[Probe types of Norwalk-like viruses genome detected by RT-PCR with seven primer pairs in Yamanashi Prefecture]

The reverse transcription-polymerase chain reaction (RT-PCR) gene assay, as well as electron microscopic examination, is commonly used to detect Norwalk-like viruses (NLVs). Types and number of primer pairs used are considered to be of critical importance for efficiency of the RT-PCR detection. This study was performed to determine primer pairs useful for the detection of NLVs. NLVs genes were detected by RT-PCR in 48 cases in Yamanashi Prefecture between December 1997 and March 2000. The probe type of the gene was G2P-C in 21, G2P-B in 10, G2P-A in 6, G1P-A in 3, G1P-B in 2, and a mixture of G2P-A and G2P-B in 6. The NLVs genes of G2P-C and G2P-B were estimated to have undergone mutation in the polymerase region and poorly specific to the primer pair 35/36, a combination that has been used most commonly for the RT-PCR assay in Japan. The primer pair G2R1/F1 that amplifies the capsid (CAP) region of NLVs genes can detect all NLVs genes of the Genogroup2. The combination of this primer pair with another primer pair G1R1/F1, which like G2R1/F1, amplifies the CAP region, makes discrimination between NLVs of different groups possible. Consequently, this combination, may be the most useful for the NLVs detection by RT-PCR.

The aetiology of non-tumorous enhancement in the hepatic hilum shown on CT hepatic arteriography

The causes of non-tumorous abnormalities in the hepatic hilum seen on CT hepatic arteriography were investigated. 13 patients with non-tumorous defects of portal perfusion in the hepatic hilum on CT arterial portography underwent both CT hepatic arteriography from the common hepatic artery and CT obtained during proper hepatic arteriography. The findings of non-tumorous portal defects on these two angiographic studies using helical CT were compared. In the 13 patients, 14 non-tumorous defects of portal perfusion in the hepatic hilum on CT arterial portography were detected as enhanced areas in 10 regions (dorsum of segment IV, 7/10; dorsum of the lateral segment, 3/4) on CT hepatic arteriography via the common hepatic artery, but none were enhanced on CT obtained during proper hepatic arteriography. In conclusion, the main cause of non-tumorous enhancement in the hepatic hilum seen on CT hepatic arteriography is non-portal direct inflow via the parabiliary venous system.

Intrahepatic portosystemic venous shunt associated with biliary atresia: case report

We describe an infant with intrahepatic portosystemic venous shunt (IPSVS), which was detected by MR angiography. IPSVS is rare and its cause is disputed. However, with improvements in imaging the number of reports of IPSVS identified incidentally in patients without definite symptoms is increasing. The present case is the first associated with congenital biliary atresia and the youngest reported in the literature.

Positions of disulfide bonds in rye (Secale cereale) seed chitinase-a

The positions of disulfide bonds of rye seed chitinase-a (RSC-a) were identified by the isolation of disulfide-containing peptides produced with enzymatic and/or chemical cleavages of RSC-a, followed by sequencing them. An unequivocal assignment of disulfide bonds in this enzyme was as follows: Cys3-Cysl8, Cys12-Cys24, Cys15-Cys42, Cys17-Cys31, and Cys35-Cys39 in the chitin-binding domain (CB domain), Cys82-Cys144, Cys156-Cys164, and Cys282-Cys295 in the catalytic domain (Cat domain), and Cys263 was a free form.

Repertoire selection by pre-B-cell receptors and B-cell receptors, and genetic control of B-cell development from immature to mature B cells

During B-cell development the surrogate light (SL) chain is selectively expressed in progenitor and precursor B cells during the developmental stages of D(H) to J(H) and V(H) to D(H)J(H) rearrangements. Approximately half of all muH chains produced by these rearrangements cannot pair with SL chains and cannot form a pre-B-cell receptor (pre-BCR). A spectrum of affinities between VpreB and individual V(H) domains generates preB cells with pre-BCR of different fitness which, in turn, determines the extent of the pre-B II-cell proliferation and the fidelity of allelic exclusion of the H chain locus. Once pre-BCR is expressed, SL chain expression is turned off. As pre-B II cells proliferate, SL is diluted out, thus limiting pre-BCR formation. As a consequence, pre-B II cells stop proliferating, become small and resting and begin to rearrange the L chain loci. Multiple rearrangements of the kappaL chain alleles are often detected in wild-type small pre-B II cells. Around 20% of the muH chain-expressing small pre-B II cells also express L chains but do not display the Ig on the surface. Hence, it is likely that not all L chains originally generated in resting pre-B II cells can pair with the muH chain previously present in that cell. The best fitting ones are selected preferentially to generate sIg+ B cells. Furthermore, the transition of immature B cells from the bone marrow to spleen and their development to mature cells appear as two separate steps controlled by different genes.

Angiomyolipoma arising in the thigh

A 41-year-old man presented with an asymptomatic mass in the right medial thigh. Magnetic resonance imaging (MRI) revealed a well-demarcated, 10-cm mass in the right adductor muscles. The margins of the mass exhibited high signal intensity and the rest showed low or iso signal intensity on T1-weighted MR images. However, the high signal intensity was decreased on T2-weighted images with fat suppression. The central part of the tumor was of inhomogeneous high signal intensity on T2-weighted images; after Gd-DTPA injection it enhanced in homogeneously on T1-weighted images with fat suppression. On dynamic computed tomography (CT) in the arterial phase, there were strongly enhancing spotty areas in the tumor. At surgery, a yellow-whitish tumor was resected and a pathological diagnosis of angiomyolipoma (AML) in the thigh was made.

