Periostin levels correlate with disease severity and chronicity in patients with atopic dermatitis

BACKGROUND

Recent findings indicate that periostin, an extracellular matrix protein induced by T helper 2 cytokines, plays a critical role in the pathogenesis of atopic dermatitis (AD).

OBJECTIVES

To determine whether serum periostin level is associated with clinical phenotype in adult patients with AD.

METHODS

An enzyme-linked immunosorbent assay was performed to determine serum periostin levels in 257 adult patients with AD, 66 patients with psoriasis vulgaris (PV) as a disease control and 25 healthy controls. Serum periostin levels were analysed together with clinical characteristics and laboratory parameters, including thymus and activation-regulated chemokine (TARC), lactate dehydrogenase (LDH), blood eosinophil count and total IgE. Immunohistochemical analysis evaluated the expression of periostin in association with various clinical phenotypes of AD. The effect of treatment on serum periostin level was also assessed.

RESULTS

Serum periostin was significantly higher in patients with AD than in patients with PV and healthy controls. Periostin level was found to be positively correlated with disease severity, TARC level, LDH level and eosinophil count, but not with IgE level. Higher serum periostin level was observed in patients with extrinsic AD compared with patients with intrinsic AD; the positive correlation of disease severity disappeared in patients with intrinsic AD. Robust expression of periostin was detected in the dermis of patients with AD with erythroderma, lichenification and, to a lesser extent, scaly erythema. Serial measurement of serum periostin revealed decreased levels of periostin after treatment for AD.

CONCLUSIONS

Periostin may play a critical role in disease severity and chronicity in the pathogenesis of AD.

Results of radiotherapy for inoperable locally advanced esophageal cancer

Three hundred and eleven patients with locally advanced esophageal cancer were treated by radiation therapy from 1968 to 1983 at Tokyo Women's Medical College. Of these, 288 patients with previously untreated, histologically confirmed squamous cell carcinoma but previously treated with curative intent, were eligible for analysis. The cumulative 5-year survival rate of 288 patients given radical radiotherapy was 9.0%. Sex, tumor length, and Stage (AJC) had a great influence on prognosis. The five-year survival rate in males was 5.4% and in females was 22.4%. The five-year survival rate in cases with a tumor length of 5 cm or less was 17.7% in 5-10 cm was 10.0%, and in 10 cm or above was 2.8% and they were 20.2% for Stage I, 9.9% for Stage II, and 2.6% for Stage III. There were no significant differences of survival rate among age, tumor site, and tumor type on X ray film. This data suggests that comparatively early, small-volume tumors share a significant potential for cure by radiotherapy, but potent combined therapy is necessary for the treatment of advanced cancers.

Randomized prospective clinical study of small, large and twice-a-day fraction radiotherapy for painful bone metastases

A prospective randomized clinical trial comparing small, large and twice-a-day fraction for the relief of painful bone metastases was performed from 1981 to 1986 at Tokyo Women's Medical College Hospital. Eighty patients with painful bone metastases (92 sites) were divided into three radiation methods which were conventional fraction scheme of 5 times/week at 2 Gy/day for a total of 30 Gy/15 fractions (Group I, TDF: 49), 2 times/week at 4.5 Gy/day for a total of 22.5 Gy/5 fractions (Group II, TDF: 50) and 3 times/week at 2 Gy/day twice a day at a minimum interval of 6 h for a total of 20 Gy/10 fractions (Group III). Pain was assessed using a score and response rate was 76% in Group I, 75% in Group II and 78% in Group III which were not statistically significant mutually. Group II and III regimes were found to have an earlier shorter onset of pain relief than Group I, but the dose of onset of pain relief was almost the same. Our data suggested that individualization of radiotherapy schedules based on to assess the patient's condition and the expected quality of life and to consider radiation site and size of field, was more important than the fractionation regime in the treatment of painful bone metastases.

Multi-institutional randomized trial of external radiotherapy with and without intraluminal brachytherapy for esophageal cancer in Japan. Japanese Society of Therapeutic Radiology and Oncology (JASTRO) Study Group

PURPOSE

With the aim of improving the results of treatment of esophageal cancer, we designed this multi-institutional, randomized trial to establish the optimal irradiation method in radical radiation therapy for esophageal cancer by clinically evaluating external irradiation alone and in combination with intraluminal brachytherapy.

