219 APPLICATION OF A MICROFLUIDIC SPERM SORTER TO THE IN VITRO PRODUCTION OF PORCINE EMBRYOS

In porcine in vitro fertilization (IVF), polyspermy is a persistent obstacle to the efficient production of normal embryos. A microfluidic sperm sorter (MFSS; Strex Inc., Osaka, Japan) was developed to isolate motile human spermatozoa (from diluted semen by two laminar flows in the microchannel). The motile spermatozoa can gradually accumulate in a chamber of the MFSS. We previously reported that the monospermy rate was higher when oocytes were co-cultured with isolated spermatozoa in an MFSS for 5 min than when spermatozoa were co-cultured traditionally in drops for 8 h (P < 0.05; Reprod. Fertil. Dev. 20, 187 abst). The present study was undertaken to compare the effect of oocyte location within the MFSS chamber on early development after IVF in the MFSS. A sperm-rich fraction from Berkshire boars was diluted at 1 × 108 cells mL–1 with modified Modena solution containing 20% seminal fluid. In the first experiment, a diluted semen sample was flowed with modified TCM-199 containing 5 mm caffeine (mm199-caf) for 5 min at room temperature. Before flowing, porcine IVM oocytes were positioned in a part of the MFSS chamber where motile spermatozoa would accumulate with mm199-caf. After flowing for 5 min, those oocytes were cultured in caffeine-free mm199 for 8 h and then in a chemically defined medium (PZM-5) for 7 days. In the second experiment, denuded oocytes were co-cultured with isolated spermatozoa at several locations in the MFSS chamber, and the penetration and monospermy rates were estimated. The concentration of motile spermatozoa was also measured at each place in the MFSS chamber after isolation for 5 min. Statistical analyses of results based on 4 to 5 replicates were carried out by ANOVA and Fisher’s PLSD post hoc test (significance, P < 0.05). When IVM oocytes were co-cultured with spermatozoa gradually accumulated in the chamber of the MFSS for 5 min, the cleavage rate (83.7 ± 6.3% of 121 oocytes) was not different from that of control oocytes co-cultured with spermatozoa (5.7 × 105 cells mL–1) in 100-μL drops for 5 min (84.6 ± 6.6% of 126 oocytes). However, the blastocyst formation rate (38.2 ± 3.3%) was higher than for the controls (20.6 ± 6.8%; P < 0.05). After flowing for 5 min, the distance from the inflow opening of the MFSS chamber to the location of the oocytes did not affect the sperm penetration rate, but did affect the monospermy rate (14.0 ± 4.0% of 48 oocytes at the nearest position to 50.0 ± 5.6% of 43 oocytes at the furthest position; P < 0.05). After flowing for 5 min, the concentration of motile spermatozoa was also different at each location (57.5 ± 5.6 × 104 cells mL–1 at the nearest position to 0.8 ± 0.5 × 104 cells mL–1 at the furthest position; P < 0.05). These observations demonstrate that co-culturing oocytes with spermatozoa that gradually accumulated in the MFSS chamber improved the efficiency of blastocyst formation in the pig, whereas efficiency was affected by the position where oocytes were located in the chamber.

Anterior communicating artery aneurysms: an overview

AComA aneurysms are most commonly found at the A1-A2 junction on the dominant side. The angle of the arteries at the bifurcation and the direction of blood flow are factors of hemodynamic stress in the apical region where these aneurysms often develop. They exist at the bifurcation of dominant A1, A2 and AComA and usually point in the direction away from the dominant A1. They are more prone to rupture and demonstrate the highest incidence of post-operative morbidity among anterior circulation aneurysms. Consideration of aneurysm morphology may be used to guide approaches in AComA aneurysms. Resection of the gyrus rectus in combination with a pterional approach was popularized by Yasargil and it became the standard for treatment or exposure of AComA aneurysms, although other skull base approaches are also widely used. Clip selection is of extreme importance and the preservation of blood flow to the perforators should be emphasized. Adequate dissection and exposure of the entire "H" complex prior to clipping is the key to a successful outcome. Separating the perforators from the neck or dome of the artery and preserving the parent vessel presents a substantial challenge to the surgeon when the aneurysm is behind the parent artery, making it difficult to achieve a good outcome.

Minimally invasive surgery for cerebral AVM in the eloquent cortex

The treatment of arteriovenous malformation (AVM) is still a challenging problem in the neurosurgical field. The usual operative procedure has been the removal of the AVM by sucking the gliosis which surrounds it. However, by using such a method in the functional area, especially the sensory and motor cortex, it has been impossible to remove the AVM without postoperative neurological deficit. Recent reports have shown that a 1 mm thickness of the brain around a large AVM is non-functioning;(1,2) therefore, we aimed to remove only the AVM without sucking the brain.

Traumatic deltoid rupture caused by seatbelt during a traffic accident: a case report

A right-handed 53-year-old man presented with a subcutaneous bruise on his right shoulder caused by a seatbelt during a traffic accident. He had no history of shoulder pain or hydrocortisone injections. The contour of the anterior deltoid was deformed and its belly was retracted distally. The active range of movement of the shoulder was limited to 120 degrees and the strength weakened to 3/5. Magnetic resonance imaging demonstrated detachment of the anterior fibres of the deltoid. Surgical repair of the deltoid and supraspinatus tendon was performed 2 months later using a pull-out suture technique. After 12 months of follow-up, the patient had returned to work without any problems. Both the range of movement and muscle strength had recovered completely.

