[Associations between Skeletal Muscle Mass, Physical Function, and Quality of Life at Diagnosis in Patients with Hematological Malignancies]

INTRODUCTION

Skeletal muscle mass is considered a prognostic factor for survival in patients with cancer. In this study, we investigated the associations between skeletal muscle mass, physical function, fatigue, and quality of life(QOL)at diagnosis in patients with hematological malignancies.

METHODS

In this study, we included 27 untreated patients with newly diagnosed hematological malignancies who visited our hospital. The patients were assessed during the period from diagnosis to the start of chemotherapy. Data regarding age, white blood cell count, hemoglobin level, platelet count, and body mass index(BMI)were obtained from the patients' medical records. In addition, skeletal muscle mass index(SMI), phase angle (PhA), grip strength, knee extension strength, and short physical performance battery, brief fatigue inventory, EuroQol 5 dimensions 5-levels, and mini nutritional assessment short-form scores were calculated.

RESULTS

The mean SMI value was 6.6±1.3 kg/m2(7.4±1.2 kg/m2 in men and 5.7±0.6 kg/m2 in women). SMI showed significant correlations with platelet count(r=-0.42, p=0.03), BMI(r=0.61, p≤0.01), PhA(r=0.54, p≤0.01), grip strength(r=0.81, p≤0.01), and knee extension strength(r=0.49, p=0.01). Multiple regression analysis, conducted using SMI as the dependent variable, revealed that BMI and grip strength were significant variables(p≤0.01).

DISCUSSION

In untreated patients with newly diagnosed hematological malignancies, SMI was associated with BMI and grip strength but not with fatigue or QOL. Assessment of BMI and grip strength at diagnosis may help predict skeletal muscle mass.

[Research of Cognitive Impairment in Lung Cancer Patients Undergoing Chemotherapy]

Nineteen non-small cell lung cancer patients admitted for chemotherapy were investigated for cognitive dysfunction and factors affecting cognitive function. The results showed that the patients experienced some decline in cognitive function, and fatigue affected cognitive function and quality of life. Cognitive function in cancer patients affects their treatment choices, employment, and social life. We need to be aware of the cognitive dysfunction of cancer patients, and at the same time, we need to intervene with consideration for cognitive function, as fatigue can easily lead to a sense of cognitive decline.

Partial Cystectomy of Paraganglioma of the Urinary Bladder Before Living Kidney Transplantation: Case Report

BACKGROUND

Paraganglioma (extra-adrenal pheochromocytoma) of the bladder is a very rare disease, accounting for 0.06% of all bladder tumors. Optimal management of bladder paraganglioma before kidney transplantation is unknown. We report a case of partial cystectomy for urinary bladder paraganglioma before living kidney transplantation.

CASE PRESENTATION

A 59-year-old man with a 27-year history of hemodialysis was referred to our department for further examination of a bladder tumor detected during pre-transplantation testing. Cystoscopy revealed a submucosal tumor on the right side of the bladder. The patient experienced a hypertensive crisis during transurethral resection of the bladder tumor. Endocrinologic and pathologic examinations confirmed the diagnosis of paraganglioma in the urinary bladder. A partial cystectomy was performed before kidney transplantation. Nine months after partial cystectomy, the patient underwent AB0-incompatible living kidney transplantation from his spouse. No disease recurrence or graft rejection was observed 12 months after the transplantation.

CONCLUSIONS

To our knowledge, this is the 1st report on the management of paraganglioma in the urinary bladder before living kidney transplantation. Kidney transplantation after partial cystectomy is an option that may be considered in patients with paraganglioma of the urinary bladder, with careful observations of bladder function and vesicoureteral reflux to the grafts.

Successful use of rivaroxaban in inferior vena cava thrombosis provoked by multiple traumatic injuries and surgeries: A case report

WHAT IS KNOWN AND OBJECTIVES

There is a lack of consensus regarding optimal anticoagulation regimen and duration for inferior vena cava (IVC) thrombus due to the paucity of clinical evidence. A case of IVC thrombus treated with 3 months of rivaroxaban therapy is reported.

CASE DESCRIPTION

Fifty-two-year-old male Caucasian presented following a motorcycle accident, with multiple left rib fractures requiring emergent amputation surgeries. During the hospitalization, he developed IVC thrombosis and completed 3 months of rivaroxaban treatment without any complication. The Doppler images at 6-week, 3-month and 6-month follow-up appointments showed no IVC thrombosis.

WHAT IS NEW AND CONCLUSION

This is the first case of IVC thrombosis successfully treated with rivaroxaban. Further case series and clinical studies are needed to guide the use of direct oral anticoagulants for IVC thrombosis.

Ischemic Preconditioning Enhances Muscle Endurance during Sustained Isometric Exercise

Ischemic preconditioning (IPC) enhances whole-body exercise endurance. However, it is poorly understood whether the beneficial effects originate from systemic (e. g., cardiovascular system) or peripheral (e. g., skeletal muscle) adaptations. The present study examined the effects of IPC on local muscle endurance during fatiguing isometric exercise. 12 male subjects performed sustained isometric unilateral knee-extension exercise at 20% of maximal voluntary contraction until failure. Prior to the exercise, subjects completed IPC or control (CON) treatments. During exercise trial, electromyography activity and near-infrared spectroscopy-derived deoxygenation in skeletal muscle were continuously recorded. Endurance time to task failure was significantly longer in IPC than in CON (mean±SE; 233±9 vs. 198±9 s, P<0.001). Quadriceps electromyography activity was not significantly different between IPC and CON. In contrast, deoxygenation dynamics in the quadriceps vastus lateralis muscle was significantly faster in IPC than in CON (27.1±3.4 vs. 35.0±3.6 s, P<0.01). The present study found that IPC can enhance muscular endurance during fatiguing isometric exercise. Moreover, IPC accelerated muscle deoxygenation dynamics during the exercise. Therefore, we suggest that the origin of beneficial effects of IPC on exercise performance may be the enhanced mitochondrial metabolism in skeletal muscle.

