Thrombolysis in acute ischemic stroke. Intra-arterial and intra-venous.

Objectives for Presentation: 1. Review thrombolytic trials in acute ischemic stroke. 2. Discuss current recommendations for acute ischemic stroke therapy. 3. Discuss the role of intra-arterial thrombolysis in acute ischemic stroke. 4. Discuss the newest thrombolytic trials and recommendations for therapy in acute stroke prevention and management.

Ovarian malignant mixed mesodermal tumor producing the free form of the beta-subunit of human chorionic gonadotropin.

We report a patient with ovarian malignant mixed mesodermal tumor (MMMT) that produced immunoreactive human chorionic gonadotropin beta-subunit (IR-hCG beta). Qualitative analysis indicated that IR-hCG beta in the patient's serum represented the free form of the beta-subunit of hCG. Immunohistochemical localization of hCG beta in MMMT was observed in the sarcomatous stroma, but not in the adenocarcinoma component. Reverse transcription-polymerase chain reaction (RT-PCR) for hCG subunits revealed that the mRNA transcripts of two of six hCG beta genes (beta-1 and -2) were predominantly expressed in the tumor tissue. The serum level of free hCG beta correlated with disease status and was helpful for monitoring the response to therapy for MMMT in this patient.

Developmental changes in Cl(-)-ATPase activity in rat brains.

Developmental changes in brain Cl(-)-ATPase activity were examined using fetal, neonatal and adult rats. The Cl(-)-ATPase activity rapidly increased over 20 postnatal days to a level four-fold higher than that in an 18-day-old fetus. On Western blot analysis using an anti-Cl(-)-ATPase/pump 51 kDa subunit (ClP51) antibody, the amount of ClP51 protein increased in parallel with Cl(-)-ATPase activity. Immunohistochemistry using the same antibody showed Cl(-)-ATPase-like immunoreactivity on the cell membranes of neurons such as cerebral and hippocampal pyramidal cells and cerebellar Purkinje cells, where the immunoreactivity increased with developmental changes in the size and shape of the neurons. These findings suggest that neuronal Cl(-)-ATPase activity markedly increases during early postnatal development with an increase in the amount of Cl(-)-ATPase protein, which may support the formation of inwardly directed neuronal Cl(-) gradients.

Immunohistochemical demonstration of Cl- pump in type A intercalated cells of rat kidney.

In order to demonstrate the localization of an ethacrynic acid-sensitive Cl- pump in the rat kidney, immunohistochemical analysis was performed using an anti-Cl- pump antibody raised against rat brain Cl- pump protein with confocal laser scanning microscopy. The antibodies against Na+,K+-ATPase, aquaporin 2 and a type B intercalated cell marker, 43-kDa protein, were also used for comparison. Anti-Cl- pump antibody recognized a 51-kDa renal protein of the same size as that in the brain on Western blots. Cl- -pump-like immunoreactivity was observed on the basolateral membranes of 42+/-3% of cortical collecting duct (CCD) cells and of 38+/-1% of outer medullar collecting duct (OMCD) cells. Such immunoreactivity in CCD was sometimes co-localized with Na+,K+-ATPase, but in OMCD, the Cl- pump-like immunoreactivity co-existed with neither Na+,K+-ATPase, aquaporin 2 nor the type B intercalated cell marker 43-kDa protein. Thus, the Cl- pump was demonstrated to be localized on the basolateral membranes of type A intercalated cells of cortical and medullary collecting ducts in the rat kidney.

Development of a cell-free binding assay for rat ICAM-1/LFA-1 interactions using a novel anti-rat LFA-1 monoclonal antibody and comparison with a cell-based assay.

