Low-dose mitomycin C, etoposide, and cisplatin for invasive vulvar Paget's disease

Abstract.

Watanabe Y, Hoshiai H, Ueda H, Nakai H, Obata K, Noda K. Low-dose mitomycin C, etoposide, and cisplatin for invasive Paget's disease.

We report the effect of low-dose mitomycin C, etoposide, and cisplatin (low-dose MEP) therapy for three patients with invasive vulvar Paget's disease (invasive VPD) who declined radical vulvectomy and skin grafting. One patient achieved a complete response, while the other two showed partial responses (PR) without grade 3 or 4 adverse effects. The two patients with PR were undergone partial vulvectomy and inguinal lymph node dissection. All patients have no sign of recurrence for 10 months after chemotherapy. Our present results suggest that low-dose MEP is an effective and safe chemotherapy for invasive VPD and low-dose MEP may significantly improve postoperative quality of life in patients with invasive VPD by avoiding extensive vulvar resection and skin grafting.

Ascending fractional pulse pressure closely relating to large artery function

It is not known whether ascending fractional pulse pressure (PPf) is related to large artery function. This study was to evaluate whether PPf is associated with large artery function by augmentation index. A total of 190 subjects were enrolled (age range: 50 to 78 years) who had normal contractions, no local asynergy, and no history of myocardial infarction. The ascending aortic pressure was measured using a fluid-filled system. To quantify the relative magnitude of the pulsatile to mean artery pressure, we normalised the pulse pressure to the mean pressure and referred to this value as PPf and the association between the PPf and the augmentation index was investigated. Augmentation index showed significant associations with PPf by univariate analysis (R = 0.690, P < 0.001). The associations between PPf and the factors influencing large artery function were examined by multivariate analysis, and PPf revealed significant associations with age, mean aortic pressure, heart rate and type 2 diabetes (R(2) = 0.477, P < 0.001). The results were that ascending aortic PPf is closely associated with large artery function detected by augmentation index.

Detection of a pineoblastoma with large central cyst in a young child

THE PATIENT

We present the very rare case of a pineoblastoma with large central cyst in a 7-year-old boy who presented with a short history of gradually worsening headache and upward gaze palsy.

IMAGING INVESTIGATIONS

On CT and MRI studies, it was seen as a peripherally calcified, irregularly shaped mass with heterogeneous low signal intensity on T1-weighted images and ringed enhancement after gadolinium administration; there was homogeneous high signal intensity on T1-weighted images.

DISCUSSION

We discuss differential diagnosis for several types of cystic tumors in the pineal region, including pineoblastomas.

Regeneration of canine peroneal nerve with the use of a polyglycolic acid-collagen tube filled with laminin-soaked collagen sponge: a comparative study of collagen sponge and collagen fibers as filling materials for nerve conduits

A novel artificial nerve conduit was developed and its efficiency was evaluated on the basis of promotion of peripheral nerve regeneration across an 80-mm gap in dogs. The nerve conduit was made of a polyglycolic acid-collagen tube filled with laminin-soaked collagen sponge. Conduits filled with either sponge- or fiber-form collagen were implanted into an 80-mm gap of the peroneal nerve (five dogs for each form). Twelve months postoperatively nerve regeneration was superior in the sponge group both morphometrically (percentage of neural tissue: fiber: 39.7 +/- 5.2, sponge: 43.0 +/- 4.5, n=3) and electrophysiologically (fiber: CMAP 1.06 +/- 0.077, SEP 1.32 +/- 0.127 sponge: CMAP 1.04 +/- 0.106, SEP 1.24 +/- 0.197, n=5), although these differences were not statistically significant. The observed regeneration was complementary to successful results reported previously in the same model, in which collagen fibers exclusively were used. The results indicate a possible superiority of collagen sponge over collagen fibers as filling materials. In addition, the mass-producibility, superior scaffolding potential, and capacity for gradual release of soluble factors of the sponge provide make it an attractive alternative to fine fibers, which are both technologically difficult and costly to produce. This newly developed nerve conduit has the potential to enhance peripheral nerve regeneration across longer gaps commonly encountered in clinical settings.

Mechanism of burn injury during magnetic resonance imaging (MRI)--simple loops can induce heat injury

To determine the mechanism of burn injury associated with magnetic resonance imaging (MRI), the induced current in the loops of a conductive lead was measured. Seven types of loops with effective areas within the range from 100 to 12 000 cm2 were made and then each loop was placed in the bore of a whole-body MR system at 0.5 T and MRI was carried out. During radio frequency (RF) irradiation, an induced voltage was observed in loops that were placed with their axes parallel to the linearly polarized transmitting RF field. The voltage had a sincfunction characteristic and was within the range 55-235 V at the RF pulse sequence for usual MR imaging. When the axis was vertical, negligible current was observed. A resistor inserted into the circuit of a 30 x 40 cm loop sparked and burned out. Simple loops of conductive material may result in the induction of a large and potentially hazardous voltage in the imaging system. Self-resonance of such a loop may add greatly to hazards by increasing the effective coupling to the RF transmitter. Also, impedance matching of the inserted resistor with the impedance of the loop increases the dissipated power at the resistor.

Clinical course and management of patients undergoing open window thoracostomy for thoracic empyema

BACKGROUND

While open window thoracostomy (OWT) is a safe procedure and is indicated in patients who have thoracic empyema either with or without a bronchopleural fistula, it may prolong the hospital stay.

OBJECTIVES

We retrospectively analyzed the relationship between the etiology of thoracic empyema and the open window interval (OWI).

METHODS

Between January 1986 and May 1997, 53 patients resistant to conventional therapy underwent OWT for thoracic empyema at the Department of Surgery of the National Minami-Fukuoka Chest Hospital. The patients were classified into five groups based on the etiological findings of thoracic empyema. 44 patients also underwent closure of the window until June 1999.

RESULTS

The average OWI was 180.4 +/- 51.9 (mean +/- SE) days for postoperative empyemas in lung cancer, 128.0 +/- 32.1 days for bacterial nontuberculous empyemas, 189.6 +/- 24.1 days for fungal empyemas, 365.8 +/- 201 days for empyemas caused by atypical mycobacteria and 322.0 +/- 58.7 days for tuberculous empyemas. There was no evidence that the OWI was related to either sex, age, etiology of thoracic empyemas, performance status, the existence of bronchopleural fistulae, complications of diabetes mellitus or preoperative malnutrition status in multivariable models. 5 patients underwent a second OWT because of recurrence of empyema. Mortality rate was 7.5%.

CONCLUSIONS

There was no relationship between clinical factors including nutritional assessment and OWI. OWT generally is a safe and effective procedure for thoracic empyema resisting to conventional therapy except that it can make an extended hospital stay necessary.

