Immunoglobulin D multiple myeloma: a case report

Immunoglobulin D (IgD) multiple myeloma is a rare disorder with a poor prognosis. We herein report a case of IgD myeloma presenting with renal failure and bicytopenia. A bone marrow biopsy specimen showed infiltration of homogeneous plasma cells, which stained positively for IgD and light chains. We review the literature and discuss the clinical manifestations, diagnosis and treatment strategy for this rare tumor.

Increased susceptibility to apoptosis induced by anti-Fas antibody in a Rothmund-Thomson syndrome lymphoblastoid cell line

Dysregulation of apoptosis leading to reduced DNA repair capacity, increased DNA mutation, and chromosomal instability is one of the pathological mechanisms associated with aging. Rothmund-Thomson syndrome (RTS) is a human genetic disease characterized by several features of premature aging. Although the genetic defect has not been identified, defects in DNA repair capacity have been implicated in the pathogenesis of this disease. To determine whether dysregulation of apoptosis is associated with the pathogenesis of RTS symptoms, we investigated the sensitivity of a lymphoblastoid cell line--derived from a young (10-year-old) individual with RTS--to cell death induced by anti-Fas antibody (clone: CH-11). Cell lines derived from a normal young (14-year-old) individual and a normal aged (79-year-old) individual were used as controls. Treatment with CH-11 (500 ng/ml) resulted in significantly decreased cell viability in the RTS cell line (42.4% +/- 4.2%) and that derived from the aged individual (47.3% +/- 9.2%) as compared to the normal young cell line (66.9% +/- 7.0%). The concentrations of CH-11 required to induce 50% cell death in the RTS (IC50, 890 ng/ml) and that derived from the aged individual (IC50, 3640 ng/ml) were lower than that of the control young cell line (IC50 > 10(5) ng/ml). The lower viability was due to increased susceptibility to apoptosis to CH-11 in the RTS (59.0% +/- 2.0%) compared to that in the normal young cell line (40.9% +/- 0.9%) as shown by 7-amino-actinomycin D (7-AAD) staining (p < .005). Treatment of the RTS cell line with acetyl-Asp-Glu-Val-Asp-aldehyde (Ac-DEVD-CHO), a specific inhibitor of caspase-3, significantly increased the cell viability after CH-11 treatment (75.9% +/- 2.2%). Taken together, these results provide the first evidence to show that RTS lymphoblastoid has an increased sensitivity to cell death mediated by Fas and that inhibition of caspase-3 activity may be a potential target in reversing the sensitivity of RTS cells to Fas-mediated apoptosis in vitro.

Naphthoquinone esters from the root of Rhinacanthus nasutus

Reinvestigation of the root of Rhinacanthus nasutus afforded, in addition to rhinacanthin-A to -D reported previously, two new dimethyldihydropyranonaphthoquinone esters (5, 6) and eight new 2-hydroxy-1,4-naphthoquinone esters (7-14) were isolated. The stereochemistry of rhinacanthin-A was determined as the R configuration. Compounds rhinacanthin-G to -N, belong to a class of 2-hydroxy-3-(3-hydroxy-2,2-dimethylpropyl)-1,4-naphthoquinone esters, and so far have been isolated only in this plant. Their biosynthesis is also discussed.

Impact of the extent of parametrial involvement in patients with carcinoma of the uterine cervix

PURPOSE

A scoring system is proposed to measure the extent of parametrial involvement and predict treatment outcome in patients with carcinoma of the uterine cervix.

METHODS AND MATERIALS

244 patients with FIGO Stage IIB (n = 146) or IIIB (n = 98) carcinoma of the uterine cervix were treated by radical radiotherapy from October 1987 to June 1992. Impact of the extent of parametrial involvement on outcome was studied. All patients were scored by the newly introduced scoring system described as follows: score 1, tumor extending <1/2 the distance to the pelvic side wall; score 2, tumor extending >1/2 the distance to the pelvic side wall but not to pelvic side wall; score 3, tumor extending to the pelvic side wall. The score in each patient was defined as the sum of the scores of both the left and right parametrial tumor extent.

