Relationship between chronic kidney disease and silent cerebral infarction in patients with Type 2 diabetes

AIMS

Silent cerebral infarction (SCI) is an independent risk factor for future symptomatic stroke. Although the prevalence of SCI is closely related to kidney function in non-diabetic individuals, evidence is lacking whether albuminuria and/or reduced estimated glomerular filtration rate (eGFR) independently increase the risk of SCI in diabetic patients. We therefore examined the relationships between albuminuria, eGFR and SCI in patients with Type 2 diabetes mellitus (T2DM).

METHODS

We studied 786 T2DM patients with an eGFR > or = 15 ml/min 1.73/m(2), including 337 women and 449 men [mean (+/- sd), age 65 +/- 11 years]. All patients underwent cranial magnetic resonance imaging (MRI) to detect SCI. GFR was estimated using the modified three-variable equation for Japanese subjects. Albuminuria was defined as a first morning urinary albumin-to-creatinine ratio (ACR) > or = 30 mg/g.

RESULTS

SCI was detected in 415 (52.8%) of the subjects. The prevalence of SCI was significantly associated with both elevated ACR and decreased eGFR in univariate analysis. In multivariate logistic regression analysis, urinary ACR remained independently associated with SCI after adjusting for conventional cardiovascular risk factors [odds ratio (OR) of urinary ACR per logarithmical value: 1.89, 95% confidence interval (CI) = 1.41-2.51, P < 0.001]; however, eGFR was no longer significantly associated with SCI (OR per ml/min 1.73/m(2) = 0.99, 95% CI = 0.98-1.00, P = 0.095).

CONCLUSION

In conclusion, albuminuria but not decreased eGFR may be an independent predictor of prevalent SCI in patients with T2DM.

Deletions involving both KCNQ2 and CHRNA4 present with benign familial neonatal seizures

OBJECTIVE

Mutations of the genes encoding subunits of potassium voltage-gated channel, KCNQ2 and KCNQ3, have been identified in patients with benign familial neonatal seizures (BFNS). This study set out to determine the frequency of microchromosomal deletions of KCNQ2 or KCNQ3 associated with BFNS.

METHODS

The study subjects were patients with BFNS (n = 22). Microdeletions were sought by multiplex ligation-dependent probe amplification and then confirmed by fluorescence in situ hybridization and characterized by array-based comparative genomic hybridization.

RESULTS

Heterozygous multiple exonic deletions of KCNQ2 were identified in 4 of 22 patients with BFNS. Concomitant deletions of adjacent genes, including nicotinic cholinergic receptor alpha4 (CHRNA4), were detected in 2 of the 4 cases. The clinical courses of patients with deletions of both KCNQ2 and CHRNA4 were those of typical BFNS, and none presented with the phenotype of autosomal dominant nocturnal frontal lobe epilepsy, some of which are caused by mutations of CHRNA4.

CONCLUSIONS

Our findings indicate that the clinical courses of patients with deletions of both KCNQ2 and CHRNA4 are indistinguishable from those of patients with deletions of KCNQ2 only.

Inhibition of Allergic Bronchoconstriction in Guinea Pigs and in Asthmatics by the Leukotriene Antagonist ONO-1078

The effect of the leukotriene receptor antagonist ONO-1078 on experimental and clinical bronchial asthma was evaluated. It was found that this compound could inhibit antigen-induced bronchoconstriction in passively sensitized guinea pigs and leukotriene D4- and allergen-induced bronchial responses in normal and in asthmatic subjects. Clinical trials in patients with chronic bronchial asthma demonstrated its effectiveness in reducing hazardous symptoms like wheezing and dyspneic attacks.

Mite serine protease activates protease-activated receptor-2 and induces cytokine release in human keratinocytes

BACKGROUND

House dust mites produce serine and cysteine proteases. Mite-derived proteases have been suggested to be involved in the pathogenesis of allergies; however, whether mite-derived serine protease activity can stimulate keratinocytes remains unknown.

METHODS

We examined the activation of primary human keratinocytes by serine protease-rich extract of whole mite culture and compared with that by recombinant group 1 allergens (rDer f 1 and rDer p 1), which exclusively exhibit cysteine protease activity.

RESULTS

Protease activity of whole mite culture extract (WCE), rDer f 1 and rDer p 1 induced the release of IL-8 and granulocyte-macrophage colony-stimulating factor. Protease activity of WCEs induced a significant upregulation of their mRNA expression but rDer f 1 had much less effect. Protease activity of the WCE stimulated intracellular Ca(2+) mobilization but rDer f 1 and rDer p 1 did not. The mobilization induced by agonists for the human protease-activated receptor (PAR)-2, an agonist peptide or trypsin, was diminished by pre-incubation of keratinocytes with WCE. rDer f 1 inefficiently cleaved a synthetic N-terminal peptide of PAR-2 at different sites from trypsin, but the resultant peptides did not stimulate the release of interleukin-8.

CONCLUSIONS

The results suggest that mite-derived serine protease activity may contribute to the pathogenesis of atopic dermatitis by activating keratinocytes via PAR-2 activation but cysteine protease activity of Der f 1 and Der p 1 acts via another mechanism.

Vulnerable plaque in a Swine model of carotid atherosclerosis

BACKGROUND AND PURPOSE

Distal embolism and acute thrombosis due to rupture of a vulnerable atherosclerotic plaque are the common mechanisms of stroke in patients with carotid disease. The purpose of this study was to develop the first animal model of vulnerable carotid atherosclerotic plaque.

MATERIALS AND METHODS

Carotid atherosclerotic models were created in 12 Yucatan minipigs by using a combination of partial ligation and high cholesterol diet. Retia mirabilia from these animals were examined histopathologically to identify distal embolism. The association of distal embolism with advanced atherosclerosis and a thin fibrous cap was analyzed by using the Fisher exact test.

