Lung Sound Analysis Is Useful for Monitoring Therapy in Patients With Bronchial Asthma.

BACKGROUND AND OBJECTIVE: Lung sound analysis (LSA) has been reported to be useful for predicting airway obstruction and inflammation in patients with bronchial asthma. Objectives: We examined whether the exhalation-to-inhalation sound pressure ratio in the middle frequency range (200-400 Hz) (E/I MF) is useful for monitoring therapy in patients with asthma. METHODS: The study population comprised 84 patients with mild to moderate asthma whose LSA data were available before and after 1 year of daily treatment with (budesonide 800 µg). We analyzed whether the E/I MF before and after treatment was associated with the fractional exhaled nitric oxide (FeNO) level, sputum eosinophil percentage, respiratory function, and airway hyperresponsiveness. RESULTS: Prior to treatment with budesonide, the E/I MF was significantly correlated with respiratory function, airway hyperresponsiveness, FeNO, and sputum eosinophil percentage. The cutoff values for the E/I MF to detect the abnormalities of respiratory function, FeNO, and sputum eosinophil percentage were 0.367, 0.358, and 0.363, respectively. With respect to the reference value, the E/I MF improved significantly in patients whose respiratory function and FeNO benefited from therapy with budesonide compared with patients whose respiratory function did not benefit from budesonide (odds ratios of 6.39 and 4.78, respectively). According to the multivariate analysis, patients whose E/I MF did not improve had a longer history of smoking (P=.038), poorer posttreatment respiratory function (P=.028), and higher posttreatment FeNO (P=.0095). CONCLUSIONS: Similar to respiratory function and FeNO, E/I MF based on LSA is a useful indicator for monitoring the efficacy of therapy in asthmatic patients.

High frequency of antibiotic-associated diarrhea due to toxin A-negative, toxin B-positive Clostridium difficile in a hospital in Japan and risk factors for infection.

Patients hospitalized in a hospital with a high incidence of antibiotic-associated diarrhea due to toxin A-negative, toxin B-positive (A-/B+) Clostridium difficile were retrospectively investigated to determine the clinical manifestations and risk factors for infection. Of 77 Clostridium difficile isolates obtained from 77 patients during the 1-year investigation period, 30 were A-/B+ and 47 were toxin A-positive, toxin B-positive (A+/B+). By pulsed-field gel electrophoresis analysis, 23 of the 30 A-/B+ strains were outbreak-related, suggesting nosocomial spread of a single type of bacterium, which mainly affected patients in the wards of respiratory medicine, hematology and neurology. Using regression analysis, three factors were found to be associated with infection by A-/B+ isolates: (i) exposure to antineoplastic agents ( P=0.01, odds ratio [OR]=5.1), (ii) the use of nasal feeding tubes ( P=0.008, OR=5.2), and (iii) assignment to a certain internal medicine ward ( P=0.05, OR=3.0). Between patients with Clostridium difficile-associated diarrhea caused by A-/B+ strains and those with A+/B+ strains, no statistically significant difference was found in body temperature, serum concentration of C-reactive protein, leukocyte count in whole blood, frequency of diarrhea, or type of underlying disease. These results indicate that A-/B+ strains of Clostridium difficile can cause intestinal infection in humans and they spread nosocomially in the same manner as A+/B+ strains.

Forebrain muscarinic control of micturition reflex in rats.

