Superoxide dismutase inhibits interleukin-1-induced degradation of human cartilage

Interleukin-1 (IL-1) is a key mediator in the pathogenesis of cartilage destruction in arthritis-related disorders. Human recombinant superoxide dismutase (SOD) blocked IL-1-mediated cartilage destruction but had no effect on IL-1-mediated changes in glycosaminoglycan and prostaglandin E2 synthesis. These data suggest that superoxide anions may be one factor of IL-1-mediated cartilage destruction.

[Simple analysis of fatty acid in human milk by HPLC]

The conventional analysis of fatty acid requires such complicated operations as extraction of total lipid, evaporation of organic layer, alkaline hydrolysis, washing with n-hexane, re-extraction of fatty acid and washing with water, and therefore, is time-consuming. Herein, we report a simplified method dispensing with the steps of the extraction of total lipids, the evaporation of organic layer and the washing with n-hexane after hydrolysis. This method showed satisfactory results on the linearity of standard curves and their productibility, and a correlation was obtained between those obtained by the traditional method and by our simple method in human milk. We employed this method for the analysis of human milk secreted between the 3rd day and the 42nd day after delivery. The concentration of total fatty acid in human milk secreted after lactation showed a higher value than that before it, while the constituent ratio of fatty acid did not show such a great difference.

[Effective dose evaluation of angiography staff]

The effective doses received by staff members involved in angiographic examinations were determined using data compiled on radiation doses obtained from monitoring personnel and phantom measurements. Thermoluminescence personnel monitors were used to evaluate the personal doses received by the staff during radiological procedures. Organ or tissue doses were determined by using phantom measurements in which a RANDO-woman phantom was used to simulate geometric conditions during actual angiographic examinations. The annual effective dosage received by radiologists was estimated to be 8 to 9 mSv per year when they wore a lead-rubber protector. When this protector was disregarded, their annual effective doses frequently went beyond the annual limit of 50 mSv. The surface dose to the female abdomen per ten months was estimated as 1.7 mSv. Thus, care should be taken by women staff members.

Escherichia coli cad operon functions as a supplier of carbon dioxide

We examined the gene expression of the Escherichia coli cad operon, which consisted of the genes cadB and cadA (lysine decarboxylase), using cells possessing cadB-lacZ fusion gene. The cad operon was expressed when O2 was limited, and the expression was optimal at pH 6.3. The beta-galactosidase activity was lowered by the addition of sodium carbonate to the medium. The expression of the cad operon was reduced in cells containing the plasmid-encoding ornithine decarboxylase, which produced carbon dioxide, indicating that the gene expression of the cad operon was regulated by carbon dioxide (or its derivatives). It is known that the Krebs cycle is a major pathway for producing carbon dioxide, and that its activity is repressed when O2 is limited. Thus, our present results suggested that the physiological role of the cad operon is to supply carbon dioxide when its internal level is lowered under O2-limiting conditions at a low pH.

Reactivity of varicella-zoster virus subunit antigens in enzyme-linked immunosorbent assay to sera from varicella, zoster, and herpes simplex virus infections

Serological responses to varicella-zoster virus (VZV) subunit antigens, such as capsid, envelope, and soluble (S) antigens, in patients with VZV and herpes simplex virus (HSV) infections were studied by comparing with responses to virion (V) antigens using an enzyme-linked immunosorbent assay (ELISA). S antigen, prepared by concentrating supernatant of VZV or HSV type 1 (HSV-1)-infected cell culture fluid, reacted strongly to sera from patients with secondary infection but reacted poorly to those from patients with a primary infection of VZV or HSV. Antibody titers to VZV-S antigen persisted for a long period in patients with VZV infections. Patients infected with VZV showed antibody increase to HSV-1, when tested by complement fixation or complement-enhanced neutralization test, in cases with a history of prior HSV infection. However, such a cross-reaction was only observed to a minor extent in ELISA test using S antigen. S antigen reaction was stronger in secondary infections in tests with various subunit antigens. Almost no cross-reactivity was observed in an immunoblotting test with S antigen. Differentiation between infections with either varicella or zoster or HSV can be made by comparison of antibody responses to V and S antigens.

[Effect of rG-CSF on the morphology and function of neutrophils in ovarian cancer chemotherapy]

The combined use of rG-CSF in ovarian cancer chemotherapy prevents a decrease in the number of neutrophils and promotes their recovery. rG-CSF also protects against infections, enhancing chemotherapeutic effectiveness. It is reported that neutrophils produced by rG-CSF not only increase in number but also in function. Some clinicians, however, doubt whether neutrophils mobilized or produced by rG-CSF have sufficient ability to function practically in clinical cases. We therefore examined, by means of flow cytometry, the neutrophils' phagocytosis and bactericidal ability and we found both normal. No morphological abnormalities were seen in these neutrophils. In our observations, moreover, no effect was exerted on the leukocyte-membrane antigen. It was concluded that (a) rG-CSF was very effective in protecting against the diminution of neutrophils by chemotherapy and (b) in promoting their recovery, and (c) also the function, morphology and leukocyte-membrane antigen of these neutrophils were normal.

