[Successful treatment of diffuse aspiration bronchiolitis by cricopharyngeal myotomy]

A 62-year-old man was admitted to our hospital with complaints of coughing and fever. He had poliomyelitis at the age of 4 years, and had experienced difficulty in swallowing and chronic aspiration for the past 3 years. A chest roentgenogram and a high-resolution CT scan obtained on admission showed many small nodular shadows in the lower lung fields. Cricopharyngeal myotomy was done to decrease aspiration. The patient was then able to eat without aspiration, and the chest-roentgenographic and CT findings improved. Diffuse aspiration bronchiolitis was diagnosed from the clinical course and the radiographic findings. Cricopharyngeal myotomy can reduce the risk of aspiration in patients with diffuse aspiration bronchiolitis.

Chicken monoclonal antibody isolated by a phage display system

A method for obtaining chicken mAb using a phage display system was established. Chickens were hyperimmunized with murine serum albumin, and polyadenylated RNA was extracted from their spleen cells. cDNA of V regions of heavy or lambda-chain genes were obtained by reverse transcription-PCR using a pair of newly designed primers. A phage display library of 1.4 x10(7) clones expressing the chicken Ab variable region as a single chain was constructed. The library was panned three times against the Ag, then screened by ELISA. Of a number of Ag-binding clones, five mAb were identified by DNA sequencing. The specificity of these mAb for serum albumin of various species was examined by ELISA. The results showed different degrees of cross-reactivity to rat serum albumin, but not to other albumin. This method provides a procedure for efficiently generating specific chicken mAb against murine proteins and against the proteins of other mammals, whose amino acid sequences are highly conserved in mammalian species. The nucleotide sequences of lambda-chains revealed components to develop diversification of chicken Ab molecules. Four to seven pseudogene sequences were found per lambda-chain, which are regarded as donors in gene conversion for preimmune repertoire formation. A total of 28 nucleotide substitutions, which may be somatic hypermutations in Ag-driven affinity maturation but could also be errors introduced during gene conversion or polymorphic residues, were found in five lambda-chains.

Mutations in the envelope gene of hepatitis B virus variants co-occurring with antibody to surface antigen in sera from patients with chronic hepatitis B

Three clones of hepatitis B virus (HBV) DNA were propagated from sera of each of five patients with chronic hepatitis B who possessed hepatitis B surface antigen (HBsAg) and antibody to HBsAg in their serum. The clones were sequenced within the envelope gene (the preS1, preS2 regions and the S gene). Clones from four patients had various missense mutations involving codons 124-147 of the S-gene which encode amino acids in the loop structures that form the conformational, common antigenic determinant of HBsAg. Clones from three patients had Asn-130 (Gly in the wild-type), which generated a potential N-glycosylation site, Asn-Thr-Ser, spanning amino acids 130-132 of the S-gene product. In addition, clones from one patient had Arg-145 (Gly in the wild-type), which has been reported in escape mutants of HBV. One of the three clones from another patient had Ser-126 in place of lle or Thr in wild-type HBV, but the remaining two had no mutations known to affect expression of the common determinant of HBsAg. The remaining patient possessed HBsAg of subtype adr and anti-HBs specific for the w determinant. Clones from this patient did not reveal any mutations which are known to affect the common antigenic determinant of HBsAg.

Chicken monoclonal antibody isolated by a phage display system

A method for obtaining chicken mAb using a phage display system was established. Chickens were hyperimmunized with murine serum albumin, and polyadenylated RNA was extracted from their spleen cells. cDNA of V regions of heavy or lambda-chain genes were obtained by reverse transcription-PCR using a pair of newly designed primers. A phage display library of 1.4 x10(7) clones expressing the chicken Ab variable region as a single chain was constructed. The library was panned three times against the Ag, then screened by ELISA. Of a number of Ag-binding clones, five mAb were identified by DNA sequencing. The specificity of these mAb for serum albumin of various species was examined by ELISA. The results showed different degrees of cross-reactivity to rat serum albumin, but not to other albumin. This method provides a procedure for efficiently generating specific chicken mAb against murine proteins and against the proteins of other mammals, whose amino acid sequences are highly conserved in mammalian species. The nucleotide sequences of lambda-chains revealed components to develop diversification of chicken Ab molecules. Four to seven pseudogene sequences were found per lambda-chain, which are regarded as donors in gene conversion for preimmune repertoire formation. A total of 28 nucleotide substitutions, which may be somatic hypermutations in Ag-driven affinity maturation but could also be errors introduced during gene conversion or polymorphic residues, were found in five lambda-chains.

