Association of MBL gene polymorphisms with major bacterial infection in patients treated with high-dose chemotherapy and autologous PBSCT

A growing body of evidence indicates that genetic factors are involved in an increased risk of infection. We investigated whether mannose-binding lectin (MBL) gene polymorphisms that cause low levels of MBL are associated with the occurrence of major infections in patients, mainly bearing hematological malignancies, after high-dose chemotherapy (HDT) rescued by autologous peripheral blood stem cell transplantation (auto-PBSCT). A retrospective evaluation of 113 patients treated with HDT and auto-PBSCT revealed that the low-producing genotypes, B/B and B/LXA, were associated with major bacterial infection (P=0.0016, OR 7.9). We next performed a nation-wide large-scale study to assess the allele frequency of the MBL coding mutation in a total of 2623 healthy individuals in Japan. The frequency of allele B was estimated to be approximately 0.2, almost the same in seven different areas of Japan. This common occurrence suggests that MBL deficiency may play an important role in the clinical settings of immunosuppression.

Feeding with powdered diet after weaning affects sex difference in acetylcholine release in the hippocampus in rats

We have reported in the past that female rats fed a powdered diet showed better spatial learning and memory functions than female rats a fed pelleted diet. In the present study, we examined the effects of feeding with powdered diet on acetylcholine release in the hippocampus in both sexes of rats. After weaning (3 weeks of age), rats were fed either standard pelleted diet or powdered diet, and after maturation (9-12 weeks of age), they were used in an in vivo microdialysis study, in which no eserine (a cholinesterase inhibitor) was added to the perfusate. The dialysate was collected from the dorsal hippocampus at 20-min intervals under freely moving conditions for more than 24 h. Acetylcholine in the dialysate was measured by high performance liquid chromatography. As we reported previously, the acetylcholine release showed a clear daily rhythm in both sexes, and males showed significantly greater acetylcholine release in the hippocampus than females in rats fed pelleted diet. Conversely, in rats fed powdered diet, no sex difference in the acetylcholine release was observed, since feeding with powdered diet significantly increased the acetylcholine release only in females. To further examine the number of cholinergic neurons in the medial septum and horizontal limb of the diagonal band of Broca, immunocytochemistry for choline acetyltransferase was performed in both sexes of rats fed either standard pelleted diet or powdered diet. However, neither sex nor feeding conditions affect the number of choline acetyltransferase immunoreactive cells in the areas. These results suggest that powdered diet after weaning enhances spontaneous acetylcholine release in the hippocampus in female rats without changes in the number of cholinergic neurons in the areas. It is possible that this effect of feeding contributes to improve the performance in spatial learning and memory functions in female rats fed powdered diet.

Palmar dislocation of the radio-carpal joint: a case report

Radio-carpal joint dislocation, with or without fracture of the radius, is an uncommon injury; only 21 cases have previously been reported. Successful treatments of closed reduction and surgery have also been reported. A 35-year-old right-handed man was injured in a traffic accident and taken to an emergency room of a hospital, where radiographic examination showed a right palmar radio-carpal joint dislocation. Three days after injury, the patient was transferred to our department at Tokyo Medical University, Tokyo. We performed percutaneous pin fixation to maintain the position of his reduced radio-carpal joint. Two years postoperatively, radiographic examination showed a complete union of the avulsion fracture of the radius and a reduction of the joint. He had no marked disturbance in his daily activities apart from a slight pain while working. He had no limitation on the range of motion of the wrist joint and his grip strength was 41.6 kg. He returned to work 3 months after injury.

Clinical pathology and therapeutic results of neurilemmoma in the upper extremity

PURPOSE

To evaluate the clinical pathology and postoperative outcomes of patients with neurilemmoma in the upper extremity who underwent tumour enucleation, and the correlation factors for neurological deficits apart from enucleation of nerve fascicles.

METHODS

Magnetic resonance imaging was used to evaluate the state of lesions of the patients with upper-extremity neurilemmoma who underwent tumour enucleation. To find out the correlation factors for neurological deficits, the patients were then divided into 2 groups based on their recovery period-group A (shorter than 6 months) and group B (at 6 months or longer). Duration of the illness, the affected nerve, and the size and histological type of the tumour were then compared between the 2 groups.

RESULTS

Of the 20 patients who underwent tumour enucleation for neurilemmoma in the upper extremity, 19 had a single nerve affected and one had multiple lesions involving two nerves. The tumours in 6 patients were of Antoni A type histology and in the remaining 14 patients were of a mixed type. Antoni B type alone was not observed. 15 patients showed postoperative neurological deficits. No neurological deficits were observed in 5 patients. Neurological deficits were fully recovered in all patients except the one with a lesion in the digital nerve. Apart from enucleation of nerve fascicles, the period required for the recovery of neurological deficits was correlated to the duration of the illness (p=0.04) and the histological type of the tumour (p=0.03).

