Circulating Syndecan-1 Levels Are Associated with Chronological Coagulofibrinolytic Responses and the Development of Disseminated Intravascular Coagulation (DIC) after Trauma: A Retrospective Observational Study

BACKGROUND

The purpose of this study was to evaluate the association between endotheliopathy represented by high levels of circulating syndecan-1 (SDC-1) and coagulofibrinolytic responses due to trauma, which can lead to disseminated intravascular coagulation (DIC).

METHODS

We retrospectively evaluated 48 eligible trauma patients immediately admitted to our hospital and assessed SDC-1 and coagulofibrinolytic parameters for 7 days after admission. We compared the longitudinal changes of coagulofibrinolytic parameters and SDC-1 levels between two groups (high and low SDC-1) according to median SDC-1 value on admission.

RESULTS

The median circulating SDC-1 level was 99.6 (61.1-214.3) ng/mL on admission, and levels remained high until 7 days after admission. Coagulofibrinolytic responses assessed by biomarkers immediately after trauma were correlated with SDC-1 elevation (thrombin-antithrombin complex, TAT: r = 0.352, p = 0.001; antithrombin, AT: r = -0.301, p < 0.001; plasmin-α₂-plasmin inhibitor complex, PIC: r = 0.503, p = 0.035; tissue plasminogen activator, tPA: r = 0.630, p < 0.001). Sustained SDC-1 elevation was associated with intense and prolonged coagulation activation, impairment of anticoagulation, and fibrinolytic activation followed by inhibition of fibrinolysis, which are the primary responses associated with development of DIC in the acute phase of trauma. Elevation of circulating SDC-1 level was also associated with consumption coagulopathy and the need for transfusion, which revealed a significant association between high SDC-1 levels and the development of DIC after trauma (area under the curve, AUC = 0.845, cut-off value = 130.38 ng/mL, p = 0.001).

CONCLUSIONS

High circulating levels of syndecan-1 were associated with intense and prolonged coagulation activation, impairment of anticoagulation, fibrinolytic activation, and consumption coagulopathy after trauma. Endotheliopathy represented by SDC-1 elevation was associated with trauma induced coagulopathy, which can lead to the development of DIC.

Dynamic coagulofibrinolytic responses under long-term VV-ECMO management without anticoagulation in a COVID-19-ARDS patient: A case report

RATIONALE

Venovenous extracorporeal membrane oxygenation (ECMO) is recommended for the treatment of critically ill patients with acute respiratory distress syndrome due to coronavirus disease 2019 (COVID-19). However, ECMO management can cause both bleeding and thrombotic complications. There are insufficient coagulofibrinolytic data for appropriate ECMO management in patients with COVID-19.

PATIENT CONCERNS

A 48-year-old man with severe COVID-19-acute respiratory distress syndrome underwent long-term venovenous ECMO management for 48 days. Refractory oronasal bleeding developed on day 13, so the administration of unfractionated heparin was ceased for 29 days.

DIAGNOSIS

The patient showed dynamic coagulofibrinolytic responses associated with ECMO management, as shown by fibrin/fibrinogen degradation products, soluble fibrin, thrombin-antithrombin complex, and plasmin-α2-plasmin inhibitor complex elevations, suggesting the development of ECMO-induced coagulopathy.

INTERVENTIONS

We assessed coagulofibrinolytic markers to decide the appropriate timing for controlling excessive activation of coagulation by exchanging ECMO circuits. Moreover, viscoelastic hemostatic assays were used for adequate transfusion of blood products.

OUTCOMES

Safe long-term ECMO management was completed, which was withdrawn on day 48. The patient was weaned off mechanical ventilation on day 57 and was transferred to another hospital for rehabilitation.

LESSONS

Monitoring the coagulofibrinolytic status using markers and viscoelastic hemostatic assays may be effective for safe long-term ECMO management even without anticoagulant therapy.

ADAMTS13 activity decreases in the early phase of trauma associated with coagulopathy and systemic inflammation: a prospective observational study

BACKGROUND

We conducted a prospective observational study for investigating the changes in the 13th member of a disintegrin-like and metalloprotease with thrombospondin type 1 motif (ADAMTS13) and its association with the coagulofibrinolytic response in adult trauma patients.

METHODS

In 39 trauma patients hospitalized for longer than 7 days, time-course changes in biomarkers of coagulofibrinolysis and systemic inflammation along with ADAMTS13 activity were examined. The patients were stratified into three groups based on ADAMTS13 activities on admission (day 0): normal group (≥70%), mildly decreased group (≥50 and < 70%) and moderately decreased group (< 50%).

RESULTS

Among 39 patients with a median Injury Severity Score (ISS) of 20, 11 patients developed disseminated intravascular coagulation (DIC) and 16 patients required transfusion. Six of 39 patients (15.4%) showed moderate decreased ADAMTS13 activity to < 50%, and 20 patients (51.3%) showed mild drops (≥50 and < 70%). These changes in ADAMTS13 activity on day 0 were significantly correlated with changes in IL-6 and other coagulofibrinolytic markers such as platelet counts, prothrombin time and fibrin/fibrinogen degradation product (FDP). Antithrombin activity (AT) and serum albumin (Alb) level showed significantly positive linear correlations with ADAMTS13 activity (AT: r = 0.513, p < 0.001; Alb: r = 0.647, p < 0.001). Simple logistic regression analyses showed that ADAMTS13 activity, if less than 50%, was significantly correlated with the development of DIC (OR 7.499, 95%CI 1.121-49.242, p = 0.038) and the need for transfusion of fresh frozen plasma (OR 9.000, 95%CI 1.327-61.025, p = 0.028).

