Interleukin-8 stimulates leukocyte migration across a monolayer of cultured rabbit gastric epithelial cells. Effect associated with the impairment of gastric epithelial barrier function

Acute Helicobacter pylori infection produces predominantly neutrophilic infiltration of the gastric mucosa. However, the precise mechanisms and mediators of neutrophil migration are not known. Interleukin-8 (IL-8), a potent chemotactic factor for neutrophils, is present at high concentration in the gastric mucosa of subjects with chronic gastritis caused by H. pylori infection. The aims of this study were to determine whether IL-8 stimulates polymorphonuclear leukocyte (PMN) migration across a cultured monolayer of rabbit gastric epithelial cells and whether PMN migration affects epithelial cell barrier function. Confluent gastric epithelial monolayers grown on the inserts were overlaid with PMNs and various amounts of IL-8 were administered into the well under the insert. Gastric epithelial barrier function was assessed by sodium back diffusion. IL-8 stimulated PMN migration across the monolayer in a dose- and time-dependent manner. PMN transmigration significantly increased sodium back diffusion. In conclusion, IL-8 induces PMN migration across a monolayer of cultured gastric epithelial cells. This IL-8 action is associated with impairment of gastric epithelial barrier function. Since H. pylori infection causes a local mucosal increase of IL-8, our present findings may explain the mechanism of H. pylori-induced PMN infiltration of the gastric glands and mucosal injury.

Complement Cls, a classical enzyme with novel functions at the endochondral ossification center: immunohistochemical staining of activated Cls with a neoantigen-specific antibody

The secondary ossification center of 14- to 16-day-old hamster tibiae was examined immunohistochemically with active and inactive Cls-specific antibodies, RK5 and RK4, respectively. At the ossification center, chondrocytes differentiate from proliferating and hypertrophic to degenerating stages, and their site is occupied by the bone marrow. Cls was strongly immunostained in hypertrophic chondrocytes. In order to discover whether Cls is activated at a particular site, the cartilage was immunostained with RK5 and RK4. RK5 mainly reacted with degrading matrix around invading vessels. In contrast, RK4 strongly stained hypertrophic chondrocytes. Immunoelectron microscopy revealed Cls on degrading fragments of chondrocytes and fibers of cartilage matrix. Decorin, one of the major matrix proteoglycans, was dose and time dependently degraded by Cls. Type II collagen and type I gelatin were also degraded. Articular cartilage from patients with rheumatoid arthritis was positively immunostained (11/12 cases) with an anti-Cls monoclonal antibody (mAb) PG11, whereas normal articular cartilage (5/5 cases) was negative, suggesting Cls participation in the etiology of rheumatoid arthritis.

Inhibition of beta-carotene and astaxanthin of NADPH-dependent microsomal phospholipid peroxidation

To evaluate the antioxidant effects of beta-carotene and astaxanthin, rat liver microsomes were exposed to a mixture of chelated iron (Fe3+/ADP) and NADPH. The carotenoids (190 pmol/mg protein) were incorporated into some of these microsomal membranes, and phospholipid hydroperoxides (PLOOH), thiobarbituric acid reactive substances (TBARS) and endogenous alpha-tocopherol content were measured over time after the initiation of oxidant stress. In control microsomes, oxidant stress led to accumulation of 1,865 (+/- 371) pmol PLOOH/mg protein during the initial 10-min peroxidation reaction, followed by a more gradual decrease during the subsequent 20-min of reaction. PLOOH accumulation during the initial 10-min reaction period was reduced to 588 (+/- 169) pmol/mg protein with beta-carotene present and 800 (+/- 288) pmol/mg protein with astaxanthin present. During the following 20-min of incubation, PLOOH levels declined in the carotenoid-supplemented microsomes but continued to increase at a slower rate in control preparations. TBARS did not show such large accumulation as observed in PLOOH during the initial 10-min incubation in any microsomal sample. The presence of carotenoids in the microsomal membrane partially inhibited the loss of alpha-tocopherol, especially during the later phase of oxidant stress. When lipid peroxidation is generated by membrane-bound cyt-P450, the specific measurement of PLOOH clearly demonstrates that the presence of carotenoids provides antioxidant protection.