RESULTS

There were 53, 47, 61, 34, 25, and 24 patients in score 1, 2, 3, 4, 5, and 6, respectively. All 244 patients were subdivided into three groups described as follows: score 1 and 2, group I; score 3 and 4, group II; score 5 and 6, group III. In univariate analysis, lower score groups had better overall survival rate (OS), disease-free survival rate (DFS), local control rate (LC), and distant metastasis-free rate (DMF) than higher score groups including groups I vs. II, II vs. III, or I vs. III. The differences were all statistically significant except for the difference of the DMF in group I vs. II. In multivariate analysis, score (range 1-6) was also statistically significant in OS (p < 0.0001), DFS (p = 0.0015), LC (p = 0.0032), and DMF (p = 0.0141).

CONCLUSIONS

The data suggested that the new scoring system defined by pelvic examination is a convenient, simple, and reliable method of measuring the degree of parametrial extension and predicting the outcome of patients with parametrial disease.

Determinative role of peroxidized low-density lipoprotein in myocardial thromboxane synthesis during pacing-induced ischaemia in humans

1. Myocardial thromboxane A2 production increases in patients with pacing-induced ischaemia and correlates with a decrease in myocardial lactate extraction. The release of myocardial thromboxane A2 before any lactate production was observed in patients with unstable angina. This study was proposed to clarify whether the early thromboxane A2 release contributed to the ongoing myocardial ischaemia and to determine which metabolites can be attributed to the thromboxane A2 release. Thirty-five patients with chest pain and positive treadmill exercise test underwent atrial pacing to the predicted maximal heart rate. The pacing was maintained at this peak rate for 10 min, then ceased. Blood samples of the ascending aorta and coronary sinus were drawn simultaneously at rest, at 2 and 10 min of peak-pacing, and 5 and 10 min after termination of the pacing; samples were used for analyses of lipid profiles, prostacyclin, thromboxane A2, lactate and lipid peroxides on plasma and low-density lipoprotein particles. 2. Twenty out of 35 patients who displayed pacing-induced ischaemia were documented by electrocardiographic evidence of ST depression > 2 mm developing after 2 min of peak-pacing [ischaemic group, ST delta(+)]. They had (i) negative fractional lactate extraction; (ii) pacing-induced decreases of plasma thromboxane A2 levels in the coronary sinus blood (564 +/- 57 versus 479 +/- 47 ng/l, P < 0.05) at 2 min of peak-pacing; the data increased at 10 min of peak-pacing (564 +/- 57 versus 620 +/- 60 ng/l, P < 0.05), then returned to baseline levels at 5 and 10 min post-pacing; (iii) significantly increased lipid peroxides on low-density lipoprotein of the coronary sinus blood at 2 and 10 min of peak-pacing (each P < 0.001), as well as at 5 min post-pacing (P < 0.05); (iv) significant correlation between thromboxane A2 levels and lipid peroxides on low-density lipoprotein of the coronary sinus blood samples. 3. In ST delta(+) patients, myocardial thromboxane synthesis changed before lactate production and correlated with the increase of lipid peroxides on low-density lipoprotein of the coronary venous blood. This implies that lipid peroxides on low-density lipoprotein participate in thromboxane production and play a determinative role in pacing-induced ischaemia.

Total skin electron beam irradiation in scleromyxoedema

We report a 44-year-old male with generalized progressive scleromyxoedema treated by total skin electron beam therapy (TSEBT) which produced a marked improvement in the skin lesion. TSEBT can provide effective treatment for patients with widespread skin involvement in scleromyxoedema.

