Zona chez un nourrisson

Herpes zoster occurs seldom in infants, especially in the absence of exposure to maternal varicella either intrauterine or postnatal. We report on a case in a 3-month-old infant admitted for herpes zoster in the sciatic nerve territory. No cutaneous eruption was found in the mother or in people who were in contact with the patient. This rare clinical situation is here reviewed, showing that the absence of antenatal or postnatal exposure to herpes viruses does not preclude the occurrence of herpes zoster infection in early infancy.

Poststreptococcal acute glomerulonephritis superimposed on bilateral renal hypoplasia

An 8-year-old girl with preexisting chronic renal failure (CRF) due to bilateral renal hypoplasia presented with edema, gross hematuria and acute deterioration of renal function. The diagnosis of poststreptococcal acute glomerulonephritis (PSAGN) was made based on clinical presentation, red blood cell casts, low level of C3 and elevated antistreptolysin 0 titer. Her course was prolonged with serum creatinine increased from the baseline level of 1.1 mg/dl to 2.2 mg/dl, returning toward the baseline level (1.2 mg/dl) after one month. Serum creatinine then started to increase again. The slope of creatinine clearance over time became steeper after the episode of PSAGN. A severe course of PSAGN and subsequent deterioration of renal function have previously been reported in patients with diabetic nephropathy or focal glomerulosclerosis. The present case along with a literature review suggests that individuals with fewer nephrons are at higher risk of severe course and outcome of PSAGN. Conversely, patients with severe PSAGN may be born with fewer nephrons due to low birth weight, unrecognized renal hypoplasia or other unknown causes.

Impact of respiratory syncytial virus infection as a cause of lower respiratory tract infection in children younger than 3 years of age in Japan

BACKGROUND

Respiratory syncytial virus (RSV) is the most important viral pathogen for lower respiratory tract infection (LRI) in infants and children. An RSV-specific monoclonal antibody has been developed to provide prophylaxis against RSV associated LRI (RSV-LRI). The objective of this study was to determine the impact of RSV as a cause of LRI in children younger than 3 years of age to provide data to aide in the implementation of forthcoming prophylaxis against RSV.

METHODS

We analyzed the viral etiology of LRI in hospitalized Japanese children younger than 3 years of age admitted to Shizuoka Red Cross Hospital from July, 1997 to June, 2000.

RESULTS

A total of 535 patients younger than 3 years of age were hospitalized with LRI at Shizuoka Red Cross Hospital from July 1, 1997 to June 30, 2000. Of these, a positive diagnosis of RSV infection was made in 168 patients (31.4%). Most of the patients with RSV infection had been well and had had no underlying disease that was defined as risk factor of RSV infection (94.0%). The peak incidence of LRI was observed in the winter each year and the number of LRI was strongly associated with the epidemic of RSV (r=0.700, P<0.0001). The number of patients with LRI younger than 6 months of age was 116 (21.7%). Of these 116 patients younger than 6 months with LRI, 55 patients (47.4%) were confirmed to have RSV infection. The proportions of RSV infection to total LRI was greatest in early infants younger than 6 months (P<0.0001). The number of patients with which RSV infection was detected in LRI patients younger than 3 years was highest during the first five months of life and there was a dramatic decrease in incidence of RSV infection with increasing age thereafter.

CONCLUSIONS

The incidence of LRI hospitalization is highly affected by RSV infection epidemic. The proportion of RSV infections among early infants younger than 6 months is greater than that of older patients. The prophylaxis against RSV will be needed to be toward early infants.

Vasculitis associated with septicemia: case report and review of the literature

We report an unusual case in which infectious endocarditis presented systemic vasculitis and glomerulonephritis as the initial manifestation of the disease. The patient was a 16-year-old girl with congenital cyanotic heart disease who presented with skin purpura, proteinuria, and hematuria. She had hypergammaglobulinemia, cryoglobulinemia, and positive circulating immune complexes. Renal biopsy revealed crescentic glomerulonephritis. Her serum C3 level, which was initially normal, became decreased, and prednisolone and azathioprine were administered with a tentative diagnosis of systemic lupus erythematosus (SLE). Soon after, she developed fever and renal failure. Blood culture grew Streptococcus pyogenes, and the diagnosis of infectious endocarditis was made. Eight cases of systemic vasculitis and glomerulonephritis associated with infectious endocarditis have been described in the literature. Infectious endocarditis should be included in the differential diagnosis of systemic vasculitis and glomerulonephritis.

