Comparison of (123)I-MIBG myocardial scintigraphy, brain perfusion SPECT, and voxel-based MRI morphometry for distinguishing between dementia with Lewy bodies and Alzheimer's disease

OBJECTIVE

This study aimed to compare the diagnostic value of (123)I-metaiodobenzylguanidine (MIBG) myocardial scintigraphy, N-isopropyl-p[(123)I]iodoamphetamine (IMP) brain perfusion single-photon emission computed tomography (SPECT), and brain magnetic resonance imaging (MRI) voxel-based morphometry (VBM) for the differentiation of dementia with Lewy bodies (DLB) and Alzheimer's disease (AD).

METHODS

Thirty-five and 34 patients with probable DLB and probable AD, respectively, were enrolled. All patients underwent (123)I-MIBG myocardial scintigraphy, (123)I-IMP brain perfusion SPECT, and brain MRI. For (123)I-MIBG imaging, we calculated early and delayed heart-to-mediastinum (H/M) uptake ratios. Three-dimensional stereotactic surface projections (3D-SSP) were used to analyze the results of (123)I-IMP SPECT. VBM with statistical parametric mapping 8 plus diffeomorphic anatomical registration using exponentiated Lie algebra (DARTEL) was used to analyze the brain MRI data.

RESULTS

The area under the receiver operating characteristic curves (AUC) for discriminating DLB and AD was highest (0.882) for the delayed H/M ratio on (123)I-MIBG scintigraphy. AUC for z-score measurement in the occipital lobe was 0.818 and that for the extent of gray matter (GM) atrophy in the whole brain was 0.788. AUC for the combination of 3D-SSP and VBM analysis was 0.836. The respective sensitivities and specificities for distinguishing DLB from AD were 97.1 and 100 % for the delayed H/M ratio using (123)I-MIBG scintigraphy; 88.6 and 73.5 % for the occipital lobe z-score using 3D-SSP analysis; 85.7 and 64.7 % for the extent of whole brain GM atrophy using voxel-based MRI morphometry; and 91.4 and 76.5 % for the combination of 3D-SSP analysis and VBM.

CONCLUSIONS

(123)I-MIBG myocardial scintigraphy was superior to brain perfusion SPECT and brain MRI using an advanced statistical technique to differentiate DLB and AD.

Three presenile patients in which neuropsychological and neuroimaging examinations suggest possible progression to dementia with Lewy bodies

We report three presenile patients who were initially suspected of having Alzheimer's disease (AD) or being in the prodromal stage of AD, regardless of visuoperceptual dysfunctions in daily living, because they lacked the core features and prodromal non-motor symptoms of dementia with Lewy bodies. Subsequently, progression to dementia with Lewy bodies was suspected based on neuropsychological and neuroimaging findings; additionally, one of the three patients suffered from visual hallucinations. Neuropsychological examinations such as subjective contours, cube copying and block design in the Wechsler Adult Intelligence Scale-III revealed visuoperceptual dysfunction in all three patients even when other cognitive functions were rather preserved. Brain magnetic resonance imaging revealed no significant brain atrophy, including in the parieto-occipital area and the hippocampus, while brain (18)F-fluorodeoxyglucose positron emission tomography demonstrated right dominant metabolic reductions in the occipital lobe, including the primary visual cortex, in all three patients. We suggest the possibility of progression to dementia with Lewy bodies, but not AD or posterior cortical atrophy. Regardless of the presence of core features and prodromal non-motor symptoms, this progression is suggested when there are difficulties only in higher-level visual processing such as subjective contours and block design in the Wechsler Adult Intelligence Scale-III, no significant atrophy of the parieto-occipital area and hippocampus on brain magnetic resonance imaging, and hypometabolism in the occipital lobe including the primary visual cortex on brain (18)F-fluorodeoxyglucose positron emission tomography.

[Content validity and inter-rater reliability of the Cognitive Fluctuation Inventory]

OBJECTIVE

The Cognitive Fluctuation Inventory (CFI) was developed to evaluate cognitive fluctuation in patients with dementia with Lewy bodies (DLB). The objective of this study was to assess the content validity and inter-rater reliability of the CFI.

SUBJECTS AND METHODS

Nine specialists in DLB treatment were invited to participate in the survey to assess the content validity of the CFI. They were asked to assess the relevance and comprehensibility of the question items. In the validation study, inter-rater reliability was assessed using the intraclass correlation coefficient (ICC).

RESULTS

Regarding content validity, all nine specialists considered the main question and sub-questions to be relevant to cognitive fluctuation in patients with DLB. Eight out of nine specialists considered the CFI to be a comprehensive measure for detecting cognitive fluctuation in patients with DLB. In the analysis, which used data from 29 patients and their caregivers, the ICC of the CFI was 0.746, which suggests good inter-rater reliability.

CONCLUSION

We found that the CFI showed good content validity and inter-rater reliability for evaluating cognitive fluctuation in patients with DLB.

