Cytokines, Vascular Endothelial Growth Factors, and PlGF in Autoimmunity: Insights From Rheumatoid Arthritis to Multiple Sclerosis

In this review, we will explore the intricate roles of cytokines and vascular endothelial growth factors in autoimmune diseases (ADs), with a particular focus on rheumatoid arthritis (RA) and multiple sclerosis (MS). AD is characterized by self-destructive immune responses due to auto-reactive T lymphocytes and Abs. Among various types of ADs, RA and MS possess inflammation as a central role but in different sites of the patients. Other common aspects among these two ADs are their chronicity and relapsing-remitting symptoms requiring continuous management. First factor inducing these ADs are cytokines, such as IL-6, TNF-α, and IL-17, which play significant roles in the pathogenesis by contributing to inflammation, immune cell activation, and tissue damage. Secondly, vascular endothelial growth factors, including VEGF and angiopoietins, are crucial in promoting angiogenesis and inflammation in these two ADs. Finally, placental growth factor (PlGF), an emerging factor with bi-directional roles in angiogenesis and T cell differentiation, as we introduce as an "angio-lymphokine" is another key factor in ADs. Thus, while angiogenesis recruits more inflammatory cells into the peripheral sites, cytokines secreted by effector cells play critical roles in the pathogenesis of ADs. Various therapeutic interventions targeting these soluble molecules have shown promise in managing autoimmune pathogenic conditions. However, delicate interplay between cytokines, angiogenic factors, and PlGF has more to be studied when considering their complementary role in actual pathogenic conditions. Understanding the complex interactions among these factors provides valuable insights for the development of innovative therapies for RA and MS, offering hope for improved patient outcomes.

Canine discrimination of ovarian cancer through volatile organic compounds

Ovarian cancer has a high mortality rate due to its unclear symptomology and the lack of precise early detection tools. If detected in the first stage, over 90% of patients reach remission. As such, developing a reliable method of early detection is crucial in reducing the mortality rate of the disease. One potential method would be to identify specific biomarkers that are unique to ovarian cancer, which could be detected using a blood test. While this can be done using gas chromatography - mass spectrometry (GC-MS), identifying these biomarkers is an enormous task. One way to expedite the process is to utilize trained scent detection canines. In this study, dogs who were previously trained to respond to positive blood samples from ovarian cancer patients were then tested on their ability to recognize samples prepared by micro-preparative gas chromatography (MP-GC) techniques. MP-GC employed a gradient-cooled glass tube connected to the GC outlet to collect GC eluents containing the plasma-derived volatiles in positive blood samples. These post-column fractions were collected at the exit of the GC according to their eluent times (i.e., 0-15 min, 15-25 min and 25-35 min or 0-35 min) and these full or fractional collections were presented to the trained dogs to judge their responses. Dogs' time spent investigating the odor was used as an indication of odor recognition and was significantly longer on the early (0-15 min) and middle (15-25 min) fractions of the ovarian cancer than the late (25-35 min) fraction of plasma odorants or either the negative fractions or distractors odorants. These findings suggest that characteristic odor biomarkers of ovarian cancer for dogs may exist in the relatively small and more volatile compounds. Additionally, variation between dogs suggests that there may be a number of different biomarkers that can be used to identify ovarian cancer.

Effects of Pre-Existing Liver Disease on Acute Pain Management Using Patient-Controlled Analgesia Fentanyl With Parecoxib After Major Liver Resection: A Retrospective, Pragmatic Study

BACKGROUND

The aim of this study was to compare the outcomes of pain management with the use of patient-controlled analgesia (PCA) fentanyl with IV parecoxib between patients with healthy liver with patients with diseased liver undergoing major liver resection.

METHODS

Patients with healthy liver undergoing partial hepatectomy as liver donors for liver transplantation (group 1) and patients with liver cirrhosis (Child's criteria A) undergoing major liver resection for hepatoma (group 2) were identified retrospectively. Both groups routinely received post-operative IV PCA fentanyl and a single dose of parecoxib 40 mg. They were followed up for 3 days or until PCA fentanyl was discontinued post-operatively. Daily Visual Analog Scale, PCA fentanyl usage, rescue attempts, and common drug side effects were collected and analyzed with the use of SPSS version 20.

RESULTS

One hundred one patients were included in the study: 54 in group 1, and 47 in group 2. There were no statistical differences between the two groups in terms of the daily and total fentanyl usage, VAS resting, and incidence of itchiness. The rate of rescue analgesia on post-operative day (POD) 1 was lower in group 2, with a value of P = .045. VAS dynamics were better on POD 1 and 2 for group 2, with P = .05 and P = .012, respectively.

CONCLUSIONS

We found that combining a single dose of IV parecoxib 40 mg with PCA fentanyl is an easy and effective method of acute pain control after major liver resection. We propose the careful usage of post-operative fentanyl and parecoxib in patients with diseased liver, given the difference in effect as compared with healthy liver.