Effect of repeated methamphetamine pretreatment on freezing behavior induced by conditioned fear stress

The present study examined the effect of methamphetamine (MA) pretreatment on conditioned fear stress in male Wistar-King rats. Rats received MA or the vehicle according to the repeated escalating dose schedule (1.25, 2.5, 3.75, and 5 mg/kg s.c. x 2/every other day for a week). After a 5-day drug abstinent period, the rats were exposed to conditioned fear stress (exposure to an environment paired previously with foot shock). Repeated but not single MA pretreatment significantly increased conditioned freezing behavior, suggesting that rats previously exposed to chronic MA are hypersensitive to subsequent stress than control rats. Repeated MA treatment did not decrease basal dopamine or serotonin concentrations in the brain. Furthermore, coadministration of MK-801 (noncompetitive NMDA antagonist), amfonelic acid (dopamine reuptake inhibitor), or fluoxetine (serotonin reuptake inhibitor) with MA did not alter the enhanced freezing behavior. Taken together, it seems that MA-induced hypersensitivity to stress is not due to the neurotoxic effect of MA. Coadministration of nemonapride (D2/3/4 antagonist) with MA prevented the MA-induced increase in freezing. These results suggest that D2/3/4 receptors play an important role for MA-induced enhancement of fear or anxiety.

Synthesis and evaluation of water-soluble polyethylene glycol-paclitaxel conjugate as a paclitaxel prodrug

Water-soluble paclitaxel may cause less side effects and be less costly to administer in comparison to a taxol formulation using a cremophor EL/alcohol vehicle. In this study, polyethylene glycol (PEG; MW 5000) was conjugated to the 2' position of paclitaxel through a spacer succinyl group. PEG-paclitaxel as a non-ionic paclitaxel prodrug was highly water soluble (> 20 mg equiv. paclitaxel/ml). The release of paclitaxel from phosphate-buffered solution was pH dependent. The half-life of PEG-paclitaxel was 7.6, 54 and 311 min at pH 9.0, 7.4 and 6.0, respectively. PEG-paclitaxel inhibited the growth of B16 melanoma cells to an extent similar to that of paclitaxel. In MCA-4 mammary tumor-bearing mice, a single dose of PEG-paclitaxel (40 mg equiv. paclitaxel/kg body weight) significantly delayed tumor growth. The average number of days for the tumor to reach 12 from 8 mm in diameter increased from 6.5 days for control animals to 8.5 days for PEG-paclitaxel-treated animals and 9.4 days for paclitaxel-treated animals. These studies demonstrated that PEG may be used as an effective solubilizing carrier for paclitaxel.

Human gingival fibroblast migration promoted by platelet-derived growth factor on titanium is correlated with release of urokinase type plasminogen activator

The purpose of this study was to examine if the migration of human gingival fibroblasts on titanium was promoted by platelet-derived growth factor (PDGF) and whether the release of urokinase-type plasminogen activator (uPA) was correlated with it. The migration of the fibroblast on titanium was significantly promoted by PDGF in a wound healing assay (p < 0.001). The promotive effect was inhibited by aprotinin, a serine protease inhibitor used for the inhibition of uPA (p < 0.001). The conditioned medium when fibroblast migration was promoted contained a higher concentration of uPA than did that of the control. These results indicated that the promotive effect of PDGF on the migration of human gingival fibroblasts on titanium was correlated with the release of uPA from the fibroblasts.

Positron emission tomography using [18F]fluorotamoxifen to evaluate therapeutic responses in patients with breast cancer: preliminary study

