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.

Inositol-1,4,5-trisphosphate-binding proteins controlling the phototransduction cascade of invertebrate visual cells

The main phototransduction cascade in invertebrate visual cells involves the turnover of phosphatidylinositol, an important biochemical mechanism common to many signal-transduction systems. Light-activated rhodopsin stimulates guanine nucleotide exchange on the Gq class of G-protein, which activates phospholipase C to hydrolyze phosphatidylinositol 4,5-bisphosphate to inositol-1,4,5-trisphosphate and diacylglycerol. Subsequently, inositol-1,4,5-trisphosphate-binding proteins continue the signal cascade. Here, we report on the first inositol-1,4,5-trisphosphate-binding proteins demonstrated in an invertebrate visual system with our investigation of the photosensitive rhabdoms of squid. We screened the ability of proteins to interact with inositol-1,4,5-trisphosphate by affinity column chromatography with an inositol-1,4,5-trisphosphate analogue. We detected an inositol-1,4,5-trisphosphate-binding affinity in phospholipase C, receptor kinase and five other proteins in the cytosolic fraction and, surprisingly, rhodopsin in the membrane fraction. A binding assay with (3)H-labelled inositol-1,4,5-trisphosphate demonstrated the inositol-1,4,5-trisphosphate affinity of each of the purified proteins. Since rhodopsin, receptor kinase and phospholipase C are involved upstream of phosphatidylinositol turnover in the signal cascade, our result suggests that phosphatidylinositol turnover is important in feedback pathways in the signalling system.

[Bronchiolitis obliterans organizing pneumonia after adjuvant thoracic radiotherapy for breast cancer: a case report]

We report a case of recurrent cough and migratory pulmonary infiltrates in a 55-year-old woman after adjuvant thoracic radiotherapy for breast cancer. The pulmonary infiltrates were initially limited to the area adjacent to the irradiated breast, but later migrated to the opposite lung. The diagnosis of bronchiolitis obliterans organizing pneumonia (BOOP) was made using a transbronchial biopsy, which disclosed intraluminal fibrosis in the distal airspace, together with a radiographic appearance typical of BOOP. This case was assumed to be in a series of reported cases of BOOP primed by radiotherapy.

Persistent behavioural changes in rats following inescapable shock stress: a potential model of posttraumatic stress disorder

Behavioural changes in rats two weeks after inescapable shock stress were studied using a shuttle-box task (active avoidance/escape). Rats exposed to inescapable shock stress two weeks beforehand showed more frequent avoidance responses and greater within-group variation in both avoidance response and general activity during the test than rats in a control group. General activity during an unstressful period (before starting the test) did not differ significantly between groups. This relatively prolonged increase in responsiveness to external stimuli in the stressful context may be a useful experimental model of posttraumatic stress disorder, especially in relation to hypervigilance.

Phase I/II study of intravenous nedaplatin and intraarterial cisplatin with transcatheter arterial embolization for patients with locally advanced uterine cervical carcinoma

BACKGROUND

Nedaplatin, a platinum analog with less renal toxicity and similar efficacy for cervical carcinoma, recently has been shown to have a synergistic effect on cervical carcinoma lines in combination with cisplatin. To determine the clinical efficacy of this combination in patients with cervical carcinoma, the authors conducted a Phase I/II study of intravenous nedaplatin and intraarterial cisplatin combined with transcatheter arterial embolization (TAE).

METHODS

Eligibility criteria were as follows: cervical carcinoma (Stages IB2-IV; International Federation of Gynecology and Obstetrics), 16-70 years of age, performance status between 0 and 2, and adequate bone marrow, renal, and hepatic function. Nedaplatin (40-70 mg/m2) was administered intravenously on Day 1 followed by intraarterial administration of cisplatin (70 mg/m2) on Day 3 via both uterine arteries by using the Seldinger method. This then was followed by TAE. This course of treatment was repeated every 3 weeks for 3 cycles.

RESULTS

Patient data were as follows: age 37-68 (median, 55 years) and Stages IB2:4, IIA:3, IIB:2, IIIA:1, IIIB:3, IVA:2 carcinoma. The response to therapy was defined by magnetic resonance imaging as follows: partial response in 60% (9 of 15) of patients, complete response in 40% (6 of 15) of patients, and an overall response rate of 100% (95% confidence interval, 78-100%). Myelosuppression was manageable. Grade 3/4 renal toxicity was observed in 2 patients who received 70 mg/m2 of nedaplatin. Thirteen patients received radical hysterectomy, 1 patient received lymph node sampling, and 11 patients received adjuvant radiotherapy or chemotherapy.

