Relationship between aspirin use and subarachnoid hemorrhage: A systematic Review and meta-analysis

BACKGROUND

Aspirin has been associated with a decreasing risk of subarachnoid hemorrhage due to its anti-inflammatory mechanism of action and potential protective properties against aneurysm growth.

OBJECTIVE

To determine the association between aneurysmal subarachnoid hemorrhage and aspirin use.

METHODS

A systematic review of the literature and a meta-analysis were performed across the PubMed database. The following keywords were used: "aspirin, acetylsalicylic acid, 2-acetyloxy-benzoic acid, ruptured intracranial aneurysm, aneurysmal subarachnoid hemorrhage, spontaneous subarachnoid hemorrhage, intracerebral hemorrhage, spontaneous aneurysmal hemorrhage, spontaneous intracerebral bleeding". Studies that were performed with animals or analyzed patients with traumatic brain injury were excluded. A total of five studies were included in our meta-analysis, with a total of 19,222 patients evaluated. Statistical analysis was performed to determine the association between the use of aspirin and the risk of subarachnoid hemorrhage.

RESULTS

Aspirin use reduce the risk of subarachnoid hemorrhage (odds ratio [OR] 0.51, 95 % confidence interval [CI] 0.34-0.76).

CONCLUSION

Although some previous studies suggested that aspirin may potentially reduce the risk of subarachnoid hemorrhage, our meta-analysis found an association between the reduction of risk of aneurysmal subarachnoid hemorrhage.

In vivo biomechanical properties of heavy versus light weight monofilament polypropylene meshes. Does the knitting pattern matter?

AIMS

This work evaluated the post-implant biomechanical properties of light-weight (LW) and heavy-weight (HW) monofilament polypropylene (PP) meshes with different knitting patterns in an animal model in vivo.

METHODS

Forty-five adult female Wistar rats were divided into three groups and randomly implanted with 32 × 32 mm HW-PP (62 gm^-2 ) orLW-PP (16 gm^-2 ) in the lower abdomen. LW-PPwas tested orthogonally (called LWL and LWT) to reproduce the longitudinal and transverse planes of the vaginal wall, respectively. Abdominal walls were removed at 7, 30, and 60 days, and then tested for tensile load (maximum load until avulsion from the tissue), deflection, and stiffness to maximum load. Explants were compared over time and between groups.

RESULTS

LW-PP meshes implanted in the LWT fashion (vaginal transverse plane) showed comparable maximum load and stiffness to HW-PP meshes, and LW-PP meshes implanted in the LWL fashion (vaginal longitudinal plane) presented lower maximum load and stiffness than the HW-PP meshes. There were no significant differences in the values of deflection at maximum load between the studied meshes as a function of time.

CONCLUSIONS

The final mechanical behavior of PP mesh can be changed by its weight and knitting pattern. These properties may be useful in making more biocompatible prostheses for pelvic organ prolapse (POP) with less foreign material to maintain longitudinal vaginal elasticity and minimize sexual symptoms while maintaining transverse resistance (i.e., between vaginal fornixes) to prevent POP recurrence. Neurourol. Urodynam. 36:73-79, 2017. © 2015 Wiley Periodicals, Inc.

Photocurrent generation of a single-gate graphene p-n junction fabricated by interfacial modification

A back-gate graphene p-n junction was achieved by selective interfacial modification of a chemical vapor deposition (CVD)-grown graphene field effect transistor (FET). Silane self-assembled monolayer (SAM) patterns were used to fabricate uniform p- and n-doped regions and a sharp p-n junction in the graphene FET channel. A gate-dependent photocurrent response was observed at the graphene p-n junction, and exhibited a maximum signal between two Dirac point voltages of SAM-doped graphene regions. A spatial photocurrent map shows that the photocurrent generated at the junction region was much larger than that from graphene/electrode junctions under the same incident laser power. This single-peak characteristic photocurrent in CVD graphene is dominated by the photothermoelectric contribution, and is highly sensitive to the power of incident laser. The SAM interfacial modification method provides a feasible route for the fabrication of efficient graphene-based photodetectors.