CONCLUSIONS

ADAMTS13 activity decreased even in the early phase of trauma, which was complicated by coagulopathy and systemic inflammation. Furthermore, the decrease in ADAMTS13 activity was correlated with DIC and plasma transfusion.

Stability of ten psychotropic drugs in formalin-fixed porcine liver homogenates

In forensic toxicology studies, drug concentrations must be estimated by the analytical data of formalin-fixed tissues if fresh or frozen tissue specimens are not available. We wished to investigate the stability and time-course of metabolism/degradation of drugs in formalin-fixed tissues using porcine liver homogenates (PLHs) instead of human tissue. Ten psychotropic drugs (amitriptyline, brotizolam, diazepam, diphenhydramine, estazolam, etizolam, levomepromazine, paroxetine, quetiapine and triazolam) were added to PLHs. After the PLHs had been fixed with neutral buffered formalin at room temperature, the concentrations of the drugs in the PLHs were determined by liquid chromatography-tandem mass spectrometry after 3 days, 1 week, 2 weeks, 4 weeks, 2 months, 4 months and 6 months. After 6 months, the residual ratio of amitriptyline, diphenhydramine and quetiapine was 80 %-95 %; that of diazepam, paroxetine and triazolam was 10 %-45 %; and that of brotizolam, etizolam and levomepromazine was 1 %-5 %. Estazolam was not detected from the first day of formalin fixation. These data suggest that the concentrations of drugs in PLHs measured after formalin fixation decreased to varying degrees compared with their initial concentrations. These time-dependent changes in drug concentration were due to degradation during preservation in formalin solution and metabolism by hepatic microsomal enzymes.

Successful treatment for disseminated intravascular coagulation (DIC) corresponding to phenotype changes in a heat stroke patient

BACKGROUND

Heat stroke induces coagulofibrinolytic activation, which leads to life-threatening disseminated intravascular coagulation (DIC). However, treatment strategies for DIC in heat stroke have not yet been established, and also, the time course changes in coagulofibrinolytic markers have not been thoroughly evaluated. We report a severe heat stroke case with DIC who was eventually saved by anti-DIC treatments in accordance with changes in coagulofibrinolytic markers.

CASE PRESENTATION

A 45-year-old man was found unconscious outside, and his body temperature was elevated to 41.9 °C. For heat stroke, we performed an immediate tracheal intubation under the general anesthesia along with cooling by iced gastric lavage, cold fluid administration, and an intravascular cooling using Thermogard™. About 4 h after admission, his core temperature fell to 37 °C. We assessed coagulofibrinolytic biomarkers and treated in accordance with changes in these parameters. This case exhibited a biphasic change varying from an enhanced to a suppressed fibrinolytic type of DIC depending on the relative balance between fibrinolytic activation and the level of plasminogen activator inhibitor-1 (PAI-1). In the early phase with consumption coagulopathy and enhanced fibrinolysis, we transfused a large amount of fresh frozen plasma (FFP) and platelets with tranexamic acid, an antifibrinolytic agent, possibly providing relief for the bleeding tendency. Anticoagulant therapy using recombinant human thrombomodulin-α (rh-TM-α) and antithrombin III (ATIII) concentrate was especially effective for DIC with a suppressed fibrinolytic phenotype in the later phase, after which organ failure that included severe hepatic failure was remarkably improved.

CONCLUSION

The present case may indicate the clinical significance of monitoring coagulifibrinolytic changes and the potential benefits of anticoagulants for heat stroke-induced DIC.

Decreased antithrombin activity in the early phase of trauma is strongly associated with extravascular leakage, but not with antithrombin consumption: a prospective observational study

Background

We conducted a prospective observational study for investigating coagulofibrinolytic changes and mechanisms of antithrombin (AT) alternations in trauma.

Methods

Trauma patients hospitalized for more than seven days were analyzed for coagulofibrinolytic biomarkers. The patients were stratified into two groups according to AT activity level on admission (day 0), comprising normal AT and low AT patients.

Results

Thirty-nine patients (median Injury Severity Score 20) exhibited initial coagulatory activation and triphasic fibrinolytic changes. AT activity did not show a negative linear correlation with levels of thrombin-antithrombin complex (TAT), a marker of coagulation activity and AT consumption, but was strongly correlated with levels of albumin (Alb), an index of vascular permeability, on day 0 (r = 0.702, p <  0.001). Furthermore, Alb was one of the independent predictors for AT on day 0. IL-6 on day 0 and thrombomodulin (TM) levels during the study period, reflecting systemic inflammation and endothelial cell injury, respectively, were significantly higher in the lower AT group (n = 10) than in the normal group (n = 29) (IL-6, p = 0.004; TM, p = 0.017). On days 2 and 4, TAT levels in the lower AT group were significantly higher than in the normal group.

Conclusions

Trauma caused clear triphasic coagulofibrinolytic changes. Decreased AT in the later phase might lead to a prolonged hypercoagulation. AT reduction in the initial phase of trauma is strongly associated with extravascular leakage as suggested by the association of Alb depletion with IL-6 and TM elevation, but not with AT consumption.

Accuracy of screw fixation using the O-arm® and StealthStation® navigation system for unstable pelvic ring fractures

PURPOSE

Screw fixation for unstable pelvic ring fractures is generally performed using the C-arm. However, some studies reported erroneous piercing with screws, nerve injuries, and vessel injuries. Recent studies have reported the efficacy of screw fixations using navigation systems. The purpose of this retrospective study was to investigate the accuracy of screw fixation using the O-arm^® imaging system and StealthStation^® navigation system for unstable pelvic ring fractures.