Significance of intracellular cations and calcium-regulating hormones on salt sensitivity in patients with essential hypertension

Although the existence of salt sensitivity in essential hypertensives has been well known, the precise mechanism(s) has not yet been elucidated. The aim of this study was to clarify the relation between the responses in blood pressure, extra- and intracellular cations and calcium-regulating hormones to oral NaCl loading in essential hypertensives. After oral NaCl loading, mean blood pressure, urinary excretions of calcium and magnesium, and PLT[Ca2+]i were significantly increased. [Ca2+]o and E[Mg]i were decreased. The changes (delta) in mean blood pressure by NaCl loading positively correlated with delta PLT[Ca2+]i and delta PTH, and negatively with delta[Ca2+]o and delta E[Mg]i. Delta PLT[Ca2+]i positively correlated with delta PTH and negatively with delta[Ca2+]o and delta E[Mg]i. From these results, the blood pressure response to oral NaCl loading is associated with the alternation of [Ca2+]i metabolism in which the changes in magnesium metabolism and calcium-regulating hormones may be involved.

High temperatures activate local viral multiplication and cell-to-cell movement of Melon necrotic spot virus but restrict expression of systemic symptoms

The infection of melon plants by Melon necrotic spot virus (MNSV) and the development of necrotic disease symptoms are a seasonal occurrence in Japan, which take place between winter and early summer, but not during mid-summer. In this paper we investigate the effect of three different temperatures (15, 20, and 25 degrees C) on the local and systemic expression of MNSV in melon plants. Previously, the incidence of plants expressing systemic symptoms caused by MNSV and other viruses was found to be greater at temperatures less than 20 degrees C. In this study, our temperature-shift experiments support previous studies that found the expression of systemic symptoms increases as temperature falls from 25 to 20 degrees C and decreases as temperature rises from 20 to 25 degrees C. However, MNSV replication in melon cells and local viral movement within leaves following the inoculation of melon protoplasts or cotyledons were more frequent at 25 degrees C than at 15 or 20 degrees C.

Preoperative stellate ganglion blockade prevents tourniquet-induced hypertension during general anesthesia

BACKGROUND

Prolonged and excessive inflation of pneumatic tourniquets leads to a hyperdynamic circulatory response. Sympathomimetic activity is an important factor in tourniquet-induced hypertension. Stellate ganglion block specifically blunts sympathetic efferent nerves and prevents hypertension induced by sympathomimetic stimulation. The present study was performed to investigate the effects of stellate ganglion block (SGB) on arterial pressure and heart rate during prolonged tourniquet use under general anesthesia.

METHODS

Twenty patients scheduled for knee arthroscopy were either treated with 10 ml of 1% lidocaine for SGB (SGB group; n = 10), or intramuscular injection (IM group; n = 10) before tourniquet inflation. Comparisons of systolic and diastolic arterial pressure and heart rate were made before and after the induction of anesthesia, 10 min after the lidocaine treatment, every 5 min during the first 60 min after tourniquet inflation, and immediately before and 5 min following deflation. The maximum values of the circulatory variables were compared.

RESULTS

Tourniquet inflation caused increases in the circulatory variables in both groups. Systolic arterial pressure in the SGB group was significantly lower than that in the IM group after 55 min of tourniquet inflation. Diastolic arterial pressure also was significantly lower in the SGB group immediately before the deflation. The maximum values of the three hemodynamic variables were significantly lower in the SGB group. Arterial pressure significantly decreased after tourniquet deflation in the IM group.

CONCLUSION

Ipsilateral SGB attenuated the hyperdynamic response mediated by prolonged tourniquet inflation during knee arthroscopy.

The bet gene of feline foamy virus is required for virus replication

Foamy viruses (FV) are complex retroviruses with additional bel genes located between env and the 3' long-terminal repeat. The functions of the bel 2 and bet genes are unknown and both are dispensable for replication of the prototypic human foamy virus in cell cultures. We examined the function(s) of bel 2 and bet of the distantly related feline foamy virus (FFV) in the proviral context. Mutagenesis was used to alter the Bel 2 and Bet or to abrogate their expression. The Bel 2/Bet mutants showed a 1000-fold reduced viral titer in feline kidney cells; in human 293T cells, viral titer was only about 10-fold reduced compared to wild-type FFV. In both cell types, the Bel 2/Bet mutations resulted in a reduced release of FFV particles. The results indicate that FFV Bet is required for efficient virus replication. The functions of the Bel 2 and Bet proteins are discussed.

Therapeutic effect of 15-deoxyspergualin on acute graft rejection in canine liver transplantation

Therapeutic effect of 15-deoxyspergualin (DSG) on acute rejection was investigated by examining hepatic functions and histological findings in a model of canine liver transplantation. When acute rejection (defined as an acute rise of hepatic functions) occurred, the recipients were treated with DSG alone or combined with a small amount of methylprednisolone (MP). The recipients in group 1 were administered no basic immunosuppressant, and those in groups 2 and 3 received cyclosporine as the basic drug. The rejections in groups 1 and 2 were treated with DSG combined with MP and those in group 3, with DSG alone. Amelioration or healing of hepatic dysfunction and histological abnormalities as seen in all groups except for one case in group 3. The observations in this study were quite similar to those in renal transplantation. Therefore, DSG therapy is expected to be useful for treating graft rejection even in clinical liver transplantation.

[Mental stress of visiting-nursing staff in cases of severely handicapped children with respirators]

We evaluated the actual condition of work and mental stress on visiting nursing staff, for the purposes of establishing a suitable visiting-nursing system for severely handicapped children. The subjects were 13 visiting nurses involved in the care of two children with Werdnig-Hoffman disease. The visiting-nursing staff was examined by questionnaire. Of these staff, 77% felt a burden from their work. They felt a burden due to the special needs of pediatric patients and the relationship between the staff and parents. The relationship between visiting-nursing staff and other medical staff, including doctors, was another main factor in this burden. The younger nurses felt this burden more strongly.