Structure of green pigment formed by the reaction of caffeic acid esters (or chlorogenic acid) with a primary amino compound

A marked greening observed in some foods such as sweet potato, burdock, and others during food processing was shown to be due to green pigment formation by the condensation reaction of two molecules of chlorogenic acid or caffeic acid ester with one molecule of a primary amino compound under aeration in alkaline solution. Reduction of the green pigment by ascorbic acid or NaBH4 gave a yellow product, which readily turn green and then blue in air. The reduced and acetylated product of the green pigment was identified to be a novel trihydroxy benzacridine derivative, and the yellowish ethanol solution of this product immediately turned green upon addition of butyl amine or diluted alkali. Therefore, the green pigment was assumed to be an oxidized quinone type product of trihydroxy benzacridine. This identification of the structure was supported by the correspondence of the measured absorption spectra with those calculated by the molecular orbital method. A possible charge transfer complex between products of different oxidation steps in green solution was proposed.

Risk factors for severe respiratory syncytial virus-associated lower respiratory tract infection in children

BACKGROUND

Respiratory syncytial virus (RSV) is the most important cause of viral lower respiratory tract infection that can be a life-threatening disease in infants and children. This study was conducted to look for independent risk factors for severe respiratory syncytial virus-associated lower respiratory tract infection (RSV-LRI) that required oxygen supplementation or mechanical ventilation.

METHODS

Medical records of patients younger than 4 years hospitalized with RSV-LRI at Shizuoka Red Cross Hospital from July 1, 1995 to June 30, 1999 were reviewed. The patients were compared using univariate and multivariate logistic regression analysis.

RESULTS

A total of 157 patients were hospitalized with RSV-LRI at Shizuoka Red Cross Hospital from the study time period. Of these, 20 patients (12.7%) were diagnosed with severe RSV-LRI. Subjects younger than 3 months of age had an odds ratio (OR) of 59.9 (95% confidence interval (CI) 14.7_244.0) for the dependent variable of severe RSV-LRI (P<0.0001). Subjects with a history of congenital heart disease also had an OR of 99.2 (95% C1 8.5-1160.1) (P<0.0005).

CONCLUSIONS

Infants younger than 3 months without any underlying diseases may be at high risk for severe RSV-LRI. Respiratory syncytial virus prophylaxis is needed not only for high-risk patients, but for healthy early infants.

Effects of hypoxia on alveolar fluid transport capacity in rat lungs

There is little information regarding the effect of hypoxia on alveolar fluid clearance capacity. We measured alveolar fluid clearance, lung water volume, plasma catecholamine concentrations, and serum osmolality in rats exposed to 10% oxygen for up to 120 h and explored the mechanisms responsible for the increase in alveolar fluid clearance. The principal results were 1) alveolar fluid clearance did not change for 48 h and then increased between 72 and 120 h of exposure to hypoxia; 2) although nutritional impairment during hypoxia decreased basal alveolar fluid clearance, endogenous norepinephrine increased net alveolar fluid clearance; 3) the changes of lung water volume and serum osmolality were not associated with those of alveolar fluid clearance; 4) an administration of beta-adrenergic agonists further increased alveolar fluid clearance; and 5) alveolar fluid clearance returned to normal within 24 h of reoxygenation after hypoxia. In conclusion, alveolar epithelial fluid transport capacity increases in rats exposed to hypoxia. It is likely that a combination of endogenous norepinephrine and nutritional impairment regulates alveolar fluid clearance under hypoxic conditions.

Assignment of 118 novel cDNAs of cynomolgus monkey brain to human chromosomes

In order to isolate genes that may not be represented in current human brain cDNA libraries, we have sequenced about 20,000 sequence tags of cDNA clones derived from cerebellum and parietal lobe of cynomolgus monkeys (Macaca fascicularis). We determined the entire cDNA sequence of approximately 700 clones whose 5'-terminal sequences showed no homology to annotated putative genes or expressed sequence tags in current databases of genetic information. From this, 118 clones with sequences encoding novel open reading frames of more than 100 amino acid residues were selected for further analysis. To localize the genes corresponding to these 118 newly identified cDNA clones on human chromosomes, we performed a homology search using the human genome sequence and fluorescent in situ hybridization. In total, 108 of 118 clones were successfully assigned to specific regions of human chromosomes. This result demonstrates that genes expressed in cynomolgus monkey are highly conserved throughout primate evolution, and that virtually all had human homologs. Furthermore, we will be able to discover novel human genes in the human genome using monkey homologs as probes.