Genotyping of Strawberry (Fragaria ananassa Duch.) Cultivars by DNA Markers: Interlaboratory Study

Fourteen Japanese laboratories validated the reproducibility of genotyping by 25 cleavage amplified polymorphic sequence (CAPS) markers for discrimination of strawberry (Fragaria ananassa Duch.) cultivars. Both the sensitivity and specificity rate of 12 markers were 100, those of another 12 were >95, and those of 1 were >90. These results indicate that the method of genotyping by the CAPS markers was highly reproducible and could provide a useful basis for practical identification of strawberry cultivars. This is the first report of the statistical validation of crop genotyping by DNA markers.

Production and characterization of recombinant human anti-HBs Fab antibodies

Recombinant human Fab antibodies were generated with different reactivities against the hepatitis B virus surface (HBs) antigen. To isolate the antibodies, a method was used that combined transformation of human B cells by Epstein-Barr virus (EBV) infection with a primer-vector system developed for isolating DNA fragments of human Ig Fab portions. With this method, monoclonal and oligoclonal cell lines producing anti-HBs antibodies were established and three anti-HBs Fab antibodies were isolated from two of these cell lines. From analysis of affinity characteristics, immunohistochemical activity, and cytolysis activity, these three Fab antibodies were classified into three different groups. The first group had high affinity for HBs, the second had the ability to kill HBV-infected cells, and the third was applicable to immunohistochemical staining with HBV-infected cells. The combined effect of these antibodies was also investigated by complement-dependent cytotoxicity assay.

Experience-dependent modulation of motor corticospinal excitability during action observation

The primate premotor cortex is endowed with an "action observation/execution matching system", that is, the same premotor neurons discharge when actions are performed and when actions are observed. Hence, this system predicts a strong visual input to the motor system. Whether this input is dependent on visual experience or not has not been previously investigated. To address this issue we compared corticospinal excitability while subjects viewed frequently observed and less frequently observed hand actions of others and of themselves. Motor corticospinal excitability was larger when the action orientations were as they are frequently observed (Self-away, subject's own hand facing out from the subject, or Other-toward, an unknown hand facing toward the subject) compared with less frequently observed actions (Self-toward, subject's own hand facing "toward" the subject, or Other-away, an unknown hand facing out from the subject). This finding suggests that the modulation of motor corticospinal excitability during action observation and hence the "action observation/execution matching system" is largely dependent upon visual experience.

Cloning and expression of human anti-tumor necrosis factor-alpha monoclonal antibodies from Epstein-Barr virus transformed oligoclonal libraries

Peripheral blood was obtained from a healthy human volunteer and transformed with Epstein-Barr virus (EBV). This produced an oligoclonal cell library in culture medium that was screened by ELISA for anti-human tumor necrosis factor-alpha (TNFalpha) activity. RNA from two positive clones was applied to RT-PCR using antibody-specific primers, and the light (kappa and lambda) and heavy chain genes (gamma and mu) were cloned into the plasmid vector pFab1-His2. The antibodies produced in Escherichia coli as Fab fragments were assayed for anti-TNFalpha activity utilizing ELISA. Two IgG1/kappa anti-TNFalpha antibodies and two IgM/kappa anti-TNFalpha antibodies were isolated. DNA sequence analysis showed that the VL and VH gene families of IgM and IgG were the same. Both the antibodies showed almost the same activity on ELISA-testing. Ten clones randomly selected from light (kappa and lambda) and heavy (gamma and mu) chain genes in the oligoclonal cell library 1D5 were sequenced, and each gene (kappa, lambda, gamma, and mu) was found to be composed of one to three different genes. These data support the conclusion that the cell clone is oligoclonal at the molecular level.

