The next generation Baylor C-Gyro Pump: antithrombogenic "free impeller" design for long-term centrifugal VAD

The new generation centrifugal blood pump, the C2 Gyro Pump "Free Impeller Model" specifically designed for long-term ventricular assistance and a bridge to transplantation, has been developed. In the free impeller design, the impeller was completely freed from mechanical tethers by eliminating the shaft. This unique design allowed the incorporation of a center-penetrating hole in the impeller, called the center conduit, which accelerates the secondary blood flow from the bottom to the top of the impeller. During in vitro performance tests, two characteristic impeller motions, called floating mode and wandering rotational axis, were observed. In the floating mode, the impeller seemed to be floating without touching the pump casing and resulted in the idea of no bearing contact. Also, the rotational axis of the impeller exhibited a small circular motion and illustrated the idea of no stationary area in the blood path. These three characteristics are expected to be advantageous for anti-thrombogenicity and low hemolysis which are essential for a long-term centrifugal VAD.

An ultimate, compact, seal-less centrifugal ventricular assist device: Baylor C-Gyro pump

We have developed a compact, seal-less, all-purpose centrifugal pump, the Baylor C-Gyro pump, which is intended as a long-term ventricular assist device (VAD) as well as a cardiopulmonary bypass pump. In attaining this goal, we began with eliminating the shaft seals by adopting a pivot bearing system at the impeller shaft. In addition, a ring magnet encased in the bottom of the impeller was coupled magnetically to a driver magnet placed outside the pump housing (C1 Prototype). This first model yielded satisfactory performance in vitro with a flow rate of 8 L/min against 250 mm Hg at 2,400 rpm, and an index of hemolysis (IH) of 0.0083 g/100 L using bovine blood. In the second model, the C1 Eccentric Inlet Port Model, the inlet bearing support bar in the prototype were eliminated without reducing the prototype's performance. These designs for antithrombogenicity are being tested by the first in vivo experiment, which has lasted for more than 2 weeks.

Totally implantable total artificial heart and ventricular assist device with multipurpose miniature electromechanical energy system

A multipurpose miniature electromechanical energy system has been developed to yield a compact, efficient, durable, and biocompatible total artificial heart (TAH) and ventricular assist device (VAD). Associated controller-driver electronics were recently miniaturized and converted into hybrid circuits. The hybrid controller consists of a microprocessor and controller, motor driver, Hall sensor, and commutation circuit hybrids. The sizing study demonstrated that all these components can be incorporated in the pumping unit of the TAH and VAD, particularly in the centerpiece of the TAH and the motor housing of the VAD. Both TAH and VAD pumping units will start when their power line is connected to either the internal power pack or the external battery unit. As a redundant driving and diagnostic port, an emergency port was newly added and will be placed in subcutaneous location. In case of system failure, the skin will be cut down, and an external motor drive or a pneumatic driver will be connected to this port to run the TAH. This will minimize the circulatory arrest time. Overall efficiency of the TAH without the transcutaneous energy transmission system was 14-18% to deliver pump outputs of 4-9 L/min against the right and left afterload pressures of 25 and 100 mm Hg. The internal power requirement ranged from 6 to 13 W. The rechargeable batteries such as NiCd or NiMH with 1 AH capacity can run the TAH for 30-45 min. The external power requirement, when TETS efficiency of 75% was assumed, ranged from 8 to 18 W. The accelerated endurance test in the 42 degrees C saline bath demonstrated stable performance over 4 months. Long-term endurance and chronic animal studies will continue toward a system with 5 years durability by the year 2000.

In vitro and in vivo validation tests for total artificial heart

Properly planned in vitro and in vivo studies are mandatory to validate blood pump performance. However, standard procedures for in vitro and in vivo tests of total artificial heart (TAH) performance still do not exist. At Baylor College of Medicine, standard tests procedures for performance validation of the totally implantable TAH have been established. In this paper, these in vitro tests protocols (performance mapping tests, accelerated endurance test, hemolysis test, flow visualization tests, etc.) are described as well as in vivo test procedures (TAH implantation procedure, including surgical technique, postoperative management and tests, etc.). In addition, pathological protocols are presented. In our experience, these procedures are very simple, easy to perform, and inexpensive. These protocols are proposed as standard in vitro and in vivo tests for a TAH.

Successful thermal management of a totally implantable ventricular assist system

Thermal management of the implantable ventricular assist system (VAS) is important not only from the pathophysiological point of view but also from the standpoint of system endurance. The heat distribution within the Baylor VAS was measured using different motor housing materials and environmental conditions. The temperature of the circulating water in the mock loop was set at 37 degrees and 42 degrees C. A polycarbonate motor housing was not a suitable material because of the high temperature development in the actuation system. An anodized aluminum housing demonstrated excellent heat conductivity. The surface temperature of this motor housing was 41.6 degrees C when immersed in circulating water at 42 degrees C. Heat conduction from the motor to the circulating blood revealed an effective thermal path. In the worst case, the heat flux of the motor to the circulating blood revealed an effective thermal path. In the worst case, the heat flux of the motor housing was calculated to be less than 0.062 W/cm2--an acceptable level for the surrounding tissues.

Flow visualization in the Baylor total artificial heart

To analyze the flow patterns of the left and right blood chambers of the total artificial heart (TAH), flow visualization studies were performed. Two setup levels were used for the flow visualization studies. For estimating the global flow patterns, the pumps were illuminated using incandescent light, and the patterns were recorded by either videotape or photography. To evaluate sectional flow patterns, a laser light was applied, and the pump could be scanned segmentally. The flow patterns were recorded by a high-speed camera. A signal was also used that synchronized the timing of the camera shutter to the pusher-plate movement signal. In the left pump chamber, major stagnations were observed in the middle area of the inflow site. To solve this problem, a modification was made that changed the inflow direction appropriately. After evaluation of the inflow port direction, a proper flow pattern was obtained, which was validated by a global flow visualization study. Furthermore, both pump chambers indicated excellent flow patterns as obtained by a segmental flow visualization study method utilizing a laser light. The Baylor TAH demonstrated excellent flow patterns in flow visualization studies, with antithrombogenicity expected. These flow visualization studies are very useful not only for validations of global flow patterns but also for validations of local areas of stagnation in various blood pumps.

