[Multiple endocrine neoplasia type 2A, type 2B and familial medullary thyroid carcinoma syndrome]

Recently, germline mutations in the RET proto-oncogene were found to be associated with multiple endocrine neoplasia (MEN) syndromes, MEN 2A, MEN 2B and Familial medullary thyroid carcinoma (FMTC). In patients with MEN 2A and FMTC different point mutations have been identified in exons 10 and 11 of the cysteine rich regions of RET. Patients with MEN 2B have a single point mutation (ATG to ACG) at codon 918 of RET. Therefore, a direct DNA testing has been developed to provide a highly accurate technique of detecting kindred members who have inherited a specific mutation associated with MEN 2A, MEN 2B or FMTC. In USA and Europe, prophylactic thyroidectomy has been performed on the basis of positive DNA testing, and the presence of a C-cell hyperplasia or a small medullary thyroid carcinoma was confirmed in each patient operated. Through nationwide survey in Japan, 233 patients with MEN 2 syndrome have been identified. They consisted of 180 MEN 2A, 18 MEN 2B, 13 FMTC and 22 unclassified patients. At follow-up, 47% of patients had recurrent medullary thyroid carcinoma and 5.7% of patients died of the disease. Genetic analysis was performed on 15 patients of 6 unrelated families in our series, and the results revealed that germinal mutations of RET as previously reported were also responsible for MEN 2 syndrome in Japanese. DNA analysis and prophylactic thyroidectomy for kindred members at risk for MEN 2 are likely to be beneficial in Japan as well.

In vitro and in vivo antibacterial activities of S-1090, a new oral cephalosporin

S-1090, a new oral cephalosporin, was active against selected gram-negative bacteria and methicillin-susceptible clinical isolates of Staphylococcus aureus, Staphylococcus epidermidis, and Staphylococcus warneri, against which it had excellent activity. S-1090 was the most active compound against Streptococcus pyogenes and Streptococcus agalactiae among the agents compared. The in vivo efficacy of S-1090 against systemic and urinary and respiratory tract infections caused by gram-positive and -negative bacteria was superior to that expected from the in vitro and in vivo activities of the agents against which it was compared.

Constitutive overexpression of the L-selectin gene in fresh leukemic cells of adult T-cell leukemia that can be transactivated by human T-cell lymphotropic virus type 1 Tax

L-selectin is an adhesion molecule of the selectin family that mediates the initial step of leukocyte adhesion to vascular endothelium. Upon cellular activation, expression of the L-selectin gene is downregulated at both the protein and mRNA levels. To understand the mechanism of leukemic cell infiltration into organs, we studied the expression and regulation of L-selectin mRNA in fresh leukemic cells of adult T-cell leukemia (ATL) patients and investigated the response of the L-selectin promoter to human T-cell lymphotropic virus type 1 (HTLV-1) Tax, which is a viral transcriptional transactivator. Flow cytometry showed that L-selectin was expressed on fresh ATL cells along with other activation antigens. Northern blot analysis showed that ATL cells overexpressed that L-selectin mRNA and that the level was aberrantly upregulated after PMA stimulation. Studies using in situ hybridization showed expression of the L-selectin mRNA in the infiltrating leukemic cells in the liver of two ATL patients. Intravenous injection of a rat T-cell line that overexpresses L-selectin showed increased organ infiltration. The induction of Tax expression in JPX9 cells resulted in about a twofold increase in the mRNA expression levels compared with the basal level. Chloramphenicol acetyltransferase (CAT) assay after transient cotransfection showed about a fivefold transactivation of the L-selectin promoter by Tax. The serum level of the shed form of L-selectin was significantly increased in ATL patients (mean +/- SD, 4,215.4 +/- 4,111 ng/mL) compared with those of asymptomatic carriers and healthy blood donors (mean +/- SD, 1,148.0 +/- 269.0 ng/mL and 991.9 +/- 224 ng/mL, respectively). These results indicated that ATL cells constitutively overexpress the L-selectin gene that can be transactivated by HTLV-1 Tax. The overexpression of L-selectin, as well as of inflammatory cytokines, by ATL cells may provide a basis for ATL cells to attach the vascular endothelium, leading to transmigration and organ infitration.

