Prevalence of fatty liver and advanced fibrosis by ultrasonography and FibroScan in a general population random sample

AIM

Fatty liver is the most common liver disease. This study examined fatty liver and advanced fibrosis prevalence in a random sample of the Japanese general population.

METHODS

A total of 6000 people randomly selected from two cities in Hiroshima Prefecture were invited to participate in this cross-sectional study originally carried out for hepatitis virus screening. Ultrasonography and FibroScan (controlled attenuation parameter [CAP] and liver stiffness measurement [LSM]) were provided as additional tests.

RESULTS

Of 6000 invited individuals, 1043 participated in hepatitis virus screening, of which 488 randomly selected individuals (median age, 56 years; interquartile range, 45-68 years; male participants, 49.8%) underwent ultrasonography, CAP, and LSM. Ultrasonography showed fatty liver in 24.6% and mild fatty liver in 32.8%. Controlled attenuation parameter showed severe steatosis in 27.5%, moderate steatosis in 12.5%, and mild steatosis in 11.1%. Overall, 62.1% were diagnosed with fatty liver based on ultrasonography or CAP. Nonalcoholic fatty liver disease (NAFLD) prevalence was 50.6%. Liver stiffness measurement found cirrhosis in 1.0% and severe fibrosis in 1.8%. Multivariate analysis of risk factors associated with ≥F2 or higher liver fibrosis showed that age ≥60 years and above (adjusted odds ratio [AOR], 3.2; 95% confidence interval [CI], 1.5-6.9; p = 0.0031), hepatitis C virus antibody positivity (AOR, 8.4; 95% CI, 1.0-68.4; p = 0.0467), and fatty liver (AOR, 2.3; 95% CI, 1.1-6.2; p = 0.0317) are independent risk factors.

CONCLUSIONS

In the general population, 62.1% had fatty liver, and NAFLD prevalence was twice as high as previously reported. Screening that is noninvasive, low-cost, and does not require special techniques or equipment is needed to detect advanced liver fibrosis.

Prevalence of Helicobacter pylori infection in the general population evaluated by a resident-register-based epidemiological study

BACKGROUND

The current status of Helicobacter pylori infection in Japan has not been investigated. We evaluated the status of H. pylori infection in a Japanese general population using large-scale resident-register-based sampling.

METHODS

All 6069 adults in a rural town and 6000 adults in two urban cities (3000 each), selected by register-based random sampling, were enrolled in our health check-up program. Antibody titers against Helicobacter pylori (cut-off value was 3 U/mL by Eiken E-plate) were evaluated, and subjects with a positive result were encouraged to undergo further examinations.

RESULTS

A total of 1586 subjects participated in serum sampling. The overall prevalence of H. pylori infection was 40.0% (634/1586), and it increased with age both in rural and urban areas. Although the overall positive rate was higher in the rural area (49.4%) than in the urban areas (35.6 and 32.3%), there was no difference in H. pylori status of younger subjects between the two areas. Among 634 patients with a positive titer, 374 (59.0%) underwent further examinations including endoscopic examination, and 180/634 (28.4%) patients received eradication therapy. Gastric neoplasms (three adenocarcinomas and one adenoma) were found in our screening program.

CONCLUSION

We clarified population-based random sampling data of H. pylori infection in a Japanese general population. In younger subjects, a decrease in the prevalence of H. pylori infection was confirmed both in rural and urban areas. This provides basic information for establishing a strategy to reduce gastric cancer deaths.

Spred2 Deficiency Exacerbates D-Galactosamine/Lipopolysaccharide -induced Acute Liver Injury in Mice via Increased Production of TNFα

Acute liver injury (ALI) is characterized by hepatocyte damage and inflammation. In the present study, we examined whether the absence of Sprouty-related EVH1-domain-containing protein 2 (Spred2), a negative regulator of the Ras/Raf/ERK/MAPK pathway, influences ALI induced by D-galactosamine (D-GalN) and lipopolysaccharide (LPS). Compared to wild-type mice, Spred2^−/− mice developed exacerbated liver injury represented by enhanced hepatocyte damage and inflammation. Enhanced ERK activation was observed in Spred2^−/−-livers, and the MEK/ERK inhibitor U0126 ameliorated ALI. Hepatic tumour necrosis factor α (TNFα) and interleukin (IL)-1β levels were increased in Spred-2^−/−-livers, and the neutralization of TNFα dramatically ameliorated ALI, which was associated with decreased levels of endogenous TNFα and IL-1β. When mice were challenged with D-GalN and TNFα, much severer ALI was observed in Spred2^−/− mice with significant increases in endogenous TNFα and IL-1β in the livers. Immunohistochemically, Kupffer cells were found to produce TNFα, and isolated Kupffer cells from Spred2^−/− mice produced significantly higher levels of TNFα than those from wild-type mice after LPS stimulation, which was significantly decreased by U0126. These results suggest that Spred2 negatively regulates D-GalN/LPS-induced ALI under the control of TNFα in Kupffer cells. Spred2 may present a therapeutic target for the treatment of ALI.

Spred2-deficiecy Protects Mice from Polymicrobial Septic Peritonitis by Enhancing Inflammation and Bacterial Clearance

Sepsis is an infection-induced systemic inflammatory syndrome and a major cause of death for critically ill patients. Here, we examined whether the absence of Sprouty-related EVH1-domain-containing protein 2 (Spred2), a negative regulator of the Ras/Raf/ERK/MAPK pathway, influences host defense against polymicrobial sepsis (PMS) induced by cecal ligation and puncture (CLP). Compared to wild-type mice, Spred2^−/− mice exhibited higher survival rates with increased level of leukocyte infiltration and local chemokine production and reduced plasma and peritoneal bacterial loads after CLP. The MEK inhibitor U0126 significantly reduced LPS-induced chemokine production by Spred2^−/− resident macrophages in vitro, and decreased CLP-induced leukocyte infiltration in vivo. Spred2^−/− resident macrophages, but not neutrophils or elicited macrophages, exhibited increased phagocytic activity. Interestingly, surface expression of complement receptor 1/2 (CR1/2) was increased in Spred2^−/− resident macrophages in response to lipopolysaccharide in a manner dependent on the ERK/MAPK pathway, and blocking CR1/2 in vivo resulted in reduced leukocyte infiltration and increased bacterial loads after CLP. Taken together, our results indicate that Spred2-deficiency protects mice from PMS via increased activation of the ERK/MAPK pathway and subsequent increase in innate immune responses. Thus, inhibiting Spred2 may present a novel means to prevent the development of PMS.

Spred-2 deficiency exacerbates lipopolysaccharide-induced acute lung inflammation in mice

Background

Acute respiratory distress syndrome (ARDS) is a severe and life-threatening acute lung injury (ALI) that is caused by noxious stimuli and pathogens. ALI is characterized by marked acute inflammation with elevated alveolar cytokine levels. Mitogen-activated protein kinase (MAPK) pathways are involved in cytokine production, but the mechanisms that regulate these pathways remain poorly characterized. Here, we focused on the role of Sprouty-related EVH1-domain-containing protein (Spred)-2, a negative regulator of the Ras-Raf-extracellular signal-regulated kinase (ERK)-MAPK pathway, in lipopolysaccharide (LPS)-induced acute lung inflammation.

