c-kit point mutation of extracellular domain in patients with myeloproliferative disorders

c-kit is a tyrosine kinase receptor whose ligand is stem cell factor (SCF). Gene alteration of the c-kit extracellular domain was analysed by polymerase chain reaction-single strand conformation polymorphism (PCR-SSCP) in 25 patients with myeloproliferative disorders (MPD). In the N-terminal part of the domain, mobility shifts indicating sequence alteration were detected in three of the patients, two primary myelofibrosis (PMF) and one chronic myelogenous leukaemia (CML). The subsequent sequencing revealed the same point mutations at codon 52 causing amino acid substitution (Asp-->Asn). To our knowledge this is the first report with a c-kit point mutation found in human fresh tumour cells.

[Detection of Helicobacter pylori by culture and the 13C-urea breath test using an automated breath 13C analyzer]

Up to now, the diagnosis of H. pylori infection has been made by the breath test using 13C-urea. In this study, 13C-urea breath samples were tested in 34 patients (peptic ulcer scar 17, chronic gastritis 17 cases) with an automated breath 13C analyzer (ABCA. Europa Scientific, Crewe, UK) and compared with the results of endoscopical diagnosis for H. pylori infection. Endoscopic and 13C-urea breath test (13C-UBT) were performed before eradicative medication. We described a modified protocol for the growth grade of H. pylori colonies in microbiology (H. pylori score), and for the delta 13C area under curve (AUC; permil*hr) obtained from each sample of expired breath. There was a significant correlation between delta 13C-AUC and the delta 13C level of each sample, but the correlation coefficient obtained at 10min (R2 = 0.582) was lower than that obtained at the other four time points (20min; 0.891, 30min; 0.949, 40min; 0.946, 50min; 0.946, 60min; 0.820). The delta 13C-AUC well correlated with H. pylori score (p < 0.01), none of 26 H. pylori positive patients detected by culture was 13C-UBT negative (delta 13C-AUC < 8.2 permil*hr in mean + 2SD of H. pylori negative group). In conclusion, 13C-UBT using ABCA has high sensitivity and specificity, and it provides a non-invasive method for the detection of H. pylori urease activity.

Diagnostic usefulness of postexercise systolic blood pressure response for detection of coronary artery disease in patients with electrocardiographic left ventricular hypertrophy

Patients with left ventricular (LV) hypertrophy often have a positive result on exercise testing despite a normal coronary arteriogram. This indicates that exercise-induced ST depression is not always an accurate indicator of the presence of coronary artery disease (CAD) in such patients. We evaluated the usefulness of the postexercise systolic blood pressure (BP) response for detection of CAD in 51 patients with both electrocardiographic evidence of LV hypertrophy and positive ST depression on treadmill exercise testing. Coronary cineangiograms showed normal coronary arteries in 23 patients (45%) (group 1) and significant CAD in 28 patients (55%) (group 2). The systolic BP ratio (systolic BP at 3 minutes of recovery divided by systolic BP at peak exercise) was significantly higher in group 2 than in group 1 (1.01 +/- 0.19 vs 0.80 +/- 0.09; p < 0.001). Analysis of the relative cumulative frequency revealed that a systolic BP ratio of 0.86 was the cutoff point for distinguishing a patient with CAD from one with normal coronary arteries. The sensitivity, specificity, and accuracy of a systolic BP ratio > or = 0.86 for detection of CAD in patients with LV hypertrophy were 79%, 83%, and 82%, respectively. Our results suggest that the use of an abnormal BP ratio, in combination with ST depression, improves the accuracy of treadmill exercise testing for detecting CAD in patients with electrocardiographic evidence of LV hypertrophy.