METHODS AND MATERIALS

The study population consisted of patients with squamous cell carcinoma who were expected to be successfully treated with radical radiation therapy. The patients who could be given intraluminal brachytherapy at the end of external irradiation of 60 Gy were stratified into 2 groups. Patients assigned to receive external irradiation alone received boost irradiation of 10 Gy/week on a schedule similar to the previous one, and with the same or smaller irradiation field. Intraluminal brachytherapy was performed, as a rule, with the reference dose point set at a depth of 5 mm of the esophageal submucosa, and a total of 10 Gy was irradiated at a daily dose of 5 Gy, on a once-weekly schedule with low-dose-rate or high-dose-rate brachytherapy equipment.

RESULTS

A total of 103 patients were registered, 94 of whom were analyzable, with 8 ineligible, and 1 for whom complete information was unavailable. The overall cumulative survival rate was 20.3% at 5 years. The cause-specific survival rate was 31.8% at 5 years. The cause-specific survival rate at 5 years was 27% in the external irradiation alone group and 38% in intraluminal brachytherapy combined group. There was no significant difference between the 2 groups (p = 0.385). However, in the patients with 5 cm or less tumor length, the cause-specific survival rate was 64% at 5 years in the intraluminal brachytherapy combined group, which showed a significant improvement over 31.5% in the external irradiation alone group (p = 0.025). In the patients with Stage T1 and T2 disease, cause-specific survival rates tended to be better in the intraluminal brachytherapy combined group than in the external irradiation alone group (p = 0.088). In the patients with more than 5 cm tumor length or Stage T3-4 disease, there were no significant differences between the two groups by treatment methods (p = 0.290). The incidence of early and late complications did not differ according to whether intraluminal brachytherapy was used.

CONCLUSION

For the purpose of establishing the usefulness of intraluminal brachytherapy, further prospective randomized studies are necessary to evaluate the efficacy in tumors with short length and those with shallow invasion, or to assess the usefulness of intraluminal brachytherapy, as additional irradiation in large advanced tumors have been shown to have disappeared by diagnostic imaging after chemoradiotherapy with 60 Gy/6w external irradiation.

Effect of LC9018 combined with radiation therapy on carcinoma of the uterine cervix. A phase III, multicenter, randomized, controlled study

BACKGROUND

The failure rate with radiation therapy alone for Stage III cervical cancer is quite high, and therefore other modalities are being pursued as adjuvants to radiation therapy in hopes of improving the results.

METHODS

A randomized, controlled, comparative study on the efficacy and safety of radiation therapy combined with LC9018 (a biologic response modifier prepared from heat-killed Lactobacillus casei YIT9018) was conducted using 228 patients with Stage IIIB cervical cancer.

RESULTS

LC9018 enhanced tumor regression (P < 0.1) by radiation after both 30 Gy of external radiation and at the completion of radiation therapy. The combination therapy also prolonged survival and the relapse-free interval (P < 0.05) compared to radiation alone. Analysis of survival using the Cox proportional hazard model indicated that use of LC9018 was a significant factor related to survival duration. Major side effects of combined LC9018 included fever and skin lesions at the injection site, but no severe symptoms were noted. Radiation-induced leukopenia was significantly less severe (P < 0.05) in the LC9018-combined group than in the radiation-alone group, suggesting that this agent might help to prevent leukopenia during radiation therapy.

CONCLUSIONS

LC9018 was shown to be an effective agent for adjuvant immunotherapy when combined with radiation therapy.

Insulin-like growth factors I and II are autocrine factors in stimulating proteoglycan synthesis, a marker of differentiated chondrocytes, acting through their respective receptors on a clonal human chondrosarcoma-derived chondrocyte cell line, HCS-2/8

