhibit the tumor growth, it did enhance the cancer vaccine effect of RenCa/IL-12. The combination therapy of RenCa/IL-12 and the systemic administration of rIL-18 retarded even the growth of established tumors. The effector cells of this combination therapy consist not only of CD8+ T cells and NK cells but also of CD4+ T cells. This synergistic cancer vaccine effect of in situ secretion of IL-12 and the systemic administration of rIL-18 may be attributed to a functional change of CD4+ T cells.

["What an ideal clinical microbiological laboratory should be"--from the position of laboratory manager]

The most important thing for clinical laboratory is the "labor-power". "Labor-power" involves knowledge, technique, activity, analysis, patience and above all else benevolence. All of these constitute an efficiency examination(that is a total analysis of necessity, rapidity, correctness, simplicity, cost).

Alexithymic characteristics of HIV-positive patients

Despite extensive psychiatric research on HIV-positive patients, there are no published studies on alexithymia. Alexithymic characteristics and related factors were examined in a sample of 81 HIV-positive patients using the modified Beth Israel Psychosomatic Questionnaire and the Social Support of Stress and Coping Inventory. The severity of alexithymia was significantly higher in HIV patients than healthy controls, suggesting the presence of secondary alexithymia. Scores on two alexithymic characteristics, affect awareness and operational thinking, significantly correlated with ratings of poor utilization and perception of social support. As the severity of HIV infection progressed, affect awareness was higher, controlling for poor utilization and perception of social support. These results suggest that secondary alexithymia, associated with poor utilization and perception of social support, may be manifest as a state reaction to approaching death.

Dual origin of the vertebral artery--case report

A 27-year-old female presented with dual origin of the left vertebral artery. Twenty-six cases of this rare congenital vascular anomaly have been reported. In general, the medial leg of the dual origin of the vertebral artery enters a higher transverse foramen (usually the fifth or less frequently the fourth) than the lateral leg, which usually enters the sixth. Exceptions to this rule occur when the medial and lateral legs of the right vertebral artery enter the right seventh and sixth transverse foramina, respectively. This congenital vascular anomaly has diagnostic and therapeutic implications in any intervention involving the proximal vertebral artery.

Synergistic enhancement of resistance to cisplatin in human bladder cancer cells by overexpression of mutant-type p53 and Bcl-2

PURPOSE

The objective of this study was to characterize the effect of mutant-type p53 and Bcl-2 expression on the sensitivity to cisplatin in a human bladder cancer cell line both in vitro and in vivo.

MATERIALS AND METHODS

We transfected mutant-type p53 cDNA, Bcl-2 cDNA, or both cDNAs into KoTCC-1, a human bladder cancer cell line that does not express mutant-type p53 or Bcl-2 protein. The effects of the overexpression of mutant-type p53, Bcl-2, or both on the sensitivity to cisplatin and the apoptotic features in vitro were evaluated by the MTT assay, staining with Hoechst 33258 and a DNA fragmentation assay. We then examined the in vivo effects of cisplatin treatment on the transfectants by subcutaneous and intraperitoneal tumor cell injection models in athymic nude mice.

RESULTS

The introduction of mutant-type p53 or Bcl-2 conferred resistance to cisplatin on KoTCC-1 cells through the inhibition of apoptosis. This phenotype was more remarkable in the cell line transfected with both mutant-type p53 and Bcl-2 than in the cell lines transfected with either mutant-type p53 or Bcl-2 alone. Furthermore, the KoTCC-1 cells transfected with both mutant-type p53 and Bcl-2 exhibited significantly higher resistance to cisplatin treatment than cells transfected with mutant-type p53 or Bcl-2 alone in experimental models in vivo.

CONCLUSIONS

These findings suggest that the overexpression of both mutant-type p53 and Bcl-2 in bladder cancer cells synergistically interferes with the therapeutic effect of cisplatin through the inhibition of the apoptotic pathway.