CONCLUSION

Most of the patients with neurilemmoma (95%) had a single nerve affected. A majority of patients (70%) had the mixed type of Antoni A and Antoni B histology; Antoni B type alone was not observed. Neurological deficits were observed in 75% of patients. In patients with neurilemmoma developing in the upper extremity, the period required for recovery from postoperative neurological deficits was short when the duration of illness was short and when Antoni A type histology was present.

Effects of electroconvulsive therapy on frontal white matter in late-life depression: a diffusion tensor imaging study

This study was conducted to elucidate the effects of electroconvulsive therapy (ECT) on frontal white matter in late-life depressed patients. Diffusion tensor imaging was performed on 8 late-life depressed patients and 12 healthy age-matched controls. The patients were scanned before and after a course of ECT. Fractional anisotropy (FA) was determined in the frontal and temporal regions and the corpus callosum. A significant white matter FA reduction was found in widespread frontal and temporal brain regions in patients with depression before ECT treatment compared with controls. A significant increase in frontal white matter FA was seen following ECT treatment. A course of bilateral ECT ameliorated white matter integrity in frontal brain regions. This suggests a strong relationship with the antidepressant action of ECT.

Therapeutic results of acromioclavicular joint dislocation complicated by rotator cuff tear

PURPOSE

To evaluate the operative findings and postoperative results of one-stage repair on patients with acromioclavicular joint dislocation complicated by rotator cuff tear.

METHODS

Between 1992 and 1999, one-stage repair was performed on 5 patients with acromioclavicular joint dislocation complicated by rotator cuff tears. Modified Cadenat procedure for acromioclavicular joint dislocation, and McLaughlin procedure for rotator cuff tear, were performed on these patients. Postoperative results at the final examination were assessed according to the criteria for therapeutic effects on shoulder joint disorders of the Japanese Orthopaedic Association.

RESULTS

There was partial-thickness cuff tear in one patient, and full-thickness cuff tear in the remaining 4 patients. In all patients, tears were located only in the supraspinatus tendon, and were medium or small ones with maximal diameter of 3 cm or less. After a mean follow-up period of 56 months (range, 36-79 months), all patients were assessed to have excellent results. No patient showed a good reduction of the acromio-clavicular joint.

CONCLUSION

For patients successfully treated by one-stage repair, satisfactory results were obtained without pain or disturbance in activities of daily living.

Diffusion tensor magnetic resonance imaging of disruption of regional white matter in schizophrenia

Diffusion tensor imaging provides a new approach for quantifying anisotropic diffusion of white matter in vivo. We used this technique to investigate subtle disruption of regional white matter in schizophrenia. Twelve patients with schizophrenia were compared with 11 healthy controls. Psychotic symptoms were assessed using the Positive and Negative Syndrome Scale. A significant fractional anisotropy (FA) reduction was found in all white matter regions bilaterally in schizophrenic patients. Higher FA of left frontal white matter correlated significantly with higher dosage of antipsychotic medication. These findings support the view that the pathological process is a distortion of the central nervous system myelination affecting the whole white matter. Our findings also show the effects of antipsychotics on the white matter in the left frontal region in schizophrenia.

[Pericardiectomy for post-coronary artery bypass grafting constrictive pericarditis; strategy for safe and complete pericardiectomy]

Surgery for constrictive pericarditis after coronary artery bypass grafting (CABG) needs complete pericardiectomy without injury to bypass grafts. We performed pericardiectomy for post-CABG constrictive pericarditis 15 months after the first surgery. Preoperative multislice helical 3-dimensional computed tomography (CT) clearly demonstrated the patent bypass grafts and anatomical relationship between grafts and surrounding organs. Among surgical approaches, we chose bilateral thoracotomy to avoid injury to the bypass grafts and to obtain a good surgical exposure, especially for pericardiectomy of the left side of the heart. Additionally, with the use of intraoperative doppler ultrasound blood flowmetry, we could safely achieve complete pericardiectomy. We conclude that the combined application of 3-dimensional CT, bilateral thoracotomy and doppler ultrasound blood flowmetry was a supreme strategy for the operation of constrictive pericarditis after CABG.