215 APPLICATION OFA MICROFLUIDIC SPERM SORTER TO THE IN VITRO FERTILIZATION OF PORCINE OOCYTES

In porcine IVF, polyspermy is a persistent obstacle to the efficient production of normal embryos in vitro. A microfluidic sperm sorter (MFSS; Strex Inc., Osaka, Japan) has been developed to isolate motile human spermatozoa (from diluted semen by 2 laminar flows in the microchannel). The motile spermatozoa can gradually accumulate in a chamber of the MFSS. In addition, we have succeeded in reducing the incidence of polyspermic penetration by a transient coincubation of oocytes with spermatozoa in the presence of caffeine, followed by culture of the oocytes in the absence of caffeine (2004 Reproduction 128, 789–800). If porcine oocytes could be cocultured with motile spermatozoa in the chamber of the MFSS, the gradual accumulation of motile spermatozoa might further improve the efficiency of production of monospermic fertilized porcine embryos. The current study was undertaken to apply the MFSS technology to porcine IVF. The sperm-rich fraction from 3 Berkshire boars was diluted at 1 � 108 cells mL–1 with modified Modena containing 20% seminal fluid, cooled to 15�C for 4 h, and kept at the same temperature until use within 2 days. Stored, diluted semen with greater than 80% viability was flowed with Tyrode lactate-HEPES-polyvinyl alcohol medium for 5 or 10 min at room temperature. The concentration and viability of spermatozoa mixed in the flowed medium were determined. In the next experiment, a diluted semen sample was flowed with modified TCM-199 containing 5 mm caffeine for 5 min at room temperature. Before flowing, porcine IVM oocytes were put into the chamber of the MFSS, where motile spermatozoa will accumulate with modified TCM-199 containing 5 mm caffeine. After flowing for 5 min, those oocytes were transferred into a 500-µL droplet of caffeine-free modified TCM-199, and culture was continued for 8 h. Statistical analyses were carried out by ANOVA and Fisher's PLSD post hoc test. After flowing for 5 min, the concentration of spermatozoa recollected from the chamber was 5.7 � 105 cells mL–1. The viability of recollected spermatozoa was significantly higher than the original flowed semen. However, when spermatozoa were flowed for 10 min, the viability of recollected spermatozoa was not different from the original flowed semen, whereas the concentration of recollected spermatozoa was 9.7 � 105 cells mL–1. When IVM oocytes were cocultured with spermatozoa gradually accumulated in the chamber of MFSS for 5 min, 35% (22 to 48%) of oocytes were penetrated, and 95% (90 to 100%) of the penetrated oocytes were monospermic. These observations demonstrate that the MFSS can separate penetrable boar spermatozoa with a high viability and sufficient concentration for IVF. Furthermore, the current data suggest the possibility of improving the efficiency of monospermic fertilization of porcine IVM oocytes by a transient coculture with MFSS.

Extended storage of granulocyte concentrates mobilized by G-CSF with/without dexamethasone and collected by bag separation method

The aim of this study was to examine the extended storage of granulocyte concentrates mobilized by granulocyte-colony-stimulating factor (G-CSF) with/without dexamethasone (DEX) and collected by a bag separation method. Ten healthy adult volunteers donated blood three times: twice after granulocyte mobilization by (1) injecting G-CSF at 3 microg kg(-1) subcutaneously (s.c.) and (2) injecting G-CSF at 3 microg kg(-1) s.c. + DEX at 8 mg per oral and once (3) for a baseline control without any forms of mobilization. Granulocytes were collected by a bag separation method. The functions (phagocytosis and oxidative killing levels), viability and levels of interleukin (IL)-1beta, IL-8, IL-6 and tumour necrosis factor-alpha of granulocytes were measured. The average numbers of granulocytes collected from 200-mL samples of whole blood from the G-CSF and G-CSF + DEX groups were 35.1 x 10(8) and 49.4 x 10(8), respectively. Phagocytosis level, oxidative killing level and the viability of the granulocytes mobilized by G-CSF with/without DEX were well maintained for up to 72 h of storage after collection. The levels of the cytokines increased in a time-dependent manner. The in vitro phagocytosis level, oxidative killing level and the viability of granulocytes mobilized by G-CSF with/without DEX and collected by bag separation method can be maintained for as long as 72 h after collection.

A Classification of Unruptured Middle Cerebral Artery Bifurcation Aneurysms that can Help in Choice of Clipping Technique

Middle cerebral artery (MCA) aneurysms comprise 20-25% of all intracranial aneurysms. The majority of middle cerebral artery aneurysms are treated by microsurgical clipping. Most of the classifications of aneurysms at present are based on size, location or pathology which are effective for the description but are less useful in preoperative planning and also in deciding on the technique or type of clip application. The aim of our study was to examine the morphological features of unruptured MCA bifurcation aneurysms which influence the techniques of clipping of these aneurysms and to attempt to subclassify unruptured middle cerebral artery aneurysms based on their preoperative 3D CTA and intraoperative characteristics so as to help in the intraoperative choice of technique and clip application, respectively. Preoperative 3D CT angiography and intraoperative images along with the record of technique and type of clips used for 141 unruptured MCA aneurysms operated at our center were studied retrospectively. Unruptured MCA bifurcation aneurysms could be subclassified into 5 types based on the similarities in their morphological features which influenced the techniques of clipping as recorded from their preoperative 3D CTA and intraoperative view. These types and the distinctive feature of each type are described. The various techniques of clipping are discussed based on these subgroups. The groups outlined make possible the establishment of a common technical approach to clipping within the groups. This classification, based on preoperative 3D CTA and intraoperative morphological features of the aneurysm and parent vessels, helps in the intraoperative choice of technique and type of clip application to tackle these lesions.

Effects of dietary energy intake and cold exposure on kinetics of plasma glucose metabolism in sheep

An isotope dilution method using [U-(13)C]glucose injection was applied to determine the effects of dietary energy intake and cold exposure on plasma glucose metabolism in sheep. The sheep were assigned to two dietary treatments and were fed on diets containing either 100% or 160% of ME and both containing 150% of dietary crude protein intake for maintenance. The sheep were exposed from a thermoneutral environment (23 degrees C) to a cold environment (2-4 degrees C) for 5 days. The isotope dilution method was performed on the 18th day in the thermoneutral environment and on the fifth day of cold exposure. Plasma concentrations of glucose and NEFA increased (p < 0.05) during cold exposure for both diets. Plasma glucose pool size remained unchanged (p = 0.67), but plasma glucose turnover rate tended to increase (p = 0.07) with increased energy intake. Both pool size and turnover rate of plasma glucose increased (p = 0.01 and p = 0.0001, respectively) during cold exposure. No significant diet x environment interaction was detected. It is concluded that plasma glucose metabolism was influenced by both dietary energy intake and cold exposure, and plasma glucose metabolism in response to cold exposure was not modified by energy intake in sheep under the conditions (2-4 degrees C on the fifth day) of the present experiment.