METHODS

The participants were 10 patients with unstable pelvic ring fractures, who underwent screw fixations using the O-arm StealthStation navigation system (nine cases with iliosacral screw and one case with lateral compression screw). We investigated operation duration, bleeding during operation, the presence of complications during operation, and the presence of cortical bone perforation by the screws based on postoperative CT scan images. We also measured the difference in screw tip positions between intraoperative navigation screen shot images and postoperative CT scan images.

RESULTS

The average operation duration was 71 min, average bleeding was 12 ml, and there were no nerve or vessel injuries during the operation. There was no cortical bone perforation by the screws. The average difference between intraoperative navigation images and postoperative CT images was 2.5 ± 0.9 mm, for all 18 screws used in this study.

CONCLUSION

Our results suggest that the O-arm StealthStation navigation system provides accurate screw fixation for unstable pelvic ring fractures.

Sudden cerebral depression detected by bispectral index monitoring in cryptococcal meningitis with elevated near-fatal cerebrospinal fluid pressure

Case

An increase in cerebrospinal fluid pressure (CSFP) is usually prominent in cryptococcal meningitis, which has a high mortality rate, so aggressive management to control CSFP is crucial. In this case, a 40‐year‐old‐man survived cryptococcal meningitis treated with continuous spinal drainage under bispectral index (BIS) monitoring. He unexpectedly showed hypertension, went into a coma, and even loss his light reflexes due to CSFP elevation. His BIS values had abruptly dropped before developing these symptoms, but dramatically recovered after lumbar puncture drainage, suggesting that BIS monitoring could reflect cerebral function changes due to CSFP alternations.

Outcome

Inducing continuous spinal drainage to control CSFP provided stable control of blood pressure and brain activity, which was continuously monitored by BIS, enabling us to provide prompt treatment.

Conclusion

Cerebral depressions due to elevated CSFP may suddenly develop, so continuous spinal drainage is needed for preventing catastrophic events. Bispectral index could be useful for detecting early changes from CSFP elevation in meningitis cases with intracranial hypertension.

Pleasant feeling from watching a comical video enhances free radical-scavenging capacity in human whole saliva

OBJECTIVE

Free radicals have been implicated in aging, mutagenesis, inflammation and other pathological conditions. We conducted a study to clarify the relation between a pleasant feeling as a psychological eustress and free radical-scavenging capacity (FRSC) in saliva.

METHODS

Saliva was collected from 27 healthy volunteers. FRSC before, during and after watching a cheerful comical video for 30 min was measured by using 1,1-diphenyl-2-picrylhydrazyl (DPPH).

RESULTS

The median values of FRSC (micromol/ml) before, at 10 and 20 min during and after watching the video were 54.5, 66.8, 66.6 and 69.4, respectively. The FRSC values obtained after watching the video were significantly higher than those before watching it (P<.001). When the FRSC before watching was taken as 1, the value for the group that felt "Very good," "Good" or "Ordinary+Dull" while watching the video for 30 min was 1.38, 1.20 or 0.98, respectively (P<.01).

CONCLUSION

Watching a comical video enhanced the FRSC in saliva; in addition, a pleasant feeling boosted it even more.

Electrochemical characterization and DNA-binding property of dipyridophenazine complexes of osmium (II)

Novel dipyridophenazine (DPPZ) complexes of osmium (II), [Os(L)2(DPPZ)]2+ [L = 2,2'-bipyridyl (bpy)(1), 4,4'-diamino-2,2'-bipyridyl (DA-bpy)(2), 4,4'-dimethyl-2,2'-bipyridyl(DM-bpy)(3), and 4,4'-dicarboxyl-2,2'-bipyridyl (DC-bpy)(4)] have been synthesized and characterized. The DNA-binding properties of the complexes were studied by electrochemical methods. As the results, complex 2 shows higher affinity to DNA than other osmium complexes. The binding constant, K of complex 2 to calf thymus DNA has been determined to be 2.3 x 10(7) M-1 by normal pulse voltammetry (NPV).

Potassium and sodium chloride ion pairs are presumed to constitute a complex during elution from a Sephadex G-15 column with sodium phosphate buffer

When a mixed solution of 0.72 M potassium and sodium chloride was eluted from a Sephadex G-15 column with 0.025 M sodium phosphate buffer (pH 7.0), the elution profiles of ions showed that the potassium and chloride ion pair from the sample and the sodium and chloride ion pair produced by ion-exchange reaction, were eluted in the same fractions as if they constituted a complex. When a mixed solution of different concentrations of potassium and sodium chloride was eluted with the same buffer, the excess amount of one ion pair over the other was eluted freely from the presumed complex.

Evaluation of osmium(II) complexes as electron transfer mediators accessible for amperometric glucose sensors

In order to lower the redox potentials of Os(III/II) complexes, the mixed ligand complexes of Os(II) were synthesized. The redox potentials of Os(III/II) complexes could be lowered by the use of 4,4'-dimethyl-2,2'-bipyridine (dmbpy), imidazole (Him) or its derivatives, and chloride ion as ligands, e.g., values of the redox (formal) potentials of 628 mV vs. Ag/AgCl for [Os(bpy)3]3+/2+ (bpy: 2,2'-bipyridine) and -6 mV for [OsCl(Him)(dmbpy)2]2+/+ were given in deaerated 0.1 mol dm-3 phosphate buffer (pH 7.0). The evaluation of Os(II) complexes as electron transfer mediators accessible for amperometric glucose sensors was examined according to the determination of the redox potentials of Os(III/II) complexes and the second-order rate constants for electron transfer between glucose oxidase (GOx) in reduced form and the Os(III) complex. Although the Os(II) complexes with lower redox potentials tended to decrease the second-order rate constants ks, the ks values for the majority of Os(II) complexes synthesized in this study were greater than that for ferrocenecarboxylic acid. Acceleration of the electron-transfer reaction is attributable to the hydrogen bonding and/or the electrostatic interaction between the Os(II) complexes and GOx. It may be consequently concluded that the mixed ligand complexes of Os(II) with bpy (dmbpy), Him (its derivatives), and Cl- can act as more efficient electron transfer mediators for the fabrication of amperometric glucose sensors.