Stabilization of iron regulatory protein 2, IRP2, by aluminum

Iron regulatory protein 2 (IRP2) is one of the central regulators of iron homeostasis. IRP2 regulates expression of molecules involved in iron metabolism by binding to iron responsive elements (IREs) in the transcripts of those molecules in iron depletion. IRP2 is regulated by the accelerated degradation initiated by the iron-catalyzed oxidation. Here we report that aluminum antagonizes the iron-induced decrease in IRE binding activity of IRP2. Aluminum also inhibits iron-induced oxidation of IRP2 in vitro. These results suggest that aluminum stabilizes IRP2 by interfering with the iron-catalyzed oxidation, which results in perturbation of iron metabolism.

Dimethylarsinic acid exposure causes accumulation of Hsp72 in cell nuclei and suppresses apoptosis in human alveolar cultured (L-132) cells

We previously found that 72-kDa heat shock protein (Hsp72) was induced and accumulated in the nuclei, together with DNA damage, in human alveolar epithelial (L-132) cells by exposure to dimethylarsinic acid (DMAA), which is a main metabolite of inorganic arsenics in mammals. In the present study, the intracellular behavior of Hsp72 was investigated during the recovery from the DNA damage induced by exposure to DMAA. L-132 cells were exposed to 10 mM DMAA for 3 h, and then incubated in DMAA-free medium. The induction of Hsp72 by exposure to DMAA reached a peak at 6-9 h after removal of DMAA. However, the cell-nuclear distribution of Hsp72 was observed until 3 h after the start of DMAA-free incubation. We further investigated the appearance of apoptosis of L-132 cells after exposure to 10 mM DMAA for 3 h. Internucleosomal DNA fragmentation and morphological changes, as criteria for the evidence of apoptosis, were observed 6-22 h after the start of DMAA-free incubation. The appearance of apoptosis was followed by the release of Hsp72 from the cell nuclei. These results suggest a possibility that the cell-nuclear Hsp72 may suppress the appearance of apoptosis in DNA-damaged cells.

Cold shock response in Escherichia coli

Sensing a sudden change of the growth temperature, all living organisms produce heat shock proteins or cold shock proteins to adapt to a given temperature. In a heat shock response, the heat shock sigma factor plays a major role in the induction of heat shock proteins including molecular chaperones and proteases, which are well-conserved from bacteria to human. In contrast, no such a sigma factor has been identified for the cold shock response. Instead, RNAs and RNA-binding proteins play a major role in cold shock response. This review describes what happens in the cell upon cold shock, how E. coli responds to cold shock, how the expression of cold shock proteins is regulated, and what their functions are.

Complex formation of MukB, MukE and MukF proteins involved in chromosome partitioning in Escherichia coli

mukF, mukE and mukB genes are essential for the process of chromosome partitioning in Escherichia coli. We have studied protein-protein interactions among MukB, MukE and MukF proteins by co-immunoprecipitation and sucrose gradient sedimentation experiments, using mukFEB null cells harboring plasmids carrying the wild-type or mutant-type mukFEB operon. MukB forms a complex with MukF and MukE. Analysis of mutant MukB proteins suggested that MukF and MukE bind the C-terminal globular domain of MukB. MukF is indispensable for an interaction between MukB and MukE; however, MukF itself is able to associate with MukB even in the absence of MukE. We have also found that MukF has a Ca(2+)-binding activity. Although purified MukF was able to make a complex either with MukE or MukB, a complex consisting of the three Muk proteins was barely detected in vitro. However, increasing the Ca(2+) or Mg(2+) concentration in the reaction partially restored complex formation. This suggests that Ca(2+) or Mg(2+) may be required for the formation of a complex consisting of the three Muk proteins, and thus may participate in a particular step during chromosome partitioning.

Successful treatment of brainstem abscess with stereotactic aspiration

BACKGROUND

Brainstem abscess is an uncommon condition associated with a high mortality. We report a case of brainstem abscess in a 51-year-old female with a pulmonary arteriovenous fistula that was cured after appropriate antibiotic therapy following stereotactic aspiration. The value of stereotactic aspiration in the management of brainstem abscess is documented with a review of the relevant literature.

