Comparing the safety and efficacy of nintedanib starting dose in patients with connective tissue disease-associated interstitial lung diseases

OBJECTIVE

This study aimed to analyse whether initiating nintedanib treatment at a reduced dose could improve the treatment continuation rate while maintaining efficacy in patients with connective tissue disease (CTD)-associated interstitial lung disease.

METHOD

In total, 51 patients (age 61.6 ± 13.2 years; 38 women, 13 men) were retrospectively analysed. The primary endpoint was the cumulative discontinuation rate due to adverse events. Secondary endpoints included changes in drug dosage, efficacy evaluated based on annual changes in forced vital capacity (FVC), and safety assessed based on the frequency of adverse events.

RESULTS

Eighteen patients who started treatment at the standard dose of 300 mg (standard dosage group) were compared with 33 patients who started treatment at a reduced dose (reduced dosage group). Systemic sclerosis was the most common CTD (n = 32), followed by idiopathic inflammatory myopathies and, rarely, rheumatoid arthritis. Both groups exhibited comparable cumulative discontinuation rates due to adverse events and similar frequencies of adverse events. No significant differences were observed in maintenance doses between the two groups; however, patients in the reduced dosage group had a lower cumulative dose for up to 52 weeks than those in the standard dosage group. No significant differences were observed in changes in FVC between the two groups.

CONCLUSION

There was no evidence for a difference between the two groups in terms of discontinuation rates, efficacy, and safety. To provide further evidence, future studies using more precise dose-escalation protocols are warranted.

Identification of type of threading dislocation causing reverse leakage in GaN p-n junctions after continuous forward current stress

Power devices are operated under harsh conditions, such as high currents and voltages, and so degradation of these devices is an important issue. Our group previously found significant increases in reverse leakage current after applying continuous forward current stress to GaN p-n junctions. In the present study, we identified the type of threading dislocations that provide pathways for this reverse leakage current. GaN p-n diodes were grown by metalorganic vapor phase epitaxy on freestanding GaN(0001) substrates with threading dislocation densities of approximately 3 × 105 cm-2. These diodes exhibited a breakdown voltage on the order of 200 V and avalanche capability. The leakage current in some diodes in response to a reverse bias was found to rapidly increase with continuous forward current injection, and leakage sites were identified by optical emission microscopy. Closed-core threading screw dislocations (TSDs) were found at five emission spots based on cross-sectional transmission electron microscopy analyses using two-beam diffraction conditions. The Burgers vectors of these dislocations were identified as [0001] using large-angle convergent-beam electron diffraction. Thus, TSDs for which b = 1c are believed to provide current leakage paths in response to forward current stress.

Local atomic structure analysis around Mg atom doped in GaN by X-ray absorption spectroscopy and spectrum simulations

The identification of the incorporated site of magnesium (Mg) and hydrogen (H) required for p-type formation in gallium nitride (GaN) power devices has been demonstrated by X-ray absorption spectroscopy (XAS). In this study, the fluorescence line of Mg with 3 × 10¹⁹ atoms cm^-3 was successfully separated from that of Ga using a superconducting tunnel junction array detector with high sensitivity and high energy resolution, and consequently the Mg K-edge XAS spectra of such dilute samples were obtained. The site of Mg atoms incorporated into the GaN lattice was identified as the Ga substitutional site by comparing the experimental XAS spectrum with the simulated spectra calculated by density functional theory. In addition, the presence or absence of H around Mg can be determined through distinctive characteristics expected from the spectrum simulations.

Generation of a novel CD30+ B cell subset producing GM-CSF and its possible link to the pathogenesis of systemic sclerosis

Systemic sclerosis (SSc) is a T helper type 2 (Th2)-associated autoimmune disease characterized by vasculopathy and fibrosis. Efficacy of B cell depletion therapy underscores antibody-independent functions of B cells in SSc. A recent study showed that the Th2 cytokine interleukin (IL)-4 induces granulocyte-macrophage colony-stimulating factor (GM-CSF)-producing effector B cells (GM-Beffs ) in humans. In this study, we sought to elucidate the generation mechanism of GM-Beffs and also determine a role of this subset in SSc. Among Th-associated cytokines, IL-4 most significantly facilitated the generation of GM-Beffs within memory B cells in healthy controls (HCs). In addition, the profibrotic cytokine transforming growth factor (TGF)-β further potentiated IL-4- and IL-13-induced GM-Beffs . Of note, tofacitinib, a Janus kinase (JAK) inhibitor, inhibited the expression of GM-CSF mRNA and protein in memory B cells induced by IL-4, but not by TGF-β. GM-Beffs were enriched within CD20+ CD30+ CD38-/low cells, a distinct population from plasmablasts, suggesting that GM-Beffs exert antibody-independent functions. GM-Beffs were also enriched in a CD30+ fraction of freshly isolated B cells. GM-Beffs generated under Th2 conditions facilitated the differentiation from CD14+ monocytes to DC-SIGN+ CD1a+ CD14- CD86+ cells, which significantly promoted the proliferation of naive T cells. CD30+ GM-Beffs were more pronounced in patients with SSc than in HCs. A subpopulation of SSc patients with the diffuse type and concomitant interstitial lung disease exhibited high numbers of GM-Beffs . Together, these findings suggest that human GM-Beffs are enriched in a CD30+ B cell subset and play a role in the pathogenesis of SSc.