Management of multidirectional instability

Since 1980, several authors have reported successful treatment of multidirectional instability with use of the inferior capsular shift. Neer's initial report in a series of 32 patients noted only one unsatisfactory result. One decade later he reported that ¿more than 100 additional inferior capsular shifts have been done with similar satisfactory results.¿ The authors have reported preliminary results following 75 inferior capsular shifts performed in young athletes. Eighty-nine percent were able to return to their major sport while seventy-three percent maintained the same level of competitiveness. Seven patients (9.3%) reported a single episode of probable subluxation that was not followed by recurrent instability and did not affect the final result, whereas two patients (2.7%) dislocated postoperatively. Both of these cases were associated with a traumatic episode. The average loss of external rotation was 7 deg. Altchek and Warren reported their results following a T-plasty modification of the Bankart procedure for multidirectional instability in 42 shoulders. The patient population differed somewhat because 38 of the 42 cases had a Bankart lesion or detachment of the labrum and glenohumeral ligament complex. Patient satisfaction was rated excellent for 40 (95%) of the shoulders. The average loss of external rotation was 5 deg. Altchek and Warren noted that throwing athletes were unable to throw a ball with as much speed as before the operation. Additionally, 7 of 42 shoulders (16%) demonstrated 2+ or greater posterior instability postoperatively. There were four cases of symptomatic recurrent instability, one anterior and three posterior, while one patient required a posterior stabilization 2 years postoperatively. Recently Cooper and Brems' reviewed their series of 43 shoulders in 38 patients with a minimum 2-year follow-up after inferior capsular shift. Thirty-nine of 43 shoulders (91%) were rated by the patient as satisfactory with no recurrent instability. Postoperatively recurrent symptomatic instability developed in four patients (11%). Two of these patients required subsequent revision inferior capsular shifts and one of those went on to a humeral head replacement for arthritis of dislocation. The latter patient had received a prior Bristow procedure. Cooper and Brems concluded that the inferior capsular shift procedure provided satisfactory objective and subjective results. Failures and recurrences of symptomatic instability generally occurred in the early postoperative period less than 2 years following surgery. Their findings did not demonstrate a deterioration of the results, with a follow-up of 6 years. The authors recently reported the results after inferior capsular shift from classic multidirectional instability in 52 shoulders. Thirty-six shoulders were approached from the anterior side and 16 from posterior. All were completely immobilized in a brace for 6 weeks postoperatively. Forty-nine shoulders were observed over 2 to 11 years (average: 5 years). Satisfactory results were achieved in 94% of cases. Turkel and coworkers demonstrated that anterior glenohumeral stability is provided by varying regions of the capsule depending on arm position. Similarly, Warner and coworkers have recently demonstrated that inferior humeral translation is restrained by the anterosuperior capsule and ligaments with the arm at the side, and by the inferior capsule and ligaments with the arm in abduction. This is consistent with the clinical findings of Neer and Foster, who described inferior humeral translation with the arm at the side and with the arm in abduction in patients with multidirectional instability, and emphasized reducing redundant capsular volume on all sides at the time of surgical reconstruction. The capsular shift procedure eliminates laxity in the rotator interval, anterosuperior capsule, and anteroinferior capsule.(ABSTRACT TRUNCATED)

