Work-related psychosocial factors and metabolic syndrome onset among workers: a systematic review and meta-analysis

BACKGROUND

Work-related psychosocial factors have been associated with metabolic syndrome. However, no systematic reviews or meta-analyses have evaluated this association.

METHODS

A systematic literature search was conducted, using PubMed, Embase, PsycINFO, PsycARTICLES and the Japan Medical Abstracts Society. Eligible studies included those that examined the previously mentioned association; had a longitudinal or prospective cohort design; were conducted among workers; provided sufficient data for calculating odds ratios, relative risks or hazard ratios with 95% confidence intervals; were original articles in English or Japanese; and were published no later than 2016. Study characteristics, exposure and outcome variables and association measures of studies were extracted by the investigators independently.

RESULTS

Among 4,664 identified studies, 8 were eligible for review and meta-analysis. The pooled risk of adverse work-related stress on metabolic syndrome onset was significant and positive (RR = 1.47; 95% CI, 1.22-1.78). Sensitivity analyses limiting only the effects of job strain and shift work also indicated a significant positive relationship (RR = 1.75; 95% CI, 1.09-2.79; and RR = 1.59; 95% CI, 1.00-2.54, P = 0.049 respectively).

CONCLUSION

This study reveals a strong positive association between work-related psychosocial factors and an elevated risk of metabolic syndrome onset. The effects of job strain and shift work on metabolic syndrome appear to be significant.

Does Internet-based cognitive behavioral therapy (iCBT) prevent major depressive episode for workers? A 12-month follow-up of a randomized controlled trial

BACKGROUND

In this study we investigated whether an Internet-based computerized cognitive behavioral therapy (iCBT) program can decrease the risk of DSM-IV-TR major depressive episodes (MDE) during a 12-month follow-up of a randomized controlled trial of Japanese workers.

METHOD

Participants were recruited from one company and three departments of another company. Those participants who did not experience MDE in the past month were randomly allocated to intervention or control groups (n = 381 for each). A 6-week, six-lesson iCBT program was provided to the intervention group. While the control group only received the usual preventive mental health service for the first 6 months, the control group was given a chance to undertake the iCBT program after a 6-month follow-up. The primary outcome was a new onset of DSM-IV-TR MDE during the 12-month follow-up, as assessed by means of the web version of the WHO Composite International Diagnostic Interview (CIDI), version 3.0 depression section.

RESULTS

The intervention group had a significantly lower incidence of MDE at the 12-month follow-up than the control group (Log-rank χ2 = 7.04, p < 0.01). The hazard ratio for the intervention group was 0.22 (95% confidence interval 0.06-0.75), when estimated by the Cox proportional hazard model.

CONCLUSIONS

The present study demonstrates that an iCBT program is effective in preventing MDE in the working population. However, it should be noted that MDE was measured by self-report, while the CIDI can measure the episodes more strictly following DSM-IV criteria.

Purification and Primary Structure of Proteinousα-Amylase Inhibitor fromStreptomyces chartreusis

A new polypeptide inhibitor, AI-409, that inhibits human salivary alpha-amylase, was purified from a fermentation broth of Streptomyces chartreusis strain No. 409. This protein consists of a single-chain polypeptide of 78 amino acid residues, and includes two disulfide bridges. The primary structure of AI-409 and the locations of the disulfide bridges were identified by enzymatic digestion and the automatic Edman technique. Enzymatic digestion was done with trypsin, carboxypeptidase Y, and chymotrypsin. One of the disulfide bridges was between Cys(10) and Cys(26), and the other between Cys(44) and Cys(71).

Detection of a single bacterial cell using a 16S ribosomal RNA-specific oligonucleotide probe designed to investigate periodontal pathogens

INTRODUCTION

The current detection methods for periodontopathogens mainly use polymerase chain reactions. However, there are few methods available for visualizing the bacteria that impact on patients with periodontal disease for use in health education. The purpose of this study was to develop a specific detection method to visualize periodontopathogenic bacteria.

METHODS

Fluorescently-labeled oligonucleotide probes directed to specific 16S ribosomal RNA (rRNA) sequences of Porphyromonas gingivalis and Aggregatibacter actinomycetemcomitans were synthesized. Cultured individual bacterial species were fixed with 4% paraformaldehyde and smeared on glass slides. Fluorescein isothiocyanate-labeled oligonucleotide probes were hybridized under stringent conditions with smeared whole cells, and then probe specificity was investigated by epifluorescence microscopy.

RESULTS

Comparatively long (50-mer) oligonucleotide probes for P. gingivalis and A. actinomycetemcomitans were designed. These probes clearly hybridized with 16S rRNA of the target species in situ and single bacterial cells were detectable visually. The probes exhibited no cross-hybridization against the additional organisms that were closely related to the target species.

CONCLUSIONS

The fluorescence in situ hybridization technique is a specific and reliable method by which to visually identify the target organisms. The oligonucleotide probes designed in this study will be useful for detecting P. gingivalis and A. actinomycetemcomitans populations.

The effect of intrathecal fentanyl added to hyperbaric bupivacaine on maternal respiratory function during Cesarean section

BACKGROUND

Subarachnoid blockade with local anesthetics induces respiratory depression. Although the addition of fentanyl to bupivacaine has become popular in subarachnoid blockade for Cesarean section, there is no information on the effect of intrathecal fentanyl on maternal spirometric respiratory function in parturients undergoing Cesarean section.

