[A case of AFP-producing gastric cancer after curative operation effectively treated with chemotherapies including hepatic arterial infusion therapy].

A 63-year-old woman was admitted complaining of epigastralgia. An endoscopic examination revealed a Borrmann type 2 lesion at the greater curvature of the middle third in the stomach. Abdominal computed tomography detected no liver metastasis. The preoperative serum alpha-phetoprotein (AFP) level was elevated to 242.9 ng/ml. 5-fluorouracil (5-FU) was given 200 mg/day for 26 days orally. Distal gastrectomy with D3+ No. 16b1 lymph node dissection, cholecystectomy and hepatic arterial canulation were performed, and mitomycin C 20 mg was injected intravenously during the operation. Immunohistochemical staining of the specimen for AFP by the SAB method was positive in the cancer lesion. After the operation, FP (cisplatin 100 mg on day 1, 5-FU 750 mg on days 1-3) therapy of one course and intrahepatic arterial infusion therapy using adriamycin 10-20 mg every 2 weeks for 7 months were conducted. Moreover, the patient took UFT 400 mg/day for 26 months orally on an outpatient basis as an adjuvant chemotherapy. The only toxicity was neutropenia (grade 3), but it abated without an interruption in the chemotherapy. The AFP level declined gradually, and returned to the normal range 1 month after surgery. The patient is still alive with no sign of hepatic metastasis or recurrence 7 years and 7 months after the gastrectomy.

Saponins of plants of Panax species collected in Central Nepal, and their chemotaxonomical significance. III.

Panax pseudo-ginseng subsp. pseudo-ginseng has a carrot like root with a small rhizome. It was shown that the saponin composition of roots and rhizomes of this subspecies collected in Tibet and China was extremely poor. From the roots and rhizomes collected in Central Nepal, (specimen-PNct), only a small amount of an oleanolic acid saponin, beta-D-glucopyranosyl-oleanolate (2) was isolated together with a polyacetylene-alcohol, panaxynol (3). In another specimen (specimen-PNs), also collected in Central Nepal, two oleanolic acid saponins, stipleanoside R2 (4) and chikusetsusaponin IV (5) were detected. No dammarane saponin was identified in either specimen. P. pseudo-ginseng subsp. himalaicus (Subsp-H) has a big rhizome with a small round root. From rhizomes and roots of this subsp. collected in Central Nepal (specimen-HNct), a fairly large amount of dammarane saponins, ginsenosides-Rb1 (6), -Rd (7), -Re (9) and -Rg1 (10), gypenoside XVII (8), notoginsenoside-R1 (11), majonoside-R2 (12) and pseudo-ginsenoside-F11 (13) were isolated, while no oleanane saponin (oleanolic acid saponin) was identified in this subsp. Based on the present and previous studies, medicinal evaluation and chemogeographical correlation of Himalayan Panax spp. are discussed.

[A patient with advanced gastric cancer who obtained downstaging and underwent radical surgery by neoadjuvant chemotherapy].

The patient was a 74-year-old man with extremely advanced gastric cancer. A CT scan of the abdomen showed enlargement of many huge abdominal para-aortic lymph nodes. Neoadjuvant chemotherapy (NAC) was planned in order to reduce or eliminate the tumor. Two cycles of FLP combination therapy (5-fluorouracil, leucovorin, cisplatin) were given. After NAC, a CT scan revealed marked shrinkage of the No. 16 lymph nodes, and a distal gastrectomy with extended radical lymph node dissection including the No. 16 nodes was performed. The histological effect was judged to be grade 2. There were no viable cancer cells in the No. 16 lymph nodes. The FLP combination therapy as NAC was so effective that it induced downstaging from stage IVb to IIIb.

The effect of auricular acupuncture on olfactory acuity.

The modulation of olfactory thresholds by auricular acupuncture at a specific auricular acupuncture point was examined. The Lung Point, supplied by the auricular branch of the vagus nerve, was employed in a controlled single blind study of a randomized population of 23 healthy volunteers. Two odorous substances, beta-Phenyl ethyl alcohol and Methyl cyclopentenolone were used to evaluate the modulation of olfactory thresholds after acupuncture. A significant decrease in the olfactory recognition threshold by acupuncture in comparison with controls (P < 0.05) for two standard odors was observed. Our findings suggest that auricular acupuncture stimulation can decrease the recognition threshold of olfactory sensitivity.

Bioactive saponins and glycosides. XI. Structures of new dammarane-type triterpene oligoglycosides, quinquenosides I, II, III, IV, and V, from American ginseng, the roots of Panax quinquefolium L.

