Adenovirus-mediated gene transfer using in-situ perfusion of the liver graft

To establish an efficient technique for adenovirus-mediated gene transfer in liver transplantation, we evaluated the in situ perfusion of liver grafts. The grafts were perfused in situ with 1 x 10(10) of E1-deleted, replication-defective adenoviral vectors encoding the LacZ gene driven by the human CMV promoter, either through the hepatic artery (group 1) or the portal vein (group 2). Group 3 animals served as negative controls; their liver grafts were perfused with lactated Ringer's solution through the portal vein. PCR confirmed the presence of viral DNA in every graft perfused with viral vectors. In X-gal staining, positive staining was observed almost exclusively at the portal triad in group 1, whereas in group 2 minimal staining was observed, predominantly in the parenchymal area. Protein production from the transfected gene was confirmed by a functional protein assay; the values were 0.16% +/- 0.07% liver protein in group 1, 0.13% +/- 0.02% in group 2, and 0.007% +/- 0.0003% in group 3 on postoperative day 2. In conclusion, in situ perfusion of the viral vectors through the hepatic artery resulted in an effective expression of the transfected gene, predominantly at the portal triad.

Involvement of endothelin in graft-versus-host disease after rat small bowel transplantation

Endothelin (ET-1) expression was evaluated by radioimmunoassay in both plasma and various tissue specimens serially obtained from LBN-F1 recipients of LEW heterotopic small bowel allografts. The recipients showed graft-versus-host disease (GVHD), which histologically became apparent on postoperative day (POD) 13. The ET-1 levels peaked on POD 9 in the kidney, lung, and host intestine at 51.0 +/- 21.1, 90.9 +/- 59.6, and 25.4 +/- 11.8 pg/g wet, respectively, and peaked on POD 11 in the plasma at 7.7 +/- 3.2 pg/ml; thereafter, they decreased to basal levels in both the plasma and tissue specimens on POD 13. An immunohistochemical study of these organs showed a corresponding increase in ET-1 staining in both the endothelial and epithelial cells on PODs 5 and 9, and a reduction in staining on POD 13. In conclusion, ET-1 was found to be increasingly released from the target cells of GVHD before any histological changes became apparent, thus suggesting the pathophysiological involvement of ET-1 in intestinal GVHD.

[Epidural anesthesia for herniorrhaphy in a patient with severe dilated cardiomyopathy (DCM) under pimobendan control]

A 60-year-old man with severe DCM was scheduled for a herniorrhaphy under epidural anesthesia using fentanyl. Three months prior to operation, the patient suffered heart failure associated with life-threatening ventricular arrhythmia. The former was successfully treated with pimobendan as the main constituent of medication, but the latter was not responsive to various antiarrhythmic drugs with the exception of aprindine. On the day of operation and for two days postoperatively, pimobendan was administered daily. A sudden drop in systemic blood pressure and central venous pressure (CVP) during anesthesia, as well as the tendency to hypotensive status in the postoperative period were well regulated with continuous infusion of dopamine and dobutamine via CVP catheter probably due to the effect of up-regulation of pimobendan, together with adjustment of the volume of intravenous fluids. No dangerous ventricular arrhythmia were observed. Thereafter the patient made uneventful progress and was discharged on the 8th postoperative day.

The effect of cyclosporin on endothelin levels after orthotopic liver transplantation in rats

To assess the effects of cyclosporin (CyA) on endothelin-1 (ET-1) in rat liver allograft rejection, we evaluated ET-1 expression in samples obtained from BN(RT1n)-to-BN (group 1) rats, DA(RT1a)-to-BN (group 2) rats, and DA-to-BN rats treated with 5 mg/kg per day of CyA (group 3). Serum and hepatic ET-1 levels, determined by a radioimmunoassay, remained unchanged in group 1. In group 2, the ET-1 levels peaked on postoperative day (POD) 5 in the liver at 344 +/- 31.6 pg/g wet, and on POD 7 in the serum at 38.7 +/- 13.1 pg/ml. In group 3, hepatic and renal ET-1 levels showed a progressive increase until POD 10, while serum ET-1 levels remained unchanged. In conclusion, acute rejection caused a temporary increase in the ET-1 level in both the serum and the liver in the early postoperative period what might have been caused by endothelial damage due to ongoing, acute rejection. CyA caused a time-dependent increase in the ET-1 level in both the liver and the kidney without an increase in the serum ET-1 level. The serum ET-1 level might have been affected by the clearance of ET from the liver or kidney.

