Human supplementary motor area is active in preparation for both voluntary muscle relaxation and contraction: subdural recording of Bereitschaftspotential

Bereitschaftspotentials (BPs) preceding muscle relaxation and contraction were compared by using subdural electrodes which were implanted onto the right medial frontal surface in two patients with supplementary motor area (SMA) seizure. The applied movement paradigm (muscle relaxation and contraction tasks) was completely the same as employed in our previous study [Terada, K., Ikeda, A., Nagamine, T. and Shibasaki, H., Electroenceph. clin. Neurophysiol., 95 (1995) 335-345]. In both patients, either negative or positive BPs were observed in the SMA-proper and supplementary negative motor area (SNMA) starting at 1.2-1.8 prior to both movements. In one patient, BP was more widespread in the relaxation task whereas more restricted to the hand area in the contraction task. In the other patient, the BPs were observed in the cortical area rostral to SNMA (pre-SMA), in addition to the SMA-proper, in both tasks. It is concluded that SMA-proper and SNMA, and probably pre-SMA as well, in humans are similarly active in preparation for both voluntary muscle contraction and relaxation.

Comparison of four types of portable peak flow meters (Mini-Wright, Assess, Pulmo-graph and Wright Pocket meters)

Ambulatory peak flow monitoring plays an important role in the diagnosis and management of patients with bronchial asthma. Today several kinds of portable peak flow meters (PFMs) are available for this purpose and sometimes comparisons between the readings of different kinds of PFMs are necessary in clinical setting. We compared four types of PFMs in patients with various respiratory diseases. The study population consisted of 294 patients with asthma, chronic obstructive pulmonary disease, diffuse panbronchiolitis and other respiratory systems, and 15 healthy volunteers. Initially, subjects underwent a spirometry until at least three acceptable forced expiratory curves were obtained. Thereafter each subject blew into a Mini-Wright meter, Assess meter, Pulmo-graph meter and Wright Pocket meter, three times in a random order, with an interval of 4 min. The highest value of three blows was recorded in each PFM measurement. Finally, a second set of spirometric measurements were obtained. Spirometric peak flow rates (PEFRs) were obtained from the best single test which gave the largest sum of forced vital capacity and forced expiratory volume in 1 s (FEV1). In cases when FEV1 in the first spirometry examination was less than 11 or the readings of the PFM were less than 3501 min-1, low-range PFMs were used. The second spirometric PEFR was used as a standard against which the reading of the PFM was compared. The correlation coefficients between the readings of each PFM and spirometric PEFR did not differ significantly from each other. The limits of agreement between each PFM were very wide. In both low- and standard-range PFM, the Assess meter had a significantly greater absolute difference from the spirometric PEFR than other PFMs. In the standard range, the Wright Pocket meter also had a greater difference than the Pulmo-graph meter. The standard-range Assess meter tended to lose its strength of correlation with the spirometric measurement at higher flow rates as did the low-range Pulmo-graph and Mini-Wright meters at the lower and higher flow rates, respectively. All four types of standard-range PFMs gave similarly valid values when spirometric PEFR was used as a reference. However, the limit of agreement between each PFM is so wide that we do not recommend the use of the readings of each meter interchangeably.

Comparison of discriminative properties among disease-specific questionnaires for measuring health-related quality of life in patients with chronic obstructive pulmonary disease

Three disease-specific, health-related quality of life (HRQL) questionnaires have been introduced to assess patients with chronic obstructive pulmonary disease (COPD): the St. George's Respiratory Questionnaire (SGRQ), the Breathing Problems Questionnaire (BPQ), and the Chronic Respiratory Disease Questionnaire (CRQ). The purpose of the present study was to make comparisons between the SGRQ, the BPQ, and the CRQ in their discriminative properties, and to clarify the characteristics of each questionnaire. One hundred forty-three patients with mild to severe COPD completed pulmonary function tests, progressive cycle ergometer testing for exercise capacity, assessment of dyspnea, anxiety, and depression, and assessment of HRQL. The frequency distributions of the questionnaire scores showed that the SGRQ and the CRQ were normally distributed and that the BPQ was skewed toward low scores. Relationships between all dimensions of the three questionnaires were significant (correlation coefficients [Rs] = 0.74 to 0.86). The three questionnaires had significant but weak correlations (Rs = -0.24 to -0.36) with some physiologic variables (VC, FEV1, and DL(CO)/VA) and mild to moderate correlations with exercise capacity and assessment of dyspnea, anxiety, and depression. Stepwise multiple regression analyses revealed that the Baseline Dyspnea Index (BDI) score, anxiety by the Hospital Anxiety Depression Scale (HAD), and maximal oxygen uptake (VO2max) accounted for 61% of the variance in the SGRQ and that the BDI and anxiety of the HAD accounted for 53 and 49% of the variance in the BPQ and the CRQ, respectively. Dyspnea and psychologic status impacted the HRQL in patients with COPD. Although no substantial differences between the SGRQ, the BPQ, and the CRQ were evident in the correlations with physiologic parameters and the influential factors, the BPQ was found to be less discriminatory than the SGRQ and the CRQ in evaluating HRQL cross-sectionally.

