A novel p63 sterile alpha motif (SAM) domain mutation in a Japanese patient with ankyloblepharon, ectodermal defects and cleft lip and palate (AEC) syndrome without ankyloblepharon

We present a sporadic case of a Japanese female infant with ectodermal dysplasia, complete cleft lip and palate, severe skin erosions at birth and recurrent scalp infection. She had typical clinical features of ankyloblepharon, ectodermal defects and cleft lip and palate (AEC) syndrome without ankyloblepharon. Histological and immunohistochemical analyses showed reduced granular cell layers and aberrant expression of the p63 protein in the suprabasal keratinocytes. Mutation analysis of the exon 13 of p63 gene revealed a heterozygous in-frame 3-bp insert (c. 538-539 ins TTC) encoding additional amino acid residues (F). This is the first report of sterile alpha motif domain mutation except for single nucleotide transitions.

Emergency endovascular stent-grafting for infected pseudoaneurysm of brachial artery

The use of covered stents in an infected field is controversial. It is generally recommended that infected aneurysms be treated using autografts or allografts. We report a case of infected brachial pseudoaneurysms that developed after medical debridement of a methicillin-resistant Staphylococcus aureus (MRSA)-infected wound of the right arm and emergency brachial artery bypass-grafting using the saphenous vein, which was successfully treated by endovascular stent-grafting followed by antibiotic administration. The present case suggests that endovascular stent-grafting prevents rupture and occlusion of infected aneurysms and enables the continued administration of antibiotics.

Amended biochemical characteristics and phylogenetic position of Treponema medium

Umemoto et al. (1997, Int J Syst Bacteriol 47, pp. 67-72) proposed spirochete strain G7201, isolated from the periodontal pocket of an adult patient, as a new species, Treponema medium. They deposited this strain in the American Type Culture Collection (ATCC) as type strain ATCC 700293T. Recently, ATCC suggested that there is a discrepancy between the previous report and the results obtained by ATCC in biochemical tests on T. medium ATCC 700293T. In this study, we re-examined and verified the biochemical characteristics of T. medium. The fermentation pattern of carbohydrates of T. medium resembled that of Treponema vincentii and Treponema denticola, but T. medium was clearly differentiated from T. vincentii in the production of indole, and from T. denticola in the hydrolysis of esculin. Also, sodium dodecylsulfate-polyacrylamide gel electrophoresis (SDS-PAGE) protein profile analysis and phylogenetic comparison of 16S rDNA sequences revealed that T. medium is clearly differentiated from any established treponemal species, which supports the validity of the proposal of Treponema medium as a new species.

Physiological responses of young Thoroughbreds during their first year of race training

Yearling horses are typically trained for more than a year before they begin racing; therefore, we questioned how relevant analyses of the initial responses to training are compared to physiological responses that occur over a year of training, and whether young horses with no history of training would respond the same as older horses that had been trained previously. We hypothesised that changes in O2 transport over the last months of a year of training would be different than at the beginning. We trained 5 yearling Thoroughbreds and evaluated metabolism, O2 transport and echocardiograms. Measurements were made before breaking (T1), after 6 months of training (T2) and following an additional 4 months of training (T3). We compared 5 trained horses (TR) with 5 untrained (UT) sex-, size- and age-matched yearlings kept at pasture and in boxes. Satellite telemetry indicated UT moved less total daily distance than TR during winter and more during summer, but UT walked for 80% of their distance, TR only 25%. The UT increased body mass (Mb) after T1 by 13% and were significantly heavier and fatter than TR. Specific aerobic capacity (VO2max/Mb) increased by 16% in both groups at T2, but by T3 was not different from T1 in UT, but was higher in TR (19%>T1, 15%>UT). In TR, specific cardiac output (Q/Mb) increased by 13% at T2, and specific stroke volume (V(S)/Mb) were larger at T2 and T3 than T1 and UT at the same times both by physiological (15-16%) and echocardiographical (22-23%) estimates. Increased Vs was a primary correlate of the sustained increase in VO2max/Mb in TR. The large increases in V(S) and VO2max had occurred by T2 and changed only slightly by T3.