Calcification of the cervical ligamentum flavum--case report

A 52-year-old male presented with calcification of the cervical ligamentum flavum manifesting as hypesthesia of the bilateral middle, ring, and little fingers and ulnar halves of both forearms, as well as motor weakness in the bilateral upper extremities and gait disturbance. Cervical x-ray tomography detected a round calcified mass on the posterior wall of the cervical canal at the C-5 level. Computed tomography showed the round, nodular calcified mass more clearly. Magnetic resonance imaging showed an epidural low intensity mass compressing and distorting the cervical cord at the C-5 level on both T1- and T2-weighted images. Administration of gadolinium-diethylenetriaminepenta-acetic acid caused marginal enhancement of the mass. The lesion was eventually removed by posterior laminectomy. The mass was composed of a very hard crystal-like calcified deposition in the ligamentum flavum. X-ray diffraction analysis of the histological specimen showed calcium pyrophosphate dihydrate (CPPD) and hydroxyapatite in the crystal-like substance, confirming that CPPD is responsible for calcification of the cervical ligamentum flavum.

Trace analysis of pesticide residues in water by high-speed narrow-bore capillary gas chromatography-mass spectrometry with programmable temperature vaporizer

A method for the rapid trace analysis of 17 residual pesticides in water by narrow-bore capillary (I.D. 100 microm) gas chromatography-mass spectrometry (GC-MS) using a programmable temperature vaporizer (PTV) was discussed. The method consisted of a large-volume injection (40 microl) by a PTV, high-speed analysis using a narrow-bore capillary column and MS detection. The PTV with solvent vent mode was very useful for large-volume injection into a narrow-bore capillary column because the injected solvent volume could be reduced to less than 2 microl. The analysis time was 8.5 min [less than 50% of the analysis time using conventional columns (I.D. 250 microm)]. A 10-ml volume of river water was extracted by dichloromethane (4 ml), and then the extract was condensed to 1 ml. This extract was analyzed. Mean recoveries for river water spiked at 100 pg/ml ranged from 83.4 to 96.7%. The limit of detections of the 17 pesticides ranged from 1 to 100 pg/ml.

Reference data of forearm bone mineral density in healthy Japanese male and female subjects in the second decade based on calendar age and puberty onset: Japanese Population Based Osteoporosis (JPOS) study

Osteoporosis is a major public health problem in Japan. The second decade is an important period in which to attain a high peak bone mass. However, normal values of forearm bone mineral density (BMD) are not well known in children and adolescents. BMD at one-third of forearm length proximal to the ulnar end plate (BMD1/3) and the ultradistal forearm (BMDud) was measured using dual-energy X-ray absorptiometry (DXA) in 1207 (631 males, 576 females) Japanese subjects aged 9-18 years. Puberty onset was assessed by questionnaire, by obtaining the time that pubic hair appeared in males and the time that menstruation started in females. BMD1/3 and BMDud increased steadily with age in males. In relation to puberty development, these parameters also increased after puberty onset although the increase in BMD1/3 was not statistically significant after the fifth year from puberty onset and that of BMDud was not significant after the sixth year from puberty onset. BMD1/3 and BMDud increased with age and then plateaued in females. The increase in BMD1/3 was not statistically significant after 15-16 years of age and that of BMDud was not significant after 13-14 years of age. In relation to puberty development, the increase in BMD1/3 leveled out after the fourth year from puberty onset and that of BMDud also plateaued after the third year from puberty onset. We provide reference values of forearm BMD in Japanese children and adolescents by DXA according to calendar age and puberty development. Peak bone mass of the forearm may be in the late second decade in Japanese females.

Sickle-tip sheath for percutaneous implantation of hepatic arterial catheter with subclavian arterial access

We used a new type of sheath-introducer to facilitate the percutaneous procedure of hepatic arterial catheter implantation with left subclavian arterial access. Insertion into the descending aorta was easy without any additional catheters because the sheath could be manipulated to the aortic arch. After hepatic arterial catheterization, the sheath was slid safely away by fitting a 5 F catheter to the end of the indwelling catheter. The procedures of sheath insertion and removal were successful in all 29 cases, without any complications. The sickle-tip sheath is a useful optional device for trans-subclavian catheterization to the hepatic artery.

The roles of preB and B cell receptors in the stepwise allelic exclusion of mouse IgH and L chain gene loci

Membrane-bound preBCR of wild-type mice, and probably also preBCR-like V(preB) muH chain complexes in lambda5-deficient mice, signal allelic exclusion so that < 0.1% of all preB-II cells and all subsequent B lineage cells express two muH chains on their surface. On the other hand a large number of muH chains which are originally generated at the transition of preB-I to preB-II cells cannot pair with surrogate L chains, cannot form a preBCR on the surface and, hence, allow two H chain alleles to be productively rearranged in one B-lineage cell. By contrast membrane-bound BCR on immature B cells does not signal allelic or isotypic exclusion Of Ig kappaL and lambdaL chain gene loci. This allows the rearrangement machinery to remain active, and secondary L chain rearrangements on one kappaL chain allele are frequently observed. Rapid selection of fitting H/L chain pairs, forming BCR on the surface, allows B-lineage cells to enter the mature B cell pool where the rearrangement machinery is shut off, securing allelic exclusion of L chain loci in most B cells.

Frequencies of multiple IgL chain gene rearrangements in single normal or kappaL chain-deficient B lineage cells

PCR analyses of the kappaL chain locus in single B-lineage cells of wild-type, Ckappa-, or JCkappa-deficient homozygous or heterozygous mice often detect multiple in- and out-of-frame rearrangements at the kappaL and lambdaL loci. They are most frequent in small pre-BII cells and equally so in wild-type and kappaL chain-deficient cells. Hence, kappaL chain production appears not to inhibit secondary rearrangements. Around 20% of all small preBII cells express IgL chains in their cytoplasm. Cells with a first productive rearrangement on one allele are favored to enter the immature B cell compartment. Thus, allelic exclusion might be secured by control of accessibility of IgL chain loci for rearrangement and by rapid selection of cells with a fitting over those with a nonfitting IgL chain.

