Diagnostic value of simultaneous 99mTc-sestamibi/123I-BMIPP imaging parameters for predicting the improvement of left ventricular wall motion after acute myocardial infarction using CZT SPECT system

Background

Although the presence of 99mTc-sestamibi/123I-BMIPP-mismatch, the reverse redistribution (RR) of 99mTc-sestamibi and RR of 123I-BMIPP in patients with acute myocardial infarction (AMI) are known to significant markers for predicting the improvement of LV wall motion in the infarcted territory in chronic phase, few studies were performed to analyze them by simultaneous dual-isotope imaging using cadmium-zinc-telluride (CZT) SPECT system.

Purpose

The purpose of this study was to evaluate whether the presence of 99mTc-sestamibi/123I-BMIPP-mismatch or RR of 99mTc-sestamibi, RR of 123I-BMIPP make better prediction of the improvement of LV wall motion in the infarcted territory.

Methods

We evaluated 42 consecutive patients with AMI who had undergone both dual-isotope SPECT in acute phase and stress myocardial SPECT using 99mTc-tracers in chronic phase by Discovery NM530c. The presence of 99mTc-sestamibi/123I-BMIPP-mismatch, RR of 99mTc-sestamibi and RR of 123I-BMIPP were determined using traditional definition. The improvement of LV wall motion in the infarcted territory from acute phase to chronic phase was assessed using QGS.

Results

Of 42 patients, the improvement of LV wall motion in the infarcted territory from acute phase to chronic phase was found in 29 patients. The presence of 99mTc-sestamibi/123I-BMIPP-mismatch and RR of 99mTc-sestamibi and RR of 123I-BMIPP were significantly linked to predict the improvement of LV wall motion (p=0.0001, p=0.0001 and p=0.002, respectively). To predict the improvement of LV wall motion in the infarcted territory in chronic phase, the presence of 99mTc-sestamibi/123I-BMIPP-mismatch showed sensitivity of 93%, specificity of 85% and accuracy of 91%, while RR of 99mTc-sestamibi and RR of 123I-BMIPP had sensitivities of 72%, 48%, specificities of 85%, 100% and accuracies of 76%, 64%, respectively. The multivariate discriminant analysis revealed that the combination of 99mTc-sestamibi/123I-BMIPP-mismatch, RR of 99mTc-sestamibi and RR of 123I-BMIPP best predicted the improvement of LV wall motion in the infarcted territory in chronic phase with sensitivity of 93%, specificity of 85% and accuracy of 91% (chi-square=40.6), compared with RR of 99mTc-sestamibi and RR of 123I-BMIPP only (sensitivity 79%, specificity 85% and accuracy of 81%, chi-square=16.9).

Conclusions

The addition of 99mTc-sestamibi/123I-BMIPP-mismatch on RR of 99mTc-sestamibi and RR of 123I-BMIPP in patients with AMI, help better predict the improvement of LV wall motion in the infarcted territory in chronic phase.

Funding Acknowledgement

Type of funding sources: None.

Association of the extent of myocardial ischemia with outcomes in patients with suspected coronary artery disease in Japan: a cohort study

Background

There is an ongoing controversy regarding the necessity of single-photon emission computed tomography (SPECT) for patients with ischemic heart diseases after the publication of the results of the ISCHEMIA trial.

Purpose

We aimed to evaluate the association of the extent of myocardial ischemia with outcomes in patients with suspected coronary artery disease in Japan.

Methods

From the data of 2780 patients with stable angina who were enrolled prospectively between January 2006 and March 2008 in Japan and had undergone physician-referred non-invasive imaging tests, 1205 patients managed with SPECT were stratified by 10% myocardial ischemia. Major adverse cardiac events (MACEs), including death, myocardial infarction, hospitalization for heart failure, and late revascularization, were followed-up for 1 year.

Results

Patients with ≥10% myocardial ischemia (n=173) were older than patients with <10% myocardial ischemia (n=1032) and had a significantly higher 1-year cumulative incidence of MACEs (9.1% vs. 1.2%, P<0.0001). After adjusting for confounders, the risk of ≥10% myocardial ischemia relative to <10% myocardial ischemia for MACEs remained significant (adjusted hazard ratio [95% confidence interval], 2.40 [1.09–5.26], P=0.029).

Conclusion

The presence of ≥10% myocardial ischemia was significantly associated with the 1-year risk for MACEs in Japanese patients with suspected coronary artery disease.

Funding Acknowledgement

Type of funding sources: None. Study flowchartOutcomes

Prediction of the improvement of left ventricular wall motion after acute myocardial infarction by simultaneous dual-isotope imaging with 99mTc-sestamibi/123I-BMIPP using cadmium-zinc-telluride SPECT

Background/Introduction

Although both the presence of 99mTc-sestamibi/123I-BMIPP mismatch and the reverse redistribution of 99mTc-sestamibi in patients with acute myocardial infarction (AMI) are known to significant markers for predicting the improvement of left ventricular (LV) wall motion in the infarcted territory in chronic phase, few studies evaluated them by simultaneous dual-isotope (99mTc-sestamibi/123I-BMIPP) imaging using cadmium-zinc-telluride (CZT) SPECT system.

Purpose

The purpose of this study was to evaluate whether the presence of 99mTc-sestamibi/123I-BMIPP mismatch or the reverse redistribution of 99mTc-sestamibi make better prediction of the improvement of LV wall motion in the infarcted territory.

Methods

We evaluated 30 consecutive patients with AMI who had undergone both dual-isotope (99mTc-sestamibi/123I-BMIPP) SPECT in acute phase and stress myocardial SPECT using 99mTc-tracers in chronic phase by Discovery NM530c. Both 99mTc-sestamibi/123I-BMIPP mismatch and reverse redistribution of 99mTc-sestamibi were determined using traditional definition. The improvement of LV wall motion in the infarcted territory from acute phase to chronic phase was assessed using QGS.

Results

Of 30 patients, the improvement of LV wall motion in the infarcted territory from acute phase to chronic phase was found in 20 patients. Both the presence of 99mTc-sestamibi/123I-BMIPP mismatch and reverse redistribution of 99mTc-sestamibi were significantly linked to predict the improvement of LV wall motion (p=0.0001, p=0.011, respectively). The respective sensitivities, specificities and accuracies in the prediction of the improvement of LV wall motion in the infarcted territory were 90%, 90% and 90% with 99mTc-sestamibi/123I-BMIPP mismatch, and 60%, 90%, 70% with reverse redistribution of 99mTc-sestamibi.

Conclusions

In the simultaneous 99mTc-sestamibi/123I-BMIPP dual-isotope imaging using CZT SPECT system, both the presence of 99mTc-sestamibi/123I-BMIPP mismatch and the reverse redistribution of 99mTc-sestamibi in acute phase are useful for predicting the improvement of LV wall motion in chronic phase, but the presence of 99mTc-sestamibi/123I-BMIPP mismatch is superior to the reverse redistribution of 99mTc-sestamibi for it.