Methods

Wild-type (WT) mice and Spred-2^−/− mice were exposed to intratracheal LPS (50 µg in 50 µL PBS) to induce pulmonary inflammation. After LPS-injection, the lungs were harvested to assess leukocyte infiltration, cytokine and chemokine production, ERK-MAPK activation and immunopathology. For exvivo experiments, alveolar macrophages were harvested from untreated WT and Spred-2^−/− mice and stimulated with LPS. In invitro experiments, specific knock down of Spred-2 by siRNA or overexpression of Spred-2 by transfection with a plasmid encoding the Spred-2 sense sequence was introduced into murine RAW264.7 macrophage cells or MLE-12 lung epithelial cells.

Results

LPS-induced acute lung inflammation was significantly exacerbated in Spred-2^−/− mice compared with WT mice, as indicated by the numbers of infiltrating leukocytes, levels of alveolar TNF-α, CXCL2 and CCL2 in a later phase, and lung pathology. U0126, a selective MEK/ERK inhibitor, reduced the augmented LPS-induced inflammation in Spred-2^−/− mice. Specific knock down of Spred-2 augmented LPS-induced cytokine and chemokine responses in RAW264.7 cells and MLE-12 cells, whereas Spred-2 overexpression decreased this response in RAW264.7 cells.

Conclusions

The ERK-MAPK pathway is involved in LPS-induced acute lung inflammation. Spred-2 controls the development of LPS-induced lung inflammation by negatively regulating the ERK-MAPK pathway. Thus, Spred-2 may represent a therapeutic target for the treatment of ALI.

Spred-2 deficiency exacerbates acetaminophen-induced hepatotoxicity in mice

MAPKs are involved in acetaminophen (APAP)-hepatotoxicity, but the regulatory mechanism remains unknown. Here, we explored the role of Spred-2 that negatively regulates Ras/ERK pathway in APAP-hepatotoxicity. Spred-2 knockout (KO) mice demonstrated exacerbated liver injury, an event that was associated with increased numbers of CD4(+) T, CD8(+) T and NK cells in the liver compared to the control. Levels of CXCL9/CXCL10 that attract and activate these cells were increased in Spred-2 KO-liver. Kupffer cells isolated from Spred-2 KO mice after APAP challenge expressed higher levels of CXCL9/CXCL10 than those from the control. Upon stimulation with APAP or IFNγ, naïve Kupffer cells from Spred-2 KO mice expressed higher levels of CXCL9/CXCL10. NK cell-depletion attenuated APAP-hepatotoxicity with lowered hepatic IFNγ and decreased numbers of not only NK cells but also CD4(+) T and CD8(+) T cells in the liver. These results suggest that Spred-2 negatively regulates APAP-hepatotoxicity under the control of Kupffer cells and NK cells.

Hybrid lethality in interspecific F1 hybrid Nicotiana gossei x N. tabacum involves a MAP-kinases signalling cascade

A cultured cell line, GTH4 (Nicotiana gossei Domin x N. tabacum L.), which exhibits hybrid lethality, died at 26 degrees C, but not at 37 degrees C. Pharmacological experiments using inhibitors of protein phosphatases and protein kinases indicated the involvement of a protein kinase signalling pathway in the cell death process. Immunoblot analysis revealed that salicylic acid-induced protein kinase (SIPK) was phosphorylated soon after the shift in temperature from 37 degrees C to 26 degrees C. Cultured cells of the hybrid of N. gossei x transgenic N. tabacum harboring a steroid (dexamethasone; DEX)-inducible NtMEK2 (DD) or NtMEK2 (KR), constitutively active and inactive forms of NtMEK2, respectively, were established. Induction of NtMEK2 (DD) by DEX in the hybrid cells induced the activation of SIPK, the generation of hydrogen peroxide (H (2)O (2)), and cell death at 37 degrees C. The activation of SIPK, generation of H (2)O (2), and cell death at 26 degrees C were compromised by DEX treatment in hybrid cells harbouring NtMEK2 (KR). This study provides evidence for the involvement of MAPK signalling in the regulation of cell death in hybrids.

Expression of KIT (CD117) in Neoplasms of the Head and Neck: An Ancillary Marker for Adenoid Cystic Carcinoma

Adenoid cystic carcinoma is an indolent salivary gland malignancy that is associated with a poor long-term prognosis. The distinction of adenoid cystic carcinoma from other head and neck neoplasms can occasionally be problematic, particularly in small biopsies. Recent studies suggest that KIT (CD117) might be useful as an ancillary marker for adenoid cystic carcinoma; however, the expression of KIT in other benign and malignant head and neck neoplasms, including those that might mimic adenoid cystic carcinoma, has not been well studied. Here we use two different antibodies against KIT to evaluate its expression in a series of 66 adenoid cystic carcinomas compared with its expression in 98 other neoplasms of the head and neck. Overall, 94% (n = 62) of adenoid cystic carcinomas from various anatomic sites and of various histologic subtypes were positive for at least one of the KIT antibodies, and 77% (n = 50) of adenoid cystic carcinoma cases were positive for both antibodies. This contrasted with only 8% (n = 8) of other head and neck neoplasms that were positive for both KIT antibodies (P <.001). It was of note that certain neoplasms, including pleomorphic adenoma, basal cell adenoma, polymorphous low-grade adenocarcinoma, and basal cell carcinoma, that can show histologic overlap with adenoid cystic carcinoma had significantly less KIT immunoreactivity than did adenoid cystic carcinoma (P <.001). In contrast, KIT expression did not reliably distinguish adenoid cystic carcinoma from basal cell adenocarcinoma and basaloid squamous carcinoma (P >.05). The overall sensitivity of the two KIT antibodies for adenoid cystic carcinoma was 82-89%, and the specificity was 87-88%. The findings in this study support the potential use of KIT immunoexpression for distinguishing adenoid cystic carcinoma from many other benign and malignant head and neck neoplasms.

Thermoinduction of genes encoding the enzymes of gibberellin biosynthesis and a putative negative regulator of gibberellin signal transduction in Eustoma grandiflorum

Eustoma grandiflorum Shinn requires vernalization for the induction of stem elongation and flowering. To investigate the role of gibberellins (GAs) in vernalization, the expression levels of genes encoding enzymes of GA biosynthesis, copalyl diphosphate synthetase, GA 20-oxidase and GA 3 beta-hydroxylase, were examined using two culitvars that show different responses to vernalization. The three genes were induced in a vernalization- and a cultivar-dependent manner. EgSPY, a putative negative regulator of GA signal transduction, was also induced during the vernalization period. The results suggest that the expression of the genes encoding GAs biosynthesis is regulated by vernalization. We postulate that EgSPY functions as a negative regulator of GA signal transduction during vernalization, inhibiting adventitious shoot elongation during vernalization.