Bonding characteristics of newly developed all-in-one adhesives

This study evaluated the microtensile bond strength and the interfacial morphology of newer adhesives. The occlusal surfaces of extracted teeth were ground flat for random allocation to four equal groups. Resin composite was bonded to each surface using either Clearfil SE Bond [SEB], Clearfil Protect Bond [PB], G-Bond [GB], or an experimental adhesive, SSB-200 [SSB]. After storage for 24 h in water at 37 degrees C, they were sectioned into beams (cross-sectional area 1 mm(2)) for microtensile bond strength testing (muTBS) at a crosshead speed of 1 mm/min. The load at failure of each was recorded; the data were analyzed by one-way ANOVA and Games Howell tests. The surfaces of the fractured specimens were observed using SEM. For the ultra-morphology of the interface, the occlusal surfaces of four more teeth were prepared as before and a thin layer of flowable resin composite was bonded to each surface using one of the four adhesives. The mean muTBS ranged from 39.68 MPa (GB) to 64.97 MPa (SEB). There were no statistical differences between SEB and SSB, or between PB and GB (p > 0.05). The muTBS of SEB and SSB were significantly greater than that of PB and GB (p < 0.05). SEMs of the fractured surfaces revealed a mixed (cohesive/interfacial) failure. TEM examination highlighted differences in the hybrid layer; SEB had a thicker layer than the others. In conclusion, the newer all-in-one adhesives produced a thin hybrid layer but varied in their bond strengths. The 2-step self-etching adhesives do not necessarily produce higher bond strengths than that of the all-in-one systems.

Radicals produced by blue-light–resin interactions alter the redox status of THP1 human monocytes

Resin composites are widely used in dentistry, and are polymerized in situ using a blue-light activated, free-radical polymerization mechanism. Blue light (400-500nm) is used to activate camphoroquinone (CQ), which decomposes to form free radicals that are stabilized by dimethyl-p-toludine (DMPT). CQ and DMPT are applied near tooth pulpal tissues and are irradiated during restorative procedures, suggesting that pulpal cells are exposed to free radicals. Because glutathione is a major component of the cellular redox management system, we tested the hypothesis that blue light irradiation would shift cellular glutathione redox balance of cells exposed to CQ and DMPT. We also measured NFkappaB activation, a redox-sensitive transcription factor that regulates inflammatory responses and glutathione synthetic enzyme levels. THP1 human monocytes were exposed to sublethal levels of CQ (0.4 mM) or DMPT (1.0 mM), with or without blue light exposure (25 J/cm(2)) from a quartz-tungsten-halogen source. The ratio of reduced to oxidized glutathione was measured using as assay based on 5,5'-dithio-bis(2-nitrobenszoic acid). NFkappaB transactivation was measured by transfection of an NFkappaB-containing plasmid linked to a luciferase reporter. Our results showed that blue light, CQ, or DMPT alone had no significant effect on cellular glutathione redox balance, but that the combination of these agents induced a marked oxidative bias, and reduced total glutathione levels up to 50%. On the other hand, light, CQ, and DMPT alone or in combination suppressed NFkappaB transactivation by >70%. Our results suggest that CQ and DMPT pose risks to pulpal tissues with or without blue light irradiation, and that multiple, interacting mechanisms shape the response to these agents.

Treatment with edaravone improves the survival rate in renal warm ischemia-reperfusion injury using rat model

Renal ischemia-reperfusion (I/R) injury during renal transplantation is a significant cause of renal dysfunction. The pathological role of free radicals in this process is a major concern. We investigated the effect of a free radical scavenger, edaravone (MCI-186), in renal I/R injury. Male Lewis rats (270 to 320 g) were used for the model. The right kidney was harvested and left renal artery and vein were clamped as laparotomy. The kidney was reperfused after 90 minutes of ischemia. Edaravone (10 mg/kg) was delivered intravenously before ischemia and after reperfusion to prevent the neutrophil activation. In the nontreatment I/R group, no rat survived beyond 4 days. However, in the edaravone I/R treatment group, one among five rats survived more than 7 days. These results suggested that treatment with edaravone ameliorated renal I/R injury, and that the agent has the potential to ameliorate preservation injury in renal transplantation.

Benefical effect of neutrophil elastase inhibitor on renal warm ischemia-reperfusion injury in the rat

Renal ischemia-reperfusion (I/R) injury is a significant problem in renal transplantation. Neutrophils play an important role in renal I/R injury. Several reports have demonstrated that neutrophil elastase derived from the activated neutrophils might play an important role in this injury. We investigated the effect of a neutrophil elastase inhibitor in renal I/R injury. Male Lewis rats (270-320 g) were used in the model. The right kidney was harvested and the left renal artery and vein were clamped at laparotomy. The kidney was reperfused after 90 minutes of ischemia. Neutrophil elastase inhibitor (ONO-5046: 30 mg/kg) was delivered intravenously before ischemia and after reperfusion to prevent neutrophil activation. In the nontreatment I/R group, no hosts survived 4 days. However, after treatment with neutrophil elastase inhibitor, 3 of 10 rats in the I/R group, survived more than 7 days. These results demonstrated that treatment with neutrophil elastase inhibitor ameliorated renal I/R injury.

The “Multi Clip” Method in Unruptured Complex Middle Cerebral Artery Aneurysms - A Case Series

This study aims to analyze the feasibility, indications and applicability of the "Multi Clip" method for accurate and complete clipping in patients with unruptured complex middle cerebral artery aneurysms. In this series, we achieved precise clipping in all cases without any intraoperative complications. On the basis of our work, we classified the necessity for multi-clipping into 3 categories: 1) precise clipping, 2) perforator preservation, and 3) reconstruction. The outcome in all patients was excellent. In conclusion, the "Multi Clip" method is a safe and an efficient procedure in cases of difficult unruptured middle cerebral artery aneurysms, where optimal neck closure cannot be obtained by single clipping.

