Collaboration of national organizations and the legislative means to advance pulmonary rehabilitation

Getting involved in the public policy process empowers health care professionals to help ensure the preservation of patient rights. An organization must form strong relationships with legislators using simple yet occasionally unconventional strategies. Too few patients currently have access to rehabilitative services. Passing national legislation promoting patient access to pulmonary rehabilitation will have a great impact by enabling more and more patients to take advantage of pulmonary rehabilitation programs because they are fully reimbursed.

Radiotherapy for Kimura's disease: the optimum dosage

PURPOSE

To evaluate retrospectively the optimum dosage of irradiation for Kimura's disease.

METHODS AND MATERIALS

Twenty patients with Kimura's disease were treated with radiotherapy. The sex ratio was 19 males to 1 female. The mean ages at onset, initial treatment, and radiotherapy were 26.2, 29.5, and 32.2 years, respectively. Radiotherapy was mainly applied for residual or recurrent tumors. The eosinophil count increased by more than 10% in 18 of the 20 patients. In most instances, irradiation was given through a single field with dosages ranging from 20 to 44 Gy.

RESULTS

At the completion of radiotherapy, a marked response in tumor size was noted in all cases. The minimum follow-up was 48 months. Local control was obtained in 23 of 31 lesions (74.1%). At dosages of < or =25 Gy, 26-30 Gy, and > 30 Gy, local control was obtained in 2 of 8 (25.0%), 9 of 10 (90.0%), and 12 of 13 sites (92.3%), respectively.

CONCLUSIONS

Radiotherapy is an effective treatment for Kimura's disease. This strongly suggests that no surgical procedure other than a biopsy should be carried out. The radiation field should be limited to the lesion and swelling of the adjacent lymph nodes as much as possible, with a optimum dosage of 26-30 Gy regardless of tumor size.

Effects of cyclosporin A and glucocorticosteroids on antigen-induced hypersensitivity to histamine in a guinea pig model of allergic rhinitis

OBJECTIVE AND DESIGN

In an attempt to study the pathogenesis of mucosal hypersensitivity in allergic rhinitis, we investigated the suppressive effects of cyclosporin A (CyA) and glucocorticosteroids on ovalbumin (OA)-induced hypersensitivity to topical histamine challenge.

MATERIALS

Actively sensitized Dunkin-Hartley guinea pigs.

TREATMENT

OA and alum were applied to guinea pigs intraperitoneally 3 times at two-week intervals. After general sensitization, OA inhalation was performed every day for 6 days as topical sensitization. Before inhalation, treatment with CyA (50 mg/kg, p.o.), glucocorticosteroids (beclomethasone propionate (1.0 mg/kg, i.p.), fluticasone propionate (FP, 0.5 mg/kg, i.p.)) or vehicle were performed, and the sensitivity to histamine was measured before and after the inhalation. Moreover, in actively (general and topical) sensitized guinea pigs, FP (0.5 mg/kg, i.p.) was applied every day for 5 days and histamine sensitivity was evaluated before and after the application.

RESULTS

We found that histamine sensitivity was significantly increased by nasal antigen challenge in this guinea pig model, and that the occurrence of histamine hypersensitivity was inhibited by the pretreatment with CyA and glucocorticosteroids. Although multiple administration of FP gradually reduced the histamine hypersensitivity according to the period of administration, it did not significantly alter the histamine hypersensitivity after the occurrence of hypersensitivity.

CONCLUSION

It is concluded that CyA and glucocorticosteroids suppress antigen-induced histamine hypersensitivity in a guinea pig model of allergic rhinitis.

