Cox multivariate regression models for estimating prognosis of patients with endometrioid adenocarcinoma of the uterine corpus who underwent thorough surgical staging

The International Federation of Gynecology and Obstetrics (FIGO) adopted surgical staging criteria in 1988. Many studies have shown that histologic grade, nuclear grade, lymph-vascular space invasion and cell type are also important predictors of survival. It has not been clarified, however, how to integrate these histopathologic variables into the process of estimating individual prognosis. We performed Cox multivariate regression analysis to create models that incorporate various histopathologic factors for estimating the prognoses of patients with endometrioid adenocarcinoma of the uterine corpus. Our study was based on data from 206 patients who underwent complete surgical staging, including systematic pelvic and para-aortic lymph node dissection. Two models resulted: one included depth of myometrial invasion, para-aortic node metastasis and the number of sites involved by the tumor among the cervix, ovary and pelvic lymph nodes (which we designated as extracorporeal spread score, ECS) and the other incorporated nuclear grade and lymph-vascular space invasion as variables. These 2 models enabled the prognosis for patients with endometrioid adenocarcinoma to be stratified into several levels according to hazard ratio. Comprehensive integration of the histopathologic prognostic factors, categorized into those relating to tumor extent and those relating to tumor virulence, should facilitate the estimation of individual prognosis more accurately than FIGO staging alone.

Distribution pattern and risk factors of pelvic and para-aortic lymph node metastasis in epithelial ovarian carcinoma

The distribution of lymph node metastasis and the clinicopathologic risk factors for nodal involvement in ovarian carcinoma need to be clarified based on systematic lymph node dissection. We studied 115 patients with ovarian carcinoma who underwent systematic pelvic and para-aortic lymph node dissection between 1987 and 1997. The incidence and distribution of lymph node metastasis are described and the clinico-pathologic risk factors for nodal involvement are investigated. Based on the occurrence of lymph node metastasis in the early stages, the incidence of solitary node involvement and the distribution of lymph node metastasis, we conclude that the primary site of nodal involvement in ovarian carcinoma is the para-aortic node (PAN), especially PAN superior to the inferior mesenteric artery (IMA). By univariate analysis, clinical stage, histologic type (mucinous vs. others), grade, multiple peritoneal metastases, peritoneal cytology, volume of ascites and serum CA125 level were correlated with overall incidence of lymph node metastasis. By performing a multivariate analysis with the clinical stage excluded, it was revealed that grade and peritoneal cytology were independent factors for PAN metastasis (p < 0.0025 and < 0.001, respectively) and that multiple peritoneal metastases and PAN metastasis were significant predictors of pelvic node metastasis (p < 0.01 and < 0.005, respectively). In conclusion, the PANs superior and inferior to IMA should be explored in staging of ovarian carcinoma that appears to be confined to the ovaries. To determine accurately the extent of disease, both the para-aortic and pelvic areas may need to be sampled or dissected in the case of ovarian carcinoma involving the peritoneal surfaces.

Carboxyl-terminal 15-amino acid sequence of NFATx1 is possibly created by tissue-specific splicing and is essential for transactivation activity in T cells

NFAT regulates transcription of a number of cytokine and other immunoregulatory genes. We have isolated NFATx, which is one of four members of the NFAT family of transcription factors and is preferentially expressed in the thymus and peripheral blood leukocytes, and an isoform of NFATx, NFATx1. Here we provide evidence showing that 15 amino acids in the carboxyl-terminal end of NFATx1 are required for its maximum transactivation activity in Jurkat T cells. A fusion between these 15 amino acids and the GAL4 DNA binding domain was capable of transactivating reporters driven by the GAL4 DNA binding site. Interestingly, this 15-amino acid transactivation sequence is well conserved in NFAT family proteins, although the sequences contiguous to the carboxyl-terminal regions of the NFAT family are much less conserved. We also report three additional isoforms of NFATx, designated NFATx2, NFATx3, and NFATx4. This transactivation sequence is altered by tissue-specific alternative splicing in newly isolated NFATx isoforms, resulting in lower transactivation activity in Jurkat T cells. NFATx1 is expressed predominantly in the thymus and peripheral blood leukocyte, while the skeletal muscle expressed primarily NFATx2. In Jurkat cells, transcription from the NFAT site of the IL-2 promoter is activated strongly by NFATx1 but only weakly by NFATx2. These data demonstrate that the 15-amino acid sequence of NFATx1 is a major transactivation sequence required for induction of genes by NFATx1 in T cells and possibly regulates NFAT activity through tissue-specific alternative splicing.

Seminoma in a postmenopausal woman with a Y;15 translocation in peripheral blood lymphocytes and a t(Y;15)/45,X Turner mosaic pattern in skin fibroblasts

We report an unusual case of a 55 year old Japanese woman with a seminoma but relatively normal menses. The patient was a phenotypic female with late onset menarche (18 years of age), who was amenorrhoeic for the first year, followed by menses of one to three days' slight flow with dysmenorrhoea, but an otherwise normal menstrual history. A typical seminoma was removed from the left adnexal region and an immature testis was identified separately as an associated right adnexal mass. Repeated karyotypic studies on peripheral blood lymphocyte cultures showed only 46,X,-Y,t(Y;15)(q12;p13). Cytogenetic examination of the patient's younger brother, who had fathered three healthy children, showed an identical karyotype. Mosaicism of 46,X,-Y,t(Y;15)(q12;p13)/45,X cell lines was found in skin samples from the patient's elbow and genital regions, although there were no clinical stigmata of Turner syndrome. An androgen receptor binding assay of cultured genital skin fibroblasts was negative. Molecular analysis using Southern blot hybridisation, PCR, and direct DNA sequencing showed that neither the patient nor her brother had a detectable deletion or other abnormalities of Y chromosome sequences, including the SRY (sex determining region of the Y chromosome) gene sequence. These findings suggest that Turner mosaicism of the 45,X cell line may have contributed to this atypical presentation in an XY female, although we cannot exclude abnormalities of other genes related to sex differentiation.