Both insulin-like growth factor (IGF)-I and IGF-II increased the synthesis of cartilage-type, large proteoglycan in a human chondrosarcoma-derived chondrocyte cell line, HCS-2/8. In contrast to the stimulatory effects of IGFs on costal chondrocytes of the young rabbit, the stimulatory effect of IGF-II on proteoglycan synthesis in HCS-2/8 cells was more potent than that of IGF-I. IGF-II, but not IGF-I, increased calcium influx into HCS-2/8 cells, and there was a close relation between the stimulation of proteoglycan synthesis and the calcium influx. [125I]IGF-I bound to HCS-2/8 cells, and this binding was competitively inhibited by low concentrations of unlabeled IGF-I, higher concentrations of IGF-II, and much higher concentrations of insulin. [125I]IGF-II also bound to the cells, and its binding was competitively inhibited by IGF-II and slightly inhibited by higher concentrations of IGF-I and much higher concentrations of insulin. When radioligand-receptor complexes were separated by SDS-PAGE and subjected to autoradiography, two major bands at 260 and 130 kDa were observed, which correspond to the IGF type II receptor (IGF-IIR) and the alpha subunit of the IGF type I receptor (IGF-IR), indicating the presence of both receptors. When confluent cultures of HCS-2/8 cells were maintained in serum-free medium, proteoglycan synthesis did not decrease unless the medium was repeatedly replaced. Conditioned medium of HCS-2/8 cells stimulated the HCS-2/8 cells to synthesize proteoglycans. RIA revealed that the cells produced both IGF-II and IGF-I. Transcripts of messenger RNAs of both IGF-I and IGF-II and both IGF-IR and IGF-IIR also were detectable by Northern analysis. Both anti-IGF-IR antibody and anti-IGF-II antibody inhibited proteoglycan synthesis. Mannose-6-phosphate, which is known to bind to IGF-IIR, stimulated proteoglycan synthesis, potentiated IGF-II-stimulated proteoglycan synthesis, and enhanced the binding affinity for IGF-II but not for IGF-I. Even in the presence of anti-IGF-IR antibody, IGF-II and mannose-6-phosphate stimulated proteoglycan synthesis in the cells. [Leu27]IGF-II, an IGF-II analogue with high affinity only for IGF-IIR, strongly stimulated proteoglycan synthesis in HCS-2/8 cells but [Arg54, Arg55]IGF-II, which binds to only IGF-IR, also stimulated proteoglycan synthesis in the cells. These findings indicate that IGF-I and IGF-II act as autocrine differentiation factors for this chondrocytic permanent cell line, HCS-2/8, mainly via respective receptors.

Comparison of parameters of 123I-MIBG scintigraphy for predicting prognosis in patients with dilated cardiomyopathy

123I-metaiodobenzylguanidine (MIBG) scintigraphy has been used to predict prognosis of patients with dilated cardiomyopathy (DCM), although it is unknown which parameter of MIBG is the most useful clinically. We studied MIBG in 59 patients with DCM, and followed them up to evaluate the prognosis of DCM. Single photon emission tomography (SPET) and planar imaging were performed, both early (e) and 4 h (delayed, d) post-injection. 201Tl (TL) SPET and radionuclide-ventriculography were also investigated. The total defect score of early and delayed MIBG and 201 Tl (MIBGeDS, MIBGdDS, TLDS) was analysed visually for each SPET image. The heart to mediastinum ratio (H/M) for both the early and delayed MIBG planar images and myocardial washout rate at 4 h were analysed quantitatively. Sixteen patients died during follow-up. Cox Hazards univariate analysis selected washout rate (P < 0.0001), H/Me (P = 0.0012), H/Md (P = 0.0001) and left ventricular ejection fraction (P = 0.0004) as indices for the prediction of cardiac death. Multivariate analysis selected washout rate as the most powerful independent predictor of prognosis (P < 0.0001). Survival curves with a threshold value of 52% for washout rate were able to differentiate a negative outcome from survival (P < 0.0001). TLDS, MIBGeDS and MIBGdDS were not useful in the prediction of prognosis. The washout rate of MIBG is the most potent predictor of cardiac death and is considered clinically useful.

AKT induces senescence in primary esophageal epithelial cells but is permissive for differentiation as revealed in organotypic culture

Epidermal growth factor receptor (EGFR) overexpression and activation is critical in the initiation and progression of cancers, especially those of epithelial origin. EGFR activation is associated with the induction of divergent signal transduction pathways and a gamut of cellular processes; however, the cell-type and tissue-type specificity conferred by certain pathways remains to be elucidated. In the context of the esophageal epithelium, a prototype stratified squamous epithelium, EGFR overexpression is relevant in the earliest events of carcinogenesis as modeled in a three-dimensional organotypic culture system. We demonstrate that the phosphatidylinositol 3-kinase (PI3K)/AKT signaling pathway, and not the MEK/MAPK (mitogen-activated protein kinase) pathway, is preferentially activated in EGFR-mediated esophageal epithelial hyperplasia, a premalignant lesion. The hyperplasia was abolished with direct inhibition of PI3K and of AKT but not with inhibition of the MAPK pathway. With the introduction of an inducible AKT vector in both primary and immortalized esophageal epithelial cells, we find that AKT overexpression and activation is permissive for complete epithelial formation in organotypic culture, but imposes a growth constraint in cells grown in monolayer. In organotypic culture, AKT mediates changes related to cell shape and size with an expansion of the differentiated compartment.