Primary localized amyloidosis of the small intestine presenting as an intestinal pseudo-obstruction: report of a case

A 47-year-old man with primary amyloidosis confined to the small intestine is reported. Thickening of the folds and multiple polypoid protrusions were found in the duodenum by upper gastrointestinal endoscopy. Because the patient presented with a persistent intestinal pseudo-obstruction, partial jejunectomy was performed. Histological examination of the resected tissue revealed massive deposits of amyloid throughout the jejunal wall. Neither a predisposing condition nor any other sites of deposition were found, and primary amyloidosis of the small intestine was diagnosed. This rare form of amyloid deposition should be recognized so that an early diagnosis can be made.

Monitoring of cytomegalovirus reactivation after allogeneic stem cell transplantation: comparison of an antigenemia assay and quantitative real-time polymerase chain reaction

Cytomegalovirus (CMV) antigenemia and quantitative real-time polymerase chain reaction (PCR) were compared for monitoring of CMV reactivation after allogeneic stem cell transplantation. The number of CMV antigen-positive cells by the antigenemia assay and the level of CMV DNA by real-time PCR correlated well. The sensitivity and specificity of the antigenemia assay was 55.4% and 95.5%, respectively, using real-time PCR as the reference standard. The probability of positive antigenemia at day 100 was 76.5%, with a median of first detection at day 37 in 51 patients, compared with a positive PCR of 84.3% and day 33, respectively. When HLA-identical sibling donor transplant recipients and other donor transplant recipients were analyzed separately, there was no difference between the two tests. However, temporal patterns of first detection of CMV antigen-positive cells and CMV DNA differed between HLA-identical and alternative recipients; patients without CMV (29%) or with sporadic positive PCR results (14%) were more common in HLA-identical sibling transplants, whereas patients with simultaneous antigenemia and positive PCR occurred more in alternative transplants (48%). Two of 51 patients (4%) developed CMV colitis despite antigenemia-guided prophylaxis, but both were successfully treated with ganciclovir. Although PCR is more sensitive than antigenemia, both tests are useful in the early detection of CMV after allogeneic stem cell transplantation.

Deletion analysis of the enolase gene (enoA) promoter from the filamentous fungus Aspegillus oryzae

The enolase gene (enoA) is one of the most strongly expressed genes in Aspergillus oryzae. To elucidate the transcription regulatory element for this strong expression and the process of glucose induction, the transcription activity of a series of truncated enoA promoters was measured by using the Escherichia coli uidA gene as a reporter. Deletion of a 104-bp region located -224 nt to -121 nt upstream of the translation initiation site caused both a drastic decrease in the beta-glucuronidase (GUS) activity and a loss of glucose induction. Northern blot analysis confirmed that the decrease in GUS activity was achieved at the transcriptional level. In addition, electrophoretic gel mobility shift assays indicated that the 104-bp region contained a 15-bp element, to which one or more A. oryzae cellular factors specifically bind. These results suggest that the 15-bp element between -195 nt and -181 nt includes the sequence essential for the transcription regulation of the A. oryzae enoA gene.

High expression of CD34-positive sinusoidal endothelial cells is a risk factor for hepatocellular carcinoma in patients with HCV-associated chronic liver diseases

CD34 has been widely used for the assessment of sinusoid-like neoangiogenesis in hepatocellular carcinoma (HCC). Recently, it was demonstrated that CD34-positive cells isolated from human peripheral blood differentiate into endothelial cells and contribute to neoangiogenesis in adults. We investigated the localization and the substantial role of CD34-positive endothelial cells in the liver with hepatitis C virus (HCV)--associated chronic liver diseases. Liver tissue sections obtained by biopsy from 56 patients with HCV-associated chronic liver diseases by were examined immunohistochemically using anti-CD34, anti-von Willebrand factor (vWF), and anti-vascular endothelial growth factor (VEGF) antibodies. CD34 was stained in the sinusoid, showing dotty, linear, semicircular, or circular patterns. However, sinusoidal expression of vWF was not substantially identified in the same specimens, indicating the existence of sinusoidal CD34-positive but vWF-negative endothelial cells. We classified these cells as CD34 LI and found that CD34 LI was correlated with the expression of VEGF. Among 34 patients with advanced-stage disease, the cumulative incidence of HCC was significantly higher in patients with CD34 LI >or= 12 (n = 16) than in those with CD34 LI < 12 (n = 18; P = .009). Moreover, among several clinicopathologic risk factors, CD34 LI could be recognized as an independently significant factor for development of HCC (relative risk, 7.36; P = .019). We conclude that CD34-positive endothelial cells are regulated by several factors, such as VEGF, and might play a substantial role in hepatocarcinogenesis. Furthermore, high expression of CD34-positive sinusoidal endothelial cells is a risk factor for HCC in patients with HCV-associated chronic liver diseases.

