Riverbank filtration: comparison of pilot scale transport with theory

Pilot-scale column experiments were conducted in this study using natural soil and river water from Ohio river to assess the removal of microbes of size ranging over 2 orders of magnitude, i.e., viruses (0.025-0.065 microm), bacteria (1-2 microm), and Cryptosporidium parvum oocysts (4-7 microm) under conditions representing normal operation and flood scour events. Among these different organisms, the bacterial indicators were transported over the longest distances and highest concentrations; whereas much greater retention was observed for smaller (i.e., viral indicators) and larger (i.e., Cryptosporidium parvum oocysts) microbes. These results are in qualitative agreement with colloid filtration theory (CFT) which predicts the least removal for micrometer size colloids, suggesting that the respective sizes of the organisms was a dominant control on their transport despite expected differences in their surface characteristics. Increased fluid velocity coupled with decreased ionic strength (representative of major flood events) decreased colloid retention, also in qualitative agreement with CFT. The retention of organisms occurred disproportionately near the source relative to the log-linear expectations of CFT, and this was true both in the presence and absence of a colmation zone, suggesting that microbial removal by the RBF system is not necessarily vulnerable to flood scour of the colmation zone.

Regulation of M2-type pyruvate kinase mediated by the high-affinity IgE receptors is required for mast cell degranulation

BACKGROUND AND PURPOSE

M2-type pyruvate kinase (M2PK) was found to interact directly with the 'ITAM' region of the gamma chain of the high-affinity IgE receptor (FcvarepsilonRI). Our hypothesis was that mast cell degranulation might require the FcvarepsilonRI-mediated inhibition of M2PK activity.

EXPERIMENTAL APPROACH

In rat basophilic leukaemia (RBL-2H3) cells, the effects of directly inhibiting M2PK or preventing the FcvarepsilonRI-mediated inhibition of M2PK (disinhibition) on degranulation was measured by hexosaminidase release. Effects of blocking the FcvarepsilonRI-mediated inhibition of M2PK was also assessed in vivo in a mouse model of allergen-induced airway hyper-responsiveness.

KEY RESULTS

Activation of FcvarepsilonRI in RBL-2H3 cells caused the rapid phosphorylation of tyrosine residues in M2PK, associated with a decrease in M2PK enzymatic activity. There was an inverse correlation between M2PK activity and mast cell degranulation. FcvarepsilonRI-mediated inhibition of M2PK involved Src kinase, phosphatidylinositol 3-kinase, PKC and calcium. Direct inhibition of M2PK potentiated FcvarepsilonRI-mediated degranulation and prevention of the FcvarepsilonRI-mediated inhibition of M2PK attenuated mast cell degranulation. Transfection of RBL-2H3 cells with M1PK which prevents FcvarepsilonRI-induced inhibition of M2PK, markedly reduced their degranulation and exogenous M1PK (i.p.) inhibited ovalbumin-induced airway hyper-responsiveness in vivo.

CONCLUSIONS AND IMPLICATIONS

We have identified a new control point and a novel biochemical pathway in the process of mast cell degranulation. Our study suggests that the FcvarepsilonRI-mediated inhibition of M2PK is a crucial step in responses to allergens. Moreover, the manipulation of glycolytic processes and intermediates could provide novel strategies for the treatment of allergic diseases.

Glial activation and matrix metalloproteinase release in cerebral malaria

Although neurological symptoms associated with cerebral malaria (CM) are largely reversible, recent studies suggest that lasting neurological sequelae can occur. This may be especially true for children, in whom persistent deficits include problems with memory and attention. Because the malaria parasite is not thought to enter the brain parenchyma, lasting deficits are likely related to factors including the host response to disease. Studies with a rodent model, and with human postmortem tissue, suggest that glial activation occurs with CM. In this review, the authors will highlight studies focused on such activation in CM. Likely causes will be discussed, which include ischemia and activation of blood brain barrier endothelial cells. The potential consequences of glial activation will also be discussed, highlighting the possibility that glial-derived proteinases contribute to structural damage of the central nervous system (CNS). Of note, for the purposes of this focused review, glial activation will refer to the activation of astrocytes and microglial cells; discussion of oligodendroglial cells will not be included. In addition, although events thought to be critical to the pathogenesis of CM and glial activation will be covered, a comprehensive review of cerebral malaria will not be presented. Excellent reviews are already available, including Coltel et al (2004; Curr Neurovasc Res 1: 91-110), Medana and Turner (2006; Int J Parasitol 36: 555-568), and Hunt et al (2006; Int J Parasitol 36: 569-582).

Multicenter phase II study of docetaxel plus oxaliplatin combination chemotherapy in patients with advanced gastric cancer

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Background: The present study was conducted to evaluate the efficacy and safety of a combination regimen of docetaxel plus oxaliplatin in patients with advanced gastric cancer. Methods: Patients with previously untreated metastatic or recurrent, measurable gastric cancer received intravenous docetaxel 65 mg/m2 plus oxaliplatin (Oxalpla®, Yuhan.Co. Seoul, Korea) 120 mg/m2 on days 1 in a 3-week cycle. Treatment was continued until disease progression, patient refusal, or an unacceptable toxicity up to 9 cycles. Results: Forty-two patients were enrolled in the current study. Of these, 39 were assessable for efficacy and 41 assessable for toxicity. Seventeen partial responses were confirmed, giving an overall response rate of 40.5% (95% CI: 26.0% to 54.1%, intention-to-treat analysis). At a median follow-up of 160.5 days, the median time to progression was 6.1 months, whereas median overall survival was not reached yet. Grade 3/4 neutropenia occurred in 10 patients, plus febrile neutropenia was observed in 3 patients. Most common non-hamatologic toxicity was nausea (grade 1/2 56.9%). There were two treatment-related deaths. Conclusions: Docetaxel and oxaliplatin combination was found to be well-tolerated and effective in patients with advanced gastric cancer. Accordingly, this regimen can be regarded as an important first-line treatment option for advanced gastric cancer.

