Site-specific mutagenesis of the calcium-binding photoprotein aequorin

The luminescent protein aequorin from the jellyfish Aequoria victoria emits light by an intramolecular reaction in the presence of a trace amount of Ca(2+). In order to understand the mechanism of the reaction, a study of structure-function relationships was undertaken with respect to modifying certain of its amino acid residues. This was done by carrying out oligonucleotide-directed site-specific mutagenesis of apoaequorin cDNA and expressing the mutagenized cDNA in Escherichia coli. Amino acid substitutions were made at the three Ca(2+)-binding sites, the three cysteines, and a histidine in one of the hydrophobic regions. Subsequent assay of the modified aequorin showed that the Ca(2+)-binding sites, the cysteines, and probably the histidine all play a role in the bioluminescence reaction of aequorin.

Source of oxygen in the CO(2) produced in the bioluminescent oxidation of firefly luciferin

Incorporation of (18)O into the CO(2) produced in the bioluminescent oxidation of firefly luciferin was studied. In H(2) (16)O medium with (18)O(2) gas, the product CO(2) contained up to 75% C(16)O(18)O, showing that one O of the product CO(2) arose from the O(2) that oxidized luciferin. This result is consistent with a dioxetane mechanism. Analysis of the mass spectral data of the CO(2) obtained in high-enrichment H(2) (18)O medium with (16)O(2) gas indicated the presence of about 20% contaminating CO(2), which contributes approximately 70% of the total incorporated (18)O. Thus the values of incorporated (18)O in H(2) (18)O medium with (16)O(2) gas have no significance in the present context. Data obtained with luciferases of the American firefly Photinus and Japanese firefly Luciola were similar.

Development and single laboratory validation of a method for citrinin

Citrinin (CIT) is a nephrotoxic secondary metabolite produced by several fungal species. CIT contamination has been reported in many cereals. Recently CIT contamination of red mold rice, used as an artificial colour, received attention because a CIT producing Monascus species was used in its production. Therefore, we developed a relatively simple method, immunoaffinity column clean-up followed by high performance liquid chromatographic (IAC-HPLC) detection, to determine CIT in red mold rice and several other commodities, and performed a single laboratory validation of the method. CIT was extracted by shaking for 30 min with 70% methanol, after which the extract was purified using an immunoaffinity column. The isolated CIT was quantitated by HPLC with fluorescence detection. Recoveries of CIT from red mold rice and koji-rice at levels of 50-2,500 µg/kg were 81-88%. RSDs, estimated with naturally contaminated red mold rice at 50, 200 and 400 µg/kg were 5.1%, 2.8% and 4.1%, respectively. Recoveries of CIT from cereals and mushroom samples at 50, 200 and 400 µg/kg were 60-123%, 69-88% and 73-100% with RSDs of 2.1-7.8%, 1.7-9.2% and 0.6-5.3%, respectively.

Influence of anti-HBc seropositivity on the risk of hepatocellular carcinoma in HCV-infected patients after adjusting for confounding factors

It is controversial whether past hepatitis B virus infection constitutes an additional risk of hepatocellular carcinoma (HCC) among patients with hepatitis C virus (HCV). The incidence of HCC between 1994 and 2004 was analysed among 1262 patients who were only positive for HCV. The cumulative incidence of HCC was assessed by Kaplan-Meier analysis and the difference between two groups was assessed by the log-rank test. The effect of anti-HBc positivity on the risk of HCC was assessed with multivariate Cox proportional analysis. Anti-HBc was positive in 522 (41.4%) patients. The proportion of male patients (56.7 vs 46.8%, P < 0.001) and mean age (60.8 vs 56.9 years, P < 0.001) were significantly higher in the anti-HBc positive group. HCC developed in 339 patients (mean follow-up 7.0 years), with cumulative incidence rates at 3, 5 and 10 years of 12.7, 24.5 and 41.9% in the anti-HBc positive group and 10.6, 17.7 and 33.4% in the negative group, respectively (P = 0.005). However, anti-HBc seropositivity did not reach statistical significance in multivariate analysis including age and gender (hazard ratio, 1.06; 95% CI, 0.85-1.31; P = 0.63). Anti-HBc positivity and HCC incidence were confounded by male gender and older age.