[Development of a multiple side-hole sheath introducer for use in aortography]

We developed a multiple side-holed sheath introducer that can also be used as a catheter for aortography before selective arteriography of the pelvic organs or lower extremities, as an alternative to straight or pig-tail catheters, which were formerly used for aortography. Aortography using the multiple side holed sheath introducer provided good detection of arteries in 100% of 10 cases, without any complications or difficulties. Thus, the present sheath introducer can replace straight or pig-tail catheters, resulting in the more economical use of one catheter prior to selective arteriography.

Aberrant gastric venous inflow to the left lobe of the liver parenchyma adjacent to the falciform ligament

Direct inflow of the aberrant right gastric vein independent of the portal venous system to the liver parenchyma is a well known cause of non-tumorous abnormalities on CT angiography. However, there have been no previous reports of aberrant gastric venous drainage as the cause of non-tumorous abnormalities in the left lobe of the liver parenchyma adjacent to the falciform ligament on CT angiography. We present a case of direct inflow of an aberrant gastric vein to this region of the liver, which influenced the non-tumorous enhancement shown by CT hepatic arteriography.

Four of five RAG-expressing JCkappa-/- small pre-BII cells have no L chain gene rearrangements: detection by high-efficiency single cell PCR

Single cell PCR assays have been further developed that detect over 80% of all VkappaJkappa, VkappaRS, and VlambdaJlambda rearrangements at efficiencies between 70% and 90%. These IgL chain gene rearrangement assays were used with small pre-BII cells that develop in comparably high numbers in the bone marrow of wild-type, Ckappa-deficient, and JCkappa-deficient homozygous and heterozygous mice. In all of these mice, only 15%-25% of all small pre-BII cells carry VlambdaJlambda rearrangements. These results confirm that lambdaL chain gene rearrangements occur independently of kappaL chain gene rearrangement and expression. They also show that a large part of the small pre-BII cells that express the rearrangement machinery can develop without IgL chain gene rearrangements.

Intrahepatic portosystemic venous shunt associated with a large abdominal tumour

Intrahepatic portosystemic venous shunt (IPSVS) is relatively uncommon, and is usually associated with chronic hepatitis or cirrhosis. We present a case of IPSVS that was considered to be caused by increased blood flow from a large abdominal tumour. The characteristic intrahepatic haemodynamics were demonstrated by CT angiography.

Focal attenuation differences in pericystic liver tissue as seen on CT hepatic arteriography and CT arterial portography: observation using a unified helical CT and angiography system

BACKGROUND

To investigate nontumorous focal enhancement (FE) with computed tomographic hepatic arteriography (CTHA) and perfusion defect (PD) with computed tomographic arterial portography (CTAP) in pericystic liver tissue.

METHODS

Incidence, shape, and size of nontumorous FE on CTHA and PD on CTAP were examined in 100 consecutive noncirrhotic and 100 consecutive cirrhotic patients.

RESULTS

FE was observed on CTHA in 77 noncirrhotic and 61 cirrhotic patients, whereas PD was observed on CTAP in 50 noncirrhotic and 51 cirrhotic patients. When both findings were visualized in both CT studies, the shape of the FE on CTHA was similar to the overlapping PD on CTAP in 81% of patients but was larger in 92% of patients.

CONCLUSIONS

FE on CTHA and PD on CTAP are frequently noted in pericystic liver tissue. The size of FE on CTHA is often larger than PD on CTAP, although the shapes are generally the same. Size discrepancy suggests the presence of both portal supply and splanchnic venous drainage.

Successful treatment of relapsed T-cell non-Hodgkin's lymphoma with allogeneic peripheral blood stem cell transplantation with double conditioning

We report a patient with T-cell non-Hodgkin's lymphoma (NHL) who relapsed after treatment with relatively intensive third-generation chemotherapy, VACOP-B, and who was safely and effectively treated with allogeneic peripheral blood stem cell transplantation (allo PBSCT) with double conditioning. The first conditioning consisted of carboplatin and etoposide. Twenty-one days later, the second conditioning was performed with cytosine arabinoside, cyclophosphamide, and total body irradiation (AraC/Cy/TBI). Between the periods of the first and second conditioning, autologous (auto) PBSCT (4.4 x 10(5) colony-forming units granulocyte/macrophage (CFU-GM)/kg, 3.8 x 10(6) CD34+ cells/kg) was performed to rescue marrow aplasia after the first conditioning. After the second conditioning, allo PBSCT (2.1 x 10(5) CFU-GM/kg, 8.2 x 10(6) CD34+ cells/kg) was performed from a human leukocyte antigen-identical sibling. Marrow reconstitution after allo PBSCT was rapid. Grade I acute graft-vs.-host disease (GVHD) involving skin and chronic GVHD on the eye was observed. No severe transplantation-related complications occurred. With a follow-up of 22 months after allogeneic PBSCT, the patient is alive without evidence of the disease. This case shows that allo PBSCT with intensive double conditioning may become a new treatment strategy to achieve long-term disease-free survival for young NHL patients of resistant relapse with a great deal of tumor burden and invasion of lymphoma cells in bone marrow.

Correlation of a defect of portal perfusion in the dorsal part of segment IV of the liver on CT arterial portography with inflow of the aberrant pancreaticoduodenal vein

The correlation between an aberrant pancreaticoduodenal vein and a portal perfusion defect in the dorsal part of segment IV as demonstrated on CT arterial portography (CTAP) was investigated. 14 patients with non-tumorous defects of portal perfusion in the dorsal part of segment IV of the liver parenchyma, shown on CTAP underwent CT during pancreaticoduodenal arteriography. The defect on CTAP was shown as an enhanced area resulting from non-portal venous inflow in eight (57%) of 14 patients on CT during pancreaticoduodenal arteriography. In conclusion, the non-portal venous supply via an aberrant pancreaticoduodenal vein occasionally causes a defect of portal perfusion in the dorsal part of segment IV on CT arterial portography.