The role of the dorsolateral prefrontal cortex during sequence learning is specific for spatial information

Many studies have implicated the dorsolateral prefrontal cortex in the acquisition of skill, including procedural sequence learning. However, the specific role it performs in sequence learning has remained uncertain. This type of skill has been intensively studied using the serial reaction time task. We used three versions of this task: a standard task where the position of the stimulus cued the response; a non-standard task where the color of the stimulus was related to the correct response; and a combined task where both the color and position simultaneously cued the response. We refer to each of these tasks based upon the cues available for guiding learning as position, color and combined tasks. The combined task usually shows an enhancement of skill acquisition, a result of being driven by two simultaneous and congruent cues. Prior to the performance of each of these tasks the function of the dorsolateral prefrontal cortex was disrupted using repetitive transcranial magnetic stimulation. This completely prevented learning within the position task, while sequence learning occurred to a similar extent in both the color and combined tasks. So, following prefrontal stimulation the expected learning enhancement in the combined task was lost, consistent with only a color cue being available to guide sequence learning in the combined task. Neither of these effects was observed following stimulation at the parietal cortex. Hence the critical role played by the dorsolateral prefrontal cortex in sequence learning is related exclusively to spatial cues. We suggest that the dorsolateral prefrontal cortex operates over the short term to retain and manipulate spatial information to allow cortical and subcortical structures to learn a predictable sequence of actions. Such functions may emerge from the broader role the dorsolateral prefrontal cortex has in spatial working memory. These results argue against the dorsolateral prefrontal cortex constituting part of the neuronal substrate responsible for general aspects of implicit or explicit sequence learning.

Four cases of bronchiolitis obliterans organizing pneumonia associated with thyroid disease

We present 4 cases of bronchiolitis obliterans organizing pneumonia (BOOP) associated with thyroid diseases. Case 1 had previously undergone surgery for thyroid cancer, and had a secondary hypothyroidism at the onset of BOOP. Case 2 developed Basedow's disease 3 months after the onset of BOOP and BOOP relapsed 21 months after the onset of Basedow's disease. Case 3 developed subacute thyroiditis 33 months after the onset of BOOP, and has had no relapse of BOOP for 7 years. Case 4 had hypothyroidism at the time of diagnosis of BOOP, and her BOOP relapsed 3 months after the initial onset of BOOP. Two of these 4 cases of BOOP with thyroid diseases relapsed, and thyroid dysfunction could modify the pathophysiology of BOOP.

Interindividual variability of the modulatory effects of repetitive transcranial magnetic stimulation on cortical excitability

Repetitive transcranial magnetic stimulation (rTMS) appears to have effects on cortical excitability that extend beyond the train of rTMS itself. These effects may be inhibitory or facilitatory and appear to depend on the frequency, intensity, duration and intertrain interval of the rTMS. Many studies assume facilitatory effects of high-frequency rTMS and inhibitory effects of low-frequency rTMS. Nevertheless, the interindividual variability of this modulation of cortical excitability by rTMS has not been systematically investigated. In this study, we applied 240 pulses of rTMS at 90% of the subjects' motor threshold to their motor cortex at different frequencies (1, 10, 15 and 20 Hz) and examined the effects on motor evoked potentials (frequency tuning curve). Although the averaged group data showed a frequency-dependent increase in cortical excitability, each subject had a different pattern of frequency tuning curve, i.e. a different modulatory effect on cortical excitability at different rTMS frequencies. The interindividual variability of these modulatory effects was still high, though less so, when the number of rTMS pulses was increased to 1,600. These findings illustrate the degree of variability of the rTMS effects in the human brain.

Interhemispheric asymmetry of motor cortical excitability in major depression as measured by transcranial magnetic stimulation

BACKGROUND

Neuroimaging studies of major depressive disorder (MDD) indicate interhemispheric differences in prefrontal cortical activity (right greater than left).

AIMS

To investigate whether there are any interhemispheric differences of motor cortical excitability in MDD.

METHOD

Eight patients with treatment-refractory MDD off medication were assessed for the severity of their depression, and transcranial magnetic stimulation studies (bilateral motor threshold and paired-pulse studies) were conducted. Eight normal controls were also studied.

RESULTS

MDD patients showed significant interhemispheric differences in motor threshold and paired-pulse curves, both of which showed lower excitability on the left hemisphere. Such differences were absent in controls.

