FRI0418 SELECTIVE PATELLAR RESURFACING IN TOTAL KNEE ARTHROPLASTY FOR THE OSTEOARTHRITIC KNEE: A PROSPECTIVE STUDY

Background:

No widely accepted view or criteria currently exist concerning whether or not patellar replacement (resurfacing) should accompany total knee arthroplasty for osteoarthritis of the knee.1)2)3)

Objectives:

We recently devised our own criteria for application of patellar replacement and performed selective patellar replacement in accordance with this set of criteria. The clinical outcome was analyzed.

Methods:

The study involved 1150 knees on which total knee arthroplasty was performed between 2005 and 2019 because of osteoarthritis of the knee. The mean age at operation was 73, and the mean postoperative follow-up period was 91 months. Our criteria for application of patellar replacement are given below. Criterion A pertains to evaluation of preoperative clinical symptoms related to the patellofemoral joint: (a) interview regarding presence/absence of pain around the patella, (b) cracking or pain heard or felt when standing up from a low chair, (c) pain when going upstairs/downstairs. Because it is difficult for individual patients to identify the origin of pain (patellofemoral joint or femorotibial joint), the examiner advised each patient about the location of the patellofemoral joint when checking for these symptoms. Criterion B pertains to intense narrowing or disappearance of the patellofemoral joint space on preoperative X-ray of the knee. Criterion C pertains to the intraoperatively assessed extent of patellar cartilage degeneration corresponding to class 4 of the Outerbridge classification. Patellar replacement was applied to cases satisfying at least one of these sets of criteria (A-a,-b,-c, B and C). Postoperatively, pain of the patellofemoral joint was evaluated again at the time of the last observation, using Criterion A-a,-b,-c.

Results:

Patellar replacement was applied to 110 knees in accordance with the criteria mentioned above. There were 82 knees satisfying at least one of the Criterion sets A-a,-b,-c, 39 knees satisfying Criterion B and 70 knees satisfying Criterion C. (Some knees satisfied 2 or 3 of Criteria A, B and C).When the pain originating from patellofemoral joint (Criterion A) was clinically assessed at the time of last observation, pain was not seen in any knee of the replacement group and the non-replacement group.

Conclusion:

Whether or not patellar replacement is needed should be determined on the basis of the symptoms or findings related to the patellofemoral joint, and we see no necessity of patellar replacement in cases free of such symptoms/findings. When surgery was performed in accordance with the criteria on patellar replacement as devised by us, the clinical outcome of the operated patellofemoral joint was favorable, although the follow-up period was not long. Although further follow-up is needed, the results obtained indicate that selective patellar replacement yields favorable outcome if applied to cases judged indicated with appropriate criteria.

References:

[1]The Effect of Surgeon Preference for Selective Patellar Resurfacing on Revision Risk in Total Knee Replacement: An Instrumental Variable Analysis of 136,116 Procedures from the Australian Orthopaedic Association National Joint Replacement Registry.

Vertullo CJ, Graves SE, Cuthbert AR, Lewis PL J Bone Joint Surg Am. 2019 Jul 17;101(14):1261-1270

[2]Resurfaced versus Non-Resurfaced Patella in Total Knee Arthroplasty.

Allen W1, Eichinger J, Friedman R. Indian J Orthop. 2018 Jul-Aug;52(4):393-398.

[3]Is Selectively Not Resurfacing the Patella an Acceptable Practice in Primary Total Knee Arthroplasty?

Maradit-Kremers H, Haque OJ, Kremers WK, Berry DJ, Lewallen DG, Trousdale RT, Sierra RJ. J Arthroplasty. 2017 Apr;32(4):1143-1147.

Disclosure of Interests:

None declared

Down-regulation of single immunoglobulin interleukin-1R-related molecule (SIGIRR)/TIR8 expression in intestinal epithelial cells during inflammation

Single immunoglobulin (Ig) interleukin-1R-related molecule (SIGIRR) is an Ig-like membrane protein critical for negative regulation of Toll-like receptor (TLR)-4-mediated signalling. We investigated SIGIRR expression and its regulation mechanism in intestinal epithelial cells (IECs) during inflammation. Endoscopic biopsy specimens were obtained from active and inactive colonic mucosa of ulcerative colitis (UC) patients, then SIGIRR expression was examined using real-time polymerase chain reaction (PCR) and immunohistochemistry (IH). Mice experimental colitis models were established by administrations of sulphonic acid (TNBS) and dextran sodium sulphate (DSS), and epithelial expression of SIGIRR was examined using real-time PCR, IH and flow cytometry. The effects of lipopolysaccharide (LPS) and tumour necrosis factor (TNF)-α on SIGIRR expression were evaluated in vitro using cultured IECs. To elucidate SIGIRR expression regulation in IECs, binding ability of the transcription factor SP1 at the responsive element of the SIGIRR promoter was examined using gel-shift and chromatin immunoprecipitation (ChIP) assays. In human colonic samples, SIGIRR was expressed mainly in IECs at levels significantly higher in inactive compared to active mucosa. In the mice, SIGIRR colonic expression decreased rapidly after colitis development and returned gradually to basal levels. Experimental colitis-mediated down-regulation of SIGIRR in IECs was also confirmed by IH and flow cytometry results. Further, inflammatory conditions induced by TLR ligands and TNF-α caused significant down-regulation of SIGIRR expression in IECs, which was dependent upon decreased SP1 binding at the responsive element of the SIGIRR promoter. We found that SIGIRR is expressed in IECs and serves as a negative regulator to maintain gut innate immunity, which is down-regulated during inflammation by inhibition of an SP1-mediated pathway.