Correlation Between Changes in End-Tidal Carbon Dioxide Concentration and Cardiac Output During Inferior Vena Cava Clamping and Unclamping in Living-donor Liver Transplantation

BACKGROUND

To test the hypothesis that low end-tidal carbon dioxide tension encountered during anhepatic phase in liver transplantation is related to hemodynamic status rather than ventilatory status, and can be used to predict the change in cardiac output during anhepatic phase.

METHODS

We retrospectively analyzed and compared data, included end-tidal carbon dioxide tension (ETCO2), arterial blood pressure, heart rate, central venous pressure, cardiac output, cardiac index, and stroke volume, before and after inferior vena cava clamping, and 0, 5, 10, 30 minutes during the anhepatic, and 5 minutes after the release of IVC cross clamp during the reperfusion phase, with paired Student t test, repeated measurement, and linear regression. P < .05 was regarded as significant.

RESULTS

The cardiac output and ETCO2 decrease significantly after clamping the inferior vena cava and increase concomitantly after unclamping. There is a positive correlation between the changes in % in cardiac output and ETCO2 (Pearson coefficient r = 0.741).

CONCLUSION

The changes in ETCO2 can be used to predict the changes of the cardiac output in % when cardiac output monitoring is not available. Before unclamping of the IVC, mild hyperventilation is suggested to prevent excessive increase in PaCO2.

A systematic review of diagnostic accuracy of vertebral fracture assessment (VFA) in postmenopausal women and elderly men

This systematic review was performed to compare the diagnostic accuracy of vertebral fracture assessment (VFA) with that of spinal radiography for identification of vertebral fractures (VFs). VFA appeared to have moderate sensitivity and high specificity for detecting VFs when compared with spinal radiography.

INTRODUCTION

VFs are recognized as the hallmark of osteoporosis, and a previous VF increases the risk of a future fracture. Therefore, the timely detection of VFs is important for prevention of further fractures. This systematic review examined the diagnostic accuracy of VFA using dual X-ray absorptiometry (DXA) to identify VFs.

METHODS

We searched for potentially relevant studies using electronic databases, including Ovid-Medline, Ovid-EMBASE, Cochrane library, and four Korean databases, from their inception to May 2013. We compared the diagnostic accuracy of VFA with that of spinal radiography for detection of VFs by analyzing the sensitivity and specificity using a 2 × 2 contingency table. Subgroup analyses were also performed on studies with a low risk of bias and applicability.

RESULTS

Twelve studies were analyzed for the diagnostic accuracy of VFA. The sensitivity and specificity were 0.70-0.93 and 0.95-1.00, respectively, analyzed on a per-vertebra basis, and 0.65-1.00 and 0.74-1.00 on a per-patient basis. The sensitivity and specificity of five studies in subgroups with a low risk of bias in the intervention test were 0.70-0.84 and 0.96-0.99, respectively. In studies with a low risk of bias in the patient selection, those based on a per-vertebra basis in three studies were 0.70-0.93 and 0.96-1.00, respectively.

CONCLUSIONS

VFA had moderate sensitivity and high specificity for detecting VF when compared with spinal radiography. However, the present findings are insufficient to assess whether spinal radiography should be replaced by VFA.

The behavioral effect of human mesenchymal stem cell transplantation in cold brain injured rats

We investigated the effect of stereotaxically transplanted human mesenchymal stem cells (hMSCs) on behavioral change after traumatic cold brain injury in adult rats. Cortical lesions (n= 20) were induced by touching a metal stamp, cooled with liquid nitrogen, to the dura over the forelimb motor cortex of adult rats. The procedure produced a localized lesion, and the animals showed significant motor deficits. hMSCs were freshly isolated from human iliac bone and cultured in tissue culture flasks with 10 ml Dulbecco's modified Eagle's medium. The animals received hMSC grafts (3 x 10(5) hMSCs) 6 days after cold lesion (n = 10). All rats were sacrificed 3 or 7 weeks after cold injury, and immunohistochemical staining was performed on brain sections to identify donor hMSCs. Neurological evaluations were performed with the forepaw adjusting step test and modified neurological scoring. Treatment with 3 x 10(5) hMSCs improved the rat's neurological functions. We also found that the transplanted cells successfully migrated into the injured brain, preferentially localized around the injury site, and expressed the neuronal and astrocyte marker. These data suggest that hMSCs may be a potential therapeutic tool for brain injuries.