[Endolotherapy of massive bleeding from the small intestinal angiodysplasia in 80-year-old patient]

Angiodysplasia is one cause of chronic gastrointestinal tract bleeding that can not be difficult to detect. In particular, angiodysplasia in the small intestine is very rare and has seldom been reported. An 80-year-old man complained of hematochezia and was admitted to other hospital on October 1991. However, no bleeding sites in the gastrointestinal tract could be revealed by radiographic and endoscopic examinations. After 8 months, he was admitted to our hospital with the same symptom on June 1992. He suffered hemorrhagic shock due to continuous bleeding. Hypotension and anemia progressed in spite of immediate blood transfusion. Emergency angiography revealed extravasation from a peripheral branch of the jejunal artery, in addition tortuous and dilated ileal arteries. Embolization was performed with the catheter inserted superselectively into the nearest arcade of the segmental branch of the vasa recta. After embolization, no complications were occurred. He was discharged and is being followed up as an outpatient.

[Concomitant intraperitoneal therapy with the antitumor polysaccharide Sizofiran and rG-CSF for ovarian cancer]

The concomitant administration of Sizofiran (a macrophage activator) and rG-CSF (which promotes neutrophil proliferation and activation) caused marked activation of intraperitoneal antitumor immunity. It promoted the induction of IL-2 receptor expression as well as the proliferation and activation of neutrophils, and also caused an increase in LAK and NK activity, which resulted in a clinical antitumor effect. Therefore, this concomitant regimen was found to be useful as maintenance therapy for ovarian cancer.

[A case uterine cervical squamous cell carcinoma successfully treated with preoperative carboplatin-based 5-drug-combined intraarterial infusion chemotherapy]

Preoperative 5-drug-combined intraarterial infusion chemotherapy using carboplatin as a main component was performed in a case of uterine cervical squamous cell carcinoma of Stage IIa. The regimen employed was as follows: carboplatin (100 mg/m2) on Day 4 and 5, vincristine (0.6 mg/m2) on Day 1, peplomycin (5 mg/body) on Day 1, 2, and 3, methotrexate (5 mg/m2) on Day 2 and 3, and doxorubicin (15 mg/m2) on Day 4. These drugs were administered into the right inguinal region through a residual catheter at 3-week intervals prior to operation. After completion of 3 courses, the patient achieved a CR confirmed by pathological analysis and diagnostic imaging followed by extended radical hysterectomy. Side effects observed, especially renal disturbance and myelosuppression, were all tolerable. Intraarterial infusion chemotherapy using carboplatin was thus suggested to be useful against malignant tumors in the gynecological field.

Chemical stimulation of the nucleus locus coeruleus: cardiovascular responses and baroreflex modification

Microinjection of glutamate (Glu, 2.5 nmol) or homocysteic acid (HA, 0.1-0.5 nmol) into the nucleus locus coeruleus (LC) decreased both blood pressure and heart rate. These microinjections also produced a facilitatory or occlusive effect on depressor and bradycardiac responses evoked by electrical stimulation of the aortic depressor nerve (ADN). Destruction of the nucleus tractus solitarius (NTS), which totally eliminated ADN-evoked responses, had no effect on the cardiovascular responses evoked by LC stimulation. These results suggest that the neuronal populations that contribute to the LC-induced cardiovascular responses overlap at least partly with the baroreflex substrate other than the NTS.

Thrombosis-inducing activity--a factor which appears in plasma of patients with allergic asthma during attack

Thrombosis-inducing activity (TIA) is a factor which was recently identified in plasma from patients with advanced lung cancer and acute respiratory tract infection. In the present study, TIA was measured during periods of attack and nonattack in patients with the allergic and nonallergic type of asthma and pulmonary emphysema with an asthmatic component. In the allergic type of asthma, the attack was accompanied by the appearance of TIA, but when the attack ended it disappeared from plasma. In the nonallergic type of asthma and emphysema with an asthmatic component, TIA remained negative even during the attack. These observations indicate that TIA has some correlations with allergic asthma.

[Clinical usefulness of benzoate tolerance test in patients with liver cirrhosis]

The capacity of the liver to metabolize intravenously loaded benzoic acid to hippuric acid was examined in 7 healthy adults and 18 patients with liver cirrhosis. Blood samples were withdrawn at 5 to 120 min after infusion of benzoic acid (15 mg/Kg), and then serum was obtained to determine the contents of the fatty acids by HPLC as well as to examine several pharmacokinetic parameters under a two-compartment model program. The urinary samples were collected at 60 min after the infusion. In the serum of the patient group, the maximum concentration (Cmax) and area under the concentration curve from zero time to the infinity (AUC) for benzoic acid remained in the normal range, but the mean transit time(MRT) and half-life time(T1/2) were significantly delayed. In serum of the patient group, the AUC for hippuric acid was hardly reduced but the Cmax was significantly reduced. Moreover, MRT, T1/2 and time to reach Cmax(Tmax) were significantly delayed. In urine at 60 min after the loading, benzoic acid was below the limit of detection and was recovered as hippuric acid with a recovery rate of 70% in the healthy adult group and 40% in the patient group.