Ubiquitin-protein ligase activity of X-linked inhibitor of apoptosis protein promotes proteasomal degradation of caspase-3 and enhances its anti-apoptotic effect in Fas-induced cell death

The inhibitor of apoptosis (IAP) family of anti-apoptotic proteins regulate programmed cell death and/or apoptosis. One such protein, X-linked IAP (XIAP), inhibits the activity of the cell death proteases, caspase-3, -7, and -9. In this study, using constitutively active mutants of caspase-3, we found that XIAP promotes the degradation of active-form caspase-3, but not procaspase-3, in living cells. The XIAP mutants, which cannot interact with caspase-3, had little or no activity of promoting the degradation of caspase-3. RING finger mutants of XIAP also could not promote the degradation of caspase-3. A proteasome inhibitor suppressed the degradation of caspase-3 by XIAP, suggesting the involvement of a ubiquitin-proteasome pathway in the degradation. An in vitro ubiquitination assay revealed that XIAP acts as a ubiquitin-protein ligase for caspase-3. Caspase-3 was ubiquitinated in the presence of XIAP in living cells. Both the association of XIAP with caspase-3 and the RING finger domain of XIAP were essential for ubiquitination. Finally, the RING finger mutants of XIAP were less effective than wild-type XIAP at preventing apoptosis induced by overexpression of either active-form caspase-3 or Fas. These results demonstrate that the ubiquitin-protein ligase activity of XIAP promotes the degradation of caspase-3, which enhances its anti-apoptotic effect.

X-linked inhibitor of apoptosis protein (XIAP) inhibits caspase-3 and -7 in distinct modes

The inhibitor of apoptosis proteins (IAP) regulates cell death by inhibiting caspases. The region of X-linked (X) IAP containing the second baculovirus IAP repeat domain (BIR2) is sufficient for inhibiting caspase-3 and -7. In this study, we found that the modes of inhibition of these two caspases were different: caspase-3 is inhibited in a competitive manner whereas caspase-7 inhibition occurs through a mixed competitive and noncompetitive mechanism. Binding assays revealed that the inhibition of caspase-3 by XIAP was totally dependent on the interaction between the active site of caspase-3 and the linker region between the BIR1 and BIR2 domains of XIAP. In contrast, the active site and the NH(2)-terminal region of caspase-7 bound to the linker region and the BIR2, respectively. Moreover the BIR2 with a mutated linker region, which inhibited caspase-3 very weakly, still bound to and inhibited caspase-7. Furthermore, a chimeric caspase-7/3 comprising the NH(2)-terminal portion of caspase-7 and COOH-terminal portion of caspase-3 was inhibited by XIAP by a mixed competitive and noncompetitive mechanism. Our results suggest that the linker region between BIR1 and BIR2 domains is responsible for active site-directed, competitive inhibition of both caspase-3 and -7, whereas the BIR2 itself is involved in noncompetitive inhibition of caspase-7.

Differential elution of sodium or potassium dihydrogen- and hydrogenphosphate ions from a Sephadex G-15 column with sodium or potassium chloride solution

When a mixed solution of sodium or potassium dihydrogenphosphate and disodium or dipotassium hydrogenphosphate was eluted from a Sephadex G-15 column with either a sodium or potassium chloride solution, the elution profiles of ions showed that the hydrogenphosphate ion was eluted more rapidly than the dihydrogenphosphate ion. When the sample solutions containing potassium dihydrogenphosphate and/or dipotassium hydrogenphosphate, all of which were supplemented with phosphorus-32-labelled potassium dihydrogenphosphate, were eluted with sodium chloride solution, the elution profiles of radioactivity showed that the dihydrogenphosphate ion changed to hydrogenphosphate ion and vice versa, depending on the pH values of the sample solution and the availability of the cation of the eluent during elution for the phosphate ion to pair with.

DNA hybridization sensor utilizing [Os(5,6-dmphen)3]2+ by square wave voltammetry

DNA hybridization detection utilizing [Os(5,6-dmphen)3]2+ (tris(5,6-dimethyl-phenanthroline) osmium(II/III)) as hybridization indicator was studied, because [Os(5,6-dmphen)3]2+ has the most largest association constant (K2+) and high current density in osmium methyl substituted phenanthroline complexes. As the result, target DNA could be detected selectively ranging from 6.9 x 10(-10) to 6.9 x 10(-5) g/mL using square wave voltammetry.

Coupling of chromatographic ion-exchange reaction with change-partner reaction. Presumed mechanism on the ion-ion interaction of inorganic ions in Sephadex G-15 columns

A sample solution containing sodium or potassium dihydrogenphosphate or disodium or dipotassium hydrogenphosphate was eluted from a Sephadex G-15 column with either sodium or potassium chloride solution in various sample-eluent systems, and every one of the four kinds of ions employed was determined in the eluate. Then, the elution profiles showed the phenomenon that a negative peak of chloride ion coexisted in the fractions of a positive peak of phosphate ion, in all sample-eluent systems employed. This phenomenon was assumed to occur by the coupled reaction of change-partner and ion-exchange reactions including ion exclusion.

