Sleep apnea syndrome. Examination of pharyngeal obstruction with high-speed MR and polysomnography

PURPOSE

We attempted to determine the usefulness of high-speed MR imaging for evaluating the severity of sleep apnea syndrome (SAS) by comparing findings of pharyngeal obstruction obtained with high-speed MR with those of all-night polysomnography (PSG).

SUBJECTS AND METHODS

A total of 33 patients with SAS underwent turbo-FLASH MR examination, while awake and after i.v. injection of hydroxyzine hydrochloride. Serial images were examined by cinemode. Pharyngeal findings on MR were divided into single-site obstruction (SO) at the velopharynx, multiple-site obstruction (MO), and no obstruction (NO). PSG findings were analyzed to determine the predominant type of apnea, severity as evaluated by an apnea index (AI), and the lowest SaO2 value during sleep.

RESULTS

Seventy-five percent of the central apnea group had SO, and 70% of the mixed apneas had MO, while only 15% of the obstructed apneas had MO. The percentage of patients with severe SAS (AI of 20% or higher) was 48% for the SO, and 70% for the MO. The lowest SaO2 value tended to be low in the mixed apnea in the case of PSG, and tended to be low in the MO at MR examination.

CONCLUSION

Analysis of pharyngeal dynamics using high-speed MR may provide some useful information for evaluating the severity of SAS.

Production of recombinant human monoclonal antibody using ras-amplified BHK-21 cells in a protein-free medium

A ras oncogene-amplified recombinant BHK-21 cell line (ras-rBHK-IgG) has been established, and was shown to hyperproduce the recombinant IgG chimeric human monoclonal antibody (hMAb) AE6F4, which recognizes lung cancer cells. We found that the ras-rBHK-IgG cell could be easily cultured in a protein-free ERDF medium supplemented with iron(III) nitrate, hydroxyethyliminodiacetic acid, and non-protein synthetic attachment factor as well as in a serum-free ERDF medium supplemented with insulin, transferrin, ethanolamine, and sodium selenite. The productivity of recombinant hMAb from the cells cultured in dishes at high cell densities was higher in protein-free medium than in serum-containing medium. True high density culture of the ras-rBHK-IgG cells was done in protein-free medium using the Tecnomouse, which is a novel hollow fiber bioreactor system. After culture for 30 days in protein-free culture, a total amount of about 14 mg of the recombinant hMAb AE6F4 was obtained, and was shown to be reactive against lung cancer cells in tissues.

Ocular and orbital imaging

The development of magnetic resonance imaging technology has proven to be a great breakthrough in diagnostic medical imaging, ophthalmologic imaging, and biomedical research. The anatomic detail demonstrated by an magnetic resonance image is a representation of at least three physical properties of static tissue: photon density and T1 and T2 relaxation times. Intrinsic differences in proton density and proton relaxation times of tissues allow excellent image contrast between various normal structures and high sensitivity for detecting pathologic states. This article discusses magnetic resonance imaging features of common ocular and orbital lesions, with emphasis on the potential of magnetic resonance imaging in ophthalmology.

Developmental changes in expression and distribution of the glutamate receptor channel delta 2 subunit according to the Purkinje cell maturation

The glutamate receptor (GluR) channel delta 2 subunit is considered to be a functional molecule involved in motor coordination, Purkinje cell synapse formation and cerebellar long-term depression. We examined developmental changes in expression and distribution of the GluR delta 2 in the mouse cerebellum by in situ hybridization and immunohistochemistry. The GluR delta 2 mRNA was detected as early as embryonic day 15 (E15) in a cell mass consisting of Purkinje neuroblasts in the posterior cerebellum. During late embryonic and postnatal periods, the GluR delta 2 mRNA was expressed abundantly and specifically in Purkinje cells. By immunohistochemistry, immunoreactivity of the GluR delta 2 was found in both shafts and spines of Purkinje dendrites at early postnatal period. By P21, however, the intense immunoreactivity became restricted to the dendritic spines, especially along the postsynaptic membrane in contact with parallel fiber terminals. These findings suggested that the transcription of the GluR delta 2 subunit occurs in the Purkinje cells from fetal through adult stage, but the intracellular localization of the protein products undergoes an alteration from non-synaptic to synaptic site when active synaptogenesis takes place.