METHODS

We tested the effect of the addition of intrathecal fentanyl to hyperbaric bupivacaine on maternal spirometric performance in 40 consenting parturients undergoing Cesarean section. The parturients were randomized into two groups: those receiving 2.0 ml of hyperbaric bupivacaine 0.5% and 0.4 ml of saline intrathecally and those receiving 2.0 ml of hyperbaric bupivacaine and 0.4 ml of fentanyl (20 microg) intrathecally. We performed spirometry on arriving at the operation room and 15 min after subarachnoid blockade.

RESULTS

Subarachnoid blockade with bupivacaine significantly decreased the peak expiratory flow rate, but did not induce significant changes in vital capacity and forced vital capacity. The addition of intrathecal fentanyl to bupivacaine improved the quality of subarachnoid blockade, but did not lead to a deterioration in respiratory function compared with intrathecal bupivacaine alone.

CONCLUSIONS

The addition of intrathecal fentanyl to hyperbaric bupivacaine did not lead to a deterioration in maternal spirometric respiratory function in parturients undergoing Cesarean section.

Characterization of CO3Ap-collagen sponges using X-ray high-resolution microtomography

For reconstruction and regeneration of hard tissues, scaffold biomaterials with large size pores and high porosity are important, in addition to their roles as supporting frames. To develop a new biodegradable scaffold biomaterial, CO3Ap, which has crystallinity and a chemical composition similar to bone, was synthesized at pH 7.4 and 60 degrees C. Then, the CO3Ap was mixed with a neutralized collagen gel and the CO3Ap-collagen mixtures with different kinds of CO3Ap contents and porosity were lyophilized into sponges. Scanning electron micrography (SEM) observation of CO3Ap-collagen sponges showed favorable pores for cell invasion. Approximately 50-300 microm size pores appeared to continue through the bulk. Higher magnification of the sponge showed a better adhesion between CO3Ap crystals and collagen. X-ray high-resolution microtomography revealed a clear image of the 3D structure of the sponges. The porosity of 0, 70 and 90%(w/w) CO3Ap-collagen sponges was 79.2 +/- 2.8%, 72.6 +/- 2.4% and 48.9 +/- 6.1%, respectively. The 70%(w/w) CO3Ap-collagen sponge appeared to be the most favorable biomaterial from the viewpoint of natural bone properties. Mouse osteoblast MC3T3-E1 cells were cultured in alphaMEM with 10% FCS for 2 weeks. Hematoxylin-eosin staining confirmed osteoblast cells invaded well into the CO3Ap-collagen sponge. These sponges are expected to be used as hard tissue scaffold biomaterials for therapeutic uses.

Action of FGMgCO3Ap-collagen composite in promoting bone formation

To improve the biological properties of materials as bone substitutes, functionally graded CO3 apatite crystals containing magnesium, FGMgCO3Ap, were synthesized to be mixed with atelocollagen and made into a composite pellet. A radio-labeled cell adhesion experiment showed that the degree of adherence of mouse MC3T3E1 osteoblast-like cells to the FGMgCO3Ap-collagen composite was better than to CO3Ap-collagen and much better than to the Ti plate. When the composites were implanted beneath the periosteum cranii of rats, the FGMgCO3Ap-collagen composite was metabolized faster than the CO3Ap-collagen composite and better formation of new bone and osteoblast arrangement at the interface between the composite and the periosteum cranii was observed. When the composites were implanted into the femur of rabbits, clear bone formation with a higher degree of bone density was observed for the FGMgCO3Ap-collagen composite. These results suggest that the Mg2+ ions taken into the apatite crystals may contribute to the acceleration of osteoblast adhesion to apatites and promote bone formation, cross-talking with osteoblasts at the molecular level.

Synthesis of functionally graded MgCO3 apatite accelerating osteoblast adhesion

As a means of improving the biological properties of materials for use as bone substitutes, functionally graded carbonate apatite containing Mg, FGMgCO3Ap, was synthesized at 60 degrees C and pH 7.4 using a gradient magnesium supply system. X-ray diffraction analysis of FGMgCO3Ap showed a poorly crystallized apatitic pattern, similar to that of human bone. ESCA analysis clearly showed the negative gradient distribution in Mg1s intensity (atomic concentration) of magnesium from the crystal surface toward the inner core. When the FGMgCO3Ap crystals were mixed with collagen, the resulting FGMgCO3Ap-collagen composite, irradiated with UV light for 4 h, retained their features in the saline solution. After washing away the nonadhesive cells, a cell adhesion assay showed that the optical density of the FGMgCO3Ap-collagen composite was higher than that of the CO3Ap-collagen composite. SEM observation showed that the osteoblast-like cells adhered well to the surface of the FGMgCO3Ap-collagen composite. Staining with hematoxylin-eosin and alizarin red confirmed the existence of a great many more cells and a thicker extracellular matrix layer on the FGMgCO3Ap-collagen composite than on the CO3Ap-collagen composite. This result demonstrated the acceleration effect of magnesium ions on osteoblast adhesion on the FGMgCO3Ap-collagen composite.

Retention of multilineage differentiation potential of mesenchymal cells during proliferation in response to FGF

Mesenchymal stem cells (MSC) that can differentiate to various connective tissue cells may be useful for autologous cell transplantation to defects of bone, cartilage, and tendon, if MSC can be expanded in vitro. However, a short life span of MSC and a reduction in their differentiation potential in culture have limited their clinical application. The purpose of this study is to identify a growth factor(s) involved in self-renewal of MSC and the maintenance of their multilineage differentiation potential. Fibroblast growth factor-2 (FGF-2) markedly increased the growth rate and the life span of rabbit, canine, and human bone marrow MSC in monolayer cultures. This effect of FGF-2 was more prominent in low-density cultures than in high-density cultures. In addition, all MSC expanded in vitro with FGF-2, but not without FGF-2, differentiated to chondrocytes in pellet cultures. The FGF+ MSC also retained the osteogenic and adipogenic potential throughout many mitotic divisions. These findings suggest that FGFs play a crucial role in self-renewal of MSC.