Up-regulation of CC chemokine receptor 6 on tonsillar T cells and its induction by in vitro stimulation with alpha-streptococci in patients with pustulosis palmaris et plantaris

Pustulosis palmaris et plantaris (PPP) is a tonsil-related disease; tonsillectomy is somewhat effective in treating the condition. However, the aetiological association between the tonsils and PPP has not yet been elucidated fully. Recently, some chemokines and chemokine receptors, including CC chemokine receptor (CCR) 4, CCR6 and CX chemokine receptor (CXCR) 3, have been reported to play important roles in the development of psoriasis, a disease related closely to PPP. In this study, we found that CCR6 expression on both tonsillar and peripheral blood T cells was up-regulated more intensively in PPP patients than in non-PPP patients (P < 0.001 for both), but CCR4 and CXCR3 expressions were not. In vitro stimulation with alpha-streptococcal antigen enhanced CCR6 expression significantly on tonsillar T cells in PPP patients (P < 0.05), but this was not observed in non-PPP patients. The chemotactic response of tonsillar T cells to the CCR6 ligand CC chemokine ligand (CCL) 20 was significantly higher in PPP patients than in non-PPP patients (P < 0.05). The percentage of CCR6-positive peripheral blood T cells decreased after tonsillectomy in PPP patients (P < 0.01); this decrease correlated with an improvement of skin lesions (P < 0.05, r = -0.63). The numbers of CCR6-positive cells and the expression of CCL20 were increased significantly in pathological lesions compared with non-pathological lesions in PPP skin (P < 0.01, P < 0.05 respectively). These results suggest that a novel immune response to alpha-streptococci may enhance CCR6 expression on T cells in tonsils and that CCR6-positive T cells may move to peripheral blood circulation, resulting in recruitment to target skin lesions expressing CCL20 in PPP patients. This may be one of the key roles in pathogenesis of the tonsil-related disease PPP.

Chronic Effects of Norepinephrine and Vasopressin on Urinary Prostaglandin E and Kallikrein Excretions in Conscious Rats

To assess in vivo functional interactions of vasopressor substances, norepinephrine and vasopressin, with renal prostaglandins and kallikrein-kinin system which are responsible for the vasodepressor mechanism in the kidney, we evaluated chronic effects of norepinephrine (1.8 mg/kg/day ip) and vasopressin (7.2 U/kg/day ip) on urinary prostaglandin E excretion and urinary kallikrein excretion in conscious rats. Both norepinephrine and vasopressin induced a sustained increase in systolic blood pressure. Norepinephrine induced slight but significant increases in urinary prostaglandin E excretion and urinary kallikrein excretion which were sustained for up to 6 days. Vasopressin induced a marked increase in urinary prostaglandin E excretion which was sustained for up to 6 days, whereas it induced a sustained decrease in urinary kallikrein excretion. Circulating angiotensin II levels was not changed by norepinephrine, but was decreased by vasopressin. These results indicate that renal prostaglandin E may not correlate with renal kallikrein-kinin and renin-angiotensin system in the responses to norepinephrine and vasopressin, and that vasopressin may be a more potent stimulator of the synthesis or release of renal prostaglandin E.

Evaluation of particle statistics in powder diffractometry by a spinner-scan method