A novel low-density lipoprotein receptor-related protein with type II membrane protein-like structure is abundant in heart

We report herein the identification of a novel member of the low-density lipoprotein receptor (LDLR) family termed LDLR-related protein 4 (LRP4). Murine LRP4 cDNA encodes a 1113-amino-acid type II membrane-like protein with eight ligand-binding repeats in two clusters. Southern blot analysis of genomic DNA from several different organisms suggests the presence of LRP4 homologues in chicken lacking the gene encoding apolipoprotein E, which is recognized by the ligand-binding repeats of LDLR. LRP4 transcripts were detected almost exclusively in heart in mouse and humans. Despite the presence of the ligand-binding repeats, COS cells transfected with LRP4 did not show surface-binding of beta-migrating very-low-density lipoprotein, suggesting that LRP4 plays a role in a pathway other than lipoprotein metabolism.

Characterization of membrane-bound serine protease related to degradation of oxidatively damaged erythrocyte membrane proteins

It has been shown that erythrocyte membrane proteins become susceptible to degradation by membrane-bound serine protease activity after oxidative modification of the membranes (M. Beppu, M. Inoue, T. Ishikawa, K. Kikugawa, Biochim. Biophys. Acta 1196 (1994) 81-87). The aim of the present study was to clarify the presence of the serine protease in oxidized erythrocyte membranes and to characterize the selectivity of the enzyme to oxidized proteins. Human erythrocytes were oxidized in vitro with xanthine/xanthine oxidase/Fe(III) and oxidized membranes isolated. Proteolytic activity of the membranes toward spectrin obtained from oxidized membranes and bovine serum albumin oxidized with H2O2/horseradish peroxidase was increased by membrane oxidation, and the degradability of the substrates was increased by substrate oxidation. The proteolytic activity was inhibited by the serine protease inhibitor diisopropyl fluorophosphate (DFP). The 72 kDa and 80 kDa proteins in the membranes were labeled by [3H]DFP when detected by sodium dodecyl sulfate-polyacrylamide gel electrophoresis under reducing conditions and subsequent fluorography. The 72 kDa protein was found to be a serine enzyme, acetylcholine esterase. The 80 kDa protein appeared to be responsible for the degradation of oxidatively damaged proteins. The 80 kDa protein was loosely bound to membranes and readily solubilized into a 0.1% NP-40 detergent solution. The presence of the same 80 kDa protease in intact erythrocyte cytosol was suggested. The increased serine protease activity in oxidized membranes can result from the increased adherence of the cytosolic 80 kDa serine protease to the membranes due to oxidation.

Accompanying arteries of the cutaneous veins and cutaneous nerves in the extremities: anatomical study and a concept of the venoadipofascial and/or neuroadipofascial pedicled fasciocutaneous flap

The arterial anatomy of the accompanying arteries of the cutaneous veins and cutaneous nerves in the extremities was investigated in 10 fresh cadavers that had been injected with a lead oxide-gelatin mixture throughout the entire body. It is well known that cutaneous nerves have neurocutaneous perforators, but it was found that cutaneous veins also have their own accompanying arteries as well. The accompanying arteries of the cutaneous veins had branches not only to the vein wall, but also to the skin, i.e., venocutaneous perforators. Based on these findings, the concept of the adipofascial pedicled fasciocutaneous flap using the accompanying arteries of the cutaneous veins, cutaneous nerves, or both was proposed.

A novel acyl-CoA synthetase, ACS5, expressed in intestinal epithelial cells and proliferating preadipocytes

We report here the identification, characterization, and expression of a novel rat acyl-CoA synthetase (ACS) designated as ACS5. ACS5 consists of 683 amino acids and is approximately 60% identical to the previously characterized ACS1 and ACS2. ACS5 was overproduced in Escherichia coli cells and then purified to near homogeneity. The purified enzyme utilized a wide range of saturated fatty acids similar to those utilized by ACS1 and ACS2, but differed in its preference for C16-C18 unsaturated fatty acids. Northern blot analysis revealed that ACS5 mRNA is present most abundantly in the small intestine, and to a much lesser extent in the lung, liver, adrenal gland, adipose tissue, and kidney. In situ hybridization of rat ileum revealed abundant accumulation of ACS5 transcripts in foveolar epithelial cells. The hepatic level of ACS5 mRNA was significantly increased by refeeding a fat-free high sucrose diet and reduced by fasting or refeeding a high cholesterol diet, whereas that in the small intestine was not significantly altered by various dietary conditions. In contrast to the absence of ACS1 mRNA in undifferentiated 3T3-L1 preadipocytes, ACS5 mRNA was present in proliferating 3T3-L1 preadipocytes and its level remained unaltered during differentiation, suggesting that ACS5 may provide the acyl-CoA utilized for the synthesis of cellular lipids in proliferating preadipocytes.

The expulsion of Echinostoma trivolvis caused by goblet cell hyperplasia in severe combined immunodeficient (SCID) mice

Mice with severe combined immunodeficiency (SCID), lacking functional T and B lymphocytes, were each infected with 40 Echinostoma trivolvis metacercarial cysts on day 0. The mice of the test group were given intramuscular injections of dexamethasone (DEX) daily for 2 weeks and necropsied on days 5, 8, 12, 15, 20 and 30 post-infection (p. i.). The control mice, not treated with DEX, were each infected with 40 echinostome cysts on day 0 and necropsied on the same days as the DEX-treated mice. In the control mice, worm rejection began about day 8 p. i. and the worms were completely rejected by day 15 p. i., corresponding to the peak in goblet cell hyperplasia, about day 12 p. i. In the DEX-treated mice, goblet cell hyperplasia was significantly suppressed and the worms were retained until day 15 p. i., and then rejected after the last treatment with DEX. The number of mucosal mast cells, that increased with worm infection and peaked about day 15 p. i., was apparently suppressed by treatment with DEX. The eosinophil number in the controls increased on day 15 p.i. approximately and then decreased. The eosinophil number in the DEX-treated mice increased as in the controls, but was significantly suppressed compared to that of the controls during the period of the experiment. Enzyme-linked immunosorbent assay (ELISA) showed no marked rise in titres of the sera IgM, IgA and IgG throughout the experiment in both groups. These results indicate that DEX-treatment delayed the rejection of E. trivolvis from the small intestine of SCID mice in association with the suppression of goblet cell hyperplasia. It is concluded that the host immune system is not involved in the rejection of E. trivolvis and the effector cells for worm rejection are goblet cells that markedly increase in numbers by infection with E. trivolvis.