Effect of beta-aminopropionitrile and hyaluronic acid on repair of collagenase-induced injury of the rabbit Achilles tendon

Collagenase was injected into the Achilles tendon of both hind legs of 10 clinically normal adult male New Zealand white rabbits. One month after induction of the injury, beta-aminoproprionitrile (BAPN) or hyaluronic acid (HA) was injected into the tendon core of the right hind leg of each rabbit, the left hind leg being left untreated. The treatment effects were evaluated by electron microscopy and analysis of the glycosaminoglycan (GAG) content of samples at 2 and 6 months post-treatment. At 2 months, collagen fibrils in tendons from both hind legs were relatively small in diameter, irregularly arranged, and interspersed with abundant active tenocytes as compared with those in normal tendon uninjured by collagenase. In the matrix, the amount of HA increased, but chondroitin-6-sulphate was eliminated. At 6 months, BAPN-treated tendons had small-diameter, regularly arranged collagen fibrils. HA-treated tendons, on the other hand, had large diameters, as well as regularly arranged collagen fibrils by comparison with non-treated tendon. The results suggest that HA, unlike BAPN, promoted healing.

Atherosclerotic plaque characterization by quantitative analysis using intravascular ultrasound: correlation with histological and immunohistochemical findings

The aim of this study was to clarify whether atherosclerotic plaque morphology, as defined by quantitative analysis with intravascular ultrasound (IVUS) images, was related to the immunohistochemical findings. Twenty-five coronary lesions in 25 patients who had ultrasound guidance during directional coronary atherectomy (DCA) were enrolled. The lesions retrieved by DCA were analyzed and divided into 3 groups (lesions infiltrated with both macrophages and lymphocytes: group IML; lesions infiltrated with macrophages but not lymphocytes: group IM; and non-infiltrated lesions: group NI). The mean plaque echo level divided by the mean adventitia echo level (MPEL/MAEL) and the heterogeneity of the distribution of plaque echo levels (HDPEL) were calculated. The proportion of patients with acute coronary syndromes was significantly different among the groups: IML (n=14), IM (n=5), and NI (71%, 0% and 17%, respectively; p<0.01). The pre-DCA HDPEL value was highest in group IML and lowest in group NI; however, no significant differences in MPEL/MAEL values were found. The results suggest that plaque morphology, as defined by IVUS images, was related to the immunohistochemical findings. The increase in HDPEL correlated with the presence of immune inflammation.

Sequence analysis of Tnf as a candidate for Idd16

Linkage analysis and congenic mapping have localized 18 loci (Idd1-18) that contribute to the development of autoimmune type 1 diabetes in the nonobese diabetic (NOD) mouse. By using a congenic NOD strain which possesses recombinant MHC from a closely related CTS strain, a susceptible region (Idd16) was mapped to the segment adjacent to, but distinct from class II A and E genes (Idd1). The tumor necrosis factor alpha gene (Tnf), which is located within the Idd16 region, has been suspected to be a candidate gene for type 1 diabetes in the NOD mouse. Although the protein-coding region in Tnf has been sequenced in the NOD mouse and its related strains, the complete upstream region (approximately 1400 bp, including the 5'-untranslated region) has not yet been studied. To study the possible contribution of the transcriptional regulation of Tnf to susceptibility to type 1 diabetes, we determined the complete nucleotide sequences of the NOD strain and its related strain, CTS, in comparison with the non-diabetic control strain, C57BL/6. The nucleotide sequence of the 5'-upstream region in the NOD mouse was identical to that in the C57BL/6 mouse, but different from that in the CTS mouse. In particular, a C to A substitution at position 3408 in the CTS mouse creates a new GATA family binding site, which may be responsible for the lower incidence of type 1 diabetes in the NOD. CTS-H-2 congenic strain despite the presence of the same class II MHC.

Analysis of various treatments for pulmonary aspergillomas

The objective of this study was to analyze the results of various treatments for pulmonary aspergilloma and to determine the surgical indications. A total of 41 patients with pulmonary aspergilloma hospitalized at the National Minamifukuoka Chest Hospital between 1973 and 1999 were analyzed with regard to their response to treatment and long-term prognosis. Five asymptomatic patients who were untreated demonstrated no change in the clinical status of aspergilloma. Analysis of the short-term response revealed surgery to be the most effective treatment. Systemic and intracavitary injections of antifungal drugs were not definitely effective, although they had a positive effect in some patients. A survival analysis revealed that all eight patients who underwent surgery are still alive. Using the Cox proportional hazard model, it was found that the favorable prognostic factors were the absence of symptoms, the absence of a superimposed bacterial infection, and surgery. There were ten deaths: three from lung cancer and seven related to uncontrollable superimposed bacterial infections, often resulting in hemoptysis. We conclude that patients with asymptomatic pulmonary aspergillomas should be clinically observed for signs of the development of lung cancer, but do not require active treatment. On the other hand, patients who are symptomatic and have uncontrollable superimposed bacterial infection will benefit from surgery.

Newly Developed Stent Graft with Micropored and Heparin Impregnated SPU Film. Long-Term Follow-up Study in Vivo

SUMMARY

The use of stents has improved results after balloon carotid angioplasty. Some materials have been reported for covering the metal surface of the stent to reduce the rate of subacute thrombosis and restenosis. We have already developed a new stent graft with thin-walled controlled micropored polymer covering, and in a previous study we confirmed tissue ingrowth via the micropores at one month in a beagle model. The progress of cell migration was controlled by micropore density using a constant micropore diameter (30mum diameter, 125mum inter-pore distance). In the present study, we applied our newly developed stent graft impregnated with heparin for implantation in the rabbit carotid artery, and carried out an angiographic and histological investigation. Our stent graft was made from a Palmaz-Schatz stent and a micropored segmental polyurethane (SPU) thin film with a heparin coating. Micropores 30mum in diameter and 125mum apart were created on the thin SPU film using an excimer laser ablation technique. The surface of the micropored film was then impregnated with photosensitive gelatin that incorporated the heparin. The metal stent was rolled up and fixed to this modified SPU film under microscopic observations. These stent grafts were deployed in the common carotid arteries (CCAs) of rabbits (37 carotid arteries, 20 rabbits). The animals were sacrificed one, two and three months later, and a histological study and scanning electron microscopy study were performed for evaluation of endoluminal endothelialization and intimal thickening at the late stage. CCAs treated with stent grafts of micropored film showed poor-patency and intimal hyperplasia compared with those treated with a simple bare stent or a heparin-impregnated stent. In terms of intimal hyperplasia and patency, the heparin-impregnated stent was superior to the bare stent. Intimal hyperplasia was prevented by control of tissue ingrowth through the micropores. The antithrombogenicity of the impregnated heparin improved patency in the early stage. Our new stent graft with a heparin-impregnated SPU film thus appears promising for prevention of restenosis due to neointimal hyperplasia.

