Effect of combined application of bFGF and inorganic polyphosphate on bioactivities of osteoblasts and initial bone regeneration

Basic fibroblast growth factor (bFGF) and inorganic polyphosphate (poly(P)) have been recognized as therapeutic agents that enhance bone regeneration. It has also been shown that poly(P) may enhance the mitogenic activity of bFGF. The purpose of this study is to evaluate the combined effect of bFGF and poly(P) on bioactivities of osteoblasts and initial bone regeneration in vitro and in vivo. MC3T3-E1 cells were treated with bFGF, poly(P) or bFGF+poly(P), then subjected to cell proliferation assay, alkaline phosphatase (ALP) activity measurement, quantitative real-time reverse transcription-polymerase chain reaction and Alizarin S Red staining. In an in vivo study, bFGF-, poly(P)- and bFGF+poly(P)-modified interconnected porous hydroxyapatite (IPHA) complexes were fabricated, and placed into the femurs of rabbits to evaluate new bone formation histologically and histomorphometrically. The highest enhancement of cell proliferation were observed in those treated with bFGF+poly(P) on days 5 and 7. Cells treated with bFGF+poly(P) also exhibited increased ALP activity on days 5 and 10, up-regulated mRNA levels of osteocalcin and osteopontin, and enhanced calcification when compared to the non-treated cells. In vivo, the highest bone formation ratio was observed in bFGF+poly(P)-modified IPHA complexes. This study indicated that co-application of bFGF and poly(P) may provide enhanced bone formation by modulating cell proliferation and the mineralization process. It is anticipated that a combined application of bFGF and poly(P) can provide a novel method for bone regeneration in clinical use.

Increased risk of exacerbating gastrointestinal disease among elderly patients following treatment with calcium channel blockers

BACKGROUND AND OBJECTIVE

Calcium channel blockers (CCBs) have been widely used for the treatment of hypertension and angina pectoris. It is presumed that CCBs decrease the lower esophageal sphincter pressure and as a result, the risk of gastrointestinal disease may be increased. Since the prevalence of gastrointestinal diseases has increased in elderly patients, it is possible that treatment with CCBs may have contributed to this increase. Therefore, we considered that the risk of exacerbating gastrointestinal disease among elderly patients by CCBs can be estimated by using the prescription ratio of antisecretory drugs as an outcome.

METHOD

We hypothesized that patients who are prescribed CCBs would increase the use of antisecretory drugs involving H(2)-receptor antagonists and proton pump inhibitors (PPIs). From January 2001 to December 2005, a dynamic retrospective cohort study was performed at three community pharmacies in Nagasaki city, Japan, to assess the use of antisecretory drugs following treatment with CCBs among elderly patients. The correlation of initiation of antisecretory drugs treatment to maintenance therapy with PPIs was determined by the Cox proportional hazards model.

RESULTS

The proposed study includes 303 patients prescribed CCBs and 258 controls. During the study period, 138 patients prescribed CCBs and 66 controls were initiated by giving antisecretory drugs; the hazard ratio was 1.40 (95% confidence interval 1.21-1.63). Eighty two patients taking CCBs and 32 controls were initiated by the maintenance therapy with PPIs; the hazard ratio was 1.48 (95% confidence interval 1.21-1.83).

CONCLUSION

Patients who simultaneously initiated the use of antisecretory drugs with CCBs could not be found. Therefore, antisecretory drugs have not been used to prevent the gastrointestinal diseases caused by CCBs. The results obtained in this study suggest that the risk of gastrointestinal disease could be increased by long-term treatment with CCBs for elderly patients.

Meniere's attacks occur in the inner ear with excessive vasopressin type-2 receptors

Meniere's disease is peculiar to humans and is characterised by episodic vertigo, fluctuating hearing loss and tinnitus, and attacks of the affliction occurring under conditions of stress. Its pathology was first revealed to be inner ear hydrops through temporal bone studies in 1938. Although subsequently proposed as a disorder of water metabolism in the inner ear, its pathogenesis remains unsolved. The present study aimed to assess the link between the inner ear pathology in Meniere's disease and vasopressin, an anti-diuretic stress hormone with a potential role in inner ear fluid homeostasis. Blood samples were obtained from Meniere's disease patients in the morning, before any surgical treatment, to examine plasma vasopressin (pAVP) levels, and then from inner ear tissue during surgical treatment, to examine vasopressin type-2 receptor (V2R) in the endolymphatic sac. pAVP and the relative V2R mRNA expression in the endolymphatic sac were examined using a real-time polymerase chain reaction. Relative cAMP activity in the endolymphatic sac was also examined using tissue culture and cAMP assay. Both pAVP (1.6-fold versus controls; P = 0.048) and inner ear V2R mRNA expression (41.5-fold versus controls; P = 0.022) were significantly higher in Meniere's patients. cAMP activity was basally up-regulated (2.1-fold versus controls) and cAMP sensitivity to vasopressin application was largely elevated (4.9-fold versus controls) in Meniere's patients. We conclude that, in the pathogenesis of inner ear hydrops, resulting in Meniere's attacks, elevation of pAVP levels (probably as a result of stress) may present as a matter of consequence, but susceptibility of the V2R-overexpressed and cAMP-hypersensitized inner ear to pAVP elevation might be essential as the basis of this disease. Further experimental and clinical studies are needed to better clarify the relationship between Meniere's disease and stress.