Increased plasma epinephrine but not reduced heart rate variability leads to ventricular arrhythmias in patients with acute myocardial infarction

Ventricular arrhythmia observed in the acute stage of myocardial infarction is profoundly related to the autonomic balance. To investigate prediction of ventricular arrhythmia, heart rate variability and plasma catecholamine concentration were simultaneously measured for a week in 17 consecutive patients with first anterior or anteroseptal Q wave infarction treated without specific coronary intervention. The cross-sectional plot of coefficient of variance (= standard deviation of N-N interval/mean N-N interval x 100; %) as a function of plasma epinephrine on the day of admission remained lower than the standard average. Ventricular premature contractions increased in proportion to the plasma epinephrine concentration. In the first week of hospitalization, plasma epinephrine concentration and frequency of premature contraction decreased exponentially, whereas the coefficient of variance showed a modest decline. Ventricular tachycardia refractory to xylocaine with rate accelerating with persistence was observed only in patients with the peak epinephrine concentration > 375 pg/ml. Plasma epinephrine concentration rather than coefficient of variance during sleep after the first acute episode is more closely related to the following triggered ventricular arrhythmia.

Cloning and DNA sequencing of the genes encoding Clostridium josui scaffolding protein CipA and cellulase CelD and identification of their gene products as major components of the cellulosome

The Clostridium josui cipA and celD genes, encoding a scaffolding-like protein (CipA) and a putative cellulase (CelD), respectively, have been cloned and sequenced. CipA, with an estimated molecular weight of 120,227, consists of an N-terminal signal peptide, a cellulose-binding domain of family III, and six successive cohesin domains. The molecular architecture of C. josui CipA is similar to those of the scaffolding proteins reported so far, such as Clostridium thermocellum CipA, Clostridium cellulovorans CbpA, and Clostridium cellulolyticum CipC, but C. josui CipA is considerably smaller than the other scaffolding proteins. CelD consists of an N-terminal signal peptide, a family 48 catalytic domain of glycosyl hydrolase, and a dockerin domain. N-terminal amino acid sequence analysis of the C. josui cellulosomal proteins indicates that both CipA and CelD are major components of the cellulosome.

[Attributable factors to the emergence of multidrug-resistant Mycobacterium tuberculosis based on the observation of consecutive drug resistance test results]

Thirty six cases with multidrug-resistant tuberculosis were retrospectively studied to define the causes attributable to the emergence of multidrug-resistant M. tuberculosis. All these tuberculosis cases were microbiologically confirmed and resistant to at least isoniazid and rifampicin. Data analysis using matched-pair sampling methods (1:3) demonstrated that the followings are the significant risk factors for the emergence of multidrug-resistant tuberculosis; incompliance to treatment (Odds ratio 21.0: 95% CI 4.10-107.63), alcohol abuse (Odds ratio 15.0: 95% CI 2.34-96.1) and the history of previous treatment (Odds ratio 5.0: 95% CI 2.04-12.21), while diabetes mellitus is not statistically significant. The incompliance to treatment which is primarily thought to be patient's responsibility results in non-optimal administration of antituberculous agents, leading to the multidrug-resistant tuberculosis. Other factors that may have contributed to the emergence of resistance included the unnecessary change of regimen before completion of chemotherapy. This is patient-unrelated situation where responsibility lies in the medical side. A clinical case presented here is an example. In this case RFP was replaced with ethambutol 3-months after the initiation of regimen including SM, INH and RFP because of abnormal elevation of GOT and GPT without any supporting evidence that RFP was causative. The readministration of RFP after 1-year cessation did not induce liver dysfunction, while the drug resistance was observed not only to RFP but also to INH. This case suggests unnecessary interruption of RFP could lead to the emergence of resistance to INH as well as RFP. One known mechanism of drug resistance is random mutation and the selection by drugs administered during the course of chemotherapy. The cases with advanced cavitary lesions would have a higher probability of the occurrence of mutation. The more the number of mutant bacilli, the higher the probability of emergence of multidrug resistance. Those cases in which longer period of time is needed for the negative conversion of M. tuberculosis should be treated with potent chemotherapy regimens under the intense supervision. Since both INH and RFP are the most potent among currently available antituberculous agents. It is crucial to preserve the potency of these essential agents before novel antituberculous are developed.

Isoproterenol-induced creatine kinase leakage in Langendorff-perfused rat heart associated with significant myocardial edema

Since the mechanism of creatine kinase (CK) leakage induced by beta-adrenoceptor activation remains unclear, we studied the effects of incremental application (10(-9) to 10(-4) M) of isoproterenol (ISP) on the CK efflux from Langendorff-perfused isolated rat hearts under aerobic conditions. Tissue water content was estimated after the perfusion experiment. ISP-induced dose-dependent CK leakage was noted in a sigmoidal fashion, which showed low temperature-dependency (Q10 of 2.41), sensitivity to cepharantine (10(-6) M) and propranolol (10(-7) to 10(-6) M) without any signs of demand ischemia or oxidant stress. CK liberation was not replicated at all by maneuvers activating cAMP-dependent protein kinase (A-kinase). Myocardial edema noted in the control ISP application was ameliorated by exposure to 10(-6) M propranolol or cepharantine (i.e., significant fall in tissue water content; p < 0.05). Histological study revealed nonspecific myocardial fiber swelling and separation without any myocyte necrosis for all the perfusion groups. These results suggest that ISP-induced CK leakage in this model is not mediated by beta-adrenoceptor stimulation, subsequent A-kinase activation or related demand ischemia, but is attributed most to the direct effects of ISP augmenting sarcolemmal CK and water permeability.