The importance of the interaction between lymphocyte function-associated antigen-1 (LFA-1) and intercellular adhesion molecule-1 (ICAM-1) in the progression of inflammatory responses in vivo has been demonstrated mainly in rats. The present study was undertaken to develop binding assays suitable for measuring the rat ICAM-1/LFA-1 interaction in vitro. We first examined binding of rat T lymphoma FTL43 cells, which express LFA-1, to immobilized rat ICAM-1. Although FTL43 cells bound avidly to immobilized ICAM-1 and the binding was abolished with anti-LFA-1 monoclonal antibodies (mAbs), the binding was not completely inhibited by most anti-ICAM-1 mAbs. We next purified rat LFA-1 from FTL43 cells and constructed a cell-free binding assay. By using a newly developed anti-rat LFA-1 mAb RL14/9, which does not inhibit ICAM-1/LFA-1 interactions, binding of purified rat LFA-1 to immobilized ICAM-1 was successfully detected, whereas only a low signal to noise ratio was observed when binding of ICAM-1 to immobilized LFA-1 was examined. Moreover, we found that simultaneous addition of purified LFA-1 and biotinylated RL14/9 to ICAM-1-coated wells resulted in more sensitive detection of rat ICAM-1/LFA-1 binding. The binding was completely blocked with both anti-LFA-1 and anti-ICAM-1 mAbs and was much more sensitive to inhibition by the ICAM-1-IgG chimera, as compared with the cell-based assay. These results indicate that the cell-free binding assay provides a rapid and sensitive method for screening rat ICAM-1/LFA-1 antagonists, whose therapeutic effect on inflammatory diseases can further be evaluated in vivo.

Inhibition of human immunodeficiency virus type 1 replication and cytokine production by fluoroquinoline derivatives.

We have recently identified 8-difluoromethoxy-1-ethyl-6-fluoro-1, 4-dihydro-7-[4-(2-methoxyphenyl)-1-piperazinyl]-4-oxoquinoline-3-carb oxylic acid (K-12) as a potent and selective inhibitor of human immunodeficiency virus type 1 (HIV-1) transcription. In the search for more effective derivatives and their mode of action, we have found 7-(3,4-dehydro-4-phenyl-1-piperidinyl)-1, 4-dihydro-6-fluoro-1-methyl-8-trifluoromethyl-4-oxoquinoline-3- carboxylic acid (K-37) and 8-difluoromethoxy-1,4-dihydro-6-fluoro-7-(3, 4-dehydro-4-phenyl-1-piperidinyl)1-[4,(1,2, 4-triazol-1-yl)methylphenyl]-4-oxoquinoline-3-carboxylic acid (K-38) to be more potent inhibitors of HIV-1 replication than K-12. The EC50 values of K-37 and K-38 for HIV-1IIIB were 27 and 3.8 nM in peripheral blood mononuclear cells, respectively. These values were approximately 3- and 24-fold lower than the EC50 of K-12. K-38 was also a more potent inhibitor of HIV-1 replication in chronically infected cells, such as tumor necrosis factor alpha-stimulated OM-10. 1 cells. K-37 and K-38 proved to be more cytotoxic than K-12 for a variety of cell lines as well as peripheral blood mononuclear cells. These compounds were more inhibitory of Tat-induced HIV-1 long terminal repeat-driven gene expression than K-12, which suggests that their mechanism of action is attributable in part to the inhibition of Tat function. Interestingly, K-37 and K-38 could suppress the production of tumor necrosis factor alpha and interleukin 6 in phytohemagglutinin-stimulated peripheral blood mononuclear cells and the expression of intercellular adhesion molecule 1 in tumor necrosis factor alpha-stimulated human umbilical vein endothelial cells at their nontoxic concentrations. In contrast, another K-12 derivative, 1, 4-dihydro-8-dimethylaminomethyl-6-fluoro-7-[4-(2-methoxyphenyl)-1-pip eradinyl]-1-methyl-4-oxoquinoline-3-carboxylic acid (K-42), had anti-HIV-1 activity and cytotoxicity profiles similar to those of K-12, but K-42 scarcely inhibited the cytokine production and intercellular adhesion molecule 1 expression.

Antiserum against Cl- pump complex recognizes 51 kDa protein, a possible catalytic unit in the rat brain.