Histopathology of coronary in-stent restenosis following gamma brachytherapy

The histopathology of in-stent restenosis (ISR) following gamma brachytherapy is described. Such histology has not been reported previously. An 82 year old man presented with recurrent ISR three months after gamma brachytherapy to an area of ISR within a native circumflex vessel. The recurrent ISR was treated with directional coronary atherectomy; the histopathology of this directional coronary atherectomy specimen is discussed. These histopathological examinations showed abundant extracellular matrix material. Surprisingly, there was a relatively small cellular (myofibroblastic) component, with an absence of endothelial cells and little evidence of active proliferation. ISR after gamma brachytherapy may be a pathologically distinct entity.

[An epithelial cyst at the frontal convexity]

We report a rare case of an epithelial cyst at the right frontal convexity. A 60-year-old woman came to our hospital suffering from dysarthria and gait disturbance. Computed tomography (CT) of the brain on admission showed a round low-density area, 6 cm in diameter, at the right frontal convexity. Midline shift and displacement of the lateral ventricle are seen. There is no contrast enhancement effect. Excision of the cyst wall and fenestration into the subarachnoid space was carried out and the patient was discharged with no neurological deficits. After 5 years, regrowth of the cyst was seen. Cyst-peritoneal shunt was performed and she was discharged uneventfully. Light microscopy showed the cyst wall consisted of a monolayer of flat epithelium and loose connective tissue. An electronmicrograph of the cyst wall showed a non-ciliated epithelial layer with microvilli and basement membrane. The epithelial cells connecting with each other through desmosome have numerous endoplasmic reticulum and mitochondria. Interdigitation of the cytoplasmic membrane was not seen. The term "epithelial cyst" seems ambiguous. We discuss the pathogenesis and the nomenclature for intracranial benign cystic lesions based on the previous literature.

[Epidural blood patch for the treatment of intracranial hypotension due to cerebrospinal fluid leakage after thoracic spine surgery]

We report a case of a 44-year-old woman successfully treated by an epidural blood patch for intracranial hypotension due to cerebrospinal fluid (CSF) leakage into the thoracic cavity after thoracic spine surgery. The patient was admitted to our hospital with the complaint of postural headaches. She had received anterior thoracic instrumentation for thoracic disc herniation four months earlier. Lumbar puncture demonstrated low CSF pressure, and Gd-enhanced MR images displayed diffuse dural enhancement. Accordingly, she was diagnosed as having intracranial hypotension. 111In-DTPA cisternography revealed a CSF leakage into the left thoracic cavity, possibly caused by dural laceration during thoracic spine surgery. To avoid the risk of direct surgery, we performed epidural blood patch; 3 ml of autologous blood was injected into the epidural cavity. Postoperatively postural headaches immediately disappeared. MRI taken one year later revealed disappearance of diffuse dural enhancement, and 111In-DTPA cisternography revealed no CSF fluid leaks. Epidural blood patch seems to be a choice of treatment for CSF leak after spinal surgery.

Free hand aspiration for large periventricular hemorrhage. Case report

BACKGROUND

At present, there are several therapeutic options, including craniotomy and stereotactic aspiration, for large intracerebral hemorrhage perforating into the lateral ventricle. In the cases with Glasgow Coma Scale (GCS) scores under 6 with anisocoria, external ventricular drainage would be the first choice [2-4]. We have also performed anterior ventricular horn puncture in a standard manner. The target was the foramen of Monro, at a depth of 5.5 cm from the inner table of the skull. The point of insertion was located just anterior to the coronal suture, approximately 10 cm above the nasion, and 3 cm from the midline [1]. However, we noticed that the insertion of a catheter into the periventricular hematoma adjacent to the lateral ventricle was made easier by tilting the catheter 30 degrees laterally as in the first case (Figure 1).

METHODS

In our method, inclining the catheter by 30 degrees laterally, we used a silicone tube 3.5 mm in internal diameter (Silascon ventricle drainage tube, Kaneka Medix Corp., Osaka, Japan) and then replaced it with another Silascon tube with a 2.5 mm-internal diameter. From January 1999 through December 2000, eleven patients who all had GCS scores under 6 and anisocoria preoperatively were treated by this method. The series included two patients who were undergoing hemodialysis because of renal failure, two with bleeding tendency because of liver dysfunction, and one with heart failure.

RESULTS

The insertion itself caused no complications. Cerebrospinal fluid was drained smoothly after removal of hematoma because the hematoma cavity connecting with the lateral ventricle was opened. Two typical cases using this technique are shown (Figures 1 and 2). All patients recovered favorable consciousness postoperatively compared with the preoperative state but hemiparesis remained. Postsurgical follow up at 3 months revealed the outcomes evaluated by Glasgow Outcome Scale (GOS) were moderate disability in 5 patients and severe disability in 6 patients .

CONCLUSION

This direct aspiration and drainage of a large intracerebral hematoma that ruptures into the lateral ventricle is superior to simple ventricular drainage in regard to the removal of the hematoma clot. This technique would be the choice especially in patients with serious complications such as cardiac disease and renal failure.

Association of glutathione with flowering in Arabidopsis thaliana

In order to study the relationship between GSH and flowering, wild-type and late-flowering mutant, fca-1, of Arabidopsis thaliana were treated with L-buthionine sulfoximine (BSO), a specific inhibitor of GSH biosynthesis, under long-day conditions. BSO treatment of the fca-1 mutant starting at 17 d after imbibition promoted flowering. However, when the treatment was started at 12 d after imbibition, BSO treatment at 10(-4) M resulted in an inhibition of flowering. This inhibitory effect of BSO on flowering was abolished by GSH treatment at 10(-4) M, although GSH treatment at an increased concentration of 10(-3) M clearly delayed flowering. In contrast, BSO treatment of wild-type plants starting at 12 d after imbibition promoted flowering, whose effect was abolished by GSH application. In the fca-1 mutant, whose endogenous GSH levels were high, chilling treatment lowered the GSH levels and promoted flowering, as was the case in the BSO treatment. An A. thaliana mutant, cad2-1, which has a defect in GSH biosynthesis also exhibited late flowering. The late-flowering phenotype of this mutant tended to be strengthened by BSO and abolished by GSH treatment. These results suggest that flowering is associated with the rate of GSH biosynthesis and/or the levels of GSH in A. thaliana.