The immunosuppressive compound FK506 does not affect expulsion of Echinostoma trivolvis in C3H mice

C3H/HeN mice were infected with Echinostoma trivolvis metacercariae on day 0, given intramuscular injections of the immunosuppressive agent FK506 daily for 5 or 7 days, and necropsied on days 5, 8, 12, 15, 20, and 30 postinfection (p.i.). Control mice were infected with the echinostomes but were not treated with FK506. A significant reduction in mastocytosis was seen from day 12 to day 15 p.i. in the treated group. No reduction was observed in numbers of goblet cells and eosinophils in the treated group. The number of white blood cells was lower in the treated mice than in the controls. No significant difference in the optical density values of immunoglobulins appeared in control versus treated mice. Treatment with FK506 did not delay worm expulsion markedly, probably because the drug did not suppress goblet-cell hyperplasia. Increased mucus production associated with goblet-cell hyperplasia is primarily involved in the expulsion of E. trivolvis in murine hosts.

Postrest shortening of the action potential duration in rabbits: in vitro and in vivo correlation

Previous evidence has shown that the action potential duration of rabbit ventricular muscle cells shortens after a rest period (postrest shortening). However, there has not been much research on postrest shortening in the intact heart. We recorded transmembrane action potentials (TAPs) of isolated papillary muscle from rabbit ventricle with glass microelectrodes and monophasic action potentials (MAPs) of the rabbit left ventricular endocardium with contact electrodes. In the in vitro experiments, repetitive regular stimuli (S1) at a cycle length of 1 sec were followed by a single extrastimulus (S2) at coupling intervals (S1S2) ranging between 0.5 sec and 8 sec. The increase in the S1S2 interval resulted in a progressive shortening of the duration of TAP elicited by the S2, which was abolished by the simultaneous application of 1 mmol/L 4-aminopyridine and 2 micromol/L ryanodine. In the in vivo experiments, regular right ventricular pacing (S1) at a cycle length of 0.35 sec was followed by a single extrastimulus (S2) with coupling intervals (S1S2) ranging between 0.25 sec and 3 sec. The increase in the S1S2 interval also resulted in a progressive shortening of the duration of MAP elicited by the S2. This is the first report to demonstrate postrest shortening in the intact heart, which probably occurs because of a mechanism analogous to that observed in the isolated ventricular muscle.

Ultrashort-time FISH for identification of the sex of peripheral-blood lymphocytes and preimplantation embryos

OBJECTIVE

The aim of this study was to shorten the time required for sex determination using peripheral-blood lymphocytes and blastomeres of human preimplantation embryos by fluorescence in situ hybridization (FISH).

METHODS

Peripheral-blood lymphocytes from a male and a female, and 8 blastomeres from 2 preimplantation embryos were analyzed by FISH. The probes used were DYZI and DXZI. The hybridization time was shortened from overnight to 30 minutes or 5 minutes, and the accuracy of FISH was compared between 5-minute, 30-minute and overnight hybridization.

RESULTS

The accuracy of the identification of the sex of lymphocytes by 5-minute hybridization FISH was more than 90%, and was the same as that achieved by 30-minute- and overnight hybridization FISH. In 5-minute hybridization FISH, the entire process was only 63 minutes. Of the 8 blastomeres, it was possible to identify the sex of 5 and was impossible to determine the sex of 1, with 2 being lost during the procedure.

CONCLUSIONS

We have established on ultrashort-time FISH method for sex determination that takes only 63 minutes.

Antimicrobial activity of a compound isolated from an oil-macerated garlic extract

A compound showing antimicrobial activity was isolated from an oil-macerated garlic extract by silica gel column chromatography and preparative TLC. On basis of the results of NMR and MS analyses, it was identified as Z-4,5,9-trithiadeca-1,6-diene-9-oxide (Z-10-devinylajoene; Z-10-DA). Z-10-DA exhibited a broad spectrum of antimicrobial activity against such microorganisms as gram-positive and gram-negative bacteria and yeasts. The antimicrobial activity of Z-10-DA was comparable to that of Z-ajoene, but was superior to that of E-ajoene. Z-10-DA and Z-ajoene are different in respect of substitution of the allyl group by the methyl group flanking a sulfinyl group. This result suggests that substitution by the methyl group would also be effective for the inhibition of microbial growth.

Elucidating the mechanism of cesium-induced sustained monomorphic ventricular tachycardia in rabbits

The mechanisms of sustained ventricular tachycardia (VT) induced by large cumulative dose of cesium chloride (Cs) remains unclear. Seven anesthetized rabbits were intravenously injected with Cs (1 mmol/kg) 3 times at 20-min intervals. The surface ECG and monophasic action potential of the left ventricular endocardium were simultaneously recorded. In another 12 rabbits, transmembrane action potentials of right ventricular muscles were recorded with glass microelectrodes. In experiments in vivo, sustained monomorphic VT was induced after the third injection of Cs, whereas the early afterdepolarization (EAD)-related nonsustained polymorphic VT was induced after the second injection. Overdrive pacing during the sustained VT resulted in postdrive acceleration. The pacing and recovery cycle lengths showed an inverse relation. In experiments in vitro, preparations were superfused with Tyrode's solution containing 7.5 mM Cs. Cs initially induced EADs. Additional exposure to Cs depolarized the membrane potential, which consequently attained threshold, producing spontaneous activities. Further exposure resulted in an induction of sustained rhythms that were accelerated by overdrive pacing. Our results indicate that the sustained rhythms at low membrane potential induced by a long exposure to Cs in vitro may underlie an electrophysiologic mechanism for the sustained VT induced after large cumulative dose of Cs in vivo.

Enhanced expression of heparin-binding EGF-like growth factor and its receptor in hypertrophied left ventricle of spontaneously hypertensive rats

OBJECTIVES

Although heparin-binding epidermal growth factor-like growth factor (HB-EGF) is thought to produce hypertrophy in isolated cardiomyocytes via an autocrine mechanism, the pathophysiological role of HB-EGF, in myocardial hypertrophy in vivo, is not yet known. To investigate the involvement of HB-EGF in cardiac remodeling associated with hypertension in vivo, we assayed the expression of HB-EGF mRNA and protein in the left ventricle (LV) during the development of left ventricular hypertrophy in spontaneously hypertensive rats (SHR).