RESULTS

Typical features of vulnerable plaques, including a thin fibrous cap, necrotic core, and intraplaque hemorrhage, were observed in this swine model of carotid atherosclerosis. Distal embolism was detected in retia mirabilia supplied by 7 of 10 carotid arteries with advanced atherosclerotic plaques, compared with 3 of 14 carotid arteries without advanced plaque (P < .05).

CONCLUSIONS

This swine model of carotid atherosclerosis contains the salient features of vulnerable plaques, including plaque rupture and distal embolism.

Plical resection in pre-temporal approach for basilar bifurcation aneurysms: preliminary surgical experience and cadaveric study

OBJECT

Although a pre-temporal approach (PA) can provide a wide space for preservation of thalamoperforating atrteries in direct surgery for basilar bifurcation aneurysms (BBAs), it cannot always secure adequate proximal control. The authors described the advantages of plical resection added to PA for BBAs.

METHODS

Between October 1998 and April 2000, eight consecutive patients with BBAs were treated in the neurosurgical department of Kurashiki Central Hospital. Among them, five patients received direct clipping using this method. There were four females and one male, ages ranging from 61 to 77 (mean 70.8 years). Mean aneurysmal size and distance between the in"terclinoidal line and the aneurysmal neck was 4.5 and 9.5 mm, respectively. The operative procedures consisted of the following components; 1) fronto-temporal craniotomy with translocation of orbito-zygomatico-malar bone for PA, 2) preservation of lateral branches of the superficial sylvian veins, 3) resection of plica dural folds to increase the operative field up to the oculomotor nerve (OMN).

RESULTS

Complete clipping was achieved without thalamic infarction or temporal contusion in all patients. Three of the five patients suffered from transient right OMN palsy which recovered within two months after surgery.

CONCLUSION

Plical resection in the pre-temporal approach might be beneficial in the surgical treatment of BBAs when proximal control seems difficult.

Systematic analysis of emotionality in consomic mouse strains established from C57BL/6J and wild-derived MSM/Ms

Consomic strains have recently attracted attention as an advantageous method to screen for genes related to developmental, physiological, and behavioral phenotypes. Recently, a new set of consomic strains was established from the Japanese wild-derived mouse strain MSM/Ms and C57BL/6JJcl. By analyzing the entire consomic panel, we were able to identify a number of chromosomes associated with anxiety-like behaviors in the open-field (OF) test, a light-dark box and an elevated plus maze. Detailed observation of the OF behavior allowed us to identify chromosomes associated with those ethological traits, such as stretch attend, rearing, and jumping. Repeated OF test trials have different meanings for animals, and we found that some chromosomes responded to only the first or second trial, while others were consistent across both trials. By examining both male and female mice, sex-dependent effects were found in several measurements. Principal component analysis of anxiety-like behaviors extracted five factors: 'general locomotor activity', 'thigmotaxis', 'risk assessment', 'open-arm exploration' and 'autonomic emotionality'. We mapped chromosomes associated with these five factors of emotionality.

Synergy and masking in odor mixtures: an electrophysiological study of orthonasal vs. retronasal perception

Perceptual interactions in a model of wine woody-fruity binary mixtures were previously reported in a psychophysical study performed through orthonasal stimulation only. However, recent studies suggested that the perception of food-like and nonfood-like odors may depend on the route of stimulation. The aim of the present study was two-fold: first to examine the neural correlates of perceptual interactions using electroencephalogram (EEG)-derived event-related potentials (ERPs) and second to test the influence of the stimulation route on quality perception. Therefore, we designed an experiment with 30 subjects to study perceptual interactions in woody-fruity mixtures and compared ortho- vs. retronasal stimulation sites on perceived odor quality and ERPs. The results revealed synergy or masking of the fruity component, depending on the woody component level. Synergy was supported by larger N1 amplitude of the ERP. Furthermore, mixtures including a medium level of the woody odor elicited a strong increase of P2 amplitude only retronasally. This study evidenced for the first time electrophysiological correlates of both perceptual synergy and masking on the early component of the ERPs and confirmed that retro- vs. orthonasal stimulation route induces different neural processes that are reflected in the late component of the ERP.

Superselective intra-arterial infusion chemotherapy for stage III/IV squamous cell carcinomas of the oral cavity: Midterm results

PURPOSE

We performed superselective intra-arterial infusion chemotherapy (SIC) according to a protocol in which drug distribution is evaluated by the use of interventional radiology (IVR)-computed tomography (CT) system, and the chemotherapy is combined with medium-dose conformal radiation therapy (CRT). We analyzed retrospectively the factors that affect the midterm survival ratio, including local response, for stage III and IV squamous cell carcinomas of the oral cavity.

MATERIALS AND METHODS

Forty consecutive patients with stage III and IV squamous cell carcinomas of the oral cavity and who had undergone both SIC and CRT were enrolled. A microcatheter was placed in the appropriate feeding artery of the tumor and cisplatin (50mg/body) was infused twice. CRT was administered with a dual-energy (4 and 10 MV) linear accelerator. The total and daily doses delivered were 30 and 2.0 Gy, respectively. Histopathologic effects were classified into five grades: grade 0 or 1 was defined as a poor response, and grade II or higher as a good response. Age, sex, stage, local response to treatment, mode of invasion and lymph node metastasis were analyzed, and differences in the midterm survival ratio were assessed.

RESULTS

The 3-year survival ratio of the 40 cases was 67%. A good local response (III or IV) was achieved in 75% of the cases. The survival ratio of the good local response group was significantly better than that of the poor response group (p=0.04). Mode of invasion (p=0.03) and lymph node metastasis (p=0.01) were also predictive of survival. In the multivariable analysis of survival, however, no variables including good local response (p=0.12), were predictive.