Angiotensin II increases plasminogen activator inhibitor-1 and tissue factor mRNA expression without changing that of tissue type plasminogen activator or tissue factor pathway inhibitor in cultured rat aortic endothelial cells

Angiotensin converting enzyme inhibitors (ACE-I) have been reported to prevent the recurrence of cardiovascular events. The mechanism of this decrease, however, can not be completely explained by anti-hypertensive and anti-hypertrophic effects of ACE-I. To investigate the mechanism of this decrease, we studied the regulation of plasminogen activator inhibitor-1 (PAI-1), tissue type plasminogen activator (TPA), tissue factor (TF), and tissue factor pathway inhibitor (TFPI) by angiotensin II (Ang II) in cultured rat aortic endothelial cells. Ang II increased PAI-1 and TF mRNA expression without affecting that of TPA or TFPI. These inductions were accompanied by increases in PAI-1 and TF activities and were inhibited by a type I Ang II receptor antagonist. The results suggest that Ang II decreases the antithrombotic properties of endothelial cells which increases the chance of thrombosis. Thus, inhibition of the renin-angiotensin system may be beneficial to prevent thrombus formation in treatment of ischemic heart disease.

Chemiluminescence-high-performance liquid chromatographic determination of tea catechin, (-)-epigallocatechin 3-gallate, at picomole levels in rat and human plasma

A method of chemiluminescence detection-high-performance liquid chromatography (CL-HPLC) for the highly specific determination of tea catechin, (-)-epigallocatechin 3-gallate (EGCg), present in rat and human plasma has been newly developed. The CL-HPLC system consists of reversed-phase HPLC and chemiluminescence detector, in which separated EGCg generates chemiluminescence at post column successively reacting with the following two chemiluminescence cocktails; 8.2 M acetaldehyde in 50 mM phosphate buffer (pH 7.4, contained 108 mg horseradish peroxidase/L) and 8.8 M hydrogen peroxide aqueous solution. The plasma EGCg was extracted by methanol. This method enables the detection of EGCg in the free form selectively at as low as 2 pmol with recovery of 84%. The EGCg concentration in fasted rat plasma was initially below the detection limit (< 2 pmol/ml), but increased to maximum level (2284 pmol/ml plasma, 1047 ng/ml; calculated 0.012% of ingested EGCg) 30 min after a single oral supplementation of 56 mg EGCg per rat. The EGCg concentration in fasted human plasma was also initially below the detection limit and increased to 341 pmol/ml (156 ng/ml; calculated 0.32% of ingested EGCg) at 60 min after a single oral intake of 97 mg EGCg per subject. The results indicated that tea catechin, EGCg, is absorbed from the digestive tract into the rat and human body and that the CL-HPLC method reported here should be a powerful tool for studying the metabolic fate and bioavailability of EGCg.

Jejunal pouch length influences metabolism after total gastrectomy

BACKGROUND/AIMS

To determine whether the length of the jejunal pouch used for reconstruction after total gastrectomy influences the postoperative metabolic and clinical outcome.

METHODOLOGY

Twenty-one patients who underwent total gastrectomy with long jejunal pouch reconstruction (length 20 cm: n = 9) or short jejunal pouch reconstruction (length 15 cm: n = 12) were studied. The volume of a single meal, clinical symptoms, glucose metabolism, and other metabolic parameters were studied.

RESULTS

Food intake, body weight, and dumping symptoms were similar in both groups, but the short pouch group had less reflux symptoms. Serum albumin and total cholesterol levels were higher in the short pouch group than in the long pouch group at 12 months postoperatively (p < 0.05). However, the short pouch group showed reduced glucose tolerance.

CONCLUSION

These findings suggest that jejunal pouch length might have a role in postoperative physiological status.

[High-dose conformal radiotherapy for glioblastoma multiforme]