[Chorea with prominent spasticity associated with an expansion of the CAG trinucleotide repeat in the IT15 gene: a case report]

A 60-year-old female, who had been noted to have slowly progressive mental changes since the age of 40, subsequently developed irregular, abrupt, jerking movements of her limbs, and coordination and walking difficulty after 15 years. Her father, aunt and sister had also been suffering from similar involuntary movements and changes of personality. Neurological examination revealed slight dementia, choreic movements and the evidence of pyramidal tract signs; i.e., she showed general hyperreflexia of extremities, bilateral ankle clonus, and extensor plantar responses of lower extremities. laboratory data were all within normal ranges except iron deficiency anemia. Axial MRI showed moderate cortical atrophy, however, without dilatation of the frontal hours of lateral ventricles and the caudate head appeared normal. Our initial impression was dentatorubropallidoluysian atrophy (DRPLA). However, the genetic analysis of her peripheral leukocytes disclosed an expansion of the CAG repeats (43 copies) in the IT15 gene in chromosome 4p, indicating the diagnosis of Huntington's disease (HD). CAG repeats in chromosome 12, known to link with DRPLA, was not expanded. Thus, this case is unique in that the classical symptomatologies of HD was betrayed by the presence of prominent pyramidal tract signs. This patient may be of importance in demonstrating the diversity of neurological symptoms and neuropathologies caused by CAG trinucleotide repeats in HD.

Improvement of nasal bioavailability of luteinizing hormone-releasing hormone agonist, buserelin, by cyclodextrin derivatives in rats

The effects of chemically modified cyclodextrins on the nasal absorption of buserelin, an agonist of luteinizing hormone-releasing hormone, were investigated in anesthetized rats. Of the cyclodextrins tested, dimethyl-beta-cyclodextrin (DM-beta-CyD) was the most effective in improving the rate and extent of the nasal bioavailability of buserelin. Fluorescence spectroscopic studies indicated that the cyclodextrins formed inclusion complexes with buserelin, which may reduce the diffusibility of buserelin across the nasal epithelium and may participate in the protection of the peptide against enzymatic degradation in the nasal mucosa. Additionally, the cyclodextrins increased the permeability of the nasal mucosa, which was the primary determinant based on the multiple regression analysis of the nasal absorption enhancement of buserelin. Scanning electron microscopic observations revealed that DM-beta-CyD induced no remarkable changes in the surface morphology of the nasal mucosa at a minimal concentration necessary to achieve substantial absorption enhancement. The present results suggest that DM-beta-CyD could improve the nasal bioavailability of buserelin and is well-tolerated by the nasal mucosa of the rat.

A Japanese family with Machado-Joseph disease characterized by initial emaciation and myoclonus

We describe a Japanese family with hereditary spinocerebellar ataxia characterized by initial emaciation and myoclonus. The proband first noted truncal ataxia, myoclonus in the shoulder and general emaciation at age 24. The other affected members of the family also had such emaciation in the early stage of the disease. The DNA analyses of the family revealed that the patients of the family are associated with the expansions of CAG repeats for Machado-Joseph disease (MJD) on the long arm of chromosome 14. Although the clinical features of MJD are very variable, general emaciation in an early stage of the disease and systemic myoclonus have not been documented. Because it is sometimes difficult to distinguish among hereditary spinocerebellar ataxias such as spinocerebellar ataxia type 1 (SCA1) or dentatorubropallidoluysian atrophy (DRPLA) by clinical features, a genetic examination provides better understanding of such a rare and ambiguous type of hereditary spinocerebellar ataxia.

Calcium-free hemodialysis is useful for evaluating parathyroid function and bone disease in chronic hemodialysis patients

By serum concentration of c-PTH, 18 hemodialysis patients were divided into 3 groups: group I (< 2.0 ng/ml, n = 8), group II (2.0-10.0 ng/ml, n = 5), group III (> 10.0 ng/ml, n = 5). When patients were dialyzed with Ca-free dialysate during the first 2 hours intact PTH level in serum shows no or slight increase in 5 out of 8 in group I.

Induction of nitrotyrosine-like immunoreactivity in the lower motor neuron of amyotrophic lateral sclerosis

Spinal cords of sporadic cases with amyotrophic lateral sclerosis (ALS) and normal controls were immunohistochemically examined using antibodies for Cu/Zn superoxide dismutase (SOD) and nitrotyrosine (NT). Immunoreactivity for Cu/Zn SOD of the motor neurons was not different between the ALS and controls. In contrast, immunoreactivity for NT was densely detected in motor neurons of ALS but was not or was only minimally detected in those of controls. The staining was also found in the axons of motor neurons of ALS, but was not found in the controls. These results suggest that nitration of protein-tyrosine residue is upregulated in motor neurons of the spinal cord of ALS.