The relationship between lifestyle, social characteristics and obesity in 3-year-old Japanese children

It has been observed that obese children receive genetic and environmental effects that are associated with them being overweight. With regard to the latter, lifestyles such as eating habits and physical activity have been focused on. In the present study, the social characteristics which would dominate their lifestyles were investigated as background variables. For this purpose, 9668 Japanese children aged three years who were all born in Toyama prefecture, Japan, in 1998, served as birth cohort subjects. For the comparison between obese (Kaup Index; mass in kg/(height in m)2 > or = 18) and nonobese (Kaup index < 18) children, irregular snack intake, physical inactivity and reduced sleeping hours were chosen as statistically significant obesity-related lifestyle indicators for the children. For social characteristics, family construction (expanded family with grandparents/nonexpanded family), main caregiver (mother/other), attending a nursery school (yes/no) and mother's employment (full-time worker/other) were chosen. These were significantly associated with the obesity-related lifestyles mentioned above using multiple logistic regression analysis adjusted for other variables of social characteristics as well as for gender and birth month (July-December/January-June). The two greatest population-attributable risk percentages were observed for mother as main caregiver (-36.5%) and attending a nursery school (-28.9%) for irregular snack intake. Therefore, these two social characteristics substantially reduced the number of children with irregular snack intake. On the other hand, the two social characteristics were reversed in children with reduced sleeping hours (population-attributable risk percentage of mother as main caregiver: 15.4%; attending a nursery school: 17%). In contrast with favourable effects on snack intake these social characteristics showed an adverse influence on the sleeping habits of children.

Influence factors on the development of obesity in 3-year-old children based on the Toyama study

BACKGROUND

Obesity in childhood increases the risk of obesity in adulthood. Obesity in adulthood is a risk factor for chronic diseases such as hypertension and atherosclerosis. Therefore, it is important to eliminate factors influencing the development of obesity in children from the viewpoint of preventive medicine. The purpose of this study is to elucidate the relationship between obesity and lifestyle in 3-year-old children in a case-control study.

METHODS

Subjects were selected from the Toyama study at health checkups for 3-year-old children which are done routinely by local governments in Japan on all children of that age. A special questionnaire consisting of items on lifestyle and environmental factors of the children and past histories of parents was distributed to the Toyama study participants beforehand and was collected at the checkup. Matched-pair comparisons were performed between obese children whose body mass index was 18 or more (N = 427) and control children (N = 854) matched by sex and birth month. Multivariate stepwise conditional logistic regression analysis was also applied to assess the influence of confounding factors.

RESULTS

The following six factors significantly influenced the development of obese 3-year-old children using the Mantel-Haenszel method: the mother's job, limited playtime outdoors (1 hour or less), snacking irregularity, an overweight father (body mass index >/= 24), an overweight mother (body mass index >/= 24), and overweight at birth (birth weight >/= 3,500 g). An overweight mother or father, limited playtime outdoors, overweight at birth, and snacking irregularity were significantly related to obesity in 3-year-old children after adjusting for confounding factors by multivariate stepwise conditional logistic regression analysis.

CONCLUSIONS

We have suggested several factors influencing the development of obesity in 3-year-old Japanese children: parental overweight and overweight at birth as host factors, physical inactivity and snacking irregularity as behavioral factors, the mother's job as an environmental factor.

The cause of nontumorous defects of portal perfusion in the hepatic hilum revealed by CT during arterial portography

OBJECTIVE

We investigated the cause of nontumorous defects of portal perfusion in the hepatic hilum revealed by CT during arterial portography (CTAP).

MATERIALS AND METHODS

One hundred sixty patients who simultaneously underwent CTAP and CT during hepatic arteriography of the common hepatic artery formed the basis of our study. The frequency, site, and shape of nontumorous defects of portal perfusion in the hepatic hilum on CTAP and the findings on CT during hepatic arteriography were determined. In 13 patients in whom nontumorous portal perfusion defects were observed on CTAP, CT was performed during selective angiography via the gastric artery, pancreaticoduodenal artery, or both.

RESULTS

Nontumorous defects of portal perfusion were detected in 49 regions in 33 of the 160 patients (dorsum of segment IV, n = 30; dorsum of the lateral segment, n = 11; segment I, n = 8). Of the 33 patients, 16 had two defects each. Of the 49 nontumorous defects of portal perfusion, 38 showed enhancement on CT during hepatic arteriography. In the 13 patients who underwent CT during selective arteriography, enhancement due to nonportal venous inflow was seen in 16 of the 19 areas of decreased nontumorous portal perfusion (dorsum of segment IV, nine of 11; dorsum of the lateral segment, four of five; segment I, three of three).

CONCLUSION

The main cause of nontumorous defects of portal perfusion in the hepatic hilum revealed by CTAP is decreased portal inflow due to nonportal supply via the parabiliary venous system. Thus, such lesions were also enhanced at a high frequency on CT during hepatic arteriography.

[Follow-up study on effects of height velocity and puberty onset on biochemical markers of bone turnover]

In order to clarify the factors which affect bone metabolism at a young age, we investigated the relationships among the change of biochemical markers of bone turnover, the height velocity (HV) and puberty onset in healthy Japanese children. One hundred and twelve children (61 boys and 51 girls) were recruited at the fourth grade level in the elementary school (9 years old) and followed for 6 years. Serum bone specific alkaline phosphatase (B-ALP), serum tartrate-resistant acid phosphatase (TR-ACP), urine hydroxyproline (Hyp) and urine calcium (Ca) were measured as the biochemical markers of bone turnover. Bone mineral density of calcaneus was also measured by ultrasound method at the first grade (12 years old) and the third grade (14 years old) of junior high school. Heights and weights of all subjects were measured every April and the HV were calculated between each year. Puberty onset was defined as the time when pubic hair appeared in boys and as the time when menarche started in girls by self-administered questionnaire. All the biochemical markers of bone metabolism except for urine Ca had a significant positive relationship with HV. The values of the markers were highest of the time when the HV was maximum. In girls, the values of the biochemical markers remained high before menarche and then decreased significantly within three years after menarche, suggesting that bone turnover changed rapidly from high turnover type to low turnover type after menarche. On the other hand, in boys, high turnover type remained for a few years after puberty onset. Bone mineral density of calcaneus by ultrasound method increased significantly in boys between the two years in junior high school, but the increase was unclear except for broadband ultrasound attenuation (BUA) in girls in the same period.