Favorable strategy for the ostial lesion of the left anterior descending coronary artery: influence on narrowing of circumflex coronary artery

We examined the effectiveness of Palmaz-Schatz (P-S) stent and directional coronary atherectomy (DCA) in ostial lesions of left anterior descending arteries (LAD). The P-S stent was implanted in 11 cases at LAD ostial lesions, and DCA was performed in 13 cases. Percent stenosis and vessel diameter at the target site and the ostium of the circumflex coronary artery (LCX) were measured before and after the procedure. The initial success rate was 100% in both groups. No major complication occurred. LAD ostial lesions were improved from 81.3+/-3.4% to -8.1+/-5.7% by P-S stent and from 82.8+/-2.6% to -2.7+/-3.9% by DCA. LCX ostial vessel diameter was not changed by DCA (from 3.0+/-0.2 mm to 3.1+/-0.3 mm); however, it was significantly decreased by P-S stent (from 2.9+/-0.2 mm to 2.6+/-0.2 mm, P < 0.01). When the angle of LAD and LCX was < or = 80 degrees from the view of RAO 30 degrees and Caudal 30 degrees, the LCX ostium was significantly narrowed by stenting at LAD ostium (P < 0.01). These findings indicate that both the P-S stent and DCA are effective and safe therapies for LAD ostial lesions in cases with LAD-LCX angle > 80 degrees. In cases with LAD-LCX angle < or = 80 degrees, however, DCA is a favored therapy rather than P-S stenting to avoid narrowing of the LCX ostium.

[Results of a survey of the treatment policy for early stage tongue and oral floor cancer]

To realize the treatment policy for early stage oral cancer, a survey of 102 institutes in Japan was performed by questionnaire. A majority of the otolaryngologists preferred surgery for the treatment of T1N0 and T2N0 cases of oral cancer. The preferred method of treatment for the T1N0 cases was simple tumor resection and that for the T2N0 cases was extended tumor resection with plastic surgery, elective neck dissection and combined radio- and/or chemotherapy. A majority of the radiologists preferred brachytherapy for T1N0 and non-invasive T2N0 cases. For invasive cases of T2N0 oral cancer, radiologists preferred either surgical treatment or the combination of brachytherapy and external irradiation.

P/Q-type Ca2+ channel blocker omega-agatoxin IVA protects against brain injury after focal ischemia in rats

Recently, P/Q-type Ca2+ channels have been shown to be involved in neurotransmission in the central nervous system in mammals. We evaluated the effects of the P/Q-type Ca2+ channel blocker omega-agatoxin IVA (omega-Aga-IVA) on brain edema formation and infarct size determined after 24 h of reperfusion following 1 h of middle cerebral artery (MCA) occlusion in rats. Intracerebroventricular (i.c.v.) treatment with omega-Aga-IVA significantly attenuated the postischemic increase of brain water content. omega-Aga-IVA also significantly reduced the size of the infarct area determined by triphenyltetrazolium chloride staining after 24 h of reperfusion. omega-Aga-IVA (30 pmol, i.c.v.), which exhibited a neuroprotective effect, had no significant effect on the magnitude of intra- and postischemic brain temperature when compared with vehicle-treated rats. This indicates that the postischemic neuroprotective effect of omega-Aga-IVA is produced by a direct and not an indirect effect via hypothermia. These results suggest that P/Q-type Ca2+ channels may be involved in the development of focal ischemic brain injury and that blockers of these channels may be therapeutically useful against ischemic injury.

Induction of ST-segment elevation by regional myocardial stretch in normal canine hearts in vivo

The purpose of this study was to evaluate ST-segment elevation induced by regional myocardial stretch without myocardial ischemia in canine hearts. A strain gauge arch (TH-601T) was sutured to the left ventricular epicardium, parallel to the short axis, to shorten the end-diastolic length of the myocardium beneath the arch (stretch zone; SZ) and to produce regional myocardial stretch in each of 6 dogs. An increase in preload caused by altering the height of a saline-filled reservoir affected prolongation or shortening of the myocardium both in the SZ and outside the arch (normal zone; NZ) to increase myocardial stretch. An epicardial electrocardiogram was recorded in both the SZ and the NZ. After suture of the strain gauge arch, the ST segment was elevated in the SZ. An increase in preload augmented stretch during systole in the SZ, resulting in additional ST-segment elevation. These results suggest that regional myocardial stretch itself plays an important role in ST-segment elevation.