A20 is an early responding negative regulator of Toll-like receptor 5 signalling in intestinal epithelial cells during inflammation

Several negative regulatory mechanisms control Toll-like receptor (TLR)-mediated inflammatory responses and restore immune system balance, including the zinc-finger protein A20, a negative regulator of TLR signalling that inhibits nuclear factor kappa B (NF-kappaB) activity. In the present study, we investigated TLR-5-mediated A20 expression and its role in intestinal epithelial cells (IECs) during inflammation. HCT-15 and HT-29 cells were stimulated with flagellin, then the expressions of A20, interleukin-1 receptor-associated kinase (IRAK-M) and Tollip were evaluated using RNase protection assay. Furthermore, experimental colitis was induced in tlr4-deficient CH3/HeJ mice by administration of dextran sodium sulphate (DSS), then flagellin was injected anally, and the colonic expression of A20 was examined by real-time polymerase chain reaction (PCR) and immunohistochemistry. To confirm flagellin-induced expression of A20, we employed an organ culture system. The role of A20 in flagellin-induced tolerance induction was evaluated in vitro, using a gene knock-down method targeting A20. A20 expression increased rapidly and peaked at 1 h after flagellin stimulation in cultured IECs, then declined gradually to the basal level. In vivo, anal injection of flagellin induced epithelial expression of A20 in injured colonic tissue, whereas flagellin did not cause a significant increase in A20 expression in non-injured normal tissue, which was also confirmed in vitro using the organ culture system. Gene knock-down using A20 siRNA did not influence tolerance induced by restimulation with flagellin. A20 is an early response negative regulator of TLR-5 signalling in IECs that functions during intestinal inflammation. Our results provide new insights into the negative feedback regulation of TLR-5 signalling that maintains the innate immune system in the gut.

Evaluation of modified crystal violet chromoendoscopy procedure using new mucosal pit pattern classification for detection of Barrett's dysplastic lesions

BACKGROUND

Pit pattern diagnosis is important for endoscopic detection of dysplastic Barrett's lesions, though using magnification endoscopy can be difficult and laborious. We investigated the usefulness of a modified crystal violet chromoendoscopy procedure and utilised a new pit pattern classification for diagnosis of dysplastic Barrett's lesions.

METHODS

A total of 1,030 patients suspected of having a columnar lined oesophagus were examined, of whom 816 demonstrated a crystal violet-stained columnar lined oesophagus. The early group of patients underwent 0.05% crystal violet chromoendoscopy, while the later group was examined using 0.03% crystal violet with 3.0% acetate. A targeted biopsy of the columnar lined oesophagus was performed using crystal violet staining after making a diagnosis of closed or open type pit pattern with a newly proposed system of classification. The relationship between type of pit pattern and histologically identified dysplastic Barrett's lesions was evaluated.

RESULTS

Dysplastic Barrett's lesions were identified in biopsy samples with an open type pit pattern with a sensitivity of 96.0%. Further, Barrett's mucosa with the intestinal predominant mucin phenotype was closely associated with the open type pit pattern (sensitivity 81.9%, specificity 95.6%).

CONCLUSIONS

The new pit pattern classification for diagnosis of Barrett's mucosa was found to be useful for identification of cases with dysplastic lesions and possible malignant potential using a crystal violet chromoendoscopic procedure.

Association of a decrease in antithrombin III activity with a perinatal elevation in aspartate aminotransferase in women with twin pregnancies: relevance to the HELLP syndrome

BACKGROUND/AIMS

Decreased antithrombin III (AT-III) activity and/or thrombocytopenia associated with an elevated serum level of aspartate aminotransferase in late pregnancy can threaten the lives of both the mother and the fetus. We investigated whether antenatal declines in AT-III activity and the platelet count occur in late twin pregnancy and whether reduced AT-III activity and/or thrombocytopenia precedes an increase in the serum level of aspartate aminotransferase.

METHODS

The platelet count, AT-III activity, and the serum level of aspartate aminotransferase were determined weekly or biweekly in 237 women with twin pregnancies in a longitudinal and partly prospective study.

RESULTS

Both AT-III activity and the platelet count decreased gradually in the last month of pregnancy, irrespective of the presence or absence of clinical signs of pre-eclampsia. A perinatal elevation in aspartate aminotransferase occurred in 36 (15%) of 237 women. The risk of a perinatal elevation in aspartate amino-transferase increased as the antenatal AT-III activity and/or the platelet count decreased. Pre-eclampsia developed in 60 women (25%). The relative risk of a perinatal aspartate aminotransferase elevation (95% confidence interval) for the 60 women with pre-eclampsia, the 60 women with a platelet count < or = the 25th percentile (164 x 10(9)/1), and the 60 women with AT-III activity < or = the 25th percentile (76% of normal) was 1.9 (1.0 to 3.4), 4.1 (2.3 to 7.5), and 5.9 (3.2 to 11.1), respectively, compared with the remaining 177 women.

CONCLUSIONS

AT-III activity and platelet count gradually decreased in the last month of twin pregnancies. A perinatal aspartate aminotransferase elevation was preceded by marked decreases in these parameters in women with twin pregnancies. The monitoring of AT-III activity and platelet count in women who exhibit a gradual decline in these parameters may help to avoid the development of severe HELLP syndrome.

