Fulminant sepsis-associated encephalopathy in two children: serial neuroimaging findings and clinical course

We report on two children with sepsis-associated encephalopathy. They presented with fulminant neurological damage on clinical, neuroimaging, and neurophysiological findings. At onset, both went into deep coma after status epilepticus, resulting in near brain death. Both patients showed diffuse brain edema on CT and severe brain dysfunction on electroencephalography within a day of onset. Brain magnetic resonance (MR) imaging of one patient on day 2 showed restricted diffusion in the basal ganglia and the subcortical white matter of the frontal and occipital lobes. Brain edema aggravated and lasted for a few months despite a variety of treatments. MR imaging in the chronic phase revealed cracking lesions extending to the cerebral white matter, the cerebellum, and the brainstem. MR angiography showed diminished intracranial major arteries. These serial neuroradiological findings suggested severe brain damage resulting from fulminant elevation of intracranial pressure, which mimicked "brain death" or "respirator brain".

Myasthenic syndrome due to defects in rapsyn: Clinical and molecular findings in 39 patients

BACKGROUND

Pathogenic mutations in rapsyn result in endplate acetylcholine receptor (AChR) deficiency and are a common cause of postsynaptic congenital myasthenic syndromes.

METHODS

Clinical, electrophysiologic, pathologic, and molecular studies were done in 39 patients.

RESULTS

In all but one patient, the disease presented in the first 2 years of life. In 9 patients, the myasthenic symptoms included constant or episodic ophthalmoparesis, and 1 patient had a pure limb-girdle phenotype. More than one-half of the patients experienced intermittent exacerbations. Long-term follow-up was available in 25 patients after start of cholinergic therapy: 21 became stable or were improved and 2 of these became asymptomatic; 3 had a progressive course; and 1 died in infancy. In 7 patients who had endplate studies, the average counts of AChR per endplate and the synaptic response to ACh were less reduced than in patients harboring low AChR expressor mutations. Eight patients were homozygous and 23 heterozygous for the common p.N88K mutation. Six mutations, comprising 3 missense mutations, an in-frame deletion, a splice-site mutation, and a nonsense mutation, are novel. Homozygosity for p.N88K was associated with varying grades of severity. No genotype-phenotype correlations were observed except in 8 Near-Eastern patients homozygous for the promoter mutation (c.-38A>G), who had a mild course.

CONCLUSIONS

All but 1 patient presented early in life and most responded to cholinergic agonists. With early diagnosis and therapy, rapsyn deficiency has a benign course in most patients. There was no consistent phenotype-genotype correlation except for an E-box mutation associated with jaw deformities.

Comparison of behaviors of two surrogates for pathogenic waterborne viruses, bacteriophages Qbeta and MS2, during the aluminum coagulation process

Differences in the behaviors of two surrogates for pathogenic waterborne viruses, F-specific RNA bacteriophages Qbeta and MS2, were investigated during the coagulation process by using river water spiked with these bacteriophages. The particle size and electrophoretic mobility of Qbeta and MS2 were similar, but the removal performances of infectious Qbeta and MS2, as measured by a plaque forming unit (PFU) method, differed markedly during the coagulation process. The removal ratio of the infectious Qbeta concentration was approximately 2log higher than that of the infectious MS2 concentration at all coagulant doses tested. The total Qbeta and MS2 bacteriophage concentrations, which were measured by a real-time reverse transcription-polymerase chain reaction (RT-PCR) method and represented the total number of bacteriophages regardless of their infectivity, were similar after the coagulation process, suggesting that the behaviors of Qbeta and MS2 as particles were similar during the coagulation process. The difference between total concentration and infectious concentration indicated that some of the bacteriophages were probably inactivated during the coagulation process. This difference was larger for Qbeta than MS2, meaning that Qbeta was more sensitive to the virucidal activity of the aluminum coagulant. Analysis of the PFU and real-time RT-PCR findings together suggested that the difference in removal performances of Qbeta and MS2 during the coagulation process was probably caused by differences not in the extent of bacteriophage entrapment in the aluminum floc particles but in the sensitivity to virucidal activity of the aluminum coagulant.