Two cases of variant form angina pectoris associated with myocardial bridge--a possible relationship among coronary vasospasm, atherosclerosis and myocardial bridge

Myocardial bridge (MB) is a congenital anomaly of the coronary artery and may occur in 5 to 12% of the human population. However, the mechanism of MB-induced myocardial ischemia is still speculative. We report 2 cases of variant form angina pectoris associated with MB in which myocardial ischemia seemed to be related to the interaction between coronary perfusion and MB. In case 1, electrocardiography during anginal attack at rest showed ST elevation in the inferior leads and MB was observed after percutaneous transluminal coronary angioplasty at the site of the right coronary artery lesion following successful dilatation. In case 2, MB of the left anterior descending coronary was located in the identical portion where coronary vasospasm was induced by intracoronary acetylcholine injection, although ischemia during the spontaneous anginal attack was limited to the inferior area of myocardium. These 2 cases suggest that MB can be, at least in some patients, one of the possible causes of the endothelial damage which seems to be related to coronary vasospasm; this was documented in both cases.

[Clinical varicella-zoster virus reinfection observed in two advanced-age persons]

We observed two mild varicella cases of an advanced-age man and woman, although varicella in the adult generally presents a more severe course than in the child. The cases had been exposed to his great-grandchild and her grandchild with varicella in their home. They did not experience neuralgia as is typical from herpes zoster. Serological examinations revealed that they had high IgG-antibodies (Ab) against varicella-zoster virus (VZV), but low anti-VZV IgM-Ab. They were also found to have a high level of Ab against VZV soluble antigens (Ag) which are generally low in primary VZV infection. Immunoblotting analysis of anti-VZV IgG-Abs using sera from case 1 or 2 showed that their reaction patterns resembled those of sera children who contracted mild varicella after immunization with varicella vaccine and a herpes zoster-patient rather than those of sera from an immunocompetent adult with varicella. These results of serological examinations and their clinical course indicated that the cases had contracted varicella in the past and were again exposed to VZV resulting in clinically overt but mild varicella.

Reduced synthesis of tissue plasminogen activator by vascular endothelium during acute myocardial infarction

We measured levels of tissue plasminogen activator (t-PA) antigen in 100 patients within six hours of the onset of acute myocardial infarction, in 34 patients with chronic angina but no recent infarction, and in 36 normal subjects. We also assayed von Willebrand factor in the acute patients and in the normal subjects. Measurements were repeated in 40 acute patients at three weeks after myocardial infarction. Although resting levels of t-PA antigen were not significantly different from normal during myocardial infarction, the capacity of the vascular endothelium to release t-PA after five minutes of venous occlusion was impaired (p less than 0.01). The acute phase vessel wall release of von Willebrand factor was increased during acute infarction (p less than 0.01). We conclude that impairment of t-PA production is associated with acute coronary thrombosis, although it is not possible to differentiate between a causative role or a secondary response due to exhaustion of the t-PA producing mechanism.

Clinical significance of benzoate-metabolizing capacity in patients with chronic liver disease: pharmacokinetic analysis

Benzoate-metabolizing capacity was studied in control subjects and in liver disease patients after intra-venous loading of 15 mg benzoate per kg of body weight. In the 7 control subjects, the mean level (+/- SEM) of Cmax for serum benzoate was 104.1 +/- 6.8 micrograms/ml, AUC was 2.57 +/- 0.32 mg.min/ml, MRT was 21.5 +/- 1.5 min and T1/2 was 15.5 +/- 1.3 min. For serum hippurate, on the other hand, Tmax was 27.9 +/- 6.0 min, Cmax was 33.4 +/- 2.1 micrograms/ml, AUC was 1.96 +/- 0.13 mg.min/ml, MRT was 39.6 +/- 2.9 min and T1/2 was 30.7 +/- 2.4 min. In 12 patients with chronic hepatitis, Cmax, AUC, MRT and T1/2 for benzoate and Tmax, MRT and T1/2 for hippurate remained at control levels, but Cmax and AUC for hippurate were slightly decreased compared to controls. However, in 18 patients with liver cirrhosis, Cmax and AUC for benzoate were in the control range but MRT and T1/2 were significantly delayed (p less than 0.01 for both). Moreover, the MRT value was increased in proportion to the severity of liver disease (p less than 0.01). AUC for hippurate was not changed to any extent, and Tmax, MRT and T1/2 were slightly delayed, while Cmax was significantly reduced. AUC, MRT and T1/2 for benzoate and Tmax, MRT and T1/2 for hippurate showed significant correlation with serum albumin levels, prothrombin time and indocyanine green clearance rate. These results suggest that benzoate-metabolizing capacity, especially as indicated by the MRT value for serum benzoate, appears to be a better index than the indocyanine green clearance rate for determining hepatic functional reserve in chronic liver disease.

[Percutaneous transluminal angioplasty of dialysis access shunts]

Sixteen balloon angioplasties were performed in 10 patients with upper-extremity dialysis access shunts. The initial success rate was 80% (12/15). Of the initial successes, 58% (7/12) were patent at six months and 13% (1/8) at one year. In nine cases, repeat PTA was necessary. The mean interval of patency was about four months. The longest interval was two and a half years. The complication of thrombosis of the loop shunt during PTA was successfully treated by fibrinolytic therapy.

[Fracture of percutaneously inserted IVC filters--two cases of Günther's filter]

During the period from 1988 to 1990, percutaneous insertion of Günther vena caval filters were performed in ten patients in our institution. In two of them, fracture and partial migration of anchoring limbs were observed. Günthter's filter is an attractive device for interventional radiologist because of its technical ease of percutaneous placement and relative stability within the vein. However, our experience suggests that this device is not entirely safe and reliable. The patients should be carefully followed up with a possibility of distal migration in mind. Further structural improvement seems necessary.

