The speed of population aging in South Korea is projected as the fastest in the world, and a long-term care insurance law has been just enacted. Therefore, it is important to estimate the number of the disabled community-dwelling elderly in South Korea. The Frenchay Activities Index (FAI) is a scale to measure higher level of physical function or activities that are necessary for independence in the community, i.e., instrumental activities of daily living (IADL). The FAI has undergone the most intensive evaluation, but there are only a few studies to establish its validity and reliability for community-dwelling elderly. In addition, a Korean version of the FAI has not been developed yet. The purpose of this study was to develop a Korean version of the FAI and analyze the related factors with IADL, using data from 770 community-dwelling elderly people in Deajeon, Korea. In the results, the reliability was acceptable (Cronbach's α coefficient = 0.796). The content and discriminative validity were found to be satisfactory. In the results of the factor analysis, a reasonable four-component solution (domestic chores, outdoor work, leisure and hobby) was found. The related factors to IADL were age, gender, education level, and living conditions. The present findings suggest that the Korean version of the FAI would be useful as a measure of IADL and the results of the factor analysis might reflect socio-cultural differences, such as illiteracy, low socioeconomic level, and sex roles of the Korean elderly.
There are no data regarding changes in plasma brain natriuretic peptide (BNP) levels in patients with Fabry's diseases during enzyme replacement therapy (ERT). We describe a patient with Fabry's disease who demonstrated the improvement in plasma brain BNP levels in response to ERT. Fabry's disease is an X-linked lysosomal storage disorder caused by a deficiency of the enzyme α-galactosidase A, which results in progressive intracellular accumulation of globotriaosylceramide (Gb3) in various organs including the heart. Cardiac involvement is frequent in Fabry's disease, resulting in cardiac dysfunction due to hypertrophic changes of the myocardium and thickening of the valves. Although ERT has been reported to improve cardiac function, no consensus has been reached regarding the effectiveness of ERT in female patients with heterozygous Fabry's disease. We report a 44-year-old woman having heterozygous Fabry's disease, who showed mitral valve thickening and regurgitation on echocardiogram. ERT was performed by intravenous infusion of recombinant α-galactosidase A every 2 weeks. We assessed the influences of ERT on cardiac function by measuring echocardiograhic parameters and monitoring BNP levels, which show treatment-induced drop in patients with heart failure. Although her cardiac function and mitral regurgitation assessed by echocardiography had not improved 18 months after the beginning of ERT, the plasma BNP level, which was 91.5 pg/ml before ERT, fell to 18.9 pg/ml. In conclusion, plasma BNP levels may be useful for evaluating the effectiveness of ERT for heterozygous Fabry's disease, even in patients who demonstrate no improvement in echocardiographic parameters of cardiac structure and function.
Innate immunity plays important roles in host defense against pathogens, but may also contribute to the development of autoimmune diseases under certain conditions. Toll-like receptors (TLRs) recognize various pathogens and induce innate immunity. We herein present a mouse model for chronic pancreatitis, which was induced by TLR3 signaling that generated the Fas/Fas ligand (FasL)-mediated cytotoxicity. An analogue of viral double-stranded RNA, polyinosinic:polycytidylic acid (poly I:C), which is recognized by TLR3, was injected into autoimmune-prone strains: MRL/Mp mice (MRL/+), MRL/Mp mice with a deficit of Fas (MRL/lpr) and MRL/Mp mice with a deficit of functional FasL (MRL/gld). The pancreatitis in MRL/+ mice was initiated by the destruction of pancreatic ductules, and its severity was significantly higher than that in MRL/lpr mice or MRL/gld mice. Using a pancreatic duct epithelial cell line MRL/S-1 newly established from the MRL/gld mouse that lacks FasL, we showed that treatment with poly I:C significantly induced the expression of Fas on the cultured cells. MRL/S-1 cells were destructed when co-cultured with splenocytes bearing intact FasL prepared from MRL/+ or MRL/lpr mice, but the magnitude of cytotoxicity was smaller with splenocytes of MRL/gld mice. Likewise, synthetic FasL protein showed cytotoxicity on MRL/S-1 cells. Furthermore, MRL/S-1 cells expressed higher levels of chemokines after the treatment with poly I:C, suggesting that the poly I:C-mediated induction of chemokines may be responsible for recruitment of lymphoid cells to the pancreatic periductular regions. These findings indicate that TLR3 signaling generates the Fas/FasL-mediated cytotoxicity, thereby leading to the development of chronic pancreatitis.
