Influence of age and gender on human lymphatic pumping pressure in the leg

Lymph transportation is controlled, at least in part, by the intrinsic pumping of lymphatic vessels. The objectives of this study were to evaluate the influences of age and gender on leg lymphatic pumping pressure. A total of 399 subjects between the ages of 20 and 91 years (199 males and 200 females) volunteered to participate in this study. Lymphatic pumping was measured in 798 legs of the 399 participants. Indocyanine green (ICG) fluorescence lymphography was performed, and the real-time fluorescence images of lymph propulsion were obtained in a sitting position using an infrared-light camera system. A custom-made transparent sphygmomanometer cuff was wrapped around the lower leg and connected to a standard mercury sphygmomanometer. The cuff was inflated, and then gradually deflated until the fluorescent dye exceeded the upper border of the cuff. Lymph pumping pressure was defined as the value of the cuff pressure when the dye exceeded the upper border of the cuff. There was a significant correlation between the leg lymphatic pumping and age: r = -0.34 (p < 0.0001). Comparison of lymphatic pumping between males and females indicated that the age-related decrease in lymphatic pumping pressure was more marked in females of postmenopausal age.

The impact of IL28B genetic variants on recurrent hepatitis C in liver transplantation: significant lessons from a dual graft case

IL28B genetic polymorphism is related to interferon-sensitivity in chronic hepatitis C, but the significance of grafts carrying different genotypes from recipients is still unclear in liver transplantation. A 51-year-old Japanese male carrying a minor genotype underwent dual liver transplantation for liver cirrhosis due to hepatitis C virus (HCV). The left lobe graft carried a major genotype, and the right a minor genotype. He achieved virological response during the course of pegylated-interferon and ribavirin therapy against recurrent hepatitis C for 2 years, but HCV relapsed immediately at the end of the therapy. Two years after antiviral therapy, liver biopsy was performed from each graft. The specimens showed A1F0 in the left lobe graft and A2F2 in the right. Moreover, quantitative polymerase chain reaction was performed using RNA extracted from each specimen to see there was no HCV RNA in the left lobe whereas there was in the right. This case provides clear evidence that IL28B genetic variants determine interferon sensitivity in recurrent hepatitis C following liver transplantation, which could result in new strategies for donor selection or for posttransplant antiviral therapy to HCV positive recipients.

Prognostic importance of the gross classification of hepatocellular carcinoma in living donor-related liver transplantation

Background

The gross classification of hepatocellular carcinoma (HCC) has been reported to be a significant prognostic factor for patients with HCC undergoing partial hepatectomy. The present study investigated whether the gross classification of HCC is also a prognostic factor in living donor-related liver transplantation (LDLT).

Methods

Some 119 patients undergoing LDLT for HCC were identified retrospectively from a prospective institutional database containing information on all LDLTs carried out between 1996 and 2009. Patients were divided into three groups according to the gross classification of the largest tumour in the explanted liver: type 1 HCC, single nodular type (81 patients); type 2, single nodular type with extranodular growth (21); and type 3, contiguous multinodular type (17). Clinicopathological factors and recurrence-free survival rates were compared.

Results

Recurrence-free survival rates for the whole group were 87·7 per cent at 1 year, 83·5 per cent at 3 years and 81·0 per cent at 5 years after LDLT. Type 3 HCC was associated with large tumour size, poor histological grade, a high incidence of microvascular invasion and multiple tumours. Independent predictors of poor recurrence-free survival were preoperative serum level of des-γ-carboxy prothrombin exceeding 300 mAU/ml, microvascular invasion and type 3 HCC.

Conclusion

The gross classification of HCC was an independent predictor for recurrence of HCC in patients undergoing LDLT.

Painless self-monitoring of blood glucose at finger sites

INTRODUCTION

Skin punctures at alternative sites can reduce the pain associated with self-monitoring of blood glucose (SMBG). However, delays in detection of blood glucose at alternative sites during rapid systemic blood glucose change have been reported. Accordingly, we developed a novel method of finger pricking and tested it to see if it would both reduce or eliminate pain and accurately reflect systemic glucose levels, even during rapid changes.

