Increased frequency of apolipoprotein epsilon 2 allele in non-insulin dependent diabetic (NIDDM) patients with nephropathy

The genetic polymorphism of apolipoprotein E (epsilon 2, epsilon 3 and epsilon 4) is associated with lipid abnormalities. It has been suggested that lipid abnormalities may contribute to the development and progression of kidney diseases, including diabetic nephropathy. Thus, in this study we compared the apo E allele frequencies among 146 non-insulin-dependent diabetic (NIDDM) patients with nephropathy, 135 NIDDM patients without nephropathy and 576 of the general Japanese population. The epsilon 2 allele frequency was significantly higher in diabetic patients with nephropathy (7.2%) and with renal failure (9.7%) than in diabetic patients without nephropathy (2.6%) and in the general Japanese population (3.7%). It is concluded that there is a possibility that the epsilon 2 allele is associated with nephropathy in NIDDM.

Contribution of endothelin-1 to warm ischemia/reperfusion injury of the rat lung

The purpose of the present study was to clarify the role of endothelin-1 (ET-1) in the pathogenesis of ischemia/reperfusion lung injury and to determine whether pretreatment with an ET receptor antagonist prevents such injury. The left lung of Sprague-Dawley rats was subjected to 60 min of no-flow warm ischemia followed by 90 min of reperfusion. The plasma ET-1 concentration increased significantly after reperfusion compared with before and after ischemia (p < 0.05). Arterial oxygen tension was reduced, and the lung tissue wet/dry weight ratio increased in post-reperfusion lungs compared with both pre-ischemia and post-ischemia lungs. Histologic study showed pulmonary edema, hemorrhage, hyaline membrane formation, and a significant increase in lung tissue neutrophils after reperfusion. In addition, the expression of ET-1 mRNA was determined by Northern blot analysis. Although ischemia did not significantly alter ET-1 expression, reperfusion increased expression in the left lung markedly and in the right lung moderately. Pre-infusion of FR139317, an ETA receptor antagonist, prevented post-reperfusion damage to the lung. These results suggest that ET-1 contributes to the ischemia/reperfusion injury of the rat lung, mediated by an ETA receptor, and that an ETA receptor antagonist may inhibit ischemia/reperfusion lung injury.

Prognostic determinants of hypertrophic cardiomyopathy--the results of the Shiga Cardiomyopathy Study

Previous studies have reported that patients with hypertrophic cardiomyopathy (HCM) are prone to sudden death. In this study, we retrospectively assessed the prognosis and any influencing factors in 83 patients (66 male, 17 female) with HCM. Twenty-two patients were obstructive, 40 were non-obstructive, 18 were apical HCM and 3 were unclassified. Four of the 83 cases progressed to left ventricular dilatation and dysfunction during the follow-up period. The mean age was 51.2 years (range 16 to 73) and the mean duration of follow-up was 6.7 years (range 0.3 to 15.1). The 5- and 10-year survival rates were 98% and 89%, respectively. Five patients dies; 3 from cardiac events (two sudden deaths and one due to congestive heart failure) and 2 from malignant diseases. The lack of a family history of sudden death and the amplitude of the S wave in lead V1 (less than 2.0 mV) were associated with a favorable prognosis. None of the patients who were diagnosed before age 50 died, but this observation was not statistically significant. None of the patients with apical HCM died, but the classification of HCM was not significantly associated with the prognosis. None of the patients without medication died and medical treatment did not influence the prognosis. Sex, family history of HCM, the patient's symptoms and physical signs, NYHA classification of cardiovascular disability, thickness of the septum and the posterior wall of the left ventricle, dimension of the left atrium, and the left and right ventricles in echocardiogram, amplitude of the R wave in lead V5, the depth of the negative T wave and atrial fibrillation did not influence the prognosis.

Primary hypoparathyroidism in Turner's syndrome

A case of hypoparathyroidism accompanied with Turner's syndrome is reported. On admission, a 44-year-old woman had facial dystonia, deafness, and primary amenorrhea. Laboratory examinations showed a decrease in serum PTH and mosaicism of 45,X and 46,XX(6:34). A brain CT revealed marked calcification in the basal ganglia, cerebellum and periventricular area. Antiparkinsonian drugs were found to be effective for the dystonia. This case therefore suggests that some relationship may exist between intracranial calcification and Turner's syndrome.

