Enhanced tissue factor activity and plasminogen activator inhibitor-1 antigen in human umbilical vein endothelial cells incubated with lipoproteins

The expression of tissue factor (TF) and plasminogen activator inhibitor (PAI)-1 was induced in cultured human umbilical vein cells (HUVEC) by very low density lipoprotein (VLDL). VLDL had a strong capacity for augmenting the expression of TF and PAI-1, while the capacity of LDL or high density lipoprotein (HDL) in this regard was very weak. VLDL and LDL also elevated TF activity in monocyte culture medium (VLDL, LDL) and the conditioned medium markedly elevated TF and PAI-1 production in HUVEC compared with directly added lipoproteins. These findings indicated that lipoproteins affect both monocyte-macrophages and endothelial cells, and that they cause a hypercoagulable-hypofibrinolytic state. It is thus possible that hyperlipidaemia could be a direct risk factor for thrombotic disease even if atherosclerotic lesions are not present.

[The factors involved in invasive ability of endometrial carcinoma cells]

The in vitro invasive ability, the expression of cell adhesion molecule E-cadherin, activity of matrix metalloproteinase (MMP) and K-ras point mutation were investigated in eight human endometrial carcinoma cell lines. 1) In vitro invasive abilities of endometrial carcinoma cell lines depend on the degree of cell differentiation and the origin of cell lines. A poorly-differentiated carcinoma cell line (NUE-1) and a cell line derived from metastatic lymph node (SNG-M) were more invasive than moderately-(HEC-1A, HEC-1BE) and well-differentiated (HEC-6, Ishikawa) cell lines. 2) Immunohistochemically, less or non-invasive cell lines expressed E-cadherin strongly, whereas a highly invasive cell line (NUE-1) expressed E-cadherin weakly. 3) When cultured on Matrigel-coated dishes, the tumor cells derived from moderately- and well-differentiated carcinoma aggregated with each other and did not invade Matrigel in the invasion assay. The aggregated cells expressed E-cadherin more strongly when cultured on Matrigel. 4) 72-kD gelatinase (MMP-2) was secreted in serum-free conditioned medium of all cell lines. In an invasive cell line (NUE-1,SNG-M), the activity of MMP-2 was stronger than in other cell lines. And the activity of 92-kDa gelatinase (MMP-9) was detected in most invasive cell line (NUE-1). 5) Point mutation of K-ras codon 12 was detected in four of eight (50%) cell lines by the PCR-RFLP method. The changes in the DNA sequence were identified, but K-ras point mutation was not correlated with in vitro invasiveness of the tumor cells.

[Management of the uterine endometrial cancer cases whose cytological and histologic specimens cannot be obtained from the uterine cavity--assessment by CA125 or vaginal ultrasonography]

An examination for endometrial cancer has been done by cytology. However, cytology is sometimes not possible because of closed or narrow cervix of postmenopausal woman. We did a retrospective study regarding the usefulness of CA125 or transvaginal ultrasonography in postmenopausal cases. The mean +/- S.D. of CA125 in normal menopausal women was 10.3 +/- 3.0 U/ml. The value of mean +/- 2S.D., the finding of Relative Operating Characteristic curve and the purpose that false positive was 0%, so we set 17 U/ml as the cut off value for CA125. In 46 cases with postmenopausal endometrial carcinoma, 23 cases were screened; and in 30 cases with surgical stage I, 10 cases were screened with this cut off value. The echoic patterns for uterine cavities which were observed by transvaginal ultrasonography were divided into 4 patterns (type I: anechoic pattern, type II: linear pattern, type III: clear mass pattern, type IV: unclear mass pattern). In 20 cases with postmenopausal endometrial cancer, 19 cases had type III or IV. In 41 normal postmenopausal women, 26 cases showed an anechoic pattern and 14 cases showed a linear pattern. It was found that 97.5% of cases with anechoic or linear patterns were normal endometrium. The screening by transvaginal ultrasonography was more useful than CA125. However CA125 was more useful than transvaginal ultrasonography in detecting lymph node metastasis.

