[The significance of heparin concentration measurement during cardiopulmonary bypass--effect of heparin-coated circuit during normothermic bypass]

Recently, use of heparin-coated circuits during normothermic cardiopulmonary bypass has become a trend in cardiovascular surgery. In light of this, heparin administration protocols during bypass should be reevaluated. In twenty patients who underwent cardiac surgery using a heparin-coated circuit under normothermia, heparin concentration was measured with Hepcon/HMS. Before initiating bypass, 300 IU/kg of heparin was administered with additional heparin to maintain activated clotting time (ACT) at more than 400 seconds. The heparin dose response (HDR) was measured before heparin administration. HDR is a heparin concentration calculated to correspond to an ACT of 480 seconds. As an index of heparin control during bypass, average heparin concentration/HDR (HC/HDR) was calculated. HC/HDR was correlated with Fibrinogen degradation products E (R = -0.52). D dimer (R = -0.45). Thrombin antithrombin complex (R = -0.54). Antithrombin III (R = 0.50) and platelet number (R = 0.44), but not with 24-hour postoperative blood loss. In conclusion, even when using a heparin-coated circuit plasma coagulation activity was not sufficiently suppressed by use of a conventional ACT monitoring protocol during normothermic bypass. Therefore, the maintenance of HC/HDR at a higher level may be indicated.

p21 expression as a predictor for favorable prognosis in squamous cell carcinoma of the lung

Although p21 WAF1/Cip1 expression has been detected immunohistochemically in non-small cell lung cancer (NSCLC), the associations between p21 expression and clinical characteristics are unknown. To determine the association between p21 expression and clinical features, p21 expression was immunohistochemically analyzed in paraffin-embedded tumor samples from 137 patients with curatively resected NSCLC. p21 expression, indicating normal p21 function, was detected in 48 (35.0%) of the 137 patients with curatively resected NSCLC and was detected more frequently in patients with stage I or II disease (40.2%) than in those with stage IIIA disease (22.5%; P = 0.0483). There was no difference in the positive rate between squamous cell carcinoma [SCC; 15 of 48 (31.3%)] and adenocarcinoma [30 of 77 (39.0%)]. For SCC, patients with tumors expressing p21 survived longer than did those with tumors negative for p21 expression; however, the corresponding survival time was not significant for adenocarcinoma. On the other hand, p53 expression, detected in 58 (42.3%) of these patients, did not act as any predictor for prognosis in either SCC or adenocarcinoma. Our findings suggest that the presence of p21 expression is associated with favorable prognosis in SCC and may be useful in obtaining candidates for adjuvant therapies from among patients with SCC.

Large-scale immunohistological staining using polyethylene glycol-embedded sections mounted on 96-well plates for monoclonal antibody screening

We have developed a rapid, large-scale immunohistological staining method for monoclonal antibody screening. Sections embedded in polyethylene glycol are mounted on 96-well plates and then subjected to immunological procedures using a 96-well format. With this method, we can prepare 10 plates (960 samples) in 1 day and then perform immunohistological procedures in 1 day by using an enzyme-linked immunosorbent assay-like 96-well format. Thus, we can avoid difficulties seen in conventional immunohistological methods that use sections mounted on glass slides. This method offers high-throughput screening of monoclonal antibodies. In addition, it has the potential of being automated.

Prognostic significance of serum p53 antibodies in squamous cell carcinoma of the lung

BACKGROUND

The prognostic significance of serum p53-Abs positivity for non-small cell lung cancer (NSCLC) is still unknown.

PATIENTS AND METHODS

To determine the prognostic value of serum p53-Abs status, we determined serum p53-Abs and immunohistochemistry in 140 patients with stage I-IIIA NSCLC.

RESULTS

p53-Abs were detected in 12.1% of all patients and in 17.6% of those with squamous cell carcinoma (SCC). Neither p53-Abs nor p53 overexpression alone was correlated with survival for all patients. When these factors were combined for SCC, seronegative patients with tumors overexpressing p53 survived significantly longer than did those with p53-Abs or p53-nonexpressing tumors. In multivariate analysis, p53-Abs status and p53 overexpression were independent prognostic factors for SCC (p = 0.0337).