Identification of differentially expressed mRNA during pancreas regeneration of rat by mRNA differential display

Pancreatectomy (Px) is known to cause islet hypertrophy and is a putative method to mimic hyperglycemia representing type II diabetes mellitus. Therefore, finding new genes related to pancreatectomy will help to understand the molecular mechanism of hypertrophy and hyperglycemia, and may provide new diagnostic markers of type II diabetes. To this end, mRNA differential display was used to isolate genes that show transcriptional changes in pancreas of rat after 90% partial pancreatectomy. Forty-nine candidate pancreas regeneration-associated transcripts were isolated. cDNA sequencing and subsequent database analysis revealed that 15 transcripts showed no significant sequence similarity to previously reported genes, whereas 34 transcripts showed significant similarity with genes deposited in the GenBank. The differential mRNA expression of 49 transcripts was confirmed using screening of slot blots and Northern blot analysis was performed to several genes. It was noteworthy that the Wnt-1 inducible signaling pathway protein-1 (WISP-1), Ras-associated protein 1B (Rap1B), vascular cell adhesion molecule-1 (VCAM-1), and huntingtin interacting protein genes (HIP) were observed to be over-expressed during pancreas regeneration. Several genes' expression was modified by pancreatectomy. Profiling of gene expression in response to pancreatectomy may lead to new insights into hypertrophy and hyperglycemia representing type II diabetes, as well as into the identification of novel diagnostic markers of type II diabetes.

Isolation and characterization of a cell-associated protein of Bacillus pumilus PH-01

A cell-associated protein released from Bacillus pumilus PH-01 showed an affinity for some dioxins, like 1,2,3,4-tetrachlorodibenzo-p-dioxin (TCDD) and 1,2,3,4-tetrachlorodibenzofuran (TCDF), and the concentration of the protein increased when B. pumilus PH-01 was boiled in minimal salts medium. Sodium dodecyl sulfate-polyacrylamide gel electrophoresis and matrix-assisted laser desorption ionization-mass spectrometry revealed that the boiled culture supernatant contained a major protein with a molecular mass of 5,313.4 Da. The adsorption behavior of the protein for 1,2,3,4-TCDD and 1,2,3,4-TCDF was examined by digesting it with proteinase K and trypsin, showing that the proteolyzed protein lost the ability to adsorb the compounds. The amino acid sequence of the protein was determined by automated Edman degradation and tandem mass spectrometry. A search of the protein databases showed no existence of proteins with an homologous sequence.

Molecular genetic analysis of reovirus isolated in Korea

Reovirus isolates from human, striped-field mouse (Apodemus agrarius) and Korean field mouse (A. peninsulae) in Korea showed extensive variability in the patterns of electrophoretic migration of the double-stranded RNA (dsRNA) genome segments. Hemagglutination inhibition (HI) test was performed for serotype determination of 12 reovirus isolates. To clarify genetic diversity and molecular phylogeny of Korean reoviruses, L1, S3 and S4 genomic segments of reoviruses were amplified by RT-PCR and directly sequenced. Among 12 reovirus strains, 9 strains were type 3 and 3 strains were type 2. The L1 was highly conserved showing 91.5-100%, 94.7-100% similarities among Korean isolates, and 77.5-97.9%, 92.6-96.8% similarities compared to other reference strains of each genotypes at nucleotide and amino acid levels, respectively. In S3 and S4 segments, 84.4-99.3%, 72.3-99% nucleotide sequence similarities and 92-99.3%, 89.1-98.4% amino acid sequence similarities among Korean isolates were observed, and 70.8-93.9%, 72.3-98.7% nucleotide sequence similarities and 81.8-100%, 88.3-97.7% amino acid sequence similarities compared with other reference strains of each genotype were observed, respectively. Phylogenetic analyses based on the S3 and S4 nucleotide sequences indicate that genotypes of reovirus are more related with geographic differences rather than host species or date of isolation.

Giant cell formation in cells exposed to 740 nm and 760 nm optical traps

BACKGROUND AND OBJECTIVE

Optical trapping is becoming a useful and widespread technique for the micromanipulation of cells and organelles. Giant cell formation following optical trapping was studied to detect the potential adverse effects.

STUDY DESIGN/MATERIALS AND METHODS

The nuclei of preselected single CHO cells were exposed to 740 nm and 760 nm laser microbeam generated by a titanium-sapphire tunable laser at 88 and 176 mW and different time exposures. The irradiated single cells were recorded and observed morphologically following exposure. Giant cells were tabulated and photographed.

RESULTS

The irradiated cells either failed to divide, or they underwent nuclear proliferation to form giant cells through endoreduplication.

CONCLUSION

Giant cells were induced by both 740 nm and 760 nm. The frequency of giant cell formation was higher for the longer time exposures and at the higher power densities. The use of an optical etalon to remove intracavity mode beating and high peak powers of the titanium-sapphire laser caused a significant reduction in the formation of giant cells.

Subcellular phototoxicity of 5-aminolaevulinic acid (ALA)

BACKGROUND AND OBJECTIVE

5-aminolaevulinic acid (ALA) is a new, promising photosensitizer for PDT of cancer. Subcellular toxicity induced by ALA and light exposure in single cells was studied to elucidate the mechanism of cell damage.

STUDY DESIGN/MATERIALS AND METHODS

CPAE, PTK2, and rat neonatal myocardial cells treated with ALA were examined for localization using fluorescence microscopy and for subcellular phototoxicity using 630 nm laser microbeam irradiation of specific subcellular regions.