Internal hydraulic loss in a seal-less centrifugal Gyro pump

A new index "loss factor Z" defined by Eq. 1 was introduced as the absolute expression of the mock loop resistance for testing a nonpulsatile pump. [formula: see text] where gamma is specific gravity of the fluid, g is the acceleration of gravity, delta P is total pressure head, and Q is flow. Z is expected to be constant, regardless of the pumping parameters. Z values obtained in the same mock loop but with different rotary blood pumps were almost identical and were defined as Z0. New methods of analysis of the flow-restrictive conditions of various rotary blood pumps are proposed in this paper: namely, differential loss factor delta Z, and loss factor sensitivity delta Z/delta A. The proposed Z-Q curves demonstrated better performance mapping than the conventional delta P-Q curves. Delta Z is the difference between the Z-Q curves of two different pumps. A is a design parameter of the pump; therefore delta Z/delta A is a quantitative expression of the effect of the design change on the hydraulic performance. These various indices were used to analyze the internal hydraulic loss of a centrifugal pump (Gyro pump). The relationship between its gap size (rotor casing) and hydraulic performance was assessed quantitatively by these indices. In this paper, the derivation processes and above-mentioned indices are described.

Cardiopulmonary bypass with Nikkiso and BioMedicus centrifugal pumps

In our department, a new compact and atraumatic centrifugal pump, Nikkiso, was developed as a second-generation cardiopulmonary bypass pump. To assess and confirm the function and controllability of this pump, comparative studies of cardiopulmonary bypass with Nikkiso and BioMedicus centrifugal pumps were performed using calves. Both pumps provided pump flows of 60-70 ml/kg/min without incidence. The hemodynamics of both groups were stable and within the normal range, and no leakage or thrombus formations were observed in either pump. All hematology and biochemistry data showed no significant differences between the two groups. Plasma free hemoglobin values of the Nikkiso pump tended to be lower than those of the BioMedicus pump. The Nikkiso pump was easy to handle because of its smaller size, and air removal was easily performed because of its low priming volume. The Nikkiso pump demonstrated easy manipulation and good controllability. This compact, atraumatic centrifugal pump meets the requirements for a second-generation cardiopulmonary bypass pump.

Treatment of severe pertussis by administration of specific gamma globulin with high titers anti-toxin antibody

Our patient presented with severe respiratory distress and marked pleocytosis. She was mechanically ventilated and received gamma globulin with high titers of anti-pertussis toxin and anti-filamentous hemagglutinin. Her clinical signs improved and a notable decrease in white blood cell count was observed. Ten months after treatment, the patient showed normal physical and mental development and anti-pertussis toxin and anti-filamentous hemagglutinin titers were significantly increased. Recently, the effectiveness of gamma globulin therapy has been emphasized again. Our experience supports the use of iv gamma globulin infusion. Also, gamma globulin did not influence the patient's own immunologic response to pertussis. Gamma globulin therapy with high anti-pertussis toxin titers could be considered for treatment of severe pertussis.

The entry and intracellular multiplication of Francisella tularensis in cultured cells: its correlation with virulence in experimental mice

Five acriflavine agglutination test-positive (acf+) colonies and five negative (acf-) colonies were isolated from each of the four strains (Ebina, CMB2, N9, and Schu) of Francisella tularensis, and the correlation between the virulence in experimental mice and the entry and intracellular multiplication in cultured mouse fibroblast cells (L-929 cells) was examined. All of the acf- colonies derived from the Ebina and CMB2 strains were highly virulent in mice, readily entering and growing well in the cells, while all of the acf- colonies from N9 and Schu strains were of low virulence and neither entered nor grew in the cells effectively. On the other hand, regardless of their parent strains, the acf+ colonies were low virulent and most of those colonies did neither enter nor grow in L-929 cells. In addition, two acf- colonies, one from the N9 and the other from the Schu strain, gained virulence through several passages in mice, and in parallel, their entry and multiplication also improved. However, two acf+ colonies from the Ebina strain and one acf+ colony from the N9 strain showed a moderate degree of the entry and multiplication although they were all low virulent. The overall results indicate that the entry and multiplication in cells are important factors regulating the virulence of F. tularensis. The results also showed, however, that they were not sole factors to elucidate the virulence of the bacterium in mice.

The role of endothelium-derived nitric oxide in acetylcholine-induced coronary vasoconstriction in closed-chest pigs

BACKGROUND

The effects of an inhibitor of endothelium-derived nitric oxide on acetylcholine (ACh)-induced coronary vasoconstriction were examined in 13 anesthetized closed-chest pigs.

METHODS

Coronary blood flow was measured using a previously implanted ultrasonic transmit-time flow probe. The diameter of the large epicardial coronary arteries was assessed by coronary arteriography.

RESULTS

Intracoronary infusions of ACh (0.1, 0.3, and 1.0 micrograms/kg/min) resulted in dose-dependent decreases in coronary blood flow. Arterial pressure and heart rate were minimally altered by ACh. The high dose of ACh decreased coronary blood flow by 67 +/- 11% and caused myocardial ischemia, demonstrated by ST-segment elevation. Coronary arteriograms revealed diffuse narrowing of peripheral coronary arteries and a filling delay of the contrast medium evoked with ACh. Vasospasm of the large epicardial coronary arteries was not observed. The decreases in coronary blood flow with ACh were inhibited by atropine (0.2 mg). Intracoronary administration of an inhibitor of endothelium-derived nitric oxide, NW-nitro-L-arginine (NNLA, 1.0 mg/kg), slightly increased arterial pressure but did not change baseline coronary blood flow. The percentage decreases in coronary blood flow induced by ACh were significantly augmented by NNLA administration, but those induced by prostaglandin F2 alpha (0.5 microgram/kg/min) were not affected by NNLA. The response of the large coronary arteries to ACh was not altered by NNLA.

CONCLUSIONS

Our results suggest that, in pigs, ACh decreased coronary blood flow and caused myocardial ischemia as a result of the direct cholinergic vasoconstriction of peripheral small coronary arteries. The augmentation of ACh-induced coronary vasoconstriction by NNLA suggests that ACh facilitated the release of endothelium-derived nitric oxide, which attenuated the direct coronary vasoconstriction induced by ACh.

Serotonin-induced coronary spasm in a swine model. A minor role of defective endothelium-derived relaxing factor

BACKGROUND

Coronary spasm may be caused by endothelial dysfunction, vascular smooth muscle hyperreactivity, or both. We aimed to determine the relative role of endothelial dysfunction and vascular smooth muscle hyperreactivity in the pathogenesis of coronary artery spasm in the swine model in vivo.

