Renal denervation for mild-moderate treatment-resistant hypertension : A timely intervention?

BACKGROUND: Renal denervation (RDN) has been proposed as a novel antihypertensive intervention for treating resistant hypertension. It remains to be investigated which patient groups can potentially benefit from RDN. The present study aimed to evaluate the efficacy and safety of RDN in patients with mild-moderate resistant hypertension, i. e., systolic office blood pressure (BP) of 140-160 mm Hg despite treatment with three antihypertensive drugs including one diuretic, or mean systolic BP by ambulatory BP monitoring (ABPM) of 135-150 mm Hg. METHODS: We evaluated data from four relevant clinical studies, all conducted in Europe, comprising 185 eligible patients. The patients' age was 62.1 ± 10.3 years and 73% were male (RDN group n = 149, control group n = 36). RESULTS: A self-control comparison showed that RDN led to significantly reduced ABPM at the 6­month follow-up (systolic ABPM: 147.3 ± 13.4 mm Hg vs. 136.9 ± 15.5 mm Hg; diastolic ABPM: 81.1 ± 9.6 mm Hg vs. 76.2 ± 9.7 mm Hg; p < 0.001). RDN was associated with a greater improvement in ABPM as compared with that in the control group (∆systolic-ABPM: -10.4 ± 9.4 vs. -3.5 ± 9.6 mm Hg, p < 0.001; ∆diastolic-ABPM: -5 ± 5.8 vs. -2.1 ± 5.5 mm Hg; p = 0.005, respectively). The decrease of office BP in the RDN group was also statistically significant. RDN led to a reduced number of antihypertensive medications. No severe adverse events were found during follow-up. Regression analysis showed that the available baseline characteristics did not correlate with the ABPM improvement after RDN. CONCLUSION: RDN appears to be a safe and effective intervention for patients with mild-moderate resistant hypertension; however, randomized studies are warranted.

Autologous stimulation of human lymphocyte subpopulation.

The background stimulation universally seen when lymphocytes are cultured in vitro has been shown to be markedly lowered by reducing the proportion of B lymphocytes. B-rich fractions of lymphocytes had extremely high background stimulation. It is concluded that stimulation of T cells, probably by autologous B cells, provides the most probable explanation for the findings described.

Number of ablated spots in the course of renal sympathetic denervation in CKD patients with uncontrolled hypertension: EnligHTN vs. Standard irrigated cardiac ablation catheter.

BACKGROUND: Hypertension was both a mutual cause and the main concern of chronic kidney disease (CKD). Blood pressure control is more problematic in the company of CKD. This study compares the effects of renal sympathetic denervation (RSD) on 24-h ambulatory blood pressure measurements (ABPM) and renal function in individuals with CKD and uncontrolled hypertension by unlike a number of ablated spots using the EnligHTN catheter and the standard irrigated cardiac ablation catheter (SICAC), Flexability. METHODS: The 112 subjects were randomly divided into two groups according to the catheter that would be used in the procedure EnligHTN (n=56) or Flexability (n=56). Into each group, we created 5 subgroups according to the number of ablated spots: 4, 8, 12, 16 and 20. All of them were followed for exactly 6 months to assess all the parameters measured in this investigation. RESULTS: Comparing the Δ 24-h systolic ABPM according to the number of ablated spots 4 and 20 for EnligHTN vs. Flexability, respectively, the differences were: -3.6±0.9 vs. -6.3±1.4mmHg (P<0.0001), and -13.9±4.8 vs. -36.3±4.3mmHg (P<0.0001). The comparisons between Δ estimated glomerular filtration rate (eGFR) according to the number of ablated spots 4 and 20 for EnligHTN vs. Flexability, respectively, were: +2.7±4.0 vs. +6.0±8.4mL/min/1.73m2 (P=0.2287), and +11.9±6.0 vs. +21.4±8.7mL/min/1.73m2 (P=0.0222). CONCLUSION: The RSD reduced the mean 24-h ABPM in subjects with CKD and uncontrolled hypertension and improved the renal function in both groups. These effects were more marked and important in subgroups underwent a great number of ablated spots using the SICAC.