Hypertension control and medication increase in primary care

Over half of treated patients with hypertension are not well controlled. However, little is known about physicians' prescribing behaviour for these patients. Our objective was to clarify whether physicians increase antihypertensive medication in patients with poorly controlled hypertension and what characteristics are predictors of medication increase. This was a retrospective cohort study by surveying medical records in primary care clinics in Tochigi, Japan. Twenty-nine of 79 randomly selected physicians agreed to select 20 consecutive hypertensive patients. This resulted in 547 patients (women 60%; mean (s.d.) age, 68 (12) years) who had blood pressure measurements taken in 1998 and prescription of antihypertensive medication in 1998 and 1999. Mean (s.d.) systolic/diastolic blood pressure was 142 (12)/81 (9) mm Hg and the percentage of patients in good control (<140/90 mm Hg), fair (140-159/90-94) and poor (> or =160/95) were 42%, 47%, and 11%, respectively. Physicians increased medication in 28% of poorly controlled patients (95% confidence interval (CI), 17-41%), which was more than those in fair (12%, 95%CI 8-16%) or good control (7%, 95%CI 4-12%). Multivariate logistic regression analysis showed that systolic and diastolic blood pressures were positively, and the number of kinds of antihypertensive medications and the age of the physician were negatively, associated with an increase in medication. In conclusion, primary care physicians did not increase antihypertensive medication adequately for patients with uncontrolled hypertension. Attempts to understand and to change physicians' prescription behaviour could reduce the burden of uncontrolled hypertension among treated hypertensive patients.

85Kr measurement system for continuous monitoring at the Meteorological Research Institute, Japan

A 85Kr measurement system for continuous monitoring based principally on the BfS-IAR method (activity measurement of 85Kr by gas counting coupled with gas chromatographic separation, using pure CH4 as carrier and Counting gas) was implemented for the first time in Japan. In this paper, a detailed description of the system and procedures is given and the inter-comparison results of our system with the BfS-IAR system are presented. A consistent temporal concentration change with high accuracy and consistency of the respective data with the BfS-IAR data (maximum difference of 5%) were achieved with the Meteorological Research Institute (MRI) system, which shows that the system is valid and reliable for the purpose of background monitoring for 85Kr in air. Also, the 85Kr monitoring record at the MRI during 1995-2001 is described. The record distinctively shows the Northern Hemispheric background 85Kr concentrations at the mid-latitude and the elevated concentrations affected by the operation of a nuclear fuel reprocessing plant in Tokai-mura, Ibaraki. Japan.

Bacterial fimbriae and their peptides activate human gingival epithelial cells through Toll-like receptor 2

Gingival epithelial cells are a central component of the barrier between oral microflora and internal tissues. Host responses to periodontopathic bacteria and surface components containing fimbriae are thought to be important in the development and progression of periodontal diseases. To elucidate this mechanism, we established immortalized human gingival epithelial cells (HGEC) that were transfected with human papillomavirus. HGEC predominantly expressed Toll-like receptor (TLR) 2, but not TLR4 or CD14. They also induced interleukin-8 (IL-8) production when stimulated with Porphyromonas gingivalis fimbriae and Staphylococcus aureus peptidoglycan, but not Escherichia coli-type synthetic lipid A. Furthermore, an active synthetic peptide composed of residues 69 to 73 (ALTTE) of the fimbrial subunit protein, derived from P. gingivalis and similar to a common component of cell wall peptidoglycans in parasitic bacteria, N-acetylmuramyl-L-alanyl-D-isoglutamine (MDP), significantly induced IL-8 production and NF-kappaB activation in HGEC, and these cytokine-producing activities were augmented by a complex of soluble CD14 and lipopolysaccharide-binding protein (LBP). IL-8 production in HGEC stimulated with these bacterial components was clearly inhibited by mouse monoclonal antibody to human TLR2. These findings suggest that P. gingivalis fimbrial protein and its active peptide are capable of activating HGEC through TLR2.

Cloning and characterization of motX, a Vibrio alginolyticus sodium-driven flagellar motor gene

Four motor proteins, MotX, MotY, PomA, and PomB, have been identified as constituents of the Na(+)-driven flagellum of Vibrio species. In this study, the complete motX gene was cloned from Vibrio alginolyticus and shown to complement three mot mutations, motX94, motX115, and motX119, as well as a V. parahaemolyticus motX mutant. The motX94 mutant contains a frameshift at Val86 of MotX, while the motX115 and motX119 mutations comprise substitutions of Ala146 to Val and Gln 194 to amber, respectively. When MotX was overexpressed in Vibrio cells, the amount of MotY detected in the membrane fraction increased, and vice versa, suggesting that MotX and MotY mutually stabilize each other by interacting at the membrane level. When a plasmid containing the motX gene was introduced into motY mutants NMB117 (motY117) and VIO542 (motY542), the mutations were suppressed. In contrast, motY could not cause the recovery of any swarm-defective motX mutants studied. Considering the above evidence, we propose that MotX is more directly involved than MotY in the mechanical functioning of the Na(+)-type flagellar motor, and that MotY may stabilize MotX to support its interaction with other Mot proteins.