Nonmyeloablative stem cell transplantation for nonmalignant diseases in children with severe organ dysfunction

Allogeneic stem cell transplantation (SCT) can cure several nonmalignant diseases in children. However, patients frequently have significant morbidity before transplantation and there is a high transplant-related mortality. Nonmyeloablative SCT might achieve the same goals but with less toxicity. Six pediatric patients with nonmalignant diseases underwent nonmyeloablative SCT from different stem cell sources. All patients were conditioned with fludarabine/melphalan with additional anti-thymocyte globulin for haploidentical grafts and prophylaxis for graft-versus-host disease (GVHD) consisting of tacrolimus and methotrexate with additional prednisolone for haploidentical grafts. Hematopoietic stem cells were neither T-cell depleted nor purged. All patients had severe organ dysfunction that precluded transplantation with conventional conditioning. Five of the six are alive and in complete disease resolution at a median of 19 months (range, 7-53 months) after SCT. One patient died of bacteremia before engraftment. Three patients achieved complete donor chimerism. Two patients remained stable mixed chimerism. Short-term toxicities were minimal. Acute and chronic GVHD were not seen. In summary, the fludarabine-based nonmyeloablative regimen followed by SCT provides a good approach for children with nonmalignant diseases. Even patients with severe organ dysfunctions had adequate engraftment with acceptable toxicities.

Therapeutic transfusions of granulocytes collected by simple bag method for children with cancer and neutropenic infections: results of a single-centre pilot study

BACKGROUND AND OBJECTIVES

Granulocyte transfusion therapy (GTX) can be effective for life-threatening infections unresponsive to conventional antimicrobial therapies in severely neutropenic children with cancer. We developed a new granulocyte collection method, named the 'bag method', in which apheresis, hydroxyethyl starch (HES) or dexamethasone are not used. We undertook a pilot study to determine the feasibility and the safety of GTX collected by the bag method for children with cancer and life-threatening infections.

MATERIALS AND METHODS

A total of 25 GTX were administered to 13 patients (median age 3 years, range: 0.3-17; median weight 10.6 kg, range: 4.5-49.8) with neutropenia-related infections. Thirteen blood-relative donors received granulocyte colony-stimulating factor (G-CSF) (5-10 microg/kg), subcutaneously, 14 h before collection. Major end-points were granulocyte yields, post-transfusion absolute neutrophil counts (ANC) in patients, donor and patient safety, and clinical outcome on day 30.

RESULTS

The median yield of ANC per 400 ml of processed whole blood was 6.2 x 10(9) (range: 2.5-15.0 x 10(9)). Patients received a mean of 6.4 +/- 0.8 x 10(8) granulocytes per kg of body weight per transfusion. The 1-h and 24-h post-transfusion ANC rose to 607 +/- 124/microl and 704 +/- 300/microl, respectively, from the baseline of 21/microl before the first GTX. Adverse reactions were observed in five of 13 donors (bone pain, headache, vasovagal reaction; all < or = grade 2) and in two of 25 transfusions of 13 patients (transient hypoxia; grade 3). Ten patients had favourable responses, and infection resolved in nine patients.

CONCLUSIONS

The bag method without apheresis relieves the physical load of donors and enables patients with a low body weight to provide an adequate dose of granulocytes.

Astringency of bovine milk whey protein

Whey protein solutions at pH 3.5 elicited an astringent taste sensation. The astringency of whey protein isolate (WPI), the process whey protein (PWP) that was prepared by heating WPI at pH 7.0, and the process whey protein prepared at pH 3.5 (aPWP) were adjusted to pH 3.5 and evaluated by 2 sensory analyses (the threshold method and the scalar scoring method) and an instrumental analysis (taste sensor method). The taste-stimulating effects of bovine and porcine gelatin were also evaluated. The threshold value of astringency of WPI, PWP, and aPWP was 1.5, 1.0, and 0.7 mg/mL, respectively, whereas the gelatins did not give definite astringency. It was confirmed by the scalar scoring method that the astringency of these proteins increased with the increase in protein concentration, and these proteins elicited strong astringency at 10 mg/mL under acidic conditions. On the other hand, the astringency was not elicited at pH 3.5 by 2 types of gelatin. A taste sensor gave specific values for whey proteins at pH 3.5, which corresponded well to those obtained by the sensory analysis. Elicitation of astringency induced by whey protein under acidic conditions would be caused by aggregation and precipitation of protein molecules in the mouth.

Intra- and extracellular reactive oxygen species generated by blue light

Blue light from dental photopolymerization devices has significant biological effects on cells. These effects may alter normal cell function of tissues exposed during placement of oral restorations, but recent data suggest that some light-induced effects may also be therapeutically useful, for example in the treatment of epithelial cancers. Reactive oxygen species (ROS) appear to mediate blue light effects in cells, but the sources of ROS (intra- versus extracellular) and their respective roles in the cellular response to blue light are not known. In the current study, we tested the hypothesis that intra- and extracellular sources of blue light-generated ROS synergize to depress mitochondrial function. Normal human epidermal keratinocytes (NHEK) and oral squamous cell carcinoma (OSC2) cells were exposed to blue light (380-500 nm; 5-60 J/cm(2)) from a dental photopolymerization source (quartz-tungsten-halogen, 550 mW/cm(2)). Light was applied in cell-culture media or balanced salt solutions with or without cells present. Intracellular ROS levels were estimated using the dihydrofluorescein diacetate (DFDA) assay; extracellular ROS levels were estimated using the leucocrystal violet assay. Cell response was estimated using the MTT mitochondrial activity assay. Blue light increased intracellular ROS equally in both NHEK and OSC2. Blue light also increased ROS levels in cell-free MEM or salt solutions, and riboflavin supplements increased ROS formation. Extracellularly applied ROS rapidly (50-400 muM, <1 min) increased intracellular ROS levels, which were higher and longer-lived in NHEK than OSC2. The type of cell-culture medium significantly affected the ability of blue light to suppress cellular mitochondrial activity; the greatest suppression was observed in DMEM-containing or NHEK media. Collectively, the data support our hypothesis that intra- and extracellularly generated ROS synergize to affect cellular mitochondrial suppression of tumor cells in response to blue light. However, the identity of blue light targets that mediate these changes remain unclear. These data support additional investigations into the risks of coincident exposure of tissues to blue light during material polymerization of restorative materials, and possible therapeutic benefits.