Distinguishing nitrogen-containing sites in SiO2/4H-SiC(0001) after nitric oxide annealing by X-ray absorption spectroscopy

The atomic structure of nitrogen at the SiO₂/4H-SiC(0001) interface has been investigated using X-ray absorption spectroscopy (XAS) in two nitric oxide annealed samples, one of which was oxidized in dry O₂ (NO-POA) prior to the experiment. The peak shapes and energies of the observed and simulated spectra are in agreement and indicate that the N-containing sites could be the substitutional C site at the interface for the NO-annealed sample and the interstitial site in the interior of SiC for the NO-POA-annealed sample. XAS analysis distinguished between the N-containing sites at the SiO₂/SiC interface.

Surface EXAFS via differential electron yield

Surface-sensitive analysis via extended X-ray absorption fine-structure (EXAFS) spectroscopy is demonstrated using a thickness-defined SiO₂ (12.4 nm)/Si sample. The proposed method exploits the differential electron yield (DEY) method wherein Auger electrons escaping from a sample surface are detected by an electron analyzer. The DEY method removes local intensity changes in the EXAFS spectra caused by photoelectrons crossing the Auger peak during X-ray energy sweeps, enabling EXAFS analysis through Fourier transformation of wide-energy-range spectral oscillations. The Si K-edge DEY X-ray absorption near-edge structure (XANES) spectrum appears to comprise high amounts of SiO₂ and low Si content, suggesting an analysis depth, as expressed using the inelastic mean free path of electrons in general electron spectroscopy, of approximately 4.2 nm. The first nearest neighbor (Si-O) distance derived from the Fourier transform of the Si K-edge DEY-EXAFS oscillation is 1.63 Å. This value is within the reported values of bulk SiO₂, showing that DEY can be used to detect a surface layer of 12.4 nm thickness with an analysis depth of approximately 4.2 nm and enable `surface EXAFS' analysis using Fourier transformation.

A new EXAFS method for the local structure analysis of low-Z elements

A unique analytical method is proposed for local structure analysis via extended X-ray absorption fine structure (EXAFS) spectroscopy. The measurement of electron energy distribution curves at various excitation photon energies using an electron energy analyzer is applied to determine a specific elemental Auger spectrum. To demonstrate the method, the N K-edge EXAFS spectra for a silicon nitride film were obtained via simultaneous measurement of the N KLL Auger and background spectra using dual-energy windows. The background spectrum was then used to remove the photoelectrons and secondary electron mixing in the energy distribution curves. The spectrum obtained following this subtraction procedure represents the `true' N K-edge EXAFS spectrum without the other absorptions that are observed in total electron yield N K-edge EXAFS spectra. The first nearest-neighbor distance (N-Si) derived from the extracted N K-edge EXAFS oscillation was in good agreement with the value derived from Si K-edge analysis. This result confirmed that the present method, referred to as differential electron yield (DEY)-EXAFS, is valid for deriving local surface structure information for low-Z elements.

A dose-escalation study of rituximab for treatment of systemic lupus erythematosus and Evans' syndrome: immunological analysis of B cells, T cells and cytokines

OBJECTIVE

Accumulating evidence suggests that B-cell depletion therapy by rituximab may be effective for autoimmune disorders. However, an optimal dose of rituximab and a mechanism of its action remain to be established. We performed a dose-escalation study for treatment of Japanese patients with autoimmune diseases including eight with SLE and one with Evans' syndrome.

METHODS

Rituximab was infused intravenously, weekly 4 times in a dose-escalating fashion at three different doses of 100, 250 or 375 mg/m(2) to three patients each. Immunological parameters were monitored at certain points until 12 months after the treatment.

RESULTS

Rituximab was well tolerated and safe in these patients. Seven out of eight SLE patients and one with Evans' syndrome clinically responded completely or partially to the treatment. Four patients achieved long-term remission (18-30 months) without any additional treatment. In these patients, a significant decrease in circulating B cells continued for 6 months after the treatment. The mean fluorescence intensities of CD19, CD21, CD40 and BR3 on the residual B cells as well as the percentage of CD69+ CD4+ T cells decreased significantly. Serum TNF-alpha levels decreased significantly on day 2. The Th1/Th2 balance of CD4+ T cells gradually shifted towards a Th1 type by 6 months.

CONCLUSION

In addition to B-cell depletion, modification of B-cell and T-cell phenotypes as well as cytokine profiles may be involved in the action of rituximab.

Association of polymorphisms in complement component C3 gene with susceptibility to systemic lupus erythematosus

OBJECTIVE

Identification of the genes responsible for systemic lupus erythematosus (SLE).