CONCLUSIONS

Our findings may aid the further understanding of the neurophysiology underlying MDD.

Modulation of corticospinal excitability by repetitive transcranial magnetic stimulation

OBJECTIVE

Repetitive transcranial magnetic stimulation (rTMS) is able to modulate the corticospinal excitability and the effects appear to last beyond the duration of the rTMS itself. Different studies, employing different rTMS parameters, report different modulation of corticospinal excitability ranging from inhibition to facilitation. Intraindividual variability of these effects and their reproducibility are unclear.

METHODS

We examined the modulatory effects of rTMS to the motor cortex at various frequencies (1, 10, 20 Hz) and at different time-points in twenty healthy volunteers.

RESULTS

We observed significant inhibition of MEPs following 1 Hz rTMS and significant facilitation of MEPs following 20 Hz rTMS for both day1 and day 2. Interestingly, at 1 Hz and 20 Hz rTMS, the modulatory effect produced by rTMS was greater on day 2. However, there was no significant change in corticospinal excitability following 10 Hz rTMS neither on day 1 nor day 2.

CONCLUSION

Our findings raise questions as to how stimulation parameters should be determined when conducting studies applying rTMS on multiple days, and in particular, studies exploring rTMS as a treatment modality in neuropsychiatric disorders.

Bacterial expression of a human recombinant monoclonal antibody fab fragment against hepatitis B surface antigen

The Fab fragment was cloned from the monoclonal cell line TAPC301-CL4, which was produced using the Epstein-Barr virus (EBV) transformation method. This cell line produces a human monoclonal antibody (CL4MAb) against the hepatitis B surface antigen (HBsAg). This MAb was shown to have hepatitis B virus (HBV) neutralizing activity in chimpanzees. The Fab fragment was produced by subjecting the heavy and light chain antibody genes of the TAPC301-CL4 cell line to reverse transcription-polymerase chain reaction, cloning the products in the plasmid vector pFab1-His2 and introducing the plasmid into bacteria. Sequence analyses of the CL4Fab fragment revealed that the light and heavy chains belong to the Vk3a and VH3 groups of the immunoglobulin (Ig) family, respectively. An enzyme-linked immunosorbent assay confirmed that specificity of the recombinant CL4Fab antibody against HBsAg was the same as that of the parental MAb. Flow cytometric analysis using PLC/PRF/5 (Alexander) cells, which express HBsAg, showed the reactivities of the CL4MAb and CL4Fab antibody were the same. These results suggest that the recombinant CL4Fab antibody produced by Escherichia coli using the new vector-primer system developed for human IgG Fab fragments has a very high affinity for the HBsAg and may be useful clinically. A source for generation of human MAb for human therapy with very stable and specific expression was thus produced by isolating antibodies from EBV-transformed cell lines.

Understanding taijin kyofusho through its treatment, Morita therapy

This article presents a brief review of the definition, nosology, history, clinical features, and etiology of taijin kyofusho. Special attention is also given to Morita therapy for taijin kyofusho. The term taijin kyofusho literally means the disorder (sho) of fear (kyofu) of interpersonal relations (taijin). Morita therapy was developed by Masatake Morita in the 1910s to treat the Japanese mental disorders called shinkeishitsu and taijin kyofusho. It is suggested that taijin kyofusho is an excellent example of a mental disorder in which understanding its treatment is an integral part of its conceptualization.

Preparation of recombinant human monoclonal antibody Fab fragments specific for Entamoeba histolytica