Funding Acknowledgement

Type of funding source: None

Prediction of myocardial viability in chronic phase in patients with acute myocardial infarction by simultaneous dual-isotope imaging with 99mTc-sestamibi/123I-BMIPP SPECT using CZT camera system

Objectives

The objective of this study was to determine the optimal cut-off value of % uptake of simultaneous dual-isotope (99mTc-sestamibi/123I-BMIPP) SPECT in patients with acute myocardial infarction (AMI) for prediction of myocardial viability in chronic phase.

Methods

We evaluated 30 consecutive patients with AMI who had undergone both dual-SPECT in acute phase and stress myocardial SPECT using 99mTc-tracers in chronic phase by Discovery NM530c. Regional % uptake with a 17-segment model was obtained using QPS software. The presence of myocardial viability was defined when regional % uptake ≥50% in 99mTc SPECT at rest in chronic phase was observed. Receiver operating characteristic (ROC) curves were analyzed to determine the optimal cutoff values of regional % uptake in both left anterior descending artery (LAD) territory and non-LAD coronary territory in acute phase to predict the myocardial viability in chronic phase.

Results

The cutoff values for prediction of viable myocardium were %uptake ≥47% for 99mTc-sestamibi, %uptake ≥31% for 123I-BMIPP in acute phase in LAD territory and %uptake ≥52% for 99mTc-sestamibi, %uptake ≥48% for 123I-BMIPP in non-LAD territory. The respective sensitivities, specificities and the area under the ROC curve (AUC) values in the prediction of myocardial viability were 92%, 92% and 0.94 with 99mTc-sestamibi, 90%, 85%, 0.92 with 123I-BMIPP in LAD territory, and 81%, 93% and 0.92 with 99mTc-sestamibi, 81%, 90%, 0.92 with 123I-BMIPP in non-LAD territory. There were no significant differences in AUC values between 99mTc-sestamibi and 123I-BMIPP in both LAD territory and non-LAD coronary territory.

Conclusions

In the simultaneous 99mTc-sestamibi/123I-BMIPP dual-isotope imaging in patients with AMI, these results suggest that not only 99mTc-sestamibi SPECT, but also 123I-BMIPP SPECT may be possible to predict the presence of myocardial viability in chronic phase. But it should be noted that the optimal cutoff values of regional % uptake in acute phase to predict the myocardial viability may differ for LAD territory and non-LAD coronary territory.

Funding Acknowledgement

Type of funding source: None

NFκB2 Gene as a Novel Candidate that Epigenetically Responds to Interval Walking Training

Physical fitness has been reported to decrease the risk of lifestyle-related diseases. The present study evaluated genome-wide methylation under the hypothesis that interval walking training (IWT) imparted beneficial effects on health, particularly by epigenetically ameliorating susceptibility to inflammation. We screened DNA from peripheral blood samples via genome-wide microarray for genes whose methylation was affected by IWT, paying special attention to promoter regions, and identified over 40 hyper- or hypo-methylated genes following IWT that were not witnessed in controls. We next selected genes in which the degree of methylation change in the promoter region was correlated with energy consumption following IWT. In this way, we found the NFκB2 gene to have increased methylation in multiple regions of its promoter sequence following participation in an exercise regimen. Next, IWT-induced NFκB2 hyper-methylation was confirmed by a quantitative PyroSequencing assessment of methylation in samples obtained from independent subjects who also underwent IWT. The increase in NFκB2 gene promoter methylation by IWT indicates that this regimen may suppress pro-inflammatory cytokines. Thus, these results provide an additional line of evidence that IWT is advantageous in promoting health from an epigenetic perspective by ameliorating susceptibility to inflammation.

β-Glucan Derived from Zymosan Acts as an Adjuvant for Collagen-Induced Arthritis

Collagen-induced arthritis (CIA) is an experimental model of rheumatoid arthritis (RA) and has helped researchers to analyze the pathogenesis of inflammatory joint disease. In classical CIA, Freund's complete adjuvant (FCA), which contains heat-killed Mycobacterium tuberculosis, is used as an adjuvant. In our previous study, we reported that particles of beta-glucan, OX-CA, derived from Candida albicans, acted as a proper adjuvant in the CIA model. In this study, to establish pure beta-glucan as an adjuvant for CIA, we tested a commercially available preparation of Zymosan A (ZYM) and modified its products. beta-Glucan fractions of ZYM were prepared by oxidation with various concentrations of NaClO. The oxidized ZYM (OX-ZYM) was mainly composed of beta-glucan. In this study, we examined its effect as an adjuvant for CIA. DBA/1 mice injected with CII and OX-CA developed arthritis 7-10 days after receiving booster injections; the OX-ZYM fractions induced arthritis with the same time course. 0.01% OX-ZYM (oxidized with a 0.01% NaClO solution) caused arthritis faster than 0.1% OX-ZYM or 0.5% OX-ZYM. In conclusion, beta-glucan derived from ZYM by brief oxidation with NaClO is a suitable adjuvant for a CIA model with anti-CII antibody production.

Rapid decrease of anti-beta-glucan antibody as an indicator for early diagnosis of carinii pneumonitis and deep mycotic infections following immunosuppressive therapy in antineutrophil cytoplasmic antibody-associated vasculitis

Deep mycosis (aspergillus pneumonia (AsP)) and carinii pneumonitis (PCP) are complications of immunosuppressive treatment for antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV). The objective was to clarify the clinical significance of plasma titer of antibody against beta-glucans (anti-BG antibody) as a predictor of complications such as AsP or PCP and the prognosis of patients. Enzyme-linked immunosorbent assay was used to measure the plasma titer of antibodies against beta-glucans (BG) from Candida albicans in 22 healthy subjects and 52 patients with various stages of AAV. The mean plasma titer of the anti-BG antibody was 2,677 +/- 1,686 U in healthy subjects, 691 +/- 522 U in patients with untreated active vasculitis (n = 14), and 547 +/- 416 U in patients soon after immunosuppressive treatment (n = 24). Healthy subjects had significantly higher antibody titers than the other two groups (P < 0.05). Repeated measurements over the clinical course of AAV revealed an increase during remission to 1,180 +/- 130 U (n = 11), while there was a significant rapid decrease to 369 +/- 441 U (P < 0.01) concomitantly with elevation in plasma C-reactive protein and BG levels in patients with AAV that had AsP or PCP infection. Antifungal therapy resulted in a rapid rise of anti-BG antibody titer. Experiments in mice suggested that the anti-BG antibody neutralizes BG. Rapid decrease of the anti-BG antibody titer may be a useful indicator for diagnosis of the presence of AsP or PCP and for estimating the prognosis of patients with these opportunistic infections during immunosuppressive treatment of AAV.