RESULTS

In CPAE and PTK2 cells, a large amount of fluorescence was detected in the peri-nuclear cytoplasm. In rat neonatal myocardial cells, the sensitizer selectively localized in the large mitochondria. In both cell types, there was little phototoxicity when the peripheral cytoplasmic region was exposed, as compared to considerable phototoxicity with exposure of either the perinuclear or nuclear regions.

CONCLUSION

Both the CPAE and PTK2 cells demonstrated that the nucleus followed by the perinuclear cytoplasm are the most sensitive cell areas with no sensitivity in the peripheral cytoplasm.

Characterization of chromosomal breakpoints in an ALL patient using cross-species color banding

Cross-species color-banded karyotype (Rx-FISH) results were compared with those of conventional G-banded metaphases from the same sample. Breakpoints and karyotype were confirmed as 46,XX,t(8;22)(q24;q11), der(9)t(1;9)(q21;p13) through the novel technology of cross-species color banding in an acute leukemic patient (ALL, L3); the karyotype was 46,XX,t(8;22)(q24;q11),der(9)t(1;9)(q25;p24) by conventional G-banding.

Asymptomatic familial cerebral aneurysms

PURPOSE

We evaluated the prevalence and features of cerebral aneurysms in the family members of people with asymptomatic aneurysms among 8680 participants undergoing magnetic resonance angiography.

METHODS

Of the 8680 participants, 380 had family histories of aneurysms and 8300 did not. The prevalence and features of asymptomatic aneurysms were compared in these two subgroups. In addition, the prevalence in all living first- or second-degree relatives was evaluated in 20 families.

RESULTS

The prevalence of asymptomatic aneurysms was 7.0% (606 of 8680 participants) overall and 10.5% (40 of 380 participants) and 6.8% (566 of 8300 participants) in the subgroups with and without family histories of aneurysms, respectively. The prevalence in the female participants with family histories of aneurysms (12.3%, 28 of 228 participants) was higher than that in the male participants with family histories of aneurysms (7.9%, 12 of 152 participants) (P < 0.0001). Compared with the entire group, this subgroup more commonly showed aneurysms situated at the junction of the internal carotid and posterior communicating arteries (P < 0.0005) and at the middle cerebral artery (P < 0.0001). The prevalence of aneurysms in 115 members of the 20 families was 33.9%. Although the members of 14 families with aneurysmal subarachnoid hemorrhage showed higher prevalence of ruptured and asymptomatic aneurysms (42.1%) than did the members of 6 families with only asymptomatic aneurysms (17.9%), the former had very low prevalence of asymptomatic aneurysms.

CONCLUSION

The prevalence of aneurysms is significantly elevated in family members of people with asymptomatic aneurysms. It is suggested that familial asymptomatic aneurysms are more likely to rupture in families having members with aneurysmal subarachnoid hemorrhage than in those without.

Characterization of the active site and thermostability regions of endoxylanase from Thermoanaerobacterium saccharolyticum B6A-RI

Deletion mutants were constructed from pZEP12, which contained the intact Thermoanaerobacterium saccharolyticum endoxylanase gene (xynA). Deletion of 1.75 kb from the N-terminal end of xynA resulted in a mutant enzyme that retained activity but lost thermostability. Deletion of 1.05 kb from the C terminus did not alter thermostability or activity. The deduced amino acid sequence of T. saccharolyticum B6A-RI endoxylanase XynA was aligned with five other family F beta-glycanases by using the PILEUP program of the Genetics Computer Group package. This multiple alignment of amino acid sequences revealed six highly conserved motifs which included the consensus sequence consisting of a hydrophobic amino acid, Ser or Thr, Glu, a hydrophobic amino acid, Asp, and a hydrophobic amino acid in the catalytic domain. Endoxylanase was inhibited by EDAC [1-(3-dimethylamino propenyl)-3-ethylcarbodiimide hydrochloride], suggesting that Asp and/or Glu was involved in catalysis. Three aspartic acids, two glutamic acids, and one histidine were conserved in all six enzymes aligned. Hydrophobic cluster analysis revealed that two Asp and one Glu occur in the same hydrophobic clusters in T. saccharolyticum B6A-RI endoxylanase and two other enzymes belonging to family F beta-glycanases and suggests their involvement in a catalytic triad. These two Asp and one Glu in XynA from T. saccharolyticum were targeted for analysis by site-specific mutagenesis. Substitution of Asp-537 and Asp-602 by Asn and Glu-600 by Gln completely destroyed endoxylanase activity. These results suggest that these three amino acids form a catalytic triad that functions in a general acid catalysis mechanism.