METHODS

Each of 35 healthy volunteers (10 females and 25 males; mean age 36.6 years, range 18-82 years) received 5 serial punctures from a lancet device on randomly selected fingers. The puncture target was the dorsal side of the finger between the nail and the distal finger joint. We used a lancet device designed for accurate punctures of 0.2, 0.3, 0.4, 0.5 and 0.6 mm depths. Immediately afterward, as a control, a conventional fingertip puncture was done on the front of a 6th finger. After each puncture, subjects were asked whether or not they felt pain.

RESULTS

Following punctures at depths of 0.2 mm and 0.3 mm, respectively, 31 of 35 subjects (89%) and 33 of 35 subjects (94%) felt no pain. Following conventional punctures, all 35 subjects (100%) felt pain. Blood sample volumes> or =2microL were obtained in all cases except for two punctures at 0.2 mm depth. Blood glucose levels did not differ with differing puncture sites, (conventional fingertip sites vs. alternative sites used in this study).

CONCLUSIONS

Our findings demonstrate that 0.2 and 0.3 mm punctures at our alternative finger site - the dorsal side of the finger between the nail and the distal finger joint - can provide blood samples sufficient for SMBG, substantially redu-ces the proportion of subjects who experience pain, and accurately reflects systemic glucose levels.

Dissociation of neurological deficits in spinal decompression illness

Functional differentiation is found in the spinal cord. A unique set of neurological deficits follows a multi-focal injury. Clinically, sensory and motor disturbance present independently, often resulting in sensory and motor deficit dissociation. This study examined 103 spinal decompression illness (DCI) cases. The neurological deficit dissociation was classified as follows: 1) Cases with sensory impairment only, or motor dysfunction alone, were tagged as having "dissociation" (44 cases); when a case was with both sensory and motor dysfunction, the spinal level of the sensory impairment was determined and was matched with the spinal segments responsible for the motor dysfunction; 2) If the two spinal areas did not match (i.e. with no regional overlap), they were tagged as having "dissociation" for each motor dysfunction (32 cases). In total, dissociation was present in 76 out of 103 cases. We concluded that clinical neurological deficit dissociation is frequently observed in spinal DCI.

The validity of the mangled extremity severity score in the assessment of upper limb injuries

The Mangled Extremity Severity Score (MESS) may be used to decide whether to perform amputation in patients with injuries involving a limb. A score of 7 points or higher indicates the need for amputation. We have treated three patients with a MESS of 7 points or higher, in two of which the injured limb was salvaged. This scoring system was originally devised to assess injuries to the lower limb. However, a MESS of 7 points as a justification for amputation does not appear appropriate when assessing injuries to the major vessels in the upper limb.

Motor learning of hands with auditory cue in patients with Parkinson’s disease

In the present research, changes in motor cortex function were observed in relation to repetitive, voluntary thumb movement (training) in patients with Parkinson's disease (PD) and normal control subjects. Changes in the direction of thumb movement due to motor evoked potential (MEP) by transcranial magnetic stimulation (TMS), after motor training with and without rhythmic sound, were measured using a strain gauge for 12 patients with PD and 9 normal control subjects. PD patients who experienced the freezing phenomena showed poor change in direction of TMS-induced movement after self-paced movement; however, marked change in direction of TMS-induced movement was observed after training with auditory cue. PD patients who had not experienced the freezing phenomena showed positive effects with the auditory cue, producing similar results as the normal control subjects. Two routes for voluntary movement are available in the nervous system. The decreased function of basal ganglia due to PD impaired the route from the basal ganglia to the supplementary motor cortex. These data suggest that the route from sensory input to cerebellum to premotor cortex could compensate for the decreased function of the route via the basal ganglia to the premotor cortex. Once change in the motor cortex occurred, such change persisted even after the interruption of training. These phenomena suggest that motor memory can be stored in the motor cortex.