Chronic bronchioloalveolitis associated with human T-cell lymphotrophic virus type I infection

The lung is a preferential site for human T-cell lymphotropic virus type I infection. This peculiar tropism for the lung is responsible for the high incidence of pulmonary involvement in patients with human T-cell lymphotropic virus type I infection. A variety of pulmonary manifestations may be present in human T-cell lymphotropic virus type I-associated pulmonary diseases, but the characteristic features of this disorder appear to be chronic bronchioloalveolitis with or without fibrotic changes of surrounding parenchyma. As for the pathogenesis of pulmonary involvement associated with human T-cell lymphotropic virus type I infection, immunologic mechanisms through T-cell activation may play an important role. Such attractive interpretations need further verification.

[Improvement of cognition after trepanation for the chronic subdural hematoma]

The cognitive functions were examined in the pre- and post-operative stages about the 16 cases of the chronic subdural hematoma. The evaluation was performed with MMS (mini-mental state) test. Although the average of the total score was 16.6 in the preoperative stage, it increased to 22.7 in the postoperative stage. Orientation of time and place, recall and the ability of writing a sentence, which were impaired prominently in the preoperative stage, improved significantly in the postoperative stage. The improvement was poorer in the patients with gait instability and in those older than 80 years. Trepanation surgery seems to be efficient for the improvement of cognition.

A comparison of different methods of spirometric measurement selection

The American Thoracic Society (ATS) and the European Respiratory Society (ERS) recommend that the largest forced vital capacity (FVC) and the largest forced expiratory volume in 1 s (FEV1) should be recorded from at least three acceptable curves independently which curve they came from. Although these recommendations have been used for decades, there is still some controversy over their validity. The purpose of this study was to determine how the intersession variability of reported FVC and FEV1 values is influenced by different methods of selection in clinical practice. The study population consisted of 283 patients with obstructive airway diseases. Spirometry was performed until three acceptable forced expiratory curves were obtained in the standing position. A second set of spirometric measurements was obtained approximately 30 min after the first set of measurements. The following sampling methods were compared: method A, the largest FVC and the largest FEV1 among all three acceptable curves (ATS-ERS recommendation); method B, the FVC and the FEV1 from the single curve that yielded the largest sum of FVC plus FEV1 (best test); method C, the average of all three acceptable curves; method D, the average of the largest two FVCs and FEV1s among all of the three acceptable curves. FVC and FEV1 determined by method B gave almost identical values to those obtained by method A in most cases. However, method A was least variable for FEV1. In addition, the differences in FEV1 values between these two methods were large in some of patients with chronic obstructive pulmonary disease. The other selection criteria compared in this study offer no clear-cut advantages over method A. The ATS ERS recommended method appeared to be slightly more reproducible than the other selection criteria, including the 'best test' method, and should therefore be the preferred method of choice.

Pharmacological treatment in acute exacerbations of chronic obstructive pulmonary disease

Exacerbations of chronic obstructive pulmonary disease (COPD) are usually treated with bronchodilator therapy, glucocorticoids and antibiotics. However, there are few experimental data on the effects of these agents in patients with acute COPD. A beta(2)-adrenoceptor agonist is usually given first because it can be expected to produce a rapid response. An anticholinergic agent should also be given when the patient is severely ill or responds inadequately to the beta(2) agonist. These agents can be administered via a nebuliser or using a metered-dose inhaler in conjunction with a spacer device. Glucocorticoids can accelerate recovery if the standard empirical regimens for acute exacerbations of asthma are used, although a longer treatment duration appears to be required. Theophylline provides little additional benefit in patients who receive frequent doses of inhaled bronchodilators and an adequate dosage of a glucocorticoid. Although the role of bacterial infections is not completely understood, the use of antibiotics is justified in patients with severe airflow limitation who have febrile tracheobronchitis.

