[Effects of bathing on lung mechanics in patients with severe COPD]

Although it is well known that the majority of patients with severe COPD complain of exacerbated dyspnea while taking a Japanese-style bath, the mechanism has not been elucidated. We therefore investigated changes in lung volume (LV) and SaO2 in 16 seated patients with severe COPD, receiving treated with home oxygen therapy (HOT), and in 10 healthy subjects (C) immersed to the navel (N) and to the shoulder (S). We then subdivided the COPD patients into 2 groups, A and B. Group A was composed of patients taking less than 2 L oxygen/min, while group B was taking equal to or greater than 2 L oxygen/min. Expiratory reserve volume (ERV) decreased with statistical significance (p < 0.05) while inspiratory capacity (IC) substantially increased as immersion progressed. However, changes in LV were smaller, as obstructive ventilatory changes progressed. It also appeared that a significant O2 desaturation occurred in patients with COPD when movement was associated with taking a bath. The drop in SaO2 during bathing was significantly improved after patients received instructions concerning posture, slow movements, and pursed-lip breathing. These findings suggest that immersion, such as when taking a Japanese-style bath, 1) may change various LV to a lesser degree than in healthy subjects because of previously existent airway obstruction in COPD, 2) may aggravate arterial desaturation through further impairment of the VA/Q imbalance, 3) instructions for COPD patients could improve, their condition while bathing and, 4) the 6 minute walking distance (6 MD) might be important in predicting the severity of arterial desaturation while COPD patients are immersed.

Association of HLA-DR, DQ genotype with different beta-cell functions at IDDM diagnosis in Japanese children

Japanese IDDM patients have been demonstrated to have unique and different HLA associations from white patients. To elucidate the effect of HLA-associated genetic factors on the clinical heterogeneity of IDDM in Japanese people, HLA-DRB1, DQA1, and DQB1 genotypes in 88 childhood-onset Japanese IDDM patients were examined by polymerase chain reaction-sequence-specific oligonucleotide (PCR-SSO) or sequence-specific primers (SSP). Of the 88 IDDM patients, 26 (29.5%) had DRB1*0405-DQA1*0302-DQB1*0401/X (DR4-DQ4/X), 38 (43.2%) had DRB1*0901-DQA1*0302-DQB1*0303/X (DR9-DQ9/X), and 9 (10.2%) were DR4/9-DQ4/9 heterozygous in the present study (X does not contain protective alleles). Clinical heterogeneity such as age distribution at onset, prevalence and serum level of anti-GAD antibodies (GADAb), and residual pancreatic beta-cell function after diagnosis were compared between patients with HLA-DR4-DQ4 and DR9-DQ9. The frequency of DR9-DQ9 genotype was significantly higher in the younger (0-10 years) than in the older (11-16 years) age-group of onset, but the frequency of DR4-DQ4 was higher in the older (11-16 years) age-group. Although no association of DR-DQ genotypes with the prevalence and serum level of GADAb was found among newly diagnosed patients, long-standing DR9-DQ9 patients had significantly higher levels of GADAb than those with DR4-DQ4. While no difference in time course of serum C-peptide (CPR) levels was detected between GADAb+ and GADAb- patients, a remarkable difference was demonstrated between DR9-DQ9 and DR4-DQ4 patients. The residual pancreatic beta-cell function was retained more in patients with DR4-DQ4 than in those with DR9-DQ9 at diagnosis through 12-18 months after diagnosis. These results suggest that the DR9-DQ9 genotype may induce stronger autoimmune destructive response (T-helper 1 function) against target beta-cells than the DR4-DQ4 genotype does. Our findings may warrant further studies on the association of diabetogenic autoimmune response with HLA class II molecules and contribute to a clarification of interracial differences in HLA-encoded susceptibility to IDDM.

[Analysis of pulmonary manifestations in patients with rheumatoid arthritis]

We studied chest X rays of 911 patients with rheumatoid arthritis (RA). The findings showed interstitial shadow in 28 patients (3.1%), pleuritis in 13 patients (1.4%) and nodular shadow in 3 patients (0.3%). RA patients with interstitial pneumonia were commonly male and older. And they had significantly high levels of rheumatoid factor (RF), RAPA and IgG-RF in serum, but they were not associated with high score of Lansbary index. All patients with more than 1500 IU/ml in RF value had a complication of interstitial pneumonia. These results suggest the importance of chest X-ray in the management of RA patients with high titer in RF.