[A study of a systemic fibrinolytic treatment of acute myocardial infarction. The effect of a moderate dose infusion of urokinase]

The clinical efficacy of intravenous fibrinolytic treatment using a moderate dose of urokinase (UK) on acute myocardial infarction (AMI) has not been well evaluated in randomized trials. In order to assess the efficacy of UK, a prospective randomized study was undertaken, aimed mainly at evaluating coronary myocardial blood flow in the infarcted myocardium using Tl-201 myocardial scintigraphy. 166 patients (131 male and 35 female, mean age 61.1 years) with AMI classified in Killip I or II who were admitted to the CCU within 24 hours of the onset of symptoms were divided into two groups; 76 patients treated with UK (UK group) and 90 patients treated with conventional therapy without UK (control group). Intravenous UK 72,000 IU was injected over 10 minutes and UK 528,000 IU was subsequently given by drip infusion over the following 12 (n = 36) or 24 hours (n = 40). There was no significant difference between the two groups with regard to the patients' background. Tl-201 uptake of infarcted myocardium in the UK group (n = 17) significantly increased in the first week compared with that on the day of admission (p less than 0.005) and a further significant increase was observed in the fourth week (p less than 0.05). In the control group (n = 10) Tl-201 uptake did not change in the first week and then increased significantly in the fourth week (p less than 0.05). Coronary angiography and left ventriculography (43 cases in the UK group and 32 cases in the control group) performed in the convalescent stage of AMI showed: 1) similar prevalence of patency of the infarct related artery (UK group: 72.1%, control group: 75.0%), 2) more prominent collateral circulation in the UK group (62.9% vs 41.4%), 3) significantly better perfusion of infarcted myocardium by coronary antegrade flow and/or collateral flow in the UK group (70.0% vs 46.9%, p less than 0.05), 4) a trend towards reduction of severe asynergy in the infarcted regional wall of the left ventricle in the UK group (16.3% vs 34.4%). The mortality rate of patients with first AMI in the UK group (n = 66) was significantly lower than that in the control group (n = 68) (4.5% vs 14.7%, p less than 0.05), and a similar trend was also found in patients with prior infarction (UK: n = 10, 0% vs control: n = 22, 13.6%).(ABSTRACT TRUNCATED AT 400 WORDS)

Carbachol enhances forskolin-stimulated cyclic AMP accumulation via activation of calmodulin system in human neuroblastoma SH-SY5Y cells

We have investigated the modulatory action of carbachol on intracellular cAMP levels in human neuroblastoma SH-SY5Y cells. Carbachol enhanced forskolin-stimulated cAMP levels in a dose-dependent manner (EC50 = 3 microM). The enhancing effect of carbachol was completely inhibited by pirenzepine and atropine. Pertussis toxin treatment of the cells partially affected the ability of carbachol. Furthermore, carbachol also enhanced the effect of vasoactive intestinal peptide (EC50 = 3 microM)-, adenosine- and prostaglandin E1-stimulated cAMP levels. The enhancing response of carbachol was sensitive to trifluoperazine but insensitive to calphostin C. These results suggest that the mechanism for carbachol-induced cAMP levels may act, at least in part, through the activation of calmodulin system in SH-SY5Y cells. Hence we describe for the first time a synergistic interaction between calmodulin- and cAMP-dependent signal transduction pathway mediated by carbachol in neuron-derived cell line.

[A case of mitral stenosis developing infective endocarditis 18 months after PTMC]

We presented here a case of mitral stenosis developing infective endocarditis 18 months after PTMC. A 33-year-old male was admitted to our hospital for the evaluation of mitral stenosis with signs of congestive heart failure. The use of PTMC was adequately indicated based on the data of previous cardiac catheterization and was successfully performed. The post-operative clinical course was good leaving only slight mitral regurgitation demonstrated by post-valvuloplasty LVG. About 18 months after PTMC, the patient developed a high fever and erythema with tenderness on his leg, so he was admitted again. Blood culture was positive for streptococcus viridans. Moreover, echocardiogram revealed valvular vegetation on the anterior mitral leaflet, which is the characteristic finding of infective endocarditis. Antibiotics were so effective that his clinical course was relatively good with minor cerebral infarction during chemotherapy. Little is known about the prognosis and late complication of PTMC. However, our reported case may suggest that prophylactic chemotherapy might be recommended at least in some cases showing mitral regurgitation after PTMC.

Determinations of organ doses and effective dose equivalents from computed tomographic examination

The organ or tissue doses were determined with a phantom measurement for 12 types of CT scanners widely used in Japan. Two types of thermoluminescent dosimeters were used for the dose determinations in a Rando woman phantom. The effective dose equivalents recommended by the International Commission on Radiological Protection were calculated using the measured organ or tissue doses. It was found that the CT scanners currently available give quite different organ or tissue doses. When selecting the optimum technical factors for scanning, therefore, it is important to take into consideration the balance of the image quality and the radiation exposure to patients.