Genes coding for human antibody Fab fragments specific for Entamoeba histolytica were cloned and expressed in Escherichia coli. Lymphocytes were separated from the peripheral blood of a patient with an amebic liver abscess. Poly(A)+ RNA was isolated from the lymphocytes, and then genes coding for the light chain and Fd region of the heavy chain were amplified by a reverse transcriptase PCR. The amplified DNA fragments were ligated with a plasmid vector and were introduced into Escherichia coli. Three thousand colonies were screened for the production of antibodies to E. histolytica HM-1:IMSS by an indirect fluorescence-antibody (IFA) test. Lysates from five Escherichia coli clones were positive. Analysis of the DNA sequences of the five clones showed that three of the five heavy-chain sequences and four of the five light-chain sequences differed from each other. When the reactivities of the Escherichia coli lysates to nine reference strains of E. histolytica were examined by the IFA test, three Fab fragments with different DNA sequences were found to react with all nine strains and another Fab fragment was found to react with seven strains. None of the four human monoclonal antibody Fab fragments reacted with Entamoeba dispar reference strains or with other enteric protozoan parasites. These results indicate that the bacterial expression system reported here is effective for the production of human monoclonal antibodies specific for E. histolytica. The recombinant human monoclonal antibody Fab fragments may be applicable for distinguishing E. histolytica from E. dispar and for use in the serodiagnosis of amebiasis.

Bacterial expression of a neutralizing mouse monoclonal antibody Fab fragment to a 150-kilodalton surface antigen of Entamoeba histolytica

A mouse monoclonal antibody (MAb) (EH3015, IgG1 with a K light chain) prepared by hybridoma technology recognizes a 150-kD surface antigen of Entamoeba histolytica and inhibits adherence and cytotoxicity of the ameba to mammalian cells. The genes encoding the light chain and the Fd region of the heavy chain of the MAb were cloned and expressed in Escherichia coli. The plasmid used was designed for the expression of Fab with a hexa-histidine tag in the periplasmic space. Recombinant Fab fragments were purified and analyzed by an indirect immunofluorescence antibody test and Western immunoblot. The specificity of the recombinant Fab fragment was comparable with the parent whole IgG. In addition, the Fab fragments significantly inhibited the adherence of E. histolytica to erythrocytes. These results suggest that the production of a neutralizing MAb in Escherichia coli is practical and efficient with this expression system.

Factors related to the relapse of bronchiolitis obliterans organizing pneumonia

STUDY OBJECTIVE

The purpose of this study is to determine factors, including laboratory data, related to the relapse of bronchiolitis obliterans organizing pneumonia (BOOP).

DESIGN

Retrospective study.

SETTING AND PATIENTS

The medical files of Fukuoka University Hospital and Nishi Fukuoka Hospital patients from 1984 to 1996 were reviewed, and 18 cases of BOOP that had been diagnosed using transbronchial or open lung biopsy were selected for evaluation.

MEASUREMENTS

The 18 cases were put into two groups composed of 7 patients who relapsed and 11 who did not relapse. Their clinical symptoms and laboratory data at first admission, including hemograms, blood chemistry tests, and pulmonary function tests were compared. Patients with or without associated diseases, such as collagen vascular diseases, were compared using the same parameters in order to examine the relationship between the associated diseases and BOOP relapse.

RESULTS

The serum levels of total protein and albumin in patients who relapsed were significantly lower than in patients who did not relapse, respectively: 5.8 (range, 4.4 to 6.2) vs 6.3 (range, 4.5 to 6.8) g/dL, p < 0.05; and 2.9 (range, 2.5 to 3.4) vs 3.7 (range, 2.8 to 4.3) g/dL, p < 0.01. Levels of serum albumin in BOOP patients with associated diseases, however, were significantly lower than in those without associated diseases, respectively: 2.95 (range, 2.5 to 3.9) vs 3.65 (range, 2.8 to 4.3) mg/dL, p < 0.05. The fall in serum albumin levels in patients who relapsed, therefore, was probably due to associated diseases. The fact that 5 of 8 patients with associated diseases relapsed but only 2 of 10 without associated diseases relapsed suggests that a relationship exists between associated diseases and the prognosis of BOOP, although this finding was not statistically significant because of the small number of cases and the heterogeneity of the associated diseases. The most striking observation was that PaO2 levels in patients who relapsed were significantly lower than in those who did not, respectively: 55.4 (range, 39.9 to 73.2) vs 78.0 (range, 48.4 to 89.4) mm Hg, p < 0.05. However, PaO2 levels were not statistically different between patients with and without associated diseases, respectively: 66.0 (range, 45.4 to 78.8) vs 71.4 (range, 39.9 to 89.4) mm Hg.