The nonselective cytotoxic cell (N cell).

When effector lymphocytes were reacted with cultured human tumors, the total cytotoxic reaction could be divided into selective and nonselective components. The nonselective part of the reaction was due to a cell type called N cells. Fractionation of effector suspension indicated that N cells were neither T nor B cells. Like B cells, N cells did not form rosettes with sheep erythrocytes; they were retained by columns coated with lg or antiserum to lg and died preferentially when stored at an ambient temperature. However, N cells were differentiated from B cells by their inability to form complement-receptor rosettes and by their survival when incubated at 30 degrees C. The effect of the nonselective cytotoxic cell must be differentiated from selective activity in studies of specificity for cell-mediated cytotoxicity.

Immunosuppressive activity of FTY720, sphingosine 1-phosphate receptor agonist: I. Prevention of allograft rejection in rats and dogs by FTY720 and FTY720-phosphate.

FTY720, a new class of immunomodulator, induces lymphopenia by sequestration of circulating lymphocytes into secondary lymphoid tissues. FTY720 at 0.1 to 1 mg/kg significantly prolonged the allograft survival in a dose-dependent manner and showed a marked synergistic effect in combination with cyclosporine (CsA) in rat skin and cardiac allograft models. In addition, the canine renal allograft survival was significantly prolonged by combination therapy with FTY720 at 0.03 to 1 mg/kg and CsA at 10 mg/kg as compared with monotherapy of FTY720 or CsA. By contrast, the combination therapy with CsA and azathioprine or CsA and mycophenolate mofetil resulted in only an additive effect in rat skin allograft. When FTY720 was administered to rats, FTY720 was metabolized by omega-oxidation of the octyl side chain, and beta-oxidation subsequently, or phosphorylated by sphingosine kinase. Omega- and beta-oxidized 4 metabolities of FTY720 at 10 mg/kg i.v. showed neither lymphopenia nor immunosuppressive activity in rat skin allograft. On the other hand, (S)-enantiomer of FTY720-phosphate at 0.1 and 1 mg/kg intravenously induced a marked lymphopenia and significantly prolonged the allograft survival in the rat allotransplantation. From these results, it is suggested the lymphopenia and the immunosuppression induced by FTY720 administration is due to the agonistic activity against SIP receptors of the active metabolite, (S)-FTY720-phosphate.

A case of MERRF associated with chronic pancreatitis.

We report the first case to our knowledge of chronic pancreatitis associated with mitochondrial encephalopathy with the A8344G mitochondrial DNA (mtDNA) mutation. This 10-year-old-girl had suffered from recurrent abdominal pain with elevated serum amylase and lipase since the age of 6, and easy fatigability, tremor and astatic seizures since the age of 8. A biopsy of quadriceps muscle revealed ragged-red-fibers and cytochrome c oxidase deficiency. Analysis of mtDNA in peripheral blood identified an A8344G mutation in the mitochondrial tRNA(Lys) gene. Taken together with physical signs of myoclonic seizures and cerebellar dysfunction, we diagnosed her as myoclonic epilepsy with ragged-red fibers associated with chronic pancreatitis. Although no association between mitochondrial disease and pancreatitis has yet been established, this case suggests it is necessary to consider the participation of mitochondrial abnormality in the pathogenesis of recurrent pancreatitis.

Potent immunosuppressants, 2-alkyl-2-aminopropane-1,3-diols.