Strong-correlation induced high-mobility electrons in Dirac semimetal of perovskite oxide

Electrons in conventional metals become less mobile under the influence of electron correlation. Contrary to this empirical knowledge, we report here that electrons with the highest mobility ever found in known bulk oxide semiconductors emerge in the strong-correlation regime of the Dirac semimetal of perovskite CaIrO₃. The transport measurements reveal that the high mobility exceeding 60,000 cm²V⁻¹s⁻¹ originates from the proximity of the Fermi energy to the Dirac node (ΔE < 10 meV). The calculation based on the density functional theory and the dynamical mean field theory reveals that the energy difference becomes smaller as the system approaches the Mott transition, highlighting a crucial role of correlation effects cooperating with the spin-orbit coupling. The correlation-induced self-tuning of Dirac node enables the quantum limit at a modest magnetic field with a giant magnetoresistance, thus providing an ideal platform to study the novel phenomena of correlated Dirac electron.

Electron correlation normally makes electrons less mobile, but it is still not clear when correlation becomes very strong in Dirac semimetals. Here, Fujioka et al. report a very high electron mobility exceeding 60,000 cm²V⁻¹s⁻¹ in correlated Dirac semimetal of perovskite CaIrO3, due to the enhanced electron correlation nearby the Mott transition.

Prospective outcomes of comminuted periarticular metacarpal and phalangeal fractures treated using a titanium plate system

PURPOSE

The purpose of this study was to prospectively evaluate clinical results for open reduction and internal fixation of unstable metaphyseal fractures of the metacarpal and phalangeal bones using a miniature titanium plate.

METHODS

Fifty-one consecutive patients with periarticular fractures with metaphyseal comminution and displacement were enrolled. Intra-articular involvement with a split or depression fracture was identified in 22 hands. Minimum follow-up was 1 year. There were 37 male and 14 female patients; average age was 38 years (range, 14-63). Of the 51 fractures, 15 were open; 8 of these had additional soft tissue injury, involving neurovascular injury in 4 and extensor tendon injury in 6. The average duration from injury to surgery was 6 days (range, 2-40 days).

RESULTS

Bone union was successfully achieved in all patients over an average period of 2.6 months. The final range of total active motion (%TAM) was excellent (>85%) for 26, good (70%-84%) for 17, fair (50%-69%) for 5, and poor (<49%) for 3. Postoperative complications occurred in 5 patients, including fracture redisplacement in 2, a collapse or absorption of the condylar head in 2, and superficial infection due to hardware exposure in one. Subsequently, 2 of these patients had malrotation deformities or osteoarthritic changes in the injured finger. Plates were removed in 30 cases, and additional surgery was required in 20 cases. Postoperative grip strength averaged 87% of the contralateral side. Statistical analysis revealed that patient age was significantly correlated with %TAM of the injured finger at 1-year follow-up (p < .01), and intra-articular (p < .05) and phalangeal bone (p < .01) involvement, as well as associated soft tissue injury (p < .05), significantly affected the range of finger motion.

CONCLUSIONS

Despite the technical demands of plating for comminuted metacarpal and phalangeal fractures, the low-profile titanium plate system was highly effective in maintaining anatomic reduction. The postoperative complication rate was relatively low, and the objective outcomes approached a reasonable level at 1-year follow-up.

TYPE OF STUDY/LEVEL OF EVIDENCE

Therapeutic IV.

Superficial esophageal cancer: multicenter analysis of results of definitive radiation therapy in Japan

PURPOSE

To assess the effectiveness of definitive radiation therapy in patients with superficial esophageal cancer.

MATERIALS AND METHODS

Method of irradiation, local control rate, survival rate, and complications were assessed in 105 patients (89 men, 16 women; age range, 50-88 years) with superficial esophageal cancer treated with definitive radiation therapy at 15 hospitals in 1981-1990.