METHODS

All the exons and putative promoter regions of 53 candidate genes (TNFRSF6/Fas, TNFSF6/FasL, Fli1, TNFSF10/TRAIL, TNFSF12/TWEAK, Bcl-2, PTEN, FADD, TRADD, CDKN1A, TNFRSF1A/TNFR1, TNFRSF4/OX40, TNFSF4/OX40L, TNFSF5/CD40L, TNFSF13B/BAFF, ICOS, CTLA4, CD28, FYN, G2A, CR2, PTPRC/CD45, CD22, CD19, Lyn, PDCD1, PTPN6, TGFB1, TGFB2, TGFB3, TGFBR1, TGFBR2, TGFBR3, CD3Z, DNASE1, APCS, MERTK, C3, C1QA, C1QB, C1QG, C2, MBL2, IGHM, IL-2, IL-4, IL-10, IFNG, TNFA, MAN2A1, TNFRSF11A/RANK, TNFRSF11B/OPG, TNFSF11/OPGL) were screened for single nucleotide polymorphisms (SNPs) and their association with SLE was assessed by case-control studies. A total of 509 cases and 964 controls of Japanese descent were enrolled.

RESULTS

A total of 316 SNPs was identified. When analysed in the Japanese population, the allele frequencies of T at rs7951 and G at rs2230201 of the C3 gene were 0.110 and 0.626, respectively, in SLE patients; significantly higher than the frequencies of 0.081 and 0.584, respectively, in controls [odds ratio (OR) = 1.40, 95% confidence interval (CI) = 1.05-1.86, P = 0.016 and OR=1.19, 95% CI = 1.01-1.41, P = 0.038, respectively]. The mean serum C3 level of carriers of the rs7951 T allele was significantly lower than that of non-carriers of the T allele in 87 SLE patients whose medical records were available (P = 0.0018).

CONCLUSION

rs7951 T allele of the C3 gene was significantly associated with SLE, and decreased serum level of C3 seems to be correlated with this allele.

High frequency Agrobacterium-mediated transformation and plant regeneration via direct shoot formation from leaf explants in Beta vulgaris and Beta maritima

We have developed a new procedure for Agrobacterium-mediated transformation of plants in the genus Beta using shoot-base as the material for Agrobacterium infection. The frequency of regeneration from shoot bases was analyzed in seven accessions of sugarbeet ( Beta vulgaris) and two accessions of B. maritima to select materials suitable for obtaining transformed plants. The frequency of transformation of the chosen accessions using Agrobacterium strain LBA4404 and selection on 150-mg/l kanamycin was found to be higher than that in previously published methods. Genomic DNA analysis and beta-glucuronidase reporter assays showed that the transgene was inherited and expressed in subsequent generations. In our method, shoot bases are prepared by a simple procedure, and transformation does not involve the callus phase, thus minimizing the occurrence of somaclonal variations.

Cibenzoline has an inhibitory effect on vasorelaxation mediated by adenosine triphosphate-sensitive K(+) channels in the rat carotid artery

Studies in cardiac myocytes have shown that cibenzoline reduces adenosine triphosphate (ATP)-sensitive K(+) currents, suggesting that this class Ia antiarrhythmic drug may modify the activity of ATP-sensitive K(+) channels in these preparations. The effects of class Ia antiarrhythmic drugs on vasodilation mediated by ion channels have not been studied. Therefore, we designed this study to examine whether cibenzoline may produce changes in vasorelaxation in response to a selective ATP-sensitive K(+) channel opener, levcromakalim, in the isolated rat carotid artery. Rings of rat carotid arteries without endothelium were suspended for isometric force recording. Concentration-response curves were obtained in a cumulative fashion. During submaximal contraction to phenylephrine (3 x 10(-7) M), vasorelaxation in response to levcromakalim (10(-8) to 10(-5) M) or 1-hydroxy-2-oxo-3-(N-methyl-3-aminopropyl)-3-methyl-1-triazene (NOC-7; 10(-10) to 10(-5) M) was obtained. During contraction to phenylephrine, levcromakalim induced concentration-dependent vasorelaxation. A selective ATP-sensitive K(+) channel antagonist, glibenclamide (5 x 10(-6) M), completely abolished vasorelaxation in response to levcromakalim, whereas a selective Ca(2+)-dependent K(+) channel antagonist, iberiotoxin (5 x 10(-8) M), did not affect the relaxation. Cibenzoline (10(-6) to 10(-5) M) significantly reduced vasorelaxation to levcromakalim in a concentration-dependent fashion. In contrast, cibenzoline (10(-5) M) did not alter vasorelaxation to a nitric oxide donor, NOC-7. These results suggest that from the clinically relevant concentrations, a novel class Ia antiarrhythmic drug, cibenzoline, impairs carotid vasodilation mediated by ATP-sensitive K(+) channels.

IMPLICATIONS

In isolated rat carotid artery, cibenzoline (10(-6) to 10(-5) M) reduced vasorelaxation to levcromakalim in a concentration-dependent fashion. These results suggest that from the clinically relevant concentrations, a novel class Ia antiarrhythmic drug, cibenzoline, impairs carotid vasodilation mediated by adenosine triphosphate-sensitive K(+) channels.