METHODS

Prior to sacrifice and assay of HB-EGF and EGF-receptor (EGF-R) mRNA, morphologic and hemodynamic variables were measured in SHR and in age-matched Wistar Kyoto rats (WKY). At 5, 9 and 12 weeks of age, rats were killed, their hearts were removed, and the expression of HB-EGF and EGF-R mRNA and protein were measured. In addition, SHR and WKY were treated with enalapril, atenolol, or both for 4 weeks.

RESULTS

In untreated SHR, double products (i.e. systolic blood pressure (sBP) multiplied by heart rate (HR), an index of mechanical load, peaked at 9 weeks. Expression of HB-EGF mRNA was also observed to peak in these animals at 9 weeks, while expression of EGF-R mRNA increased from 5 to 9 weeks, but remained constant thereafter. In untreated WKY, double products and EGF-R mRNA expression did not change over time, whereas the level of HB-EGF message increased gradually. Antibody to HB-EGF reacted primarily with myocyte membranes in SHR, whereas antibody to EGF-R reacted mainly with interstitial cells in these animals. The angiotensin-converting enzyme inhibitor, enalapril, markedly decreased sBP in SHR, whereas the beta 1-adrenoreceptor antagonist, atenolol, significantly decreased HR. While neither alone affected the expression of HB-EGF mRNA, their combination significantly reduced the expression of HB-EGF mRNA, as well as double products, in these rats, but had no effect on expression of EGF-R mRNA.

CONCLUSIONS

The enhanced expression of HB-EGF mRNA and protein in LV of SHR suggest that this growth factor may play an important role during the early development of LV hypertrophy and cardiac fibrosis in SHR. The association between double products and HB-EGF expression suggest that the latter may be induced by increased mechanical load and may contribute, in turn, to cardiac remodeling.

Circadian rhythm of the signal averaged electrocardiogram and its relation to heart rate variability in healthy subjects

OBJECTIVE

To examine the circadian variation in the signal averaged electrocardiogram (saECG) and heart rate variability and investigate their relations in healthy subjects.

METHODS

24 hour ECGs were obtained with a three channel recorder using bipolar X, Y, and Z leads in 20 healthy subjects. The following variables were determined hourly: heart rate, filtered QRS (f-QRS) duration, low and high frequency components of heart rate variability (LF and HF), and the LF/HF ratio.

RESULTS

Heart rate, f-QRS duration, HF, and the LF/HF ratio showed significant circadian rhythms, as determined by the single cosinor method. Heart rate and the LF/HF ratio increased during daytime, and f-QRS duration and HF increased at night. f-QRS duration was negatively correlated with heart rate (r = 0.95, p < 0.001) and the LF/HF ratio (r = 0.94, p < 0.001) and positively with HF (r = 0.93, p < 0.001).

CONCLUSIONS

f-QRS duration has a significant circadian rhythm in healthy subjects and is closely related to the circadian rhythm of autonomic tone.

Bcl-2 expression and prognosis of patients with endometrial carcinoma

Bcl-2 protein inhibits apoptosis, reduces the requirement for growth factors, and thereby extends the survival of cells. Recent findings of Bcl-2 in several solid tumors suggest that it might contribute to the genesis of some types of cancer. Over-expression of Bcl-2 might play a role in carcinogenesis and malignant progression of endometrial carcinoma. The aims of this study were to determine Bcl-2 expression in endometrial carcinoma in relation to other histopathologic prognostic factors, and to test its prognostic significance in patients with endometrial carcinoma. A total of 61 endometrioid-type endometrial carcinomas were immunohistochemically investigated for Bcl-2 expression on cryostat sections. Bcl-2 localization was observed in cytoplasm in 18 tumors, in nucleus in 27 tumors, or in both in 5 tumors. In 11 tumors, Bcl-2 was observed neither in cytoplasm nor in nucleus. There was not a statistically significant relationship between grade of tumor and Bcl-2 expression. Cytoplasmic Bcl-2 became less frequently expressed as the tumor invaded the myometrium deeper (p < 0.025). Retroperitoneal lymph-node dissection was performed in 57 patients. Multiple-regression analysis showed that lymph-vascular space invasion and nuclear expression of Bcl-2 were correlated to pelvic lymph-node metastasis (p < 0.0001 and < 0.05 respectively). Univariate Cox regression analysis revealed that nuclear Bcl-2 expression was associated with shorter survival (p < 0.05) than that of patients with cytoplasmic Bcl-2 expression. Pelvic node metastasis was a significant prognostic factor for patients who underwent systematic retroperitoneal lymph-node dissection. Cox multivariate-regression analysis revealed that pelvic node metastasis and cervical invasion were the most important prognostic factors in this series of patients. When the analysis was made after exclusion of pelvic node metastasis, histologic grade (hazard ratio = 2.4), cervical invasion (hazard ratio = 3.7) and nuclear Bcl-2 expression (hazard ratio = 11.5) were shown to be significant predictors of survival of the patients. These results indicate that aberrant Bcl-2 expression might be involved in malignant progression of endometrioid-type endometrial carcinoma. Site of Bcl-2 localization may be an important predictor of prognosis for patients with endometrioid-type endometrial carcinoma.

Signal-averaged electrocardiogram shows a heart rate dependent diurnal variation in healthy subjects

It has not been determined if signal-averaged electrocardiograms (SAECGs) have a diurnal variation. We recorded 3-channel 24-hour ECGs in 30 healthy volunteers and calculated the following parameters for the first 500 sec of every hour over the 24-hour period: the mean heart rate, the filtered QRS duration (f-QRS), the root-mean-square voltage of the signals in the last 40 msec of the QRS (RMS40), and the duration of low-amplitude signals (< 40 microV) in the terminal portion of the QRS (LAS40). Heart rate and RMS40 increased in the daytime compared with the nighttime; f-QRS and LAS40 increased during the nighttime hours. The f-QRS and LAS40 were negatively correlated with heart rate in all and 22 (73%) of 30 subjects, respectively, and RMS40 was positively correlated with heart rate in 21 subjects (70%). In conclusion, SAECGs exhibit a clear diurnal variation in healthy subjects, which is closely related to changes in heart rate.

