Correlations between bone mineral density and demographic, lifestyle, and biochemical variables in community-dwelling Japanese women 69 years of age and over

INTRODUCTION

A few epidemiologic studies have comprehensively attempted to identify risk factors for low bone mineral density (BMD) in elderly Asian women. The purpose of this study was to identify demographic, lifestyle, and biochemical factors correlated with BMD in elderly Japanese women 69 years of age and over.

METHODS

The study design was cross-sectional. The subjects were 583 ambulatory women aged 69 years and over, and their average age was 74.3 (SD 4.4) years. Predictor variables were age, reproductive history, anthropometric indices, grip strength, calcium intake, lifestyle information, and serum 25-hydroxyvitamin D, 1,25-dihydroxyvitamin D (1,25(OH)(2)D), osteocalcin (OC), and undercarboxylated osteocalcin (ucOC) values. The outcome variable was forearm BMD measured with a DTX-200 osteometer.

RESULTS

Simple linear regression analyses showed that BMD was significantly positively associated with body height, weight, body mass index, grip strength, serum albumin concentration, and "housework," and negatively associated with age, years since menopause, age at menarche, number of children, serum 1,25(OH)(2)D concentration, serum OC concentration, and ucOC concentration. The stepwise multiple regression analysis showed that weight (beta=0.00316, SE=0.00028, R(2)=0.180), age (beta=-0.00321, SE=0.00050, R(2)=0.108), log-transformed serum OC (beta=-0.0445, SE=0.0064, R(2)=0.053), log-transformed serum 1,25(OH)(2)D (beta=-0.0401, SE=0.0074, R(2)=0.050), "farmwork" (beta=0.00904, SE=0.00426, R(2)=0.005), and serum 25(OH)D concentration (beta=0.000281, SE=0.000120, R(2)=0.003) were significantly associated with BMD.

CONCLUSION

It was concluded that body weight is a major predictor of forearm BMD among the factors measured in this study in independent Japanese women 69 years of age and over and that serum 1,25(OH)(2)D concentration may be associated with cortical BMD. Maintenance of body weight is very important for maintaining BMD in this population, unless a large weight aggravates obesity-related diseases. A follow-up study is needed to confirm these findings.

Clinical and prognostic importance of serotyping Mycobacterium avium-Mycobacterium intracellulare complex isolates in human immunodeficiency virus-negative patients

We studied whether the serotypes of Mycobacterium avium-Mycobacterium intracellulare complex (MAC) isolates determine the prognosis for pulmonary MAC disease. We prospectively monitored a cohort of 68 patients with pulmonary MAC disease for whom the serotype-specific glycopeptidolipids in isolates were identified using thin-layer chromatography and fast atom bombardment mass-spectrometry in 1990 and 1995. Serovar 4 Mycobacterium avium was detected in 40/68 patients (58.8%). Other serotypes were serotypes 1 (five cases), 6 (three cases), 8 (seven cases), 9 (three cases), 14 (four cases), and 16 (six cases). Patients with serovar 4 were significantly (P < 0.01) younger (63.0 +/- 9.8 years) than patients with other serotypes (71.8 +/- 10.3). Patients who failed treatment had a significantly poorer prognosis than other patients. There were no cases of MAC-related death in the cured group. Chest radiographic findings progressively worsened in 36 (90%) of patients with serotype 4, and 14/36 died from respiratory failure caused by pulmonary Mycobacterium avium disease. The patients with serotype 4 had a significantly poorer prognosis than patients with other serotypes. These results show that both the outcome of chemotherapy and the serotypes of MAC isolates are important for assessing the prognosis of pulmonary MAC disease.

Observation of surface Andreev bound States of superfluid 3He by transverse acoustic impedance measurements

Complex transverse acoustic impedance of the superfluid (3)He-B was measured at the frequencies of 10 to 80 MHz at 17.0 bar by a cw bridge method. The observed temperature dependence was well explained by the quasiclassical theory with random S-matrix model for a diffusive surface. The temperature dependence was influenced by pair breaking and by quasiparticle density of states at the surface, which was drastically modified from the bulk one by the presence of surface Andreev bound states.