Cell Wall .BETA.-Glucan Derived from Candida albicans Acts as a Trigger for Autoimmune Arthritis in SKG Mice

SKG mice are a recently established experimental model for rheumatoid arthritis (RA). Although they spontaneously develop chronic autoimmune arthritis under conventional conditions, SKG mice failed to develop chronic arthritis in a strictly controlled specific pathogen-free (SPF) environment. Beta-glucan (BG) from Laminaria digitata, laminarin (LAM), induced arthritis under SPF conditions, thus BG would be a pathogenic factor for arthritis in SKG mice. Therefore, we prepared BG from Candida albicans, a pathogenic fungus and investigated whether BG from C. albicans induced arthritis in SKG mice under SPF conditions. SKG mice were injected intraperitoneally with particulate BG (oxidative-Candida albicans (OX-CA)), soluble BG (Candida soluble beta-glucan (CSBG)) from C. albicans and LAM as a positive control. In addition, schizophyllan (SPG) from Schizophyllum commune or Mycobacterium whole cells were injected into SKG mice to induce arthritis. Mice injected with OX-CA, CSBG and SPG had more severe arthritis than with LAM, and whole Mycobacterium cells. IL-6 concentration in sera from SKG mice injected with OX-CA or CSBG was high, whereas not detected in sera from mice treated with LAM. In histological analysis, infiltration of inflammatory cells was observed in SKG mice injected with BG. These results suggest that fungal infection may be a factor to induce and exacerbate autoimmune diseases such as RA.

F1 hybrid mice (BALB/c x DBA/1) are resistant to collagen-induced arthritis with beta-glucan as an adjuvant

Collagen-induced arthritis (CIA) is an experimental model of rheumatoid arthritis (RA) used for studying the clinical, immunological and genetic factors of the disease. Many studies of genetic susceptibility to CIA have been performed, usually with two strains of mice, DBA/1 and B10.RIII, since they are highly susceptible to CIA. Furthermore, F1 hybrid mice of susceptible and resistant strains reportedly develop arthritis. Recently, we reported that particles of beta-glucan, OX-CA, prepared from Candida albicans by NaClO-oxidation, acted as an adjuvant for CIA. Although, there have been many studies about the relationship between antigen and the major histocompatibility complex (MHC) in F1 hybrid mice, little is known argument about susceptibility to adjuvants. Therefore, we checked the susceptibility of F1 hybrids to CIA using OX-CA as an adjuvant. BALB/c and DBA/1 were mated to generate F1 hybrids which were then immunized with type II collagen (CII) plus Freund's complete adjuvant (FCA) or OX-CA. The results showed that F1 hybrids injected with CII plus FCA developed severe arthritis at an incidence ratio 80%, versus only 20% in mice injected with CII plus OX-CA. Furthermore, levels of anti-CII antibody, especially of the IgG2a subclass, in sera from mice treated with CII plus OX-CA were significantly low. Susceptibility to CIA might depend on not only MHC but also the adjuvant used for immunoactivation.

Effect of Candida albicans cell wall glucan as adjuvant for induction of autoimmune arthritis in mice

Collagen-induced arthritis (CIA) is an experimental model of rheumatoid arthritis (RA) and has aided research into the pathogenesis of inflammatory joint disease. Typically, Type II collagen (CII) emulsified with Freund's complete adjuvant (FCA) is injected into DBA/1 mice. After a booster injection, the mice develop inflammation of the paws. But the fact that the immunization of CII alone does not induce arthritis suggests that activation of the immune system by an adjuvant is necessary for induction of the arthritis. In the present study, we investigated the ability of beta-glucans derived from Candida albicans to act as an adjuvant to induce autoimmune arthritis. DBA/1 mice were injected with CII emulsified with FCA or particulate beta-glucan, OX-CA, on day 0 and given a booster at day 21. Mice immunized with CII plus OX-CA developed arthritis at around 7-10 days after the booster injection. Similarly, mice administered CII emulsified with FCA developed arthritis with the same time course. The mice immunized with CII and OX-CA had a more severe arthritis than those immunized with CII and FCA. Histological changes and production of anti-CII antibody were observed regardless of the type of injection. In addition, components of C. albicans were also tested for their ability to induce arthritis as an adjuvant. The results showed that CSBG, which is a soluble beta-glucan, acted as an adjuvant for CIA but CAWS, which is a mannoprotein-beta-glucan complex, did not. In conclusion, beta-glucan derived from C. albicans acted as an adjuvant and the injection with CII resulted in arthritis with the production of anti-CII autoantibody. The results strongly suggested that fungal metabolites such as beta-glucans have the capacity to induce and exacerbate autoimmune diseases such as RA.

Anti-fungal Activity of Sulfamethoxazole toward Aspergillus Species

Invasive mycosis has significantly increased in frequency among immunocompromised hosts leading to excessive morbidity and mortality. The combination of sulfamethoxazole (SMX) and trimethoprim (TMP) has been used extensively for the treatment and prophylaxis of infections by various microbes. The purpose of this study is to estimate the anti-fungal activity of SMX-TMP and examine the mechanism of activity. To investigate the antimicrobial activity of SMX-TMP in vitro, a mixture of SMX and TMP at 5:1 was serially diluted and added to potato dextrose agar medium or C-limiting agar medium. Aspergillus species were inoculated on the medium plate with SMX-TMP. The growth of A. fumigatus and A. oryzae was inhibited by addition of SMX-TMP. The anti-Aspergillus effect depended on not TMP but SMX and that was inhibited by p-aminobenzoic acid (PABA). A. niger was not sensitive against SMX-TMP in PDA medium, but sensitive in C-limiting medium. Those results showed that the activity depends on culture medium. Furthermore, addition of human serum did not influence the activity of SMX. The finding in this study suggested that SMX might be effective against Aspergillus species in clinical practice and prophylaxis treatment.

Influence of arginine deimination on antigenicity of fibrinogen

Autoreactivity is controlled at various steps by numerous mechanisms and is a key to understanding and treating autoimmune disease. Recently, an antibody against deiminated fibrinogen (DI-FBG) was detected in patients with rheumatoid arthritis (RA) with high specificity and sensitivity. DI-FBG converted enzymically by peptidyl arginine deiminase, was also detected in synovial membrane. In the present study, we investigated whether antibody to DI-FBG is produced in mice immunized with DI-FBG. Mice were immunized with DI-FBG in the presence or absence of adjuvant. Production of the specific antibody was only induced with adjuvant. The resulting antibody was specific for DI-FBG and did not react with intact/native fibrinogen. Furthermore, it recognized deiminated human fibrinogen and cyclic citrullinated peptide (CCP). These results suggested that mouse fibrinogen acquires antigenicity in mice through deimination and therefore, autoantibody such as that detected in RA patients specifically may be induced.