A histologically distinctive interstitial pneumonia induced by overexpression of the interleukin 6, transforming growth factor beta 1, or platelet-derived growth factor B gene

Interstitial pneumonia is characterized by alveolitis with resulting fibrosis of the interstitium. To determine the relevance of humoral factors in the pathogenesis of interstitial pneumonia, we introduced expression vectors into Wistar rats via the trachea to locally overexpress humoral factors in the lungs. Human interleukin (IL) 6 and IL-6 receptor genes induced lymphocytic alveolitis without marked fibroblast proliferation. In contrast, overexpression of human transforming growth factor beta 1 or human platelet-derived growth factor B gene induced only mild or apparent cellular infiltration in the alveoli, respectively. However, both factors induced significant proliferation of fibroblasts and deposition of collagen fibrils. These histopathologic changes induced by the transforming growth factor beta 1 and platelet-derived growth factor B gene are partly akin to those changes seen in lung tissues from patients with pulmonary fibrosis and markedly contrast with the changes induced by overexpression of the IL-6 and IL-6 receptor genes that mimics lymphocytic interstitial pneumonia.

Increase in cystine transport activity and glutathione level in mouse peritoneal macrophages exposed to oxidized low-density lipoprotein

The transport of cystine has been investigated in mouse peritoneal macrophages incubated with oxidized low-density lipoprotein (oxi-LDL; low-density lipoprotein, LDL). The transport activity for cystine was potently induced by oxi-LDL but not by native or acetylated LDL. The response of the cells to oxi-LDL was dependent on the extent of oxidative modification of LDL. The transport activity for other amino acids was not induced by oxi-LDL. GSH content increased in macrophages incubated with oxi-LDL and this increase was accounted for by the induction of the cystine transport activity because the increase was completely blocked by glutamate or homocysteate which shared the transport system for cystine and thus inhibited the uptake of cystine competitively.

Recurrent brief episodes with psychotic features in adolescence: periodic psychosis of puberty revisited

BACKGROUND

There are many reports of adolescents with periodic episodes each followed by complete remission within 2 weeks, but the nosology and long-term prognosis of such cases have not been elucidated.

METHOD

A prospective follow-up study on 11 cases (nine girls and two boys) meeting predetermined criteria is reported.

RESULTS

The first several episodes were found to meet ICD-10 symptomatic criteria for recurrent depressive disorder in all cases, and except for two cases, showed psychotic features. The episodes were linked to one phase of the menstrual cycle in only two of six girls with regular menses. There were no recurrences while on lithium in eight of nine cases. Of eight patients followed up 5-14 years after the first onset, three had been well, three had become bipolar and two were still suffering from brief depressive episodes.

CONCLUSIONS

Recurrent brief episodes in adolescence tend to show a near-monthly rhythm and psychotic features. Most of them appear to the manifestations of affective illness and may be treated and prevented as such.

Intercellular adhesion molecule-1 (ICAM-1) in the sera of patients with Graves' disease: correlation with disease activity and treatment status

Intercellular adhesion molecule (ICAM-1), a ligand for lymphocyte function-associated antigen-1 (LFA-1), plays an important role in a variety of immune-mediated mechanisms such as lymphocyte attachment to cultured Graves' thyroid cells. We report the detection of a soluble form of the ICAM-1 molecule (sICAM-1) in sera from patients with Graves' disease (GD) and other thyroid disorders. The mean (+/- SD) sICAM-1 concentration in 28 euthyroid control subjects was 1931 +/- 681 pmol/L. The mean sICAM-1 concentration in 25 untreated hyperthyroid patients with GD was significantly elevated (3065 +/- 890 pmol/L), and decreased significantly (2489 +/- 845 pmol/L) after treatment with antithyroid drugs and/or 131I. Of 14 GD patients who had been in remission following administration of antithyroid drugs, 12 had recurrent disease. In 10 of the 12 patients in whom GD recurred, the sICAM-1 concentration (3807 +/- 796 pmol/L) increased significantly. The mean sICAM-1 concentration in patients with hypothyroidism due to chronic thyroiditis (n = 15:2895 +/- 569 pmol/L) was significantly elevated over that of control subjects, and not different from untreated hyperthyroid patients. The mean sICAM-1 concentration in patients with subacute thyroiditis (n = 13: 3036 +/- 441 pmol/L) was significantly elevated, while the mean sICAM-1 concentration in patients with nodular goiter (n = 10: 2318 +/- 490 pmol/L) was within the normal range. These results indicate that mean serum sICAM-1 concentration was significantly elevated in patients with untreated GD, and it decreased after treatment and increased at the time of recurrence. Therefore, the elevated serum concentration of sICAM-1 in patient with GD probably reflects ongoing immune processes.