Radiofrequency catheter ablation of left ventricular outflow tract tachycardia: report of two cases

Idiopathic ventricular tachycardia (VT) originating from the left ventricular outflow tract (LVOT) is rare. We report two patients whose QRS configuration during VT commonly showed an inferior axis and monophasic R waves in all the precordial leads. The mechanism of these VTs appeared to be triggered activity. From mapping and ablation, the origin of these VTs was determined to be in the most posterior LVOT, corresponding to the aortomitral continuity (left fibrous trigone).

Retroviral gene transfer for the assignment of Fanconi anemia (FA) patients to a FA complementation group

Fanconi anemia (FA) is an autosomal recessive disorder characterized by bone marrow failure, cancer susceptibility, and a variety of developmental defects. The disease is clinically heterogeneous; eight different complementation groups (FA A-H) and, thus, genetic loci have been discovered. Two genes, FAA and FAC, have been cloned. Disease-associated mutations have been detected and rapid mutation screening makes possible the assignment of patients without resorting to time-consuming cell fusion and complementation analysis. Amplification of specific cDNAs from RNA followed by direct or indirect sequence analysis is a standard method for mutation detection. During the course of such examinations of the FAC gene, we have noted that frequently only one of the expressed alleles is successfully amplified. This can lead to false assignment of patients to a complementation group. As we report here, such cases can be rapidly clarified by retroviral gene transfer and complementation analysis.

Escherichia coli cytidine deaminase provides a molecular model for ApoB RNA editing and a mechanism for RNA substrate recognition

ApoB RNA-editing enzyme (APOBEC-1) is a cytidine deaminase. Molecular modeling and mutagenesis show that APOBEC-1 is related in quaternary and tertiary structure to Escherichia coli cytidine deaminase (ECCDA). Both enzymes form a homodimer with composite active sites constructed with contributions from each monomer. Significant gaps are present in the APOBEC-1 sequence, compared to ECCDA. The combined mass of the gaps (10 kDa) matches that for the minimal RNA substrate. Their location in ECCDA suggests how APOBEC-1 can be reshaped to accommodate an RNA substrate. In this model, the asymmetrical binding to one active site of a downstream U (equivalent to the deamination product) helps target the other active site for deamination of the upstream C substrate.

Human apolipoprotein B RNA editing deaminase gene (APOBEC1)

Genomic clones encoding the human APOBEC1 gene and its 5' flanking region have been isolated and characterized. The human gene contains five coding exons. The introns dividing these exons correspond exactly to those found in the mouse gene. The translation initiation site, ATG, is located in exon 2 at the same site as in the mouse. The 5' flanking sequence contains two Alu repeats of the Sq family. Primer extension analysis demonstrated the presence of two major transcription initiation sites. The first transcription initiation site delineates the beginning of a noncoding first exon and resides downstream of the first Alu sequence. The second transcription initiation site is within the second Alu repeat. This Alu repeat resides within the first intron, which is spliced out of the transcript from the first start site. Neither transcription initiation site has a TATA or CCAT box. Comparison with the mouse gene suggests that the Alu sequence insertion split the intestinal promoter and that subsequently the down-stream Alu sequence took on a promoter function. No evidence was found for a far upstream non-tissue-specific promoter similar to that demonstrated in the mouse gene. Rather, consideration of results from the marsupial APOBEC-1 gene suggests that this upstream mouse promoter may have had a later evolutionary origin.

Clinical suppression of bradycardia dependent premature ventricular contractions by the potassium channel opener nicorandil

OBJECTIVE

To assess the clinical antiarrhythmic effect of nicorandil, a potassium channel opener; on premature ventricular contractions.

DESIGN AND PATIENTS

The effect of oral nicorandil (15 to 60 mg daily for four weeks) on premature ventricular contractions was investigated in 20 patients (11 female, nine male, mean (SD) age 63 (17) years) who underwent 24 hour ambulatory ECG. Patients were classified into two groups based on the relation between the frequency of premature ventricular contractions and heart rate: (1) those with a positive correlation (n = 9); and (2) those with a bidirectional correlation (n = 11), characterised by an increased frequency of premature contractions at low heart rates and a decreased frequency at high heart rates.

RESULTS

Nicorandil reduced the frequency of premature ventricular contractions by 75% in five patients in group 2, but was not effective in any patient in group 1. The heart rate at which the frequency of premature ventricular contractions peaked was significantly lower in the five responders in group 2 than in the six non-responders (63.2 (3.7) v 76.3 (12.4) beats/min, p < 0.05).

CONCLUSIONS

Nicorandil may suppress premature ventricular contractions when they occur mainly at a low heart rate.

[An observation on tuberculosis associated with HIV infection in Japan]

OBJECTIVE

To observe the reported cases of tuberculosis (TB) with HIV infection in Japan, in terms of their main clinical features and related factors.

METHODS

A voluntary reporting network has been organized by the authors who are specialists of TB or respiratory medicine in tuberculosis institutions located roughly all over the country. The members have been encouraged to report not only their own cases but cases seen by their friends or in other institutions.

RESULTS

By the end of 1996, a total of 71 cases have been reported of which 59 were TB and 12 NTM cases. Nationality of the cases were; Japan 48, Other Asian countries 16, Others 7. All of the NTM cases were Japanese. 30% of the cases were aged less than 30 years, 24% were thirties, 24% forties, 17% fifties and 6% were those aged 60 years or older. The cases were clearly younger than the TB cases in the national TB registry, and older than HIV-infected persons as known from the HIV surveillance system. 97% of the TB cases were bacteriologically confirmed cases. Eight of NTM cases were positive for MAC, others for M.kansasii. 42% of the cases had extra-pulmonary disease, including disseminated infections seen among 19%. Of TB cases 25% were excreting bacilli resistant to any of the anti-TB drugs which was higher than in the case of general TB population (10-15%). 11% of TB cases had past history of TB treatment. The cases had severe immunological impairment, 79% of the cases having CD4+ cell count less than 100. The route of HIV infection were; 51% heterosexual, 13% homosexual, 13% through blood preparations, etc.