EUS and ERCP features of nonalcoholic duct-destructive, mass-forming pancreatitis before and after treatment with prednisolone

Nonalcoholic, duct-destructive, mass-forming pancreatitis in a 28-year-old man was presented with endoscopic ultrasonographic (EUS) and endoscopic retrograde cholangiopancreatographic (ERCP) findings before and after corticoid therapy. Because this disease is often mistaken for a malignant tumor, EUS combined with ERCP may provide imaging characteristics useful for differentiation from malignant tumor, for early diagnosis, and for monitoring therapeutic effects.

Neutrophil proteinase 3-mediated induction of bioactive IL-18 secretion by human oral epithelial cells

IL-18, a potent IFN-gamma-inducing cytokine, is expressed by various nonimmune cells as well as macrophages, suggesting that it has important physiological and immunological roles. The present study focused on the mechanism of active IL-18 induction from human oral epithelial cells. The epithelial cells and the cell lines constitutively express IL-18 mRNA and the 24-kDa precursor form of IL-18. Bioactive IL-18 exhibiting IFN-gamma-inducing activity was detected in the supernatant of the cells on costimulation with neutrophil proteinase 3 (PR3) and LPS for 24 h after IFN-gamma-priming for 3 days. An active 18-kDa form of IL-18 was detected in lysate and supernatant of the cells only after the above treatment and the induction was inhibited by cycloheximide and by serine proteinase inhibitors. After the treatment, lactate dehydrogenase activity was not detected in the cell culture supernatant, and PR3 was detected only in the membrane and not in cytoplasm fractions of the cells. Caspase-1 was not detected in the cells even after the treatment and the IL-18 induction was not inhibited by a caspase-1 inhibitor. These results suggest that the PR3-mediated induction of bioactive IL-18 secretion from oral epithelial cells in combination with LPS after IFN-gamma-priming occurred via a caspase-1-independent pathway, and provide new insight into the possible involvement of a neutrophil proteinase in the induction of bioactive IL-18 in oral inflammation such as periodontitis.

Embryonal carcinoma of the testis associated with prostate cancer in a 72-year-old man

A 72-year-old Japanese man presented with a painless swollen left scrotal mass with elevated levels of serum alpha-fetoprotein and prostate specific antigen. The patient underwent high orchiectomy under diagnosis and a final pathological examination revealed embryonal carcinoma of the left testis. A systematic needle prostate biopsy under guidance of transrectal ultrasound revealed prostate cancer (Gleason score, 8) on the left lobe (T2aN0M0). Systemic chemotherapy was given for retroperitoneal lymph node metastasis of testicular cancer and hormonal therapy (LH-RH analog) was given for prostate cancer. The patient was well with no evidence of metastasis from the testicular cancer or prostate cancer and with no elevation of serum alpha-fetoprotein or prostate specific antigen 26 months after the orchiectomy.

Selective localization of G protein gamma5 subunit in the subventricular zone of the lateral ventricle and rostral migratory stream of the adult rat brain

G proteins play important roles in transmembrane signal transduction, and various isoforms of each subunit, alpha, beta and gamma, are highly expressed in the brain. The Ggamma5 subunit is a minor isoform in the adult brain, but we have previously shown it to be highly expressed in the proliferative region of the ventricular zone in the rat embryonic brain. We show here that Ggamma5 is also selectively localized in a proliferative region in the adult rat brain, including the subventricular zone of the lateral ventricle and rostral migratory stream. The Galphai2 subunit colocalized with Ggamma5 in these regions, the two subunits being present in neuronal precursors and ependymal cells but not in proliferating astrocytes. In addition, intense staining of Ggamma5 was seen in axons of the olfactory neurons, which are known to regenerate. These results suggest specific roles for Ggamma5 in precursor cells during neurogenesis so that this isoform might be a useful biological marker.

Mechanical properties of artificial tracheas composed of a mesh cylinder and a spiral stent

Much work has been done on the materials used for mesh-type artificial tracheas, but a precise mechanical evaluation of these structures has not yet been performed. In the present study, we determined the mechanical properties of typical mesh-type artificial tracheas and compared them with those of native trachea. Four types of artificial trachea were made and used for the mechanical tests. The basic frame of all the specimens was composed of a mesh cylinder and a spiral stent. The specimen whose mesh was sealed with collagen sponge showed almost the same behavior in the force-strain curve under compression, suggesting that collagen sealing has little effect on mechanical properties. Agreement between measured and estimated mechanical properties was good, especially in the low strain region, suggesting that artificial tracheas can be designed in terms of mechanical properties by mainly considering the basic frame structure.

Galpha11 induces caspase-mediated proteolytic activation of Rho-associated kinase, ROCK-I, in HeLa cells

Expression of the constitutively active mutant of Galpha(11) (Galpha(11)QL) induces the formation of vinculin-containing focal adhesion-like structures in HeLa cells. This was found to be inhibited by Y-27632, a specific inhibitor of Rho-associated kinases (ROCK), but not by co-expression with a dominant negative mutant of RhoA, suggesting Rho-independent activation of ROCK by Galpha(11)QL. Investigation of trypan blue exclusion and immunocytochemistry with an antibody against cleaved caspase revealed the cellular phenotype of Galpha(11)QL-expressing cells to be identical to that displayed by cells undergoing apoptosis, and the caspase inhibitor zVAD-fmk blocked all morphological changes induced by Galpha(11)QL. Transfection of Galpha(11)QL induced cleavage of ROCK-I, and this proteolysis was also prevented by zVAD-fmk. ROCK-I C-terminally truncated at its authentic caspase sites also induced the formation of vinculin-containing focal adhesion-like structures. In addition, cleavage of ROCK-I was observed when cells overexpressing m1 muscarinic acetylcholine receptors were stimulated with carbachol. These results suggest that Galpha(11) induces proteolytic activation of ROCK-I by caspase and thereby regulates the actin cytoskeleton during apoptosis.

Insulin secretion to glucose as well as nonglucose stimuli is impaired in spontaneously diabetic Nagoya-Shibata-Yasuda mice

To clarify the mechanisms of impaired insulin secretion in Nagoya-Shibata-Yasuda (NSY) mice, an inbred strain of mice with spontaneous development of type 2 (non-insulin-dependent) diabetes mellitus, the insulin response to glucose (5.5 to 27.8 mmol/L) and nonglucose stimuli (glibenclamide, arginine, and BayK8644, a Ca-channel opener) was studied in vitro using isolated islets from male NSY and control C3H/He mice at 36 weeks of age by the batch incubation method. Insulin response to 5.5 mmol/L glucose was not significantly different between NSY and C3H/He mice, but insulin response to a high concentration of glucose (> or = 11.1 mmol/L) was significantly smaller in NSY mice than in control C3H/He mice. The dose-response curve of insulin secretion showed a markedly reduced maximum response, but almost normal glucose sensitivity in NSY islets. Insulin responses to glibenclamide (1 mmol/L), arginine (20 mmol/L), and BayK8644 (0.1 mmol/L) were also significantly smaller in NSY mice than in C3H/He mice. Insulin content of islets, in contrast, was significantly higher in NSY mice than in C3H/He mice. The impaired insulin response to glucose and nonglucose stimuli together with higher insulin content in islets in the NSY mouse suggest that a defect in voltage-dependent Ca(2+)-channel or thereafter in the cascade of insulin secretion may be responsible for impaired insulin secretion in NSY mice. NSY mice, therefore, could be a novel animal model of type 2 diabetes with a defect in insulin secretion at a different site from that in previously known animal models.