CONCLUSIONS

These findings suggest that the combination of p53Abs seropositivity and p53 overexpression may be a prognostic factor for SCC.

Transcutaneous needle biopsy of the lung

PURPOSE

To evaluate the usefulness of transcutaneous needle biopsy (TCNB).

MATERIAL AND METHODS

From May 1988 to December 1994, we performed TCNB under fluoroscopic control in 408 patients with mass lesions of the peripheral lung. The Surecut needle (1.5 mm) was selected mainly because of its ability to obtain specimens large enough for histological examination. Of the 408 patients, 286 had had previous bronchofiberscopic examinations but no definite diagnosis had been reached.

RESULTS

A definite diagnosis was obtained by TCNB in 305 (74.7%) of 408 cases (251 malignant neoplasms, 54 benign lesions). In malignant neoplasms, the pathological diagnosis based on cytology and histology together was more reliable than that based on cytology alone. Although the complications of this procedure (such as pneumothorax) were within the range of acceptability, care should be taken to avoid air embolism and the seeding of cancer cells along the needle tract.

CONCLUSION

TCNB with the Surecut needle is a useful procedure with relatively low risk.

Analysis of the functional domain of the rat liver mitochondrial import receptor Tom20

Tom20 is an outer mitochondrial membrane protein and functions as a component of the import receptor complex for the cytoplasmically synthesized mitochondrial precursor proteins. It consists of the N-terminal membrane-anchor segment, the tetratricopeptide repeat (TPR) motif, a charged amino acids-rich linker segment between the membrane anchor and the TPR motif, and the C-terminal acidic amino acid cluster. To assess the functional significance of these segments in mammalian Tom20, we cloned rat Tom20 and expressed mutant rat Tom20 proteins in Deltatom20 yeast cells and examined their ability to complement the defects of respiration-driven growth and mitochondrial protein import. Tom20N69, a mutant consisting of the membrane anchor and the linker segments, was targeted to mitochondria and complemented the growth and import defects as efficiently as wild-type Tom20, whereas a mutant lacking the linker segment did not. In vitro protein import into mitochondria isolated from the complemented yeast cells revealed that the precursor targeted to yeast Tom70 was efficiently imported into the mitochondria via rat Tom20N69. Thus the linker segment is essential for the function of rat Tom20, whereas the TPR motif and the C-terminal acidic amino acids are not.

Binding of mitochondrial precursor proteins to the cytoplasmic domains of the import receptors Tom70 and Tom20 is determined by cytoplasmic chaperones

We have reconstituted the early steps of precursor targeting to mitochondria in a defined and soluble system consisting of the cytosolic domains of the yeast mitochondrial import receptors Tom20 and Tom70, precursor to bovine adrenal adrenodoxin (which has a cleavable targeting signal) and rat liver cytosolic chaperones hsp70 and mitochondrial import-stimulating factor (MSF). The Tom70 domain only bound the precursor in the presence of MSF, yielding a precursor-MSF-Tom70 complex; ATP hydrolysis by MSF released MSF and generated a precursor-Tom70 complex whose formation was inhibited by an excess of a functional presequence peptide, but not by 150 mM NaCl. In the presence of the Tom20 domain, ATP caused transfer of the precursor from the precursor-MSF-Tom70 complex to Tom20. The Tom20 domain alone only bound the precursor in the presence of hsp70; hsp70 itself was not incorporated into the resulting complex. Formation of the Tom20-precursor complex was inhibited by excess presequence peptide or by 150 mM NaCl. Similar results were obtained with the ADP/ATP carrier and porin precursors, which both lack a cleaved targeting signal. Correct targeting of a precursor to mitochondrial import receptors thus requires cytosolic chaperones, irrespective of the presence or absence of a cleavable presequence.