255 PRONUCLEUS FORMATION IN RAT ZONA-FREE OOCYTES CO-CULTURED WITH HOMOLOGOUS POST-THAW SPERMATOZOA

The aim of the present study was to develop an IVF system with frozen/thawed rat spermatozoa. We examined the effect of cooling rate to 5.0°C on post-thaw sperm motility and membrane integrity, and also investigated the ability of post-thaw spermatozoa to form pronuclei. Under room temperature, epididymal spermatozoa of Wistar rats were collected in 2.0 mL of egg yolk medium containing 8.0% (w/v) lactose monohydrate and 0.7% (v/v) Equex Stem. Samples were loaded into 0.25-mL straws and cooled to 5.0°C in the chamber of a programmed freezer. For cryopreservation, the samples were exposed to liquid nitrogen (LN) vapor for 10 min and then plunged into LN. Straws were thawed in a 37.0°C water bath for 10 s. Ovulated oocytes were collected and the zona pellucidae were removed with 0.1% pronase. One-hundred μL of thawed samples were put into a droplet of 400 μL R1ECM and pre-incubated for 1 h. R1ECM solution was added to the droplet to adjust to 0.5–1.5 × 106 sperm mL−1. The zona-free oocytes were then transferred into the droplet and co-cultured for 10 h. Oocytes were observed for pronuclei formation by means of an inverted phase contrast microscope. In Experiment I, the influence of sperm cooling rate to 5.0°C on sperm motility and membrane integrity was evaluated. Portions of samples were cooled at 54.0°C/min, 0.9°C/min, 0.5°C/min, and 0.3°C/min. The remainders were then frozen. The non-cooled samples were designated as controls. In Experiment II, we examined whether post-thaw spermatozoa have the ability to form pronuclei in vitro or not. All percentage data were arc-sine transformed and then analyzed by the Student's t-test. In Experiment I, the membrane integrity between the spermatozoa cooled at 0.5°C/min and the non-cooled spermatozoa was not different (38.1% vs. 37.2%; P > 0.05), but the integrity of these was higher than in spermatozoa cooled directly at 54.0°C/min (38.1% vs. 25.3%; P < 0.05). After culture for 1 h, the motility of spermatozoa cooled at 0.5°C/min was higher than that of those cooled at 54.0°C/min (61.3% vs. 53.3%; P < 0.05). At 2 h post-thaw the motility of spermatozoa cooled at 0.5°C/min was higher than that of spermatozoa cooled at 54.0°C/min and at 0.9°C/min (11.0% vs. 4.5%, 4.9%; P < 0.05). The membrane integrity of post-thaw spermatozoa cooled at 0.5°C/min was also higher compared to that of spermatozoa cooled at 54.0°C/min (22.5% vs. 8.4%; P < 0.01). In Experiment II, 28 (26.2%) of 107 oocytes had pronuclei when the post-thaw spermatozoa cooled at 0.5°C/min were used. The results indicated that the frozen/thawed spermatozoa cooled to 5.0°C at 0.5°C/min showed higher sperm motility and membrane integrity, and that spermatozoa can form pronuclei in homologous zona-free oocytes in vitro. Although in the rat sperm damage occurred during cooling to 5.0°C, and sperm motility and membrane integrity were also decreased by the cold shock, it is possible to decrease the damage by cooling slowly to 5.0°C at 0.5°C/min.

Pathogenicity by parenteral injection of fowl adenovirus isolated from gizzard erosion and resistance to reinfection in adenoviral gizzard erosion in chickens

The pathogenicity of a serotype-1 fowl adenovirus (FAV-99ZH), which causes adenoviral gizzard erosion by oral inoculation in chickens, was investigated in specific pathogen-free white leghorn chickens. In trial 1, 14 chickens were inoculated intravenously with the virus at 21 days of age and euthanatized for necropsy within 1-14 days of inoculation. Gizzard erosion was grossly observed from day 7 postinoculation (PI), and histologically, FAV-99ZH antigen-positive, basophilic intranuclear inclusion bodies were seen in the gizzard lesions from day 7 to 11 PI. Necrotizing pancreatitis, and cholecystitis and cholangitis associated with the inclusions were observed from day 3 to 14 PI (pancreatitis) and from day 5 to 9 PI (cholecystitis and cholangitis), respectively. The inclusions were also observed in the epithelial cells of the cecal tonsils from day 3 to 5 PI. The virus was recovered from samples of the lesions. It was revealed that FAV-99ZH causes not only gizzard erosion but also pancreatitis, cholecystitis, and cholangitis by intravenous inoculation in chickens. In trial 2, 10 chickens were inoculated orally with the virus twice, at 13 and 36 days of age, and euthanatized for necropsy within 4-17 days after reinfection. Macroscopically, focal gizzard lesions were observed; however, neither necrosis nor inclusions were observed by microscopy. Moreover, FAV was not recovered from the gizzard or rectum of any of the chickens at necropsy. This suggests that the gizzard lesions occurred as a result of the primary infection, and that the chickens were able to resist reinfection.