[The lipoproteins in human diabetic cataract]

Four kinds of lipoproteins contained in human diabetic cataract lens were separated by of sequential flotation in an ultracentrifuge, and the quantities of each were determined by selective precipitation. Chylomicron, very low density lipoprotein (VLDL), low density lipoprotein (LDL), and high density lipoprotein (HDL) were separated from cataract lenses as lipoprotein fractions, and quantified. Chylomicron was present in the largest quantity among the four. There was no significant difference between the total amount of lipoprotein contained in diabetic cataract lenses (96.95 +/- 4.03 micrograms/lens) and that in senile cataract lenses (89.51 +/- 8.35 micrograms/lens). The quantities of VLDL and LDL, however, were significantly larger in diabetic cataract lenses (14.84 +/- 0.55 and 20.97 +/- 0.58 micrograms/lens, respectively) than in senile cataract lenses (6.30 +/- 0.46 and 7.45 +/- 0.61 micrograms/lens, respectively). We demonstrated histologically that LDL receptors are localized on the lens epithelium and its underlying layer.

Stenotic lesions in vascular access: treatment with transluminal angioplasty using high-pressure balloons

In our institute, one hundred sixty-four balloon dilatations of stenotic lesions in vascular access have been performed since November 1991. All of these procedures were done with high-pressure balloon catheters. In addition to seventy-four cases treated with only percutaneous transluminal angioplasty, there were thirty-four cases which were treated by thrombectomy and/or surgical revision with subsequent intraoperative balloon angioplasty. These angioplastic procedures were initially successful in 142 (87%) of 164 stenoses. The patency rate after 3 months was 68%; after 6 months, 42%; and after 1 year, 25%. There were no serious adverse reactions in our series. This procedure can be safely done with minimal traumatization and, although long-term patency rates are low, repeated dilatations can be performed with ease, when restenosis occurs, to keep a fistula functioning for a long time in appropriate patients.

[Adrenal hepatoid carcinoma producing alpha-fetoprotein: a case report]

A case of left adrenal hepatoid carcinoma is reported. The patient was a 57-year-old male and his chief complaint was general fatigue. Preoperative laboratory data showed markedly increased levels of alpha-fetoprotein (AFP) (30,500 ng/ml) and PIVKA-II (3.01 AU/ml). Both computed tomography (CT) and magnetic resonance computed tomography (MRCT) showed left adrenal tumor (8 x 5 cm). Angiography showed hypervascular tumor over the upper pole of the left kidney. Thoracoabdominal nephro-adrenalectomy was performed. Histological examination demonstrated hepatoid carcinoma of the left adrenal gland. AFP was positive in the tumor cells. The levels of both AFP and PIVKA-II dropped to the normal range postoperatively. Hepatoid carcinoma in the urological field is very rare. As hepatoid carcinoma in the Japanese literature in the urological field, there were only 4 cases of renal tumor, 2 cases of renal pelvic tumor, 2 cases of retroperitoneal space and 1 case of urachal tumor. This is the first report of adrenal hepatoid carcinoma in Japan.

PACS in Osaka University Hospital

To develop the hospital information system, the radiological information system, and the picture archiving and communication system for our new hospital, we analysed the data volume at each step of the flow in our present film-based system. After that, we used a small PACS, and it indicated the problems in it. From the analysis of the data volume of the film-based system, it was found out that digital data should be compressed, and prefetching techniques should be employed for digital PACS. Several types of display terminals had been proved to be necessary for different purposes. An RIS connection was thought to be obligatory to avoid incorrect input of ID on the image. Image input terminals should have edit functions for easy recognition of the image information. Taking account of these requirements for digital PACS, we are developing an actual total PACS.

Technology assessment of PACS in Osaka University Hospital

This paper describes a methodology of PACS technology assessment and gives examples of the results of measurement of 24 items of PACS-related situations of image diagnosis systems in Osaka University Hospital before a PACS is installed. These data are to be compared with the data which will be measured after PACS is installed in the new Osaka University Hospital, in order to complete our technology assessment. We propose common variables, units, and conditions of measurement, in order to establish a standard method of data comparison between before and after PACS installation in hospitals at large. We designed our PACS taking technology assessment into account. We do not stop the technology assessment at the efficacy evaluation, because PACS must be more than a tool for radiological practice. We extend the technology assessment into the effectiveness evaluation, so that PACS is a part of radiological practice itself, and diagnostic accuracy, economy and efficiency are the results of PACS operation.

A subtype of diabetes mellitus associated with a mutation of mitochondrial DNA

BACKGROUND

Several families have been described in which a mutation of mitochondrial DNA, the substitution of guanine for adenine (A-->G) at position 3243 of leucine transfer RNA, is associated with diabetes mellitus and deafness. The prevalence, clinical features, and pathophysiology of diabetes with this mutation are largely undefined.