Functional contribution of the cholinergic pathway between the frontal cortex and basal nucleus of Meynert to micturition reflex was investigated. Male Wistar rats were subjected to bilateral lesion of the basal forebrain by ibotenic acid (IA) injection (7.5 microg/rat on each side) (BF rats). Phosphate buffered saline (PBS) was injected into control rats (sham operated rats; SO rats). Cystometrograms were obtained from conscious BF and SO rats 7-10 days after IA/PBS injection. Bladder capacity (BC) of BF rats was significantly smaller than that of SO rats (approximately 43.7%) and was accompanied by decrease in choline-acetyltransferase activity in the frontal cortices. Oxotremorine M, a muscarinic receptor agonist, increased BC in BF rats, while pirenzepine, an M1 muscarinic receptor antagonist, counteracted the effect of the oxotremorine M-induced increase in BC. Injection of oxotremorine M into the dorsal pontine tegmentum (DPT) reduced BC in BF and SO rats, while injection of pirenzepine had no effect on cystometrograms. These findings indicate that the M1 muscarinic receptor plays a part in the forebrain inhibitory mechanisms involved in the micturition reflex and that muscarinic receptor in the DPT contributes to excitatory control of micturition reflex.

Sensitization of human malignant glioma cell lines to tumor necrosis factor-induced apoptosis by cisplatin.

Most tumors, including gliomas, are resistant to tumor necrosis factor (TNF) cytotoxicity unless protein or RNA synthesis is inhibited. We investigated the effects of the combined use of TNF-alpha and cisplatin (CDDP) on cultured malignant glioma cells, T98G, U373MG, A172, and U87MG. All glioma cell lines were sensitive to treatment with CDDP but resistant to TNF-alpha during 24 h-incubation. The combined use of CDDP and TNF-alpha had synergistic effects on T98G and U87MG but not on U373MG and A172 cells. Sequential treatments showed that only pretreatment with CDDP for 2 h followed by TNF-alpha for 22 h was synergistic on cell cytotoxicity. Annexin V-flow cytometry and terminal deoxynucleotidyl transferase-mediated dUTP nick-end-labeling assay showed that TNF-alpha can induce apoptosis in cells treated with CDDP. Although only sensitive cell lines express transcripts for p75 TNF receptor 2, changes in TNF receptors were not found to contribute to the susceptibility to TNF-alpha. The production of interleukin-6, a representative cytoprotective cytokine, from glioma cells stimulated by TNF-alpha was suppressed by the combined use of actinomycin D, but not CDDP. Our results indicate that CDDP can sensitize glioma cells to TNF-alpha-induced apoptosis by a mechanism other than blocking the cytoprotective protein production.

GABAergic contribution to rat bladder hyperactivity after middle cerebral artery occlusion.

To evaluate the influences of gamma-aminobutyric acid (GABA) mechanisms on bladder hyperactivity after left middle cerebral artery occlusion, cystometric recordings were obtained from unanesthetized female rats. Intracerebroventricular administration of both muscimol (GABA(A) receptor agonist; 0.1-10 nmol) and baclofen (GABA(B) receptor agonist; 0.1-3 nmol) produced dose-dependent inhibitions of micturition with increases in bladder capacity (BC). The effects of high doses (1-10 nmol) were similar in sham-operated (SO) and cerebral-infarcted (CI) rats. However, lower doses of muscimol (0.1 or 0.3 nmol) and baclofen (0.1 nmol) reduced BC in CI rats. After bicuculline (GABA(A) receptor antagonist; 1 or 3 nmol) administration, BC in both SO and CI rats first decreased and subsequently increased. An increase in urethral pressure was observed after administration of bicuculline (3 nmol) but not with either muscimol or baclofen. Infarct volumes in muscimol-, bicuculline-, or baclofen-treated rats were not significantly different from those of vehicle-treated rats. These results suggest that GABAergic mechanisms inhibit the micturition reflex at the supraspinal level but that this can change as a result of CI.

Replication timing of the human X-inactivation center (XIC) region: correlation with chromosome bands.