Regulation by an extract of embryonic chick brain of the densities of voltage-dependent Na+ and Ca2+ channels in embryonic chick skeletal muscle cells during their development in culture

We studied the chronic effects of a brain extract (BE) prepared from chick embryonic brains on voltage-dependent Na+ channels (VDNCs) and Ca2+ channels (VDCCs) during the development of chick skeletal muscle cells in culture. The maximum rates of rise of Na+ and Ca2+ action potentials were measured electrophysiologically in an attempt to determine the effects of BE on the densities of these channels. The basic culture medium was supplemented with chick transferrin instead of whole-embryo extract and skeletal muscle cells were grown in the absence or in the presence of crude BE or fractionated BE. Long-term inclusion of BE to the culture medium increased the densities of both VDNCs and L-type VDCCs. By contrast, BE apparently decreased the density of T-type VDCCs. Our results indicate that BE contains some protein(s) that has a negative effect on the density of T-type VDCCs of skeletal muscle cells at a less differentiated stage and that this effect of BE is closely associated with subsequent regulation of the densities of VDNCs and L-type VDCCs. Possible roles of the influx of Ca2+ ions through T-type and L-type VDCCs in the control of the densities of VDNCs and L-type VDCCs are discussed.

Single-strand conformation polymorphism (SSCP) can be explained by semistable conformation dynamics of single-stranded DNA

The cause of separation in gel electrophoresis between highly homologous ss (single-stranded) DNAs as observed in SSCP (single-strand conformation polymorphism) was pursued. Advancing our previous explanation [J. Biochem. 99, 663-671 (1986)], the mobility difference of ssDNAs was correlated to differences in their dynamic conformation (not to differences in their most stable structure), focusing on point-substituted sites. The contribution of semistable conformation dynamics was considered to be critical. Putative factors which may influence mobility (i.e., length of ssDNAs, location of substituted sites, and types of substitutions) were experimentally examined and critically discussed. Understanding of these phenomena should yield improvements in various techniques, such as SSCP, and in evaluation of the solution structures of DNA.

Analysis of tardy ulnar nerve palsy associated with cubitus varus deformity after a supracondylar fracture of the humerus: a report of four cases

Four cases of tardy ulnar nerve palsy associated with a cubitus varus deformity of the elbow secondary to a supracondylar fracture of the humerus are presented. All patients had surgical management of their ulnar nerve palsy. In two patients, the ulnar nerve was entrapped by scar tissue at the abnormal position and the nerve developed a sharp V-shaped kink when the elbow was flexed. In one patient, the ulnar nerve displaced anteriorly with elbow flexion and spontaneously reduced into the ulnar nerve groove with elbow extension. In one patient, the ulnar nerve remained in the ulnar nerve groove; however, it was entrapped by fibrous bands arising from the flexor carpi ulnaris. It is speculated that malunion resulting in cubitus varus deformity will alter the anatomy at the elbow and that this can have a direct effect on the position and instability of the ulnar nerve. Incongruity of the elbow joint due to cubitus varus deformity also may cause osteoarthritis changes. As a result, ulnar neuropathy may develop from irritation to the ulnar nerve from the posttraumatic osteoarthritic changes at the elbow joint.

A case of peculiar plantar warts. Human papillomavirus type 60 infection

BACKGROUND

Various kinds of viral warts have their own typical clinical appearances and histologic properties. From each of them, a corresponding unique type of human papillomavirus (HPV) has been detected. More than 60 types of HPV have been identified from the warts and other squamous cell epithelial tumors. Human papillomavirus type 60 has been identified in an epidermal cyst on the sole. We present a case of a peculiar plantar wart infected with HPV type 60.

OBSERVATIONS

A 21-year-old male student complained of yellowish hyperkeratotic slightly elevated nodules on the right plantar arch. The surface of the nodules was not papillary, but a normal ridge pattern of the sole could be traced. Histologic findings included moderate acanthosis, papillomatosis, and eosinophilic intracytoplasmic large granules with or without surrounded vacuoles. These were noted in the middle and upper epidermis, including the hypertrophic stratum corneum. Virologic findings included HPV antigen detected by anti-HPV polyclonal antibody. The DNA of HPV type 60 was detected by in situ hybridization.

CONCLUSION

A new type of plantar wart infected with HPV type 60 is reported. It shows unique clinical and histologic findings that can be distinguished from those of ordinary verruca or myrmecia on the sole.

Ca2+/calmodulin-dependent regulation of the density of Na+ channels in embryonic chick skeletal muscle cells during their development in culture

Regulation of the density of voltage-dependent Na+ channels (VDNC) was studied in chick myotubes during their development in culture. The density of VDNC was assessed quantitatively in terms of the maximum rate of rise (M.R.R.) of Na+ spikes. Chronic treatment of myotubes, whose density of VDNC had reached a plateau level after 6 days in culture, with the calmodulin (CaM) inhibitor W-7 caused a further increase in the density. A derivative of W-7, known as W-5, which has a lower affinity for CaM than does W-7, was without effect. A selective inhibitor of Ca2+/CaM-dependent protein kinase II (CaM-KII), namely, KN-62, also caused an increase in the density of VDNC when its effect was examined in mature myotubes. A structural analogue of KN-62, namely, KN-04, which is a much less effective inhibitor of CaM-KII, was without effect. These results suggest that density of VDNC in developing myotubes is regulated by Ca2+/CaM and CaM-KII. However, the role of CaM-KII in this regulation is not straightforward since it appears to decrease the density of VDNC in mature myotubes, but to increase their density in immature myotubes.