The production and clearance of endothelin and its influence on kidney function after liver transplantation in rats

To assess the involvement of endothelin-1 (ET-1) in rat liver allograft rejection, we evaluated ET-1 expression in tissues obtained from BN (RT1n) to BN rats (group 1), and DA (RT1a) to BN rats (group 2). The ET-1 levels in group 1, determined by radioimmunoassay, remained low in the serum, liver, and bile, but in group 2, they peaked on postoperative day (POD) 5 in the liver, kidney, bile, and urine, at 344 +/- 31.6 pg/gwet, 306 +/- 97.4 pg/gwet, 1008 +/- 258 pg/day, and 156 +/- 45 pg/day, respectively, whereas levels in the serum peaked on POD 7 at 38.7 +/- 13.1 pg/ml. In the portal vein (PV) ET-1 showed extremely high levels without statistical difference between groups 1 and 2, at 93.0 +/- 15.5, and 83.0 +/- 9.84 pg/ml on POD 7, respectively. However, in the suprahepatic vena cava (SHVC) and the abdominal aorta (AO), the ET-1 levels were statistically higher in group 2 compared to group 1 (P < 0.01). Immunohistochemical staining showed decreased staining of the liver and kidney in group 2 on POD 7. In conclusion, increasing levels of ET-1 were released from the liver and kidney during the early stage of rejection, resulting in the high ET-1 levels in these tissues, which were cleared promptly. However, an increased production of ET-1 was not observed in association with the release of ET-1.

The chromosomal organization of the human endogenous retrovirus-like sequence HERV-H: clustering of the HERV-H sequences in a 300-kb region close to the GRPR locus on the X chromosome

Within the haploid genome there are approximately 1,000 copies of the human endogenous retrovirus-like sequence, HERV-H. Although these sequences are scattered throughout the entire genome, in situ hybridization experiments revealed that there are discrete clusters positioned on chromosomes 1 p and 7 q. In this study, we have located three HERV-H sequences which were unexpectedly clustered within a 300-kilobase region close to the GRPR locus on the X chromosome. In previous studies, no clustering of this sequence has been reported at this locus. Our finding demonstrates that, like other repetitive sequences, clustering of HERV-H occurs in the human genome, although these sequences may not always be detected by in situ hybridization methods.

Hypocalcemia associated with 5-fluorouracil and low dose leucovorin in patients with advanced colorectal or gastric carcinomas

BACKGROUND

The biochemical modulation of 5-fluorouracil (5-FU) by leucovorin (LV) has demonstrated significantly increased response rates in comparison with the use of 5-FU alone in patients with advanced colorectal carcinoma. However, the higher response rate of LV/5-FU may occur at the expense of increased toxicity and side effects such as diarrhea, myelosuppression, and mucositis. During chemotherapy, a high incidence of hypocalcemia associated with this chemotherapy regimen was noted. This study was therefore aimed at assessing the side effects of chemotherapy using low dose LV/5-FU on calcium metabolism.

METHODS

Twenty-five patients with advanced gastric or colorectal carcinoma were treated with chemotherapy comprised of low dose LV administered at 20 mg/m2/ day by intravenous bolus, followed by 1-hour intravenous infusion of 5-FU at 425-600 mg/m2/day for 5 consecutive days every 28 days.

RESULTS

The toxic effects were generally mild, and included diarrhea, mucositis, leukopenia, and nausea/vomiting. Fifteen patients (65%) experienced hypocalcemia. The plasma 1,25-(OH)2D3 levels were significantly reduced on Day 5 due to the chemotherapy.