Cell death and longevity: implications of Fas-mediated apoptosis in T-cell senescence

Two prominent features of immune senescence are altered T-cell phenotype and reduced T-cell response. We have previously shown that T-cell senescence is greatly reduced in CD2-fas transgenic mice, in which the Fas apoptosis molecule is constantly expressed on T cells. Using a different experimental approach, the relationship between T-cell senescence and apoptosis was analyzed on human peripheral blood mononuclear cells. The results indicate that there was increased apoptosis of CD45RO- (CD45RA+) T cells upon activation. We propose that this could account for the increase in CD45RO+ "memory" T cells with aging in humans. T-cell responsiveness remained high in CD2-fas transgenic aged mice, but there was no increase in overall life span of these mice. Increased T-cell responsiveness was associated with an increased acute-phase response and serum amyloid A deposition in the glomerulus of aged CD2-fas transgenic mice. Therefore, restoration of the T-cell immune function using a CD2-fas transgene produced undesirable side-effects to aged transgenic mice. In addition to its role in activation-induced cell death, Fas-mediated apoptosis may be important in deleting T cells in response to DNA damage. It may also inhibit cell-cycle progression by cleaving various kinases and DNA repair enzymes. We observed that cell lines derived from human premature aging diseases have a higher sensitivity to Fas-mediated apoptosis. The implications of these observations are discussed.

Bile duct hamartomas. A report of two cases

Bile duct hamartomas (von Meyenburg's complexes) of the liver are usually detected at laparotomy or autopsy as an incidental finding, and usually they are multiple. We report two cases of proved bile duct hamartomas of the liver. The first was in a 65-year-old man whose initial sepsis and many hepatic lesions were interpreted as microabscess of the liver. The second patient was a 39-year-old man, a hepatitis B surface antigen carrier, in whom an incidental hepatic tumor was found. We suggest that liver biopsy be done in hepatic lesions with uncertain clinical features, because the histologic findings may change the treatment plan.

Detection of hepatic neoplasms by computed tomographic arterial portography in cirrhotic patients

Computed tomography (CT) during arterial portography (CTAP) is useful in detecting hepatic tumors but cirrhotic change may interfere with portal flow and the prediction of resectability. We evaluated the usefulness of CTAP in detecting hepatic tumors, especially hepatocellular carcinoma (HCC), in patients with or without cirrhotic change. Ninety-six patients with pathologically proven hepatic tumors were assessed, of whom 90 had hepatocellular carcinoma. The tumors had been previously detected by abdominal ultrasound and CT scans, after which the patients were referred for angiography and CTAP. The CTAP findings were compared with ultrasonographic, conventional CT, angiographic, and subsequent surgical and pathologic findings regarding size, number, and location of the hepatic lesions. CTAP detected 134 of 143 pathologically proven lesions. The overall sensitivity of CTAP in the 96 patients was 94%, with a false-positive rate of 22%. The detection rate of CTAP for tumors less than 2 cm in diameter was high (92%). The sensitivity and false-positive rate for CTAP in 60 cirrhotic patients were 94% and 23%, respectively, CTAP is a sensitive imaging modality for detection of hepatic neoplasms even in patients with cirrhosis, but its false-positive rate is high.

Dominant negative activity of mutant thyroid hormone alpha1 receptors from patients with hepatocellular carcinoma