The immune system preferentially clears Theiler's virus from the gray matter of the central nervous system

Infection of susceptible strains of mice with Daniel's (DA) strains of Theiler's murine encephalomyelitis virus (DAV) results in virus persistence in the central nervous system (CNS) white matter and chronic demyelination similar to that observed in multiple sclerosis. We investigated whether persistence is due to the immune system more efficiently clearing DAV from gray than from white matter of the CNS. Severe combined immunodeficient (SCID) and immunocompetent C.B-17 mice were infected with DAV to determine the kinetics, temporal distribution, and tropism of the virus in CNS. In early disease (6 h to 7 days postinfection), DAV replicated with similar kinetics in the brains and spinal cords of SCID and immunocompetent mice and in gray and white matter. DAV RNA was localized within 48 h in CNS cells of all phenotypes, including neurons, oligodendrocytes, astrocytes, and macrophages/microglia. In late disease (13 to 17 days postinfection), SCID mice became moribund and permitted higher DAV replication in both gray and white matter. In contrast, immunocompetent mice cleared virus from the gray matter but showed replication in the white matter of their brains and spinal cords. Reconstitution of SCID mice with nonimmune splenocytes or anti-DAV antibodies after establishment of infection demonstrated that both cellular and humoral immune responses decreased virus from the gray matter; however, the cellular responses were more effective. SCID mice reconstituted with splenocytes depleted of CD4+ or CD8+ T lymphocytes cleared virus from the gray matter but allowed replication in the white matter. These studies demonstrate that both neurons and glia are infected early following DAV infection but that virus persistence in the white matter is due to preferential clearance of virus from the gray matter by the immune system.

Evaluation of the role of adenotonsillar hypertrophy and facial morphology in children with obstructive sleep apnea

We evaluated the role of adenotonsillar hypertrophy and facial morphology in children with obstructive sleep apnea (OSA) and compared these data with an age-matched control group. We performed cephalometric analysis to evaluate facial morphology using lateral facilal roentgenograms. Adenotonsillar and maxillary hypertrophy was remarkable in OSA children. Maxillary protrusion was significantly smaller in the OSA group than in the control group in older children (5-9 years old). Mandibular protrusion was significantly smaller in the OSA group even at younger ages (1-2 years old). The hyoid bone was significantly lower in the OSA group than in the control group at age 3-6 years. Both environmental factors due to upper airway obstruction and genetic factors are suspected as causes of abnormal facial morphology in OSA children.

Topical antigen provocation increases the number of immunoreactive IL-4-, IL-5- and IL-6-positive cells in the nasal mucosa of patients with perennial allergic rhinitis

To evaluate the role of Th2-type cytokines in the nasal mucosa which has been repeatedly exposed to antigen, an immunohistological study for IL-4, IL-5 and IL-6 was performed in patients with perennial allergic rhinitis and non allergic rhinosinusitis. The numbers of immunoreactive (ir)-IL-4, ir-IL-5 and ir-IL-6-positive cells were significantly higher in allergic mucosa than in nonallergic mucosa. In allergic mucosa, the numbers of these ir-cytokine-positive cells were significantly higher in the antigen-challenged site than in the control site. When the patients were divided into an early group (4-6 h after challenge) and a later group (15-25 h after challenge), only the change of ir-IL-4-positive cells was remarkable in the former group, whereas those of the ir-IL-4, ir-IL-5 and ir-IL-6-positive cells were significant in the latter group. These results suggest that antigen-induced upregulation of IL-4, IL-5 and IL-6 is important in the pathogenesis of perennial allergic rhinitis.