Precision of quantitative ultrasound measurement of the heel bone and effects of ambient temperature on the parameters

The goal of this study was to determine the magnitude of measurement error of a quantitative ultrasound (QUS) measurement system of the heel bone in a practical setting and to examine the effects of ambient temperature in the test room on QUS parameters. We assessed the intratest, intertest and interdevice coefficients of variation (CVs) for speed of sound (SOS), broadband ultrasound attenuation (BUA) and stiffness in vitro using phantoms and in vivo using volunteers. The intratest CV was the smallest and the interdevice CV was the greatest for every QUS parameter. The intertest CVs in vivo were 0.50% for SOS, 2.53% for BUA and 4.38% for stiffness. The standardized precision error (sPE) of stiffness, however, was smaller than those of the other two parameters. The intertest sPEs in vivo of the QUS parameters were 2-3 times greater than that of the spine bone mineral density (BMD) as measured by dual-energy X-ray absorptiometry (DXA). Using an average of duplicate measurements for the representative value of a subject could improve sPE of the QUS parameters to around 2 times greater than that of spine BMD. We examined five phantoms each with the QUS system under the ambient temperature conditions of 10, 20 and 30 degrees C. The lower the room temperature, the greater the values of all the QUS parameters obtained. We then assessed the effect of the season on the QUS parameters in healthy five women. SOS and stiffness were significantly greater in February (room temperature, 12.6 degrees C) than in June (22.4 degrees C) by 0.74% and 3.2% of overall means, respectively, by 10.1% and 4.3% as a standardized difference, or by 0.422 and 0.214 in Z-scores. This difference was likely to be caused by the difference in heel temperature between the seasons. The precision of the QUS system was inferior to that of conventional DXA densitometry. We recommend that institutions using several QUS system devices throughout the year at various locations monitor the precision of each device, make duplicate measurements for a single subject, use the same device for each patient being followed, and control the heel temperature of subjects by keeping the test room temperature constant throughout the year.

Psychotherapy, today and tomorrow: status quo of behavior and cognitive therapy and its efficacy

This paper reviews the development of behavior therapy, its applications, and the characteristics that make this form of therapy unique and applicable to a wide range of problems. Behavior therapy started from learning theory. It has adopted other theoretical bases and produced numerous techniques as a result of efforts to apply its principles to clinical problems. Recently, cognitive techniques of behavior therapy have been growing. The characteristics of behavior therapy are: (i) problem oriented and practical; (ii) emphasis on real life and living skills; and (iii) concrete viewpoint and techniques. These characteristics enable wide application. Today, many studies show the superior efficacy of behavior therapy for various mental and physical problems. Some well-documented techniques can be performed by non-professionals. The techniques and the viewpoint of behavior therapy would be accepted widely in Pacific Rim countries in the future.

[Studies on carcinogenicity of asbestos with special reference to interaction between viruses and cultured cells]

To investigate effects of asbestos on the process of cancer development, the capacity of asbestos which increases cellular uptake of external carcinogens was tested for asbestos-mediated viral RNA transfection in cultured cells. For the transfection, crocidolite, amosite, anthophyllite and chrysotile were placed onto Vero-E6 cells with poliovirus RNA inoculum, respectively. All asbestos samples mediated viral RNA transfection compared with the background including only viral RNA. The transfection was much greater with combined exposure to asbestos and kaolin than with exposure to asbestos alone.

Focal fatty change in segment IV of the liver occurring after gastrectomy

In some cases, focal fatty change of the liver parenchyma has been attributed to local systemic venous inflow replacing the portal venous supply. However, no reports of focal fatty change in the dorsal portion of segment IV of the liver caused by direct inflow of an aberrant pancreaticoduodenal vein (APDV) through the parabiliary venous system (PVS) are available. We report a 60-year-old woman with focal fatty change in segment IV of the liver which occurred after gastrectomy with APDV shown on CT performed during selective gastroduodenal arteriography.

Irregular regeneration of hepatocytes and risk of hepatocellular carcinoma in chronic hepatitis and cirrhosis with hepatitis-C-virus infection

BACKGROUND

Hepatocellular carcinoma (HCC) commonly develops in patients with chronic hepatitis or cirrhosis of the liver caused by hepatitis-C-virus (HCV) infection. We prospectively studied whether irregular regeneration of hepatocytes is a risk factor for HCC in these patients.

METHODS

242 patients were enrolled after liver biopsy and followed up by ultrasonographic scanning every 3 months. We examined age, sex, platelet count, the diagnosis of cirrhosis or chronic hepatitis, liver-cell dysplasia, and irregular regeneration. We classified irregular regeneration as slight or severe, based on histological expression of pleiomorphism, anisocytosis, bulging, and map-like distribution of hepatocytes.

FINDINGS

37 of 63 patients with cirrhosis and 26 of 179 with chronic hepatitis were judged to have severe irregular regeneration. HCC was diagnosed in 33 of 63 patients with cirrhosis (29 had severe irregular regeneration) and 12 of 179 patients with chronic hepatitis (11 had severe irregular regeneration) during mean follow-up of 5.5 years (SD 4.1; range 1-16). Multivariate analysis with a proportional-hazards model showed severe irregular regeneration (relative risk 15.1 [95% CI 5.6-40.7], p<0.0001) and a diagnosis of cirrhosis (3.8 [1.7-8.2], p=0.0008) to be significant risk factors for HCC. Within the diagnostic categories, irregular regeneration was also significant (cirrhosis 6.8 [2.1-21.9], p=0.0014; chronic hepatitis 28.5 [2.9-276.4], p=0.0038).

INTERPRETATION

We recommend that liver biopsy to look for irregular regeneration should be done in patients with HCV-related chronic liver diseases. Those with severe irregular regeneration should be followed up carefully.