Complementary DNAs for two mutant thyroid hormone alpha1 receptors (TR alpha1) were isolated from hepatocellular carcinomas of two patients. Sequence analyses of the complementary DNAs showed a single Val390Ala and double Pro398Ser/Glu350Lys mutations in mutants H and L, respectively. We characterized their hormone-binding, DNA-binding, and dominant negative activities. Mutants H and L did not bind the hormone T3. Their DNA-binding activities were analyzed using three types of thyroid hormone response elements (TREs) in which the half-site binding motifs are arranged in an everted repeat (Lys), an inverted repeat (Pal), or a direct repeat separated by four nucleotides (DR4). Compared with wild-type TR alpha1 (w-TR alpha1), which bound these TREs with different homodimer/monomer ratios, binding of mutant L to the three TREs as homodimers was reduced by approximately 90%. However, binding of mutant H to these TREs was more complex. Although it bound normally to DR4 as homodimers, its binding to Lys as homodimers was reduced by approximately 80%. Surprisingly, its binding to Pal was markedly enhanced compared with w-TR alpha1. The binding of these two mutants to the three TREs as heterodimers with retinoid X receptors (RXR alpha and -beta) was not significantly affected. Consistent with the lack of T3-binding activity, both mutants had lost their trans-activation capacity. Mutants H and L exhibited dominant negative activity, but differed in their TRE dependency. The dominant negative potency of mutant H was in the rank order of Pal > DR4 > Lys, whereas no TRE dependency was observed for mutant L. The present study indicates that mutations of the TR alpha gene do occur in patients and that these novel TR alpha1 mutants provide a valuable tool to further understand the molecular basis of the dominant negative action of mutant TRs.

Short-term treatment with low-dose pravastatin attenuates oxidative susceptibility of low-density lipoprotein in hypercholesterolemic patients

The effects of treatment with low-dose 3-hydroxy-3-methylglutaryl-coenzyme A reductase inhibitor pravastatin on the changes of chemical composition and in vitro oxidative susceptibility of low-density lipoprotein (LDL) were studied in 20 type Ila hyperlipidemic patients with a plasma total cholesterol level > 240 mg/dL at the end of a diet control period for 3 months using the American Heart Association recommended step I diet. Treatment with pravastatin in a dose of 5 mg twice daily for 4 weeks resulted in lowering plasma total and LDL cholesterol levels by 17.0% and 22.9%, respectively. There was no further decline in plasma lipid thereafter. Chemical composition analysis showed that LDL particles did not contain significantly less cholesterol and thiobarbituric acid reactive substances (TBARS) until the end of 8 weeks (130.6 +/- 17.8 vs. 106.6 +/- 37.1 mg/mg protein, P < 0.05 and 0.16 +/- 0.06 vs. 0.08 +/- 0.02 nmol/mg protein, P < 0.005, respectively). Vitamin E, phospholipid, and triglyceride contents remained at the same levels throughout the study. In terms of oxidative kinetics, lag time and time to maximal diene concentration were not prolonged during the treatment period for 12 weeks, while total diene concentration and reaction rate were not significantly reduced until 8 weeks of treatment. Plasma enzyme activity of glutathione reductase and peroxidase, as well as the whole blood level of reduced and oxidized glutathione, remained similar during the study. In conclusion, pravastatin, at the low dose of 5 mg twice daily, produced a significant decline in plasma lipid levels to a steady-state range by 4 weeks; however, 8-weeks treatment is necessary to reduce the cholesterol and TBARS content, as well as to attenuate the oxidative susceptibility of LDL. These effects are not related to the antioxidant glutathione.

Cloning and expression of a developmentally regulated transcript MXR7 in hepatocellular carcinoma: biological significance and temporospatial distribution

Using the differential display method to analyze mRNA expression in hepatocellular carcinoma (HCC) and nontumor livers, we cloned a full-length cDNA of 2263 bp, which was designated GTR2-2 and was identical with MXR7. The MXR7 mRNA was detected in 143 of 191 (74.8%) primary and recurrent HCCs taken from 154 patients but only in 5 (3.2%) nontumor livers. MXR7 mRNA was detected in one of two hepatoblastomas but not in hepatocellular adenoma, cholangiocarcinoma, or metastatic carcinomas to the liver. In human cancer of other anatomical sites, MXR7 mRNA was detected in low levels in one Wilms' tumor and in 4 of 40 gastric adenocarcinomas but not in several other types of cancer and 21 nonhepatocellular human tumor cell lines examined. MXR7 mRNA was expressed in high levels in the placenta, fetal liver, lung, and kidney, but it was undetectable in adult liver and was expressed in very low levels in adult lung and kidney. Our observations suggest that the MXR7 gene is regulated developmentally and expressed preferentially in HCC. To study its potential biological significance, we selected 113 patients who had unicentric primary HCC and had been followed for more than 4 years for further analysis. The MXR7 mRNA expression correlated closely with elevated serum alpha-fetoprotein (AFP) levels (88 versus 55%; P = 0.0001) and with expression of AFP mRNA (87 versus 55%; P = 0.005) and CD24 mRNA in HCC (80 versus 50%; P < 0.04), high tumor grade (76 versus 56%; P = 0.05), and tumor invasion (76 versus 55%; P < 0.05), but not with patient outcome. In HCC < or =3 cm, the frequency (77%) of MXR7 mRNA expression was significantly higher than that of elevated serum AFP (43%; P < 0.007) and AFP mRNA expression in HCC (41%; P < 0.004). Thus, MXR7 may serve as a sensitive early tumor marker for HCC and warrants more study to better understand its biological function.