METHODS AND RESULTS

In Göttingen miniature pigs given a high cholesterol diet, a segment of the left coronary artery was denuded and irradiated with x-ray (total, 30 Gy). Three months after endothelial denudation and irradiation, vasomotor responses of the denuded and control sites to agonists were assessed by quantitative arteriography. Serotonin (10 micrograms/kg) provoked coronary spasm at the denuded site (diameter reduction, 79 +/- 6%) associated with ST elevation but not at the nondenuded control site (21 +/- 6%). Intracoronary infusion of N omega-nitro-L-arginine methyl ester (LNNA, an inhibitor of endothelium-derived nitric oxide) of 1 and 3 mg/kg potentiated constriction evoked with serotonin (1, 3, 10 micrograms/kg) at the control site but did not alter it at the denuded site. However, serotonin-induced constriction after LNNA was still less at the control site (31 +/- 3%) than at the denuded site (80 +/- 5%). Endothelium-dependent vasodilation with substance P (0.1, 1, 10 ng/kg), which was inhibited by LNNA, was less (P < .01) at the denuded site than at the control site, whereas vasodilation with the nitrovasodilator SIN-1 (0.1, 1, 10 ng/kg) was comparable between the two sites. Histological study revealed regenerated endothelial cells and intimal thickening at the denuded site.

CONCLUSIONS

The results suggest that the denuded segment of the coronary artery with regenerated endothelium was associated with defective endothelium-dependent vasodilation mediated by nitric oxide and vascular smooth muscle hyperreactivity to serotonin. However, provocation of coronary spasm with serotonin resulted primarily from vascular smooth muscle hyperreactivity but not by defective nitric oxide production in this swine model.

A fluid dynamic analysis of a rotary blood pump for design improvement

The proper design of a left ventricular assist device (LVAD) requires an understanding of the pump's fluid dynamic and biocompatible properties. A hydraulically efficient system minimizes the power required for pumping. Biocompatibility refers to the ability to pump blood with minimal hemolysis and thrombus formation. Typically, shear stresses below a threshold level will not damage blood significantly. A fluid dynamic analysis of a prototype centrifugal pump designed for use as an LVAD was performed to establish flow characteristics. A flow visualization technique using Amberlite particles suspended in a glycerin/water blood analogue was used. The system was illuminated with a 1 mm planar beam strobed helium-neon laser, and the results were recorded photographically. An analysis of photographs revealed laminar and turbulent flows with vortices within an illuminated plane in both the inlet and outlet port areas. From these data, velocity and shear stress profiles were generated that showed possible areas of improvement. It was concluded that the outlet port design could be improved by changing its angle and the continuity of its expansion. The inlet port could also be improved by smoothing the transition area between the inlet tube and the pump body to allow for gradual acceleration of the entering fluid.

Baylor Gyro Pump: a completely seal-less centrifugal pump aiming for long-term circulatory support

A seal-less centrifugal pump aiming for long-term circulatory support has been developed. In this model, shaft seals that cause thrombus formation and blood leakage were eliminated. A brushless direct current motor was incorporated as a driving unit, and pivot bearings were used to support the impeller. With reference to its motor-driven system, this pump was named the M-Gyro Pump. The first model (M1) yielded an index of hemolysis of 0.005 g/100 L using bovine blood and demonstrated satisfactory performance as a right heart assist for 2 days (4 L/min, 60 mm Hg, 1,800 rpm). The second model (M2) has been developed for left heart assist by employing a stronger motor. The pump capacity was improved to 6 L/min against 240 mm Hg at 1,800 rpm, but significant heat generation was observed. By optimization of motor efficiency, the M2 model can be improved to meet the requirements of a pump for left heart assist.

Effects of fixation and varying target length on the sensitivity of polymerase chain reaction for detection of human T-cell leukemia virus type I proviral DNA in formalin-fixed tissue sections

In this study, the fixation condition most suitable for maintaining the sensitivity of the polymerase chain reaction (PCR) was investigated by using the alpha-tubulin gene sequence, and the PCR procedure most effective for detecting human T-cell leukemia virus type I (HTLV-I) proviral sequences in fixed, embedded tissues of adult T-cell leukemia patients was explored. First, the sensitivity of the PCR targeting a 286-bp alpha-tubulin sequence was studied in tissue sections fixed in several fixatives for various periods at 25 or 4 degrees C. For histological examination, fixation with 10% buffered formalin at a lower temperature for a shorter period was found to be preferable to retain the sensitivity. And the HTLV-I sequence was detected in only 7 of 18 specimens (38.9%) when the 374-bp sequence of the gag region was targeted, but the rate increased to 77.8% (14 of 18 specimens) when the length of the target sequence was reduced to 120 bp within the same region. Therefore, the one-round PCR targeting a shorter sequence is preferable for application of PCR to archival fixed tissue specimens, the fixation condition of which may not be ideal for DNA preservation.

The Baylor-ABI electromechanical total artificial heart. Accelerated endurance testing

To test the durability of each part or assembled component of the Baylor-ABI total artificial heart (TAH), the authors performed an endurance test under severe conditions. The TAH was immersed in a saline bath at 42 degrees C, which is 4-5 degrees C higher than normal body temperature. This is an accelerated endurance test because of the elevated temperatures. In this accelerated endurance test loop, the 42 degrees C heated saline was circulated not only in the pump but also outside the pump. During pumping, temperatures of the motor and outside surface of the centerpiece were continuously measured. This testing showed that during almost 4 months of pumping no electromechanical troubles were observed. Both inside (motor) and outside temperatures were stable and the differences in both temperatures were only 3-4 degrees C, demonstrating that heat generation is not a problem. The voltage and current required in this system remained constant, indicating stable and reliable performance. Based on these results, this pump is expected to run continuously over a long duration in a normal physiologic environment. This accelerated endurance test system is very suitable for estimating the influence of heat generation by the actuator of blood pumps. It is also quite useful in validating the durability of various cardiac prosthesis.

Development of the Baylor-Nikkiso centrifugal pump with a purging system for circulatory support

The Baylor-Nikkiso centrifugal pump is a magnetically coupled system with a V-ring seal separating the pump and the actuator chamber. To prevent thrombus formation behind the impeller and to extend the life of the pump to 2 weeks of continuous operation, we incorporated a purging chamber behind the V-ring seal. An external pump connected to this purging chamber infused fluid at a constant rate to wash the shaft-seal area. To evaluate the effectiveness of the purging system, we have carried out biventricular bypass experiments using calves. The purging system was successful in reducing the level of thrombus formation after 2 weeks of operation. The results of these studies confirmed that the Baylor-Nikkiso centrifugal pump with this purging system is suitable for at least 2 weeks of continuous operation as a circulatory support system.