CONCLUSIONS

The severity of hypoxemia at first medical examination may be an important determinant for the subsequent BOOP relapse.

Human monoclonal anti-HCMV neutralizing antibody from phage display libraries

Human cytomegalovirus (HCMV) infection in immunocompromised patients causes considerable morbidity and mortality. Although ganciclovir prophylaxis reduces the incidence of HCMV disease, severe side effects raise serious problems. Thus, the development of new strategies for prophylaxis are clearly needed, and human monoclonal antibodies offer a potential alternative. We describe the cloning, using the phage display system, of a recombinant human Fab fragment against HCMV. A phage display library with 4 x 10(6) clones was panned three times against lysates of HCMV-infected cells, and screened by ELISA. Of six antigen-binding clones, one monoclonal antibody reacted strongly to HCMV. In immunostaining analysis, this Fab was able to stain HCMV-infected cells from 24 h post-infection (pi) through to 96 h pi, but not at 6 h pi. In the presence of cytosine arabinoside, HCMV-infected cells were not stained, even at 24 h pi. These results indicate that an HCMV protein that was recognized by the Fab was synthesized in the late phase of infection. In addition, this Fab exhibited neutralizing activity: at 1 microg/ml it reduced HCMV plaque formation by 50%. The Fab was able to neutralize three HCMV strains, but it did not neutralize HSV-1 or -2 infection.

The development of a sensitive and specific enzyme immunoassay for FK480, a novel cholecystokinin type-A receptor antagonist, in human plasma

A sensitive and specific enzyme immunoassay for FK480, a novel cholecystokinin type-A (CCK-A) receptor antagonist, was developed to study the pharmacokinetics of the drug at low-dose administration using a specific monoclonal antibody. The high performance liquid chromatography (HPLC) method had been used for studying toxicokinetics, but its determination limit (2.5 ng ml-1) was too high for use in clinical studies. Subsequently we developed an enzyme immunoassay (EIA) using rabbit anti-FK480 serum (polyclonal antibody). It had higher sensitivity (0.1 ng ml-1) when 0.5 ml of plasma was used but its specificity was low because of the cross-reactivity of the metabolites of FK480. Therefore we produced several monoclonal antibodies for FK480 by cell fusion, and selected the antibody which was least cross-reactive for the isolated metabolites of FK480. Finally we developed a sensitive and specific EIA using this monoclonal antibody. The lower limit of quantification of this method was 0.2 ng ml-1 when 0.2 ml of human plasma was used. The coefficient of variation over the calibration range (0.2-10 ng ml-1) was less than 15%. We used this method for clinical studies, and it showed a good correlation to the HPLC method when plasma concentration was 2.5 ng ml-1 or more.

Real-time analysis for MBE by time-resolved core-level photoelectron spectroscopy

A system has been developed for the real-time analysis of surface reactions during molecular beam epitaxial growth which uses photoelectron spectroscopy with VUV light taken from synchrotron radiation. This system consists of a synchrotron radiation beamline and growth/analysis apparatus in which photoelectron spectroscopy is performed with sub-second time resolution. In this system, photoelectron spectra are measured in sequence by a 'non-scanning' measurement method that enables the acquisition of snapshot photoelectron spectra using a multi-channel detector. This non-scanning measurement method was enabled by equipping an electric field correction grid. This system was used to monitor the photoelectron spectra of a GaSb(001) surface.

Optical design for a bending-magnet beamline based on a varied-line-spacing plane grating

A vacuum ultraviolet beamline with a grazing-incidence constant-deviation-angle monochromator, equipped with a varied-line-spacing plane grating, has been designed for a bending-magnet light source. This type of monochromator has become very popular because of its high resolution, high throughput, simple scanning mechanism and fixed exit slit. To improve the energy resolution for a wide spectral range, Yan & Yagishita [(1995), KEK Report 95-9. KEK, Tsukuba, Ibaraki 305, Japan] proposed eliminating the defocus aberration at two specific energies in the spectral range, and their monochromator successfully achieved higher energy resolution by using an undulator light source. The possibility of applying this method to a bending-magnet beamline was examined and it was found that high performance can be achieved even using a bending-magnet light source with wide emittance. Performance evaluation relating to energy resolution, photon flux and spot size are reported.

