Efficacy and safety of live varicella zoster vaccine in diabetes: a randomized, double-blind, placebo-controlled trial.

AIMS: To elucidate varicella zoster virus (VZV)-specific cell-mediated immunity and humoral immunogenicity against live attenuated Oka varicella zoster vaccine concurrently vaccinated with 23-valent pneumococcal polysaccharide vaccine (PPSV23) in elderly people with diabetes mellitus. METHODS: This double-blind randomized controlled single-centre study of 60-70-year-old people with diabetes compared immunity and safety profiles 3 months after one dose of varicella zoster vaccine or placebo. PPSV23 was immunized simultaneously. Primary analysis evaluated cell-mediated immunity using the VZV skin test. Secondary analyses were a VZV interferon-γ enzyme-linked immunospot (ELISPOT) assay and immunoadherence haemagglutination test. Adverse experiences were recorded using diary questionnaires. RESULTS: By intent-to-treat analysis, 27 participants with diabetes who had been administered the vaccine were compared with 27 participants who were given a placebo. Changes in skin test scores were 0.41 ± 0.80 and 0.11 ± 0.93 (P = 0.2155), and geometric mean fold rises of the ELISPOT counts were 1.2 [95% confidence interval (CI) 0.2, 7.9] and 1.2 (95% CI 0.2, 7.3) (P = 0.989) in the vaccine and placebo groups, respectively. The geometric mean titre did not increase 3 months after vaccination in either group. No vaccination-related severe adverse experience was reported and no participant developed herpes zoster. DISCUSSION: Our previous results demonstrated that varicella zoster vaccine safely enhanced VZV-specific immunity in elderly people with or without diabetes. The results of this study showed that varicella zoster vaccine can be used safely, but it cannot boost virus-specific immunity in elderly people with diabetes when administered with concurrent PPSV23. Alternative strategies are needed to prevent VZV-associated diseases in this population.

A combination of ultrasound-guided rectus sheath and transversus abdominis plane blocks is superior to either block alone for pain control after gynecological transumbilical single incision laparoscopic surgery.

PURPOSE: To investigate the efficacy of the combination of ultrasound-guided rectus sheath (RS) and transversus abdominis plane (TAP) blocks compared with TAP or RS block alone in gynecological single-incision laparoscopic surgery (SILS). MATERIALS AND METHODS: Bilateral TAP blocks (Group A, n = 12), TAP and RS blocks (Group B, n = 12), and RS blocks (Group C, n = 12) with 40 ml ropivacaine/patient were performed for ovarian tumor SILS. The analgesic effects were evaluated using a numerical rating scale (NRS) at zero, six, 12, 24, and 48 hours post-surgery. RESULTS: Umbilical pain on completion of general anesthesia was significantly less frequent in Group B (1/12) than Group A (7/12) (p = 0.03). The postoperative NRS scores were significantly lower in Group B than Group A at zero (p = 0.02) and six (p = 0.03) hours and Group C at zero (p = 0.001), six (p = 0.02), and 12 (p = 0.004) hours. CONCLUSION: The combination of RS and TAP blocks reduced early postoperative pain compared with RS or TAP block alone for gynecological SILS.

Major orthopaedic surgeries for haemophilia with inhibitors using rFVIIa.

SUMMARY: Between 2000 and 2008, 11 major orthopaedic surgeries for 7 congenital haemophilia patients with inhibitors were performed by the first author as the primary doctor using recombinant activated factor VII (rFVIIa). Orthopaedic surgical treatments were performed for six surgeries for four high-responder haemophilia A patients, three surgeries for two high-responder haemophilia B patients and two surgeries for one low-responder haemophilia B patient. This low-responder patient is allergic to factor IX products, so he usually uses rFVIIa as a haemostatic agent. All of the surgeries were major, such as joint arthroplasty, arthroscopic synovectomy, and a combination of both, and excellent surgical results were achieved. Seven cases were controlled by bolus infusion of rFVIIa, and the other four cases were controlled by combined bolus and continuous infusion of rFVIIa. An anti-fibrolytic agent was used for all cases. There were no thrombogenic adverse effects, only two bleeding episodes. As for haemostatic control, nine surgeries were excellent, one was good and one was fair. This report is the largest clinical report on major orthopaedic surgeries at a single institute. We have concluded that the combination of bolus and continuous infusion of rFVIIa is safe and effective, and more convenient to administer than simple bolus infusion therapy to achieve haemostasis at peri-operative periods. In addition, our data also concurs with the data of several previous reports which showed that orthopaedic surgery for haemophilia patients with inhibitors by means of rFVIIa is safe and effective.