Concentration of placental protein 19 in body fluid and placental tissues

Placental protein 19 (PP19) is one of the new placental tissue proteins identified in extracts from human term placenta by Bohn and Winkler. We measured the PP19 concentration in body fluids and placental tissue by radioimmunoassay; the minimum detectable dose of standard was 1.5 ng/ml. Although ethylene diamine tetraacetic acid (EDTA-2K) inhibited the immunoreaction between PP19 (225/242) and anti-PP19 antibody (632 ZA), the PP19 concentration did not differ between serum and heparin and sodium citrate plasmas. The serum PP19 concentration was increased by hemolysis. In blood cell fractions separated by the Ficoll-Paque/Macrodex method, polymorphonuclear leukocyte fraction contained the highest PP19 concentration. The circulating serum PP19 concentration was 4.5 +/- 1.1 ng/ml (mean +/- standard deviation) in the proliferative phase (n = 8) and 5.1 +/- 1.6 ng/ml in the secretory phase (n = 7) for nonpregnant women, and 4.6 +/- 2.2 ng/ml from men (n = 12). Seminal plasma (n = 8) contained 212.2 +/- 99.7 ng/ml. The maternal serum PP19 concentration in 291 normal pregnancies increased from 6.2 ng/ml (median) at 6-7 weeks of gestation to 34.1 ng/ml at 38-39 weeks. The mean PP19 concentration was higher in amniotic fluid and retroplacental blood, but lower in umbilical cord blood than that in circulating maternal serum. In hydatidiform mole, vesicular fluid contained high PP19 concentration (1154.6 +/- 659.5 ng/ml), although these maternal serum concentration was not statistically higher than normal range. The chorionic villous trophoblast contained more PP19 than decidua, chorion, and amnion. These results suggest that PP19 has an extraplacental source, even though the chorionic villous trophoblast may be the main source throughout pregnancy.

Angiographic response to a vasodilating drug, nicorandil, in patients with coronary artery disease

To investigate the usefulness of nicorandil as an antianginal drug, we compared the coronary vasodilatory response in nonstenotic coronary artery segments and the hemodynamic response in 26 coronary artery disease patients. Both responses were studied prior to sublingual administration of 10 mg of this drug and 10, 30 and 60 min afterward. The plasma nicorandil concentration was determined up to 120 min after administration. The mean coronary dilating ratio of nicorandil was 117% 30 min after administration (p less than 0.01) and showed a good correlation to the plasma nicorandil concentration. The mean maximum dilating ratio of each patient was 125%. There was no difference between individual coronary arteries or between proximal and distal segments in terms of the coronary artery dilating ratio. The plasma nicorandil concentration required for 120% dilation of the coronary arteries was 26 ng/ml, 89 ng/ml and 142 ng/ml for those cases with variant angina, exertional angina and postinfarction angina, respectively. Hemodynamic changes due to administration of this drug included a decrease in blood pressure, and a reduction in total peripheral resistance, rate-pressure product, pulmonary capillary pressure and stroke-work index. These results indicate that the antianginal effects of nicorandil are derived from its coronary vasodilatory action and an inhibitory effect on myocardial oxygen consumption.

Comparative study of placental protein 19, human chorionic gonadotrophin and pregnancy-specific beta 1-glycoprotein as immunohistochemical markers for extravillous trophoblast in pregnancy and trophoblastic disease

PP19, a new placental tissue protein, has alpha 1-beta 1 electrophoretic mobility, a molecular weight of 36,500 and 3.9% carbohydrate. To study immunocytochemical PP19 localization in extravillous trophoblast, we obtained formalin-fixed specimens from extravillous tubal pregnancy at gestational weeks (GW) 7-9 (12 blocks); four early intrauterine pregnancies at GW 7-13 (12 blocks); four late pregnancies at GW 28-38 complicated with intramural uterine myoma, placenta increta and abruptio placenta (8 blocks); four invasive complete moles (9 blocks); and seven primary and metastatic gestational choriocarcinomas (12 blocks). Immunohistochemical staining was done for PP19, pregnancy-specific beta 1-glycoprotein (SP1) and human chorionic gonadotrophin (hCG) using the indirect-labeled antibody method [purified PP19 (Lot no. 225/242) and antibody against PP19 (Lot no. 632ZA) prepared by H. Bohn, antibodies against hCG (Behringwerke, Marburg, FRG) and SP1 (Dakopatts, Copenhagen, Denmark)]. In both early and late intrauterine pregnancies, the extravillous syncytiotrophoblastic cell (XST) showed positive staining for hCG and SP1 in the cytoplasm, as well as for PP19, which stained more intensively in the nucleus than in the cytoplasm. The three proteins were not seen in the evtravillous cytotrophoblastic cell (XCT) in the trophoblastic cell column and shell. The interstitial cytotrophoblast-like cell (ICT), which infiltrated into the decidua and myometrium, and their blood vessels, was immunoreactively positive for PP19 but negative for hCG and SP1 with the exception of SP1-positive ICT in the myometrium in late pregnancy. XST and ICT in the endosalpinx of tubal pregnancy stained for all three proteins.(ABSTRACT TRUNCATED AT 250 WORDS)

Molecular cloning and characterization of MACIF, an inhibitor of membrane channel formation of complement

Human erythrocytes contain a membrane protein, MACIF, which inhibits the formation of a membrane attack complex (MAC) of complement. We have cloned and sequenced the complementary DNA of MACIF messenger RNA. The amino acid sequence predicted from its nucleotide sequence consists of 128 amino acids. The amino-terminal 25 residues may correspond to a signal peptide. The carboxy-terminal sequence confirmed that MACIF is a glycosylphosphatidylinositol (GPI)-anchored protein. The amino acid sequence of MACIF was partially determined by established techniques for protein chemistry and the resultant sequence was consistent with that predicted from the nucleotide sequence. The results of sequence analyses also suggested that asparagine at the 18th position was N-glycosylated. When mRNA obtained from the MACIF cDNA clone with SP6 RNA polymerase was microinjected into Xenopus oocytes, the oocytes synthesized a product which exhibited MACIF activity and reacted with anti-MACIF antibody. Comparison of the predicted sequence revealed significant homology with mouse Ly-6 antigens.