Neurological manifestations in Japanese Ama divers

Repetitive breath-hold (BH) diving can lead to accumulation of nitrogen (N2) in blood and tissues, which may give rise to decompression illness (DCI). An unusual condition is "Taravana", the diving syndrome reported by Cross in the 1960s. That report generated wide discussion as to whether BH diving can cause DCI. Paulev was the first person to suggest the link between DCI and BH diving. He, a submarine medical officer developed symptoms of DCI after a series of BH dives, having proceeded the dives by spending time in a hyperbaric chamber at 20 meters for 8 minutes. Recently four professional Japanese BH divers (Ama) with histories of diving accidents were reported. Magnetic resonance imaging of these divers detected cerebral infarcts localized in the watershed areas of the brain. A survey conducted on their island revealed that many Ama divers had experienced stroke-like events. A clinical feature of DCI in BH diving is that the damage is limited to the brain. Although the mechanisms of brain damage in BH diving are unclear, N2 bubbles passing through the lungs or the heart so as to become arterialized are most likely to be the etiological factor.

High-density AFLP map of nonbrittle rachis 1 (btr1) and 2 (btr2) genes in barley (Hordeum vulgare L.)

Wild relatives of barley disperse their seeds at maturity by means of their brittle rachis. In cultivated barley, brittleness of the rachis was lost during domestication. Nonbrittle rachis of occidental barley lines is controlled by a single gene (btr1) on chromosome 3H. However, nonbrittle rachis of oriental barley lines is controlled by a major gene (btr2) on chromosome 3H and two quantitative trait loci on chromosomes 5HL and 7H. This result suggests multiple mutations of the genes involved in the formation of brittle rachis in oriental lines. The btr1 and btr2 loci did not recombine in the mapping population analyzed. This result agrees with the theory of tight linkage between the two loci. A high-density amplified fragment-length polymorphism (AFLP) map of the btr1/btr2 region was constructed, providing an average density of 0.08 cM/locus. A phylogenetic tree based on the AFLPs showed clear separation of occidental and oriental barley lines. Thus, barley consists of at least two lineages as far as revealed by molecular markers linked to nonbrittle rachis genes.

Identification and mapping of cleistogamy genes in barley

Cleistogamy is a closed type of flowering with ensured self-pollination and an important trait to study evolutionary development in flower organs, reproduction systems, gene flow, and disease control. Still, very limited information is available about the genetic control and regulatory mechanism of this trait in barley. In this work, from the eight crosses between cleistogamous and chasmogamous accessions, five crosses generated chasmogamous F1 plants and their F2 plants segregated as 3 chasmogamous:1 cleistogamous, whereas three crosses generated cleistogamous F1 plants, and their F2 plants segregated as 1 chasmogamous:3 cleistogamous. Although a single gene was responsible for the control of cleistogamy in these two groups of crosses, the direction of dominance was opposite, suggesting two genes, cly1 and Cly2, for the genetic control of cleistogamy in barley. Epistatic type of gene interaction between the two loci was detected. In the analysis of 99 recombinant inbred lines of 'Azumamugi' x 'Kanto Nakate Gold' and doubled haploid lines of 'Harrington' x 'Mikamo Golden', where in both crosses F1 was chasmogamous, the cly1 locus has been mapped on chromosome 2HL. Using the analysis of the F2 population of 'Misato Golden' and 'Satsuki Nijo' where F1 was cleistogamous, the Cly2 locus was mapped in the same region of chromosome 2HL. Because the cly1 and Cly2 loci were mapped in the same region in these three different mapping populations, it was concluded that the expression of cleistogamy is under the control of two tightly linked genes or different alleles of the same gene.

Induction of cyclooxygenase-1 in cultured synovial cells isolated from rheumatoid arthritis patients

OBJECTIVE AND DESIGN

The aim of this study was to confirm the involvement of cyclooxygenase (COX)-1 in rheumatoid arthritis (RA).

MATERIALS AND SUBJECTS

Synovial cells isolated from arthritic patients were cultured primarily and consecutively for 8 passages.

TREATMENT

The cultured synovial cells were incubated with 10 ng/ml of interleukin-1alpha (IL-1alpha) for 6 h.

METHODS

The effects of either COX-1 or COX-2 selective inhibitor on prostaglandin E2 (PGE2) production was estimated by enzyme-linked immunosorbent assay (ELISA) and the expression of COX-1 and COX-2 were determined by Western blotting and immunocytochemistry.