We purified Cl- pump in the rat brain and obtained 520 or 580 kDa protein complexes which consisted of 62, 60, 55 and 51 kDa proteins. An antiserum against 520 kDa protein complex recognized 51 kDa protein in both 520 and 580 kDa complexes, and reduced both Cl(-)-ATPase and Cl(-) pump activities. Such an immunoreactive 51 kDa protein was found in the brain, spinal cord and kidney. When incubated with [gamma-(32)P]ATP, the protein complex yielded phosphorylated 51 kDa protein, the label being hydroxylamine-sensitive and increased in the presence of Cl- and/or an inhibitor of Cl- pump, ethacrynic acid. Thus, the antibody appears to recognize a possible catalytic subunit of Cl- pump, 51 kDa protein, in the rat.

CI-ATPase and Na+/K(+)-ATPase activities in Alzheimer's disease brains.

The enzyme activities and the protein levels of Cl(-)-ATPase and Na+/K(+)-ATPase were examined in Alzheimer's disease (AD) brains. Cl(-)-ATPase and Na+/K(+)-ATPase activities in AD brains (n = 13) were significantly lower than those in age-matched control brains (n = 12). In contrast, there was no significant difference in anion-insensitive Mg2(+)-ATPase activity between the two groups. Western blot analysis revealed that the protein levels of Cl(-)-ATPase, Na+/K(+)-ATPase and neuron specific Na+/K(+)-ATPase alpha3 isoform were also significantly reduced in AD brains, while the amount of protein disulfide isomerase, one of the house keeping membrane proteins, was not different between the two groups. The data first demonstrated that Cl(-)-ATPase and Na+/K(+)-ATPase are selectively impaired in AD brains, which may reduce the gradients of Na(+), K(+) and Cl(-) across the cell membranes to cause excitotoxic cellular response and the resulting neuronal death.

Constitutive expression of ICAM-1 in rat microvascular systems analyzed by laser confocal microscopy.

The present study aimed to demonstrate constitutive expression of the intercellular adhesion molecule (ICAM)-1 among arterioles, capillaries, and venules in the mesentery and liver and to examine the interaction between cultured endothelial cells and leukocytes in rats. ICAM-1 expression in the microvessels in vivo was visually demonstrated by laser confocal fluorescence microscopy. A monoclonal antibody against rat ICAM-1 (1A29) was labeled with fluorescein isothiocyanate, and the binding ratio between the fluorescence and immunoglobulin was determined for data calibration. Intravascularly administered fluorescein isothiocyanate-labeled 1A29 was distributed heterogeneously among the hierarchy of microvessels in the mesentery: postcapillary venules were the major portion expressing ICAM-1 constitutively, and the density of 1A29 bound to their endothelium was at least 10 times higher than that in true capillaries and arterioles in the same mesentery. On the other hand, the liver expressed ICAM-1 abundantly in sinusoids to the extent similar to that in central venules. These results suggest that postcapillary venules serve as an active gateway with the readiness to help adhere circulating leukocytes exposed to proinflammatory stimuli in acute inflammation.

Staphylococcus aureus in the anterior nares and subungual spaces of the hands in atopic dermatitis.

We examined the prevalence of Staphylococcus aureus in the anterior nares and the subungual spaces of the hands of patients with atopic dermatitis to determine whether the presence of S. aureus at these sites may contribute to the aggravation of the dermatitic skin lesions. The prevalence of S. aureus in the anterior nares of patients with atopic dermatitis was over five times higher than that in the anterior nares of patients with other skin diseases or in healthy adult controls, and the prevalence of S. aureus in the subungual spaces was 10 times higher in patients with atopic dermatitis than in those with other skin diseases or in controls. Both the anterior nares and the subungual spaces of the hands are important reservoirs of S. aureus in atopic dermatitis. The phage type of S. aureus strains isolated from the anterior nares is similar to that of the strains isolated from the subungual spaces.

Scrape cytology of pemphigus vulgaris of the nipple, a mimicker of Paget's disease.

