Vitamin K prophylaxis to prevent neonatal vitamin K deficient intracranial haemorrhage in Shizuoka prefecture

OBJECTIVE

To compare three methods of vitamin K prophylaxis for neonatal vitamin K deficient intracranial haemorrhage.

DESIGN

We designed three strategies for vitamin K prophylaxis: 1. therapeutic administration of vitamin K in a mass screening system using the hepaplastin test; 2. routine oral administration of vitamin K to newborn infants; and 3. administration of vitamin K to lactating mothers during the late neonatal period in addition to the routine method. We evaluated the efficacy of these methods by determining hepaplastin test values at the first month of age.

POPULATION

66,076 full term healthy newborn infants without any complications.

RESULTS

Of 55,513 infants in the mass screening system, 3068 infants received vitamin K therapeutically. At the first month of age, in the group where vitamin K was administered therapeutically, 56 infants (1.83%) exhibited low hepaplastin test values (< 40%) despite vitamin K administration. But extremely low values (< 20%), indicating a very high risk of neonatal intracranial haemorrhage, were observed in 34 (0.06%) of 52,445 infants who did not receive vitamin K. In the routine administration system, oral administration of vitamin K twice within the first week of life showed a lower incidence (0.19%) of low level cases than a single administration (1.56%). An additional administration of vitamin K to lactating mothers throughout the late neonatal period showed an effective result.

Active secretion of drugs from the small intestinal epithelium in rats by P-glycoprotein functioning as an absorption barrier

Because the significance of P-glycoprotein in the in-vivo secretion of beta-blockers in intestinal epithelial cells is unclear, the secretory mechanism for beta-blockers and other drugs has been evaluated. Uptake of the beta-blockers acebutolol, celiprolol, nadolol and timolol, and the antiarrhythmic agent, quinidine by the multidrug-resistant leukaemic cell line variant K562/ADM was significantly lower than that by drug-sensitive K562 cells, suggesting that these beta-blockers are transported by P-glycoprotein out of cells. The reduced uptake of acebutolol by the drug-resistant K562/ADM cells was reversed by treating the cells with anti-P-glycoprotein monoclonal antibody, MRK16, whereas no such alteration in uptake was observed for drug-sensitive K562 cells. Acebutolol uptake by K562/ADM cells was, moreover, markedly enhanced, in a concentration-dependent manner, in the presence of the specific P-glycoprotein inhibitors, MS-209 and cyclosporin. Caco-2 cells were used for evaluation of the role of P-glycoprotein in intestinal permeability to drugs in-vitro. Basolateral-to-apical transport of acebutolol was twice that in the reverse direction. A similar polarized flux was also observed in the transport of vinblastine, but not in that of acetamide or mannitol. When in-vivo intestinal absorption was evaluated by the rat jejunal loop method, with simultaneous intravenous administration of a P-glycoprotein inhibitor, cyclosporin, intestinal absorption of both acebutolol and vinblastine increased 2.6- and 2.2-fold, respectively, but no such enhancement was observed in the absorption of acetamide. The effect of cyclosporin on the intestinal absorption of several drugs was further examined, and the extent of the contribution of P-glycoprotein as an absorption barrier to those drugs was evaluated. ATP depletion by occlusion of the superior mesenteric artery resulted in a clear increase in epithelial permeability to vinblastine, but not to 3-O-methylglucose or acetamide, indicating that vinblastine is secreted by ATP-dependent P-glycoprotein into the lumen. These findings demonstrate that P-glycoprotein plays a role as an absorption barrier by transporting several drugs from intestinal cells into the lumen.

Expression of interleukin-8 receptors in the gestational tissues before and after initiation of labor: immunohistochemical study

BACKGROUND

Interleukin-8 (IL-8) has an essential role in the mechanism of parturition. IL-8 induces its effect through specific cell binding receptors. The main purpose of this research was to elucidate the presence of IL-8 receptors in the gestational tissues and their relation to parturition.