Dynamics and morphology of superfluid bubbles in 4He quantum crystals

Superfluid bubbles in a 4He quantum crystal, which we refer to as quantum negative crystals, were investigated in bcc and hcp phases by visualizing their forms and motions at various temperatures. They were nearly spherical in bcc phase and faceted on the c-plane in their upper part in hcp phase. They steadily rose in the crystal due to gravity. Their direction was vertical in bcc phase and obliquely parallel to the c-facet in hcp phase. We also observed a slowing down of negative crystal in hcp phase caused by the appearance of the a-facet when temperature was lowered. Dynamics and morphology became successively anisotropic with cooling. The driving force by gravity for this motion was derived in the spherical case. Growth coefficient obtained by this model agreed well with the reported values.

[Grading of officially acknowledged respiratory disability and exercise disorders using cardiopulmonary exercise testing in patients with chronic respiratory diseases]

This study examines whether the grading of officially acknowledged respiratory disability reflects exercise disorders in patients with chronic respiratory diseases. In order to do this, we analyzed the cardiopulmonary exercise testing (CPET) data of 258 patients with chronic obstructive pulmonary disease (COPD), 125 with sequela of pulmonary tuberculosis (TB) and 52 with interstitial pneumonia between 1989 and 2002. The peak oxygen uptakes of grade 1 and 3 COPD patients were 12.4 +/- 3.8 and 14.9 +/- 4.3 ml/min/kg (mean +/- SD), respectively. The worse the grade, the lower was the peak oxygen uptake, the differences being significant in COPD patients. Despite this, the peak oxygen uptake range overlapped greatly between grade 1 and grade 3 COPD patients. Sixty percent of patients with TB and 46% of patients with IP whose peak oxygen uptakes were similar to those of grade 1 COPD patients failed to be acknowledged as grade 1. There were no significant differences between the peak oxygen uptake of grade 1 COPD patients and grade 1 TB patients, grade 3 TB patients, and grade 4 IP patients. Patients with TB and IP showed more severe ventilatory and gas exchange disorders than those with COPD. We concluded that the present system of acknowledgement of respiratory disability in Japan did not accurately reflect exercise disorders in patients with chronic respiratory diseases. As well as this, we argue that there is discrimination between patients with COPD, TB and IP. It is necessary to establish an alternative system, reflecting exercise disorders evaluated by CPET to offer a more accurate acknowledgement.

Rapid serodiagnosis of active pulmonary Mycobacterium tuberculosis by analysis of results from multiple antigen-specific tests

We have prospectively analyzed three antigens for serodiagnosis of tuberculosis (TB). These antigens were tuberculous glycolipid antigen, lypoarabinomannan polysaccharide antigen, and antigen 60 (A60), which was derived from purified protein derivatives. Of the 131 patients with active pulmonary TB, 57 were both smear and culture negative and 14 had chronic active pulmonary TB that remained smear positive for >12 months of chemotherapy. One hundred twenty healthy adults were controls. The percentages of patients positive in all three tests were 58.8% for smear-positive active pulmonary TB and 71.4% for chronic active pulmonary TB. When the results of the three serodiagnostic tests were evaluated in combination, the sensitivity increased to 91.5% in patients with active pulmonary TB and to 86.0% in smear- and culture-negative patients. The false-positive rate of the three-test combination was 12.5% in the healthy control groups. In conclusion, it was not possible to detect all of the antibodies against antigenic substances in the cell walls of the tuberculous bacilli in the sera of all TB patients by using available serodiagnostic tests. However, the combined use of tests with three separate antigens maximizes the effectiveness of serodiagnosis.