RESULTS

IL-1alpha-induced PGE2 production in synovial cells isolated from RA in primary culture was inhibited by mofezolac, a selective inhibitor of COX-1, as well as NS-398, a specific inhibitor of COX-2. The similar inhibitory patterns were obtained in the RA-derived synovial cells within 3 passages. However, COX activity in the RA-derived synovial cells after 5 passages was inhibited by NS-398, but not by mofezolac. In contrast, COX activity in primary and consecutively cultured synovial cells isolated from osteoarthritis (OA) or normal arthritis was inhibited by NS-398, but not by mofezolac. Western blot and immunocytochemical analyses of COX-1 and COX-2 in the synovial cells isolated from RA patients within 3 passages showed an induction in both COX-1 and COX-2 expression by IL-1alpha. The induction of both COX-1 and COX-2 was inhibited by dexamethasone.

CONCLUSIONS

These experiments demonstrate COX-1 induction in synovial cells isolated from RA patients, suggesting that COX-1 is involved in the progression of RA.

Evaluation of HBO2 therapy in pneumatosis cystoides intestinalis

Pneumatosis cystoides intestinalis (PCI) is a disease characterized by retention of gas in the intestinal wall. Retention of gas can be caused by three mechanisms; gas entry through the intestinal mucosa, gas dissection from the pulmonary alveoli and bronchi, and gas generation in the mucous membrane. Since gas in cysts is composed almost entirely of nitrogen, hyperbaric oxygen therapy (HBO2) is effective for treating PCI due to the oxygen windows effect. However, PCI, caused by a mechanism involving pulmonary alveoli or branches, can become aggravated by HBO2. Therefore, we propose modifying HBO2 protocols for cases that do not require an invasive treatment. This study describes favorable results obtained in 2 PCI cases after HBO2 therapy according to our protocol.

Decompression sickness and recreational scuba divers

OBJECTIVES

The aim of this study is to clear the status of recreational scuba divers in Japan for promoting safety in recreational diving.

METHODS

A five year (from 1996 to 2001) questionnaire survey was performed of Japanese divers at the Osezaki area in Japan. The subjects of this survey included diving instructors as well as recreational divers. Based on the obtained data, the study investigated the theory predicted incidence of decompression sickness (DCS) among Japanese recreational divers.

RESULTS

The average (SD) of the maximum depth for diving was 37.4 (13.1) metres, which was deeper than the recommended depth of recreational diving. The incident rate of nitrogen narcosis (12%) was the most frequent, followed by barotraumas of the ear (11%) and barotraumas of the paranasal sinus (5.6%). The rate of DCS was 1.9 % (60 divers) during investigated period, and that DCS occurred once per 19 011 dives in calculation.

CONCLUSIONS

This investigation showed that the status of leisure diving in Japan is still serious, because DCS would be expected to occur once a weekend in Japan. It is speculated that many divers may develop DCS while moving through high altitudes after diving, particularly at the Osezaki diving spot in Japan. Based on the results of this study, it is emphasised that every Japanese leisure diver should take an increasing interest in the safety of diving activity.

Cortical reorganization in training

Plasticity within the human central motor system occurs and has been studied with transcranial magnetic stimulation in patients with amputations, spinal cord injuries, and ischemic nerve block. These studies have identified a pattern of motor system reorganization that results in enlarged muscle representation areas and large motor evoked potentials (MEPs) for muscles immediately proximal to the lesion. Some of these changes are apparent minutes after ischemic nerve block, weeks after spinal cord injury, and as early as six months after amputation.These studies motivated us to study the cortical motor reorganization after finger movement training in normals and after anastomosis of intercostal nerves to the musculocutaneous nerve in young patients with cervical root avulsions due to a traumatic motorcycle injury.

Development of myopia as a hazard for workers in pneumatic caissons

BACKGROUND/AIM

Pneumatic caisson engineering has been developed for large civil engineering constructions. Because of complaints of blurred vision by personnel working in pneumatic caissons, the development of myopia was suspected. The aim of this study was to determine the cause of the blurred vision and the mechanism underlying the changes.