Left atrial systolic function assessed by left atrial ejection force in patients with sick sinus syndrome and paroxysmal atrial fibrillation

We evaluated left atrial systolic function using left atrial ejection force (LAEF) in 19 patients with sick sinus syndrome (SSS) and in 20 with paroxysmal atrial fibrillation (Paf) whose ages ranged from 48 to 80 years. We also evaluated 35 normal individuals for comparison. The LAEF was calculated as 1/3 x mitral valve area x (peak velocity of A wave)2 using two-dimensional and pulsed-Doppler echocardiography according to Newton's law of motion and hydrodynamics. In normal individuals, LAEF positively correlated with age (r = 0.82, p < 0.01). Normal LAEF was calculated as 0.098 x age - 0.74 (kdynes) from the regression line. Because of this correlation, we used age-corrected LAEF (%LAEF) that was calculated as (measured LAEF / normal LAEF) x 100. The results showed that this value was 53+/-26% in patients with SSS and 54+/-26% in patients with Paf. Both were significantly lower than normal individuals (p < 0.001). Among SSS subtypes, %LAEF was lower in types II and III than in type I (51+/-14%, 37+/-19%, and 81+/-35%, respectively). In conclusion, left atrial systolic function is depressed in patients with Paf and SSS, in particular, types II and III. These results suggest that the pathological abnormalities extend not only to the sinus node but also to the left atrial muscle in patients with SSS and Paf.

Two novel actinidine-type monoterpene alkaloids from Incarvillea delavayi

Two new actinidine-type monoterpene alkaloids, delavayines B (1) and C (2), were isolated from the MeOH extract of the aerial parts of Incarvillea delavayi, a close species of which, I. sinensis, is used as an analgesic for rheumatic pain in China, and the structures have been elucidated on the basis of spectroscopic evidence.

Experience with the pedicled latissimus dorsi flap for finger reconstruction

The pedicled latissimus dorsi flap was used for the reconstruction of finger function in 12 patients with severely disabled hands. The fascial origin of the muscle was sutured directly to finger flexors in 6 patients, and to extensors in the other 6 patients in the forearm without severing the neurovascular pedicle. Voluntary contraction of the muscle was obtained in all patients. Useful tendon gliding was achieved in 6 patients, thereby providing total active motion of fingers of >100 degrees. In the remaining 6 patients, however, several problems such as stiff finger joints prevented appropriate tendon gliding, resulting in total active motion of <60 degrees. When these problems are overcome, the pedicled latissimus dorsi muscle can yield satisfactory excursion for extrinsic tendons of the fingers. In contrast to free muscle transplantation, early and predictable recovery of function can be obtained using this particular technique without any risk of denervation of the muscle.

Dysplasia and cancer in the dextran sulfate sodium mouse colitis model. Relevance to colitis-associated neoplasia in the human: a study of histopathology, B-catenin and p53 expression and the role of inflammation

Animal models of colitis, which develop dysplasia and cancer similar to human ulcerative colitis are needed to further investigate the dysplasia cancer sequence. This study describes the expression of B-catenin and p53 along with the histopathology and inflammation scores as they relate to dysplasia and cancer in the dextran sulfate sodium (DSS) colitis model. Swiss Webster mice were fed with 5% DSS as follows: group A, four cycles of DSS, 84 days total (1 cycle = 7 days DSS + 14 days H(2)O); group B, four cycles DSS followed by 120 days H(2)O, 204 days total; group C, 7 days DSS followed by 180 days H(2)O, 187 days total; group D, 7 days DSS followed by 90 days H(2)O, 97 days total. The incidences of dysplasia and/or cancer were 15.8, 37.5, 18.1 and 0% in groups A-D, respectively. Dysplasia and/or cancer occurred as flat lesions or as dysplasia-associated lesion or mass (DALM) as observed in the human. Thirty-three percent of cancers had associated dysplasia. Within group A, inflammation scores were significantly higher in animals with dysplasia and/or cancer compared with those without dysplasia and/or cancer (P < 0. 05-P < 0.0001). Inflammation scores were significantly higher in animals with cancers versus those with dysplasia (P < 0.015) and in flat dysplasia and/or cancer versus DALM (P < 0.0042). B-catenin showed translocation from the cell membrane to the cytoplasm and/or nucleus in 100% of DALM and 5.8% of flat dysplasia and/or cancer. A total of 94.2% of flat dysplasia and/or cancer had exclusive cell membrane expression compared with 0% DALM (P < 0.0001). Only 7.4% of dysplasia and/or cancer showed nuclear expression of p53. In colitis-associated dysplasia and/or cancer in the DSS model: (i) histology resembles that in the human; (ii) inflammation plays a significant role in the dysplasia cancer sequence and whether dysplasia and/or cancer grows as a flat lesion or a DALM; (iii) the early molecular pathways are different for flat dysplasia and/or cancer versus DALM, with nuclear/cytoplasmic translocation of B-catenin as an early event in DALM but not flat dysplasia and/or cancer; and (iv) p53 has little or no role in dysplasia and/or cancer. This well characterized model provides an excellent vehicle for studying the roles of inflammation, the molecular events and the role of chemopreventive agents in colitis-associated neoplasia.

Antinociceptive substances from Incarvillea delavayi

Antinociceptive activities of an Incarvillea delavayi extract, as well as its constituents, 8-epideoxyloganic acid and delavayine A, were evaluated in the acetic acid induced writhing test in mice. An oral administration of the delavayi extract weakly decreased the number of writhings and stretchings in this test, in a dose-dependent manner. Furthermore, orally administered 8-epideoxyloganic acid showed weak antinociceptive activity, whereas administration by subcutaneous injection did not. However, subcutaneous injection of delavayine A, a novel monoterpene alkaloid, showed a more significant level of antinociceptive activity.