Elevated sensitivity to gibberellin by vernalization in the vegetative rosette plants of Eustoma grandiflorum and Arabidopsis thaliana

Changes in the sensitivity to gibberellin (GA) after vernalization were studied in the vegetative rosette of Eustoma grandiflorum and late flowering Arabidopsis thaliana mutant, fca-1. The sensitivity to GA after vernalization was monitored using the bolting rate of plants that were grown on a medium containing GA(3) or ancymidol. The bolting rates were higher in vernalized plants than non-vernalized plants when the same GA(3) concentration was used. There was a positive relationship between the duration of vernalization and the bolting rate in E. grandiflorum. In contrast, a negative relationship between the duration of treatment and bolting rate was found in the non-vernalized plants. In fca-1, the flowering time of vernalized plants was significantly reduced compared with the non-vernalized plants under various concentrations of GA(3) treatment. To elucidate whether this elevated sensitivity relates to the efficiency of GA signal transduction, we measured the transcript amounts of Expansin (Exp), which is up-regulated by GA, and GA20-oxidase (GA20ox) and GA3 beta-hydroxylase (GA3betahy), which are down-regulated by GA. The transcript amounts were estimated using the Taq-Man PCR system based on combinations of primers and probes that specifically detect the genes, and normalized by the transcript amount of ubiquitin gene measured as an internal standard. For each concentration of GA treatments examined, Expansin of both E. grandiflorum and A. thaliana was induced at a higher rate in the vernalized plants than in the non-vernalized plants. The expression of GA20ox and GA3betahy of E. grandiflorum decreased faster in the vernalized plants than the non-vernalized plants. We conclude that vernalization is a critical environmental cue not only for initiating GA biosyntheses in vegetative rosette, but also for elevating the GA sensitivity of the plants via a GA signal transduction pathway.

Evidence of alpha-adrenoceptor-mediated chronotropic action in children

We investigated alpha-adrenoceptor-mediated positive chronotropic action in children using a pharmacological autonomic function test. Under cardiac vagal and sympathetic blockade, chronotropic responses to intravenous infusion of an alpha-agonist, phenylephrine, were determined in 129 patients with suspected autonomic dysfunction. Heart rate changes to phenylephrine infusion (0.4 microg/kg/min) for 5 minutes ranged from -2 to 50 beats/min (mean +/- SD, 13.8 +/- 9.7 beats/min). alpha-Adrenoceptor-mediated chronotropic (APC) action more than 5 beats/min was observed in 88 (68%) subjects. APC was negatively correlated with age. Multivariate analysis showed that APC was correlated negatively with beta-sympathetic tone and positively correlated with intrinsic heart rate. These results suggest that the alpha-adrenoceptor-mediated chronotropic action is a developmental phenomenon and may play an important role in controlling heart rate in response to cardiac sympathetic activation.

Oxidation products of uric acid and ascorbic acid in preterm infants with chronic lung disease

Allantoin, the oxidation product of uric acid (UA), can be used as an in vivo marker of free radical generation. The aims of the present study were to evaluate the allantoin changes in plasma and bronchoalveolar lavage fluid (BALF) as well as to examine plasma levels of ascorbic acid (AA) and its oxidation product, dehydroascorbic acid (DHAA), in infants with or without chronic lung disease (CLD) during the first week of life. The study population was 20 infants of 24-30 weeks gestation, comprising 10 who subsequently developed CLD and 10 without CLD. In the CLD infants, the plasma allantoin/UA ratio showed a significant increase after day 1 and continued to increase gradually to reach a peak on day 6 (6.5 +/- 4.1% for CLD and 2.1 +/- 0.9% for non-CLD infants). The allantoin/UA ratio in BALF was also higher in CLD infants and the difference reached significance on days 4-6 (41.2 +/- 15.8% for CLD and 11.7 +/- 9.9% for non-CLD infants). In contrast to allantoin, the plasma DHAA/AA ratio did not differ between the 2 groups throughout the study period. Our findings that the allantoin/UA ratios were significantly higher in CLD than non-CLD infants not only in plasma but also in BALF, and that the intergroup differences of this ratio in both plasma and BALF was more prominent in the latter half of the first week of life further confirm our previous speculation that oxygen radicals are involved in the development of neonatal CLD.

yam8(+), a Schizosaccharomyces pombe gene, is a potential homologue of the Saccharomyces cerevisiae MID1 gene encoding a stretch-activated Ca(2+)-permeable channel

The Saccharomyces cerevisiae MID1 gene encodes a stretch-activated Ca(2+)-permeable channel. In a protein database, we found a Schizosaccharomyces pombe gene whose predicted protein shows 26% identical and 62% similar to the Mid1 channel in amino acid sequence. cDNA derived from this gene, designated yam8(+), was isolated by reverse transcription-polymerase chain reaction (RT-PCR). Further analysis showed that the Yam8 protein consists of 486 amino acids and has 6 hydrophobic segments. The yam8(+) cDNA, placed under the S. cerevisiae TDH3 promoter, partially complemented the mating pheromone-induced death (mid) phenotype of the S. cerevisiae mid1 mutant. The expression of the yam8(+) cDNA in the mid1 mutant cells partially remediated the mid phenotype and resulted in a slight increase in Ca(2+) uptake activity. These findings suggest that Yam8 is a potential homologue of Mid1.

[A case of a pituitary mass in association with sarcoidosis]

We report a case of a pituitary mass associated with sarcoidosis. Natural regression of the mass was demonstrated after the replacement of corticosteroid hormone. A seventy-one-year old man presented with blurred vision and general fatigability, and admitted to our hospital. He was diagnosed to have ophthalmic and pulmonary sarcoidosis. Two months later, he consulted our hospital again, with complaints of fatigability and vomiting. Laboratory data showed hyponatremia, and CT scan revealed a suprasellar mass. He had no neurological deficits. Diabetes insipidus was not observed. Magnetic resonance image showed a heterogeneously enhanced intrasellar and suprasellar dumbbell shaped mass and thickening of the pituitary stalk. Hormonal examination revealed corticosteroid insufficiency and hypothyroidism, possibly caused by the pituitary mass. Replacement of corticosteroid hormone significantly improved his fatigability. Two months later, follow-up MRI showed regression of the pituitary mass. Based on the clinical and radiological findings, pituitary mass was strongly suggested to be caused by sarcoidosis. We recommend prompt steroid treatment for such a pituitary mass and strict follow-up MRI study.

Living related liver transplantation: histopathologic analysis of graft dysfunction in 304 patients

Between June 1990 and August 1997, 304 mainly pediatric patients underwent a total of 311 orthotopic living related liver transplantations (LRLTs) under tacrolimus immunosuppression at Kyoto University Hospital. Congenital biliary atresia was the most common underlying disease. The donor was a parent, and the left lateral segments were used as grafts in most cases. The average number of loci of HLA-A, -B, and -DR mismatches between the donor and the recipient were 2.1. Forty-three transplants were ABO-incompatible. Liver histology at the time of abnormal liver function after transplantation was analyzed. Preservation injury was rare and mild. Acute cellular rejection (ACR) occurred in 36% of transplants during the first 6 months. Average rejection activity index (the Banff schema) was 4.2 and severe rejection was rarely seen. The number of mismatching HLA loci and immunosuppression regimens affected the incidence of ACR. Chronic rejection (CR) occurred in 2% of transplants. Concerning humoral rejection, no hyperacute rejection was seen. However, hepatic artery thrombosis (delayed hyperacute rejection) was seen in an ABO-incompatible transplant. Acute hepatitis, including those related to cytomegalovirus and Epstein-Barr virus, occurred in 17% of transplants. Chronic hepatitis, including hepatitis B and C, developed in 3%. Acute or chronic cholangitis occurred in 16%, and a significantly higher incidence of cholangitis was found in ABO-incompatible transplants. Posttransplantation lymphoproliferative disease developed in 2%. In LRLT, milder preservation injury and less frequent ACR and CR were suggested, probably because of the short cold-ischemia time and the advantages of HLA histocompatibility, respectively.

