Diabetic peripheral neuropathy and prevalence of erectile dysfunction in Japanese patients aged <65 years with type 2 diabetes mellitus: The Dogo Study

Only limited epidemiological evidence exists regarding the relationship between diabetic neuropathy and erectile dysfunction (ED) among Japanese patients with type 2 diabetes mellitus. To investigate the relationship between diabetic neuropathy and ED among Japanese patients with type 2 diabetes mellitus, a multicenter cross-sectional study was conducted in 287 male Japanese patients with type 2 diabetes mellitus, age (19-65 years). Diabetic neuropathy was diagnosed if the patients showed two or more of the following three characteristics: neuropathic symptoms, decreased or disappeared Achilles tendon reflex and/or abnormal vibration perception. ED, moderate to severe ED, and severe ED were defined as present when a subject had a Sexual Health Inventory for Men score <22, <12 and <8, respectively. The prevalence values of diabetic neuropathy and severe ED were 47.0 and 39.0%, respectively. Diabetic neuropathy was independently positively associated with severe ED, but not ED and moderate ED: the adjusted odds ratio was 1.90 (95% confidence interval: 1.08-3.38). No relationships were found between diabetic retinopathy or diabetic nephropathy and ED. Diabetic neuropathy is positively associated with severe erectile dysfunction among Japanese type 2 diabetes mellitus patients aged <65 years.

Decompression procedure using a microendoscopic technique for thoracic myelopathy caused by ossification of the ligamentum flavum

BACKGROUND

Microendoscopic discectomy (MED) is one of the minimally invasive endoscopic procedures for treating lumbar disc herniation. The aim of this case report is to describe a patient with thoracic ossification of the ligamentum flavum (OLF) that was completely removed using the microendoscopic technique.

CASE REPORT

We report on a 62-year-old male patient who presented with thoracic myelopathy caused by OLF at the Th11-12. A posterior decompression via spinous process splitting approach using the microendoscopic technique at the Th11-12 was performed. The bilateral ossified ligamentum flavum could be en bloc removed separately. A sufficient decompression of the spinal cord and the spinal canal with no evidence of damage on the paraspinal muscles was demonstrated on magnetic resonance images after surgery. The patient's neurological symptoms were alleviated at 24 months after surgery. There was no evidence of postoperative instability at the final follow-up.

CONCLUSION

The authors found that the microendoscopic technique could be applied to decompression surgery for thoracic OLF. The procedure could provide a sufficient decompression with minimum damage to the paraspinal muscles. However, the microendoscopic procedure should be indicated only for select thoracic OLF, such as OLF without fusion at the middle of the spinal canal and OLF without dural ossification, because of its technical difficulties.

Multi-institutional phase II study of carboplatin-gemcitabine combination chemotherapy in elderly patients (pts) with advanced non-small cell lung cancer (NSCLC)

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Background: Because elderly pts may tolerate platinum-based combination chemotherapy poorly, single-agent chemotherapy is selected for the treatment regimen. However, retrospective subgroup analyses have consistently indicated that elderly pts indeed benefit from platinum-based combination chemotherapy as well as their younger counterparts. This phase II study evaluated the efficacy and safety of carboplatin-gemcitabine combination chemotherapy in elderly pts with advanced NSCLC. Methods: Fifty-four pts aged more than 70 years old (median, 77; range, 70–88) with previously untreated advanced NSCLC were enrolled on this trial. Additional criteria included the presence of measurable lesions, an Eastern Cooperative Oncology Group performance status of 0 or 1, and adequate organ function. Pts received carboplatin at an area under the curve of 4 mg/ml/min on the first day and gemcitabine at 1000 mg/m2 on the first and eighth day of consecutive 3 week periods. The primary endpoint was to determine the objective response rate of this platinum-doublet regimen. The RECIST criteria were used to measure response. Results: Enrolled pts included 15/39 with stage IIIB/IV diseases. Fifty-one out of enrolled pts were eligible for efficacy and safety analyses. The median number of treatment cycles was 4 (range, 1–7). Fifteen partial responses (response rate: 29%) were obtained. The median TTP was 118 days. Hematological toxicities of grade 3/4 included leukopenia (46%), neutropenia (72%) and thrombocytopenia (50%). Non-hematological toxicities of grade 3/4 included nausea (6%), appetite loss (7%), fatigue (7%) and infection (9%). Conclusions: The combination carboplatin-gemcitabine at these doses has shown activity with a favorable toxicity profile for fit elderly pts with advanced NSCLC.