The cysteinyl leukotrienes (LTs), LTC4, LTD4, and LTE4, are potent inflammatory mediators and are involved in allergic reactions, such as bronchoconstriction, eosinophilic inflammation, and allergic cell proliferation. The present study aimed to elucidate the role of constitutively produced cysteinyl LTs in mast cell activation. We used a newly developed quantification method based on mass spectrometry to detect cysteinyl LTs in the cultured medium of mouse bone marrow-derived mast cells (BMMCs), which were obtained by interleukin (IL)-3-conditioned culture of mouse bone marrow. BMMCs were stimulated with immunoglobulin (Ig) E and antigen (IgE/Ag) or lipopolysaccharide for 1 or 24 h. This new quantification method revealed that unstimulated BMMCs produced and secreted LTB4 and LTE4 after 24 h of incubation. The treatment of unstimulated BMMCs for 2 h with montelukast, an antagonist of a cysteinyl LT receptor, CysLT1, resulted in the suppression of a downstream signaling event of this receptor, i.e., the decrease in phosphorylation of extracellular responsive kinases. Thus, cysteinyl LTs constitutively simulate BMMCs through the CysLT1 receptor in an autocrine manner. Treatment of BMMCs for 3 weeks with montelukast, which caused long-term inhibition of the autocrine cyteinyl LT-derived signal, significantly attenuated the IgE/Ag-dependent degranulation, as judged by the decrease in the release of β-hexosaminidase, an enzyme contained in the granules, whereas the production of cytokines, such as IL-6 and tumor necrosis factor-α, were largely unaffected. In conclusion, an autocrine signal derived from constitutively produced cysteinyl LTs predisposes mast cells to the degranulation upon allergic stimulation.
Neurofibromas are benign tumors that comprise primarily of Schwann cells and fibroblasts. Mast cells have been found scattered in the tumor tissue, and their role in promoting the proliferation of neurofibroma has been suggested. Tranilast (N-[3,4-dimethoxycinnamolyl]anthranilic acid) is an anti-allergic drug that inhibits release of the chemical mediators from mast cells and it used for the treatment of keloids and hypertrophic scars by its inhibition of growth-promoting transforming growth factor (TGF)-β1 from fibroblasts. We assumed that tranilast would suppress neurofibroma cell growth. In order to prove this hypothesis, we investigated the effectiveness of tranilast in inhibiting the tumor growth using a new cell culture system obtained from patients with neurofibromas. We called this culture system with the mixture of Schwann cells and fibroblasts “NF1 cells culture”. Mast cells were differentiated from CD34+ peripheral blood mononuclear cells of normal healthy subjects, and were co-cultured with NF1 cells. Three days after tranilast (10 ∼ 100 μM) added to the culture dishes, we counted viable cell numbers and measured the concentrations of TGF-β1, stem cell factor (SCF) and tryptase, which exists in the histamine granule, in the culture medium. Tranilast significantly suppressed proliferation of the NF1 cells and lowered the levels of TGF-β1, SCF and tryptase. These results suggest that tranilast retards tumor proliferation through not only suppression of cell growth factor, but also the inhibition of a chemical mediator released from mast cells. Thus, tranilast can be a potent therapeutic agent to inhibit the growth of neurofibromas.
Gallbladder carcinoma (GBC) is an aggressive malignancy with high mortality, mainly due to the reduced chance of curative resection and the resistance to chemotherapeutic drugs. Here, we showed that cellular Fas-associated death domain-like interleukin-1 converting enzyme inhibitory protein (c-FLIP), an anti-apoptotic protein, was over-expressed in the most of gallbladder carcinoma tissues, as judged by immunohistochemistry. Semi-quantitation was performed by determining the percentage of c-FLIP-positive cells: no positive cells (−), ∼ 1% positive cells (+), ∼ 30% positive cells (++), and >70% positive cells (+++). Out of the 35 tissue specimens of gallbladder carcinoma, positive c-FLIP expression was found in 26 samples (6/positive+++, 13/++, 7/+), whereas negative or weak c-FLIP staining was detected in normal (1/+, 9/−) and adenomatous (2/+, 8/−) gallbladder tissues. Then, we used a small interference RNA (siRNA), which can substantially down-regulate the expression levels of c-FLIP mRNA and protein in GBC-SD and SGC-996 human gallbladder carcinoma cells, as confirmed by real-time PCR and western blot analyses. Furthermore, the combined treatment with the c-FLIP siRNA and tumor necrosis factor (TNF)-related apoptosis-inducing ligand (TRAIL) significantly induced apoptosis in gallbladder carcinoma cells, as judged by the increases in pyknosis, caspase-3/7 activities, and Annexin V-propidium iodide labeling, a marker for chromatin condensation. Thus, the siRNA-mediated down-regulation of c-FLIP profoundly enhances the sensitivity to TRAIL-induced apoptosis. In conclusion, c-FLIP expression is up-regulated in gallbladder carcinoma and the down-regulation of c-FLIP sensitizes TRAIL-induced apoptosis. The present study provides a potent strategy for the treatment of gallbladder carcinoma by targeting the c-FLIP.