Neurotensin inhibition of GABAergic transmission via mGluR-induced endocannabinoid signalling in rat periaqueductal grey.

Neurotensin modulates pain via its actions within descending analgesic pathways which include brain regions such as the midbrain periaqueductal grey (PAG). The aim of this study was to examine the cellular actions of neurotensin on PAG neurons. Whole cell patch clamp recordings were made from rat midbrain PAG slices in vitro to examine the postsynaptic effects of neurotensin and its effects on GABA(A) mediated inhibitory postsynaptic currents (IPSCs). Neurotensin (100-300 nM) produced an inward current in subpopulations of opioid sensitive and insensitive PAG neurons which did not reverse over membrane potentials between -50 and -130 mV. The neurotensin induced current was abolished by the NTS1 and NTS1/2 antagonists SR48692 (300 nM) and SR142948A (300 nM). Neurotensin also produced a reduction in the amplitude of evoked IPSCs, but had no effect on the rate and amplitude of TTX-resistant miniature IPSCs. The neurotensin induced inhibition of evoked IPSCs was reduced by the mGluR5 antagonist MPEP (5microM) and abolished by the cannabinoid CB(1) receptor antagonist AM251 (3 microM). These results suggest that neurotensin produces direct neuronal depolarisation via NTS1 receptors and inhibits GABAergic synaptic transmission within the PAG. The inhibition of synaptic transmission is mediated by neuronal excitation and action potential dependent release of glutamate, leading to mGluR5 mediated production of endocannabinoids which activate presynaptic CB(1) receptors. Thus, neurotensin has cellular actions within the PAG which are consistent with both algesic and analgesic activity, some of which are mediated via the endocannabinoid system.

Cross sections for electron impact excitation of the C (1)Pi and D (1)Sigma(+) electronic states in N(2)O.

Differential and integral cross sections for electron-impact excitation of the dipole-allowed C (1)Pi and D (1)Sigma(+) electronic states of nitrous oxide have been measured. The differential cross sections were determined by analysis of normalized energy-loss spectra obtained using a crossed-beam apparatus at six electron energies in the range 15-200 eV. Integral cross sections were subsequently derived from these data. The present work was undertaken in order to check both the validity of the only other comprehensive experimental study into these excitation processes [Marinkovic et al., J. Phys. B 32, 1949 (1998)] and to extend the energy range of those data. Agreement with the earlier data, particularly at the lower common energies, was typically found to be fair. In addition, the BEf-scaling approach [Kim, J. Chem. Phys. 126, 064305 (2007)] is used to calculate integral cross sections for the C (1)Pi and D (1)Sigma(+) states, from their respective thresholds to 5000 eV. In general, good agreement is found between the experimental integral cross sections and those calculated within the BEf-scaling paradigm, the only exception being at the lowest energies of this study. Finally, optical oscillator strengths, also determined as a part of the present investigations, were found to be in fair accordance with previous corresponding determinations.

A large contribution of a cyclic AMP-independent pathway to turtle olfactory transduction.

