Arterial Occlusion Sites on Magnetic Resonance Angiography Influence the Efficacy of Intravenous Low-Dose (0·6 mg/kg) Alteplase Therapy for Ischaemic Stroke

Aims

To determine the predictors of efficacy, including magnetic resonance imaging information, for low-dose intravenous alteplase therapy for stroke patients.

Methods

Seventy-eight patients were prospectively enrolled in a single Stroke Unit (SU) receiving alteplase at a dose of 0·6 mg/kg during the initial 27 months after its approval in Japan. Ischaemic changes and vascular lesions were identified using computed tomography, diffusion-weighted magnetic resonance imaging, and magnetic resonance angiography. Early ischaemic signs were assessed using the Alberta Stroke Program Early CT Score.

Results

The median baseline National Institutes of Health Stroke Scale score of 78 patients was 12. In 19 patients (24%), the National Institutes of Health Stroke Scale score improved by ≥8 points at 24 h. After multivariate adjustment, occlusion at the internal carotid artery (odds ratio 11·82, 95% confidence interval 1·73–142·74), Alberta Stroke Program Early CT Score on diffusion-weighted imaging ≤6 (15·23, 1·88–351·50), and a lower National Institutes of Health Stroke Scale score (1·24, 1·08–1·47, per 1-point decrease) were inversely correlated with early improvement. Four patients (5%) had symptomatic intracranial haemorrhage. At 3 months, 76 patients (98%) survived, and 36 of 78 patients (46%) overall, but only two of 19 patients (11%) with internal carotid artery occlusion, had a favourable functional outcome, corresponding to a modified Rankin scale score 1. After multivariate adjustment, internal carotid artery occlusion (odds ratio 15·84, 95% confidence interval 3·12–128·69) and Alberta Stroke Program Early CT Score on diffusion-weighted imaging ≤6(15·62, 1·78–410·12) were independent predictors of poor outcome.

Conclusions

Intravenous alteplase therapy at a dose of 0·6 mg/kg resulted in a relatively good overall outcome when compared with outcomes reported by western studies using an alteplase dose of 0·9 mg/kg. However, patients with occlusion at the internal carotid artery did not respond to this low-dose alteplase therapy.

Symptoms of delusion: the effects of discontinuation of low-dose venlafaxine

OBJECTIVE

We report a patient who experienced delusional symptoms during gradual discontinuation of low-dose venlafaxine and required antipsychotic treatment.

METHOD

Case report.

RESULTS

A 31-year-old woman with major depression had been treated abroad with venlafaxine before returning to Japan. Since venlafaxine is unavailable here, we supplemented her regular venlafaxine dosage of 37.5 mg/day with clomipramine 20 mg/day. After 5 weeks we reduced venlafaxine to 18.75 mg/day and uptitrated clomipramine to 40 mg/day. Four days later she developed delusions of reference, palpitations and nausea. Clomipramine was increased to 60 mg/day, and her symptoms subsided. Eight weeks later her supply of venlafaxine ran out, and within 4 days her condition deteriorated into more severe symptoms that required 4 months' antipsychotic treatment.

CONCLUSION

We speculate that her symptoms were discontinuation syndrome, including psychotic symptoms and physical symptoms, caused by (i) venlafaxine-clomipramine interaction and/or (ii) the serotonin reuptake inhibitor-like effects of low-dose venlafaxine.

EFFECT OF LIFESTYLE FACTORS ONINFERTILITY IN MEN

Environmental factors, changes in lifestyle and occupational exposures are responsible for declining human semen quality. We investigated the effects of history of surgery and lifestyle choices on infertility of 271 infertile men and 251 healthy volunteers. The frequency of varicocelectomy was significantly higher in infertile men (2.9%) than in controls (0.4%; P < 0.05). Alcohol use was significantly more common in infertile men (92%) than in controls (80%; P < 0.01). Satisfaction with sexual life was greater in controls (85%) than in infertile men (77%; P < 0.05). Other factors had no effect.