Expression of syndecan-2, -4, and fibroblast growth factor receptor type 1 in human periodontal ligament fibroblasts and down-regulation of these membrane proteins during maturation in culture

Syndecans are transmembrane heparan sulfate proteoglycans. They are known to interact with basic fibroblast growth factor (bFGF), and it has been suggested that they play important roles in the growth, morphology, and migration of a variety of cell types. We examined the expression of syndecans and fibroblast growth factor receptor type 1 (FGFR1) in periodontal ligament (PDL) cells, because these membrane proteins may play roles in the control of growth and differentiation during regeneration of PDL. Reverse-transcription/polymerase chain-reaction (RT-PCR) showed that PDL cells expressed syndecan-2 and -4 mRNAs. This was confirmed by sequence analysis of the PCR products. When PDL cells were maintained for 25 days, alkaline phosphatase (ALPase) activity gradually increased and reached a maximal level on day 20. Northern blotting analysis showed that PDL cells expressed 2.3-kb syndecan-2, 2.6-kb syndecan-4, and 2.8-kb FGFR1 mRNAs throughout the entire culture period, whereas no syndecan-1 mRNA was detectable by this method. Maximal levels of syndecan-2, -4, and FGFR1 mRNAs were observed on day 5. However, their levels were markedly decreased on days 20 and 25. Accordingly, the inhibitory effect of bFGF on ALPase activity was less on day 20 than on day 5. When PDL cells were pre-treated with heparitinase, a mitogenic response of PDL cells to bFGF was decreased. These observations indicate that PDL cells express syndecan-2, -4, and FGFR1 mRNAs, and that those levels are changed with the increase in ALPase activity in culture. The reductions in syndecan-2, -4, and FGFR1 levels may be involved in the control of growth and differentiation of PDL cells during development and regeneration.

Estradiol enhances the production of mineralized nodules by human periodontal ligament cells

A primary objective in the treatment of periodontal disease is the regeneration of the mineralized and soft connective tissue. PDL cells produce mineralized nodules in vitro which is one of the important functions of PDL cells for regenerative therapy. The purpose of this study was to investigate the effects of estradiol on mineralized nodule formation by human PDL cells. PDL cells were obtained from healthy donors and maintained in DMEM with 10% fetal bovine serum. Serum-free medium was used when the effects of estradiol were tested. ALP activity in the supernatant of cells disrupted by sonication was analyzed spectrophotometrically. The formation of mineralized nodules was assessed by staining the PDL cells with alizarine red and counting the number of nodules. at Estradiol 20 ng/ml significantly enhanced the ALP activity and mineralized nodule formation compared to the control. These results suggested that estrogen status may modify the regenerative activity of periodontal tissue.

Analysis of oestrogen receptor mRNA by reverse transcriptase-polymerase chain reaction in human periodontal ligament cells

Periodontal ligament (PDL) cells have osteoblast-like features and are capable of differentiating into osteogenic cells. As human osteoblasts express oestrogen receptor mRNA, it is possible that PDL cells do so also, but findings have been conflicting. To determine whether they do express oestrogen receptor mRNA, the reverse transcriptase-polymerase chain reaction was performed with two different primers. Cells were obtained from a healthy periodontal ligament of premolar extracted for orthodontic reasons. The human breast adenocarcinoma cell-line MCF7 was used as a positive control. Expression of oestrogen receptor mRNA was detected in PDL cells with one of the primers but with less intensity than in MCF7 cells. Southern hybridization confirmed these results. These findings suggest that PDL cells express oestrogen receptor mRNA at low levels.

Experimental stationary potential recorded with using spine and skull model

This study aims at investigating experimentally the structural effects of various shapes of volume conductors, which are surrounded by an insulated skull and spinal canal model, on nerve action potentials (NAP). NAP were recorded through volume conductors inside and outside a model. We noted stationary potentials emerged at where the volume conductor made structural transitions. These results were analyzed using the field diagram of isopotential curves. The diagrams of the electrical field demonstrated that the stationary potentials arise owing to abrupt disequilibrium of the electrical field brought about by the change of the volume conductor surrounded by the insulated model.

[The developmental process of employee maladjustment in work place]

A causal model of job stressors and stress reactions was examined to clarify the developmental process of employee maladjustment in work place. Two thousand seven hundred twenty-eight (2728) employees of a research institute in the automobile industry completed Job Stress Scale (JSS), which measured job stressors, stress reactions, coping strategies, and social support. Three hundred ninety-two (392) employees with high stress reaction scores were interviewed to obtain information to construct a theoretical model. Then, the model was evaluated with covariance structure analysis. Results showed that the quantitative job stressors had only an indirect effect, mediated by fatigue and irritability, on mental instability, whereas qualitative ones had both direct and indirect effects. The findings suggest that the developmental processes of employee maladjustment in work place differ depending on the kind of job stressors they experience.