METHODS

We studied 55 patients with insulin-dependent diabetes mellitus (IDDM) and a family history of diabetes (group 1), 85 patients with IDDM and no family history of diabetes (group 2), 100 patients with non-insulin-dependent diabetes mellitus (NIDDM) and a family history of diabetes (group 3), and 5 patients with diabetes and deafness (group 4) for the mutation. We also studied the prevalence and characteristics of diabetes in 39 patients with a syndrome consisting of mitochondrial myopathy, encephalopathy, lactic acidosis, and stroke-like episodes who were known to have the mutation and 127 of their relatives (group 5).

RESULTS

We identified 16 unrelated patients with diabetes associated with the A-->G mutation: 3 patients from group 1 (6 percent), 2 patients from group 3 (2 percent), 3 patients from group 4 (60 percent), and 8 patients from group 5 (21 percent). We also identified 16 additional subjects who had diabetes and the mutation among 42 relatives of the patients with diabetes and the mutation in groups 1, 2, 3, and 4 and 20 affected subjects among the 127 relatives of the patients in group 5. Diabetes cosegregated with the mutation in a fashion consistent with maternal transmission, was frequently (in 61 percent of cases) associated with sensory hearing loss, and was generally accompanied by impaired insulin secretion.

CONCLUSIONS

Diabetes mellitus associated with the A-->G mutation at position 3243 of mitochondrial leucine transfer RNA represents a subtype of diabetes found in both patients with IDDM and patients with NIDDM in Japan.

[Inherited abnormality of thyroxine-binding globulin: its gene abnormality and pathogenesis]

Inherited TBG abnormalities manifest complete deficiency (CD), partial deficiency (PD) or excess in blood. Analysis of the TBG gene revealed that all cases with CD and PD studied so far had mutations within the exon. A nucleotide substitution was found in each case of PD and one of three cases of CD. In two other cases of CD, there was a nucleotide deletion. By the transfection study, it was revealed that TBG-CD secretion was completely blocked due to an impaired transport from rough endoplasmic reticulum to Golgi apparatus. The cause of PD is also explained by a partial impairment of TBG secretion. However, a pathogenesis of TBG excess has not been clarified yet.

[Usefulness of CA125 determination in the diagnosis of lymph node metastasis in post menopausal uterine endometrial carcinoma]

It has been difficult to diagnose all but advanced cases of lymph node metastases with CT or MRI. It has been reported that the serum value of CA125 rises with the stage of endometrial cancer. This level is lower in the postmenopausal period than before menopause. In this study, we have examined the usefulness of CA125 for the assessment of lymph node metastasis in 43 postmenopausal endometrial cancer cases. There were significant differences in the CA125 level between lymph node metastasis positive cases and negative cases, between cancers occupying > or = 1/2 and < 1/2 of the uterine cavity, between lesions of > or = 1/3 and < 1/3 depth, and between surgical stages I, and III and IV. There was no significant correlation between serum CA125 levels and histological type. The serum CA125 value (mean +/- S.D., U/ml) was 179.0 +/- 291.0 (N = 6) in cases with lymph node metastasis and 15.8 +/- 8.5 (N = 37) in cases without metastasis (p < 0.001). We concluded that 32U/ml, which equals the mean + 2S.D., is a useful cut off value for suspicion of lymph node metastasis. The sensitivity and specificity of this cut off value were 100 (6/6) and 91.9% (34/37), respectively. This standard seems likely to considerably increase the accuracy of diagnosis of lymph node metastasis when taken in combination with the several factors already known to predict this. It may also be useful to diagnose lymph node metastasis in the preoperative period. Although the number of cases in this study was small, the data seem very promising for planning therapy for individual cases.(ABSTRACT TRUNCATED AT 250 WORDS)

[A case of capillary hemangioma of the testis in a child]

Testicular tumors derived from connective tissue, blood vessels and musculature are uncommon and intratesticular tumors of vascular origin are extremely rare. A rare case of capillary hemangioma of the testis in a child is reported. An 11-year-old boy was admitted with the chief complaint of painless mass in the right scrotum. He was diagnosed with a right testicular tumor by physical examination and ultrasonography, preoperatively. Right high orchiectomy was done on December 10, 1990. The testis measured 2.5 x 2.3 x 1.5 cm. Pathologically, the tumor was diagnosed as a capillary hemangioma of the testis.