[Regional analysis of "medical care for severely handicapped children at school" in Yamaguchi Prefecture: a hospital-based study]

We conducted a hospital based investigation of the actual conditions of medical care at schools. There were the seventy-four children in need of some type of medical care. These children had severe handicaps both mentally and physically. The suction of oral secretions and tube feeding are the two main problems in medical care in school. Most of them were given this medical care by their mothers. From the point of view of children's independence and mother's respite in caring, medical care in school could be provided by the school teachers. The Ministry of Education has made progress in the study of medical care practice. Our team attempted to develop a strategy for the practice of medical care in our prefecture.

Mental stress test is an effective inducer of vasospastic angina pectoris: comparison with cold pressor, hyperventilation and master two-step exercise test

BACKGROUND

Cold pressor, hyperventilation and exercise stress tests were usually used for inducing an angina attack in patients with vasospastic angina pectoris. We induced vasospastic angina attack using the mental calculation stress test, and compared the results with those using other stress tests.

SUBJECTS AND METHODS

Subjects were 29 patients with vasospastic angina pectoris. Their ages were 60.8+/-8.4 years. Coronary vasospasm was induced by an acetylcholine infusion test during coronary angiography. The mental stress test was performed as follows; after memorizing six digits numbers, they repeated these numbers in reverse for 5 min, and performed serial subtraction of 17 from 1000 for 5 min. Blood pressure, heart rate and ECG were recorded every 1-5 min during the mental stress test. The serum concentrations of epinephrine and norepinephrine were measured before and during the mental stress test. We compared these results with those obtained using cold pressor, hyperventilation and the Master two-step exercise stress test.

RESULTS

(1) Eight of the 29 patients (28%) showed ischemic ST-T change, which was caused by the mental stress test. (2) The increase in norepinephrine was greater in patients with an ST-T change than without an ST-T change (0.11+/-0.06 vs. 0.04+/-0.04 ng/ml, P<0.01). (3) The incidence of the ST-T change caused by the mental stress test (28%) was similar to the cold pressor test (27%) and greater than that caused by the hyperventilation test (13%). The incidence of ST-T change caused by the Master two-step test was 55%.

CONCLUSIONS

The mental stress test is an effective inducer of vasospastic angina attack, and attack may be induced by neurohumoral vasoconstrictive reflex and/or increased left ventricular afterload.

[A clinical study of bladder cancer in adolescent patients]

PURPOSE

We have reviewed clinical characteristics of bladder cancer in adolescent patients.

MATERIALS AND METHODS

Between 1978 and 1997, we have experienced eight bladder cancer patients of 7 men and 1 woman under 30 years old. Two patients were less than 20 years old and six patient were more than 20 years old. We have reviewed initial symptoms, diagnostic methods, cystoscopic findings, methods of treatment, pathological findings, and prognosis of these patients.

RESULTS

The most common chief complaint was asymptomatic macroscopic hematuria. Cystoscopically, all tumors were papillary and solitary except in one case. All of tumors were superficial transitional cell carcinomas and treated with transurethral resection (TUR). Although the tumors in patients of less than 20 years old were pathologically grade 1 and 2, two cases of grade 3 tumors were found in patients more than 20 years old. The prognosis of these patients were good, for none of them was dead and the recurrence rate after TUR was 12.5% (1/8).

CONCLUSIONS

We considered that characteristics of bladder cancer in adolescent patients were low stage, low grade, and good prognosis. But it was found that high grade tumors were contained in patients more than 20 years old.

Estimation of the systolic pulmonary arterial pressure using contrast-enhanced continuous-wave Doppler in patients with trivial tricuspid regurgitation

Noninvasive estimation of pulmonary arterial pressure is important for hemodynamic monitoring of patients with heart disease. In patients with tricuspid regurgitation (TR), the peak velocity of TR on continuous-wave (CW) Doppler can be used to estimate the systolic pulmonary arterial pressure (PAPs) using the simplified Bernoulli equation. We evaluated a new technique of contrast-enhanced CW Doppler for calculating PAPs in patients with trivial TR. Forty-one patients without visible TR detected by color Doppler, pulsed Doppler or CW Doppler were evaluated. Age ranged from 19 to 73 (55 +/- 12) years old. Tricuspid flow signals were recorded on CW Doppler after intravenous administration of indocyanin green (ICG) or Albunex. PAPs was calculated as; PAPs = 4 x VTR2 + 10 mmHg, where VTR is the peak velocity of TR. PAPs calculated using contrast-enhanced CW Doppler was compared with PAPs measured by the following cardiac catheterization. 1) TR signals were recorded using the contrast-enhanced CW Doppler technique in 39 of 41 patients (95%) after intravenous administration of contrast agents. 2) The error of estimate of PAPs using the contrast-enhanced CW Doppler technique was -2.4 +/- 7.5 mmHg, and the percent error was -10.7 +/- 32.4% in all patients. In 20 of 39 patients (51%), the error of estimate was within +/- 5 mmHg. 3) PAPs was overestimated by 12.2 +/- 6.1 mmHg in patients with good contrast enhancement of TR signals. The contrast-enhanced CW Doppler technique is useful for estimating PAPs noninvasively in patients with trivial TR. It is better to assume the right atrial pressure as 3-5 mmHg, not 10 mmHg, in patients with good enhancement of trivial TR. Physiological TR may be enhanced by contrast agents in these patients.

Depletion of colonic detoxication enzyme activity in mice with dextran sulphate sodium-induced colitis

BACKGROUND

The increased risk of colonic malignancies in individuals with ulcerative colitis has prompted a search for early biomarkers of disease progression.

AIM

To characterize Phase II detoxication enzyme expression during acute and chronic colitis. The mouse model of dextran sulphate sodium (DSS)-induced colitis represents a relevant system with which to sequentially evaluate the spectrum of biochemical changes associated with colorectal cancer risk.