Fractionated stereotactic radiotherapy using CyberKnife for the treatment of large brain metastases: a dose escalation study

AIMS

To evaluate the toxicity and efficacy of fractionated stereotactic radiotherapy (FSRT) with doses of 18-30 Gy in three fractions and 21-35 Gy in five fractions against large brain metastases.

MATERIALS AND METHODS

Between 2005 and 2012, 61 large brain metastases (≥ 2.5 cm in maximum diameter) of a total of 102 in 54 patients were treated with FSRT as a first-line therapy. Neurological symptoms were observed in 47 of the 54 patients before FSRT. Three fractions were applied to tumours with a maximum diameter ≥ 2.5 cm and <4 cm, and five fractions were used for brain metastases ≥ 4 cm. After ensuring that the toxicities were acceptable (≤ grade 2), doses were escalated in steps. Doses to the large brain metastases were as follows: level I, 18-22 Gy/three fractions or 21-25 Gy/five fractions; level II, 22-27 Gy/three fractions or 25-31 Gy/five fractions; level III, 27-30 Gy/three fractions or 31-35 Gy/five fractions. Level III was the target dose level.

RESULTS

Overall survival rates were 52 and 31% at 6 and 12 months, respectively. Local tumour control rates of the 102 total brain metastases were 84 and 78% at 6 and 12 months, respectively. Local tumour control rates of the 61 large brain metastases were 77 and 69% at 6 and 12 months, respectively. Grade 3 or higher toxicities were not observed.

CONCLUSIONS

The highest dose levels of 27-30 Gy/three fractions and 31-35 Gy/five fractions seemed to be tolerable and effective in controlling large brain metastases. These doses can be used in future studies on FSRT for large brain metastases.

Neuropsychological detection of the early stage of amnestic mild cognitive impairment without objective memory impairment

AIM

We investigate the assessment method to detect the early stage of amnestic mild cognitive impairment (aMCI) using Wechsler Memory Scale - Revised (WMS-R) and Wechsler Adult Intelligence Scale - Third Edition (WAIS-III).

METHODS

Three groups (normal group, aMCI group, and early aMCI group), controlled for age and years of education, underwent brain (18)F-fluorodeoxyglucose positron emission tomography ((18)F-FDG PET), WAIS-III, WMS-R, and other tests. The early aMCI group does not fulfill the clinical diagnostic criteria of aMCI because patients do not have objective memory impairment, but their clinical symptoms and results of (18)F-FDG PET indicate that they should be included in the category of aMCI.

RESULTS

The discrepancy of scores between Verbal IQ and General Memory had the highest accuracy in discriminating between normal and early aMCI groups.

CONCLUSION

The cutoff point determined in this study is useful to detect an early stage of aMCI, which may be distinguished from aMCI using the current criteria.

Improvement in delusions and hallucinations in patients with dementia with Lewy bodies upon administration of yokukansan, a traditional Japanese medicine

BACKGROUND

This multicentre open-label trial examined the efficacy and safety of the traditional Japanese medicine, or Kampo medicine, yokukansan (YKS), for behavioural and psychological symptoms of dementia (BPSD) in patients with dementia with Lewy bodies.

METHODS

Sixty-three dementia with Lewy bodies patients with probable BPSD (M:W, 30:33; mean age, 78.2±5.8 years) were enrolled and treated with YKS for 4 weeks.

RESULTS

Significant improvements in Neuropsychiatric Inventory scores (mean decrease, 12.5 points; P<0.001) and Zarit Burden Interview-Japanese edition tests (mean decrease, 3.6 points; P=0.024) were observed. In patients who consented to an assessment after 2 weeks of treatment, a time-dependent significant improvement was observed in the Neuropsychiatric Inventory score (n=23; mean decrease, 14.4; P<0.001), each subscale, including delusions and hallucinations, the Zarit Burden Interview-Japanese edition (n=22; mean decrease, 8.2; P<0.01) and the behavioural pathology in Alzheimer's disease insomnia subscale. The Mini-Mental State Examination and the Disability Assessment for Dementia (DAD) showed no significant change. Adverse events were observed in 11 (18%) patients. Three patients (5%) discontinued YKS due to adverse reactions, namely, spasticity and exacerbation of BPSD, edema, and nausea. Hypokalaemia (<3.5 mEq/L) was present in four patients (6%) at the study endpoint. Worsening of extrapyramidal symptoms was not observed.

CONCLUSION

YKS improved BPSD in dementia with Lewy bodies patients and caregiver burden scores without deterioration in cognitive function. YKS is useful for the treatment of delusions and hallucinations in BPSD.