Effect of intravenous streptokinase as compared with that of tissue plasminogen activator on left ventricular function after first myocardial infarction

In a double-blind trial comparing two thrombolytic agents as treatment for acute myocardial infarction, we randomized 270 consecutive patients an average (+/- SD) of 2.5 +/- 0.6 hours after the onset of chest pain from a first myocardial infarction--135 to receive intravenous streptokinase (1.5 million units over 30 minutes) and 135 to receive intravenous recombinant tissue plasminogen activator (rt-PA) (100 mg over three hours). The primary end point was left ventricular function as assessed by cineangiography performed three weeks after infarction. The effects of the two agents on left ventricular function were similar. The ejection fraction was identical (58 +/- 12 percent) in both groups. The end-systolic volume was 61 +/- 29 ml in the streptokinase group and 66 +/- 31 ml in the rt-PA group (P not significant). Patency rates at three weeks for the infarct-related artery were also similar (75 percent in the streptokinase group and 76 percent in the rt-PA group). Reinfarction rates at 30 days were the same (5 percent) in both groups. One patient had a fatal intracerebral hemorrhage 13 hours after receiving rt-PA, and another had a fatal cerebellar hemorrhage 21 hours after receiving rt-PA for reinfarction nine days after treatment with streptokinase. An intention-to-treat analysis revealed that mortality at 30 days was 3.7 percent in the rt-PA group as compared with 7.4 percent in the streptokinase group (P greater than 0.2). Follow-up for a mean of 9.0 months revealed no significant difference in survival; we observed 12 deaths (8.9 percent) in the streptokinase group and 8 deaths (5.9 percent) in the rt-PA group (P = 0.34). We conclude that rt-PA and streptokinase, in the doses given, have similar effects on left ventricular function after a first myocardial infarction. Because of the small number of deaths, it is not possible to determine whether their effects on mortality are similar.

Comparative restriction endonuclease analysis of varicella-zoster virus clinical isolates

The DNAs of 67 isolates of varicella-zoster virus (VZV) obtained from 31 individuals were compared by restriction endonuclease analysis using BamHI, EcoRI, PstI and SmaI. All of the epidemiologically unrelated 26 isolates could be differentiated using SmaI and another one or two enzymes. However, the DNA cleavage profiles of multiple VZV isolates from the same patient and the isolates from a group of patients who were infected with VZV from the same source were found to be identical to each other, as reported previously. No patients were found who were simultaneously infected with different VZV strains. Moreover, VZV showed no change in DNA fragment profiles after serial passages not only through human embryonic lung cells but also through patients.

Coronary artery-left ventricular fistulae with atrial septal defect

We describe a 65-year-old woman who had coronary artery-left ventricular fistula associated with atrial septal defect of the sinus venosus type, and left-sided heart failure. Although a cardiac valve anomaly associated with coronary artery fistula has been described, atrial septal defect has not been reported previously in this condition.

[Radiotherapy for T1 and T2 carcinomas of the tongue: combination therapy using low-dose external irradiation and an interstitial implant]

Between January 1975 and October 1984, 114 previously untreated patients with squamous cell carcinoma of the tongue were treated by a radical course of irradiation at the Jikei University Hospital. Of these patients, eighty with T1 or T2 lesions are analyzed in this paper, some having been treated with an interstitial implant alone or with a combination of external irradiation and an interstitial implant. The two-year local control rate of the primary lesion reached 85% in T1 patients, and 68% for those graded T2. Late radiation injuries were seen in 18% of the cases with local control beyond one year. Most of these injuries, however, healed with conservative therapy. The cumulative 5-year survival rate was 75% in T1 patients, and 52% for those graded T2. The combination of low dose external irradiation (20-30 Gy) and an interstitial implant showed the same local control rate, the same incidence of late injury, and the same survival rate as those who received an interstitial implant alone. In cases that were given combination therapy, the sum dose of about 80 Gy was necessary for local control.

Postsystolic shortening of acutely ischemic canine myocardium predicts early and late recovery of function after coronary artery reperfusion

