The effect of Juzen-taiho-to/TJ-48 on the expression of killer-cell immunoglobulin-like receptors (CD158a/b) on peripheral lymphocytes in vitro experiment.

Juzen-taiho-to (TJ-48), a mixture of extracts from 10 medicinal herbs, has been used traditionally to treat patients with anemia, anorexia or fatigue. It is well known that the treatment of TJ-48 result in the decrease of patient's complaints, as well as the increase of NK cytolytic activity (NK activity) although its augmentation is not clear in the other kampo formula from the clinical viewpoint. To investigate its biological activities, such as the augmentation of NK activity, we analyzed the effects of TJ-48 on the expression of killer-cell immunoglobulin-like receptors (KIRs) in vitro experiment. The peripheral lymphocytes were incubated in medium alone, or medium containing TJ-48 or interleukin-2 (IL-2) plus TJ-48 at several concentrations for 48 h. After each incubation, cells were collected and their KIRs were detected by flow cytometry using monoclonal antibodies CD158a and CD158b. TJ-48 increased the populations of CD16+CD158a+ and CD16+CD158b+ cells in a dose-dependent manner. In contrast, CD16-CD158a/b+ cells did not increase. Additionally, the extract of TJ-48 enhanced the increase of KIRs expression induced by IL-2. These actions contribute to the augmentation of NK cytolytic activity by TJ-48, and might explain, in part, its antitumor effects which has been observed in vivo.

Effect of alumina femoral heads on polyethylene wear in cemented total hip arthroplasty. Old versus current alumina.

We examined the behaviour of alumina ceramic heads in 156 cemented total hip arthroplasties, at a minimum follow-up of eight years. They were divided into three groups according to the size of the femoral head; 22, 26, and 28 mm. We measured polyethylene wear radiologically using a computer-aided technique. The linear wear rate of polyethylene sockets for the 28 mm heads was high (0.156 mm/year), whereas those for the 22 and 26 mm heads were relatively low (0.090 and 0.098 mm/year, respectively). Moreover, the surface roughness data of retrieved femoral heads clearly showed maintenance of an excellent surface finish of the current alumina. We conclude that the alumina ceramic femoral heads currently used are associated with a reduced rate of polyethylene wear.

The effects of hydraulic pressure on atrial natriuretic peptide during rehabilitative head-out water immersion.

To study the hydraulic effects of subtotal immersion as a rehabilitative hydrotherapy, we examined the change in serum levels of atrial natriuretic peptide, catecholamine, cortisol and interleukins in 12 healthy volunteers. The subjects soaked in 42 degrees C water of 70 cm depth up to chin level in the upright seated position for 10 min. The serum level of atrial natriuretic peptide increased significantly 15 min after the start of subtotal immersion, though that of brain natriuretic peptide did not change. The serum dopamine level increased significantly 15 min after immersion, though neither the serum epinephrine nor norepinephrine levels did. In addition, 30 min after the start of immersion, the serum levels of atrial natriuretic peptide and dopamine decreased to those before immersion. The serum level of adrenocorticotropic hormone increased 15 min after immersion, though those of cortisol, interleukin-1beta and 6, and tumor necrotic factor-alpha did not change. It is suggested that 10-min head-out water immersion increased atrial natriuretic peptide partly due to increased venous return or right atrial load by hydraulic pressure.

Breathing out into water during subtotal immersion: a therapy for chronic pulmonary emphysema.

OBJECTIVE: To determine the importance of a breathing out into water exercise during subtotal immersion for emphysematous patients. DESIGN: Results of a respiratory function test and arterial blood gas analysis were examined to compare the programs of breathing exercise with and without the breathing out into water exercise. The breathing exercises in a pool filled with 38 degrees C water were performed 30 min/day, 5 days/wk, for 2 mo in 17 patients with stable chronic emphysema. Patients were randomly assigned to breathing exercise programs including subtotal water immersion with the nose and mouth either immersed (9 patients) or out of the water (8 patients) during exhalation. RESULTS: The ratio of %forced expired volume in 1 sec to forced vital capacity and %forced vital capacity at rest were significantly increased in the program with the breathing out into water exercise, but they did not change in the program without the breathing out into water exercise. A significant increase in peak flow was observed in the former program, although it did not change in the latter program. The maximal expiratory flow at 25% did not change in either program. Pao2 was significantly increased and Paco2 was significantly decreased in the former program, although a trend for a decrease in Paco2 was observed in the latter program. CONCLUSIONS: These results suggest that the breathing out into water exercise enhances the effects of a breathing exercise during immersion and is useful in rehabilitation for chronic pulmonary emphysema.

Clinical analysis of breathing exercise during immersion in 38 degrees C water for obstructive and constrictive pulmonary diseases.

Breathing exercises during immersion in 38 degrees C water were performed in 22 patients with bronchial asthma, pulmonary emphysema and constrictive pulmonary diseases. The patients entered a pool filled with 38 degrees C water to shoulder level. While standing, they breathed in deeply and breathed out slowly through the mouth into water while sinking the nose below the water level. This breathing method was repeated for 20 min. with a 5-min. rest out of water and this cycle was performed twice a day for two months. Respiratory function test and arterial blood gas analysis were examined before and after the two-month exercise program. FEV1.0% was significantly increased in patients with asthma and emphysema (p = 0.042 and 0.032, respectively) but did not change in patients with constrictive pulmonary diseases. %FVC, PF and Vmf25 did not change in any of the diseases. PaO2 was significantly increased in emphysematous patients (p = 0.0002) and PaCO2 was significantly decreased in asthmatic and emphysematous patients (p = 0.034 and 0.046, respectively). These results suggest that our breathing exercise by immersion is useful in patients with asthma and emphysema but is less effective in patients with constrictive pulmonary diseases.