Although multiple pathways are involved in the olfactory transduction mechanism, cAMP-dependent pathway has been considered to contribute mainly to the transduction. We examined the degree of contribution of cAMP-independent pathway to the turtle olfactory response by recording inward currents from isolated cells, nerve impulses from cilia and olfactory bulbar responses. The results obtained by the three recordings were essentially consistent with each other, but detail studies were carried out by recording the bulbar response to obtain quantitative data. Application of an odorant cocktail to the isolated olfactory neuron after injection of 1 mM cAMP from the patch pipette elicited a large inward current. Mean amplitude of inward currents evoked by the cocktail with 1 mM cAMP in the patch pipette was similar to that without cAMP in the pipette. Application of the cocktail after the response to 50 microM forskolin was adapted also induced a large inward current. Application of the odorant cocktail to the olfactory epithelium, after the response to 50 microM forskolin was adapted, brought about an appreciable increase in the impulse frequency. The bulbar response to forskolin alone reached a saturation level around 10 microM. After the response to 50 microM forskolin was adapted, 11 species of odorants were applied to the olfactory epithelium. The magnitudes of responses to the odorants after forskolin were 45-80% of those of the control responses. There was no essential difference in the degree of the suppression by forskolin between cAMP- and IP3-producing odorants classified in the rat, suggesting that certain part of the forskolin-suppressive component was brought about by nonspecific action of forskolin. Application of a membrane permeant cAMP analogue, cpt-cAMP elicited a large response, and 0.1 mM citralva after 3 mM cpt-cAMP elicited 51% of the control response which was close to the response to citralva after 50 microM forskolin. A membrane permeant cGMP analogue, db-cGMP elicited a small response and the response to 0.1 mM citralva was unaffected by db-cGMP. It was concluded that cAMP-independent (probably IP3-independent) pathway greatly contributes to the turtle olfactory transduction.

Knocking out ubiquitin proteasome system function in vivo and in vitro with genetically encodable tandem ubiquitin.

At present, the 26S proteasome-specific inhibitor is not available. We constructed polyubiquitin derivatives that contained a tandem repeat of ubiquitins and were insensitive to ubiquitin hydrolases. When these artificial polyubiquitins (tUbs, tandem ubiquitins) were overproduced in the wild-type yeast strain, growth was strongly inhibited, probably because of inhibition of the 26S proteasome. We also found that several substrates of the ubiquitin-proteasome pathway were stabilized by expressing tUbs in vivo. tUbs containing four units or more of the ubiquitin monomer were found to form a complex with the 26S proteasome. We showed that tUb bound to the 26S proteasome inhibited the in vitro degradation of polyubiquitinylated Sic1 by the 26S proteasome. When tUB6 (six-mer) messenger RNA was injected into Xenopus embryos, cell division was inhibited, suggesting that tUb can be used as a versatile inhibitor of the 26S proteasome.

Differential phosphorylation of CK8 and CK18 by 12-O-tetradecanoyl-phorbol-13-acetate in primary cultures of mouse hepatocytes.

The phosphorylation of cytokeratin was investigated in primary cultures of hepatocytes. The two hepatocyte cytokeratins CK8 and CK18 (55,000 and 49,000 M(r) respectively) were phosphorylated, CK8 being more phosphorylated than CK18. Treatment of the hepatocytes with 150 nM 12-O-tetradecanoyl-phorbol-13-acetate (TPA) an activator of protein kinase C induced a transient increase in the level of phosphorylation of CK8 but not CK18. This effect was maximal after 15 min of TPA treatment and was maintained for up to 3 h. After 22 h of treatment with TPA, which down-regulates protein kinase C, CK8 phosphorylation was returned to the basal level. Further addition of TPA to the 22-h treated cells did not cause an increase in CK8 phosphorylation. Indirect immunofluorescence microscopy with a monoclonal antibody to CK8 indicated that while the addition of TPA induced the formation of granular cytokeratin aggregates in some hepatocytes, in most hepatocytes no major changes in the intermediate filament network were observed. Staining for actin showed that actin microfilaments were rapidly reorganized after the treatment and a loss of stress fibres were observed. We propose that CK8 is an in vivo substrate for protein kinase C and that the specific phosphorylation of CK8 plays a role in protein kinase C signal transduction.

Inhibition of bone resorption by pamidronate cannot restore normal gain in cortical bone mass and strength in tail-suspended rapidly growing rats.