Mild alkalinization and acidification differentially modify the effects of lidocaine or mexiletine on vasorelaxation mediated by ATP-sensitive K+ channels

BACKGROUND

The previous study by the authors showed that the class Ib antiarrhythmic drug lidocaine impairs but mexiletine augments vasorelaxation mediated by adenosine triphosphate-sensitive K+ channels. Lidocaine and mexiletine have different values of the negative logarithm of the drug-proton dissociation constant, indicating that the ion channel-blocking effects of these drugs under different pH levels may vary. However, the role of pH in the effects of lidocaine and mexiletine on vasodilation mediated by K+ channels has not been studied. Therefore, the current study was designed to examine whether the inhibition and augmentation of vasorelaxation in response to an adenosine triphosphate-sensitive K+ channel opener, levcromakalim, by the clinically relevant concentrations of lidocaine or mexiletine are modified by mild alkalinization or acidification in the isolated rat aorta.

METHODS

Rings of the rat aorta without endothelium were suspended for isometric force recording. Three types of modified Krebs-Ringer solutions (pH 7.2, 7.4, and 7.6) were prepared by changing the composition of NaCl and NaHCO3. During contractions in response to phenylephrine (3 x 10(-7) M), relaxations in response to levcromakalim (10(-8) to 10(-5) M) were obtained. Lidocaine (10(-5) to 10(-4) M), mexiletine (10(-5) to 10(-4) M), or glibenclamide (10(-5) M) was applied 15 min before addition of phenylephrine.

RESULTS

Relaxations in response to levcromakalim, which are abolished by the selective adenosine triphosphate-sensitive K+ channel antagonist glibenclamide (10(-5) M), were not different among the three pH groups. In the normal Krebs-Ringer solution of pH 7.4, lidocaine significantly reduced these relaxations in a concentration-dependent fashion. Alkalinization of pH 7.6 augmented the inhibitory effect of lidocaine on these relaxations, whereas acidification of pH 7.2 substantially abolished this effect. In contrast, mexiletine pH independently augmented relaxations in response to levcromakalim. Glibenclamide (10(-5) M) abolished these relaxations in arteries treated with mexiletine (10(-4) M) in any pH group.

CONCLUSIONS

These results suggest that even under conditions of such mild alkalosis or acidosis, vasorelaxation via adenosine triphosphate-sensitive K+ channels is dependent on pH in the presence of clinically relevant concentrations of lidocaine but not mexiletine.

Cloning and biochemical characterization of Co(2+)-activated bromoperoxidase-esterase (perhydrolase) from Pseudomonas putida IF-3 strain

The gene encoding Co(2+)-activated bromoperoxidase (BPO)-esterase (EST), catalyzing the organic acid-assisted bromination of some organic compounds with H2O2 and Br(-) and quite specific hydrolysis of (R)-acetylthioisobutyric acid methyl ester, was cloned from the chromosomal DNA of the Pseudomonas putida IF-3 strain. The bpo-est gene comprises 831 bp and encoded a protein of 30181 Da. The enzyme was expressed at a high level in Escherichia coli and purified to homogeneity by ammonium sulfate fractionation and two-step column chromatographies. The recombinant enzyme required acetic acid, propionic acid, isobutyric acid or n-butyric acid in addition to H2O2 and Br(-) for the brominating reaction and was activated by Co(2+) ions. It catalyzed the bromination of styrene and indene to give the corresponding racemic bromohydrin. Although the enzyme did not release free peracetic acid in the reaction mixture, chemical reaction with peracetic acid could well explain such enzymatic reactions via a peracetic acid intermediate. The results indicated that the enzyme was a novel Co(2+)-activated organic acid-dependent BPO (perhydrolase)-EST, belonging to the non-metal haloperoxidase-hydrolase family.

Polyethylene glycol-modified concanavalin A as an effective agent to stimulate anti-tumor cytotoxicity

The jack bean lectin, concanavalin A (Con A), was modified with 2,4-bis[O-methoxypoly(ethylene glycol)]-6-chloro-s-triazine, activated PEG2, to form PEG-Con A. The immunoreactivity of PEG-Con A towards anti-Con A antibodies was reduced by increasing the degree of modification of amino groups in the Con A molecule. PEG-Con A had a complete reduction of the immunogenicity in mice and prolonged the clearance-time in blood. Although the mitogenic activity of Con A towards murine spleen cells was reduced by the conjugation with activated PEG2, the administration of PEG-Con A to mice enhanced the anti-tumor cytotoxicity of peripheral lymphocytes against melanoma B16 cells.

Laparoscopic adrenalectomy for pheochromocytoma: comparison with open adrenalectomy and comparison of laparoscopic surgery for pheochromocytoma versus other adrenal tumors

OBJECTIVE

To compare the efficacy of laparoscopic adrenalectomy for pheochromocytoma with that of conventional open adrenalectomy for pheochromocytoma and laparoscopic surgery for other adrenal tumors.

PATIENTS AND METHODS

Fifty-four patients with adrenal tumors, including 10 cases of pheochromocytoma, 18 cases of Cushing's syndrome, 20 cases of primary aldosteronism, and 6 cases of nonfunctioning tumors, were evaluated. A historical group of 7 consecutive patients who underwent conventional open adrenalectomy for pheochromocytoma was also studied.