A case of histologically and immunocytochemically confirmed pemphigus vulgaris of the nipple examined by scrape cytology is reported. The scrape cytology showed isolated and somewhat loosely clustered cells with basophilic cytoplasm and vesicular hyperchromatic nuclei dysplaying prominent nucleoli, suggesting Paget's disease of the nipple. However, histological examination of the resected tissue together with the direct immunofluorescence technique for demonstration of in vivo-bound immunoglobulin to epithelium confirmed the diagnosis of pemphigus vulgaris. The use of an immunoperoxidase stain for IgG on the Papaniolaou-destained smear also gave a positive reaction on the cell membranes and provided a precise cellular diagnosis of the lesions. Cytodiagnostic pitfalls of these rare breast lesions are discussed, as well as the diagnostic value of immunocytochemistry.

Intra-arterial administration of the angiogenesis inhibitor TNP-470 blocks liver metastasis in a rabbit model.

We evaluated the best route of administration of TNP-470, an angiogenesis inhibitor, by comparing the anti-tumour effects and toxicity following injection via the hepatic artery, the portal vein, or the jugular vein in a rabbit model of liver metastases. Following the injections of 1 x 10(6) VX2 carcinoma cells into the portal vein of rabbits, 50 mg of TNP-470 was injected continuously into the hepatic artery, portal vein, or jugular vein for 7 days. The number of tumours on the surface of the liver was counted 14 days following the start of the infusion, and the serum glutamic-oxaloacetic transamine (GOT), glutamic-pyruvic transaminase (GPT) and total bilirubin concentrations were examined. In addition, a coloured silicon rubber was injected into the vessels of the liver to visualise the capillary networks around the tumours and assess the degree of suppression of angiogenesis by TNP-470. The mean number of tumours following intra-arterial injection (17.5 +/- 2.9) was significantly less than the control (237.0 +/- 34.0) (P < 0.05). The mean numbers of the tumours following intraportal (89.1 +/- 16.0) and intravenous (140.6 +/- 31.2) injection were both less than the controls (215.3 +/- 45.5, 284.8 +/- 55.4 respectively), but the differences were not significant. We conclude that intra-arterial injection of TNP-470 is the most effective method for preventing liver metastases in this model.

Combination assay of urinary beta-core fragment of human chorionic gonadotropin with serum tumor markers in gynecologic cancers.

Ectopic production of the immunoreactive beta-subunit of human chorionic gonadotropin (IR-hCG beta) by gynecologic malignancies has been well recognized, but IR-hCG beta has not yet been established as a clinically useful tumor marker, except for germ cell tumors. We measured the concentrations of IR-hCG beta-related molecules, intact hCG, free hCG beta, and beta-CF, in the sera and urine of patients with various gynecologic cancers (cervical, endometrial, and ovarian cancers) to assess their clinical usefulness as a tumor marker in comparison with serum tumor markers such as CEA, SCC, CA125, and CA19-9. The highest incidence of IR-hCG beta was obtained in the assay for beta-CF in the urine, with positive rates of 47.7% (94 of 197) for cervical, 37.8% (14 of 37) for endometrial, and 84.4% (38 of 45) for ovarian cancers with a cut-off value of 0.2 ng/mg of creatinine. In cervical cancer, there was no significant correlation between the concentrations of urinary beta-CF and serum SCC, and 57.9% (114 of 197) of the patients were detected by the combination assay of these tumor markers. Serial determination in 22 cervical cancer patients with elevated urinary beta-CF level prior to therapy showed that its level decreased after successful treatment, but 4 of 5 patients with persistent or recurrent disease had elevated levels of urinary beta-CF. All of the ovarian cancer patients examined were detected by the combination assay of urinary beta-CF and serum CA125. The levels of urinary beta-CF showed little correlation with those of the serum tumor markers, indicating the usefulness of the combination assay of urinary beta-CF with serum tumor markers for detecting cervical and ovarian cancers.

Staphylococcus aureus isolated from nostril anteriors and subungual spaces of the hand: comparative study of medical staff, patients, and normal controls.