CONCLUSIONS

The toxic effects of the regimen were generally mild. However, a high percentage of hypocalcemia occurred with the combination of LV/5-FU. It is therefore necessary to examine carefully the serum calcium levels of patients when using this chemotherapeutic modality.

Adult T-cell leukemia/lymphoma with a giant gastric tumor: a case report

A rare case of adult T-cell leukemia/lymphoma with a giant exophytic gastric tumor invading the anterior abdominal wall is presented. The patient was a 52-year-old woman, who had a history of strongyloidiasis. Although the patient was serologically positive for HTLV-I antibody, there were no lymphoma cells in the peripheral blood or systemic lymphadenopathy. After two cycles of combination chemotherapy, the tumor was surgically resected. The pathological diagnosis of the resected specimen was T-cell lymphoma of the diffuse mixed cell type. Flow-cytometric analysis of the lymphoma showed a CD4+ and CD8+ phenotype. One month after surgery, the patient developed hypercalcemia, resulting in acute renal and respiratory failure, and died. The prognosis of lymphoma-type ATL is known to be extremely poor, and thus we should bear in mind that ATL can take the form of a primary gastric mass without leukemic manifestations.

Adenovirus-mediated gene transfer using ex vivo perfusion of the heart graft

A replication-deficient adenovirus was used for ex vivo gene transfer into rat heart grafts under conditions simulating clinical transplantation. The adenoviral vector, AdHCMVsp1LacZ, containing an expression cassette of Escherichiae coli lacZ, was used to perfuse heart grafts during cold ischemia before transplantation. Heart grafts were perfused with University of Wisconsin (UW) solution containing either 0 pfu, 5 x 10(10) pfu, or 1 x 10(11) pfu of viral vector, and were preserved for either 2 or 4 h and then transplanted into syngeneic recipients. The animals were killed at 1, 7, and 14 days after transplantation. The infection rate was assessed by histochemical staining for beta-galactosidase. Using polymerase chain reaction (PCR), viral DNA presence was confirmed in every graft perfused with viral vectors. The protein production from the transfected gene was confirmed by a functional protein assay. An efficient gene transfer was achieved with an infection rate of 1%-1.5% for all cardiac myocytes, as assessed by 5-bromo-4-chloro-indolyl-beta-D-galactopyranoside (X-gal) staining. All studies were negative in the control grafts. Gene expression persisted for at least 10 days after transplantation. We thus conclude that an efficient adenovirus-mediated gene transfection and expression of gene products can be achieved in ex vivo perfusion of the heart graft during cold preservation.

Effects of exhaustive endurance exercise and its one-week daily repetition on neutrophil count and functional status in untrained men

Whereas endurance exercise is known to induce marked neutrophilia, it remains to be fully understood as to whether the cell functions are altered as well as whether the adaptability of the responses to training occurs. To address both of these issues, we undertook the present longitudinal investigation in ten healthy untrained men (20-24 years, VO2max 39.1 +/- 4.2 ml/kg/min). The exercise protocol was 7 consecutive sessions of the same workload performed each day for 1.5 h at an intensity of 70% of VO2max. Peripheral blood samples were obtained before, immediately after, and 1 h after exercise on Days 1, 4, and 7, and served for determination of total and differential leukocyte counts, chemotaxis and chemiluminescence of neutrophils. Acute endurance exercise caused marked peripheral neutrophilia with significant increase in both absolute number and relative proportion of band neutrophils (p < 0.01, respectively), indicating partial recruitment of bone marrow neutrophils. While chemotaxis remained unaltered following exercise, reactive oxygen species generation of neutrophils, measured by luminol-dependent chemiluminescence upon stimulation with opsonized zymosan, was not only significantly enhanced following exercise (p < 0.01), but also associated with the proportional increase in band neutrophils (r = 0.727, p < 0.05), suggesting that neutrophils mobilized from the bone marrow following endurance exercise may possess higher responsiveness. On the other hand, the magnitude of the exercise-induced changes was reduced gradually by daily repeated exposure to endurance exercise, but none of the trends were significant except the decline in resting segmented neutrophil counts (p < 0.05) at least during a 1-wk period of repeated exercise sessions.