RESULTS

Laparoscopic adrenalectomy for pheochromocytoma was successful in 9 of the 10 patients. There was no difference in tumor size, operation time, estimated blood loss, or occurrence of hypertensive episodes during surgery between patients treated with laparoscopic procedures and those treated with open surgery. However, the number of days to first postoperative oral feeding and first ambulation, length of hospitalization, and number of patients requiring parenteral analgesics were significantly smaller after laparoscopic surgery than after open surgery. There was no significant difference in operation time, estimated blood loss, incidence of intraoperative complications, or postoperative recovery between patients who underwent laparoscopic adrenalectomy for pheochromocytoma and those who underwent laparoscopic surgery for other adrenal lesions.

CONCLUSIONS

Laparoscopic adrenalectomy does not increase the specific risks associated with surgery for pheochromocytoma. It is a minimally invasive alternative to conventional open adrenalectomy.

An analysis of risk factors for upper urinary tract deterioration in patients with myelodysplasia

OBJECTIVE

To identify the risk factors for upper urinary tract deterioration in a retrospective study of patients with myelodysplasia.

PATIENTS AND METHODS

The medical history, radiographic studies and urodynamic results from 39 children with myelodysplasia who were treated at our hospital were reviewed retrospectively to obtain more accurate data in the prognosis of such patients. The upper urinary tracts were assessed by cysto-urethrography and excretory urography to determine the incidence of vesico-ureteric reflux (VUR) and hydronephrosis. The relationships between the urodynamic variables, including vesical compliance, detrusor hyper-reflexia, detrusor-sphincter dyssynergia (DSD) and the maximum urethral closing pressure (MUCP) to such upper tract deterioration were evaluated using both univariate and multiple logistic regression analysis.

RESULTS

The univariate analysis showed low vesical compliance, a high level of MUCP and the presence of DSD to be significant factors for the incidence of VUR. Low vesical compliance and a high level of MUCP also correlated with the incidence of hydronephrosis. The multivariate analysis showed a significant relationship between urodynamic values and upper urinary tract deterioration. The incidence of VUR was strongly correlated with a high MUCP and the presence of DSD. A high MUCP was also a significant factor in the incidence of hydronephrosis.

CONCLUSION

Urodynamic results associated directly with the abnormal function of urethral control are significantly correlated with the cause of upper tract deterioration in patients with myelodysplasia.

Ovarian carcinoma with fistula formation to the sigmoid colon and ileum: report of a case

We describe herein an extremely rare case of clear cell type ovarian carcinoma resulting in fistula formation into the colon and intestine. The patient was a 61-year-old woman in whom a large tumor with extravasation from the sigmoid colon was found by barium enema examination. The tumor was preoperatively diagnosed as left ovarian cancer by angiography which showed the tumor feeder arising from the left ovarian and uterine arteries.

Expression of heavy-chain constant region of immunoglobulin and T-cell receptor gene transcripts in human non-hematopoietic tumor cell lines

Expression of gene transcripts for immunoglobulins and a T-cell receptor was investigated in non-hematopoietic tumor cell lines using the highly sensitive RT-nested PCR method. These proteins are reported to be produced and secreted or expressed in malignancies originating from hematopoietic organs only. Originally designed PCR primers for different exons coding for the heavy-chain constant regions of IgM, IgD, IgG3, IgG1, IgE, and IgA and the T-cell receptor-alpha were used. All gene transcripts were detected in the 5 investigated cancer cell lines without exception. The results suggest that even non-hematopoietic cancer cells transcribe immunoglobulin and T-cell receptor genes and may produce the corresponding proteins.

Antitumor effect of medium-chain triglyceride and its influence on the self-defense system of the body

Medium-chain triglyceride (MCT), long-chain triglyceride (LCT), and their mixture were compared in reference to both cytotoxic effect against human tumor cells and influence on the immune system. MCT showed more potent cytotoxicity than LCT. Continuous contact with MCT also inhibited the cytotoxic effect of lymphokine-activated killer (LAK) cells much more strongly than LCT. However, there is a discrepancy between the concentration of MCT, or the mixture, that could suppress the growth of tumor cells and the concentration that inhibited the cytotoxicity of LAK cells. Moreover, no damage was observed in PBL or LAK cells or in their cytotoxicity when the cells were incubated with TG for 2 h a day. Thus, short-term contact with TG could inhibit tumor growth while immune system was maintained within normal range. Clinically fine control of the concentration of injected triglycerides, especially MCT, can be expected to provide potent antitumor effect and maintenance of normal immune system.

A single human cell expresses all messenger ribonucleic acids: the arrow of time in a cell

Expression of 25 mRNAs in a single human lymphocyte was investigated using the reverse transcription nested polymerase chain reaction (RT nested PCR) method. Proteins corresponding to the mRNA investigated were mucin antigen, melanoma antigen, pregnancy-specific beta-1 glycoprotein 4, phenylethanolamine-N-methyl-transferase, beta B3-crystallin, homeobox 4A, interleukin 2, cluster of differentiation 8, progesterone receptor, parathyroid hormone, gastrin, cholecystokinin/pancreozymin, glucagon, insulin, enkephalin, thyroid stimulating hormone, adrenocorticotropic hormone, synapsin I, immunoglobulin (Ig)M, IgD, IgG1, IgG3, IgE, IgA, and T cell receptor alpha. All mRNAs were detected in single lymphocytes of two individuals, without exception. In addition, transcripts of IgM, IgD, IgG1, IgG3, IgE, IgA, and the T cell receptor a gene were detected in single sperms. The results strongly suggest the possibility that all mRNAs may be expressed in a single human cell, of both somatic and germ lineage. Thus, cells can consume energy in vain to produce functionally meaningless gene transcripts. However, this basal or illegitimate transcription may be essential for the birth of living matter: the arrow of time in a cell. Moreover, the phenomenon implies the potential of using lymphocytes in place of inaccessible tissue for the diagnosis of genetic diseases.