CASE REPORT

A 51-year-old female with a pulmonary arteriovenous fistula suffered fever, diplopia and weakness on the right side. Magnetic resonance (MR) imaging of the brain showed a large cystic mass with ring-like enhancement in the brainstem. A diagnosis of brainstem abscess as a complication of pulmonary arteriovenous fistula was made. MR imaging-guided stereotactic exploration was carried out via the suboccipital transcerebellar approach and the pathogen of the brainstem abscess was identified. The brainstem abscess was cured after treatment employing antibiotics to which the pathogen was sensitive.

CONCLUSIONS

Stereotactic aspiration is an effective procedure for brainstem abscesses. This procedure is less invasive than open surgery and can be performed even in patients in poor general condition.

Identification and characterization of five cspA homologous genes from Myxococcus xanthus

Escherichia coli contains a large CspA family consisting of nine homologues, in which four are cold-shock inducible and one is stationary-phase inducible. Here, we demonstrate that Myxococcus xanthus possesses at least five CspA homologues, CspA to CspE. Hydrophobic residues forming a hydrophobic core, and aromatic residues, which are included in functional motifs RNP-1 and RNP-2 involved in binding to RNA and ssDNA, are well conserved. These facts suggest that M. xanthus CspA homologues have a similar structure and function as E. coli CspA. However, in contrast to the E. coli CspA family, the expression of M. xanthus csp genes as judged by primer extension analysis is not significantly regulated by temperature changes, except for cspB of which expression was reduced to less than 10% upon heat shock at 42 degrees C. Such constitutive expression of the csp genes may be important for M. xanthus, a soil-dwelling bacterium, to survive under conditions of exposure to various environmental changes in nature.

Identification of the von Hippel-lindau tumor-suppressor protein as part of an active E3 ubiquitin ligase complex

Mutations of von Hippel-Lindau disease (VHL) tumor-suppressor gene product (pVHL) are found in patients with dominant inherited VHL syndrome and in the vast majority of sporadic clear cell renal carcinomas. The function of the pVHL protein has not been clarified. pVHL has been shown to form a complex with elongin B and elongin C (VBC) and with cullin (CUL)-2. In light of the structural analogy of VBC-CUL-2 to SKP1-CUL-1-F-box ubiquitin ligases, the ubiquitin ligase activity of VBC-CUL-2 was examined in this study. We show that VBC-CUL-2 exhibits ubiquitin ligase activity, and we identified UbcH5a, b, and c, but not CDC34, as the ubiquitin-conjugating enzymes of the VBC-CUL-2 ubiquitin ligase. The protein Rbx1/ROC1 enhances ligase activity of VBC-CUL-2 as it does in the SKP1-CUL-1-F-box protein ligase complex. We also found that pVHL associates with two proteins, p100 and p220, which migrate at a similar molecular weight as two major bands in the ubiquitination assay. Furthermore, naturally occurring pVHL missense mutations, including mutants capable of forming a complex with elongin B-elongin C-CUL-2, fail to associate with p100 and p220 and cannot exhibit the E3 ligase activity. These results suggest that pVHL might be the substrate recognition subunit of the VBC-CUL-2 E3 ligase. This is also, to our knowledge, the first example of a human tumor-suppressor protein being directly involved in the ubiquitin conjugation system which leads to the targeted degradation of substrate proteins.

Relative expression of matrix metalloproteinase-2 and tissue inhibitor of metalloproteinase-2 in mouse renal cell carcinoma cells regulates their metastatic potential