101CRYOPRESERVATION OF RAT EPIDIDYMAL SPERM: COMPARISON OF TWO COOLING PROTOCOLS

The present study examined post-thaw motility, plasma membrane integrity and fertility of rat epididymal sperm cooled by two procedures to +5°C, and then cryopreserved by controlled-rate freezing. Wistar rats were used in the present study. In protocol-I (2001 Reproduction 122, 463), epididymides were collected from a mature male and placed in a plastic dish containing 2mL of freezing medium I [23% (v/v) egg yolk, 8% (w/v) lactose monohydrate and antibiotics]. The epididymides were dissected with scissors to release epididymal sperm. The semen was kept at 15°C for 30min and then held at 5°C for 30min. The cooling rate from 15°C to 5°C was 0.3°Cmin−1. The cooled semen was diluted with 2mL of freezing medium II [freezing medium I with 1.4% (v/v) Equex Stm (ES, Nova Chemical Sales, Inc., Scituate, MA, USA)]. Mixed semen was aspirated into 0.25-mL straws and exposed to liquid nitrogen (LN) vapor for 10min. The straws were then plunged into LN. In protocol-II, epididymides were collected from a mature male and placed in 4mL of freezing medium III [freezing medium I and 0.7% (v/v) ES]. The epididymides were dissected with scissors and held for 10min at room temperature to release epididymal sperm. The semen was loaded into 0.25-mL straws and kept at 15°C for 15min and then held at 5°C for 15min. The cooling rate from 15°C to 5°C was 0.7°Cmin−1. The cooled straws were then exposed to LN vapor for 10min and plunged into LN. Straws were thawed in a 37°C water bath for 10s. Thawed semen in a straw was diluted with 1mL of KRB medium with 0.4% (w/v) bovine serum albumin (BSA, fraction V, Sigma, Tokyo, Japan) at 37°C and then incubated at 37°C in 5% CO2 in humidified air. The percentage of motile spermatozoa was assessed visibly and determined by direct observation at 37°C under a light microscopy at 100×. The sperm membrane integrity was determined using a commercial Live/Dead sperm viability kit (Molecular Probes, Inc., Eugene, OR, USA) which differentiates between cells with intact plasma membranes and those with damaged membranes by fluorescent staining patterns observed with a fluorescence microscope (Olympus, IX-71, Tokyo, Japan). Similar levels of sperm motility were observed immediately after thawing of sperm from both protocols. However, after 2h of incubation, the post-thaw motility of sperm frozen by protocol-II was significantly (P&lt;0.01) higher than that of protocol-I. Sperm membrane integrity immediately after thawing was also higher for sperm frozen by protocol-II (22.1% v. 9.3%, P&lt;0.01). Sperm frozen/thawed by protocol-II was inseminated into the top of the uterine horns of recipient females to confirm fertility. Two of three inseminated females became pregnant and gave birth to 5 pups. These results suggest that loading sperm into straws before cooling and subsequent slow cooling at 5°C to 0.7°Cmin−1 increases post-thaw survival of rat epididymal sperm.

Outbreaks of adenoviral gizzard erosion in slaughtered broiler chickens in Japan

Gizzard erosion in broiler chickens was investigated at 18 slaughterhouses in Japan. The condition was observed in 13 of them, and adenoviral gizzard erosion (AGE) was diagnosed histologically, immunohistochemically and virologically in the eroded gizzards from nine of these 13. The antigen-positive intranuclear inclusion body of group 1 fowl adenovirus was observed in the epithelial cells of the affected gizzards, and fowl adenoviruses were isolated from the lesions. In two of the slaughterhouses the total weights of the gizzards disposed of in three years were 3590 kg (0.40 per cent of the gizzards inspected) and 2880 kg (0.19 per cent). Sixteen of the 19 outbreaks of gizzard erosion on 15 farms that were confirmed in three of the slaughterhouses, including the previous two slaughterhouses, were diagnosed as AGE, and the condition was suspected in the other three outbreaks. Most of the adenoviruses isolated were identified as serotype-1 by PCR-restriction fragment length polymorphism. No apparent clinical signs were observed in any of the affected flocks.