Gene cloning, sequencing, and biochemical characterization of endoxylanase from Thermoanaerobacterium saccharolyticum B6A-RI

The gene encoding endoxylanase (xynA) from Thermoanaerobacterium saccharolyticum B6A-RI was cloned and expressed in Escherichia coli. A putative 33-amino-acid signal peptide, which corresponded to the N-terminal amino acids, was encoded by xynA. An open reading frame of 3,471 bp, corresponding to 1,157 amino acid residues, was found, giving the xynA gene product a molecular mass of 130 kDa. xynA from T. saccharolyticum B6A-RI had strong similarity to genes from family F beta-glycanases. The temperature and pH optimum for the activity of the cloned endoxylanase were 70 degrees C and 5.5, respectively. The cloned endoxylanase A was stable at 75 degrees C for 60 min and displayed a specific activity of 227.4 U/mg of protein on oat spelt xylan. The cloned xylanase was an endo-acting enzyme.

Genetic organization, sequence and biochemical characterization of recombinant beta-xylosidase from Thermoanaerobacterium saccharolyticum strain B6A-RI

Endoxylanase (xynA) and beta-xylosidase (xynB) genes from Thermoanerobacterium saccharolyticum were subcloned from a cosmid clone (pXDM1) to generate pXPH3. The nucleotide sequence of a PstI-HindIII fragment in pXPH3 that contained xynB revealed an open reading frame (ORF) of 1500 bp encoding a 55 kDa protein. Another open reading frame (ORF1) of unknown function was found 21 bp downstream from the first stop codon of xynB. xynB, ORF1 and xynA had the same direction of transcription. xynB from T. saccharolyticum strain B6A-RI exhibited 45% amino acid similarity, with 18% amino acid identity to xynA of T. saccharolyticum strain B6A-RI, and 61% similarity and 37% identity with the beta-xylosidase gene from Caldocellum saccharolyticum. Recombinant beta-xylosidase was purified from E. coli (pXPH3) cells. The enzyme was a monomer with a molecular mass of 55 kDa. The specific activity and pH and temperature optima for hydrolysis of p-nitrophenyl-beta-D-xylopyranoside (pNPX) were 5.53 U mg-1, 5.5 and 70 degrees C, respectively. The beta-xylosidase was stable at 65 degrees C, but lost activity at 85 degrees C. The purified enzyme had hydrolytic activity towards xylopentose, xylotriose, xylobiose and pNPX, but had no activity toward xylan.

Cloning, sequencing and biochemical characterization of xylose isomerase from Thermoanaerobacterium saccharolyticum strain B6A-RI

The xylose isomerase gene from Thermoanaerobacterium saccharolyticum strain B6A-RI was cloned by complementation using Escherichia coli xyl-5 mutant strain HB101. One positive clone was detected and the recombinant plasmid, pZX16, was isolated. The clone contained the vector pUC18 and an insert fragment of 4.5 kb. The cloned xylose isomerase gene (xylA) was expressed constitutively in E. coli. The gene contained one open reading frame (ORF) of 1317 bp, which corresponds to 439 amino acid residues. The molecular mass of the gene product was calculated to be 50474 Da from the deduced amino acid sequence. A putative promoter region (Pribnow box), TATAATATATAAT, which repeated twice at the -10 region in E. coli, was found 25 bp upstream of the ribosomal binding site. The deduced amino acid sequence of T. saccharolyticum strain B6A-RI xylose isomerase exhibited very high homology to those from Thermoanaerobacterium thermosulfurigenes 4B (formerly Clostridium thermosulfurogenes 4B) and Thermoanaerobacter ethanolicus 39E (formerly Clostridium thermohydrosulfuricum 39E). Codon usage in xynA, xynB and xylA showed a clear propensity for AT-containing isocodons. The native molecular mass of the purified recombinant thermostable xylose isomerase was 200 kDa, and the enzyme was a tetramer comprised of identical subunits. The apparent temperature and pH optima for activity of the cloned xylose isomerase were 80 degrees C and 7.0 to 7.5, respectively.

Regulation and Characterization of Xylanolytic Enzymes of Thermoanaerobacterium saccharolyticum B6A-RI

During growth on xylan and xylose Thermoanaerobacterium saccharolyticum B6A-RI produced endoxylanase, β-xylosidase, arabinofuranosidase, and acetyl esterase, and the first three activities appeared to be produced coordinately. During nonlimiting growth on xylan, these enzyme activities were predominantly cell associated; however, during growth on limiting concentrations of xylan, the majority of endoxylanase activity was extracellular rather than cell associated. Endoxylanase, β-xylosidase, and arabinofuranosidase activities were induced by xylan, xylose, and arabinose, respectively. Acetyl esterase activity was constitutive, and endoxylanase activity was catabolite repressed by glucose. Extracellular endoxylanase existed as a high-molecular-weight complex (molecular weight, more than 10 6 ). When analyzed by sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE) and zymograms, the crude endoxylanase complex was composed of at least six activity bands. Endoxylanase was purified by gel filtration with Sephacryl S-300 and affinity chromatography with xylan coupled to Sepharose CL-4B preequilibrated to 45�C with 50 mM sodium acetate buffer (pH 4.0) and eluted with 0.1% soluble xylan. A single area of endoxylanase activity was identified on the zymogram; when this activity was analyzed by SDS-PAGE, it was composed of a major protein with a molecular weight of approximately 160,000 and a minor protein with a molecular weight of approximately 130,000. The endoxylanase activity stained with Schiff's reagent, indicative of glycoproteins, displayed a specific activity of 41 U/mg of protein on xylan, and had pH and temperature optima of 6.0 and 70�C, respectively.