Antiviral response by natural killer cells through TRAIL gene induction by IFN-alpha/beta

Natural killer (NK) cells play an important role in early defense against viral infection. The cytotoxic activity of NK cells is increased by interferon-alpha/beta (IFN-alpha/beta), produced en masse in virally infected cells. However, the mechanism(s) by which IFN-alpha/beta contribute to the NK-cell-mediated antiviral response is not well understood. Here we provide evidence that the cytotoxicity of NK cells is enhanced by IFN-alpha/beta through induction of TNF-related apoptosis-inducing ligand (TRAIL). Isolation and analysis of the murine TRAIL promoter revealed the presence of an IFN-stimulated response element (ISRE), which binds to the transcription factor ISGF3 (interferon stimulated gene factor-3). This promoter is indeed activated by IFN-beta in ISGF3-dependent manner. We also show that virally infected cells, but not uninfected cells, are susceptible to TRAIL-mediated cytotoxicity in vitro, and that the TRAIL expressed in NK cells is indeed crucial in limiting virus replication in vivo. Thus, our study reveals a new molecular link between IFN-alpha/beta signaling and activation of NK cells in antiviral response of the host.

Antiviral response by natural killer cells through TRAIL gene induction by IFN-alpha/beta

Natural killer (NK) cells play an important role in early defense against viral infection. The cytotoxic activity of NK cells is increased by interferon-alpha/beta (IFN-alpha/beta), produced en masse in virally infected cells. However, the mechanism(s) by which IFN-alpha/beta contribute to the NK-cell-mediated antiviral response is not well understood. Here we provide evidence that the cytotoxicity of NK cells is enhanced by IFN-alpha/beta through induction of TNF-related apoptosis-inducing ligand (TRAIL). Isolation and analysis of the murine TRAIL promoter revealed the presence of an IFN-stimulated response element (ISRE), which binds to the transcription factor ISGF3 (interferon stimulated gene factor-3). This promoter is indeed activated by IFN-beta in ISGF3-dependent manner. We also show that virally infected cells, but not uninfected cells, are susceptible to TRAIL-mediated cytotoxicity in vitro, and that the TRAIL expressed in NK cells is indeed crucial in limiting virus replication in vivo. Thus, our study reveals a new molecular link between IFN-alpha/beta signaling and activation of NK cells in antiviral response of the host.

Antiviral response by natural killer cells through TRAIL gene induction by IFN-alpha/beta

Natural killer (NK) cells play an important role in early defense against viral infection. The cytotoxic activity of NK cells is increased by interferon-alpha/beta (IFN-alpha/beta), produced en masse in virally infected cells. However, the mechanism(s) by which IFN-alpha/beta contribute to the NK-cell-mediated antiviral response is not well understood. Here we provide evidence that the cytotoxicity of NK cells is enhanced by IFN-alpha/beta through induction of TNF-related apoptosis-inducing ligand (TRAIL). Isolation and analysis of the murine TRAIL promoter revealed the presence of an IFN-stimulated response element (ISRE), which binds to the transcription factor ISGF3 (interferon stimulated gene factor-3). This promoter is indeed activated by IFN-beta in ISGF3-dependent manner. We also show that virally infected cells, but not uninfected cells, are susceptible to TRAIL-mediated cytotoxicity in vitro, and that the TRAIL expressed in NK cells is indeed crucial in limiting virus replication in vivo. Thus, our study reveals a new molecular link between IFN-alpha/beta signaling and activation of NK cells in antiviral response of the host.

[Cerebral autoregulation during sevoflurane or isoflurane anesthesia: evaluation with transient hyperemic response]

We investigated dynamic cerebral autoregulation during N2O-O2/fentanyl anesthesia (baseline) plus 1.0 and 2.0 minimum alveolar anesthetic concentrations (MAC) of sevoflurane or isoflurane anesthesia in 14 patients undergoing non-neurosurgical operation. Cerebral blood flow velocity in the right middle cerebral artery (Vmca) was measured continuously using transcranial Doppler ultrasonography. At normocapnia, dynamic cerebral autoregulation was tested by transient hyperemic response (a response of Vmca after a brief compression of the ipsilateral common carotid artery). For quantitative comparisons, ratio of systolic Vmca before, to immediately after compression (THRR) was calculated. Values of THRR were 1.14 +/- 0.03 (mean +/- SD), 1.15 +/- 0.04, and 1.12 +/- 0.03 during baseline, 1.0, and 2.0 MAC sevoflurane anesthesia, respectively. THRR was not significantly different among the 3 conditions. In contrast, THRR values were 1.17 +/- 0.03, 1.07 +/- 0.02, and 1.01 +/- 0.01 during baseline, 1.0, and 2.0 MAC isoflurane anesthesia, respectively. THRR was significantly attenuated in a dose dependent manner during isoflurane anesthesia. These results indicate that dynamic cerebral autoregulation is preserved during 2.0 MAC sevoflurane anesthesia, but not during 1.0 MAC isoflurane anesthesia.

Antiviral response by natural killer cells through TRAIL gene induction by IFN-alpha/beta

Natural killer (NK) cells play an important role in early defense against viral infection. The cytotoxic activity of NK cells is increased by interferon-alpha/beta (IFN-alpha/beta), produced en masse in virally infected cells. However, the mechanism(s) by which IFN-alpha/beta contribute to the NK-cell-mediated antiviral response is not well understood. Here we provide evidence that the cytotoxicity of NK cells is enhanced by IFN-alpha/beta through induction of TNF-related apoptosis-inducing ligand (TRAIL). Isolation and analysis of the murine TRAIL promoter revealed the presence of an IFN-stimulated response element (ISRE), which binds to the transcription factor ISGF3 (interferon stimulated gene factor-3). This promoter is indeed activated by IFN-beta in ISGF3-dependent manner. We also show that virally infected cells, but not uninfected cells, are susceptible to TRAIL-mediated cytotoxicity in vitro, and that the TRAIL expressed in NK cells is indeed crucial in limiting virus replication in vivo. Thus, our study reveals a new molecular link between IFN-alpha/beta signaling and activation of NK cells in antiviral response of the host.

The influence of nitroglycerin and prostaglandin E1 on dynamic cerebral autoregulation in adult patients during propofol and fentanyl anaesthesia

We investigated dynamic cerebral autoregulation in 24 normocapnic adult patients during propofol and fentanyl anaesthesia. Hypotension was induced, to a mean arterial pressure (MAP) of 60-65 mmHg, using nitroglycerin or prostaglandin E1. Time-averaged mean cerebral blood flow velocity in the right middle cerebral artery was measured continuously using transcranial Doppler sonography. Dynamic autoregulatory response was activated by a sudden decrease in MAP following release of bilateral thigh cuffs (thigh cuff test) and evaluated as a dynamic rate of autoregulation (dRoR in % x s(-1)). The cuff test was repeated to obtain two values of dRoR during baseline and during induced hypotension; the data were then averaged. The mean value of dRoR during baseline and during induced hypotension was 14.2 (2.9) and 14.2 (1.6) % x s(-1), respectively, in the nitroglycerin group, and 14.6 (2.6) and 14.4 (2.4) % x s(-1), in the prostaglandin E1 group. We were unable to demonstrate significant between- or within-group differences in dRoR. Thus, we conclude that nitroglycerin and prostaglandin E1 do not attenuate dynamic cerebral autoregulation.