Inhibitory effects of heparin, aspirin and ketanserin on coronary artery vasoconstriction after arterial balloon injury in hypercholesterolemic miniature pigs

OBJECTIVES

The present study aimed to clarify the effects of heparin, aspirin and ketanserin on coronary artery vasoconstriction after arterial balloon injury.

BACKGROUND

The mechanisms of coronary artery vasoconstriction after coronary angioplasty are not well understood.

METHODS

After being fed a cholesterol-rich diet for 1 month, 71 Göttingen miniature pigs were randomly allotted to five groups: 16 pigs with no pretreatment (group A); 21 pigs pretreated with heparin, 3,000 U (group B); 13 pigs pretreated with aspirin, 50 mg/day orally for 2 days (group C); 11 pigs pretreated with ketanserin, 1 mg/kg body weight (group D); 10 pigs pretreated with aspirin, 50 mg/day for 2 days, heparin, 6,000 U and ketanserin, 1 mg/kg (group E). After this pretreatment, the left anterior descending or the left circumflex coronary artery, or both, was denuded by a 2F balloon catheter.

RESULTS

The coronary vasoconstriction at the injured sites reached a peak level 6 min after the arterial injury and subsided within 30 min. The coronary vasoconstriction at the injured site 6 min after arterial injury was 56 +/- 5% in group A, which was significantly greater than that in group B (28 +/- 6%, p < 0.01), group C (25 +/- 5%, p < 0.01), group D (26 +/- 7%, p < 0.01) or group E (24 +/- 5%, p < 0.01), whereas there was no significant difference in the coronary vasoconstriction among the latter four groups.

CONCLUSION

These results suggest that serotonin released from aggregating platelets plays a major part in the platelet-dependent coronary artery vasoconstriction after arterial injury.

Flow visualization evaluation of secondary flow in a centrifugal blood pump

To design a less hemolytic and more antithrombogenic centrifugal blood pump, secondary flow, i.e., vortex and turbulent flow, must be properly controlled. An irregular stream pattern is a cause of hemolysis, and good wash-out around the shaft minimizes thrombus formation. In this study, flow visualization methods were applied to evaluate secondary flow in a centrifugal blood pump. Correlation with results of in vitro hemolysis tests was investigated. Separation of the stream lines from the vanes and patterns implying the existence of vortices were observed in the impeller that showed high hemolysis. By adjustment of vane angles, these irregular patterns could be minimized, and hemolysis decreased as well. Using a similar technique, the flow pattern at the back of the impeller could be visualized, which enabled further investigation of the effects of secondary flow on thrombus formation. This flow visualization was effective in examining secondary flow patterns.

Hypercholesterolemia increases endothelial superoxide anion production

Indirect evidence suggests accelerated degradation of endothelium-derived nitric oxide (ENDO) by superoxide anion (O2-) in hypercholesterolemic vessels (HV). To directly measure O2- production by normal vessels (NV) and HV, we used an assay for O2- based on the chemiluminescence (CL) of lucigenin (L). HV (1 mo cholesterol-fed rabbits) produced threefold more O2- than NV (1.47 +/- 0.20 nM/mg tissue/min, n = 7 vs. 0.52 +/- 0.05 nmol/mg tissue/min, n = 8, P < 0.001). Endothelial removal increased O2- production in NV (0.73 +/- 0.08, n = 6, P < 0.05), while decreasing it in HV (0.76 +/- 0.15, n = 5, P < 0.05). There was no difference between denuded HV and denuded NV. Oxypurinol, a noncompetitive inhibitor of xanthine oxidase, normalized O2- production in HV, but had no effect in NV. In separate isometric tension studies treatment with oxypurinol improved acetylcholine induced relaxations in HV, while having no effect on responses in normal vessels. Oxypurinol did not alter relaxations to nitroprusside. Thus, the endothelium is a source of O2- in hypercholesterolemia probably via xanthine oxidase activation. Increased endothelial O2- production in HV may inactivate endothelium-derived nitric oxide and provide a source for other oxygen radicals, contributing to the early atherosclerotic process.

Phenotypes of mononuclear cell infiltrates in human central nervous system

Using a panel of monoclonal antibodies applicable for identification of cell types in paraffin sections, the prevalence of mononuclear cell infiltrates with different phenotypes was estimated in large areas taken from 11 cases of acute and chronic inflammatory diseases in the human central nervous system. The present study clearly demonstrated a diversity of inflammatory mononuclear cell infiltrates, and the dominance of cell types in individual lesions appeared to be determined by both the nature of the diseases and the age of the lesions. The possible pathognomonic significance of a relatively high prevalence of CD4+CD45RO+ lymphocytes in acute rabies and in a convalescent stage of Japanese encephalitis and subacute sclerosing panencephalitis is discussed.

Subacute panencephalitis associated with chronic graft-versus-host disease

A unique form of subacute panencephalitis developed in a child with aplastic anemia 8 months after an allogeneic bone marrow transplantation (BMT). It was characterized by parenchymal infiltration of CD3 lymphocytes, a marked increase in the number of microglia strongly expressing HLA-DR antigens in both the gray and white matter, and diffuse degeneration of the cerebral white matter. The onset of neurological symptoms coincided with the development of chronic systemic graft-versus-host disease (GVHD). Cellular infiltrates in the CNS lesions were exclusively CD3 lymphocytes intermingled with a small number of monocytes labeled with CD68. There was a preponderance of cells of the CD45RB phenotype. The pathological changes in visceral organs were consistent with those of chronic GVHD. In addition, scrutiny of immunohistochemistry disclosed sparse infiltration of CD3 lymphocytes and diffuse gliosis in the cerebral white matter of another child with chronic GVHD who died 9 months after allogeneic BMT. These cases are suggestive of a potential risk of CNS involvement in GVHD.

Correlation between the virulence of Francisella tularensis in experimental mice and its acriflavine reaction

Correlation between the virulence of Francisella tularensis in experimental mice and its acriflavine reaction was studied. The cultures derived from all four strains (Ebina, CMB2, Schu, and N9) that had long been subcultured on agar media yielded two types of colonies, i.e., acriflavine reaction-positive (acf+) and acriflavine reaction-negative (acf-) colonies. All acf+ colonies, regardless of their parent strains, were shown to be low virulent in mice. Acf- colonies were shown to be either high (Ebina, CMB2) or low (Schu, N9) virulent. The low-virulent acf- colonies gained virulence during several passages in mice, whereas the acf+ colonies remained low virulent even after the animal passages.