To clarify the significance of the balance between matrix metalloproteinase-2 (MMP-2) and tissue inhibitor of metalloproteinase-2 (TIMP-2) in the progression of renal cell carcinoma, we transfected both the MMP-2 and TIMP-2 genes simultaneously into RenCa, a mouse renal cell carcinoma cell line that does not express detectable levels of either MMP-2 or TIMP-2 mRNAs, and established several clones with various MMP-2:TIMP-2 expression ratios. On the basis of the quantitative evaluation of the MMP-2: TIMP-2 mRNA expression ratio by Northern blot analysis, we selected a clone overexpressing MMP-2 alone (RenCa/M), a clone overexpressing TIMP-2 alone (RenCa/T), and two kinds of clones overexpressing both, i.e., one with a high (RenCa/MTh) and one with a low (RenCa/MTl) MMP-2: TIMP-2 ratio, to compare the tumor cell phenotypes. In an in vitro tumor cell invasion assay, the MMP-2:TIMP-2 ratios of the RenCa sublines were directly correlated with their invasive potential. The invasive abilities of the parental RenCa cells induced by conditioned media from RenCa sublines were also correlated with the MMP-2:TIMP-2 ratios of the sublines. The cell adhesion assay showed the inverse correlation between the MMP-2 expression levels in the sublines and their cell adhesion to several extracellular matrix components. Furthermore, when injected i.v. or into the renal subcapsule in syngeneic mice, RenCa sublines formed metastatic nodules in the lungs, and the number of nodules was correlated with the MMP-2:TIMP-2 ratio of each clone. In contrast, despite the growth-inhibitory effects of TIMP-2 overexpression, MMP-2 overexpression had no effect on either proliferation in vitro of RenCa sublines or on their growth as tumors in vivo. These results suggest that the MMP-2:TIMP-2 expression ratio is a critical factor in the invasion and metastasis of renal cell carcinoma.

Tea catechin supplementation increases antioxidant capacity and prevents phospholipid hydroperoxidation in plasma of humans

The effect of green tea catechin supplementation on antioxidant capacity of human plasma was investigated. Eighteen healthy male volunteers who orally ingested green tea extract (254 mg of total catechins/subject) showed 267 pmol of epigallocatechin-3-gallate (EGCg) per milliliter of plasma at 60 min after administration. The plasma phosphatidylcholine hydroperoxide (PCOOH) levels attenuated from 73.7 pmol/mL in the control to 44.6 pmol/mL in catechin-treated subjects, being correlated inversely with the increase in plasma EGCg level. The results suggested that drinking green tea contributes to prevent cardiovascular disease by increasing plasma antioxidant capacity in humans.

Mutation analysis of the 5' untranslated region of the cold shock cspA mRNA of Escherichia coli

The mRNA for CspA, a major cold shock protein in Escherichia coli, contains an unusually long (159 bases) 5' untranslated region (5'-UTR), and its stability has been shown to play a major role in cold shock induction of CspA. The 5'-UTR of the cspA mRNA has a negative effect on its expression at 37 degrees C but has a positive effect upon cold shock. In this report, a series of cspA-lacZ fusions having a 26- to 32-base deletion in the 5'-UTR were constructed to examine the roles of specific regions within the 5'-UTR in cspA expression. It was found that none of the deletion mutations had significant effects on the stability of mRNA at both 37 and 15 degrees C. However, two mutations (Delta56-86 and Delta86-117) caused a substantial increase of beta-galactosidase activity at 37 degrees C, indicating that the deleted regions contain a negative cis element(s) for translation. A mutation (Delta2-27) deleting the highly conserved cold box sequence had little effect on cold shock induction of beta-galactosidase. Interestingly, three mutations (Delta28-55, Delta86-117, and Delta118-143) caused poor cold shock induction of beta-galactosidase. In particular, the Delta118-143 mutation reduced the translation efficiency of the cspA mRNA to less than 10% of that of the wild-type construct. The deleted region contains a 13-base sequence named upstream box (bases 123 to 135), which is highly conserved in cspA, cspB, cspG, and cspI, and is located 11 bases upstream of the Shine-Dalgarno (SD) sequence. The upstream box might be another cis element involved in translation efficiency of the cspA mRNA in addition to the SD sequence and the downstream box sequence. The relationship between the mRNA secondary structure and translation efficiency is discussed.