RESULTS

All lesions were confirmed to be squamous cell carcinoma. The overall 5-year survival rate was 38.7%; the 5-year disease-specific survival rate was 71.0%. The 2-year local control rate was 83.0%. Late complications occurred in 16 patients. The prevalence of complications was relatively high in the group treated with intraluminal radiation therapy.

CONCLUSION

Local control and survival rates in patients treated with radiation therapy were excellent, especially in the group treated with external and intraluminal radiation therapy; however, the optimal dose and optimal combination of external and intraluminal radiation therapy should be further assessed.

Photosynthetic productivity of conical helical tubular photobioreactors incorporatingChlorellasp. under various culture medium flow conditions

The characteristics of the flow of culture medium significantly affects the photosynthetic productivity of bioreactors incorporating microalgae. Therefore, in order to optimize the performance of a conical helical tubular photobioreactor (CHTP) designed to be useful in practical applications, we characterized the flow pattern of the culture medium through the reactor. The effects of medium flow conditions on the photosynthetic productivity of Chlorella sp. were investigated using several different CHTP units with 0.50-m2 installation areas which were designed to vary the direction and rate of flow driven by airlift. In addition, the performance of two- and four-unit systems constructed by combining individual CHTP units was evaluated. We found that when medium flowed from the bottom to the top of the photostage, it exhibited smoother flow of culture medium than when flowing from top to bottom, which led to higher photosynthetic productivity by the former. Consistent with theoretical calculations, varying the lengths of vertical flow passages caused flow rates to vary, and higher flow rates meant smoother circulation of medium and better photosynthetic performance. Flow of medium through a four-unit CHTP system was similar to that in single units, enabling a photosynthetic productivity of 31.0 g-dry biomass per m2-installation area per day to be achieved, which corresponded to a photosynthetic efficiency of 7.50% (photosynthetically active radiation (PAR; 400-700 nm)). This high photosynthetic performance was possible because smoother medium flow attained in single units was also attained in the four-unit system.

Factors affecting the occurrence of urothelial tumors in dye workers exposed to aromatic amines

BACKGROUND

Past studies have analyzed individual jobs in dyestuff factories, materials manufactured and handled, age at exposure, and the duration of exposure in factories as factors related to the occurrence of urothelial tumors. None of these studies was based on long-term observation, and the factors involved in the occurrence of urothelial tumors remain controversial. In this study, various factors that may affect the occurrence of urothelial tumors in dye workers were assessed by multivariate analysis.

METHODS

Three hundred and sixty-three workers in nine member factories of the Dyestuff Industrial Cooperative Association were included the study. Factory A is a large dyestuff chemical factory in Wakayama City with 218 dye workers. The other eight smaller factories employ a total of 145 dye workers. Correlations of tumor occurrence with a variety of factors, such as dyestuff intermediates manufactured and handled, types of job in the factory, age at the beginning of occupational exposure, and the duration of exposure were examined by multivariate analysis using multiple logistic models.

RESULTS

Urothelial tumors were found in 58 (16.0%) of the 363 dye workers in the nine member factories of the Cooperative Association examined in the present study. The incidence in workers in Factory A, 5.5% (12 patients), was significantly (P < 0.01) lower than the overall incidence, while that in the eight small factories, 31.7% (46 patients), was significantly (P < 0.01) higher than the overall incidence. The risk factors significantly related to tumor occurrence in the 363 dye workers were benzidine (odds ratio, 8.302) as a dyestuff intermediate, manufacturing work (odds ratio, 4.631), and a long period of exposure (odds ratio, 1.018). Correlations of the tumor occurrence with the various factors were examined by multivariate analysis using multiple logistic models. In the total of 363 workers, benzidine as an intermediate (P < 0.05), manufacturing work (P < 0.01) and the duration of exposure (P < 0.01) were found to have contributed to the urothelial tumor occurrence. In Factory A, benzidine as an intermediate (P < 0.01) and duration of exposure (P < 0.05) contributed significantly to tumor occurrence.

CONCLUSIONS

1) The manufacturing and handling of benzidine and duration of exposure contribute significantly to the occurrence of occupational urothelial tumor, the former more strongly than the latter; 2) the contribution of different job types to tumor occurrence may be dependent upon the industrial health and safety practices in each factory.