Usefulness of bronchoalveolar lavage for the diagnosis and treatment of refractory pneumonia in a patient with Kostmann syndrome, a severe congenital neutropenia

An 11-year-old girl with Kostmann syndrome developed refractory pneumonia. Culture of oral discharge, throat-swab specimens, and blood could not identity the causative organism, and systemic antimicrobial therapy failed to achieve improvement. We then performed diagnostic bronchoalveolar lavage (BAL) and culture of BAL fluid (BALF) yielded Pseudomonas aeruginosa. Therapeutic BAL using gentamicin produced a striking improvement of her pneumonia.

CONCLUSION

In immunocompromised children with pneumonia, BAL helps to identify the causative organism. If the patient is unresponsive to systemic antimicrobial therapy, BAL using antimicrobial agents is also worth trying.

Classification of prepaid cards based on multivariate treatment of data obtained by X-ray fluorescence analysis

Two hundred prepaid cards, which had been used in Nagoya-city's subway in Japan, and another 32 prepaid cards (11 were real turnpike cards, 20 were counterfeit cards and 1 was a white card) were evaluated by X-ray fluorescence (XRF) without any pre-treatment. A preliminary investigation was performed on 200 prepaid cards in order to find an identification method for the turnpike cards. By plotting the relative intensity of titanium versus that of iron obtained by XRF, the cards were clearly classified into seven groups. On the other hand, the cards could be divided into four groups by a multivariate analysis using the relative intensities of five elements such as chlorine, calcium or tin, titanium, iron and barium. Using these results to classify the Japanese turnpike cards, they were divided into three groups or two groups. One of three groups or two groups was the counterfeit card group.

Analysis of pyrolysis products of dimethylamphetamine

This study examines the pyrolysis products of dimethylamphetamine (DMAMP) and its pyrolysis mechanism. A sealed glass tube, in which DMAMP-HCI was placed, was wrapped with pyrolysis-foil and heated at the Curie point of the pyrolysis-foil. The pyrolysis products of DMAMP were detected by gas chromatography-mass spectrometry (GC-MS), headspace (HS)-GC-MS and liquid chromatography-electrospray ionization-mass spectrometry (LC-ESI-MS). DMAMP-d6-HCl, in which all the hydrogen atoms of the two methyl groups of DMAMP were substituted with deuterium atoms, was pyrolyzed to investigate the elimination and transformation reactions of the methyl group. Methamphetamine (MAMP) and amphetamine (AMP) were produced via demethylation reaction by heating DMAMP, and the maximum amounts of MAMP and AMP were about 31.8% and 13.7% of the starting DMAMP at 358 degrees C and 386 degrees C, respectively. The reactions of a chlorine anion and DMAMP with a methyl group eliminated from the dimethylamino group of DMAMP resulted in the formation of methyl chloride and benzylethyltrimethylammonium, respectively. These results indicate that one of the demethylation and methylation reactions occurs in the form of a methyl cation.

Molecular cloning and characterization of a gene expressed in mouse developing tongue, mDscr5 gene, a homolog of human DSCR5 (Down syndrome Critical Region gene 5)

For understanding the pathogenesis of Down syndrome (DS), it is important to identify and characterize the genes on Chromosome (Chr) 21, especially those in the Down syndrome critical region (DSCR) on Chr 21q22.2. Recently we have determined 33.5 Mb (more than 99%) of DNA sequence of Chr 21 and, from these sequence data, we identified a novel gene, DSCR5 (transcript = 0.8 kb), from DSCR by combination of computational gene prediction and cDNA screening. For functional analysis of DSCR5, we identified a mouse homolog of the DSCR5 cDNA, and termed it mDscr5 (transcript length = 0.8 kb). The gene was mapped to mouse Chr 16 C3-C4, the syntenic region of human Chr 21, and encodes an amino acid of 132 residues with 90% identity to DSCR5. In situ hybridization showed that mDscr5 is predominantly expressed in the developing tongue. To our best knowledge, no other gene in DSCR is reported to be expressed in tongue, so that DSCR5 may be the first candidate to elucidate the pathophysiology of tongue malformation observed in DS.