Postsystolic shortening and thickening of ischemic and postischemic myocardium are well-recognized phenomena, but their significance is controversial. To discover whether postsystolic shortening and thickening might represent an active process and to establish their place as possible predictors of functional recovery during and after recovery from ischemia, we examined correlations in severely ischemic dyskinetic myocardial segments in 14 open-chest anesthetized dogs (90 minutes' ischemia, n = 9; 180 minutes' ischemia, n = 5) between the magnitudes of postsystolic shortening and thickening during ischemia and either the magnitudes of systolic shortening and thickening in the same segments before coronary occlusion or the magnitudes of shortening and thickening at 30-60 minutes and at 2-3 weeks after reperfusion. We found positive correlations between preocclusion shortening and postsystolic shortening (r = 0.44, n = 33 myocardial segments; p less than 0.02) and between preocclusion thickening and postsystolic thickening (r = 0.73, n = 13 segments; p less than 0.01), both measured at 5 minutes after onset of ischemia. Strong correlations were found also between postsystolic shortening and thickening measured immediately before reperfusion and systolic shortening and thickening measured after recovery at 2-3 weeks (r = 0.73, n = 28; p less than 0.001 for shortening; r = 0.79, n = 12; p less than 0.01 for thickening). Significant but less-exact correlations were found between postsystolic shortening and thickening measured immediately before reperfusion and early recovery of shortening and thickening at 30-60 minutes after reperfusion (during the "stunned myocardium" period). Postsystolic shortening and thickening persisted early after reperfusion in dogs that had had 90 minutes of ischemia, and this predicted further significant return of function at 2-3 weeks. However, dogs that had had 180 minutes of ischemia did not have postsystolic shortening or thickening during early recovery and showed no further return of function at 2-3 weeks. The magnitudes of postsystolic shortening and thickening immediately before reperfusion were better predictors of late return of function than the histological appearance of the ischemic segments at 2-3 weeks or the magnitude of their blood flow during ischemia (15 +/- 3 micron microspheres). From correlations made immediately before reperfusion with those at functional recovery after reperfusion, we conclude that postsystolic shortening and thickening of dyskinetic myocardial segments are markers of their potential for recovery.(ABSTRACT TRUNCATED AT 400 WORDS)

Placental protein 21. Localization in human placenta and concentrations in the body fluids of men and nonpregnant and pregnant women

The immunohistochemical localization of placental protein 21 (PP21) was marked in the syncytial brush border and basal membrane during the 1st and 2nd trimesters of pregnancy and also in the chorionic epithelial brush border and basement membrane at term. A weaker stain was found in the cell membranes of amniotic epithelial and chorionic trophoblast cells. Neither heparin nor changes in temperature significantly influenced PP21 concentration. Relatively high serum PP21 concentrations were measured during the follicular and luteal phases in healthy nonpregnant women and in healthy men whose seminal plasma also showed a high PP21 concentration. Serum PP21 levels in normal pregnancy rose from a median of 29.1 ng/ml at 6-7 weeks of gestation to 82.0 ng/ml at 36-37 weeks of gestation. Although maternal urine showed low PP21 levels during pregnancy, amniotic fluid PP21 levels were higher at 7-21 weeks of gestation than at term. Cord blood sera showed almost the same PP21 concentration as maternal sera, but retroplacental blood showed much higher levels. Maternal serum PP21 levels in hydatidiform mole patients did not differ from the normal pregnancy range, although their molar vesicular fluids contained higher PP21 concentrations. These results suggest an extraplacental source for PP21.

Characteristic differences in immunohistochemical localization of new placental proteins (PP1, PP19, PP21) in the human placenta

The immunohistochemical localization in the human placenta of new placental proteins PP1, PP19, and PP21 was clarified using modified indirect enzyme-labeled antibody method and compared with that of pregnancy-specific beta 1-glycoprotein (SP1). The major results are as follows: positive staining for PP1 was seen at the nucleus and cytoplasm of villous cytotrophoblasts, the X cells at the basal plate, and of chorionic trophoblasts, while the decidua cells and amnion were not stained. PP19 was characteristically seen in the nucleus and cytoplasm of syncytiotrophoblasts. X cells in basal plate, chorionic trophoblasts, and maternal leukocytes. The villous cytotrophoblasts, decidua cells, and amnion were not stained. PP21 localization was found at the microvilli and basal membrane of syncytiotrophoblasts and at the cytotrophoblast plasma membrane of the chorionic villus in early gestation. In late gestation, increased staining was seen at the syncytiotrophoblast microvilli and the villous basement membrane, and moderate staining at plasma membrane of the amniotic epithelium and chorionic trophoblasts. SP1 was found only at the syncytiotrophoblast cytoplasm of chorionic villi. Studies using these four placental proteins simultaneously may therefore provide a new key learning about unknown metabolic functions of trophoblasts.

Post-systolic shortening: a marker of potential for early recovery of acutely ischaemic myocardium in the dog

Regional diastolic wall motion was studied with sonomicrometry in 30 open chest anaesthetised dogs after left anterior descending stenosis or occlusion. Post-systolic shortening and thickening, defined as the magnitude of segment shortening or wall thickening that occurred after end systole, was measured in peripheral and central ischaemic segments. These post-systolic events developed concurrently with impaired systolic shortening or thickening, either immediately after acute coronary occlusion or during progressive stenosis, and persisted with the development of dyskinesis and during reperfusion. The magnitude of these events in dyskinetic segments of 24 dogs was considerable, reaching 50(2)% (mean(SEM)) and 33(3)% of shortening or thickening that was present before coronary occlusion. Post-systolic shortening and thickening were maximum at 100(2) ms after peak negative dP/dt. Significant correlations were found between systolic shortening or thickening before coronary occlusion and post-systolic shortening (r = 0.74, 56 segments) or thickening (r = 0.84, 19 segments) after occlusion, but there was no correlation between post-systolic shortening or thickening and dyskinetic lengthening or thinning. In seven dogs followed for 4 h after coronary occlusion post-systolic shortening fell by 15% in peripheral segments and by 70% in central segments (p less than 0.002). In 17 dogs reperfused after 60 (n = 9) or 90 (n = 8) min of coronary occlusion the maximal recovery of systolic shortening early after reperfusion was significantly related to the magnitude of post-systolic shortening immediately before reperfusion (60 min occlusion r = 0.84, 90 min occlusion r = 0.88). These data show that post-systolic shortening is a marker of potential for early recovery of function of acutely ischaemic myocardium and suggest that it is due, at least in part, to an active process.