Object representation in the ventral premotor cortex (area F5) of the monkey

Visual and motor properties of single neurons of monkey ventral premotor cortex (area F5) were studied in a behavioral paradigm consisting of four conditions: object grasping in light, object grasping in dark, object fixation, and fixation of a spot of light. The employed objects were six different three-dimensional (3-D) geometric solids. Two main types of neurons were distinguished: motor neurons (n = 25) and visuomotor neurons (n = 24). Motor neurons discharged in association with grasping movements. Most of them (n = 17) discharged selectively during a particular type of grip. Different objects, if grasped in similar way, determined similar neuronal motor responses. Visuomotor neurons also discharged during active movements, but, in addition, they fired also in response to the presentation of 3-D objects. The majority of visuomotor neurons (n = 16) showed selectivity for one or few objects. The response was present both in object grasping in light and in object fixation conditions. Visuomotor neurons that selectively discharged to the presentation of a given object discharged also selectively during grasping of that object. In conclusion, object shape is coded in F5 even when a response to that object is not required. The possible visual or motor nature of this object coding is discussed.

[A case report of Vp3 hepatocellular carcinoma responding to multidisciplinary treatment]

We report a 60-year-old man who had hepatocellular carcinoma with tumor thrombus in the main portal vein and left portal branch (VP3HCC). He was treated with transarterial chemo-embolization, surgical resection and intra-arterial infusion chemotherapy. He is now surviving without any sign of recurrence for 12 months after the initial therapy, even though the prognosis of VP3HCC is poor. This is a case in which the effect of multidisciplinary treatment was indicated.

Spatial light modulators for projection displays

Spatial light modulators (SLM's) consisting of a polymer-dispersed liquid crystal (PDLC) film and a Bi(12)SiO(20) photoconductor are discussed and demonstrated. This device, which uses light scattering in the PDLC film, has several advantages including no polarizer, a low optical loss, and video-rate operation. The device was designed by use of an electrical-image method. High-definition SLM's with a limiting resolution (36-50 line pairs/mm) were fabricated by stacking of an optimized mirror and the PDLC film. The device, which was incorporated into a Schlieren system with a 1-kW xenon lamp, provided high-contrast video images and a total luminous flux of 1000 lm.

The TINS Lecture. The parietal association cortex in depth perception and visual control of hand action

Recent neurophysiological studies in alert monkeys have revealed that the parietal association cortex plays a crucial role in depth perception and visually guided hand movement. The following five classes of parietal neurons covering various aspects of these functions have been identified: (1) depth-selective visual-fixation (VF) neurons of the inferior parietal lobule (IPL), representing egocentric distance; (2) depth-movement sensitive (DMS) neurons of V5A and the ventral intraparietal (VIP) area representing direction of linear movement in 3-D space; (3) depth-rotation-sensitive (RS) neurons of V5A and the posterior parietal (PP) area representing direction of rotary movement in space; (4) visually responsive manipulation-related neurons (visual-dominant or visual-and-motor type) of the anterior intraparietal (AIP) area, representing 3-D shape or orientation (or both) of objects for manipulation; and (5) axis-orientation-selective (AOS) and surface-orientation-selective (SOS) neurons in the caudal intraparietal sulcus (cIPS) sensitive to binocular disparity and representing the 3-D orientation of the longitudinal axes and flat surfaces, respectively. Some AOS and SOS neurons are selective in both orientation and shape. Thus the dorsal visual pathway is divided into at least two subsystems, V5A, PP and VIP areas for motion vision and V6, LIP and cIPS areas for coding position and 3-D features. The cIPS sends the signals of 3-D features of objects to the AIP area, which is reciprocally connected to the ventral premotor (F5) area and plays an essential role in matching hand orientation and shaping with 3-D objects for manipulation.

Heparan sulfate isomers in cerebral arteries of Japanese women with aging and with atherosclerosis--heparitinase and high-performance liquid chromatography determinations

Composition of heparan sulfate (HS) isomers from unaffected and atherosclerotic cerebral arteries (isolated by autopsy) of Japanese women, of various ages, was studied. HS isomers were separated as disaccharide units by high-performance liquid chromatography after degeneration with HS and heparin lyases. Heparitinase facilitated differentiation of eight unsaturated disaccharides (deltaDi-S(HS)) of vascular HS isomers. The HS isomers in the cerebral arteries consisted of approximately half the total glycosaminoglycans (GAGs). Both HS (and GAGs) tended to increase with the processes of aging but decreased with the advancing development of atherosclerosis. The HS isomers consisted of a higher proportion of non-sulfated disaccharide, about 2/3 of the total HS, followed by mono-sulfated and bis-sulfated saccharides; in addition, heparin existed, albeit in minute amounts. The proportion of deltaDi-S(HS) rich in sulfate compared with HS isomers tended to increase with aging but most decreased during formation of the atheroma. Putative functions of HS isomers in cerebral arteries are discussed, based on the characteristic distribution of HS components.