[Prognostic significance of myocardial imaging with iodine-123 beta-methyl-p-iodophenyl-pentadecanoic acid in patients with angina pectoris]

OBJECTIVES

To assess the clinical significance of iodine-123 beta-methyl-p-iodophenyl-pentadecanoic acid(BMIPP) single photon emission computed tomography(SPECT), the predictive value of BMIPP imaging in patients with angina pectoris was evaluated.

METHODS

One hundred seventy-four patients who underwent BMIPP imaging in our institution were aged 61.8 +/- 11 years. One hundred thirty-five patients had stable angina and 39 had unstable angina at the time of examination. Patients with previous myocardial infarction or myocardial disorders were excluded. Early and delayed images were acquired in BMIPP SPECT, and the images were analyzed visually. Cardiac events were classified into hard and soft events: the former consisted of cardiac death and nonfatal myocardial infarction, and the latter included coronary revascularization and heart failure.

RESULTS

The findings of BMIPP imaging were normal in 82 patients and abnormal in 92. During follow-up of 15.5 +/- 9.5 months, hard events were observed in 4 patients and soft events in 53. In patients with normal BMIPP imaging, soft events were observed in nine patients, but no hard event was encountered. Furthermore, in patients with both normal BMIPP and stress thallium imagings, no cardiac event was observed during 2 years. In contrast, 4 hard events and 44 soft events occurred in patients with abnormal BMIPP imaging. Patients with abnormal BMIPP imaging had a higher incidence of soft events than those with normal BMIPP imaging, regardless of the type of angina(16/62 vs 3/73, p < 0.0005 for stable angina; 28/30 vs 6/9, p < 0.0001 for unstable angina).

CONCLUSIONS

The finding of BMIPP imaging correlates well with the mid-term prognosis of patients with angina pectoris. Since BMIPP SPECT is performed without stress to the patient, this imaging modality is important in evaluating patients with stable or unstable angina.

Telemedical support using real-time ultrasonography and endoscopy images

We developed a telecommunications apparatus (TMS-6101, NIHON KOHDEN WELLNESS CORPORATION, Tokyo, Japan) and evaluated its clinical utility as a telemedical support system. It is capable of transmitting on a real-time basis such vital signs as blood pressure, arterial O2 saturation and ECG recordings, which are measured at bedside using the Life-Mate monitor (NIHON KOHDEN WELLNESS Co.). It is also capable of transmitting moving video-camera pictures in real time. In this study we assessed its application for telemedical supports with particular emphasis on ultrasonography and endoscopy images since reports of such applications are lacking. Employing this system, several kinds of technically demanding endoscopic procedures were supported successfully under the supervision of at least one off-site specialist physician. The system proved to be a very useful medical resource, since it facilitated high quality medical care and specialist consultation at any location without those specialists traveling to the scene.

Peripheral nerve lengthening by controlled isolated distraction: a new animal model

We have developed a simple and effective animal model to study the distraction neurogenesis utilizing the sciatic nerve-lengthening technique in rats. The model allows macroscopic, physiological, and histological evaluation of the distraction site. Fourteen adult Harlan Sprague Dawley rats (300-350 g) were used in this study. A 10 mm segment of the right sciatic nerve of each animal in the nerve-lengthening group was resected. Gradual nerve lengthening was performed by advancing the proximal nerve stump at a rate of 1 mm/day. The proximal stump neuroma was then resected and a direct nerve anastomosis was performed. On the left side a standard autogenous nerve-grafting procedure was performed with a 10 mm segment of sciatic nerve used as an in situ nerve graft. Three months after the second surgery, the sciatic nerves were exposed and investigated by gross observation and EMG followed by histological processing and tissue analysis. Neomicrovascularization was observed surrounding the sciatic nerve anastomosis in all five specimens of the nerve-lengthening group as compared to the more white-colored scar tissue that was observed in the nerve-grafting group. The EMG results were similar for both groups. Histological studies of the lengthened nerves showed axon morphology equivalent to the grafted nerves. This study demonstrated a clear evidence of the successful nerve regeneration within a segmental nerve gap by nerve lengthening.

[Indication and effectiveness of endoscopic percutaneous gastrostomy as a route of parenteral alimentation for the home care patient]

We are managing 8 home care patients who have a gastrostomy made using an endoscopic percutaneous technique as a route of parenteral alimentation. Based on our experience, the preconditions for an endoscopic percutaneous gastrostomy as a route of parenteral alimentation are 1. normal gastrointestinal function, 2. difficulty in swallowing, 3. possibility that the caregiver can manage the gastrostomy. When we performed an endoscopic percutaneous gastrostomy as a route of parenteral alimentation for 8 home care patients, we obtained the several advantages mentioned below. 1. Swallowing pneumonia was prevented. 2. Adequate amount of alimental liquid could be infused. 3. Patient could take a bath or shower with the gastrostomy, and good QOL was realized. 4. The home care patient with the gastrostomy could have a satisfactorily long life.

T-cell-mediated regulation of osteoclastogenesis by signalling cross-talk between RANKL and IFN-gamma

Bone resorption is regulated by the immune system, where T-cell expression of RANKL (receptor activator of nuclear factor (NF)-kappaB ligand), a member of the tumour-necrosis factor family that is essential for osteoclastogenesis, may contribute to pathological conditions, such as autoimmune arthritis. However, whether activated T cells maintain bone homeostasis by counterbalancing the action of RANKL remains unknown. Here we show that T-cell production of interferon (IFN)-gamma strongly suppresses osteoclastogenesis by interfering with the RANKL-RANK signalling pathway. IFN-gamma induces rapid degradation of the RANK adapter protein, TRAF6 (tumour necrosis factor receptor-associated factor 6), which results in strong inhibition of the RANKL-induced activation of the transcription factor NF-kappaB and JNK. This inhibition of osteoclastogenesis is rescued by overexpressing TRAF6 in precursor cells, which indicates that TRAF6 is the target critical for the IFN-gamma action. Furthermore, we provide evidence that the accelerated degradation of TRAF6 requires both its ubiquitination, which is initiated by RANKL, and IFN-gamma-induced activation of the ubiquitin-proteasome system. Our study shows that there is cross-talk between the tumour necrosis factor and IFN families of cytokines, through which IFN-gamma provides a negative link between T-cell activation and bone resorption. Our results may offer a therapeutic approach to treat the inflammation-induced tissue breakdown.

CD8(+) T cell-mediated skin disease in mice lacking IRF-2, the transcriptional attenuator of interferon-alpha/beta signaling

The balanced action of cytokines is known to be critical for the maintenance of homeostatic immune responses. Here, we report the development of an inflammatory skin disease involving CD8(+) T cells, in mice lacking the transcription factor, interferon regulatory factor-2 (IRF-2). CD8(+) T cells exhibit in vitro hyper-responsiveness to antigen stimulation, accompanied with a notable upregulation of the expression of genes induced by interferon-alpha/beta (IFN-alpha/beta). Furthermore, both disease development and CD8(+) T cell abnormality are suppressed by the introduction of nullizygosity to the genes that positively regulate the IFN-alpha/beta signaling pathway. IRF-2 may represent a unique negative regulator, attenuating IFN-alpha/beta-induced gene transcription, which is necessary for balancing the beneficial and harmful effects of IFN-alpha/beta signaling in the immune system.

