Increased Natural Killer-Cell Activity is Associated with Infertile Women

PROBLEM: An increase in natural killer (NK)-cell activity has been observed in women with unexplained recurrent miscarriages. Because of the many similarities between infertility and early pregnancy loss patients, we investigated whether infertile women had raised NK-cell activity. METHOD OF STUDY: We tested 94 infertile women who, in spite of treatment, were unable to conceive for 6 or more months. NK-cell activity was measured by using a chromium-51 release cytotoxicity assay. with K562 human myeloid leukemia cells as targets. RESULTS: NK-cell activity of the infertile group (mean +/- SD; 40.2%+/-14.7) was significantly higher than the control group (31.5%+/-11.9, P < 0.0001). The increased NK-cell activity was not associated with age, infertile duration, depression scores, treated hyperprolactinemia, or treated endometriosis. CONCLUSIONS: In certain patients, elevated NK-cell activity may be considered an independent risk factor for infertility.     

乳腺癌HPV感染与临床病理学探讨

目的探讨乳腺癌及乳腺良性病变中人乳头状瘤病毒(HPV)感染的差异;HPV感染与乳腺癌病理类型的关系及对乳腺癌细胞形态产生的影响。方法在116例乳腺标本中,计进展期乳腺癌73例,乳腺良性病变43例。用显微镜观察浸润性导管癌细胞核异形性分级(nucleargrading,NG)、病毒感染相关的细胞内包涵体(inclusionbody)和“凹空细胞”(koilocytosis)样改变;以原位杂交法检测病变组织的HPVDNA。结果在73例乳腺癌中,29例(39.73%)HPV原位杂交检测呈阳性,43例乳腺良性病变中仅1例(2.33%)纤维腺瘤的部分上皮细胞呈HPV阳性。乳腺癌组HPV感染率明显高于乳腺良性病变组(P<0.001);HPV阳性病例集中在恶性程度较高的化生性癌和NG3、NG2组中(P<0.001)。73例乳腺癌中有21例(28.77%)可见癌细胞核内或核旁胞浆内包涵体,13例(17.81%)癌灶内见“凹空细胞”样改变。于有包涵体或“凹空细胞”样改变的乳腺癌病例,HPV阳性率分别超过70%和80%。结论部分乳腺癌及少数乳腺良性病变组织内存在HPV病毒感染。HPV阳性的乳腺癌恶性程度较高,临床上应密切随访。包涵体和“凹空细胞”样改变可在部分乳腺癌中出现,但出现率不高,然而原位杂交显示上述改变与HPV感染密切相关。     

Two-dimensional autoregressive analysis of carotid artery blood flow waveform in children with isolated atrial septal defect

BACKGROUND: The aim of the present study was to analyze the carotid artery blood flow waveform, using a two-dimensional autoregressive modeling approach and component analysis, and to determine the relation between cardiac contractility, peripheral and cerebral circulation and characteristic values of component activities of carotid artery blood flow waveform in patients with atrial septal defect (ASD), with or without congestive heart failure. METHODS AND RESULTS: We analyzed the carotid artery blood flow waveform of nine patients with ASD and 35 normal controls using a two-dimensional autoregressive modeling approach. The component of impulse response was divided into six groups according to the damping frequency: (i) group I, 0 Hz; (ii) group II, 1-5 Hz; (iii) group III, 5-8 Hz; (iv) group IV, 8-13 Hz; (v) group V, 13-17 Hz and (vi) group VI, > 17 Hz. The decrease of impulse response power-density in patients of groups I, II, III and IV and the prolongation of damping time for patients in groups I and II were particularly noticeable in two ASD patients, whose pulmonary to systemic blood flow ratio was more than 2.7 and whose left ventricular stroke volume was less than 33.1 mL/m2. The power-density of groups I and II varied with cardiac contractility and the power-density of groups III and IV varied with cerebral circulation. In contrast, the damping time of groups I and II changed with the reflection velocity from the position of arterial reflection against blood flow from left ventricle. CONCLUSIONS: These results may be influenced by the decrease in left ventricular stroke volume and velocity in arterial reflection.     