Association between nasal allergy and a coding variant of the Fc epsilon RI beta gene Glu237Gly in a Japanese population

The gene for the beta-chain of the high-affinity receptor for IgE (Fc epsilon RI beta) has been proposed as a candidate gene for atopy. A coding variant Glu237Gly has been studied in various populations with asthma and atopy, and the results were controversial for association of the variant with atopy/asthma. Because nasal allergy is a more common atopic disease and shows less remission than asthma, we analyzed whether the Glu237Gly variant is correlated with nasal allergy. The study enrolled 233 patients with nasal allergy and 100 control subjects. Further, three subgroups were selected: patients with perennial nasal allergy (n=149), Japanese cedar pollinosis (n=189), and allergy to multiple allergens (n=45). The allele frequency of Gly237 in the controls and patients was 0.14 and 0.20, and the frequency of Gly237-positive subjects was 0.23 and 0.356, respectively. There was a significant association between Gly237-positivity and nasal allergy, perennial nasal allergy, Japanese cedar pollinosis, and allergy to multiple allergens. Among all 333 subjects we observed a significant relationship between Gly237 and elevated levels of serum total IgE (>250 IU/ml) and very high IgE (>1000 IU/ml). Among patients positive for a specific IgE, Gly237 was significantly associated with high IgE for house dust, mite, and Japanese cedar pollen. These results suggest that the Glu237Gly variant of the Fc epsilon RI beta gene is involved in the development of nasal allergy through the process for the production of both specific and nonspecific IgE antibodies.

Phase II randomized clinical trial of LC9018 concurrently used with radiation in the treatment of carcinoma of the uterine cervix. Its effect on tumor reduction and histology

The clinical efficacy of LC9018, a biological response modifier prepared from heat-killed Lactobacillus casei YTT9018, used in combination with radiation was studied in a randomized controlled trial on 61 patients with carcinoma of the uterine cervix of Stage IIB or III. The combination therapy with LC9018 demonstrated a significant effect on tumor reduction, compared with radiation therapy alone, at the cumulative doses of 15-Gy and 30-Gy external irradiation (P less than 0.05). Histologic study confirmed that LC9018 also enhanced the therapeutic effect of the irradiation. Moreover, LC9018 seemed to be useful in protecting the patients from leukopenia during radiotherapy. This study suggests that LC9018, when used in combination with radiotherapy, will be an effective adjuvant immunotherapeutic agent. More studies in a large series of patients will, however, be needed to establish its long-term efficacy, safety, and effects on both prognosis and enhancing radiotherapy.

Radiation therapy alone in the treatment of carcinoma of the uterine cervix: review of experience at Tokyo Women's Medical College (1969-1983)

Three hundred thirteen patients presented with squamous cell carcinoma of the uterine cervix at Tokyo Women's Medical College from 1969 to 1983. The results are presented here. All of the patients were treated by radiotherapy with curative intent with a combination of intracavitary cesium by low-dose rate, using T.A.O. afterloading applicators, which was made of flexible tubes to adapt to the physique of Japanese women by Tazaki, E., Arai, T. and Oryu, S. and external irradiation. One hundred and sixty patients (51.1%) presented with FIGO Stage III disease, 23 patients (7.3%) presented with Stage I disease, and 75 (24.0%) with Stage II. The 5-year cumulative survival rate was 81.7% for Stage I, 76.8% for Stage II, 53.3% for Stage III, 29.2% for Stage IVa, and 10.5% for Stage IVb, respectively. The overall 5-year survival rate was 55.8%. The local regional recurrence rate according to stage was 13.6% in Stage I, 22.4% in Stage II, 41.3% in Stage IIII, and 46.7% in Stage IVa. The incidence of locoregional recurrence rate was 35.6% and distant metastasis 37.8%. The incidence of complications involving bleeding and pain which required hospitalization, was 12.2% in all patients. Only four required surgery to manage serious complications.