[Vitamin deficiencies and hypervitaminosis]

There have recently been very few deficiencies with respect to fat soluble and water soluble vitamins in Japan All-trans-retinoic acid as induction or maintenance treatment improves disease free and overall survival against acute promyelocytic leukemia. In the isolated vitamin E deficiencies gene mutation has been cleared for alpha-tocopherol transferprotein. Recently, a relation of nutritional vitamin K intake and senile osteoporosis in women was epidemiologically demonstrated on a prospective study. Thiamin was yet noticed as development of deficiency in alcoholism, while the importance of supplemental folic acid during pregnancy has become especially clear in light of studies showing that folic acid supplements reduce the risk of neural tube defects in the fetus. With respect to hypervitaminosis, the Council for Responsible Nutrition (CRN), USA, has established safe intakes by identifying the NOAEL (No Observed Adverse Effect Level) and LOAEL (Lowest Observed Adverse Effect Level). Summaries of NOAEL and LOAEL for individual vitamins were shown.

CT findings of BALTOMA

OBJECTIVE

To review the CT findings of BALTOMA, a low-grade malignant lymphoma originating from bronchus-associated lymphoid tissue (BALT).

METHODS

The CT findings, symptoms, and clinical courses of BALTOMA in five patients were reviewed. The specimens obtained at operation were investigated, and the pathological findings were compared with the CT findings.

RESULTS

There were no symptoms in four patients and normal laboratory data in all patients. One patient who complained of general malaise underwent surgery under suspicion of lung carcinoma. Four patients were observed from 4 months to 7 years and 1 month under the diagnosis of organizing pneumonia or chronic inflammatory processes. On CT images a localized lesion was seen in four cases, while multiple lesions were seen in one case. Attenuation of the lesions was between 39.15 and 60 HU on nonenhanced CT. Lesions were homogeneously enhanced by contrast material. The margins of the lesion were clearly demarcated by interlobular septa in one portion and were unclear in the other portion in all cases. Air bronchograms were seen in four cases. CT angiogram signs were seen in three of four cases in which contrast study was performed. There was no lymphadenopathy, pleural changes, or invasion to other organs. The pathological investigation revealed small lymphocytes that showed monoclonality in all cases.

CONCLUSIONS

Awareness of the CT findings of BALTOMA can help to avoid misinterpreting BALTOMA as chronic inflammation and/or lung carcinoma. When a slowly progressive chronic pneumonia is being followed up, transbronchial lung biopsy and immunoglobulin staining of lymphocytes should be recommended for the correct diagnosis.

Proposed standard for human blood vitamin B1 value using HPLC. The Committee for Vitamin Laboratory Standards, Japan

Standard reference ranges for all laboratory test values are mandatory. This study was designed to establish a reference range for blood vitamin B1 levels, since the normal range has not been determined in the Japanese population. We founded the Japan Committee for Vitamin Laboratory Standards, which was incorporated with the Vitamin Society of Japan and the Japanese Society of Nutrition and Food Science. We standardized whole blood vitamin B1 levels using three HPLC techniques (post-column reverse-phase HPLC, pre-column reverse-phase HPLC, and precolumn GP-HPLC). The reference range was obtained in 54 volunteers administered a 1,800 kcal diet with 2 mg of vitamin B1 (1.74 mg measured) daily to avoid marginal vitamin B1 deficiency in the population. The range for each assay was 26-47, 28-51, and 28-56 ng/ml, respectively. Our data suggest that 26-28 ng/ml is the lower limit of normal for whole blood vitamin B1, but further studies in a larger population are needed in order to obtain more definitive results.

Developmental changes in the expression of alpha-tocopherol transfer protein during the neonatal period of rat

It is well known that the cellular concentration of alpha-tocopherol (alpha-toc) is about 10-fold greater than that of gamma-tocopherol (gamma-toc) despite the ingestion of a large amount of gamma-toc in the diet. Recently, this discrimination of tocopherol is considered to be attributed to alpha-tocopherol transfer protein (alpha-TTP) which binds to alpha-toc in preference to the other forms of tocopherol in the liver. In the present study, developmental changes in expression of alpha-TTP after birth were investigated using rats with respect to plasma changes of tocopherols. The expression of alpha-TTP in the neonatal rat liver, which was very low immediately after birth, increased steadily during the two weeks of life before weanling and reached the adult level at four weeks. During the suckling period, the plasma ratio of alpha-toc to gamma-toc linearly increased, because plasma alpha-toc which was low immediately after birth, increased rapidly during the period, while gamma-toc remained unchanged. The increase in the ratio seemed to correlate with the developmental expression of alpha-TTP in the liver during this period.

Effect of alpha-tocopherol status on alpha-tocopherol transfer protein expression and its messenger RNA level in rat liver

Studies were designed to explore the role of vitamin E nutritional status in regulating the synthesis of alpha-tocopherol transfer protein (alphaTTP) in rat liver. In vitamin E-replete rats, expression of this protein and its specific messenger RNA (mRNA) was decreased by about 300% compared with rats with normal vitamin E levels. In vitamin E-depleted rats, the alphaTTP-specific mRNA level increased to about 150% of that in the normal vitamin E group. However, protein expression remained constant. These findings indicate that the synthesis of alphaTTP can be regulated by the vitamin E nutritional status.

Case report of rec(7)dup(7q)inv(7)(p22q22) and a review of the recombinants resulting from parental pericentric inversions on any chromosomes

We report a rare case of duplication for 7q22 --> 7qter and deletion for 7p22 --> 7pter, resulting from a meiotic recombination of a paternal pericentric inversion, inv(7)(p22q22). The newborn boy had the 7q trisomy syndrome. In addition, the diagnosis of chondrodysplasia punctata was made from lumbar and hand X-ray films taken soon after birth. Only two cases of rec(7)dup(7q), both in a single family, have been reported previously. We review 133 offspring with recombinations resulting from pericentric inversions on any chromosomes reported between 1981 and 1995. Of the 133 cases, 110 had a long-arm duplication and short-arm deletion, while only 23 had a short-arm duplication and long-arm deletion. In 85 of the 133 cases, the mother was an inversion carrier (five carriers had two affected offspring), and in 46, the carrier was a father (one carrier had three affected offspring). Kaiser [Hum Genet 1984;68:1-47] reviewed 63 offspring with recombinations derived from a parental pericentric inversion reported between 1972 and 1981. In both surveys, recombinations resulting from pericentric inversions of chromosomes 1, 12, 19, and Y were not found.