The purpose of this study was to evaluate the impact of administering high doses by rotational multi-leaf collimator (MLC) conformal radiation therapy. From 1984 to 1995, thirty-five consecutive cases with glioblastoma multiforme were treated using rotational MLC conformal therapy. There were 23 men and 12 women, with an average age of 45 years (12-73 years). Median Karnofsky performance score was 80(30-100). Median tumor volume was 56 cc (8-800 cc). All patients underwent surgical intervention (only biopsy in one, partial resection in 13, subtotal resection in 18, and gross total resection in three). Radiation dose ranged from 60 to 80 Gy (mean 68.5 Gy) in 21 patients treated before 1991, and was 90 Gy in the 14 patients treated thereafter. Biweekly intravenous chemotherapy was also administered in both arms. The 1-year, 2-year, and 5-year survival rates were 72%, 43%, and 21%, respectively. Residual tumor volume was the only statistically significant factor for survival by multivariable analysis. The five-year survival rate of patients with residual tumors 2 cm or less in diameter was as high as 44%. Local failure was observed in 15 of the 18 patients in the lower dose group, whereas it was observed in only 4 of the 10 patients in the higher dose group. The difference was statistically significant. Rotational conformal therapy in combination with intensive surgical resection showed a favorable outcome. However, increased dose did not lead to higher survival rate.

Successful treatment of brain metastases from ovarian cancer using gamma-knife radiosurgery

We describe a case with multiple brain metastases from ovarian cancer which were successfully treated by a multimodality approach including gamma-knife radiosurgery. This case was diagnosed as epithelial ovarian cancer, FIGO stage IV, with supraclavicular lymph node metastasis and malignant pleural effusion. She underwent cisplatin-based chemotherapy before and after cytoreductive surgery for 9 months and then achieved clinical complete remission for 27 months. Multiple brain metastases occurred 36 months after the initial diagnosis of ovarian cancer. She had no recurrent lesions outside the brain. She underwent surgical resection of the two accessible lesions and then gamma-knife radiosurgery for another unresectable lesion after 30 Gy cranial irradiation. The multimodal treatment including gamma-knife radiosurgery has produced complete remission of multiple brain metastases for 21 months with good quality of life. Accordingly, at the moment, i.e., 5 years after the initial diagnosis of the disease, she remains in a disease-free state.

Reflux esophagitis after total gastrectomy with jejunal pouch reconstruction: comparison of long and short pouches

OBJECTIVE

To evaluate the effect of the type of jejunal pouch (long or short) on reflux esophagitis after total gastrectomy.

METHODS

Two groups of patients who underwent jejunal pouch reconstruction (long pouch, n = 9; short pouch, n = 9) after total gastrectomy were compared, and each was also compared with a group of healthy control subjects (n = 9). Reflux symptoms were assessed using a reflux score questionnaire derived from Moran's graded reflux questionnaire. Scintigraphy was performed to evaluate quantitatively intestinoesophageal reflux and pouch emptying time (t75%).

RESULTS

Heartburn was more common in the long pouch group than in the short pouch group (56 vs 11%, p < 0.05), and the reflux score was significantly higher in the long pouch group (mean score 3.0 vs 1.0, p < 0.01). The scintigraphic reflux index in the long pouch group, short pouch group, and control group was 9.57 +/- 5.52, 7.05 +/- 3.35, and 1.55 +/- 0.70, respectively. The reflux index in the entire group of patients was significantly higher than that in the control group (p < 0.005). In addition, t75% was significantly longer in the long pouch group (46.0 +/- 16.2 min) than in the short pouch group (21.1 +/- 15.39 min).

CONCLUSION

Our findings suggest that reconstruction with a short jejunal pouch is more effective than a long pouch in preventing reflux symptoms.

[Defective generation of NK1.1+ T cells in aly/aly mice associated with thymic architecture]

It has been reported that positive selection of natural killer antigen 1.1+ (NK1.1+) T cell antigen receptor (TCR) alpha beta+ thymocytes recently identified among CD4+8- and CD4-8- subpopulations is attributable to major histocompatibility complex (MHC) class Ib ligands expressed on bone marrow (BM) derived components in the thymus. This selection pattern is quite different from NK1.1-T cells of main stream. In the present study, we investigated generation of NK1.1+ TCR alpha beta+ cells in the thymus of aly/aly mouse which lacks lymph nodes and Peyer's patches and shows abnormalities of thymic and splenic structure. We found that the proportion of the NK1.1+ TCR alpha beta+ thymocytes was extremely low in these mice as compared with aly/aly+ and normal C57BL/6 mice. Thymic reconstitution by BM cells from aly/aly+ mice which possess a normal population of NK1.1+ TCR alpha beta+ thymocytes did not restore the NK1.1+ TCR alpha beta+ cell population in the thymus of lethally irradiated aly/aly mouse. When deoxy-guanosine (dGuo)-treated fetal thymi from (B6 x B10.G) F1 mice were transplanted to aly/aly mice which had been thymectomized and reconstituted with BM cells of aly/aly mice, normal proportions of the NK1.1+ TCR alpha beta+ thymocytes were observed in the thymus grafts. Furthermore it was demonstrated that NK1.1+ T cells in aly/aly mice were unable to produce efficiently IL-4 upon in vivo stimulation with anti-CD3. These findings demonstrate that the development of NK1.1+ TCR alpha beta+ cells is accomplished under the influence of not only BM derived components but also in intact microenvironment of lymphoid tissues.