Effects of thyroid hormone on serum glycated albumin levels: study on non-diabetic subjects

Glycated albumin (GA) is used alongside glycated hemoglobin (HbA(1C)) as an indicator of glycemic control. Although serum GA levels are affected mainly by plasma glucose, they are also influenced by serum albumin metabolism. Thyroid hormone is known to promote albumin catabolism, and it is thus thought to affect serum GA levels. In the present study, the effects of thyroid hormone on serum GA measurements were investigated in patients with thyroid dysfunction. Six patients with untreated hypothyroidism and 17 patients with untreated thyrotoxicosis were investigated. Patients who had anemia or diabetes were excluded. A total of 25 non-diabetic, euthyroid individuals were enrolled as controls. HbA(1C), serum GA, thyroid-stimulating hormone (TSH), free triiodothyronine (T(3)), and free thyroxine (T(4)) levels were measured in all these subjects, and their relationships were examined. Although no intergroup differences were observed for HbA(1C), serum GA was significantly higher among patients with hypothyroidism than controls, and significantly lower among patients with thyrotoxicosis. Serum GA had a significant positive correlation with serum TSH and significant inverse correlations with free T(3) and free T(4). Thyroid hormone levels are inversely associated with serum GA levels. Cautions are necessary when evaluating serum GA levels in patients with thyroid dysfunction.

Frontal bone window improves the ability of transcranial color-coded sonography to visualize the anterior cerebral artery of Asian patients with stroke

The frontal bone window (FBW) is a promising approach in evaluating the anterior cerebral artery. The goal of the present study was to determine the rates of detection of the basal cerebral arteries by using the FBW alone and a combination of the FBW with the temporal bone window (TBW) in 163 patients. The combined application improved detection rates of A1 (58.6% versus 46.0%, P = .001) and A2 (43.6% versus 6.7%, P < .001) compared with the TBW alone.

Precision measurement of neutrino oscillation parameters with KamLAND

The KamLAND experiment has determined a precise value for the neutrino oscillation parameter Deltam21(2) and stringent constraints on theta12. The exposure to nuclear reactor antineutrinos is increased almost fourfold over previous results to 2.44 x 10(32) proton yr due to longer livetime and an enlarged fiducial volume. An undistorted reactor nu[over]e energy spectrum is now rejected at >5sigma. Analysis of the reactor spectrum above the inverse beta decay energy threshold, and including geoneutrinos, gives a best fit at Deltam21(2)=7.58(-0.13)(+0.14)(stat) -0.15+0.15(syst) x 10(-5) eV2 and tan2theta12=0.56(-0.07)+0.10(stat) -0.06+0.10(syst). Local Deltachi2 minima at higher and lower Deltam21(2) are disfavored at >4sigma. Combining with solar neutrino data, we obtain Deltam21(2)=7.59(-0.21)+0.21 x 10(-5) eV2 and tan2theta12=0.47(-0.05)+0.06.

Association of polymorphisms in the haplotype block spanning the alternatively spliced exons of the NTNG1 gene at 1p13.3 with schizophrenia in Japanese populations

Chromosome 1p13 is linked with schizophrenia in Japanese families, and one of the candidate genes in this region is the netrin G1 (NTNG1) gene at 1p13.3. Associations of 56 tag single-nucleotide polymorphisms (SNPs) with schizophrenia were explored by transmission disequilibrium analysis in 160 Japanese trios and by case-control analysis in 2,174 Japanese cases and 2,054 Japanese controls. An association between SNP rs628117 and schizophrenia was identified by case-control comparison (nominal allelic p=0.0009; corrected p=0.006). The associated polymorphism is located in intron 9 and in the haplotype block encompassing the alternatively spliced exons of the gene. Allelic association of a different SNP in the same haplotype block in Japanese families was previously reported. These findings support that the NTNG1 gene is associated with schizophrenia in the Japanese.

Bickerstaff's brainstem encephalitis and Fisher syndrome form a continuous spectrum: clinical analysis of 581 cases

Whether Bickerstaff's brainstem encephalitis (BBE) is a distinct disease or a subtype of Fisher syndrome (FS) is unclear as there have been no clinical studies with sufficiently large numbers of patients with FS or BBE. Our aim was to clarify the nosological relationship. Medical records of patients suffering acute ophthalmoplegia and ataxia within four weeks of onset were reviewed. BBE was the diagnosis for patients with impaired consciousness, FS for those with clear consciousness and areflexia. Clinical features, neuroimages, and laboratory findings were analyzed. Patients were grouped as having BBE (n = 53), FS (n = 466), or as unclassified (n = 62). The BBE and FS groups had similar features; positive serum anti-GQ1b IgG antibody (68 % versus 83 %), antecedent Campylobacter jejuni infection (23 % versus 21 %), CSF albuminocytological dissociation (46 % versus 76 %), brain MRI abnormality (11 % versus 2 %), and abnormal EEG findings (57 % versus 25 %). BBE (n = 4) and FS (n = 28) subgroups underwent detailed electrophysiological testing. Both groups frequently showed absent soleus H-reflexes, but normal sensory nerve conduction (75 % versus 74 %) and a 1-Hz power spectrum peak on postural body sway analysis (67 % versus 72 %). Common autoantibodies, antecedent infections, and MRI and neurophysiological results found in this large study offer conclusive evidence that Bickerstaff's brainstem encephalitis and Fisher syndrome form a continuous spectrum with variable CNS and PNS involvement.