Optimal configuration of pyrene excimer induced by the excimer-forming two-probe nucleic acid hybridization method

Excimer-forming two-probe nucleic acid hybridization (ETPH) method with pyrene as a fluorophore enables homogeneous hybridization assays. We examined the effect of linker length between a pyrene residue and a terminal sugar moiety on Tm of hybrids in the presence of 20% dimethylformamide (DMF). The results including those of CD measurements indicated no interaction of pyrene residues with the duplex formed between a target 32-mer and a pyrenemethyliodoacetamide-introduced 16-mer probe (PMIA-P5)/a pyrenebutanoic acid-introduced 16-mer probe (PBuA-P3), which is the best pair of probes for intense excimer emission. This was also supported by a computer-assisted molecular modeling using Insight II and Discover software.

The effects of oestrogen on osteocalcin production by human periodontal ligament cells

The purpose was to investigate the effects of oestradiol on the function of periodontal ligament (PDL) cells by measuring the production of osteocalcin in vitro. Cells were obtained from the healthy periodontal ligament of teeth extracted from two males and two females for orthodontic reasons. Serum-free medium was used when testing the effects of oestradiol on PDL cells. The amount of osteocalcin in the culture medium was analysed by two-step sandwich enzyme immunoassay in the presence or absence of oestradiol. It was shown that oestradiol enhanced the production of osteocalcin by PDL cells in a time- and dose-dependent manner. PDL cells obtained from both male and female donors were affected by oestradiol. It thus appears that oestradiol is one of the factors important for PDL cells to express their function.

Syndecan-3 and the control of chondrocyte proliferation during endochondral ossification

During endochondral ossification, chondrocytes progress through several stages of maturation before they are replaced by bone cells. Chondrocyte proliferation, the first step in this complex multistage process, is strictly controlled both spatially and temporally but its underlying mechanisms of regulation remain unclear. In this study we asked whether chondrocytes produce syndecan-3, a cell surface receptor for growth factors such as fibroblast growth factor 2 (FGF-2), and whether syndecan-3 may play a role in proliferation during chondrocyte maturation. We found that proliferating immature cartilage from chick embryo tibia and sternum contained significant amounts of syndecan-3 mRNA, whereas mature hypertrophic cartilage contained markedly lower transcript levels. Immunohistochemical analyses on sections of Day 18 chick embryo tibia revealed that syndecan-3 was spatially restricted and indeed detectable only in immature proliferating chondrocytes in the top zone of growth plate. These syndecan-3-rich proliferating chondrocytes lay beneath developing articular chondrocytes rich in their typical matrix protein tenascin-C, resulting in a striking boundary between these two populations of chondrocytes. Immature proliferating chondrocyte populations reared in growth-promoting culture conditions displayed strong continuous syndecan-3 gene expression; upon induction of maturation by vitamin C treatment, syndecan-3 gene expression was markedly down-regulated. Treatment with FGF-2 for 24 h stimulated both syndecan-3 gene expression and chondrocyte proliferation; this growth stimulation was counteracted by cotreatment with heparinase I or III. The results of the study indicate that syndecan-3 participates in the maturation of chondrocytes during endochondral ossification and represents a regulator of the proliferative phase of this multistage process.

The role of physicochemical properties of biomaterials and bacterial cell adhesion in vitro

This study was undertaken to investigate the physicochemical aspects of the interaction between the surface of biomaterials and bacterial cell membranes in vitro, aimed at studying the mechanisms of bacterial adhesion to biomaterials. Correlations were made between the number of adherent bacterial cells (S. aureus) and each of the calculated components of surface free energy (i.e., dispersion, polarity and hydrogen bond) of biomaterials. The effect of antibodies to cell-adhesion molecules on bacterial adhesion was also studied using monoclonal antibodies to vitronectin receptor, fibronectin receptor and CD44. This study indicates the polarity component of surface free energy plays a dominant role in the process of bacterial adhesion at least in vitro. The number of cells adherent to materials decreased to 44-73% of the control value in the presence of antibodies tested, showing that cell adhesion molecules affect adherence to biomaterials. Moreover, the results suggested that bacterial adhesion was prevented by specific blockade of cell adhesion molecule receptors.

Expression of syndecan-3 and tenascin-C: possible involvement in periosteum development

The development of cartilaginous elements of long bone during embryogenesis and postnatal bone repair processes is a complex process that involves skeletal cells and surrounding mesenchymal periosteal cells. Relatively little is known of the mechanisms underlying these processes. Previous studies from this and other laboratories have suggested that the extracellular matrix protein tenascin-C is involved in skeletogenesis. Using in situ hybridization and immunofluorescence, we extended those studies by comparing the expression of tenascin-C with that of syndecan-3, which belongs to a family of cell surface receptors with which tenascins are known to interact. We found that syndecan-3 transcripts at first were very abundant in the presumptive periosteum surrounding the diaphysis of early chondrocytic skeletal elements in chick limb. As the elements developed further, syndecan-3 gene expression decreased in the diaphyseal periosteum, whereas it became stronger around the early epiphysis and within the forming articular cells. However, as the diaphyseal periosteum initiated osteogenesis and gave rise to the intramembranous bone collar, syndecan-3 gene expression increased again. At early stages of skeletogenesis: the tenascin-C gene exhibited patterns of expression that were similar to and temporally followed, those of the syndecan-3 gene. At later stages, however, tenascin-C gene expression was markedly reduced during intramembranous osteogenesis around the diaphysis. In addition, although syndecan-3 gene expression was low in osteoblasts and osteocytes located deep into trabecular bone, tenascin-C gene expression remained strong. Thus, tenascin-C and syndecan-3 display distinct temporal and spatial patterns of expression in periosteum and during the development of long bone. Given their multidomain structure and specific patterns of expression, these macromolecules may regulate site-specific skeletal processes, including interactions between developing periosteum and chondrocytes and delineation of the early cartilaginous skeletal elements.