Intradermal transfer of caspase-1 (CASP1) DNA into mouse dissects: role of CASP1 in interleukin-1beta associated skin inflammation and apoptotic cell death

Caspase-1 (CASP1) interleukin-1beta (IL-1beta) converting enzyme (ICE) has been cloned as a specific enzyme which activates the biologically inactive pro-form of IL-1beta into biological active IL-1beta. Based on the significant homology to Ced-3, Caenorhabditis elegans apoptotic gene and, proof of apoptotic activity of ICE in rat fibroblasts, ICE was renamed as CASP1. In contrast to in vitro functions, the in vivo significance of high expression of CASP1 in skin remains to be elucidated. We transferred plasmid DNA encoding murine CASP1 with beta-actin promoter into mouse skin. The CASP1 DNA-injected skin, but not skin injected with control plasmid without CASP1, developed localized erythema with subcutaneous nodules. The nodules were associated with marked inflammatory infiltrates. The apoptotic cells detected by the TUNEL method were distributed in and around the inflammatory foci. The plasma IL-1beta level of CASP1 DNA-injected mouse was elevated compared with that of the control DNA-injected mouse. These inflammatory reactions of CASP1 DNA-injected skin were suppressed by treatment with neutralizing anti-murine IL-1beta antibodies, but the TUNEL positive apoptotic cells were still detected. This study clearly demonstrate dual roles of CASP1 in causing IL-1beta associated granulomatous skin infiltration and inducing apoptotic cell death in vivo.

Clinical outcome of high-dose chemotherapy combined with peripheral blood stem cell transplantation for male germ cell tumors

Peripheral blood stem cell transplantation (PBSCT) is widely performed currently instead of bone marrow transplantation (BMT) because bone marrow reconstruction is better and the procedure is less invasive. We applied 26 courses of high-dose chemotherapy (1250 mg/m2 of carboplatin, 1500 mg/m2 of etoposide and 7.5 g/m2 of ifosfamide) to 14 male patients with germ cell tumors. Eleven patients underwent high-dose chemotherapy as induction after two to three courses of conventional BEP therapy. The remaining three patients had recurrent disease after conventional chemotherapies. Peripheral blood stem cells were harvested during previous chemotherapy and sufficient CD34+ cells were harvested for transplantation. Although all patients had grade 4 hematotoxicity, the white blood cell count recovered to more than 1000/microl within 8-11 days after PBSCT. No treatment-related death was found. Nine of 14 patients (64.3%) remain disease free at 18 months of median follow up time (range 12-60). We conclude that high-dose chemotherapy is a safe and effective means of treating advanced or refractory germ cell tumors in male patients.

Calcium ionophore, ionomycin inhibits growth of human bladder cancer cells both in vitro and in vivo with alteration of Bcl-2 and Bax expression levels

PURPOSE

The objective of this study was to characterize the antiproliferative effects of the calcium ionophore, ionomycin on the human bladder cancer cell line HT1376 both in vitro and in vivo.

MATERIALS AND METHODS

The in vitro growth rate of HT1376 after treatment with ionomycin was measured by using the MTT assay. The apoptotic features in HT1376 after ionomycin treatment were evaluated by flow cytometric analysis and DNA degradation assay. Bcl-2 and Bax expression levels in HT1376 after ionomycin treatment were examined by Northern and Western blot analyses. The effects of intratumoral injection of ionomycin on the growth of subcutaneous HT1376 tumors established in athymic nude mice were then tested. The efficacy of combined treatment with ionomycin and cisplatin against HT1376 growth was also examined.

RESULTS

The in vitro growth rate of HT1376 was suppressed by ionomycin in a dose- and time-dependent manner, and characteristic apoptotic DNA degradation was observed in HT1376. Ionomycin treatment caused a marked decrease in the ratios of Bcl-2 to Bax mRNA and protein in HT1376 cells. Intratumoral injection of ionomycin into subcutaneous HT1376 tumors reduced the tumorigenicity in nude mice. Furthermore, these in vivo growth-inhibitory effects of ionomycin were significantly enhanced by pretreatment with cisplatin.

CONCLUSIONS

These findings suggest that ionomycin-based therapy could be used as a novel therapeutic strategy for advanced bladder cancer through the effective induction of apoptosis by decreasing the ratio of Bcl-2 to Bax.