Submicrometre-area high-energy-resolution photoelectron spectroscopy system

A submicrometre-area photoelectron spectroscopy system that uses a multi-layer-coated Schwarzschild objective as the soft X-ray microbeam optics has been developed. The system is located at an undulator beamline (BL-16U) at the Photon Factory in the High Energy Accelerator Research Organization. By knife-edge measurement, the microbeam size was estimated to be 160 nm at the sample position using a 25-75% criterion. Photoelectron spectral measurements revealed that the Fermi edge width was 0.12 eV, which means that the instrumental resolution was 0.05 eV, after removing the natural broadening of the Fermi edge at room temperature. This system offers both high energy resolution and high spatial resolution.

[Neutralizing human antibody specific for human cytomegalovirus in E. coli expression system]

We isolated neutralizing human Fab fragment specific for human cytomegalovirus (HCMV) by phage display system. Fab libraries were constructed from peripheral lymphocyte of healthy individual. In several clones reacted for HCMV-infected HEL cells, one clone, designated 13-3, stained HCMV infected cells at 96 hrs post infection. It didn't react to cells at 6 hrs post infection or infected cells in the presence of AraC, meaning that 13-3 recognized protein synthesized at late times of infection. It also neutralized HCMV, Towne strain, efficiently. This neutralizing activity was specific for HCMV and no effect for HSV-1 and 2.

Free rectus abdominis musculocutaneous flap for head and neck reconstruction

Surgery in the head and neck often results in large and complex tissue defects. The free rectus abdominis musculocutaneous flap has many advantages for reconstruction of these defects. A good volume of tissue can be harvested with a long and large-diameter vascular pedicle. A reliable blood supply enables thinning, shaping and molding of the flap, and it can be elevated with the patient in the supine position. The harvesting technique is easy with good visualization. The authors prefer this free flap for reconstructing relatively large defects in the head and neck, and have had experience with 55 cases, which were analyzed for results and complications.

Disseminated intravascular coagulation associated with pulmonary tuberculosis

Disseminated intravascular coagulation (DIC) is a very rare complication of pulmonary tuberculosis. We herein describe a case of cavitary tuberculosis complicated with DIC. Rifampin was considered to deteriorate the clinical course of DIC in this case.

[Pulmonary function during exercise before and after radical esophagectomy for esophageal cancer]

Since the postoperative long-term evaluation for thoracic esophageal carcinoma had not been sufficient by a conventional respiratory function test alone, investigation was carried out by observing the changes in motor tolerance. The subjects were selected of 50 cases who elapsed more than 3 months before and after the operation among the cases who had been undergone radical operations with right thoracotomy and laparotomy for thoracic esophageal carcinoma; and then all of the subjects were subjected to a conventional respiratory function test and a respiratory movement loading test. Furthermore, investigation by use of multivariate analysis (Quantification: Class 1) was conducted for the factors relating to the depression of respiratory movement. For loading the movement, bicycle-type ergometer were employed, and a graded gradual-increase loading method was adopted. With the general respiratory function test, vital capacity was depressed from a preoperative average value of 2.1 +/- 0.4 (1/m2) to a postoperative average value of 1.6 +/- 0.3 (1/m2) showing a depressing trend being significant to a postoperative condition (p < 0.0001), and no significant postoperative difference was observed for FEV 1.0%. Even in such a condition, no significant depression was observed for oxygen intake at resting, but the maximum oxygen intake showed a significant depression (p < 0.0001) from a preoperative average value of 22.3 +/- 5.0 to a postoperative average value of 19.3 +/- 4.1 ml/min/kg. The maximum carbon oxide evacuation showed a significant depression (p < 0.0001) after operation. The ventilation quantity in a course of movement showed a depressing trend after operation, with be number of respiration in an increasing trend, showing a shallow-but-quick respiratory pattern. Mobility restriction due to circulation factors was not observed, and also the nutrition before and after operation did not show any significant difference in the blood examination. But the lactic acid during movement showed a significant increase after operation. As described above, it is considered that a pattern of restrictive impairment at resting increased an oxygen equivalent resulted from depression of oxygen intake by the movement, an increase in dead space ventilation rate for minute ventilation at movement, and a shallow-but-quick respiratory pattern have caused aggravation of the ventilation efficiency, which finally led to the interruption of movement. In a long-term period, as clinical factors relating to those, cigarette smoking, nutrition before operation, age, and postoperative radiation therapy are concerned, which were thus considered the key factors in considering the postoperative long-term QOL. Nutrition and rehabilitation by continuous muscle training is necessary to improve the long-term QOL, after radical esophagectomy.