CONCLUSION

Our new protocol improved local response, but it did not contribute to the survival ratio.

Intraarterial infusion chemotherapy and conformal radiotherapy for cancer of the mouth: prediction of the histological response to therapy with magnetic resonance imaging

BACKGROUND

Although intraarterial chemotherapy has been used to treat head and neck cancers, some cases have shown poor response. If we can predict the response to this therapy on MRI, individual treatment plans may be altered to the most appropriate form of treatment.

PURPOSE

To evaluate whether MRI can predict the histological response to preoperative chemoirradiation in patients with cancer of the mouth.

MATERIAL AND METHODS

This study comprised of 29 consecutive patients with 30 oral cancers. All patients underwent tumor resection after intraarterial infusion chemotherapy and conformal radiotherapy. We compared the margin of the tumor, the presence of bone invasion, tumor area, and volume on pre- and post-treatment MRI with histological responses.

RESULTS

Eighteen lesions showed an excellent response, nine exhibited a good response, and three a poor response. Only the tumor area on pretreatment T1-weighted images and the tumor area and volume on pretreatment enhanced T1-weighted images were significantly correlated with the histological response (P = 0.039, 0.008, and 0.016, respectively); smaller cancers showed better responses. The other factors were not significantly correlated with the histological responses.

CONCLUSION

MRI parameters, excluding initial tumor area and volume, were not predictive of the histological response of oral tumors to preoperative treatment.

An atomic seesaw switch formed by tilted asymmetric Sn-Ge dimers on a Ge (001) surface

When tin (Sn) atoms are deposited on a clean germanium (Ge) (001) surface at room temperature, buckled dimers originating from the Sn atoms are formed at the Ge-dimer position. We identified the dimer as a heterogeneous Sn-Ge dimer by reversing its buckling orientation with a scanning tunneling microscope (STM) at 80 kelvin. An atomic seesaw switch was formed for one-dimensional electronic conduction in the Ge dimer-row direction by using the STM to reversibly flip the buckling orientation of the Sn-Ge dimer and to set up standing-wave states.

Superselective arterial infusion chemotherapy for squamous cell carcinomas of the oral cavity: histopathologic effects on metastatic neck lymph nodes

We have performed superselective intra-arterial infusion chemotherapy (SIC) on carcinomas of the oral cavity according to a protocol in which the distribution of the drug was evaluated by the use of a combined CT and angiography system, and the chemotherapy was combined with medium-dose conformal radiation therapy (CRT). The purpose of this study was to evaluate the pathological effect of this treatment on the metastatic neck lymph nodes (LNs). Twenty consecutive patients who had metastatic neck LNs from squamous cell carcinomas of the mouth and who underwent both SIC and CRT were included in this study, in which a total of 22 LNs were evaluated. A microcatheter was placed in the appropriate feeding artery of the tumor, such as the internal maxillary artery, facial artery, lingual artery and external carotid artery (ECA), and cisplatin (50 mg/body) was infused twice through a microcatheter. The CRT was administered with a dual-energy (4 and 10 MV) linear accelerator. The total and daily doses delivered were 30 and 2.0 Gy, respectively. Intra-arterial infusion to the LNs was divided into two groups: superselective infusion (mainly to the submandibular LNs via the facial artery, n = 10) and nonsuperselective infusion via the ECA (n = 12). The distribution of cisplatin into the LNs was confirmed by slow-infusion CT. Histopathologic effects on the LNs were evaluated on the specimens obtained during the operation and classified into five grades (0: no or minimal response: I: disappearance of less than three quarters of the tumor cells: II: disappearance of more than three quarters of the tumor cells: III: disappearance of viable tumor cells with a small amount of residual nonviable tumor cells: IV: complete disappearance of all viable and nonviable tumor cells). Grade 0 or 1 was defined as poor response and Grade II or more as good response. Twenty-three LNs from nine patients without CRT and SIC were served as control. In the superselective infusion group, all 10 LNs showed good response (response rate, 100%: grade II = 4, grade III = 3, grade IV = 3). In the non-superselective group, however, 6 of 12 LNs showed poor response (response rate, 50%: grade 0 = 2, grade I = 4, grade II = 2, grade III = 2, grade IV = 2). All 23 control LNs with no treatment showed grade 0 response. Superselective infusion seems necessary to obtain good histopathologic effects on the metastatic LNs. SIC combined with CRT can be applied to the metastatic LNs.

Swine model of carotid artery atherosclerosis: experimental induction by surgical partial ligation and dietary hypercholesterolemia

INTRODUCTION

Limited availability of a large animal model of carotid atherosclerosis has limited preclinical evaluation of endovascular therapeutic devices. The present study is aimed at developing such animal models with a novel approach, emphasizing the role of hemodynamics.

METHODS

Using 18 carotid arteries from 9 miniswine, surgical partial ligation (approximately 80% stenosis) was carried out in untreated (group I; n = 6) and balloon-injured arteries (group II; n = 9). Three arteries were subjected to sham-operation for control (group III; n = 3). All animals were fed with a high-fat diet until sacrifice. Angiograms and histologic sections of the vessels were analyzed to evaluate both models.

RESULTS

Atherosclerotic changes were confirmed in 6 of 6 in group I and 6 of 9 arteries in group II, whereas all in group III remained intact. Three arteries in group II resulted in thrombotic occlusion. Advanced plaques with intraplaque hemorrhage and/or calcification were seen in 4 of 6 arteries in group I but none in group II. The cross-sectional area stenosis and atherosclerotic stage for plaques in group I were both significantly higher than that in groups II and III.

CONCLUSION

In this series, surgical partial ligation with concomitant dietary hyperlipidemia is an appropriate experimental technique to develop advanced atherosclerotic plaques with minimal technical complications. This model showed no evidence of such benefits when applied in balloon-injured arteries.