Sternocleidomastoid muscle-clavicle myoosseous flap for single-stage reconstruction of postoperative tracheal defects in patients with invasive thyroid tumor. Three case reports

In this report, we present 3 cases with thyroid carcinoma with tracheal invasion. In all cases, the tracheal defects were simultaneously reconstructed using a sternocleidomastoid muscle-clavicle myoosseous flap. We were able to close the tracheostomas without trouble, and no stenotic lesions or late complications were noted. This myoosseous composite flap has proved itself to be a reliable material for laryngotracheal reconstruction in some cases with thyroid carcinoma.

Effects of transforming growth factor-beta and platelet-derived growth factor on oligodendrocyte precursors: insights gained from a neuronal cell line

Conditioned medium derived from a rat central nervous system neuronal cell line B104 (B104 CM) was shown previously to contain uncharacterized potent mitogen(s) for oligodendrocyte/type-2 astrocyte (O-2A) progenitor cells. In this study, we demonstrated that B104 cells produce and secrete platelet-derived growth factor (PDGF)-AA homodimer, but not PDGF-B chain. B104 cells did not express other known potent mitogens for O-2A progenitor cells, including fibroblast growth factor-2 and neurotrophin-3. Unexpectedly, B104 cells also expressed transcripts of transforming growth factor-beta1 (TGF-beta1) and -beta2 (TGF-beta2), which are known to regulate O-2A progenitor cell differentiation and proliferation, and secreted exclusively the 25-kDa active forms of TGF-beta1 and TGF-beta2. Neutralization of B104 CM with anti-PDGF-AA antibody decreased proliferation of O-2A progenitor cells, whereas neutralization with anti-TGF-beta antibodies had no effect. The combination of PDGF and TGF-beta on proliferation was not equivalent to the effect of B104 CM, indicating the possibility of an unidentified growth factor. B104 CM maintained a high expression of PDGF-alpha receptor in oligodendrocytes. The observation that both a stimulatory factor (PDGF-AA) and a regulatory factor (TGF-beta) for O-2A progenitor cell proliferation and differentiation are produced from a single neuronal cell line emphasizes the potential critical interaction between neurons and O-2A progenitor cells in myelination and possibly in remyelination.

Effects of a cysteinyl leukotriene antagonist, ONO-1078 (pranlukast), on total airway resistance after antigen challenge in sensitized guinea pigs

OBJECTIVE AND DESIGN

To define the role of leukotriene (LT) in allergic rhinitis, we examined the effects of a cysteinyl (Cys) LT antagonist (ONO-1078, pranlukast).

MATERIAL

Actively sensitized Dunkin-Hartley guinea pigs.

TREATMENT

ONO-1078 (pranlukast), 3-100 mg/kg p.o. 1 h before antigen challenge.

METHODS

Nasal symptoms (sneezing, nasal scratches), changes of total airway resistance (TAR by plethysmography) and eosinophil infiltration into the nasal mucosa were determined following topical antigen (OA) challenge. Dunnet's test (TAR and symptoms) and the Mann-Whitney U-test (eosinophils) were applied.

RESULTS

Control animals showed bi-phasic nasal responses, peaking 10 min and 240 min after the topical antigen challenge, respectively. While the early-phase response was characterized by nasal symptoms of sneezing and scratching accompanied by the increase in TAR, the late-phase was characterized by an increase in TAR accompanied by eosinophil infiltration into nasal mucosa. The nasal symptoms (sneezing and scratching) were not inhibited by pretreatment with ONO-1078 at doses up to 100 mg/kg (p.o., n = 15). Although early peak responses of TAR were not affected with even the highest dose (30 mg/kg, p.o., n = 6), late-phase TAR peak response (control: 174.8 +/- 8.2%, n = 6) were significantly inhibited by 10 mg/ kg (142.7 +/- 15.8%; p < 0.05, n = 6) and 30 mg/kg (118.0 +/- 6.6%; p < 0.01, n = 6) of ONO-1078 (p.o.). In addition, the eosinophil infiltration induced by the antigen was not inhibited by ONO-1078 (30 and 100 mg/kg, p.o., n = 6).