Reattachment of the greater trochanter using the Dall-Miles cable grip system in revision hip arthroplasty

Clinical and radiographic results of trochanteric osteotomy after revision hip arthroplasty in 62 hips were reviewed. The osteotomized fragment had been reattached using the Dall-Miles cable grip system in each hip. The patients' average age at operation was 64.4 years (range, 40-86 years). The average duration of follow-up was 30.0 months (range. 12-60 months). Trochanteric nonunion was found in 19 hips (30.6%). Trochanteric nonunion developed in 14 (38.9%) of 36 hips with each cable attached around the medial cortex bone, in 2 (16.7%) of 12 hips with each cable passed in a drill hole, and in 3 (21.4%) of 14 hips with one cable passed through a hole and the other attached around the medial cortex. Fragmentation developed in 18 hips (29.0%). In 3 of these 18, the fragments had migrated close to the acetabular component. Cable breakage was seen in 4 hips (6.5%), and bone absorption around the cable in the medial cortex was seen in 17 hips (27.4%). There were 16 hips (25.8%) that presented symptoms at the greater trochanter, including spontaneous pain and tenderness. When the Dall Miles cable grip device is used for reattachment of the greater trochanter, attention should be paid to the condition of the trochanteric bed, the tension of the abductor muscles, and to the placement of the cables and the H-shaped grip.

Experimental infection of cynomolgus and African green monkeys with human herpesvirus 6

Cynomolgus and African green monkeys were inoculated with human herpesvirus 6 (HHV-6). An antibody response was first observed 10 days and 5 days after inoculation of cynomolgus monkeys and African green monkeys, respectively, and was detectable for the duration of the experiment (33 days). HHV-6 DNA was first detected by the polymerase chain reaction in mononuclear cells of one cynomolgus monkey and one African green monkey 10 days after virus inoculation, and in a total of three of four cynomolgus monkeys (75%) and four of five African green monkeys (80%) later after inoculation. Furthermore, HHV-6 DNA was detected in the lymph nodes and spleen of monkeys killed 33 days after virus inoculation. A rash was observed on the trunk of one African green monkey 13 days after virus inoculation, otherwise the infection was asymptomatic. When mononuclear cells from both groups of monkeys were cultured in medium containing concanavalin A and interleukin 2, and infected with HHV-6 in vitro, virus replication was observed. The data suggest that HHV-6 infects these species of monkey and that this system could be useful as an animal model of HHV-6 infection.

Histatin as a synergistic stimulator with epidermal growth factor of rabbit chondrocyte proliferation

Histatin 5 dose-dependently increased DNA synthesis in rabbit costal chondrocytes in culture. The level of DNA synthesis was stimulated by histatin 5 to about 4 times that of the control. The combination of histatin 5 and epidermal growth factor (EGF) increased the DNA synthesis to about 40 times that of the control while EGF alone stimulated it 15-fold, indicating synergistic stimulation by both factors. Enzyme-linked immunosorbent assay using anti-histatin 5 demonstrated that human serum contained histatin-like substances. These findings suggest that histatins play an important role in chondrocyte proliferation, presumably as a physiological modulator of the action of EGF.

Roles of potassium channels and nitric oxide in modulation of uterine contractions in rat pregnancy

OBJECTIVE

We sought to study the involvement of potassium channels in the inhibition by nitric oxide of spontaneous contractions in isolated uterine rings from midterm and term pregnant rats.

STUDY DESIGN

Uterine rings from Sprague-Dawley rats at midterm and term gestation were used for isometric tension recording. The inhibition of spontaneous contractile activity by potassium channel openers and nitric oxide was studied in the absence and presence of potassium channel inhibitors.

RESULTS

The adenosine triphosphate-dependent potassium channel opener levcromakalim inhibited spontaneous contractions in rings from both midterm and term pregnant rats in a concentration-dependent manner, and the effects were significantly attenuated by pretreatment with selective inhibitor of the adenosine triphosphate-dependent potassium channel inhibitor glibenclamide. The opener of calcium-dependent potassium channel NS 1619 inhibited spontaneous contractions in rings from midterm but significantly less so in rings from term pregnant rats in a concentration-dependent manner, and the effect was significantly attenuated by pretreatment with potassium channel inhibitors tetraethylammonium and tetrabutylammonium but not with glibenclamide. Rings from midterm and term pregnant rats were more sensitive to the inhibitory effect of levcromakalim compared with NS 1619. Nitric oxide donor diethylamine-nitric oxide inhibited spontaneous contractions in rings from midterm but significantly less in rings from term pregnant rats in a concentration-dependent manner, and the effect was attenuated by tetraethylammonium and tetrabutylammonium but not by glibenclamide.