Lower haemoglobin level and subsequent decline in kidney function in type 2 diabetic adults without clinical albuminuria

AIMS/HYPOTHESIS

Anaemia has been suggested to be an independent risk factor for subsequent progression of advanced diabetic nephropathy; however, the relationship between haemoglobin levels and progression of nephropathy in patients without clinical albuminuria is unknown.

METHODS

We conducted this prospective hospital-based cohort study of 464 type 2 diabetic patients (149 women and 315 men, 55+/-13 [mean+/-SD] years of age) with serum creatinine <177 micromol/l (2.00 mg/dl) and urinary albumin : creatinine ratio <300 mg/g creatinine. GFR was estimated using the equation formulated by the Modification of Diet in Renal Disease Study group, refitted for Japanese individuals. Most patients had haemoglobin concentrations in the normal range (144+/-15 g/l), only modest renal impairment (GFR: 74.8+/-14.5 ml min(-1) 1.73 m(-2)), and normal urinary albumin levels (81.5/18.5% with normo-/microalbuminuria). The primary outcome measurement was the rate of change in GFR determined by regression analysis with GFR as a function of time. Patients were followed up for a mean observation period of 5.0+/-0.9 (range: 2.5 to 6.2) years.

RESULTS

Univariate and multiple regression analyses yielded a significant association between the rate of change in GFR and baseline haemoglobin concentration. After adjusting for covariates, the rate of decline in GFR was significantly greater in patients in the lowest haemoglobin quartile (-3.27 ml min(-1) 1.73 m(-2) year(-1)) than in the third (-2.71 ml min(-1) 1.73 m(-2) year(-1), p = 0.024) and highest quartiles (-2.78 ml min(-1) 1.73 m(-2) year(-1), p = 0.046).

CONCLUSIONS/INTERPRETATION

Lower haemoglobin concentrations in type 2 diabetic patients without clinical albuminuria may be a significant predictor of subsequent decline in GFR.

Expression and cellular localization of calcitonin receptor: RT-PCR and in situ hybridization studies

Calcitonin receptor (CTR) has been identified in bone, kidney and brain, but precise tissue distribution and cellular localization remain to be established. In this study, we carried out in situ hybridization (ISH) analysis of CTR in rats and found intensive signals in exocrine glands, including salivary gland, exocrine pancreas and fundic glands of the glandular stomach, and epithelia of the seminal vesicle and prostatic glands. On the other hand, no signals were seen in the mesenchymal tissue including muscle, and connective and hematopoietic tissues. RT-PCR analysis showed that both CTR isoforms, C1a and C1b, were expressed in the central nervous system, only C1a isoform in the digestive, respiratory, urinary, reproductive and endocrine systems, and neither isoform in the mesenchymal tissue and hematopoietic tissues. These results showed that expression of CTR isoforms varies among various tissues, suggesting that CT functions through different mechanisms.

Cytosine-adenine repeat polymorphism at calcitonin gene locus associated with serum osteocalcin level in Japanese women

Bone mineral density and the serum concentration of osteocalcin are influenced by multiple genetic factors, including hormone and genes. Our aim was to evaluate the correlation between the dinucleotide (cytosine (C)-adenine (A)) repeat polymorphism at the calcitonin locus and bone mineral density and serum osteocalcin levels. Sixty-six healthy Japanese women over 50 years of age were included in this study. The bone mineral density of the second to fourth lumbar vertebrae was measured using dual-energy X-ray absorptiometry and serum osteocalcin was measured using an immunoradiometric assay. We isolated DNA from peripheral leukocytes and genotyped the cytosine-adenine repeats at the calcitonin locus using the polymerase chain reaction. We found that bone mineral density was not correlated with the number of cytosine-adenine repeats. However, the circulating osteocalcin level was significantly different among the different cytosine-adenine repeat groups. The osteocalcin level of the 10/17 (C-A) heterozygote group was significantly lower than those of the other groups (p<0.01). The 10/17 (C-A) and 17/17 (C-A) genotypes are common in the Japanese population, and the osteocalcin levels of the 10/17 heterozygotes were significantly lower than those of the 17/17 homozygote (p<0.05). Our findings suggest that the cytosine-adenine repeat at the calcitonin gene locus may be one of the genetic factors that regulate serum osteocalcin levels in Japanese women.

Insulin Independence of Unstable Diabetic Patient After Single Living Donor Islet Transplantation

BACKGROUND

Current success in islet transplantation will lead to a donor shortage. Living donor islet transplantation could be an alternative approach to expand the potential donor pool. In this study we describe the first successful living donor islet transplantation for unstable diabetes, performed at Kyoto University Hospital on January 19, 2005.

METHODS

The donor was a healthy 56-year-old woman and mother of the recipient. The recipient was a 27-year-old woman with insulin-dependent diabetes since the age of 15 years. She experienced frequent hypoglycemic unawareness episodes. Her blood glucose concentration was difficult to control and C-peptide level was negative after glucagon stimulation. She needed an average 28 of units of insulin per day. The donor underwent a distal pancreatectomy and islets were isolated from the resected pancreas graft. The total islet yield was 408,114 islet equivalents and isolated islets were immediately transplanted into the recipient's liver.

RESULTS

After transplant, the blood glucose level of the recipient was tightly controlled without hypoglycemic episodes. She was discharged on day 37 with a normal oral glucose tolerance test (OGTT). The recipient remained insulin-independent for >3 months, since day 22 posttransplant. The donor's postoperative clinical course was uneventful. She was discharged on postoperative day 18 and returned to her job within 1 month.

CONCLUSIONS

We report the first successful living donor islet transplantation for the treatment of unstable diabetes. We believe that living donor islet transplantation may become an option in the treatment of insulin-dependent diabetes.