Study on biological monitoring of fenpropathrin exposure in application by utilizing urinary 3-phenoxybenzoic acid level

To estimate pesticide exposure faced by applicators, an investigation of exposure-absorption was conducted on two applicators under routine working conditions and using regular procedures during pesticide spraying of greenhouse strawberries with fenpropathrin. The authors hypothesized that 3-phenoxybenzoic acid (3-PBA) is a urinary excreted metabolite of fenpropathrin, a synthetic pyrethroid pesticide with 3-phenoxybenzyl moiety, and its determination would help to improve the assessment of fenpropathrin exposure-absorption in applicators. The extent of exposure-absorption was evaluated by the determination of urinary level of 3-PBA (biological monitoring), the amount of the chemical adhered to clothes and permeated to the skin surface, and its concentration in the air of the greenhouse. The results showed that the fenpropathrin concentration in the air was less than 0.1 μg/m(3). The amount of adhesion was less than 0.001 to 10.25 μg/cm(2), and there was very little permeation. However, the urinary 3-PBA concentration by biological monitoring appeared to be approximately twice that of pre-exposure levels in both applicators. This finding demonstrates that the applicators were exposed to fenpropathrin and absorbed it during spraying. We conclude that the fenpropathrin exposure-absorption in application could be estimated by the determination of urinary 3-PBA. This method of biological monitoring may be more useful indicator to accurately evaluate the working conditions in application.

"Transmural air leak": a computed tomographic finding following endoscopic submucosal dissection of gastric tumors

BACKGROUND AND STUDY AIMS

A small amount of free air, visible on CT but not on plain chest radiography, which appeared following endoscopic submucosal dissection (ESD) of a gastric neoplasm without endoscopically visible perforation, was defined as a "transmural air leak", and a prospective, consecutive entry study was performed to determine its incidence and clinical significance.

PATIENTS AND METHODS

Between January 2006 and September 2008, ESD was performed for 246 gastric lesions in 246 consecutive patients. Abdominal CT scan was performed 1 day after ESD. In addition, chest radiography and blood biochemistry tests were performed at different time points before and after ESD.

RESULTS

Two hundred and nineteen lesions (89 %) were curatively removed by ESD. Among the total of 246 patients, we encountered endoscopically visible perforation during ESD in 2 patients (0.8 %), and clinically suspected perforation diagnosed by the presence of free air on chest radiography but invisible during ESD in 3 patients (1 %), while transmural air leak was observed in another 33 (13 %). Air leak occurred in cases where resection size was larger, procedure time longer, and the muscularis propria on the ulcer base was exposed at the end of ESD. Patients with air leaks developed pyrexia at a higher rate than those without (36 % vs. 16 %, P = 0.018). These patients recovered with antibiotics and required no endoscopic or surgical intervention. The presence of an air leak did not affect the duration of hospital stay.

CONCLUSIONS

A transmural air leak was observed in 13 % of the patients undergoing ESD. Larger resection size, prolonged procedure time, and exposure of the muscularis propria on the ulcer base were risk factors for transmural air leak, but the outcome of patients with this complication was good.

The first autopsied case of diffuse Lewy body disease (DLBD): re-examination by recent immunostaining methods: The 50th Anniversary of Japanese Society of Neuropathology

Materials from our first autopsied case of diffuse Lewy body disease (DLBD), that was originally reported in 1976, were re-examined using recent immunohistochemical methods. Lewy pathology consisting of Lewy bodies and Lewy neurites appeared much more marked with alpha-synuclein immunostaining than had been detected with classical stainings. This case and our other similar cases prompted us to propose the terms "Lewy body disease" in 1980 and "diffuse Lewy body disease" in 1984. We also reported in 1990 that DLBD was classified into two forms: a pure form and a common form. Based on these studies the term "dementia with Lewy bodies (DLB)" was proposed in 1996. Since 1980, we have insisted that DLB, Parkinson disease (PD), and PD with dementia (PDD) should be understood within the spectrum of Lewy body disease. This insistence has been recently accepted by the International Workshop and the International Working Group on DLB and PDD in 2005 and in 2006, respectively.

Evaluation of Probable or Possible Dementia with Lewy Bodies Using 123I-IMP Brain Perfusion SPECT, 123I-MIBG, and 99mTc-MIBI Myocardial SPECT

We evaluated the diagnostic usefulness of combination studies with a statistical mapping method in N-isopropyl-p-(123)I-iodoamphetamine ((123)I-IMP) brain perfusion SPECT, cardiac sympathetic nerve function by (123)I-metaiodobenzylguanidine ((123)I-MIBG), and myocardial function by electrocardiographically gated (99m)Tc-sestamibi ((99m)Tc-MIBI) SPECT for patients with probable or possible dementia with Lewy bodies (DLB).

METHODS

Twelve patients with probable DLB (7 male, 5 female; mean age +/- SD, 72.3 +/- 5.63 y; range, 65-82 y) and 9 patients with possible DLB (3 male, 6 female; mean age +/- SD, 73.1 +/- 9.23 y; range, 59-88 y) were enrolled in this study. (123)I-IMP SPECT images were analyzed with 3-dimensional stereotactic surface projections (3D-SSP) and the severity of ischemia was classified objectively using quantitatively analytic and display software; stereotactic extraction estimation (SEE) methods were compared with a normal database. In addition, we evaluated (123)I-MIBG heart-to-mediastinum (H/M) uptake ratios. Moreover, we performed (99m)Tc-MIBI SPECT to evaluate myocardial perfusion and the left ventricular ejection fraction (LVEF) compared with a normal database.