No significant financial relationships to disclose.

Assessment of the risk of infection by Cryptosporidium and Giardia in non-potable reclaimed water

Quantitative risk assessment for Cryptosporidium oocysts and Giardia cysts was performed to determine the public health significance of non-potable use of tertiary treated reclaimed water. Seven reclaimed water treatment plants in the southwestern United States participated in this study. The average public exposure to oocysts and cysts was estimated, based on concentrations, recovery efficiency, viability and three exposure scenarios. The exponential dose-response model was chosen to determine the probability of infection from ingestion of various numbers of oocysts and cysts. The risks of infection for Giardia were approximately one or two orders of magnitude higher than those for Cryptosporidium. The combined risks of infection from oocysts and cysts at sites using a combination of chlorination and UV disinfection would meet the annual acceptable risk of 1.00E-04, whereas those at the other utilities using only chlorination indicated higher probability of infection than the 1.00E-04 resulting from accidental consumption of a small amount of non-potable reclaimed water.

Frequency specific hearing improvement in microvascular decompression of the cochlear nerve

BACKGROUND

Microvascular compressions of the cochlear nerve can lead to hearing loss. Due to the tonotopic organization of the cochlear nerve any focal compression of the cochlear nerve will result in a frequency specific hearing loss. Decompressing the cochlear nerve could result in a frequency specific hearing improvement, without improving overall hearing.

METHOD

Thirty one patients underwent microvascular decompression operations of the vestibulocochlear nerve for vertigo or tinnitus. Preoperative audiograms were substracted from postoperative audiograms obtained 2 years after microvascular decompression. The frequencies of maximal hearing improvement postoperatively were determined.

FINDINGS

Of the 31 patients studied, 19 had improvements of 5 dB or more at one or more frequencies postoperatively, and 15 patients had improvements of 10 dB or more. Three patients had improvements of 25 dB or more postoperatively. The postoperative hearing improvement was frequency-specific and related to the anatomical location of the vascular contact on the auditory nerve. The improvement of hearing becomes diluted when the difference between pre- and postoperative hearing thresholds are averaged over all audiometric frequencies. We therefore present results for each frequency that was tested.

CONCLUSIONS

Microvascular decompression of the cochlear nerve can improve hearing in selected patients. The improvement seems too small to justify decompressive surgery for the sole purpose of hearing improvement, but it could be considered if associated short vertigo spells, ipsilateral tinnitus, otalgia and cryptogenic hemifacial spasm are present. Decompression should be performed early, before BAEP changes become noticeable. 3D-MRI could become a valuable tool for selecting good surgical candidates.

Waveguides, resonators and their coupled elements in photonic crystal slabs

The design, fabrication, and measurement of photonic-band-gap (PBG) waveguides, resonators and their coupled elements in two-dimensional photonic crystal (PhC) slabs have been investigated. We have studied various loss mechanisms in PBG waveguides and have achieved a very low propagation loss (~1 dB/mm). For these waveguides, we have observed a large group delay (>100 ps) by time-domain measurement. As regards PBG resonators, we realize very high-Q and small volume resonators in PhC slabs by appropriate design. Finally, we demonstrate various forms of coupled elements of waveguides and resonators: 2-port resonant-tunneling transmission devices, 4-port channel-drop devices using the slow light mode, and 3-port channel-drop devices using the resonant-tunneling process.

Qi therapy as an intervention to reduce chronic pain and to enhance mood in elderly subjects: a pilot study

Qi therapy (or external Qi) is an oriental complementary therapy preventing, curing disease and strengthens health and improving the human potentiality through regulation of body. It is increasingly being used to improve the quality of life, but there is little direct evidence of its efficacy. This study assessed the effects of Qi therapy (QT) on reducing pain and enhancing mood states in elderly subjects with chronic pain. We studied 40 elderly participants with chronic pain, who were randomly allocated to receive QT (n=20) or standard care (n=20). The experimental group receives Qi therapy twice a week for 2 weeks (total 4 times), and control group received general care at the same time and the same amount of duration. We measured pain level and Profile of Mood State (POMS) to explore participants' response to Qi therapy. There was a significant reduction in pain (p<0.0001) after QT and an improved positive mood state (p<0.0001). These findings suggest that Qi therapy may have a role in helping the elderly to cope with their pain and mood disturbances.

Korean American health insurance and health services utilization

The purpose of this ethnic group study was to describe the unique pattern of Korean Americans, as compared with the aggregate of Asian Americans, for: (a) the predisposing, enabling, and need factors for health service utilization, focusing specifically on the role of health insurance coverage; and (b) predictors of health insurance coverage. Using the behavioral model for health service utilization, data were selected from the 1992 National Health Insurance Survey (NHIS, 1994) for Korean Americans (n = 345) and Asian Americans (n = 3,059). Results differed between the Korean American group and the Asian American group. Health insurance coverage was the strongest predictor of Korean American utilization, and need factors lacked significance, suggesting that uninsured Korean Americans have less access regardless of need. For the aggregate Asian American group, need factors tempered the influence of health insurance on utilization. Results of this type of study may be helpful for designing and implementing health care services tailored for specific ethnic at-risk markets.

Abnormal exploratory eye movements in schizophrenic patients vs healthy subjects

OBJECTIVE

We examined previously described exploratory eye movements abnormalities as biologic markers in schizophrenic patients in comparison with age-matched healthy subjects.