Effect of intravenous streptokinase on left ventricular function and early survival after acute myocardial infarction

In a double-blind trial of streptokinase for acute myocardial infarction, 219 consecutive patients presenting with infarction within four hours (mean, 3.0 +/- 0.8) of the onset of chest pain were randomly assigned to treatment with streptokinase (1.5 million units) or placebo, given intravenously over 30 minutes. The primary end point of the study was left ventricular function in patients with first infarctions. Patients who could undergo beta-blockade also received intravenous propranolol. Heparin (for 48 hours) and a combination of low-dose aspirin and dipyridamole were administered to both groups until cineangiography was performed at three weeks. In the patients with first infarctions treated with streptokinase, the left ventricular ejection fraction was 6 percentage points higher (streptokinase vs. placebo, 59 +/- 10.5 vs. 53 +/- 13.5 percent; P less than 0.005), with benefit to patients with either anterior infarction (57 +/- 11.9 vs. 49 +/- 15.9 percent; P less than 0.05) or inferior infarction (60 +/- 9.1 vs. 55 +/- 11.3 percent; P less than 0.05). Left ventricular function was improved regardless of whether concomitant propranolol was given. Survival (at 30 days) was improved with streptokinase: 2 deaths occurred among 79 patients who received this drug, as compared with 12 deaths among 93 patients who received placebo (2.5 vs. 12.9 percent, P = 0.012). Rates of reinfarction (streptokinase vs. placebo, 3 vs. 1 percent) and requirements for surgery or angioplasty (7 vs. 5 percent) were similar in the two groups. We conclude that administration of intravenous streptokinase (1.5 million units) to patients with a first myocardial infarction results in improved left ventricular function and short-term survival.

[Results of fetoscopic examinations at our hospital]

From 1983 to 1985, antenatal diagnosis by fetoscopy under ultrasound guidance has been performed at our institute for 17 pregnant women between 15 and 34 weeks of gestation. Indications for fetoscopy were visualization of the fetus, placenta, and amniotic membrane for morphological anomaly and fetal blood sampling for coagulation disorder. The diagnosis, made by visual observation of the fetus, blood coagulation tests, and karyotyping revealed 12 normal fetuses and 5 abnormal fetuses (one having chromosome abnormality, one amniotic band syndrome, one cephalothracopagus, one Beckwith-Wiedemann syndrome, and one sacral tumor). Courses of pregnancy following fetoscopy resulted in four normal full-term deliveries, six premature deliveries due to four hydramnions and two spontaneous ruptures of the membrane more than 14 weeks after fetoscopy. Three other pregnancies were interrupted due to intrauterine fetal death 11 weeks after fetoscopy in one case and to therapeutic abortion for maternal complications such as toxemia of pregnancy in two cases. The outcome of one case was unknown because the mother had moved away. The other pregnancy is still under observation at the third trimester. Although no complications in the fetuses were seen following fetoscopy, complications in the mothers included two cases of genital bleeding, one case of amniotic fluid leakage, and one cases of abruption of the fetal membrane. Symptoms in all four cases disappeared during several days of bed rest. These results demonstrate the importance of fetoscopy in prenatal diagnosis.

Diagnostic reliability of simultaneous measurements of beta human chorionic gonadotropin and pregnancy-specific beta-1-glycoprotein in serum of patients with trophoblastic disease

Serum levels for beta-human chorionic gonadotropin (beta-hCG) and pregnancy-specific beta 1-glycoprotein (SP1) in patients with trophoblastic disease were measured by radioimmunoassay and enzyme-linked immunosorbent assay. The beta-hCG:SP1 ratios were below 1.0 in all 22 cases of complete hydatidiform mole and in 8 of 9 cases of partial hydatidiform mole. Two (10.5%) of 19 cases of invasive mole involving metastasis had ratios that rose above 1.0 during chemotherapy. Ratios ranged from 1.6 to 29 in 11 of 15 cases of choriocarcinoma before chemotherapy. The remaining 4 cases, diagnosed within 3 months of antecedent pregnancy, had ratios below 0.99. Thus, the difference between choriocarcinoma and nonchoriocarcinoma beta-hCG:SP1 ratios may be due to trophoblastic differentiation based on the developmental stage and with trophoblast age, or due to the mass and potential activity of trophoblastic cells.

Serum concentration of placental proteins (PP5 and PP10) in toxemia of pregnancy as related to intrauterine growth retardation

Maternal serum concentrations of placental proteins 5 (PP5) and 10 (PP10) were measured by radioimmunoassay in 568 samples obtained from 308 healthy pregnant women and 63 women having toxemia of pregnancy. Below-normal PP5 values were more widely distributed in the mild than in the severe toxemia group, while the incidence of above-normal PP5 values was found only in the severe toxemia group. The incidence of below-normal PP10 values was higher in the severe than in the mild toxemia group. Our study thus suggests that simultaneous measurement of PP5 and PP10 concentrations in maternal serum in toxemia of pregnancy is a useful monitoring technique for predicting progressive pathological change and placental dysfunction related to IUGR.