Maxillary osteomyelitis secondary to osteopetrosis

A 41-year-old Japanese woman complained of a gradually enlarging swelling of her left cheek for seven months. She was diagnosed with osteopetrosis by standard skeletal radiographs, and her cheek swelling was diagnosed as maxillary osteomyelitis secondary to osteopetrosis. She underwent a left partial maxillectomy, and her post-operative course was stable with no complications. A literature review is also presented.

[The platelet aggregation inhibiting activity in human placenta--study on the ADP degrading activity of human placental villi]

We studied the platelet aggregation inhibiting activity and ADP degrading activity of human placental villi (tissue culture supernatant) and brush border membrane vesicles (BBMV) and obtained the following results. 1. There existed a platelet aggregation inhibiting activity in tissue culture supernatant of villi (S-villi) but not in that of decidua or amnion. The S-villi inhibited the platelet aggregation induced by ADP, but not that induced by collagen, arachidonic acid or ristocetin. And, there was also ADP degrading activity (ADPase activity) in the S-villi. ADP was quickly degraded by S-villi. When ADP was preincubated with S-villi, the platelet aggregation induced by ADP was completely lost. 2. There was very strong platelet aggregation inhibiting activity in placental BBMV. The BBMV almost completely inhibited the platelet aggregation induced by ADP, collagen, arachidonic acid and ristocetin. And there was very strong ADP degrading activity in the placental BBMV. ADP was quickly degraded by BBMV. When ADP was preincubated with BBMV, the platelet aggregation induced by ADP was completely lost. 3. The enzymatic character (heat stability, enzymatic kinetics, Ca++ dependency and pH dependency) of ADP degrading activity in BBMV was very similar to that in S-villi. 4. The ADP degrading activity of both S-villi and solubilized BBMV were fractionated by anion exchange column chromatography and gel filtration column chromatography in similar patterns, and it was shown that ADP degrading substance of both S-villi and solubilized BBMV had a molecular weight of about 60K.

A new instrument for use with Nd:YAG in tonsillectomy

In tonsillectomy, unexpected bleeding can be one of the most troublesome surgical procedures to perform. To resolve some inherent problems, we have developed a new elevator with contact Nd:YAG laser probe for blunt dissection around the tonsillar capsule. Of 63 cases of laser tonsillectomies performed over 5 years, 51 cases were performed using conventional contact Nd:YAG laser probe and a chisel type dissector. Tonsillectomy in the remaining 12 cases was undertaken by the newly developed elevator with contact Nd:YAG laser probe. We compared clinical evaluation between laser and conventional procedures. Additionally, the advantage of laser tonsillectomy is discussed.

The prevalence at birth of cogenital malformations at a maternity hospital in Osaka City, 1948-1990

The frequencies of congenital malformations at St. Barnabas' Hospital, Osaka were studied during the period 1948-1990. There were 1,418 malformed infants diagnosed during the first week of life among a total number of 131,996 births during the period. Of the 1.07% of malformed children, 0.90% had single and 0.17% had multiple malformations. The birth prevalence was 1.07% in singletons and 1.20% in twins. There was significant difference in prevalence between males (1.15%) and females (0.97%). The prevalence was 0.88% for the period 1948-1958 and increased with each year cohort up to the recent period when the value was 1.38%. Varus deformities of feet was the most common defect (23.4 per 10,000 births), followed by polydactyly (finger) (7.8), anencephaly (7.1), cleft lip and palate (6.5), syndactyly (toe) (6.5), cleft lip (6.3), and Down's syndrome (6.1). The prevalence of conjoined twins was 1 in 65,551 deliveries. Significant differences occurred between males and females for cleft palate, cleft lip and palate, syndactyly (finger), oligodactyly (finger), and hypoplastic auricle. The prevalences for valgus deformities of feet, syndactyly (toe) and atresia ani increased significantly with the year cohort, whereas the prevalence of cleft palate decreased significantly with the year cohort. Overall prevalence was significantly higher in 1970-1990 (1.28% than in 1948-1969 (0.88%). Similar results were examined for cleft lip and palate, syndactyly (finger), syndactyly (toe), hypospadias, hydrocele testis, and Down's syndrome.

Detection of IL-6 in human milk and its involvement in IgA production

A large amount of interleukin-6 (IL-6) was found to be contained in human whey. The concentration of IL-6 in colostrum was significantly higher than that in serum or in milk taken 1 month after parturition. Colostrum contained many more mononuclear cells than late milk. In terms of the proportion of monocytes, T cells and B cells, however, there is no difference between colostrum and late milk. There is a significantly positive correlation between the concentration of IL-6 and the number of mononuclear cells in milk. This demonstrates that IL-6 in whey is derived in part from mononuclear cells. Stimulation of human milk mononuclear cells by Staphylococcus aureus Cowan I in the presence of anti-IL-6 antibody markedly decreased the production of IgA. This suggests that IL-6 contained in milk is closely associated with the local production of IgA in the breast.