MATERIAL AND METHODS

Using an eye-mark recorder, eye movements were analysed for mean gazing time, total number of gazing points, mean eye scanning length, total eye scanning length, and total gazing times as subjects viewed six simple pictures in preparation for copying them.

RESULTS

In-patients, and to a lesser extent, out-patients, with schizophrenia showed a longer gazing time, fewer gazing points, a shorter mean and total eye scanning length. and longer gazing time than healthy subjects. In schizophrenic patients. negative symptom scores were positively correlated with mean gazing time (r = 0.33), and negatively correlated with the total number of gazing points (r = -0.29) as well as, the mean (r = -0.40) and total scanning length (r = -0.46).

CONCLUSION

Exploratory eye movements are a biologic marker useful for evaluation of schizophrenia.

Effects of emitted Qi on in vitro natural killer cell cytotoxic activity

The present study investigated the effects of Korean Qi-therapy, ChunSoo Energy Healing, on natural killer (NK) cell cytotoxicity in vitro depending on Qi-treatment time and the types of cells treated. NK cell cytotoxicity was assayed by measuring LDH release from tumor target cells (K562 cell lines). NK activity was significantly increased by emitted-Qi treatment of 30 sec duration. Three and 5 minutes of Qi projection created the greatest increase in NK cell activity when mixtures of NK cells and K562 cells were treated (1.81 and 2.12 fold for 4 hr culture; 1.54 and 1.36 for 16 hr culture, respectively). NK cell activity increased significantly in Qi-treated K562 cells alone (1.13 fold, p<0.05) compared to control. These results are consistent with in vivo Qi-therapy on humans and suggests that emitted-Qi has an acute stimulatory effect on NK cell activity. This study provides direct scientific support that Qi as such may positively affect human cellular immunity.

Sequence-selective DNA binding drugs mithramycin A and chromomycin A3 are potent inhibitors of neuronal apoptosis induced by oxidative stress and DNA damage in cortical neurons

Global inhibitors of RNA or protein synthesis such as actinomycin D or cycloheximide abrogate neuronal apoptosis induced by numerous pathological stimuli in vitro and in vivo. The clinical application of actinomycin D or cycloheximide to human neurological disease has been limited by the toxicities of these agents. To overcome these toxicities, strategies must be developed to inhibit selectively the expression of deleterious proapoptotic proteins, while leaving the expression of antiapoptotic, proregeneration, and other critical homeostatic proteins unperturbed. Mithramycin A (trade name Plicamycin) is an aureolic acid antibiotic that has been used in humans to treat hypercalcemia and several types of cancers. This class of agents is believed to act, in part, by selectively inhibiting gene expression by displacing transcriptional activators that bind to G-C-rich regions of promoters. Here we demonstrate that mithramycin A and its structural analog chromomycin A3 are potent inhibitors of neuronal apoptosis induced by glutathione depletion-induced oxidative stress or the DNA-damaging agent camptothecin. We correlate the protective effects of mithramycin A with its ability to inhibit enhanced DNA binding of the transcription factors Sp1 and Sp3 to their cognate "G-C" box induced by oxidative stress or DNA damage. The protective effects of mithramycin A cannot be attributed to global inhibition of protein synthesis. Together, these results suggest that mithramycin A and its structural analogs may be effective agents for the treatment of neurological diseases associated with aberrant activation of apoptosis and highlight the potential use of sequence-selective DNA-binding drugs as neurological therapeutics.

Cnidicin, a coumarin, from the root of Angelica koreana, inhibits the degranulation of mast cell and the NO generation in RAW 264.7 cells

Cnidicin (1) and five related coumarins were isolated from the root extract of Angelica koreana (Umbelliferae) as active principles responsible for the inhibitory effect on the degranulation process of cultured mast cells. Cnidicin (1) demonstrated a significant inhibition upon the release of beta-hexosaminidase from the cultured RBL-2H3 cells in a dose dependent manner (IC50 value, 25 microM) and upon the nitric oxide production from the activated RAW264.7 cells (IC50 value, 7.5 microM). In agreement with this, cnidicin inhibited the expression of nitric oxide synthase in RAW264.7 cells.

Usefulness of high-resolution magnetic resonance cisternography in patients with hemifacial spasm

To analyse the usefulness of preoperative magnetic resonance (MR) cisternography in patients with hemifacial spasm (HFS), MR observations were compared with surgical findings. High-definition images were obtained using MR cisternography which employed a long echo train length, fast spin-echo sequence, which revealed both nerves and blood vessels without any contrast media. In 35 HFS patients, certified radiologists examined the presence of vascular compression of the facial nerve and identified the offending vessels. MR cisternography depicted neurovascular compression in 31 patients (sensitivity 88.6%) and correctly determined the offending vessels in 28 patients. In 4 patients, MR cisternography revealed the presence of the vessel near the facial nerve, but the radiologist evaluated the compression as questionable (false-negative rate 11.4%). Even in these patients, MR cisternography revealed the precise anatomy of cerebellopontine (CP) cistern. High-resolution MR cisternography is useful in identifying the vessels and nerve bundles in the CP cistern, and in so doing can provide surgeons with valuable information regarding neurovascular decompression for HFS.