Several immunosuppressants, ISP-I [(2S,3R,4R)-(E)-2-amino-3,4-dihydroxy-2-(hydroxymethyl)-14-oxoeicos++ +-6-enoic acid, myriocin = thermozymocidin] and mycestericins A-G, were isolated from culture broths of Isaria sinclairii and Mycelia sterilia, respectively. In order to investigate structure-activity relationships, extensive modifications of ISP-I were conducted, and it was established that the fundamental structure possessing the immunosuppressive activity is a symmetrical 2-alkyl-2-aminopropane-1,3-diol. The tetradecyl, pentadecyl, and hexadecyl derivatives prolonged rat skin allograft survival in the combination of LEW donor and F344 recipient and were more effective than cyclosporin A. Among them, 2-amino-2-tetradecylpropane-1,3-diol hydrochloride, ISP-I-55, showed the lowest toxicity. ISP-I-55 is a promising lead compound for the development of effective immunosuppressants for organ transplantations and for the treatment of autoimmune diseases.

Synthesis and immunosuppressive activity of 2-substituted 2-aminopropane-1,3-diols and 2-aminoethanols.

A series of 2-substituted 2-aminopropane-1,3-diols was synthesized and evaluated for their lymphocyte-decreasing effect and immunosuppressive effect on rat skin allograft. A phenyl ring was introduced into the alkyl chain of the lead compound 3, which is an immunosuppressive agent structurally simplified from myriocin (1, ISP-I) via compound 2. The potency of the various compounds was dependent upon the position of the phenyl ring within the alkyl side chain. The most suitable length between the quaternary carbon atom and the phenyl ring was two carbon atoms. 2-Substituted 2-aminoethanols were successively synthesized and evaluated for their T-cell-decreasing effect and immunosuppressive effect using a popliteal lymph node gain assay in rats. The absolute configuration at the quaternary carbon affected the activity, and the (pro-S)-hydroxymethyl group of compound 6 was essential for potent immunosuppressive activity. Favorable substituents for the (pro-R)-hydroxymethyl group of 6 were hydroxyalkyl (hydroxyethyl and hydroxypropyl) or lower alkyl (methyl and ethyl) groups. 2-Amino-2-[2-(4-octylphenyl)ethyl]propane-1,3-diol hydrochloride (6, FTY720) was found to possess considerable activity and is expected to be useful as an immunosuppressive drug for organ transplantation.

Molecular cloning, expression analysis and functional confirmation of two ecdysone receptor isoforms from the rice stem borer Chilo suppressalis.

PCR techniques were used to clone and identify cDNAs for ecdysone receptor A and B1 (EcR-A and EcR-B1) isoforms from the rice stem borer, Chilo suppressalis. They differ only in the N-terminal A/B regions and show high sequence identities to other insects' EcRs. At the wandering stage, EcR-B1 mRNA was expressed more abundantly in the midgut than in the epidermis and fat body, whereas expression levels of EcR-A mRNA were similar in the three tissues. In the epidermis of the last instar larvae, the maximal mRNA expression of both EcR-A and EcR-B1 was observed from the wandering to prepupal stages prior to the peak of ecdysteroid titer in the hemolymph. In gel mobility shift assays, in vitro translated C. suppressalis EcR-B1 (CsEcR-B1) and Bombyx mori ultraspiracle (BmUSP) proteins bound to the Pal 1 and Drosophila melanogaster hsp27 ecdysone response element as a heterodimer. These results indicate that the cDNAs isolated here encode functional ecdysone receptors.

cDNA cloning and characterization of Bombyx mori juvenile hormone esterase: an inducible gene by the imidazole insect growth regulator KK-42.