[The study on the degradation of prostacyclin activity in tissue culture supernatant of human placental villi]

To clarify the role of placental villi in maintaining microcirculation in the placenta, we investigated the action to protect the activity of prostacyclin in the tissue culture supernatant of human placental villi. 1. The platelet aggregation inhibiting activity of prostacyclin was decreased very rapidly in Ringer buffer. 2. The tissue culture supernatant of human placental villi has an action which protects the activity of prostacyclin. On the other hand, in the tissue culture supernatant of human placental decidua no such action is prominent. 3. Human chorionic gonadotropin (hCG) also has an action which protects the activity of prostacyclin. These results indicated that human placental villi play an important role in maintaining placental microcirculation by producing substances which have a protective on the activity of prostacyclin.

[The role of vitamin E during pregnancy--anti-platelet aggregation activity of alpha-tocopherol]

To clarify the role of vitamin E (alpha-tocopherol) during pregnancy, we mainly investigated the relation between platelet function and vitamin E and obtained the following results. 1. The concentration of vitamin E (alpha-tocopherol) in plasma and platelet increased gradually during pregnancy. The concentration of vitamin E in plasma was 6.65 micrograms/ml in non pregnant women and 15.5 micrograms/ml in full term pregnant women. And the concentration of vitamin E in platelet was 99 micrograms/g protein in non pregnant women and 244 micrograms/g protein in full term pregnant women. 2. Vitamin E (alpha-tocopherol) inhibited platelet aggregation induced by ADP (adenosine diphosphate) and PAF(platelet activating factor). At a concentration of 500 micrograms/ml vitamin E almost completely inhibited platelet aggregation induced by ADP and PAF. 3. There exists a strong platelet aggregation inhibiting activity in human placental brush border membrane vesicles. At a protein concentration of 20 micrograms/ml the brush border membrane vesicles almost completely inhibited platelet aggregation induced by ADP and PAF. 4. With the co-existence of the brush border membrane vesicles, the platelet aggregation inhibiting activity of vitamin E (alpha-tocopherol) increased prominently. These results indicate that vitamin E plays an important role in the regulation of platelet function and might contribute to the maintenance of placental microcirculation by inhibiting platelet aggregation.

[A study of underlying immunoglobulin production by neonates]

During the prenatal period the ability of the fetus mononuclear cells (MNC) to produce antibodies is impaired. 1. In term infants, IgG production with only Staphylococcus aureus Cowan I strain (SAC) stimulation was significantly decreased (p less than 0.00005) as compared with adults. However, when adult MNC supernatant stimulated with Pokeweed mitogen (PWM-sup) was given to full term infants, antibody production significantly increased. 2. The activity inducing antibody production in the full term infant MNC is present primarily in the adult T cell culture supernatant. 3. B cell differentiation factor gamma (BCDF gamma) and BCDF mu, which induce IgG and IgM production, respectively, were significantly reduced in premature and full term infants (p less than 0.00005) as compared with adult. 4. By giving adult PWM-sup to the under 33-week-old infants MNC with SAC stimulation, the induction of both IgG and IgM was reduced, and IgG production was especially inadequate. From the above, it is thought that in full term infants, the production of BCDF gamma and BCDF mu which are produced by T cells is reduced compared to that of adults, and that this is mainly responsible for the reduced antibody production. In addition, in the under 33-week-old infants, the immaturity of B cells and inadequate BCDF production induce underlying poor or inadequate immunoglobulin production.

The mechanism of human placental urea transport: a study using placental brush border (microvillous) membrane vesicles

To elucidate the mechanism of placental amino acid transport, the transport of amino acids into brush border membrane vesicles was investigated using brush border membrane vesicles (BBMV) separated from the human full-term placenta. 1. The transport of l-alanine and l-glutamine into the brush border membrane vesicles prepared from either early gestational placenta or full-termed placenta disclosed a typical overshooting phenomenon in the presence of H+ concentration gradient (extravesicular pH greater than intravesicular pH). 2. The H(+)-dependent overshooting transport of urea into the brush border membrane vesicles disappeared in the presence of H+ ionophore. 3. The initial velocity of H+ concentration gradient dependent uptake of urea into the brush border membrane vesicles was regulated by the saturation kinetics determined by the concentration of urea. The values of Km and Vmax, calculated as the kinetic parameters of urea transport by reciprocal plotting of the initial velocity of uptake and the concentration of urea, were 10.8 mM and 410 mumol/mg protein/10 sec, respectively. The above results indicate that a transport system which transports urea in exchange for H+ exists in human full-term placental microvillous membrane.

[Skin approximation using Nd: YAG laser in head and neck surgery]

Laser is useful for surgery to cut, coagulate, vaporize and weld the tissue. Recently, low power laser was utilized for the treatment of ulcer, pain and vascular anastomosis. We applied low power Nd: YAG laser irradiation for skin approximation. An experimental study was carried out by using the Nd: YAG laser in approximating the surgically cut skin wound of guinea pigs. Healing of the wound was observed on post operative days of 3, 7 and 21, respectively. Laser approximation for the incised skin showed less scaring and faster healing than conventional suture technique. This laser technique will be beneficial as one of the new procedures of skin suture in clinical practice. The results were discussed from either technical or cosmetic standpoint.