METHODS

Acute and chronic colitis were induced in Swiss Webster mice by administering DSS in the drinking water (5%) for 1-4 cycles. Each cycle consisted of 7 days DSS and 14 days of water. The glutathione S-transferase (GST) activity, gamma-glutamylcysteine synthetase (gamma-GCS) activity and glutathione content of the colonic tissues were determined at various time points throughout the experiment. Alterations in GST isozyme expression were confirmed by Western and Northern blot.

RESULTS

GST activity was reduced significantly in the colon by the end of Cycle 1 (84% of control values). Specific activities continued to decrease with subsequent cycles of DSS exposure. By the end of Cycle 4, glutathione levels and gamma-GCS activity had reached 29% and 56% of control, respectively.

CONCLUSIONS

These data suggest that detoxication enzyme depletion is associated with both acute and chronic colitis and may be an important event in the progression of ulcerative colitis to colon cancer.

DNA ploidy, Ki-67 and p53 as indicators of lymph node metastasis in early gastric carcinoma

OBJECTIVE

To perform flow cytometric and immunohistochemical analysis of early gastric carcinoma in order to investigate the clinical value of DNA ploidy, Ki-67 and p53 as indicators of lymph node metastasis.

STUDY DESIGN

We studied 108 cases of surgically resected early gastric carcinoma, which comprised 21 cases showing positive lymph node metastasis (group A) and 87 cases showing negative lymph node metastasis (group B).

RESULTS

Aneuploidy was seen in 16 cases (76.2%) in group A in contrast to 10 cases (11.5%) in group B (P = .0029). The mean value of the Ki-67 labeling rate in all cases was 21.9%, and 15 cases (79.0%) showed a Ki-67 labeling rate of more than 21.9% in group A, while they numbered 31 (37.4%) in group B (P = .0016). Cases with cell positive for p53 protein numbered 15 (75%) in group A, while they numbered 38 (46%) in group B (P = .0460).

CONCLUSION

DNA aneuploidy, a high labeling rate of Ki-67 and overexpression of p53 are all useful indicators of lymph node metastasis in patients with early gastric carcinoma.

Metabolic and endocrine responses to cold exposure in chronically incubated extrauterine goat fetuses

To investigate developmental aspects of metabolic and endocrine responses to cold exposure in fetuses, we conducted experiments on six goat fetuses, three aged 95-116 d of gestation (dGA; group I), and three aged 122-134 dGA (group II), using an extrauterine fetal incubation system that provided arterio-venous extracorporeal membrane oxygenation (A-V ECMO). The fetuses were cannulated via the umbilical vessels, and their blood gas exchange was totally supported by A-V ECMO, while they were maintained in an isothermal incubator containing artificial amniotic fluid. After confirming that fetuses were in metabolically stable condition in the extrauterine incubation system, fetal core temperature was lowered by 2 degrees C over 2 h by decreasing the temperature of incubating fluid from 39.5 degrees C. During and after cold exposure, fetal heart rate and arterial blood pressure remained unchanged. We observed significant increases in oxygen consumption and plasma concentrations of norepinephrine, epinephrine, adrenocorticotropic hormone, and cortisol in group II but not in group I fetuses. In addition, based on regression analysis, maximal changes of these parameters during cold exposure were linearly correlated with gestational age significantly, and the regression lines were found to intersect the x (gestational age) axis at around 98-106 dGA. These results suggest that metabolic and endocrine responses to cold exposure develop with gestational age in the goat fetus, the responses being manifested around 100 dGA.

A new immunosuppressant, FTY720, prolongs limb allograft survival in rats

A new immunosuppressant, FTY720, was applied to limb allotransplants and its effectiveness was investigated. Using inbred rats, for which the major histocompatibility complexes were completely mismatched, 31 limb transplantations were performed and FTY720 was administered at a dose of 1.5 or 3 mg per kilogram per day for 10 days postoperatively. Rejection was monitored by the appearance of the skin of the grafted hind limb, soft radiograph, microangiography, and histology. In animals receiving no immunosuppressive therapy, the mean onset of rejection was 4.2+/-1.0 days postoperatively, and the grafted limbs became acutely necrotic. The mean onset of rejection was 6.0+/-0.9 days in animals receiving FTY720 at a dose of 1.5 mg per kilogram per day and 7.9+/-1.5 days in animals receiving FTY720 at a dose of 3 mg per kilogram per day. Survival of the grafted limbs was significantly prolonged compared with that in animals without immunosuppression. The immunosuppressive effect of FTY720 appeared to be dose dependent; however, complete suppression of rejection could not be obtained with FTY720 therapy alone.

[Analysis of DNA ploidy pattern and overexpression of p53 protein in cases of early gastric carcinoma with lymph node metastasis]

Twenty-one cases of surgically resected early gastric carcinoma with lymph nodal involvement (4 mucosal and 17 submucosal carcinomas) and 37 cases of that with no lymph nodal involvement (14 mucosal and 23 submucosal) were investigated by means of flow cytometry and immunohistochemical staining in order to clarify the correlation between lymph node metastasis and DNA ploidy pattern as well as overexpression of p53 protein. DNA aneuploidy was found to show a significantly higher frequency in submucosal carcinomas (60.0%) than in mucosal ones (22.2%), and also a significantly higher frequency in node positive cases (76.2%) than in node negative ones (32.4%). Meanwhile, the overexpression of p53 protein showed higher frequency in submucosal carcinomas (52.5%) than in mucosal ones (22.2%), and also higher frequency in node positive cases (47.6%) compared with that in node negative ones (40.5%). However there was no significant difference either in relation to the depth of tumor invasion or the lymph node metastasis. Thus, DNA aneuploidy showed a significant correlation to the depth of cancer invasion as well as lymph node metastasis, which was regarded as a useful indicator for the preoperative estimation of the depth of tumor invasion as well as lymph node metastasis.

Relationship of alcohol use, physical activity and dietary habits with serum carotenoids, retinol and alpha-tocopherol among male Japanese smokers

BACKGROUND

Despite considerable interest in the anticarcinogenic and anti-atherosclerotic effects of carotenoids and alpha-tocopherol, little is known about determinants of these serum micronutrients.