CONCLUSIONS

The maximum tolerable dose was 70 mg/m2 nedaplatin, and the dose-limiting toxicity was renal toxicity. The recommended dose was 60 mg/m2 nedaplatin intravenously followed by 70 mg/m2 cisplatin intraarterially. Intravenous nedaplatin followed by intraarterial cisplatin with TAE appears to be very effective for locally advanced cervical carcinoma.

Microstructure of ceramic coating on titanium surface as a result of hydrothermal treatment

Hydroxyapatite coating on commercially pure titanium has been produced by a biomimetic method in order to improve osteointegration for medical implant purposes. A specific chemical treatment by etching titanium substrate with different concentrations of NaOH aqueous solution at 130 degrees C in an autoclave, followed by heat treatment at 600 degrees C was selected to obtain an activated titanium substrate. The microporous surface obtained has allowed the nucleation and growth of a calcium phosphate layer by soaking the substrate in a simulated body fluid (SBF). Scanning electron microscopy (SEM) together with energy dispersive analyzer for X-ray (EDS), X-ray diffraction (XRD) as well as Fourier transform infrared spectroscopy (FT-IR) were employed to evaluate the hydroxyapatite coating. A homogeneous structure coating without cracks defined the chemical treatment condition of the substrate.

[Clinical characterization of B cell lymphoma-associated hemophagocytic syndrome]

Malignant lymphoma is a major cause of hemophagocytic syndrome (HPS), in which reactive macrophages, phagocytic red blood cells, white blood cells, and platelets proliferate in bone marrow, liver, and spleen. In contrast to T/NK-cell lymphoma-associated hemophagocytic syndrome (T/NK-LAHS), few cases of B-LAHS have been reported; thus, the clinical characterization of B-LAHS remains to be established. We describe here four cases of B-LAHS that include the following features: (1) HPS was the initial presentation; (2) bone marrow involvement with large-cell lymphomas was noted in all cases, despite lack of remarkable lymphadenopathy; (3) no active infection with Epstein-Barr virus as the etiological agent was confirmed; (4) except for the spleen in one case, primary site of lymphoma could not be determined; and (5) serum IL-6, soluble IL-2 receptor, and IFN-gamma- but not TNF-alpha and IL-1 beta-, were significantly elevated. Such characteristics are peculiar to and different from those usually seen in B-cell lymphoma, suggesting that B-LAHS is a unique clinical entity among B-cell lymphomas.

[A study of liver metastasis from colorectal cancer in which hepatic resection was performed after hepatic arterial infusion chemotherapy]

We experienced 5 cases of liver metastases from colorectal cancer, in which hepatic resection was carried out after down sizing by hepatic arterial infusion chemotherapy. In addition, a histological study about the effect of chemotherapy on the liver tumor was performed. Primary lesions were located at the sigmoid colon (2), cecum (1), descending colon (1) and rectum (1). We carried out hepatic arterial infusion chemotherapy using mainly 5-FU. The total amount of 5-FU was 10-81 g. Tumor volumes were reduced by 12.5-24%, and they were judged PR. However, surgery was indicated due to obstruction of the proper hepatic artery or other side effects. Postoperative courses were uneventful and the hospital stays were from 17-61 days, and all patients were still alive in tumor-free condition at writing. By the histological study of the excised specimen, we recognized not only remarkable fibrous changes or calcifications but also overt viable cancerous cells. We conclude that the option of hepatic resection after controlling the development of the cancer by hepatic arterial infusion chemotherapy is a rational strategy of treatment for liver metastasis from colorectal cancer.

Cell cycle-dependent regulation of TIAP/m-survivin expression

TIAP, a murine homologue of human survivin, is a member of the inhibitor of apoptosis (IAP) family and is specifically expressed at G2/M phase of the cell cycle. To elucidate regulatory mechanisms of the cycle-dependent expression, we have analyzed the promoter region of TIAP/mouse survivin (m-survivin). The 5'-flanking region of the TIAP/m-survivin gene contained a TATA-less promoter, two AP2 sites, three NF-kB sites, one Sp1 site, many cell cycle-dependent elements (CDEs) and one cell cycle gene homology region (CHR). Primer extension and 5'-rapid amplification of cDNA ends identified one transcription start site at position -100 upstream of the ATG start site (+1). TIAP/m-survivin promoter-luciferase analysis identified a minimal promoter region within the most proximal -271 bp upstream of the ATG start site, and the region between -410 and -272 was critical for the enhancer activity. The combination between the CHR at -51 and the CDE at -57 is also essential for the cell cycle-dependent expression. Mutation of the CDE/CHR element and the enhancer elements may cause disordered expression of TIAP/m-survivin to affect cell survival and oncogenesis.