Simple Evaluation of Engraftment by Secretory Unit of Islet Transplant Objects for Living Donor and Cadaveric Donor Fresh or Cultured Islet Transplantation

BACKGROUND

Evaluation of engraftment is important to assess the success of islet transplantation. Recently we developed secretory unit of islet transplant objects (SUITO) index for simple evaluation of engraftment. Assuming that normal subjects aged <40 years have 100% pancreatic beta-cell function, SUITO index was calculated by the formula: 1500 x fasting C-peptide immunoreactivity [ng/dL]/(fasting blood glucose [mg/dL] - 63). In this study, we compared the efficacy of islet transplantation from cadaveric and living donors using the SUITO index.

METHODS

We performed eight islet transplantations with non-heart-beating donors (NHBDs) into five patients. Two patients received fresh islets once, one patient received fresh islets twice, one patient received cultured islets once, and one patient received cultured islets twice plus fresh islets once. In addition, one patient received fresh islets from a living donor. We calculated the SUITO index from postoperative days 3 to 30 for each case.

RESULTS

Mean SUITO index after one fresh islet transplant was 11.7 +/- 1.0, after two fresh islet transplants was 28.5 +/- 3.4, after one cultured islet transplant was 2.1 +/- 0.4, after two cultured islet transplant was 12.1 +/- 1.9, and after two cultured islet transplant plus one fresh islet transplant was 26.7 +/- 1.7. The mean SUITO index after single living donor islet transplant was 40.7 +/- 2.6, which was significantly higher compared with all other groups. Insulin independence was obtained when the SUITO index was >26, which might reflect that 26% beta-cell mass was required for insulin independence.

CONCLUSION

SUITO index is useful to evaluate islet engraftment and to predict the possibility of insulin independence.

The functional sites of chlorophylls in D1 and D2 subunits of photosystem II identified by pulsed EPR

The functional site of ChlZ, an auxiliary electron donor to P680+, was determined by pulsed ELDOR applied to a radical pair of YD * and Chlz+ in oriented PS II membranes from spinach. The radical-radical distance was determined to be 29.5 A and its direction was 50 degrees from the membrane normal, indicating that a chlorophyll on the D2 protein is responsible for the EPR Chlz+ signal. Spin polarized ESEEM (Electronin Spin Echo Envelop Modulation) of a 3Chl and QA - radical pair induced by a laser flash was observed in reaction center D1D2Cytb559 complex, in which QA was functionally reconstituted with DBMIB and reduced chemically. QA -ESEEM showed a characteristic oscillating time profile due to dipolar coupling with 3Chl. By fitting with the dipolar interaction parameters, the distance between 3Chl and QA - was determined to be 25.9 A, indicating that the accessory chlorophyll on the D1 protein is responsible for the 3Chl signal.

Differential modulation of human basophil functions through prostaglandin D2 receptors DP and chemoattractant receptor-homologous molecule expressed on Th2 cells/DP2

BACKGROUND

Both prostaglandin (PG) D receptor (DP) and CRTH2 (chemoattractant receptor-homologous molecule expressed on Th2 cells)/DP2 are high-affinity receptors for PGD2. Previous studies have demonstrated that PGD2 enhances releasability and induces CRTH2/DP2-mediated migration in human basophils, but the precise effects of PGD2 on basophils as well as receptor usage have not been fully clarified.

OBJECTIVE

We comprehensively explored the roles of DP and CRTH2/DP2 in basophil functions by using selective agonists and antagonists for each receptor.

METHODS

DP and CRTH2/DP2 transcripts were quantified by real-time PCR. We studied the effects of selective agonists (DP: BW245C; CRTH2/DP2: 13,14-dihydro-15-keto (DK)-PGD2) and/or antagonists (DP: BWA868C; CRTH2/DP2: ramatroban) on Ca2+ mobilization, migration, degranulation, CD11b expression and survival of human basophils.

RESULTS

Basophils expressed transcripts of both DP and CRTH2/DP2, but the levels of CRTH2/DP2 transcripts were ca. 100-fold higher compared with DP transcripts. Ca2+ influx was induced in basophils by either PGD2 or DK-PGD2/CRTH2 agonist but not by BW245C/DP agonist. Basophils treated with PGD2 were completely desensitized to subsequent stimulation with DK-PGD2, but not vice versa. DK-PGD2 as well as PGD2 up-regulated CD11b expression, induced migration and enhanced degranulation, and those effects were completely antagonized by ramatroban/CRTH2 antagonist. In contrast, BW245C/DP agonist exhibited an inhibitory effect on basophil migration and IgE-mediated degranulation, and the migration inhibitory effect was effectively antagonized by BWA868C/DP antagonist. On the other hand, while PGD2 significantly shortened the basophil life-span, neither DK-PGD2/CRTH2 agonist nor BW245C/DP agonist did.

CONCLUSION

CRTH2/DP2 is primarily responsible for the pro-inflammatory effects of PGD2 on human basophils, while DP introduces negative signals capable of antagonizing the effects of CRTH2/DP2 in these cells. The effects of PGD2 on longevity imply a mechanism(s) other than via DP or CRTH2/DP2. CRTH2/DP2 on basophils may afford opportunities for therapeutic targeting in allergic inflammation.

Acute flank pain, an unusual first symptom of a spinal arteriovenous malformation

This case report describes a 46-year-old man whose first symptom was an attack of acute flank pain, followed by the gradual onset neurological symptoms. We demonstrated a small nidus and serpentine signal-void area in the spinal cord by MRI and diagnosed a glomus type of spinal arteriovenous malformation (AVM). Flank pain is a rare initial finding in an adult with spinal AVM. In cases with acute flank pain, neurologists should consider spinal AVM as a differential diagnosis.