CONCLUSIONS

Our results suggest that Cys LT may play an important role in the late-phase increase in TAR in the guinea pig model of allergic rhinitis.

Chlorpromazine reduces toxicity and Ca2+ uptake induced by amyloid beta protein (25-35) in vitro

Amyloid beta protein (A beta), has been reported to be toxic to neurons in vitro. However, the molecular mechanism leading to neuronal death remains unknown. Here we report protective effects of phenothiazines, a class of neuroleptic agent, against A beta toxicity in primary cultures of rat cortical neurons and PC12 cells. beta(25-35), an active sequence of A beta, showed dose-dependent reduction of the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl tetrazolium bromide dye (MTT) reductivity, and chlorpromazine (CPZ), promethazine or trifluoperazine restored it at micromolar concentration. The significant increase in Ca2+ uptake by chronic treatment of beta(25-35) was reduced not only by nimodipine but also by CPZ. These results suggest that phenothiazines attenuate beta(25-35) toxicity possibly by reducing of Ca2+ influx through L-type Ca2+ channels.

Prognostic factors and treatment outcome in non-Hodgkin's lymphoma of Waldeyer's ring

Prognostic factors and treatment outcome of 71 patients with non-Hodgkin's lymphoma of Waldeyer's ring were analyzed retrospectively. In univariate analyses, unfavorable prognosis was associated with primary disease in the base of the tongue, stage III-IV diseases, B-symptoms, high-grade histology, T-cell phenotype, elevated serum LDH levels, decreased peripheral blood lymphocyte counts, and negative response on delayed type hypersensitivity skin reactions. Multivariate analysis showed that stage III-IV and T-cell phenotype were significant independent risk factors for death. In stage I-II lymphomas, patients with unilateral large or bilateral cervical lymph node involvement had a poorer prognosis. In stage I-II lymphomas with intermediate or high-grade histology, patients who had received radiotherapy with MTCOP-P chemotherapy (pirarubicin, cyclophosphamide, vincristine, methotrexate with leucovorin rescue, peplomycin, and predonisolone) showed significantly better 5-year disease-free survival rate compared with patients treated with radiotherapy alone.

The effects of NK1 receptor antagonists (FK224 and FK888) on agonist- and antigen-induced nasal microvascular leakage in guinea pigs

OBJECTIVE

To study the inhibitory effects of two NK1 receptor antagonists on substance P (SP) and antigen-induced increase of nasal vascular permeability in ovalbumen (OA)-sensitized guinea pigs.

MATERIAL

Male Dunkin-Hartley guinea pigs.

TREATMENT

SP (100 mumol/l), FK224 (1-10 mumol/kg) and FK888 (0.2-2 mumol/kg).

METHODS

The in vivo model of nasal microvascular leakage was used for nasal allergic challenge in ovalbumin (OA)-sensitized guinea pigs, or nasal stimulation with substance P (SP) in non-sensitized animals. Nasal microvascular leakage was measured by the accumulation of Evans Blue dye after intravenous injection.

RESULTS

Following nasal stimulation with SP 100 microM, the concentration of dye in the nasal lavage fluid rapidly increased. NK1 receptor antagonists FK224 (10 mumol/kg i.v.) and FK888 (2 mumol/kg i.v.) inhibited SP-induced microvascular leakage. In OA-sensitized guinea pigs, exudation of dye into nasal lavage fluid was observed soon after topical antigenic stimulation and continued for over 60 min. Both NK1 receptor antagonists inhibited the immediate phase of the antigen-induced microvascular leakage.

CONCLUSIONS

We conclude that the immediate change of vascular permeability during the nasal allergic response is mediated by activation of the NK1 receptor in the guinea-pig.