Sharing Pacific-Rim experiences in disasters: summary and action plan

INTRODUCTION

The discussions in this theme provided an opportunity to address the unique hazards facing the Pacific Rim.

METHODS

Details of the methods used are provided in the preceding paper. The chairs moderated all presentations and produced a summary that was presented to an assembly of all of the delegates. Since the findings from the Theme 3 and Theme 7 groups were similar, the chairs of both groups presided over one workshop that resulted in the generation of a set of action plans that then were reported to the collective group of all delegates.

RESULTS

The main points developed during the presentations and discussion included: (1) communication, (2) coordination, (3) advance planning and risk assessment, and (4) resources and knowledge.

DISCUSSION

Action plans were summarized in the following ideas: (1) plan disaster responses including the different types, identification of hazards, focusing training based on experiences, and provision of public education; (2) improve coordination and control; (3) maintain communications, assuming infrastructure breakdown; (4) maximize mitigation through standardized evaluations, the creation of a legal framework, and recognition of advocacy and public participation; and (5) provide resources and knowledge through access to existing therapies, the media, and increasing and decentralizing hospital inventories.

CONCLUSIONS

The problems in the Asia-Pacific rim are little different from those encountered elsewhere in the world. They should be addressed in common with the rest of the world.

[Effects of lumbar sympathetic ganglion block in a patient with acquired lymphangioma]

A 70-year-old woman developed lymphangioma following surgery for cervical cancer and subsequent radiotherapy. The operation was performed 12 years ago, and a swelling of lower extremities was recognized 8 years ago. Her lower extremities became greatly edematous, and leakage of lymph to the groin was observed. We performed bilateral lumbar sympathetic ganglion block. After the block, lymphedema was relieved dramatically, and the leakage of the lymph to the groin was gradually reduced. We conclude that lumbar sympathetic ganglion block may be very effective in some patients with acquired lymphangioma.

Post-resuscitative hypothermic bypass reduces ischemic brain injury in swine

OBJECTIVES

Increasing human and laboratory evidence suggests that post-resuscitative brain hypothermia reduces the pathologic consequences of brain ischemia. Using a swine model of prolonged cardiac arrest, this investigation sought to determine whether unilateral hypothermic carotid bypass was capable of inducing selective brain hypothermia and reducing neurohistologic damage.

METHODS

Ventricular fibrillation was induced in common swine (n = 12). After 20 minutes of cardiopulmonary arrest (without ventilatory support or cardiopulmonary resuscitation), systemic extracorporeal bypass was instituted to restore coronary and cerebral perfusion, followed by restoration of normal sinus rhythm. Animals randomized to the normal brain temperature (NBT) cohort received mechanical ventilation and intravenous fluids for 24 hours. The selective brain hypothermia (SBH) cohort received 12 hours of femoral/carotid bypass at 32 degrees C. The bypass temperature was then increased one degree per hour until reaching 37 degrees C and continued at this temperature until completion of the protocol (24 hours). Histopathologic damage was evaluated in two areas of the hippocampus.

RESULTS

Normal sinus rhythm was restored in all animals after the systemic (femoral/femoral) bypass was initiated. Nasal temperature (surrogate measure of brain temperature) remained higher than 37.0 degrees C throughout the 24-hour recovery period in the NBT animals. In the SBH cohort, right nasal temperature dropped to the mild hypothermic range (<34 degrees C) two hours after institution of femoral/carotid bypass. This was maintained throughout the 12-hour cooling period without hemodynamic compromise. There was a significant improvement in the neurohistology scores in the CA1 region of the hippocampus of the SBH treated animals as compared with those of the NBT cohort.

CONCLUSIONS

Post-resuscitative selective brain hypothermia reduced regional ischemic brain damage in swine with prolonged ventricular fibrillation.

[Prevalence, awareness, treatment, and control of hypertension in Japanese rural communities]

BACKGROUND

In Japan, a national survey indicated that only 7% of hypertensive patients had a blood pressure less than 140/90 mmHg. There have been no reports of studies investigating all of the prevalence of hypertension, the percentage of subjects who are aware of hypertension, the percentage being treated, and the percentage that are well-controlled (awareness, treatment and control, respectively) among hypertensives in the Japanese general population.