[Early repair of ventricular septal rupture in patients over 80 years of age: infarction exclusion technique]

Since 1994, three patients more than 80 years of age underwent early repair of ventricular septal rupture complicating acute myocardial infarction at our hospital. The infarction exclusion technique introduced by David and Komeda was employed. Average aortic clamp time, cardiopulmonary bypass time and operation time were 83 minutes, 129 minutes and 228 minutes, respectively. No hemostatic suture were required to the left ventricular suture line. All patients survived. One patient with posterior ventricular septal rupture had residual shunt and necessitated transient hemodialysis but recovered. Thus, the infarction exclusion technique seems to be useful in the elderly with unfavorable tissue fragility.

Inhibitory effects of persimmon (Diospyros kaki) extract and related polyphenol compounds on growth of human lymphoid leukemia cells

We have investigated the effects of persimmon (Diospyros kaki) extract (PS) and related polyphenol compounds such as catechin (C), epicatechin (EC), epicatechingallate (ECG), epigallocatechin (EGC), and epigallocatechingallate (EGCG) on the growth of human lymphoid leukemia Molt 4B cells. We found that PS, ECG, EGC, and EGCG strongly inhibited the growth of the cells in a dose-dependent manner, while C and EC inhibited the growth of the cells only moderately. Ornithine decarboxylase (ODC), a rate-limiting enzyme of polyamine biosynthesis, was inhibited by 10-20% by these polyphenol compounds. The morphology of the Molt 4B cells indicated severe damage 3 days after treatment with PS, ECG, EGC, and EGCG. Irregular shape of the cells and DNA fragmentation were observed in PS, ECG, EGC, or EGCG-treated cells. These results suggest that PS, ECG, EGC, and EGCG induce apoptosis (programmed cell death) of Molt 4B cells.

[Hypercoagulable state in Duchenne muscular dystrophy]

Pulmonary and cerebral infarctions have come to be noticed as life-threatening complications of Duchenne muscular dystrophy (DMD). In order to elucidate the underlying mechanism of hypercoagulable state, was studied following markers of coagulation and fiblinolysis in 69 DMD and 50 control patients showing no signs of thrombosis: prothrombin time, activated partial thrombin time, thrombotest, fibrinogen, fibrinogen degradation product, thrombin-antithrombin III complex (TAT), alpha 2-plasmin inhibitor plasmin complex (PIC), D-dimer, protein C activity, protein S, antithrombin III, XII factor, thrombomodulin and plasminogen activity. 66 out of 69 patients (96%) showed abnormal results in more than one of these studies, among which abnormally low thrombotest (78%), high TAT (61%) and high PIC (40.3%), were very frequently observed. The results were not correlated to the age, the activity of daily living and the respiratory of cardiac functions. Significantly smaller number of the control patients suffering from other neuromuscular diseases showed abnormal results, while the ambulatory DMD patients not infrequently showed hypercoagulable state. These results strongly suggest that unknown inherent factor(s) as well as inevitable immobilization and cardiac dysfunction play(s) an important role in the development of hypercoagulable state in this intractable disorder.

A comparison of young and aged populations for the diphtheria and tetanus antitoxin titers in Japan

The antitoxin levels for diphtheria and tetanus were measured with samples of a young group immunized with diphtheria-tetanus-acellular pertussis combined vaccine and those of an aged group, members of which had not received vaccination in their youth. In the young group members of which had already received basic immunization with diphtheria-tetanus-acellular pertussis combined vaccine, the levels of both antitoxins rose well after injection at 11 to 12 years old with diphtheria-tetanus combined toxoids and remained high until 20 years of age. In the aged group, more than 80% showed antitoxin levels above 0.01 u/ml for diphtheria, while all had levels below that for tetanus, except three persons with confirmed tetanus immunization history. Maintenance of the protective antitoxin levels in the population by vaccination is necessary to prevent outbreaks of infection among unvaccinated or only partially immunized persons.