Regulation of chondrocyte maturation by fibroblast growth factor-2 and parathyroid hormone

Fibroblast growth factor-2 and parathyroid hormone are strong modulators of the maturation process of chondrocytes during endochondral ossification. To clarify whether and how these agents may exert stage-specific effects during this process, we analyzed the responsiveness and phenotypic consequences of treatment with fibroblast growth factor-2 or parathyroid hormone on chondrocytes at different stages of maturation. Populations of immature lower sternal, maturing upper sternal, and hypertrophic tibial growth plate chondrocytes were isolated from day 18-20 chick embryos and were allowed to resume the maturation process by growth in standard monolayer cultures. Treatment of immature lower sternal cultures with as little as 0.1 ng/ml of fibroblast growth factor-2 or 10(-10) M parathyroid hormone prevented both the emergence of mature type-X collagen-synthesizing chondrocytes and the ensuing enlargement of cells that occurred in control (untreated) cultures. Similarly, the treatment of cultured early maturing upper sternal cells with these factors severely reduced the synthesis of type-X collagen and alkaline phosphatase activity and the levels of their respective mRNAs. In sharp contrast, when the cultured upper sternal cells were allowed to grow and mature further before treatment, the responsiveness to fibroblast growth factor-2 was markedly reduced and the responsiveness to parathyroid hormone remained strong and largely unchanged. Cultures of hypertrophic tibial growth plate cells displayed a similar reduced sensitivity to fibroblast growth factor-2, as also indicated by the lack of mitogenic effects, and strong sensitivity to parathyroid hormone. The phenotypic changes induced by treatment with either of these factors were fully reversible when cultures that had been treated were placed in control medium. The results demonstrate that fibroblast growth factor-2 and parathyroid hormone are equally potent in affecting the early stages of maturation but exert differential effects as the cells progress along the maturation pathway. The factors appear to be part of sequentially acting mechanisms to ensure normal progression of chondrocyte maturation during endochondral ossification.

Syndecan-3, tenascin-C, and the development of cartilaginous skeletal elements and joints in chick limbs

The mechanisms by which the early limb cell condensations and interzone mesenchyme give rise to skeletal elements and joints are poorly understood. Previous work from this laboratory has shown that the extracellular matrix protein tenascin-C is associated with articular cartilage and joint tissue development; others have shown that tenascin-C may exert its biological activities via interactions with cell surface receptors, such as syndecans. To further analyze the roles of tenascin-C and its putative receptors in skeletal development, we carried out a detailed in situ hybridization analysis of tenascin-C and syndecan-3 gene expression during development of chick limb skeletal elements and joints. We found that as the early mesenchymal condensations chondrify around day 5 (E5) of development, they become surrounded by a thick syndecan-3 rich perichondrium while tenascin-C transcripts are much fewer and restricted to diaphyseal perichondrium and developing interzones. Similar patterns were observed as distal carpal and digit condensations formed in older embryos. As the cartilaginous long bone models elongated proximo-distally and joint formation proceeded with age, we observed that syndecan-3 transcripts decrease significantly along the diaphysis and remain very abundant along the metaphysis and in the epiphyseal articular cap and interzone. Conversely, tenascin-C RNAs remain abundant along the diaphysis and begin to increase at the epiphysis and in interzone-derived tissues, such as menisci and joint capsule. By E10, the skeletal elements have well-defined morphologies, endochondral ossification has initiated in their diaphysis, and diaphyseal perichondrium has become periosteum. These developmental changes were accompanied by equally marked changes in gene expression; these included a marked increase in tenascin-C gene expression in articular cap, fragmentation of tenascin-C gene expression along the periosteum, reinitiation of syndecan-3 gene expression in periosteum, and differential gene expression in osteoprogenitor cells. The sheer complexity of the gene expression patterns documented in this study attests to the complexity of processes that bring about normal skelatogenesis. Clearly, tenascin-C and syndecan-3 appear to be closely associated with several of these processes, particularly in establishing tissue boundaries (perichondrium and periosteum) between condensations and surrounding mesenchymal cells, in regulating perichondral cell differentiation and incorporation into the growing skeletal elements, and in the genesis of epiphyseal chondrocytes and associated joint tissues.

Successful management of tracheo-innominate artery fistula using interposition of a thymus pedicle flap

Tracheo-innominate artery fistula is usually a fatal complication of tracheostomy. The trachea and innominate artery were successfully reconstructed in an 11-year-old girl who presented with this complication. The thymus was interposed between these two structures in order to prevent further long-term complications.

Effects of hyaluronic acid on the release of cartilage matrix proteoglycan and fibronectin from the cell matrix layer of chondrocyte cultures: interactions between hyaluronic acid and chondroitin sulfate glycosaminoglycan

Hyaluronic acid (HA) of large sizes suppressed the release of cartilage matrix proteoglycan, fibronectin, and other macromolecules from the cell matrix layer of chondrocyte cultures, perhaps because HA of large sizes formed a viscous barrier in the matrix by its interactions with other extracellular matrix macromolecules. To test this possibility, we determined the viscosity of solutions containing HA of various sizes in the presence of proteoglycan monomer or chondroitin sulfate glycosaminoglycan (GAG). Not only the monomer but also chondroitin sulfate increased the viscosity of HA solutions, depending on the size of HA. These findings suggest that HA of large sizes increases the viscosity near the surface of articular cartilage by sugar-sugar and by sugar-protein interactions and that the increase of viscosity is involved in the protective action of HA on arthritic cartilage.