Effects of zonisamide on dopaminergic system

Effects of zonisamide (ZNS) on extracellular dopamine (DA), its precursor 3,4-dihydroxyphenylalanine (DOPA), its metabolites 3,4-dihydroxyphenylacetic acid (DOPAC) and homovanillic acid (HVA) levels in the striatum as well as hippocampus of freely moving rats were studied. Intracellular DA, DOPA, DOPAC and HVA levels, as well as DOPA accumulation as an index of tyrosine hydroxylase activity in the rat brain in vivo, DA re-uptake in the striatum and hippocampus, and monoamine oxidase (MAO) activities were also determined. Acute administrations of therapeutic ZNS doses (20 and 50 mg/kg) increased striatal extracellular DOPA levels, intracellular striatal and hippocampal DOPA levels, and stimulated DOPA accumulation in both brain regions. ZNS also increased striatal and hippocampal intracellular as well as extracellular DA and HVA levels, but decreased those of DOPAC levels. Chronic (3 weeks) administrations of therapeutic ZNS doses (20 and 50 mg/kg/day) increased intracellular DA, DOPA, DOPAC and HVA levels in striatum and hippocampus. ZNS-induced changes were greater in intracellular levels than in extracellular levels. Acute and chronic supratherapeutic ZNS dose (100 mg/kg) administration decreased intracellular levels of all substances detectable in both brain regions, and inhibited DOPA accumulation. Both subtypes of MAO (type A and type B) activities were weakly inhibited by ZNS. ZNS showed no effect on DA re-uptake in striatum nor in hippocampus. These results suggest that therapeutic ZNS doses increase DOPA accumulation as well as both intracellular and extracellular DA, DOPA and HVA levels. However, such doses also decrease extracellular and intracellular DOPAC levels by enhancing DA synthesis and/or by selectively inhibiting MAO-B activities. In addition, chronic therapeutic ZNS dose administration enhances DA synthesis, which results in increased intracellular DA, its precursor and its metabolites levels. On the other hand, both acute and chronic supratherapeutic ZNS dose administrations inhibit DA turnover. These ZNS effects on DA metabolism are at least partly involved in the mechanisms of action of ZNS.

Dental health indicator based on a questionnaire

Dentistry has lacked an effective indicator of the impact of dental problems on a person's daily life. Subjective factors in dental health need to be included in order to improve current indicators. The purpose of this research was to develop a new type of indicator recorded from a questionnaire which takes account of subjective factors in dental health. The indicator we constructed has the following advantages. 1. Calculation process is simple in practice. 2. The indicator values range from 0 to 100, with values closer to 100 indicating a more favorable condition for the individual. 3. The distribution of indicator values is similar to the normal distribution. 4. The score of each item is reflected on the indicator, suggesting the individual's characteristics in terms of dental health. 5. Although it is principally an indicator for individuals, it can also be applied to groups. This study will also provide a model for the preparation of a dental health indicator.

[Effect of reimplantation response on recipient pulmonary hemodynamics in single lung transplantation]

Until now, reimplantation response (RR) has been thought to be a transient dysfunction of the transplanted lung in single lung transplantation. How does RR influence on the native lung in single lung transplantation? We studied the influence of RR to the native lung with 20 dogs which were divided separated into 3 groups. In group I (6 dogs) and II (6), left lung allotransplantation without immunosuppression was performed. In group II, PGI2 was administered to the donors at 1 microgram/kg/min for 60 minutes iv drip infusion during lung extraction and super oxide dismutase (SOD) was administered to the recipients at 20 mg/kg just before reperfusion of the transplanted lung. In group III (8), allotransplantation with immunosuppression (CYA 20 mg/kg, AZ 4 mg/kg) was done using PGI2 and SOD in the same way as group II. In all groups doppler flow probes were attached to the ascending aorta and left pulmonary artery. For over 1 week, pulmonary hemodynamics was evaluated. In group I pulmonary arterial pressure increased up to 38.7 +/- 19.7 mmHg on 3 postoperative day, which showed significant difference (p < 0.05) from group II. An increase in vascular resistance of the transplanted lung was recognized right after transplantation in the both groups (0.212 +/- 0.058 mmHg/ml/kg to 0.487 +/- 0.114 in group I, 0.207 +/- 0.072 to 0.407 +/- 0.172 in group II). However, vascular resistance of the right lung increased in group I against group II right after transplantation (0.182 +/- 0.116 to 0.367 +/- 0.195 in group I, 0.183 +/- 0.116 to 0.214 +/- 0.149 in group II), which showed significant difference (p < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