Increased plasma tetrahydrobiopterin in septic shock is a possible therapeutic target

Hemoperfusion with a column of polymyxin B immobilized on fibers (PMX) has been used to adsorb endotoxin in-patients with septic shock. PMX hemoperfusion (PMX-H) increases blood pressure (BP) too rapidly for the effect to be attributable to endotoxin removal. Since inducible NO synthase (iNOS) is known to be involved in the profound hypotension, we hypothesized that a decrease of tetrahydrobiopterin (BH(4)), an essential cofactor of iNOS, might account for the rapid effect of PMX-H on BP, if plasma BH(4) is increased concomitantly with NO in septic shock patients and if PMX can decrease BH(4). BH(4) was evaluated by measuring total biopterin, which can include derivatives of BH(4) by using high-performance liquid chromatography (HPLC). We confirmed that PMX fabric time dependently decreased total biopterin concentration in vitro. The plasma level of total biopterin in shock patients was indeed markedly elevated compared with that in volunteers (131.1+/-33.4 vs. 10.4+/-1.1 nM, n=5, P<0.01). Level of NO metabolites (NOx) were 173.9+/-104.7 versus 28.7+/-11.6 µM (P<0.01). In beagles, plasma total biopterin was 44.7+/-6.9 nM at baseline, reached 118+/-28.6 nM after lipopolysaccharide (LPS) injection, and fell to 70.2+/-15.8 nM after PMX-H. Plasma NOx concentration was increased from 15.2+/-4.2 to 41.0+/-7.5 µM by LPS treatment. BP was 130+/-11.3 mmHg at baseline, 82.2+/-8.3 mmHg at 14 h after LPS, and 115.2+/-16.0 mmHg after PMX-H. In rats, plasma total biopterin was 88.8+/-1.5 nM at baseline, 383.7+/-144.2 nM after LPS and 177.0+/-14.2 nM after PMX-H. Plasma NOx was also increased after LPS (from 34.6+/-4.4 to 1445.6+/-376.0 nM). The marked increase in total biopterin concomitantly with NOx in septic shock patients and its reduction by PMX-H in animal models of septic shock are consistent with our hypothesis, and appear to justify further research on BH(4) removal as a potential therapeutic target.

Beta1-adrenergic agonist is a potent stimulator of alveolar fluid clearance in hyperoxic rat lungs

Because it was still uncertain whether a stimulation of beta1-adrenoceptors accelerated alveolar fluid clearance in hyperoxic lung injury, the effect of denopamine, a selective beta1-adrenergic agonist, on alveolar fluid clearance was determined in rats exposed to 93% oxygen for 48 and 56 h. Alveolar fluid clearance was measured by the progressive increase in the concentration of Evans blue labeled albumin instilled into the alveolar spaces over 1 h at 37 degrees C in isolated rat lungs. The principle results were as follows: 1) Although lung water volume increased in rats exposed to hyperoxia for 48 and 56 h, basal alveolar fluid clearance did not change for up to 56 h; 2) Denopamine increased alveolar fluid clearance in rats exposed to hyperoxia as well as in rats without exposure to hyperoxia; 3) Denopamine primarily increased amiloride-insensitive alveolar fluid clearance in rats exposed to hyperoxia; 4) The potency of denopmaine was similar to that of terbutaline, a selective beta2-adrenergic agonist. In summary, denopamine is a potent stimulator of alveolar fluid clearance in rats exposed to hyperoxia.

Cloning, expression analysis, and chromosomal mapping of GTPBP2, a novel member of the G protein family

We have identified a novel gene encoding a protein bearing GTP-binding motifs, the characteristics of GTP-binding proteins (G proteins). The deduced amino acid sequence exhibited the highest overall homology with GTPBP1 and its mouse orthologue GP-1. Hence, we named the gene GTPBP2. The mouse orthologue of this gene, Gtpbp2, showed 98% identity with GTPBP2 over the entire protein (the HGMW-approved nomenclature symbol is GTPBP2 and mouse orthologue is Gtpbp2). A phylogenetic analysis showed GTPBP2 and homologous G proteins (GTPBP1, AGP-1, and CGP-1) did not belong to major G protein families. They formed a distinct branch in the phylogenetic tree, suggesting that they constitute a novel G protein family. A 2. 9kb mRNA was predominantly detected in the testis along with various other organs. In situ hybridization analysis revealed that Gtpbp2 was predominantly expressed in spermatocytes and round-spermatids in the testis. These novel genes were localized to human chromosome 6p21.1-2 and mouse chromosome 17qC-D.