The insect growth regulator (IGR) imidazole KK-42 induces hemolymph juvenile hormone esterase activity and precocious metamorphosis in Bombyx mori. As an initial step to understand the molecular action of KK-42, we isolated a full-length of juvenile hormone esterase cDNA from B. mori (BmJHE). The deduced amino acid sequence of BmJHE showed high identity to JHEs of Heliothis virescens (54%) and Choristoneura fumiferana (52%). Recombinant BmJHE protein expressed in the baculovirus expression system hydrolyzed 3H-JH III and JH analog, HEPTAT, indicating that BmJHE cDNA encodes functional JH esterase. Northern blot analysis showed that the BmJHE transcript was present predominantly in the fat body at the beginning of the last larval instar. During this instar, BmJHE transcript increased gradually until day 7, then decreased, and increased again on day 10 in the fat body. This temporary expression pattern was similar to that of JHE enzyme activity in hemolymph. In contrast, in the 4th instar, the BmJHE transcript was present in the fat body even though hemolymph JHE activity was very low. Western blot analysis using anti-BmJHE antiserum showed BmJHE protein was present in hemolymph during the 5th instar but not during the 4th instar. These results indicate that BmJHE protein is secreted into hemolymph at the metamorphic stage. Hemolymph JHE activity was high in precociously metamorphosed 4th instar larvae (treated KK-42) but low in normal 4th and extra-molted 6th instar larvae (fed 20E). KK-42-treated larvae showed high expression level of BmJHE transcript in the fat body, suggesting that KK-42 enhances BmJHE gene expression in the fat body.

Immunochemical evidence for the occurrence of Mu class glutathione S-transferase in human fetal livers.

Immunoblot analysis showed that alpha-class glutathione S-transferase (GST), which is one of the major forms in adult human liver, was expressed in human fetal liver. Mu-class GST was also expressed in fetal liver. The majority of mu-class GST expressed in adult liver consisted of a subunit with a molecular weight of 27 kDa on sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE), whereas two subunits of 27 and 26 kDa were detected in fetal liver as proteins immunochemically related to mu-class GST. On reverse-phase HPLC, these two subunits cross-reactive with antibodies to rat GST 3-3 in fetal liver were indistinguishable from each other in their retention time; though, they could be separated by chromatofocusing analysis. The molecular weights of GSTs immunochemically related to rat GST 3-3, eluted at pH 7.1, 6.4, and 5.7, were 27, 27 and 26, and 26 kDa, respectively. In addition, the N-terminal amino acid sequence of these subunits suggested that GSTs related to rat GST 3-3 expressed in fetal liver may be homodimeric and heterodimeric proteins. As expected, pi-class GST was found to be a major form of GST in fetal liver but not in adult liver. In contrast, the GST immunochemically related to rat GST Yrs-Yrs, which is classified as theta-class GST, was detected in adult liver but not in fetal liver. These results indicate that several isoenzymes of GST are expressed in human fetal liver, but they are not the same as those in adult liver.

The relationship between the response to external light stimulation and behavioral states in the human fetus: how it differs from vibroacoustic stimulation.

OBJECTIVE: To determine the effects of external light stimulation on fetal behavioral states and know the difference from those of vibroacoustic stimulation. METHODS: A flashlight and a vibroacoustic stimulator was applied directly on the maternal abdomen to determine the response of 56 normal fetuses at 36-40 weeks gestation. Fetal heart rate (FHR) and body movements were recorded using an actocardiograph, and fetal eye movements were observed using real-time ultrasonography. Using Nijhuis's criteria, the fetal behavioral states (1F-4F) were determined. FHR acceleration was considered a fetal response to the stimulations. RESULTS: The lag time between stimulation and fetal response was within 4 s. A positive response rate to the light stimulation was higher at behavioral states 2F (82%) and 3F (83%) than at state 1F (4%). Light stimulation changed the behavioral state of two of the six 3F fetuses (33%) from 3F to 4F. No change of state was observed in fetuses that were in states 1F and 2F. For vibroacoustic stimulation, fetal response was 100% positive and changes of states were observed frequently irrespective of the behavioral state before the stimulation. CONCLUSION: Fetal response to light stimulation is closely connected to fetal behavioral states and may reflect some distinct stages of the sleep-wakefulness cycle.

Fungal metabolites. Part 14. Novel potent immunosuppressants, mycestericins, produced by Mycelia sterilia.

Mycestericins A, B, C, D and E were isolated from the culture broth of Mycelia sterilia ATCC 20349 along with thermozymocidin (= myriocin). Their structures were elucidated on the basis of spectroscopic studies and chemical evidence. The acetate of mycestericin C was identical with the acetate of 6,7-dihydromyriocin. Mycestericins suppressed the proliferation of lymphocytes in the mouse allogeneic mixed lymphocyte reaction, with a potency similar to that of myriocin.