The uncertainty in measured diffraction intensities caused by particle statistics, which originates from the limited number of crystallites satisfying the diffraction condition, has been evaluated by a step-scan measurement about the rotation angle of a specimen-spinning attachment of a laboratory powder X-ray diffractometer. The residual statistical variance of the spinner-scan intensity data, after subtraction of periodic drift and variance caused by counting statistics, was assigned to the variance caused by particle statistics. Particle statistics for a standard Si powder (NIST SRM640c) and three size fractions (nominally 3–7, 8–12 and 18–22 µm in Stokes diameter) of quartz powder separated by a sedimentation method have been analysed by scanning electron microscopy (SEM) and the spinner-scan method using a powder X-ray diffractometer. It has been confirmed that the observed ratio of the squared diffraction-peak intensity to the variance caused by particle statistics is proportional to the multiplicity of reflections predicted by the crystal structure. The spinner-scan intensity data for the standard Si powder (NIST SRM640c), the effective particle diameter of which was estimated at 5.6 µm by SEM image analysis, was used as the standard for crystallite-size evaluation of quartz powder based on analysis of spinner-scan data. The effective crystallite diameters of the three quartz powder samples have been estimated at 6.5 (2), 11.7 (2) and 22.8 (2) µm by the analysis of the spinner-scan data, while the effective particle diameters evaluated by SEM image analysis are 7.1, 12 and 25 µm, respectively. Other possible applications of the analysis of particle statistics based on the spinner-scan method are also discussed.

Visceral fat accumulation is an independent risk factor for hepatocellular carcinoma recurrence after curative treatment in patients with suspected NASH

BACKGROUND AND AIMS

Visceral fat accumulation reportedly increases the risk of hepatocellular carcinoma (HCC) development in patients with chronic liver disease. However, it has not been fully elucidated whether visceral fat accumulation increases the risk of HCC recurrence after curative treatment in patients with suspected non-alcoholic steatohepatitis (NASH). Therefore this was investigated in the current study.

METHODS

62 patients with naive HCC with suspected NASH were enrolled. All were curatively treated with percutaneous radiofrequency ablation between 1999 and 2006. The visceral fat area (VFA) was determined in each patient from CT images, taken at the time of HCC diagnosis. Patients were divided into two groups based on VFA: the high VFA group (>130 cm(2) in males, >90 cm(2) in females, n = 27) and the others (n = 35). The effects of VFA on HCC recurrence were analysed together with other factors including patients' background, tumour-related factors and liver function-related factors.

RESULTS

The cumulative recurrence rates differed significantly between the two groups; 15.9, 56.5 and 75.1% at 1, 2 and 3 years, respectively, in the high VFA group, and 9.7, 31.1 and 43.1%, respectively, in the controls (p = 0.018). Multivariate analysis indicated visceral fat accumulation (risk ratio 1.08, per 10 cm(2), p = 0.046) and older age (risk ratio 1.06 per 1 year, p = 0.04) as independent risk factors of HCC recurrence.

CONCLUSIONS

Visceral fat accumulation is an independent risk factor of HCC recurrence after curative treatment in patients with suspected NASH.

A pharmacogenetic UGT1A1 dose-escalation study for recurrent and refractory gynecologic cancer patients treated with combination therapy of irinotecan and cisplatin

e16536

Background: In addition to polymorphisms of UGT1A1*28, UGT1A1*6 has been recognized as a risk factor for severe irinotecal-related toxicities. We have conducted an UGT1A1 genotype-based dose-escalation study for recurrent and refractory gynecologic cancer patients (pts) treated with combination with irinotecan and cisplatin (CPT-P). Methods: Pts eligible for this study had histologically confirmed uterine cancer or ovarian cancer, who received CPT-P; a course of therapy consisting of 40–80 mg/m2 of irinotecan on days 1, 8, and 15 and 60 mg/m2 of cisplatin on day 1, q4weeks. Polymorphisms of UGT1A1*28 and *6 were analyzed and the pts were categorized into three groups (wild-type, hetoro-type, and homo-type). Pharmacokinetics of CPT-11, SN-38, SN-38 glucuronide (SN-38G), and platinums were analyzed according to the UGT1A1 genotyping. Results: During August 2008 and December 2008, 17 pts were enrolled in this study; 12 ovarian cancers and 5 uterine cancers. Genotypes of UGT1A1 were wild in 9 pts (53%), *28 in 4 pts (24%), *6 in 3 pts (18%), *6/*6 in 1 pt (6%). At the starting doses of irinotecan (60 mg/m2 for wild-type and 40 mg/m2 for hetero-/homo-type), dose limiting toxicities were observed in two of six wild-type cases and one of six hetero-type cases. Pharmacokinetic analyses revealed hetero-type cases were associated with lower area under time-concentartion curve (AUC) SN-38G to SN-38 (AUCSN-38G/AUCSN-38) compared with wild-type cases (p = 0.02), however, there was no significant difference of AUCSN-38at the starting dose. Additionally, AUC of platinum was slightly higher in hetero-type cases in comparison with wild-type cases (p = 0.04). Pharmacokinetics of the drugs were similar between *28 and *6 cases. Conclusions: The present study indicated clinical significance of UGT1A1 genotyping upon pharmcokinetics of not only SN-38G/SN-38 but also platinum. In addition to UGT1A1*28, UGT1A1*6 was a key candidate to influence the pharmacokinetics of CPT-P regimen in gynecologic cancer patients.