Prognostic predictors for survival in patients with COPD using cardiopulmonary exercise testing

We studied the relationship between physiologic parameters in cardiopulmonary exercise testing (CPET) and prognosis in terms of survival time in patients with chronic obstructive pulmonary disease (COPD) in order to accurately assess the severity of the disease. From a group of 195 patients with COPD who had consecutively undergone CPET between July 1989 and October 1997, we enrolled 120 subjects (mean age 67.6 years, 104 males) with exertional dyspnoea into a cohort protocol. Of these subjects, 34 (28.3%) died during the 3-5-year follow-up period after CPET. By univariate analysis, the following factors were significantly associated with survival time: age, body mass index, %FVC, %FEV1, FEV1%, PaCO2 at rest, severity of exercise-induced hypoxemia evaluated by DeltaPaO2/DeltaVO2 (PaO2-slope), oxygen uptake, ventilation, tidal volume, PaCO2 and oxygen pulse at maximum exercise, as well as prescribing long-term oxygen therapy. By multivariate analysis, age and the PaO2-slope showed significance as independent prognostic factors, and the PaO2-slope was most closely associated with the survival time. These results reveal that CPET is a useful technique to accurately assess the relationship between the functional impairments and the prognosis of patients with COPD.

A comparison between low-flow leak test and oxygen flush leak test

PURPOSE

The clinical efficacy of two methods of preanesthetic leak test,namely the oxygen flush leak test (OFLT) and the low-flow leak test (LFLT), was compared regarding their ability to detect leakage in the anesthesia circuit and their accuracy.

METHODS

Examinees comprised 16 staff anesthesiologists and 7 physicians undergoing anesthesia training at our institution. They performed the two leak tests on anesthesia machines with some intentional leaks (0.1-1.0 l.min(-1)). The leakage detection rates (LDR) were analyzed by the chi(2)-test. The ability to detect leaks was measured by recording how many leaks were detected by 50% (LDR(50)) and 95% (LDR(95)) of the examinees.

RESULTS

The LDRs in the two tests were significantly different (chi(2)- analysis, P < 0.0001). Both LDR(50) and LDR(95) for the LFLT (0.23 and 0.41 l.min(-1), respectively) were smaller than the values for the OFLT (0.37 and 0.82 l.min(-1), respectively). The sensitivity and specificity of the LFLT (0.97 and 0.84, respectively) were higher than those of the OFLT (0.78 and 0.80, respectively).

CONCLUSION

The LFLT was found to be superior to the OFLT regarding leak detection and reliability. We therefore recommend the LFLT for preanesthetic leak testing.

Analysis of Pfmdr 1 gene in mefloquine-resistant Plasmodium falciparum

Drug resistance in Plasmodium falciparum is a serious problem in most endemic areas. Recent studies have suggested the potential involvement of genes in the MDR gene family in resistance to quinoline-containing compounds in P. falciparum. In our present studies, a molecular analysis of pfmdr 1 in isolate strain of P. falciparum, 523a R, from Japanese mefloquine-resistant patient was done to determine the reported association of pfmdr 1 intragenic alleles and mefloquine resistance, and to examine the antimalarial activities of several antimalarial agents against the P. falciparum strain. The antimalarial activities against the strain was decreased susceptibility to mefloquine, artemisinin and halofantrine, in contrast increased susceptibility to chloroquine. The DNA sequence analysis of pfmdr 1 gene in a strain reveled no association of intragenic alleles with mefloquine resistance. Furthermore, the overexpression of pfmdr1 mRNA have been observed and it is about 7.2 times higher than sensitive strain. Our data shows that overexpression of pfmdr1 gene may be associated in mefloquine-resistance mechanism.

[Long-term care insurance eligibility in Japan for patients having home oxygen therapy]

In Japan, long-term care insurance (LTCI) for the elderly has been available since April 2000. Eligibility levels for LTCI for patients with home oxygen therapy (HOT) was investigated for two periods during a 20-month interval between April 2000 and December 2001. During these periods, we hosted a seminar on respiratory care, taking the form of a special report on the daily life of HOT patients. This report was submitted to an expert committee in order to inform the members of the committee about the characteristics of HOT patients. Of 76 HOT patients who had utilized visiting-nurse services, 58 applied for an assessment for LTCI eligibility. The levels determined were less than those expected by the patients' doctors (Categories: Not fulfilling the criteria, seven cases; Rejected, 13 cases; Assistance-required, six cases; Care-required, level 1, 14 cases; Care-required, level 2, 10 cases; Care-required, level 3, three cases; Care-required, level 4, three cases; and Care-required, level 5, two cases). As many as six of the 27 patients who used home mechanical ventilation were rejected. There were also patients who were forced to stop the care services that they had been receiving. Forty patients, including eight who applied for a re-assessment, were finally assigned to a Care-required category. The home-help service was the most frequently utilized (35.0%). Day services, short stay, and the visiting-bathing service, which are commonly used for patients with cerebral apoplexy sequela, were not needed nearly as much (5.0%, 2.5%, 2.5%, respectively). The eligibility levels at the second point of evaluation were higher than those at the first point in 37.5% of the patients, and equal in 58.3%. In the 39 new-applicant patients at the second point of evaluation, the ratio of Care-required patients was significantly increased (62.7% to 72.2%, p < 0.05). The eligibility level is primarily decided by computer using a score derived from a form that contains 73 questions about the physical condition of the applicant. However, this information is inadequate for a precise assessment of the impairment of the HOT patients. The final decision on a patient is made by an expert committee, based on both the primary result and the report of the doctor in charge of that patient. It may be effective to inform the members involved in the final decision about the characteristics or special needs resulting from the disease that necessitates HOT. However, we believe that it may be more important to find a way to increase the validity of the primary judging. We would argue that a method for proper assessment of HOT patients should be designed.