CONCLUSIONS

There is gestational age-dependent refractoriness to calcium-dependent potassium but not adenosine triphosphate-dependent potassium channel opener-induced inhibition of spontaneous contractile activity of isolated rat uterine rings. Nitric oxide inhibits uterine contractions by opening of calcium-dependent potassium channels in pregnant rat myometrium. Refractoriness to nitric oxide toward term may result from decreased probability to open or number of calcium-dependent potassium channels.

Treatment of superficial esophageal cancer by external radiation therapy alone: results of a multi-institutional experience

PURPOSE

To assess the effectiveness and toxicity of external radiation therapy for superficial esophageal cancer.

METHODS AND MATERIALS

During the period from March 1979 to November 1996, 78 patients with superficial esophageal cancer received radiation therapy without intracavitary irradiation at nine radiotherapy institutions in Japan. All patients had histologically-proven squamous cell carcinoma. Endoscopic ultrasonography was performed in 34 patients to discriminate mucosal from submucosal cancer. Most of the patients had received radiation therapy using conventional fractionation at an average dose of 65.5 Gy.

RESULTS

The survival rates at 1, 2, and 5 years were 88%, 73%, and 45%, respectively. The local control rates at 1, 2, and 5 years were 85%, 79%, and 66%, respectively. Although the difference was not significant, the survival rate of cancer patients with a tumor invading the submucosa was lower than that of the other patients. In 6 mucosal cancer patients, local recurrence was observed in 1 patient with extensive cancer. Regional lymph node recurrence and distant failure were not observed in mucosal cancer patients, while in 28 submucosal cancer patients, the 5-year survival rate and relapse free rate were only 49% and 43%, respectively. Univariate and multivariate analysis identified age as the only significant prognostic factor. Severe late injury, such as esophageal ulcer, perforation, and bleeding, was not observed.

CONCLUSION

External radiation therapy is effective for mucosal cancer. However, further investigation is needed to establish a better standard treatment protocol for submucosal cancer.

Micropatterning of Ni particles on a BaTiO3 green sheet using a self-assembled monolayer

We studied surface modification of ceramic BaTiO(3) green sheets including polyvinylbutyral (PVB) as an organic binder and successfully fabricated a patterned self-assembled monolayer (SAM) which has a region of amino groups and a region of silanol groups on the green sheet. The patterned SAM was then immersed in water containing Ni particles that show negative zeta potential in water. Ni particles were attracted to the amino groups of the patterned SAM that show positive zeta potential by attractive electrostatic interaction. Consequently, a micropattern of Ni particles was achieved using a SAM at room temperature in water. This process can be used to fabricate a thin uniform internal Ni electrode for miniaturized high-performance multilayer ceramic capacitors (MLCC).

Mastoparan elicits prostaglandin E2 generation and inhibits inositol phosphate accumulation via different mechanisms in rabbit astrocytes

The effects of mastoparan on phosphoinositide hydrolysis and prostaglandin E2 (PGE2) generation were investigated in astrocytes cultured from rabbit brain. Mastoparan inhibited the accumulations of [3H]inositol phosphates induced by bradykinin (1 microM) in a time- and concentration-dependent manner. Mastoparan (3-30 microM) also released PGE2 in a time- and concentration-dependent manner. Mastoparan-induced release of PGE2 was inhibited by indomethacin, a cyclooxygenase inhibitor, by dexamethasone, a steroidal anti-inflammatory drug, and by pertussis toxin, an inactivator of some G proteins, such as Gi and Go. Mastoparan also caused [3H]arachidonic acid liberation, which was inhibited by dexamethasone or pertussis toxin. In contrast, indomethacin, dexamethasone and pertussis toxin failed to attenuate mastoparan-induced inhibition of [3H]inositol phosphate accumulation induced by bradykinin. Thus, mastoparan-induced inhibition of phosphoinositide hydrolysis does not involve pertussis toxin-sensitive G protein nor arachidonic acid metabolites. In addition to the inhibition of phospholipase C, mastoparan activates phospholipase A2 through pertussis toxin-sensitive G protein.

A new fetal therapy for chylothorax: pleurodesis with OK-432

We present a case of pleurodesis by intrapleural injection of OK-432 for the treatment of fetal chylothorax at an early gestational age. OK-432 injection achieved rapid and effective control of pleural effusion with no adverse effects.