The methanolic extract and 1-butanol-soluble fraction of American ginseng, the roots of Panax quinquefolium L., were found to exhibit a protective effect on liver injury induced by D-galactosamine and lipopolysaccharide. Five new dammarane-type triterpene oligoglycosides called quinquenosides I, II, III, IV, and V were isolated together with fourteen known dammarane-type triterpene oligoglycosides such as chikusetsusaponin IVa, pseudo-ginsenoside-RC1, malonyl-ginsenoside-Rb1, and notoginsenosides-A,-C, and -K from the 1-butanol-soluble fraction. From the ethyl acetate-soluble fraction, four known acetylenic compounds and 6'-O-acetyl ginsenoside-Rg1 were isolated. The structures of quinquenosides I, II, III, IV, and V were determined on the basis of chemical and physicochemical evidence as 3-O-[6-O-(E)-2-butenoyl-beta-D-glucopyranosyl(1-->2)-beta-D- glucopyranosyl]-20-O-(beta-D-glucopyranosyl) 20(S)-protopanaxadiol (quinquenoside I), 3-O-[6-O-(E)-2-octenoyl-beta-D- glucopyranosyl(1-->2)-beta-D-glucopyranosyl]-20-O-[beta-D-glucopyranosyl (1-->6)-beta-D-glucopyranosyl] 20(S)-protopanaxadiol (quinquenoside II), 3-O-[beta-D-glucopyranosyl (1-->2)-6-O-acetyl-beta-D-glucopyranosyl]-20-O-(beta-D-glucopyranosyl) 20(S)-protopanaxadiol (quinquenoside III), 3-O-[beta-D-glucopyranosyl(1-->2)-beta-D-glucopyranosyl]-20-O-beta-D- glucopyranosyl(1-->6)-beta-D-glucopyranosyl]-3 beta, 7 beta, 20(S)-trihydroxydammar-5,24-diene (quinquenoside IV), and 3-O-[beta-D-glucopyranosyl(1-->2)-beta-D-glucopyranosyl]-20-O-[alpha-D- glucopyranosyl(1-->4)-beta-D-glucopyranosyl(1-->6)-beta-D-glucopyranosyl ] 20(S)-protopanaxadiol (quinquenoside V).

[The building of a health center from the point of view of planners and doctors: a case study]. / Processo de construção de um distrito de saúde na perspectiva de gestores e médicos: estudo de caso.

OBJECTIVE: The relationship between the structure of the health center and the population seeking comprehensive health care. METHOD: It was studied a health center of the county of S. Paulo (Brazil) in the period of 1989 to 1992. The speech of managers at three levels, regional, district and local, as well as the speech of physicians who were working at the Primary Health Care Units, was analysed. The concept of comprehensive care covers five dimensions: 1) the individual and not the illness itself as the primary aim; 2) the individual or group as a whole; 3) the intervention provided by other types of care; 4) different treatment for those who live in different situations; 5) the intervention in the general living conditions of the population. RESULTS: It was concluded that the relationship between the district structure and the seek for comprehensive care was dependent on the following: health planning, emphasizing a wider view of the real life situation of the population connected to the Primary Health Care Unit; the kind of interaction between different members of the staff; better organization of the work and of the reference and counter-reference networks and a good relationship with other health departments, thus making possible better comprehensive care. COMMENTS: Being a local care unit does not enable the health district to meet the challenge of being the "locus" of knowledge, work and power as between the population and the workers and among the different groups within these two sectors.

Bioactive saponins and glycosides. VIII. Notoginseng (1): new dammarane-type triterpene oligoglycosides, notoginsenosides-A, -B, -C, and -D, from the dried root of Panax notoginseng (Burk.) F.H. Chen.