Adenoviral gizzard erosion in commercial broiler chickens

Pathologic and immunohistochemical changes caused by group I of the fowl adenovirus (FAV) serotype-1 99ZH strain, isolated from broiler chickens exhibiting gizzard erosion, were investigated in commercial broiler chickens. One hundred twenty-two chickens were inoculated with the strain by both oral and ocular routes at 1, 3, or 5 weeks of age and euthanatized for necropsy within 4-18 days of inoculation. Focal gizzard erosions were observed in the inoculated chickens of each age group. A histologically degenerative koilin layer, necrotic mucosa, intranuclear inclusion bodies in the glandular epithelial cells, inflammatory cell infiltrations in the lamina propria, submucosa, and a muscle layer were seen in the gizzards. Immunohistochemical staining showed evidence of FAV antigens in the intranuclear inclusion bodies. These findings were recognized regardless of their maternal antibody levels for FAV serotype-1. Gizzard lesions appeared later in the lower-dose-inoculated chickens than in the higher-dose-inoculated chickens. Numerous CD3-positive cells and IgY-positive plasma cells were seen in the gizzard lesions. In 5-week-old chickens the heterophil infiltrations in the lesions were milder than in younger chickens. Intranuclear inclusion bodies also were observed in the epithelial cells of the ileum or cecal tonsils of some chickens. Thus, this study shows that FAV-99ZH causes adenoviral gizzard erosion in broiler chickens without hepatic or pancreatic lesions and that cell infiltration is more severe than in dietary gizzard erosions.

Impairments and prognostic factors for survival in patients with idiopathic pulmonary fibrosis

The aim of the present study was to evaluate exercise limiting factors using cardiopulmonary exercise testing (CPET) in patients with idiopathic pulmonary fibrosis (IPF), and to investigate whether these parameters are related to survival after CPET. We evaluated 41 patients with IPF (mean 68.2 years, 27 male) who performed CPET. The exercise capacity in patients with IPF was limited more strongly by gas exchange and/or ventilatory impairments, compared with cardiac impairment. Using univariate analysis, the severity of exercise-induced hypoxemia (EIH) evaluated by deltaPaO2/deltaVO2 (PaO2-slope), oxygen uptake at maximum exercise, oxygen pulse at maximum exercise, ventilatory equivalent for carbon dioxide at maximum exercise and age were significantly related to the survival rate. Interestingly, the PaO2-slope was most closely correlated with the survival rate using multiple analysis with a stepwise evaluation. Nevertheless, PaO2 at rest and at maximum exercise were not factors influencing survival. In patients with IPF, CPET can simultaneously evaluate the ability of both the cardiovascular and respiratory systems, and should be available so that parameters can be derived to make the necessary prognostic estimations, with the most useful parameter being the degree of EIH as represented by the PaO2-slope.

Prospective clinical evaluation of the serologic tuberculous glycolipid test in combination with the nucleic acid amplification test

We have conducted a prospective controlled multicenter study to evaluate differences in the levels of clinical utility of the tuberculous glycolipid (TBGL) serodiagnostic test and the nucleic acid amplification test in patients with smear-negative active pulmonary tuberculosis (TB). The TBGL test and the PCR test were individually not so useful for the rapid diagnosis of smear-negative active pulmonary TB. However, clinical utility was considerably improved by using the TBGL test and the PCR test in combination, especially in patients with smear-negative and culture-negative active pulmonary TB and in patients with minimally advanced lesions.