METHODS

The association of lifestyle factors including alcohol use, physical activity and dietary habits with serum levels of carotenoids (lycopene, lutein, cryptoxanthin and beta-carotene), retinol and alpha-tocopherol were studied in 194 healthy men aged 24-60 years who smoked > 15 cigarettes/day. A self-administered questionnaire ascertained consumption frequency of 12 food items, alcohol consumption, levels of physical activity and the number of cigarettes smoked per day.

RESULTS

Of the dietary items studied, total vegetable intake was significantly, positively associated with beta-carotene levels, as was fruit intake with serum levels of each carotenoid. Tofu intake was unexpectedly, but strongly related to decreased levels of cryptoxanthin and beta-carotene. None of the food items was materially related to serum levels of retinol and alpha-tocopherol. Alcohol consumption was most strongly and inversely associated with levels of all the carotenoids except lutein, whereas was positively associated with retinol level but not with alpha-tocopherol level. Frequency of participation in sports was significantly and positively associated with both retinol and alpha-tocopherol levels. The amount of cigarettes smoked per day was unrelated to each micronutrient level in this study of moderate or heavy smokers.

CONCLUSIONS

The consumption of vegetables and fruits is an important determinant of serum carotenoid levels even in smokers. Alcohol consumption is inversely associated with carotenoid levels, although the mechanism for this is not clear. Tofu and physical activity influence serum levels of antioxidative micronutrients, and these relationships need further studies.

Contrast-enhanced radiographic computed tomographic findings in patients with straight back syndrome

Straight back syndrome (SBS) is usually diagnosed by physical and chest radiographic findings. Radiographic computed tomographic (CT) findings are very useful for the diagnosis and the evaluation of its severity. The purpose is to evaluate the relationship between chest X-ray film and CT findings.

SUBJECTS

We evaluated 26 patients (SBS group) and 11 normal subjects (control group). SBS group consisted of 15 patients without structural heart disease (group I) and 11 patients with other heart disease (group II).

METHODS

(1) On the chest X-ray film, antero-posterior diameter (APD) of the thorax, transthoracic diameter (TTD), and APD/TTD ratio were measured. (2) On the CT image, three parameters were calculated; APD of the left atrium (LA diameter), APD/transverse diameter ratio of the heart (flattening ratio) and left side shift ratio of the heart (shifting ratio). (3) CT parameters were compared with APD/TTD ratio in patients and control group.

RESULTS

(1) APD/TTD ratio was smaller in group I and II than control group (30.0 +/- 5.4, 30.5 +/- 4.0 v 44.6 +/- 2.7%, p < .001). (2) LA diameter was smaller in group I and II than control group (23.2 +/- 4.1, 26.0 +/- 8.6 v 30.0 +/- 6.5 mm, p < .01). Flattening ratio was also smaller in group I and II than control group (59.2 +/- 9.4, 61.8 +/- 8.6 v 75.4 +/- 13.2%, p < .01). Shifting ratio was greater in group I and II than control group (10.9 +/- 5.0, 11.9 +/- 4.5 v 8.4 +/- 4.0%, p < .01). (3) APD/TTD ratio correlated with LA diameter (r = .39, p < .05) and flattening ratio (r = .53, p < .001). APD/TTD ratio did not correlate with shifting ratio (r = -.27, NS).

CONCLUSIONS

APD/TTD ratio correlated with LA diameter and flattening ratio rather than shifting ratio. LA diameter and flattening ratio on the CT image were more useful for evaluating the severity.

Enzyme immunoassay for conjugated cholic and 1 beta-hydroxycholic acids in urine of early infancy

A direct competitive heterologous enzyme immunoassay (EIA) for conjugated cholic acid (CA) was developed using horseradish peroxidase labeled antigen having a shorter bridge length than that of the immunogen. An appropriate dose-response curve for conjugated CA was obtained in the range of 0.05-50 ng/well. Specificity of the EIA proved satisfactory in terms of cross-reactivities to 23 kinds of related bile acids. The proposed method was evaluated to be useful for the determination of conjugated CA in urine with acceptable accuracy and inter- and intra-assay precision. The results of analysis showed a reverse relationship between age and urinary excretion ratio of conjugated 1 beta-hydroxy-CA to conjugated CA in the first 9 months after birth.

Different immunosuppressive effects of liposomal FK506 in liver and kidney transplantation

The efficacy of liposomal FK506 was compared between a canine liver transplantation model and a canine kidney transplantation model. The present study revealed that liposomal FK506 increased immunosuppressive efficacy of FK506 in liver transplantation but decreased in kidney transplantation. Because liposomal FK506 increased FK506 levels in the liver and spleen, and decreased FK506 levels in the kidney, it was suggested that enhanced immunosuppressive efficacy in liver transplantation should be attributed to the local immunosuppressive effects in the hepatic allograft rather than effective suppression of splenocyte activity.

[Rhabdomyosarcoma of the bladder: a case report]

A 15-year-old man with the chief complaint of general fatigue was referred to our hospital on November 11, 1993. Bilateral percutaneous nephrostomy was performed for postrenal anuria. X-ray examinations revealed a huge intrapelvic tumor, and it was histopathologically diagnosed as rhabdomyosarcoma by transrectal needle biopsy. He was initially treated with combination chemotherapy regimen of vincristine, actinomycin-D and cyclophosphamide (VAC therapy). Pelvic exenteration was performed on December 15, 1993. Histopathological findings were alveolar rhabdomyosarcoma with degenerative change and partial necrosis. After the operation, he was given two course of VAC therapy. In May, 1994, brain metastasis occurred, so 4 courses of VAC therapy were administered. For a very short period, neurological symptoms improved, but he died of pneumonia on November 15, 1994.