MATERIALS AND METHODS

Fetal membranes, placenta, umbilical cord and myometrial samples were collected before the initiation of labor during elective Cesarean sections (n = 15). Similar biopsies (except myometrial samples) were also gathered after normal vaginal delivery (n = 15). Immunohistochemical staining for IL-8 receptors type I and II was carried out for the fresh frozen sections of all samples. Immunoreactive score (IRS) was calculated for the stained sections.

RESULTS

IL-8 Receptors type I and II were recognized in the fetal membranes, placenta, umbilical cord and myometrial samples collected from patients before the initiation of labor. The staining of amnion and placentas were found to be more intensified in the samples collected after vaginal delivery compared to those from elective cesarean sections and before initiation of labor.

CONCLUSIONS

Increased expression of IL-8 receptors after initiation of labor may indicate that IL-8 receptors might have a role during parturition.

Urinary trypsin inhibitor: a new drug to treat preterm labor: a comparative study with ritodrine

Prevention of preterm delivery is one of the difficult problems facing obstetricians. beta Adrenergic agonists, especially ritodrine, are commonly used in these cases.

OBJECTIVES

The aim of this research was to study and compare the effect of urinary trypsin inhibitor (UTI) which has anti-inflammatory anti-cytokine effects with ritodrine in treating preterm labor.

STUDY DESIGN

Patients in preterm delivery were randomly selected to be treated either by ritodrine or UTI. In the ritodrine group, uterine contractions were initially suppressed by high doses of ritodrine (up to 300 micrograms/min) and then a maintenance dose was given until 35 weeks of gestation. In the UTI group one vaginal suppository (5000 U) was used daily for 2 weeks. Patients with recurrent preterm uterine contraction during the initial 14 days of treatment, who needed course of other drugs to suppress the contractions, were excluded from the study. Patients responding to the drugs were followed until delivery. Tocolytic index and elastase concentration in the cervical mucus was calculated. Recurrence rate of uterine contraction and time of elongation of pregnancy since the beginning of treatment was calculated.

RESULTS

UTI was more effective than ritodrine in inhibition of recurrent uterine contraction and elongation of pregnancy. No side effects could be observed after treatment with UTI for the mother or the fetus.

CONCLUSION

UTI may be a new therapeutic method for the inhibition of preterm delivery through suppression of cytokines and inflammatory mediators.

Transvenous hemodynamic assessment of arteriovenous malformations and fistulas. Preliminary clinical experience in Doppler guidewire monitoring of embolotherapy

BACKGROUND AND PURPOSE

Transvenous monitoring of blood flow through intracranial vascular malformations was performed with an intravascular Doppler guidewire to assess hemodynamic changes during endovascular embolotherapy.

METHODS

Flow velocity was assessed in the intracranial venous sinuses of two patients with arteriovenous malformations and seven patients with dural arteriovenous fistulas. In all cases, the Doppler guidewire was positioned in the dural sinuses coaxially through a 2.1F microcatheter. The Doppler guidewire was then advanced to the site of arteriovenous shunting for sampling of venous average peak velocity (APV) and pulsatility index. In two cases, simultaneous feeding artery flow velocity was monitored by transcranial color-coded duplex sonography.

RESULTS

Before embolotherapy, the flow pattern in the venous sinuses was pulsatile, with a mean (+/-SD) APV of 39.0 +/- 22.5 cm/s. Total or near-total embolization was achieved in six of the nine cases. After embolization, the flow pattern became less pulsatile and the APV was reduced to a mean of 21.2 +/- 14.6 cm/s (P = .0123, one-tailed paired t test). The pulsatility index was used to calculate the maximum minus the minimum peak velocity (MxPV-MnPV). This was reduced from an average of 27.0 +/- 8.7 cm/s to 13.5 +/- 8.3 cm/s after treatment (P = .0456). A parallel reduction in APV of the feeding arteries was observed with embolization.

CONCLUSIONS

Preliminary clinical experience indicates that transvenous assessment of two parameters, APV and MxPV-MnPV, is useful in the hemodynamic evaluation of intracranial arteriovenous shunts. This valuable hemodynamic information may be used for objective and quantitative monitoring during embolotherapy of intracranial vascular malformations.