RESULTS

3D-SSP images of group comparison with healthy control subjects showed significantly decreased perfusion in the parietotemporal, occipital cortex, posterior cingulated, and precuneus regions in the probable DLB group but no significant reduction in the possible DLB group. Mean H/M ratios in the probable DLB group were significantly lower than those of the possible DLB group and the control group, respectively. Ten of 12 patients (83.3%) with probable DLB and 1 of 9 patients (11.1%) with possible DLB showed severe reduction in the bilateral occipital lobe and also a low (123)I-MIBG uptake. One patient (8.3%) with probable DLB and 2 patients (22.2%) with possible DLB showed no bilateral occipital hypoperfusion but showed low (123)I-MIBG uptake. One patient (8.3%) with probable DLB and 6 patients (66.7%) with possible DLB showed no occipital hypoperfusion and normal (123)I-MIBG uptake. (99m)Tc-MIBI gated SPECT did not indicate any wall motion abnormality in any subjects.

CONCLUSION

These results suggest that combined examination of cerebral blood flow with 3D-SSP and SEE analysis, and cardiac sympathetic nerve function with (123)I-MIBG, would be a useful supporting diagnostic method in patients with DLB-particularly, in possible DLB and when cerebral blood flow does not indicate occipital hypoperfusion.

Effect of slow movement and stretch-shortening cycle on lower extremity muscle activity and joint moments during squat

AIM

The purpose of the present study was to compare activity patterns of 8 muscles that cross the ankle, knee and hip joints under different conditions of squatting.

METHODS

Ten male athletes performed squats at 3 different speeds (slow, normal, quick). Variables such as net moment and power about the joint were calculated during the descending and ascending phases of each squat. Using surface electrodes placed over the 8 lower extremity muscles, %iEMG was calculated during the ascending phase of each squat.

RESULTS

In the descending phase, activities of the following 7 muscles were significantly greater for the quick squat (QS) than the normal squat (NS) or slow squat (SS): erector spinae (ES), gluteus maximus (Gmax), gluteus medius (Gmed), rectus femoris (RF), biceps femoris (BF), adductor longus (AL), and vastus lateralis (VL). Median frequency (MDF) of the Gmax muscle was significantly lower for NS than QS, and activity of the BF was significantly lower for NS than QS or SS. Mean moment of the hip joint was significantly lower for SS than QS. In the ascending phase, activities of the following 7 muscles were significantly greater for QS and NS than SS: ES, Gmax, Gmed, RF, BF, AL, and VL. MDF of the Gmax muscle was significantly lower for NS than QS, and the activity of the BF was significantly lower for NS than QS or SS. Mean moment of the hip joint was significantly higher for QS than SS or NS. Mean moment of the knee was significantly lower for SS than NS or QS.

CONCLUSIONS

For QS, a stretch-shortening cycle increased the load on the Gmax. Mean muscle activity was less for SS than NS, and MDF was greater for SS than NS. These results suggest that SS mobilizes type-2 muscle fibers, despite the slow movement involved and the low risk of injury.

Practical Consideration about Cost Functions of Spatial Independent Component Analysis in Medical Image Processing

Independent component analysis (ICA) is widely used for signal separation in various fields. However, low signal to noise ratio (SNR) of data sometimes causes failures in component estimation. We have proposed a spatial ICA-based method for extracting a blood-related component from medical images measured with positron emission tomography (PET) to omit arterial blood sampling, in which a cost function was designed in consideration of statistical properties of components. In this study, spatial ICA with the proposed cost function or kurtosis, a conventional cost function, was applied to real PET images measured with three kinds of radiopharmaceuticals, and the estimation results were compared. The proposed cost function fails to estimate components from the PET data with low SNR because it is sensitive to outliers. Experimental results suggest that a cost function should be selected depending on SNR of data.

3D Imaging System for Visualizing and Monitoring Patients

Three-dimensional (3D) visualization or 3D monitoring of patients or infected animals is useful in actual clinical environment. We propose a 3D imaging system with a single camera and multiple mirrors. The camera is located directly above the object and the multiple mirrors are placed surrounding the object. The single captured image includes multiple viewpoint images: the object captured directly and the same objects reflected by the mirrors. After a simple calibration of the measurement, the 3D volume data are reconstructed with the visual hull based method. Texture mapping is also performed to enhance the reality. A living object was observed in usual environment using this system. The results have demonstrated effectiveness of the system.

Clonic perseveration in the subacute stage of Japanese encephalitis

We report a very rare case of Japanese encephalitis (JE) presenting with reversible stereotyped movement in the subacute stage. A 58-year-old woman presented with high fever, headache, nausea, vomiting, and consciousness disturbance. Cranial magnetic resonance imaging (MRI) of fluid attenuated inversion recovery (FLAIR) and T2-weighted image (WI) showed high intensity areas in the bilateral thalamus, caudate nucleus and hippocampus. She developed coma, convulsion, and ballism in the acute stage. One month after onset, she showed rhythmic, stereotyped, repetitive movements with hypoperfusion in the thalamus and frontal cortex on single photon emission computed tomography (SPECT). Three months later, her stereotyped movement improved accompanied by recovery of hypoperfusion in the thalamus and frontal cortex on SPECT. We speculated that her stereotyped movement was clonic perseveration due to frontal dysfunction induced by thalamofrontal disconnection.