Cloning and expression of the Clostridium thermosulfurogenes glucose isomerase gene in Escherichia coli and Bacillus subtilis

The gene that encodes thermostable glucose isomerase in Clostridium thermosulfurogenes was cloned by complementation of glucose isomerase activity in a xylA mutant of Escherichia coli. A new assay method for thermostable glucose isomerase activity on agar plates, using a top agar mixture containing fructose, glucose oxidase, peroxidase, and benzidine, was developed. One positive clone, carrying plasmid pCGI38, was isolated from a cosmid library of C. thermosulfurogenes DNA. The plasmid was further subcloned into a Bacillus cloning vector, pTB523, to generate shuttle plasmid pMLG1, which is able to replicate in both E. coli and Bacillus subtilis. Expression of the thermostable glucose isomerase gene in both species was constitutive, whereas synthesis of the enzyme in C. thermosulfurogenes was inducible by D-xylose. B. subtilis and E. coli produced higher levels of thermostable glucose isomerase (1.54 and 0.46 U/mg of protein, respectively) than did C. thermosulfurogenes (0.29 U/mg of protein). The glucose isomerases synthesized in E. coli and B. subtilis were purified to homogeneity and displayed properties (subunit Mr, 50,000; tetrameric molecular structure; thermostability; metal ion requirement; and apparent temperature and pH optima) identical to those of the native enzyme purified from C. thermosulfurogenes. Simple heat treatment of crude extracts from E. coli and B. subtilis cells carrying the recombinant plasmid at 85 degrees C for 15 min generated 80% pure glucose isomerase. The maximum conversion yield of glucose (35%, wt/wt) to fructose with the thermostable glucose isomerase (10.8 U/g of dry substrate) was 52% at pH 7.0 and 70 degrees C.

[Pneumothorax, subcutaneous emphysema and mediastinal emphysema in transnasally intubated patients]

A 41-year-old woman was admitted to our clinic because of an acute subdural hematoma. After an emergency operation her neurological status improved with an increase in the Glasgow Coma Scale score from 6 to 11. On the second postoperative day she developed frequent episodes of clonic convulsive seizures localized in the face and the left upper extremity, and her level of consciousness deteriorated. Next day she was transnasally intubated for respiratory management, but no mechanical ventilation was required. While she was undergoing the CT scanning 5 days after intubation, respiratory arrest and cyanosis developed all of a sudden, and her face and neck became swollen. The chest x-ray revealed a marked subcutaneous emphysema, mediastinal emphysema and bilateral pneumothorax. CT at that time showed a diffuse low density area in the right hemisphere, and a marked midline shift returned. She did not regain consciousness and died 12 days after the incident. At autopsy an ulcer was observed in the wall of the trachea, where the tip or the cuff of the transnasal tracheal tube was supposed to be present. No perforation, however, was there. Case 2: A 75-year-old woman was admitted to our hospital because of SAH. In hospital course she was also transnasally intubated and required no mechanical ventilation. When she was undergoing the CT scanning 3 days after intubation, she developed subcutaneous and mediastinal emphysema similarly to case 1. Although it is reported to be not a rare complication in patients on a mechanical ventilator, subcutaneous emphysema or pneumothorax is extremely rare in those intubated patients with spontaneous respiration. The mechanism of these complications in these cases is briefly discussed.

Purification and characterization of a novel thermostable beta-amylase from Clostridium thermosulphurogenes

An extracellular beta-amylase from Clostridium thermosulphurogenes was purified 811-fold to homogeneity, and its general molecular, physico-chemical and catalytic properties were determined. The native enzyme was a tetramer of 210 kDa composed of a single type subunit; its 20 amino acid N-terminus displayed 45% homology with Bacillus polymyxa beta-amylase. The beta-amylase was enriched in both acidic and hydrophobic amino acids. The pure enzyme displayed an isoelectric point of 5.1 and a pH activity optimum of 5.5. The optimum temperature for beta-amylase activity was 75 degrees C, and enzyme thermostability at 80 degrees C was enhanced by substrate and Ca2+ addition. The beta-amylase hydrolysed amylose to maltose and amylopectin and glycogen to maltose and limit dextrins, and it was inhibited by alpha- and beta-cyclodextrins. The enzyme displayed kcat. and Km values for boiled soluble starch of 400,000 min-1 per mol and 1.68 mg/ml, respectively. The enzyme was antigenically distinct from plant beta-amylases.