Primary malignant melanoma of the male urethra

BACKGROUND

We describe a rare case of malignant melanoma originating from the male urethra.

METHODS/RESULTS

This case, which presented a tan-colored lesion at the distal urethra on urethroscopy, was considered as transitional cell carcinoma by transurethral biopsy. Pathologic examination of widely resected urethra revealed scattering cells, which included melanin granules in cytoplasm, and then immunohistochemical stains established the diagnosis as amelanotic melanoma. Although partial penectomy and inguinal lymph node dissection were subsequently performed, 7 months later, total cystourethrectomy was required because of multifocal recurrence at the residual urethra.

CONCLUSIONS

In cases of amelanotic melanoma, it should be noted that a lack of melanin granules in tumor cells may lead pathologists and urologists to a misdiagnosis due to the histologic non-specific appearance. With respect to surgical management, of significance is the fact that malignant melanoma may progress multifocally along the total urethra; therefore, total urethrectomy should be considered as radical surgery for the primary site, even if the tumor is confined to the distal urethra.

[Papillary adenocarcinoma of the prostate: report of 3 cases]

We report here 3 cases of papillary adenocarcinoma of the prostate. In all 3 cases, the tumors were discernible on cystourethroscopy and transurethral biopsy established the diagnosis, whereas no significant finding was found on digital rectal examination. Although androgen deprivation therapy was administered in all cases, different surgical procedures were employed according to the stage in each case. In case 1, since the papillary tumor was confined within the prostatic urethra, complete resection was accomplished by transurethral resection (TUR). In case 2, since pelvic lymph nodes metastases were found, local radiation therapy was added. In case 3, since the patient had vesical invasion of tumor total cysto-prostatectomy was performed. Papillary adenocarcinoma of the prostate originates from the prostatic duct, resulting in existence at the "central portion" of the prostate gland. Cystourethroscopy and transurethral biopsy is helpful for diagnosis of this disease, whereas rectal digital examination is useless. As a surgical procedure for the primary site, TUR may be efficient for tumors confined within the prostatic urethra, although more extensive surgery may be necessary for those with a more invasive profile.

Leiomyosarcoma of the spermatic cord

BACKGROUND

A rare case of leiomyosarcoma from the spermatic cord is described. A 72-year-old man complained of a hard, golf-ball sized mass in the right inguinal canal.

METHODS

Transinguinal radical orchiectomy was performed and histologic examination revealed leiomyosarcoma originating from the spermatic cord. Distant metastases were not observed by further examinations. Radiation as adjuvant therapy was carried out in order to prevent the local recurrence.

RESULTS/DISCUSSION

The patient has been alive for 16 months with no evidence of disease. In leiomyosarcoma of the spermatic cord, locoregional recurrence is common. In addition to transinguinal radical orchiectomy, local radiation therapy should be carried out as an adjuvant.

[Transitional cell carcinoma in the ureter showing inverted proliferation: a case report]

A case of transitional cell carcinoma in the ureter showing inverted proliferation is reported. A tumor in the middle third of the right ureter was found in a 67-year-old male complaining of gross hematuria. Since positive findings of malignancy were obtained in a washing examination of urine cytology, right nephroureterectomy was performed. The gross specimen consisted of a polypoid and pedunculated 22 x 8 mm tumor which showed a smooth surface as in normal ureteral mucosa. Histopathologically, the tumor was lined with normal transitional epithelium but filled with transitional cell carcinoma, grade 1. Diagnosis and treatment of ureteral tumors showing inverted proliferation are discussed.

[Telemedical support in emergency medicine]

In July 1997 we began support of paramedics who would respond to emergency scenes using a telecommunications system based in the hospital emergency unit. However, since no telecommunications system that could be employed on the actual clinical site was available, we had to develop a new system. Our telecommunications system (TMS-6101, NIHON KOHDEN WELLNES Co., Tokyo, Japan) can transmit vital signs in real time and interactively transmit several types of moving images. Because the current infrastructure for radio communications cannot provide adequate telemedical support for paramedics, we are using the new system for clinical support between our unit and associated hospitals. Based on 57 cases of clinical telemedical intervention, the system has enabled high-quality decision making by specialists without the need for them to travel to the scene or transport X-rays films, ultrasonographic reports, or endoscopic results. If this newly developed telecommunications system is employed for telemedical interventions in medical facilities in remote areas or on remote islands, medical consultations for Japanese individuals overseas, night-time first aid in urban areas, and in disaster situations, the physicians on both side of the line will be able to obtain a wealth of timely information, greatly influencing outcome in both emergency and nonemergency cases.

[Anesthetic management for renal tumor extending to the inferior vena cava]

A 58 year-old woman underwent radical nephrectomy, thrombectomy and ileo-cecal resection for renal tumor with thrombus involving the inferior vena cava and ascending colon cancer. In a patient having tumor thrombus extending to the vena cava, recognition of the position of the thrombus is important for surgical and anesthetic management in pre- and intra-operative periods. Transesophageal echocardiography (TEE) enabled us to visualize the real-time movement and deformity of thrombus by surgical manipulation and compression during operation. TEE seemed also very useful not only in understanding the hemodynamics during operation but also in detecting the residual tumor and the blood flow in liver and the inferior vena cava after operation.

Requirement for IRF-1 in the microenvironment supporting development of natural killer cells

Natural killer (NK) cells are critical for both innate and adaptive immunity. The development of NK cells requires interactions between their progenitors and the bone-marrow microenvironment; however, little is known about the molecular nature of such interactions. Mice that do not express the transcription factor interferon-regulatory factor-1 (IRF-1; such mice are IRF-1(-/-) mice) have been shown to exhibit a severe NK-cell deficiency. Here we demonstrate that the lack of IRF-1 affects the radiation-resistant cells that constitute the microenvironment required for NK-cell development, but not the NK-cell progenitors themselves. We also show that IRF-1(-/-) bone-marrow cells can generate functional NK cells when cultured with the cytokine interleukin-15 and that the interleukin-15 gene is transcriptionally regulated by IRF-1. These results reveal, for the first time, a molecular mechanism by which the bone-marrow microenvironment supports NK-cell development.

[Metastasis of renal cell carcinoma to ipsilateral adrenal residuum and contralateral adrenal gland after radical nephrectomy: a case report]

A 68-year-old woman had undergone radical nephrectomy via a transabdominal approach 4 years earlier for a 8 cm tumor located from the midportion to the upper pole of the right kidney. Pathological diagnosis was renal cell carcinoma (RCC), clear cell subtype, G2, pT2pN0M0. Four years postoperatively, followup computed tomography scan revealed masses in bilateral adrenal region (6 cm in diameter on the left side and 5 cm on the light). Bilateral adrenalectomy confirmed the diagnosis of adrenal metastases from clear cell carcinoma. It was concluded that the tumor had metastasized to the ipsilateral adrenal tissue as the residuum of the previous surgery. She has been treated by oral steroid supplementation without evidence of recurrence for 18 months.