Changes in parathyroid hormone receptors during chondrocyte cytodifferentiation

The purpose of this study was to investigate the relationship between changes in parathyroid hormone (PTH) receptor levels and chondrocyte maturation during endochondral ossification. Chondrocytes were isolated from the growth plate of rabbit ribs and maintained in the presence of 10% serum in mass cultures. Treatment with PTH-(1-84) and a PTH-(1-34) fragment suppressed the increases in alkaline phosphatase activity and in type X collagen and 1 alpha,25-dihydroxyvitamin D3 receptor levels and abolished 45Ca incorporation into mineral, all of which occurred in parallel untreated cultures in the hypertrophic (terminal) stage. These effects of PTH were observed at low concentrations (10(-10) to 10(-9) M) and within 24-48 h of treatment. PTH-(1-84) and PTH-(1-34) also increased [35S]sulfate incorporation into newly synthesized proteoglycans. In contrast, the middle and carboxyl-terminal fragments of PTH tested had little effect on proteoglycan synthesis or terminal differentiation. The binding of 125I-PTH-(1-34) to cells in the growth plate was greater than that to cells in liver, skin, muscle, brain, or kidney. When the correlation between binding levels and stage of maturation was examined, we found that 125I-PTH-(1-34) binding to its 72-kDa receptor was low in resting and proliferating chondrocytes, increased 10-fold in matrix-forming chondrocytes, and thereafter decreased in hypertrophic chondrocytes both in vitro and in situ. Scatchard analysis revealed that the changes in PTH binding were due to changes in the number, and not in the affinity, of the receptor. The changes in PTH-(1-34) binding paralleled those in [35S]sulfate incorporation into proteoglycans. These findings suggest that stage-dependent increases in PTH/PTH-related peptide receptor levels localize the hormone stimulation of proteoglycan synthesis and inhibition of precocious hypertrophy in the matrix-forming zone of growth plates.

Metastatic thyroid cancer presenting as thyrotoxicosis: report of three cases

Three patients with metastatic thyroid follicular carcinoma developed thyrotoxicosis. Two had mild T3 toxicosis without detectable TSH binding inhibitor immunoglobulins (TBII) or thyroid stimulating antibodies (TSAb). Considerable concentration of 131I by tumours occurred, although serum TSH was undetectable. The third patient developed thyrotoxicosis several months after treatment with 131I had commenced and this was associated with concurrent increase in both TBII (90%; normal, less than 11%) and TSAb (2100%). We conclude that thyrotoxicosis in patients with metastatic thyroid carcinoma may result from a large bulk of tumour functioning either autonomously or after stimulation by TSH receptor antibodies.

Spinal cord injury hospitalisation in a rehabilitation hospital in Japan

The Kanagawa Rehabilitation Hospital was established by Kanagawa Prefecture 20 years ago. The hospital has a 40 bed SCI unit and has been providing comprehensive medical and rehabilitation services for SCI patients of this prefecture. A letter of enquiry to 404 major surgical units within this prefecture revealed that 630 SCI patients had been under care in this prefecture during a period of 3 years. Of these, the Frankel grade A, B and C patients, were assumed to be rehabilitation candidates, totalling about 130 in this prefecture per year. The inpatient medical record revealed that we treated 770 SCI patients from 1986 to 1991. From this data, we estimated that the hospital accepted an average of 54.5 SCI patients per year for rehabilitation purposes. Other inpatients were rehospitalised for various complications. According to the study of 125 patients who were hospitalised for comprehensive rehabilitation, they waited an average of 139 days and stayed in the hospital for 288 days. The increasing number of chronic patients who required treatment of complications appeared to be delaying the early admission of rehabilitation patients. The medical treatment cost for those with spinal cord injuries was less than that for the average patient with other types of medical conditions.

Impaired sensory conduction in a mixed nerve induced by high frequency stimulation of the muscle fibres. An experimental study in cats

To see if symptoms such as sensory disturbance or numbness worsen during exercise as is thought to occur in entrapment neuropathy, we studied the interaction between sensory and muscle nerve fibres in a mixed nerve in cats. Stimulation electrodes were placed on both the deep (muscle) and superficial (sensory) branch of the radial nerve at the elbow. High frequency stimulation at 100 Hz was applied to one branch for five minutes and the nerve action potential of the other branch was recorded at the axilla where the radial nerve is mixed. The stimulation decreased the amplitude of the nerve action potential and prolonged its latency. Recovery from these changes was gradual, and changes were the same whichever branch was stimulated. When a cat's leg was made ischaemic, the changes were more pronounced. The changes in the nerve action potential may have arisen from ischaemia in the nerve, possibly caused by high frequency stimulation.

Prostaglandin E1 as a hypotensive drug during general anesthesia for total hip replacement

STUDY OBJECTIVE

To determine the effect of intravenous administration of prostaglandin E1 (PGE1) in inducing controlled hypotension during general anesthesia.

DESIGN

Randomized, prospective study.

SETTING

Inpatient surgery at a university hospital.

PATIENTS

57 ASA physical status I and II patients scheduled for total hip replacement.

INTERVENTIONS

In 29 patients undergoing total hip replacement, PGE1 (0.11 +/- 0.03 micrograms/kg/min) was infused to induce hypotension during general anesthesia with enflurane, isoflurane, or sevoflurane in nitrous oxide and oxygen. In another 28 patients, the control group, normotensive anesthesia was performed for the same procedure.