Non-Hodgkin's lymphoma of the pleural cavity developing from long-standing pyothorax

Malignant lymphomas developing in tissue affected by a long-standing severe inflammatory process of nonautoimmune nature are presented. Two men and a woman aged 50, 58, and 73 years, were admitted after 22 to 30 year histories of pyothorax resulting from artificial pneumothorax for the treatment of pulmonary tuberculosis or tuberculous pleuritis. The diagnoses at admission were chronic pyothorax associated with a lung mass. Microscopically, tumors diffusely or locally proliferated with thickened pleura were present. A histologic examination showed that all the tumors were diffuse non-Hodgkin's lymphomas (NHL) of immunoblastic type with (one case) or without (two cases) plasmacytoid differentiation. Immunohistochemistry on paraffin sections revealed restricted expression of immunoglobulin light chains in one case showing plasmacytoid differentiation. A review of the literature showed that malignant lymphomas of this type have been reported exclusively from Japan but never from Western countries.

The impact-absorbing effects of facial fractures in closed-head injuries. An analysis of 210 patients

A series of 210 patients with facial fractures sufficiently severe to require cranial computerized tomography (CT) to evaluate suspected closed-head injury (CHI) was studied. The injuries were separated into five grades of severity based on neurological examination, including cranial CT. The injuries were also grouped into three categories based on facial regional involvement, using chi-square contingency table analysis. The data demonstrated that patients with upper facial fractures were at greatest risk for serious CHI. Injuries to both the mandibular and the midfacial regions with no upper facial involvement more frequently resulted in mild CHI with a modest likelihood of no neurological deficits. Trauma to only the mandibular region or to only the midfacial region was least likely to involve CHI.

[Chronic empyema: key-point and results of our one-step operation]

A new operative method named as "Extraperiosteal air plombage" against chronic empyema were performed to 80 patients and its cure rate by the first operation was 93.8% which is a good and high rate. Know-how to perform the operation without failure is (1) to complete the excoriation of the pleural debris, (2) to seal completely the leakage such as bronchiolar fistula, (3) to perform the extraperiosteal abbration rather over much to attach the lung to the muscle layer, (4) to close the chest wall completely, and (5) to wash out thoroughly the extraperiosteal cavity with brush and enough saline solution and to use the effective antibiotica.

[Surgical therapeutic planning for non-small cell lung cancer]

The survival rates of 380 resected cases of lung cancer in our hospital were analyzed according to curability and histological cell type. The overall 5-year survival rate for stage I a cases was 64.5%, that for stage I b 52.3%, and that for stage II 26.7%. However, there were distinct differences in survival rates between stages I a-II with mediastinal lymph node dissection and those without mediastinal lymph node dissection. Of these 380 tumors, many were advanced (for instance, stage III tumors comprised 180 cases). T3 tumors had better prognosis (40.7% showing 5-year survival) than N2 tumors (26.7% showing 5-year survival). Among stage III tumors, squamous cell carcinoma (T3: 41%, N2: 36.7% showing 5-year survival) had a better prognosis than adenocarcinoma (T3: 16.1%, N2: 21.4%). T3N2 tumors, however, had such a poor prognosis that the value of surgery in these cases seemed questionable. Adjuvant therapy should therefore be evaluated accurately in future to improve prognosis. It was stressed that a randomized controlled study would be needed to evaluate the effectiveness of adjuvant therapy.

Chiasmal syndrome in sarcoidosis

Four patients had involvement of the anterior visual pathway by sarcoidosis. In two cases recognition of the systemic disease was delayed because only visual symptoms were present. Three cases had evidence of hypothalamic-pituitary axis dysfunction, with histologically proved granulomatous infiltration of this region. The chiasmal syndrome in sarcoidosis is characterized by a pattern of blindness in one eye, atrophy of the optic discs, and temporal visual field loss in the contralateral eye with variable degrees of pituitary dysfunction. The condition is medically treatable and simulates the clinical and even the roentgenographic appearance of a pituitary tumor.

Bronchodilator effects of low doses of oral theophylline and terbutaline in asthmatic subjects

The acute pulmonary and cardiovascular effects of single doses of theophylline 130 mg and terbutaline 2.5 mg administered alone and in combination were compared with placebo over a period of seven hours in 16 stable asthmatic subjects. Terbutaline 2.5 mg produced significant bronchodilatation that peaked at three hours and lasted for four to six hours. Theophylline 130 mg produced small increments in serum theophylline concentration (1.5-4.5 microgram/ml), did not produce greater bronchodilatation than placebo and did not provide additional bronchodilatation when combined with terbutaline 2.5 mg. The clinical implications of these findings with respect to the possible utility of combining low doses of theophylline with low doses of a beta-adrenergic stimulant are discussed.