[The maintenance of placental circulation--the study on the platelet inhibition activity of placental chorioepithelial brush border membrane]

We studied the platelet aggregation inhibiting activity of human placental syncytiotrophoblast brush border membrane vesicles (BBMV) and obtained the following results. 1. There existed a very strong platelet aggregation inhibiting activity in placental BBMV. The BBMV almost completely inhibited the platelet aggregation induced by ADP, arachidonic acid and ristocetin. 2. There existed a very strong ADP degrading activity (ADPase activity) in the placental BBMV. ADP was quickly decomposed to AMP by BBMV. 3. Placental BBMV inhibited platelet TXA2 (TXB2) production. In the 0.04 mg/ml protein concentration of BBMV, platelet TXA2 production was almost completely inhibited. 4. There existed a very strong platelet aggregation inhibiting activity in solved BBMV. Soluble BBMV almost completely inhibited the platelet aggregation induced by ADP and arachidonic acid but did not inhibit the platelet aggregation induced by ristocetin. 5. ADP decomposing activity and platelet TXA2 production inhibiting activity were separated by anion exchange column chromatography of soluble BBMV. 6. When BBMV was treated with ultrasonic waves to destroy the membrane structure, only the activity inhibiting ristocetin-induced platelet aggregation was markedly decreased.

p24 protein of a human T-lymphotropic virus type-I (HTLV-I) producing cell line (TCL-Kan) reacts with some normal pregnant women's sera

Some HTLV-1 antibody carrying pregnant women, who are rated by the gelatin particle agglutination (PA) method, show no expression of HTLV-I antigen in their peripheral blood lymphocytes. Paying attention to this fact, the authors recently studied the reaction of the antibody contained in the PA-positive sera with the antigen protein used for the PA method. This study demonstrated that the protein responsible for non-specific reaction has a molecular weight of 24,000 and that the isoelectric point of this protein differs from that of HTLV-I specific protein.

Identification of HTLV-I sequence in cord blood mononuclear cells of neonates born to HTLV-I antigen/antibody-positive mothers by polymerase chain reaction

We developed a polymerase chain reaction (PCR) method which has high sensitivity and simple technique in order to investigate the presence or absence of human T lymphotropic virus type I (HTLV-I) provirus in cord blood mononuclear cells of neonates born to HTLV-I carrier mothers. Out of 40, three subjects were found to contain the HTLV-I provirus genome. These three subjects remained HTLV-I sequence-positive in follow-up study. On the other hand, when examined by a conventional technique for detection of HTLV-I-associated antigen on peripheral mononuclear cells, all 40 neonates were HTLV-I-associated antigen-negative. These results suggest that PCR is more sensitive than the conventional antigen detection method and is useful in early detection of HTLV-I infection in neonates born to HTLV-I carriers.

Production of IL-6 (BSF-2/IFN beta 2) by mononuclear cells in premature and term infants

The production of interleukin 6 (IL-6) was examined in premature neonates (48 cases, including 3 miscarried fetuses) and fullterm neonates (20 cases). The IL-6 production by mononuclear cells was measured after stimulation with Staphylococcus aureus Cowan Strain I (SAC), phytohemagglutinin (PHA) or lipopolysaccharide (LPS). The production in full-term neonates was similar to that in healthy adults, whereas it was significantly lower in premature neonates without premature rupture of the membrane (PROM). However, in premature infants with PROM a normal level of IL-6 production was observed in mononuclear cells stimulated with SAC, PHA and LPS. Furthermore, there was a positive correlation between the IgM concentration in the cord serum and IL-6 production by LPS-stimulated mononuclear cells.

[Detection of HTLV-I genome in infants born to HTLV-I seropositive mothers by polymerase chain reaction]

We developed a new method to detect human T cell leukemia virus type I (HTLV-I) provirus by amplifying the pX region of the HTLV-I genome by means of the polymerase chain reaction (PCR) method. This new method was used to examine babies delivered by HTLV-I carrier women for HTLV-I vertical transmission. It was found that intra-uterine infection with HTLV-I can occur, though rarely, and some babies carry HTLV-I provirus despite their negative response to HTLV-I antibody, and, noticeably, some of the babies found negative by the conventional antigen detection method may be positive when tested by the PCR method. It was also confirmed with the PCR method that the incidence of vertical transmission of HTLV-I can be reduced to about 1/5 by replacing breast feeding with bottle feeding and frozen mother's milk feeding. It was also found that vertical transmission of HTLV-I can occur at high incidence rates even when the duration of breast feeding is 3 months or less.

[The study on the platelet aggregation inhibition activity of placental brush border (the mechanism of platelet aggregation inhibition)]

To clarify the role of placental brush border in the regulation of placental microcirculation, we investigated the platelet aggregation inhibition activity of placental brush border membrane vesicles (BBMV) and obtained the following results. 1. There was very strong platelet aggregation inhibiting activity in placental BBMV. In the 20-40 micrograms/ml protein concentration, the BBMV almost completely inhibited the platelet aggregation induced by ADP, arachidonic acid and collagen, and in the 100-150 micrograms/ml protein concentration, the BBMV almost completely inhibited the platelet aggregation induced by ristocetin. 2. There existed a very strong ADP degrading activity (ADPase activity) in the placental BBMV. The platelet aggregation activity of ADP was completely lost when ADP was preincubated with the placental BBMV. 3. The placental BBMV inhibited platelet malondialdehyde (MDA) production. With the 20 micrograms/ml and 100 micrograms/ml protein concentrations of placental BBMV, 22% and 65% of platelet MDA production was inhibited respectively.