No significant financial relationships to disclose.

A feasibility study of intravenous (IV) paclitaxel, intraperitoneal (IP) carboplatin, and IP paclitaxel in patients with epithelial ovarian carcinoma, fallopian tube carcinoma, or peritoneal carcinoma

e16549

Background: This is a feasibility study for a future trial to assess the feasibility of intravenous (IV) paclitaxel, intraperitoneal (IP) carboplatin and IP paclitaxel (TCipTip therapy) in patients with epithelial ovarian carcinoma, fallopian tube carcinoma or peritoneal carcinoma. Methods: The patients eligible for this study had histologically confirmed, stage IC-IV epithelial ovarian carcinoma, fallopian tube carcinoma or peritoneal carcinoma. IV paclitaxel was administered at 135 mg/m2 followed by IP carboplatin administration based on the area under the curve =6 on day1, and IP paclitaxel was administered at 60 mg/m2 on day 8. To ensure the safety, the three initial patients received 45 mg/m2 of IP paclitaxel on day 8. The toxicity grade was determined by CTCAE version 3. This study has been approved by the institutional review committee. Results: During November 2007 and December 2008, 10 patients were entered in this study. The patients included 7 epithelial ovarian carcinoma (stage IC, 2; stage IIIC, 5), 2 stage IIIC primary peritoneal carcinoma, and 1 stage IIA fallopian tube carcinoma. There were 7 serous adenocarcinoma, 2 endometrioid adenocarcinoma, 1 clear cell adenocarcinoma. The incidences of grade 3/4 hematological toxicities were 48% for neutropenia, 28% for thrombocytopenia, and 48% for anemia. Grade 3/4 neurotoxicity, abdominal pain nor IP catheter related toxicity was not observed. IP paclitaxel at 2nd or 3rd cycle was skipped in 4 patients by grade 3/4 neutropenia (grade 3, 3; grade 4, 1 ). Conclusions: TCipTip therapy is feasible for patients with epithelial ovarian carcinoma, fallopian tube carcinoma or peritoneal carcinoma.

No significant financial relationships to disclose.

Anomalous origin of the anterior choroidal artery

SUMMARY

We describe a very rare case of anomalous origin of the anterior choroidal artery. In our case the anterior choroidal artery arises from the internal carotid artery proximal to the posterior communicating artery.

A simple fibreoptic assisted laryngoscope for paediatric difficult intubation: a manikin study

The fibreoptic assisted laryngoscope is a new airway device. We compared the fibreoptic assisted laryngoscope with the Bullard laryngoscope, Macintosh laryngoscope and fibreoptic bronchoscope in a manikin with a simulated Cormack and Lehane Grade 4 laryngoscopic view. Eighteen anaesthetists intubated the manikin's trachea using these devices and the success rate of intubation was measured. They were then asked to rate the subjective difficulty of intubation. The success rate (95% confidence interval) was 100% (94.6-100) with the fibreoptic assisted laryngoscope, 88.9% (80.5-97.3) using the Bullard laryngoscope, 37.0% (24.1-49.9) with the Macintosh laryngoscope, and 22.2% (11.1-33.3) using the fibreoptic bronchoscope. Tracheal intubation using the fibreoptic assisted laryngoscope or Bullard laryngoscope is easier than that using the Macintosh laryngoscope or fibreoptic bronchoscope by subjective difficulty score. All of the intubations were successful with the fibreoptic assisted laryngoscope without practice. These results suggest that fibreoptic assisted laryngoscope may be a useful tool for paediatric difficult intubation.