[Preoperative management-cardiac, pulmonary, and renal dysfunction]

Surgical stress against esophageal cancer is quite heavy, because such a patient is usually old and is hyponutrionized due to inadequate peroral intake, as well as suffered from advanced stage of cancer. Thus, the patient suffering from esophageal cancer should have already various degrees of cardiac, pulmonary, or renal dysfunctions preoperatively. From this point of view, we must take care of such patients very carefully, and sometimes make a decision of the decrease of the radicality in surgery. This part describes the management of preoperative complications with cardiac, pulmonary, and renal dysfunction. Such complications must be treated before radical surgery, and be assessed by cardiologists, pulmonary physicians, and anesthesiologists.

Parietal neurons related to memory-guided hand manipulation

1. We recorded activity of the hand-manipulation-task-related neurons in the posterolateral bank of the anterior intraparietal sulcus (area AIP) of the monkey parietal cortex during a delayed hand manipulation task. 2. We examined mainly the object-type visual-dominant and visual-and-motor neurons that responded to the sight of objects for manipulation. The majority of these neurons (32 of 48) showed sustained activity during the delay period in the dark before manipulation of preferred objects. 3. Six visual-and-motor neurons showed set-related activity before the hand manipulation in the dark, so that their delay period activity was likely to be related to motor preparation. 4. The delay period activity of 18 visual-dominant and visual-and-motor neurons without set-related activity was likely to represent spatial features of objects, because the majority of the neurons showed the same selectivity in the shape and/or orientation during object fixation and the delay period. 5. Of these 18 neurons, 10 showed sustained activity in the dark after brief illumination of objects during a light-interrupted fixation task, suggesting that they store the short-term memory of objects without the intention to remember. 6. The results suggest that the visual memory of three-dimensional features of objects is likely to be incorporated in area AIP and to be used for the guidance of hand manipulation.

Clinical significance and time course of antibodies to glutamic acid decarboxylase in Japanese children with type I (insulin-dependent) diabetes mellitus

Although anti-glutamic acid decarboxylase antibodies (GADAb) have been reported to be a useful diagnostic and predictive marker of insulin-dependent diabetes mellitus (IDDM, type 1 DM) in Caucasians, a precise analysis of GADAb in Japanese children has not been reported. We examined the clinical significance and time course of GADAb in Japanese IDDM children, who have different genetic backgrounds from Caucasians. Twenty-three of 34 (67.6%) sera from recent-onset (< 6 months) IDDM, and 16 of 49 (32.7%) sera from long-standing (> or = 2 years) IDDM patients were positive for GADAb. This prevalence of GADAb in IDDM patients was significantly higher than in normal controls and the other groups including non-insulin-dependent DM, autoimmune thyroid disease and congenital hypothyroidism, and was also significantly higher in recent-onset than in long-standing IDDM. Time course analysis suggested that autoimmune response against GAD could follow different courses in individual cases after the initiation of insulin therapy. The incidence of GADAb was significantly higher in females than in males in the older age group (11-15 years). Other clinical features including residual pancreatic beta-cell function after diagnosis were demonstrated to be similar between GADAb-positive and -negative patients. In conclusion, this study using the newly established radioimmunoassay (RIA) for GADAb revealed a high prevalence of autoimmune reactivity to GAD in Japanese IDDM children. These results, using this RIA procedure, might assist in laying the groundwork for future trials of immunomodulation therapy for IDDM in Japan.

Epithelial-mesenchymal transformation of a newly established cell line from ovarian adenosarcoma by transforming growth factor-beta1

We report on 2 cell lines (designated OVAK-I and OVAK-II) established from an adenosarcoma, a rare variant of a malignant Mullerian mixed tumor, of the ovary. OVAK-I was not tumorigenic in nude mice and showed no responsiveness to transforming growth factor (TGF)-beta1, whereas OVAK-II was tumorigenic and had various biological properties. Light- and electron-microscopic studies showed that the morphology of the cells was converted from an epithelial to a mesenchymal form by TGF-betaI. Furthermore, the protein and mRNA expressions of the epithelial marker carcinoembryonic antigen and the mesenchymal marker vimentin were down- and up-regulated, respectively, by TGF-beta1. These findings suggested that TGF-beta1 plays a role in epithelial-mesenchymal transformation and support the single-stem-cell theory which explains the origin of malignant Mullerian mixed tumors: that the epithelial and mesenchymal components of these tumors are of common stem-cell origin.