[Acute myelogenous leukemia developing in pregnancy with complete remission--a case report]

A 27-year-old woman was admitted to our hospital complaining of purpuras and legs' edema in the 38th week of pregnancy. On admission, the hemoglobin was 7.8 g/dl, platelets 20,000/microliter and WBC 6,600/microliters with 52% blast cells. Bone marrow aspirate demonstrated 77.2% myeloblasts with prominent Auer rods, consistent with acute myelogenous leukemia. Receiving packed-red-cell and platelet transfusions, she delivered a normal male infant in the 39th week of pregnancy by normal labor. After delivery, she was placed on a combination chemotherapy of BHAC-MMP, subsequently DNR added. Four weeks later, a complete remission was obtained, lasting for almost one year, and her child has grown well without hematological disorder. Microscopic findings of the placenta obtained at delivery revealed no invasion of leukemic cells, but 9% blast cells were present in the placental cord blood. We reviewed 18 cases reported in Japan of acute leukemia in gestational period, that could obtain complete remission and keep the children growing well. Placental transmission of leukemic cells from mother to infant was discussed.

IL-2 receptor expression and function on human cord blood mononuclear cells following PHA and anti-CD3 antibody stimulation

Interleukin-2 receptors (IL-2R) on mononuclear cells from human umbilical cord blood were investigated after stimulation by phytohemagglutinin (PHA) and anti-CD3 antibody. The proportion of cells expressing the Tac antigen (IL-2R alpha, p55) did not differ from that for adult mononuclear cells. However, the levels of high affinity IL-2R (H-IL-2R) and low affinity IL-2R (L-IL-2R) present on the PHA blasts of cord blood cells were shown to be twice and three times, respectively, that of adults by interleukin-2 (IL-2) binding assay. The level of low affinity IL-2R in the cord blood cells was approximately double that of adult cells after activation by anti-CD3 antibody, but no difference was observed in the levels of high affinity IL-2R. Functional investigation of IL-2R revealed that the amount of internalized IL-2 in PHA-stimulated cord blood mononuclear cells was twice that in adult mononuclear cells but there were no differences between them in the time course of internalization and degradation. Although there were significant numbers of H-IL-2R in premature (25 and 28 weeks) infants following PHA stimulation, there were markedly fewer following anti-CD3 stimulation. Prematurity of the T-cell activation system through the CD3 pathway at this stage is therefore indicated.

Detection of HTLV-I genome in seronegative infants born to HTLV-I seropositive mothers by polymerase chain reaction

We applied the polymerase chain reaction (PCR) method to detect gag, env and pX sequences of human T cell leukemia virus type I (HTLV-I) provirus in peripheral blood lymphocytes of seronegative infants born to HTLV-I seropositive mothers. Out of 22, five subjects were found to contain the HTLV-I provirus genome. Two of the five cases were judged to be negative for not only anti-HTLV-I antibodies but also the viral antigens on cultivated lymphocytes by the conventional antibody/antigen detection methods. These results indicate that PCR is of great use as a simple and highly sensitive method detect HTLV-I infection.

Bottle-feeding can prevent transmission of HTLV-I from mothers to their babies

Breast-feeding is a major factor in the vertical transmission of human T-lymphotropic virus type I (HTLV-I). We studied whether such transmission may be prevented by bottle-feeding. HTLV-I infection was detected by both HTLV-I antigen and antibody tests. Thirty bottle-fed babies were examined 24 months after birth; only one was found to be HTLV-I antigen-positive. This infection rate was lower than that for breast-fed babies in whom HTLV-I antigen was detected in 24 of the 31 24-month-old babies born to HTLV-I positive mothers in a previous study. These results suggest that most vertical transmission of HTLV-I is attributable to breast-feeding and can be prevented by bottle-feeding.

Effect of freeze-thawing breast milk on vertical HTLV-I transmission from seropositive mothers to children

Breast feeding is known to be a major cause of vertical transmission of HTLV-I from mothers to her children. The infectiousness of HTLV-I in breast milk was reported to be lost during freezing and thawing processes. We therefore administered frozen-and-thawed breast milk of HTLV-I carriers to their babies. Among the 13 babies given the frozen-and-thawed breast milk (now 12 months of age), no infection has been found yet. This result suggests that freezing and thawing of breast milk is a promising method for the prevention of vertical HTLV-I infection to breast-fed babies.

The problem of hemoglobin switching in premature infants and IUGR infants

Understanding the hemoglobin switching regulation mechanism in extremely premature infants is particularly important for understanding the extrauterine adaptation of the infants. In this study, we sought to identify factors influencing oxygen affinity in fetal blood and neonatal blood and obtained these results. (1) Aging is required for hemoglobin switching. (2) Switching in premature infants (27 to 32 weeks) is delayed at least 3 weeks in comparison with full-term infants. (3) A delay in the switching of fetal hemoglobin to adult hemoglobin was confirmed in IUGR (intrauterine growth retardation) infants. However, there is a compensatory increase in 2, 3-DPG for adaptation after birth. (4) A delay in 2, 3-DPG increase was observed in RDS (respiratory distress syndrome) infants, and oxygen affinity remained high.