Distinction between some saccharides in scattered optical sum frequency intensity images

Using an optical sum frequency (SF) microscope with visible and infrared light pulses for excitation, we have attempted to distinguish among four saccharide species. The saccharides we studied were d-glucose, amylopectin, beta-cyclodextrin, and amylose. The wavelength of the infrared light was resonant to CH vibration. Amylose showed very weak sum frequency scattering for CH vibration among the four saccharides. As for the other three saccharides, we found a big difference in the sum frequency spectra of their CH stretching vibration near 2900 cm-1, when the incident visible and infrared light pulses were p- and s-polarized, respectively. Based on these facts, we have demonstrated a distinction between these three saccharides in the scattered SF intensity images.

Treatment of Ruptured Intracranial Aneurysms: Our Approach

OBJECTIVE

Subarachnoid hemorrhage (SAH) often results in devastating neurological deficits requiring hospitalization and loss of independence. This is often a difficult time for patients and their families who are struggling to cope with this sudden illness. Current treatment options include surgical clipping of the aneurysm or endovascular obliteration using Guglielmi detachable coils. Our purpose in writing this paper was to review the factors that determine the choice of treatment. In addition to this we wanted to study the benefits of surgical clipping for ruptured aneurysms over endovascular coiling.

MATERIAL AND METHODS

We studied--retrospectively--450 cases of ruptured cerebral aneurysms admitted to our institution from 1997 to 2003. Out of these, 324 were subjected to surgical clipping and 126 to endovascular techniques. The outcome was studied using the Glasgow Outcome Score (GOS).

RESULTS

Of the 324 cases of surgical clipping 222 had a good recovery, 38 had moderate disability, 15 had severe disability, 13 became vegetative and 36 patients died. In the endovascular group 34 had a good recovery, 22 had moderate disability, 18 had severe disability, 15 became vegetative and 37 patients died. Grade to Outcome was compared for both forms of treatment. In our series clipping for ruptured aneurysm was preferred to coiling in fusiform-shaped aneurysms, large or giant aneurysms, MCA aneurysms, blister aneurysms, complex configurations, partially thrombosed aneurysms and aneurysms associated with cerebral hemorrhage. Coiling was performed for basilar tip and trunk aneurysms, high anterior communicating artery aneurysms, patients in subacute stages of subarachnoid hemorrhage, and those with associated medical complications.

CONCLUSION

Based on this study we were able to formulate a few definite indications for clipping, even in the times of advanced endovascular techniques. In addition we could also prove the benefits of surgical clipping over the endovascular technique in severe subarachnoid hemorrhage.

Immunohistochemical study of autoimmune pancreatitis using anti-IgG4 antibody and patients' sera

AIMS

Autoimmune pancreatitis (AIP), characterized by raised serum IgG4 levels, is frequently complicated by disorders of extrapancreatic organs. The aim of the present study was to examine immunohistochemically which extrapancreatic organs are affected, and whether an autoantibody to such organs is present in the serum of AIP patients.

METHODS

Various tissues/organs obtained from AIP patients were studied immunohistochemically with an anti-IgG4 antibody. To examine the presence of an autoantibody in the serum of AIP patients, sera were incubated with various normal organs/tissues extracted for other diseases, followed by detection with an anti-IgG4 antibody. Sera were also examined before and after glucocorticoid therapy.

RESULTS

Marked infiltration of IgG4+ plasma cells was observed in the pancreas, liver, bile duct and salivary gland of many of the AIP patients examined. The normal epithelia of the pancreatic ducts, bile ducts, gallbladder and salivary gland ducts reacting with the patients' sera were detectable by the anti-IgG4 antibody. Following glucocorticoid therapy the IgG4 antibody from the patients' sera showed decreased reactivity with these tissues.

CONCLUSIONS

AIP may also affect extrapancreatic organs, the serum of AIP patients may contain an IgG4 autoantibody to various organs and glucocorticoid therapy may improve such disorders.

The Effect of Clipping and Coiling in Acute Severe Subarachnoid Hemorrhage after International Subarachnoid Aneurysmal Trial (ISAT) Results

Cerebral aneurysms are treated by two methods: direct microsurgical clipping and endovascular coiling. Both are selected based on definite guidelines for clinicoradiological criteria as follows: Endovascular therapy comprising of GDC embolization, CSF wash-out with UK or TP A were performed in cases with Hunt and Kosnik grade 4 (GCS 7, 8), and grade 5 (without hydrocephalus or intracranial hemorrhage), age>70 years, subacute stage (4--14 days of vasospasm), basilar aneurysm and peripheral MCA/PCA aneurysms. Microsurgical clipping with a drainage procedure was performed in cases with Hunt and Kosnik grades 0--3, grade 4 (GCS 9--12), age less than 70 years, grade 5 with hydrocephalus or intracerebral hematoma and acute stage (0--3 days after bleed). The patient's outcome was measured using GOS (Glasgow outcome score) at the time of discharge. In our series of severe (poor grade) SAH cases, 120 cases underwent clipping and 59 cases underwent coiling. Although they accounted for 37.8 % and 48 % of total SAH cases, respectively, the outcome was satisfactory. Good recovery and moderate disability, together termed "favorable outcome" was found in 69.16 % of clipping cases and 44.06 % of coiling cases. Clipping had a better outcome than coiling in cases of acute severe SAH in our series. The golden hour resuscitation, pre-hospital care and the adjunctive treatment strategies like hypothermia are discussed. A critical appraisal of the ISAT of microsurgical clipping versus coiling is used for comparison of our results.

Clip reconstruction for a case of peripheral posterior inferior cerebellar artery aneurysm: case report

The authors report an unusual surgical treatment for an aneurysm on the left peripheral posterior inferior cerebellar artery (PICA). The computed tomographic scan showed subarachnoid haemorrhage and a haematoma in the left cerebellar region close to the fourth ventricle. The 3D CT angiography demonstrated an aneurysm on the left peripheral PICA which was confirmed on four-vessel angiography. The aneurysm was approached through a posterior suboccipital craniotomy and the PICA was reconstructed with multiple clips. The literature concerning peripheral PICA aneurysms and their treatment is reviewed and discussed.