Differentiation of a Ewing's sarcoma cell line towards neural and mesenchymal cell lineages

Two different pathways of differentiation were investigated in Ewing's sarcoma (ES) cell line, designated CADO-ES1, which has been established in our laboratory. This cell line was induced to differentiate and display a neural phenotype when treated with dibutyryl cyclic adenosine monophosphate or when cultured in serum-free medium (HB101). In these in vitro differentiation studies, two different phenotypes were demonstrated by light and electron microscopy. One phenotype, present in a major portion of the cell population, had long neurites in which microtubules were ultrastructurally demonstrated. The other one, present in a minor portion of the cell population, consisted of flat cells with many short processes. After differentiation in serum-free medium, tumorigenicity in nude mice or colony-forming efficiency in soft agar was strongly depressed. In the cells, N-myc, c-fos and c-src genes were not amplified, and although c-myc was amplified by up to 2-fold, depending on the culture conditions, this appeared to be unrelated to the changes of phenotype. When tumor cells were transplanted into nude mice, cartilage was formed. The cartilage was immunoreactive with the antibody for HLA-ABC, indicating that it was derived from the tumor cells, not from mouse tissue.

Dual pertussis toxin-sensitive pathway of zymosan-induced activation in guinea pig macrophages. An anti-CR3 antibody-inhibitable stimulation of phagocytosis and -resistant stimulation of O2- production and arachidonate release

Complement receptor type 3 (CR3)-mediated cellular responses in guinea pig macrophages were investigated by using zymosan and serum-opsonized zymosan (SOZ) as the multivalent ligand for CR3. The ingestion of zymosan and SOZ was accompanied by O2- generation and arachidonate release. These responses were suppressed by prior exposure of macrophages to pertussis toxin (PT). Opsonization of zymosan gave rise to more than 6-fold activation of the ingestion, whereas the magnitude of either arachidonate release or O2- generation was unchanged. The Fab' fragment of anti-Z-1, a monoclonal antibody specific for the alpha chain of guinea pig CR3, inhibited the ingestion of zymosan by 60% without affecting zymosan-induced arachidonate release and O2- generation. These data suggested that there might be at least two functionally distinct binding sites for zymosan. O2- generation and arachidonate release might be regulated through one site and phagocytosis another. Both sites should be coupled to PT-sensitive GTP binding protein.

Progesterone increases the production of tissue inhibitor of metalloproteinases-2 in rabbit uterine cervical fibroblasts

Rabbit uterine cervical fibroblasts in culture produces tissue inhibitor of metalloproteinases (TIMP)-1 and TIMP-2. When cells were treated with physiological concentrations of progesterone, the production of two TIMPs increased, and essentially all TIMP-2 was found to be complexed with promatrix metalloproteinase 2 (proMMP-2)/progelatinase A. Progesterone did not modulate the production of proMMP-2 and resulted in the increased total amount of proMMP-2-TIMP-2 complex. These observations provide the first evidence that progesterone participates in maintaining the homeostasis of connective tissue matrix in uterine cervix by augmenting both TIMP-1 and TIMP-2 production along with the known suppressive effects on the proMMP-1 and proMMP-3 production.

Calcium channel beta-subunit binds to a conserved motif in the I-II cytoplasmic linker of the alpha 1-subunit

The beta-subunit is an integral component of purified voltage-sensitive Ca2+ channels. Modulation of Ca2+ channel activity by the beta-subunit, which includes significant increases in transmembrane current and/or changes in kinetics, is observed on coexpression of six alpha 1-subunit genes with four beta-subunit genes in all alpha 1-beta combinations tested. Recent reports suggest that this regulation is not due to targeting of the alpha 1-subunit to the plasma membrane but is probably a result of a conformational change induced by the beta-subunit. Here we report that the beta-subunit binds to the cytoplasmic linker between repeats I and II of the dihydropyridine-sensitive alpha 1-subunits from skeletal (alpha 1S) and cardiac muscles (alpha 1C-a), and also with the more distantly related neuronal alpha 1A and omega-conotoxin GVIA-sensitive alpha 1B-subunits. Sequence analysis of the beta-subunit binding site identifies a conserved motif (QQ-E--L-GY--WI--E) positioned 24 amino acids from the IS6 transmembrane domain in each alpha 1-subunit. Mutations within this motif reduce the stimulation of peak currents by the beta-subunit and alter inactivation kinetics and voltage-dependence of activation. Conservation of the beta-subunit binding motif in these functionally distinct calcium channels suggests a critical role for the I-II cytoplasmic linker of the alpha 1-subunit in channel modulation by the beta-subunit.