Regulatory mechanisms of ethylene biosynthesis in response to various stimuli during maturation and ripening in fig fruit (Ficus carica L.)

In order to obtain a greater uniformity of maturation, the growth of the fig fruit (Ficus carica L.) can be stimulated by the application of either olive oil, ethrel/ethephon or auxin. The three treatments induce ethylene production in figs. In this study, we investigated the regulatory mechanisms responsible for oil, auxin and ethylene induced ethylene production in figs. The ethylene production in response to olive oil, auxin, and propylene treatments and during ripening were all induced by 1-methylcyclopropene (1-MCP) and inhibited by propylene indicating a negative feedback regulation mechanism. Three 1-aminocyclopropane-1-carboxylic acid (ACC) synthase genes (Fc-ACS1, Fc-ACS2 and Fc-ACS3) and one ACC oxidase gene (Fc-ACO1) were isolated and their expression patterns in response to either oil, propylene or auxin treatment in figs determined. The expression patterns of Fc-ACS1 and Fc-ACO1 were clearly inhibited by 1-MCP and induced by propylene in oil treated and ripe fruits indicating positive regulation by ethylene, whereas Fc-ACS2 gene expression was induced by 1-MCP and inhibited by propylene indicating negative regulation by ethylene. The Fc-ACS3 mRNA showed high level accumulation in the auxin treated fruit. The inhibition of Fc-ACS3 gene by 1-MCP in oil treated and in ripe fruits suggests that auxin and ethylene modulate the expression of this gene by multi-responsive signal transduction pathway mechanisms. We further report that the olive oil-induced ethylene in figs involves the ACC-dependent pathway and that multiple ethylene regulatory pathways are involved during maturation and ripening in figs and each specific pathway depends on the inducer/stimulus.

IGF-I regulates pro-opiomelanocortin and GH gene expression in the mouse pituitary gland

IGF-I is expressed in somatotrophs, and IGF-I receptors are expressed in most somatotrophs and some corticotrophs in the mouse pituitary gland. Our recent study demonstrated that IGF-I stimulates the proliferation of corticotrophs in the mouse pituitary. These results suggested that somatotrophs regulate corticotrophic functions as well as somatotrophic functions by the mediation of IGF-I molecules. The present study aimed to clarify factors regulating pituitary IGF-I expression and also the roles exerted by IGF-I within the mouse anterior pituitary gland. Mouse anterior pituitary cells were isolated and cultured under serum-free conditions. GH (0.5 or 1 microg/ml), ACTH (10(-8) or 10(-7) M), GH-releasing hormone (GHRH; 10(-8) or 10(-7) M), dexamethasone (DEX; 10(-8) or 10(-7) M) and estradiol-17beta (e2; 10(-11) or 10(-9) M) were given for 24 h. IGF-I mRNA levels were measured using competitive RT-PCR, and GH and pro-opiomelanocortin (POMC) mRNA levels were measured using Northern blotting analysis. GH treatment significantly increased IGF-I mRNA levels (1.5- or 2.1-fold). ACTH treatment did not alter GH and IGF-I mRNA levels. IGF-I treatment decreased GH mRNA levels (0.7- or 0.5-fold), but increased POMC mRNA levels (1.8-fold). GH treatment (4 or 8 microg/ml) for 4 days increased POMC mRNA levels. GHRH treatment increased GH mRNA levels (1.3-fold), but not IGF-I mRNA levels. DEX treatment significantly decreased IGF-I mRNA levels (0.8-fold). e2 treatment did not affect IGF-I mRNA levels. GH receptor mRNA, probably with GH-binding protein mRNA, was detected in somatotrophs, and some mammotrophs and gonadotrophs by in situ hybridization using GH receptor cDNA as a probe. These results suggested that IGF-I expression in somatotrophs is regulated by pituitary GH, and that IGF-I suppresses GH expression and stimulates POMC expression at the transcription level. Pituitary IGF-I produced in somatotrophs is probably involved in the regulation of somatotroph and corticotroph functions.

Protection against ischemic brain damage by GDNF affecting cell survival and death signals

Neuroprotective effects of glial cell line-derived neurotrophic factor (GDNF) on cell survival and death signals were investigated after 90 min of transient middle cerebral artery occlusion (MCAO) in rats. Immunoreactivities of phosphorylated Akt (p-Akt), cleaved caspase-9 (c-cas9), and -3 (c-cas3) increased after the reperfusion in the penumbra in vehicle group with peaks at 3 h, 8 h, and 1 day, respectively. Topical application of GDNF (6.8 micrograms/9 microliters) on brain surface potentiated and prolonged p-Akt activation, but suppressed activation of the caspases, and reduced the number of terminal deoxynucleotidyl transferase-mediated dUDP-biotin in situ nick labeling (TUNEL) positive cells. These results suggest that GDNF plays a protective role against ischemic injury by controlling the balance between Akt pathway and caspase cascades.