Developmental changes in alpha-tocopherol, especially during infantile period

Developmental changes in expression of alpha-TTP after birth were investigated using rats with respect to plasma changes of tocopherols. The expression of alpha-TTP in the neonatal rat liver, which was very low immediately after birth, increased steadily during the two weeks of life before weanling and reached the adult level at 4 weeks. During the suckling period, the plasma ratio of alpha-tocopherol to gamma-tocopherol linearly increased, because plasma alpha-tocopherol was low immediately after birth, increased rapidly during the period, while gamma-tocopherol remained unchanged. The increase in the ratio seemed to correlate with the developmental expression of alpha-TTP in the liver during this period. The ratio also reached the adult level after 4 weeks. The expression of alpha-TTP was investigated using primary cultured rat hepatocytes. The expression of alpha-TTP was found to be extremely low after 20 h of culture. The decrease in alpha-TTP expression was exacerbated by adding epidermal growth factor to the culture medium and was inhibited by adding dexamethasone. These observations suggest that expression of alpha-TTP may be affected by the state of hepatic differentiation. The Western and Northern blot analysis of alpha-TTP in vitamin E deficient and enriched rats were compared to control rats. The decrease of mRNA of alpha-TTP observed in alpha-Toc-enriched rat liver and the increase of mRNA observed in the vitamin E deficient rat liver indicate the synthesis of alpha-TTP, although alpha-TTP itself was not altered.

Pulmonary involvement in polymyositis and dermatomyositis: sequential evaluation with CT

OBJECTIVE

The characteristic findings of pulmonary involvement in polymyositis (PM) or dermatomyositis (DM) and the change in findings before and after treatment were evaluated with sequential high-resolution CT studies.

MATERIALS AND METHODS

CT images of pulmonary involvement in 19 patients with PM or DM were reviewed. During a period of 2-61 months, 17 of these patients underwent sequential CT before and after treatment with corticosteroids, immunosuppressants, or both.

RESULTS

Findings of the initial CT studies included pleural irregularities and prominent interlobular septa (n = 19), ground-glass attenuation (n = 19), patchy consolidation (n = 19), parenchymal bands (n = 15), irregular peribronchovascular thickening (n = 15), and subpleural lines (n = 7). Honeycombing was not detected on any CT images. These findings were more remarkable in the lower portion and the subpleural area of the lungs. In 16 of the 17 patients who underwent sequential CT conditions such as patchy consolidation, parenchymal bands, and irregular peribronchovascular thickening improved, becoming pleural irregularities and prominent interlobular septa, ground-glass attenuation, and subpleural lines on follow-up CT scans.

CONCLUSION

Consolidation with patchy and subpleural distribution, parenchymal bands, and irregular peribronchovascular thickening were characteristic and reversible CT findings in patients with PM or DM.

Haemodynamic changes during vasodepressor syncope in children and autonomic function

We investigated postural haemodynamic changes in 24 boys and 30 girls, aged 8-16 years, with orthostatic intolerance. During the orthostatic test, nine boys and seven girls (30%) developed a vasodepressor attack (orthostatic-positive group). The orthostatic-positive group had a more marked increase in heart rate (HR) with slightly lower systolic blood pressure than the orthostatic-negative group during standing, with no significant difference in cardiac output (CO). The shift of blood volume from the intrathoracic region to the lower part of the body determined by electrical impedance and plasma catecholamines on rising were identical in the two groups. At the onset of the vasodepressor attack, CO did not change significantly, indicating that sudden arterial vasodilatation was the cause. In a pharmacological study on autonomic function, higher sensitivity of alpha-adrenoceptor in the resistance vessels was found in the orthostatic-positive group, but there was no significant difference in the basal level of cardiac vagal and sympathetic activity and in cardiac beta-adrenoceptor sensitivity between the two groups. The stepwise regression analysis showed that the magnitude of HR increment during standing was the most useful indicator in predicting the occurrence of a vasodepressor attack. These results suggest that low sympathetic activity in the resistance vessels together with an exaggerated rise in HR during upright posture is strongly associated with vasovagal and vasodepressor attacks in children.

[Usefulness of MRA in an infant with cerebral infarction due to streptococcal meningitis]

We described a 4-month-old boy with cerebral infarction due to streptococcal meningitis. He complained of cough and high fever for 2 days. On the next day he admitted to our hospital because of bad humor, drowsiness, and vomiting associated with high fever, respiratory failure and loss of consciousness. On admission, he had opisthotonic posturing, anisocoria and elevated deep tendon reflexes with left side dominance. The cerebrospinal fluid showed increased cells (564/mm3), protein (295 mg/dl), and decreased sugar (1 mg/dl). Streptococcus pneumoniae was detected in the cerebrospinal fluid. Despite intensive treatment by antibiotics, glycerol, and dexamethasone, general condition was worsened, MRI showed a high intense area along the territory of bilateral anterior cerebral arteries and left middle cerebral artery 3-D time-of-flight MRA revealed a decreased signal of these arteries, confirming cerebral infarction. Recanalization of the arteries were observed 17 days after the first MRA examination. Since complication of cerebral infarction influences the prognosis of meningitis, repetitive MRA is very beneficial in patients with bacterial meningitis in order to evaluate the vascular lesion.

Is Baker's cyst a risk factor for pulmonary embolism?

We encountered a 73-year-old man with acute pulmonary embolism (PE) and Baker's cyst. Venography revealed that the right popliteal vein was compressed by Baker's cyst and deep venous thrombosis (DVT) had developed. DVT associated with Baker's cyst is rather common and these two conditions are thought to be causally related. Baker's cyst is the most frequent mass lesion in the popliteal region. We suggest that Baker's cyst is a risk factor for PE as well as surgery and trauma.

[Dermatomyositis complicated by sarcoidosis]

We encountered a patient with dermatomyositis complicated by sarcoidosis. A 57-year-old woman was admitted to our hospital because of fever dry cough, and myalgias. There were reticular shadows on her chest X-ray film. Although the typical skin rash and myositis suggested the diagnosis of dermatomyositis biopsy specimens from a salivary gland, muscle, and lung revealed noncaseating granulomas as well. Uveitis was also noted. These findings suggested the coexistence of sarcoidosis with dermatomyositis. Examination of the lung-biopsy specimens showed interstitial pneumonia compatible with dermatomyositis, except for the granuloma. The typical rash of dermatomyositis and pathological findings of the lung specimen were inconsistent with sarcoidosis. Therefore we concluded that this patient had both dermatomyositis and sarcoidosis. This case sheds new light on the importance of pathological examinations.

Diurnal variation in intragastric pH in children with and without peptic ulcers

Diurnal variation in intragastric pH in children with peptic ulcers has not been previously reported. Therefore, we monitored intragastric pH during a 24-h period in 82 subjects (10 children with gastric ulcers, 9 children with duodenal ulcers, 58 non-ulcer (comparison group) children, and 5 healthy adults) using a monopolar glass pH electrode. The percent of readings below pH 2, 3, 4, and 5 for each subject was calculated and compared between the comparison group and the two ulcer groups using means and slopes (i.e. changes in percent with age for each group) of percent readings for each pH analysis. In the comparison group children, gastric acidity increased with age and reached adult levels by 14 y. Mean readings for all pH analyses in gastric ulcer children were lower than those in age-adjusted comparison children (p < 0.05). The slopes of the relationships between age and the percent time below any pH for the gastric ulcer group were different from those in the comparison group (p < 0.05) and were negative for all pH analyses. The mean time below pH 2 in children with duodenal ulcers was greater than that in age-adjusted comparison children (p = 0.002). The slope of the relationship between age and the percent time below pH 2 in the duodenal ulcer group was different from that in the comparison group (p < 0.05). Gastric acidity in children with primary gastric ulcers was reduced during childhood, but in children with primary duodenal ulcer, gastric acidity was at or above adult levels.