Effects of vasopressin V1 and V2 receptor antagonists on the development of salt-induced hypertension in Dahl rats

To determine whether the vasopressor and antidiuretic actions of arginine vasopressin (AVP) may participate in the development of salt-induced hypertension, we examined the long-term effects of AVP V1 and V2 receptor antagonists on blood pressure (BP) in Dahl-Iwai salt-sensitive (DS) and salt-resistant (DR) rats. From age 7 weeks, DS and DR rats were fed a diet containing 8% NaCl, alone (control group); 8% NaCl and 1% OPC-21268 (V1 antagonist-treated group); or 8% NaCl and 0.05% OPC-31260 (V2 antagonist-treated group). The pressor response to AVP was significantly inhibited in DS rats treated with OPC-21268. Urinary volume and water intake were significantly increased by administration of OPC-31260; this increase was greater in DR rats than in DS rats. Indirect BP measurements obtained using tailcuff plethysmography showed that DS but not DR rats developed hypertension when fed high-salt diets. However, chronic treatment with either OPC-21268 or OPC-31260 did not alter the course of hypertension in DS rats, despite the effective blocking actions of these antagonists. This finding also was confirmed by direct BP measurements. Our results indicate that even if AVP plays a role in salt-induced hypertension peripheral blockade of either subtype of AVP receptors does not prevent the development of hypertension in DS rats.

A histological study of the cardiac muscle of the human superior and inferior venae cavae

Human superior and inferior venae cavae at the orifices to hearts obtained from two cadavers were histologically examined with regard to the distribution of cardiac muscle fibers in their walls. The superior vena cava contained cardiac muscle fibers together with smooth muscle fibers. The cardiac muscle fibers were distributed uninterruptedly from the atrium to the root of the azygos vein, covering a length of 45 mm. Cardiac myocytes were present outside the smooth muscle and coursed in bundles longitudinally, obliquely, or circularly. Cardiac myocytes occupied one to two thirds of the wall thickness, but decreased in amount toward the periphery. The inferior vena cava also contained both cardiac and smooth muscle fibers. The cardiac muscle fibers extended continuously, covering a distance of 18 mm from the atrium to a level just under the diaphragm. Their fibers were bundled, running circularly or obliquely, and being more abundant in the anterior wall than in the posterior. From these findings, the venae cavae close to the atrium are histologically regarded as an extension of the atrium. The venae cavae close to the atrium probably contract together with the atrium and work as a functional valve that contributes to the pumping mechanism of the heart.

Isolation and characterization of two distinct cDNA clones encoding corn seed cysteine proteinases

We obtained two cDNA clones encoding corn seed cysteine proteinases (CCP1 and CCP2). Sequence analysis showed that CCP1 consists of 371 amino acid residues, in a prepro-protein form, with two unique short insertions in the mature protein region that are not found in papain or other common CPs. CCP2 consists of 360 amino acid residues with a vacuole sorting signal in the pro-sequence region. An amino acid sequence similarity of 42% was found between the mature protein region of CCP1 and that of CCP2. Although CCP1 is highly homologous to pea 15a CP (72%) and Arabidopsis thaliana RD 19 CP (79%), both of which are known to be induced only when the plant is exposed to a dehydrated environment, it showed very low homologies to other known cysteine proteinases (38-43%). CCP2 showed as much as 87% and 89% identity to rice oryzain gamma and barley aleurain, respectively. We also observed that the CCP1 mRNA is expressed in ripened corn seeds, although its expression reaches a maximum 5 days after the onset of germination. On the other hand, the CCP2 mRNA is expressed only during germination, with maximum expression at the 3-day stage. These results suggest the presence of at least two cysteine proteinases playing differential roles in the corn seeds.