Effect of pancuronium on intraocular pressure changes induced by succinylcholine

The study was undertaken to evaluate the influence of pretreatment with a small dose of pancuronium on intraocular pressure changes associated with administration of succinylcholine and tracheal intubation. Thirty patients divided into control and study groups were anaesthetized with sodium thiopentone (3-5 mg mg.kg-1) and intubation with the aid of succinylcholine (1 mg.kg-1). The control group received saline pretreatment while the study group received pancuronium 1 mg three minutes before succinylcholine. Anaesthesia was maintained with nitrous oxide and oxygen (70:30). A Schiotz tonometer was used to measure intraocular pressure before induction of anaesthesia, one minute after succinylcholine and immediately after intubation. Patients in the control group demonstrated significant elevation of intraocular pressure at one minute after succinylcholine and immediately after intubation, while the study group showed no significant change at the same observation periods. These findings indicate that pretreatment with pancuronium 1 mg three minutes before succinylcholine may be beneficial in patients with high intraocular pressure and penetrating injuries of the eye.

Basal ganglia calcification in Kearns-Sayre syndrome

The Kearns-Sayre syndrome (KSS) appears to be a distinctive disorder characterized by progressive external ophthalmoplegia, pigmentary degeneration of the retina, heart block, and elevated CSF protein levels. Recent reports have suggested that abnormalities of muscle mitochondria may also be a consistent finding in KSS. We recently examined a patient with KSS whose skeletal muscle contained abnormal mitochondria. In addition, a computerized tomographic scan of the head showed cerebellar and brain stem atrophy, as well as calcification in the region of the basal ganglia.

Meningioma of the paranasal sinuses

Meningiomas originating in the paranasal sinuses are rare. These tumors are thought to arise from embryonal arachnoid nests which were pinched off and left behind during embryonic development. We have described various radiographic findings of two patients with meningioma arising in the paranasal sinuses (frontal sinus origin in a 65-year-old female, and sphenoid sinus origin in a 26-year-old female). The paranasal origin of meningioma was accurately determined on the basis of CT and arteriography. A review of the 11 cases previously reported and our cases indicates that there are no specific clinical or radiographic findings of meningiomas of the paranasal sinuses.

Spontaneous spinal epidural hematoma in the young

There have been few descriptions of spontaneous epidural hematoma of the spinal cord in children. Duration of symptoms in previous cases has varied from hours to days. We recently evaluated a 6-year-old girl with cord compression from an extradural clot, who complained of thoracic back pain for 3 months before becoming paraplegic. Our experience suggests that spontaneous epidural bleeding may be responsible for episodic back pain and cord compression in children.

Subacute effects of heavy marihuana smoking on pulmonary function in healthy men

To evaluate the subacute effects of heavy marihuana smoking on the lung, pulmonary function was tested in 28 healthy young male experienced cannabis users, before and after 47 to 59 days of daily ad-libitum marihuana smoking (mean of 5.2 marihuana cigarettes per day per subject, 2.2 per cent delta9-tetrahydrocannabinol). Base-line pulmonary-function studies were nearly all within normal limits, but after 47 to 59 days of heavy smoking, statistically significant decreases in forced expired volume in one second (3 +/- 1 per cent, S.E.), maximal mid-expiratory flow rate (11 +/- 2 per cent), plethysmographic specific airway conductance (16 +/- 2 per cent) and diffusing capacity (8 +/- 2 per cent) were noted as compared with the base-line studies. The decreases in maximal mid-expiratory flow rate and specific airway conductance were correlated with the quantity of marihuana smoked. These findings suggest that customary social use of marihuana may not result in detectable functional respiratory impairment in healthy young men, whereas very heavy marihuana smoking for six to eight weeks causes mild but statistically significant airway obstruction.

Double-blind comparison of acute bronchial and cardiovascular effects of oral terbutaline and ephedrine

Acute effects of oral terbutaline (5 mg), ephedrine (25 mg) and placebo on bronchial dynamics, heart rate, systolic and diastolic pressure and arterial blood gases at rest were compared over a period of 7 hours in 20 subjects with bronchial asthma using a double-blind crossover technique. Both terbutaline and ephedrine caused significant bronchodilation, but the effect of terbutaline on specific airway conductance (SGA) was significantly greater (peak mean increase in SGA 0.069 vs 0.027 L/sec/cm H2O/L), had an earlier onset (30 minutes vs 1 hour) and lasted longer (7 hours vs 4 hours) than that of ephedrine. Slight but significant increases in arterial Po2 were noted following institution of both ephedrine and terbutaline, suggesting improvement in ventilation-perfusion relationships. Both drugs caused modest but statistically significant increases in heart rate of 8.4-10.9 beats/min and the mean peak increase following terbutaline (8.4 beats/min) was comparable to that following ephedrine. In constrast to ephedrine, terbutaline caused significant, although slight, increases in systolic pressure and decreases in diastolic pressure, indicating that this drug, in the dose recommended for clinical use, is not free of cardiovascular effects.