The human genome is composed of long-range G+C% mosaic structures, which are thought to be related to chromosome bands. Replication timing during S phase is associated with chromosomal band zones; thus, band boundaries are thought to correspond to regions where replication timing switches. The proximal limit of the human X-inactivation center (XIC) has been localized cytologically to the junction zone between Xq13.1 and Xq13.2. Using PCR-based quantification of the newly replicated DNA from cell-cycle fractionated THP-1 cells, the replication timing in and around the XIC was determined at the genome sequence level. We found two regions where replication timing changes from the early to late period during S phase. One is located near a large inverted duplication proximal to the XIC, and the other is near the XIST locus. We propose that the 1Mb late-replicated zone (from the large inverted duplication to XIST) corresponds to a G-band Xq13.2. Several common characteristics were observed in the XIST region and the MHC class II-III junction which was previously defined as a band boundary. These characteristics included differential high-density clustering of Alu and LINE repeats, and the presence of polypurine/polypyrimidine tracts, MER41A, MER57 and MER58B.

[Primary AA type amyloidosis of the urinary bladder: a case report].

Primary amyloidosis of the urinary bladder is a rare disease entity. A total of 61 cases have been reported in the Japanese literature, and most of them were AL type amyloidosis. We report here a case of primary AA type amyloidosis. A 52-year-old man presented with a chief complaint of asymptomatic gross hematuria. Cystoscopy revealed yellowish elevated lesions, transurethral mucosal biopsies were performed, and the histopathological diagnosis indicated a primary AA type amyloidosis of the urinary bladder. Systemic amyloidosis was clinically eliminated. The yellowish lesions in the bladder through cystoscopy disappeared spontaneously one year later without any specific treatment, but periodical work-up may be necessary to rule out recurrence of the disease or bladder tumor.

A probable relationship between an endogenous digitalis-like substance and concentric cardiac hypertrophy in primary aldosteronism.

A 44-year-old woman was admitted to our hospital due to severe hypertension. An electrocardiogram (ECG) and an echocardiogram showed severe left ventricular hypertrophy. Her plasma aldosterone level was elevated. Magnetic resonance imaging revealed a small mass in the right adrenal gland. Before removal of the tumor, plasma endogenous digitalis-like substance (EDLS) levels were elevated. After removal of the tumor, EDLS levels quickly returned to the normal level. A series of echocardiograms and ECGs over a 6- year period after removal of the tumor showed marked regression of cardiac hypertrophy. These findings suggest that EDLS may be closely related to the development of concentric cardiac hypertrophy in primary aldosteronism.

Oxidative modification of apolipoprotein E in human very-low-density lipoprotein and its inhibition by glycosaminoglycans.

The mechanism of metal ion-catalyzed oxidative modification of apolipoprotein E (apoE) in human very-low-density lipoprotein (VLDL) and its inhibition by glycosaminoglycan (GAG) was investigated in vitro. The VLDL oxidation catalyzed by Cu2+ led to the lipid peroxidation, the formation of aggregates, and covalent modification of apoE. The modified apoE lost heparin-binding activity. These results suggest that the lipid peroxidation of VLDL and modification of apoE cause impairment of lipid uptake by cells and deposit the oxidized lipids in the tissues. The lipid peroxidation and oxidative modification of apoE in VLDL mediated by Cu2+ and an aqueous radical generator were suppressed by GAG, heparan sulfate, heparin, and chondroitin sulfate A, even though GAGs demonstrated no ability to scavenge alpha,alpha-diphenyl-beta-picrylhydrazyl radical. There were no relationships between inhibitory activity of GAGs in the VLDL oxidation and their number of sulfate groups which possess chelating activity of metal ion. Therefore, it can be considered that the inhibition of VLDL oxidation by GAGs is possibly due to the interaction between GAG and VLDL which bring about the steric hindrance, interference with the reaction between VLDL particle and the reactive oxygen species. These studies suggest that GAGs preserve the biological functions of apoE from oxidative stress.

Modulation of the heat-induced activation of mitogen-activated protein (MAP) kinase by quercetin.