[A case of severe odontogenic infection with allergic skin reaction for beta-lactam antibiotics]

A 54-aged woman consulted with right buccal phlegmon caused by lower apical periodontitis. The primary chemotherapy using flomoxef induced allergic skin eruption. A decision was made for using clindamycin, levofloxacin and fosfomycin as chemotherapeutic agents. Cultured organisms from the abscess revealed the mixed infection with Streptococcus sanguis, Veillonella sp., Prevotella loescheii, Wolinella spp. On 12th hospital day, her serum CRP turned to negative. This case carried numerous implications for the use of antibiotics as chemotherapy agents.

Pigmented variant of benign oncocytic lesion of the pharynx

A case of pigmented variant of benign oncocytic lesions is reported. The lesion was incidentally found in the pharynx of a 69-year-old man, and the gross appearances were multiple, small, flat elevations with black discoloration. Microscopically, ducts of seromucinous glands were replaced by melanin-containing oncocytes and adjacent dendritic melanocytes. To date, such a pigmented variant of benign oncocytic lesion has not been reported before.

Mn-metalloporphyrin conjugated with Gd-DTPA (Gd-ATN10): tumor enhancement agent for magnetic resonance imaging

A conjugate of manganese-metalloporphyrin and gadolinium (Gd)-diethylenetriaminepenta-acetic acid (Gd-ATN10) was developed as a tumor-specific enhancement agent for magnetic resonance (MR) imaging. Gd-ATN10 was evaluated in an experimental 9L gliosarcoma rat tumor model. T1-weighted MR imaging showed enhancement of the tumor which persisted for up to 24 hours. Gd concentration measurement by inductively coupled plasma atomic emission spectroscopy revealed the peak Gd concentration was reached after 30 minutes and Gd was retained in the blood and tumor up to 24 hours. There was no uptake of Gd in the normal brain and little in the skin. Gd-porphyrin derivatives are potentially useful agents for tumor diagnosis on MR imaging and for neutron capture therapy.

Direct evidence for the expression of multiple endogenous retroviruses in the synovial compartment in rheumatoid arthritis

OBJECTIVE

Circumstantial evidence links retroviruses (RVs) with human autoimmune diseases. The aim of the present study was to obtain direct evidence of RV gene expression in rheumatoid arthritis (RA).

METHODS

Synovial samples were obtained from patients with RA, patients with osteoarthritis (OA), and normal control subjects. Reverse transcription-polymerase chain reaction (RT-PCR) was performed using synovial RNA and primers to conserved sequences in the polymerase (pol) genes of known RVs.

RESULTS

PCR products (n = 857) were cloned and sequenced. Multiple pol transcripts, many with open reading frames, were expressed in every sample. Sequences were aligned and classified into 6 families (F1-F6) that contained 33 groups of known and unknown endogenous RVs (ERVs), each distinguished by a specific, deduced peptide motif. The frequency of sequences in each family was similar between RA, OA, and normal synovial tissue, but differed significantly in RA synovial fluid cells. F1 sequences (undefined, but related to murine and primate type C RVs) were lower in frequency, F2 (ERV-9-related), F4 (HERV-K-related), and F6 (HERV-L-related) sequences were higher in frequency, and F3 (RTVL-H-related) sequences were not detected, in the RA synovial fluid cells compared with the RA synovial tissues.

CONCLUSION

Multiple ERVs are expressed in normal and diseased synovial compartments, but specific transcripts can be differentially expressed in RA.