Association of ZNF74 gene genotypes with age-at-onset of schizophrenia

Because of the manifestation of schizophrenic symptoms in individuals with interstitial deletions of chromosome 22q11.2, genes located in 22q11.2 are positional candidates for schizophrenia susceptibility. We genotyped five polymorphisms at D22S941, D22S944, D22S264, and D22S311, and the COMT gene in the common 3Mbp deletion region associated with 22q11 deletion syndrome in 300 Japanese schizophrenics and 300 controls and identified one patient with 22q11 deletion (Arinami et al., 2001). The results showed a trend of different genotypic distributions in D22S264 between patients with schizophrenia and controls (non-corrected p=0.04). Given this finding, we searched for mutations in the ZNF74 gene, which is located 11.2Kbp centromeric to D22S264. The ZNF74 gene is a member of the KRAB-zinc finger gene family and is expressed in the developing brain. Four polymorphisms, 1150T/C, IVS2a-40G/A, E/K46, and [K/N551;L/F552], were detected. The first three polymorphisms were in almost complete linkage disequilibrium. Case-control comparisons for these polymorphisms resulted in similar genotypic and allelic frequencies in patients and controls. The polymorphisms, however, were significantly associated with age-at-onset of schizophrenia (n<0.0001). Subsequent analyses in another Japanese schizophrenic population (n=169) confirmed an age-at-onset association (p<0.0001). These findings suggest that the ZNF74 gene plays a role as one of the modifying factors for schizophrenia.

Screening for 22q11 deletions in a schizophrenia population

Since the recognition that adults with velocardiofacial syndrome (VCFS), which is associated with hemizygous interstitial deletions of chromosome 22q11, frequently show psychotic symptoms, deletion of the 22q11.2 region has been proposed as a common genetic abnormality associated with schizophrenia. In studies of schizophrenia patients, such deletions have been detected in more than 1% of schizophrenics, indicating the likely presence of this deletion in a significant number of patients. In this study, we screened for 22q11.2 deletions by genotyping microsatellite markers in 300 schizophrenics and 300 normal controls. The 22q11.2 deletion was confirmed by fluorescent in situ hybridization (FISH). One patient with schizophrenia was found to have a 22q11.2 deletion. The patient was mildly retarded but did not have craniofacial, palatal, or cardiac malformations characteristic of VCFS. Our results indicate that 22q11.2 deletion does not contribute substantially to the development of schizophrenia in general. However, our findings establish the existence of physically near-normal individuals with 22q11.2 deletion among learning disabled or mildly retarded persons with schizophrenia.

[Cooperative medical care by physicians of general hospitals and psychiatrists of an alcoholism treatment unit in Mie Prefecture]

Clinical practice of psychiatric liaison with physicians is the first step for an early treatment of alcohol dependence. Screening patients with alcohol dependence in general hospitals, carrying out intervention, and referring them to psychiatric specialists are running smoothly by the cooperation of member of the Mie Association for the Study of Alcohol-related Diseases. This association is being conducted by managers constituted of doctors, nurses, and medical social workers and the meeting is held every 6 months at district general hospitals to achieve three objectives; 1) evoking a sense of responsibility for alcoholic patients in the mind of general hospital staffs, 2) developing a network for psychiatric liaison with physicians to care patients of their alcohol dependence, and 3) keeping up activities of the association. We have already held the regular meeting 12 times, and prepared pamphlets for screening alcohol misuse and for early intervention. A course for learning skills of early intervention in this summer won the favor of participants. Through case conference of alcoholism and full accounts of the experiences given by recovered patients or their families, meeting attendants know patients' distress, families' sorrow, and their delight brought by the recovery, and are motivated to assist patients with alcohol dependence. Thus, "Spirit to Spirit" is a keyword to develop a network of the cooperative medical care for supporting patients with alcohol dependence. Referral of alcoholic patients to psychiatrists and/or psychiatric liaison therapy is promoted by a reliable, faithful, and face to face relationship between physicians and psychiatrists. Physicians' learning the skill for early intervention in alcohol dependence is followed by an increase in referral of patients to psychiatrists, and which suggests the importance of providing teaching and training of medical care for alcohol dependence to medical staffs including doctors of emergency care units, orthopedics, obstetrics, and dentistry. Therefore, systematic tools for screening alcohol dependence in general practice, and for referring patients to psychiatrics after brief intervention are needed to be prepared under the leadership of a learned society. Popularizing the skill of brief intervention in general medical practice is also indispensable for advising alcoholic patients about changing their drinking pattern or abstinence.