Human and mouse homologues of the Drosophila melanogaster tweety (tty) gene: a novel gene family encoding predicted transmembrane proteins

We have cloned cDNA for TTYH1, a human homologue of the Drosophila melanogaster tweety (tty) gene. The 450-residue predicted protein shows 27% amino acid sequence identity (51% similarity) to the Drosophila protein, which contains an additional C-terminal repetitive region. A second Drosophila homologue exhibits 42% identity (65% similarity) to the tty protein. Mouse (Ttyh1), macaque, and Caenorhabditis elegans homologues were also identified, and the complete coding sequence for the mouse gene was determined. The mouse protein is 91% identical to the human protein. Hydrophobicity analysis of the tty-related proteins indicates that they represent a new family of membrane proteins with five potential membrane-spanning regions. The yeast FTR1 and FTH1 iron transporter proteins and the mammalian neurotensin receptors 1 and 2 have a similar hydrophobicity profile, although there is no detectable sequence homology to the tty-related proteins. This suggests that the tweety-related proteins could be involved in transport of iron or other divalent cations or alternatively that they may be membrane-bound receptors. TTYH1 was mapped to chromosome 19q13.4 by FISH and by radiation hybrid mapping using the Stanford G3 panel.

cDNA cloning and chromosomal mapping of mouse BH-protocadherin

We isolated and determined the sequence of cDNA encoding mouse BH-protocadherin (BH-Pcdh) from heart. It encodes a 1069 amino acids (aa) polypeptide exhibiting an overall 97% identity with human BH-Pcdh-a and 83% identity with Xenopus NF-protocadherin. We also determined the alternatively spliced cytoplasmic tail sequence. The cytoplasmic tail of mouse BH-Pcdh-b is short (2 aa) compared with that of human BH-Pcdh-b (14 aa). The cytoplasmic tail of mouse BH-Pcdh-c showed 100% aa identity with that of human BH-Pcdh-c except for a 8-amino-acid insertion. Northern blot analysis revealed two major transcripts were expressed in brain and heart. Mouse BH-Pcdh-a mRNA was detected as a single band of approximately 5.5-kb. The mRNA level of mouse BH-Pcdh-a and -c were persistently detected by RT-PCR in developmental process of brain and heart, but that of mouse BH-Pcdh-b was elevated only in fetus and neonatal stage of brain. The chromosomal location of the mouse BH-Pcdh gene was determined as 5C3-D using fluorescence in situ hybridization.

Expression of mitogen-activated protein kinase family in rat renal development

BACKGROUND

Among mitogen-activated protein kinase (MAPK) family members, extracellular signal-regulated kinase (ERK) promotes proliferation or differentiation, whereas c-Jun N-terminal kinase (JNK) and p38 MAPK (p38) are thought to inhibit cell growth and induce apoptosis. MAPK phosphatase-1 (MKP-1) inactivates and modulates MAPKs. During renal development, large scale proliferation and apoptosis occur. We investigated the temporal and spatial expression patterns of MAPKs and MKP-1 in rat kidney during development.

METHODS

Western blot analysis and immunohistochemistry were performed in the developing and mature kidney of the rat.

RESULTS

The expression of ERK, p38, and MKP-1 were high in developing kidney. On the other hand, JNK was abundantly expressed in adult kidney. Active forms of ERK, p38, and JNK correlated with the protein expression levels. Immunohistochemical studies revealed that ERK was strongly expressed by blastema cells, mesenchymal cells, and ureteric bud tips in nephrogenic zone of embryonic kidney. In neonatal kidney, ERK was more abundant in the deep cortex and the medulla corresponding to tubule maturation. p38 and MKP-1 were detected uniformly in mesenchymal cells, mesangial cells, and ureteric bud epithelia of fetal kidney without an obvious correlation with the occurrence of apoptosis. JNK was expressed by tubular cells and podocytes of adult kidney.

CONCLUSIONS

ERK, p38, and MKP-1 are strongly expressed in developing kidney, and JNK is detected predominantly in adult kidney. Both the temporal and spatial expression of ERK coincides with the maturation of the kidney.