An epidemiologic investigation of methicillin-resistant Staphylococcus aureus (MRSA) and Staphylococcus aureus (S. aureus) colonization was conducted at Kansai Medical University Hospital between 1990 and 1991. The incidence of nasal and subungual positivity for S. aureus was examined in a total of 156 subjects including inpatients, physicians, and nurses at a ward for dermatology, plastic surgery, and emergency patients, outpatients with atopic dermatitis and other skin diseases, and normal controls. Inpatients were most heavily colonized with MRSA (40.8%), but S. aureus colonization was most frequent in outpatients with atopic dermatitis (95.5%). Not only nostrils, which have been much discussed as a reservoir of S. aureus, but also subungual spaces seemed to be havens of S. aureus. Twelve out of 22 atopic dermatitis patients were positive for S. aureus on skin regions, and coagulase and phage testing showed a correlation between the nasal and skin-colonizing S. aureus. Coagulase type II and phase type NT (not typable) were the predominant types of S. aureus, including MRSA.

[Inhibition of liver metastases in rabbits by arterial infusion of angiogenesis inhibitor, TNP-470].

We examined the prevention of liver metastases by arterial infusion of the angiogenesis inhibitor, TNP-470, in Japanese White Rabbits; 1.0 x 10(6) of VX2 carcinoma cells were injected into the mesenteric vein for tumor inoculation. Then the rabbits were divided into the following two groups. Group 1: 2 ml of distilled water was continuously injected into the common hepatic artery of control for 7 days. Group 2: 50 mg of TNP-470 solved in 2 ml of distilled water was continuously administered into the common hepatic artery for 7 days. On day 14, the number of metastases on each liver surface was counted. The mean number of metastases were 237.0 +/- 133.26 and 24.4 +/- 15.05 in Group 1 and 2, respectively. There was a significant difference between the two groups (p < 0.05). We found no side effects of TNP-470 such as body weight loss or liver disfunction. Microphil was injected into the common hepatic artery to observe the neovasculature. The proliferation of tumor vessels was suppressed in Group 2. We considered that arterial infusion of TNP-470 is effective to prevent liver metastases, because the blood supply to liver metastases is well developed from the hepatic artery, and TNP-470 is directly effective on the endothelium itself, and inhibits neovascularization.

[Recurrence and survival rate of advanced gastric cancer after preoperative EAP-II intra-arterial infusion therapy].

Ninety-eight patients with advanced gastric cancers underwent gastrectomy from Jan. 1989 to Dec. 1991. For these patients, preoperative intra-arterial injection therapy using EAP-II (etoposide 100 mg, epirubicin 20 mg, carboplatin 100 mg) was given to 24 patients. In this report, the recurrence and survival rate of these patients were investigated. After curative resection, the survival rate of patients with EAP-II 36 months after operation was 76.9%, while that of patients without EAP-II was 78.6%. There were no significant differences between these two groups. Two peritoneal carcinomatoses and two liver metastases were seen in patients with EAP-II (recurrence rate, 30.7%). Eight recurrences were observed in patients without preoperative injection therapy (peritoneal dissemination, 4; local recurrence, 3; lymph node recurrence, 1). Previously, we reported that drugs were remarkably accumulated in gastric cancer tissue and regional lymph nodes after EAP-II intra-arterial injection therapy. This high accumulation might cause no local or lymph node recurrence was seen in patient with EAP-II. Thus, it was concluded that preoperative EAP-II intra-arterial injection may prevent local and lymph node recurrences, and that further study of the combination and dose of anti-cancer drug needed to improve the postoperative survival rate in advanced gastric cancer patients.

An epidemiological study of methicillin-resistant Staphylococcus aureus (MRSA) isolated from medical staff, inpatients, and hospital environment in one ward at our hospital.