The glycosidic fraction from the dried roots of Panax notoginseng (Burk.) F.H. Chen was found to show protective effect on liver injury induced by D-galactosamine and lipopolysaccharide. From the glycosidic fraction with hepatoprotective effect, nine new dammarane-type triterpene oligoglycosides, notoginsenosides-A, -B, -C, -D, -E, -G, -H, -I, and -J and an acetylenic fatty acid glycoside, notoginsenic acid beta-sophoroside, were isolated together with fourteen known dammarane-type triterpene oligoglycosides. The structures of notoginsenosides-A, -B, -C and -D were determined on the basis of chemical and physicochemical evidence, which included the chemical correlation with ginsenoside-Rb1 using photosensitized oxygenation, as follows: notoginsenoside A; 3-O-[beta-D-glucopyranosyl (1-->2)-beta-D-glucopyranosyl]-20-O-[beta-D-glucopyranosyl (1-->6)-beta-D-glucopyranosyl] 3 beta, 12 beta,20(S),25-tetrahydroxydammar -23-ene; B; 3-O-[beta-D-glucopyranosyl (1-->2)-beta-D-glucopyranosyl]-20-O-[beta-D-glucopyranosyl (1-->6)-beta-D- glucopyranosyl] 3 beta, 12 beta,20(S)-trihydroxydammar-25-en-24-one, C; 3-O-[beta-D-glucopyranosyl (1-->2)-beta-D-glucopyranosyl]-20-O-[beta-D -glucopyranosyl (1-->6)-beta-D-glucopyranosyl] 3 beta,12 beta,20(S)- trihydroxy-24 zeta-hydroperoxydammar-25-ene, and D; 3-O-[beta-D-xylopyranosyl (1-->2)-beta-D-glucopyranosyl (1-->2)-beta-D-glucopyranosyl]-20-O-[beta-D-xylopyranosyl (1-->6)-beta-D-glucopyranosyl (1-->6)-beta-D-glucopyranosyl]20(S)-protopanaxadiol, respectively.

Inhibition of aldose reductase by dihydroflavonols in Engelhardtia chrysolepis and effects on other enzymes.

Astilbin and neoastilbin, dihydroflavonol rhamnosides from Engelhardtia chrysolepis, showed potent inhibition of lens aldose reductase. Kinetic analysis showed astilbin exhibited uncompetitive inhibition against both dl-glyceraldehyde and NADPH. These taxifolin glycosides were selective inhibitors of aldose reductase with no inhibition of NADH oxidase.

Localization of mRNAs of voltage-dependent Ca(2+)-channels: four subtypes of alpha 1- and beta-subunits in developing and mature rat brain.

The heterogeneous gene expression for four subtypes of alpha 1 (A,B,C,D)- and beta (beta 1,beta 2,beta 3,beta 4)-subunits of voltage-dependent calcium channels was demonstrated in developing and adult rat brain by in situ hybridization histochemistry. In the adult rat brain the gene expression for A- and B-subtypes was predominant in the cerebellar cortex and hippocampal neuronal layers, with the A-subtype expressed most intensely in the Purkinje cells, while the expression for C- and D-subtypes was predominant in the olfactory mitral and granule cells and the dentate granule cells. The expression of beta 1-mRNA was prominent in the olfactory mitral cells and dentate granule cells whereas that of beta 2-mRNA was evident in the hippocampal neuronal layers and cerebellar Purkinje cells. The expression of beta 3-mRNA was prominent in the olfactory mitral and internal granule cells and medial habenula, whereas that of beta 4-mRNA in the olfactory mitral cells and cerebellar Purkinje and granule cells. Comparison between the expression patterns for individual alpha- and beta-subunits suggests that the beta 4-subunit contributes to P-type channel, whereas the beta 1- and beta 3-subunits contribute respectively to D- and C-subtypes of L-type channels, although dissociation in the expression patterns were also noted in several brain regions. In addition to neuronal populations, the gene expression for the C-subtype of L-type channel was detected at substantial level in glial cells. In developing brains, the genes for the all subtypes of alpha 1- and beta-subunits were expressed in the mantle zones, but not the ventricular zones, of the entire neuraxis and the expression was more or less attenuated during early postnatal periods in most of the brain regions except for the olfactory bulb, hippocampus and cerebellar cortex, suggesting that the Ca(2+)-channels are intimately involved in the neuronal differentiation.

Inhibitory effects of cucurbitane triterpenoids on Epstein-Barr virus activation and two-stage carcinogenesis of skin tumors.

To search for possible anti-tumor-promoters, we carried out a primary screening of 21 cucurbitane triterpenoids using an in vitro assay system. Of these triterpenoids, scandenoside R6 (6), 23,24-dihydrocucurbitacin F (14), 25-acetyl-23,24-dihydrocucurbitacin F (15), 2-O-beta-D-glucopyranosyl-23,24-dihydrocucurbitacin F (17) and cucurbitacin F (18) exhibited significant inhibitory effects on Epstein-Barr virus (EBV) activation induced by the tumor promoter, 12-O-tetradecanoyl-phorbol-13-acetate (TPA). Further, compounds 14 and 17 exhibited remarkable anti-tumor-promotion effects on mouse skin tumor promotion in an in vivo two-stage carcinogenesis test.

Saponins from Vietnamese ginseng, Panax vietnamensis Ha et Grushv. collected in central Vietnam. III.