MEASUREMENTS AND MAIN RESULTS

Systolic blood pressure decreased significantly (p < 0.01) from 136 +/- 22 mmHg to 93 +/- 10 mmHg during PGE1 infusion, although heart rate did not change significantly. Arterial hemoglobin oxygen saturation showed a mild but significant decrease (p < 0.05) during PGE1 infusion. Blood loss (480 +/- 132 ml) and blood transfusion (280 +/- 260 ml) during surgery were significantly less in patients with hypotensive anesthesia (p < 0.01 and p < 0.05, respectively) than in patients with normotensive anesthesia (667 +/- 326 ml and 468 +/- 395 ml, respectively). Blood loss and blood transfusion after surgery were similar in both groups. In the recovery room or surgical ward, 3 of 29 patients with hypotensive anesthesia needed rapid blood transfusion because of moderate hypotension. The volume of urine during surgery was significantly less (p < 0.05) in the control group. Two patients developed mild phlebitis at the site of the PGE1 infusion, but there were no serious side effects.

CONCLUSION

These data suggest that PGE1 can be used safely to induce hypotension, thereby reducing blood loss during total hip replacement with general anesthesia.

Effects of hyaluronic acid on the release of proteoglycan from the cell matrix in rabbit chondrocyte cultures in the presence and absence of cytokines

OBJECTIVE

To investigate the effects of hyaluronic acid (HA) on the release of proteoglycan by cultured rabbit chondrocytes.

METHODS

Articular cartilage chondrocytes were isolated from the knee joints of New Zealand white rabbits. Proteoglycan synthesis after incubation with HA was determined by measuring 35S-sulfate incorporation. Cells incubated with HA were labeled with 3H-glucosamine and applied to a Sepharose CL-2B column. After incubation of confluent cells with 35S-sulfate and then with HA in various concentrations in the presence or absence of cytokines, proteoglycan release from the cell matrix layer was measured.

RESULTS

HA (M(r) 3 x 10(5) to 19 x 10(5)), at 10 micrograms/ml to 1 mg/ml, had little effect on the incorporation of 35S-sulfate or 3H-glucosamine into cartilage matrix proteoglycans, or on the hydrodynamic size of proteoglycan monomers, in rabbit chondrocyte cultures. However, at 10-1,000 micrograms/ml, HA suppressed the release of 35S-proteoglycans from the cell matrix layer into the medium in the presence and absence of interleukin-1, tumor necrosis factor alpha, or basic fibroblast growth factor.

CONCLUSION

These results suggest that HA is a potent inhibitor of the displacement of matrix proteoglycan into culture medium.

Cineradiographic study of wrist motion after fracture of the distal radius

Residual dorsal tilt is one of the main deformative factors in the malunion of fractures of the distal radius. We investigated the effect of such tilt on the range of wrist motion and on carpal alignment in a cineradiographic study of wrist motion in 30 patients with extra-articular Colles' fracture. With increased dorsal tilt, the range of wrist motion became more restricted and abnormalities of carpal alignment during wrist motion became apparent. When the dorsal tilt was less than 10 degrees, the effects on the range of motion and on the dynamic carpal alignment were small.

Purification and characterization of phosphoenolpyruvate phosphomutase from Pseudomonas gladioli B-1

Phosphoenolpyruvate phosphomutase (PEPPM) catalyzes C-P bond formation by intramolecular rearrangement of phosphoenolpyruvate to phosphonopyruvate (PnPy). We purified PEPPM from a gram-negative bacterium, Pseudomonas gladioli B-1 isolated as a C-P compound producer. The equilibrium of this reaction favors the formation of the phosphate ester by cleaving the C-P bond of PnPy, but the C-P bond-forming reaction is physiologically significant. The C-P bond-forming activity of PEPPM was confirmed with a purified protein. The molecular mass of the native enzyme was estimated to be 263 and 220 kDa by gel filtration and polyacrylamide gel electrophoresis, respectively. A subunit molecular mass of 61 kDa was determined by sodium dodecyl sulfate-polyacrylamide gel electrophoresis, indicating that the native protein was a tetramer. The optimum pH and temperature were 7.5 to 8.0 and 40 degrees C, respectively. The Km value for PnPy was 19 +/- 3.5 microM, and the maximum initial velocity of the conversion of PnPy to phosphoenolpyruvate was 200 microM/s/mg. PEPPM was activated by the presence of the divalent metal ion, and the Km values were 3.5 +/- 1.4 microM for Mg2+, 16 +/- 5 nM for Mn2+, 3.0 +/- 1.5 microM for Zn2+, and 1.2 +/- 0.2 microM for Co2+.

[Clinical evaluation of myocardial protection by oxygenated crystalloid cardioplegic solutions with DBcAMP]

Possible enhancement of myocardial protection by adding DBcAMP and oxygenation of a crystalloid cardioplegic solution (CCS) was evaluated in a three group study. The patients having coronary bypass operation or valvular operation were divided into three groups, each consisting of 15 patients, and differing only in the type of CCS employed. Group I was protected by nonoxygenated CCS (PO2 190 mmHg, PCO2, 32 mmHg, pH 7.78, K 30 mmEq/L), Group II by adding DBcAMP to nonoxygenated CCS and Group III by adding DBcAMP to oxygenated CCS (PO2 790 mmHg, PCO2 26 mmHg, pH 7.87). Group III had significantly improved CI and double product (p less than 0.05) compared with Group II. However, CPK, CPK-MB, and myoglobin in the serum were similar in each group. Lactate and pyruvate ratio (L/P) in the coronary sinus bloods were improved to lower value after the pump than before the pump only in Group III. Base excess in the coronary sinus held on alkalosis after aortic declamp only in Group III. The refunction time was significantly shortest with Group III than with other groups (p less than 0.01, 0.05) and Group II was significantly shorter than Group I (p less than 0.05). It is concluded that oxygenation and adding DBcAMP to CCS are effectual for the myocardial metabolism and protect the myocardial damage during cardiac arrest.