Isolation and mapping of human homologues of an imprinted mouse gene U2af1-rs1

We have isolated human homologues of the imprinted mouse gene, U2af1-rs1. Two different types of cDNAs and three distinct genomic DNAs belonging to different groups were isolated. We have identified chromosomal genes corresponding to each cDNA by restriction mapping and sequencing. Using both a panel of rodent/human somatic cell hybrids and fluorescence in situ hybridization, group 1 and group 2 genes were mapped to chromosome 5q22 and chromosome Xp22.1, respectively. We designated group 1 and group 2 genes as human U2AF1-RS1 and U2AF1-RS2, respectively, because these genes corresponded to mouse U2af1-rs1 (chromosome 11) and U2af1-rs2 (chromosome X), which we also isolated and mapped. Amino acid sequences of human U2AF1-RS1 and U2AF-RS2 showed significant homology to U2AF small subunit. The group 3 gene, designated as U2AF1-RS3, of which the cDNA has not yet been isolated, was mapped to chromosome 19p13.2.

[Usefulness of endotoxin-specific limulus test for the measurement of endotoxin in cerebrospinal fluid in diagnosis of bacterial meningitis]

Using a new endotoxin-specific chromogneic limulus assay (Endoscopy test), endotoxin concentrations were measured in 93 specimens of cerebrospinal fluid (CSF) from 66 pediatric patients. Eighteen patients were diagnosed as having menigitios. Of these, 6 cases (group A) with gram-negative meningitis proven by culture had high CSF endotoxin concentrations of 115.3, (82-133) (median, range) pg/ml. Ten cases (group B) with gram-positive or aseptic meningitis had endotoxin concentrations of 2.15 (0.1-3.6) pg ml. Other 2 cases with bacterial meningitis (group C), in whom no pathogen was detected, had CSF endotoxin concentrations of more than 100 pg/ml. Four cases with encephalitis (group D) and 45 cases with non-meningitis or non- encephalitis (group E), had CSF endotoxin concentrations of less than 5 pg/ml. Despite a negative culture after antibiotic treatment in group A patients, endotoxin was cleared slowly from the CSF. A clearing of endotoxin from CSF was followed by alleviation of fever with a more gradual decline in CRP values. In 2 cases of group C, the negative bacterial culture appeared to be attributable to the previous treatment with antibiotics. However, these patients had high CSF endotoxin levels, indicating gram negative bacterial meningitis. In 17 CSF specimens from 5 patients of group A, in whom Haemophilus influenzae was detected on admission, an additional a latex agglutination test for the detection of H. influenzae polysaccharide antigen was performed. Only 3 specimens from 3 patients with CSF endotoxin concentrations of more than 80 pg/ml had a positive agglutination test. These results suggest that quantitation of endotoxin concentrations is useful for the diagnosis of gram-negative meningitis. And also, the clearance of endotoxin from CSF during treatment appears to be useful in determining the timing of when antibiotic should be stopped.

Inhibitory effect of a synthetic protease inhibitor (gabexate mesilate) on the respiratory burst oxidase in human neutrophils

We investigated the mechanism by which the synthetic protease inhibitor gabexate mesilate inhibits the production of the superoxide anion by human neutrophils. We found that gabexate mesilate suppressed SOD-inhibitable cytochrome c reduction in a dose-dependent manner in intact neutrophils activated with phorbol ester. Gabexate mesilate slightly scavenged the superoxide anion in the pyrogallol assay. The reagent also inhibited superoxide anion production in a dose-dependent manner in a cell-free oxidase-activating system. Translocation of the cytosolic respiratory burst oxidase components, the 47- and 65-kDa proteins, to membranes was suppressed by the reagent in intact cells stimulated with phorbol ester. Gabexate mesilate also reduced arachidonic acid-induced translocation of the components to the membrane fraction in the cell-free system. These results demonstrate that gabexate mesilate suppresses superoxide anion production by reducing the translocation of the 47- and 65-kDa proteins to the plasma membrane.