Expression of Peroxisome Proliferator-Activated Receptor-γ in Renal Ischemia-Reperfusion Injury

The pathogenesis of ischemia-reperfusion injury is known to involve cytokines and particularly surface adhesion molecules, the expression of which initiates the attachment of inflammatory cells. Peroxisome proliferator-activated receptor (PPAR)-gamma is considered an important immunomodulatory factor as well as a fatty acid regulator. In this study, we researched the expression of PPAR-gamma in renal ischemia-reperfusion injury of the rat. The right kidney was harvested and left renal artery and vein were clamped under laparotomy. The kidney was reperfused after 90 minutes of ischemia, and rats were sacrificed at 0, 1.5, 3, 5, 12, and 24 hours after reperfusion. PPAR-gamma expression was analyzed by immunohistochemical staining using monoclonal antibody. In normal kidney, PPAR-gamma staining was weak on endothelial cells, including mesangial cells. On the other hand, PPAR-gamma staining was weak on interstitial cells and strong on collecting ducts of medulla. From 1.5 to 5 hours after reperfusion, PPAR-gamma staining was strong on endothelial cells, moderate on interstitial cells, and strong on collecting ducts. Twelve hours after reperfusion, PPAR-gamma staining was weak on endothelial cells, moderate on interstitial cells, and strong on collecting ducts. PPAR-gamma is induced on collecting ducts, interstitial cells, and endothelial cells in a rat model having renal ischemia-reperfusion injury.

The expression of cyclooxygenases and lipoxygenases in renal ischemia-reperfusion injury

Recent studies of ischemia-reperfusion (I/R) injury have focused on the function of neutrophils as well as the actions of inflammatory cytokines. However, few reports address cyclooxygenases (COXs) and lipoxygenases (LOXs). We researched the expression of COXs (COX-1 and COX-2) and LOXs (5-LOX and 12-LOX) in rat renal I/R injury. The right kidney of male Lewis rats was excised, and the left renal artery and vein clamped for a 90-minute ischemia time. Rats were humanely killed at 0, 1.5, 3, 5, and 12 hours after reperfusion. COX and LOX expressions were studied using immunohistostaining. COX-2 and LOX expressions were observed only on endothelial cells of normal kidney. From 1.5 to 5 hours after reperfusion, COX-2 and LOXs expressions gradually intensified on endothelial cells. COX-2 and LOXs expression were most intense on endothelial cells at 5 hours after reperfusion. Twelve hours after reperfusion, necrosis extended throughout the ischemic kidney and nearly all the tubular epithelial cells were destroyed. Thus, at 12 hours after reperfusion, COX-2 and LOXs expressions on endothelial cells became weaker. However, COX-1 expression was not different at every time after reperfusion. COX-2 and LOXs were expressed in a rat model showing renal I/R injury. Several hours after the maximum of COX-2 and LOXs expressions, the maximal renal I/R injury was observed. These results suggest a relationship between COX-2 and LOXs expressions and renal I/R injury.

Study of peroxisome proliferator-activated receptor (PPAR)-gamma in renal ischemia-reperfusion injury

Recent studies of ischemia-reperfusion (I/R) injury have focused on the function of neutrophils, the action mechanism of inflammatory cytokines. However, few reports have addressed peroxisome proliferator-activated receptor (PPAR)-gamma. PPAR-gamma is a ligand-activated transcriptional factor belonging to the steroid receptor superfamily. It plays a role in both adipocyte differentiation and tumorigenesis. We researched the expression of PPAR-gamma in renal I/R injury of the rat. Male Lewis rats were used. The right kidney was harvested and the left renal artery and vein were clamped at 90 minutes of ischemic time. Rats were killed at 0, 1.5, 3, 5, and 12 hours after reperfusion. PPAR-gamma expression was studied by immunohistostaining. PPAR-gamma expression was observed only on mesangial and endothelial cells of normal kidney. From 1.5 to 3 hours after reperfusion, PPAR-gamma expression gradually became stronger on mesangial and endothelial cells. PPAR-gamma expression was most intense on mesangial cells and endothelial cells at 3 hours after reperfusion. Twelve hours after reperfusion, necrosis extended throughout the ischemic kidney and nearly all the tubular epithelial cells were destroyed, but 12 hours after reperfusion PPAR-gamma expression gradually became weaker on mesangial and endothelial cells. PPAR-gamma was expressed in the rat model having renal I/R injury. Several hours after maximal of PPAR-gamma expression, maximal renal I/R injury was observed. These results may indicate a relationship between PPAR-gamma expression and renal I/R injury.

Insulin secretion and glucose uptake in hypomagnesemic sheep fed a low magnesium, high potassium diet

Hyperglycemic and euglycemic clamp experiments were conducted to evaluate insulin secretion and glucose uptake in the hypomagnesemic sheep fed a low magnesium (Mg), high potassium (K) diet. Five mature sheep were fed a semipurified diet containing 0.24% Mg and 0.56% K (control diet) and five were fed 0.04% Mg and 3.78% K (low Mg/high K diet) for at least 2 weeks. In the hyperglycemic clamp experiment, plasma glucose concentrations were raised and maintained at a hyperglycemic steady-state (approximately 130 mg/100 ml) by variable rates of glucose infusion during the experimental period (120 minutes). The insulin response in the sheep fed the low Mg/high K diet (31.0 microU/ml) were significantly (P < 0.01) lower than those (111.7 microU/ml) of the sheep fed the control diet. In the euglycemic clamp experiment, insulin was infused at rates of 5, 10, 15, or 20 mU/kg/min, each followed by variable rates of glucose infusion to maintain a euglycemic steady-state (basal fasting levels). Hypomagnesemic sheep fed the low Mg/high K diet had significantly (P < 0.01) lower mean glucose disposal (3.72 mg/kg/min) across the insulin infusion rates compared with those of the sheep fed the control diet (5.37 mg/kg/min). These results suggest that glucose-induced insulin secretion and insulin-induced glucose uptake would be depressed in hypomagnesemic sheep and are caused by feeding the low Mg/high K diet.