Immunomodulation by vitamin B12: augmentation of CD8+ T lymphocytes and natural killer (NK) cell activity in vitamin B12-deficient patients by methyl-B12 treatment.

It has been suggested that vitamin B12 (vit.B12) plays an important role in immune system regulation, but the details are still obscure. In order to examine the action of vit.B12 on cells of the human immune system, lymphocyte subpopulations and NK cell activity were evaluated in 11 patients with vit.B12 deficiency anaemia and in 13 control subjects. Decreases in the number of lymphocytes and CD8+ cells and in the proportion of CD4+ cells, an abnormally high CD4/CD8 ratio, and suppressed NK cell activity were noted in patients compared with control subjects. In all 11 patients and eight control subjects, these immune parameters were evaluated before and after methyl-B12 injection. The lymphocyte counts and number of CD8+ cells increased both in patients and in control subjects. The high CD4/CD8 ratio and suppressed NK cell activity were improved by methyl-B12 treatment. Augmentation of CD3-CD16+ cells occurred in patients after methyl-B12 treatment. In contrast, antibody-dependent cell-mediated cytotoxicity (ADCC) activity, lectin-stimulated lymphocyte blast formation, and serum levels of immunoglobulins were not changed by methyl-B12 treatment. These results indicate that vit.B12 might play an important role in cellular immunity, especially relativing to CD8+ cells and the NK cell system, which suggests effects on cytotoxic cells. We conclude that vit.B12 acts as an immunomodulator for cellular immunity.

Treatment of refractory cases of atopic dermatitis with acidic hot-spring bathing.

The incidence of refractory atopic dermatitis has increased in teenagers and young adults. The purpose of this study was to control the skin symptoms of such patients in daily life. Seventy patients repeatedly took a 10-min 42 degrees C acidic hot-spring bath twice daily. The skin symptoms were improved in 76% of cases. In 30 of 42 responders examined Staphylococcus aureus, detected on the skin surface, disappeared or decreased through balneotherapy. In contrast, S. aureus remained unchanged in 8 of 10 non-responders examined. Thus, the balneotherapy using acidic hot-spring water may be useful for controlling the skin symptoms of acute flares of refractory cases of atopic dermatitis.

[Physical therapy in a pool as rehabilitation for chronic obstructive pulmonary disease in the elderly].

The pulmonary function test and arterial blood gas analysis were performed before and after a 2-month rehabilitation program in a pool filled with 38 degrees C hot-spring water in 15 elderly patients (75.7 +/- 3.7 years of age; 12 males and 3 females; 6 cases of pulmonary emphysema and 9 cases of bronchial asthma) and 10 young patients (56.4 +/- 14.2 years of age, 7 males and 3 females; 4 cases of pulmonary emphysema and 6 cases of bronchial asthma) with stable chronic obstructive pulmonary disease treated at Gunma University Hospital between 1995 and 1996. After the exercise program, the ratio of forced expired volume in one second to forced vital capacity (FEV1.0%) was significantly increased (p < 0.05), while the ratio of forced vital capacity to predicted normal value (%VC) did not change in either group. Furthermore, a tendency toward an increase in peak flow (PF) and maximal expiratory flow at 25 and 50 percent (V25 and V50) was observed in both groups. An increase in PaO2 was observed in both groups, while an decrease in PaCO2 was observed in the young group (p < 0.05). These effects were observed more clearly in patients with asthma than in those with emphysema. The changes in pulmonary function and arterial blood gas were considered to be resulted from respiratory muscle training and expiration into water in addition to an increase in cardiac output by hydraulic pressure. Therefore, physical therapy in a pool filled with hot-spring water may be useful in treating chronic obstructive pulmonary disease in elderly as well as in young patients.

A transient rise in plasma beta-endorphin after a traditional 47 degrees C hot-spring bath in Kusatsu-spa, Japan.

To clarify the mechanism of the intoxicating feeling attained after a traditional 47 degrees C hot-spring bath called 'jikan-yu' in Kusatsu-spa, Japan, we examined the change in plasma levels of beta-endorphin and methionine enkephalin in 7 healthy subjects. The mean sublingual temperature rose from 36.8 degrees C to 38.6 degrees C and the plasma beta-endorphin level from 16.2 pg/ml to 49.5 pg/ml 2 minutes after completing a 3-minute bath in 47 degrees C hot-spring water. However, the plasma methionine enkephalin level was not changed. This feeling of intoxication may be explained by the transient rise in plasma beta-endorphin level.

[Absorption of 5-FU orally administered in a patient with postoperative gastric cancer under artificial dialysis].

A patient under artificial dialysis due to chronic renal failure suffered from gastric cancer concurrently. This patient underwent subtotal gastrectomy followed by consecutive oral administration of 5-FU (tablets) as a postoperative adjuvant chemotherapy. The 5-FU level in the peripheral blood on oral administration at 50 mg remained at 0.007-0.01 microgram/ml over 2 hours. This feature of 5-FU blood level is not seen in gastric cancer patients with normal renal functions on administration of 5-FU tablets, and it seems to approximate the features of a 5-FU prodrug level in the blood upon oral administration. Neither the influence of dialysis on the absorption of orally administered 5-FU nor side effects caused by 5-FU were observed. The above findings suggest that it may be possible to maintain a certain blood level of 5-FU and to perform adjuvant chemotherapy even in cancer patients under artificial dialysis, as long as the dose is controlled carefully.