Electrophysiological studies of early stage corticobasal degeneration

We conducted electrophysiological studies in two Asian patients with probable corticobasal degeneration (CBD). The duration of illness from onset was 16 and 20 months, respectively. The clinical manifestations were markedly asymmetric and characterized by cortical sensory loss, apraxia, action myoclonus, action tremor, and akinetic-rigid parkinsonism. Neither patient responded to levodopa therapy. Simple photon-emission computed tomography (SPECT) study showed significantly decreased regional cerebral blood flow in the frontoparietal areas and thalamus opposite to the predominantly affected limb. A series of electrophysiological studies failed to identify giant somatosensory evoked potentials (SEPs), enhanced long latency electromyography (EMG) reflex, and cortical spikes preceding myoclonic jerk. However, the earliest cortical component of the median nerve SEP was exclusively enlarged in one patient and preserved with depression of the subsequent components in the other patient. Significantly shorter postmotor-evoked potential (MEP) silent period was found after the transcranial magnetic stimulation of the motor cortex in both patients. CBD is a unique clinical entity characterized by action myoclonus probably the result of the pathologic hyperexcitability of the motor cortex, based on a loss of inhibitory input from the sensory cortex.

[Effect of treatment on health-related quality of life in patients with asthma]

The aim of the study was to assess the effect of treatment on health-related quality of life (HRQoL) in patients with asthma. We used the Japanese version of the Living With Asthma Questionnaire (LWAQ) as an asthma-specific HRQoL measure. Thirty-four new patients were enrolled and treated according to Guidelines on the Management of Asthma by the British Thoracic Society. The LWAQ and spirometry were evaluated on the initial visit, and three and six months after treatment. The LWAQ score, forced expiratory volume in one second (FEV1), and forced vital capacity (FVC) were significantly improved three months after treatment. The Japanese version of the LWAQ was reliable. For the first three months, there were no correlations between changes in FEV1 or FVC and LWAQ scores (Rs = 0.11-0.25). Pulmonary functions could not predict HRQoL well. Therefore, HRQoL should be measured directly to assess HRQoL in asthmatics.

Molecular cloning of bovine thyrotropin-releasing hormone receptor gene

The genomic DNA encoding bovine Thyrotropin-Releasing Hormone Receptor (TRHR) was isolated from a bovine (Holstein) genomic library. Using PCR fragments of bovine candidate TRHR Transmembrane domain (TMD-III-IV) and C-terminus domain of mouse TRHR cDNA as probes, 9 x 10(5) plaques were screened to obtain several clones each containing the N-terminus or C-terminus domain. The bovine TRHR gene encoded 398 amino acids and has a long intron. The identity of the deduced amino acid sequence of bovine TRHR exceeded 88% that of mouse, rat or human. RT-PCR analysis indicated TRHR mRNA to be expressed in the pituitary and brain.

Intraoperative blood salvage in abdominal simple total hysterectomy for uterine myoma

OBJECTIVE

To investigate the safety and usefulness of salvage-type autologous blood transfusion for abdominal simple total hysterectomy for uterine myoma.

METHODS

Forty patients with uterine myoma diagnosed histologically were treated by abdominal simple total hysterectomy using an intraoperative blood salvage apparatus. Bacterial contamination in the processed blood was studied.

RESULTS

Homologous blood transfusion was unnecessary. There was a positive relationship between bleeding volume and the hemoglobin (g) level in the processed blood. All vaginal swabs were positive for bacteria. Bacterial cultures of all processed blood samples without an antibiotic were positive whereas results were negative in 11 (50%) of the processed blood samples with an antibiotic. There were no significant side effects after reinfusion.

CONCLUSION

Salvage-type autologous blood transfusion in abdominal simple total hysterectomy for uterine myoma was safe and its future use is promising.