[The study on the human placental L-lactate transport mechanism (using placental microvillous membrane vesicles)]

To elucidate the human placental L-lactate transport mechanism, we investigated L-lactate uptake by microvillous membrane vesicles (MMV) prepared from full termed human placenta using the rapid filtration technique. 1. The transport of L-lactate into the MMV was not dependent on the Na+ electrochemical gradient (extravesicular greater than intravesicular). 2. The transport of L-lactate into the MMV was dependent on the H+ gradient (extravesicular greater than intravesicular) and this H+ dependent L-lactate uptake showed a tendency to overshoot. This overshoot disappeared with the addition of H+ ionophore (FCCP). 3. The initial rate of this H+ dependent L-lactate transport into the MMV exhibited saturation kinetics with respect to the L-lactate concentration: An apparent Km of 4.35mM and Vmax of 2.78n mol/mg protein/20sec were calculated. These results indicated that there existed a H+ and L-lactate transport system in human placental MMV.

[Pharmacokinetic and clinical studies of cefodizime in the field of obstetrics and gynecology]

Cefodizime (THR-221, CDZM), a new antibiotic, was studied pharmacokinetically and clinically. The results obtained are summarized as follows: 1. Concentrations of CDZM in internal genital tissues were quite high after an intravenous infusion. 2. Clinical effects of the therapy with CDZM using intravenous infusion twice daily were evaluated in 1 patient with endometritis, 2 patients with pyometra, 1 patient with extragenital abscess and 1 patient with BARTHOLIN'S gland abscess. Clinical responses were good in all 5 patients. No side effects nor abnormal laboratory test values due to the drug were noted.

Characterization of the CA125 antigen secreted from a newly established human ovarian cancer cell line (SHIN-3)

A cell line (designated SHIN-3) was established from a 56-year-old Japanese woman diagnosed as having serous cystadenocarcinoma of the ovary. SHIN-3 produced the tumor marker, CA125. When samples were subjected to one-dimensional gel electrophoresis followed by immunoblotting with anti-CA125 antibody, antigen binding appeared in the low-molecular-mass fraction around 50 KDa as well as in the high-molecular-mass fraction (more than 200 KDa). Subsequent resolution of this lower-molecular-mass component by two-dimensional gel electrophoresis gave rise to bands of 49 KDa near an isoelectric point of 7.3. Treatment of the CA125 antigen with 10 mM periodic acid resulted in no loss of activity. However, reduction and alkylation in 6 M guanidine-HCl or treatment at 100 degrees C for 20 min resulted in complete loss of activity. Treatment with various glycosidases did not inhibit activity, whereas digestion with proteases (except for papain) produced complete loss of activity, suggesting that the CA125 antigenic determinant is composed of conformationally dependent peptides.

Interleukin-2 production by human fetal lymphocytes

IL-2 production by PHA-stimulated human lymphocytes in umbilical blood was studied ontogenetically. Lymphocytes from the 16-week-old fetus produced appreciable amounts of interleukin-2 (IL-2). In 16- to 36-week-old fetuses the IL-2 production rate was found to be significantly higher than that in adults. When signal transduction, which is mediated by high affinity IL-2 receptors (IL-2R), was studied after adding exogenous IL-2 to PHA-blast lymphocytes, the response of the 24-week-old fetus was similar to that of adults. These results indicate that the attainment of IL-2 production and the function of IL-2 receptors are completed at a relatively early stage of fetal development.

Acinic cell carcinoma originating in the nasal cavity

The nasal cavity is a rare site for an acinic cell carcinoma. We have treated one such tumor in a 68-year-old man. He underwent a Denker's operation under general anesthesia and then received postoperative irradiation at 50 Gy. He has been kept asymptomatic for the past 2 years. To the best of our knowledge, this case is the third report on the acinic cell tumor in the nasal cavity. A brief literature review is also presented.

[A phase II study of Futraful suppository in head and neck cancer]

A phase II study of FT-207 suppository (Futraful Suppository) for head and neck cancer was conducted at the Kagoshima University Hospital Dept. of Otorhinolaryngology and its 6 affiliated hospitals. Forty cases with head and neck cancer were entered in the trial, of which 37 were perfectly evaluable. Partial response (PR) (16.7%) was achieved in one of 6 patients with maxillary cancer, in 2 of 9 cases with oral cancer (22.2%), in one of 7 with laryngeal cancer (14.3%), in 3 of 13 with pharyngeal cancer, while 2 of the same 13 achieved a complete response (CR) (38.5%), for a total response rate of 24.3%. FT-207 suppository was continuously administered as standard, at a dose of 750 mg each twice daily, or 1,500 mg/day. The response rate was dose-dependent; 2 CR cases with a total dose of 105 g for administration over a total period of more than 150 days. Adverse effects appearing in 35.0% of the overall were mainly anorexia, nausea and vomiting; none of them, however, were serious.

[Experimental and clinical studies on laserthermia in head and neck cancers]

A synthetic ceramic probe allows a wider angle of irradiation and diffusion of low power energy, below 3W, using an interstitial technique for producing local hyperthermia of Nd: YAG laser (Laserthermia). We studied the influences of this laserthermia procedure in experimental animals and patients with head and neck cancer. The histological findings after laserthermia in the rabbit tongues showed no marked tissue damage in the heated area. Biochemical analysis of arachidonic acid cascade metabolites in these tissues revealed an immediate increase of 12-, 15- HETEs and PGE2 and 3 at days after hyperthermia, but at 8 days these metabolites returned to control levels. The effectiveness of laserthermia on human thyroid cancer implanted in nude mice was compared with that in cisplatin treatment and in combined therapy with both. The most predominant effectiveness was found in the animals receiving therapy combining cisplatin and laserthermia. Laserthermia in combination with radio-chemotherapy was applied in 21 cases with head and neck cancer. Good efficacy was obtained in 17 patients, especially in those with oropharyngeal cancer, showing CR in 4 cases and PR in 13 cases.