Amyloid beta protein potentiates Ca2+ influx through L-type voltage-sensitive Ca2+ channels: a possible involvement of free radicals

Amyloid beta protein (A beta), the central constituent of senile plaques in Alzheimer's disease (AD) brain, is known to exert toxic effects on cultured neurons. The role of the voltage-sensitive Ca2+ channel (VSCC) in beta (25-35) neurotoxicity was examined using rat cultured cortical and hippocampal neurons. When L-type VSCCs were blocked by application of nimodipine, beta (25-35) neurotoxicity was attenuated, whereas application of omega-conotoxin GVIA (omega-CgTX-GVIA) or omega-agatoxin IVA (omega-Aga-IVA), the blocker for N- or P/Q-type VSCCs, had no effects. Whole-cell patch-clamp studies indicated that the Ca2+ current density of beta (25-35)-treated neurons is about twofold higher than that of control neurons. Also, beta (25-35) increased Ca2+ uptake, which was sensitive to nimodipine. The 2', 7'-dichlorofluorescin diacetate assay showed the ability of beta (25-35) to produce reactive oxygen species. Nimodipine had no effect on the level of free radicals. In contrast, vitamin E, a radical scavenger, reduced the level of free radicals, neurotoxicity, and Ca2+ uptake. These results suggest that beta (25-35) generates free radicals, which in turn, increase Ca2+ influx via the L-type VSCC, thereby inducing neurotoxicity.

[Studies on murine model of nasal allergy]

For the purpose of making a murine model of nasal allergy, we performed the ovalbumin (OA)-sensitization on groups of BALB/c mice in four different ways. The 1st group was sensitized with OA + alum by introperitoneal myection on day 1, 5 and 21, and the 2nd group was added OA nasal drips on day 28, 34. The 3rd group was performed OA + alum nasal dripping on day 1, 5 and 21, and the 4th was a added OA nasal dripping in the same way with the 2nd group. The observed OA-induced nasal symptoms, mucosal eosinophillia and 8 days-PCA titer were remarkable in 2nd group, moreover it also showed higher histamine hypersensitivity than other groups. We concluded that mice sensitized by OA with alum are useful for research of nasal allergy, for the reason that they posses three features of nasal allergy, anti-intigen-induced nasal symptoms, eosinophils infiltration and antigen-specific PCA titer as index of IgE increasing.

In vivo effects of monoclonal antibody against ICAM-1 and LFA-1 on antigen-induced nasal symptoms and eosinophilia in sensitized rats

We applied anti-ICAM-1 and anti-LFA-1 monoclonal antibody (mAb) to ovalbumin-sensitized rats and examined the effects on nasal eosinophilia and nasal symptoms following topical antigen challenge. In a general and local immunization (GLI) group of rats, the mAbs were applied during the booster topical immunization period. In a general immunization group and a local immunization (LI) group of rats, the mAbs were applied during the immunization period. The number of sneezes and nasal scratching movements occurring soon after topical antigen (Ag) challenge was significantly suppressed in the GLI and LI group rats. Eosinophil infiltration into nasal mucosa 24 h after Ag challenge was also significantly suppressed in GLI and LI group rats. These findings suggest that the ICAM-1/LFA-1 system is important in topical allergic inflammation in rats.

Central nervous system remyelination clinical application of basic neuroscience principles

Studies in both humans and experimental animals have demonstrated that myelin repair in the CNS is a normal physiological response to myelin damage, similar to tissue injury elsewhere in the body. The unanswered question is why myelin repair is incomplete in multiple sclerosis patients. In this paper we review the morphological characteristics of remyelination, discuss the available animal models of CNS demyelination and their usefulness to identify the molecular, cellular, and morphological events involved in CNS myelin repair, examine the use of immunosuppression, immunoglobulins, protein growth factors, and glial cell transplantation at the primary experimental therapies designed to promote CNS remyelination, and address the potential electrophysiological and clinical benefits of myelin repair in the CNS.