The human coagulation factor VIII (FVIII) is essential in the intrinsic pathway of blood coagulation and circulates mainly as a non-covalently bound complex with the von Willebrand factor (VWF). This complex (FVIII/VWF) protects FVIII from degradation and cellular uptake, although no biological role has been identified yet for this complex. The FVIII/VWF complex was purified from a healthy donor's plasma by affinity chromatography on a Sepharose 4B-Concanavalin A column and was used to determine its capability to interact with erythrocytes and platelets. The purified FVIII/VWF complex at 6.0 and 12 μg/ml agglutinates rabbit and bovine erythrocytes, and showed negative agglutination with erythrocytes from other species including human ABO. Treatment of erythrocytes with Clostridium perfringens sialidase or trypsin increased four-fold the activity toward rabbit erythrocytes and positive agglutination for human A and B erythrocytes, suggesting the presence of FVIII/VWF-cryptic receptors in these erythrocytes. Goat, pig, or human O erythrocytes were not agglutinated even after enzymatic treatment. Fucose or N-acetyl-glucosamine (GlcNAc), at 10 mM, inhibited agglutinating activity of the complex with rabbit, human A and B erythrocytes, whereas galactose and N-acetyl-galactosamine, even at 200 mM, showed no effect on the complex activity. The FVIII/VWF complex, at 1.5 μg/200,000 platelets, significantly decreased platelet aggregation (p < 0.001) when compared with the effect of platelet-rich plasma; this effect was inhibited with 15 mM GlcNAc or fucose. ELISA assays on FVIII/VWF coated polystyrene plates confirmed specific binding to fucose- or biotinylated GlcNAc-dextran derivatives. We therefore propose that the FVIII/VWF complex possesses lectin activity.
Small lesions are frequently detected in the lung with computed tomography (CT) in clinical practice. It is important to know the CT features of small-sized periphearal small cell lung cancer (SCLC) for early-stage diagnosis. We reviewed the CT findings of SCLC that presented as a solitary peripheral nodule without associated lymphadenopathy. This study included 12 patients (11 men and 1 woman; mean age, 68.5 years) with peripheral SCLC of diameters ranging from 9 - 28 mm (mean, 15.4 mm). We evaluated the findings with thin-section CT for each peripheral tumor; emphasis was laid on the predominant internal characteristics (whether the mass is solid), tumor-lung interface characteristics (whether the mass is well-defined with a smooth surface or with lobulation or spiculation), and surrounding structures (the presence or absence of perivascular thickening adjacent to the tumor). In all patients, most portions of the tumor consisted of a non-calcified solid mass. Contrast enhancement in varying degrees was observed in the tumors of all 8 patients, who were evaluated with enhanced CT. The tumor-lung interface characteristics observed on the CT images included a well-defined mass with a smooth surface (n = 5), a well-defined mass with lobulation (n = 3), and a mass with spiculation (n = 4). An irregular perivascular thickening adjacent to the tumor was observed in 4 patients. We conclude that peripheral SCLC without associated lymphadenopathy manifests as a non-calcified solid mass and is occasionally characterized by perivascular thickening.
Bach1 is a basic region-leucine zipper (bZip) protein that forms heterodimers with the small Maf proteins and functions as a repressor of gene expression. One of the target genes of Bach1 is Hmox-1 that encodes heme oxygenase-1 (HO-1). HO-1 degrades heme into carbon monoxide (CO), biliverdin, and iron. HO-1 is strongly induced by various stresses as well as its substrate heme, and protects cells and tissues against insults through diverse cytoprotective functions of the reaction products CO and biliverdin. Bach1-deficiency in mice leads to higher expression of Hmox-1 in various tissues. Here we investigated the effects of Bach1-deficiency in mice on tissue injuries: hepatic injury induced by D-galactosamine (GalN) and lipopolysaccharide (LPS), and mouse paw edema induced by carrageenin, polysaccharide derived from various seaweeds. Bach1-deficiency suppressed induction of plasma alanine aminotransferase (ALT) and aspartate aminotransferase (AST) activities in response to the GalN/LPS-treatment. However, production of tumor necrosis factor alpha (TNF-α) and nitric oxide (NO), both being cytotoxic mediators in LPS-induced hepatic injury, in Bach1-deficient mice and their peritoneal macrophages was similar to wild type controls. In contrast, Bach1-deficiency did not affect extent of mouse paw edema induced by carrageenin, which enhances vascular permeability by activating kinin release. These results indicate that Bach1 plays an inhibitory role in the cytoprotection of LPS-induced liver injury but not in the kinin-mediated inflammatory edema. The inhibitory role for Bach1 may stem from its activity to repress gene expression including HO-1.