Complete amino acid sequences of chitinase-1 and -2 from bulbs of genus Tulipa

The complete amino acid sequences of tulip bulb chitinase-1 and -2 (TBC-1 and -2) were determined. The sequences of the TBC-1 and TBC-2 were solved by analysis of peptides derived by enzymatic digestions as well as by chemical cleavages with cyanogen bromide (CNBr), o-iodosobenzoic acid, and hydroxylamine. TBC-1 and TBC-2 both consisted of 275 amino acid residues and had molecular masses of 30,825 and 30,863, respectively. They shared 247 identical residues, that is 90% identity. Comparison of their sequences with that of gladiolus bulb class IIIb chitinase-a (GBC-a) showed that 63% of the residues of both TBC-1 and TBC-2 are identical to that of GBC-a. From these results, it was seen that TBC-1 and -2 are class IIIb chitinases. The characteristic difference in specific activity between TBC-1 and -2 was also discussed on the basis of their amino acid sequences.

Complete amino acid sequence of chitinase-A from leaves of pokeweed (Phytolacca americana)

The complete amino acid sequence of pokeweed leaf chitinase-A was determined. First all 11 tryptic peptides from the reduced and S-carboxymethylated form of the enzyme were sequenced. Then the same form of the enzyme was cleaved with cyanogen bromide, giving three fragments. The fragments were digested with chymotrypsin or Staphylococcus aureus V8 protease. Last, the 11 tryptic peptides were put in order. Of seven cysteine residues, six were linked by disulfide bonds (between Cys25 and Cys74, Cys89 and Cys98, and Cys195 and Cys208); Cys176 was free. The enzyme consisted of 208 amino acid residues and had a molecular weight of 22,391. It consisted of only one polypeptide chain without a chitin-binding domain. The length of the chain was almost the same as that of the catalytic domains of class IL chitinases. These findings suggested that this enzyme is a new kind of class IIL chitinase, although its sequence resembles that of catalytic domains of class IL chitinases more than that of the class IIL chitinases reported so far. Discussion on the involvement of specific tryptophan residue in the active site of PLC-A is also given based on the sequence similarity with rye seed chitinase-c.

Isolation and characterization of chitinase isoforms from the bulbs of four species of the genus Tulipa

Six chitinase isoforms, designated TBC-1 to TBC-6, were purified to homogenity from the bulbs of four species (Tulipa bakeri, T. tarda, T. turkestanica, and T. praestans) of the genus Tulipa by CM-cellulose column chromatography, Butyl-Toyopearl 650M hydrophobic column chromatography, gel filtration on Sephadex G-75, and Mono-S fast protein liquid chromatography (FPLC). The chitinases had molecular weights of 30,000 and isoelectric points of 5.2 to 6.1. These chitinases were found to proteins with similar amino acid compositions and N-terminal sequences. The tulip chitinases all had two half-cystine residues, one more than gladiolus bulb class IIIb chitinase, but many fewer than chitinases of plant class I (15-17 Cys residues/mol), II (5-8 Cys residues/mol), or III (6 Cys residues/mol). The N-terminal sequences of tulip chitinases were similar to the sequence of the gladiolus chitinase, but did not resemble sequence of any class of plant chitinase. The optimal pH of these chitinases toward glycolchitin was pH 5. TBC-1 hydrolyzed (GlcNAc)6 into (GlcNAc)2, (GlcNAc)3, and (GlcNAc)4, and hydrolyzed (GlcNAc)5 into (GlcNAc)2 and (GlcNAc)3.

High incidence of chemotherapy-induced acral erythema in female patients with non-Hodgkin's lymphoma treated with the VACOP-B regimen

Seven patients, all females out of 29 with non-Hodgkin's lymphoma (NHL) (16 males and 13 females) treated with the VACOP-B regimen utilizing granulocyte-colony-stimulating factor (G-CSF) support developed chemotherapy-induced acral erythema (CAE). In contrast, none of 32 patients with NHL who were treated with CHOP, MACOP-B, or biweekly CHOP regimens without G-CSF developed CAE. Total dose intensities of VACOP-B regimen were higher than those of the three other regimens. However, no significant difference in dose intensities of each drug in the patients treated with the VACOP-B regimen was found between male and female patients and between female patients with or without CAE. The cause of the high incidence of CAE (7/13) in the female patients treated with VACOP-B regimen remains unknown. However, female sex hormones may increase susceptibility to CAE. Since the occurrence of CAE interrupts intensive chemotherapy and reduces the cure rate, high risk patients for CAE should be carefully monitored for early symptoms and signs of CAE and should be treated early and appropriately.

Complete amino acid sequence of chitinase-a from bulbs of gladiolus (Gladiolus gandavensis)

The complete amino acid sequence of gladiolus bulb chitinase-a (GBC-a) was determined. First the tryptic peptides from GBC-a after it was reduced and S-carboxymethylated were sequenced and then the peptides were further studied by chemical cleavage of the enzyme. GBC-a consisted of 274 amino acid residues and had a molecular mass of 30,714 Da. Two consensus sequences essential for chitinase activity by plant class III chitinases were conserved in GBC-a, although its sequence similarity with plant class III chitinases was less than 20%. Sequence comparison of GBC-a with sequences of other proteins in a protein identification resource (PIR) showed that the GBC-a sequence was 33% similar to that of narbonin, a seed storage 2S globulin from narbon beans.