Positron emission tomography (PET) was used to assess the biodistribution and clinical usefulness of [18F]fluorotamoxifen (FTX) in 10 patients with estrogen-receptor(ER)-positive breast tumors. Ten patients with ER-positive breast cancer were prospectively studied, and the consecutive PET imagings (each takes 15 or 20 min) were obtained for 60 or 80 min after the injection of 88.8-392.2 MBq (2.4-10.6 mCi) of [18F]FTX. Twenty three suspected primary or metastatic lesions in 10 patients were evaluated and the tumor uptakes of [18F]FTX in nineteen tumor lesions were correlated to the response of tamoxifen therapy. Three lesions in three patients were considered to be truly negative for breast cancer on the bases of biopsy specimens and/or clinical course. Five (71.4%) of seven patients and 16 (80.0%) of 20 lesions were interpreted to be truly positive for breast cancer. The mean standardized uptake value (SUV) of the radiotracer in tumor was 3.0 on delayed images. There was no significant correlation between the standardized uptake values of [18F]FTX and the ER concentrations in primary lesions. Nineteen tumor lesions in six patients were evaluable to compare the [18F]FTX uptake with responses to tamoxifen therapy after the PET study. Three patients who had a good response to tamoxifen therapy showed positive lesions on PET images, whereas two of three patients who had a poor response showed negative lesions and one showed mixed results. There was no significant difference of [18F]FTX uptake in bone lesions between good and poor responders. However, when bone lesions were excluded, [18F]FTX uptakes in tumors with good responses were significantly higher than those with poor responses (mean and standard deviation of SUV: 2.46 +/- 0.62 vs 1.37 +/- 0.59, P < 0.05). PET imaging using [18F]FTX provides useful information in predicting the effect of tamoxifen therapy in patients with ER-positive breast cancer. Further study is warranted to confirm the clinical utility of PET using [18F]FTX in breast cancer patients.

Myocardial infarction in rats: high-resolution single-photon emission tomographic imaging with a pinhole collimator

The purpose of this study was to evaluate the accuracy of myocardial imaging by means of high-resolution single-photon emission tomography (SPET) with a pinhole collimator in rats with experimental infarction. Myocardial infarctions were induced in male Wistar rats by ligation of the left coronary artery for 30 min, followed by reperfusion. Two days after the reperfusion, pinhole SPET was performed after the intravenous administration of 111 MBq of thallium-201 chloride, using a rotating gamma camera equipped with a pinhole insert (2.0-mm aperture) in a low-energy pinhole collimator. SPET projection data were collected at 6 degrees increments over 360 degrees using a 4-cm radius of rotation to reconstruct the short- and long-axis images. Projection data were acquired in 15 or 30 s, the SPET imaging being accomplished within 40 min after the injection of 201Tl. After SPET, the rats were sacrificed to remove the hearts for autoradiography (ARG) and nitroblue tetrazolium (NBT) staining as a visual correlative study. Quantitative correlative studies between pinhole SPET and ARG were performed with linear regression analysis for infarct size and distribution properties (relative counts on SPET images and relative density on autoradiographs) on the short-axis sections. All infarcts (4 mm in minimum diameter) in seven rats were detected by pinhole SPET. The SPET images in rats with or without myocardial infarction were consistent with the findings of ARG and NBT staining. There were significant correlations between pinhole SPET and ARG with respect to the infarct size (r=0.933, P <0.001; n=15) and the relative radiotracer distribution (r=0.931, P <0.001; n=68). This study therefore confirmed the accuracy of myocardial pinhole SPET imaging in rats with myocardial infarction. This method may partially substitute for ARG and prove useful for assessing new myocardial imaging agents in vivo in small laboratory animals.

Connexin expression in the salivary glands

To investigate the ultrastructure of gap junctions and functional differences between connexin (gap junction structural protein) 32 and 43 in the rat submandibular and sublingual glands, tracer and freeze-fracture methods were carried out, and the expression of both connexins was examined. In both glands, western blot analysis with anti-connexin 32 and 43 antibodies revealed bands of about 27kD and 43kD, respectively. Immunofluorescence showed the presence of connexin32-positive spots between acinar cells in both glands. In contrast, connexin43-positive spots were observed at the periphery of the acinar structures in either gland. Positive spots for both connexins could not be detected between ductal cells in both glands. By immunocytochemistry, connexin32 was found on the gap junctional membranes of acinar cells and connexin43 on the gap junctional membranes of myoepithelial cells. It is surmised that connexin32 of the gap junction is related to the secretory function of acinar cells and that connexin43 is associated with the contraction of the myoepithelial cells.

Bilateral internal carotid artery agenesis

Images

[Chemotherapy for two patients with non-Hodgkin's lymphoma in hemodialysis]

There are few reports on chemotherapy of non-Hodgkin's lymphoma (NHL) in patients with chronic renal failure. Two long-term hemodialysis patients were treated for NHL with modified CHOP therapy. The plasma pharmacokinetics of adriamycin (ADR) and etoposide (VP-16) were investigated in these patients. In the first case, NHL was diagnosed in a 37-year-old male (diffuse pleomorphic, T cell type, stage I E). After 4 courses of chemotherapy, he achieved complete remission. The second case, was a 56-year-old male who was admitted to our hospital with melena and abdominal pain. A diagnosis of NHL (diffuse mixed, B cell type, stage III E) was made. Complete remission was achieved with 2 courses of chemotherapy. Levels of hematological and neurological toxicity were moderately severe but tolerable. Pharmacokinetics of ADR and VP-16 in these patients were similar to those in patients with normal renal function. These results suggested that ADR and VP-16 were effective drugs for hemodialysis patients with NHL.