Evidence for the occurrence of multiple aspartic proteinases in rice seeds

Using reverse transcription polymerase chain reaction (RT-PCR), we identified two cDNA fragments encoding aspartic proteinases (APs). The encoded proteins, pL4 and pL5, are similar in sequence to other plant APs including barley AP and cardoon flower AP (cyprosin). The identity was 58-76% with one another. Genomic Southern blot analysis suggested that the rice AP gene constitutes a multigene family.

Imidapril hydrochloride in essential hypertension: a double-blind comparative study using enalapril maleate as a control

OBJECTIVE

To assess the value of using imidapril hydrochloride (ACE/TA-6366), a long-acting angiotensin converting enzyme (ACE) inhibitor developed in Japan, to treat patients with essential hypertension.

PATIENTS AND METHODS

A double-blind, comparative, phase III study was carried out using enalapril maleate as a control, with a 4-week observation period and a 12-week treatment period. Both drugs were started at a dose of 5 mg once a day, increasing to 10 mg in patients whose antihypertensive response was insufficient after 4 weeks. The study included 231 outpatients aged 30-74 years; of these, 108 in the imidapril group and 115 in the enalapril group were assessed. There were no differences in background factors between groups.

RESULTS

An adequate antihypertensive effect was observed in 71.3% (77/108) in the imidapril group in in 66.1% (76/115) in the enalapril group, with no significant difference between groups. The pulse rate was unchanged in both groups. The drug had no adverse effects in 86.1% (93/108) of the imidapril group and 79.1% (91/115) of the enalapril group, with no significant difference between groups. Adverse drug effects were observed din 5.6% (6/108) of the imidapril group and 12.2% (14/115) of the enalapril group. Cough was the most frequent side effect, reported in 0.9% (1/108) of the imidapril group and 7.0% (8/115) of the enalapril group. Other side effects were reported in 4.6% (5/108) of the imidapril group and 5.2% (6/115) of the enalapril group. Abnormal laboratory values were observed in 3.7% (4/108) of the imidapril group and 0.9% (1/115) of the enalapril group.

CONCLUSIONS

Imidapril showed excellent clinical efficacy and safety compared to enalapril. The low incidence of cough is of particular interest.

Changes in plasma vasopressin levels and cardiovascular function due to postural changes in diabetic neuropathy

Decreases in blood pressure are well known to increase the release of vasopressin. Studies were carried out to investigate whether vasopressin responses to postural changes in blood pressure are maintained in diabetic patients with orthostatic hypotension [DM-OH(+)] as well as non-diabetic patients with orthostatic hypotension [nonDM-OH(+)] and these responses were compared with those observed in normal subjects and diabetic patients without orthostatic hypotension [DM-OH(-)]. After 30 min in the supine position, the upright posture for 40 min was maintained and then the supine for 10 min. Blood pressure and heart rate (HR) were measured every 5 min and plasma vasopressin levels (plasma AVP) were determined every 10 min. In normal subjects and DM-OH(-), mean arterial blood pressure (MABP) did not change, but HR increased significantly by the upright position. Plasma AVP did not change in these groups. On the other hand, in DM-OH(+) MABP fell abruptly and remained to decrease during the upright posture. The HR responses in this group, however, were similar to those in normal control and DM-OH(-). Plasma AVP in DM-OH(+) significantly increased only at 30 min during upright. These increases were significantly greater than those in normal and DM-OH(-). There were significant correlation in changes in MABP (delta MAP) and plasma AVP (delta AVP) in DM-OH(+) (delta AVP = -0.13 MABP + 1.5, r = -0.32, p < 0.01). Relationship between delta MABP and delta AVP in nonDM-OH(+) was similar to that in DM-OH(+). It is concluded that AVP responses to orthostatic hypotension in diabetic and non-diabetic neuropathies were attenuated, but heart rate responses in these patients ware well reserved.