Expression of heavy-chain constant region of immunoglobulin and T-cell receptor gene transcripts in human non-hematopoietic tumor cell lines

Expression of gene transcripts for immunoglobulins and a T-cell receptor was investigated in non-hematopoietic tumor cell lines using the highly sensitive RT-nested PCR method. These proteins are reported to be produced and secreted or expressed in malignancies originating from hematopoietic organs only. Originally designed PCR primers for different exons coding for the heavy-chain constant regions of IgM, IgD, IgG3, IgG1, IgE, and IgA and the T-cell receptor-alpha were used. All gene transcripts were detected in the 5 investigated cancer cell lines without exception. The results suggest that even non-hematopoietic cancer cells transcribe immunoglobulin and T-cell receptor genes and may produce the corresponding proteins.

Expression of SRY gene transcripts with a longer 3' untranslated sequence in adult human male lymphocytes and tumor cells

Using 3' RACE PCR and the repeated nested-PCR method, the expression of transcripts of the sex-determining gene SRY was investigated in single lymphocytes from a human adult male and in male tumor cell lines. The gene is functionally transcribed in the early stages of embryogenesis and mRNA is also expressed in adult testes. However, in this study, SRY gene transcripts were also detected in somatic cells of adult male and in tumor cells. Moreover, this mRNA possessed a longer additional untranslated exon. Although expression of the transcripts might not have any functional meaning in these cells, these new findings support the hypothesis that any given human cell can contain illegitimate mRNAs.

Application of microwave tissue coagulator in partial nephrectomy for renal cell carcinoma

PURPOSE

At partial nephrectomy there is a risk of excessive blood loss, which necessitates transfusion and also results in renal function deterioration when a vascular clamp is used. We evaluated the usefulness of a microwave tissue coagulator for partial nephrectomy for renal cell carcinoma.

MATERIALS AND METHODS

Partial nephrectomy was performed without renal pedicle clamping using a microwave tissue coagulator in 4 patients with a small kidney tumor.

RESULTS

In 3 of the 4 patients partial nephrectomy was successful using a microwave tissue coagulator without renal pedicle clamping. Mean operative time and blood loss were 203 minutes and 153 ml., respectively, and there were no significant complications. In the remaining case partial kidney resection was also performed without any complications. However, nephrectomy was required due to possible incomplete tumor resection.

CONCLUSIONS

Partial nephrectomy using a microwave tissue coagulator can be safe and successful without renal pedicle clamping. However, the insertion line of the microwave electrode must be carefully determined for resection to be curative and safe, just as when making the cut line for conventional partial nephrectomy or tumor enucleation.

The expression of urokinase type plasminogen activator is a novel prognostic factor in dukes B and C colorectal cancer

Urokinase type plasminogen activator (u-PA) secreted by cancer cells is considered to play a key role in promoting invasion and metastasis of cancer cells. This study was designed to evaluate the expression and prognostic value of u-PA in Dukes B and C colorectal cancer. u-PA expression was investigated in 57 Dukes B or C colorectal cancers using a monoclonal antibody against u-PA. u-PA expression was mainly observed on the cytoplasm of cancer cells, and was associated with relapse, especially hematogenous metastasis (p=0.025, the chi2 test). Patients with high u-PA expression had a lower rate of DFS (9/22 events) compared to those with low u-PA expression (6/35 events) (p=0.061, log-rank test). This study demonstrated that u-PA expression might be a novel prognostic factor in Dukes B and C colorectal cancer.

Immunohistochemical Detection of P-glycoprotein in Breast Cancer and Its Significance as a Prognostic Factor

Overexpression of P-glycoprotein (Pgp) in tumors is one of the major mechanisms which mediates the multidrug resistance (MDR) phenotype. To evaluate the prognostic significance of Pgp in breast cancer, Pgp expression was examined in paraffin-embedded tissue sections of 94 breast cancer specimens by immunohistochemistry. Tissue specimens were obtained by mastectomy without preoperative chemotherapy. UIC2 monoclonal antibody which recognizes an extracellular epitope of human Pgp was employed. Of the 94 breast cancer specimens, 35(37.2%)were positive for Pgp expression. Pgp expression had no correlation with menopausal or hormone receptor status, axillary Iymph node involvement or tumor size. However, a significant correlation was observed between Pgp expression and disease relapse (p=0.0322). Pgp-positive patients showed a significantly shorter disease-free survival period than Pgp-negative patients by the Kaplan-Meier method (p=0.0433). These results suggest that immunohistochemical detection of Pgp in breast cancer tissue may have prognostic value after radical operation.