Hepatocyte growth factor (HGF) produced by peritoneal fibroblasts may affect mesothelial cell morphology and promote peritoneal dissemination

Mesothelial cell monolayers have been reported to prevent infiltration of cancer cells into the peritoneum. We have previously reported that peritoneal fibrosis induced by gastric cancer cells prior to metastatization may provide a congenial environment for peritoneal metastases. In this study, we investigated the effects of peritoneal fibroblasts on peritoneal mesothelial cell morphology. Human gastric cancer (OCUM-2MD3), peritoneal fibroblast (NF-2P) and mesothelial (MS-1) cell lines were established in our laboratory. Histology of the peritoneum was investigated following intraperitoneal inoculation of serum-free conditioned media (SF-CM) from OCUM-2MD3 cells into nude mice. SF-CM from peritoneal fibroblasts was added to monolayer-cultured mesothelial cells, and their morphology was examined by phase-contrast microscopy. This experiment was conducted in the presence and absence of neutralizing antibodies against various factors. Mesothelial cells exposed to fibroblasts proliferation became hemispherical and separated from each other, while unexposed mesothelium remained as a flat monolayer. Cultured-mesothelial cells rounded up or exhibited a fibroblast-like shape following the addition of peritoneal fibroblast SF-CM. Anti-hepatocyte growth factor (HGF) neutralizing antibody partly inhibited this effect. We suggest that soluble factors, such as HGF, produced by peritoneal fibroblasts affect the morphology of mesothelial cells in monolayers so that the resulting environment may become prone to the peritoneal dissemination of cancer cells.

Is preoperative hepatic arterial chemoembolization safe and effective for hepatocellular carcinoma?

OBJECTIVE

The value of preoperative transcatheter arterial chemoembolization (TACE) for hepatocellular carcinoma (HCC) has not been duly appreciated. The authors assessed the advantages and disadvantages of preoperative TACE by reviewing their experience with the procedure.

METHODS

A total of 140 patients who underwent hepatectomy for HCC were entered into the study (105 received preoperative TACE and 35 did not). The authors investigated the reduction of tumor size and the complications after TACE, as well as the relationship between the interval from TACE to resection and the occurrence of complications. They compared postoperative morbidity and mortality between the TACE and non-TACE groups. They also compared survival and disease-free survival between the two groups, as well as between subgroups, defined by the extent of tumor necrosis achieved with TACE.

RESULTS

A distinct reduction of tumor size was observed in approximately half of the TACE group. However, there were 68 appreciable complications of TACE in 56 patients (53.3%), and the interval between TACE and resection was significantly prolonged in the patients with complications. The postoperative morbidity and mortality rates of the TACE group were not different from those of the non-TACE group. Preoperative TACE did not improve the survival or disease-free survival of the whole patient group after hepatectomy. In addition, the survival and disease-free survival rates of the three TACE subgroups were not different from those of the non-TACE group.

CONCLUSIONS

Preoperative TACE should only be performed to reduce tumor bulk in patients with HCC with borderline resectability. In such patients, increased tumor resectability appears to improve the survival rate. Preoperative TACE does not promote tumor recurrence.

Anorexia nervosa with recurrent hypoglycemic coma and cerebral hemorrhage

A 22-year-old woman with anorexia nervosa showed recurrent hypoglycemic coma and cerebral hemorrhage (Weber's syndrome). She also showed marked liver dysfunction. However, the liver damage was unlikely the main cause of these complications, because liver function tests were improved, and platelet count and prothrombin time were normal when cerebral bleeding occurred. These complications could be induced by her severe malnutrition. Although she rejected any nutritional support before cerebral hemorrhage, she began to accept glucose infusion after the episode, and psychiatric and nutritional states were apparently improved. Cerebral hemorrhage was a turning point in her disease.