A new enzymatic method for the determination of inulin

A new enzymatic method for the determination of inulin in plasma and urine, using inulase (EC 3.2.1.7), fructokinase (EC 2.7.1.4), phosphoglucoisomerase (EC 5.3.1.9) and glucose-6-phosphate dehydrogenase (EC 1.1.1.49) is described. The assay is based on the hydrolysis of inulin or Inutest (INutest which is the injectable form of inulin), by inulase and the determination of fructose released. The assay was linear up to 2 g/L of Inutest. The within-batch and between batch coefficients of variation were 2.3% and 2.2%, respectively. Recovery of added Inutest from plasma and urine was 98-102%. There was no interference from glucose (27.7 mmol/L), fructose (1.7 mmol/L) or mannose (1.7 mmol/L). When inulin clearance (using this method) and thiosulphate clearance were compared in 37 patients the inulin clearance was 9.3 mL/min (12%) lower than the thiosulphate clearance. We conclude that this enzymatic method is a simple and specific method.

Long-term spatial cognitive impairment after middle cerebral artery occlusion in rats: no involvement of the hippocampus

The behavioral and neurochemical changes in the chronic phase of permanent occlusion of the right middle cerebral artery (MCA) in rats were investigated. One month after MCA occlusion, 23 rats were unable to solve a radial eight-arm maze task during an entire 1-month period, whereas seven rats were able to solve this task. Three months after occlusion, 19 MCA-occluded rats failed to solve the task successfully again for at least 1 month (the cognitively impaired rats), whereas 11 MCA-occluded rats were able to solve it (the cognitively unimpaired rats). The rats that underwent behavioral testing were examined for any changes in the acetylcholine (ACh) levels in the hippocampus using HPLC with electrochemical detection or the formation of long-term potentiation (LTP) in the population spike of the hippocampal CA1 field. The immunohistochemical distribution of either the microtubule-associated protein 2 (MAP2) or glial fibrillary acidic protein (GFAP) in the hippocampus of the cognitively impaired rats was also studied. In the cognitively impaired rats, neither the suppression of the induction of LTP, nor the degradation of MAP2, nor the increase in the GFAP immunoreactivity was observed in the hippocampus. The levels of ACh in the hippocampus did not change significantly among the cognitively impaired, unimpaired, and the sham-operated rats. These results suggest that MCA occlusion is capable of producing long-term spatial cognitive disturbance in rats without any evidence of neurobiological damage in the hippocampus.

Reduction of left ventricular hypertrophy with St. Jude Medical 19 mm valve prosthesis

To determine the permissible range of the St. Jude Medical 19 mm valve (SJM19) as an aortic prosthesis, transvalvular maximal pressure gradient (maxPG) and postoperative reduction of left ventricular (LV) hypertrophy were examined in 21 patients (body surface area [BSA] 1.28-1.56 m2, mean 1.42 m2). Doppler echocardiographically measured maxPG at rest was 31 +/- 16 mmHg, which showed no significant difference from the differences in patients' diseases (aortic regurgitation = AR or stenosis = AS), or BSA. The maxPG, also measured during dobutamine administration when they were less than 40 mmHg at rest, increased significantly from 21 +/- 11 mmHg to 32.1 +/- 15 mmHg, having no differences from the differences in diseases or BSA. Reduction of LV hypertrophy was achieved postoperatively (mean postoperative period of ten months), with the reduction rates of 26 +/- 19% in LV mass and 21 +/- 15% in LV cross-sectional area. No significant differences were found between the reduction rates and the differences in the patients' diseases or BSA. These results indicate that, following the implantation of SJM19, LV hypertrophy was reduced in patients with AR as well as with AS, when their BSA values were less than 1.6 m2. However, limited use is recommended because the increase in pressure gradient during exercise cannot be ignored.