Reappraisal of regional thiamine content in the central nervous system of the normal and thiamine-deficient mice

The regional distribution of thiamine and its phosphate esters was measured in the central nervous system (CNS) of normal and thiamine-deficient mice. Twelve small areas were punched out from frozen sections and they were individually analyzed by high performance liquid chromatography (HPLC). Regional difference was noted in both the content and ratio of thiamine and its phosphate esters in the normal CNS. In pyrithiamine-induced thiamine deficiency, thiamine pyrophosphate (TPP) content in all the areas was reduced to less than 13% of the control values on day 10, when the neurological signs developed. Although there were considerable regional variations in the reduction rate of thiamine and its phosphate esters, no correlation was established between the severity of tissue damage and the magnitude of thiamine reduction in individual areas. These results indicate that a derangement in TPP-dependent processes, either alone or in combination with other factors, plays a more critical role in the neuronal damage under thiamine deficiency than depletion of thiamine compounds per se.

Role of coronary artery spasm in progression of organic coronary stenosis and acute myocardial infarction in a swine model. Importance of mode of onset and duration of coronary artery spasm

BACKGROUND

Coronary spasm may play an important role in progression of organic coronary stenosis and myocardial infarction, but the mechanisms responsible for these complications are not known. This study aimed to examine whether the mode of onset and the duration of coronary spasm influenced progression of organic coronary stenosis and acute myocardial infarction in a swine model of coronary spasm.

METHODS AND RESULTS

Göttingen miniature pigs were subjected to cholesterol feeding, balloon-induced coronary arterial denudation, and x-ray irradiation. Five months later, coronary spasm was induced by intracoronary injection of serotonin. In 10 pigs, coronary spasm was provoked abruptly and maintained for 25 minutes by five repeated intracoronary injections of serotonin (10 micrograms/kg) every 5 minutes (group A, abrupt onset and short duration). In group B, coronary spasm was provoked gradually by intracoronary injections of serotonin at graded doses of 0.1, 0.3, and 0.6 microgram/kg every 5 minutes and was then maintained for 25 minutes in four pigs (group B1, gradual onset and short duration) and for 120 minutes in six pigs (group B2, gradual onset and long duration) by repeated intracoronary injections of serotonin (10 micrograms/kg) every 5 minutes. Intramural hemorrhage was noted histologically at the spastic site more frequently in group A with abrupt onset (nine of 10 pigs) than in group B with gradual onset (two of 10 pigs) (p < 0.01). Progression of organic coronary stenosis due to intramural hemorrhage was noted in seven pigs (six pigs in group A and one pig in group B), including three cases of total coronary occlusion. Evidence for the evolution of acute myocardial infarction (serial ECG findings, left ventriculograms, and histological findings) was noted in one pig (7%) of group A or B1 with short duration and in five of six pigs (83%) in group B2 with long duration (p < 0.01 versus group A and B1).

CONCLUSIONS

These results indicate that: 1) intramural hemorrhage was frequently induced by coronary spasm of abrupt but not of gradual onset, 2) intramural hemorrhage resulted in acute progression of coronary stenosis and sometimes resulted in persistent total coronary occlusion leading to acute myocardial infarction, and 3) prolonged coronary spasm resulted in acute myocardial infarction without progression of organic coronary stenosis.

A seal-less centrifugal pump (Baylor Gyro Pump) for application to long-term circulatory support

We are developing a new centrifugal pump, the Baylor Gyro Centrifugal Pump (Gyro Pump), which can function for more than 2 weeks. The concept of the Gyro Pump is that a one-piece rotor-impeller with embedded permanent magnets, driven directly by a brushless direct current motor stator placed outside, rotates like a "gyroscope," and the rotor-impeller is supported by one pivot bearing at the bottom in accordance with the gyroscopic principle. This concept enables us to eliminate a driving shaft and a seal between the driving shaft and the blood chamber, which results in extending the life of the centrifugal pump. The blood passes through the space between the motor stator and the rotor to the impeller portion. In this preliminary phase, two pivot bearings were applied to support the rotor-impeller at the top and the bottom inside the blood chamber. Both pivot bearings showed less blood trauma and less thrombogenicity in in vitro and in vivo studies. The Gyro Pump is a promising second-generation centrifugal pump for long-term circulatory support in the near future.

Versatile one-piece total artificial heart for bridge to transplantation or permanent heart replacement

A versatile, one-piece total artificial heart (TAH) system that can be driven by either an electromechanical acutator (EM-TAH) or a pneumatic source (P-TAH) has been developed. The common units for both TAHs are the conically shaped left and right pusher-plate-type pumps (63 ml SV) that sandwich a thin centerpiece (18 mm) having a respective actuator. The EM actuator, mounted in the middle of the centerpiece, consists of a direct-current brushless motor and a roller screw while the pneumatic actuator consists of a low-pressure air source. The outer diameter of the pumping unit is 97 mm with its central thickness being 82 mm; overall volume is 510 cc. The TAH is operated in the left master alternative ejection mode with the left pump fill signal. High-flex-life Hexsyn rubber is used as the diaphragm, and the blood-contacting surface is coated with dry gelatin. The TAH can provide 3-8 L/min flow with a preload of 1-10 mm Hg against 100 mm Hg afterload. Anatomical fit of the pumping unit has been demonstrated in the pericardial space of 26 heart transplant recipients with average body weight of 78 kg. To date, 2 P-TAH and 4 EM-TAH (1 week) implantations were performed in 80-100 kg calves demonstrating excellent anatomical fit, controllability, and biocompatibility. This versatile TAH is suitable for a bridge to transplantation or permanent heart replacement.

Baylor multipurpose circulatory support system for short- to long-term use

A multipurpose circulatory support system has been developed as both a temporary and permanent device in total artificial hearts (TAHs) and ventricular assist devices (VADs). The multipurpose concept was derived from the development of a totally implantable electromechanical, one-piece TAH. The blood pump is pneumatically driven in short-term use and is electromechanically driven in long-term or permanent use. Both TAH and VAD versions consist of the same components, except for the actuation mechanism. The common components are a compact pumping chamber with the same configuration, a blood contacting surface biolized with gelatin, a pusher-plate, a Hexsyn rubber diaphragm (University of Akron, Akron, OH) and bovine pericardial valves. Both TAHs and VADs have 63 ml of stroke volume, and the VADs are compact compared with other available investigational device exemption devices. Currently, 1 week survival has been achieved using the electromechanical TAH and 2 week survival using the electromechanimcal VAD without anticoagulation. Results suggest that the currently developed system could be applied in varied patients as a temporary device after cardiotomy, a long-term device for bridge to transplantation, or a permanent device for end-stage heart disease.