Effect of rice-cooking water to the daily arsenic intake in Bangladesh: results of field surveys and rice-cooking experiments

The effect of rice-cooking water to the daily arsenic intake of Bangladeshi people was investigated. At the first field survey, uncooked rice and cooked rice of 29 families were collected. Their arsenic concentrations were 0.22+/-0.11 and 0.26+/-0.15 mg/kg dry wt, respectively. In 15 families, arsenic concentration in rice increased after cooking. Good correlation (R(2)=0.89) was observed between arsenic in rice-cooking water and the difference of arsenic concentration in rice by cooking. In the second survey, we collected one-day duplicated food of 18 families. As a result, we estimated that six of 18 families likely used the arsenic contaminated water for cooking rice even they drank less arsenic-contaminated water for drinking purpose. We also conducted rice-cooking experiments in the laboratory, changing arsenic concentration in rice-cooking water. Clear linear relationships were obtained between the arsenic in rice-cooking water and the difference of arsenic concentration in rice by cooking. Factors that affect arsenic concentration in cooked rice are suggested as follows: (1) arsenic concentration in uncooked rice, (2) that in rice-cooking water, (3) difference in water content of rice before and after cooking, and (4) types of rice, especially, the difference between parboiled and non-parboiled rice.

Optimal design of a tuned liquid damper using a magnetic fluid with one electromagnet

Characteristics of a tuned magnetic fluid damper are examined. The optimal depth of a magnetic fluid in a cylindrical container is calculated using a linear analysis of a magnetic fluid sloshing. In order to avoid swirling in lower depth fluids, several experiments using greater fluid depths are carried out and a good damping range is obtained.

Should balloon-occluded retrograde transvenous obliteration be the first-line interventional radiologic treatment for bleeding duodenal varices? A case report and review of the literature

We report a 78-year-old woman who presented with repeated tarry stools, and having lower duodenal variceal bleeding caused by portal hypertension. Endoscopic therapy had been attempted, but was impossible because the endoscope could not be inserted into the lower duodenum. Thus, the lower duodenal variceal bleeding was treated with balloon-occluded retrograde transvenous obliteration in combination with embolization using microcoils. Complete hemostasis was achieved without complications, and neither the recurrence of varices nor rebleeding has occurred for the last 3 years. A review of the English-language literature reveals only 11 such cases. The world literature is reviewed.

Inhibitory effect of endothelin A receptor blockade on tumor growth and liver metastasis of a human gastric cancer cell line

BACKGROUND

With metastatic progression, gastric cancer is incurable. Using a DNA microarray, we performed differential gene expression analysis of established highly metastatic gastric cancer cell lines and compared the findings with those from a low-metastatic parental cell line. The results demonstrated that the endothelin A receptor (ET-A) gene was the only one from the highly metastatic cell lines that was generally up-regulated.

METHODS

To investigate the role that ET-A plays in gastric cancer metastasis, we studied the effect of an ET-A-selective antagonist, YM598, on cell proliferation, tumor growth, and liver metastasis of the highly liver metastatic cell line AZ-H5c, established from the low metastatic human gastric cancer cell line AZ-521.

RESULTS

An in vivo study using nude mice demonstrated that YM598 had a significant growth inhibition effect on AZ-H5c at doses of 0.5-10.0 mg/kg. The liver metastatic rate was also significantly reduced by YM598: control, 83.3%; 1 mg/kg dosage, 16.7%; 10 mg/kg, 20%; and pretreatment at 1 mg/kg, 16.7%. There was no evidence of gross toxicity resulting from the YM598 treatment.

CONCLUSION

The ET-A blockade by YM598 had a strong inhibitory effect against tumor growth and liver metastasis of the gastric cancer cell lines. These data suggest that YM598 has potential as a novel therapeutic agent for inhibiting liver metastasis of gastric cancer.