Five new dammarane saponins derived from four new aglycones were isolated from the rhizomes and roots of Panax vietnamensis Ha et Grushv. On the basis of physicochemical and spectral evidence, the structures of these compounds were established as 6-O-beta-D-glucopyranosyl 20(S),25-epoxydammarane-3 beta,6 alpha,12 beta,24 alpha-tetrol (1), 6-O-beta-D-xylopyranosyl-(1-->2)-beta-D-glucopyranosyl 20(S),25-epoxydammarane-3 beta,6 alpha,12 beta,24 alpha-tetrol (2), 6-O-beta-D-glucopyranosyl dammarane-3 beta,6 alpha,12 beta,20(S),24 xi,25-hexol (5), 3-O-[beta-D-glucopyranosyl-(1-->2)-beta-D-glucopyranosyl]-20-O-beta-D- glucopyranosyl dammarane-3 beta,12 beta,20(S),24 xi,25-pentol (8) and 6-O-beta-D-xylopyranosyl-(1-->2)-beta-D-glucopyranosyl 20(S),24(S)-epoxydammarane-3 beta,6 alpha,12 beta,25 xi,26-pentol (10). The trivial names, vina-ginsenoside-R10, -R11, -R12, -R13 and -R14, respectively, were assigned to the new saponins.

Diterpenoid glycosyl esters from Phlomis younghusbandii and P. medicinalis roots.

From the roots of Phlomis younghusbandii collected in Tibet, new furanolabdane-type diterpenoid glycosides named phlomisosides III and IV were isolated together with a known sweet furanolabdane-type diterpenoid glycoside, phlomisoside I. The structure of the common aglycone of phlomisosides III and IV, which we have named phlomisoic acid, was established as 15,16-epoxy-8,13(16),14-labdatrien-19-oic acid by MS and NMR spectroscopy. Phlomisosides III and IV are tasteless and the structures of these were determined to be the beta-D-xylopyranosyl(1-->2)-beta-D-glucopyranosyl and the alpha-L-rhamnopyranosyl(1-->2)-beta-D-glucopyranosyl ester of phlomisoic acid by chemical and spectroscopic methods, respectively. The diterpenoid glycoside constituents of the roots of P. medicinalis collected in Tibet were also elucidated, and baiyunoside and phlomisosides II and III were isolated and identified.

Saponins from Vietnamese Ginseng, Panax vietnamensis HA et Grushv. Collected in central Vietnam. II.

Further investigation on the saponin composition of rhizomes and roots of Panax vietnamensis HA et GRUSHV. has resulted in the isolation and structural elucidation of seven new dammarane saponins named vina-ginsenosides-R3 (12), -R4 (11), -R5 (16), -R6 (17), -R7 (6), -R8 (20), -R9 (22), together with the identification of six known saponins including 20-gluco-ginsenoside-Rf (10), ginsenoside-Rc (4), notoginsenoside-R6 (9), quinquenoside-R1 (5), gypenoside XVII (2) and majoroside F1 (21). The structures of the novel saponins were established on the basis of chemical and spectral evidence. Vina-ginsenoside-R3 is the first naturally occurring glycoside of dammarenediol II, while vina-ginsenosides-R5 and -R6, two ocotillol-type saponins, are two other examples of saponins having the rare alpha-glucosyl linkage.

Molecular cloning of a novel isotype of Mg(2+)-dependent protein phosphatase beta (type 2C beta) enriched in brain and heart.

Two complementary DNA (cDNA) clones (pTK-1 and -2) encoding two distinct isotypes of mouse Mg(2+)-dependent protein phosphatase beta (MPP beta-1 and -2, respectively) were isolated from a melanocyte cDNA library. Although mouse pTK-1 is orthologous to the rat cDNA (JW5) reported previously [Wenk, J., Trompeter, H.I., Pettrich, K.G., Cohen, P.T.W., Campbell, D.G., and Mieskes, G. (1992) FEBS Lett. 297, 135-138], pTK-2 is a novel cDNA clone. It was strongly suggested that the pTK-1 and -2 cDNAs are splicing variants of a single pre-mRNA. The difference in the amino acid sequences between MPP beta-1 and -2 was observed only at the carboxy-terminal regions. Both the recombinant MPP beta-1 and -2 expressed in Escherichia coli cells were immunoreactive to an anti-MPP beta antibody and exhibited Mg(2+)-dependent and okadaic acid-insensitive protein phosphatase activities with similar substrate specificities. Although the mRNA of MPP beta-1 was expressed ubiquitously in various mouse tissues, that of MPP beta-2 was expressed exclusively in brain and heart. These results suggest the difference in the physiological roles of these two enzyme isotypes.