Glutamate enhances caspase-3 immunoreactivity in cultured spinal cord neurons of newborn rats

The role of glutamate in the mechanism of spinal neuron death is not fully understood. With addition of glutamate to primary culture of 11-day-old rat spinal cord, the number of caspase-3 positive small neurons of the dorsal horn greatly increased at 6-24 h in contrast to the case with vehicle. The addition of glutamate made caspase-3 immunoreactivity stronger in the cytoplasm of large motor neurons in the ventral horn. The present results show that excessive amount of glutamate enhances apoptotic pathway through caspase-3 in cultured spinal neurons of newborn rat.

Glial cell line-derived neurotrophic factor protein prevents motor neuron loss of transgenic model mice for amyotrophic lateral sclerosis

Effects of glial cell line-derived neurotrophic factor (GDNF) were studied in transgenic (Tg) mice model for amyotrophic lateral sclerosis. GDNF protein or vehicle was injected three times a week from 35 weeks of age into the right gastrocnemius muscle of Tg mice carrying mutant human Cu/Zn superoxide dismutase gene, and histological analysis was performed at 46 weeks. Clinical data showed a tendency of improvement, but was not significantly different between the two animal groups. In contrast, total number of and phospho-Akt (p-Akt) positive large motor neurons in the treated side was significantly more preserved in GDNF-treated group than in vehicle group (p < 0.05). Immunoreactivity of phospho-ERK and active caspases-3 and -9 showed no difference. These results indicate that the intramuscular injection of GDNF protein prevented motor neuron loss while preserving survival p-Akt signal and without affecting caspase activations, suggesting a future possibility for the therapy of the disease.

Activation of cell-survival signal Akt by GDNF in normal rat brain

Glial cell line-derived neurotrophic factor (GDNF) activates protein kinase Akt/PKB by phosphorylation (p-Akt) which plays key roles in cell survival. In the current study, we investigated a temporal expression of p-Akt by immunohistochemical analysis after a topical application of GDNF to normal cerebral hemisphere of rats. Although p-Akt immunoreactivity was weakly present in the sham control neural cells, GDNF application greatly enhanced it at 3 h, which lasted until 1 day. These results indicate that p-Akt is expressed in neuronal cells under physiological conditions, and that topical application of GDNF greatly enhanced the phosphorylation of Akt in normal rat brain.

Enhanced phosphorylation of PTEN in rat brain after transient middle cerebral artery occlusion

A phosphatase PTEN (phosphatase and tensin homologue deleted on chromosome 10) is a tumor suppressor gene that suppresses cell growth, inhibits cell migration, and induces apoptosis. Phosphorylated form of PTEN (p-PTEN) is a key survival factor relating PI3K-Akt pathway and their downstream effectors. A spatiotemporal profiles of PTEN and p-PTEN expression were immunohistochemically examined after 90 min of transient middle cerebral artery occlusion in rats. In the ischemic core, PTEN progressively decreased by 3 days, whereas a rapid but transient increase of p-PTEN was found with a peak at 1 h after the reperfusion. In contrast, in the ischemic penumbra, PTEN showed a minor change and a gradual but sustained p-PTEN expression was observed in the ischemic penumbra with a peak at 12 h. In addition, the balance of population among strongly, moderately, and weakly stained cells was different between the ischemic core and penumbra at their peak time points. These results suggest an important role of p-PTEN for cell survival after ischemia as an upstream regulator for PI3K-Akt.

A case of paroxysmal kinesigenic dyskinesia with spastic paraparesis

We report the first case of paroxysmal kinesigenic dyskinesia (PKD) with spastic paraparesis. A 17-year-old male began to show a dystonic posture in both his upper limbs when walking at age 12 years. Neurological examination revealed bilateral talipes cavus, spasticity in all extremities with general hyperreflexia and pathological reflexes. On starting to walk, he showed a dystonic posture in bilateral maniphalanx, wrists, elbows, and toes. Magnetic resonance imaging (MRI) revealed high T2-weighted signal intensity in bilateral pyramidal tract. Although the combination of pyramidal and the basal ganglia disorders is very rare, the present case suggests an inter-relation of the pyramidal and the basal ganglia systems.

Tardive decrease of astrocytic glutamate transporter protein in transgenic mice with ALS-linked mutant SOD1

The expressions of glutamate transporter proteins were immunocytochemically examined in the spinal cord of transgenic mice harboring a Gly93 --> Ala (G93A) mutant human SOD1 gene. Astroglial EAAT2 protein level was preserved in the ventral horn even after the beginning of paralysis, and finally decreased at terminal stage of the disease (35 weeks of age), when neuronal EAAT3 protein level was also decreased. In contrast, glial fibrillary acidic protein (GFAP) immunoreactivity progressively increased from 25 weeks of age in the ventral horn. The present results show interesting dissociative expressions of astroglial proteins EAAT2 and GFAP in the same ventral horn, but suggest not an early and primary role of EAAT2 in the motoneuronal death of this model.