Expression of interleukin-18 and its receptor in mouse ovary

PROBLEM

Interleukin-18 (IL-18) strongly induces interferon-gamma production and is produced not only by types of immune cells but also by types of non-immune cells. Ovulation is thought to be an inflammation-like reaction in which many pro-inflammatory cytokines are involved. We investigated whether IL-18 is involved in the functions of ovary.

METHOD OF STUDY

The 4-week-old immature female mice were examined for IL-18 and IL-18 receptor (IL-18R) expression on their ovaries under stimulation with pregnant mare's serum gonadotropin (PMSG) and human chorionic gonadotropin (hCG) by immunohistochemical staining, Western blotting and reverse transcript-polymerase chain reaction. The IL-18R was blocked by the injection of anti-IL-18R monoclonal antibody to immature mice during PMSG-hCG stimulation, and the number of ovulated ova was counted.

RESULTS

The expression of both proteins and mRNA of IL-18 and IL-18R were very low in immature ovaries before stimulation, but after PMSG injection both IL-18 and IL-18R increased dramatically in theca cells and reached a maximum level at the peri-ovulatory phase then slightly lowered, but still kept a high level during the luteal phase in the corpus luteum. The treatment of IL-18R monoclonal antibody to the mice during ovarian stimulation reduced the number of ovulated ova and inhibited the expansion of cumulus cells surrounding the ovum.

CONCLUSION

IL-18 and IL-18R play roles in various kinds of function of ovary.

A gelatin coated collagen-polyglycolic acid composite membrane as a dural substitute

We designed a new biodegradable composite membrane for use as a dural substitute. This membrane is composed of polyglycolic acid (PGA) mesh, collagen sponge, and gelatin sponge. Collagen layers are attached on both sides of the PGA mesh. One side of the membrane is coated with freeze-dried gelatin to prevent tissue adhesion. We examined the mechanical properties of the membrane and evaluated its efficacy in vivo by implanting it into dogs. When the mechanical properties of the membrane were measured under wet conditions, tensile strength and resistance against cutting by a suture were approximately 20 N/cm and 13 N, respectively, which are adequate for a surgical material. In the in vivo experiment, our dural substitute was implanted into six adult beagle dogs to repair a 25 x 15 mm defect in the dura mater. Two dogs each were killed at 2 and 4 months after implantation and two were observed over 6 months. At 4 months after implantation, the implanted dural substitute was almost absorbed and a fibrous membrane resembling native host dura had regenerated at the site. No foreign body reaction or significant adhesion to the cerebral cortex was observed. These results indicate the clinical potential of our novel dural substitute.

Hyperinsulinemia as a risk factor for restenosis after coronary balloon angioplasty

The present study evaluated whether hyperinsulinemia is a predictor of restenosis after coronary balloon angioplasty in 69 patients who underwent elective coronary balloon angioplasty; patients were excluded if they were known diabetics being treated with insulin. Quantitative coronary angiography was performed before and after angioplasty and at follow-up. Restenosis was defined as the presence of > or = 50% stenosis at follow-up. Plasma insulin responses before, 30, 60, and 120 min after 75 g glucose load (OGTT) were measured. Plasma insulin levels were higher in patients with restenosis than in patients without restenosis. Minimal lumen diameter at follow-up was smaller, and percent diameter stenosis at follow-up was higher and late loss was greater in the highest sum of insulin levels during OGTT (sigma insulin) quartile (0.95+/-0.15 vs 1.47+/-0.09 mm, p=0.005; 66.3+/-5.8 vs 40.5+/-3.3%, p=0.0003; 0.90+/-0.15 vs 0.49+/-0.08 mm, p=0.02). Even after adjustment for coronary risk factors and administration of angiotensin converting enzyme inhibitors, the association of hyperinsulinemia with restenosis leads to the conclusion that hyperinsulinemia is a strong risk factor for restenosis.

[Analysis of 200 university hospital hearing aid clinic patients]

We statistically studied patients who visited our hearing aid clinic to determine what segment of the population may benefit from hearing aids. Subjects were 200 patients from 5 to 89 years of age who had visited the Hearing Aid Clinic of Otorhinolaryngology, Nagoya University Hospital, between January 1998 and March 2000. This clinic lent out hearing aids. Subjects were divided into 2 groups those having their own hearing aids either new or earlier (HA group) and those giving up hearing aids after a trial (non-HA group). Mean better hearing levels in pure tone average were 50.6 dB in the HA group and 44.5 dB in the non-HA group. Mean better maximum speech recognition scores were 81.5% in the HA group and 85.3% in the non-HA group. The distribution of better hearing has shown that patients with mild hearing loss (better pure tone average < 40 dB) account for more than a quarter of all hearing aid clinic patients. Among patients with mild hearing loss, 60% had their own hearing aids. The need for rehabilitation in the mild hearing loss population thus appears large. Their intent to wear hearing aids influenced whether patients agreed or declined hearing aids after a trial. The period from use until patients made a decision was 2 weeks in 65% of those declining use and 35% of those agreeing to use. Over 15% of those agreeing called for a trial period longer than 8 weeks. Hearing aid trials provide useful information for both patients and surgeons before choosing surgery for a difficult ear condition. In this research, 18 patients needed counseling about both amplification and surgery. Bridging between ear surgery and hearing aid wearing is a vital role of hearing aid clinics at university hospitals.

Pinonaldehyde and some other organics in rain and snow in central Japan

Solvent-extractable organic compounds in the rain and snow collected at local cities in the mountainous region in central Japan, were analyzed by GC/MS and GC. Pinonaldehyde (2,2-dimethyl-3-acetyl-cyclobutyl-ethanal), an atmospheric reaction product of alpha-pinene, was detected in the rain and snow for the first time, and n-alkanes (C17-C33), fatty acids (C8-C23), and benzoic acid were also detected as major organic components. Concentrations of pinonaldehyde, C17-C33 n-alkanes, C8-C11 fatty acids, C12-C23 fatty acids and benzoic acid ranged between <0.02-13, 0.10-35, 0.55-5.7, 4.2-19 and <0.02-6.0 microg/l, respectively. Their composition showed some difference in summer and winter. In summer, fatty acids and benzoic acid were more abundant, while pinonaldehyde and n-alkanes were much less. Higher photochemical reactivity and higher bioactivity in summer could explain these seasonal changes except for pinonaldehyde, which would suffer from further oxidation in the atmosphere after its photochemical production from alpha-pinene. Predominance of pinonaldehyde and C12-C23 fatty acids in the rain and snow showed a remarkable contrast to n-alkanes in aerosol phase, which were the most abundant components. It indicated that oxygenated products from biogenic compounds might be important as cloud condensation nuclei in forest areas.