Adipostatins A and B, new inhibitors of glycerol-3-phosphate dehydrogenase

As a result of screening for inhibitors of glycerol-3-phosphate dehydrogenase, which may be effective to prevent corpulence, we isolated two inhibitors named adipostatin A and adipostatin B from the culture broth of Streptomyces cyaneus 2299-SV1. Their structures have been established to be 5-n-pentadecylresorcinol and 5-isopentadecylresorcinol, respectively. Adipostatin A and adipostatin B inhibited glycerol-3-phosphate dehydrogenase at the IC50 values of 4.1 microM and 4.5 microM, respectively. These compounds prevented triglyceride accumulation in 3T3-L1 cells at a concentration of the microM level.

Expression of the differentiated phenotype of chondrocyte in adjuvant induced arthritis of rat

Rat cartilage tissue was found to produce two types of proteoglycan monomers distinguished by density gradient centrifugation under dissociative condition and with different molecular size (PG I and PG II) as observed in cultured rabbit costal chondrocyte and human cartilaginous tissues. The incorporation of 35S-sulfate and distribution of the molecular size of proteoglycan (PG) were studied to determine the differentiated phenotypes of chondrocyte in adjuvant induced arthritis of rats. The cartilaginous tissue from the acute inflammatory phase shows a low incorporation of 35S-sulfate into PGs but produce the same hydrodynamic size as that of the control. After that acute phase the incorporation recovered suggesting of a repair phase. But in the chronic phase both the incorporation and the produced hydrodynamic size of PGs were severely alternated. With our method this paper shows the drastic alternation about the cartilaginous properties of rat chondrocytes under these circumstances.

Surgical management of the coronary artery to pulmonary artery fistulas; a case of a large ruptured aneurysm

Three patients were treated for coronary artery-pulmonary artery fistula. Each was asymptomatic due to a coronary artery fistula. There was one instance each of myocardial infarction, mitral stenosis and a large closed ruptured aneurysm including a thrombus. All the fistulas were comprised of several small plexiform arranged vessels. The left to right shunt ratio was approximately 8 percent or less. A surgical operation was performed to close the drainage orifice of the fistulas through pulmonary arteriotomy under cardiopulmonary bypass in two patients while one patient underwent a ligation of a large abnormal vessel to the aneurysm followed by a resection of the aneurysm without cardiopulmonary bypass. A large saccular aneurysm of such fistulas is rare and a rupture of such an aneurysm is even more rare. The surgical management of coronary artery fistulas is also discussed herein.

[A case report of type II dissecting aneurysm after aortic valve replacement, successful repair by the modified Cabrol's method]

A case of type II dissecting aneurysm after aortic valve replacement was reported. The patient was a 66-year-old man, who was diagnosed as III degree aortic valve regurgitation without aortic dilatation, and performed aortic valve replacement with a 27A Omniscience prosthesis. Postoperative course was very smooth for 7 years, however he was admitted to our hospital of the sudden anterior chest pain. Computed tomography and aortography revealed marked dilatation and dissection of ascending aorta and occlusion of the right coronary artery. The operation of the modified Cabrol's method was performed, and he is well alive one and half a year after operation. Dissecting aneurysm in the late term after aortic valve replacement is rare, and its prognosis and re-operative results are very poor.

Regional blood flow in skeletal muscle measured by the heated thermocouple method during electrical nerve stimulation of the canine gracilis muscle

Skeletal muscle blood flow (MBF) and intramuscular pressure (IMP) were measured using a heated thermocouple (HTC) and a solid-state catheter-tip transducer during electrical nerve stimulation in the gracilis muscle of anesthetized dogs. MBF values obtained simultaneously by the HTC method and the inhalated hydrogen gas (H2) clearance method showed an excellent linear regression with a correlation coefficient of 0.93. Electrical nerve stimulation at frequencies of 5 and 100 Hz increased total MBF, determined by an electromagnetic flowmeter, over control values 6.57 +/- 0.82 and 6.32 +/- 0.93 ml/min/100 g, respectively. Regional MBF at 5 Hz stimulation determined with HTC increased in the same magnitude both at the midpoint and the distal portion of the gracilis muscle. However, following 100 Hz stimulation, MBF at the midpoint was decreased from 8.15 +/- 1.55 to 4.09 +/- 1.54 ml/min/100 g, whereas at the distal portion flow was increased from 6.39 +/- 1.71 to 21.2 +/- 5.29 ml/min/100 g. IMP in both regions was low and approximately 2.0 mmHg at rest. IMP was remarkably increased to 27.9 +/- 8.43 mmHg at the midpoint but not in the distal portion during 100 Hz tetanic contraction, but showed no significant change in either region following 5 Hz stimulation. These data suggest that HTC can serve to measure MBF, and that following 100 Hz tetanic contraction, increased IMP may be associated with decreased regional MBF, irrespective of a total increase in flow in the gracilis muscle.