Depressurization amorphization of single-crystal boron carbide

We report depressurization amorphization of single-crystal boron carbide (B4C) investigated by in situ high-pressure Raman spectroscopy. It was found that localized amorphization of B4C takes place during unloading from high pressures, and nonhydrostatic stresses play a critical role in the high-pressure phase transition. First-principles molecular dynamics simulations reveal that the depressurization amorphization results from pressure-induced irreversible bending of C-B-C atomic chains cross-linking 12 atom icosahedra at the rhombohedral vertices.

Reversals in two dextral flounder species, Microstomus achne and Cleisthenes pinetorum (Pleuronectida; Teleostei), from Japan

Reversals are described in Microstomus achne (three specimens) and Cleisthenes pinetorum (one specimen) collected from the Pacific coast of northern Japan, being the first published records of reversals in these genera.

Primary clear cell carcinoma of the peritoneum: report of two cases and a review of the literature

The most common neoplasms of the peritoneum are malignant mesothelioma and serous papillary adenocarcinoma. Clear cell carcinoma (CCC) is mostly derived from the ovary and often associated with endometriosis. We describe the clinicopathologic features of two cases diagnosed as CCC of the peritoneum origin. Case 1, a 53-year-old woman, presented with upper abdominal and pelvic tumors. Case 2, a 66-year-old woman, presented with massive ascites and abdominal tumor. The ovaries and uterine endometrium of these cases were not affected, and the tumors were diagnosed as Stage IIIc CCC of the peritoneum origin. Pathologically, endometriosis was not observed in either case. Adjuvant chemotherapy using irinotecan and cisplatin was effective in one case. The cases and a review of the literature suggested that residual tumor volume size determines the survival of these patients, and that the tumors show resistance to conventional platinum-based chemotherapy.

[Ross operation and mitral valve repair for active infective endocarditis]

A 17-year-old woman was admitted to our hospital for the treatment of infective endocarditis. Echocardiography showed vegetation on the aortic valve and the anterior leaflet of the mitral valve. Because of the evidence of multiple embolisms including coronary, splenic, and right brachial arteries, emergency Ross operation was performed using Prima PLUS stentless valve for reconstruction of the right ventricular outflow tract and so was mitral valve repair with autologous pericardial patch. Although cerebral hemorrhage occurred postoperatively, she recovered well without any neurological deficit. She was in good condition without any anticoagulation therapy 12 months after surgery. The Ross operation and mitral valve repair are useful for the treatment of aortic and mitral infective endocarditis, especially in young women with the potential of future pregnancy and labor.

Combination chemotherapy of intraperitoneal carboplatin and intravenous paclitaxel in suboptimally debulked epithelial ovarian cancer

The objective of this study was to retrospectively assess the efficacy and safety of combination chemotherapy of intraperitoneal (IP) carboplatin and intravenous (IV) paclitaxel in suboptimally debulked ovarian cancer. Between March 1998 and March 2006, 44 patients with histologically confirmed epithelial ovarian carcinoma or peritoneal carcinoma with a residual mass greater than 1 cm received combination chemotherapy of IV paclitaxel and IP carboplatin. Administration of IV paclitaxel at 175 mg/m2 immediately followed by IP carboplatin at an area under the curve of 6 was scheduled every 3 weeks for at least six cycles. The diagnosis and stage were ovarian carcinoma stage II in 8, III in 25, and IV in 6 cases, and peritoneal carcinoma stage III in 5 cases. Eighty-three percent of patients completed more than six cycles of chemotherapy. The incidences of grade 3/4 hematologic toxicities were 41 (93%) for neutrocytopenia, 10 (41%) for thrombocytopenia, and 18 (23%) for anemia. Observed grade 3/4 nonhematologic toxicities were 1 (2%) for allergy, 1 (2%) for fatigue, 1 (2%) for vomiting, 1 (2%) for liver dysfunction, and 4 (9%) for peripheral neuropathy. Two patients (5%) encountered catheter problems (one obstruction and one infection). Overall response rate was 80% (16 complete response, 19 partial response, 3 stable disease, and 6 progressive disease). Median progression-free survival and overall survival were 24 and 31 months, respectively. Combination chemotherapy of IP carboplatin and IV paclitaxel is effective and safe in suboptimally debulked ovarian cancer, and further evaluation is warranted.