Neural mechanisms of visual guidance of hand action in the parietal cortex of the monkey

We studied the functional properties of the hand manipulation task-related neurons (N = 136) in the posterior bank of the intraparietal sulcus (IPS) using four kinds of objects for manipulation. We performed cluster analysis by comparing the profiles of activity of these neurons across objects during manipulation in the light, and classified them into nine groups, four highly selective, four moderately selective, and one nonselective group. Activity profiles of these neurons across objects were analyzed in four task conditions: object manipulation and object fixation both in the light and in the dark. Cells were classified as "motor-dominant," "visual-dominant," and "visual and motor" neurons, and the latter two were further subdivided into object type and non-object type. Most of the highly selective neurons (35 of 136) preferred the same object for manipulation in the dark as in the light. The object type "visual and motor" neurons preferred the same object for manipulation and fixation, suggesting that these neurons play an important role in matching the pattern of hand movement to the visuo-spatial characteristics of the object to be manipulated. A large majority of highly selective hand manipulation neurons were localized in the rostral part of the posterior bank of IPS, which we designated as the anterior intraparietal (AIP) area. We propose a conceptual model of the system for visual guidance of hand action including parietal hand manipulation neurons.

High-performance liquid chromatographic identification of eight constitutional disaccharides from heparan sulfate isomers digested with heparitinases

Identification with specific heparan sulfate-lyases, heparitinase I and heparinase of the constitutional unsaturated disaccharide (delta Di-SHS) derived from heparan sulfate (HS) isomers and heparin was achieved using high-performance liquid chromatography (HPLC) with a sulfonated styrene-divinylbenzene copolymer. Eight delta Di-SHS products derived from HS isomers were identified. Enzymatic digestion with heparitinase I and heparinase converts heterogeneous sulfated HS isomers and heparin into different delta Di-SHS. The practical application of these enzymes was examined using specific enzymes and HPLC. In a patient with Hurler syndrome, eight individual delta i-SHS were identified in urinary HS isomers.

Interleukin 10 reduces mortality from severe peritonitis in mice

Interleukin 10 (IL-10) is known to suppress the induction of proinflammatory cytokines such as tumor necrosis factor (TNF) and IL-1 and is itself induced by monocytes and macrophages during sepsis. We studied the therapeutic efficacy of IL-10 by testing its effect on the survival rate in the murine cecal ligation-and-puncture (CLP) model. Administration of 1 microgram or more of recombinant murine IL-10 6 h after induction of sepsis decreased lethality in septic mice significantly and also suppressed the elevation of circulating TNF after sepsis. However, treatment with the same dose of IL-10 simultaneously or 6 h before induction of CLP had no effect on survival, and treatment with anti-TNF antibody after induction of CLP had no effect on the survival rate. These data suggest that cytokine modulation with IL-10 is a potential candidate for the treatment of sepsis and sepsis-related multiple organ failure.

Interleukin-1 receptor antagonist modifies the changes in vital organs induced by acute necrotizing pancreatitis in a rat experimental model

OBJECTIVE

Interleukin-1 (IL-1) is a mediator in some critical conditions such as septic shock and multiple organ failure. Acute pancreatitis is one of the noted causes of multiple organ failure but the mechanism by which local inflammation progresses to systemic disease is unknown. In this study, we used an IL-1 receptor antagonist (IL-1ra) to investigate whether multiple organ failure due to acute pancreatitis is mediated by IL-1, as in other causes such as severe infection, trauma, and major surgery.

DESIGN

Prospective, randomized, controlled trial.

SETTING

Research laboratory of a university medical school.

SUBJECTS

Specific pathogen-free male Wistar rats weighing 200 to 250 g.

INTERVENTIONS

Necrotizing pancreatitis was induced by retrograde injection of deoxycholate solution into the biliopancreatic duct. IL-1ra was injected intravenously at a dose of 10 mg/kg 15 mins before induction of acute pancreatitis and then infused continuously at a rate of 5 mg/kg/hr for the following 24 hrs.

MEASUREMENTS AND MAIN RESULTS

Although treatment with recombinant human IL-1ra did not affect the degree of local pancreatic insult, it significantly reduced mortality, improved urine output as an indicator of the state of shock, and ameliorated the accumulation of neutrophils into the lung in a rat experimental pancreatitis model.

CONCLUSIONS

We concluded that multiple organ failure in severe pancreatitis is mediated, at least in part, by IL-1 through the activation of neutrophils. Furthermore, we concluded that circulatory collapse may also be important in the mechanism of the lethal effect of pancreatitis.