Serum bone alkaline phosphatase isoenzyme levels in normal children and children with growth hormone (GH) deficiency: a potential marker for bone formation and response to GH therapy

Serum bone alkaline phosphatase (B-ALP) has been considered to be a good marker for bone formation. Recently, a specific immunoradiometric assay for serum B-ALP has been developed. Using this system, we measured the serum levels of B-ALP in 363 normal children (207 males and 156 females, age 0-18 yr) and in 20 GH-deficient children (age 5-13 yr) who showed significant bone growth during GH therapy. We found the following results. 1) There were no significant circadian variations in serum B-ALP levels (coefficients of variation: 2.10-9.66%). 2) In normal children, serum B-ALP levels were high in infants and gradually declined and increased again during puberty. During the pubertal period, the highest serum B-ALP values were observed at midpuberty (stage 3 of breast and pubic hair development and 4-12 mL of testicular volume). 3) Serum B-ALP levels were significantly correlated with levels of the carboxy-terminal propeptide of type 1 procollagen (r = 0.447, P < 0.0001) and osteocalcin (r = 0.433, P < 0.0001). 4) After beginning GH therapy, serum B-ALP levels increased significantly; a 26% increase in serum B-ALP level was observed after 3 months of GH therapy. 5) The ratio between serum B-ALP level after 3 months of GH therapy and before GH therapy was positively correlated with the GH-induced improvement in the height SD score (height SD score after 1 yr of GH therapy minus that before GH therapy) and improvement in the height velocity SD score (height velocity SD score during GH therapy minus before GH therapy) (r = 0.531, P < 0.05 and r = 0.608, P < 0.01, respectively). 6) The increment of SD score in serum B-ALP level after 1 yr of GH treatment was also significantly correlated with that for bone mineral density after 1 yr of GH therapy (r = 0.663, P < 0.005). These results show that B-ALP levels are a useful marker for bone formation because B-ALP levels increased when the growth rate accelerated. Serum B-ALP is a potential predictor of the effectiveness of GH therapy, because the serum level after 3 months of GH therapy reflects the outcome of 1 yr of GH therapy.

Multistage regulation of Th1-type immune responses by the transcription factor IRF-1

Eradication of a given pathogen is dependent on the selective differentiation of T helper (Th) cells into Th1 or Th2 types. We show here that T cells from mice lacking the transcription factor IRF-1 fail to mount Th1 responses and instead exclusively undergo Th2 differentiation in vitro. Compromised Th1 differentiation is found to be associated with defects in multiple cell types, namely impaired production of interleukin-12 by macrophages, hyporesponsiveness of CD4+ T cells to interleukin-12, and defective development of natural killer cells. These results indicate the involvement of IRF-1 in multiple stages of the Th1 limb of the immune response.

Long-term results of ethanol embolization of renal cell carcinoma

This retrospective study was conducted to evaluate the long-term results of transarterial embolization with absolute ethanol (ethanol-TAE) for patients with renal cell carcinoma (RCC). Twenty-eight patients, including 15 stage IVb patients, underwent ethanol-TAE, with 12 of them followed by nephrectomy. The cumulative survival rates after 1, 3, and 5 years were 71%, 54%, and 54% in the surgical group, and 54%, 33%, and 22% in the non-surgical group. From the results, we recommend ethanol-TAE for advanced stage patients for the following reasons: first, it can be a useful alternative to nephrectomy in high-risk patients; second, ethanol-TAE can decrease the primary tumor size increasing operability; and third, local tumor control may result in longer survival.

Psychosocial aspects in long-term survivors of testicular cancer

PURPOSE

We assessed the psychosocial well-being in cured testicular cancer patients who had undergone chemotherapy with or without retroperitoneal lymph node dissection, radiotherapy or surveillance therapy.

MATERIALS AND METHODS

The sample consisted of 83 cured testicular cancer patients of whom 34 had undergone cisplatin-based combination chemotherapy with or without retroperitoneal lymph node dissection (chemotherapy group), 42 had received infradiaphragmatic radiotherapy (radiotherapy group) and 7 had received surveillance therapy (surveillance group). The questionnaire reported demographic data, psychosocial well-being, working ability, satisfaction with life, relationships, and general health and fitness.

RESULTS

For questions dealing with psychological distress there were no differences among the groups. However, a significant number of patients in all groups reported greater feelings of anxiety about health and future since treatment. Working ability was significantly better in the chemotherapy and radiotherapy groups than in the surveillance group (p < 0.05 and p < 0.01, respectively). Interestingly, the patients who received the most extensive treatment (chemotherapy plus retroperitoneal lymph node dissection) reported the best working ability. Using the satisfaction with life scale, patients in the chemotherapy and radiotherapy groups showed significantly higher scores than those in the surveillance group (p < 0.05). The majority of the patients reported no significant change in long-term relationships with family, friends and spouse.

CONCLUSIONS

The development of psychosocial problems during long-term adjustment seems to be low regardless of treatment received. Although a significant number of patients reported a higher incidence of anxiety and depression since the illness, the overall attitude was positive toward life. With regard to treatment type, patients in the chemotherapy and radiotherapy groups had better working ability and greater satisfaction with life than the surveillance group.

Shorter interval between cycles of cyclophosphamide, doxorubicin, cisplatin using recombinant human granulocyte colony-stimulating factor for urothelial cancer--phase I/II study

BACKGROUND

Despite improvement in the response rate and protraction of the progression-free period of urothelial cancer produced by chemotherapy, severe bone marrow suppression often results in delays in the initiation of treatment cycles and/or decreases in drug dosages. Reduction of leukopenia during chemotherapy has been demonstrated by the combined administration of granulocyte colony-stimulating factor (G-CSF) in various malignancies.

METHODS

A phase I/II study was conducted to assess whether the interval between cycles of CISCA (cyclophosphamide, doxorubicin, cisplatin) chemotherapy could be shortened under support of recombinant human granulocyte colony-stimulating factor (rhG-CSF) for urothelial cancer. Three or more patients with transitional cell carcinoma of the urinary tract were allocated to each of four different treatment intervals (step 1: 28 days, step 2: 21 days, step 3: 17 days, and step 4: 14 days) by reducing the interval in a step-wise manner. Two mg/kg/day of a rhG-CSF, lenograstim, was injected subcutaneously on days 3 to 16 (until day 14 for the 14-day interval group).

RESULTS

Sixteen patients were enrolled, four patients were treated with the step 1 protocol, five with step 2, four with step 3, and three with step 4. Leukopenia/neutropenia was the most severe toxic reaction, but none of the patients at any step manifested neutropenia of WHO grade 4 for more than four days. There were no significant differences in the hematological and nonhematological toxicities among the 4 steps. Seven of eight patients with measurable diseases were treated with CISCA on shortened schedules (steps 2-4), and one complete remission (CR) and four partial responses (PR) were demonstrated.