Escherichia coli strain RDEC-1 AF/R1 endogenous fimbrial glycoconjugate receptor molecules in rabbit small intestine

Escherichia coli strain RDEC-1 causes a diarrheagenic infection in rabbits with AF/R1 fimbriae, which have been identified as an important colonization factor in RDEC-1 adherence leading to disease. The AF/R1-mediated RDEC-1 adherence model has been used as a model systems for E. coli diarrheal diseases. In this study, RDEC-1 adhered specifically to small intestinal brush borders, with both sialic acid and beta-galactosyl residues apparently involved. The AF/R1-mediated adherence activity of [(14)C]-labeled RDEC-1 was analyzed quantitatively by using 24-well plates coated with purified brush borders and purified microvilli. Two microvillus membrane proteins (130 and 140 kDa) were individually isolated, and chicken antibody raised to each protein inhibited bacterial adherence. These same two proteins, previously shown to be recognized by AF/R1, were individually digested with trypsin, and the amino acid sequences of peptides were determined by reversed-phase capillary liquid chromatography-mass spectrometry tandem mass spectrometry (LC-MS). This LC-MS analysis indicated that these proteins are subunits of the rabbit sucrase-isomaltase protein (SI) complex. Guinea pig serum raised to purified rabbit SI complex inhibited bacterial adherence to microvilli. Additionally, as determined by high-performance thin-layer chromatography and autoradiography, RDEC-1 adhered selectively, via AF/R1 fimbriae, to a glycolipid tentatively identified as galactosylceramide (Gal beta 1-1Cer) in the lipid extract of rabbit small intestinal brush borders. RDEC-1 adherence to Gal beta 1-1Cer was partially inhibited in the presence of galactose. These combined results indicate that the endogenous receptor molecule for AF/R1 fimbriae of RDEC-1 is each individual component of the SI complex, although binding to glycolipid may be responsible for an additional adherence mechanism.

Regulation of neutrophil adhesion by pituitary growth hormone accompanies tyrosine phosphorylation of Jak2, p125FAK, and paxillin

Neutrophil adhesion is fundamentally important during the onset of inflammatory responses. The adhesion signaling pathways control neutrophil arrest and extravasation and influence neutrophil shape and function at sites of inflammation. In the present study the intracellular signaling pathways for the adhesion of human neutrophils by pituitary growth hormone (GH) were examined. Pituitary GH triggered the tyrosine phosphorylation of Janus kinase 2 (Jak2) and STAT3 in neutrophils. In addition, pituitary GH treatment resulted in the morphological changes and the tyrosine phosphorylation of focal adhesion kinase (p125FAK) and paxillin. Preincubation with genistein, a tyrosine kinase inhibitor, blocked the GH-stimulated adhesion and Jak2, STAT3, p125FAK, and paxillin phosphorylation. Confocal microscopy revealed that pituitary GH stimulates the focal localization of p125FAK, paxillin, phosphotyrosine, and filamentous actin filament into the membrane rufflings and uropods of human neutrophils. Immunoprecipitation experiments revealed a physical association of Jak2 with p125FAK via STAT3 in vivo. Also an in vitro kinase assay showed an augmentation of p125FAK autophosphorylation as a result of pituitary GH treatment. These results suggest that pituitary GH modulates neutrophil adhesion through tyrosine phosphorylation of Jak2, p125FAK, and paxillin and actin polymerization.

Modified partial hyperfractionation in radiotherapy for bulky uterine cervical cancer: reduction of overall treatment time

PURPOSE

The purpose of this study was to assess the feasibility and toxicity of modified fractionation of external beam radiation with the intention of reducing the overall treatment time (OT) by 1 week in cervical cancer.

METHODS AND MATERIALS

Thirty-one patients (Group 1, n = 31) with bulky cervical cancer (>/= 4 cm with Stage II and III, >/= 5 cm with Stage IB2) were entered into the twice a day (b.i. d.) protocol (18 Gy/10 fx in 2 weeks followed by 18 Gy/12 fx, b.i.d. in 6 days, then midline block at 36 Gy with 45 Gy to the whole pelvis and 51-59 Gy to the parametrium). These patients underwent high-dose-rate brachytherapy with 4 Gy/fx x 7 to point A, biweekly. During the same period, patients with non-bulky tumors (Group 2, n = 31) received conventional treatment and similar brachytherapy.

RESULTS

The OT of Group 1 was 7 weeks or less in 61.3%, 7.1-8 weeks in 29%, and more than 8 weeks in 9.7% (19.4%, 51.6%, and 29% in Group 2, respectively, p = 0.003). Incidences of acute complications and treatment breaks were similar in both groups. Late complication (rectal bleeding) occurred only in Group 1 (13%, 4/31), but was self-limited. Locoregional failures occurred within 2 years after completion of radiation therapy in both groups (16% and 13% in Group 1 and 2, respectively, with minimum and median follow-ups of 2 years and 34 months).

CONCLUSION

Partial hyperfractionation on the third week of radiation permitted patients to finish their treatment with shorter OT without excessive acute complications and with acceptable grade 2 late rectal bleeding complications. This treatment scheme may be an effective method for the improvement of local control of bulky cervical cancer.

Modulation of neuroendocrinological function by psychosomatic training: acute effect of ChunDoSunBup Qi-training on growth hormone, insulin-like growth factor (IGF)-I, and insulin-like growth factor binding protein (IGFBP)-3 in men

The neuroendocrine system is regarded as the major link between the psychological state and the immune system in man. The present study was undertaken to examine the acute effect of ChunDoSunBup Qi-training, a traditional psychosomatic training, on the plasma level of growth hormone (GH), insulin-like growth factor (IGF)-I and insulin like growth factor binding protein (IGFBP)-3 in young men. To characterize the plasma level of hormones and the pattern of IGFBP-3 at pre- (-10 min), mid-time (40 min), and immediately after (post-time, +10 min) Qi-training, radioimmunoassay (RIA) and western ligand blot (WLB) analysis were used. The plasma level of GH at the mid-time was significantly increased (P<0.05) compared to the level at pre-time of Qi-training. The plasma level of IGF-I was also increased at mid-time (P<0.05) and immediately after Qi-training. There was a significant correlation between the levels of GH and IGF-I immediately after Qi-training (r=0.69, P<0.01). In this study, the change of IGFBP-3 among the several IGFBPs was determined. There was a relative shift in IGFBP-3 for the 43-kDa fraction during mid-time of Qi-training (P<0.05). These results suggest that Qi-training influences the growth hormone, IGF-I and IGFBP-3 status via brain-target organ axis in men.