Metaxin is a component of a preprotein import complex in the outer membrane of the mammalian mitochondrion

Metaxin, a novel gene located between the glucocerebrosidase and thrombospondin 3 genes in the mouse, is essential for survival of the postimplantation mouse embryo. In this study, the subcellular location, domain structure, and biochemical function of metaxin were investigated. Anti-recombinant metaxin antibodies recognized 35- and 70-kDa proteins in mitochondria from various tissues; the 35-kDa protein is consistent in size with the predicted translation product of metaxin cDNA. When metaxin cDNA was transfected into COS cells, immunofluorescence staining demonstrated that the protein is located in mitochondria. Metaxin contains a putative mitochondrial outer membrane signal anchor domain at its C terminus, and a truncated form of metaxin lacking this signal anchor domain had a reduced association with mitochondria. In addition, metaxin was highly susceptible to proteases in intact mitochondria. We therefore conclude that metaxin is a mitochondrial protein that extends into the cytosol while anchored into the outer membrane at its C terminus. In its N-terminal region, metaxin shows significant sequence identity to Tom37, a component of the outer membrane portion of the mitochondrial preprotein translocation apparatus in Saccharomyces cerevisiae, but important structural differences, including apparently different mechanisms of targeting to membranes, also exist between the two proteins. Given the similar subcellular locations of metaxin and Tom37, the possible role of metaxin in mitochondrial preprotein import was investigated. Antibodies against metaxin, when preincubated with mitochondria, partially inhibited the uptake of radiolabeled preadrenodoxin into mitochondria. Metaxin is therefore the second mammalian component of the protein translocation apparatus of the mitochondrial outer membrane to be characterized at the molecular level and the first for which an inherited mutation has been described. The early embryonic lethal phenotype of mice lacking metaxin demonstrates that efficient import of proteins into mitochondria is crucial for cellular survival. The characterization of metaxin provides an opportunity to elucidate similarities and possible differences in the mechanisms of protein import between fungi and mammals and in the phenotypes of fungi and mammals lacking mitochondrial import receptors.

[Histological study of micrognathic development in mouse fetus induced by 3,3-dimethyl-1-phenyltriazene]

The purpose of this study was to investigate the influence of 3,3-dimethyl-1-phenyltriazene (DMPT) on development of craniofacial structures in mouse fetus. (1) Pregnant C57BL/6 mice were treated with 30 mg/kg DMPT injection on days 10.5 approximately 13.5 of gestation. The fetuses were analyzed on day 15.0. The incidence of micrognathia was formed 100% in the treated group on days 10.5 and 11.0, and then decreased remarkably after day 11.5. This result suggested that the critical period of micrognathic development is days 10.5 approximately 11.0. (2) The fetuses, injected 30 mg/kg DMPT on day 10.5, were sacrificed on days 11.0 approximately 18.0. Their heads were used for the following histomorphological analyses: 1. clearing and Alcian blue-alizarin red double staining and 2. lateral graphic reconstruction using serial frontal sections. Dysmorphology of the anterior portion of Meckel's and nasal septal cartilage became evident after day 13.0, however, nasal capsule cartilage was hardly affected. It was concluded that hypoplastic Meckel's cartilage, caused by the administration of DMPT, induced mandibular dysmorphogenesis.

[A case of extracardiac noncoronary sinus Valsalva aneurysm associated with aortic regugitation]

A case of extracardiac noncoronary sinus Valsalva aneurysm was reported. A 11-year-old male with history of mild AR was admitted to the hospital due to severe AR. Echocardiography revealed that the severe AR and an aneurysm in the posterior part of the ascending aorta. Angiography revealed that the origin of the aneurysm was noncoronary sinus. Operative findings showed that the aneurysm sized 23 mm by 25 mm was an extracardiac type which grew posteroinferiorily at the left side of noncoronary sinus and that the dilation. Neither aortic valve nor the aortic route showed degenerative change. The ptosis of the valvular ring due to aneurysmal dilation of the noncoronary sinus caused AR. Then, valve repair composed by commissuroplasty and commissural suspension was carried out. And intraluminal patch closure technique in which the longitudinal diameter of patch was half of that of the aneurysm was effective on suspension of the valvular ring. Postoperative echocardiography showed decreasing of AR.