[Comparison of biochemical properties of human airway tryptase isolated from mucoid sputum with those of lung mast cell tryptase]

We found a novel trypsin-like enzyme (tryptase) in sputum from patients with chronic airway diseases, and named this enzyme human airway tryptase (HAT). To clarify its physiological significance in the airway, we compared biochemical properties of purified HAT with those of purified lung mast cell tryptase (MCT). Studies with model peptide substrates showed that both the HAT and MCT preferentially cleaved the COOH-terminal side of arginine residues of certain peptides, but substrate specificities to nine synthetic model substrates of HAT differed from those of MCT. Effects of protease inhibitors on the two enzymes were examined at a concentration of 10 microM. Both the HAT and MCT were strongly inhibited by the trypsin inhibitors leupeptin, antipain, and aprotinin. An alpha-1-protease inhibitor inhibited HAT by 50%, but it did not inhibit MCT. In contrast, a secretory leukocyte protease inhibitor strongly inhibited MCT, but not HAT. Mucoid sputum from patients with chronic bronchitis contained much more HAT than MCT. These differences in biochemical properties between HAT and MCT indicate that they play different physiological roles in the airways.

Inter-alpha-trypsin inhibitor bound to tumor cells is cleaved into the heavy chains and the light chain on the cell surface

Inter-alpha-trypsin inhibitor (ITI), a human serum protease inhibitor of molecular mass 240 kDa which may release physiological derivatives, has been shown to interact with hyaluronic acid (HA), resulting in pericellular matrix stabilization (Chen, L., Mao, S.J.T., McLean, L. R., Powers, R. W., and Larsen, W. J. (1994) J. Biol. Chem. 269, 28282-28287). The purpose of this study is to determine whether ITI binding to tumor cell surface is mediated by urinary trypsin inhibitor (UTI)-receptor or cell-associated hyaluronic acid (HA). We demonstrated specific complex formation of the heavy (H) chains of ITI with HA. Binding of the H-chains of ITI to immobilized HA was detected and quantified using colorimetric immunoassays. Binding was time-, temperature-, and concentration-dependent. However, UTI and HI-8 (the carboxyl terminus of UTI) failed to bind to immobilized HA. ITI bound to HA remained functional protease inhibiting activity. After incubation of SMT-cc1 cells with purified biotinylated ITI, biotinylated ITI is bound to the cells, dissociated, and gives rise to the H-chains and UTI on the cell surface. The cell surface receptor-bound UTI derived from ITI may be the result of the limited proteolysis on the cell surface. In the cells treated with hyaluronidase, bound H-chains disappeared from the surface of the cells, while most of the cell surface ITI derivatives was present in deglycosylated UTI (28 kDa). It is suggested that the binding of ITI to the cell surface is mediated by HA on the cells. This was confirmed by the fact that the hyaluronidase-treated cells can abolish the ITI binding. The cell surface UTI formation was inhibited by diisopropyl fluorophosphate, phenylmethylsulfonyl fluoride, and eglin C, suggesting that elastase-like enzyme(s) may be responsible for the UTI formation. Preincubation of the cells with UTI did not decrease in exogenously added ITI on the cell surface. A model for cell surface UTI formation is proposed in which ITI binding to cells from serum used for the culture is followed by the limited proteolysis by trace amounts of active serine proteases, to form cell-surface receptor-bound UTI and the H-chains intercalated into cell surface HA. This process is subject to regulation of cell-associated UTI and of stabilization of pericellular matrix.

Case report. Antenatal diagnosis of chorioangioma of the placenta: MR features

We report a case of chorioangioma of the placenta, in which MR findings were useful in establishing the antenatal diagnosis. Polyhydramnios and a placental tumor that was 5 cm in size were visualized. The tumor had relatively high signal intensities on proton density imaging and T2-weighted imaging and showed partially high intensity signal rims on T1-weighted imaging, especially when using a breath-holding technique. Magnetic resonance imaging has an important role in detection and diagnosis of these lesions, particularly the larger tumors, so that appropriate steps can be taken to deal with the complications that may accompany this tumor.