METHODS

12 caisson workers underwent a complete ophthalmological examination after completing up to 11 weeks of work (4 days/week) in a pneumatic caisson. Six months later, nine of the workers were examined again.

RESULTS

Nine subjects were myopic at the initial examination, and seven of these were considered to have developed the myopia after starting to work in the pneumatic caisson. Six months after completion of the work, the mean refractive change was significantly towards hyperopia.

CONCLUSIONS

The blurred vision in pneumatic caisson workers was in all likelihood due to the development of myopia. The refractive shift towards hyperopia after completion of work in the pneumatic caisson supports this and demonstrates that the changes were temporary. The myopia is similar to the myopia seen in patients treated by hyperbaric oxygen. Careful monitoring of the refraction of caisson workers should be performed for industrial health control.

Identification of QTLs controlling tissue-culture traits in barley ( Hordeum vulgare L.)

Quantitative trait loci (QTLs) controlling callus growth (CG), subsequent shoot differentiation ratio (SD) and green shoot ratio (GS) in immature embryo culture were identified in barley. A base map was developed from 99 recombinant inbred lines (RILs) of 'Azumamugi' x 'Kanto Nakate Gold'. The tissue-culture traits were evaluated at the F(7) and F(10) generations of the RILs. The RILs showed wide and continuous variations in each of the three tissue-culture traits. Three QTLs for CG, three QTLs for SD and two QTLs for GS were detected by using composite interval mapping. A QTL for SD on chromosome 3H had a large effect, and 'Kanto Nakate Gold', which has a high differentiation ability, contributed to this QTL. The location of this QTL is identical to, or very close to, the uzu locus. We discuss the relationships between tissue-culture loci in 'Azumamugi' x 'Kanto Nakate Gold' and those in other mapping populations.

Molecular mapping of the intermedium spike-c ( int-c) and non-brittle rachis 1 ( btr1) loci in barley ( Hordeum vulgare L.)

Lateral spikelet fertility and a non-brittle rachis are key characters in studying the evolution of barley. The fertility of lateral spikelets is controlled predominantly by the alleles at the vrs1 locus on chromosome 2HL and is modified by the alleles at the int-c locus on chromosome 4HS. The non-brittle rachis is controlled by alleles at two tightly linked loci, btr1 and btr2, on chromosome 3HS. This paper presents the integration of the int-c and btr1 loci in molecular linkage maps of barley. The int-c locus was mapped to the end of chromosome 4HS, 8.2 cM distal from the MWG2033 locus. The analysis was followed by a composite interval mapping of quantitative trait loci, which verified the position of the int-c locus. Linkage analysis using recombinant inbred lines showed that the btr1 locus is flanked between two AFLP loci, e14m27.4.1 and e15m19.7, with map distances of 3.1 cM and 4.2 cM, respectively. The molecular markers will expedite further high-density mapping of the int-c and btr1 loci.

The assessment of posture control in the elderly using the displacement of the center of pressure after forward platform translation

We investigated the change of the center of pressure (COP) after forward platform translations in healthy subjects. These studies were performed on 26 normal young subjects and 20 healthy elderly subjects, who had a normal neurologic examination. Subjects stood barefoot on a three dimensional force plate on the platform, with feet parallel. The duration of the forward platform translations was 0.15s, and the displacements were 3.75, 7.5, 10, 15, 20, and 30 mm. Six trials were carried out at random. The COP data were recorded for 35s during standing, and were analyzed for 5s after translation. With the platform translation displacements from 3.75 to 15 mm, displacement of the COP showed a tendency to increase in all subjects. Whereas with the stimuli between 20 and 30 mm, the results were more varied. The elderly group showed significantly (p<0.05) larger sway than the young group. These results indicate that the individual ability of posture control may be assessed by means of measuring the sway of the center of gravity after platform translation. Electromyography was carried out simultaneously, it showed that elderly people contrary to young subjects used proximal biceps femoris and distal foot muscles at an early stage of the platform translation (p<0.05), suggesting lack of ankle stability with aging.