Increased serum soluble Fas ligand associated with recurrent B-cell non-Hodgkin's lymphoma after autologous peripheral blood stem cell transplantation

Fas-ligand (FasL) is a member of the tumor necrosis factor family and transmits apoptotic cell death signal by binding to its receptor, Fas. FasL is expressed on the cell surface of activated T-cell and natural killer (NK) cell. It has been shown that the FasL can be released from the cell surface by metalloproteinase. The serum soluble FasL (sFasL) is increased in some patients with NK cell lymphoma/large granular lymphocytic leukemia. We have recently seen a patient with recurrent B-cell lymphoma accompanied with an increased serum sFasL level after autologous peripheral blood stem cell transplantation. The sFasL was markedly decreased with the tumor regression induced by the chemotherapy. We present here the first case of an elevated serum sFasL level associated with B-cell lineage malignancy and discuss the possible clinical value of sFasL.

Elevated circulating levels and cardiac secretion of soluble Fas ligand in patients with congestive heart failure

The circulating levels of soluble Fas ligand was increased in patients with advanced congestive heart failure. This study also indicates that the failing heart may contribute to the increased concentration of soluble Fas ligand in patients with congestive heart failure.

Calpain inhibitor-1 reduces infarct size and DNA fragmentation of myocardium in ischemic/reperfused rat heart

Myocardial ischemia/reperfusion activates a calcium-dependent protease, calpain, in the ischemic myocytes. It is not known whether calpain is involved in the mechanism of ischemia/reperfusion injury in hearts. Thus the purpose of this study was to clarify the effect of a selective calpain inhibitor (CAI) on infarct size and the extent of DNA damage in ischemic/reperfused rat hearts. Rats were divided in four groups (n = 7 each). In saline group, 0.3 ml of saline was administered (i.v.) 10 min before 30-min coronary occlusion followed by 6-h reperfusion. In vehicle group, 0.3 ml of 10% dimethyl sulfoxide (DMSO) was administered 10 min before the 30-min ischemia. CAI (0.5 mg/kg) was administered 10 min before the 30-min ischemia (CAI-A group) and 10 min before the 6-h reperfusion period (CAI-B group). Infarct size was detected with triphenyl tetrazolium chloride, and DNA fragmentation was detected by agarose gel electrophoresis and by in situ nick end labeling (ISEL). Infarct size was significantly smaller in the CAI-A group compared with the vehicle group (13+/-9% vs. 48+/-12%; p < 0.01), and the incidence of ISEL-positive myocyte nuclei in the subendocardial region was significantly reduced in the CAI-A group compared with the vehicle group (26+/-3% vs. 59+/-6%; p < 0.01). However, the effects of CAI in CAI-B group were not significant. Activation of calpain is involved in the mechanism of ischemia/reperfusion injury, and the preischemic administration of CAI was effective in reducing myocardial infarct size and the DNA damage of the myocytes in ischemic/reperfused rat heart.

Transcatheter arterial embolization for impending rupture of an isolated internal iliac artery aneurysm complicated with disseminated intravascular coagulation

A 90-year-old male, with impending rupture of an isolated internal iliac artery aneurysm (IIAA) complicated with disseminated intravascular coagulation (DIC) was successfully treated with transcatheter arterial embolization (TAE). After TAE, enlargement of the aneurysm was arrested and coagulation-fibrinolytic abnormalities induced by DIC improved without severe complications. Although IIAA is relatively rare, the post-operative mortality of patients with ruptures is reportedly high. We assessed the usefulness of this procedure for impending rupture of IIAA, especially for patients in high risk groups.

[Characteristics of anti-microbial agents and its clinical choice for H. pylori treatment]

Eradication of Helicobacter pylori (H. pylori) is now established as main treatment of upper-gastrointestinal diseases. Resistance to H. pylori and acid condition in the stomach were important factors which influenced H. pylori eradication. Recolonized H. pylori strains will be easily resistant to metronidazole and clarithromycin, whereas almost all of H. pylori strains are sensitive to amoxicillin. On the other hand, amoxicillin targets cell wall biosynthesis and clarithromycin inhibits protein synthesis of Helicobacter pylori mainly in the growth phase which induced high intragastric pH condition, however, metronidazole targets DNA and, therefore, is independent of the stationary or growth phase distribution. To established a optimal regimen for Helicobacter pylori treatment, several factors included them should be account according to the parmacokinetical standings.