Effects of quercetin, a bioflavonoid compound, on heat-induced activation of mitogen-activated protein (MAP) kinase in rat hepatoma (H4) cells were examined. Quercetin decreased cell viability and induced DNA fragmentation in heat-shocked H4 cells. MAP kinase in heat-shocked cells was activated and reached a peak at 1 hr after the heat shock, and then gradually decreased. Quercetin inhibited the heat-induced activation of MAP kinase observed at 1 hr after heat shock, but markedly stimulated MAP kinase activity at 4 hr after heat shock. Thus, quercetin modulated the heat-induced activation of MAP kinase in a biphasic manner. Present observations indicate that quercetin modulates protein phosphorylation, especially that controled by MAP kinase, in early events of heat shock response.

Analysis of heat shock-induced monophosphorylation of stathmin in human T lymphoblastic cell line JURKAT by two-dimensional gel electrophoresis.

Two-dimensional gel electrophoresis (2-DE) was used to study alterations in intracellular proteins of the human T lymphoblastic cell line JURKAT by heat shock at 45 degrees C for 30 min. The 2-DE patterns indicated an increase in the amount of a spot of molecular weight (M(r)) 18,500 and isoelectric point (pI) 5.6, which was a monophosphorylated form of stathmin. Stathmin is a major substrate for a proline-rich peptide-specific serine protein kinase, a mitogen-activated protein kinase, however, the enzyme was not activated by the heat shock. Further examinations of the effects of cAMP, phorbol myristate acetate, cyclosporin A, and staurosporine on phosphorylation suggest that cyclin-dependent kinases might be responsible for the heat shock-induced monophosphorylation of stathmin.

Alpha 1-antichymotrypsin inhibits chymotrypsin-induced apoptosis in rat hepatoma cells.

Increased serum levels of alpha1-antichymotrypsin (alpha 1ACT) are observed in some cancer patients, especially those with hepatocellular carcinoma. A possible role of alpha 1ACT in tumour growth has been suggested, but this remains uncertain. We have demonstrated that alpha 1ACT inhibited chymotrypsin-induced apoptosis in rat hepatoma H4 cells. Even low concentrations of chymotrypsin (but not trypsin) induce apoptosis in H4 cells with a minimum effective concentration of 2.4 x 10(-2) units/ml (0.5 microg/ml), and this apoptosis was inhibited by alpha 1ACT in a concentration-dependent manner. Furthermore, the concentrations of alpha 1ACT required to inhibit the apoptosis were lower than normal serum levels. These results may indicate that alpha 1ACT plays a role in the apoptosis of rat hepatoma cells.

Brain metastasis in malignant pleural mesothelioma.

A 55-year-old male who had a remote history of occupational asbestos exposure consulted us because of chest pain. Chest X-ray revealed diffuse pleural thickening and pleural effusion on the right. A diagnosis of malignant mesothelioma, biphasic type was made by needle pleural biopsy. Fourteen months later, the patient died of brain metastasis. At autopsy, malignant mesothelioma of the pleura with metastasis to the brain and bilateral adrenal glands was observed. Brain metastases proven by autopsy are rare in cases of malignant mesothelioma. The ferruginous body count in the lung tissue was 16 per gram of wet weight.

Gene structure of mouse Cyp3a11: evidence for an enhancer element within its 5' flanking sequences.

A mouse Cyp3a11 gene was isolated from a mouse sperm DNA library with mouse Cyp3a11 cDNA as a probe. The nucleotide sequences determined for the gene and the 5' flanking region revealed that the mouse Cyp3a11 gene was composed of 13 exons and 12 introns. The exons spun about 23 kb. The nucleotide sequence of the exons was completely identical to Cyp3a11 cDNA. Within the 5' flanking sequence, putative binding sites of several transcriptional factors were found. Transient transfection assays were carried out with HepG2 cells, a human hepatoma cell line, using constructs containing different lengths of 5' flanking sequence fused to a reporter, chloramphenicol acetyltransferase gene. The results showed that a cis-acting element(s) was located from -1609 to -907.