Long-term follow-up study of Crohn's disease in Japan. The Research Committee of Inflammatory Bowel Disease in Japan

Two hundred and three patients with Crohn's disease seen at Kyushu University, Fukuoka University, and their affiliated centers from 1973 to 1988 were followed for 4.4 +/- 3.2 years (mean +/- SD), to evaluate the prognosis relative to life span and surgery. Cumulative survival rate and cumulative operation rate were calculated by the life table method. Cumulative survival rates 5 and 10 years after diagnosis were 98.9% and 98.9%, respectively; these figures were not different from the expected survival rates in the sex-and age-matched general population. Cumulative operation rates 5 and 10 years after the onset of symptoms were 16.2% and 39.1%, respectively, In a second study, we investigated 419 patients with Crohn's disease, diagnosed at nine institutions from 1975 to 1990. The follow-up period was 6.3 +/- 3.9 years and the information was obtained from mailed questionnaires. Cumulative survival rates 5 and 10 years after diagnosis were 99.2% and 96.9%, respectively. Cumulative operation rates 5 and 10 years after the onset of symptoms were 30.3% and 70.8%, respectively. These results indicate that the prognosis of Japanese patients with Crohn's disease may be superior to that reported in Western countries.

Mutations of the p53 gene in myelodysplastic syndrome and overt leukemia

We analysed p53 mutations in 24 patients with myelodysplastic syndrome (MDS) and overt acute myeloid leukaemia after a period of MDS, using polymerase chain reaction-single strand conformation polymorphism analysis. In exons 5 to 8, mobility shifts were detected in five of the 24 patients. Sequence analysis was subsequently performed, and four missense mutations (16.7%) and one silent nucleotide substitution were identified. Patients harbouring mutations were characterized as having advanced disease. Loss of the wild type allele was observed in three of the four patients with missense mutations. No mobility shifts of the N-ras or FMS gene were detected in these four patients. We next analysed the correlation of the p53 mutations with the progression of MDS in three patients. The mutation was accompanied by the progression in two of the three patients. These findings suggest that mutations of the p53 gene are associated with progression in some cases of MDS, while being compatible with stable disease or clonal evolution in others.

Reduced cell motility and enhanced focal adhesion contact formation in cells from FAK-deficient mice

The intracellular protein tyrosine kinase FAK (focal adhesion kinase) was originally identified gy its high level of tyrosine phosphorylation in v-src-transformed cells. FAK is also highly phosphorylated during early development. In cultured cells it is localized to focal adhesion contacts and becomes phosphorylated and activated in response to integrin-mediated binding of cells to the extracellular matrix, suggesting an important role in cell adhesion and/or migration. We have generated FAK-deficient mice by gene targeting to examine the role of FAK during development. Mutant embryos displayed a general defect of mesoderm development, and cells from these embryos had reduced mobility in vitro. Surprisingly, the number of focal adhesions was increased in FAK-deficient cells, suggesting that FAK may be involved in the turnover of focal adhesion contacts during cell migration.

Synthesis of 2(1H)-quinolinone derivatives and their inhibitory activity on the release of 12(S)-hydroxyeicosatetraenoic acid (12-HETE) from platelets

A search for potent inhibitors of release of 12(S)-hydroxyeicosatetraenoic acid (12-HETE), which plays an important role in the pathogenesis of various circulatory disorders and arteriosclerosis, led us to 6-[4-(1-cyclohexyl-5-tetrazolyl)butoxy]-3,4-dihydro-2(1H)-quinolinone (cilostazol) and 2(1H)-quinolinone derivatives having an azole group in the side chain. Many 2(1H)-quinolinone derivatives were synthesized and tested in vitro for the inhibitory activity in human platelets. 3,4-Dihydro-6-[3-(1-o-tolylimidazol-2-yl)sulfinylpropoxy]-2( 1H)-quinolinone (5k) was found to be one of the most potent inhibitors of 12-HETE release, being more potent than esculetin. In addition, the sulfoxide 5k showed in vivo inhibitory activity on platelet adhesion in rats. Since 5k is racemic, the enantiomers were prepared and their potencies were compared in vitro and in vivo. (S)-(+)-5k had the best pharmacological profile and was selected as a candidate drug for further development. The structure-activity relationships are discussed.