Therapeutic time window of adenovirus-mediated GDNF gene transfer after transient middle cerebral artery occlusion in rat

The time dependent influence of adenovirus-mediated glial cell line-derived neurotrophic factor (GDNF) gene (Ad-GDNF) was examined after 90 min of transient middle cerebral artery occlusion (MCAO) in rats. Treatment with Ad-GDNF significantly reduced the infarct volume when immediately administered after the reperfusion, but became insignificant when administered at 1 h after the reperfusion as were the cases treated with vehicle- and adenoviral vector containing the E. coli lacZ gene (Ad-LacZ)-treated groups. The protective effect of GDNF was related to the significant reduction of the number of TUNEL positive cells as well as immunohistochemical positive cells for active caspase-3 but not -9. These results showed that exogenous GDNF gene transfer successfully reduced the infarct size in a time-dependant manner by suppressing active caspase-3 but not active caspase-9. However, the therapeutic time window was shorter than the effect of GDNF protein itself previously reported.

Early decrease of the immunophilin FKBP 52 in the spinal cord of a transgenic model for amyotrophic lateral sclerosis

Expressions of immunophilin FKBP-12 and FKBP-52 were examined in the spinal cord of transgenic mice with an ALS-linked mutant Cu/Zn superoxide dismutase (SOD1) gene. The immunoreactivity of FKBP-12 was present predominantly in the cytoplasm, but did not show a difference between age-matched wild type and transgenic (Tg) mice at 25 and 35 weeks. In contrast, the immunoreactivity of FKBP-52 was predominantly present in the nucleus, which progressively declined only in the Tg mice as early as an early presymptomatic stage at 25 weeks of age in the anterior horn neurons. The present result suggests that the downregulation of FKBP-52 may be involved in the pathogenesis in the early stages of amyotrophic lateral sclerosis (ALS).

Effects of short- and long-acting dopamine agonists on sensitized dopaminergic neurotransmission in rats with unilateral 6-OHDA lesions

The effects of short and long-acting dopamine agonists on sensitized dopaminergic transmission in an animal model of Parkinson's disease were investigated. Rats with 6-hydroxydopamine (6-OHDA) lesions of the left nigrostriatal dopaminergic pathway were pre-exposed i.p. to 50 mg/kg methyl levodopa for 10 days. After a 7-day withdrawal period, these animals were treated with saline i.p., 0.05 mg/kg apomorphine s.c., or 0.5 mg/kg cabergoline i.p., once daily for 7 days. On the 8th day, rats in each treatment group received a challenge dose of 0.05 mg/kg apomorphine or saline s.c. The temporal changes in the number of rotations away from the 6-OHDA lesion side were evaluated after the challenge. The apomorphine challenge increased the number of rotations more markedly in the apomorphine pretreated rats than in the other pretreatment groups. In cabergoline pretreated rats, the number of rotations was significantly lower than that of saline-pretreated animals. Pretreatment with saline did not alter the apomorphine sensitivity of rotational behavior. These findings suggest that the repeated administration of long-acting dopamine agonists may reduce sensitized dopaminergic transmission in dopamine-depleted rats, whereas short-acting ones may further enhance sensitization of the transmission process.

Nocturnal blood pressure dip in CADASIL

The influence of a nocturnal blood pressure dip on cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) has not yet been clarified. We attempted to examine a correlation with the nocturnal blood pressure dip and CADASIL. We monitored circadian blood pressure patterns by the use of a portable blood pressure monitoring device in five patients with CADASIL and 10 age- and sex-matched control subjects. Based on nocturnal fall in mean arterial blood pressure (MABP), we classified patients into extreme dippers (nocturnal reduction of MABP > or =20%), dippers (> or =10% but <20%), nondippers (<10% but > or =0%), and inverted dippers (<0%). Three patients revealed non-dipper and two inverted dipper. Nighttime MABP fall was significantly lower in patients compared with control subjects (P<0.01). This study suggests that a lower nocturnal blood pressure fall may be partly associated with incidence and/or worsening of deep white matter lesions in CADASIL.

Temporal and spatial differences of PSA-NCAM expression between young-adult and aged rats in normal and ischemic brains

Highly polysialylated neural cell adhesion molecule (PSA-NCAM) is transiently expressed specifically in newly generated cells, and is important for migration and neurite outgrowth. To investigate the effect of aging on the migration of neural stem cell (NSC) after brain ischemia, the spatiotemporal expressions of immunoreactive PSA-NCAM were examined at 4 h or 1, 3 or 7 days after 90 min of middle cerebral artery occlusion (MCAO) in the young-adult or aged rats. In the sham control brain, PSA-NCAM staining was slightly observed both in dorsal and ventral parts of subventricular zone (SVZ) in the aged brain, but only in the dorsal part of SVZ in the young brain. After transient MCAO, immunoreactivity for PSA-NCAM increased in the number and the intensity in SVZ ipsilateral to MCAO in the young-adult brains and became the peak at 1 day, while that was at 3 days in the aged brains. These findings suggest that PSA-NCAM was located in different spatial distribution in normal condition between young and old rats. PSA-NCAM was induced after ischemia, and the temporal expression was also different after transient MCAO between young and older rats.