[Clinical features of eight cases of opportunistic fungal pneumonias].

We evaluated eight cases of pulmonary mycosis in immuno compromised hosts. The underlying diseases were lung cancer with chemotherapy in one case, post bone marrow transplantation (post BMT) in two cases, acquired immunodeficiency syndrome (AIDS) in one case and bronchial asthma with massive steroid therapy in four cases. The causative fungi were Candida sp. in three cases, Aspergillus sp. in four cases, Tricosporon sp. in one case. Prognosis was guarded despite antifungal treatment. Five cases deteriorated and died of fungal infection. In five cases, who died of deterioration, 31.6 days was required from appearance of abnormal infiltration in the chest X-ray to determination of the causative fungi (including two cases who were diagnosed by autopsy) on the average. In three successfully treated cases, the average duration from the appearance of abnormal infiltration in the chest X-ray for the determination of the causative fungi was 8.3 days. On the contrary, the average duration between the appearance of abnormal infiltration in the chest X-ray and the initiation of antifungal treatment was 2.6 days who died of deterioration and 8.3 days who survived. We conclude that early identification of causative fungi and not quick institution of antifungal treatment was mandatory in the treatment of opportunistic fungal pneumonia.

Effects of cytokines on oxygen radical production by peripheral blood monocytes and alveolar macrophages in patients with lung cancer.

The effects of cytokines (interleukin-2, tumor necrosis factor-alpha and interferon-gamma) on the ability of peripheral blood monocytes and alveolar macrophages to produce oxygen radicals were examined by the chemiluminescence assay in patients with lung cancer. Oxygen radical production by peripheral blood monocytes before stimulation with cytokines was lower in the lung cancer group than in healthy controls, suggesting reduced immune function in lung cancer patients. However, the activity in the lung cancer group was elevated to the control level when the monocytes were stimulated by any of the three aforementioned cytokines. Oxygen radical production by alveolar macrophages did not differ significantly between nonstimulated monocytes from lung cancer patients and those from healthy controls. In the lung cancer group, stimulation of the macrophages with any of the three cytokines elevated their ability to produce oxygen radicals to the same extent as in the control group. The results suggest that stimulation of macrophages by interleukin-2, tumor necrosis factor-alpha or interferon-gamma can exert an antitumor action in patients with lung cancer.

Lung microvascular pressure profile in acute lung injury.

To clarify the role of microvessels in the development of pulmonary hypertension of acute lung injury, we induced lung edema by oleic acid (OA) in ten artificially perfused cat lungs and measured microvascular pressure. Pulmonary artery pressure (Ppa) and pressure of 30-50 microns arteriole (Parteriole) increased from 19.2 +/- 1.4 and 15.7 +/- 1.0 cmH2O before to 30.5 +/- 5.0 cmH2O and 22.7 +/- 2.4 cmH2O after edema, respectively. Pressure of 30-50 microns venule (Pvenule) and venous occlusion pressure (Pvo) did not change significantly after edema. Double occlusion pressure (Pdo) which represents pulmonary microvascular pressure increased from 14.5 +/- 0.6 to 17.7 +/- 2.0 cmH2O. Pressure gradient in the artery, i.e., between Ppa and Parteriole and in the microvessels, i.e., between Parteriole and Pvenule increased when lung became edematous. Pressure gradient in vein, i.e., between Pvenule to left atrium was not affected by edema. Pdo was in the midst of Parteriole and Pvenule in both edematous and non-edematous lung. In acute lung injury, increase of microvascular resistance was followed by an increase of arterial resistance and caused pulmonary hypertension.

Insulin stimulates protein synthesis of glycogen synthase in rat hepatoma H4 cells associated with acceleration of translation rate.