Complementary Distributions of Amyloid-β and Neprilysin in the Brains of Dogs and Cats

Neprilysin is an amyloid-β-degrading enzyme localized in the brain parenchyma. The involvement of neprilysin in the pathogenesis of Alzheimer's disease has recently received much attention. We examined the localization of neprilysin and amyloid-β, as well as the activity of neprilysin, in the brains of dogs and cats of various ages to clarify the relationship between neprilysin activity and amyloid-β deposition. The distribution of neprilysin was almost identical in dogs and cats, being high in the striatum, globus pallidus, and substantia nigra, but very low in the cerebral cortex. The white matter and hippocampus were negative. Neprilysin activity in the brain regions in dogs and cats was ranked from high to low as follows: thalamus/striatum > cerebral cortex > hippocampus > white matter. Amyloid-β deposition was first detected at 7 and 10 years of age in dogs and cats, respectively, and both the quantity and frequency of deposition increased with age. In both species, amyloid-β deposition appeared in the cerebral cortex and the hippocampus. In summary, the localization of neprilysin and neprilysin activity, and that of amyloid-β, were complementary in the brains of dogs and cats.

Unilateral optical nerve hypoplasia in a Beagle dog

Unilateral (left eye) optic nerve hypoplasia was detected in a six-month-old male Beagle dog. Vision testing indicated that the left eye had poor vision and testing the pupillary light reflex showed the left eye to have an absence of the afferent pathway of the reflex but it had a normal efferent pathway. Ophthalmoscopy revealed a small-sized optic disc, winding retinal artery and dilated retinal vasculature in the left globe. Electroretinography showed no abnormal findings even in the left globe. Histopathologically, the left optic nerve was markedly hypoplastic and was composed of sparse neural elements and a moderate amount of connective and glial tissues. In the retina of the left globe, the nerve fibre layer and the ganglion cell layer were reduced in thickness, although a small number of ganglion cells were still present. There were no abnormal findings detected in the right globe and the right optic nerve. The brain appeared normal macroscopically.

Management of total paralysis of the brachial plexus by the double free-muscle transfer technique

The double free-muscle transfer technique achieved a dramatic revolution in the treatment of total paralysis of the brachial plexus by providing universal prehensile function, although several requirements such as successful free-muscle transfers, stability of the proximal joints and prolonged postoperative rehabilitation are necessary for the success of this procedure. To obtain the best outcome of double free-muscle transfer, it is imperative to understand the key factors, viz. selection of the donor muscle, meticulous microsurgical technique, importance of proximal joint stability, selection of the kind of grip and postoperative rehabilitation. Double free-muscle transfer is not a simple microsurgical muscle transfer for finger movement, but a universal reconstructive procedure for total paralysis of the upper limb.

Correction of the disease phenotype in the mouse model of Stargardt disease by lentiviral gene therapy

Autosomal recessive Stargardt disease (STGD1) is a macular dystrophy caused by mutations in the ABCA4 (ABCR) gene. The disease phenotype that is most recognized in STGD1 patients, and also in the Abca4-/- mouse (a disease model), is lipofuscin accumulation in retinal pigment epithelium. Here, we tested whether delivery of the normal (wt) human ABCA4 gene to the subretinal space of the Abca4 -/- mice via lentiviral vectors would correct the disease phenotype; that is, reduce accumulation of the lipofuscin pigment A2E. Equine infectious anemia virus (EIAV)-derived lentiviral vectors were constructed expressing either the human ABCA4 gene or the LacZ reporter gene under the control of the constitutive (CMV) or photoreceptor-specific (Rho) promoters. Abca4-/- mice were injected subretinally with 1 microl ( approximately 5.0 x 10(5) TU) of each EIAV vector in one eye at postnatal days 4 and 5. An injection of saline, an EIAV-null vector, or an uninjected contralateral eye served as a control. Mice were killed at various times after injection to determine photoreceptor (PR) transduction efficiency and A2E concentrations. EIAV-LacZ vectors transduced from 5 to 20% of the PRs in the injected area in mice. Most importantly, a single subretinal injection of EIAV-CMV-ABCA4 to Abca4-/- mouse eyes substantially reduced disease-associated A2E accumulation compared to untreated and mock-treated control eyes. Treated eyes of Abca4-/- mice accumulated 8-12 pmol per eye (s.d.=2.7) of A2E 1 year after treatment, amounts comparable to wt controls, whereas mock-treated or untreated eyes had 3-5 times more A2E (27-39 pmol per eye, s.d.=1.5; P=0.001-0.005). Although extrapolation to humans requires caution, the high transduction efficiency of both rod and cone photoreceptors and the statistically significant reduction of A2E accumulation in the mouse model of STGD1 suggest that lentiviral gene therapy is a potentially efficient tool for treating ABCA4-associated diseases.