To clarify how the changes in bone formation and resorption affect bone volume and strength after mechanical unloading, the effect of inhibition of bone resorption by a potent bisphosphonate, pamidronate, on bone mineral density (BMD), histology, and strength of hind limb bones was examined using tail-suspended growing rats. Tail suspension for 14 days reduced the gain in the BMD of the femur at both the metaphysis rich in trabecular bone and the diaphysis rich in cortical bone. Treatment with pamidronate increased the total BMD as well as that of the metaphysis of the femur but had almost no effect on the BMD of the diaphysis in both control and tail-suspended rats. Histological examinations revealed that 14-day tail suspension caused a loss of secondary cancellous bone with a reduction in the trabecular number and thickness in comparison with control rats. In the femoral diaphysis, the diameter and cortical bone thickness increased to a lesser degree in tail-suspended rats when compared with rats without tail suspension, and a marked reduction in bone formation and the layers of alkaline phosphatase-positive cells was observed at the periosteal side. Pamidronate treatment increased secondary cancellous bone but could not restore normal growth-induced periosteal bone apposition and bone strength. Because the material strength of the femoral diaphysis at the tissue level was not affected by pamidronate treatment, the inability of pamidronate to prevent the reduction in physical strength of the femoral diaphysis does not appear to be due to a change in the quality of newly formed bone. These results demonstrate that tail suspension reduces the growth-induced periosteal modelling drift and that the antiresorptive agent pamidronate is unable to restore normal periosteal bone apposition.

Molecular cloning of a putative serotonin receptor gene from barnacle, Balanus amphitrite.

We isolated a putative serotonin receptor gene from a genomic library of the barnacle, balanus amphitrite Darwin, using an Ncol fragment of the barnacle G protein-coupled receptor gene that is homologous to the alpha 2-adrenoceptor. The cloned genomic DNA had no intron and specified an open reading frame of 1137 base pairs encoding 379 amino acids (aa). The predicted aa sequence has a typical seven hydrophobic transmembrane spanning region and a consensus G protein-binding motif. This receptor was most homologous to the human 5HT1A receptor and closely related to other 5HT1 receptor subtypes.

Molecular cloning of a new member of the putative G protein-coupled receptor gene from barnacle Balanus amphitrite.

An intronless gene encoding a putative G protein-coupled receptor was isolated from the genomic library of barnacle Balanus amphitrite Darwin, with probes obtained from degenerate polymerase chain reaction (PCR) primers used to amplify putative transmembrane regions. The cloned genome DNA specifies an open reading frame of 1431 bp encoding 476 amino acids with seven hydrophobic transmembrane (TM)-spanning regions. The predicted protein contains potential asparagine-linked glycosylation and serine/threonine phosphorylation sites in the N-terminal and intracellular loops, respectively. Moreover, the protein has a consensus G protein-binding motif (Ala-Ile-Ser-Leu-Asp-Arg-Tyr-Leu-Ala) in TM domain III. This receptor is most closely related to human alpha 2-adrenergic receptor with 36.9% identity in 409 amino acids overlap. It is also homologous to human serotonin1A (5HT), snail pond 5HT and mouse D2-dopamine receptors with 33-36% identities. Within TM regions among these biogenic amine receptors, the cloned receptor shows considerable amino acid homology with more than 40% overall identities.

The 26 S proteasome is activated at two points in the ascidian cell cycle.

The proteasome undergoes cell cycle-dependent changes in its subcellular distribution during ascidian embryonic development [(1992) Dev. Biol. 151, 27-33]. In this study, we demonstrate that the 26 S proteasome is markedly activated in both prophase and metaphase of the mitotic cell cycle in the ascidian embryos in comparison with the case of the 20 S proteasome. These results suggest that the 26 S proteasome is activated and participates in proteolysis at the restricted stages of the cell cycle.

Clinical and neuroradiologic findings of congenital hydrocephalus in infant born to mother with HTLV-I-associated myelopathy.