Optical Tamm states in one-dimensional magnetophotonic structures

We demonstrate the existence of a spectrally narrow localized surface state, the so-called optical Tamm state, at the interface between one-dimensional magnetophotonic and nonmagnetic photonic crystals. The state is spectrally located inside the photonic band gaps of each of the photonic crystals comprising this magnetophotonic structure. This state is associated with a sharp transmission peak through the sample and is responsible for the substantial enhancement of the Faraday rotation for the corresponding wavelength. The experimental results are in excellent agreement with the theoretical predictions.

Disordered states in IPA-Cu(ClxBr1-x)3 induced by bond randomness

The mixtures of two spin-gap compounds IPA-Cu(ClxBr1-x)3 are studied by electron paramagnetic resonance and magnetization processes [M(H)]. From electron paramagnetic resonance spectra, the symmetry of the spin-gap state breaks down, even for x=0.99. From M(H) curves for x=0.95 and 0.92, however, spin gaps survive below mu0Hc1=10+/-1 T, and the M(H) slopes bend at mu0Hc3=40+/-1 T, below the saturation field Hc2. Such a curvature suggests an exotic phase transition: Bose-Einstein condensation of spin triplets occurs at Hc1 <H <Hc3 and a Bose-glass state may be realized at Hc3 <H <Hc2, successively. As a result, the possibility of fine-tuning the density of bosons by H provides a tool for determining the role of the interactions.

The role of a nuclear protein, histone H1, on signalling pathways for the maturation of dendritic cells

We have demonstrated previously that liver allograft tolerance is associated with the immunosuppressive activity of anti-histone H1 autoreactive antibodies induced in the serum of liver transplantation. Furthermore, we and others have shown that nuclear proteins such as histone H1 and high mobility group box 1 play an important role in maturation of dendritic cells (DCs), although the precise mechanisms are still unknown. In the present study, we focus upon the significance of histone H1 on DCs in terms of the intracellular signalling pathway of DCs. Our immunostaining and immunoblot studies demonstrated that histone H1 was detected in cytoplasm and culture supernatants upon the activation of DCs. Histone H1 blockage by anti-histone H1 antibody down-regulated the intracellular activation of mitogen-activated protein kinases (MAPKs) (p38) and IkappaBalpha of DCs, and inhibited DC activity in the proliferation of CD4+ T cells. On the other hand, the addition of histone H1 without endotoxin stimulation up-regulated major histocompatibility complex class II, the CD80 and CD86 surface markers of DCs and the activation of MAPKs (p38 and extracellular-regulated kinase 1/2) and IkappaBalpha. These results suggest that the translocation of histone H1 from nuclei to cytoplasm and the release of their own histone H1 are necessary for the maturation of DCs and the activation for T lymphocytes.

Development and single laboratory validation of a method for patulin determination in fruit juices

Patulin contamination is known in various fruit products, including apple products. In this study, a solid phase extraction clean-up method was developed and validated for patulin in various fruit juices. Patulin was extracted from samples with ethyl acetate and then diluted with hexane. Patulin was isolated with a silica gel cartridge column, then analysed by reverse phase liquid chromatography with UV detection. The detection and quantitation limits were 0.06 and 0.15 ng, respectively. Recoveries within a day, and between days, were determined. Within day recoveries of patulin (n=6) at 5.0 and 50.0 µg/kg were 96-105% and 89-95%, respectively, with relative standard deviations (RSD) of 2.4-6.9 and 0.7-1.7%, respectively. Between day recoveries at 5.0 and 50.0 µg/kg were 96-108% and 92-94%, respectively, with RSDs of 7.1-12.1 and 2.3-4.1%, respectively. Average recoveries of patulin in the range from 2.0 to 80.0 µg/kg were 114 to 93%.