Protein import into mammalian mitochondria. Characterization of the intermediates along the import pathway of the precursor into the matrix

We have characterized several intermediates in the mitochondrial import stimulation factor (MSF)-dependent import into mammalian mitochondria of a matrix-targeted precursor, preadrenodoxin (pAd). In the first step, pAd docks onto the 37-kDa protein of the outer membrane (OM37) as a complex with MSF (stage I intermediate). It is then transferred to the import pore of OM in the presence of ATP, but in the absence of Deltapsi across the inner membrane (IM), to form stage II intermediate. Depletion of matrix ATP in the presence of both extramitochondrial ATP and Deltapsi induces accumulation of stage III intermediate, which is a mixture of the precursor with different intramitochondrial localizations: the precursor whose presequence had crossed either OM (IIIa) or both OM and IM (IIIb), but with a bulk portion remaining exposed to the cytosol and the precursor whose presequence had crossed both membranes, but with a residual portion staying within the intermembrane space (IIIc). These intermediates are on the correct import pathway and are characteristic in their protease accessibility, salt extractability, and antibody accessibility, as well as in their energy requirement for the chase reaction.

[Chemotherapy of small cell lung cancer]

Chemotherapy of small cell lung cancer is reviewed. Combination chemotherapy with cisplatin/etoposide (PE) or CAV (cyclophosphamide, adriamycin and vincristine) alternating with PE was established as standard regimens. Dose intensive chemotherapy, such as weekly regimens or using G-CSF, is being investigated. In patients with limited disease (LD), combined modality treatment is proven to produce favorable results, but the best sequence or fractionation of thoracic radiotherapy is unknown. More progress in the treatment of small cell lung cancer is expected.

Induction of programmed cell death (apoptosis) in human lymphoid leukemia cells by catechin compounds

The need for antitumor compounds with novel mechanisms of action is great. The exposure of human lymphoid leukemia Molt 4B cells to epigallocatechin (EGC), epigallocatechin gallate (EGCG), and persimmon extract (PS) led to both growth inhibition and the induction of programmed cell death (apoptosis). The fragmentation of DNA to oligonucleosomal-sized fragments, characteristic of programmed cell death, was determined to be concentration- and time-dependent. These data provide the first evidence that catechin compounds and persimmon extract containing all these catechin compounds induce programmed cell death.

[Different mechanism may underlie respiratory failure of myotonic and Duchenne muscular dystrophies--a pulseoxymetric and spirometric study]

Respiratory failure is an important cause of death in many neuromuscular diseases. We studied the relationship between nocturnal hypoxemia and respiratory muscle weakness by nocturnal pulseoxymetry and spirometry in two major hereditary myopathies, myotonic and Duchenne muscular dystrophies (MD and DMD respectively). In DMD significant nocturnal periodic hypoxemia appears only in cases with vital capacity lower than 20% of its expected value, suggesting that % vital capacity is a useful index of early respiratory failure. In contrast there was no correlation between vital capacity and severity of hypoxemia in MD patients. Therefore, we conclude respiratory muscle weakness is a single important factor which determines the severity of respiratory failure in DMD, while another/other factor (s), such as disturbance of respiratory control or myotonia, may play an important role in MD.

Chlovalicin, a new cytocidal antibiotic produced by Sporothrix sp. FO-4649. II. Physicochemical properties and structural elucidation

A new growth inhibitor of IL-6 responsive MH60 cells, chlovalicin (MW; 332, C16H25O5Cl), was found in cultures of Sporothrix sp. FO-4649, together with a known sesquiterpene, ovalicin. The structure of chlovalicin was elucidated by spectroscopic methods. Chlovalicin possesses a chlorinated methylene moiety at the C-1 position, and it corresponds to halogenated products derived from the epoxide ring attached to the C-1 position of ovalicin. The absolute configuration of chlovalicin was clarified as 1S, 2R, 3S, 1'S, 2'R by chemical transformation from ovalicin.