Increased soluble Fas-ligand in sera of bone marrow transplant recipients with acute graft-versus-host disease

Acute graft-versus-host disease (aGVHD) is a major complication following allogeneic bone marrow transplantation (BMT). Recently, accumulating evidence indicates that the Fas/Fas ligand (FasL) system is implicated in the pathogenesis of aGVHD in murine models. We determined the serum levels of soluble FasL (sFasL) in BMT recipients using an enzyme-linked immunosorbent assay. The serum sFasL was suppressed during the period of myelosuppression following the preparative regimen and subsequently increased with hematopoietic reconstitution after BMT. In patients with aGVHD, the serum sFasL level was significantly higher than in those without aGVHD. In the mixed lymphocyte reaction assay, sFasL in the supernatants was increased with a significant correlation to the level of 3H-thymidine uptake. Our findings suggest that the Fas/FasL system is activated by allogeneic stimulation and may have close correlation to the development of aGVHD in human BMT.

Giant cell fibroblastoma associated with dermatofibrosarcoma protuberans: a case report

A case of congenital giant cell fibroblastoma (GCF) associated with dermatofibrosarcoma protuberans (DFSP) in a 1.5-year-old girl is reported. The GCF component was characterized by a mixed proliferation of fibroblastic cells and multinucleated giant cells and sinusoid-like spaces. The DFSP component, which was spatially distinct from the GCF region, was composed of short spindle-shaped cells arranged in a storiform pattern. Mitotic figures were frequently identified in the DFSP area but not in the GCF region. Immunohistochemically, tumor cells in both components were positive for CD34. The Ki-67 labeling index of the DFSP area (4.9%) was markedly higher than that of the GCF (0.5%). Ultrastructurally, spindle-shaped tumor cells in both components, as well as giant cells, were fibroblastic cells that frequently exhibited multilobulated nuclei. This case illustrates the close histogenetic relationship between GCF and DFSP, although the degree of proliferative activity is much higher in the DFSP area.

Effect of the Kobe earthquake on stress and glycemic control in patients with diabetes mellitus

OBJECTIVE

To examine the effects of the Kobe, Japan, earthquake, a life-threatening event, on stress and glycemic control in diabetic patients.

PATIENTS AND METHODS

Hemoglobin A1c levels before and after the earthquake were evaluated in diabetic patients in Kobe (N = 157; magnitude, 7.2) and in Osaka, Japan, as a control (N = 277; magnitude, 4.2), where little damage to houses and traffic facilities occurred. Glycosylated hemoglobin levels were also compared with those of 2 years before and 1 year after the earthquake. The General Health Questionnaire (GHQ) and a self-administered questionnaire regarding damage to houses and relatives killed or injured were used to assess psychological and mental stresses on earthquake survivors.

RESULTS

Glycemic control was aggravated in diabetic patients after the earthquake in Kobe but not in Osaka. THe GHQ scores were significantly higher in the patients in Kobe than those in Osaka. Increased hemoglobin A1c concentrations and high scores on the GHQ were especially evident in diabetic patients with severe damage to houses and/or with relatives killed or injured.

CONCLUSION

These results suggest an association between chronic, life-threatening stress and the worsening of metabolic control in patients with diabetes mellitus.

Chemiluminescent derivatization of adenyl compounds with glyoxal derivatives in the presence of heteropoly acids and its application to the simple and sensitive determination of DNA

A chemiluminescence (CL) determination of adenyl compounds is described. CL derivatization of adenyl compounds with methylglyoxal dimethyl acetal was performed in the presence of tungstosilicic acid and propan-2-ol. CL from adenyl compounds was produced by hydrogen peroxide and L-cysteine ethyl ester in DMF and water. The proposed method is highly sensitive and specific to compounds containing adenine. Adenine was determined in the range 1.0 x 10(-3)-5.0 x 10(-8) M with the detection limit of 3.0 x 10(-8) M (150 fmol per assay). The method was applied to the determination of DNA and detection limits of a few nanograms of DNA achieved.