Effect of Qi-training on blood pressure, heart rate and respiration rate

To examine the physiological effects of Korean traditional Qi-training, we investigated the changes in blood pressure, heart and respiratory rates before, during and after ChunDoSunBup (CDSB) Qi-training. Twelve normal healthy CDSB Qi-trainees (19-37 years old; trained for 1.3 +/- 0.2 years; 9 men and 3 women) volunteered to participate in this study. Heart rate, respiratory rate, systolic blood pressure and rate-pressure product were significantly decreased during Qi-training. From these results, we suggest that CDSB Qi-training has physiological effects that indicate stabilization of cardiovascular system.

A simple technique for neurovascular decompression of the cranial nerves

Various synthetic materials and plastic adhesives are used for neurovascular decompression, but they may have some adverse effects on nervous tissue. We used fibrin glue alone for neurovascular decompression and obtained excellent results without complications or recurrence, compared with the previous technique with a prosthesis or plastic adhesive.

A Minnesota multiphasic personality inventory profile of ChunDoSunBup qi-trainees: a preliminary study

The aim of this study is to explore the effects of ChunDoSunBup Qi-training on personality traits. Twenty-six normal healthy subjects (mean age = 26.58 +/- 6.56) and 26 CDSB Qi-trainees (mean age = 27.74 +/- 5.21) participated in this study. Analysis of MMPI profiles showed that CDSB Qi-trainees scored significantly lower on Depression (D), Hysteria (Hy), Paranoia (Pa), Schizophrenia (Sc) and Frequency (F) and significantly higher on the Correction (K) Scales. In addition, CDSB Qi-trainees reported a significantly lower Cook-Medley Hostility (Ho) scale than that of controls. This preliminary study suggests that CDSB Qi-training may be effective in protection as well as restoration of emotional, psychological symptomatology and personality trait disorder.

Aneurysm of persistent primitive hypoglossal artery

A patient with a ruptured intracranial aneurysm of the right persistent primitive hypoglossal artery is described. Clipping of the aneurysmal neck was achieved by a far lateral approach together with drilling of the jugular tubercle, and it was concluded that this approach should be followed for safe and complete clipping.

One-stage removal of a large dumb-bell-shaped cervical neurinoma without laminectomy or interbody fusion in a child

A 12-year-old boy had a large dumb-bell-shaped cervical neurinoma originating at the C5 spinal root that was removed in a one-stage operation through the enlarged C4/5 intervertebral foramen. This technique required no laminectomy, discectomy or interbody fusion, which may frequently produce spinal deformity in children.

Protection from oxidative stress-induced apoptosis in cortical neuronal cultures by iron chelators is associated with enhanced DNA binding of hypoxia-inducible factor-1 and ATF-1/CREB and increased expression of glycolytic enzymes, p21(waf1/cip1), and erythropoietin

Iron chelators are pluripotent neuronal antiapoptotic agents that have been shown to enhance metabolic recovery in cerebral ischemia models. The precise mechanism(s) by which these agents exert their effects remains unclear. Recent studies have demonstrated that iron chelators activate a hypoxia signal transduction pathway in non-neuronal cells that culminates in the stabilization of the transcriptional activator hypoxia-inducible factor-1 (HIF-1) and increased expression of gene products that mediate hypoxic adaptation. We examined the hypothesis that iron chelators prevent oxidative stress-induced death in cortical neuronal cultures by inducing expression of HIF-1 and its target genes. We report that the structurally distinct iron chelators deferoxamine mesylate and mimosine prevent apoptosis induced by glutathione depletion and oxidative stress in embryonic cortical neuronal cultures. The protective effects of iron chelators are correlated with their ability to enhance DNA binding of HIF-1 and activating transcription factor 1(ATF-1)/cAMP response element-binding protein (CREB) to the hypoxia response element in cortical cultures and the H19-7 hippocampal neuronal cell line. We show that mRNA, protein, and/or activity levels for genes whose expression is known to be regulated by HIF-1, including glycolytic enzymes, p21(waf1/cip1), and erythropoietin, are increased in cortical neuronal cultures in response to iron chelator treatment. Finally, we demonstrate that cobalt chloride, which also activates HIF-1 and ATF-1/CREB in cortical cultures, also prevents oxidative stress-induced death in these cells. Altogether, these results suggest that iron chelators exert their neuroprotective effects, in part, by activating a signal transduction pathway leading to increased expression of genes known to compensate for hypoxic or oxidative stress.

An arachnoid cyst involving only the hypoglossal nerve: case report and review of the literature

We describe a patient with an arachnoid cyst, possibly of traumatic origin, at the hypoglossal canal producing atrophy of the tongue. An arachnoid cyst should be considered in the differential diagnosis of any patient with a localized cystic mass around the cranial nerves at the base of the skull.