Bone strength and histomorphometry of the distal femur

The ultimate bone strength of the distal femur was measured radially, by indentation testing, around the transepicondylar line in 3 mm depth steps up to 12 mm below the subchondral bone plate. Specimens from 10 cadavers were used. This orientation of specimens was chosen as a way to provide measurement in a more physiologic orientation for load bearing and to standardize the assessment. Bone hardness declined sharply over the first 6 mm below the surface, tending to plateau at deeper levels. Within the top 6 mm layer the lateral condyle was softer than both the medial condyle and the central patellofemoral area (P < .05), but at deeper levels it maintained greater hardness. Of the histomorphometric parameters, those showing the greatest consistent correlation with hardness were bone volume fraction and trabecular separation. When the tibiofemoral and patellofemoral compartments were compared it was found that for a given value of bone volume fraction, condylar bone is marginally harder than patellofemoral bone. The data are relevant to the design of implants that match their geometric and material properties to the shape and strength of the underlying bone.

Calcium channels in embryonic chick skeletal muscle cells after cultivation with calcium channel blocker

The effects of chronic treatment with calcium channel blockers were studied on the expression of voltage-dependent calcium channels (VDCCs) in chick skeletal muscle cells developing in culture. Myotubes were treated after 2 days in culture with either 20 microM D600 or 10 microM nifedipine, and measurements were made of the maximum rate of rise (M.R.R.) of the two components of action potential, operated by T- and L-type VDCCs, respectively. Treatment with either blocker reduced the M.R.R. of the action potential component operated by the L-type VDCC throughout the culture period examined. The M.R.R. of the T-type VDCC component, on the other hand, was unaffected by either treatment. The reduction in the M.R.R. of the L-type component in blocker-treated cells is thought to be due to the down-regulation of the expression of L-type VDCC. Thus, it appears that the expression of L-type VDCC in the chick skeletal muscle cells can be regulated by a function of L-type VDCC, which mediate the entry of Ca2+ into the cells. The physiological significance of the L-type VDCC, which expressed prominently early in the development of skeletal muscle cells, for the differentiation of excitability is discussed.

Chronic treatment with D600 enhances development of sodium channels in cultured chick skeletal muscle cells

We have studied the long-term effects of D600, a blocker of L-type voltage-dependent Ca channels (VDCC), on the development of voltage-dependent Na channels (VDNC) that are sensitive to tetrodotoxin (TTX), by electrophysiological measurements of the maximum rate of rise of the TTX-sensitive Na spike in cultured chick skeletal muscle cells. Chronic treatment with D600 (2-20 microM) caused a dose-dependent increase in the density of VDNC. The density of VDNC was increased by 150-250% when D600 was added to the cultures at 20 microM from the second day of culture onward. Co-treatment with an inhibitor of the transcription of RNA from DNA, alpha-amanitin, or with cycloheximide, an inhibitor of protein synthesis, prevented the up-regulation by D600. Nifedipine, a different type of blocker of L-type VDCC, was also effective in increasing the density of VDNC, and BAY K 8644, an agonist of L-type VDCC, had the opposite effect. It is suggested that the effect of D600 was mediated via a mechanism specific for L-type VDCC that involves regulation of cytosolic levels of Ca2+ and protein synthesis de novo.

Pharmacological properties of two types of calcium channel in embryonic chick skeletal muscle cells in culture

We have studied the effects of organic and inorganic Ca channel blockers on the two-component action potentials (low- and high-threshold components) in cultured chick skeletal muscle cells, which are generated by the T- and L-type voltage-dependent Ca channels (VDCCs), respectively. Nifedipine and D600 effectively blocked the high-threshold component of the action potential, whereas omega-conotoxin and phenytoin had no effect on this component. By contrast, the low-threshold component was insensitive to all of these organic Ca channel blockers. Blocking effects of polyvalent cations were observed with the following rank order of relative potency (mean apparent dissociation constant in microM): La3+ (14.7) greater than Ni2+ (20.7) greater than Cd2+ (51.2) greater than Co2+ (912) for the low-threshold component, and Cd2+ (0.7) greater than La3+ (29.2) greater than Co2+ (431) greater than Ni2+ (1241) for the high-threshold component. Taken together, these findings suggest that the pharmacological properties of the T- and L-type VDCCs in cultured chick skeletal muscle cells may differ from those in other preparations.

Aromatase inhibitors in cigarette smoke, tobacco leaves and other plants

A chance observation that cigarette smoke interferes with the aromatase assay led us to investigate tobacco leaf and smoke extracts for the presence of aromatase inhibitors. The highest inhibitory activity was found in the basic fraction of cigarette smoke. Further purification of this fraction led to the identification of N-n-octanoylnornicotine. Synthesis and testing of a series of acylated nornicotines and anabasines for their ability to inhibit aromatase showed an interesting correlation of activity with the length of the acyl carbon chain, with maximum activity at C-11. The acylated derivatives showed activity which was significantly greater than that of nicotine and anabasine. In vivo studies in rats indicated that administration of this inhibitor delayed the onset of NMU-induced breast carcinoma and altered the estrus cycle. These in vivo studies suggest that tobacco alkaloid derivatives exert their effects by suppression of the aromatase enzyme system. Toxicity studies indicated relatively low toxicity with LD50 for N-n-octanoylnornicotine = 367 mg/kg body weight. When extracts from thirty five varieties of vegetables, plant leaves, and fruits were analyzed, seventeen showed quantitatively significant aromatase inhibition which was comparable to that of green tobacco leaf, suggesting that naturally occurring substances may affect endocrine function through aromatase inhibition.

[An experimental study of bone remodeling influenced by mechanical stress]

Bone remodeling influenced by mechanical stresses was studied using ambulatory chickens. They were divided into four groups with the different mechanical forces applied to the leg. I: running along a circular track, II: walking or standing on one leg, III: control, IV: casting. The animals were sacrificed after 12 weeks and undecalcified cross-sections of femurs and tibias were examined using a tetracycline labeling method. Bone formation was evident at both metaphyses of the femur and at the proximal metaphysis of the tibia. More bone formation was observed at the medial quarter of both femur and tibia than in comparison with the lateral quarter. There was, however, no difference in the membraneous ossification between the medial and lateral quarters in Group II. The lack of significant cortical drift at the medial side of the femur and tibia suggests that no bending moment is generated by standing on one leg.