Biochemical changes in the cervical tissue of rabbit induced by interleukin-8, interleukin-1beta, dehydroepiandrosterone sulphate and prostaglandin E2: a comparative study

The aim of this research was to study and compare the mechanism of action of interleukin (IL)-8, IL-1beta dehydroepiandrosterone sulphate (DHEA-S) and prostaglandin (PG)E2 on the cervix. Five equal groups of pregnant rabbits (n = 45) were tested by either placebo or tested drugs in the form of vaginal suppositories once daily for 3 days. The suppositories contained human recombinant IL-8 (100 ng), IL-1beta (200 ng), DHEA-S (10 mg) or PGE2 (1 mg). All rabbits were tested by one dose, two doses or three doses. Consistency, dilatation and water contents were estimated 24 h after the last dose of treatment. Leukocyte infiltration of the cervices was studied after staining the cervical tissue sections with antirabbit RT2 monoclonal antibodies. Relative collagen concentration was assessed after staining with Picrosirius Red. Collagenase, gelatinase and elastase activities were measured in 100 mg of homogenized cervical connective tissue. Water contents were significantly increased in all tested cervices. Neutrophil numbers were increased in IL-8 and IL-1beta groups after the second dose of treatment (P < 0.0005 and 0.001 respectively). In the PGE2 group, neutrophils were increased after the third dose of treatment, whereas in DHEA-S group no significant changes were observed. Collagen content was significantly decreased in IL-8, IL-1beta and PGE2 groups after the first dose of treatment (P < 0.004, and 0.005 and 0.03 respectively). In the DHEA-S group, the decrease in collagen content occurred after the third dose (P < 0.05). Collagenase activity was markedly increased in IL-8, IL-1, and DHEA-S groups after the second dose of treatment (P < 0.001, 0.003 and 0.007 respectively). No significant increase in collagenase activity was found in PGE2 group. Gelatinase activity was significantly increased in IL-8, IL-1beta, PGE2 and DHEA-S groups after the second dose of treatment (P < 0.008, 0.01, 0.003 and 0.05 respectively). Also, elastase activity was increased after the second dose of treatment in all groups (P < 0.001, 0.001, 0.001 and 0.006 respectively). Our data suggest that ripening of the cervix in rabbit can be initiated by different mechanisms. Cytokines play a vital role in cervical ripening, especially IL-8 and IL-1. IL-8 is one of the factors which could ripen the cervix in a manner similar to the physiological process at term.

Irreversible sinus node dysfunction induced by resumption of lithium therapy

We present the case of a 56-year-old woman with syncope and sinus node dysfunction after long-term lithium therapy. Following lithium discontinuation, sinus node function recovered completely. After resuming low doses of lithium, however, severe sinus node dysfunction recurred. Thereafter, sinus node function did not recover after lithium was discontinued, and a permanent pacemaker was implanted. These findings suggest that irreversible sinus node dysfunction should be recognized as a potentially fatal, albeit rare, risk of lithium therapy, and that previous recovery from sinus node dysfunction after long-term lithium treatment cannot always guarantee the reversible nature of this abnormality after resumption of lithium therapy.

Expression of urokinase and urinary trypsin inhibitor in metastatic and non-metastatic murine Lewis lung carcinoma cells

The murine Lewis lung carcinoma 3LL cells give rise to spontaneous and experimental lung metastasis in C57BL/6 mice. Tumor cells maintained by serial subcutaneous transplantation in mice retain their ability to form lung metastasis, while cells carried in vitro loose metastatic potential with time. In order to obtain the non-metastatic subline, 3LL cells selected for its high lung colonization potential was grown continuously in vitro for 24 weeks. The present study was undertaken to characterize the expression of both urokinase-type plasminogen activator (uPA) and urinary trypsin inhibitor (UTI) in the non-metastatic (3LL(-)) and the metastatic (3LL(+)) cells. Both cells were tested on the Matrigel for invasive ability using a modified Boyden chamber and assayed for expression of uPA and UTI. The 3LL(+) cells secreted 5 times more uPA (6.25 mu g per 10(6) cells per 24 h) than the 3LL(-) cells (1.25 mu g per 10(6) cells per 24 h). The 3LL(+) cells, which expressed 2 times more cell-surface receptor-bound enzymatically active uPA (0.32 +/- 0.06 OD405) than the 3LL(-) cells (0.15 +/- 0.03 OD405), had larger amounts of cell-surface receptor-bound uPA. On the other hands, UTI levels in the conditioned media was decreased 25-fold in the 3LL(+) cells (0.05 mu g/10(6) cells/24 h) compared to the 3LL(-) cells (1.25 mu g/10(6) cells/24 h). The 3LL(-) cells expressed significantly higher levels of cell-associated UTI as indicated by a cell ELISA (3LL(+), 0.30 +/- 0.04 OD450; 3LL(-), 1.30 +/- 0.21 OD450) and by Western blot analysis. Metastatic competence in the 3LL(+) tumor model is associated with increased expression and release of uPA, as well as decreased UTI production, consistent with a more invasive phenotype. These data support our hypothesis that UTI may contribute to the inhibition of uPA expression in tumor cells.