Genetic analysis of the roles of daf-28 and age-1 in regulating Caenorhabditis elegans dauer formation

Based on environmental cues, the nervous system of Caenorhabditis elegans regulates formation of the dauer larva, an alternative larval form specialized for long-term survival under harsh conditions. Mutations that cause constitutive or defective dauer formation (Daf-c or Daf-d) have been identified and the genes ordered in a branched pathway. Most Daf-c mutations also affect recovery from the dauer stage. The semi-dominant mutation daf-28(sa191) is Daf-c but has no apparent effect on dauer recovery. We use this unique aspect of daf-28(sa191) to characterize the effects of several Daf-d and synthetic Daf-c mutations on dauer recovery. We present double mutant analysis that indicates that daf-28(sa191) acts at a novel point downstream in the genetic pathway for dauer formation. We also show that daf-28(sa191) causes a modest increase (12-13%) in life span. The phenotypes and genetic interactions of daf-28(sa191) are most similar to those of daf-2 and daf-23 mutations, which also cause a dramatic increase in life span. We present mapping and complementation data that suggest that daf-23 is the same gene as age-1, identified previously by mutations that extend life span. We find that age-1 alleles are also Daf-c at 27 degrees.

The influence of aortic calcification on spinal bone mineral density in vitro

We examined the influence of aortic calcification on the spine phantom bone mineral density (BMD). Soft X-ray photographs of human aortae were taken to calculate the percent calcification of aortic tissues. Human aorta laid on lumber spine phantom was placed in the bottom of 15 cm of water and BMD and bone mineral content (BMC) were measured in the anteroposterior view. Samples with severe aortic calcification (over 30%) caused a 2.5% increase of BMD. There might be a relatively small influence of aortic calcification on the value of L2-L4 BMD, but changes over time in a patient could falsely elevate values.

Early detection of platelet activation after coronary angioplasty

BACKGROUND

Although platelet activation has been considered an important reaction after percutaneous transluminal coronary angioplasty (PTCA), it is still difficult to detect the activated platelets in vivo directly.

METHODS

To detect platelets activated at an early stage after PTCA, blood samples were take from the coronary sinus and the aorta in 22 patients with coronary artery disease, who underwent PTCA for a lesion of the left anterior descending artery. Ten patients with coronary artery disease, who underwent diagnostic coronary angiography only, were compared with them. The expression of activation-dependent granular protein, CD62P (P-selectin) and CD63, on the platelet membrane surface was analysed using flow cytometry. The plasma thrombomodulin level was also measured.

RESULTS

The percentage of platelets positive for CD62P (0.53 +/- 0.04 to 0.80 +/- 0.11%, P < 0.01) and CD63 (16.0 +/- 1.4 to 19.8 +/- 2.0%, P < 0.05) increased after PTCA in the coronary sinus, although it did not change in the aorta. The plasma thrombomodulin level also increased after PTCA in the coronary sinus (16.7 +/- 1.0 to 20.4 +/- 2.0 mu/ml, P < 0.05). However, these parameters did not change after coronary angiography only. After PTCA, the plasma thrombomodulin level was correlated with the percentage of platelets positive for CD62P (r = 0.88, P < 0.001) and with that for CD63 (r = 0.69, P < 0.001) in the coronary sinus.

CONCLUSIONS

PTCA produced activation of circulatory platelets, which might have been caused by balloon-induced vascular endothelial injury. One should take care to avoid needless vascular injury during the PTCA procedure to inhibit the platelet activation.

Phylogenetic tree-based epidemiological analysis of hepatitis C virus transmission in a region of Japan with a high prevalence of infection

Local clustering of hepatitis C virus (HCV) infection has been demonstrated in various regions in Japan. HCV genotypes have now been compared between infected individuals from districts of Saga prefecture with either a high (H district) or low (L district) prevalence of HCV-seropositivity. The prevalence of HCV genotype 1b was significantly higher (P < 0.001) in the H district (45/50; 90%) than in the L district (19/36; 52.8%). A phylogenetic tree was constructed based on the genomic sequences of viral isolates from 20 patients infected with genotype 1b in the H district. Almost all these HCV strains clustered in the same regions of the tree. With regard to risk factors for HCV transmission, the percentage of patients with a history of surgery was significantly higher in the H district than in the L district (58 versus 33.3%; P < 0.05). Of 20 patients infected with similar strains of HCV in the H district, 16 (80%) had at least one parenteral risk factor associated with medical care. These results indicate an increased transmission of similar strains of HCV in the H district as a result of nosocomial infection.