Clinical features associated with correction of T-cell senescence: increased acute-phase response, amyloidosis and arthritis

Two prominent features associated with immunosenescence are thymic involution and altered T-cell phenotype and responsiveness. We have shown previously that in CD2-fas transgenic mice, in which the Fas apoptosis molecule is constituatively expressed on T cells, T-cell senescence is greatly reduced. Using a different experimental approach, the relationship between T-cell senescence and apoptosis was analyzed on human PBMCs. The results indicate that there was increased apoptosis of CD45RO- (CD45RA+) T cells upon activation. We propose that this could account for the increase in CD45RO+ 'memory' T cells with aging in humans. Together these results are consistent with the notion that T-cell senescence is associated with altered apoptosis and decreased T-cell responsiveness. T-cell responsiveness remained high in CD2-fas transgenic aged mice, but there was no increase in overall life span of the mice. Increased T-cell responsiveness was associated with an increased acute-phase response and amyloid A deposition in the glomerulus of these mice. These data suggest that restoration of the T-cell immune function in aged individuals must be carried out in concert with correction of other immune factors that down modulate the acute-phase response to prevent undesirable side-effects.

Retinoic acid syndrome: a case report

All-trans-retinoic acid (ATRA) is a differentiation agent which can induce complete remission in a majority of patients with acute promyelocytic leukemia (APL). Unfortunately, about one-fourth of patients thus treated may develop potentially fatal complications, including respiratory distress, fever, pericardial and pleural effusion, renal failure and hypotension which constitute the retinoic acid syndrome (RA syndrome). We report one APL patient, who presented with leukocytosis and subacute disseminated intravascular coagulopathy, and developed RA syndrome during treatment with ATRA.

Influence of rotator cuff tearing on glenohumeral stability

This study hypothesizes that full-thickness tearing of the rotator cuff can lead to joint instability and that the degree of instability depends on the size and location of the tear. Twelve cadaveric shoulder specimens were divided into two groups: group 1 had a circular tear centered at the critical area, and group 2 had a circular tear centered at the rotator interval. Each group was tested at 2.5 cm and 5 cm tear sizes. Unloaded, and with the arm in 90 degrees flexion and full internal rotation, the humeral head shifted posteriorly. With loading, a large and more anteriorly located defect had the most influence on stability. The tear size had the greatest effect on stability in the inferior direction for group 1 and on the anterior direction for group 2. The tear location had the most significant effect on stability in the inferior and anterior directions for the smaller tear and on the anterior direction for a larger tear.