Induction of HELLP syndrome-like biochemical parameters by stimulation of the celiac ganglion in rats

OBJECTIVE

An animal model of HELLP (hemolysis, elevated liver enzymes, low platelets) syndrome was developed by means of stimulation of the celiac ganglion in rats.

METHODS

The celiac ganglion in pregnant or non-pregnant rats was exposed to endotoxin (lipopolysaccharide, LPS) (500 micrograms/50 microliters), potassium chloride (0.2 mol/l/50 microliters), or saline solution (50 microliters). In another group of rats the bifurcation of the abdominal aorta was exposed to LPS (500 micrograms/50 microliters). Blood pressure, platelet count, hematocrit, serum aspartate transaminase (AST), alanine transaminase (ALT), lactate dehydrogenase (LDH), and plasma norepinephrine and epinephrine were measured for 6 h after treatment. Histopathologic studies were also performed in these rats.

RESULTS

A significant increase in blood pressure, AST, ALT, LDH, norepinephrine, and epinephrine was found in the endotoxin-treated pregnant rats compared with control rats treated with the saline solution. A significant decrease in platelet count was found in endotoxin-treated pregnant rats compared with the control rats. A significant increase in blood pressure, AST, norepinephrine, and epinephrine was found in the potassium chloride-treated pregnant rats compared with control rats. Blood pressure and biochemical parameters remained unchanged in the pregnant rats treated with LPS at the bifurcation of the abdominal aorta, as in those treated with saline at the celiac ganglion. Histologic examination of liver tissues treated with LPS or potassium chloride showed varying degrees of ischemic necrosis of hepatocytes similar to that observed in the human HELLP syndrome. Blood pressure, biochemical parameters, and histologic findings in non-pregnant rats were almost the same as those in pregnant rats.

CONCLUSION

This study suggests that exogenous stimulation of the celiac ganglion causes an increase in the blood pressure and liver ischemia, resulting in HELLP syndrome-like disease in pregnant and non-pregnant rats.

Characterization and tissue distribution of opioid-binding cell adhesion molecule (OBCAM) using monoclonal antibodies

Monoclonal antibodies to opioid-binding cell adhesion molecule (OBCAM) were produced against a synthetic OBCAM peptide. Immunoblotting analysis revealed that the antibodies reacted with 58 and/or 51 kDa proteins in P2 membranes from bovine, rat, mouse, guinea pig and rabbit brains. In bovine brain, the 58 and 51 kDa proteins were present in the striatum and cerebral cortex at high levels, but not in the pituitary. OBCAM was also detected in the cerebellum mainly in the 51 kDa form. In other tissues, the proteins were found in the spleen at very low levels, but not at all in the liver or kidney of the rat. OBCAM was effectively solubilized from bovine P2 membranes by bacterial phosphatidylinositol specific-phospholipase C (PI-PLC), indicating that OBCAM is a glycosylphosphatidylinositol (GPI)-anchored protein. PI-PLC treatment, however, had little effect on the opioid binding activity of the residual P2 membranes. The molecular weight of the proteins (58 and 51 kDa) was reduced to 36 kDa following treatment with N-glycanase but not further reduced after subsequent treatment with neuraminidase and O-glycanase, suggesting that OBCAM has N-glycosylated carbohydrate chains and that its two isoforms are different, at least, in the degree of N-glycosylation. Taken together, these results suggest that OBCAM consists of 58/51 kDa GPI-anchored glycoproteins which are highly N-glycosylated and are expressed mainly in the nervous system.