Location of the non-heme iron center on the alpha subunit of photoreactive nitrile hydratase from Rhodococcus sp. N-771

Nitrile hydratase (NHase) from Rhodococcus sp. N-771, which possesses a non-heme iron center binding nitric oxide (NO), is activated by light irradiation. To localize the iron center in the protein, we quantified Fe atoms and performed FTIR measurements of the isolated alpha and beta subunits. The native NHase and the isolated alpha subunit contained about 1.0 and 0.8 mol Fe per mol protein, respectively, whereas the beta subunit contained only a trace of Fe. An NO stretching band was observed at 1852 cm-1 in the FTIR spectrum of the alpha subunit, but not in that of the beta subunit. Upon light irradiation of the alpha subunit, the affinity of the Fe atom decreased and the NO band disappeared from the FTIR spectrum. These observations indicate that the non-heme iron center, which is responsible for the photoreaction, is present in the alpha subunit.

Occurrence of poly(alpha2,8-deaminoneuraminic acid) in mammalian tissues: widespread and developmentally regulated but highly selective expression on glycoproteins

In tissues of higher organisms homopolymers of alpha2,8-linked N-acetylneuraminic acid can be found as a posttranslational modification on selected proteins. We report here the discovery of homopolymers of alpha2,8-linked deaminoneuraminic acid [poly(alpha2,8-KDN)] in various tissues derived from all three germ layers in vertebrates including mammals. The monoclonal antibody kdn8kdn in conjunction with a bacterial KDNase permitted the detection of poly(alpha2,8-KDN) by immunohistochemistry and immunoblotting. Further evidence for the existence of poly(alpha2,8-KDN) was obtained by gas/liquid chromatography. The poly(alpha2,8-KDN) glycan was detectable in all tissues studied with the exception of mucus-producing cells present in various organs, the extracellular matrix, and basement membranes. However, in certain organs such as muscle, kidney, lung, and brain its expression was developmentally regulated. Despite its widespread tissue distribution, the poly(alpha2,8-KDN) glycan was detected on a single 150-kDa glycoprotein except for a single >350-kDa glycoprotein in kidney, which makes it most distinctive among polysialic acids. The ubiquitous yet selective expression may be indicative of a general function of the poly(alpha2,8-KDN)-bearing glycoproteins.

The influence of work loads on regional differences in sweating rates

The influence of work loads (20, 40 and 60% VO2max) on regional differences in sweating rates was investigated in six healthy male students. The ratios of local sweating rate (msw) on the chest and back to estimated total sweating rate (mean msw of four sites examined x body surface area) at 20% work load were significantly greater than those on the forearm and forehead, whereas the ratio on the forehead at 60% work load was greater than at the other sites. The ratios on the forearm at 40 and 60% work loads were significantly greater than at 20% work load. The regional differences in sweating rates change with the increase in work load as seen by the greater variation in the ratios of msw on each site at 20% work load compared with 40 and 60% work loads. The results indicate that redistribution of this sweat activity to whole body or head with the rise in work load induces favorable conditions for evaporation and controlling brain temperature.

Atherosclerotic abdominal aorta saccular protrusion

Fourteen saccular abdominal aortic protrusion patients (ages ranged from 55 to 84, mean age 69.1 years) were reported. Their lesions were pathologically or bacteriologically suggested to be of atherosclerotic origin. Other origins were eliminated by using the patients past history or physical and diagnostic examination. All patients were classified into 1 of 3 types; solitary, adjacent to fusiform AAA, and independent of fusiform AAA. Diagnosis and surgical techniques were complicated when coexisting with a fusiform abdominal aortic aneurysm (AAA) and located in the AAA neck. The treatment of choice for 13 patients was surgery. Postoperatively two patients died of hepatic failure at 5 weeks, and from apoplexia at four months, after surgery, respectively. The remaining patients' prognosis is good after a 3-month to 6-year follow-up with a mean period of 2.9 years except 1 medically treated patient. Accordingly, atherosclerotic abdominal aorta saccular protrusion should be carefully diagnosed and be surgically treated in the usual AAA manner. Only juxtarenal saccular protrusions require careful reconstruction, preserving the renal or visceral function.