Synthesis and biological activity of novel 1,3-benzoxazine derivatives as K+ channel openers

A new series of 1,3-benzoxazine derivatives with a 2-pyridine 1-oxide group at C4 was designed to explore novel K+ channel openers. Synthesis was carried out by using a palladium(0)-catalyzed carbon-carbon bond formation reaction of imino-triflates with organozinc reagents and via a new one-pot 1,3-benzoxazine skeleton formation reaction of benzoylpyridines. The compounds were tested for vasorelaxant activity in tetraethylammonium chloride (TEA) and BaCl2-induced and high KCl-induced contraction of rat aorta to identify potential K+ channel openers, and also for oral hypotensive effects in spontaneously hypertensive rats. An electron-withdrawing group with the proper shape at C6 and a methyl or halogeno group at C7 of the 1,3-benzoxazine nucleus were required for the development of optimal vasorelaxant and hypotensive activity. In particular, 2-(6-bromo-7-chloro-2,2-dimethyl-2H-1,3-benzoxazin-4-yl)pyridine 1-oxide (71) showed more potent vasorelaxant activity (EC50 = 0.14 microM) against TEA and BaCl2-induced contraction and longer-lasting hypotensive effects than cromakalim (1).

[Levels of alpha-elastin and of desmosine as indexes of elastase-induced lung injury in rats]

Two markers of elastin degradation, alpha-elastin and desmosine levels, were measured in sera from rats after single tracheal instillations of porcine pancreatic elastase (PPE). Biochemical and pathophysiological changes in the lung were also studied. Male Wistar rats were divided into three groups. The control group received one intratracheal dose of saline (0.3 ml). The PPE 60 group received one intratracheal dose of 60 U of PPE. The PPE 120 group received one intratracheal dose of 120 of PPE. Blood samples were collected 0, 1, 3, 5, 7, 14, 28, and 56 days after the intervention, and levels of alpha-elastin and desmosine were measured by enzyme-linked immunosorbent assay. At the end of the study (day 56), lung volumes and static pressure-volume curves were measured by body pletysmography. Then the rats were killed and the mean linear intercept was measured as defined by Thurlbeck. The serum alpha-elastin level in the PPE 120 group on day 7 was significantly higher (p < 0.05) than those in other groups. Desmosine values on day 1 in the PPE 60 group and on days 1 and 7 in the PPE 120 group were significantly higher (p < 0.05) than those in the control group. Functional and morphometric analyses revealed that the PPE 120 group had more emphysematous changes than the control group (p < 0.01) and more than the PPE 60 group (p < 0.05). These results suggest that levels of alpha-elastin and of desmosine reflect changes that occur in the early stages of lung injury, and that these changes are related to abnormalities found in rat lungs on day 56.

Stereoselective synthesis and thromboxane A2 (TXA2) receptor antagonistic activity of optically active phenol derivatives

Enantiomers of four potent nonprostanoid thromboxane A2 (TXA2) receptor antagonists, (+/-)-7-(4-fluorophenyl)-7-(2-hydroxyphenyl)heptanoic acids (1-4), were synthesized stereoselectively by direct ortho-alkylation of phenols under modified Mitsunobu conditions. The reaction of 5 eq of phenols (6a-c) with 1 eq of (S)- or (R)-methyl 7-(4-fluorophenyl)-7-hydroxyheptanoate ((S)- or (R)-7) afforded ortho-alkylated phenol derivatives (6a-c) enantioselectively in 33 to 42% chemical yield and 90 to 93% ee. In these compounds, the (R)-enantiomers (1-4) exhibited potent TXA2 receptor antagonistic activity and the (S)-isomer (3) was much less active. In particular, compound (R)-3 strongly inhibited U-46619-induced human platelet aggregation (IC50 = 48 nM), and also showed a very potent inhibitory effect with a minimum effective dose (MED) of 0.3 mg/kg (p.o.) on U-46619-induced bronchoconstriction in guinea pigs.