Biochemical changes in the cervical mucus after application of laminaria tent

BACKGROUND

This research was aimed to study the biochemical changes in cervical mucus after application of laminaria tent.

MATERIAL AND METHODS

Cervical mucus was collected before and after insertion of laminaria tent from 20 normal pregnant women in the first and second trimesters. Interleukin-1 beta, IL-8, collagenase activity, elastase activity, PGE2 and PGF2 alpha were measured in the collected samples. Laminaria tent was also inserted in one vaginal cervix of five non-pregnant rabbits and the clinical and histological changes were compared with five non-treated rabbits. Collagen contents were assessed histologically and Leukocyte number was counted.

RESULTS

IL-1 beta and IL-8 and elastase activity were significantly increased after insertion of laminaria (p<0.0001 and 0.001 respectively). Collagenase activity was not significantly changed. Whereas concentration of PGE2 and PGF2 alpha in the mucus were markedly increased (p<0.0001 and 0.001 respectively). Collagen contents were significantly decreased in laminaria and opposite side cervices (p<0.0001). No significant changes in leukocyte count could be observed in treated and non treated cervices.

CONCLUSIONS

Insertion of laminaria leads to increase concentration of IL-1 beta, IL-8, PGE2, PGF2 alpha and elastase activity. Mechanical stretching of the cervix and biochemical changes in cervical mucus may explain the mechanism of cervical ripening induced by laminaria.

Stretching of fetal membranes increases the concentration of interleukin-8 and collagenase activity

OBJECTIVE

The aim of this study was to determine whether stretching of fetal membranes can increase interleukin-8 concentration and collagenase activity.

STUDY DESIGN

Strips of whole fetal membranes, amnion, or muscles of the lower uterine segment were stretched for 2 or 4 hours. Interleukin-8 and collagenase activity were measured in homogenized control and stretched samples. Immunohistochemical staining for interleukin-8 was carried out.

RESULTS

The interleukin-8 concentration increased significantly after the whole fetal membranes were stretched for 2 and 4 hours (p <0.0007 and 0.001, respectively). Also, stretching of amnion and muscles of the lower uterine segment for 2 and 4 hours increased the concentration of interleukin-8 significantly (p <0.0007 after 2 and 4 hours, respectively). Collagenase activity was significantly increased after stretching of amnion, amniochorion, and muscles of the lower uterine segment for 4 hours (p <0.0007, 0.006, and 0.0007, respectively). After stretching, samples were darkly stained for interleukin-8 compared with control nonstretched samples.

CONCLUSION

Stretching of amnion, amniochorion, and muscles of the lower uterine segment increased interleukin-8 production and collagenase activity.

Immunohistological study in cases of HELLP syndrome (hemolysis, elevated liver enzymes and low platelets) and acute fatty liver of pregnancy

We immunohistologically studied the hepatic tissue sections in cases with the syndrome of hemolysis, elevated liver enzymes, and low platelets (HELLP syndrome; n = 2) and acute fatty liver of pregnancy (AFLP; n = 2) compared to necropsy controls. Unlike in the AFLP cases, a marked infiltration of neutrophils in liver tissues was found in both cases of the HELLP syndrome. Immunostaining with the antihuman (polyclonal) TNF-alpha, IL-1 beta, IL-8 and antihuman neutrophil elastase (monoclonal antibody) was performed in paraffin-embedded hepatic tissue sections. Liver tissues in HELLP syndrome patients were stained strongly with TNF-alpha and neutrophil elastase antibody. The strongest staining pattern was observed in the eclamptic case, whereas in the AFLP cases, as in the necropsy controls, a very weak staining for anti-TNF-alpha and elastase antibody was found. The liver sections of the HELLP syndrome cases were moderately stained with polyclonal IL-1 beta and IL-8 antibodies whereas AFLP and controls had a very faint staining. Significant correlations were found between the numbers of necrotic hepatocytes and elastase dots in the same microscopic fields (randomly selected) of liver sections from two cases of HELLP syndrome (r2 = 0.63; p < 0.0001), which might suggest a neutrophil-mediated tissue damage in such a disease. This study suggests that a cytokine- and neutrophil-mediated liver injury occurs in the HELLP syndrome but not in AFLP.