[Application of laser spectroscopy for 13C-breath tests]

A new device Tunable Diode Laser Spectroscopy (LS) was developed for the analysis of isotope ratios of 13CO2/12CO2. Its applicability for breath tests was validated. The exhaled breath is collected in a 2 l aluminum bag, of which CO2 is separated by cryogenic system and introduced into LS. Repeat measurements (8 times) of two kinds of gases (delta 13C:-2.62 and - 1.14%) revealed 0.045% and 0.065% variation (IS.D.), from which precision of measurement was estimated as 0.2% (3S.D.). Seven healthy volunteers were given orally different dose of 13C-glycine (50 mg-200 mg in 5 subjects) and 13C-methacetin (30 mg and 150 mg in 2 subjects). One patient with gastric ulcer with helicobacter pylori (HP) infection was given 100 mg of 13C-urea. Serial breath samples (9-15) were taken and measured both by LS and mass spectrometer (MS) thereafter. Appreciable peaks were obtained at 30-50 min. after glycine and methacetin ingestions. The height of the peaks were dose dependent. Increased excretion of 13CO2 characteristics to HP infection was obtained in 13C-urea breath test. Measured values with LS were identical with those measured with MS (60 samples) with the range of difference within 0.2% (3S.D.). [Y (LS) = 1.02X (MS) + 0.55, r = 0.996] We conclude the LS is suitable for various 13C-breath tests.

Structure-activity relationships of dermorphin analogues containing chiral piperazin-2-one and piperazine derivatives

The amide and ester carbonyl groups of four piperazin-2-one derivatives (N,N'-ethylene-bridged dipeptide ethyl esters) constructed from (R)- or (S)-phenylalanine and glycine were reduced with borane-tetrahydrofuran complex to produce the corresponding piperazine derivatives in 70-80% yields. These piperazin-2-one or piperazine derivatives were used as the carboxyl-terminal residues of eight dermorphin analogues (H-tyrosyl-D-alanyl-piperazine derivatives were used as the carboxyl-terminal residues of eight dermorphin analogues (H-tyrosyl-D-alanyl-piperazin-2-one or piperazine derivatives) whose opiate activities were examined in vitro by use of the guinea pig ileum and the mouse vas deferens assays. It was found in the guinea pig ileum assay that the configuration of pheylalanine and the replacement of the piperazin-2-one ring with a piperazine ring are important for enhancing or reducing the opiate activities of these analogues.

[Polyangiitis overlap syndrome with multiple pulmonary aneurysms and renal vascular hypertension]

A 37-year-old man with multiple nodules on a chest X-ray film, hypertension, and proteinuria was admitted to our hospital in September, 1993. Thirteen years earlier, he had been admitted to another hospital because of bloody sputum, fever, and dyspnea. He also had slight oral aphthae and slight iridocyclitis. A chest X-ray film at that time showed bilateral diffuse reticular shadows, and his illness was diagnosed as acute interstitial pneumonitis. Since that time, he had been continuously receiving tapering doses of prednisolone. His chest symptoms were relieved, and the findings on the chest X-ray film resolved with that treatment. In 1993, he also had positive tests for HBs antigen and for HLA-B51, and he was found to have renal vascular hypertension. Chest CT films and a pulmonary angiogram showed multiple aneurysms and occlusions of pulmonary arteries. A renal angiogram showed multiple intraparenchymal aneurysms of renal arteries. A specimen taken by open-lung biopsy showed healed endoarteritis obliterans of muscular arteries and no alveolitis. His illness was diagnosed as polyangiitis overlap syndrome, because of the unclassified systemic necrotizing vasculitis.