[Successful treatment of diffuse aspiration bronchiolitis by cricopharyngeal myotomy]

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

Management and ultrasonographic appearance of infantile hypertrophic pyloric stenosis with intravenous atropine sulfate

Some infants with hypertrophic pyloric stenosis (HPS) have responded to oral atropine treatment. To achieve sufficient effect of atropine, it must be administered intravenously (i.v.). Therefore, with ultrasonography, we studied the changes in the pyloric muscle in HPS during and after intravenous administration of atropine. Twenty-three infants were studied. Atropine sulfate was initially administered at a dose of 0.04 mg/kg day i.v., and the dose was increased by 0.01 mg/kg/day until vomiting ceased. When vomiting ceased after administration of intravenous atropine sulfate, the infants received oral atropine sulfate at twice the effective intravenous dose; this was continued for 2 weeks. Ultrasonography was repeated until pyloric muscles normalized. Twenty-two infants were free from vomiting after 1-8 days of intravenous atropine sulfate (dosages of 0.04-0.11 mg/kg/day). In 21 infants, weight gain continued after atropine treatment even though no change in thickness of the pyloric muscles was demonstrated ultrasonographically. Only 2 infants required pyloromyotomy because of prolonged treatment or a mistake in underdosing of oral atropine. All of the 21 infants who recovered after intravenous atropine without surgery had normalization of pyloric muscle caliber, as shown by ultrasonography 4-12 months after treatment. Atropine is an effective medicine for HPS. Regression of pyloric thickening after vomiting has been controlled implies that pyloric muscle hypertrophy could be worsened by the spasm that occurs in HPS.

The effects of the noradrenaline precursor, L-threo-3,4-dihydroxyphenylserine, in children with orthostatic intolerance

To evaluate the usefulness of L-threo-3,4-dihydroxyphenylserine (L-DOPS), a precursor of noradrenaline, in the treatment of orthostatic intolerance in children, we examined the circulatory responses to orthostatic stress and clinical symptoms before and after medication. Seven children with orthostatic intolerance, two boys and five girls, aged 11-15 years (mean age 13.3 years), were studied. L-DOPS (100-200 mg) was administered orally once or twice a day for 4 weeks. Blood pressure (BP) and heart rate (HR) were measured with a non-invasive beat-to-beat method (Finapres). All had a marked reduction in BP (delta SBP/DBP = -50 +/- 9/-27 +/- 6 mmHg) with prolonged recovery time in the initial phase during standing. After L-DOPS for 4 weeks, BP reduction in the initial phase was significantly attenuated (delta SBP/DBP = -37 +/- 9/-17 +/- 7 mmHg, p < 0.05) and recovery time was normalized in all, although supine BP and HR were unchanged. Two reported relief of all symptoms, while in five symptoms were markedly improved. There were no adverse effects reported. These preliminary studies have indicated that L-DOPS may be an effective drug for the treatment of orthostatic intolerance in children.

Beat-to-beat blood pressure and heart rate responses to active standing in Japanese children

Some pubertal children are susceptible to orthostatic stress but little is known about mechanisms of circulatory adjustment to the posture change in children. We investigated beat-to-beat blood pressure (BP) and heart rate (HR) responses to active standing in 173 schoolchildren, 92 boys and 81 girls, aged 6-18 years (mean age: 13.4 years) using a non-invasive continuous monitoring system (Finapres 2300, Ohmeda). The subjects were divided into four age groups: prepubertal I (7-9 years), prepubertal II (10-12 years), pubertal (13-15 years) and young adult (16-18 years). Supine BP increased and HR decreased with age. At the onset of active standing two older groups showed a significantly larger initial drop than the prepubertal groups (-36 +/- 15 versus -15 +/- 16% reduction for systolic BP and -36 +/- 14 versus -20 +/- 19% for diastolic BP, respectively, p < 0.01). Moreover, the pubertal group had a significantly smaller vasoconstrictor index than prepubertals and two older groups had a significantly more prolonged BP recovery time. In keeping with this the pubertal group most frequently had hypotensive symptoms during active standing. The rise in HR at the peak was higher in two older groups than in prepubertals (34 +/- 9 versus 29 +/- 8 beats/min-1, respectively, p < 0.001), whereas the baroreflex index was almost identical for the four groups. The effect of body proportion on BP responses was not found. There was no significant difference in BP and HR changes in the later stage during 7 min of standing. These results indicated that pubertal children were more susceptible to orthostatic stress, probably due to abnormal BP responses in the initial phase of active standing, which seemed to reflect enhanced cardiopulmonary reflexes and diminished sympathetic activation associated with the age. Moreover, BP reduction at an initial drop of more than 60% or a recovery time of more than 25 s might be postulated to be an abnormal circulatory response.

Glycated Cu,Zn-superoxide dismutase in rat lenses: evidence for the presence of fragmentation in vivo

Cu,Zn-superoxide dismutase (Cu,Zn-SOD) exists in tissues of rats as both glycated and non-glycated forms when separated by boronate acid column chromatography. Glycated Cu.Zn-SOD is most abundant in rat lenses compared to other tissues. In normal rats lens levels of glycated Cu.Zn-SOD showed a gradual increase with age, whereas in diabetic rats substantial increases were observed. Immunoblotting analyses, using anti-hexitol lysine IgG, indicated that glycated Cu.Zn-SOD contains Amadori products. Moreover, Cu.Zn-SOD in lenses was site-specifically fragmented probably because of glycation. This the first report of a fragmented protein, such as Cu,Zn-SOD, occurring in vivo.

Age-related changes of alpha-tocopherol transfer protein expression in rat liver

Developmental changes in expression of alpha-tocopherol transfer protein (alpha-TTP) after birth were investigated using rats with respect to plasma changes of tocopherols. The expression of alpha-TTP in the neonatal rat liver, which was very low immediately after birth, increased steadily during the two weeks of life before weanling and reached the adult level at four weeks. During the suckling period, the plasma ratio of alpha-tocopherol to gamma-tocopherol linearly increased, because plasma alpha-tocopherol which was low immediately after birth, increased rapidly during the period, while gamma-tocopherol remained unchanged. The increase in the ratio seemed to correlate with the developmental expression of alpha-TTP in the liver during this period. The ratio also reached the adult level after four weeks. The expression of alpha-TTP was investigated using primary cultured rat hepatocytes. The expression of alpha-TTP was found to be extremely low after 20h of culture. The decrease in alpha-TTP expression was exacerbated by adding epidermal growth factor to the culture medium and was inhibited by adding dexamethasone. These observations suggest that expression of alpha-TTP may be affected by the state of hepatic differentiation.