Expression of CD44 adhesion molecules in nonpapillary renal cell carcinoma and normal kidneys

OBJECTIVES

To analyze the relationship between the alterations in the expression of the CD44 gene in nonpapillary renal cell carcinoma (RCC) and several clinicopathologic factors.

METHODS

The expression of the CD44 gene in 10 human RCC cell lines, 60 nonpapillary RCC tumor samples, and 15 normal kidney samples was investigated by reverse-transcription polymerase chain reaction (RT-PCR) using a set of primers capable of amplifying all CD44 variant isoforms. The results were analyzed with respect to several clinicopathologic factors.

RESULTS

Nine of the 10 human RCC cell lines predominantly expressed the standard CD44 isoform (CD44s); CD44v10 was the major isoform in the 10th RCC cell line. The 15 normal kidney samples revealed the identical CD44 gene expression pattern; that is, CD44s, CD44v8-10, and CD44v10 were detectable in normal kidneys, and among them, CD44s was expressed most dominantly. In the 60 nonpapillary RCC samples, CD44s, CD44v8-10, and CD44v10 were the major isoforms in 46 (77%), 11 (18%), and 3 (5%) cases, respectively. Furthermore, the incidence of the predominant expression of CD44v8-10 in high-stage RCC was significantly higher than that in low-stage RCC. CD44s was more frequently expressed as a major isoform in clear cell RCC than in other histologic types of RCC.

CONCLUSIONS

The results of this study show that the alternative splicing pattern of CD44 gene in RCC is different in each histologic type of RCC and suggest that CD44v8-10 upregulation in the progression of nonpapillary RCC is important.

Synergistic antitumor effects of interleukin-12 gene transfer and systemic administration of interleukin-18 in a mouse bladder cancer model

We introduced the interleukin-12 (IL-12) gene into the mouse bladder cancer cell line (MBT2) to establish sublines that secrete bioactive IL-12. IL-12-secreting MBT2 (MBT2/IL-12) sublines were completely rejected when subcutaneously implanted into immunocompetent syngeneic C3H mice. Although this antitumor effect did not change when IL-12-secreting cells were injected into immunodeficient mice whose CD8(+) T or CD4(+) T cells had been depleted by the corresponding antibody, it was abrogated when natural killer cells were depleted by anti-asialoGM1 antibody. In addition, when parental MBT2 cells mixed with MBT2/IL-12 cells were subcutaneously injected into mice, admixed MBT2/IL-12 inhibited the growth of the parental tumor. Furthermore, this antitumor effect was enhanced by systemic IL-18 administration. This synergism was abrogated when the mice were treated with interferon-gamma-neutralizing antibody in vivo. In conclusion, local secretion of IL-12 led to effective antitumor activity that was enhanced by systemic administration of IL-18. Interferon-gamma plays an important role in the synergism of IL-12 gene transduction and systemic administration of IL-18.

Cavernous angioma of the optic chiasm--case report

A 31-year-old female presented with cavernous angioma originating from the optic chiasm manifesting as sudden onset of right retroorbital pain and right visual disturbance. She had a psychomotor seizure 10 years ago. Cavernous angioma at the right basal ganglia had been partially removed at that time. After the operation, the patient had left hemiparesis, but gradually improved. Neurological examination revealed decreased right visual acuity, left homonymous hemianopsia, and left hemiparesis. Magnetic resonance imaging revealed a mixed signal intensity mass at the right optic nerve to the optic chiasm with a low signal intensity rim on T2-weighted imaging, situated at the right basal ganglia where the cavernous angioma had been partially resected. Right frontotemporal craniotomy was performed by the pterional approach. A subpial hematoma was situated at the right optic nerve to the optic chiasm. The hematoma with an angiomatous component was completely resected from the surrounding structure. Histological examination of the specimens confirmed cavernous angioma. Postoperatively, her right visual acuity was slightly improved, but the visual field defect was unchanged. We emphasize the importance of correct diagnosis by magnetic resonance imaging and subsequent resection for preserving and improving the visual function of patients with cavernous angiomas of the optic chiasm.