17 alpha-Hydroxyprogesterone suppresses neovascularization induced by HPLC-purified ovarian hyaluronic acid-like glycosaminoglycan in mice

HPLC-purified glycosaminoglycans (hpGAG) prepared from extracts of non-luteal mouse (JcL:ICR strain) ovaries were assayed for neovascularization by implanting Elvax films, containing test samples, on the lateral wall of the sheath of m. rectus abdominis in adult female mice of the same strain. Neovascularization occurred in a dose-dependent manner, and was characterized by capillary outgrowth extending into the tissue surrounding the implant. The single major peak of purified GAG on a column of TSK gel DEAE got out of order after treatment with streptococcal hyaluronidase or nitrous acid. The activity of this fraction was also greatly reduced when treated with streptococcal hyaluronidase or nitrous acid. When hpGAG was embedded in the implant with 17 alpha-hydroxyprogesterone at a dose of 20 micrograms/film, neovascularization induced by means of hpGAGs was suppressed. Progesterone at a dose of 50 micrograms/film did not suppress the neovascularization induced by ovarian hpGAG. These findings suggest that 17 alpha-hydroxyprogesterone suppresses the angiogenic activity of hyaluronic acid-like hpGAG in the ovary.

Evaluation of disease activity in patients with moderately active ulcerative colitis: comparisons between a new activity index and Truelove and Witts' classification

OBJECTIVES

We have recently proposed a new activity index (AI) for ulcerative colitis. The aim of this study was to examine how AI would reflect the effect of medical therapy in comparison with Truelove and Witts' criteria.

METHODS

In this trial, we studied 35 patients with extensive colitis who persisted with moderate disease for 2 wk. They showed no change in disease activity according to Truelove and Witts' classification despite 2 wk of corticosteroid therapy. Nine of the 35 patients underwent surgery (operated group), and 26 responded to the medical therapy and went into remission (nonoperated group).

RESULTS

In the nonoperated group, AI values significantly decreased at 1 and 2 wk after treatment compared with pretreatment values, whereas there was no significant change in AI in the operated group during the clinical course. Remission occurred in all patients indicating below 180 of AI values 2 wk after therapy, whereas approximately 65% of patients indicating above 180 of AI values subsequently needed colectomy.

CONCLUSIONS

This study suggests that AI will be useful in evaluation of response to medical therapy and prediction of remission and colectomy in patients with moderately active ulcerative colitis.

Effects of a selective endothelin A-receptor antagonist, BQ-123, in salt-loaded stroke-prone spontaneously hypertensive rats

1. We examined the effects of a selective endothelin A (ETA)-receptor antagonist, BQ-123, on the development of hypertension and organ damage in stroke-prone spontaneously hypertensive rats (SHRSP) given 1% NaCl for 6 weeks. 2. BQ-123 at doses of 0.7, 2.1 and 7.1 mg/day was continuously administered for 6 weeks to 8 week old salt-loaded SHRSP, who were given water containing 1% NaCl for the following 6 weeks, via a subcutaneous osmotic minipump. 3. Development of high blood pressure was accelerated in salt-loaded SHRSP compared with that in non-salt-loaded SHRSP. After 6 weeks of salt-loading, incidence of cerebral infarction, renal sclerosis and renal fibrosis were greater in salt-loaded than non-salt-loaded SHRSP. 4. BQ-123 attenuated the age-related rise in blood pressure in a dose-dependent manner. The effect coincided with reduction in the incidence of cerebral infarction and prevention of renal sclerosis and fibrosis. Kidney function was improved as observed by an increase in glomerular filtration rate and decreases in urinary protein excretion, blood urea nitrogen and fractional sodium excretion. Furthermore, BQ-123 prevented increases in the heart weight/bodyweight ratio and aortic wall thickness in salt-loaded SHRSP. 5. These results suggest that endogenous endothelin-1 (ET-1) and ETA-receptors may be, at least in part, involved in the pathogenesis of hypertension and organ damage in salt-loaded SHRSP.