The clinical significance of the scaphoid cortical ring sign: a study of normal wrist X-rays

The scaphoid cortical ring sign, identified as a radiological indicator of rotary subluxation of the scaphoid, is frequently seen on normal wrist X-rays. This study examined the clinical significance of this sign in 139 normal wrists in 114 patients, with a mean age of 52 (range 15-81) years. In this study, there were no significant relationships between the appearance of a cortical ring sign and age, gender or hand dominance. Consequently, a cortical ring sign indicates scaphoid flexion, but may be visible in the normal wrist at any age or gender and in either hand and is not necessarily an indicator of pathology in the wrist.

AP214, an analogue of alpha-melanocyte-stimulating hormone, ameliorates sepsis-induced acute kidney injury and mortality

Sepsis remains a serious problem in critically ill patients with the mortality increasing to over half when there is attendant acute kidney injury. alpha-Melanocyte-stimulating hormone is a potent anti-inflammatory cytokine that inhibits many forms of inflammation including that with acute kidney injury. We tested whether a new alpha-melanocyte-stimulating hormone analogue (AP214), which has increased binding affinity to melanocortin receptors, improves sepsis-induced kidney injury and mortality using a cecal ligation and puncture mouse model. In the lethal cecal ligation-puncture model of sepsis, severe hypotension and bradycardia resulted and AP214 attenuated acute kidney injury of the lethal model with a bell-shaped dose-response curve. An optimum AP214 dose reduced acute kidney injury even when it was administered 6 h after surgery and it significantly improved blood pressure and heart rate. AP214 reduced serum TNF-alpha and IL-10 levels with a bell-shaped dose-response curve. Additionally; NF-kappaB activation in the kidney and spleen, and splenocyte apoptosis were decreased by the treatment. AP214 significantly improved survival in both lethal and sublethal models. We have shown that AP214 improves hemodynamic failure, acute kidney injury, mortality and splenocyte apoptosis attenuating pro- and anti-inflammatory actions due to sepsis.

Wrist flexion contracture: an unusual complication following palmaris longus tendon harvest

We describe a case of 3-year-old girl in whom flexion contracture of the wrist developed following harvest of the palmaris longus tendon with a tendon stripper.

UTGB/medaka: genomic resource database for medaka biology

Medaka (Oryzias latipes) is a small egg-laying freshwater teleost native to East Asia that has become an excellent model system for developmental genetics and evolutionary biology. The draft medaka genome sequence (700 Mb) was reported in June 2007, and its substantial genomic resources have been opened to the public through the University of Tokyo Genome Browser Medaka (UTGB/medaka) database. This database provides basic genomic information, such as predicted genes, expressed sequence tags (ESTs), guanine/cytosine (GC) content, repeats and comparative genomics, as well as unique data resources including (i) 2473 genetic markers and experimentally confirmed PCR primers that amplify these markers, (ii) 142,414 bacterial artificial chromosome (BAC) and 217,344 fosmid end sequences that amount to 15.0- and 11.1-fold clone coverage of the entire genome, respectively, and were used for draft genome assembly, (iii) 16,519,460 single nucleotide polymorphisms (SNPs), and 2 859 905 insertions/deletions detected between two medaka inbred strain genomes and (iv) 841 235 5'-end serial analyses of gene-expression (SAGE) tags that identified 344 266 transcription start sites on the genome. UTGB/medaka is available at: http://medaka.utgenome.org/.

Time and cost involved in the care of newly registered patients with diabetes mellitus and other lifestyle diseases at diabetes clinics in Japan (JDDM 4)

AIMS

To study the time and cost involved in the care of newly registered outpatients with Type 2 diabetes mellitus (DM), compared with patients with hypertension and/or hyperlipidaemia (HTL).

METHODS

A total of 313 patients with DM and 58 patients with HTL without diabetes were registered on their first visits to 11 diabetes clinics across Japan. The time and cost involved in their care was recorded over the following 5 months.