Recombinant human erythropoietin stimulates tubular reabsorption of sodium in anesthetized rabbits

To determine whether recombinant human erythropoietin (rHuEPO) exerts a direct vasoconstrictive effect on renal arteries or affects renal function, we measured renal hemodynamics and renal function during a 30-min intrarenal infusion of rHuEPO in anesthetized rabbits without renal failure. Intrarenal infusion of rHuEPO at a rate of 100 U/min did not alter mean arterial pressure, renal blood flow, or renal vascular resistance, as compared with controls treated with vehicle. There were no significant rHuEPO-associated changes in glomerular filtration rate, filtration fraction, or arterial hematocrit. However, urine volume, urinary excretion of sodium and potassium, and fractional sodium excretion were significantly reduced by intrarenal infusion of rHuEPO. These observations indicate that rHuEPO has no direct effects on mean arterial pressure or renal hemodynamics, but that it stimulates net tubular sodium reabsorption, and reduces urine volume and urinary excretion of sodium and potassium in anesthetized rabbits without renal failure.

High glucose augments angiotensin II action by inhibiting NO synthesis in in vitro microperfused rabbit afferent arterioles

Preglomerular afferent arteriole (Af-Art) is a crucial vascular segment in the control of glomerular hemodynamics. We have recently reported that vascular reactivity of Af-Art is modulated by nitric oxide (NO). However, little is known about its reactivity under pathophysiological conditions such as diabetes, which is often accompanied by abnormal glomerular hemodynamics. In the present study, we examined the direct effects of high glucose, the hallmark of diabetes, on the vascular reactivity of Af-Art. Rabbit Af-Arts were microperfused for three hours with medium 199 containing either normal (5.5 mM; NG-Af-Arts) or high concentrations (30 mM; HG30-Af-Arts) of glucose, and then vascular reactivity was examined. Sensitivity to angiotensin II (Ang II) was significantly higher in HG30-Af-Arts than in NG-Af-Arts. Ang II began to cause significant constriction from 10(-9) M in NG-Af-Arts (18 +/- 3%, N = 6, P < 0.01) and from 10(-11) M in HG30-Af-Arts (9 +/- 2%, N = 6, P < 0.01). NO synthesis inhibition with 10(-4) M nitro-L-arginine methyl ester (L-NAME) increased the sensitivity to Ang II in NG-Af-Arts without affecting Ang II action in HG30-Af-Arts. In L-NAME-pretreated NG-Af-Arts, Ang II began to cause constriction from 10(-11) M (11 +/- 3%, N = 6, P < 0.01). Thus, pretreatment with L-NAME abolished the difference in sensitivity to Ang II between NG- and HG30-Af-Arts, suggesting impaired NO synthesis in HG30-Af-Arts.(ABSTRACT TRUNCATED AT 250 WORDS)

Role of atrial natriuretic peptide in interleukin 1 beta-induced natriuresis in conscious rats

To assess whether atrial natriuretic peptide (ANP) plays a role in the natriuresis induced by interleukin 1 beta (IL-1 beta), the following experiments were carried out. Experiment (Ex) I: IL-1 beta (7.5 micrograms/kg BW) was given intravenously (i.v.) in conscious hydrated rats (n = 6). Plasma ANP, vasopressin (AVP) osmolality (Posm), Na and K, urine Na (UNa V) and K excretion (UK V), osmolality and flow (UF), and mean arterial blood pressure (MABP) and heart rate were simultaneously determined. In the control group (n = 6), the drug was omitted, and the same protocols were carried out. Ex II: Three mg/kg BW of the specific ANP antagonist, HS-142-1 (HS), was administered i.v. and then, IL-1 beta (7.5 micrograms/kg BW) was given i.v. (n = 6). In the HS alone group (n = 6), IL-1 beta was omitted. The experimental protocols were the same as those in Ex I. IL-1 beta increased significantly plasma ANP and AVP and UNa V, but not UF, accompanied by decreases in Posm and UKV and increases in MABP (ExI). HS inhibited the natriuresis mediated by IL-1 beta, despite increases in plasma ANP and had no influence on plasma AVP and MABP. In the control (ExI) and HS alone (ExII) groups, these parameters did not change, except for decreases in Posm in both groups and increased plasma ANP in the latter. These results suggest that plasma ANP may play an essential role in the IL-1 beta-mediated natriuresis.