Prediction of maximal oxygen uptake by squat test in men and women

To examine the reproducibility of simple tests including step, squat and double quick tests, the respective tests were performed twice in 242 college women. The step test for 1, 2 or 3 min and the squat test for 1 or 1.5 min were adopted as simple endurance tests with superior reproducibility. Then 30 men (18-26 yr) and 32 women (18-34 yr) participated in a maximal O2 uptake (VO2max) test and the simple endurance tests. The scores (the sum of heart beats for 30-60, 90-120, 150-180 seconds in a sitting posture following the exercise) in the respective simple endurance tests were significantly correlated (P < 0.001) with VO2max per kilogram body weight in the men and women. For example, the equation relating VO2max to the score (X) of the squat test for 1.5 min in men was: VO2max (ml. kg-1. min-1) = -0.261X + 85.19 (r = -0.820, P < 0.001). The discrepancies between VO2max predicted by using the respective estimation equations and that determined by the direct method were 6.3% (by the step test for 3 min) approximately 8.1% (by the squat test for 1 min) in men and 4.7% (by the step test for 2 min) approximately 6.1% (by the squat test for 1 min) in women. Significant correlations were observed between the respective scores in the simple endurance tests (P < 0.001) and between % body fat and the scores (P < 0.01) in both men and women, but not for height vs. the scores. These results suggest that VO2max can be estimated not only by the step test for 1, 2 or 3 min but also the squat test for 1 or 1.5 min.

Two-dimensional crystallization and cryo-electron microscopy of photosystem II

Two dimensional (2D) crystals of photosystem II (PSII) were obtained from n-heptyl-beta-D-thioglucoside-solubilized monomers of spinach PSII complex by conventional detergent dialysis. The 2D crystals were either large cylindrical vesicles (1 to 2 micrometer by 4 to 6 micrometer as flattened vesicles) or large monolayer sheets (ca. 1 micrometer X 1 micrometer), both suitable for cryo-electron microscopy. Images of unstained crystals embedded in ice were recorded using low-dose microscopy and analyzed by digital image processing. Both types of crystals had the same unit cell size and the same packing arrangement of PSII particles. The plane group was p22(1)2(1) and the unit cell was rectangular with dimensions of 16.7 nm X 15.3 nm containing four monomers (two face-up and two face-down). SDS-PAGE and immunoblot analyses of the 2D crystal indicated that the constituent subunits of particles in the 2D were CP47, D1, D2, cytochrome b-559 and psbI protein. A projection map of 20 A resolution revealed that each monomer has asymmetrical shape with a length of 8.1 nm and a maximal width of 7.5 nm consisting of four areas of density. Two high-density areas with similar sizes were located close to each other to form a roughly rectangular core of 4.0 nm X 6.5 nm. From its size similarity to the size of the L/M heterodimer of the bacterial reaction center, this high density core area was tentatively assigned to the D1/D2 heterodimer. The remaining large and small areas were also tentatively assigned to CP47 and cytochrome b-559 plus psbI protein respectively.

Synthesis and hypolipidemic activities of novel 2-[4-[diethoxyphosphoryl)methyl]phenyl]quinazolines and 4(3H)-quinazolinones

The novel compound NO-1886, 4-[(diethoxyphosphoryl)methyl]-N-(4-bromo-2-cyanophenyl)-ben zamide, is a hypolipidemic agent, which appears to increase lipoprotein lipase activity in rats. Various analogs of NO-1886 were synthesized to study the structure-activity relationship of this hypolipidemic drug. A novel series of quinazolines and 4(3H)-quinazolinones were prepared by cyclization of NO-1886 derivatives. Derivatives bearing a 4-[(diethoxyphosphoryl)-methyl]phenyl] group at the 2-position were found to lower triglyceride and total cholesterol levels. In accord with the decrease in log P*, quinazolines and 4(3H)-quinazolinones showed good absorption and hypolipidemic activity. When the quinazolinone ring system is substituted at positions 6 and 7 with methoxy groups, increased hypolipidemic activity was observed. The highest hypolipidemic activity was observed when the 3-position was substituted by a methyl or benzyl group.