Telecontrolled micromanipulator system (NeuRobot) for minimally invasive neurosurgery

BACKGROUND

To perform less invasive neurosurgery, a telecontrolled micromanipulator system has been developed and applied to clinical situations. Basic experiments for telesurgery have also been conducted.

METHOD

A cadaver head was used to carry out surgical simulation of the opening of the sylvian fissure and third ventriculostomy. After obtaining permission from the Ethical Committee of Shinshu University School of Medicine, part of the recurrent meningioma in a 45-year-old man was removed. As basic experiment for telesurgery, surgical simulation was also conducted in a rat brain with the operating console transported to a hospital 40 km distant from the University.

FINDINGS

Opening of the sylvian fissure and third ventriculostomy were accurately performed. Tumour removal in a patient with recurrent meningioma was safely achieved. Surgical simulation in the rat brain was accurately and correctly carried out, operated on from a hospital 40 km distant.

CONCLUSIONS

The NeuRobot, telecontrolled micromanipulator system, can be used as a tool for less invasive neurosurgery.

Selective expansion of T cell receptor (TCR) V beta 6 in tonsillar and peripheral blood T cells and its induction by in vitro stimulation with Haemophilus parainfluenzae in patients with IgA nephropathy

IgA nephropathy (IgAN), the most common form of primary glomerulonephritis, is recognized as a disease that often becomes worse during acute tonsillitis. Although many reports have shown that tonsillectomy is an effective treatment for IgAN patients, the immunological evidence has not yet been investigated fully. In this study, we compared the expression of T cell receptor (TCR) V beta families in tonsillar T cells of IgAN patients to those of non-IgAN patients. The reverse transcription-polymerase chain reaction (RT-PCR) and flow cytometric analyses showed that the TCR V beta 6 was used more frequently in tonsillar T cells of IgAN patients than in those of non-IgAN patients (P < 0.01 each). Similarly, the proportions of TCR V beta 6-positive cells in peripheral blood T cells were significantly higher in IgAN patients than in non-IgAN patients (P < 0.05). After tonsillectomy, the proportions decreased in IgAN patients (P < 0.05), but did not in non-IgAN patients. Furthermore, in vitro stimulation with Haemophilus parainfluenzae antigen, which is reported to deposit in the glomerular mesangium of IgAN, enhanced expression of TCR V beta 6 in tonsillar T cells from both IgAN and non-IgAN patients. These results suggest that TCR V beta 6-positive tonsillar T cells might be activated by H. parainfluenzae, move into the kidney through blood circulation and induce glomerulonephritis.

Evaluation of the Airway Scope, a new video laryngoscope, in tracheal intubation by naive operators: a manikin study

BACKGROUND AND AIM

The Airway Scope (AWS) is a new video laryngoscope. The purpose of this study was to compare the AWS and Macintosh laryngoscopes with regard to their usefulness for beginners in tracheal intubation.

METHODS

Thirty-one nurses with no previous experience of tracheal intubation used each device 10 times to intubate the trachea of a manikin (Laerdal Airway Managemant Trainer, Laerdal, Stavanger, Norway). Intubation correctly completed within 30 s was regarded as successful. The intubation time, success rate, number of esophageal intubations and dental clicks, and subjective evaluation of difficulty of intubation [rated from 1 (extremely easy) to 5 (extremely difficult)] were recorded.

RESULTS

The average intubation time was significantly shorter for AWS than for the Macintosh laryngoscope (16.7 +/- 11.0 s vs. 23.2 +/- 24.9 s; mean +/- standard deviation; P = 0.0297), and the success rate with AWS was significantly greater (91.3% vs. 79.4%; P < 0.001). In the total of 310 intubation attempts for each device, the number of esophageal intubations (0/310 with AWS vs. 20/310 with the Macintosh laryngoscope) and dental clicks (0/310 with AWS vs. 40/310 with the Macintosh laryngoscope) differed significantly (P < 0.001). AWS was rated as easier to use than the Macintosh laryngoscope (P < 0.001).

CONCLUSION

AWS is more useful for beginners as it provides quicker and easier tracheal intubation.