Expression of P-glycoprotein and p53 in advanced hepatocellular carcinoma treated by single agent chemotherapy: clinical correlation

Hepatocellular carcinoma (HCC), a chemoresistant tumour, is the most common fatal cancer in Taiwan. Hepatocellular carcinoma frequently expresses a high level of P-glycoprotein (P-gp), which is a specific phenotype of a multidrug-resistance gene, and harbours mutations of the tumour suppressor gene p53. A modulatory relationship between p53 and P-gp has been reported. In this study, we analysed the expression of P-gp in relation to chemotherapeutic response and p5353 protein expression in advanced HCC. Prechemotherapeutic tumour samples were obtained from 25 patients with HCC which had been treated with either etoposide (VP-16) or doxorubicin. P-glycoprotein and p53 in HCC were visualized by immunohistochemical staining using the monoclonal antibodies JSB-1 and DO1, respectively. We investigated the correlation of P-gp expression with chemotherapeutic responses, clinicopathological features and p53 protein expression. In our study, seven cases achieved partial remission, and the remaining 18 cases had a poor response to chemotherapy. Expression of P-gp was observed in 13 tumours (52%). Positive P-gp protein expression was significantly associated with non-responders (8% or 1/13 vs 50% or 6/12, P = 0.03). Thus, P-gp expression inversely correlated with chemotherapeutic response. Expression of p53 protein was seen in 12 cases and did not correlate with chemosensitivity or P-gp expression. In summary, P-gp expression correlates with the chemosensitivity of HCC that has been treated with VP-16 or doxorubicin and p 53 mutations do not appear to be a major determinant of P-gp expression in advanced HCC.

Autopsy findings on patients with AIDS in Taiwan

At National Taiwan University Hospital, from 1986 to 1996, autopsies were performed on 16 patients with acquired immunodeficiency syndrome. There were 15 men and 1 woman. Fourteen of these male patients had contracted the disease as a result of sexual practice, among which 9 were homosexual, 1 was bisexual and 4 were heterosexual. One of the patients had become infected by sharing a syringe during intravenous drug use. The female was a sex worker. Among these patients, only 2 had been tested for HIV before developing AIDS. On autopsy, lymphoid depletion and thymus atrophy were found in all patients. Testicular atrophy was noted in all the male patients. Three patients died of malignant lymphoma. Twelve patients died of opportunistic infections and 1 committed suicide. The initial opportunistic infection was usually oral candidiasis. Pneumocystis carinii pneumonia (PCP) was the most common opportunistic infection developed in the early stage while cytomegalovirus (CMV) infection was the most common one found in the late stage. Mycobacterium infection had developed in 8 patients. Six patients had disseminated Kaposi's sarcoma (KS) and 4 of them were homosexual. In 4 patients, biopsy specimens were proved to have KS associated viral (HHV-8) genome. Malignant lymphoma was found in 4 cases, all were of high grade B cell type. Epstein-Barr virus (EBV) encoding small RNA (EBER1) was demonstrated in all the lymphomas. In conclusion, (1) the prevalence of tuberculosis (38%) in patients with AIDS in Taiwan is high; (2) the most common opportunistic infections in this series are candidiasis, PCP and CMV infections; (3) the incidence of AIDS related non-Hodgkin's lymphoma in Taiwan has increased since 1995.

Increased acute-phase response and renal amyloidosis in aged CD2-fas-transgenic mice

We previously demonstrated that increased Fas expression in T cells of aged CD2-fas transgenic (Fas-Tg) CD-1 mice results in an increased immune response and T cell apoptosis. Surprisingly, despite prevention of T cell immune senescence, the average life span of Fas-Tg mice is comparable with that of nontransgenic (non-Tg) mice. Histopathologic evaluation of tissue sections showed that nearly 50% of the aged (>18-mo-old) Fas-Tg mice developed renal amyloid A amyloidosis, whereas no amyloid deposition was observed in aged non-Tg mice. The amyloid A deposition was observed primarily in glomeruli by using immunohistochemical stains and electron microscopy. The full-length amino acid coding sequence of serum amyloid A2 cDNA in CD-1 mice was identical to that of amyloid A amyloidosis-susceptible BALB/c mice. Although there was no significant difference in steady-state serum amyloid A level in the serum of aged non-Tg and Fas-Tg mice, challenging mice with staphylococcal enterotoxin B resulted in significantly higher serum levels of serum amyloid A on day 2 and IL-6 on days 1 and 2 and a higher magnitude of weight loss on day 7 in aged Fas-Tg mice compared with young mice. These parameters, at the indicated time points, were equivalent between young and aged non-Tg mice. Taken together, our data suggest that prevention of T cell senescence in Fas-Tg mice may be a factor in induction of an excessive acute-phase response triggered by T cell activation. The Fas-Tg mice are a novel model for understanding the immunologic mechanisms leading to secondary amyloidosis.