Role of LPS length in clearance rate of bacteria from the bloodstream in mice

Strains of Pseudomonas aeruginosa isolated from patients with cystic fibrosis (CF) never spread systemically. This may be due to serum sensitivity since these strains are very sensitive to complement-mediated bactericidal activity. A serum-resistant mutant, P. aeruginosa TUM3 HSR, was obtained from serum-sensitive strain TUM3 from a CF patient in order to clarify the mechanism of failure of systemic spread. LPS profiles on silver-stained gels and immunological analysis revealed that a long O-polysaccharide side chain was overproduced on the LPS molecules of TUM3 HSR as compared with the LPS of TUM3. The clearance rate from the bloodstream in mice was compared in the two strains. The number of TUM3 bacteria in 1 ml of blood, 10 min after injection into the tail vein, significantly decreased from 1.7 x 10(8) to 3.7 x 10(5) c.f.u. ml-1. In contrast, TUM3 HSR was not eliminated during the same period (decrease from 1.9 x 10(8) to 3.4 x 10(7) c.f.u. ml-1). Interestingly, these isogenic strains were not killed by 40% murine serum, probably reflecting immaturity of the complement-mediated killing system in mice. These results pointed to a correlation between LPS structure and blood clearance rate in mice. This was confirmed by examining blood clearance kinetics using the smooth-LPS strain Salmonella typhimurium LT2 and LPS-deficient mutants derived from it. S. typhimurium LT2 resisted blood clearance while the LPS-deficient mutants were cleared rapidly. None of the S. typhimurium strains were killed by murine serum. The number of P. aeruginosa TUM3 and S. typhimurium LPS-deficient mutants trapped in the liver following injection into the peripheral circulation was greater than that of their counterparts.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult T cell leukemia following HTLV-I-associated myelopathy/tropical spastic paraparesis: case reports and implication to the natural course of ATL

Adult T cell leukemia (ATL) is the T cell malignancy caused by human T lymphotropic virus type I (HTLV-I), and HTLV-I is also the causative agent of HTLV-I-associated myelopathy/tropical spastic paraparesis (HAM/TSP). Although HTLV-I causes both diseases, concomitant occurrence is reported to be rare. This paper describes two cases of HAM/TSP that developed into lymphoma-type ATL after the onset of HAM/TSP. In one case, the same HTLV-I infected clone could be detected by polymerase chain reaction in peripheral blood obtained when the patient was diagnosed as HAM/TSP. This finding showed that the HTLV-I clone already existed at the stage of HAM/TSP. Since frequent detection of clonal proliferation of HTLV-I infected cells has been reported previously in patients with HAM/TSP, careful follow-up is needed for patients with HAM/TSP.

Expression of AML1 and ETO Transcripts in hematopoietic cells

Recently, two genes, AML1 and ETO have been isolated from the chromosomal breakpoint of t(8;21). In this study, we isolated and identified fusion transcripts from a leukemic cell line carrying t(8;21). We demonstrated by PCR analysis that these transcripts are consistently expressed in fresh leukemic cells with t(8;21). On the other hand, the wild type of ETO is expressed in several hematopoietic cells from different lineage, while the expression of AML1 was present in all hematopoietic cells investigated. These widespread expression suggests these molecules play an essential role in hematopoiesis.

Effects of VA-045 on peripheral and central circulation in anesthetized dogs

1. The effects of VA-045, a novel apovincaminic acid derivative, vinpocetine, apovincaminic acid, brovincamine and nicergoline on peripheral and cerebral circulation were examined in anesthetized dogs. 2. Peripheral circulation: VA-045 induced a transient decrease in both blood pressure (BP) and heart rate (HR) andd an increase in vertebral arterial blood flow (VBF) without affecting femoral arterial blood flow (FBF) or carotid arterial blood flow (CBF). Vinpocetine had no effect on BP, HR, VBF, FBF or CBF. Apovincaminic acid decreased HR and increased VBF without affecting FBF, CBF or BP. Brovincamine increased VBF and decreased CBF without affecting BP or FBF. Nicergoline decrease BP without affecting VBF, FBA or CBF. 3. Cerebral circulation: VA-045 increased cerebral blood flow (CerBF) without affecting BP. Brovincamine also increased CerBF and decreased BP. The potency of VA-045 in increasing CerBF was stronger than that of brovincamine. Vinpocetine and apovincaminic acid had no effect on BP or CerBF. Nicergoline decreased BP but did not affect CerBF. 4. These findings indicate that VA-045 has a more selective vasodilative effect on the vertebral and cerebral arteries than the other reference drugs.

Arthroscopic evaluation and treatment of the rotator cuff

Arthroscopy has improved our diagnostic assessment of rotator cuff disease, especially in understanding patterns of articular surface partial-thickness tears. Arthroscopic subacromial decompression is a proven and reliable alternative to open acromioplasty. Despite continued controversy, most partial-thickness rotator cuff tears may be satisfactorily treated by arthroscopic debridement and decompression. The role for debridement and decompression without repair for full-thickness rotator cuff tears seems less than initially suggested, as several recent independent studies have documented results inferior to open repair. Arthroscopically assisted mini-open repair of small, full-thickness rotator cuff tears is a reliable procedure. Arthroscopic repair appears promising, but is not yet well enough documented to be considered a standard treatment.