Conversion of glutathione into cadystins and their analogs catalyzed by carboxypeptidase Y

Cadystins induced in a fission yeast treated with Cd2+ are the higher homologs of glutathione. In the present work, glutathione was incubated with Carboxypeptidase Y at a high substrate concentration. The reaction afforded not only the degraded product, but also cadystins and their analogs. A possible transformation pathway for glutathione by this enzyme is proposed.

Chlovalicin, a new cytocidal antibiotic produced by Sporothrix sp. FO-4649. I. Taxonomy, fermentation, isolation and biological activities

Selective growth inhibition against IL-6 dependent cells was detected in fermentation extracts of a fungal strain FO-4649 which was characterized as Sporothrix species. An active metabolite (1) termed chlovalicin was isolated together with ovalicin and two other ovalicin derivatives (compounds 3 and 4). Chlovalicin, a ovalicin derivative with a chlorinated methylene moiety at the C-1 position of the cyclohexane ring, dose-dependently inhibited the growth of IL-6 dependent MH60 cells (IC50, 7.5 microM) in the presence of 0.2 U/ml IL-6 and, to a lesser extent, the growth of B16 melanoma cells (IC50, 38 microM). Among the other three compounds, only ovalicin showed inhibitory activity (IC50, 27 microM) against MH60 cells. These four compounds did not show any antimicrobial activity at a concentration of 1000 micrograms/ml.

[Surgical treatment for subacute left ventricular free wall rupture complicating acute myocardial infarction--pericardial patch gluing method]

We reviewed 22 cases with surgical repair for subacute left ventricular free wall rupture complicating acute myocardial infarction. Different operative technique was used. Direct closure or patch repair with infarctectomy was preformed in first patients with a great difficulty in hemostasis. Since 1988 we sutured a large pericardial patch covering the infarcted myocardium under extra corporeal circulation in 11 patients (pericardial patch suture technique). From 1993 we began to glue a pericardial patch with Aron alpha without cardiopulmonary bypass (pericardial patch gluing technique). There were eight early death and four late death. Most common cause of death was low cardiac output syndrome (LOS). With medical therapy 13 patients in cardiogenic shock improved before surgery and only three developed postoperative LOS, but all six patients with sustained shock developed LOS without survivor (p = 0.007). Two of the five patients underwent direct closure or infarctectomy and seven of the 11 employed pericardial patch suture technique developed LOS, but none of the six used pericardial patch gluing technique developed LOS. Medical treatment such as intraaortic balloon pumping, catecholamine and subxyphoid drainage in order to improve hemodynamic condition before surgery is extremely important. Pericardial patch gluing technique seems to be useful since cardiac function would be maximally preserved.

Pro-gastrin-releasing peptide (31-98) as a tumour marker of small-cell lung cancer: comparative evaluation with neuron-specific enolase

We attempted to clarify whether serum levels of a carboxy-terminal fragment of ProGRP, ProGRP(31-98), could serve as a more accurate tumour marker in patients with SCLC than neuron-specific enolase (NSE). ProGRP(31-98) and NSE were measured retrospectively in 101 newly diagnosed untreated patients with SCLC, 111 with non-small-cell lung cancer (NSCLC) and 114 patients with non-malignant lung diseases. ProGRP(31-98) and NSE levels were determined using a sandwich enzyme-linked immunosorbent assay. Sensitivity in SCLC patients was 72.3% for ProGRP(31-98) and 62.4% for NSE. Comparing the area under curve (AUC) of 'receiver operator characteristics' of ProGRP(31-98) with that of NSE, ProGRP(31-98) was the more powerful marker in the diagnosis of SCLC (P = 0.0001). Serum levels of ProGRP(31-98) were higher in the 40 patients with extensive disease than in the 61 patients with limited disease (P = 0.0082). ProGRP(31-98) was significantly higher in patients with pure small-cell carcinoma than in patients with mixed small-cell/large-cell carcinoma (P = 0.02). In serial measurement in 16 patients responding to treatment, a high degree of correlation was noted between the decrease in serum ProGRP(31-98) levels and clinical response during the second week after treatment (P = 0.0045). These results indicate that the determination of serum ProGRP(31-98) levels plays an important role in the diagnosis and treatment of SCLC patients.