Failure of germinal center formation and impairment of response to endotoxin in tumor necrosis factor alpha-deficient mice

To study the pathophysiologic roles of TNF alpha, we produced TNF alpha gene-disrupted mice by gene targeting. TNF alpha-deficient mice develop normally without any alteration in the lymphocyte populations. However, in these mice, the germinal center formation in the peripheral lymphoid organs failed in response to the T cell-dependent antigens. TNF alpha-deficient mice are resistant to lethal doses of endotoxin and D-galactosamine without hepatocyte apoptosis, yet demonstrate thymus apoptosis. Our results indicated an important role for TNF alpha in germinal center formation and in the sepsis-induced hepatocyte apoptosis that precedes liver failure.

Scalp-recorded, ictal focal DC shift in a patient with tonic seizure

PURPOSE

We recorded focal ictal DC shifts from scalp electrodes in a 9-year-old boy with intractable, clinically generalized tonic seizures. The patient had a high intensity signal abnormality of the left temporal cortex with thickening of the gyri on T2-weighted MRI.

METHODS

Scalp digital EEGs were recorded using electrodes made of silver/silver chloride. The low frequency filter (LFF) was set at 0.016 Hz. Recorded seizures were subsequently analyzed with LFF settings of 1.0, 0.016 and 0.03 Hz.

RESULTS

All recorded seizures initially showed diffuse, low voltage, high frequency activity (electrodecremental pattern) followed 10-20 s later by quasirhythmic activity over the left frontotemporal region. In two seizures, LFF of 0.016-0.03 Hz revealed a slow negative shift over the left frontotemporal area simultaneously with onset of the bilateral electrodecremental pattern. However, in the other seizures, this initial slow negative shift was obscured by artifacts. Subsequent electrocorticography (ECoG) delineated frequent epileptiform discharges in the left temporal as well as frontal cortex.

CONCLUSIONS

Scalp-recorded ictal DC shifts may help identify focal epileptogenic brain area in patients with clinically generalized seizures although the technique is vulnerable to artifact.

Molecular cloning and functional expression of a cDNA encoding a new member of mixed lineage protein kinase from human brain

We have cloned a novel protein kinase from human cerebellum and named it LZK (leucine zipper-bearing kinase). The LZK cDNA encoded a 966-amino acid polypeptide that contains a kinase catalytic domain and double leucine/isoleucine zippers separated by a short spacer region. The amino acid sequence of the kinase catalytic domain was a hybrid between those in serine/threonine and tyrosine protein kinases, indicating that LZK belongs to the subfamily of the mixed lineage kinase (MLK) family. The kinase catalytic domain of LZK was most similar to DLK (Holtzman, L. B., Merritt, S.E., and Fan, G. (1994) J. Biol. Chem. 269, 30808-30817), MUK (Hirai, S., Izawa, M., Osada, S., Spyrou, G., and Ohno, S. (1996) Oncogene 12, 641-650), and ZPK (Reddy, U. R., and Presure, D. (1994) Biochem. Biophys. Res. Commun. 202, 613-620), which belong to the same subfamily of the MLK family. However, besides the kinase catalytic domain and double leucine/isoleucine zippers, there was no significant homology with known proteins. The recombinant LZK autophosphorylated in the presence of ATP and divalent cations, and exhibited serine/threonine kinase catalytic activity. Northern blot analysis revealed that LZK is expressed most strongly in the pancreas, with a pattern that differs from other MLKs. Expression of LZK in COS7 cells induced phosphorylation of c-Jun and activation of JNK-1, indicating the association of LZK in the c-Jun amino-terminal kinase/stress-activated protein kinase pathway. The expressed LZK was detected primarily in the membrane fraction, suggesting that LZK interacts with other cellular components in vivo.

Frontopolar ictal epileptiform discharges on scalp electroencephalogram in temporal lobe epilepsy

We report 3 patients with medically intractable complex partial seizures (CPS) arising from the temporal lobe judged by surgical outcome, in whom scalp electroencephalogram (EEG) showed ictal epileptiform discharges at the frontopolar region. In all patients, results of cranial magnetic resonance imaging (MRI), positron emission tomography (PET), and ictal single photon emission computed tomography (SPECT) were consistent with those of temporal lobe epilepsy (TLE). The epileptogenic area was defined in the temporal lobe by chronic subdural recording in 2 patients. After surgical treatment (amygdalohippocampectomy, anterior temporal lobectomy, and temporal lesionectomy, respectively), all 3 patients became seizure-free and the interictal frontopolar epileptiform discharges on scalp EEG disappeared. Patients with TLE may show ictal scalp EEG with frontopolar onset. This is most likely explained by direction of dipolar orientation of epileptiform discharges in 1 of our patients; rapid spread of ictal activity to the frontopolar area can also be considered in the 2.