Determination of absolute configuration and biological activity of new immunosuppressants, mycestericins D, E, F and G.

Mycestericins D, E, F and G were isolated from the culture broth of Mycelia sterilia ATCC 20349 as potent immunosuppressants. Mycestericins F and G were identical with dihydromycestericins D and E, respectively. Their absolute configurations were determined by use of the modified MOSHER'S method and by comparison of the CD spectra of their benzoate derivatives with those of synthetic analogs. Mycestericins D, E, F and G suppressed the proliferation of lymphocytes in the mouse allogeneic mixed lymphocyte reaction.

Hormonal control of a metamorphosis-specific transcriptional factor Broad-Complex in silkworm.

Insect metamorphosis is induced by the steroid 20-hydroxyecdysone (20E) in the absence of sesquiterpenoid juvenile hormone (JH). In Drosophila melanogaster, the Broad-Complex (BR-C) transcriptional factor plays critical roles during metamorphosis. We isolated cDNAs encoding BR-C in the silkworm Bombyx mori and examined their mRNA expression. cDNAs for three BR-C isoforms with zinc finger pairs (Z1, Z2 and Z4) and four isoforms lacking them were cloned. Their mRNAs were expressed in multiple tissues at the larval-pupal metamorphosis. In the anterior silk gland, BR-C mRNAs were expressed at the end of the last larval instar but not expressed during the penultimate instar. 20E administration induced BR-C mRNA expression and JH suppressed 20E-induced BR-C expression in this tissue both in vivo and in vitro. Thus, BR-C mRNAs are inducible by 20E only in the absence of JH, a finding that explains their metamorphosis-specific expression.

The different mobility of complementary strands depends on the proportion AC/GT.

The electrophoretic mobility of DNA fragments on denaturing polyacrylamide gel depends on various factors. One of these is the base composition of a single-stranded DNA (ssDNA). We confirmed that one strand and its complementary strand of polymerase chain reaction (PCR) products migrated with different mobilities in all alleles detected at 12 out of the 13 short tandem repeat (STR) loci studied. The mobility differences between complementary strands (MD) were also observed regardless of end-polishing with Pfu DNA polymerase. MD was therefore not influenced by additional nucleotides to each strand of the PCR products. We then analyzed the relation between MD and the base composition using one representative allele at each of the 13 loci. The results indicated that MD was affected by the adenine plus cytosine (AC) content in the ssDNA and was proportional to the values of the AC content divided by the guanine plus thymine (GT) content in the AC-rich strand (the proportion AC/GT). When the proportion AC/GT was well-balanced, MD decreased. The same tendency was observed even in the end-polished strands. In this study, the electrophoretic mobility of an ssDNA on denaturing polyacrylamide gels was shown to depend on the proportion AC/GT. Unless the same side of the PCR products is labelled in the context of a PCR-based STR typing, distinct alleles may be mistaken for identical ones because of the different mobility of complementary strands. Accordingly, the labelled strand should be described if only one strand of the PCR products is detected. When using an allelic ladder marker as a size standard, the labelled side should be unified between STR alleles and the allelic ladder alleles.

Regional differences in homicide patterns in five areas of Japan.

This article describes regional differences in the homicide patterns which occurred in Sapporo City and the surrounding area, and in Akita, Ibaraki, Chiba and Toyama prefectures in Japan. Information collected from each case of homicide included factors such as age, sex of the victim and assailant, causes of death, disposition of the offender, relationship between assailant and victim, reasons for criminal action, et al. The statistical features of homicidal episodes among the five different regions showed considerable variation, as follows. The mean death rates for homicide (number of victims per 100,000 of population) during the period 1986-1995 were 0.44 (Sapporo), 0.8 (Akita), 0.58 (Toyama), 0.7 (Ibaraki) and 0.75 (Chiba), respectively. Close family relationship between the victim and assailant was observed in the homicidal acts which occurred in Sapporo, Akita and Toyama. Assailant's relationship to victim was commonly extra-familial in Ibaraki and Chiba-neighboring megalopolis Tokyo, where some events of murder by a foreigner occurred. Homicide by female assailant, murder by mentally abnormal killers and homicide-suicide events were closely associated with family members. And these factors contributed to the considerable number of victims in Sapporo, Akita and Toyama. But, this close family relationship of the victim to the assailant did not correspond with the elevation in the number of deaths, and it was rather inversely related to the higher death rates recognized in Ibaraki and Chiba. This comparative study suggested that rapid urbanization considerably affects regional differences in homicide patterns.