Factors influencing postoperative speech function of tongue cancer patients following reconstruction with fasciocutaneous/myocutaneous flaps—a multicenter study

This study investigated postoperative speech function in tongue cancer patients following reconstruction with fasciocutaneous/myocutaneous flaps, to clarify the factor(s) influencing outcome. Eighty-one patients, enrolled from 11 Japanese institutions, were classified into three groups by the site of resection: lateral (N=51), anterior (N=17) and combined (N=13). The lateral group was divided into three subgroups and the anterior group into two subgroups by the size of resection. Mandibulectomy had been performed in 43 patients and radiation therapy in 24 patients. Reconstruction was accomplished by radial forearm flap (N=50), rectus abdominis myocutaneous flap (N=18), pectoralis major myocutaneous flap (N=11), latissimus dorsi myocutaneous flap (N=1) or scapula flap (N=1). Speech function was evaluated with two objective tests and three self-reporting questionnaires. The influence of tongue mobility, age at operation and examination, time interval to examination, and type of flap reconstruction on the functional results was also investigated. Better results were obtained with lateral type resections, smaller excisions, greater tongue mobility, younger patients and longer interval to examination. Mandibulectomy and radiation therapy were negative factors. Type of flap reconstruction had no effect on functional outcome. A treatment method with less functional interference should be developed, particularly for patients anticipated to be in poor functional state postoperatively.

Radioactive decay speedup at T=5 K: electron-capture decay rate of (7)Be encapsulated in C(60)

The electron-capture (EC) decay rate of (7)Be in C(60) at the temperature of liquid helium (T=5 K) was measured and compared with the rate in Be metal at T=293 K. We found that the half-life of (7)Be in endohedral C(60) ((7)Be@C(60)) at a temperature close to T=5 K is 52.47+/-0.04 d, a value that is 0.34% faster than that at T=293 K. In this environment, the half-life of (7)Be is nearly 1.5% faster than that inside Be metal at room temperature (T=293 K). We then interpreted our observations in terms of calculations of the electron density at the (7)Be nucleus position inside the C(60); further, we estimate theoretically the temperature dependence (at T=0 K and 293 K) of the electron density at the Be nucleus position in the stable center inside C(60). The theoretical estimates were almost in agreement with the experimental observations.

Effects of preceding sialadenitis on the development of autoimmunity against salivary gland

OBJECTIVE

The mechanism underlying the onset and development of autoimmune diseases such as Sjogren's syndrome is not well understood. Here, we examined the effects of preceding inflammation of the salivary gland at the onset of autoimmunity against the salivary gland.

MATERIALS AND METHODS

One side of the submandibular gland duct was ligated in mice and the effect on the contralateral gland was investigated. After histological evaluation with hematoxylin and eosin staining, the presence of autoantibodies and immune compounds was examined.

RESULTS

In all five strains of mice that were used, the salivary gland of the ligated side showed severe inflammation and atrophic change. In two mouse strains (SJL/J and PL/J), mild sialadenitis was observed on the non-ligated side 8 weeks after ligation. Autoantibodies reacting to the salivary gland were detected in three mouse strains (C3H/He, SJL/J, and PL/J). Immune complex was also detected in the duct basement membrane.

CONCLUSION

The results indicate that the autoimmune mechanism is activated by the transient inflammation in the salivary gland under a specific genetic background.

RGC32, a novel p53-inducible gene, is located on centrosomes during mitosis and results in G2/M arrest

To identify target genes for the hemizygous deletions of chromosome 13 that are recurrently observed in malignant gliomas, we performed genome-wide DNA copy-number analysis using array-based comparative genomic hybridization and gene expression analysis using an oligonucleotide-array. The response gene to complement 32 (RGC32) at 13q14.11 was identified as a deletion target, and its expression was frequently silenced in glioma cell lines compared with normal brain. Levels of RGC32 mRNA tended to decrease toward higher grades of primary astrocytomas, especially in tumors with mutations of p53. Expression of RGC32 mRNA was dramatically increased by exogenous p53 in a p53-mutant glioma cell line, and also by endogenous p53 in response to DNA damage in p53+/+ colon-cancer cells, but not in isogenic p53-/- cells. Chromatin immunoprecipitation and reporter assays demonstrated binding of endogenous p53 protein to the promoter region of the RGC32 gene, implying p53-dependent transcriptional activity. Transiently and stably overexpressed RGC32 suppressed the growth of glioma cells, probably owing to induction of G2/M arrest. Immunocytochemical analysis revealed a concentration of RGC32 protein at the centrosome during mitosis. RGC32 formed a protein complex with polo-like kinase 1 and was phosphorylated in vitro. These observations implied a novel mechanism by which p53 might negatively regulate cell-cycle progression by way of this newly identified transcriptional target. Our results provide the first evidence that RGC32 might be a possible tumor-suppressor for glioma, that it is directly induced by p53, and that it mediates the arrest of mitotic progression.