Sonodynamic changes after transcatheter arterial embolization in a vaginal hemangioma: case report

A 36-year-old pregnant woman with a rapidly growing hemangioma in the vagina was treated by transcatheter arterial embolization after delivery. Blood flow characteristics within the tumor were evaluated using transvaginal color Doppler ultrasound both before and after the embolization. The vascular resistance in the tumor vessels within the vaginal hemangioma was observed to be significantly decreased; the tumor reduced in volume following this non-surgical treatment.

The effect of nitric oxide on uterine and umbilical artery flow velocity waveform in pre-eclampsia

We compared the flow velocity waveforms of uterine and umbilical arteries in normotensive and pre-eclamptic patients at mid-gestation. In a randomised controlled trial we tested the effects of isosorbide dinitrate (ISDN, nitric oxide donor) patch therapy on the flow velocity waveform of pre-eclamptic patients at mid-gestation. The resistance indices (RI) of human uterine and umbilical arteries were higher in pre-eclamptic patients compared to the normotensive patients. ISDN patch therapy significantly reduced the increased RI values of the umbilical artery in pre-eclamptic patients without any change in systemic blood pressures, but the RI values of the uterine artery were not significantly attenuated. The change of the umbilical artery might be due to the improvement of end-diastolic flow velocity. These results suggest that the feto-placental circulation in pre-eclampsia, perhaps due to the disturbance of the endothelium-dependent vaso-relaxation system, and that ISDN therapy may improve the impaired endothelium dependent nitric oxide system.

Small-cell carcinoma of the endometrium: an immunohistochemical and ultrastructural analysis

Small-cell carcinoma of the endometrium is a rare neoplasm, and its aggressive behavior has been reported. We report a case of small-cell carcinoma occurring primarily in the endometrium of a 62-year-old woman with postmenopausal vaginal bleeding and lower abdominal pain. The excised uterus showed a necrotic polypoid mass and histologically displayed an endometrial small-cell carcinoma. Immuno-histochemically, the tumor cells were positive for cytokeratin, the epithelial membrane antigen, neuron-specific enolase, and chromogranin, but were negative for the leukocyte common antigen and Grimelius stain. Ultrastructural analysis revealed the presence of dense core granules in the cytoplasm of tumor cells. The patient died 2 months after surgery because of aggressive behavior of the tumor. We wish to distinguish small-cell carcinoma of the endometrium from conventional epithelial tumors of the endometrium, because of the former's distinctive histopathologic, immunohistochemical, and ultrastructural characteristics.

Development of a virtual sand box: an application of virtual environment for psychological treatment

The sand play technique has often been used in psychological treatments or in the diagnosis of autism patients. In this paper, the prototype application called "virtual sand box" is developed as a virtual environment to support this technique. Experimental results show the advantages of applying virtual reality technology to clinical medicine; particularly with respect to the diagnosis of people with psychological and psychiatrical difficulties such as autism and neurosis. The actual system has been implemented by using a graphics workstation, a wide-view field display, and 3D input devices.

Comparison of nitric oxide and prostacyclin in endothelium-dependent vasorelaxation of human umbilical artery at midgestation

OBJECTIVE

We intended to compare the relative importance of nitric oxide and prostacyclin as endothelium-derived vasorelaxing factors released by histamine in human umbilical artery at the midstage (18 to 22 weeks) of gestation.

STUDY DESIGN

By use of very thin muscle strips, which allows rapid diffusional access of applied drugs (in a few seconds), isometric tensions were recorded in response to histamine. The histamine-induced contractions and the relaxing effect of histamine on the potassium chloride (39 mmol/L) contractions were studied in relation to the existence of endothelium, L-NG-nitro arginine, and indomethacin. The relaxing effects of glyceryl trinitrate and prostacyclin on the potassium chloride contractions were also examined.