Association of erythrocyte indices with glycated haemoglobin in pre-menopausal women

AIMS

Although HbA(1c) is known to be affected by the lifespan of erythrocytes, any association of erythrocyte indices with HbA(1c) in subjects without anaemia is poorly understood. Pre-menopausal women may be relatively iron deficient because of menstruation. In this study, we examined the relationship between HbA(1c) and erythrocyte indices in pre- and post-menopausal women.

METHODS

We determined HbA(1c), red blood cell (RBC) count, haematocrit, haemoglobin, mean corpuscular volume (MCV) and mean corpuscular haemoglobin (MCH) in 423 women with normal glucose tolerance who had undergone health checks. In addition, age at menopause was recorded in post-menopausal subjects.

RESULTS

RBC counts of the 180 pre-menopausal women were positively associated with HbA(1c), whereas haemoglobin, MCV and MCH showed a negative association. In contrast, no significant association of any indices with HbA(1c) was detected in the 243 post-menopausal women. Stepwise multivariate regression analysis in the pre-menopausal women identified fasting plasma glucose and age as positively associated and MCH as negatively associated with HbA(1c), regardless of whether or not these pre-menopausal women were anaemic.

CONCLUSIONS

Erythrocyte indices are associated with HbA(1c), independently of plasma glucose levels, in pre-menopausal women even when they are not anaemic. This should be appreciated when interpreting HbA(1c) in pre-menopausal patients with diabetes.

PICK1 is not a susceptibility gene for schizophrenia in a Japanese population: association study in a large case-control population

The protein interacting with C-kinase 1 (PICK1) has been implicated in the susceptibility to schizophrenia. PICK1 interacts with enzymes and receptors that play roles in the pathogenesis of schizophrenia via glutamatergic dysfunction. Recently, two studies reported associations between schizophrenia and two PICK1 gene polymorphisms, rs3952 in Chinese and Japanese populations and rs2076369 in a Japanese population. We attempted to confirm these associations in a case-control study of 1765 Japanese patients with schizophrenia and 1851 Japanese control subjects. Neither polymorphism was associated with schizophrenia (rs3952, p=0.755; rs2076369, p=0.997). A haplotype block with these polymorphisms spanning the 5' region of the PICK1 gene showed high linkage disequilibrium in the Japanese population (D'=0.98, r(2)=0.34); however, neither haplotype was significantly associated with schizophrenia. We conclude that the common haplotypes and polymorphisms of the PICK1 gene identified thus far are unlikely to contribute to genetic susceptibility to schizophrenia in the Japanese population.

RGS4 is not a susceptibility gene for schizophrenia in Japanese: association study in a large case-control population

The regulator of the G-protein signaling 4 (RGS4) has been implicated in the susceptibility to schizophrenia. RGS4 interacts with ErbB3 that acts as receptors for neuregulin 1 and these proteins may play a role in the pathogenesis of schizophrenia via glutamatergic dysfunction. Recently, two meta-analysis studies provided different interpretations for the genetic association between RGS4 and schizophrenia. We attempted to confirm this association in a case-control study of 1918 Japanese patients with schizophrenia and 1909 Japanese control subjects. Four widely studied single nucleotide polymorphisms (SNPs) were genotyped, and none showed association with schizophrenia. SNP 1 (rs10917670), p=0.92; SNP 4 (rs951436), p=0.91; SNP 7 (rs951439), p=0.27; and SNP 18 (rs2661319), p=0.43. A haplotype block constructed by these SNPs spans the 5' flanking region to the 5' mid-region of the RGS4 gene. Previous meta-analysis showed that both two major haplotypes of this block were risk haplotypes. The two common haplotypes were observed in the Japanese population. However, neither haplotype was significantly associated with schizophrenia. We conclude that the common haplotypes and SNPs of the RGS4 gene identified thus far are unlikely to contribute to the genetic susceptibility to schizophrenia in the Japanese population.

Prospective study on anti-ganglioside antibodies in childhood Guillain-Barré syndrome

BACKGROUND

Antiganglioside antibodies have been reported to play a part in the pathophysiology of Guillain-Barré syndrome (GBS).