New evidence for the involvement of oxygen radicals in triggering neonatal chronic lung disease

We measured the plasma concentration of allantoin, an oxidation product of uric acid and an "in vivo" marker of free radical generation, within 24-48 h after birth in 10 premature infants who subsequently developed chronic lung disease (CLD) and 9 infants without CLD (non-CLD). The plasma allantoin level (mean +/- SD, 25.9 +/- 9.8 microM for CLD versus 11.0 +/- 5.7 microM for non-CLD, p < 0.01) and the allantoin/urate ratio (5.8 +/- 2.0% for CLD infants versus 2.4 +/- 0.9% for non-CLD infants, p < 0.01) were significantly higher in the CLD group than those in the non-CLD group. These observations suggest the possible involvement of oxygen radicals in triggering CLD. In addition, the plasma allantoin concentration and the allantoin/urate ratio may be useful early predictors of the development of CLD.

Developmental changes of tetrahydrobiopterin in rat and human erythrocytes

In the present study, we investigated the developmental changes of (1) plasma and erythrocyte tetrahydrobiopterin (BH4); (2) erythrocyte GTP cyclohydrolase (the rate-limiting enzyme of BH4 biosynthesis); (3) the permeability of erythrocyte membrane to BH4; and (4) plasma phenylalanine, both in healthy human subjects and Wistar rats. In vitro experiments demonstrated passive transport of BH4 into erythrocytes. In humans, BH4 levels as well as the other parameters were fairly consistent across all age groups. In contrast, Wistar rats showed significant developmental changes in erythrocyte BH4, which were not simply correlated to either GTP cyclohydrolase, permeability to BH4 or plasma phenylalanine levels. This may suggest the existence of other factors regulating the homeostasis of BH4, such as BH4-binding capacity in plasma and/or erythrocytes. These species/age differences in erythrocyte characteristics may influence the pharmacological behavior and clinical efficacy of BH4 in humans and experimental animals.

Plasma levels of retinol, retinol-binding protein, all-trans beta-carotene and cryptoxanthin in low birth weight infants

In neonatal medicine, it is thought that retinol is useful for preventing CLD and for fetal development. However, beta-carotene had other vitamin A precursors have not been studied in neonates with CLD or others disorders. Cord blood of neonates including ELBW and VLBW infants was assayed for plasma levels of retinol, RBP, beta-carotene and cryptoxanthin. Plasma beta-carotene levels in ELBW and VLBW were lower than that in term infants, but plasma cryptoxanthin levels in ELBW and VLBW were about the same as in term infants. Plasma retinol and RBP levels showed almost same levels during 23-41 gestational weeks. Maternal smoking reduced plasma beta-carotene but not cryptoxanthin, retinol, or RBP levels. IUGR was associated with increased cryptoxanthin levels in cord blood. Serious neonatal diseases, including CLD and ROP manifested no significant effects on the cord blood vitamin levels. Thus, the occurrence of these diseases at birth could not be predicted by examination of vitamin levels in cord blood.

4-oxo retinoic acid for refractory acute promyelocytic leukemia in children with all-trans retinoic acid therapy

Therapy with all-trans retinoic acid (ATRA) achieves complete remission in a high proportion of patients with acute promyelocytic leukemia (APL), but the efficacy is reported to relate to plasma ATRA level after oral administration. The pharmacokinetics of ATRA and 4-oxo all-trans retinoic acid (4-oxo ATRA), a metabolite of ATRA, were studied in four children with APL at the time of initial oral administration. After administration of ATRA at a dose of 30 mg/m2, the peak plasma ATRA level was 20-741 ng/ml and was reached at 60-120 min. The patient with the lowest peak plasma level did not achieve complete remission and had a very high 4-oxo ATRA level compared to the patients with complete remission. These findings suggest that accelerated metabolism of ATRA plays a role in the failure of this agent in the patients without remission.

Hepatic damage induced by perfusion of radical generating azo compound and its inhibition by vitamin E

The damaging effect of perfusion of hydrophilic radical generating azo compound on the liver of normal and vitamin E-deficient rats and its inhibition by antioxidants were studied in order to increase understanding of the action of free radicals on biological tissues. The hepatic damage was evaluated from the release of cytosolic enzymes such as glutamic oxaloacetic transaminase and glutamic pyruvic transaminase, mitochondrial oxidation metabolism and morphological change. Two kinds of hydrophilic azo compounds were used, one which decomposes spontaneously at a uniform rate to generate free radicals and the other which does not. The former induced hepatic damage in a dose-dependent manner, while the latter did not exert any damage. Both endogenous vitamin E in the membranes and a water soluble vitamin E analogue added simultaneously with a radical initiator suppressed the hepatic damage. These results show that the hepatic damage induced by perfusion of radical generating azo compound is caused not by the azo compound itself but by free radicals.

Enhancement of damage-specific DNA binding of XPA by interaction with the ERCC1 DNA repair protein

The human XPA and ERCC1 proteins, which are involved in early steps of nucleotide excision repair of DNA, specifically interacted in an in vitro binding assay and a yeast two-hybrid assay. A stretch of consecutive glutamic acid residues in XPA was needed for binding to ERCC1. Binding of XPA to damaged DNA was markedly increased by the interaction of the XPA and ERCC1 proteins. ERCC1 did not enhance binding to DNA when a truncated XPA protein, MF122, was used in place of the XPA protein. MF122 retains damaged DNA binding activity but lacks the region for protein-protein interaction including the E-cluster region. These results suggest that the XPA/ERCC1 interaction may participate in damage-recognition as well as in incision at the 5' site of damage during nucleotide excision repair.

[A case of lung cancer with choroidal metastasis]

A 72-year-old woman was admitted to our hospital because of a mass shadow in the left upper lobe on chest roentgenograms. She had noticed floaters in both visual fields 2 months before admission. Percutaneous aspiration of the lung lesion was done, and revealed poorly differentiated squamous cell carcinoma. Metastatic tumors were noted in the choroid of both eyes and in both kidneys. These lesions responded partially to systemic chemotherapy and the floaters disappeared. There have been few reports of metastatic choroidal tumors, but most cite the lung and the breast as the primary sites. We should pay attention to ophthalmologic findings because lung cancer may metastasize to the choroid.

9-cis beta-carotene in human plasma and blood cells after ingestion of beta-carotene

For 44 wk, thirty male volunteers were given daily either 60 mg of synthesized all-trans beta-carotene, a naturally-occurring beta-carotene derived from Dunaliella bardawil, or a placebo. Basal levels of 9-cis beta-carotene in plasma, platelets, and mononuclear cells were 10, 20, and 25% of those of the all-trans form, respectively. The plasma levels reached a maximum after two weeks of administration and plateaued thereafter in the subjects who took the beta-carotene preparations. The all-trans beta-carotene level in the subjects given the synthesized all-trans form was almost twice that for the Dunaliella preparation. The plasma 9-cis level was found to be higher in the all-trans beta-carotene group than in the Dunaliella group, despite no intake of the 9-cis form in the all-trans group and the higher intake of the 9-cis form in the Dunaliella group. This finding suggests that isomerization of the all-trans form to the 9-cis form may occur in the body either during or after absorption.