CONCLUSIONS

CISCA chemotherapy supported by rhG-CSF was safely shortened to a 14-day interval in the pilot study. The potential role of rhG-CSF in shortening the interval of CISCA, as well as the benefit of the intensified schedule, remains to be clarified.

Ubiquitous interleukin-1 alpha in fetal bovine serum may mislead the experimental results in vitro

Fetal bovine sera (FBS) from several commercial suppliers were fractionated by gel filtration. Interleukin-1 (IL-1) activity was bioassayed using the IL-1-specific murine T cell line D10(N4)M. All the sera examined contained IL-1-like activity, with molecular weights (M(r)) of 30 kDa and 15-10 kDa. Under isoelectric focusing (IEF), the majority of IL-1 activity in either 30 kDa or 15-10 kDa fractions was focused into a position of pl 5. The activity recovered from either IEF or gel filtration was inhibited by either recombinant human IL-1 receptor antagonist (rhlL-1ra) or by the antibody against human IL-1 alpha. These biological and physicochemical properties strongly suggest that the active molecules were bovine IL-1 alpha and its precursor. There was no correlation between the amount of endotoxin and IL-1 activity. Quantification of the fractionated IL-1 indicated its presence in concentrations of 200-5000 pg/ml equivalent to human IL-1. However, high levels of IL-1 were not apparent in unfractionated FBS. Proliferation of T cells in the presence of FBS absorbed with protein A-Sepharose was greater than that of cells in original FBS. Therefore, the activity in FBS as a whole appeared to result from the balance between IL-1 and the inhibitory molecule(s). These results suggest that data obtained from experiments conducted in the presence of FBS may be influenced by the effect of bovine IL-1.

Thermostable N-carbamoyl-D-amino acid amidohydrolase: screening, purification and characterization

A thermostable N-carbamoyl-D-amino acid amidohydrolase was found in the cells of newly isolated bacterium. Blastobacter sp. A17p-4. The bacterium also showed D-specific hydantoinase activity. The N-carbamoyl-D-amino acid amidohydrolase activity of the cells exhibited a temperature optimum at 50-55 degrees C, and was stable up to 50 degrees C. The N-carbamoyl-D-amino acid amidohydrolase of Blastobacter sp. A17p-4 was purified to homogeneity and characterized. It has a relative molecular weight of about 120,000 and consists of three identical subunits with a relative molecular weight of about 40,000. N-Carbamoyl-D-amino acids having hydrophobic groups served as good substrates for the enzyme. It has been suggested that D-amino acid production from DL-5-substituted hydantoin involves the action of a series of enzymes involved in pyrimidine degradation, namely amide-ring opening enzyme, dihydropyrimidinase, and N-carbamoylamide hydrolyzing enzyme, beta-ureidopropionase. However, the purified enzyme did not hydrolyze beta-ureidopropionate; suggesting that the N-carbamoyl-D-amino acid amidohydrolase coexisting with D-specific hydantoinase, probably dihydropyrimidinase, in Blastobacter sp. A17p-4 is different from beta-ureidopropionase.

[The collateral ligaments of the elbow joint: their functional anatomy with special reference to the pathology and treatment of post-traumatic stiff elbow]

Factors which cause stiff elbow were investigated both experimentally and clinically. Since a thickened and shortened medial collateral ligament is often seen in stiff elbow, then changes in the length of the medial collateral ligament (MCL) and in the length of the lateral collateral ligament (LCL) were investigated in cadaver elbow specimens, and correlated with the observed range of motion. The MCL was divided into five bundles, and the LCL into three bundles. The length changes during flexion and extension of the elbow joint were measured, and the length change pattern was found to be different from bundle to bundle. The lengths of the LCL and the anterior oblique ligament (AOL) of the MCL changed little during elbow flexion. On the other hand, the length of the posterior oblique ligament (POL) of the MCL considerably increased when the elbow joint was flexed. The more posterior the bundle was, the larger the change in length that was observed. Because the origin of the POL is far distant from the axis of motion, it was suspected that a shortening in the POL was one of the most important pathologic changes in stiff elbow. The results of the biomechanic study were applied to a subsequent clinical study. Scar formation or ectopic ossification on the medial and/or posterior parts of the elbow joint was observed in 38 of 43 cases at surgery. These pathologic regions were resected, including the scarred POL. The intra-operative findings revealed that the major restraints in stiff elbow were the medial and/or posterior parts of the elbow. The importance of the shortened POL in the clinical pathology of stiff elbow was clearly demonstrated.

[Evaluation of clinical efficacy and safety of cefpodoxime proxetil (CPDX-PR) in acute uncomplicated cystitis]

One hundred and fifty female patients with acute uncomplicated cystitis were given 200 mg of CPDX-PR twice daily for 3-7 days to evaluate both its overall clinical efficacy and its adverse effects. In 82 cases (Group I) in which it was administered for 3 days, the overall clinical efficacy, evaluated by the criteria proposed by the Japanese UTI committee, was excellent in 64 cases, moderate in 17 and poor in one, with the effective rate being 98.8%. In 35 cases (Group II) in which it was administered for 4-7 days, the overall clinical efficacy was excellent in 18 cases, moderate in 15 and poor in 2, with the effective rate being 94.3%. The overall clinical evaluation was not performed in another 33 cases because they were given CPDX-PR for more than 8 days or 300 mg/day. Subjective adverse effects such as hoarseness and lingual inflammation were observed in only one of the 150 cases, but they disappeared spontaneously after the cessation of administration of CPDX-PR. These findings suggest that CPDX-PR is one of the most effective and safe antibiotic in the treatment of acute uncomplicated cystitis.

Differences in interleukin 1 (IL-1), IL-6, tumor necrosis factor and IL-1 receptor antagonist production by human monocytes stimulated with muramyl dipeptide (MDP) and its stearoyl derivative, romurtide

The immunostimulatory reagents muramyl dipeptide (MDP) and its stearoyl derivative romurtide [MDP-Lys(L18)] were assessed for cytokine inducing activity in human monocytes. Both MDP and romurtide stimulated the production of interleukin-1 (IL-1), IL-6, tumor necrosis factor (TNF) and IL-1 receptor antagonist (IL-1Ra). Kinetics study indicated that IL-1, TNF and IL-1Ra were induced after 4 h stimulation but IL-6 was produced at a later phase. Romurtide induced these cytokines for longer period that MDP. Dose-response study indicated that romurtide was far more potent than MDP in induction of IL-1, IL-6 and TNF. Although the magnitude of the IL-1 and IL-6 induction was almost the same, that of TNF induction was greater in romurtide-stimulated monocytes than in MDP-stimulated cells. Among IL-1, IL-1 beta appeared to be a major product. In contrast to other cytokines, IL-1Ra was induced by MDP and romurtide in a similar dose and time dependent manner with similar magnitude of response. These studies indicate that MDP and romurtide, especially romurtide, are very potent inducers of both immunostimulatory and immunosuppressive cytokines by human monocytes but with different efficacy and kinetics.