Increased acute-phase response and renal amyloidosis in aged CD2-fas-transgenic mice

We previously demonstrated that increased Fas expression in T cells of aged CD2-fas transgenic (Fas-Tg) CD-1 mice results in an increased immune response and T cell apoptosis. Surprisingly, despite prevention of T cell immune senescence, the average life span of Fas-Tg mice is comparable with that of nontransgenic (non-Tg) mice. Histopathologic evaluation of tissue sections showed that nearly 50% of the aged (&gt;18-mo-old) Fas-Tg mice developed renal amyloid A amyloidosis, whereas no amyloid deposition was observed in aged non-Tg mice. The amyloid A deposition was observed primarily in glomeruli by using immunohistochemical stains and electron microscopy. The full-length amino acid coding sequence of serum amyloid A2 cDNA in CD-1 mice was identical to that of amyloid A amyloidosis-susceptible BALB/c mice. Although there was no significant difference in steady-state serum amyloid A level in the serum of aged non-Tg and Fas-Tg mice, challenging mice with staphylococcal enterotoxin B resulted in significantly higher serum levels of serum amyloid A on day 2 and IL-6 on days 1 and 2 and a higher magnitude of weight loss on day 7 in aged Fas-Tg mice compared with young mice. These parameters, at the indicated time points, were equivalent between young and aged non-Tg mice. Taken together, our data suggest that prevention of T cell senescence in Fas-Tg mice may be a factor in induction of an excessive acute-phase response triggered by T cell activation. The Fas-Tg mice are a novel model for understanding the immunologic mechanisms leading to secondary amyloidosis.

Physiological elongation of ligamentous complex surrounding the hindfoot joints: in vitro biomechanical study

Ligaments surrounding the hindfoot joints play an important role in hindfoot stability. This in vitro study investigated anatomical and biomechanical characteristics of nine major ligamentous structures, including length and orientation at neutral position and physiological elongation with the foot in five different positions relative to the neutral position. The results showed that ligament elongation depended on the ligament length, orientation in neutral position, and movement of bones to which they were attached.

The anti-tumor effect of Ganoderma lucidum is mediated by cytokines released from activated macrophages and T lymphocytes

The present study was to ascertain the immunomodulating and anti-tumor effects of Ganoderma (G.) lucidum. Polysaccharides (PS) from fresh fruiting bodies of G. lucidum (PS-G) were isolated and used to potentiate cytokine production by human monocytes-macrophages and T lymphocytes. Our results had shown that the levels of interleukin (IL)-1 beta, tumor necrosis factor (TNF)- alpha, and IL-6 in macrophage cultures treated with PS-G (100 micrograms/ml) were 5.1-, 9.8- and 29-fold higher, respectively, than those of untreated controls. In addition, the release of interferon (IFN)- gamma from T lymphocytes was also greatly promoted in the presence of PS-G (25-100 micrograms/ml). Furthermore, these cytokine-containing mononuclear cell-conditioned media (PSG-MNC-CM) were found to suppress the proliferation and clonogenicity of both the HL-60 and the U937 leukemic cell lines. DNA labeling and gel electrophoresis showed that treatment with PSG-MNC-CM markedly induced leukemic-cell apoptosis. Flow-cytometric analysis revealed that few (2.3 +/- 0.8%) apoptotic cells were seen in the control cultures, while PSG-MNC-CM treatment resulted in a significant increase in the apoptotic population both in the HL-60 (38.3 +/- 4.5%) and in the U937 (44.5 +/- 3.8%) cells. In addition, 40 to 45% of the treated leukemic cells were triggered to differentiate into mature monocytic cells expressing CD14 and CD68 surface antigens. However, PS-G alone had no such effects even at a higher dose of 400 micrograms/ml. Since untreated macrophages and T lymphocytes produced little or no cytokine, and normal MNC-CM did not suppress leukemic cell growth, it was suggestive that the anti-tumor activity of PSG-MNC-CM was derived from the elevated levels of cytokines. Antibody-neutralization studies further revealed that the anti-tumor cytokines in the PSG-MNC-CM were mainly of TNF- alpha and IFN- gamma, and these 2 cytokines acted synergistically on the inhibition of leukemic-cell growth.