Adrenoceptor antagonists, but not guanethidine, reduce glucopenia-induced glucagon secretion from perfused rat pancreas

This study was designed to investigate (1) whether norepinephrine is released in response to glucopenia in vitro, thereby stimulating glucagon secretion and, (2) the modulating effects of norepinephrine on insulin and glucagon secretion, using isolated perfused rat pancreas preparations. Simultaneous addition of the adrenergic receptor antagonists yohimbine, prazosin and propranolol, each at a concentration of 10-(5) mol/l, significantly potentiated glucose-stimulated insulin secretion (6.23 +/- 0.76 vs. 2.11 +/- 0.72 (control) nmol/min, P < 0.01), and suppressed glucopenia-induced glucagon secretion (0.59 +/- 0.10 vs. 1.34 + 0.18 (control) ng/min, P < 0.05). Also, 10-(5) mol/l yohimbine alone significantly potentiated glucose-stimulated insulin secretion (4.86 +/- 0.50 nmol/min, P < 0.05). The norepinephrine release inhibitor, guanethidine, significantly inhibited tyramine-induced secretion of both norepinephrine (7.86 +/- 0.77 vs. 49.7 +/- 2.3 nmol/min, P < 0.01) and glucagon (0.31 +/- 0.08 vs. 1.21 +/- 0.15 ng/min, P < 0.01), but exerted no effects on glucopenia-induced secretion of either norepinephrine or glucagon. We conclude that these results further support the concept that the neurotransmitter norepinephrine is released in response to glucopenia in vitro, and modulates insulin and glucagon secretion. Our data do not, however, provide evidence indicating that glucopenia-induced glucagon secretion is mainly mediated by activation of sympathetic nerve terminals around the alpha-cells in the isolated perfused rat pancreas.

Exon redefinition by a point mutation within exon 5 of the glucose-6-phosphatase gene is the major cause of glycogen storage disease type 1a in Japan

Glycogen storage disease (GSD) type 1a (von Gierke disease) is an autosomal recessive disorder caused by a deficiency in microsomal glucose-6-phosphatase (G6Pase). We have identified a novel mutation in the G6Pase gene of a individual with GSD type 1a. The cDNA from the patient's liver revealed a 91-nt deletion in exon 5. The genomic DNA from the patient's white blood cells revealed no deletion or mutation at the splicing junction of intron 4 and exon 5. The 3' splicing occurred 91 bp from the 5' site of exon 5 (at position 732 in the coding region), causing a substitution of a single nucleotide (G to T) at position 727 in the coding region. Further confirmation of the missplicing was obtained by transient expression of allelic minigene constructs into animal cells. Another eight unrelated families of nine Japanese patients were all found to have this mutation. This mutation is a new type of splicing mutation in the G6Pase gene, and 91% of patients and carriers suffering from GSD1a in Japan are detectable with this splicing mutation.

Comparison of incorporation and extension of nucleotides in vitro opposite 8-hydroxyguanine (7,8-dihydro-8-oxoguanine) in hot spots of the c-Ha-ras gene

DNA templates with 8-hydroxyguanine (7,8-dihydro-8-oxoguanine, oh8Gua) at a site corresponding to the first or second position of codon 12 of the c-Ha-ras gene were prepared, and the nucleotides inserted opposite the modified base were compared. The Klenow fragment (KF) of Escherichia coli DNA polymerase I inserted C opposite oh8Gua at both positions. Taq DNA polymerase incorporated C and A opposite oh8Gua, and the ratio of C to A was higher at the first position than at the second position. DNA polymerase alpha (pol alpha) inserted A and C at the first position, and A at the second position of codon 12, indicating that the ratio of C to A was higher at the first position. Moreover, we studied the extensions of bases paired with oh8Gua by DNA polymerases with or without 3'-5' exonuclease activity. G and T opposite oh8Gua were removed, and subsequently C was inserted by KF. We found that an oh8Gua:A pair was recognized by the exonuclease activity of the enzyme and that A was partially substituted by C. On the other hand, pol alpha extended only C and A opposite oh8Gua. No difference was observed with oh8Gua at the two positions. These results indicate that the ratio of nucleotides incorporated opposite oh8Gua depends on the sequence context, while there is no particular difference in the extension of base pairs involving oh8Gua by DNA polymerases.

Exogenous insulin dose-dependently suppresses glucopenia-induced glucagon secretion from perfused rat pancreas

To clarify the role of insulin in modulating the glucagon response to glucose concentration changes, we investigated the effects of exogenous insulin (10 mU/mL, 100 mU/mL, and 3.3 U/mL) on responses to high glucose (5.6-->16.7 mmol/L), low glucose (5.6-->1.4 mmol/L), and arginine (10 mmol/L) stimulation using the perfused rat pancreas. Although glucagon levels were slightly suppressed by all of the exogenous insulin concentrations tested for the initial few minutes at 5.6 mmol/L glucose, baseline levels were maintained thereafter. Glucagon responses to high or normal glucose concentrations were not altered, but glucopenia-induced glucagon secretion was significantly suppressed as compared with that of controls (0.77 +/- 0.14 ng/min [10 mU/mL, n = 5], 0.55 +/- 0.14 ng/min [100 mU/mL, n = 5], 0.27 +/- 0.13 ng/min [3.3 U/mL, n = 5] v 1.38 +/- 0.20 ng/min [controls, n = 9], P < 0.05, respectively). The first phase of the glucagon response to arginine was potentiated (2.03 +/- 0.24 v 1.17 +/- 0.22 ng/min, P < .05) by 10 mU/mL exogenous insulin. The second phase of the glucagon response to arginine was significantly suppressed in the presence of higher concentrations of exogenous insulin (1.16 +/- 0.23 ng/min [100 mU/mL], 0.96 +/- 0.08 ng/min [3.3 U/mL] v 1.57 +/- 0.17 ng/min, P < .05, respectively). These results suggest that glucagon secretion is modified by the combined suppressive effects of glucose and insulin, although it is mainly glucose that mediates glucagon secretion in the physiological glucose range. Glucopenia- or arginine-induced glucagon secretion is suppressed by insulin.