[Surgical management for atrial septal defect secundum in aged patients]

Between 1989 and 1992, atrial septal defect secundum (ASD) were closed in 8 patients aged 51 to 77 years with the use of cardiopulmonary bypass. The notable characteristics in our cases were; 1) All but one had slight or moderate left to right shunt ratios. Although pulmonary hypertension was present, the obstructive pulmonary vascular change had not progressed so far. 2) Atrial fibrillation was present in 6 patients (75%) and some other cardiac lesions (atrioventricular insufficiency, ischemic heart disease, intracardiac anomaly) coexisted with ASD in a high frequency. And surgical procedures other than ASD closure were required in 5 patients. 3) We must take care to prevent cardiac complications (i.e., arrhythmia) as well as extracardiac malfunctions in postoperative care, because aged patients had some organic dysfunctions of respiratory, renal and hepatic systems. 4) Post-operative courses were satisfactory and there was no operative mortality. All patients obtained improvements in their quality of life. Consequently, we concluded that surgical closure is recommended even for aged patients with ASD, except for Eisenmenger's syndrome.

Social environment affects synaptic structure in the glomerulus of the accessory olfactory bulb of the hamster

The accessory olfactory bulb (AOB) is the primary center of the vomeronasal chemosensory system. The effects of differential rearing on the numerical density and size of synapse as well as neuronal size were examined in the AOB of adult hamster. At 30 days from birth, male littermates were assigned to one of three experimental conditions. (1) the IC (isolated condition), where a male animal was housed alone, (2) the NC (neighbor condition), where one male was separated from two females by wire shields, and (3) the SC (social condition), where two males and two females were housed together. After 2 months of differential rearing, the AOBs of male littermates from each experimental set were prepared for morphological examination. The lengths of synaptic contact zones and the density of synapses in the glomeruli of the AOB as well as the area of somata of mitral/tufted cells were measured with an image analyzer. The synaptic contact zone was longer in the SC compared with both the IC and the NC while there was no difference in the synaptic density among the three groups. The somal area of mitral/tufted cells was larger in both the SC and the NC compared with the IC. These results indicate that the exposure to different rearing conditions induces differential morphological changes in both synapses and somata in the AOB of adult hamster.

Gene screening in Japanese families with complete deficiency of thyroxine-binding globulin demonstrates that a nucleotide deletion at codon 352 may be a race specific mutation

OBJECTIVE

Thyroxine-binding globulin (TBG) is a serum protein that transports 75% of circulating thyroxine. Eleven naturally occurring mutations in the human TBG gene have been identified, ten of which alter the properties of the molecule. Three of these mutations produce complete deficiency of TBG (TBG-CD) and four are associated with a second mutation in codon 283 (TBG-poly) which is polymorphic in some ethnic groups but, when present alone, does not alter the properties of the TBG molecule. In this communication we investigate whether two unrelated Japanese families with TBG-CD harboured the TBG-CDJ mutation in codon 352 associated with TBG-CD in families residing in more distant locations of the Japanese Islands. In addition we examined the possible association with TBG-poly and its incidence in the Japanese population.

DESIGN

Mutant alleles were identified by amplification of genomic DNAs by the polymerase chain reaction, using allele-specific oligonucleotide primers.

PATIENTS

Eight family members and 25 normal subjects.

MEASUREMENTS

Serum free thyroxine and TBG concentration were measured by a conventional radioimmunoassay and a more sensitive enzyme immunoassay. Genomic DNAs were extracted from white blood cells and specific mutations at codons 352 and 283 were identified by allele-specific amplification.

RESULTS

Three males and three females, whose serum TBG levels were decreased, had mutations at codon 352 as hemizygous and heterozygous, respectively. This mutation was not present in the DNA of any of the related or unrelated subjects with normal TBG concentration. The presence of TBG-poly was demonstrated in only one heterozygous family member and in six out of 30 alleles (20%) in normal unrelated subjects. The frequency of this TBG polymorphism in the Japanese is similar to that of 16% reported in French Canadians.

CONCLUSIONS

We conclude that TBG-CDJ might be a prevalent cause of complete deficiency of thyroxine-binding globulin in the Japanese and that TBG-poly probably appeared before the divergence of human races.

Lesch-Nyhan syndrome: successful prevention of lower lip ulceration caused by self-mutilation by use of mouth guard

Lesch-Nyhan syndrome (LNS) is a disorder caused by congenital absence of a purine metabolic enzyme, hypoxanthine guanine phosphoribosyl-transferase (HGPRT). This syndrome is characterized clinically by hyperuricemia and neurologic features including choreoathetoid spasticity, self-mutilation, and mental retardation. We report on a patient in whom self-mutilation of the lower lip was suppressed with the help of a mouth guard made from soft resin.