[Neurodevelopmental outcome of children with idiopathic toe-walking]

Twenty-six children with idiopathic toe-walking (ITW) were evaluated as to their neurodevelopmental outcome by means of a follow-up study. The ages of the subjects at the last follow-up ranged from 3 years and 4 months to 14 years and 10 months (mean: 7 years and 4 months). The neurodevelopmental outcome in the subjects was normal intelligence in 22 (of which 5 were clumsy and 4 were hyperkinetic), and borderline intelligence in 4 (of which 2 were clumsy). Thus, 13 of the 26 cases (50%) had neurodevelopmental problems including clumsiness and hyperkinesia. It is noteworthy that there was a high rate of the neurodevelopmental problems among the children with ITW. The clinical course of children with ITW should be carefully followed-up, and the appropriate care and intervention should be given to them, when the children are found to have these problems.

Segmentation gene product Fushi tarazu is an LXXLL motif-dependent coactivator for orphan receptor FTZ-F1

Orphan receptors for whom cognate ligands have not yet been identified form a large subclass within the nuclear receptor superfamily. To address one aspect of how they might regulate transcription, we analyzed the mode of interaction between the Drosophila orphan receptor FTZ-F1 (NR5A3) and a segmentation gene product Fushi tarazu (FTZ). Strong interaction between these two factors was detected by use of the mammalian one- and two-hybrid interaction assays without addition of ligand. This interaction required the AF-2 core and putative ligand-binding domain of FTZ-F1 and the LXXLL motif of FTZ. The requirement of these elements was further confirmed by examination of their target gene expression in Drosophila embryos and observation of a cuticle phenotype in transgenic fly lines that express mutated factors. In Drosophila cultured cells, FTZ is required for FTZ-F1 activation of a FTZ-F1 reporter gene. These results reveal a resemblance in the mode of interaction between FTZ-F1 and FTZ and that of nuclear receptor-coactivator and indicate that direct interaction is required for regulation of gene expression by FTZ-F1. Thus, we propose that FTZ may represent a category of LXXLL motif-dependent coactivators for nuclear receptors.

Pronociceptive effects of nociceptin/orphanin FQ (13-17) at peripheral and spinal level in mice

The heptadecapeptide nociceptin/orphanin FQ (N/OFQ) is reported to be metabolized by aminopeptidase N and endopeptidase 24.15. In the present study, N/OFQ C-terminal fragments elicited nociceptive responses in the peripheral nociceptors and in the spinal cord, whereas N-terminal fragments had no significant nociception. The nociceptive effect of N/OFQ (13-17) was most potent and remained unchanged in N/OFQ peptide receptor (NOPR) gene knockout mice, indicating that N/OFQ (13-17)-induced nociception is mediated through a novel mechanism independent of the activation of NOPR. This finding was further confirmed by in vitro guanosine 5'-O-(3-[35S]thio)triphosphate binding experiments, in which N/OFQ (13-17) showed no significant binding activity in baculovirus/sf21 cells expressing NOPR together with G protein alpha(i)1-, beta1-, and gamma2-subunits, whereas N/OFQ showed stimulation in a concentration-dependent manner. On the other hand, although a typical bell-shaped dose-response relationship was observed with a wide range of N/OFQ doses in both peripheral and central nociception tests, N/OFQ (13-17) did not show bell-shaped dose-response relationship in the central nociception test. This finding indicates that N/OFQ (13-17), in contrast to N/OFQ, lacks the postsynaptic antinociceptive actions modulating substance P signaling in the spinal cord. Together, our results suggest that C-terminal fragments of N/OFQ have potent nociceptive actions, and N/OFQ (13-17) could have the potential to mediate its actions through a novel mechanism independent of the activation of NOPR in the nociceptors and in spinal synapses.

Qualitative analyses of clock drawings in Alzheimer's disease and vascular dementia

Although quantitative analyses of clock drawings (CD) have achieved widespread clinical use as a cognitive screening, little is known about the qualitative profiles of CD in Alzheimer's disease (AD) and vascular dementia (VD). To address this issue, the present study examined the significance of qualitative analyses of CD in AD and VD. Sixty-seven AD patients, 44 VD patients and eight controls underwent a clock drawing test and took the Mini-Mental State Examinations (MMSE). In the dementia groups, quantitative scores significantly decreased compared with controls and were significantly correlated with MMSE scores. Qualitative analysis demonstrated that in AD patients qualitative error patterns were stable and independent of severity. In contrast, in VD patients the frequency of graphic difficulties and conceptual deficit increased, while the frequency of spatial and/or planning deficit decreased, as severity worsened. In mild dementia groups the frequency of spatial and/or planning deficit was significantly higher in VD. In moderate dementia groups, the frequency of graphic difficulties was significantly higher in VD and the difference in the frequency of spatial and/or planning deficit seen in mild dementia disappeared. The present study suggests that qualitative analyses of clock drawings could demonstrate the neuropsychological profiles of AD and VD and their differences between these dementias.

Relationship between regional cerebral blood flow and verbal fluency in Alzheimer's disease

Category and letter verbal fluency tests are widely used for dementia detection and severity measure. Performances of these tasks have been regarded to be mainly associated with the left frontal lobe function. However, some recent studies suggest that there are different neuropsychological bases between these two tasks, and the brain region which contributes to these performances still remains unclear in Alzheimer's disease (AD). To clarify the neural basis of verbal fluency in AD, we examined the relationship between performances of these tasks and regional cerebral blood flow (rCBF). Twenty-five AD patients were administered verbal fluency tasks and single photon emission computed tomography (SPECT) scans. Thirteen cortical regions of interest were symmetrically defined in each hemisphere. Letter fluency scores were correlated significantly only with the left prefrontal (Brodmann's area (BA) 10-46) regional cerebral blood flow (rCBF). In contrast, category fluency scores were correlated most strongly with the left temporal rCBF and also with the left prefrontal (BA 10-46) rCBF. In conclusion, the present study suggests that left prefrontal (BA 10-46) dysfunction contributes to decline in both letter and category fluency scores in AD, while typical posterior dysfunction of AD has a closer relationship with decline in category fluency scores.