[The character of premature baby's blood taurine concentration and urinary taurine excretion]

The concentration of taurine in fetal blood and in mother's milk is very high. In the present study, in order to elucidate the nutritional role of taurine during fetal and neonatal age we investigated the urinary taurine excretion and the blood taurine concentration change in premature babies. 1. The blood taurine concentration of infants on the first postnatal day decreased along with gestation between 7-10 gestational months. On the other hand, there was no difference in the concentrations of blood total amino acids in infants on the first postnatal day in 7-10 gestational months. 2. The blood taurine concentration of infants decreased remarkably during one week after birth. This tendency to decrease was more prominent in premature infants--those at 8 to 10 gestational months. 3. The urinary excretion of taurine and total amino acids of infants remarkably decreased along with gestation between 7-10 gestational months. This tendency to decrease was the most prominent in infants between 7 and 8 gestational months.

Laserthermia on head and neck malignancies--experimental and clinical studies

In recent years, remarkable progress has been made in thermotherapy. However, there is little information on localized laser hyperthermia (laserthermia) or on conventional hyperthermia technique applied to head and neck cancers. We have developed a ceramic probe to insert into tumor tissue and irradiate the Nd:YAG laser omnidirectionally. This probe can heat a spherical range of 1.5 cm to 43 degrees C. This paper concerns experimental and clinical studies on the effectiveness of laserthermia using our technique in the tumor of head and neck regions. The results obtained were as follows: histological findings and biochemical studies of arachidonic acid metabolites on normal rabbit tongue after laserthermia showed very slight effect and relatively short duration of the concomitant inflammation. The combination of laserthermia and CDDP chemotherapy was found to give a much better cytocidal effect on the tumor tissue in nude mice implanted with human thyroid cancer cells. In a clinical study on 21 cases with head and neck cancers, four cases showed complete and 13 cases showed partial remission after combined treatments of laserthermia and radiochemotherapy. Both basic experimental and clinical results have indicated a role for laserthermia in the treatment of head and neck cancer. Possible uses include the treatment of early cancer as well as advanced or recurrent cancer, where its therapeutic effect may be increased by combination with radiotherapy or chemotherapy.

[The role of glutathione on placental amino acid transport (using microvillous membrane vesicles)]

To elucidate the role of glutathione (GSH) on placental amino acid transport, we investigated L-lysine transport using microvillous membrane vesicles prepared from full term human placenta. 1. The transport of L-lysine into microvillous membrane vesicles was not affected by glutathione. 2. The transport of L-lysine into microvillous membrane vesicles was inhibited by inorganic mercury (Hg2+), and 0.1mM Hg2+ inhibited 34% of this transport and 1mM Hg2+ inhibited 50%. 3. The transport of L-lysine inhibited by Hg2+ was almost completely restored when glutathione was added simultaneously. These results indicated that glutathione defended the inhibitory action of inorganic mercury on L-lysine transport across microvillous membrane.

[The effect of antibiotics (gentamicin) on placental amino acid transport activity (using human placental microvillous membrane vesicles)]

In order to elucidate the effect of antibiotics (gentamicin) on placental amino acids transport, we investigated L-alanine transport using microvillous membrane vesicles prepared from full-term human placental by a rapid filtration technique. 1. The active transport of L-alanine into microvillous membrane vesicles was dependent on Na+ electrochemical gradient (extravesicular greater than intravesicular). And the double reciprocal plot of this Na+ dependent initial uptake rate versus L-alanine concentration exhibited an apparent Km of 0.79 + 0.23mM and a Vmax of 3.56 + 0.70n mol/mg protein/20 sec. 2. Gentamicin did not affect the Km value of this Na+ dependent L-alanine transport kinetics (0.77 + 0.19 mM [lmM gentamicin], 0.79 + 0.21mM [10mM gentamicin]). On the other hand, gentamicin apparently decreased, the Vmax value of this transport kinetics (1.99 + 0.48n mol/mg protein/20 sec [1mM gentamicin], 1.12 + 0.32n mol/mg protein/20 sec [10mM gentamicin]).

[Immunoglobulin production of neonate--T lymphocyte subset and production of cytokine]

On the mechanism underlying the repression of antibody production encountered in the new-born, in this study we used the induction of antibody-producing cells on mitogen stimulation of PWM and SAC, identification of T-cell subsets through two-color FACS and the evaluation of cytokine production of IL-1, IL-2 and BCGF with the following results; 1. The cord blood IgG level rose with gestational weeks due to active transport from the mother. The IgM level was low in full term infants. A natural antibody first appeared in the 16th week. 2. Antibody production on mitogen stimulation in infants was remarkably less than in adults. The inability to produce antibodies appears to be closely related to T-cell factors. 3. In examination of the cell surface maker, new-born infants show less suppressor T-cell but significantly more suppressor inducer T-cell than in adults and that its much smaller number of helper T-cells are insufficient for antibody production. 4. Production of IL-1 in full term infants was significantly lower and that in premature subjects was much lower than that in adults. In full term infants, IL-2 was about the same as in adults, and BCGF production was greater than in adults not depressed in full term infants, and were significantly higher in premature infants than that in adults.