[Use of jerk-locked back averaging for detecting the epileptiform discharge in a patient with supplementary motor seizure]

A 23-year-old, right handed women has suffered from supplementary motor seizures manifesting tonic followed by clonic contractions of the left foot, occasionally spreading to the left hand and trunk, since the age of 7 years. The mean frequency of seizures on admission was about 10 times per day. A brain MRI showed an abnormal intensity area about 3 cm in diameter in the right mesial frontal lobe involving the superior frontal and cingulate gyri. Six habitual seizures were recorded during long-term monitoring with digital EEG segments time-locked to the clonic contractions of the left foot, a negative spike was detected about 50 ms before the EMG onset at the midline fronto-central area slightly lateralized to the left. In the focal motor seizure arising from the mesial frontal lobe like in the present case, jerk-locked back averaging helps detecting the epileptiform activity which is otherwise undetectable.

Human second somatosensory area: subdural and magnetoencephalographic recording of somatosensory evoked responses

OBJECTIVE

To investigate somesthetic functions of the perisylvian cortex.

METHODS

Somatosensory evoked magnetic fields (SEFs) and somatosensory evoked potentials (SEPs) of the perisylvian cortex were recorded directly from subdural electrodes in a patient with a left frontal brain tumour.

RESULTS

The most prominent SEP components after electrical stimulation of the right and left hands and the right foot were double peaked negativity recorded just above the sylvian fissure (latency 80 to 150 ms), respectively (N1a and N1b). Generator sources for the magnetoencephalographic counterparts of those peaks (N1a(m) and N1b(m)) were both localised at the upper bank of the sylvian fissure, and those of N1a(m) were more anteromedially located than those of N1b(m).

CONCLUSIONS

These findings suggest the existence of at least two separate somatosensory areas within the human perisylvian cortex.

Cortical mechanism underlying externally cued gait initiation studied by contingent negative variation

In order to clarify the cortical mechanism underlying gait initiation, we examined the scalp distribution of the contingent negative variation (CNV) preceding externally cued gait initiation in a simple reaction-time paradigm in 10 healthy right-handed men, and compared the results with the CNV preceding simple foot dorsiflexion. A pair of auditory stimuli was given with an interstimulus (S1-S2) interval of 2 s and gait consisting of at least 3 steps was initiated with the right footstep as fast as possible in response to S2. Brisk dorsiflexion of the right foot was employed as a control task. It was found that the late CNV in the gait initiation task started about 1 s before S2, and was largest at Cz (-9.3 +/- 3.1 microV) without clear asymmetry over the scalp. However, it was ill defined in the parietal area. In the foot dorsiflexion task, the late CNV was maximal at Cz (-7.1 +/- 2.9 microV), and clearly seen also over the parietal area. The late CNV at Cz was significantly (P < 0.01) larger in the gait initiation than in the simple foot dorsiflexion. The amplitude of the late CNV preceding the foot dorsiflexion task was not significantly different between the sitting and the standing posture. In view of the results of previous invasive studies in both humans and animals which showed some frontal areas, including the supplementary motor area (SMA) and the primary motor cortex, as the generators of the late CNV, it is suggested that the cerebral cortex is active in initiation of externally triggered gait in a different way from the simple foot movement, and that bilateral SMAs may play a more important role in gait initiation than in simple foot movement.