Fibrinolysis during normal pregnancy and severe preeclampsia relationships between plasma levels of plasminogen activators and inhibitors

The antigen levels of plasminogen activator inhibitor type 1 (PAI-1), plasminogen activator inhibitor type 2 (PAI-2), tissue-type plasminogen activator (t-PA), and urokinase-type plasminogen activator (u-PA) were measured during pregnancy and severe preeclampsia. The PAI-1 and PAI-2 antigen levels increased linearly during pregnancy and promptly returned to the level of non-pregnant women after delivery. The t-PA and u-PA antigen levels increased slowly and linearly during pregnancy. In severe preeclampsia, the PAI-2 antigen level was lower than that observed during the 3rd trimester of normal pregnancy, and the t-PA antigen level was higher than that during the 3rd trimester of normal pregnancy. Immunohistochemical examination of placental tissue showed that the PAI-2 and u-PA antigens were localized in syncytiotrophoblasts. In severe preeclampsia, the PAI-2 and u-PA antigens in placental tissue did not stain as clearly as during the 3rd trimester of normal pregnancy. The PAI-2 and u-PA antigen levels showed a positive correlation with birth weight. Therefore, PAI-2 may be an important marker of placental function and abnormality in pregnancies.

Correlated plasma elastase and sera cytotoxicity in eclampsia. A possible role of endothelin-1 induced neutrophil activation in preeclampsia-eclampsia

The activation of neutrophils was studied in preeclampsia (n = 10) and eclampsia (n = 20) compared to normotensive controls (n = 10) and nonpregnant essential hypertensives (n = 10). Plasma elastase levels were raised in preeclampsia (0.53 +/- 0.32 microgram/mL, P < .002) and eclampsia (1.26 +/- 0.8 microgram/mL, P < .001) respectively compared to normal pregnancies (0.032 +/- 0.009 microgram/mL). The plasma elastases were more elevated in eclamptic cases compared to essential hypertensive (0.53 +/- 0.27 microgram/mL; P = .01) patients. We analyzed the correlation among elastase values, systolic (SBP), mean blood pressures (MBP), endothelin-1 (ET-1) levels and sera cytotoxicity (as measured by fura-2 release from human umbilical venous endothelial cell culture) in eclamptic cases. SBP and MBP were significantly correlated with plasma elastase levels in preeclampsia (r = 0.67, 0.63, respectively; P < .03) and eclampsia (r = 0.49, 0.49, respectively; P < .02). ET-1 levels were correlated with SBP (P = .003) and MBP (P = .001) and corresponding elastase levels (r = 0.606, P < .003) in eclamptic patients. Doses of 10, 25, and 50 pmol/mL of ET-1 increased elastase release in human neutrophil cultures dose and time dependently. Cytotoxicity of eclamptic sera correlated (P < .001) to the corresponding plasma elastase values. Therefore, this study suggests that neutrophil activation and ET-1 induced neutrophil activation occurs in this disease.

Effects of urinary trypsin inhibitor on myometrial contraction in term and preterm deliveries

The aim of this research was to study the concentration of urinary trypsin inhibitor in amniotic fluid (AF) and its effect on myometrial contraction in term and preterm deliveries. Urinary trypsin inhibitor was measured in AF of term and preterm labor. Immunohistochemical staining of amnion and myometrium was carried out. Isometric uterine contraction was studied to elucidate the effect of AF and urinary trypsin inhibitor on the contractile activity of term and preterm myometrium. The effect of urinary trypsin inhibitor on the production of prostaglandin E2 (PGE2) from myometrial cultures stimulated by IL-8, IL-1 and LPS was verified. Urinary trypsin inhibitor was significantly increased in AF of cases of preterm delivery (p < 0.0001). Amnion and myometrium of preterm deliveries were faintly stained for urinary trypsin inhibitor compared to term delivery. Amniotic fluid and urinary trypsin inhibitor could successfully inhibit-myometrial contraction. Also, urinary trypsin inhibitor could significantly inhibit the production of PGE2 in the myometrial cell cultures stimulated by IL-1 and LPS (p < 0.001 and 0.0005). IL-8 has no significant effect on PGE2 production from myometrial cell culture. Urinary trypsin inhibitor suppresses myometrial contraction in term and preterm deliveries. It may play a role in maintaining normal pregnancy and preventing preterm delivery.