Methicillin-resistant Staphylococcus aureus (MRSA) is one of the most important causative microorganisms for nosocomial infections. Recently, the incidence of isolation of MRSA has been increasing every year in Japan and is, notably, much more frequently found in inpatients than in outpatients. Therefore, we have done epidemiological studies of MRSA isolated from medical staff, inpatients, and the hospital environment in one ward of our hospital. Thereafter, we examined the antibiotic susceptibility (ABPC, DMPPC, CET, CMZ, IPM, GM, MINO, OFLX, EM, CLDM, VCM), phage typing, and coagulase typing of these MRSA. MRSA were isolated more frequently from anterior nares of inpatients than from doctors and nurses. MRSA were isolated more frequently from the environment near carriers of MRSA. Coagulase type II and phage type N.T. (not typable) were the dominant types of MRSA in our hospital (69% and 61%). MRSA strains were resistant to most antibiotics with a few exceptions (VCM, IPM, CMZ, CET). The high isolation frequency of MRSA in our hospital seems to suggest that inpatients who are carrying MRSA spread MRSA throughout the hospital environment and that the anterior nares of inpatients are the major MRSA harbor.

[An epidemiological study of methicillin-resistant Staphylococcus aureus (MRSA) isolated from medical staffs, inpatients and hospital environments at our hospital].

Methicillin-resistant Staphylococcus aureus (MRSA) is one of the most important microorganisms which is causative of the nosocomial infections. Recently the incidence of isolation of MRSA is increasing from year to year in Japan. Especially MRSA isolated from inpatients are much higher than from outpatients. Therefore we have done epidemiological studies about MRSA isolated from medical staffs, inpatients and hospital environments in our hospital. Thereafter we examined phage typing and coagulase typing of those MRSA. MRSA were isolated more frequently from anterior nares of inpatients in compare with doctors and nurses. MRSA were isolated more frequently from the environments of MRSA carriers. Coagulase type II and phage type N.T. (not typable) were dominant type of MRSA in our hospital (69% and 61%). Our studies have revealed that the isolation frequency of MRSA is very high in our hospital. It seems to suggest that inpatients who are carrying MRSA are spreading MRSA out hospital environments and medical staffs.

[A study on work and daily life factors affecting the health of taxi drivers].

In order to elucidate factors affecting taxi drivers health, a questionnaire survey was performed on 5523 taxi drivers and health examinations were conducted on 311 taxi drivers from among them. Analysis by a method of multivariate analysis called Quantification II was performed with dependent variables being blood pressure, the number of subjective symptoms and fatigue on rising, and independent variables being work and daily life conditions. The major results of this survey were as follows: 1) A tendency for hypertension risk to increase with degree of obesity, and both employment as a taxi driver for 1-4 years and over twenty years of taxi driving were positively associated with increase in risk for hypertension. 2) Common factors to all types of work shifts which were related to an increase in the number of subjective symptoms were irregularity of meals, insufficient rest on off days, large number of years engagement at taxi driving, frequent frightening experiences while driving and comparatively short driving distance in one shift. 3) Common factors to all types of work shifts that were connected with fatigue at the time of rising were insufficient rest on off days and long years engagement in taxi driving.

ICAM-1-dependent pathway is critically involved in the pathogenesis of adjuvant arthritis in rats.

Intercellular adhesion molecule 1 (ICAM-1) plays important roles in immune responses. In order to examine whether ICAM-1 is involved in pathogenesis of adjuvant arthritis (AA), we investigated the effect of anti-ICAM-1 mAb, 1A29, on AA in rats. In vivo administration of 1A29 exerted a very strong suppressive effect on the development of arthritis and induced a marked reduction of inflammatory parameters. 1A29 suppressed the Ag-specific proliferative response of lymph node cells from AA rats, suggesting that the mAb blocked the Ag recognition phase. The study using adoptive transfer of AA revealed that 1A29 completely inhibited production of arthritogenic lymphocytes in donors and partially suppressed progression of arthritis in recipients caused by these lymphocytes. These findings indicated that the inhibitory effect of 1A29 on development of arthritis was at least twofold, i.e., 1) interference with cell-cell interaction between APC and T cells, which resulted in abrogation of effector cell generation; and 2) blocking of effector cell migration to inflammatory lesions. These results indicated that ICAM-1-dependent pathway is critically involved in the pathogenesis of AA. The data support the concept that ICAM-1-dependent pathways are important in chronic inflammatory disease.