[Experimental study of the mechanism of peritoneal dissemination--with special reference to scanning electron microscopic observations]

Most malignant ovarian tumors metastasize by peritoneal dissemination and have a poor prognosis. Few studies have been made to determine how free ovarian tumor cells act on the peritoneum and become lodged and proliferate therein and much still remains to be clarified concerning this issue. In the present study, we transplanted 2 X 10(6) cells of JOHYL-1 strain established from an atypical dysgerminoma into the peritoneal cavity of nude mice observed serially morphological changes in the peritoneum resulting from tumor cell dissemination both by light microscopy and SEM. The findings thus obtained may be summarized as follows: From 5 to 7 days after intraperitoneal transplantation of tumor cells, mesothelial cells of the peritoneum began to swell, with the intercellular boundaries becoming distinct. Microvilli of the mesothelial cells increased in number, forming a mesh-like structure, and in some places were found to be in direct contact with a tumor cell. From 10 days after tumor cell transplantation onwards the mesothelium showed enlarged intercellular spaces in some places, and at these sites tumor cells were seen to have adhered. On other sites mesothelial cells were being partially lost. From 11 days after being transplanted, the tumor cells started proliferating and infiltrating in the muscle layer. Concerning the site of tumor cell implantation, evidence was obtained showing that tumor cells adhered to intercellular spaces of mesothelial cells, and/or in defects formed on connective tissue by a loss of mesothelial cells. The study thus demonstrated a salient usefulness of the JOHYL-1 ascites type cell line, with a reliably great capacity for growth in vivo, as an experimental model for the study of peritoneal dissemination of tumor cells.

[Biochemical activity in peritoneal effusion of ovarian malignancy]

This study was provided biochemical findings on ascitic fluid following the treatment of patients with ovarian tumors. The results were as follows: LDH and LDH isozyme. The ascitic fluid from patients with germ cell tumors showed an LDH1 value of 38.8% with an H/M ratio of 2.82, which were significantly higher than those found in the benign tumor group (LDH1, 15.2%: H/M ratio, 1.05). In cases of adenocarcinomas, the LDH5 value was 27.2%, compared to 15.7% in cases of benign tumors. Of 28 patients with adenocarcinoma, 15 patients (53.6%) were positive for this elevation. The decline in total LDH activity and elevation of H/M ratio were observed as a general tendency in patients satisfactorily responding to treatment. ALP and ALP isozyme. The malignant tumor group displayed higher values for both total ALP activity and HSAP in ascitic fluid, as compared with the benign tumor group. In the malignant tumor group, alpha 2 and alpha 2-beta regions were prominent in the isozyme pattern and the isozymes of the same regions remained even after inactivation by heat. The total activity decreased significantly in the responders to treatment. TP, alpha 1-AT, alpha 1-AG, alpha 2-M and IgG. The ascitic fluid levels of alpha 1-AT, alpha 2-M and IgG did not significantly differ among the group of patients with germ cell tumors, the group of patients with ovarian gonadal stroma and the group of patients with benign tumors. In the adenocarcinoma group the alpha 1-AT and alpha 2-M levels were higher than those in the benign tumor group. The ascitic fluid alpha 1-AG level and alpha 1-AG/TP ratio were elevated in tumors of germ cell origin and in adenocarcinomas; they tended to correlate with the degree of malignancy of the tumor. The results of the present study suggest that simultaneous measurement of the ascitic fluid levels of LDH isozymes, ALP isozymes, alpha 1-AG, alpha 1-AT, alpha 2-M and IgG may play a potential adjunctive role in providing information for diagnostic differentiation between benign and malignancy, estimation of the histologic type and extent of neoplastic growth, evaluation of the therapeutic response and prediction of the clinical progress.

[A study on factors influencing survival in stage I ovarian cancer]

Early diagnosis is difficult in ovarian cancer and the prognosis is unfavorable even in stage I case. A total of 131 cases with stage I ovarian carcinoma were treated at our institution, 73 were stage Ia, 13 were stage Ib, 45 were stage Ic and 39 were LPM. To define the criteria for selection of therapy, we retrospectively reviewed the stage I ovarian cancer. The results were as follows: The best survival rate was demonstrated in 96% of LPM cases followed by 73% of endometrioid adeno-carcinoma. Cases with rupture of capsule and with ascites at surgery influenced the 5 year survival rate. We observed no difference in survival rate between the conservative operation (unilateral salpingo-oophorectomy) group and the complete operation (bilateral salpingo-oophorectomy and total hysterectomy) group. Those who had received postoperative chemotherapy showed the longest survival rate of 86%. Evaluation of deaths; 9 of 21 with stage Ic died within 12 months after surgery, and 4 of 7 with stage Iai between 1 and 3 years. The analysis has shown the importance of adequate postoperative treatment and of strict follow-up to guard against recurrence of malignancy in patients with ruptured tumor capsules as well as in those with ascites.