We describe clinical and neuroradiologic findings in a male infant with congenital hydrocephalus born to a mother who developed human T-cell lymphotropic virus type I (HTLV-I)-associated myelopathy. Ultrasonography at age 20 days showed multiple cysts in the subependymal germinal matrix and enlarged lateral ventricles. Elevation of serum HTLV-I antibody suggested that his hydrocephalus was probably due to intrauterine HTLV-I infection. HTLV-I may cause neurotropic infection in utero.

Effective induction and acquisition of human monoclonal IgE antibodies reactive with house-dust mite extracts.

IgE plays a critical role in acute hypersensitivity such as anaphylaxis, asthma, and atopic dermatitis. IgE antibody is, therefore, an essential reagent for studying the mechanisms of these diseases. However, it is difficult to obtain IgE antibody in amounts sufficient for research use because IgE-producing lymphocytes are very rare. To overcome this problem, we investigated the requirements for generating IgE-secreting human hybridomas using in vitro immunization of peripheral blood lymphocytes. First, culture conditions were optimized for IgE production by a combination of the immunomodulatory mediators interleukin-2, interleukin-4, interleukin-6, and muramyl dipeptide. Second, the addition of mite antigen to the cultures resulted in an increased production of antigen-specific IgE as well as antigen-specific IgG and IgM. When activated lymphocytes in these cultures were fused with Burkitt lymphoma cells, ICLU-B, antigen-specific IgE-secreting hybridomas were obtained with high efficiency. These results demonstrate that our culture and in vitro immunization system for human peripheral blood lymphocytes is useful for obtaining antigen-specific IgE.

Response to skin grafts exchanged among siblings of larval and adult gynogenetic diploids in Xenopus laevis.

Gynogenetic diploid individuals were produced in an anuran amphibian, Xenopus laevis, and their response to skin grafts exchanged among siblings was studied. All skin grafts exchanged among nongynogenetic sibling froglets, as well as those from genetically unrelated donors, were rejected within 30 days. More than half (57%) of the gynogens that received grafts from sibling partners exhibited a prolonged survival (over 30 days), including long-term survival of over 120 days in 13%. The skin grafted from genetically unrelated froglets onto Nieuwkoop and Faber stage 42-56 larvae and onto perimetamorphic stage 58-65 animals was rejected within 30 days. Similarly, most (96%) of the skin grafts from outbred sibling froglets onto larvae at these stages were rejected acutely or subacutely (12-39 days). However, the skin grafted from sibling froglets to gynogens at larval stage 42-56 and perimetamorphic stage 58-61 enjoyed a long-term survival significantly more frequently (81%) than that in the final metamorphic (stage 64-65) counterparts (57%). These results support the view that in the adult Xenopus allograft responses are reactions to a single MHC as well as to cumulative, multiple minor H-locus barriers. The results also suggest that in larval stages the responses against minor H-locus barriers are generated only mildly.

Thymocyte precursors in early-thymectomized Xenopus: migration into and differentiation in allogenic thymus grafts.

In an anuran amphibian, Xenopus laevis, thymectomy of 4-day-old larvae abrogates T-cell dependent immune responsiveness. When such early-thymectomized (TX) diploid frogs were implanted with histocompatible triploid thymuses and grafted 8 weeks later with skin from third-party donors, the grafts were rejected relatively normally in 20-27 days. Microspectrophotometric determination of ploidy 3-5 months after thymus reconstitution revealed that most thymocytes were donor-derived. In contrast, when TX frogs received allogeneic triploid thymuses, they rejected skin grafts from a third-party donor relatively slowly (48-92 days) but did not reject skin from the thymus donor. Most thymocytes in such animals were of host origin. Host thymocytes were present 4 weeks after thymus implantation and became dominant population by 12 weeks. Few thymus implant-derived donor cells were detectable in the host spleen. These data suggest that existence of precursor cells in TX Xenopus that can functionally differentiate along a T-cell pathway as a result of microenvironment provided by the thymus implant.