Increased plasma alpha (1 --> 3)-L-fucosyltransferase activities in patients with hepatocellular carcinoma

Alpha (1 --> 3)-L-fucosyltransferase (alpha 1,3FT) activity was determined in plasma of patients with chronic liver diseases, namely, chronic hepatitis (CH), liver cirrhosis (LC) and hepatocellular carcinoma (HCC), The plasma alpha 1,3FT activity was significantly higher (p < 0.01) in chronic liver diseases than that in normal controls. The enzyme activity in plasma of patients with HCC was also significantly higher than that in LC (p < 0.05) or that in CH (p < 0.01). However, no significant difference was observed in the enzyme activity between LC and CH. Plasma alpha 1,3FT activity in patients with HCC was not significantly changed before and after transcatheter arterial embolization. In addition, the enzyme activity in the homogenate of the cirrhotic liver tissue was higher than that in the preparation of the hepatoma tissue in the same patient. These results suggest that the increased plasma alpha 1,3FT activity in patients with HCC reflects mainly the enzyme activity of cirrhotic liver tissue, not that of hepatoma tissue. The significance of the elevated levels of plasma alpha 1,3FT and its decreased hepatoma tissue activity in patients with HCC, compared with that in LC, remains to be clarified.

The influence of exo-enzyme S and proteases on endogenous Pseudomonas aeruginosa bacteraemia in mice

The role of Pseudomonas aeruginosa exo-enzymes was evaluated in a murine model of endogenous bacteraemia in which the bacteria invaded the bloodstream after oral dosing. Although an elastase mutant PAO-E64 was as virulent as its parent strain PAO1, an exo-enzyme S-deficient mutant, DG1-ExS5 and alkaline protease mutants PAKS-16, PAKS-17, PAKS-19, were less virulent than their parent strains, DG1 and PAKS-1, respectively (p < 0.01). Thus exo-enzyme S and alkaline protease, but not elastase, appear to contribute to the pathogenicity of P. aeruginosa in this model.

Spastic tetraplegia as an initial manifestation of familial Alzheimer's disease

Two sisters with familial Alzheimer's disease developed spastic gait disturbance as an initial manifestation. Their gait disturbance progressed gradually, followed by dementia a few years later. Post-mortem examination of one of the patients disclosed degeneration of the thalamus and corticospinal tract in addition to numerous senile plaques and neurofibrillary tangles in the neocortex, both of which were confirmed by immunohistochemistry. This is the first report in which clinicopathological evaluation is sufficient to establish a new variant of Alzheimer's disease presenting initially as spastic tetraplegia.

Staurosporine potentiates cAMP-mediated promoter activity of the vasoactive intestinal polypeptide gene in rat pheochromocytoma PC12 cells

The potent protein kinase inhibitor staurosporine enhances cAMP-mediated responses in human neuroblastoma cells as represented by neurite extension and induction of tyrosine hydroxylase. To explore how staurosporine regulates cAMP signaling pathway, we examined transcriptional activity of the human vasoactive intestinal polypeptide (VIP) gene promoter carrying a cAMP-responsive element. In PC12 cells stably transfected with a reporter plasmid, staurosporine alone had little effect; however, in combination with forskolin or dibutyryl cAMP, staurosporine dose-dependently (1-50 nM) enhanced cAMP-mediated transcription from the VIP gene promoter, which was comparable to that maximally induced by cAMP plus 12-O-tetradecanoylphorbol-13-acetate. This is the first report of potentiation of cAMP-mediated promoter activity by staurosporine in neuroendocrine cells.