Saponins from Vietnamese ginseng, Panax vietnamensis Ha et Grushv. Collected in central Vietnam. I.

From rhizomes and roots of Panax vietnamensis Ha et Grushv., Araliaceae, commonly known as Vietnamese Ginseng, two new acetylate saponins named vina-ginsenoside-R1 (13) and vina-ginsenoside-R2 (15) were isolated. On the basis of chemical and spectral data, 13 was formulated as monoacetyl 24(S)-pseudo-ginsenoside-F11 and 15 was proved to be monoacetyl majonside-R2. Besides the two new saponins and beta-sitosteryl-3-O-beta-D-glucopyranoside, sixteen known saponins were also isolated and identified. Dammarane saponins:ginsenoside-Rh1 and 20(R)-ginsenoside-Rh1 (1), ginsenosides-Rg1 (2), -Re (3), -Rd (6), -Rb3 (7), -Rb2 (8), -Rb1 (9), pseudo-ginsenoside-RS1 (= monoacetyl ginsenoside-Re, 4), notoginsenosides-R1 (5) and -Fa (10). Ocotillol-type saponins:pseudo-ginsenoside-RT4 (11), 24(S)-pseudo-ginsenoside-F11 (12), majonosides-R1 (16) and -R2 (14). Oleanolic acid saponins:ginsenoside-Ro (= chikusetsusaponin V, 17) and hemsloside-Ma3 (18), a saponin previously isolated from a cucurbitaceous plant, Hemsleya macrosperma C. Y. Wu. Despite having large horizontally elongated rhizomes, the underground part of this plant contains mainly dammarane saponins and a small amount of oleanolic acid saponins. In addition, the yield of ocotillol-type saponins, especially majonoside-R2, is surprisingly very high (more than 5% and ca. half of the total yield of saponin). This characteristic saponin composition has made Vietnamese Ginseng an interesting species among Panax spp.

The effect of nifedipine on monocrotaline-induced pulmonary hypertension in rats.

Effective drug therapy for pulmonary hypertension has not yet been developed. This study was designed to estimate the long-term hemodynamic and histopathological effects of nifedipine on severe pulmonary hypertension using animal models. Injection of one dose of monocrotaline produced subacute pulmonary hypertension in 7 week old Sprague-Dawley rats. Nifedipine (10 mg/kg) was administered intraperitoneally every day. For 5 weeks, bodyweight and hemodynamic parameters were measured, and right ventricle (RV) and left ventricle with septum (LV + S) were weighed separately. Medial thickness of the small pulmonary arterial wall was calculated by Suwa's method. Compared with the control group, the increase in right ventricular systolic pressure, total pulmonary resistance index, weight ratio of RV/(LV + S and medial hypertrophy in the nifedipine-treated rats were significantly limited without causing systemic hypotension. These results suggest that treatment with nifedipine may also be effective in attenuation of pulmonary hypertension when applied to humans.

Tannins and related compounds. CXXII. New dimeric, trimeric and tetrameric ellagitannins, lambertianins A-D, from Rubus lambertianus Seringe.

Chemical examination of the leaves of Rubus lambertianus Seringe (Rosaceae) has led to the isolation of four new ellagitannins, which were characterized on the basis of chemical and spectroscopic evidence to be dimers [lambertianins A (6) and B (7)], a trimer [lambertianin C (8)] and a tetramer [lambertianin D (10)], all having sanguisorbic acid ester group(s) as linking unit(s) between glucopyranose moieties. Furthermore, HPLC analyses of fifteen Rubus species collected in Japan and Taiwan revealed that the trimer (8) and the tetramer (10), together with sanguiin H-6 (1), occur widely in these species.

[Studies on triterpenoid constituents of the roots of Lantana camara].

Eight triterpenoids were isolated from the roots of Lantana camara. On the basis of their chemical properties and spectral data (UV, IR, MS, 1HNMR, 13CNMR), they were identified as lantanolic acid (I), 22 beta-O-angeloyl-lantanolic acid (II), oleanolic acid (III), 22 beta-O-angeloyl-oleanolic acid (IV), 22 beta-O-senecioyl-oleanolic acid (V), 22 beta-hydroxy-oleanolic acid (VI), 19 alpha-hydroxy-ursolic acid (VII) and 3 beta-isovaleroyl-19 alpha-hydroxy-ursolic acid (VIII). II was obtained for the first time from plant. VIII is a new compound named lantaiursolic acid.