Effects of ChunDoSunBup Qi-training on growth hormone, insulin-like growth factor-I, and testosterone in young and elderly subjects

We observed the response of plasma growth hormone (GH), insulin-like growth factor-I (IGF-I) and testosterone (T) to an acute period of ChunDoSunBup (CDSB) Qi-training. Although the basal level of GH was not different between the two groups, after the portion of the training in which the subjects were physically active (the mid-training point), plasma GH levels increased by 7.26 fold (p < 0.05) in the elderly trainees and by 1.66 fold (p < 0.05) in the young. In response to CDSB Qi-training, IGF-I levels in the young increased significantly at mid-training point, but there were no increase in the elderly. Significant correlations existed between GH and IGF-I levels in the young subjects, but not in the elderly. The T level at the mid-training point increased significantly in elderly subjects but not in the young. These results suggest that CDSB Qi-training is a potential method for modulating of the secretion of growth factor in the young and the elderly, but that the elderly IGF-I response does not equal that of the young. In addition, our study suggests CDSB Qi-training may be one mode of therapy applicable to growth factor related disorders such as GH deficiency in children and osteoporosis in the elderly, especially women.

Eighteen-year survival of a patient with malignant pleomorphic xanthoastrocytoma associated with von Recklinghausen neurofibromatosis

The authors report the first adult case of pleomorphic xanthoastrocytoma associated with neurofibromatosis-1. A 40-year-old man with history of neurofibromatosis-1 underwent total removal of a right temporo-parietal superficial glioma followed by radiation therapy. Eighteen years after surgery, the patient remained well with no tumour recurrence, which prompted review of the surgical material. The diagnosis of pleomorphic xanthoastrocytoma was then made though the tumour exhibited malignant features histologically, with marked necrosis. This extremely good clinical outcome suggest that some astrocytoma tumours in patients with neurofibromatosis might be associated with a favourable prognosis.

Neurovascular compression syndrome of the eighth cranial nerve. Can the site of compression explain the symptoms?

Considerable skepticism still exists concerning the concept of neurovascular compression (NVC) syndromes of the eighth cranial nerve (8th N). If such syndromes exist, the sites of compression of the nerve must explain the symptoms encountered. We recorded compound action potentials of the cochlear nerve (CCAPs) during neurovascular decompression (NVD) to examine the topography of the three components of the 8th N. The sites of compression of the 8th N in cases of NVC syndrome confirmed at surgery were superimposed on the topography of the CN and vestibular nerve (VN) in order to determine the relationship between the sites of compression and the symptoms. CCAPs were clearly and consistently recorded on the caudal surface of the 8th N along the midline. In patients with vertigo and tinnitus there was vascular compression of the rostroventral (VN) and caudal surface (CN) of the nerve, respectively. In patients with both vertigo and tinnitus, there was compression of both VN and CN. Our findings clearly demonstrate that the symptoms of NVC of the 8th N depend on the part of the nerve that is compressed by blood vessels, and they support the concept of NVC syndrome of the 8th N.

Potentiation of cholecystokinin and secretin-induced pancreatic exocrine secretion by endogenous insulin in humans

To investigate the effects of endogenous insulin on pancreatic exocrine secretion in humans, we evaluated the pure pancreatic juice obtained by endoscopic cannulation of the main pancreatic duct in 21 healthy subjects (14 men and seven women). Samples of pancreatic juices were collected after intravenous injection of either glucose (50%, 40 ml), secretin (0.25 CU/kg), and cholecystokinin-8 (CCK) (40 ng/kg), or a combination of glucose, secretin, and CCK in six 5-min periods. The responses of plasma glucose, insulin, and C-peptide to intravenous administration of glucose were measured. After infusion of glucose, the plasma insulin and C-peptide levels were significantly increased and remained at high levels during 30-min experiments, intravenous administration of secretin and CCK resulted in significant increases of pancreatic secretion including volume, bicarbonate, and protein output. When glucose was simultaneously administered with secretin and CCK, pancreatic secretion was significantly increased, more than the effects achieved by the secretin and CCK. However, glucose alone did not increase basal pancreatic secretion. These observations suggest that endogenous insulin intensifies pancreatic secretion stimulated by secretin and CCK in humans.

Magnetic resonance cisternography used to determine precise topography of the facial nerve and three components of the eighth cranial nerve in the internal auditory canal and cerebellopontine cistern

OBJECT

The detailed anatomy of intracranial structures has been studied mainly in cadavers, but the absence of cerebrospinal fluid and blood pressure in these models distorts normal spatial relationships. The authors investigated the rotation of the facial nerve (FN), superior vestibular nerve (SVN), inferior vestibular nerve (IVN), and cochlear nerve (CN) in the internal auditory canal (IAC) and cerebellopontine cistern in human volunteers and compared their results with those reported in cadaver studies.

METHODS

The IACs and cerebellopontine cisterns of 30 normal adults (34 sides) were examined using magnetic resonance (MR) cisternography with a heavily T2-weighted two-dimensional fast spin-echo technique. The positions of the four components were unaffected by the presence of the meatal loop of the anterior inferior cerebellar artery in the IAC. The spatial relationship between the FN and SVN was quite constant, but the spatial relationship between the CN and SVN was quite variable: the former changed position, mainly in the IAC, on nine (26.5%) of 34 sides, and in the cerebellopontine cistern on the other sides (73.5%), conflicting with findings in cadaver studies.

CONCLUSIONS

It is more accurate to describe the CN and IVN as coursing beneath the SVN in either the IAC or cerebellopontine cistern, rather than stating that the three components rotate, as reported in cadaver studies. The MR cisternography studies provided quite detailed information about the topography of the four components and the relationship between the blood vessels and cranial nerves in the IAC and the cerebellopontine cistern.