[The effects of UVA irradiation on human neutrophil function]

We investigated the in vitro effects of ultraviolet A (UVA) irradiation on human neutrophil function. For measurements of reactive oxygen species (ROS) and serum opsonic activity, chemiluminescence was used. Chemotactic activity was determined by the Boyden technique. In this study, for detection of the effects of UVA irradiation on human neutrophil ROS production, we used luminol-dependent and lucigenin-dependent chemiluminescence, in addition to two kinds of action stimuli, opsonized zymosan and phorbol myristate acetate (PMA). We found that UVA irradiation at low doses of UVA (0.2-0.4J/cm2) did not affect the generation of OC1-, and it was suggested that high doses of UVA (0.6-1.0J/cm2) suppressed OC1- production by inactivating the signalling cascade which induces ROS on the membrane surface of neutrophils. No significant difference was observed in the chemotactic activity. The serum opsonic activity was increased by UVA irradiation. These results suggest that low doses of UVA do not impair neutrophil phagocytic activity, and that higher doses of UVA suppress the ROS generating capacity of neutrophils. However, to compensate for ths suppression, serum opsonic activity was induced, so it seemed that the neutrophil-related immune system could be retained.

Stabilometric assessment in the anterior cruciate ligament-reconstructed knee

OBJECTIVE

To examine the hypotheses that anterior cruciate ligament (ACL) reconstruction improves the proprioception of the knee beyond the level of ACL-deficient knees, and that proprioception of the knee correlates well with knee function after ACL reconstruction.

PATIENTS

Fifty-three patients with ACL-reconstructed knees (22 men and 31 women), 30 physically active healthy volunteers with normal knees (15 men and 15 women), and 30 patients with chronic ACL-deficient knees (15 men and 15 women).

MAIN OUTCOME MEASURES

A stabilometric assessment, which is considered to be a useful method for evaluating proprioception objectively, was used to compare the one-leg standing balance among three groups; and the relationship between subjective knee function, satisfaction, hop index, knee laxity, isokinetic thigh muscle strength, and one-leg standing balance in the ACL-reconstructed patients was also analyzed.

RESULTS

The one-leg standing balance of the patients with ACL-reconstructed knees was still impaired compared with that of healthy volunteers (men, p < 0.05; women, p < 0.01), but significantly better than that of the patients with ACL-deficient knees (men, p < 0.001; women, p < 0.001). The one-leg standing balance of the patients with ACL-reconstructed knees correlated well with their functional outcomes such as subjective knee function (men, p < 0.001; women, p < 0.01), satisfaction (men, p < 0.01; women, p < 0.001), and hop index (men, p < 0.001; women, p < 0.001), whereas poor correlation was seen between functional outcomes and mechanical stability.

CONCLUSIONS

The results suggest that knee function after ACL-reconstruction should be closely related with knee proprioception, and indicate that the usefulness of stabilometric assessment in the evaluation of the function of ACL-reconstructed knees.

Synchronous double cancers of the remnant stomach and pancreas: report of a case

We present here in the case of a 75-year-old man who developed synchronous double cancers of the remnant stomach and pancreas 12 years after undergoing distal gastrectomy for gastric carcinoma. The patient was referred to our hospital in March, 1993, with a provisional diagnosis of carcinoma of the remnant stomach. Laboratory data on admission showed an abnormal level of CA19-9 (116.1 U/ml) and positive occult blood in the stools. An upper gastrointestinal series and gastroendoscopy demonstrated an ulcerative polypoid tumor in the gastric stump proximal to the gastroduo-denostomy anastomosis, and a biopsy confirmed the findings of mucinous adenocarcinoma. Abdominal computed tomography (CT) scan revealed a low-density nodule anterior to the abdominal aorta, suggestive of a nodal metastasis. A laparotomy was performed which also disclosed a low-density mass located within the head of the pancreas. The patient was subsequently diagnosed as having double carcinomas of the remnant stomach and pancreas, and total gastrectomy and pancreatoduodenectomy were carried out. The histologic sections from the remnant stomach showed mucinous adenocarcinoma, whereas those from the pancreas showed tubular adenocarcinoma. Double carcinomas in this association are extremely rare and this case may in fact be the first observation of synchronous double cancers of the remnant stomach and pancreas.