DISCUSSION

Although there may be many cases not included in this observation, it is considered to well reflect the real situation of the problem of Japan. More attention should be paid to HIV infection of the patients in the clinical practice of TB in Japan.

Dissociation of Oct-1 from the nuclear peripheral structure induces the cellular aging-associated collagenase gene expression

The cellular aging-associated transcriptional repressor that we previously named as Orpheus was identical to Oct-1, a member of the POU domain family. Oct-1 represses the collagenase gene, one of the cellular aging-associated genes, by interacting with an AT-rich cis-element in the upstream of the gene in preimmortalized cells at earlier population-doubling levels and in immortalized cells. In these stages of cells, considerable fractions of the Oct-1 protein were prominently localized in the nuclear periphery and colocalized with lamin B. During the cellular aging process, however, this subspecies of Oct-1 disappeared from the nuclear periphery. The cells lacking the nuclear peripheral Oct-1 protein exhibited strong collagenase expression and carried typical senescent morphologies. Concomitantly, the binding activity and the amount of nuclear Oct-1 protein were reduced in the aging process and resumed after immortalization. However, the whole cellular amounts of Oct-1 protein were not significantly changed during either process. Thus, the cellular aging-associated genes including the collagenase gene seemed to be derepressed by the dissociation of Oct-1 protein from the nuclear peripheral structure. Oct-1 may form a transcriptional repressive apparatus by anchoring nuclear matrix attachment regions onto the nuclear lamina in the nuclear periphery.

The expulsion of Echinostoma trivolvis: worm kinetics and intestinal reactions in C3H/HeN mice treated with dexamethasone

C3H/HeN mice were each infected with 40 Echinostoma trivolvis metacercarial cysts on day 0, given intramuscular injections of dexamethasone (DEX) daily for 30 days, and necropsied on days 5, 8, 12, 15, 20 and 30 p. i. Control mice were each infected with 40 echinostome cysts on day 0, but were not treated with DEX and necropsied on the same days as the DEX-treated mice. DEX treatment caused an inhibition of worm expulsion and suppressed the increase in goblet cell numbers that peaked around day 12 p. i. in the untreated control mice. Increase in the number of mucosal mast cells and eosinophils in the control mice that peaked around day 15 and 12 p. i., respectively, was also suppressed by the DEX treatment. The mean body area of the worms from the DEX-treated mice was about the same as that of the control worms on day 5 p. i., and then significantly greater than the control worms on days 8 and 12 p. i. The worms in the treated mice continued to grow until the end of the experiment, on day 30 p. i. Enzyme-linked immunosorbent assay (ELISA) showed that serum IgM from the treated and control mice increased from day 12 p. i., peaked on day 15 p. i., and then decreased. An IgM titre of the treated mice was slightly higher than that of the controls. No marked rise in IgG and IgA titres occurred throughout the experiment in both groups.

Venous drainage of the radial forearm and anterior tibial reverse flow flaps: anatomical and radiographic perfusion studies

The anatomy of the venous system in the pedicles of the radial forearm and anterior tibial reverse flow flaps was investigated in fresh cadavers (n = 6) and their drainage pathways were observed in a radiographic perfusion study of the veins of 2 radial forearm and 2 anterior tibial pedicles. The venous system was found to consist mainly of three types of veins: venae comitantes, communicating veins between the venae comitantes, and vasa vasorum. Valves were identified in all three types of vein. In the venous system, including the vasa vasorum, there was no route of reverse flow that did not pass directly through valves. Valve incompetence was demonstrated in the radiographic perfusion study. However, valve incompetence did not occur in all valves and a difference in valve resistance against reverse flow pressure existed. Veins with relatively weak valve resistance became the drainage pathway. A possible cause of the difference in valve resistance was differences in the anatomy of the valve sinuses.

Three-dimensional reconstruction of cutaneous arteries of the back by computer graphic imaging

Computer graphics using a personal computer were introduced to demonstrate the three-dimensional architecture of cutaneous arteries of the back in humans: the direct cutaneous artery of the circumflex scapular artery and the perforating cutaneous branches and musculocutaneous perforators of the superficial cervical, posterior intercostal, and thoracodorsal arteries. The entire thickness of the skin and underlying subcutaneous tissue over the deep fascia was obtained from five fresh cadavers injected systemically with lead oxide-gelatin mixture, and the integument was divided into the three layers; the skin, superficial adipofascial layer with the superficial fascia, and the deep adipofascial layer. Computer graphic reconstruction of the cutaneous arteries was performed using data based on angiograms of the three layers. The computer graphic depictions demonstrated in which layer cutaneous arteries branched and how the vessels were running in each layer by displaying each layer in different colors: red, yellow, and blue. Knowledge of the three-dimensional structure and architecture of the cutaneous arteries will aid in the development of flaps that use a portion of the skin and subcutaneous adipofascial tissue.

[Aortic arch surgery in the elderly]

A consecutive series of 16 patients over 75 years old who underwent aortic arch operations with hypothermic selective cerebral perfusion from 1994 to 1997 was analyzed. These patients (group O) was compared with 18 patients aged from 70 to 74-year-old (group M) and 38 patients under the age of 69 (group Y) who underwent aortic arch operation during the same period. There were 5 males and 11 females with a mean age of 77.8 years (range 75 to 86) in group O. Twelve patients were in aortic dissection and 4 patients were in atherosclerotic aneurysms. There were 5 hospital deaths (31.2%) in group O, 2 (11.1%) in group M and 2 (5.3%) in group Y. There was significant difference in hospital mortality rate between group O and group Y. Cerebral complication occurred in 2 patients (12.5%) and postoperative respiratory failure occurred in 7 (47%) in group O. Aortic arch operations for the elderly patients can be performed with increased but operative mortality in the elderly patients remains high. In this study, we discussed that influence of risk factors on the operative result and operative indication in the elderly patients.