RESULTS

In the first 3 months, there was an extensive time commitment to both groups. The time spent by physicians was 1.5 times longer for DM than for HTL. The total care time spent by all the care providers for DM was twice that for HTL. The cost of DM care was twice that for HTL, with the cost of medicines excluded. However, half of the cost for DM was for laboratory tests. When these were excluded, and the remaining cost divided by the time spent, the amount for DM was half of that for HTL. Over the 5 months, mean glycated haemoglobin (HbA(1c)) in DM patients improved from 8.0% to 6.5%, and 72% of DM patients achieved the glycaemic target of HbA(1c) < or = 6.5%.

CONCLUSIONS

DM care in a diabetes clinic requires a great deal more time and resources than HTL to achieve the best outcome. An educational system for self care, presently lacking in the primary care setting in Japan, would improve glycaemic control for DM patients in the community.

Thermus thermophilus TMY isolated from silica scale taken from a geothermal power plant

AIMS

To identify an extreme thermophile, strain TMY, isolated from silica scale from the geothermal electric power plant and to examine microdiversity of Thermus thermophilus strains.

MATERIALS AND RESULTS

The isolated strain TMY was identified by morphological, biochemical and physiological tests. Phylogenetic comparison of the strain and other Thermus strains with 16S rDNA analysis, RAPD and ERIC-PCR fingerprinting were performed. Strain TMY was closely related to strain which was isolated from a hot spring in New Zealand and shown to belong to the Japanese Thermus cluster. However, there were considerable genetic differences between strain TMY and other Thermus species using DNA fingerprinting.

CONCLUSIONS

Based on morphological, physiological and genetic properties, strain TMY could be a strain of T. thermophilus. The distinct properties of strain TMY suggest that microdiversity of T. thermophilus strains should be considered.

SIGNIFICANCE AND IMPACT OF THE STUDY

The results of this study have demonstrated genetic diversity within T. thermophilus strains, which were previously masked by an almost identical 16S rDNA sequence. RAPD and ERIC-PCR could be potential methods for distinguishing between Thermus strains.

Lack of polymorphisms in the coding region of the highly conserved gene encoding transcription elongationfactor S-II (TCEA1)

Transcription elongation factor S-II stimulates mRNA chain elongation catalyzed by RNA polymerase II. S-II is highly conserved among eukaryotes and is essential for definitive hematopoiesis in mice. In the present study, we report the identification of five novel nucleotide variations in the human S-II gene in the Japanese population. All five variations were located in introns, and no polymorphisms were found in the protein-coding region, suggesting strong negative selection during gene evolution. Together with the SNPs (single nucleotide polymorphisms) reported in the National Center for Biotechnology Information SNP database, our results provide tools for evaluating the role of S-II in complex genetic diseases, such as congenital hematopoietic disorders.

Radio-frequency ablation (RFA) is equivalent in therapeutic effect but safer compared to microwave coagulation therapy (MCT) for hepatocellular carcinoma

15064

Background: Radio-frequency ablation (RFA) and microwave coagulation therapy (MCT) have been developed as a useful locoregional treatment for hepatocellular carcinoma (HCC). It is still unclear which ablation therapy is superior for the patients with HCC, from the viewpoint of not only short term but also long term outcome. Methods: Between January 1991 and December 2005, 430 patients with HCC were treated with ablation therapy (230 RFA and 200 MCT) in our institution. Enroll criteria of this therapy were as follows; 1) unresectable HCCs, 2) each smaller than 3 cm, 3) up to three nodules, 4) without vascular invasion. Either percutaneous (P), endoscopic (E) or open (O) approach was selected individually based on location, size, number, or other factors. Treatment was repeated until complete ablation of HCC. Results: 1. Proportion of Child B or C was 62% and 60%; Stage III or IV was 56% and 58% in the patients with RFA and MCT, respectively. 2. Average tumor size and tumor number was 27mm/2.5 and 26mm/1.9 in the two groups. 3. Approaches were P: 55%, E: 33%, O: 12% in RFA and P: 48%, E: 30%, O: 22% in MCT. 4. Number of treatment was 1.1 in RFA and 1.2 in MCT. 5. Recurrence rate at the therapeutic site was 8% in RFA and 12% in MCT. Especially, endoscopic RFA provided a quite low recurrence rate (3%). 6. Cumulative 5-year survival was 52% versus 45% in the two groups. 7. Complication rate was significantly lower in RFA (5%) compared to MCT (11%). Intraabdominal tumor seeding (1% in MCT) and liver abscess formation (4% in MCT) was never encountered in RFA. Conclusions: Radio-frequency ablation for hepatocellular carcinoma is a safer procedure and can provide a similar favorable long- term prognosis compared to microwave coagulation therapy.

No significant financial relationships to disclose.