Interleukin-18 stimulates hematopoietic cytokine and growth factor formation and augments circulating granulocytes in mice

Because interleukin-18 (IL-18) is similar to IL-1 and is known to be involved in the hematopoietic progenitor cell growth, the effect of IL-18 on circulating cell populations was examined. Repeated administration of IL-18 induced significant amounts of neutrophilia in mice. In parallel, high levels of interferon-gamma (IFN-gamma), IL-6, and granulocyte-macrophage colony-stimulating factor (GM-CSF) were detected in the serum of these mice. Interestingly, the cytokine profiles as well as the cell populations in circulation altered around 2 weeks after the beginning of IL-18 administration. A weak but definite eosinophilia was observed concurrently with the appearance of serum IL-5. Consistent with these observations, IL-18 induced secretion of IFN-gamma, GM-CSF, and IL-6 from splenocytes in culture. IL-18 also induced low levels of IL-5 in the splenocyte culture, which was inhibited by IL-12. However, markedly high levels of IL-5 were secreted into the culture medium when splenocytes from IFN-gamma-deficient mice were stimulated by IL-18. CD4(+) T cells strongly responded to IL-18 to secrete IL-5 and GM-CSF. IL-18 stimulated secretion of IL-6 and expression of G-CSF mRNA in splenic adherent cells. Expression of IL-18 receptors was detected in CD4(+) T cells and splenic adherent cells (macrophages). These results show that IL-18 stimulates CD4(+) T cells and macrophages to secrete IL-5, GM-CSF, IL-6, and granulocyte-colony stimulating factor in the absence of IL-12, which in turn induces hematopoietic cell proliferation causing neutrophilia and eosinophilia in mice.

Clinicopathologic and immunohistochemical features and microsatellite status of endometrial cancer of the uterine isthmus

To clarify the clinicopathologic, molecular, and immunohistochemical characteristics of uterine isthmic endometrial cancer (UIE), we examined 13 cases of UIE and compared them with 33 cases of endometrial cancer of the uterine corpus (UCE) with respect to clinicopathologic factors, the expression of p53, the estrogen receptor (ER) and the progesterone receptor (PR) status, DNA ploidy, and microsatellite instability (MSI). Five (38.4%) of the UIE patients had stage I, two (15.4%) had stage II, and six (46.2%) had stage III disease (FIGO 1988). Myometrial invasion was confirmed in 92.3% of the UIE patients, and these patients had a higher (p < 0.05) frequency of > 50% myometrial invasion (46.2%) than the patients with UCE (15.2%). Moreover, the UIE patients had a higher frequency of positive peritoneal cytology (p < 0.05) and pelvic lymph node metastases (p < 0.05). No UIE tumors exhibited MSI, and the tumors in these patients had a higher expression of p53 (p < 0.01), a lower expression of ER (p < 0.05) and PR (p < 0.05), and a higher frequency of DNA aneuploidy (p < 0.01) than the UCE tumors. These findings suggest that the UIE is clearly different from UCE in the clinicopathologic, immunohistochemical features, and microsatellite status.

Medicinal foodstuffs. XXVII. Saponin constituents of gotu kola (2): structures of new ursane- and oleanane-type triterpene oligoglycosides, centellasaponins B, C, and D, from Centella asiatica cultivated in Sri Lanka

Ursane- and oleanane-type triterpene oligoglycosides, centellasaponins B, C, and D, were isolated from the aerial parts of Centella asiatica (L.) Urban cultivated in Sri Lanka together with madecassoside, asiaticoside, asiaticoside B, and sceffoleoside A. The chemical structures of centellasaponins B, C, and D were determined on the basis of chemical and physicochemical evidence to be madecassic acid 28-O-beta-D-glucopyranosyl(1-->6)-beta-D-glucopyranoside, madasiatic acid 28-O-alpha-L-rhamnopyranosyl(1-->4)-beta-D-glucopyranosyl(1-->6)-beta-D-glucopyranoside, and 3beta,6beta,23-trihydroxyolean-12-en-28-oic acid 28-O-alpha-L-rhamnopyranosyl(1-->4)-beta-D-glucopyranosyl(1-->6)-beta-D-glucopyranoside, respectively.

Neurobiology of the Edg2 lysophosphatidic acid receptor

Lysophosphatidic acid (LPA, 1-acyl-sn-glycerol-3-phosphate) is a well-known lipid growth factor that is found widely in various tissues including brain and is reported to drive different intracellular signaling pathways. In the nervous system, LPA studies have drawn many neuroscientists' attention because it has some actions related to neurogenesis such as cell rounding and proliferation. Remarkable advances in this field have been obtained along with the discovery of the cDNA clone for its receptor, vzg1/edg2, a member of the seven transmembrane-type edg family. Successive studies have revealed that edg2 activation by LPA mediates several neurobiological actions related to neurogenesis, neuronal excitability and survival activity on developing and postnatal neurons. Here we focused their molecular basis of signaling through G proteins and in vivo roles of edg2 in such neurobiological events.

Beef tallow, but not perilla or corn oil, promotion of rat prostate and intestinal carcinogenesis by 3,2'-dimethyl-4-aminobiphenyl

The modifying effects of three kinds of fat (corn oil, beef tallow or perilla oil, each at 20% in the diet) on F344 rat prostate carcinogenesis induced by 3,2'-dimethyl-4-aminobiphenyl (DMAB) were investigated. Non-invasive carcinomas of the ventral prostate were induced by DMAB alone and invasive carcinomas of the other prostate lobes and seminal vesicles by DMAB and testosterone propionate (TP). Eight groups of F344 rats were initiated with 50 mg / kg body weight of DMAB at 2-week intervals for the first 20 weeks, four also receiving TP, extended until week 60. The animals received basal chow powder diet or one of three high fat diets throughout the experiment (60 weeks). One further group served as a non-carcinogen-treated control maintained on basal chow powder diet. Beef tallow significantly increased the development of ventral prostate carcinomas with DMAB alone (from 15 to 45%, P < 0.05), while perilla oil reduced the incidence of prostatic intraepithelial neoplasia (PIN) in the ventral lobe of rats given DMA + TP (from 70 to 10%, P < 0.01), but not in those given DMAB alone. No other effects of high fats were observed regarding PIN or invasive cancers of the dorsolateral and anterior prostate or seminal vesicles. A satellite experiment demonstrated that all high fat diets for 4 weeks increased the 5-bromo-2-deoxyuridine (BrdU) labeling index of prostate epithelial cells, suggesting that a high fat intake, irrespective of the fatty acid composition, may accelerate cell kinetics in the prostate. Of the three high fat diets, beef tallow was also found to increase intestinal carcinogenesis. Thus, the present data revealed carcinogenesis in the prostate and intestine to be promoted by beef tallow.

Tracheal allotransplantation in beagle dogs without immunosuppressants

BACKGROUND

The antigenicity of tracheal grafts is still unclear. We investigated the possibility of performing tracheal allotransplantation without immunosuppressants.

METHODS

Intrathoracic five-ring tracheal replacements were performed in beagle dogs without immunosuppressants (n = 18). The dogs were divided into 9 pairs, and grafts were exchanged within the pairs. In group 1 (n = 6), the paired dogs were blood relatives, whereas in group 2 (n = 12), the paired dogs were not related. Full-thickness skin transplantation was also performed in both groups.

RESULTS

In group 1, 5 animals survived uneventfully for more than 3 months. No stenosis was observed in any of the dogs. In group 2, the grafts were incorporated by the host trachea in 2 dogs. Four animals died of airway obstruction within 3 months. Moderate or slight airway stenosis was observed in 6 dogs. Rejection was confirmed by histologic examination. In both groups, all of the skin allografts were destroyed within 2 weeks.