Identification of the aspartic acid residue located at or near substrate-binding site of rye seed chitinase-c

Carboxyl groups of rye seed chitinase-c (RSC-c) were modified with 1-ethyl-3-(3-dimethylaminopropyl)carbodiimide (EDC) and glycine ethyl ester (GEE) at pH 5.5 and 5 degrees C in the presence and absence of (GlcNAc)4. In the absence of (GlcNAc)4, 5.2 carboxyl groups were modified by 90 min-reaction and the chitinase activity was reduced to 2.0%, while in the presence of (GlcNAc)4, 4.6 carboxyl groups were modified and 72% of the activity was retained. To identify the carboxyl group protected by (GlcNAc)4 from the modification, RSC-c was first modified with EDC and GEE in the presence of (GlcNAc)4 and then radiolabeled with EDC and [14C]GEE in the absence of (GlcNAc)4. Analyses of the radioactive peptides from the tryptic and chymotryptic digests of radiolabeled RSC-c showed that the main radiolabeled carboxyl group is that of Asp95, suggesting that Asp95 is located at or near substrate-binding site of RSC-c.

Purification and characterization of two chitinase isoforms from the bulbs of gladiolus (Gladiolus gandavensis)

Two chitinase isoforms, designated GBC-a and GBC-b, were purified from the bulbs of gladiolus (Gladiolus gandavensis) using CM-cellulose column chromatography followed by Butyl-Toyopearl 650 M hydrophobic column chromatography, gel filtration on Sephadex G-75, and Mono-S FPLC. GBC-a and GBC-b are weakly acidic and weakly basic proteins with molecular masses of 30 kDa, and isoelectric points of 6.0 and 7.5, respectively. GBC-a and GBC-b were found to be homologous proteins with similar amino acid compositions and N-terminal sequences. The number of half-cystine residues in GBC-a and GBC-b was only one each, which is much lower than those of plant class I (15-17 Cys residues/mol), class II (5-8 Cys residues/mol), and class III (6 Cys residues/mol) chitinases. The N-terminal sequences of GBC-a and GBC-b were completely different from those of plant three classes of chitinases. The optimal pHs of these chitinases toward glycolchitin were pH 5. GBC-a hydrolyzed (GlcNAc)5 into (GlcNAc)2, (GlcNAc)3 and (GlcNAc)4, and (GlcNAc)5 into (GlcNAc)2 and (GlcNAc)3.

[Enhancement pattern of hepatic metastases from colorectal cancer on CT arteriography]

The enhancement pattern of hepatic metastases from colorectal cancer on CT arteriography (CTA) was evaluated in 79 cases with 405 lesions. Sixty-two percent of overall lesions irrespective of size showed ring-like enhancement, and 33% of lesions less than 1 cm in diameter showed homogeneous enhancement. In pathological examination of 59 resected lesions, the enhancement pattern on CTA had a good correlation with the extent of tumor cellularity, necrosis or fibrosis in the lesions. And in 8.5% of resected lesions, the extent of enhancement on CTA was larger than that of perfusion defect on CT arterial portography, which was almost equal to the size in the resected specimen. In such lesions, the enhancement on CTA might include enhancement of normal hepatic parenchyma around the lesion.

Ischaemic heart disease deaths in a Japanese rural area evaluated by clinical records

A community-based survey to examine the actual number of ischaemic heart disease (IHD) deaths was undertaken in the western area of Toyama, a rural area with a population of 209,000. IHD deaths (International Classification of Diseases [ICD], ninth revision, codes 410-414) and heart failure (HF) deaths (ICD code 428) according to the death certificate aged 15 to 74 in 1987 to 1990 were reevaluated from medical records using the criteria of the multinational monitoring of trends and determinants in cardiovascular disease (MONICA). Of 97 subjects with IHD and of 170 subjects with HF according to the death certificate, 85 cases (87.6%) and 143 cases (84.1%) could be examined, respectively. Using the MONICA criteria, of 85 subjects with IHD, 18 (21.2%) were reevaluated as "definite acute myocardial infarction (AMI)" and 30 (35.3%) as "possible AMI". On the other hand, of 143 subjects with HF, 1 (0.7%) were reevaluated as "definite AMI" and 12 (8.4%) as "possible AMI". From these results, the number of deaths as reevaluated IHD was estimated 104.5 in the study period, and it was 7.7% increase at least compared with the number of deaths judged from the death certificate.

Postlaminectomy adhesion of the cauda equina. Changes of postoperative vascular permeability of the equina in rats

STUDY DESIGN

The authors evaluated the vascular permeability changes of the cauda equina after lumbar laminectomy in rats.

OBJECTIVES

To clarify the early vascular responses in postlaminectomy adhesive arachnoiditis.

SUMMARY OF BACKGROUND DATA

Laminectomy-induced cauda equina adhesion has been visualized by postoperative serial magnetic resonance imaging in humans. In laminectomized rats, fibrinous exudation was apparent among the adhered cauda equina. To date, there has been no report of substantial changes in vascular permeability in the cauda equina after lumbar laminectomy.

METHODS

Wistar rats laminectomized from L5-L6 were used for four studies; 1) Evans blue albumin tracer study; 2) horseradish peroxidase tracer study; 3) lanthanum tracer study; and 4) fluoroscein isothiocyanate-dextran (molecular weights: 20K, 70K, and 150K) tracer study. Untreated rats were used as controls.

RESULTS

1) In the laminectomized (L5-L6) area, the cauda equina tended to conglomerate from 3 hours after surgery; this was relatively resolved by 6 weeks. Extravascular leakage of Evans blue albumin in the cauda equina appeared at 3 hours after surgery and reached a plateau at 24 hours; it mostly disappeared by 6 weeks. At 24 hours after surgery, the extent of Evans blue albumin extravasation was seen in one or more levels adjacent to the laminectomized area. Evans blue albumin leakage and cauda equina adhesion started to appear in nearly a same phase after laminectomy, followed by a plateau of vascular permeability facilitating complete cauda equina adhesion by 24 hours after surgery. The restoration of Evans blue albumin leakage was noted 1 week after surgery, and tended to precede recovery of the cauda equina adhesion; 2) in the laminectomy group, Horseradish peroxidase penetrated from the lumen to the extracellular space beyond the basal laminae of the endothelial cells. Numerous horseradish peroxidase-labeled vesicles in the endothelial cells were found; 3) There was a significant increase in lanthanum distribution in the endothelial cytoplasm at the laminectomized levels. Lanthanum filled the interendothelial clefts beyond the tight junction, but did not penetrate through the perivascular basal laminae; 4) Fluoroscein isothiocyanate-dextran (20K, 70K, 150K) permeability increased in the laminectomy group, but there was no difference in extravasation of fluoroscein isothiocyanate-dextran, irrespective of the molecular weight.