Neurovascular decompression for trigeminal neuralgia in elderly patients

The operative findings and outcomes of neurovascular decompression for trigeminal neuralgia were compared between patients aged 75 years and older (elderly group, 17 patients) and patients aged under 75 years (nonelderly group, 115 patients). There were no statistically significant differences in the operative findings or outcomes between the two groups, except in the percentage of patients who had been treated with carbamazepine. Neurovascular decompression for trigeminal neuralgia can be performed in elderly patients with the same operative results as in nonelderly patients. If other treatments (especially carbamazepine treatment) prove ineffective, neurovascular decompression should be considered in elderly patients before they become too old to undergo surgery. However, neurovascular decompression in elderly patients requires great care, as the venous system, including the superior petrosal vein, should be preserved and retraction of the cerebellum should be avoided whenever possible to maintain correct blood circulation in the cerebellum and brainstem.

Neurovascular compression syndrome of the eighth cranial nerve. What are the most reliable diagnostic signs?

Forty-three surgical cases were retrospectively analyzed to establish diagnostic criteria and operative indications for vertigo and tinnitus due to neurovascular compression (NVC) of the eighth cranial nerve (8th N). Many NVC syndromes were mistakenly diagnosed as Ménière's disease or benign paroxysmal positional vertigo. NVC was confirmed in 31 of the 43 patients. Neurovascular decompression (NVD) resulted in complete recovery or marked improvement of subjective symptoms in all 19 cases with vertigo (100%), and in 19 of 29 patients with tinnitus (65.5%). Multiple factor analysis revealed that abnormal caloric responses have high diagnostic value for vertigo due to NVC. Vertigo due to NVC is of short duration (a few sec to a few min.) in the early phase of the disease, which becomes longer and hearing becomes impaired as the history of NVC lengthens. Low pitch pulsatile and high pitch continuous tinnitus are probably due to NVC and are cured by NVD if hearing is still preserved. Tinnitus associated with hemifacial spasm is strongly indicative of NVD. Decompression of the 8th N should be performed in the early phase of disease, since cochlear and vestibular functions are irreversibly impaired if NVC continues for a long period of time.

Atypical hemifacial spasm

Among 155 cases of hemifacial spasm (HFS), the authors found two cases of atypical HFS (1.3%) in which spasm started with the orbicularis oris and buccinator muscles, and gradually spread upward to involve the orbicularis occuli muscle, whereas the reverse process is usually seen in cases of typical HFS. The compression site in cases of atypical HFS is the posterior/rostral aspect of the facial nerve (FN), whereas it was the anterior/caudal aspect of the FN in all cases of typical HFS except for one. The meatal loop of the anterior inferior cerebellar artery (AICA) compressed the FN when the vessel passed between the FN and the eighth cranial nerve (8th N). These findings suggest that the topographical organization in the FN in the cerebellopontine cistern may be reversed to a peripheral distribution: the fibres on the posterior/rostral side of the FN innervate the lower part of the facial muscles, and those in the anterior/caudal side of the nerve innervate the upper part of the facial muscles. When examining patients with HFS, we must very carefully determine whether patients have typical or atypical HFS, to determine whether blood vessels (usually the meatal loop of the AICA) between the FN and the 8th N as well as at the root exit zone of the FN are to be decompressed.

Acute effects of chundosunbup qi-training on blood concentrations of TSH, calcitonin, PTH and thyroid hormones in elderly subjects

The present study investigated how the systemic treatment of a programmed exercise, ChunDoSunBup (CDSB) Qi-training, affects the secretion of thyroid and parathyroid hormones in elderly subjects (10 male and 5 female). Plasma concentrations of thyroid stimulating hormone (TSH), triiodothyronine (T3), thyroxine (T4), parathyroid hormone (PTH), ionized calcium, and calcitonin were determined. CDSB Qi-training induces a slight increase in TSH. Both T4 and T3 were increased at the mid-time of CDSB Qi-training (p < 0.05). There were significant correlations only between T3 and T4 at mid-training. This shows that increase in the plasma level of T3 was associated with the secretion of T4. The plasma concentrations of calcitonin and PTH were increased at mid-time and post-time of CDSB Qi-training. But ionized calcium was decreased slightly by CDSB Qi-training. These results suggest that Qi-training modulates the secretion of thyroid hormones, calcium metabolism, and parathyroid hormones in the elderly. However, whether the long-term practice of CDSB Qi-training might change bone metabolism and have longitudinal effects on the thyroid hormone of the elderly need further investigation.

Effects of chundosunbup Qi-training on psychological adjustments: a cross-sectional study

This cross-sectional investigation evaluated the trend of psychological changes by ChunDoSunBup (CDSB) Qi-training using a self-report inventory of emotional distress, Symptom Check List-90-Revision (SCL-90-R). 41 normal healthy subjects (mean age = 20.98 +/- 5.39) and 123 CDSB Qi-trainees (divided into three groups, Q1, Q2 and Q3) participated in this study. Group Q1 has received 1-4 months CDSB Qi-training (age 21.95 +/- 7.82, n = 41); Q2 has 5-12 months Qi-training (age 20.0 +/- 7.75, n = 41); and Q3 has more than 13 months Qi-training (age 22.68 +/- 6.72, n = 41). Our results show that Qi-trainees over 13 months had significantly lower scores compared to controls. A significant negative correlation was found between the Qi-training period and all SCL-90-R subscales except phobic anxiety. These results suggest that CDSB Qi-training is effective in protection as well as reduction of psychological symptomatology.