Industry forum: Progress in pursuit of therapeutic A2A antagonists: The adenosine A2A receptor selective antagonist KW6002: Research and development toward a novel nondopaminergic therapy for Parkinson's disease

Research and development of the adenosine A2A receptor selective antagonist KW6002 have focused on developing a novel nondopaminergic therapy for Parkinson's disease (PD). Salient pharmacologic features of KW6002 were investigated in several animal models of PD. In rodent and primate models, KW6002 provides symptomatic relief from parkinsonian motor deficits without provoking dyskinesia or exacerbating existing dyskinesias. The major target neurons of the A2A receptor antagonist were identified as GABAergic striatopallidal medium spiny neurons. A possible mechanism of A2A receptor antagonist action in PD has been proposed based on the involvement of striatal and pallidal presynaptic A2A receptors in the "dual" modulation of GABAergic synaptic transmission. Experiments with dopamine D2 receptor knockout mice showed that A2A receptors can function and anti-PD activities of A2A antagonists can occur independent of the dopaminergic system. Clinical studies of KW6002 in patients with advanced PD with L-dopa-related motor complications yielded promising results with regard to motor symptom relief without motor side effects. The development of KW6002 represents the first time that a concept gleaned from A2A biologic research has been applied successfully to "proof of concept" clinical studies. The selective A2A antagonist should provide a novel nondopaminergic approach to PD therapy.

Differential regulation of Th1 responses and CD154 expression in human CD4+ T cells by IFN-alpha

Like interleukin (IL)-12, interferon (IFN)-alpha has been shown to play an important role in inducing human Th1 responses. Recent studies have shown that human Th1 responses driven by IL-12 are associated with enhanced expression of CD154. The present study examined the effects of IFN-alpha on CD154 expression in human CD4+ T cells, with special attention to the relationship with Th1 responses. Highly purified CD4+ T cells from healthy donors were stimulated with immobilized anti-CD3 with or without IFN-alpha and IL-12 in the complete absence of accessory cells. IFN-alpha suppressed CD154 protein and mRNA expression in CD4+ T cells at the initial phase of activation with immobilized anti-CD3, but enhanced it in the subsequent maturation phase irrespective of the presence of IL-12. By contrast, IFN-alpha by itself did not enhance IFN-gamma production or mRNA expression in CD4+ T cells in the absence of IL-12 even in the presence of stimulation with anti-CD28, but enhanced it in the presence of IL-12. Accordingly, IFN-alpha enhanced IL-12Rbeta2 mRNA expression in anti-CD3-stimulated CD4+ T cells. Neither IFN-alpha nor IL-12 influenced the stability of CD154 mRNA in anti-CD3-activated CD4+ T cells. These results indicate that IFN-alpha by itself enhances CD154 expression in CD4+ T cells independently of the induction of IFN-gamma mRNA expression. The data also suggest that the optimal induction of human Th1 responses by IFN-alpha might require the presence of IL-12 and that the induction of Th1 responses and CD154 expression in human CD4+ T cells might be regulated through different mechanisms.

A mouse model of the atopic eczema/dermatitis syndrome by repeated application of a crude extract of house-dust mite Dermatophagoides farinae

BACKGROUND

We cultured Dermatophagoides farinae (Df), one of the most common mites in house dust and the most important allergen among natural allergens. With this material, we attempted to produce an animal model of the atopic eczema/dermatitis syndrome (AEDS).

METHODS

We cultured Df mites in high density and prepared a crude extract of Df (DfE) together with the culture medium. We applied the extract to the back skin of NC/Nga and BALB/c mice three times per week for 8 weeks.

RESULTS

In the NC/Nga group, dryness or scaling appeared on the skin, and scratching behavior increased at the second week in the DfE-treated group. Skin erosion and hemorrhage occurred at the fourth week. The epidermis thickened and deepened into the upper dermis, in which mast cells were highly accumulated, corresponding with the skin lesion of AEDS patients. Specific IgE and IgG to DfE and total IgE were elevated in the sera. Mice treated with an extract of mite culture medium did not develop skin lesions. In the BALB/c group, mice developed specific IgE and IgG to DfE, however, no typical skin lesions appeared. Mast cells in the upper dermis did not increase.

CONCLUSIONS

Repeated painting of Dermatophagoides extract produced IgE-associated AEDS-like lesions on the skin of NC mice.

cDNA cloning, functional expression and characterization of kynurenine 3-hydroxylase of Anopheles stephensi (Diptera: Culicidae)

Kynurenine 3-hydroxylase (K3H) is a NADPH-dependent flavin monooxygenase involved in the tryptophan pathway. Xanthurenic acid (XA) is a metabolite of this pathway and has recently been identified as a gamete activating factor (GAF) of the malarial parasite. We cloned K3H cDNA from Anopheles stephensi (AsK3H), because anopheline mosquitoes are a vector of the human malaria parasite, Plasmodium falciparum and the catalytic function of AsK3H in XA production. Recombinant AsK3H protein was expressed in Sf-9 cells using the baculovirus system and its enzymatic properties were characterized. The specific activities of crude cell lysate and affinity purified protein were 94.9 +/- 6.2 and 865.6 +/- 10.5 nmol/min/mg protein, respectively. The optimum pH of AsK3H was 7.0. Analysis of AsK3H gene expression using RT-PCR revealed that AsK3H was constitutively expressed in egg, larva, pupa and adult.