Alternative translation initiation generates acyl-CoA synthetase 3 isoforms with heterogeneous amino termini

ACS3 is a recently identified acyl-CoA synthetase (ACS) isozyme that preferentially utilizes laurate, myristate, arachidonate, and eicosapentaenoate among saturated and unsaturated long chain fatty acids. The ACS3 purified from COS cells transfected with the ACS3 cDNA was separated by SDS-PAGE into two major forms of 79 and 80 kDa. We report here that alternative translation initiation from ACS3 mRNA gives rise to these two isoforms of ACS3. In vitro mutagenesis of the ACS3 cDNA revealed that the translation of the 80-kDa and 79-kDa isoforms started from the first and second in-frame AUGs, respectively. The two isoforms of ACS3 expressed in COS cells exhibited similar levels of ACS activities toward palmitate and myristate. Immunocytochemistry of intact COS cells transfected with various ACS3 expression vectors suggested that the two forms are localized in the extranuclear compartment, where they exhibit a reticular pattern. In rat cerebrum, the 80-kDa isoform of ACS3 was detected mainly in the microsomal fraction. Only a trace amount of the 79-kDa isoform was detected in rat cerebrum, whereas both forms were detected in rat glioma cell line KEG1 cells.

Aneurysm of aberrant right subclavian [corrected] artery arising from diverticulum of Kommerell. Report of a case with tracheal compression

A 74-year-old woman presented with severe dyspnea without dysphagia. Computed tomographic scans and Digital subtraction angiography revealed the left aortic arch with an aberrant right subclavian artery arising from the Kommerell's diverticulum and tracheal compression. The aortic arch and the Kommerell's diverticulum were aneurysmal and were responsible for this compression. Surgical relief was accomplished by replacement of the aortic arch and reconstruction of the four brachiocephalic vessels with vascular prostheses through a median sternotomy incision extending into the right supraclavicular region.

Peritoneal cytology and its prognostic value in endometrial carcinoma

BACKGROUND

There has been a controversy about the prognostic significance of positive peritoneal cytology in endometrial carcinoma.

MATERIALS AND METHODS

Peritoneal cytology was obtained at the time of surgery, including systematic retroperitoneal lymph node dissection, in 114 patients.

RESULTS

The incidence of positive peritoneal cytology was 35.1%. The 5-year survival rates of the stage IIIA and IIIC (FIGO, 1988) cases were 82.8% and 58.3%, respectively. In pathological stage I (the disease was histologically confined to the uterine corpus), there was no significant difference in 5-year survival rates between patients with and without positive peritoneal cytology. Though the patients in stage IIIA who had only positive peritoneal cytology were given no postoperative therapy unless they had extrauterine disease, no patients developed recurrence. In stages IIIC and IV, the prognosis was significantly poorer for patients with positive peritoneal cytology than for those with negative cytology.

CONCLUSION

Positive peritoneal cytology is not an adverse prognostic factor endometrial carcinoma if disease is limited to the uterus.

Circadian variation of QT interval dispersion: correlation with heart rate variability

The circadian variation of QT interval dispersion and its correlation with heart rate variability (HRV) was examined in 17 normal subjects by using 24-hour recordings of three-lead electrocardiograms. Measurements of HRV, R-R intervals, and QT intervals were made for the first 6 minutes of each hour over a 24-hour period. Spectral analysis of HRV yielded low-frequency power (LF) (0.04-0.15 Hz), high-frequency power (HF) (0.15-0.40 Hz), and the ratio of LF to HF (LF/HF). A rate-corrected QT interval (QTc) was calculated by Bazett's formula, and QT and QTc dispersion was defined as the difference between the maximum and minimum values in any two leads. High-frequency power and QT interval were greater at night than during the day: conversely, LF/HF and dispersion of QT and QTc were greater during the day. The QTc interval remained virtually unchanged throughout the 24-hour period. The dispersion of QTc showed a significant negative correlation with HF and a significant positive correlation with LF/HF. The results suggest that an increased sympathetic tone or a decreased vagal tone increases QT dispersion in healthy subjects.

Characterization of macrophages isolated from the maternal surface of human term placenta by a new method of urokinase treatment

OBJECTIVES

This study was performed to establish a new method for isolating macrophages from the maternal surface of human term placenta by urokinase treatment and to characterize their immunological functions.

METHODS

Macrophages were recovered from the maternal surface of 6 human term placentas by urokinase treatment, adherence to plastic, and density gradient centrifugation using Percoll. The cells retrieved were tested for their surface markers by immunofluorescent staining. Their antigen-presenting capacity was examined by use of a mixed lymphocytes culture (MLC) test. In 2 cases, human leucocyte antigen (HLA) typing was performed.

RESULTS

An average of 4 x 10(6) macrophage-like cells were obtained per whole placenta. More than 90% of them were positive for CD14, HLA-DR, and DQ surface antigens. An MLC test revealed that they had antigen-presenting capacity. Of the 6 cases, 2 showed positive MLC test results with maternal peripheral-blood mononuclear cells. In 1 of the 2 cases, macrophages with paternal HLA phenotypes were identified.

CONCLUSION

The urokinase treatment is a new useful method for isolating macrophages from the maternal surface of human term placenta. Using this method, we obtained macrophages of paternal HLA phenotypes (fetal origin) that might have migrated to the maternal surface of human term placenta.

A novel arachidonate-preferring acyl-CoA synthetase is present in steroidogenic cells of the rat adrenal, ovary, and testis

We report herein the cDNA cloning of a novel rat acyl-CoA synthetase (ACS) that preferentially uses arachidonate and eicosapentaenoate. This newly identified ACS (designated ACS4) contains 670 amino acids and is 68% identical to rat ACS3, a previously characterized ACS that is highly expressed in brain. ACS4 was overproduced in Escherichia coli and the resulting enzyme was purified to homogeneity. The purified enzyme utilizes arachidonate and eicosapentaenoate most preferentially among C8-C22 saturated fatty acids and C14-C22 unsaturated fatty acids. Kinetic analyses revealed that the enzyme has a high affinity for arachidonate and eicosapentaenoate and low affinity for palmitate. ACS4 transcripts are detectable in a wide range of tissues, with the highest level in adrenal gland. Immunoreactivity to ACS4 was detected in the zona fasciculata and reticularis of adrenal gland, in the corpus luteum and stromal luteinized cells in ovary, and in the Leydig cells of testis.