First record of Eustrongylides tubifex (Dioctophymatidae) from little grebe, Tachybaptus ruficollis in Japan

A nematode species belonging to the genus Eustrongylides (Dioctophymatidae) was obtained from the proventriculus of Tachybaptus ruficollis, found in December, 1995 in Kobe City, Hyogo Prefecture, Japan. Observation under a scanning electron microscope to investigate anterior extremity with the labial papillae in two circles showed that this species is identical to E. tubifex. This is the first record of this species in Japan.

Thrombomodulin is a new biological and prognostic marker for breast cancer: an immunohistochemical study

BACKGROUND

Thrombomodulin (TM) is a natural anticoagulant which inhibits thrombin. Recent studies have reported that TM is correlated with vascular diseases and a few cancers. The aim of this study was to evaluate the role and the prognostic value of TM in breast cancer.

PATIENTS AND METHODS

TM expression in samples from 60 invasive breast cancer patients was examined immunohistochemically with a polyclonal antibody against TM.

RESULTS

TM staining was observed mainly on both the cytoplasm and cell surface in cancer cells and on endothelial cells around or in cancer tissue. TM expression in cancer cells was not correlated with the clinicopathological features. However, low TM expression was significantly correlated with a high relapse rate (p = 0.047 by the chi 2 test and 0.05 by the Kaplan-Meier method).

CONCLUSIONS

TM might play an active role in cancer invasion and metastasis, and serve as a new prognostic factor in invasive breast cancer.

Urokinase type plasminogen activator receptor is a novel prognostic factor in breast cancer

BACKGROUND

There have been many reports that the u-PA system plays an important role in cancer invasion and metastasis. The binding of u-PA to its specific cell-surface receptor, u-PAR, is necessary for the activation of u-PA system. The aim of this study is to evaluate the role and the prognostic value of u-PAR in cancer invasion and metastasis.

PATIENTS AND METHODS

u-PAR expression in 104 breast cancers was investigated immunohistochemically using a monoclonal antibody against u-PAR.

RESULTS

u-PAR expression was mainly observed both on cancer cells and stromal cells. Patients with high u-PAR expression in cancer cells or stromal cells had a high relapse rate compared with patients with low u-PAR expression by the Kaplan-Meier method (p = 0.035 and 0.011, respectively). In uni- and multivariate analysis, u-PAR expression in stromal cells was significantly correlated with relapse (p = 0.017 and 0.043, respectively).

CONCLUSIONS

This study has shown that not only cancer cells but also stromal cells have an important roles in breast cancer invasion and metastasis, and that u-PAR expression in cancer cells and stromal cells might be a novel prognostic factor in breast cancer.

A possibility of all mRNA expression in a human single lymphocyte

Expression of gene transcripts for 16 proteins was investigated in a human single lymphocyte using RT-nested PCR method. Examined mRNAs were for IL-2, CD8, progesterone receptor, parathyroid hormone, gastrin, glucagon, cholecystokinin/pancreozymin, insulin, enkephalin, thyroid stimulating hormone, MUC1, MAGE1, pregnancy-specific beta-1 glycoprotein 4, phenylethanolamine-N-methyltransferase, beta B3-crystallin and HOX4A. Most of the proteins were thought to be functionally irrelevant to a lymphocyte. All of them were detected in a lymphocyte without exception. The result suggests that there is a possibility of all mRNA expression in a human single cell.

Possible involvement of calpain in the growth of estrogen receptor positive breast cancer cells

Calpain (Ca2(+)-activated neutral protease, EC 3.4.22.17) has been reported to hydrolyze the estrogen receptor (ER). However, there has been no report available regarding the role of calpain in the growth of breast cancer cells. To investigate the role of calpain in the growth of various breast cancer cell lines, we employed a synthetic peptide, calpeptin, which is a cell permeable specific inhibitor of calpain. Calpeptin inhibited the cell growth of ER positive breast cancer cells, such as MCF-7, T-47D, and ZR-75-1 in a dose dependent manner in the presence of E2. However, the growth of ER negative breast cancer cells, MDA-MB-231, was not inhibited by calpeptin. It is suggested that calpain plays an important role in the growth of ER positive breast cancer cells.

Polyethylene glycol-modified pokeweed mitogen (PWM) as a potential non-immunogenic stimulator of lymphokine-activated killer cells

Among the various plant lectins, pokeweed mitoge (PWM) is most effective in enhancing the cytotoxicity of human lymphokine-activated killer (LAK) cells. However, the use of PWM in adoptive immunotherapy has been limited due to the strong immune response against the protein of plant origin. Amino groups in PWM was modified with 2,4-bis[O-methoxypoly(ethylene glycol)]-6-chioro-s-triazine, activated PEG2, to form PEG-PWM conjugates. Its immunoreactivity towards anti-PWM antibodies was reduced by increasing the degree of modification of amino groups in PWM. PEG-PWM, in which 54% of amino groups in PWM was modified with activated PEG2, had a nearly complete reduction of immunoreactivity. Intraperitoneal administration of PEG-PWM to mice did not produce substantial levels of anti-PWM antibodies. Nevertheless, PEG-PWM retained the ability to induce the maximum levels of cytotoxicity of human LAK cells in vitro.