AIMS

To investigate the prevalence and correlation of anti-ganglioside antibodies with clinical data in children with GBS in a multicentre clinical trial.

METHODS

Immunoglobin (Ig)G and IgM to GM1, GM1b, GD1a, GalNAc-GD1a, GD1b, GT1a, and GQ1b were measured by ELISA in sera obtained before treatment. In addition, serological testing for Campylobacter jejuni was carried out. In parallel, a group of adults with GBS and a control group of children without GBS or other inflammatory diseases were evaluated.

RESULTS

Sera from 63 children with GBS, 36 adults with GBS and 41 children without GBS were evaluated. Four of the children with GBS showed positive IgG to GM1, in one case combined with anti-GalNAc-GD1a and in one with anti-GD1b. Two others showed isolated positive IgG to GD1b and GT1a. One showed increased anti-GalNAc-GD1a IgM. In 5 of the 63 children, serological evidence of a recent infection with C jejuni was found, and this correlated significantly with the raised antibodies (p = 0.001). In the control group without GBS, no child showed positive IgG, but one showed anti-GalNAc-GD1a IgM. Compared with the adults with GBS, the frequency of antibodies in children was insignificantly lower. In our study, patients with positive antibodies did not show a more severe GBS course or worse outcome than those who were seronegative, and we could not show an increased incidence of axonal dysfunction.

CONCLUSIONS

In some children with GBS, one can detect raised IgG against various gangliosides, similar to that in adults. A recent infection with C jejuni is markedly associated with the presence of these antibodies. However, in contrast with what has been reported in adults, in this study we were unable to show a negative effect of these findings on the clinical course.

Relationship of bacterial strains to clinical syndromes of Campylobacter-associated neuropathies

BACKGROUND

Clinical and serologic studies suggest that Guillain-Barré syndrome (GBS) and atypical GBS with preserved muscle stretch reflexes (MSRs) form a continuous spectrum as well as do Fisher syndrome (FS), FS/GBS overlap, Bickerstaff brainstem encephalitis (BBE), BBE/GBS overlap, acute ophthalmoparesis (AO), ataxic GBS, and acute oropharyngeal palsy.

OBJECTIVE

To clarify the spectrum of neurologic disorders that occur subsequent to Campylobacter jejuni enteritis.

METHODS

We recruited patients with various neurologic conditions and from whom C jejuni was isolated. Bacterial features were investigated.

RESULTS

Diagnoses for the patients from whom C jejuni was isolated were GBS (n = 90), FS (n = 22), MSR-preserved GBS (n = 10), FS/GBS (n = 6), BBE (n = 1), BBE/GBS (n = 2), AO (n = 3), ataxic GBS (n = 1), and acute oropharyngeal palsy (n = 3). Isolates from MSR-preserved GBS were similar to those of GBS in serotype (HS:19), genotype (lipo-oligosaccharide [LOS] locus class A or B, cst-II genotype [Thr51]), and GM1 or GD1a epitope expression on LOS. FS/GBS overlap, BBE, BBE/GBS overlap, AO, ataxic GBS, and acute oropharyngeal palsy isolates were similar to those of FS in serotype (HS:2 or HS:4-complex), genotype (LOS locus class A or B, cst-II genotype [Asn51]), and GQ1b epitope expression on LOS.

CONCLUSIONS

The bacterial findings support the proposal that Guillain-Barré syndrome (GBS) and muscle stretch reflex-preserved GBS comprise a continuous spectrum as well as do Fisher syndrome (FS), FS/GBS overlap, Bickerstaff brainstem encephalitis (BBE), BBE/GBS overlap, acute ophthalmoparesis, ataxic GBS, and acute oropharyngeal palsy.

Mosquito larvicidal effectiveness of EcoBio-Block S: a novel integrated water-purifying concrete block formulation containing insect growth regulator pyriproxyfen

EcoBio-Block S, a novel controlled release system (CRS) for the insect growth regulator pyriproxyfen, uses a water-purifying concrete block system (EcoBio-Block) composed of a porous volcanic rock and cement, and it incorporates the aerobic bacterial groups of Bacillus subtilis natto. EcoBio-Block S showed high inhibitory activity against mosquito emergence as well as a water-purifying effect. Chemical analysis and bioassay showed that EcoBio-Block S provides a high-performance CRS that controls the release of pyriproxyfen at low levels according to "zero order kinetics".