The medaka draft genome and insights into vertebrate genome evolution

Teleosts comprise more than half of all vertebrate species and have adapted to a variety of marine and freshwater habitats. Their genome evolution and diversification are important subjects for the understanding of vertebrate evolution. Although draft genome sequences of two pufferfishes have been published, analysis of more fish genomes is desirable. Here we report a high-quality draft genome sequence of a small egg-laying freshwater teleost, medaka (Oryzias latipes). Medaka is native to East Asia and an excellent model system for a wide range of biology, including ecotoxicology, carcinogenesis, sex determination and developmental genetics. In the assembled medaka genome (700 megabases), which is less than half of the zebrafish genome, we predicted 20,141 genes, including approximately 2,900 new genes, using 5'-end serial analysis of gene expression tag information. We found single nucleotide polymorphisms (SNPs) at an average rate of 3.42% between the two inbred strains derived from two regional populations; this is the highest SNP rate seen in any vertebrate species. Analyses based on the dense SNP information show a strict genetic separation of 4 million years (Myr) between the two populations, and suggest that differential selective pressures acted on specific gene categories. Four-way comparisons with the human, pufferfish (Tetraodon), zebrafish and medaka genomes revealed that eight major interchromosomal rearrangements took place in a remarkably short period of approximately 50 Myr after the whole-genome duplication event in the teleost ancestor and afterwards, intriguingly, the medaka genome preserved its ancestral karyotype for more than 300 Myr.

An improved computer-aided diagnosis scheme using the nearest neighbor criterion for determining histological classification of clustered microcalcifications

OBJECTIVES

Our purpose was to evaluate the potential usefulness of the nearest neighbor case which was assumed to be the similar case in a CAD scheme for determining the histological classification of clustered microcalcifications.

METHODS

Our database consisted of current and previous magnification mammograms obtained from 93 patients before and after three-month follow-up examination. It included 11 invasive carcinomas, 19 noninvasive carcinomas of the comedo type, 25 non-invasive carcinomas of the noncomedo type, 23 mastopathies, and 15 fibroadenomas. Six objective features on clustered microcalcifications were first extracted from each of the current and the previous images. The nearest neighbor case was then identified by the Euclidean distance in the previous and current feature-space. The histological classification of an unknown new case in question was assumed to be the same as that of the nearest neighbor case which has the shortest Euclidean distance in our database.

RESULTS

The classification accuracies were 90.9% for invasive carcinoma, 89.5% for noninvasive carcinoma of the comedo type, 96.0% for noninvasive carcinoma of the noncomedo type, 82.6% for mastopathy, and 93.3% for fibroadenoma. These results were substantially higher than those with our previous CAD scheme.

CONCLUSION

The nearest neighbor criterion was useful in a CAD scheme for determining the histological classification.

Auditory and tactile processing in a postmeningitic deaf-blind patient with a cochlear implant

The authors examined the neural function of a postmeningitic deaf-blind patient who regained his hearing with a multichannel cochlear implant. Auditory stimuli activated the temporal cortices of both sides in a manner similar to that of controls, reflecting the successful recruitment of the auditory cortex after implantation. The patient's occipital lobes were deactivated during the tactile language task, the results of which were completely different from those before cochlear implantation.

Arthoscopic diagnosis of partial scapholunate ligament tears as a cause of radial sided wrist pain in patients with inconclusive x-ray and MRI findings

To clarify the pathology of radial-sided wrist pain with inconclusive X-ray and MRI findings, we performed arthroscopic examinations of 11 wrists in 10 patients. Physical examination and various image investigations could not identify the cause of the pain. Arthroscopy revealed partial to complete tears of the scapho-lunate interosseous ligament and synovitis and/or chondral bone defects at the scaphotrapezio-trapezoidal joint in all 11 wrists. Surgical procedures consisted of eight simple synovectomies, two ligament reconstructions and one percutaneous pinning. Pain relief was achieved in 10 wrists. One wrist which had a simple synovectomy did not recover, so underwent secondary scaphotrapezio-trapezoidal fusion. In conclusion, we found that various degrees of scapholunate interosseous ligament tear and scaphotrapezio-trapezoidal joint osteoarthritis were the main causes of radial-sided wrist pain with inconclusive X-ray and simple MRI findings.

Histopathological changes in the brain of mouse fetuses by etoposide-administration

Etoposide (VP-16), a topoisomerase II inhibitor, is an anti-tumor agent which is also known to show embryotoxicity, and teratogenicity when administered to pregnant rodents. We examined VP-16-induced histopathological changes in the brain of mouse fetuses. Pregnant mice were intraperitoneally injected with VP-16 (4 mg/kg) on day 12 of gestation (GD 12), and fetuses were collected from 1 to 48 hours after treatment (HAT). Mitotic neuroepithelial cells in the telencephalic wall prominently decreased at 2 HAT, and were hardly observed at 4 HAT. The number of pyknotic neuroepithelial cells in the fetal brain began to increase at 4 HAT, and became prominent from 8 to 24 HAT. These pyknotic cells were also positively stained by TUNEL method, which can detect fragmented DNA, and showed ultrastructural characteristics of apoptosis. Additionally, these cells were also positive for cleaved caspase-3, an essential executioner of apoptosis. This indicated that excessive neuroepithelial cell apoptosis was induced in the brain of mouse fetuses following VP-16 treatment on GD 12.