Infiltration of helper/inducer T lymphocytes heralds central nervous system damage in human T-cell leukemia virus infection

Cellular infiltrates in new and old lesions in two cases of human T-cell leukemia virus associated myelopathy (HAM) were analyzed with anti-CD3 antibody and OPD4 antibody recognizing CD4 + CD45RO + T lymphocytes. A subset of CD4 lymphocytes with helper/inducer function and labeled with OPD4 constitutes up to 65% of CD3 cells in new lesions in the pons and the cervical cord. In contrast, nonhelper cells and macrophages were dominant in long-standing spinal cord lesions of these HAM cases and inflammatory lesions in two cases of Japanese encephalitis. Thus, unlike in viral infections, the central nervous system (CNS) tissue damage associated with human T-cell leukemia virus (HTLV-1) infection appeared to be heralded by the infiltration of helper/inducer T cells.

Sensitivity of the polymerase chain reaction for detecting human T-cell leukemia virus type I sequences in paraffin-embedded tissue. Effect of unbuffered formalin fixation

Recently, the application of the polymerase chain reaction (PCR) to formalin-fixed paraffin-embedded tissue has been reported. But formalin, especially unbuffered formalin, is known to break DNA into small fragments. DNA extracted from MT-2 cells fixed in unbuffered formalin for various periods of time were subjected to the PCR and the effect of unbuffered formalin fixation on the ability of the PCR to detect exogenous sequences; i.e., human T-cell leukemia virus type I (HTLV-I) proviral DNA, was examined. The sensitivity of the PCR decreased as a function of both the duration of fixation and the length of the expected DNA products. When the expected length of the PCR product was about 200 bp, a slight decrease in the sensitivity was observed after 4-day fixation. When it was about 300 bp, a similar decrease was observed following 4-h fixation. In the case of a 500 bp product, the sensitivity began to decrease after 30-min fixation and a 100-fold decrease was observed after 10-day fixation. A decrease was not observed, however, with a 100 bp product. The appropriate design of primers, especially with regard to the length of the amplified product, is essential to keep the sensitivity of the PCR, particularly when the target tissues have been fixed in unbuffered formalin.

Gelatin particle agglutination test for early serodiagnosis of Japanese spotted fever

A gelatin particle agglutination (PA) test for Japanese spotted fever has been developed. Gelatin particles were sensitized with a sonicated causative rickettsia and used as antigens. The antibodies by PA test were detected as early as days 4-7 after the onset, whereas those by indirect immunoperoxidase (IP) test were detected after days 8-11. In addition, PA titers were higher than IP titers before days 20-23. The agglutinins detected by PA test were proven to be IgM because they were all sensitive to dithiothreitol. PA test was, however, less specific than IP test, giving a little nonspecific reaction to the sera from patients with scrub typhus and from individuals unrelated to those two rickettsioses. Nevertheless, PA test, which is simple, rapid, and easy to interpret the results, is useful for the early serodiagnosis of Japanese spotted fever.

Search for human T-cell leukemia virus type I (HTLV-I) proviral sequences by polymerase chain reaction in the central nervous system tissue of HTLV-I-associated myelopathy

Using the polymerase chain reaction (PCR), proviral DNA sequences of the pol and env regions of human T-cell leukemia virus type I (HTLV-I) were directly amplified in paraffin-embedded and frozen tissue sections of active inflammatory central nervous system (CNS) lesions in three autopsy cases of HTLV-I-associated myelopathy (HAM) with serological confirmation. In parallel, the enumeration of UCHL-1 (monoclonal antibody reactive to T-cells) positive cells in the tissue sections subjected to PCR were carried out. Although the control DNA sequence of parathyroid hormone-like peptide gene was definitely amplified, no signals for HTLV-I proviral sequences were detected in these specimens. The number of UCHL-1 positive cell nuclei was almost on the border line of our PCR sensitivity in formalin-fixed tissue, which was estimated to be 20-200 copies. Therefore, it is unlikely that the central nervous system tissue damage in HAM/TSP is a consequence of productive infection of HTLV-I in the CNS tissue.

Effects of endothelin-1 on epicardial coronary tone, coronary blood flow, ECG-ST change and regional wall motion in anesthetized dogs

The effects of intracoronary-administrated endothelin-1 on coronary hemodynamics and regional myocardial function were studied in anesthetized open-chest dogs. Epicardial coronary diameter (CoD) and coronary blood flow (CBF) were measured by a sonomicrometer of 10 MHz piezoelectric crystals and an electro-magnetic flow probe on the left circumflex coronary artery (LCX). Regional wall motion was sonomicrometrically measured at regions supplied by the LCX and left anterior descending artery (LAD) and electrocardiograms were recorded. Endothelin-1, administered as a bolus injections into the LCX via an intracoronary cannula, in a dose-dependent manner reduced COD and CBF. The extent of the reduction of COD and CBF at a dose-dependent manner reduced COD and CBF. The extent of the reduction of COD and CBF at a dose of 300 pmol was 12.3 +/- 1.5% (P less than 0.01) and 86 +/- 5% (P less than 0.01), respectively, of the control. The extent of CBF reduction and deterioration of systolic wall motion were linearly related with the dosage of endothelin-1. ST-elevation (lead II) and fatal ECG abnormalities, including complete atrioventricular block or ventricular fibrillation, were observed with doses above 60 and 100 pmol, respectively. Coronary angiography revealed that filling defects of dye were propagated from the third or distal branches to those of more proximal arteries when the doses of endothelin-1 were cumulatively infused into the LCX. Accordingly, lethal myocardial ischemia induced by endothelin-1 is produced by critical obstruction of rather small coronary vessels.

An indirect microhemagglutination test for Lyme disease

We have developed an indirect microhemagglutination test (IMHA) for detecting antibodies to Borrelia burgdorferi using formalin-fixed chicken erythrocytes sensitized with a sonicated extract of the bacteria. The specificity of IMHA for Lyme disease was compared with that of a conventional indirect immunoperoxidase technique (IP) using sera from the patients with syphilis, randomly-chosen outpatients unrelated to Lyme disease, and from normal individuals. The IMHA was more specific than IP, giving little cross-reaction with syphilis. The IMHA also gave little background reactions with the sera of individuals unrelated to Lyme disease or syphilis. Therefore, the IMHA could be a useful test for the serodiagnosis of Lyme disease.