Apoptosis as a mechanism of lectin-dependent monocyte-mediated cytotoxicity

In this study we investigated the mechanisms of cytotoxicity mediated by pokeweed mitogen (PWM)-activated human peripheral blood monocytes. By using DNA electrophoresis and propidium iodide (PI)-DNA staining flow cytometry, we demonstrated that apoptotic cell death of target U937 cells and Raji cells was induced in lectin (PWM)-dependent monocyte-mediated cytotoxicity (LDMC). The LDMC-mediated DNA fragmentation in U937 cells and Raji cells was induced in lectin (PWM)-dependent monocyte mediated cytotoxicity(LDMC). The LDMC-mediated DNA fragmentation in U937 cells was completely inhibited by anti-TNF alpha monoclonal antibody (mAb), but not by the addition of monosaccharide (N-acetylglucosamine, GlcNAc, a sugar specifically recognized by PWM and a lectin-like receptor on monocytes). In contrast, GlcNAc inhibited the DNA fragmentation in Raji cells induced by LDMC which the anti-TNF alpha mAb had no effect. PWM was found to stimulate the production of nitric oxide (NO) from monocytes. The NO-production was enhanced in the presence of target Raji cells, while the enhancement was abolished by the treatment with GlcNAc. By flow cytometry, we found that PWM bound to tumour cells as well as monocytes, and inhibited the expression of HLA-DR antigen on tumour cells. These results suggest that the presence of lectin molecules on the surface of monocytes and tumour cells may bring the two cells together, thus facilitating the induction of apoptosis in target cells by triggering the production of cytolytic factors (TNF and NO) and the modification of target cell surface antigen (HLA-DR).

Gene transcripts of eleven proteins with specific functions are all detected in human normal cells and tumor cell lines: a possible DNA-->RNA basal constant flow

Existance of messenger ribonucleic acids of eleven functionally differentiated proteins in normal human cells and tumor cell lines was investigated using reverse transcription--nested polymerase chain reaction method. Examined gene transcripts were those of progesterone receptor, estrogen receptor, interleukin 2, CD8, parathyroid hormone, cholecystokinin/pancreozymin, glucagon, insulin, adrenocorticotropic hormone, enkephalin and thyroid stimulating hormone. In RT-PCR almost all primers were originally designed and sequences of PCR products were confirmed by the Sanger's method. Investigated cells were normal human peripheral mononuclear cells and their subsets, lymphokine-activated killer cells, gastric mucosal cells, sperm and fifteen established tumor cell lines. All of the examined mRNAs were detected in all of the above cell groups. Therefore, cells of independent tissues or tumors share same kinds of mRNA such as steroid hormone receptors, cytokine, lymphocyte surface molecule and parathyroid, digestive and cerebral hormones. These findings strongly suggest that every cell can express every mRNA. Beneath the cell differentiation there may exist a DNA-->RNA basal constant flow, the arrow of time captured in a cell.

Senile plaques and other senile changes in the brain of an aged American black bear

A female American black bear (Euarctos ursus americanus) over 20 years old had shown epileptiform neurologic signs starting in March 1992 and was found dead unexpectedly 8 months later. At necropsy, pulmonary and intrabronchial hemorrhage was noted. In the brain, the leptomeninges exhibited slight thickening, and petechiae were evident in the hippocampus. Histopathologic examination of the brain revealed several senile changes: numerous senile plaques, amyloid deposition in cerebromeningeal arterioles, mineral deposition in the pallidum, and numerous corpora amylacea in the cerebellum.

[Therapeutic strategy for anaplastic carcinoma and malignant lymphoma of the thyroid]

Therapeutic strategies for anaplastic carcinoma and malignant lymphoma of the thyroid are reviewed. Because of the rarity of both diseases among thyroid malignancies, the generally accepted treatment policy has not been established, although the importance of radiation therapy and chemotherapy has been well recognized for the treatment of both diseases. Hyperfractionated radiation therapy combined with suitable systemic chemotherapy will counter anaplastic thyroid carcinoma and prolong survival. Most patients with thyroid malignant lymphoma have better prognoses than anaplastic carcinoma patients. But delayed diagnosis and inadequate treatment still results in a poor prognosis, in spite of the more treatable characteristics of thyroid malignant lymphoma than anaplastic thyroid carcinoma. At present, early detection of the tumor and selection of a suitable therapy is necessary for the improvement of prognosis, and further clinical studies are required to establish effective regimens for multidisciplinary treatment.

Penile prostheses for the management of the neuropathic bladder and sexual dysfunction in spinal cord injury patients: long term follow up

During the last 10 years, 90 penile prostheses were implanted in 82 patients with spinal cord injury. Surgery was done 1 month to 25 years (average 4.8 years) after the injury. The follow up period ranged from 1 to 10 years (average 4 years). A prosthesis was implanted for urinary management in 51 patients (62%), for sexual dysfunction in 10 patients (12%) and for both purposes in 21 patients (26%). Ninety-three per cent of the patients who used the implant for urinary management and 64% of the patients who used it for sexual dysfunction were satisfactory. We experienced three extrusions and nine surgical removals due to pain, difficulty of catheterisation and infection (the complication rate was 13.3%). Generally speaking, a penile prosthesis improves the quality of life of patients with spinal cord injury significantly; however, extrusion and infection are still significant problems.