Negative correlation between bone mineral density and TSH receptor antibodies in male patients with untreated Graves' disease

INTRODUCTION

Although it has been established that hyperthyroidism leads to reduced bone mineral density (BMD), with accelerated bone turnover promoting bone resorption in female patients, there is a dearth of data for male patients with hyperthyroidism. This study evaluated BMD and bone metabolism in male patients with Graves' disease.

METHODS

The study included 56 Japanese male patients with newly diagnosed Graves' disease and 34 normal Japanese male control subjects of similar age and body mass index. We used dual energy x-ray absorptiometry to measure BMD at sites with different cortical/cancellous bone ratios (lumbar spine, femoral neck, and distal radius).

RESULTS

At the lumbar spine and the distal radius, BMD and T-scores were significantly lower for patients than for controls. At the femoral neck, on the other hand, the same values were relatively, but not significantly, lower in patients than in controls. However, Z-scores at all three sites were significantly lower for patients than for controls. The Z -score at the distal radius of patients was significantly lower than that at their lumbar spine and femoral neck. In addition, Z-score at the distal radius correlated negatively with age, free thyroxine, thyroid stimulating hormone receptor antibodies, thyroid stimulating antibody, and urinary N-terminal telopeptide of type I collagen normalized by creatinine.

CONCLUSIONS

These results indicate a high prevalence of cortical bone loss in male patients with Graves' disease, especially elderly patients. We conclude that BMD measurement is crucial in all Graves' disease patients regardless of their gender and that the radial BMD as well as BMD at the lumbar spine and femoral neck should be monitored to effectively prevent bone loss and subsequent fracture.

Molecular mechanisms of hydroxyurea(HU)-induced apoptosis in the mouse fetal brain

Hydroxyurea (HU), a potent mammalian teratogen, affects proliferating embryonic cells and inhibits DNA synthesis. The teratogenic potential of HU has been well known in experimental animals for several decades. In this study, we investigated molecular mechanisms of HU-induced apoptosis in the telencephalon of the fetal brain by exposing pregnant mice to HU on day 13 of gestation. The number of TUNEL-positive cells began to increase at 3 h, peaked at 12 h, and rapidly decreased at 24 h. Although changes of p53 mRNA expression were not observed by RT-PCR, a p53-positive reaction was detected immunohistochemically in the nuclei of neuroepithelial cells from 1 h to 6 h, and p53-protein expression was simultaneously identified by Western blot analysis. The expression of p53-target genes was detected at both the mRNA and protein. The mRNA levels of apotosis-related genes (fas, fasL, and bax) and cell cycle-related genes (mdm2 and p21) were significantly elevated, and the degree to and sequence in which these target genes expressed was similar to those for fas, fasL, mdm2 and p21. Flow-cytometric and Western blot analyses of cell cycle-related proteins suggested that neuroepithelial cells are arrested at the S checkpoint from 3 to 6 h and at the G2/M checkpoint at 12 h, respectively. HU-induced apoptosis is considered to be mediated by p53 in the fetal brain.

Serological and immunohistochemical studies on porcine-serum-induced hepatic fibrosis in rats

We previously reported that the strain difference in the development of porcine-serum (PS)-induced rat hepatic fibrosis was closely related to the difference in the mode of MHC class-II-related genes expression. This study was carried out to clarify the serological and immunohistochemical changes in this hepatic fibrosis model. Six-week-old male Brown Norway (BN) and Wistar rats were injected with 0.5 ml of sterile PS twice a week for up to 8 weeks. The serum levels of PS-specific IgG1, IgG2a, and IgM were elevated more prominently in BN rats than Wistar rats. In the liver, significant increases in the numbers of PS-, OX-6 (RT1.B)-, CD4-, CD8, ED1-, and ED2-positive cells occurred earlier in BN rats than Wistar rats. At 8 weeks, deposition of PS and immunoglobulins was observed in hepatic fibrous septa and renal glomerular mesangium, and IgG1- and IgG2a-positive cells were found in the white pulp of the spleen. The present results suggest that humoral immunity probably regulated by MHC class II molecules and inflammatory cells may be involved in PS-induced hepatic fibrosis in rats.