Quantitative analysis of synaptogenesis in the inner plexiform layer of macaque monkey fovea

Synaptogenesis has been tracked by using quantitative electron microscopic methods in the inner plexiform layer (IPL) of the developing Macaca monkey fovea from fetal day (Fd) 55 to Fd132. Vesicle-containing profiles were classified according to whether (1) they contained a ribbon indicating that they originated from a bipolar cell, or (2) the profile formed a junction. Group 2 was further subdivided by morphological characteristics into (2a) amacrine, (2b) bipolar, or (2c) unknown profiles. Ribbon-containing bipolar profiles are clearly identifiable at Fd55 when they occur at a density of 0.9/100 microns2. Bipolar synapses increase rapidly to 4.7/100 microns2 by Fd88, similar to their density at Fd132. Identifiable amacrine profiles forming a junction are rare at Fd55-68. By Fd88, amacrine synaptic density has jumped to 6.7/100 microns2 and continues to increase to 9.5/100 microns2 at Fd132. These quantitative data strongly suggest that, at the Macaca fovea, bipolar synaptogenesis both begins and ends before amacrine synaptogenesis. The large number of immature amacrine synaptic profiles and densities at Fd132 suggests that amacrine synapses continue to form after Fd132. This study confirms that cone-dominated monkey fovea has a different sequence of synaptogenesis than the rod-dominated peripheral retina (Nishimura and Rakic, [1985] J. Comp. Neurol 241:420-434). The data support the concept that synaptic developmental sequence is determined by the type of photoreceptor which dominates a particular retinal region or species. Bipolar ribbon synapses are observed in the outer half of the IPL at Fd55, are present in the inner IPL at Fd60, and then, with increasing age, are found throughout the IPL. This pattern strongly suggests that vertical OFF bipolar pathways form earlier than ON pathways in the IPL. In contrast, amacrine profiles are found throughout the IPL at the youngest ages, with an adult-like banding pattern present by Fd132.

Sutureless anastomosis using a biofragmentable anastomosis ring

The biofragmentable anastomosis ring (BAR) is composed of polyglycolic acid and barium sulfate. When used for intestinal anastomosis, the BAR fragments after the anastomosis is established. We used this device in 43 patients. In three patients, the anastomosis with BAR was abandoned due to technical difficulties. A total of 43 anastomoses with BAR were performed in 40 patients. The operations in which BAR was used included right hemicolectomy in 12 patients, transverse colectomy in 7, sigmoidectomy in 11, small bowel resection in 5 and other bowel resections in 8. The time spent for the BAR anastomsis ranged from 7 to 30 min with a mean of 15.2 min, which was significantly shorter than that of conventional hand-sutured anastomosis in 23 cases. The fragmentation and excretion of the BAR occurred from 14 to 49 days later with a mean of 21.8 days. There was only one instance of anastomotic leakage (1/40, 2.5%), which occurred in a patient with a cytomegaloviral infection of the intestine. A postoperative barium enema study in 28 patients showed no passage disturbance through the anastomosis. In conclusion, the anastomosis using BAR is considered to be a simple, safe, and fast method for performing either colonic or small intestinal anastomosis.

Lithium addition to neuroleptic treatment in chronic schizophrenia: a randomized, double-blind, placebo-controlled, cross-over study

We studied the effect of lithium addition to neuroleptic treatment in chronic schizophrenia, for which contradictory results have been produced in previous studies. Twenty-one chronic schizophrenic inpatients received lithium in a study with randomized, double-blind, placebo-controlled, cross-over design consisting of 8 weeks each of treatment with lithium capsules and identical placebo capsules. The total Brief Psychiatric Rating Scale (BPRS) scores at week 8 of the lithium treatment were improved significantly compared with those at week 8 of the placebo treatment. Of the BPRS subscales, however, only anxiety-depression improved, whereas none of the subscales for anergia, thought disturbance, activation and hostile-suspiciousness improved. There was no significant difference between the total Scale for the Assessment of Negative Symptoms (SANS) scores at any time during lithium and placebo treatment. These results suggest that the addition of lithium to neuroleptic treatment improves anxiety-depression in chronic schizophrenia.