Ultrafast optical nonlinearity in the quasi-one-dimensional mott insulator Sr2CuO3

We report strong instantaneous photoinduced absorption in the quasi-one-dimensional Mott insulator Sr2CuO3 in the IR spectral region. The observed photoinduced absorption is to an even-parity two-photon state that occurs immediately above the absorption edge. Theoretical calculation based on a two-band extended Hubbard model explains the experimental features and indicates that the strong two-photon absorption is due to a very large dipole coupling between nearly degenerate one- and two-photon states. Room temperature picosecond recovery of the optical transparency suggests the strong potential of Sr2CuO3 for all-optical switching.

Psychological changes of Japan Self-Defense Forces personnel during selection and training for the peacekeeping mission in the Golan Heights

We sought to determine whether a selection process for deployment had a measurable effect on psychological symptoms by comparing scores on the Yatabe-Guilford Personality Index, the Manifest Anxiety Scale, and the 30-item version of the General Health Questionnaire between deployed and nondeployed mission candidates from the Japan Self-Defense Forces. The studies were undertaken in Japan during education and training for the United Nations peacekeeping mission in the Golan Heights. The participants included 80 candidates for deployment. Personnel who were not deployed had significantly higher measures of manifest anxiety and general psychological distress than deployed personnel, whereas deployed personnel showed more symptoms suggesting somatization. The selection process and training for deployment appear to have been stressful for all personnel, whether deployed or not.

Ultrafast spin dynamics and critical behavior in half-metallic ferromagnet: Sr2FeMoO6

Ultrafast spin dynamics in ferromagnetic half-metallic compound Sr2FeMoO6 is investigated by pump-probe measurements of the magneto-optical Kerr effect. The half-metallic nature of this material gives rise to anomalous thermal insulation between spins and electrons and allows us to pursue the spin dynamics from a few to several hundred picoseconds after the optical excitation. The optically detected magnetization dynamics clearly shows the crossover from microscopic photoinduced demagnetization to macroscopic critical behavior with universal power law divergence of relaxation time for a wide dynamical critical region.

[A case of primary pulmonary artery myxosarcoma associated with severe pulmonary hypertension]

A 50-year-old man presented with progressive dyspnea on exertion, but with no history of chest pain or syncope. Chronic pulmonary thromboembolism was suspected and he was referred to our hospital. On ausculation, a grade 3 systolic murmur was heard, that was loudest in the fifth intercostal space lateral to the right sternal border. Chest radiography showed mild cardiomegaly and ventilation-perfusion scan revealed absence of perfusion in the left lung and the upper field of the right lung. Contrast-enhanced helical CT showed large mural defects in both main pulmonary arteries, clearly delineated by contrast medium. The left pulmonary artery was nearly completely occluded, and eccentric defects were observed projecting into the lumen of the pulmonary trunk. A tumor originating in the pulmonary artery was suspected, but a definitive diagnosis of the mass could not be made with pulmonary angiography and magnetic resonance imaging. The mean pulmonary arterial pressure was 50 mmHg. Further radiologic examinations failed to reveal the source of the embolus or tumor. It was decided to attempt surgical excision under total cardiopulmonary bypass. At operation, a gelatinous, lustrous, yellowish mass was found partially occluding the right main pulmonary artery and completely occluding the left. The tumor adhered tightly to the intima of the vessel and was inoperable. The patient could not be weaned from percutaneous cardiopulmonary support and died 3 days after surgery. Histologic examination of the excised specimen revealed myxosarcoma.

Mechanism of ribosome RNA apurinic site specific lyase

A new enzyme, which we named ribosome RNA apurinic site specific lyase (RALyase), has been characterized. The enzyme specifically cleaves a phosphodiester bond at the apurinic site in the sarcin/ricin domain of 28S rRNA in ribosomes. The cut ends of wheat 28S rRNA were determined as 5'---GUACG-alpha-hydroxy-alpha, beta-unsaturated aldehyde and pGAGGA---3' for the 3' fragment, demonstrating that the enzyme catalyzes the beta-elimination reaction.