RESULTS

The contractile responses to histamine were more sensitive and the relation tensions of histamine contractions, compared with the 39 mmol/L K(+)-induced contractions, were large in endothelium-denuded strips than in endothelium-intact strips. Histamine contractions were enhanced in endothelium-intact strips in the presence of 10 mumol/L L-NG-nitro arginine (competitive inhibitor of nitric oxide synthase) but not in the presence of 10 mumol/L indomethacin (cyclooxygenase inhibitor). Histamine produced a concentration-dependent relaxation during the maintained contraction induced by 39 mmol/L K+. These histamine-induced relaxations were completely blocked by L-NG-nitro arginine but not by indomethacin. Glyceryl trinitrate and prostacyclin relaxed the sustained contractions induced by 39 mmol/L K+ in a dose-dependent manner; however, the degree of relaxation by glyceryl trinitrate was more prominent than that by prostacyclin.

CONCLUSION

These results suggest that nitric oxide is more potent than prostacyclin as a vasorelaxing substance released from the endothelium and that nitric oxide has an important role for controlling fetoplacental circulation at midgestation.

A 4-week repeated percutaneous dose toxicity study of calcipotriol (MC903) followed by a 4-week recovery test in dogs

A 4-week repeated percutaneous dose toxicity of calcipotriol (MC903), an anti-psoriasic agent, followed by a 4-week recovery was studied in beagle dogs at doses of 0.04, 0.4 and 4 micrograms/kg/day. 1. In general conditions, reddening, desquamation, rash, and wet and hot skin were observed at the skin of application site at 4 micrograms/kg/day. 2. In urinalysis, a tendency to an increase in Ca level, was observed at 4 micrograms/kg/ day. In hematology, an increase in the segmented neutrophils and tendency to a decrease in the lymphocyte counts were observed at 4 micrograms/kg/day. In biochemistry of serum, an increase in gamma-globulin ratio, and decreases in A/G and albumin ratios were observed at 4 micrograms/kg/day. 3. In organ weights, tendency to decreases of the absolute and relative weights in the thymus was observed at 4 micrograms/kg/day. 4. Histopathological examination revealed squamous cell hyperplasia and hyperkeratosis at the skin of application site at 4 micrograms/kg/day. 5. The above changes disappeared after the 4-week recovery period and suggested that they were reversible. 6. On the basis of results obtained in the present study, it is considered that 0.4 microgram/kg/day is the no-toxic dose of MC903 applied percutaneously in both sexes of beagle dogs.

[A 26-week repeated percutaneous dose toxicity study of calcipotriol (MC903) in rats]

A 26-week repeated percutaneous dose toxicity of calcipotriol (MC903), an anti-psoriasic agent, was studied in Slc:SD rats at doses of 0.8, 4 and 20 micrograms/kg/day as low, mid and high dose levels. 1. No mortality were observed in both sexes of all groups including control. An increased water consumption was observed in females at mid dose and in both sexes at high dose. 2. An increased incidence of the corneal opacity in males at mid dose and in both sexes at high dose was noted significantly as compared with that observed in control. Urinalysis revealed a slight increased urinary volume, increased excretions of Ca and IP, and lower pH in both sexes at more than mid dose. Levels of the serum IP in females and Ca in both sexes were elevated at high dose. 3. The increased weights of the kidney in males and adrenal gland in females were observed at high dose. The kidney in females at mid dose and in both sexes at high dose showed a higher incidence of mineralization than in control. Furthermore, osteosclerosis of the sternum and femur in both sexes, and hyperkeratosis of the skin at application site in females at high dose were observed. Electron microscopic examination revealed no abnormality in the liver and kidney. 4. On the basis of results obtained in the present study, it is considered that 0.8 microgram/kg/day is the no-toxic dose of MC903 applied percutaneously in both sexes of rats.