Electrophoretic mobility shift scanning using an automated infrared DNA sequencer

Electrophoretic mobility shift assay (EMSA) is widely used in the study of sequence-specific DNA-binding proteins, including transcription factors and mismatch binding proteins. We have established a non-radioisotope-based protocol for EMSA that features an automated DNA sequencer with an infrared fluorescent dye (IRDye) detection unit. Our modification of the elec- trophoresis unit, which includes cooling the gel plates with a reduced well-to-read length, has made it possible to detect shifted bands within 1 h. Further, we have developed a rapid ligation-based method for generating IRDye-labeled probes with an approximately 60% cost reduction. This method has the advantages of real-time scanning, stability of labeled probes, and better safety associated with nonradioactive methods of detection. Analysis of a promoter from an industrially important filamentous fungus, Aspergillus oryzae, in a prototype experiment revealed that the method we describe has potential for use in systematic scanning and identification of the functionally important elements to which cellular factors bind in a sequence-specific manner.

Combining transcatheter arterial chemoembolization with percutaneous ethanol injection therapy for small size hepatocellular carcinoma

For patients with unresectable small size HCC, percutaneous ethanol injection therapy (PEIT) is used as a non-surgical treatment because it is difficult to achieve complete tumor necrosis by transcatheter arterial chemoembolization (TAE) alone. However, some small HCCs (<21 mm in diameter) are resistant to PEIT with incomplete tumor necrosis, which is associated with insufficient ethanol injection to the tumor. For more effective treatment for HCC, we performed a combination of TAE and PEIT on patients with small size HCC and evaluated the cumulative recurrence and survival rates. The recurrence rate in patients treated with the combination was less than that of TAE or PEIT alone. There were five patients without tumor recurrence during the follow-up period and three out of these underwent the combination treatment. The period of no recurrence was 33.4 months on average. In conclusion, we recommend combination therapy with TAE and PEIT for patients to accomplish more effective treatment of small size HCC.

p21WAF1/CTP1 expression and hepatitis virus type

Since p21WAF1/CIP1 (p21) is a universal inhibitor of cyclin-dependent kinases and is regulated transcriptionally by p53, which is activated by DNA stress, its expression reflects DNA stress in chronic hepatitis. Recently an association with both hepatitis B and C virus and the expression of p53 or p21 was reported. We analyzed p21 expression in 18 cases of HBV-associated chronic liver diseases and 32 cases of HCV-associated chronic liver diseases by immunohistochemical analysis, and investigated the possible association between hepatocyte p21 expression and hepatic inflammation, fibrosis, and especially hepatitis virus type. The p21-positive hepatocytes were more numerous in areas of intense inflammation and spotty necrosis and areas close to fibrosis, and they increased according to the degrees of grading and staging. The p21 labeling index (LI) in patients with liver cirrhosis was significantly higher than that in patients with chronic hepatitis of both hepatitis viral types (5.84 +/- 0.61 vs 12.0 +/- 0.83, P < 0.0001 in hepatitis B, 10.28 +/- 0.80 vs 15.6 +/- 1.09, P = 0.0004 in hepatitis C), Furthermore, the p21 LI was significantly higher in HCV-associated liver disease than in HBV-associated liver disease in every group (4.02 +/- 0.48 vs 7.74 +/- 0.96, P = 0.021 in low grade group, 7.35 +/- 0.46 vs 12.8 +/- 0.57, P < 0.0001 in high grade, 12.0 +/- 0.83 vs 15.6 +/- 1.09, P = 0.034 in liver cirrhosis). In, conclusion, p21 expression was up-regulated by the stress of inflammation and fibrosis and might be influenced by viral proteins in human chronic liver disease.

Hepatocellular carcinoma associated with hemophagocytic syndrome

Hepatocellular carcinoma may manifest various paraneoplastic syndromes. There are some reports describing hematological change due to hepatocellular carcinoma. However, there have been no reports on hepatocellular carcinoma accompanied by hemophagocytic syndrome. We report here for the first time a 51-year-old man with a liver tumor and pancytopenia. Since the patient had showed a strong hemorrhagic diathesis because of thrombocytopenia, we treated him with blood transfusion, but there was no response. Thereafter, we administered the anticancer agents thinking that the hematological change was due to the liver tumor. Though a slight curative effect was obtained, we had to discontinue the treatment because the patient complained of severe side effects. Finally, the patient died of acute cholangitis. Although we could not determine the cause of the pancytopenia before he died, autopsy findings indicated that hemophagocytic syndrome had occurred. Hemophagocytic syndrome related to a solid tumor very rarely occurs. However, when malignant tumor is accompanied by pancytopenia, hemophagocytic syndrome should be considered.