OBJECTIVE

To investigate the prevalence of hypertension, and awareness, treatment and control of hypertension among hypertensives in a Japanese rural population.

DESIGN

A cross-sectional analysis of base-line data of the Jichi Medical School Cohort Study.

SETTING

Twelve rural communities is 8 prefectures in Japan.

PARTICIPANTS

Community-dwelling people who participated in the health examination program in 1992-1995.

MAIN OUTCOME MEASURES

Blood pressure (BP) measured once in the sitting position after a 5-minute rest using oscillometric automatic BP monitors (BP203RV-II; Nippon Colin, Japan), and history of hypertension assessed using a self-administered questionnaire.

RESULTS

We analyzed data from 11,302 subjects (4,415 men and 6,887 women). The mean (standard deviation) age was 55(12) years for men and 55(11) years for women. Mean systolic BP and diastolic BP levels were, respectively, 131(21) mmHg and 79(12) mmHg for men and 128(21) mmHg and 76(12) mmHg for women. Prevalence of hypertension (systolic BP > or = 140 mmHg or diastolic BP > or = 90 mmHg or on antihypertensive medication) was 37% for men and 33% for women. Percentages for awareness (on medication or present past history), treatment and control (both systolic BP < 140 mmHg and diastolic BP < 90 mmHg) were, respectively, 39%, 27% and 10% for men and 46%, 38% and 13% for women.

CONCLUSIONS

About one third of the study popUlation were hypertensive, and awareness, treatment and control of hypertension among the hypertensives were 43%, 34% and 12%, respectively. Less than half of the hypertensives were well-controlled even when measurement bias was considered. In the rural Japanese population, improvements are required with regard to awareness, treatment and control of hypertension.

[Persistent left-sided superior vena cava diagnosed after flow-directed pulmonary artery catheterization; report of a case]

We describe a case of persistent left-sided superior vena cava discovered after insertion of a pulmonary artery (PA) catheter. The diagnosis was suggested by chest X-ray after PA catheter placement and was subsequently confirmed by an echocardiograph. A 68-year-old man was admitted to our ICU because of septic shock induced by MRSA enterocolitis. In order to monitor the hemodynamic state of the patient, a PA catheter was inserted through the left subclavian vein after placement of a central venous and flexible double lumen catheters through the right internal jugular and subclavian veins, respectively. A chest X-ray showed the PA catheter passing along the left border of the heart. An echocardiograph showed the PA catheter passing through the coronary sinus into the pulmonary artery. Anesthesiologists and intensivists should be aware of the occurrence of left-sided superior vena cava in order not to mistake catheters placed in it as being in the arterial circulation or malpositioned outside of the venous circulation.

Alpha-like activity in terminal stage of Creutzfeldt-Jakob disease

We report a case of Creutzfeldt-Jakob disease showing various changes in electroencephalogram (EEG) throughout the course of the disease. The patient's EEG patterns showed periodic synchronous discharge in the intermediate stage of the disease, delta activity in the advanced stage and alpha-like activity in the terminal stage. The mechanism generating alpha-like activity may resemble, at least in part, that of an alpha coma.

Gap junctional communication between the satellite cells of rat dorsal root ganglia

Many studies have described the ultrastructure of the dorsal root ganglia in various embryonic and adult animals, but in spite of the efforts of many investigators the functional role of the satellite cells in this tissue is not clearly understood. In this study, we discuss the function of this cell type based on the concept of cell-to-cell interaction through gap junctions. Five male 60 day-old Wistar strain rats were used. All animals were anesthetized with pentobarbital and perfused with glutaraldehyde fixative, then the dorsal root ganglia in levels L4, L5 and L6 were taken from each rat. After postosmication, the specimens were prepared for observation by transmission electron microscopy. All nerve cells were completely surrounded by satellite cell cytoplasmic expansions. The boundaries between adjacent nerve cells and satellite cells were complicated due to the presence of perikaryal projections of nerve cells. Gap junctions which showed the typical trilamellar structure of plasma membranes were found mainly between satellite cell processes belonging to the same nerve cell. On the other hand, some gap junctions were found between the satellite cell projections belonging to different nerve cells. The size of the gap junctions ranged from 300 to 400 nm. No gap junctions were associated with the plasma membrane of any nerve cell. In conclusion, only satellite cells can share free transcellular exchange of cytoplasmic molecules such as ions, amino acids, sugars and several second messengers including cAMP and inositol 1,4,5-triphosphate by way of gap junctions in dorsal root ganglia.