Current status and future potential of computer-aided diagnosis in medical imaging

Computer-aided diagnosis (CAD) has become one of the major research subjects in medical imaging and diagnostic radiology. The basic concept of CAD is to provide a computer output as a second opinion to assist radiologists' image interpretation by improving the accuracy and consistency of radiological diagnosis and also by reducing the image reading time. In this article, a number of CAD schemes are presented, with emphasis on potential clinical applications. These schemes include: (1) detection and classification of lung nodules on digital chest radiographs; (2) detection of nodules in low dose CT; (3) distinction between benign and malignant nodules on high resolution CT; (4) usefulness of similar images for distinction between benign and malignant lesions; (5) quantitative analysis of diffuse lung diseases on high resolution CT; and (6) detection of intracranial aneurysms in magnetic resonance angiography. Because CAD can be applied to all imaging modalities, all body parts and all kinds of examinations, it is likely that CAD will have a major impact on medical imaging and diagnostic radiology in the 21st century.

Arthroplasty of the Elbow Joint Using Vascularized Iliac Bone Graft for Reconstruction of Massive Bone Defect of the Distal Humerus

The authors present a case of a 39-year-old man with an enormous bone defect of the distal humerus secondary to an infected nonunion, who was successfully reconstructed using a vascularized iliac bone graft. The use of a vascularized iliac bone graft may be an option for reconstructing such massive defects of the metaphyseal area of the humerus.

Changes in histology and expression of cytokines and chemokines in the rat lung following exposure to ovalbumin

Brown Norway (BN) and Fischer 344 (F344) rats were exposed to aerosol of 1% ovalbumin (OVA) solution for 30 min at 1 week after the second sensitization with 1 mg of OVA at 2-week intervals. Changes in the histology and expression of cytokines and chemokines in the lung were examined for up to 96 h after the exposure. The lung weight significantly increased in BN rats but not in F344 rats. Histologically, in the lung of BN rats, multiple foci of hemorrhage in the alveolar space with infiltration of eosinophils and macrophages in the surrounding alveolar septa were first observed. Thereafter, granulomatous lesions developed in the preexisting hemorrhagic foci, finally resulting in formation of multiple eosinophilic granulomas. On the other hand, in F344 rats, infiltration of eosinophils and macrophages was observed around the vessels and bronchi. Thereafter it progressed gradually, resulting in mild thickening of alveolar septa. The levels of Th1- (interferon-gamma and interleukin 2 (IL-2)) and Th2-related cytokines (IL-4 and IL-5) and chemokines (eotaxin and monocyte chemoattractant protein-1) mRNAs measured by reverse transcription-polymerase chain reaction method were elevated in the lung of both strains, and the levels were higher in BN rats than in F344 rats. These results suggest that BN rats are more sensitive to OVA-sensitization/inhalation than F344 rats and that the difference in the severity of lung lesions between BN and F344 rats may reflect the difference in the expression levels of cytokines and chemokines between these two strains.

GM2-gangliosidosis variant 0 (Sandhoff-like disease) in a family of Japanese domestic cats

A five-month-old, female Japanese domestic shorthair cat with proportionate dwarfism developed neurological disorders, including ataxia, decreased postural responses and generalised body and head tremors, at between two and five months of age. Leucocytosis due to lymphocytosis with abnormal cytoplasmic vacuolations was observed. The concentration of G(M2)-ganglioside in its cerebrospinal fluid was markedly higher than in normal cats, and the activities of beta-hexosaminidases A and B in its leucocytes were markedly reduced. On the basis of these biochemical data, the cat was diagnosed antemortem with G(M2)-gangliosidosis variant 0 (Sandhoff-like disease). The neurological signs became more severe and the cat died at 10 months of age. Histopathologically, neurons throughout the central nervous system were distended, and an ultrastructural study revealed membranous cytoplasmic bodies in these distended neurons. The compound which accumulated in the brain was identified as G(M2)-ganglioside, confirming G(M2)-gangliosidosis. A family study revealed that there were probable heterozygous carriers in which the activities of leucocyte beta-hexosaminidases A and B were less than half the normal value. The Sandhoff-like disease observed in this family of Japanese domestic cats is the first occurrence reported in Japan.

Significance of administration of fat emulsion: hepatic changes in infant rats receiving total parenteral nutrition with and without fat

Total parenteral nutrition (TPN) is associated with cholestasis and hepatic steatosis, which can be lethal in infants who cannot be fed orally. The present animal study focused on the metabolic complications in the liver that may occur due to the excessive administration of fat-free TPN. Thirty infant (3-week-old) male SD rats weighing 60-70 g were randomly allocated to five groups (n = 6): the OD group received an oral diet, the FT group received an oral diet and was fasted overnight on the last day of experiment before sacrifice, the 0% fat group received TPN without fat, the 20% fat group received TPN with 20% of calories from fat emulsion, and the 40% fat group received TPN with 40% of calories from fat emulsion. All TPN regimens were isocaloric, isonitrogenic, and administered for 4 days. In the 0% fat group, plasma levels of liver enzymes were significantly higher than in the other groups. Pathological examination showed hepatomegaly and severe fatty changes without cholestasis in the 0% fat group. The results of this study in infant rats indicate the importance of including fat in the TPN regimen in order to prevent the abnormal hepatic changes associated with the excessive administration of fat-free TPN.