CONCLUSIONS

After tracheal allotransplantation, long-term survival was achieved, especially in recipient dogs that were blood relatives of donors. We conclude that it is possible to perform tracheal allotransplantation using histocompatible matched grafts without immunosuppressants.

Haplotype tagging for the identification of common disease genes

Genome-wide linkage disequilibrium (LD) mapping of common disease genes could be more powerful than linkage analysis if the appropriate density of polymorphic markers were known and if the genotyping effort and cost of producing such an LD map could be reduced. Although different metrics that measure the extent of LD have been evaluated, even the most recent studies have not placed significant emphasis on the most informative and cost-effective method of LD mapping-that based on haplotypes. We have scanned 135 kb of DNA from nine genes, genotyped 122 single-nucleotide polymorphisms (SNPs; approximately 184,000 genotypes) and determined the common haplotypes in a minimum of 384 European individuals for each gene. Here we show how knowledge of the common haplotypes and the SNPs that tag them can be used to (i) explain the often complex patterns of LD between adjacent markers, (ii) reduce genotyping significantly (in this case from 122 to 34 SNPs), (iii) scan the common variation of a gene sensitively and comprehensively and (iv) provide key fine-mapping data within regions of strong LD. Our results also indicate that, at least for the genes studied here, the current version of dbSNP would have been of limited utility for LD mapping because many common haplotypes could not be defined. A directed re-sequencing effort of the approximately 10% of the genome in or near genes in the major ethnic groups would aid the systematic evaluation of the common variant model of common disease.

A potent AMPA/kainate receptor antagonist, YM90K, attenuates the loss of N-acetylaspartate in the hippocampal CA1 area after transient unilateral forebrain ischemia in gerbils

By analyzing histological damages and the regional N-acetylaspartate (NAA) level simultaneously, we evaluated the effect of an alpha-amino-3-hydroxy-5-methylisoxazole-4-propionate (AMPA)/kainate receptor antagonist, YM90K [6-(1H-imidazol-1-yl)-7-nitro-2,3-(1H,4H)-quinoxalinedione monohydrochloride], in unilateral forebrain ischemia in gerbils. The right common carotid artery was clipped for 5 min under ether anesthesia, and reperfused for 7 days. The frozen brain sections were lyophilized and the hippocampal CA1 area was dissected out for HPLC assay of NAA. An adjacent section was stained with hematoxylin-eosin for counting survived neurons per 1 mm pyramidal layer of the hippocampal CA1 area. Postischemic administration of YM90K at 20 mg/kg and 25 mg/kg attenuated the decrease of both the number of survived neurons and the NAA level on the ischemic side in a dose-dependent manner. A significant linear correlation was observed between the NAA level and the number of intact neurons. These results indicated that the NAA level could be used as an index of neuroprotective effects of pharmacological agents in global cerebral ischemia.

Replacing factor-dependency with that for lysozyme: affordable culture of IL-6-dependent hybridoma by transfecting artificial cell surface receptor

Cytokines and growth factors are indispensable for the propagation and maintenance of factor-dependent mammalian cells. However, cytokines are often so expensive that the use of factor-dependent cells for industrial applications such as protein production is often not practical. Based on our previous design of a binary hen egg lysozyme (HEL)-specific receptor composed of portions of the anti-HEL antibody and the erythropoietin receptor, a new pair of chimeric receptors having the intracellular domain of gp130 were made and transfected to an interleukin-6 (IL-6)-dependent hybridoma, 7TD1. The clone expressing the two new receptors showed clear HEL dose-dependent cell growth and monoclonal antibody production in both serum-based and serum-free media without IL-6. These results establish the feasibility of applying receptor design to tailor cells for the inexpensive induction of cell growth for the purpose of producing therapeutic products.

Dynamin GTPase domain mutants block endocytic vesicle formation at morphologically distinct stages

Abundant evidence has shown that the GTPase dynamin is required for receptor-mediated endocytosis, but its exact role in endocytic clathrin-coated vesicle formation remains to be established. Whereas dynamin GTPase domain mutants that are defective in GTP binding and hydrolysis are potent dominant-negative inhibitors of receptor-mediated endocytosis, overexpression of dynamin GTPase effector domain (GED) mutants that are selectively defective in assembly-stimulated GTPase-activating protein activity can stimulate the formation of constricted coated pits and receptor-mediated endocytosis. These apparently conflicting results suggest that a complex relationship exists between dynamin's GTPase cycle of binding and hydrolysis and its role in endocytic coated vesicle formation. We sought to explore this complex relationship by generating dynamin GTPase mutants predicted to be defective at distinct stages of its GTPase cycle and examining the structural intermediates that accumulate in cells overexpressing these mutants. We report that the effects of nucleotide-binding domain mutants on dynamin's GTPase cycle in vitro are not as predicted by comparison to other GTPase superfamily members. Specifically, GTP and GDP association was destabilized for each of the GTPase domain mutants we analyzed. Nonetheless, we find that overexpression of dynamin mutants with subtle differences in their GTPase properties can lead to the accumulation of distinct intermediates in endocytic coated vesicle formation.

Analysis of transient expression of estrogen receptor-alpha in newborn rat primary auditory cortex

In the primary temporal cortex (Te1) of newborn rats, we detected transient expression of alpha-type estrogen receptor (ER alpha). Since they have a pyramidal-like shape, they are considered neurons. By immunohistochemistry we found that they were absolutely devoid of glial fibrillary acidic protein but some of them contained calretinin, a calcium binding protein. It is already known that neurons in layer V of the Te1 extend their projections to the contralateral side of the Te1, the ipsilateral inferior colliculus, or the ipsilateral medial geniculate nucleus. Thus, we applied a retrograde track tracer into those regions of newborn rats and examined the possible colocalization of ER alpha signals and the tracer in the same cells. So far no clear colocalization of both signals has been detected in cells in the Te1. Thus, the cells expressing ER alpha transiently are not projecting to the assumed regions, at least at the newborn age examined in the present experiment. The possibility exists that (1) they are not projection neurons but local interneurons, (2) even though they are projection neurons, they did not have any synaptic contacts with their target region(s), (3) they may die after they are attached to the target neurons. Further analyses are needed to clarify the biological roles of ER alpha expressed transiently in these neurons. On the other hand, no ER beta cells were detected in the same region of the brain under the same condition. Thus, this finding was limited to the ER alpha.

[Proton MR spectroscopy of nonketotic hyperglycinemia]

Proton magnetic resonance spectroscopy (MRS) can noninvasively detect brain metabolites in vivo. A girl with the neonatal type of nonketotic hyperglycinemia was studied by MRS using a long-echo-time point-resolved technique. The proton spectrum from a volume of 15 x 15 x 15 mm cube located in her left parietal white matter exhibited a glycine signal at 3.5 ppm. Subsequent measurements (3 months to 2 years of age) showed a time course of glycine/creatine ratio similar to the changes of the glycine levels in the blood and cerebrospinal fluid. Our findings suggest that MRS is a noninvasive diagnostic tool useful in monitoring the brain glycine level directly in patients with nonketotic hyperglycinemia.