Bond strength and SEM observation of CO2 laser irradiated dentin, bonded with simplified-step adhesives

This study investigated, mechanically and morphologically, whether the dentin surface irradiated by CO2 laser could be a possible adherent when bonded with simplified-step adhesives. Buccal enamel and cementum of extracted human premolars were removed to expose a flat dentin surface. The dentin surfaces were irradiated continuously with CO2 laser at 1.0 W. Before bonding with either a single-bottle adhesive (Single Bond) or a self-etching priming system (Mega Bond), the irradiated dentin surface was treated as follows: no treatment, NaHCO3 powder abrasion and wet-grinding with 600-grit SiC paper. The treated dentin surfaces were bonded to resin composite with either of the two adhesives. Non-irradiated dentin surfaces were also used as control. Resin bonded specimens were stored in water at 37 degrees C for 24 hours and subjected to microtensile bond test. Additionally, to observe the resin/irradiated dentin interface, resin-bonded specimens were similarly prepared, sectioned into slabs, embedded in epoxy resin, polished with diamond pastes, sputter coated Au-Pd and examined with scanning electron microscopy (SEM). After SEM observation, the specimens were further polished with diamond paste to remove the Au-Pd sputter-coat, immersed in HCL and NaOCl and finally observed by SEM again. In the presence of carbonized dentin, microtensile bond strength drastically decreased but recovered to the control value by removing the carbonized dentin layer visually with SiC paper for both adhesive systems. However, the laser-affected dentin that remained on the bonded interface was easily dissolved with NaOCl and HCl.

Study of cyclooxygenase-2 in renal ischemia-reperfusion injury

The pathogenesis of ischemia-reperfusion (I/R) injury is known to involve cytokines and particularly surface adhesion molecules, the expression of which initiates the attachment of inflammatory cells. Cyclooxygenase (COX)-1 and COX-2 catalyze the initial key enzymatic steps in the metabolism of arachidonic acid. COX-1 is constitutively expressed in most tissues, whereas COX-2 is induced in response to proinflamamatory cytokines and stress. In this study we examined the expression of COX-1 and COX-2 in the rat after 90 minutes of warm-I/R injury. Rats were sacrificed at 0, 1.5, 3, 5, 12, and 24 hours after reperfusion. COX-2 expressions were analyzed by immunohistochemical staining, which was graded on a scale of 0 to 4. All results are presented as the mean values +/- SD. Data analyses used analysis of variance. COX-2 expression was most intense on endothelial cells at 3 and 5 hours after reperfusion. From 12 to 24 hours after reperfusion COX-2 expression on endothelial cells gradually became weaker. COX-2 expression scores were significantly higher at 1.5, 3, 5, 12, and 24 hours after reperfusion than at 0 hours. However, there were no differences in COX-1 expression after reperfusion. Several hours after the maximum of COX-2 expression the maximum renal I/R injury was observed. These results suggest a relationship between COX-2 expression and renal I/R injury.

Dental adhesive compounds alter glutathione levels but not glutathione redox balance in human THP-1 monocytic cells

The use of hydrophilic dental monomers in dentin bonding agents has vastly improved resin-dentin bond strengths, but incomplete polymerization of these monomers and their leaching into adjacent (pulpal) oral tissues has raised concerns about their biocompatibility. The sublethal effects of these resins are virtually unknown, but their electrophilic nature led to the hypothesis that they may alter cellular oxidative stress pathways. Glutathione balance between reduced (GSH) and oxidized (GSSG) is a major mechanism by which cells maintain redox balance and was therefore the focus of the current investigation. THP-1 human monocytic cells were exposed to hydroxyethyl methacrylate (HEMA), benzoyl peroxide (BPO), camphorquinone (CQ), or triethyelene glycol dimethacrylate (TEGDMA) for 24 h at sublethal doses, then GSH and GSSG levels were measured by means of Ellman's method adapted for cell culture. The results indicate that these dental resin compounds act at least partly via oxidative stress by increasing GSH levels at sublethal concentrations. However, the GSH-GSSG ratio was relatively unaffected. Only BPO altered the GSH-GSSG ratio at 24 h, again at sublethal levels (7.5-15 micromol/L). The results support the hypothesis that resin monomers act, at least in part, via oxidative stress, and that oxidative-stress pathways should be one focus of future investigations of monomer biocompatibility.

Fluid movement across the resin-dentin interface during and after bonding

This study evaluated the extent of water penetration through resin-dentin interfaces before and after being sealed with adhesives. Four adhesive resin systems (2 total-etch adhesives and 2 self-etching primer adhesives) were used in this study. Dentin disks were placed in a split-chamber device, and in situ fluid movement across dentin was measured, with and without physiological pressure, during bonding procedures or 24 hrs after bonding. The fluid movement across dentin occurs via dentin tubules after acid-etching. Large outward or inward fluid shifts across dentin were observed during air-drying and light-curing for resin application. The amount of fluid movement across resin-bonded dentin when total-etch adhesives were used was significantly greater than that with self-etching adhesives. The milder acid-etching effects of self-etching primers may retain hybridized smear plugs within the tubules that reduce outward fluid flow, resulting in superior dentin sealing.

Autologous hematopoietic stem cell transplantation for refractory antiphospholipid syndrome causing myocardial necrosis

Autologous hematopoietic stem cell transplantation (HSCT) is currently being evaluated as a treatment for autoimmune diseases, including systemic lupus erythematosus (SLE), that are associated with a very severe prognosis. We describe a 27-year-old woman with SLE with a 10-year history of refractory antiphospholipid syndrome (APS). She developed progressive myocardial necrosis despite treatment with corticosteroids, cyclophosphamide (CYC), cyclosporine, and immunopheresis. After conditioning with CYC, fludarabine, and antithymocyte globulin, autologous HSCT using CD34(+) selection was performed. After transplantation, the clinical symptoms caused by APS remitted, and the serum anticardiolipin antibody level decreased. Remission has persisted for 21 months after transplantation. Although a longer follow-up is required for the assessment of efficacy, autologous HSCT may cure patients with refractory APS.

Effect of dietary protein intake on plasma leucine flux, protein synthesis, and degradation in sheep

Combined experiments of an isotope dilution method of [1-(13)C]leucine with open circuit calorimetry and a nitrogen (N) balance test were applied to determine the effect of dietary crude protein (CP) intake on plasma leucine flux and protein synthesis and degradation in four sheep. The experiment was conducted in a 3 x 4 Latin rectangle design of three 3-week periods. Dietary CP intake was 5.6, 7.7, and 10.8 g/(kg(0.75) x d). Metabolizable energy intake was 120% of requirement for all dietary treatments. [1-(13)C]Leucine was intravenously infused for 8 h and blood and breath samples were collected during the latter 2-h period of infusion. Isotopic enrichments of plasma [1-(13)C]leucine, alpha-[1-(13)C]ketoisocaproic acid, and exhaled (13)CO(2) were determined. For the N balance test, N digestibility, N excretion in urine, and protein balance (N x 6.25) increased with increasing dietary CP intake. Rates of plasma leucine turnover, protein synthesis, and degradation changed toward reduction with increased dietary CP intake. It is likely that in sheep, high CP intake enhances protein deposition with reduced protein degradation rather than increased protein synthesis.