A RANDOMIZED COMPARATIVE STUDY OF THE BANDLOOP VERSUS THE STANDARD LOOP FOR TRANSURETHRAL RESECTION OF THE PROSTATE

PURPOSE: The Bandloop is a new electroresection loop that is broader than the standard loop and thickens from front to back. We compared the safety and efficacy of the Bandloop to the conventional loop electrode for transurethral prostatectomy. MATERIALS AND METHODS: A randomized prospective study was performed on 53 patients with lower urinary tract symptoms and estimated prostatic volume greater than 30 ml. on transrectal ultrasonography. The Bandloop was used in 25 cases (Bandloop group) and standard loop was used in 28 (standard group). Surgical outcomes, including International Prostate Symptom Score, resected prostatic weight, operative time, uroflowmetry, post-void residual urine, postoperative catheterization period, time to disappearance of macrohematuria, and serial changes of hemoglobin and urinalysis, between the 2 groups were compared. RESULTS: A total of 23 Bandloop and 28 standard loop cases were evaluable. There was no difference in preoperative estimated prostatic volume (mean 44.7 versus 47.8 ml.), resected prostatic weight (36.5 versus 29.4 gm.) or operative time (61 versus 60 minutes) between the 2 groups. The ratio of resected weight-to-estimated prostatic volume was significantly greater in the standard group (81.4% versus 61.9%). There was no difference in postoperative catheterization period (3.3 versus 3.4 days) or time to disappearance of macroscopic hematuria (5.0 versus 5.0 days). Postoperative changes in symptom score (-15.1 versus -15.9), maximum flow rate (11.8 versus 16.3 ml. per second at 12 weeks) and residual volume (-31.6 versus -48.6 ml. at 12 weeks) demonstrated no significant difference between the 2 groups. There was no difference in intraoperative and postoperative bleeding estimated by serial changes in serum hemoglobin and urinalysis after surgery. No patient had major complications or required transfusion. CONCLUSIONS: Transurethral prostatectomy using the Bandloop is as safe and effective in achieving subjective and objective improvements as standard transurethral prostatectomy. However, our randomized study indicates that the Bandloop offers no advantage compared to the standard loop electrode for transurethral prostatectomy.     

Role of megalin, a proximal tubular endocytic receptor, in the pathogenesis of diabetic and metabolic syndrome-related nephropathies: protein metabolic overload hypothesis

SUMMARY:   Megalin is an endocytic receptor on the apical membranes of proximal tubule cells (PTC) in the kidney, and is involved in the reabsorption and metabolism of various proteins that have been filtered by glomeruli. Patients with diabetes, especially type 2 diabetes, or metabolic syndrome are likely to have elevated serum levels of advanced glycation end products, liver-type fatty acid binding protein, angiotensin II, insulin and leptin, and renal metabolism of these proteins is potentially overloaded. Some of these proteins are themselves nephrotoxic, while others are carriers of nephrotoxic molecules. Megalin is involved in the proximal tubular uptake of these proteins. We hypothesize that megalin-mediated metabolic overload in PTC leads to compensatory cellular hypertrophy and sustained Na⁺ reabsorption, causing systemic hypertension and glomerular hyperfiltration via tubuloglomerular feedback, and named this as 'protein metabolic overload hypothesis'. Impaired metabolism of bioactive proteins such as angiotensin II and insulin in PTC may enhance hypertrophy of PTC and/or Na⁺ reabsorption. Sleep apnoea syndrome, a frequent complication of diabetes and metabolic syndrome, may cause renal hypoxia and result in relative overload of protein metabolism in the kidneys. The development of strategies to identify patients with diabetes or metabolic syndrome who are at high risk for renal metabolic overload would allow intensive treatment of these patients in an effort to prevent the development of nephropathy. Further studies on the intracellular molecular signalling associated with megalin-mediated metabolic pathways may lead to the development of novel strategies for the treatment of nephropathies related to diabetes and metabolic syndrome.     

Distribution of enzymes of nucleic acid metabolism in cow snout epidermis

Certain enzymes participating in the degradation of DNA have been measured in cow snout epidermis, liver, kidney and intestinal epithelium. High activities were found in epidermis compared to other tissues. The enzyme profile of the epidermis was investigated in relation to depth. Those enzymes directly concerned with DNA degradation occurred mainly in the upper (keratinizing) layer.     

Transcatheter Arterial Chemo-Embolization (TAC-E) for Patients with Locally Advanced Breast Cancer

Preoperative transcatheter arterial chemo-embolization (TAC-E)was used for 19 patients with locally advanced breast cancer,to eradicate the extensive loco-regional areas prior to surgeryand hopefully to reduce the postoperative recurrence rate. Theresults were as follows: (1) Each primary tumor showed markedregression within 2 weeks after TAC-E. (2) Surgicopathologyconfirmed the excellent efficacy of TAC-E against both primarytumors and metastatic lymph node tumors. (3) Side effects dueto this treatment were few, compared with other forms of cancerchemotherapy. (4) The prognosis of each patient was good. We conclude that preoperative TAC-E has a great potential forthe treatment of locally advanced breast cancer.     