Immunotherapy is well-practiced as one of the main adjuvant therapies for melanoma patients. Until now, many immunotherapeutic investigations have focused on improving the effector side of the antitumor response, but only a few studies have been concerned with preventing the loss of tumor-associated antigen (TAA) expression. Loss of TAA should be an important problem for the recognition of tumor cells by cytotoxic T lymphocytes. If any agents that augment the expression of melanoma antigens were found, they could improve the efficacy of immunotherapy by increasing the antigens. To detect effective chemicals, we made a fluorescent cellular reporter system for screening promising candidate chemicals. In this system, the fusion gene of the Melan-A/MART-1 promoter sequence followed by the green fluorescent protein (GFP) coding region was stably transfected into MUX human melanoma cells which are known to express little or no Melan-A/MART-1. Melan-A/MART-1 is a well-known melanoma antigen recognized by autologous cytotoxic T cells, and is a glycoprotein associated with the melanosome, the organelle in which melanin synthesis proceeds. By using this screening system, daunorubicin, doxorubicin and cytochalasin D, which enhanced the green fluorescent, were selected and then were confirmed to actually increase the expression of Melan-A/MART-1 mRNA and protein in human melanoma cells of MU89, MM96L+ and SK-MEL-28, but also in low-antigen presenting cells such as MM96L-, MUX, and A375. In conclusion, we have successfully established a well-functioning screening system, which will allow us to find candidate chemicals that up-regulate or maintain the melanoma antigen expression.
It has been established that various forms of physical and psychological stress reduce sexual functions. However, there is no study yet evaluating the functional changes over cavernosal pressure in rats exposed to restraint stress. In this study, we aimed to investigate the convenience of the restraint stress model that may be used to determine the disruptive effects of stress on erectile function. Sprague Dawley rats were randomized into two groups as control (n = 7) and stress (n = 7) groups. In the stress group, rats were placed for 60 minutes in a cylindrical plastic tube with holes for fresh air supply (restraint stress). Following the stress application, several parameters for erectile responses were evaluated immediately. The control animals were maintained at room temperature without any procedure until the measurement. During the electrical stimulation of cavernous nerve, we measured the intracavernous pressure (ICP), the ratio of ICP to the mean arterial pressure (MAP), and detumescence time. There were significant decreases in ICP (24.4 ± 4.1 vs 53.4 ± 4.5 mmHg, p < 0.01), ICP/MAP (34.4 ± 7.8% vs 55.7 ± 3.9%, p < 0.05), and detumescence time (31.7 ± 6.1 vs 78.6 ± 12.8 sec, p < 0.01) in stress group when compared to control group. Thus, restraint stress declined detumescence time and decreased intracavernosal pressure in male rats. In conclusion, restraint stress model in rats may be useful for determining the effects of stress on erectile response. Even a short-term restraint stress may cause erectile dysfunction.
Social health insurance (SHI) has covered only 60% of healthcare payments in Korea; therefore, Koreans rely upon supplementary private health insurance (SPHI) to cover the rest of the payments. SPHI status is assumed to affect clinical treatment and outcome of patients with stomach cancer, which is the most prevalent cancer among Koreans. This study examined the relationships between SPHI and diagnosis, treatment, utilization, and survival among stomach cancer patients. Patients (n = 3,780) who underwent a radical gastrectomy from 2000 to 2003 were examined retrospectively. The mean age of all patients was 58 years, and 1,377 patients (36%) had one or more SPHI plan. Univariate analysis was used to examine differences between SPHI and non-SPHI patients in terms of demographic, socioeconomic, and clinical characteristics, followed by a multiple analysis with adjustment for the above parameters. SPHI patients were 5% more likely to visit a physician (p < 0.001) and were 0.8 times less likely to die (p = 0.03) than non-SPHI patients. In contrast, no difference was observed between the two groups in the stage of cancer at diagnosis, which may reflect the fact that the majority of Korean SPHI plans do not cover cancer screening services. Moreover, no significant difference was detected in the use of adjuvant therapy between groups, because it was covered by SHI. In conclusion, SPHI is a determinant of healthcare utilization and survival among stomach cancer patients. It is necessary for health policymakers to consider the benefits of SPHI in financing healthcare services.