Amelanotic malignant melanoma arising in an ovarian cystic teratoma: a case report

BACKGROUND

Malignant melanoma arising in a cystic teratoma is extremely rare. We report the clinicopathologic and cytopathologic features of an amelanotic malignant melanoma arising in an ovarian cystic teratoma.

CASE

A 55-year-old woman presented with an asymptomatic right ovarian mass, showing features of cystic teratoma according to preoperative computed tomography and magnetic resonance imaging. The resected teratoma was suspected to include a nonepithelial malignancy in a touch preparation from a solid component. The tumor showed immunoreactivity for Melan-A, S-100 and HMB-45 in the absence of melanin granules, which established the diagnosis of amelanotic malignant melanoma arising in an ovarian cystic teratoma.

CONCLUSION

Cytopathologic findings from touch preparations and immunohistochemical staining are useful for the diagnosis of amelanotic malignant melanoma arising in an ovarian cystic teratoma.

Neurosteroids stimulate G protein-coupled sigma receptors in mouse brain synaptic membrane

Dehydroepiandrosterone, its sulfate (DHEAS) and pregnenolone sulfate, representative neurosteroids as well as (+)-pentazocine concentration-dependently stimulated the [35S]GTPgammaS binding in synaptic membranes of mouse prefrontal cortex. These stimulations were blocked by NE-100, a sigma-receptor antagonist, and by progesterone, another type of neurosteroid. The DHEAS-induced stimulation was blocked by the pertussis toxin (PTX)-treatment, and completely recovered by reconstitution of PTX-treated membranes with recombinant G(i1), but not with G(oA). DHEAS also stimulated the [35S]GTPgammaS binding in the coronal sections of mouse brain in NE-100- or progesterone-reversible manner. These findings suggest that some neurosteroids may act on metabotropic sigma receptors, and this study may be the first to show the coupling of neurosteroid binding site and G(i).

Neurofibromatosis type 1 with basilar artery fusiform aneurysm manifesting Wallenberg's syndrome

A case of neurofibromatosis type 1 (NF1) manifesting Wallenberg's syndrome and fusiform aneurysm of the basilar artery is reported. The patient suddenly developed dysarthria, walking difficulty and sensory disturbance. Neurological examination suggested Wallenberg's syndrome and MR imaging confirmed an ischemic lesion at the left lateral medulla oblongata. Cerebral angiography revealed a fusiform aneurysm at the middle portion of the basilar artery. However, there was no occlusive change in either the posterior inferior cerebellar artery or the vertebral artery. The clinical and radiological features are discussed together with a review of NF1 cases with intracranial aneurysms in the literature.

Pulsatility of brachial artery pressure is associated with an increased risk of coronary artery disease in men

OBJECTIVES

The purpose of this study was to evaluate whether the pulsatility of brachial artery pressure is related to an increased risk of coronary artery disease (CAD). On the basis of vascular mechanics, we recently reported that relative pulse pressure can predict the occurrence of restenosis after percutaneous transluminal coronary angioplasty. We also hypothesized that relative pulse pressure of the brachial arterial pressure waveform is associated with an increased risk of CAD.

DESIGN

A cross-sectional study.

PATIENTS

We enrolled 172 men who had the same cardiac performances.

MAIN OUTCOME MEASURES

We measured their brachial artery pressures with a sphygmomanometer. To quantify the relative magnitude of the pulsatility to diastolic pressure, we made use of the ratio of pulse pressure to diastolic pressure (PP/DP). We investigated the effects of the PP/DP in relation to the risk of CAD.

RESULTS

PP/DP was associated with an increased risk of CAD. The prevalence rates of significant stenosis were 28.1% for the lowest, 43.1% for the middle and 49.1% for the highest tertile of PP/DP levels. The age-adjusted odds ratio of CAD was 2.23 (95% confidence interval 0.98-5.04) for the middle tertile of the PP/DP level and 2.55 (1.10-5.93) for the highest tertile compared with the lowest tertile.

CONCLUSIONS

The pulsatility of the brachial artery pressure was associated with an increased risk of CAD.

Heat shock protein 70 expression increased in rabbit müller cells in the ischemia-reperfusion model

Heat shock protein 70 (HSP70) expression in the rabbit retina was evaluated in the ischemia-reperfusion model. Ischemia was induced by increasing the pressure in the anterior chamber, and the retinas were collected 1 or 12 h after reperfusion. HSP70 expression was examined by Western blot, confocal laser scanning microscopy and immunoelectron microscopy. Western blot showed that HSP70 was significantly increased in the retina 12 h after reperfusion, compared with normal control or 1 h after reperfusion. Confocal microscopy demonstrated that HSP70 was constitutive in Müller cells and that its expression was increased 12 h after reperfusion. Electron microscopy showed that glycogen-like granules were significantly decreased with prominent endoplasmic reticulum 1 h after reperfusion. Twelve hours after reperfusion, however, the density of glycogen-like granules was restored, and immunoelectron microscopy indicated that HSP70 was associated with the organelles of the Müller cells. Taken together, these data suggest that HSP70 in Müller cells plays a role in accommodation to stress.

Aldose reductase inhibitors from the fruits of Caesalpinia ferrea Mart

Aldose reductase inhibitors were isolated from an extract of the dry fruits of Caesalpinia ferrea Mart. (Leguminosae). Compound 2 was identified as ellagic acid by comparison with a reference sample. The structure of compound 1 was elucidated as 2-(2,3,6-trihydroxy-4-carboxyphenyl) ellagic acid on the basis of spectral evidence, especially 2D-NMR data (HMQC, HMBC and NOESY). These two compounds inhibited aldose reductase in a non-competitive manner.

Cell density-dependent death mode switch of cultured cortical neurons under serum-free starvation stress

1. Cell death mode switch of cortical neurons from E17 rats was studied. Cells rapidly died under the serum-free condition. The time-course of cell death was markedly delayed by increasing cell density for primary culture in the trypan blue exclusion, LDH release, and MTT assays. 2. By analyzing cell death by the use of double staining using PI/TUNEL and PI/Annexin V combinations, the mode in the low density culture was found to be necrosis, while that in the high density culture was apoptosis. 3. The intracellular ATP level after the start of serum-free culture rapidly decline to 25% of 0-time level in the low density culture, but it was 60% in the high density culture. Both oligomycin and zVAD-fmk markedly decreased ATP levels and the population of TUNEL-positive neurons, while 3-aminobenzamide slightly increased these indices. 4. Thus. it is strongly suggested that the cell death mode switch from necrosis to apoptosis is closely related to intracellular ATP levels, and some conditioned medium factors observed in the high density culture may affect both ATP level and cell death mode switch.