The occurrence of novel 9-O-sulfated N-glycolylneuraminic acid-capped alpha2-->5-Oglycolyl-linked oligo/polyNeu5Gc chains in sea urchin egg cell surface glycoprotein. Identification of a new chain termination signal for polysialyltransferase

We report the isolation and structural characterization of an oligo/polysialic acid-containing glycopeptide fraction (designated ESP-Sia) prepared from the egg cell surface complex of the sea urchin, Hemicentrotus pulcherrimus, by exhaustive pronase treatment. The carbohydrate chains isolated from ESP-Sia were shown to consist of O-linked oligo/polysialic acid-containing glycan units and N-linked carbohydrate chains. The present studies have revealed that the O-linked oligo/polysialic acid-containing glycan chains derived from the ESP-Sia were similar to those present in egg jelly coat polysialylated glycoprotein in being composed of tandem repeats of N-glycolylneuraminic acid (Neu5Gc) glycosidically linked in a novel fashion through the glycolyl group, (-->5-OglycolylNeu5Gcalpha2-->)n. However, they differ from the egg jelly coat in two key respects. First, the average degree of polymerization of the oligo/polysialic acid chains of ESP-Sia is only 3; a value far lower than that found in the jelly coat glycoprotein (average degree of polymerization was about 20). Second, ESP-Sia is uniquely characterized by the presence of 9-O-sulfated N-glycolylneuraminic acid (Neu5Gc9HSO3) residues at the nonreducing termini of the (-->5-OglycolylNeu5Gcalpha 2-->)n chains. The terminal sialyl residues in the Neu5Gc9HSO3 alpha2-->(-->5-OglycolylNeu5Gcalpha2-->)n chains were totally resistant to exosialidases. The discovery of Neu5Gc9HSO3 as the nonreducing terminal residue of oligo/poly(-->5-OglycolylNeu5Gcalpha 2-->) group is especially noteworthy in that Neu5Gc9HSO3 appears to be of limited distribution among glycoconjugates. Following the earlier discovery of oligo/polysialic acid chains capped with KDN, i.e. KDN alpha2-->(-->8Neu5Gcalpha2-->)n, found in rainbow trout egg polysialoglycoproteins, it now appears that the sulfated Neu5Gc can serve a similar capping function.

Substrate specificity of rainbow trout testis CMP-3-deoxy-D-glycero-D-galacto-nonulosonic acid (CMP-Kdn) synthetase: kinetic studies of the reaction of natural and synthetic analogues of nonulosonic acid catalyzed by CMP-Kdn synthetase

In this report we present kinetic data of the activation reaction of several synthetic 3-deoxy-D-glycero-D-galacto-nonulosonic acid (Kdn) and N-acetylneuraminic acid (Neu5Ac) analogues catalyzed by the rainbow trout testis CMP-Kdn synthetase. This enzyme showed broad substrate specificity in terms of substitutions at C4 or C5 position of Kdn and Neu5Ac. In contrast, calf brain CMP-N-acylneuraminic acid synthetase had narrow substrate specificity, being active only on various N-acyl analogues of Neu5Ac and only slightly active on Kdn derivatives. Usefulness of the trout testis enzyme for synthesis of various CMP-sialate analogues, which could be donor substrates for sialyltransferases, was demonstrated.

Studies on selectin blocker. 1. Structure-activity relationships of sialyl Lewis X analogs

As part of our studies of selectin blockers, we prepared 1-deoxy-3'-O-sulfo LeX analogs (1-3), 1-deoxy-3'-O-phosphono LeX analogs (4), and 1-deoxy sLeX analogs (5-7), and examined their inhibitory activities against natural ligand (sLeX) binding to E-selectin, P-selectin, and L-selectin. The 1-deoxy sLeX 5 was up to 20 times more potent an inhibitor than the sLeX tetrasaccharide toward P- and L-selectin binding. This indicates that the modification of the 1 or 2 position of sLeX is useful in the design of a more potent selectin blocker.

Lesser sac hernia through the gastrocolic ligament: CT diagnosis

We present a case of a lesser sac hernia of the ileum through a defect in the gastrocolic ligament with reemergence through a defect in the gastrohepatic ligament. Computed tomography (CT) revealed the herniated bowel surrounded by the liver, the stomach and the pancreas, and demonstrated the defect in the gastrocolic ligament between the stomach and the transverse colon.