[In vitro sensitivity test of a cultured human ovarian cancer cell line to anticancer agents]

In vitro tests were performed to assess the sensitivity to six anticancer agents-ACT-D, ADM, CDDP, CQ, 5-FU and MMC-of a JOHYL-1 (ascites type) cell line from human dysgerminoma which was used as challenge strain. For comparative assessment, anticancer sensitivity was expressed as the ratio of IC50 and IC90 to LD50 (i.v.) in mice. Drug dose-response and time-response curves were plotted, and the IC50 ratio was calculated, for each test compound in order to investigate the mechanism of anticancer action. The results obtained were as follows. CQ proved to be remarkably active and ADM fairly active against JOHYL-1 (ascites), but 5-FU, CDDP and MMC varied remarkably with the parameter of measurement employed. Analysis of IC50 ratio data and patterns of cell growth inhibition indicated the growth-inhibitory effect of CDDP to be concentration-and time-dependent. The results of the present study are in close accord with the pattern of action reported in the literature.

[Clinical significance of new tumor marker CA 125 in gynecological cancer--particularly usefulness in diagnosis of ovarian cancer]

A concentration in sera of a new antigen CA125 related to cancer of the ovary was measured by radioimmunoassay which used a monoclonal antibody, and its usefulness as a tumor marker in the diagnosis of cancer of the ovary was investigated. The mean values for CA125 in sera of healthy controls (80 females) were 14.2 +/- 12.2 U/ml. Mean values for CA125 in sera of various patients were 29.0 +/- 39.6 for myoma uteri (30 cases), 26.7 +/- 30.1 for benign ovarian tumors (10 cases), 64.4 +/- 146.2 for cervical carcinoma (14 cases), and 31.5 +/- 19.8 for endometrial carcinoma (6 cases), whereas the mean values for ovarian cancers (23 cases) were as high as 311.3 +/- 250.4. On the other hand, positive rates for CA125, when the cut-off value was set to 65 U/ml, were 1.3% for healthy controls (1 out of 80 cases), 10.0% for myoma uteri (3 out of 30 cases), 10.0% for benign ovarian tumors (1 out of 10 cases), 14.3% for cervical carcinoma (2 out of 14 cases), and 16.7% for endometrial carcinoma (1 out of 6 cases), whereas the positive rate for ovarian cancers was 78.3% (18 out of 23 cases). Especially for serous cystadenocarcinoma, the positive rate was 100% (10 out of 10 cases). From the above, the measurement of CA125 in sera was considered to be significant in the diagnosis of ovarian cancer.

In vitro transformation by bovine papillomavirus

We have studied tumorigenic transformation of mouse tissue culture cells by bovine papillomavirus (BPV) as a model of papillomavirus-induced cell proliferation. When BPV or its 7.9-kb full-length viral DNA genome induces focal transformation of mouse calls, the viral DNA is maintained in the transformed cells as multiple extrachromosomal copies. The transforming capacity was initially localized to a 69% subgenomic fragment of the viral DNA genome. We have further characterized the BPV DNA sequences that can encode the transforming function by generating and analyzing the transforming activity of a series of BPV DNA deletion mutants. The results indicated that two discontinuous segments of the viral DNA are required for transformation. One segment, near the 5' end of the 69% transforming fragment, probably represents a control element of the viral DNA. The second segment, which lies within the 3' end of the 69% fragment, encodes transforming sequences of the viral DNA. A retroviral control element (the long terminal repeat DNA. A retroviral control element (the long terminal repeat DNA of Harvey murine sarcoma virus) will activate the 2.3-kb segment at the 3' end of the 69% fragment to transform the mouse cells.

Clear-cell syringoma. Association with diabetes mellitus

Only one case of clear-cell syringoma has been reported in the United States, whereas six cases have already been reported in Japan, and ours described herein constitute an eighth and ninth. Eight of the total of nine cases of clear-cell syringoma were associated with diabetes mellitus. In this report, we summarize these nine cases and emphasize the close relationship between clear-cell syringoma and diabetes mellitus.

The transforming function of bovine papillomavirus DNA

When bovine papillomavirus (BPV) or its 7.9-kilobase full viral DNA genome induces focal transformation of mouse cells, the viral DNA is maintained in the transformed cells as multiple episomal copies. This transforming capacity and maintenance of the episomal state previously has been localized to a 69% subgenomic fragment of the viral DNA genome. We now have characterized further the BPV DNA sequences that can encode the transforming function. We first created a series of BPV DNA deletion mutants and correlated the location of the deletions with the capacity of the deleted viral DNAs to induce transformation of mouse cells. The results indicated that two discontinuous segments of the viral DNA were required for transformation. One segment, near the 5' end of the 69% transforming fragment, probably represents a control element of the viral DNA. The second segment, which lies within the 3' end of the 69% fragment, encodes transforming sequences of the viral DNA; ligation of a retroviral control element (the long terminal repeat DNA of Harvey murine sarcoma virus) to the 2.3-kilobase segment at the 3' end of the 69% fragment induces transformation of mouse cells. In contrast to mouse cells transformed by the full-length BPV DNA genome, the cells transformed by the deleted BPV DNA genomes contained few viral DNA copies; at least some copies appeared to be integrated. We conclude that different viral functions mediate cellular transformation and maintain the viral DNA in its episomal state.

Antinuclear antibodies in localized scleroderma

When HeLa cells were used as the substrate for detection by the indirect immunofluorescence method, antinuclear antibodies were demonstrated in 16 of 22 (72.7%) sera from patients with localized scleroderma. When mouse kidney sections were used, the positive rate for antinuclear antibodies was 50% (11 of 22). In the 3 subgroups of localized scleroderma, frequencies of antinuclear antibodies on HeLa cells were as follows: morphea, 50% (2 of 4), generalized morphea, 100% (6 of 6), linear scleroderma, 67% (8 of 12). Antibodies to centromere, Scl-70, nuclear RNP, Sm, and SS-B antigens were not detected in any patients with localized scleroderma. The high frequency of antinuclear antibodies in localized scleroderma sera suggests that localized scleroderma is a disease which, though different from diffuse scleroderma, also involves an immunologic abnormality.