Bond strength of simplified-step adhesives to enamel prepared with two different diamond burs

BACKGROUND

Self-etching primers are reported to produce considerable etching on flat enamel surfaces. However, little is known about the influence of different enamel surface textures. In this study the influence of grinding enamel on bond strength of two all-in-one and one two-step adhesives was investigated.

METHODS

Resin composite was bonded to the ground enamel of extracted human third molars that was reduced 0.5 mm from the buccal or lingual surfaces using either regular- or superfine-grit diamond burs with each of the three adhesives. After 24 hours in 37 degrees C water, the specimens were sectioned into slabs of 0.7 mm thickness, trimmed to an hourglass configuration, and subjected to microtensile bond strength (MTBS) testing.

RESULTS

For all adhesive systems, MTBS to enamel ground with a regular-grit diamond bur was not significantly different from that with a superfine-grit diamond bur. The etching patterns of these adhesives were partly varied according to the aggressiveness of the adhesives.

CONCLUSION

The use of two different burs does not affect the tensile bond strength of the adhesives to enamel.

In vivo degradation of resin-dentin bonds produced by a self-etch vs. a total-etch adhesive system

The purpose of this study was to evaluate the long-term durability of in vivo bond strengths and the morphological changes of interfaces between dentin and two adhesive systems. Class V preparations were prepared on the facial surfaces of 14 intact teeth of two monkeys and restored with a combination of Unifil Bond/Z250 or Single Bond/Z250. One year later, 10 additional teeth were restored with the same materials and the monkeys were killed after 24 h. All of the restored teeth were subjected to microtensile bond strength ( micro TBS) testing. The debonded surfaces of the dentin sides were morphologically observed using Fe-scanning electron microscopy (SEM), as were the polished cross-sections of resin-dentin interfaces. For both Unifil Bond and Single Bond, the micro TBS at 24 h was significantly higher than that at 1 yr. Fe-SEM observations of polished cross-sectioned and fractured surfaces showed that porosity within the hybrid layers produced by Single Bond increased over time. However, the interface produced by Unifil Bond revealed no noticeable changes in morphology between 24-h and 1-yr specimens. It is concluded that even though the bond strengths of both adhesive systems declined over time, the bonding interface using self-etching primers was relatively stable over time compared to the wet bonding system.

Association between up-regulation of stress-responsive genes and hypomethylation of genomic DNA in tobacco plants

Transcripts that specifically accumulate in transgenic tobacco plants expressing an anti-sense construct for a tobacco type I DNA methyltransferase, NtMET1, were screened by the differential display method. Of the 31 genes identified, 16 encoded proteins with known functions; ten of these were related to biotic and abiotic stress responses, and the other six to cellular functions. In order to examine whether expression of these genes is correlated with DNA methylation status under natural stress conditions, a pathogen-responsive gene (NtAlix1) was selected as representative, and assayed for transcript induction and genomic methylation in tobacco plants infected with tobacco mosaic virus (TMV). In inoculated leaves of wild-type plants, NtAlix1 transcripts began to accumulate 12 h after the onset of the hypersensitive response (HR), and levels remained high for up to 24 h. Changes in the methylation status at the locus became obvious 24 h later, as detected by digestion of genomic DNA with a methylation-sensitive restriction enzyme. The results suggest that the level of DNA methylation may change in response to external stresses, and that this is closely related to the activation of stress-responsive genes.

Multiseptate gallbladder: diagnostic value of MR cholangiography and ultrasonography

Multiseptate gallbladder is a rare congenital malformation. We present a case that emphasizes the importance of ultrasonography and magnetic resonance imaging. Ultrasound examination of the abdomen showed multiple linear internal echoes consistent with multiple septa crossing the entire gallbladder lumen, creating a honeycomb appearance. Magnetic resonance cholangiopancreatography showed a grapelike cluster of the whole gallbladder.

Prediction of Impending Rupture in Aneurysms Using 4D-CTA: Histopathological Verification of a Real-Time Minimally Invasive Tool in Unruptured Aneurysms

The authors describe the use of a 4D-CT angiogram to predict impending rupture in intact aneurysms, as a real-time, less invasive imaging technique. Histopathological verification and immunostaining of the bleb site performed on the study population reveals the significant predictive value of this tool. The point of maximum amplitude of pulsation of the aneurysm wall in unison with the RR interval of the electrocardiogram determines the potential rupture point. This helps in prioritizing the intervention for unruptured aneurysm cases, provides an effective screening of the high-risk population, and aids preoperative planning of clip application.

In vitro effect of nanoleakage expression on resin-dentin bond strengths analyzed by microtensile bond test, SEM/EDX and TEM

This study evaluated the effect of multiple consecutive adhesive resin coatings of adhesive bonded to human dentin on nanoleakage and resin-dentin bond strength. Resin bonded dentin specimens were prepared using a total-etch adhesive (One-Step Plus) applied as multiple consecutive coating, or using two self-etch adhesive systems (iBond or Fluoro Bond). For the total-etch adhesive, resin application and air evaporation were performed 1, 2, 3, or 4 times. The self-etch adhesives were applied according to manufacturers' instructions. Resin-dentin bonded beams were prepared and immersed in water (control) or ammoniacal silver nitrate. After storage, microtensile bond strengths were measured. The fractured surfaces were examined by scanning and transmission electron microscopy (SEM and TEM), and energy-dispersive X-ray spectrometry (EDX). No significant differences in bond strength were found between water and silver nitrate storage groups. Several types of silver depositions (spotted, reticular, or water trees) were found in adhesive joints. The bond strengths of the single coated specimens of the total-etch adhesive were significantly lower than those receiving 2-4 coatings. Single coats produced more nanoleakage than multiple coats. However, no correlation was found between the bond strengths and nanoleakage between the different adhesives (total-etch adhesive with different conditions or self-etch adhesives).