Electrocochleography during experimental cochlear ischemia of the guinea pig

It has been postulated that impairment of cochlear blood flow (CoBF) is one of the most important causes of hearing loss occurring during acoustic neuroma (AN) surgery. However, it remains unclear how the degree of cochlear ischemia influences the evoked responses in electrocochleography. (ECochG) which has been used for monitoring cochlear functions. In the present study, we investigated alterations in ECochG during cochlear ischemia of varying degree in the guinea pig. In order to induce cochlear ischemia, the anterior inferior cerebellar artery (AICA) was mechanically compressed via the transclival approach. The compression of AICA resulted in the reduction of CoBF in 55 out of 70 guinea pigs. A constant reduction of CoBF was maintained during the compression of AICA in 44 (63%) guinea pigs. CoBF abruptly decreased upon compressing AICA, and promptly recovered after releasing the compression. N1 and N2 in ECochG were also altered by compression. During 3-min ischemia, N1 and N2 disappeared in 36% and 41% of the cases, respectively. The residual CoBF in cases whose N1 and N2 disappeared was significantly lower than that in other cases whose N1 and N2 were sustained during 3-min ischemia. In addition, there was a tendency that the lower the residual CoBF was, the shorter the survival time of N1 and N2. In cases whose N1 and N2 did not disappear, the prolongation of N1 and N2 latencies after 3-min ischemia was positively correlated to the residual CoBF. On the basis of these results, we discuss the mechanisms underlying the changes in CoBF and ECochG during cochlear ischemia, and conclude that the degree of cochlear ischemia during AN surgery can be estimated with ECochG.

[Dip-shaped hearing loss of Békésy audiogram in high school students]

Small dip-shaped hearing loss may be frequently observed on Bekesy audiograms in ears without any hearing loss on pure tone audiograms. Hearing tests and otoacoustic emission measurements were performed in club member of 2 senior high schools (K-D School and S-D School), in order to determine any relationship between inner ear impairments and the small dips on Bekesy audiograms. In the kendo, soccer, tennis and orchestral music clubs of K-D School micro-dips in depth over 10 dB were found to have incidences between 40% and 53%, and the micro-dips were distributed in frequencies above 5 kHz. In the of kendo, tennis, brass band and tea ceremony clubs of S-D School the incidences of micro-dips ears were between 30% and 48%, and the micro-dips tended to be distributed in higher frequencies except in the tea ceremony club. The micro-dips in the ears of the tea ceremony club members were distributed over all the frequencies examined, but most of them disappeared when counted for dip size above 15 dB remaining an ear at 7.5 kHz. Incidences of earphone or headphone users as a hobby were in the range of 30 to 70% in members of all clubs. There were no characteristic findings of clubs in the incidences of the earphone or headphone users. The degree of association between the micro-dip ears and the use of earphone or headphone was low. C-EOAEs which had a 6 ms or longer duration of evoked otoacoustic emissions were detected with an incidence of 40 to 65% and there was a significant association between the micro-dip ears and the C-EOAE ears. Incidences of spontaneous otoacoustic emissions were between 26% and 28% in all clubs and there were differences in the incidences between sexes. The frequency distribution of the spontaneous otoacoustic emissions were remarkably different to that of the micro-dips. To determine whether the C-EOAEs express a predisposition to inner ear susceptibility to noise-induced hearing loss and to ascertain that the micro-dip is a precursor notice to noise-induced hearing loss, further follow-up surveys are needed.

Recommendation of early surgery from the viewpoint of daily quality of life

We surveyed pre- and postoperative levels of satisfaction with a range of the daily quality-of-life (QOL) domains in 132 sets of epilepsy surgery patients and their families. All patients underwent resective surgery for temporal lobe epilepsy and were monitored for > 2 years. Patient and family assessments showed patients' overall QOL markedly improves after surgery, depending on freedom from seizures. However, factors such as social contacts, family relations, or financial status improved little. Some families and patients were not satisfied with the postsurgical status, despite freedom from seizures. Patients who had surgery at a later age were not so satisfied with their postsurgical status as were patients who had surgery at a younger age, particularly on the QOL domains of role activities, memory function, leisure activities, or emotional well-being. This lower satisfaction level in older patients likely results from a variety of problems affecting patients during the long-lasting epileptic process; social handicaps, psychologic conflicts, and deterioration of cognitive/behavioral functions. Based on each case, we recommend that investigations start at an early stage of the illness, so that surgical intervention may be considered as early as possible.