Serial MRI findings in patient with chronic cryptococcus meningo-encephalitis

We describe the serial changes of magnetic resonance imaging (MRI) in a patient with chronic cryptococcus meningo-encephalitis. In the subacute phase, MRI revealed a focal lesion with hyperintensity on T2-weighted image (WI) in the left thalamus. At 11 months after the onset, MRI showed a focal lesion with hyperintensity on T2-WI in the right pons that was enhanced with gadolinium (Gd). At 13 months after the onset, the lesion in the left thalamus became rim enhanced with Gd. After antifungal therapy (amphotericin B and 5-flucytosine), the rim enhancement in the left thalamus and the high signal intensity area in the right pons decreased. Cryptococcoma should be in the differential from other ring enhancing lesions.

[Gene therapy and neurotrophic factor treatment for amyotrophic lateral sclerosis]

Although excitotoxic and oxidative stress play important roles in spinal neuron death, the exact mechanisms are not fully understood. We examined cell damage of primary culture of 11-day-old rat spinal cord by addition of glutamate, nitric oxide (NO) or peroxynitrite (PN) with detection of terminal deoxynucleotidyl transferase-mediated dUTP-biotin in situ nick end labeling (TUNEL). With addition of glutamate, NOC18 (a slow NO releaser) or PN, TUNEL positive nuclei were found in spinal large motor neurons from 24 h, and the positive cell proportion greatly increased at 48 h in contrast to the vehicle. The present results suggest that both excitotoxic and oxidative stress play important role in the apoptotic pathway in cultured rat spinal neurons. To examine a possible protective effect of exogenous glial cell line-derived neurotrophic factor (GDNF) gene expression in transgenic (Tg) mice carrying a Gly 93Ala (G93A) mutant SOD1 gene found in human familial ALS, a replication defective adenoviral vector containing GDNF gene was directly injected unilaterally into leg muscles. There were significantly more large motoneurons in GDNF-treated Tg mice than in untreated and Ad-Laz-treated group. The number of large motoneurons in GDNF-treated side of Tg mice were significantly more than that in untreated side. These observations demonstrate that GDNF gene therapy in a mouse model of FALS promotes the survival of motoneurons, suggesting that a similar approach might delay the progression of neurodegeneration of ALS.

Effect of diazepam binding inhibitor (DBI) on the fluid intake, preference and the taste reactivity in mice

We have reported that a diazepam binding inhibitor (DBI)-like peptide is released by the aversive quinine stimuli 'Chem. Senses 25 (2000) 739'. To determine the effect of DBI on the fluid intake, we injected a DBI peptide fragment into the fourth ventricle in mice. DBI suppressed the intake of 5% sucrose, water and 0.9 mM quinine-HCl and the preference for 0.05% saccharin. Administration (i.p.) of flumazenil, a benzodiazepine receptor antagonist, 20 min before the injection of DBI (i.c.v.) antagonized the suppressive effect of DBI on the intake and the preference for saccharin. We also studied the dose dependency of the effect of DBI on the intake of 5% sucrose. Injection of DBI in excess of 3 microg suppressed the intake of 5% sucrose in mice. Furthermore, injection of DBI (i.c.v.) increased the aversive response to 0.9% NaCl in the taste reactivity in mice. These results suggest that DBI affect the preference to food.

Intraoperative identification of regenerated chorda tympani nerve and its relationship to recovered taste function

This study demonstrated a simple method of repairing the severed chorda tympani nerve and a method of intraoperative identification of regenerated nerves, and evaluated taste function of regenerated nerves. Seven patients who underwent staged tympanoplasty and whose chorda tympani nerve was severed during primary surgery were evaluated. When the chorda tympani nerve was severed during primary surgery, proximal and distal stumps were anastomosed or approximated almost in the original position and fixed with fibrin glue on the temporal muscle fascia used to reconstruct the eardrum by the underlay method. During primary surgery, end-to-end anastomosis was possible in 3 patients but nerve gap defects remained in the other 4 patients. In all 7 patients, regenerated nerves were identified during secondary surgery not in the tympanic cavity but in the submucosal layer of the previously reconstructed eardrum. In all patients, complete or incomplete recovery of taste perception was observed by both the filter paper disk method and electrogustometry, suggesting that the regenerated nerves had actual taste function. From these results, it was concluded that the severed chorda tympani nerve could regenerate in the reconstructed eardrum even if nerve gap defects remained between the proximal and distal cut ends, when repair or approximation of the nerve was properly completed.

Two Japanese CADASIL families with a R141C mutation in the Notch3 gene

Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is a rare hereditary disease characterized by recurrent transient ischemic attacks (TIA) and strokes, and vascular dementia with Notch3 gene mutations as the cause of the disease. To date, there are only a few Japanese families ever reported with a mutation in the gene. Here, we report two more Japanese CADASIL families carrying a missense mutation in the Notch3 gene (R141C) with a unique lesion in the corpus callosum. This is the first report of two unrelated Japanese CADASIL families with a R141C mutation in the Notch3 gene. Although the disease is very rare among the Japanese population, our result suggests a possible relationship of this particular mutation (R141C) with the lesions of the corpus callosum.