Choline acetyltransferase activity and evoked spinal cord potentials for diagnosis of brachial plexus injury

The purpose of this study is to investigate the diagnostic value of evoked spinal cord potentials (ESCPs) and choline acetyltransferase (CAT) activity during exploration of injuries to the brachial plexus. We assessed 25 spinal roots in 19 patients. The results of the two investigations were consistent in all except two roots. Although assessment of ESCPs is easy and quick, it mainly records the nerve potentials along the sensory pathway. Although measurement of CAT activity needs a specimen of the nerve and the availability of a radioisotope laboratory, it gives direct information regarding the motor function of ventral spinal roots. These two techniques should be complementary to each other in order to achieve a more accurate diagnosis.

Lumbar Intervertebral Body Fusion Cages: Histological Evaluation of Clinically Failed Cages Retrieved from Humans

The purpose of this study is to investigate the diagnostic value of evoked spinal cord potentials (ESCPs) and choline acetyltransferase (CAT) activity during exploration of injuries to the brachial plexus. We assessed 25 spinal roots in 19 patients. The results of the two investigations were consistent in all except two roots. Although assessment of ESCPs is easy and quick, it mainly records the nerve potentials along the sensory pathway. Although measurement of CAT activity needs a specimen of the nerve and the availability of a radioisotope laboratory, it gives direct information regarding the motor function of ventral spinal roots. These two techniques should be complementary to each other in order to achieve a more accurate diagnosis.

Comparison of 1% and 2% lidocaine epidural anaesthesia combined with sevoflurane general anaesthesia utilizing a constant bispectral index

BACKGROUND

The authors compared the effects of epidural anaesthesia with lidocaine 1% and lidocaine 2% on haemodynamic variables, sevoflurane requirements, and stress hormone responses during surgery under combined epidural/general anaesthesia with bispectral index score (BIS) kept within the range 40-50.

METHODS

Thirty-three patients undergoing lower abdominal surgery were randomly divided into two groups to receive lidocaine 1% or 2% by epidural with sevoflurane general anaesthesia. Sevoflurane was adjusted to achieve a target BIS of 40-50 during maintenance of anaesthesia with nitrous oxide 60% in oxygen. Measurements included the inspired (FI(SEVO)) and the end-tidal sevoflurane concentrations (E'(SEVO)), blood pressure (BP), and heart rate (HR) before surgery and every 5 min during surgery for 2 h. Plasma samples were taken immediately before and during surgery for measurements of catecholamines, cortisol, and lidocaine.

RESULTS

During surgery, both groups were similar for HR, BP and BIS, but FI(SEVO) and E'(SEVO) were significantly higher and more variable with lidocaine 1% than with 2%. Intraoperative plasma concentrations of epinephrine and cortisol were found to be higher with lidocaine 1% as compared with 2%.

CONCLUSIONS

To maintain BIS of 40-50 during combined epidural/general anaesthesia for lower abdominal surgery, sevoflurane concentrations were lower and less variable with lidocaine 2% than with 1%. In addition, the larger concentration of lidocaine suppressed the stress hormone responses better.

Sunburn reaction in the dorsal skin of hypotrichotic WBN/ILA-Ht rats

The dorsal skin responses to a single irradiation with a high-dose of UVB (10kJ/m2) were examined histologically and immunohistochemically in UVB-sensitive Wistar-derived hypotrichotic WBN/ILA-Ht rats (HtRs). Sunburn cells (SBCs) which were characterized by pyknotic nuclei and eosinophilic cytoplasm and had ultrastructual characteristics of apoptotic cells were first observed in the epidermis at 3 hours (h) after irradiation. The number peaked at 6 h, and then decreased rapidly. The expressions of p53 protein, which is known to be closely related to the formation of SBCs, and of p21 protein, which is one of the transcriptional target genes of p53, were immunohistochemically detected, and their labeling index (LI) in the epidermis peaked at 12 to 24 h (p53) or at 24h (p21) after irradiation. On the other hand, proliferating cell nuclear antigen (PCNA)-LI in keratinocytes was significantly lower than the control group at 6 h after irradiation and thereafter it increased and became significantly higher than the control group from 24 to 48 h. At 48 h, moderate hyperplasia with moderate numbers of mitotic keratinocytes was first observed in the epidermis. In the dermis, mild edema developed from 12 to 36 h and it accompanied mild lymphocyte infiltration at 36 h. Judging from the present results, it was suggested that some factors other than p53 might be involved in SBC formation, and that p53 might induce p21 protein and play an important role in cell growth arrest in keratinocytes after UVB irradiation.