The development of interneurons in the chick embryo spinal cord following in vivo treatment with retinoic acid

To investigate the role of retinoic acid (RA) in the development of interneurons in the spinal cord, we examined the expression of cellular retinoic acid binding protein type I (CRABP I). The earliest developing interneurons in the chick spinal cord can be divided into two major groups: circumferential (C) neurons and primitive longitudinal (PL) neurons. In brachial segments, both types of interneurons began to express CRABP I at stage (st.) 13+ of the V. Hamburger and H.L. Hamilton (1951, J. Morphol. 88:49-92) stage series, which is before the onset of axonogenesis. Subsequently, with the onset of axonal outgrowth, C neurons and PL neurons expressed CRABP I in their cell bodies, axons, and growth cones. The expression of CRABP I was developmentally regulated. CRABP I immunoreactivity gradually decreased after st. 36 (embryonic day [E] 10) such that no interneurons expressed this protein by E21. The transient expression of CRABP I during a period of intensive axonal growth suggested that RA may be involved in the development of interneurons. To test this idea, we implanted an all-trans RA-containing ion exchange bead into either rostral segments of the spinal cord at st. 12-13 or into caudal segments at st. 15-16, all stages that are well before the appearance of CRABP-I-positive neurons in these segments. In the RA-treated spinal cord, increased numbers of pyknotic cells were found predominantly in dorsal regions, presumably reflecting the death of neuroepithelial cells, C neurons and premigratory neural crest cells. Surviving C neurons in the RA-treated spinal cord extended their axons ventrally toward the floor plate as in control embryos. PL neurons also projected their axons rostrally or caudally in the RA-treated spinal cord, similarly to control embryos. However, the proportion of caudally projecting PL neurons was significantly increased in segments rostral to the RA-containing bead. These results suggest that RA may regulate the survival and axonal orientation (directionality) of subpopulations of spinal interneurons.

GAPO syndrome: report on the first case in Japan

We studied a 3.5-year-old Japanese boy with growth retardation, alopecia, pseudoanodontia, and bilateral papilledema. He was born of nonconsanguineous parents, but his paternal grandparents were related. From his characteristic physical manifestations, we diagnosed him as the first known case of GAPO syndrome in Japan and perhaps in the Mongoloid race. Our case had prominent dilatation of scalp veins and an audible intracranial bruit. Cranial angiography documented a narrowing of the sigmoid sinuses, with no flow to either jugular vein. We discuss here the relationships between optic atrophy and intracranial vascular changes in this syndrome.

Electron paramagnetic resonance studies of ferric cytochrome c' from photosynthetic bacteria

Electronic ground nature of ferric cytochromes c' isolated from five photosynthetic bacteria. Chromatium vinosum ATCC 17899, Rhodobacter capsulatus ATCC 11166, Rhodopseudomonas palustris ATCC 17001, Rhodospirillum molischianum ATCC 14031, and Rhodospirillum rubrum ATCC 11170 has been investigated by electron paramagnetic resonance (EPR) spectroscopy. EPR spectra indicate that the electronic ground state of five ferric cytochromes c' is a quantum mechanical admixed-spin state of a high spin (S = 5/2) and an intermediate spin (S = 3/2) at pH 7.2 and is high-spin state at pH 11.0. At physiological pH, however, the content of an intermediate spin state differs with the bacterial source of the protein: approximately 50%, Chromatium vinosum; approximately 40%, Rhodobacter capsulatus and Rhodopseudomonas palustris; approximately 10%, Rhodospirillum molischianum and Rhodospirillum rubrum. Computer simulation of the spectra supports this diversity of the contribution of an intermediate spin state. Model studies of the ferric porphyrin complexes suggest that the correlation between content of an intermediate spin state and heme iron displacement from the mean heme plane. Therefore, the variation of the content of an intermediate spin state observed in the present study reflects the subtle difference in the degree of heme iron displacement among the proteins.

Expression of NOR-1 and its closely related members of the steroid/thyroid hormone receptor superfamily in human neuroblastoma cell lines

Previously, we isolated a cDNA of neuron derived orphan receptor (NOR-1), a putative transcription factor with strong homologies to the orphan nuclear receptors NGFI-B and NURR1. In the present study, we examined the gene expression of NOR-1 as well as NGFI-B and NURR1 in human neuroblastoma cell lines by reverse transcription-polymerase chain reaction and nucleotide sequencing. Although the mRNAs of these orphan receptors were detected in all six neuroblastoma cell lines examined, basal expression levels of these genes varied among cell lines. Treatment with forskolin and 12-O-tetradecanoylphorbol-13-acetate rapidly increased the expression of all these genes in neuroblastoma NB-OK-1 cells. This induction did not require de novo protein synthesis, indicating that the NOR-1 gene as well as NGFI-B and NURR1 genes is an immediate-early gene. This is the first demonstration of NOR-1 gene expression in tumor cell lines.