Exercise-induced electrocardiographic changes in patients with chronic respiratory diseases: differential diagnosis by 99mTc-tetrofosmin SPECT

Evaluation of possible cardiac complications is essential for safe and effective respiratory rehabilitation of patients with chronic respiratory diseases (CRDs). The aim of this study is to clarify the pathophysiology of electrocardiographic (ECG) changes during exercise and the prevalence of coronary artery disease (CAD) in CRD patients without a history of myocardial ischemia.

METHODS

We studied 42 CRD patients with exercise-induced ST depression by cardiopulmonary exercise testing (CPET). They were selected from 249 consecutive CRD patients without any history of CAD who underwent CPET between January 1999 and December 2001. Thirty-three patients without respiratory diseases who had positive ST depression during exercise were selected as disease control subjects. Exercise myocardial SPECT was performed to evaluate myocardial ischemia and right ventricular (RV) overload as measured by increased RV uptake.

RESULTS

Among the 249 consecutive CRD patients without any history of CAD, positive ST depression during exercise was found in 42 (16.9%). Only 2 of the 42 patients (4.8%) had an ST depression other than in II, III, or aVF leads. The incidence of myocardial ischemia by perfusion SPECT was significantly lower in CRD patients (26.2%) than in disease control subjects (78.8%). The most common finding in the CRD patients during exercise was RV overload but without ischemia (26 cases; 61.9%). Ischemia was found in 11 patients (26.2%), with 10 of these patients also having RV overload. Neither ischemia nor RV overload was found in 5 patients (11.9%); these patients were eventually diagnosed as normal.

CONCLUSION

The incidence of myocardial ischemia as determined by perfusion SPECT was low in CRD patients with positive exercise-induced ECG changes. On the other hand, RV overload was observed in most such cases. Cardiac perfusion SPECT is a useful technique to evaluate cardiac ischemia and RV overload simultaneously. CPET with 12-lead ECG monitoring is necessary in CRD patients before respiratory rehabilitation. Further examination for ischemia should be done if positive ST depression is found.

Experimental reproduction of postweaning multisystemic wasting syndrome in cesarean-derived, colostrum-deprived piglets inoculated with porcine circovirus type 2 (PCV2): investigation of quantitative PCV2 distribution and antibody responses

Sixteen cesarean-derived, colostrum-deprived piglets were inoculated intranasally with porcine circovirus type 2 (PCV2), originally isolated from a pig affected with postweaning multisystemic wasting syndrome (PMWS). At 1 day postinoculation (PI), 3 of the 5 piglets in the uninoculated control group were moved to the room of inoculated piglets for contact exposure. Porcine circovirus type 2 was detected by polymerase chain reaction (PCR) in swabs from inoculated piglets from 1 day PI and from contact piglets from 2 days after cohabitation. Porcine circovirus type 2 was also detected in all serum samples but not in control piglets 7 days PI. Until the end of study, PCV2 was detected in swabs and serum samples by PCR but not in the control piglets. One inoculated piglet died suddenly without clinical signs 19 days PI. Beginning at 14 days PI, 5 piglets, including 1 contact piglet, had clinical signs of depression, anorexia, and icterus, and 1 inoculated piglet died 21 days PI. Most of the piglets exhibiting the above clinical signs became moribund and were necropsied 21 and 28 days PI. In the piglets that showed clinical signs, gross lesions, including icterus of liver and hemorrhage in stomach, and typical histopathological lesions of PMWS, such as lymphoid depletion and basophilic intracytoplasmic inclusion bodies in lymph nodes and other tissues, were observed. Porcine circovirus type 2 was detected by PCR in all tissue samples except in those of the control piglets. Porcine circovirus type 2 was recovered from several tissue samples of the piglets necropsied until 35 days PI. In particular, PCV2 was recovered in high titer from most of the tissue samples of the piglets exhibiting clinical signs. Serum antibody against PCV2 was mostly detected in inoculated piglets and in contact piglets 14 and 21 days PI by an indirect fluorescence antibody test but was not detected in the piglets exhibiting clinical signs until 28 days PI. These results indicate that PCV2 was able to induce clinical PMWS in the absence of other swine pathogens and that there were significant differences in both the quantitative PCV2 distribution in tissues and the antibody response between the piglets that were infected and developed PMWS and those that were infected but remained healthy.