A curious autopsy case of a car crash in which self-strangulation and lung collapse were found: a case report

A curious autopsy case following the car crash of a 20-year-old male, in which self-strangulation and lung collapse were observed, is presented. His motor vehicle had crashed into a restaurant as a result of self-strangulation using an electrical cord wound four times around his neck. At autopsy, we found small rupture holes of spontaneous bullae in both lung apices, which had probably taken place upon collision during driving, petechial hemorrhages in the face skin and the absence of severe injuries. Since it seemed unlikely that the small holes in both lung apices caused fatal pneumothorax instantly, the cause of his death was judged to be asphyxia due to self-strangulation. It is not clear whether the self-strangulation was suicidal or autoerotic, because neither traces of suicidal intent nor circumstances suggesting either of them were disclosed.

Cryogenic oven-trapping gas chromatography for analysis of volatile organic compounds in body fluids

Cryogenic oven-trapping (COT) with capillary GC has been successfully applied to analysis of chloroform, dichloromethane, trichloroethylene, diethyl ether, the components of solvent thinner (ethyl acetate, benzene, n-butanol, toluene, and others), xylene isomers, cyanide, ethanol, hexanes, general anesthetics, and styrene in human body fluids. This COT-GC technique was compared with headspace solid-phase microextraction (SPME) coupled with GC for some volatile organic compounds (VOC); for all compounds compared the sensitivity achieved using COT-GC was more than ten times higher than for headspace SPME-GC. The COT-GC method is recommended for widespread use in forensic and environmental toxicology, because it is simple, requires no special GC operations, and yet enables high sensitivity and high resolution.

Synthesis and antiallergic activity of 11-(aminoalkylidene)-6,11-dihydrodibenz[b,e]oxepin derivatives

A new series of 11-substituted 6,11-dihydrodibenz[b,e]oxepin-2-carboxylic acid derivatives was synthesized and demonstrated to be orally active antiallergic agents. These compounds are structurally related to 1 (KW-4994), which we had reported previously to be a new antiallergic agent. Most compounds synthesized exhibited potent inhibitory effects on 48-h homologous passive cutaneous anaphylaxis (PCA) in rats and on IgG1-mediated bronchoconstriction in guinea pigs. Additionally, compounds possessing a terminal carboxyl group at the 2-position of the dibenz[b,e]oxepin ring system exhibited inhibitory effects on specific [3H]pyrilamine binding to guinea pig cerebellum histamine H1 receptors, whereas these demonstrated negligible effects on specific [3H]QNB binding to rat striatum muscarinic acetylcholine M1 receptors. Structure-activity relationship studies revealed that the following key elements were required for enhanced antiallergic activities: (1) a 3-(dimethylamino)propylidene group as the side chain at the 11-position, (2) a terminal carboxyl moiety at the 2-position, and (3) a dibenzoxepin ring system. Among the compounds synthesized, (Z)-11-[3-(dimethylamino)propylidene]-6,11-dihydrodibenz [b,e]oxepin-2-acetic acid hydrochloride (16) was selected for further evaluation. It had an ED50 value of 0.049 mg/kg po in the PCA test in rats and an ID50 value of 0.030 mg/kg po in inhibiting anaphylactic bronchoconstriction in guinea pigs. Furthermore, it had a Ki value of 16 +/- 0.35 nM for the histamine H1 receptor, while it exhibited negligible CNS side effects up to a dose of 600 mg/kg po. Compound 16 is now under clinical evaluation as KW-4679.

Wide distribution of Plasmodium ovale in Myanmar

The presence of Plasmodium ovale has never been previously reported in Myanmar. Using blood samples obtained in many villages across the country between 1996 and 2000, molecular diagnosis of Plasmodium species was made with semi- or full-nested polymerase chain reaction (PCR) with species-specific primers, followed by agarose gel electrophoresis to detect amplification products. The presence of P. ovale was also confirmed with the another PCR-based diagnosis, the microtiterplate hybridization (MPH) method using species-specific probes. Both methods target the A type of the small subunit ribosomal RNA gene of the four human malaria parasites. Plasmodium ovale DNA was amplified in samples from 65 (4.9%) of 1323 PCR-positive patients, with perfect agreement between results obtained by nested PCR and MPH. Only four P. ovale-infected patients had single-species infection; all others were coinfected with P. falciparum, P. vivax and/or P. malariae. Quadruple infections were observed in six subjects. Parasites with typical P. ovale morphology were found in only 19 patients by conventional microscopy of Giemsa-stained thin smears or fluorescence microscopy of acridine orange-stained thin smears. Plasmodium ovale infections were found in villages situated in the southern, central and western regions of Myanmar, suggesting that P. ovale may be widely distributed in this country.

Increased levels of a TH2-type CC chemokine thymus and activation-regulated chemokine (TARC) in serum and induced sputum of asthmatics

BACKGROUND

Cytokines liberated by TH2 cells play crucial roles in the pathogenesis of bronchial asthma. Recent studies have demonstrated that CC chemokine receptor (CCR)4 is preferentially expressed by TH2 cells. These facts suggest possible involvement of two CCR4-specific ligands i.e., thymus and activation-regulated chemokine (TARC) and macrophage-derived chemokine (MDC), in the pathogenesis of bronchial asthma via recruitment of TH2 cells to inflammatory sites. We investigated the levels of TARC and MDC in the serum and induced sputum of asthmatics.

METHODS

The levels of TARC in the serum (46 asthmatics and 26 healthy subjects) and induced sputum (30 asthmatics and 6 healthy subjects) were measured using a highly sensitive ELISA system. The levels of eotaxin and MDC were also measured by ELISA.

RESULTS

TARC, but not MDC, was significantly increased in asthmatic sera (P<0.001). Although MDC was undetectable in the sputum of most cases by our assay system, sputum TARC was significantly increased (P=0.027).

CONCLUSIONS

The elevated TARC levels in asthmatics might be involved in the pathophysiology of asthma.