Fip-vvo, a new fungal immunomodulatory protein isolated from Volvariella volvacea

A new fungal immunomodulatory protein (Fip) has been purified from the edible mushroom, Volvariella volvacea, and designated Fip-vvo. Analysis of the purified protein by SDS/PAGE followed by Coomassie Blue staining demonstrated that Fip-vvo is a single polypeptide with an apparent molecular mass of 15 kDa. Periodic acid/Schiff staining showed that this single polypeptide lacks carbohydrates. Using an in vitro bioassay measuring blast-formation stimulatory activity, Fip-vvo was shown to stimulate the maximum proliferation of human peripheral blood lymphocytes at a concentration of 5 microg/ml. Fip-vvo was capable of agglutinating rat red blood cells. Neither haemagglutination nor mitogenic activities were inhibited by mono- or dimeric sugars. In vivo, repeat administration of Fip-vvo greatly reduced the production of BSA-induced Arthus reaction in mice, whereas little effect was observed on the prevention of systemic anaphylaxis reactions. The selectively enhanced transcriptional expression of interleukin (IL)-2, IL-4, interferon-gamma, tumour necrosis factor-alpha, lymphotoxin and IL-2 receptor by Fip-vvo was also demonstrated by reverse transcriptase-PCR. This finding suggests that Fip-vvo exerts its immunomodulatory effects via cytokine regulation. In addition, the complete amino acid sequence of Fip-vvo was obtained by direct protein sequencing. This protein consists of 112 amino acid residues with a blocked N-terminal end and has a calculated molecular mass of 12667 Da not including the N-terminal blocking group. By gel filtration analysis, Fip-vvo exhibited a molecular mass of 26 kDa for the native molecules in PBS. This result indicates that native Fip-vvo is most likely a non-covalently associated homodimeric molecule.

Immunohistochemical analyses of p53 protein expression in breast cancers in Taiwan: a clinicopathologic study

Immunohistochemical analysis of the p53 protein was performed on paraffin sections of tumor tissue from 210 breast cancer patients. All patients had a follow-up period of more than 5 years. Protein expression of p53 was detected in 64 patients (30.5%). There was significant correlation between p53 protein expression and a high histologic grade (grade II vs grade I/II, 49% vs 23.6%, p = 0.0008) and high mitotic index (> or = 10/10 hpf vs < 10/10 hpf, 42.9% vs 19.6%, p = 0.0004), but not with axillary node status, stromal lymphocytic infiltration, or estrogen receptor or progesterone receptor status. We found that p53 protein expression was not a significant factor in predicting 5-year mortality.

Primary transplantation of allogeneic peripheral blood stem cell for severe aplastic anemia

Primary allogeneic peripheral blood stem cell transplantation (allo-PBSCT) has not been previously described in the treatment of severe aplastic anemia (SAA). We report a patient with SAA who underwent primary allo-PBSCT with cells from her HLA-identical sibling and achieved rapid bone marrow reconstitution. The patient has been in complete remission with normal blood counts for 9 months following allo-PBSCT. This suggests that primary allo-PBSCT is a safe and effective alternative in the treatment of SAA.