The assessment of trigeminal sensory nerve paraesthesia after bilateral sagittal split osteotomy: modified somatosensory evoked potentials recording method

Trigeminal neurosensory impairment is frequently observed following orthognathic surgery. The purpose of the present study is to visualize the degree of trigeminal nerve impairment following bilateral sagittal split osteotomy (BSSO). Twenty patients who underwent BSSO were in the present study. To record the modified somatosensory evoked potentials (SEP), two electrostimulation clips were applied. One clip was placed on the mucous surface of the lower lip and the other was placed on the skin surface. Each contact surface contained a separate 2 mm diameter silver anode and cathode attached to a 5 x 15 mm basement plate. The results obtained using this method revealed that complete recovery from neural impairment was observed in 7 cases (36.8%) on the right operative side and 4 (20.0%) on the left side at 6 months postoperatively. A definite delay in latency was observed on the left operative side at all the examination periods. The recovery period evaluated by the SEP method was longer than that of the objective two-point discrimination thresholds. Clinical records obtained showed considerable implications for trigeminal nerve function after BSSO.

Stereo fluoroscopy-assisted percutaneous needle puncture of the vertebral body

The purpose was to determine whether real-time three-dimensional imaging by stereo fluoroscope could alleviate the nuisance of moving the fluoroscope C-arm during needle biopsy of the spine. Fifteen lumbar vertebrae of four beagle dog cadavers were used in a simulation. We used a newly devised portable-type stereo fluoroscope, which alternatively exposes the X-ray from left and right X-ray tubes so that a surgeon can decode left and right images displayed alternately on a monitor by using polarizing glasses. A 2-mm-diameter Kirschner wire was inserted into the vertebral bodies by a posterolateral approach without moving the C-arm. An axial view of the roentgenogram of each vertebra found all 15 wires to be appropriately inserted. This would appear to be a time-saving feature.

Genetic analysis in Japanese kindreds of congenital type I antithrombin deficiency causing thrombosis

We have identified two novel minor deletions (case 1; -TA or -AT at nucleotide 9831-3 in exon 5 and case 2; -A at nucleotide 7640-1 in exon 4), one novel nonsense mutation (case 3; TAT to TAA at nucleotide 7491 in exon 4), and one recurrent nonsense mutation (case 4; CGA to TGA at nucleotide 5381 in exon 3A) in Japanese kindreds with congenital type I antithrombin deficiency. The deletion detected in case 1 represented a symmetric element (CTCTGTCTC) and possessed a direct repeat (CTCTATGTCTC). The deletion in case 2 was recognized in a consensus sequence (TGAAT) and possessed a direct repeat (GATGAA). The nonsense mutation in case 3 formed a palindrome (CCGTTAACGG) and that in case 4 was caused by a CpG dinucleotide mutation. These results confirm that the mutations of congenital type I antithrombin deficiency are not random events but are influenced strongly by DNA sequences.

Generation of NK1.1+ T cell antigen receptor alpha/beta+ thymocytes associated with intact thymic structure

The development of T cells within the thymus is largely dependent on intact cortical and medullary epithelial cells. However, it has been reported that positive selection of natural killer antigen 1.1+ (NK1.1+) T cell antigen receptor (TCR)-alpha/beta+ thymocytes recently identified among CD4+8- and CD4-8- subpopulations is attributable to major histocompatibility complex class Ib ligands expressed on bone marrow (BM)-derived components in the thymus. In the present study, we investigated generation of NK1.1+ TCR-alpha/beta+ cells in the thymus of the aly/aly mouse which lacks lymph nodes and Peyer's patches and shows abnormalities of thymic and splenic structure. We found that the proportion of the NK1.1+ TCR-alpha/beta+ thymocytes was extremely low in these mice as compared with aly/+ and normal C57BL/6 mice. Thymic reconstitution by BM cells from aly/+ mice that possess a normal population of NK1.1+ TCR-alpha/beta+ cell population did not restore the NK1.1+ TCR-alpha/beta+ cell population in the thymus of lethally irradiated aly/aly mouse. When deoxyguanosine-treated fetal thymi from (B6 x B10.G)F1 mice were transplanted to aly/aly mice that had been thymectomized and reconstituted with BM cells of aly/aly mice, normal proportions of the NK1.1+ TCR-alpha/beta+ thymocytes were present in the thymus grafts. These findings demonstrate that the development of NK1.1+ TCR-alpha/beta+ thymocytes is accomplished under the influence not only of BM-derived components, but also of irradiation-resistant or deoxyguanosine-resistant components and an intact microenvironment of the thymus.