Aurantiamide acetate, a selective cathepsin inhibitor, produced by Aspergillus penicilloides

Aurantiamide acetate was isolated from the fermentation broth of Aspergillus penicilloides for the first time. Aurantiamide acetate inhibited cysteine proteinases, in particular, cathepsin L (3.4.22.15) and B (3.4.22.1) with IC50 of 12 microM and 49 microM, respectively. In the adjuvant-arthritic rat model, subcutaneously administered 10 mg/kg body weight of this compound suppressed hind paw swelling.

Rapid development of brain hypothermia using femoral-carotid bypass

OBJECTIVES

Advances in the field of cardiopulmonary resuscitation have led to an increasing number of patients initially surviving sudden cardiac arrest. Unfortunately, most of these patients do not recover from the resultant anoxic brain insult. Several animal and human trials have suggested that post-resuscitative brain hypothermia may improve neurologic recovery after cardiopulmonary arrest. Present cooling methods are slow, induce only brain surface cooling, or result in systemic hypothermia. The authors tested the hypothesis that unilateral hypothermic carotid bypass would induce bilateral brain cooling without evoking systemic hypothermia or hemodynamic instability.

METHODS

Anesthetized, ventilated common swine (n = 6, 24-37 kg) underwent right femoral and carotid artery bypass cannulation. Central and peripheral hemodynamic parameters were recorded every 2 minutes throughout the procedure. Thermodynamic parameters included bilateral frontal lobe, bilateral nasopharyngeal, pulmonary artery, and rectal temperatures. Hypothermic femoral-carotid bypass was accomplished by drawing blood from the right femoral artery, cooling it to 24 degrees C, and returning it to the right carotid artery at a flow rate of 5 mL/kg/min for 30 minutes.

RESULTS

With initiation of cooling, brain temperatures dropped rapidly from baseline of 37.2 degrees C to 30.6 degrees C (right frontal lobe) and 33.1 degrees C (left frontal lobe) at 30 minutes. Pulmonary artery and rectal temperatures also decreased, but never reached mild hypothermic levels (34 degrees C). There was no significant change in any hemodynamic parameters during brain cooling.

CONCLUSIONS

Femoral-carotid hypothermic bypass rapidly induced a state of selective brain hypothermia without causing systemic hypothermia or hemodynamic instability.

A HMG-CoA reductase inhibitor possesses a potent anti-atherosclerotic effect other than serum lipid lowering effects--the relevance of endothelial nitric oxide synthase and superoxide anion scavenging action

We have determined whether the anti-atherosclerotic effect of a 3-hydroxy-3-methyl-glutaryl-CoA (HMG-CoA) reductase inhibitor (fluvastatin) is mediated through nitric oxide (NO) as well as affecting plasma lipids. NO related vascular responses, endothelial nitric oxide synthase (eNOS) mRNA and superoxide anion (O(2)(-)) release were examined in vascular walls of oophorectomized female rabbits fed 0.5% cholesterol chow for 12 weeks with or without fluvastatin (2 mg/kg per day). Serum lipid profile was not different between two groups. NO dependent responses stimulated by acetylcholine and calcium ionophore A23187 and tone related basal NO response induced by N(G)-monomethyl-L-arginine acetate (L-NMA); nitric oxide synthase inhibitor were all improved by fluvastatin treatment. Endothelium independent vasorelaxation induced by nitroglycerin was not different between the two groups of rabbits' arteries. Fluvastatin treatment increased cyclic GMP concentration in aorta of rabbits. eNOS mRNA expression and O(2)(-) release were measured in aorta using competitive reverse transcription-polymerase chain reaction (RT-PCR) and with lucigenin analogue, 2-methyl-3,7-dihydroimidazol [1,2-a]pyrazine-3-one (MCLA) chemiluminescence methods. eNOS mRNA in the endothelial cells of aorta was significantly up-regulated and O(2)(-) production was significantly reduced in fluvastatin treated rabbit aorta. Anti-macrophage staining area, but not anti-smooth muscle cell derived actin stained area in the aorta was also reduced by fluvastatin treatment. Conclusion, fluvastatin, a HMG-CoA reductase inhibitor, retards the initiation of atherosclerosis formation through the improvement of NO bioavailability by both up-regulation of eNOS mRNA and decrease of O(2)(-) production in vascular endothelial cells, and this means that part of the anti-atherosclerotic effect of fluvastatin may be due to nonlipid factors.