CONCLUSION

Laminectomy consistently induced an increase in vascular permeability in the cauda equina, an increase of vesicular transport in the endothelial cell, and opening of the tight junction early after laminectomy, suggesting breakdown of the blood nerve barrier in the cauda equina. The accelerated permeability may enhance cauda equina adhesion.

Primary obsessional slowness: long-term findings

Cases of slowness among patients who spent large amounts of time to perform daily activities were first reported in 1974, and described as primary obsessional slowness (POS). It was observed that it was neither obsessive thoughts nor compulsions that directly hindered their daily activities. However, in more than 20 years following the original report, the diagnostic independence of POS remains controversial, some insisting that obsessional slowness can be explained as secondary. The authors experienced four cases in Japan which share the same characteristics as the original cases. Long-term observation and treatment has led us to support the diagnostic independence of POS. Slowness remained after other accompanying symptoms of obsessive-compulsive disorder had been successfully treated, showing that the slowness of our patients was not secondary.

A case of internal carotid artery occlusion complicating embolization of the external carotid artery system

A case of visual disturbance by embolization through the external carotid artery (ECA) after internal carotid artery (ICA) occlusion is reported. A 65-year-old female presented left ICA occlusion 14 years ago. She was admitted with acute deterioration of left visual acuity. Ophthalmologically, the retinal central artery was occluded. Cerebral angiography disclosed an irregular wall at the left ICA stump and stenosis of the maxillary artery. Carotid endarterectomy of the common carotid artery, ECA and residual ICA was performed and atheromatous plaque with ulceration was removed. The postoperative course was uneventful. We discuss cases of ICA occlusion in relation to visual impairment.

Myoepithelial hamartoma of the ileum causing intussusception in an infant

Intussusception is a relatively common pediatric gastrointestinal emergency, although the etiology in most cases remains unknown. In a small number of cases the lead point is a tumor or tumor-like lesion of the small bowel. We report an unusual case of a myoepithelial hamartoma of the ileum causing an intussusception in a 4-month-old boy. This is the second such report in the literature.

Aberrant overexpression of the Wilms tumor gene (WT1) in human leukemia

To clarify whether the expression of the WT1 gene in leukemic cells is aberrant or merely reflects that in normal counterparts, the expression levels of the WT1 gene were quantitated for normal hematopoietic progenitor cells. Bone marrow (BM) and umbilical cord blood (CB) cells were fluorescence-activated cell sorting (FACS)-sorted into CD34+ and CD34- cell populations, and the CD34+ cells into nine subsets (CD34+ CD33-, CD34+ CD33+, CD34+ CD38-, CD34+ CD38+, CD34+ HLA-DR-, CD34+ HLA-DR+, CD34+ c-kit(high), CD34+ c-kit(low), and CD34+ c-kit-) according to the expression levels of CD34, CD33, CD38, HLA-DR, and c-kit. Moreover, acute myeloid leukemic cells were also FACS-sorted into four populations (CD34+ CD33-, CD34+ CD33+, CD34- CD33+, and CD34- CD33-). FACS-sorted normal hematopoietic progenitor and leukemic cells and FACS-unsorted leukemic cells were examined for the WT1 expression by quantitative reverse transcriptase-polymerase chain reaction. The WT1 expression in the CD34+ and CD34- cell populations and in the nine CD34+ subsets of BM and CB was at either very low (1.0 to 2.4 x 10(-2)) or undetectable (< 10(-2)) levels (the WT1 expression level of K562 cells was defined as 1.0), whereas the average levels of WT1 expression in FACS-sorted and -unsorted leukemic cells were 2.4 to 9.3 x 10(-1). Thus, the WT1 expression levels in normal hematopoietic progenitor cells were at least 10 times less than those in leukemic cells. Therefore, we could not find any normal counterparts of BM or CB that expressed the WT1 at levels comparable with those in leukemic cells. These results indicate an aberrant overexpression of the WT1 gene in leukemic cells and imply the involvement of this gene in human leukemogenesis.

Myoepithelial hamartoma of the ileum causing intussusception in an infant

Intussusception is a relatively common pediatric gastrointestinal emergency, although the etiology in most cases remains unknown. In a small number of cases the lead point is a tumor or tumor-like lesion of the small bowel. We report an unusual case of a myoepithelial hamartoma of the ileum causing an intussusception in a 4-month-old boy. This is the second such report in the literature.

Lineage- and differentiation stage-specific expression of LSM-1 (LPAP), a possible substrate for CD45, in human hematopoietic cells

CD45, a transmembrane tyrosine phosphatase, is found on almost all nucleated hematopoietic cells and plays a crucial role in lymphocyte activation and differentiation. We recently achieved isolation of the human LSM-1 (hLSM-1) gene, whose product is a possible substrate for CD45, and we raised antibodies against the hLSM-1 protein. hLSM-1 expression in hematopoietic cells was examined with Northern and Western blot, fluorescence-activated cell sorter, and immunocytochemical analyses. It was found that in the lymphoid lineage, T and B lymphocytes as well as NK cells expressed LSM-1, whereas terminally differentiated plasma cells did not. As for the myeloid lineage, immature myeloid cells expressed LSM-1, whereas terminally differentiated granulocytes and monocytes did not. In the erythroid lineage, normal erythroblasts expressed very low levels of LSM-1, while erythroid cell lines (K562 and HEL) did not. Megakaryocytes did not express LSM-1. Both CD34+/CD33- and CD34+/CD33+ hematopoietic progenitor cells weakly expressed LSM-1. These results showed that LSM-1 is expressed in a lineage- and differentiation stage-specific fashion.