Enlargement of mandibular canal without hypesthesia caused by extranodal non-Hodgkin's lymphoma: a case report

A rare condition of enlargement of the mandibular canal caused by an extra-nodal non-Hodgkin's lymphoma in a 59-year-old Japanese woman was reported. The patient had a swelling of the hard palate and protrusion of both ocular bulbs, which had been present for 10 years. A panoramic radiograph revealed that the right mandibular canal was widely enlarged, extending from the mandibular foramen to the mental foramen, without bone destruction. The continuous dilation of the mandibular canal to an approximate 15-mm width was associated with peripheral bony sclerosis. Computed tomography and magnetic resonance imaging showed a soft tissue tumor inside the mandibular canal. The lesion demonstrated expansive growth in the orbits, extending to the skull base through the superior orbital fissures and cavernous sinus. The lymphoma was suspected to have grown so slowly that the adjacent mandibular canal and ocular bulbs enlarged without destroying the normal bone and nervous tissue.

A highly efficient and robust cell-free protein synthesis system prepared from wheat embryos: plants apparently contain a suicide system directed at ribosomes

Current cell-free protein synthesis systems can synthesize proteins with high speed and accuracy, but produce only a low yield because of their instability over time. Here we describe the preparation of a highly efficient but also robust cell-free system from wheat embryos. We first investigated the source of the instability of existing systems in light of endogenous ribosome-inactivating proteins and found that ribosome inactivation by tritin occurs already during extract preparation and continues during incubation for protein synthesis. Therefore, we prepared our system from extensively washed embryos that are devoid of contamination by endosperm, the source of tritin and possibly other inhibitors. In a batch system, we observed continuous translation for 4 h, and sucrose density gradient analysis showed formation of large polysomes, indicating high protein synthesis activity. When the reaction was performed in a dialysis bag, enabling the continuous supply of substrates together with the continuous removal of small byproducts, translation proceeded for >60 h, yielding 1-4 mg of enzymatically active proteins, and 0.6 mg of a 126-kDa tobacco mosaic virus protein, per milliliter of reaction volume. Our results demonstrate that plants contain endogenous inhibitors of translation and that after their elimination the translational apparatus is very stable. This contrasts with the common belief that cell-free translation systems are inherently unstable, even fragile. Our method is useful for the preparation of large amounts of active protein as well as for the study of protein synthesis itself.

A new class of enzyme acting on damaged ribosomes: ribosomal RNA apurinic site specific lyase found in wheat germ

A new enzyme, which we named ribosomal RNA apurinic site specific lyase (RALyase), is described. The protein was found in wheat embryos and has a molecular weight of 50 625 Da. The enzyme specifically cleaves the phosphodiester bond at the 3' side of the apurinic site introduced by ribosome-inactivating proteins into the sarcin/ricin domain of 28S rRNA. The 3' and 5' ends of wheat 28S rRNA at the cleavage site are 5'-GUACG-alpha-hydroxy-alpha, beta-unsaturated aldehyde and pGAGGA-3', demonstrating that the enzyme catalyzes a beta-elimination reaction. The substrate specificity of the enzyme is extremely high: it acts only at the apurinic site in the sarcin/ricin domain of intact ribosomes, not on deproteinized rRNA or DNA containing apurinic sites. The amino acid sequences of five endopeptidase LysC-liberated peptides from the purified enzyme were determined and used to obtain a cDNA sequence. The open reading frame encodes a protein of 456 amino acids, and a homology search revealed a related rice protein. Similar enzyme activities were also found in other plants that express ribosome-inactivating proteins. We believe that RALyase is part of a complex self-defense mechanism.

Impaired pancreatic exocrine function in rats with carbon tetrachloride-induced liver cirrhosis

BACKGROUND

Substantial numbers of studies have revealed the close correlation between chronic pancreatitis and cirrhosis in human. However, the situation with regard to pancreatic enzyme secretion is less clear.

AIM

The aim of the study was to investigate pancreatic exocrine function in rats with carbon tetrachloride-induced liver cirrhosis in rats.