Quality of life: a possible health index for the elderly.

To assess whether quality of life (QOL) could be employed as an outcome measure of health programs for elderly populations, we evaluated the relationship between subjective assessment of QOL ("morale scale") and objective constituents of active life such as activities of daily living (ADL), instrumental ADL (IADL) and work status along with determination of active life expectancy (ALE) in a rural district in Japan (n = 13,529). The QOL scale was positively correlated with ADL, IADL and work status but not with age. Validity and test-retest reliability were satisfactory as regards the small subsamples of respondents. ALE of the elderly aged 60 to 64 was 15.2 years, while their life expectancy was 27.1 years. Factors associated with lower ADL included age, lower IADL and joblessness. The QOL measurement and the objective variables can be incorporated into an assessment of the health status of the elderly in addition to conventional indices based on mortality.

[Basic studies on abdominal injuries. Part 1: Degree of depression of abdominal wall by compression].

The degree of depression of the abdominal surface by compression was measured in 121 healthy adult male having an average age of 20.4 years. Three disks of different sizes (10, 25, and 45 mm in diameter) were attached to the edge of the baresthesiometer, and pressures of 1, 3 and 5 kg were applied to the 10 mm disk, and 1, 3, 5, and 7 kg to the other disks. The regions tested were the medial abdomen approximately 2 cm above the umbilicus and the left and right flanks at the level of umbilicus. The higher the pressure administered, the greater the depression formed on each disk. Severe pain occurred in the nonanesthetized person, and it was difficult to increase the pressure to a higher level than 7 kg. At each pressure, the smallest disk produced larger depression than did the other two. The degree of depression was related to the total pressure administered rather than to the amount of pressure per unit area. The distribution of measured value was shown to be normal. After the largest depression for each region had been determined, a pressure of 7 kg was imposed on the 25-mm disk. On the medial abdomen, the anatomical position generated a mean depression of 6.3 cm, and the spine position a depression of 5.04 cm. On the flank, mean value of the depression was approximately 5.7 cm, and did not differ between the anatomical and supine positions and between the right and left flanks.(ABSTRACT TRUNCATED AT 250 WORDS)

Sequence variation found in the flanking region of a trimeric short tandem repeat at the PLA2 locus: its considerable effect on estimating alleles.

Amplified alleles at the PLA2 short tandem repeat locus were sequenced and analyzed using different combinations of the PCR primer. When changing one side of the primers from the previous design to our original one, additional alleles, which had been previously hidden, could be newly detected in two out of 60 DNA samples of unrelated Japanese individuals. The sequence data revealed both 'hidden alleles' to be accompanied by a 3-bp deletion in the 5'-flanking region of the trimeric short tandem repeat. The position of the deletion corresponded to the exact 3' end of the primer, which had been formerly used. In the present case, both of the base numbers, which constituted the core repeat unit and which were deleted in the 'hidden alleles', were equal. Therefore, it was impossible to distinguish an allele from that with not only an additional trimeric repeat but a 3-bp deletion without the sequence analysis. This result indicates that the estimated allele size does not always reflect the difference in the repeat number even if the alleles regularly differ in size by one repeat unit. Moreover, this study suggests the presence of apparent homozygotes, of which the fellow of the heterozygous alleles is hidden by an unsuccessful amplification due to the sequence variation.