To assess the regulatory mechanism of insulin action on the biosynthesis of glycogen synthase under long-term control, we investigated post-transcriptional and post-translational regulation by insulin of glycogen synthase in rat hepatoma H4 cells. Glycogen synthase protein gradually increased in response to insulin and peaked at 6 h during a 24-h insulin incubation (185% of the control), corresponding with the second peak of glycogen synthase activation measured by the activity ratio (low glucose 6-P/high glucose 6-P). The effect of insulin on synthesis of glycogen synthase protein was assessed by measuring the incorporation of [35S]-methionine into the enzyme protein during a 6-h insulin incubation. The amount of [35S]-methionine incorporation into glycogen synthase was increased in response to insulin with time, and peaked at 4 h (250% of the control). The degradation of glycogen synthase examined by measuring the rate of reduction of [35S]-methionine for 6 h after the tracer incubation for 12 h was not affected by insulin. The results indicate that (a) insulin induces glycogen synthase activity by accumulating the enzyme protein due to stimulation of protein synthesis rather than inhibition of protein degradation and (b) insulin-reduced stability of glycogen synthase mRNA is caused by acceleration of the translation rate.

[Allergic granulomatous angitis with hyper expression of eosinophilic adhesion molecules].

A 43-year-old man who had been treated for bronchial asthma presented with an increase in dry coughing and wheezing for one and a half years. In August 1994, the patient noted progressive dyspnea on exertion. A chest radiograph revealed nodular opacity in the right upper lung field. In November 1994, the patient was admitted to Kinki University Hospital with an erythematous rash on the soles of both feet. Examination of a specimen biopsy of the skin lesion revealed granuloma with eosinophil infiltration. Peripheral blood eosinohilia was noted and a bone marrow examination also revealed an increased level of eosinophils. Another chest radiograph revedaled that the nodular opacity had disappeared and a new bilateral pleural effusion was seen. Eosinophils were the predominant cells in the pleural effusion. the patient's condition was further complicated by myocarditis. Allergic granulomatous angitis (Churg-Strauss syndrome) was diagnosed and steroid therapy was started. After the start of steroid therapy, the skin eruption disappered and the myocarditis became less severe. Symptoms of asthma were also well controlled. The eosinophils had hypersegmented unclei and increased expression of adhesion molecules on their surfaces.

Assessment of serum CYFRA 21-1 in lung cancer.

BACKGROUND: Cytokeratins are the intermediate filaments of the cytoskeletal protein located in normal epithelia, tumor, and cultured cells. Recently, a fragment of cytokeratin subunit 19, referred to as CYFRA 21-1, detected in the serum of patients with nonsmall cell lung cancer, has been reported as a new tumor marker. This article reports the results of a study of serum fragment CYFRA 21-1, measured by immunoradiometric assay, as a marker of lung cancer. METHODS: One hundred fourteen patients with primary lung cancer, 6 patients with malignant solid tumor, 116 patients with a variety of benign diseases, and 29 normal individuals were entered into the study. Serum CYFRA 21-1 levels were obtained by means of immunoradiometric assay using the CYFRA 21-1 EIA (enzyme immunoassay) kit. In addition, we studied other tumor markers, including carcinoembryonic antigen (CEA), squamous cell carcinoma antigen (SCC), and neuron specific enolase (NSE), as a means of lung cancer diagnosis. RESULTS: The diagnostic accuracy and sensitivity of serum CYFRA 21-1 for the detection of lung cancer were highest among the four markers. The serum CYFRA 21-1 levels were most highly elevated in lung carcinoma patients (in particular UICC Stage IV patients) across different histologic types and attained 85.1% sensitivity when using a threshold of 3.5 ng/mL. The diagnostic sensitivity for detecting lung carcinoma was substantially enhanced by means of combined assays of CYFRA 21-1 with CEA overall for lung cancer, with SCC for squamous cell carcinoma, and with CEA for adenocarcinoma. CONCLUSIONS: These findings suggest that serum assays of CYFRA 21-1 are clinically useful for the diagnosis of lung carcinoma.