Comparative study of auricular dimensions for the normal auricles of microtia patients, their parents, and normal individuals

We measured the dimensions of the normal auricle in microtia patients and those of both auricles in their parents, and compared the findings with data obtained in normal individuals. The physiognomical auricular length and width dimensions of the normal auricles in microtia patients were significantly smaller than those in normal individuals. The auricular length of the parents of microtia patients was also significantly smaller than in normal individuals. The auricles of the parents on the same side as those affected by microtia in the patients tended to be smaller than those on the contralateral side.

Saturable, non-Michaelis-Menten uptake of liposomes by the reticuloendothelial system

Multilamellar vesicles (300-350 nm) were infused into the rat femoral vein at the rate of 4, 40 and 400 nmol phosphatidycholine min-1 for 6 h using [3H]inulin as an aqueous marker. The time courses of blood concentration of vesicles, normalized for infusion rate, were not superimposable, showing the non-linearity of liposome disposition in the blood circulation. These time courses of blood concentration were well fitted by a single Michaelis-Menten equation. On the other hand, the time courses of tissue content could not be so accommodated. Additionally, the observed relationship between the uptake of liposomes by the liver and their clearance from it and other organs differed essentially from a simulation based on Michaelis-Menten type saturable kinetics. Therefore, it is suggested that there is a time-dependent non-Michaelis-Menten type process in the phagocytosis of macrophages in the reticuloendothelial system.

Magnetic resonance images of chronic subdural hematomas

Magnetic resonance imaging (MRI) and computerized tomography (CT) scans of 18 patients with 20 chronic subdural hematomas were compared. In many ways, MRI was superior to CT for demonstrating the hematomas. In general, chronic subdural hematomas were hyperintense on both T1- and T2-weighted MRI. The T1 values of chronic subdural hematomas were significantly shorter than gray matter values and significantly longer than white matter values. The T2 values were significantly longer than both gray matter and white matter values. These findings were consistent with previous reports. However, six hematomas (30%) were iso- or hypointense on T1-weighted images. Possible mechanisms responsible for the difference in intensity of chronic subdural hematoma on MRI are discussed, and the important role of methemoglobin formation is emphasized.

Local cellular immunity in tuberculous pleurisy

The characteristics and function of lymphocytes in both pleural exudate and peripheral blood in 18 patients with tuberculous pleurisy were studied. The pleural fluid of 13 of 16 patients with tuberculous pleurisy had more T-lymphocytes than the peripheral blood. The difference between them was significant by the t test (p less than 0.05). When lymphocytes in peripheral blood were cocultured with purified protein derivative (PPD), lymphocytes from only 4 of 18 patients produced immune interferon on the fifth day. The titer was only 4 or 8 units/ml. On the contrary, lymphocytes in pleural fluid from 17 of 18 patients reacted to PPD and produced immune interferon on the fifth day, and titers were much higher (more than 128 units/ml) than those of lymphocytes in peripheral blood. When the relationship between the interferon titer produced by lymphocytes in pleural effusion and tuberculin skin reaction was investigated, the group with the stronger skin reactions showed a significantly higher interferon production (p less than 0.05). In conclusion, exudative-sensitized lymphocytes in morbid sites reacted to the specific antigen more effectively and produced titers of lymphokines than circulating lymphocytes.