[The role of interstitial hyaluronan in acute lung injury]

The pulmonary interstitium may affect the movement of water, macromolecules, and inflammatory cells between capillaries and lymphatics. Hyaluronan (hyaluronic acid), a glycosaminoglycan of the interstitial matrix, helps to retain water in the lung interstitium and to exclude proteins. Marked reduction of interstitial hyaluronan by infusion of hyaluronidase decreased the resistance to fluid transport and decreased water retention in the interstitium, and thus accelerated lymphatic removal of fluid filtered across capillary walls. However, reduction of hyaluronan increased the accumulation of neutrophils in the lung and exacerbated acute lung injury caused by pancreatic elastase. Interstitial hyaluronan may protect against acute inflammatory changes in elastase-induced lung injury.

Measured context-sensitive half-times of remifentanil and alfentanil

BACKGROUND

The context-sensitive half-time, rather than the terminal elimination half-life, has been proposed as a more clinically relevant measure of decreasing drug concentration after a constant infusion of a given duration. The context-sensitive half-time is derived from computer modelling using known pharmacokinetic parameters. The modelled context-sensitive half-time for a 3-h infusion of alfentanil is 50-55 min and is 3 min for remifentanil. The terminal elimination half-life is 111 min for alfentanil and 12-30 min for remifentanil. It has not been tested whether the modelled context-sensitive half-time reflects the true time for a 50% decrease in drug concentration or drug effect.

METHODS

Thirty volunteers received a 3-h infusion of remifentanil or alfentanil at equieffective concentrations. Depression of minute ventilation to 7.5% ETCO2 was used as a measure of drug effect. Minute ventilation response was measured, and blood samples for drug concentration were taken during and after drug infusion. The recovery of minute ventilation (drug effect) and decrease in blood drug concentration was plotted, and the time for a 50% change was determined.

RESULTS

The measured pharmacokinetic context-sensitive half-time for remifentanil after a 3-h infusion was 3.2 +/- 0.9 min, and its pharmacodynamic offset was 5.4 +/- 1.8 min. Alfentanil's measured pharmacokinetic context-sensitive half-time was 47.3 +/- 12 min, and its pharmacodynamic offset was 54.0 +/- 48 min. The terminal elimination half-life modelled from the volunteers was 11.8 +/- 5.1 min for remifentanil and 76.5 +/- 12.6 min for alfentanil.

CONCLUSIONS

The measured context-sensitive half-times were in close agreement with the context-sensitive half-times previously modelled for these drugs. The results of this study confirm the value of the context-sensitive half-time in describing drug offset compared to the terminal elimination half-life.

The conservative treatment of complete tears of the anterior cruciate ligament in skeletally immature patients

We describe the results of conservative treatment for complete midsubstance tears of the anterior cruciate ligament (ACL) in 18 skeletally immature patients, followed for a minimum of 36 months. Six patients had an ACL reconstruction during the follow-up period and were assessed immediately before their operation. The average time from initial injury to evaluation was 51 months. All patients had symptoms when reviewed. The modified Lysholm knee score showed one excellent result, one good, eight fair, and eight poor with a mean score of 64.3. Only one patient had returned to her preinjury level of athletics. Secondary meniscal tears were confirmed in six patients, and three more had the clinical signs of a tear at follow-up. Radiological evidence of degenerative changes was found in 11 of the 18 patients. We conclude that the results of non-operative treatment for ACL injuries in this age group are poor and not acceptable.