Thoracoscopic surgery and pleurodesis for pleuroperitoneal communication in patients on continuous ambulatory peritoneal dialysis.

Two patients on continuous ambulatory peritoneal dialysis (CAPD) developed right massive hydrothorax and were diagnosed as having pleuroperitoneal communication. Thoracoscopic surgery and pleurodesis were performed. It showed that one was caused by multiple flaws in the diaphragm and that the other was attributable to multiple blebs in the diaphragmatic dome. After the procedure, both of them had no recurrence of hydrothorax and underwent CAPD safely. We recommend thoracoscopic surgery and pleurodesis as the first choice of therapeutic methods for pleuroperitoneal communication.

Central alveolar hypoventilation syndrome (Ondine's curse) with gastroesophageal reflux.

Congenital central hypoventilation syndrome (Ondine's curse) is a rare disorder with lack of automatic control of ventilation during sleep. We have reported a case of Ondine's curse in a patient who underwent Nissen's fundoplication for gastroesophageal reflux (GER) at age 5 months. Ventilatory challenge test during sleep was done to confirm central alveolar hypoventilation. This female patient, without cor pulmonale, was a good candidate for diaphragm pacing. Thus, the patient underwent implantation of a diaphragm pacer at age 3 years; she had required mechanical ventilation since birth. Diagnosis, pathogenesis, and problems in the setting of diaphragm pacing for an infant are discussed.

A complementary DNA for an ascidian embryonic nuclear antigen Hgv2 encodes a protein closely related to the amphibian histone-binding protein N1.

We have isolated and sequenced a cDNA clone encoding an ascidian embryonic nuclear protein, Hgv2. An insert about 2 kb long covered almost the entire length of 2.3-kb Hgv2 mRNA. The amino acid sequence of Hgv2 deduced from the cDNA sequence showed that this protein is related to the amphibian karyophilic histone-binding protein N1, which is thought to be involved in nucleosome assembly. Homology between these two proteins is evident from their extremely similar amino acid compositions and hydropathy profiles. In addition, Hgv2 protein has sequences strikingly similar to the nuclear targeting signal of N1. This is therefore the first report of molecular cloning of a homologue of N1 in non-amphibian species. Putative histone-binding domains of N1 are composed of two acidic residue-rich clusters. Hgv2 polypeptide contains two highly acidic regions, but amino acid sequences of the regions are not conserved. Since Hgv2 protein exists in nuclei of every embryonic cell but disappears from nuclei of metamorphosed juvenile tissues, this protein may function as a nucleosome assembly factor during rapid embryonic cell divisions.

Limited proteolysis of filamin is catalyzed by caspase-3 in U937 and Jurkat cells.

Members of the caspase family have been implicated as key mediators of apoptosis in mammalian cells. However, few of their substrates are known to have physiological significance in the apoptotic process. We focused our screening for caspase substrates on cytoskeletal proteins. We found that an actin binding protein, filamin, was cleaved from 280 kDa to 170, 150, and 120 kDa major N-terminal fragments, and 135, 120, and 110 kDa major C-terminal fragments when apoptosis was induced by etoposide in both the human monoblastic leukemia cell line U937, and the human T lymphoblastic cell line Jurkat. The cleavage of filamin was blocked by a cell permeable inhibitor of caspase-3-like protease, Ac-DEVD-cho, but not by an inhibitor of caspase-1-like protease, Ac-YVAD-cho. These results suggest that filamin is cleaved by a caspase-3-like protease. To examine whether caspase-3 cleaves filamin in vitro, we prepared a recombinant active form of caspase-3 directly using a Pichia pastoris overexpression system. When we applied recombinant active caspase-3 to the cell lysate of U937 and Jurkat cells, filamin was cleaved into the same fragments seen in apoptosis-induced cells in vivo. Platelet filamin was also cleaved directly from 280 kDa to 170, 150, and 120 kDa N-terminal fragments, and the cleavage pattern was the same as observed in apoptotic human cells in vivo. These results suggest that filamin is an in vivo substrate of caspase-3.