METHODS

Pancreatic exocrine function and morphology in Sprague-Dawley rats with carbon tetrachloride-induced liver cirrhosis were investigated. Pancreatic exocrine functions stimulated by cholecystokinin-8 and other secretagogs were assessed in isolated pancreatic acini, and in vivo and morphological changes were studied by routine histological examination and electron microscopy.

RESULTS

The basal and cholecystokinin-8-stimulated amylase releases from acini and acinar amylase content were significantly lower in the cirrhotic rats than the control. None of the secretagogs induced the some amount of amylase release in cirrhotic as in control rats. Volume of the pancreatic juice and outputs of amylase and protein were significantly decreased under basal and cholecystokinin-8-stimulated conditions in vivo. Electron microscopy revealed most of the rough-surfaced endoplasmic reticulum accompanying less numbers of ribosomes to be dilated and some mitochondria to be swollen in cirrhotic rats.

CONCLUSION

Pancreatic exocrine functions are decreased in cirrhotic rats owing to alterations at the electron microscopic levels, reflecting an impaired acinar intracellular messenger system.

Nucleation and growth of hydroxyapatite on titanium pretreated in NaOH solution: experiments and thermodynamic explanation

Titanium was submitted to chemical attack with sodium hydroxide solution under hydrothermal (SBF) conditions and then kept for 4 weeks in simulated body fluid after heat treatment. The resultant coating titanium samples were characterized regarding nucleation and growth of hydroxyapatite on their surfaces using scanning electron microscopy and energy dispersive spectroscopy, as well as low angle X-ray diffraction. In order to obtain a thermodynamic explanation of same results, Eh-pH diagrams of Na-Ti-H2O and Ca-Ti-H2O systems at 25, 100, 200, and 300 degrees C were built for selected activities of the species in aqueous solutions. Values of pairs corresponding to the predominance limit of the species in solution at equilibrium with 0.21 atm of oxygen pressure were taken from these Eh-pH diagrams for subsequent building of the pNa-pH and pCa-pH diagrams of the same systems at each referred temperature (pi = -log10ai). In addition, the titanate-apatite free energy of formation was estimated and then a pCa-pH diagram of the Ca-P-Ti-H2O system at 25 degrees C was built. Examination of the resultant diagrams could elucidate the thermodynamic viability of the process.

A pilot study of CPT-11 and cisplatin for ovarian clear cell adenocarcinoma

BACKGROUND

Ovarian clear cell adenocarcinoma is known to have poorer prognosis than ovarian serous cystadenocarcinoma. Cyclophosphamide plus cisplatin has been the standard therapy for ovarian cancer, but ovarian clear cell adenocarcinoma dose not respond to this therapy. The treatment for ovarian clear cell adenocarcinoma has not been established. We planned a pilot study of CPT-11 and cisplatin for the treatment of ovarian clear cell adenocarcinoma.

METHODS

First, three patients were administered 70 mg/m2 of cisplatin intravenously on day 1 and 60 mg/m2 of CPT-11 intravenously on days 1, 8 and 15. Treatment was repeated every 4 weeks. Other patients were administered 75 mg/m2 of cisplatin intraperitoneally on day 1 and 60 mg/m2 of CPT-11 intravenously on days 1, 8 and 15. Treatment was repeated every 4 weeks.

RESULTS

A total of 10 patients were entered in this study and a total of 43 courses were administered. 1 CR, 1 PR and 1 PD were observed in patients with measurable lesion. Grade 3 leukopenia was experienced in seven patients, grade 3 thrombocytopenia in two and grade 3 anemia in five. Grade 3 liver toxicity was observed in one patient and grade 3 diarrhea in one patient. No grade 4 toxicity was experienced.

CONCLUSION

CPT-11 plus cisplatin is feasible and has efficacy for ovarian clear cell adenocarcinoma. This regimen should be explored in a phase II study.

Simple bone cyst of the mandibular condyle with severe osteoarthritis: report of a case

A rare case of simple bone cyst in the mandibular condyle of a 33-year-old woman is reported. The condition was difficult to diagnose because the cyst was accompanied by severe osteoarthritis. T1-weighted magnetic resonance (MR) images revealed a cystic lesion with intermediate signal intensity within the condylar head and an irregular margin with intermediate signal intensity on the superior surface of the condyle. The patient was treated by high condylectomy, discectomy and reconstruction by sagittal split ramus osteotomy. Histopathological examination showed a simple bone cyst in the condylar head and erosion of the anterior articular surface due to degenerative changes.