[A 26-week repeated subcutaneous dose toxicity study of calcipotriol (MC903) followed by a 5-week recovery test in rats]

A 26-week repeated subcutaneous dose toxicity of calcipotriol (MC903), an anti-psoriasic agent, followed by a recovery for 5 weeks was studied in Slc:SD rats at doses of 0.4, 2 and 10 micrograms/kg/day as low, mid and high dose levels. 1. No mortality during the experimental period was observed in both sexes of all groups including control. An increased incidence of opacity of the eyeball surface in males was noted at high dose. There were no difference in body weight and food consumption between control. An increased water consumption in both sexes was observed at high dose. 2. An increased incidence of the corneal opacity was noted significantly at high dose in both sexes compared with that observed in control. Urinalysis revealed the increased excretions of Ca at more than mid dose, and Na, Cl and IP in males at high dose, and an decreased urinary volume in females and lower pH in both sexes at high dose. An increased serum Ca level in males at mid dose and in both sexes at high dose, and an elevated ALP activity in males at high dose were observed. The increased weights of the kidney in males at more than mid dose and adrenal gland in both sexes at high dose were observed. The increased incidence of mineralization of the cornea and kidney was noted significantly in males at more than mid dose as compared with control. Dilatation of endoplasmic reticulum of distal tubular cells of the kidney in both sexes was observed at high dose on electron microscopic examination. 3. After a 5-week recovery period, the changes related with the treatment of MC903 almost disappeared except for mineralizations of the cornea and kidney. 4. On the basis of results obtained in the present study, it is considered that 0.4 microgram/kg/day is the no-toxic dose of MC903 administered subcutaneously in both sexes of rats.

[An antigenicity study of calcipotriol (MC903)]

Antigenicity of calcipotriol (MC903), an anti-psoriasic agent, was investigated in mice and guinea-pigs. 1. In mice, MC903 administered alone or with an adjuvant (Alum) did not result in the production of MC903-specific IgE antibody. 2. In guinea-pigs sensitized with MC903 alone or plus an adjuvant (FCA), systemic anaphylaxis was not induced by challenging with MC903. IgG1 antibody in MC903-sensitized guinea-pigs was not detected by the 4-hr PCA test. 3. Ovalbumin induced the production of ovalbumin-specific IgE antibody in mice, and ovalbumin-specific IgG1 antibody in guinea-pigs. Intense systemic anaphylaxis in the ovalbumin-sensitized guinea-pigs was induced by challenging with ovalbumin. 4. Results obtained in the present study suggest that MC903 does not induce the production of IgE antibody in mouse, and IgG1 antibody in guinea-pig, and in MC903-sensitized guinea-pig systemic anaphylaxis is not induced by challenging with MC903.

[Reproductive and developmental toxicity studies of calcipotriol (MC903): (2)--A teratogenicity study in rats by subcutaneous administration]

Teratogenicity of calcipotriol (MC903), an anti-psoriasic agent, was studied. MC903 at doses of 6.25, 12.5 and 25 micrograms/kg/day were subcutaneously administered to pregnant Slc:SD rats from day 7 to 17 of gestation. 1. In animals administered 25 micrograms/kg/day MC903, food consumption decreased significantly and body weight gains lowered marginally. MC903 administered at any doses did not adversely affect female animals in regard to pregnancy, delivery and maternal behavior. 2. In fetuses, suppression of growth were noted at 25 micrograms/kg group. However, fetotoxicity and teratogenicity were not noted at all groups administered MC903. 3. In F1 pups, the postnatal growth, development, responses, behaviors, learning ability and reproductive ability were not influenced. Additionally, no embryonic or fetal abnormalities of their fetuses (F2) were detected. 4. On the basis of results obtained in the present study, it is considered that the no-toxic doses level of MC903 are 12.5 micrograms/kg/day for pregnant animals and fetuses, 25 micrograms/kg/day for pups.

[Reproductive and developmental toxicity studies of calcipotriol (MC903): (1)--A fertility study in rats by subcutaneous administration]

Calcipotriol (MC903), an anti-psoriasic agent, was given subcutaneously at dose levels of 1, 5 and 25 micrograms/kg/day during the pre-pairing period (9 weeks prior to pairing in males and 2 weeks prior to pairing in females) and the pairing period to male and female rats and in the early stage of pregnancy (day 0 through 7 of gestation) to female rats, and the effects of the test compound on male and female reproductive performance and fetal development were evaluated. 1. In the male 25 micrograms/kg group, opacity of the eyeball surface was observed, and depression of body weight gain, and decreases of body weight and food consumption, and increases in the weight of the kidney were statistically significant in comparison with vehicle controls. 2. In the female 25 micrograms/kg group, depression of body weight gain and food consumption were statistically significant in comparison with vehicle controls. 3. No changes in parameters of reproductive performance were seen in any dosed groups. 4. No changes in parameters of implantation performance were seen. There were no treated-related abnormalities in fetal mortality, weights of fetuses, and external, visceral and skeletal examinations. Based on there results, it is considered that in the present study the no-toxic dose levels of MC903 were 5 micrograms/kg/day for parents, 25 micrograms/kg/day for reproductive performance and fetal development.