[Pulmonary tuberculosis among foreign students of Japanese-language schools in Fukuoka City]

Chest mass examination for foreign students of Japanese-language schools in Fukuoka city was performed in 1991, and 1992. In 1991, 3 out of 237 students and in 1992, 9 out of 657 students were registered as pulmonary tuberculosis patients. Their home countries were China, Taiwan, and Korea. The incidence rates were 1,266 and 1,270 per 100,000 persons in 1991 and 1992, respectively, and were much higher than those of corresponding Japanese groups in the same period. Patients of severe types of pulmonary tuberculosis or smear positive cases were few. Though the treatments were interrupted in 4 out of 12 patients because of their return to their home countries, in the others the success rate of the treatment was as good as in Japanese patients. It is recommended that health examination including chest radiography should be performed for foreign students of Japanese-language school as soon as possible after their entrance to Japan.

Defective insulin and glucagon secretion in isolated perfused pancreata of diabetic WBN/Kob rats

To elucidate the pathophysiology of diabetes mellitus in male WBN/Kob rats, we performed pancreatic perfusion experiments and histopathological studies. Intraperitoneal glucose tolerance tests showed a diabetic pattern in 12-month-old WBN/Kob rats. In perfused pancreata of WBN/Kob rats, both the first and the second phases of insulin secretion in response to a 16.7 mM glucose challenge were markedly reduced compared with those in age-matched Wistar rats (p < 0.01, respectively). Furthermore, the insulin secretion rate in response to glucopenia (1.4 mM) was significantly higher (p < 0.05) and the decrement in insulin secretion was significantly lower (p < 0.05) in WBN/Kob rats. The decrement in glucagon secretion with 16.7 mM glucose was significantly blunted (p < 0.001), and the glucagon secretion rate in response to glucopenia was also significantly lower in WBN/Kob rats than in controls (p < 0.01). Although insulin secretion in response to 10 mM arginine was also moderately reduced in WBN/Kob rats (p < 0.05), the glucagon secretion rates in response to 10 mM arginine were similar in the two groups. Histopathological examination revealed widespread disappearance of acinar cells and islets, inflammatory changes, and marked fibrosis in the pancreata of WBN/Kob rats. Immunohistochemical studies showed decreased numbers of B cells in the islets of WBN/Kob rats. These findings suggest that this WBN/Kob rat strain is a useful model for studying not only pathogenesis, but also pathophysiology, i.e., defective hormonal secretion, in some types of human diabetes mellitus.

Simple method of hyperthermo-chemo-hypoxic isolated liver perfusion for hepatic metastases

As a regional therapy for hepatic malignancy, we developed a simple method of isolated liver perfusion (hyperthermo-chemo-hypoxic). In the present study, the influence of this method on the hepatic tissue and other organs was experimentally evaluated and applied it to seven patients. Experimentally, all dogs survived without hepatic insufficiency and systemic toxicity. Clinically, one patient died on postoperative day 14 of hepatic failure. The reason was that liver temperature reached 43 degrees C, which seemed to be the maximum limit for thermal toxic effect to the human liver. The other six patients well tolerated the perfusion with mild increases of serum aminotransferase and total bilirubin levels and decreases of hepaprastin levels. Serum aminotransferase and total bilirubin and hepaprastin levels returned to normal levels by postoperative day 14. There were no significant differences between the isolated liver perfusion group (n = 7) and hepatectomy-only group (n = 27). Six patients were disease-free during the observation period after the perfusion. This system is a simple, useful method for treating patients with metastatic cancer limited to the liver.

Effects of diazoxide on alpha- and beta-cell function in isolated perfused rat pancreas

To elucidate the effects of diazoxide on insulin and glucagon secretion at normal, high and low glucose concentrations and 10 mmol/l arginine, we performed pancreatic perfusion experiments. The insulin secretion rate in response to 16.7 mmol/l glucose was dose-dependently suppressed by concomitant infusion of diazoxide (100 and 300 mumol/l). Both the first and second phases of glucose-stimulated insulin secretion were significantly reduced in the presence of diazoxide as compared with controls. Basal glucagon secretion rate at 5.6 mmol/l glucose was significantly reduced by the administration of both 100 and 300 mumol/l diazoxide. Furthermore, the glucagon secretion rate at a high glucose concentration (16.7 mmol/l) was significantly lower with 300 mumol/l diazoxide than in the control. The glucagon secretion rate with glucopenia (1.4 mmol/l) was also significantly lower with 100 and 300 mumol/l diazoxide than in the control. The insulin secretion rate in response to 10 mmol/l arginine was also dose-dependently suppressed by concomitant infusion of diazoxide. The glucagon secretion rate in response to 10 mmol/l arginine was, however, significantly higher with 100 mumol/l diazoxide while not being significantly different with 300 mumol/l diazoxide. These findings suggest that some mechanism(s) which can be inhibited by diazoxide is involved in glucagon, as well as insulin, secretion in isolated perfused rat pancreas.

[Research trend for pathogenesis of sarcoidosis--streptococcal cell wall component (SCW)]

In search for the pathogenetic factors, we have found the following: 1) Chronic bacterial foci in the upper airway is showing adverse effect on clinical course of sarcoidosis. Alpha-streptococcus is mainly detected. 2) The prevalence of chronic tonsillitis in sarcoidosis is high if compared with that among Japanese adults examined by rhinolaryngologists. 3) The development of noncaseating epithelioid granulomas is reported after injections of an aqueous suspension of alpha-streptococcal cell wall (SCW) fragments into susceptible Lewis female rats. 4) Both protracted clinical course in sarcoidosis and higher responsiveness to SCW antigen are related to HLA-DR4, DR9 and DRw8. These results suggest that in sarcoidosis significance of persistence of antigen in upper respiratory tract and the significant correlation between SCW binding to Ia and immunogenicity, implicated by Schaeffer's, are seen.