Superoxide scavenging activity of erythromycin-iron complex

We evaluated superoxide (O2-.) scavenging activity of erythromycin (EM) and of EM-iron complex by means of electron spin resonance spectroscopy, luminol-dependent chemiluminescence assay, and cytochrome c reduction assay. The EM-iron complex was produced by mixing EM with equal molar iron chloride and was stable in neutral buffer. The EM-iron complex reduced the amount of O2-. produced by xanthine oxidase/hypoxanthine without inhibiting the enzyme activity. It also reduced the amount of O2-. release from phorbor ester-stimulated human neutrophils and alveolar macrophages. EM alone showed few such effects. The scavenging activity of the complex was equal to that of L-ascorbic acid. These results in vitro suggest a possibility that the O2-.-scavenging effect of EM-iron complex contributes to the anti-inflammatory action of EM used in treating chronic inflammatory lung disease independent of its antimicrobial activity.

[Long-term prognosis in patients with exercise-induced ST-segment elevation after myocardial infarction]

The present study investigated whether the exercise-induced ST-segment elevation can predict the prognosis for patients with myocardial infarction. Among 529 patients with myocardial infarction, 411 underwent treadmill exercise testing about 5 weeks after the onset. All patients were followed up (mean [+/-SD] 54 +/- 41 months) to compare the incidence of cardiac events. One hundred and eighteen patients (22%) could not perform the exercise test due to cardiac or noncardiac limitation. Ineligibility for exercise test was most useful for risk stratification. Multivariate analysis showed that elimination from the stress test with cardiac limitation was the most significant predictor for cardiac death. Excluding the 16 patients with bundle branch block, the 395 patients were classified into four groups of ST-segment elevation (107 cases, 27%), ST-segment elevation combined with depression (22 cases, 6%), ST-segment depression (106 cases, 27%), ST-segment unchanged (160 cases, 40%). Among the various stress test abnormalities, only low exercise duration was a predictor for cardiac death. ST-depression and ST-elevation combined with depression were independent risk predictors for all cardiac events. Most patients with ST-elevation had single-vessel disease with excellent exercise capacity and low incidence of cardiac events. ST-segment elevation during exercise 5 weeks after myocardial infarction is not associated with a poor prognosis.

[A study of aortic calcification uremia]

For the purpose of clarifying the relationship between aortic calcification and several factors associated with uremia, aortic calcification was estimated in autopsied uremic patients as well as in uremic rats treated in 1, 25 dihydroxyvitamin D3 (1, 25D). Aortic calcification was evaluated by radiographic, pathologic and chemical studies in 28 patients on long-term homodialysis and in 11 non-uremic autopsied subjects as controls. Chest or abdominal X-ray showed the presence of aortic calcification in 48% of the hemodialyzed patients and 9% of the control subjects. Von Kossa staining of the aorta revealed positive tissue calcification in 43% of the hemodialyzed patients and in 18% of the control subjects. Calcium content of the aorta was increased in the hemodialyzed patients compared with the control subjects. Findings of aortic calcification in the hemodialyzed patients were correlated with their age and serum Ca x P products. In uremic rats, administration of 1, 25D increased serum Ca x P products and the calcium content of the aorta. On the other hand, treatment with Ca antagonist or magnesium inhibited elevation of the calcium content of the aorta induced by 1, 25D in the uremic rats. These results suggest that serum Ca x P product is a factor promoting aortic calcification and that calcium antagonist and magnesium may protect from the progression of aortic calcification in uremia.

Significance of informed consent and truth-telling for quality of life in terminal cancer patients

For 12 patients with terminal stage cancer who died within the period from June 1995 to the present, we retrospectively evaluated the correlation between the "information" concerning disclosure of the "diagnosis," "pathology," and "prognosis," with the length of the last admission before the death, "sedation" near death, and the choice of "do not resuscitate (DNR)." The average length of admission before death was markedly shorter for patients who had been told either the "diagnosis," "pathology," or "prognosis" than for patients who had not. A statistically significant difference was observed between those who had been told and those who had not been told the "pathology." Similarly, "sedation" tended to be done for those who had been provided with information on cancer. It was suggested that telling patients with terminal stage cancer the truth about "diagnosis," "pathology," and "prognosis" is important for them to spend a fulfilling terminal stage.