[Reproductive and developmental toxicity studies of calcipotriol (MC903): (4)--A perinatal and postnatal study in rats by subcutaneous administration]

Perinatal and postnatal toxicity of calcipotriol (MC903), an antipsoriasic agent, was studied. MC903 at doses of 6.25, 12.5 and 25 micrograms/kg/day were subcutaneously administered to pregnant Slc:SD rats from day 17 of gestation to day 21 after delivery. 1. Administration of MC903 at any doses did not adversely affect pregnant animals in regard to gestation, delivery and maternal behavior. In dams administered MC903 25 micrograms/kg/day, food consumption and body weight gain were marginally lower than those of control animals during lactation period. 2. In group administered MC903 25 micrograms/kg/day, body weight gain in F1 offsprings was significantly lower as compared with those of control group. The drug did not have any adverse effects on the postnatal development of the offspring such as differentiation, functional development, emotionality, motor ability, learning ability or reproductive performance. 3. On the basis of results obtained in the present study, it is considered that the no-toxic dose level for general toxicity and reproduction in the dams was estimated to be 12.5 and 25 micrograms/kg/day, respectively, the no-toxic dose levels in the offspring was also estimated to be 12.5 micrograms/kg/day.

[Single dose toxicity studies of calcipotriol (MC903) in rats and dogs]

A single dose toxicity of calcipotriol (MC903), an anti-psoriasic agent, administered subcutaneously (s.c.) and percutaneously (p.c.) was studied in Slc:SD rats (s.c. and p.c.) and beagle dogs (s.c.). The LD50 values of MC903 were as follows: rats, 2.19 mg/kg in males and 2.51 mg/kg in females by s.c., and more than 15 mg/kg in both sexes by p.c.; dogs, more than 1.5 mg/kg in males by p.c. No sexual difference was noted in LD50 values of rats. Death of rats was observed from 1 to 3 days after administration by both routes. Dead animals showed decreases in body weight and locomotor activity, reddish tear, abnormal gait and dirty hair by both routes. Furthermore, dead animals administered by s.c. showed salivation, nasal discharge, piloerection, ptosis, diarrhea, urorrhea, nasal and vaginal bleeding, subnormal temperature, loose stool, cyanosis, irregular and deep respirations, clonic and tonic convulsions. Survival of rats showed similar signs to those of dead animals except for nasal discharge, nasal and vaginal bleeding, cyanosis, agonal respiration and convulsion. Discoloration of the kidney, white patch of the heart and a dilatation of the stomach wall were observed on macroscopic examinations. No mortalities were observed in dogs which showed vomiting, conjunctival congestion, circumoral and auricular reddenings, periblepharal purplish reddening, decreases in locomotor activity and defecation, emaciation, eye discharge, skin desquamation of treated area and an increase in respiration. On macroscopic examination, desquamation of the skin, reddening of the circumoral mucosa, pale gray yellow striations in renal tubules of the cortex and discoloration of the thyroid were observed. Histopathological findings revealed epidermal thickening with parakeratosis, fibrocytes, hypertrophy and hypersecretion of the sebaceous and sweat glands, formation of epitheloid glanulomas and infiltration of neutrophils in the subcutaneous tissues. Furthermore, moderate calcium deposits in the renal tubules, fatty cells and slight calcium deposits in interstitial tissues of the thyroid, and a cystic nest of an ectopic intestinal epithelium between muscle layers of the duodenum were observed at the highest dose. On the basis of results obtained in the present study, rats administered MC903 by s.c. or p.c. died probably due to the circulatory and renal disturbance resulted from effects of this drug on the heart and kidney.