Mutagenicity of (p-nitrophenyl)adenines in Salmonella typhimurium

Adenine derivatives having a p-nitrophenyl group at position 2, 8, or 9 were directly mutagenic towards Salmonella typhimurium strains TA98 and TA100, whereas N6-(p-nitrophenyl)adenine was not mutagenic. 2,9- And 8,9-bis-(p-nitrophenyl)adenines were also mutagenic, but N6,9-bis-(p-nitrophenyl)adenine was not. The study on 13 (p-nitrophenyl)adenine derivatives for their Salmonella mutagenicity indicates that only those having a p-nitrophenyl ring directly linked to the purine ring are mutagenic, implying the importance of the coplanar character of the nitrophenyl and the purine rings. The nitro group seems essential for the mutagenicity, as shown from the results of assays using nitroarene-sensitive and -insensitive Salmonella strains. The mutagenic potency of this class of compounds is high, comparable to that of 2-nitrofluorene.

Clinical manifestations of tularemia in Japan--analysis of 1,355 cases observed between 1924 and 1987

A total of 1,355 cases of tularemia observed between 1924 and 1987 in Japan were viewed on the basis of clinical manifestations and the results were compared with those in the United States. The incubation period varied from one day to over one month. In 75.5% of cases, the symptoms of illness appeared within seven days with the peak on the third day. A sudden onset of flu-like symptoms was generally observed, and 92% of cases was followed by regional lymph node swelling which mostly appeared in axillary and cubital regions. They were observed predominantly at the left rather than the right side. In contrast with the cases in the United States, the number of cases of ulceroglandular type in Japan was only one third of those of glandular type. None of the pleuropulmonary cases or fatal tularemia have been reported in Japan. The number of oropharyngeal cases has remarkably increased after World War II, and is still on the rise, presumably because of the change of dietary habits in Japan. All these characteristics of Japanese tularemia are assumed to be caused by low virulence of Japanese strains of Francisella tularensis.

Microagglutination test for early and specific serodiagnosis of tularemia

A microagglutination test with safranin-stained Francisella tularensis antigen was compared with a conventional tube agglutination test for the serodiagnosis of tularemia. The microagglutination test was performed in round-bottom microtiter plates by using 0.025 ml of the antisera and of the antigen. The antibody titers obtained by using the microagglutination test were 8 to 64 times higher than those seen with the tube agglutination. By the microagglutination test, the serum agglutinins were detected 3 days earlier in rabbits and 9 days earlier in humans than by the tube agglutination test. The microagglutination test also detected residual circulating antibodies in humans more than 20 years after recovery from infection. These early agglutinins were shown to be in the immunoglobulin M class because of their sensitivities to 2-mercaptoethanol. No significant group agglutination reaction with Brucella abortus was observed. These observations indicate that the microagglutination test is a useful tool for the early and specific serodiagnosis of tularemia.

Targeting of adoptively transferred experimental allergic encephalitis lesion at the sites of wallerian degeneration

To clarify the implication of the major histocompatibility complex class II (Ia) antigen induction in microglia following Wallerian degeneration in the central nervous system (CNS), experimental allergic encephalitis (EAE) was adoptively transferred to Lewis rats in which Ia antigens had been induced in microglia at the sites of Wallerian degeneration. In addition to randomly distributed typical EAE lesions, the recipient rats developed distinct inflammatory lesions in accord with the distribution of Ia-positive microglia; i.e., in the ipsilateral thalamus after cortical cryoinjury, and in the ipsilateral optic nerve, the contralateral optic tract and superior colliculus after unilateral eye ball enucleation. Thus, the EAE locus may be targeted by this approach. The inflammatory response was inducible by transfer of myelin basic protein-stimulated lymphocytes but not by transfer of phytohemagglutinin-stimulated or non-stimulated lymphocytes. When examined using monoclonal antibody surface markers; OX-6 for Ia antigen, W3/13 for pan T lymphocyte and OX-8 for cytotoxic/suppresser T lymphocyte, the types of lymphocytes in these lesions did not differ from those in ordinary EAE lesions in the spinal cord. The potential role of non-immunologically induced Ia-positive cell clusters that serve as a target for autoimmune CNS diseases was discussed.

Cytotropism of Theiler's murine encephalomyelitis viruses in oligodendrocyte-enriched cultures

The cytotropism of two strains, GDVII and DA, of Theiler's murine encephalomyelitis viruses (TMEV) was studied in the oligodendrocyte-enriched murine neural cell cultures. Both GDVII and DA caused cytopathic effects in the neural cell cultures, and double immunostaining for galactocerebroside (Gal-Cer), a marker molecule for oligodendrocyte, and viral antigens disclosed a dual expression of Gal-Cer and viral antigens in over 80% of cells in both cultures 24 h after infection with either GDVII or DA. The kinetics of cell-free and cell-associated infectivity were not significantly different between two cultures. These in vitro observations suggest that neither replication in oligodendrocyte nor cell-associated infectivity is a sole factor in discriminating those two subgroups of TMEV with regard to the demyelinating activity, and that virus cell binding may play an important role in virus persistence and TMEV-induced demyelination.

Intraneuronal laminin-like immunoreactivity in the human central nervous system

Because laminin possesses potent neurotrophic activity, laminin-like immunoreactivity was investigated in formalin-fixed human brains, using affinity-purified anti-human placental laminin rabbit serum. Distinct laminin-like immunoreactivity was observed in neuronal soma of certain nuclear groups, and a 180-kDa band was noted in an immunoblot study of the supernatant of brain homogenate. These observations imply that many but not all central neurons have laminin-like immunoreactive molecules. Their functional role, however, remains to be clarified.

2-(p-Nitrophenyl)-2'-deoxyadenosine, a new type of mutagenic nucleoside

A crude preparation of 2-phenyladenosine was found to be mutagenic in the Ames Salmonella assay. In the purification of this preparation, it was revealed that 2-phenyladenosine itself was nonmutagenic but that 2-(m- and p-nitrophenyl)-adenosines (5m,p) contaminating the sample were the mutagenic principles. A structure-activity relationship study was carried out, and it was found that 5p, 2-(p-nitrophenyl)-adenine (7p), and 2-(p-nitrophenyl)-2'-deoxyadenosine (15p) were strongly mutagenic toward S. typhimurium TA98 and TA100 without metabolic activation, the potency being in the order 15p greater than 7p greater than 5p. The potency of 15p in TA98 was one order of magnitude greater than that of 4-nitroquinoline N-oxide. 15p also showed mutagenicity in the mouse cell line FM3A in culture.