Hemifacial spasm caused by vascular compression of the distal portion of the facial nerve. Report of seven cases

It is generally accepted that hemifacial spasm (HFS) and trigeminal neuralgia are caused by compression of the facial nerve (seventh cranial nerve) or the trigeminal nerve (fifth cranial nerve) at the nerve's root exit (or entry) zone (REZ); thus, neurosurgeons generally perform neurovascular decompression at the REZ. Neurosurgeons tend to ignore vascular compression at distal portions of the seventh cranial nerve, even when found incidentally while performing neurovascular decompression at the REZ of that nerve, because compression of distal portions of the seventh cranial nerve has not been regarded as a cause of HFS. Recently the authors treated seven cases of HFS in which compression of the distal portion of the seventh cranial nerve produced symptoms. The anterior inferior cerebellar artery (AICA) was the offending vessel in five of these cases. Great care must be taken not to stretch the internal auditory arteries during manipulation of the AICA because these small arteries are quite vulnerable to surgical manipulation and the patient may experience hearing loss postoperatively. It must be kept in mind that compression of distal portions of the seventh cranial nerve may be responsible for HFS in cases in which neurovascular compression at the REZ is not confirmed intraoperatively and in cases in which neurovascular decompression at the nerve's REZ does not cure HFS. Surgical procedures for decompression of the distal portion of the seventh cranial nerve as well as decompression at the REZ should be performed when a deep vascular groove is noticed at the distal site of compression of the nerve.

Neurovascular decompression of the eighth cranial nerve in patients with hemifacial spasm and incidental tinnitus: an alternative way to study tinnitus

OBJECT

The authors sought to clarify the clinical characteristics of tinnitus resulting from neurovascular compression (NVC) of the eighth cranial nerve.

METHODS

The authors explored the eighth cranial nerve in the cerebellopontine cistern during neurovascular decompression (NVD) of the facial nerve in 10 patients with hemifacial spasm who suffered from incidental tinnitus on the same side. The diagnosis of NVC of the eighth cranial nerve was confirmed in all patients. This condition was found in only seven of 114 patients with hemifacial spasm alone, indicating that NVC of the eighth cranial nerve is one of the causes of tinnitus (p < 0.001, chi-square test). The tinnitus resolved or was markedly improved after NVD of the eighth cranial nerve in eight patients (80%). Both pulsatile and continuous tinnitus responded well to NVD. All patients experienced various degrees of sensorineural hearing disturbance, but other neurotological examinations provided poor diagnostic value.

CONCLUSIONS

It is the authors' opinion that sensorineural hearing loss and positive findings on magnetic resonance imaging are the most reliable evidence for the presence of tinnitus caused by NVC of the eighth cranial nerve.

Cerebral blood flow autoregulation following subarachnoid hemorrhage in rats: chronic vasospasm shifts the upper and lower limits of the autoregulatory range toward higher blood pressures

We sought to determine whether chronic vasospasm following subarachnoid hemorrhage (SAH) would abolish the cerebral blood flow (CBF) autoregulation in anesthetized Sprague-Dawley rats. SAH was induced by intracisternal injection of autologous blood; in control animals saline was injected instead. CBF was measured 48 h after SAH, that is during chronic vasospasm, by laser-Doppler flowmetry over the frontal cortex under condition of hypertension (SAH, n = 6; control, n = 8) or hypotension (SAH, n = 6; control, n = 6). Hyper- and hypotension were induced by increasing mean arterial blood pressure (MABP) stepwise from 90 to 180 mmHg with phenylephrine (0.1-10 micrograms/min i.v.), or by decreasing it from 90 to 40 mmHg by controlled hemorrhage. An autoregulatory index (AI) expressed as delta CBF (%) per 10 mmHg increase or decrease in MABP was employed to analyze CBF response. CBF remained constant (-7 < AI < 7) at MABPs ranging from 60 to 130 mmHg in the control group and from 70 to 140 mmHg in the SAH group, showing CBF autoregulation. In the SAH group, that is, the upper and the lower limits of autoregulatory range were increased by 10 mmHg (p < 0.05). SAH did not increase intracranial pressure significantly (control 9.2 +/- 0.67 vs. SAH 10.0 +/- 1.05 mmHg, n = 5) 48 h after SAH was induced. These results indicate that, during chronic vasospasm, SAH does not abolish the autoregulation process but raises its lower and upper blood pressure limits. The capacity of spastic cerebral arteries to dilate in case of hypotension decreased, while their tolerance to hypertension increased.

Identification of new urinary metabolites of famprofazone in humans

Urinary metabolites of famprofazone following oral administration in humans were identified by gas chromatography-mass spectrometry with electron impact-ionization and comparison with the spectra and retention times of authentic standards. The metabolites were determined following selective derivatization with N-methyl-bis-trifluoroacetamide (MBTFA) and N-methyl-N-trimethyl silyl trifluoroacetamide (MSTFA). Famprofazone was rapidly and extensively metabolized by N-dealkylation, beta-hydroxylation, and p-hydroxylation. The major metabolite, representing approximately 15% of the dose, was methamphetamine. The other metabolites, which were present in minor amounts, were amphetamine, norephedrine, norpseudoephedrine, ephedrine, pseudoephedrine, p-hydroxyamphetamine, p-hydroxymethamphetamine, and p-hydroxydemethyl famprofazone.

Changes in alpha wave and state anxiety during ChunDoSunBup Qi-training in trainees with open eyes

We investigated the effects of ChunDoSunBup (CDSB) Qi-training, one of the Korean popular Qi-training systems, on EEG patterns, activation coefficients and state anxiety in 13 trainees with open eyes. CDSB Qi-training procedure consists of 3 stages: sound exercise, reciting Chunmoon, which is similar to a mantra; haeng-gong, a kind of body motion; and mediation. Compared to the control state (resting state before Qi-training), subjects reported less state anxiety, their activation coefficients decreased significantly during sound exercise and meditation in the occipital regions. Mean relative power and changes of mean absolute power of alpha wave increased significantly during sound exercise and meditation in the occipital regions. These results suggest that sound exercise and meditation in ChunDoSunBup Qi-training may reduce activation of the visual cortex and influence the thalamus and other functions of the brain. These could reduce anxiety levels and modulate the psychological, neurological, and physiological functions in man.