The expression of dystrophin and alpha1-syntrophin during skeletal muscle regeneration

The expression of dystrophin and alpha1-syntrophin in rat tibialis anterior muscles were evaluated during a cycle of regeneration after myonecrosis induced by the injection of cardiotoxin. Immunohistochemical studies were performed in cryosections of muscles on days 1, 3, 5, 7, 10, 14, 21 and 28 after injection of cardiotoxin. Western blot analysis was also examined in muscle on days 1, 3, 5, 7, 10, 14, 21 and 28. In immunohistochemical studies, dystrophin was stained weakly at the sarcolemma of some regenerating muscle fibers on day 3, and by day 10 it was stained strongly on almost all regenerating muscle fibers. Alpha1-syntrophin was stained weakly at the sarcolemma of some regenerating fibers on day 5, and by day 14 it was detected on all regenerating muscle fibers. In Western blot analysis, dystrophin (DYS1) and alpha1-syntrophin (alpha1S) were completely absent on day 1. Re-expression of DYS1 and alpha1S was visible by day 5 and accelerated thereafter. The Western blots of DYS1 and alpha1S were densitometrically analyzed on each day. The protein levels on each day were converted to the percentage of the protein level on day 28, which was taken as 100%. From the sequential line based on these data, the following results were obtained on the chronological course of DYS1 and alpha1S. DYS1: 25% of the protein level on day 28 was reached by 3.5 days, 50% was reached by 5.3 days, and 90% was reached by 6.9 days. Alpha1S: 25% of the protein level on day 28 was reached by 4.6 days, 50% was reached by 6.0 days, and 90% was reached by 12.5 days. In this study, DYS1 regenerated earlier than alpha1S at the sarcolemma of regenerating muscle fibers.

A case of death due to rescue action by a power shovel after being buried alive

We report a rare case of death due to rescue using a power shovel. A 41-year-old female was accidentally buried alive by a landslide of the earth and sand upon working at a construction site. One of her colleagues started to save her using a power shovel. However, she was dug out dead at the spot about 10 min after the accident with marked head and face injuries. The autopsy disclosed that there was extensive laceration across the face and head with marked skull bone fractures. Around these injuries, extensive hemorrhage could be observed as a vital reaction. Asphyxial death had to be taken into consideration, because she was buried under the earth and sand for about 10 min; but we finally judged that the cause of her death was head injury by the power shovel inflicted during the attempted rescue.

[Outbreak of methicillin-resistant Staphylococcus aureus (MRSA) infection or colonization among patients with neoplastic disease: a clinico-epidemiological study of 11 cases]

MRSA infection or colonization developed in eleven patients with neoplastic disease including malignant lymphoma (5 cases), soft tissue sarcoma (2 cases), acute myeloblastic leukemia (one), myelodysplastic syndrome (one), multiple myeloma (one), and mesothelioma (one) at our ward from October to December 1999. The infections were pneumonia (six cases), enteritis (three), bacteremia (one), and wound infection (one). Ten of 11 cases received antimicrobial agent (s) during one month before isolation of MRSA, suggesting selection of MRSA. Five cases improved and survived, but six cases died of infection. At the isolation of MRSA, the neutrophil count (NC) of the alive cases was 1, 500/microliter or more but the NC of five cases who died was less than 1,000/microliter, especially less than 100/microliter in three cases who had just received a cancer chemotherapy. Pulsed-field gel electrophoresis, performed in 9 cases, showed an identical DNA-pattern of MRSA in 7 cases, indicating a nosocomial infection. Our method to prevent spread of MRSA targeting solely the patients with MRSA infection was obviously unsatisfactory. We should target also the cases of MRSA colonization and make an effort to wash hands more vigorously. Furthermore, radical reformation such as increasing single sick-rooms drastically and increasing the number of nursing staff is also required.

Characterization and identification of exflagellation-inducing factor in the salivary gland of Anopheles stephensi (Diptera: Culicidae)

Gamete activation factor (GAF) induces exflagellation of Plasmodium microgametes. We found GAF in the salivary glands of female mosquitoes, Anopheles stephensi. The exflagellation was induced in a concentration-dependent manner in the supernatant of salivary gland's crude homogenate. The exflagellation-inducing activity in the salivary gland was higher than that in the midgut and the head. GAF in the salivary glands was found to be heat stable and low molecular weight (<3000 molecular weight). Analysis of the supernatant by capillary electrophoresis and UV absorbance profile showed that the salivary glands contained xanthurenic acid, which was previously identified as GAF in the head of A. stephensi. The exflagellation-inducing activity in the salivary gland declined immediately after a blood meal, implying that GAF was in the saliva, and was delivered into the midgut together with the blood and induced exflagellation in the midgut.

Sensitive determination of four general anaesthetics in human whole blood by capillary gas chromatography with cryogenic oven trapping

Four general anaesthetics, sevoflurane, isoflurane, enflurane and halothane, in human whole blood, have been found measurable with very high sensitivity by capillary gas chromatography-flame ionization detection (GC-FID) with cryogenic oven trapping upon injection of headspace (HS) vapor sample. To a 7-ml vial, containing 0.48 ml of distilled water and 20 microl of internal standard solution (5 microg), a 0.5-ml of whole blood sample spiked with or without anaesthetics, was added, and the mixture was heated at 55 degrees C for 15 min. A measure of 10 ml HS vapor was injected into the GC in the splitless mode at -40 degrees C oven temperature, which was programmed up to 250 degrees C. All four peaks were clearly separated; no impurity peaks were found among their peaks. Their extraction efficiencies were about 10%. The calibration curves showed good linearity in the range of 0.5-20 microg/ml; their detection limits were 10-100 ng/ml, which are almost comparable to those by previous reports. The coefficients of intra-day and day-to-day variations were 6.5-9.8 and 7.3-17.2%, respectively. Isoflurane or enflurane was also measured from whole blood samples in which three volunteers inhaled each compound.