Plasma P selectin (GMP-140) and glycocalicin are elevated in preeclampsia and eclampsia: their significances

OBJECTIVE

We measured the concentrations of plasma P selectin (or GMP-140) and glycocalicin in preeclamptic and eclamptic women. Correlations between these two parameters and blood pressures, platelet counts, or plasma thrombin-antithrombin complex values were evaluated.

STUDY DESIGN

By use of enzyme-linked immunosorbent assays we measured the plasma GMP-140 and glycocalicin levels in normal pregnancies (n = 10) and preeclamptic (n = 10) and eclamptic (n = 20) pregnancies. The glycocalicin index was calculated as follows: (glycocalicin x [250 x 10(6)/ml])/(Individual platelet counts). Correlations between plasma GMP-140, glycocalicin, glycocalicin index values, blood pressures, platelet counts, and plasma thrombin-antithrombin complex values were analyzed.

RESULTS

Plasma GMP-140 levels were found to be significantly elevated in preeclamptic (p < 0.0005) and eclamptic cases (p < 0.0001) compared with normotensive controls. Plasma glycocalicin (p = 0.01, 0.007) and glycocalicin index (p = 0.005, 0.002) values were also markedly elevated in preeclamptic and eclamptic patients compared with normal pregnant patients. Significant correlations between platelet counts or plasma thrombin-antithrombin complex levels and their corresponding plasma GMP-140 and glycocalicin and glycocalicin index values have been found in preeclamptic and eclamptic cases. However, blood pressures had correlations with GMP-140, glycocalicin, and glycocalicin index values in eclamptic cases.

CONCLUSIONS

We demonstrated an elevation of plasma GMP-140 and platelet glycocalicin in preeclampsia and eclampsia. This study also reflects the usefulness of glycocalicin as a marker of platelet activation or turnover and endothelial dysfunction in these diseases.

Dehydroepiandrosterone sulfate potentiates the effect of interleukin-8 on the cervix

Dehydroepiandrosterone sulfate (DHA-S) is one of the successful drugs used to induce cervical ripening. There is growing evidence that interleukin-8 (IL-8) plays an essential role during cervical ripening. IL-8 was found to be hormonally controlled in the cervix. The aim of this research was to study the effect of DHA-S on the function of IL-8 on the cervix. Sixteen pregnant white New Zealand rabbits where tested either by placebo (adeps solidus, n = 4), DHA-S (10 mg, n = 4), IL-8 (100 ng, n = 4) or combination of DHA-S and IL-8 (n = 4). Collagen contents in the cervices were assessed histologically after staining with picrosirius red. The number of neutrophils in 5 random fields of the cervical tissue was counted in all groups. Collagenase, elastase and gelatinase were measured in those groups. The collagen content of the cervices was significantly decreased after treatment with DHA-S, IL-8 or a combination of both drugs compared to the control group (p < 0.004, 0.001 and 0.001, respectively). A maximal decrease in collagen content was found in the DHA-S + IL-8-treated group (71.5%). Neutrophil infiltration was significantly increased in the IL-8 and DHA-S + IL-8-treated groups (p < 0.0001). Neutrophil numbers in the DHA-S + IL-8-treated group were significantly higher than in the IL-8 group (p < 0.006). Collagenase activity was increased in the DHA-S, IL-8 and DHA-S + IL-8 groups compared to the control group (p < 0.02, 0.008 and 0.001, respectively). Elastase activity was also significantly increased in the same groups (p < 0.002, 0.005 and 0.001, respectively). A similar increment was found in gelatinase activity (p < 0.004, 0.0001 and 0.0001, respectively). DHA-S has a synergistic effect with IL-8 during cervical ripening.