Event-related potentials associated with judgment: comparison of S1- and S2-choice conditions in a contingent negative variation (CNV) paradigm

To elucidate the functional role of association cortex in judgment and decision-making about external stimuli, the scalp topography of contingent negative variation (CNV) recorded in 9 normal volunteers was compared in two settings; dichotomous S1- and S2-choice paradigms using right wrist extension or flexion movement upon S2 as the choice reaction task with an S1-S2 interstimulus interval of 2 s. Two main findings were obtained. First, early CNV in the S1-choice paradigm consisted of a frontal to frontopolar midline negative potential, most likely representing judgment more than orienting response, and a left-sided parietal positive potential, at least partially representing P3b, whereas in the S2-choice paradigm it consisted only of a smaller frontal negative potential shift, most likely representing merely an orienting response. This suggests that the prefrontal and left parietal association cortexes might be active in the judgment and decision-making process. Second, after S2, two positive peaks (334 and 545 ms after S2) were observed at the midline central to left parietal areas only in the S2-choice paradigm. In the S1-choice paradigm, one large negative peak (275 ms after S2) was observed. We postulate that the first peak of the S2-choice paradigm is related to decision making or judgment and that the second peak is related to the following cognitive process. We conclude that at least the prefrontal and parietal association cortexes generate transient potentials accompanying judgment, and possibly decision making.

Cerebral hemodynamics and histological changes following acute cerebral venous occlusion in cats

Using an acute cerebral venous occlusion model prepared by injecting cyanoacrylate into the cerebral venous system, superior sagittal sinus pressure (SSSP) and regional cerebral blood flow (r-CBF) were measured. In the same model, changes in cerebral metabolism at the site of r-CBF measurement were observed using magnetic resonance imaging (MRI) and magnetic resonance spectroscopy (MRS). Cases were classified according to occlusion site: group SSS [occlusion of the superior sagittal sinus (SSS) only], group LS[occlusion of SSS plus lateral sinus (LS)] and group CV[SSS and LS plus cortical veins (CV)]. In groups SSS and LS, SSSP changed very little up to 6 hours after occlusion. In group LS, r-CBF decreased slightly, but the change was not significant. In contrast, an increase in SSSP and decrease in r-CBF were observed in group CV. Phosphorus MRS also demonstrated a decrease in phosphocreatinine (PCr) and adenosine triphosphate (ATP) and increase in inorganic phosphorus (Pi) following occlusion. Histopathological examination of group CV revealed dramatic changes, including the development of intracerebral hematoma and edema. Experimental application of the proposed model revealed that widespread occlusion of the sinuses can cause an increase in intravenous pressure with a concomitant decrease in r-CBF, resulting in metabolic complications such as a decrease in PCr and ATP and an increase in Pi.

Equine inhibin/activin beta A-subunit mRNA is expressed in the endometrial gland, but not in the trophoblast, during pregnancy

The expression of both inhibin alpha- and inhibin/activin beta A-subunit mRNA was examined in equine uteroplacental tissues collected during pregnancy (days 90 to 300). Northern blot analysis revealed that 5 transcripts (7.0, 4.1, 3.4, 2.6, 1.5 kb) of beta A-subunit were present, and the most abundantly expressed transcript was the 1.5 kb one. Relatively high levels of the 1.5 kb transcript were seen in the second trimester of pregnancy compared to what was found in the third trimester. To identify the tissue localization of beta A-subunit mRNA, in situ hybridization was performed, and the positive signal was observed exclusively in the endometrial glands, but not in the fetal placental tissue (trophoblast) at days 150, 210, and 300 of pregnancy. On the other hand, inhibin alpha-subunit transcript could not be detected at any stage of pregnancy examined either by Northern blot analysis or in situ hybridization. Although the factor(s) regulating the gene expression of beta A-subunit in this equine tissue is currently unknown, these results suggest that activin, but not inhibin, is predominantly produced in the endometrial glands of the pregnant mare, and thus produced activin may play a paracrine or endocrine role during pregnancy in this species.

Molecular cloning of bovine CD14 gene

Genomic DNA encoding bovine CD14 was isolated from a bovine (Holstein) genomic library. Utilizing PCR fragment of mouse CD14 gene as a probe, we screened 9 x 10(5) plaques and obtained 3 clones containing the bovine CD14 gene. DNA sequencing showed that bovine CD14 gene encodes 373 amino acids, and the coding sequence was separated by a 90 nt intron. The identity of the deduced amino acid sequence of bovine CD14 was 61-73% to those of mouse, rabbit and human. Northern blot analysis revealed that CD14 mRNA (1.5 kb) was expressed in the lung. Expression of CD14 mRNA was stimulated about 2-fold in bovine peripheral blood macrophage activated with LPS in vitro.