Macrofollicular variant of papillary thyroid carcinoma

A rare case of a macrofollicular variant of papillary thyroid carcinoma occurring in an 18-years-old male is described. The extirpated tumor, 5.5 × 5.5 × 3.5 cm In size, was well demarcated and multinodular, and histopathologically showed a predominantly macrofolllcular structure reminiscent of adenomatous goiter or macrofollicular adenoma. In the tumor tissue, however, there were several small foci of microfollicular or paplllary structure with the nuclei charae teristic of papillary carcinoma. Parts of the macrofollicular areas also showed similar nuclear characteristics with a transition to microfollicular or papillary areas. Incomplete capsular invasion and minimal vascular invasion were also present. Additional resected specimens contained small metastatic nodules in the residual left lobe and lymph nodes. Immunohistochemistry showed a small number of p53-positive tumor cells in the microfollicular or papillary areas. It is suggested that this tumor is a well-differentiated variant which should be distinguished from benign thyroid lesions, although there have been some cases of metastases which appear related to capsular and/or vascular invasion.     

Irradiated fetal thymus transplantation in a patient with combined immunodeficiency with predominant T cell defect

A 6 month old boy was diagnosed as a case of combined immunodeficiency (with predominant T cell defect by previous classification). His T cell count was decreased, his B cell count in peripheral blood was increased, his serum IgG level was decreased, his serum IgM level was normal and the thymus was not evident on CT scans and magnetic resonance imaging. Administration of the thymus hormone, thymosin, led to a partial recovery of T cell function without normalization of the T cell count. At age 26 months the patient received an irradiated thymus transplantation from a 16 week old female fetus. After the transplantation, the T cell count (mainly CD4⁺ cells) increased by 50–70%. A mild graft-versus-host reaction (GVHR) occurred and several immunosuppressants were prescribed. Chromosome analysis showed that the T cells have both 46 XY and 46 XX karyotypes while the B cells have the 46 XY karyotype alone. His cellular immunity (skin tests, DNA synthesis, mixed lymphocyte reaction, cytotoxic activity and natural killer cell function) and his serum IgG level remained low. However, being on regular r-globulin therapy and oral anti-fungal drugs, he is now living normally with almost no trouble at age 6 years and 3 months. This case showed that irradiated thymus transplantation might be a useful method when an adequate donor for bone marrow transplantation is not available. The unexpected observation that the increased T cells were mainly CD4 may be related to the mild GVHR and the clinical improvement.     

Re-treatment regimens for acute stage of Kawasaki disease patients who failed to respond to initial intravenous immunoglobulin therapy: Analysis from the 17th nationwide survey

BACKGROUND: Current regimens for re-treatment of patients with Kawasaki disease who failed to respond to the initial intravenous immunoglobulin (IVIG) therapy are still uncertain. The purpose of this study is to reveal what regimens were used as the initial therapy and re-treatment for acute stage of Kawasaki disease in the current Japanese medical setting. METHODS: The 17th nationwide survey on Kawasaki disease covered patients whose onset was in 2001 and 2002. In questionnaires sent to all hospitals with a bed capacity of 100 or more and a pediatric department, several questions related to therapeutic regimens for Kawasaki disease were posed. The authors observed the proportions of hospitals that had regimens for patients who failed to respond to the initial therapy. RESULTS: Among those hospitals that responded to the survey, 1052 (64.1%) reported that at least one patient with Kawasaki disease visited the hospital. Among these 1052 hospitals, 73.3% had a regimen to administer 30-39 mg/kg per day of oral aspirin with initial IVIG. The proportion of hospitals that used 1 g/kg per day of IVIG for 2 days was the largest among the options for the initial treatment. For those patients who fail to respond to the initial therapy, 464 hospitals (44.1%) reported that their pediatricians would use additional IVIG only. The number of hospitals that planned to administer high-dose IVIG and ulinastatin was 185 (17.6%). The number of hospitals having regimens of additional IVIG and steroids was 54 (5.1%). CONCLUSIONS: The current status of the treatment for patients with Kawasaki disease not responding to the initial IVIG therapy in Japan was revealed. A randomized trial of a large sample is needed to ascertain the effectiveness of several options for re-treating Kawasaki disease.