In vitro selection and characterization of human immunodeficiency virus type 1 (HIV-1) isolates with reduced sensitivity to hydroxyethylamino sulfonamide inhibitors of HIV-1 aspartyl protease

Human immunodeficiency virus type 1 (HIV-1) variants with reduced sensitivity to the hydroxyethylamino sulfonamide protease inhibitors VB-11,328 and VX-478 have been selected in vitro by two independent serial passage protocols with HIV-1 in CEM-SS and MT-4 cell lines. Virus populations with greater than 100-fold-increased resistance to both inhibitors compared with the parental virus have been obtained. DNA sequence analyses of the protease genes from VB-11,328- and VX-478-resistant variants reveal a sequential accumulation of point mutations, with similar resistance patterns occurring for the two inhibitors. The deduced amino acid substitutions in the resistant protease are Leu-10-->Phe, Met-46-->Ile, Ile-47-->Val, and Ile-50-->Val. This is the first observation in HIV protease resistance studies of an Ile-50-->Val mutation, a mutation that appears to arise uniquely against the sulfonamide inhibitor class. When the substitutions observed were introduced as single mutations into an HIV-1 infectious clone (HXB2), only the Ile-50-->Val mutant showed reduced sensitivity (two- to threefold) to VB-11,328 and VX-478. A triple protease mutant infectious clone carrying the mutations Met-46-->Ile, Ile-47-->Val, and Ile-50-->Val, however, showed much greater reduction in sensitivity (14- to 20-fold) to VB-11,328 and VX-478. The same mutations were studied in recombinant HIV protease. The mutant protease Ile-50-->Val displays a much lower affinity for the inhibitors than the parent enzyme (< or = 80-fold). The protease triply mutated at Met-46-->Ile, Ile-47-->Val, and Ile-50-->Val shows an even greater decrease in inhibitor binding (< or = 270-fold). The sulfonamide-resistant HIV protease variants remain sensitive to inhibitors from other chemical classes (Ro 31-8959 and L-735,524), suggesting possibilities for clinical use of HIV protease inhibitors in combination or serially.

Degradation-resistant character of synthetic hydroxyapatite blocks filled in bone defects

The long-term changes of both the implanted hydroxyapatite (HA) blocks and the bone around them were observed radiologically to investigate the clinical usefulness of HA. HA blocks were used as a space filler in surgically created bone defects of seven cases due to curettage of bone tumours or removal for bone grafts, and they were followed up for 78 to 109 months. Bone formation around HA blocks peaked within 1 year after implantation, and then it faded gradually. However, shapes of HA blocks were rarely changed in all the cases. A clear zone around HA blocks was never observed . HA blocks were biocompatible and demonstrated a character resistant to degradation.

Blood-brain barrier disturbance following localized hyperthermia in rats

We investigated the morphological effect of hyperthermia on the blood-brain barrier (BBB). The heads of rats were heated locally using flood-lamps. BBB changes were assessed morphologically with horseradish peroxidase (HRP). Histological examinations were carried out 2 and 6 h, 1 and 3 days, and 1 week after the hyperthermia. The acute thermal lesions had three zones, i.e. a necrotic zone, a reactive zone and a permeable zone of viable brain tissue. HRP extravasation was seen in the necrotic zone and the permeable zone. Electron micrographic observation revealed HRP had entered the CNS through damaged endothelial cells and disruption of the tight junctions in the necrotic zone, and through numerous pinocytotic vesicles in the permeable zone. BBB opening to HRP was observed from 6 h to 3 days after hyperthermia.

A novel isoenzyme of ascorbate peroxidase localized on glyoxysomal and leaf peroxisomal membranes in pumpkin

A novel isoenzyme of ascorbate peroxidase with molecular mass of 31 kDa was found to be localized on membranes of microbodies. Intact microbodies had no latent ascorbate peroxidase activity, an indication that the active site of the ascorbate peroxidase was exposed to the cytosol and the peroxidase would scavenge hydrogen peroxide leaked from microbodies.