Infectious cDNA clones of the DA strain of Theiler's murine encephalomyelitis virus

The DA strain and other members of the TO subgroup of Theiler's murine encephalomyelitis viruses cause a persistent demyelinating infection, whereas the GDVII strain and other GDVII subgroup strains cause an acute lethal polioencephalomyelitis. We generated an infectious DA cDNA clone inserted into a transcription vector. Virus derived from transfection of transcripts produced a demyelinating disease indistinguishable from that of wild-type virus. The infectious clone provides a critical reagent for the production of interstrain recombinant viruses to help identify genetic loci responsible for the biological activities of the strains.

Mongolian spots associated with cleft lip

Of the present series comprising 66 newborns with cleft lip, 13 (20%) had pigmented macules in the labial skin on the lateral side of the cleft. Histological examination using serial sections were performed on 47 cases and showed evidence of dermal melanocytosis in 40 cases (85%) consisting of 33 (70%) without clinically detectable macules and 7 (15%) with obvious pigmented macules. The fusiform cells in the dermis were positive for dopa reaction and anti-melanocyte antibody. The high incidence of dermal melanocytosis is comparable to that of common Mongolian spots in Asian babies.

Serial assessment of myocardial infarction by using gated MR imaging and Gd-DTPA

In order to assess the usefulness of Gd-DTPA in the evaluation of myocardial infarction, 17 patients were examined with gated MR imaging. Scans were made by using a spin-echo pulse sequence before and after IV administration of 0.15 mmol/kg of Gd-DTPA. The images were made at four intervals (average of 5, 12, 30, and 90 days) after the onset of the infarction. Gd-DTPA uptake at the infarcted area was graded as marked, moderate, or no increase in signal intensity by visual inspection. At these four time intervals, an area of increased signal intensity in the infarcted myocardium was detected on T1-weighted images after administration of Gd-DTPA in 14 (82%) of 17 cases, 16 (94%) of 17 cases, six (38%) of 16 cases, and three (21%) of 14 cases, respectively. Markedly increased signal intensity in infarcted areas was shown on T1-weighted images with Gd-DTPA at 5 and 12 days. The ratio of gadolinium uptake in the infarcted area to that in normal myocardium also was evaluated. At 5 and 12 days, the mean increase in signal intensity in the infarcted area was significantly higher than that in a normal area, but not at 30 and 90 days. Increased signal intensity also was apparent on T2-weighted images without Gd-DTPA at 5 and 12 days; however, the use of late echo reduced the signal-to-noise ratio, leading to image degradation. Uptake of Gd-DTPA was a positive marker in acute myocardial infarction, but no significant uptake of Gd-DTPA occurred in chronic myocardial infarction.

Neurotoxic activity in HTLV-I carrier lymphocyte culture

A close association between human T-lymphotropic virus type I (HTLV-I) infection and a group of chronic myelopathies of unknown etiology has recently been established and the name "HTLV-I associated myelopathy" (HAM) has been coined. Although the mechanism of neural tissue damage in HAM remains virtually unknown, several lines of evidence suggest the involvement of a soluble factor(s) including cytokines and viral proteins in the disease process. In this study, we examined cytopathic effects of the supernatants from 6 HTLV-I carrier human T lymphocyte cell lines on 4 human and one murine neuroblastoma cell lines, and 2 human glioma cell lines. Among 6 lymphocyte cell culture supernatants, only 1 from MT-2 cell culture repeatedly exerted cytopathic effects on human neuroblastoma cells, particularly on IMR-32 cells: marked retraction of neurites leading to cellular clumping. This activity was neither abolished by treatment of the medium at 80 degrees C for 30 min or by UV-irradiation, nor was it neutralized by anti-HTLV-I antibodies. The MT-2 supernatant also induced mild cytopathic changes in 2 other human neuroblastoma cell lines and 2 human glioma cell lines. This activity was abolished by treatment of the medium at 80 degrees C for 30 min but not at 56 degrees C for 30 min. Myelinated murine cerebellum explants and other cell lines showed no morphological changes when incubated with the MT-2 supernatant. In addition, the growth of THP-1 cells, a monocyte/macrophage lineage cell line, was remarkably suppressed when maintained in the MT-2 conditioned medium, accompanied by enhancement of phagocytic activity. The THP-1 conditioned medium, on the other hand, suppressed tumor necrosis factor (TNF) activity detected in the MT-2 culture. These observations suggest that HTLV-I induced cytokines may directly act on neural cells, but their action appears to be regulated by the intricate interactions of lymphocytic and monocytic cells.

Defective immune response to Epstein-Barr virus in patients with acute lymphocytic leukemia

Thirteen children with acute lymphocytic leukemia (ALL) receiving maintenance chemotherapy were tested for anti-Epstein-Barr virus (EBV) antibodies, EBV specific cytotoxic T lymphocyte (EBV-CTL) activity and spontaneous cytotoxicity against Raji cells in order to define the defective cellular immunity in ALL children during complete remission. Among 10 seropositive patients, anti-virus capsid antigen (VCA) antibody titer varied from 1:20 to 1:320 and anti-EBV nuclear antigen (EBNA) antibody was not detectable in four. No patients were positive for anti-early antigen (EA) antibody. EBV-CTL activity and interleukin 2 (IL-2) or interferon alpha (IFN-alpha) augmented EBV-CTL activity in eight seropositive patients was significantly lower than that in the seropositive age matched control group. IFN-alpha, OK-432 or IL-2 augmented spontaneous cytotoxicity were also significantly lower in the patients compared to those in the control group. These defective killer cell activities may allow EBV-infections to enter a severe, fulminant or persistently active state in the patients with ALL receiving aggressive maintenance chemotherapy.

Viral infectious complementary-DNA studies may identify nonviral genes critical to central nervous system disease

A major interest of modern science and medicine is the delineation of genes that cause disease. In the case of cancer, the study of viral oncogenic genes led to the recognition of similar human genes that play an important role in this disease. In an analogous fashion, the identification of viral genes important in central nervous system disease may lead to the recognition of related cellular genes that are important in nonviral central nervous system disease. New molecular techniques now provide tools for identification of pathogenic viral genes and elucidation of mechanisms of disease production. Positive-strand RNA viruses such as picornaviruses provide an especially attractive model system for studies of central nervous system disease-producing genes. A limitation in molecular studies of these viruses has resulted from an inability to use restriction enzymes, since these enzymes are active against DNA and not RNA. This limitation has recently been overcome with the preparation of infectious picornavirus complementary-DNA. This review highlights the importance of infectious complementary-DNA in pathogenesis studies and provides a glimpse of the impact of such studies on neurology.