No significant financial relationships to disclose.

Regulation of renal cell carcinoma cell proliferation, invasion and metastasis by connexin 32 gene

Gap junctions composed of connexin (Cx), a large protein family with a number of subtypes, are a main apparatus to maintain cellular homeostasis in many organs. Gap junctional intercellular communication (GJIC) is actively involved in all aspects of the cellular life cycle, ranging from cell growth to cell death. It is also known that the Cx gene acts as a tumor-suppressor due to the maintenance of cellular homeostasis via GJIC. In addition to this function, recent data show that the GJIC-independent function of Cx gene contributes to the tumor-suppressive effect of the gene with specificity to certain cells. With respect to the tumor-suppressive effects, Cx genes acts as tumor-suppressors in primary cancers, but the effects are still conflicting in invasive and metastatic cancers. We have previously reported that Cx32 is specifically downregulated in human renal cell carcinoma (RCC) cell lines as well as cancerous regions when compared to normal regions in kidneys. In recent studies, we have also reported that Cx32 suppresses growth, invasion and metastasis of RCC cells. In this minireview, we refer to a new aspect of Cx32-dependent functions against cell proliferation, invasion and metastasis in RCC cells, especially in a GJIC-independent manner.

Randomised phase II study of docetaxel/cisplatin vs docetaxel/irinotecan in advanced non-small-cell lung cancer: a West Japan Thoracic Oncology Group Study (WJTOG9803)

Docetaxel plus cisplatin and docetaxel plus irinotecan are active and well-tolerated chemotherapy regimens for advanced non-small-cell lung cancer (NSCLC). A randomised phase II study compared their efficacy and toxicity in 108 patients with stage IIIb/IV NSCLC, who were randomised to receive docetaxel 60 mg m⁻² and cisplatin 80 mg m⁻² on day 1 (DC; n=51), or docetaxel 60 mg m⁻² on day 8 and irinotecan 60 mg m⁻² on day 1 and 8 (DI; n=57) every 3 weeks. Response rates were 37% for DC and 32% for DI patients. Median survival times and 1- and 2-year survival rates were 50 weeks (95% confidence interval: 34–78 weeks), 47 and 25% for DC, and 46 weeks (95% confidence interval: 37–54 weeks), 40 and 18% for DI, respectively. The progression-free survival time was 20 weeks (95% confidence interval: 14–25 weeks) with DC and 18 (95% confidence interval: 12–22 weeks) with DI. Significantly more DI than DC patients had grade 4 leucopenia and neutropenia (P<0.01); more DC patients had grade ⩾2 thrombocytopenia (P<0.01). Nausea and vomiting was more pronounced with DC (P<0.01); diarrhoea was more common with DI (P=0.01). Three treatment-related deaths occurred in DC patients. In conclusion, although the DI and DC regimens had different toxicity profiles, there was no significant difference in survival.

Effect of prophylactic administration of hyperimmune plasma to prevent Rhodococcus equi infection on foals from endemically affected farms

The effect on foals of prophylactic administration of hyperimmune plasma to prevent R. equi infection was investigated on three farms at which R. equi infection was endemic. Sixteen foals between 10 and 39 days of age were intravenously given 1-21 of hyperimmune plasma. ELISA antibody titres against R. equi were significantly increased and maintained at high levels for over 30 days in most of the recipient foals. The prevalence of R. equi infection was 6.3% (1/16) in the foals that received the immune plasma, and 26.3% (5/19) in the control foals not given the immune plasma on the three farms. For 2 years before and after this field trial on the three farms, 18 of 64 foals (28.1%) showed clinical signs of respiratory tract infection and four of them died of R. equi pneumonia. Heavy contamination of horses and their environment with virulent R. equi was detected by colony blotting, and plasmid profiles also suggested that foals on the three farms were constantly exposed to virulent R. equi. The results of this field trial support previous observations by some researchers that the administration of hyperimmune plasma to foals in the early days of life promotes prevention of R. equi infection on endemic farms; however, the mechanism of hyperimmune plasma protection remains unclear.

Attritional flexor tendon ruptures due to distal radius fracture and associated with volar displacement of the distal ulna: a case report

Flexor tendon rupture following distal radius fractures are rare. In this report, a volarly displaced distal ulna that perforated the volar wrist capsule caused delayed flexor tendon ruptures 25 years after a distal radius fracture. The repair with free tendon graft and the excision of the distal ulna produced a successful result.

Morphological analysis of cervical vertebrae in ataxic foals

Morphological differences between cervical vertebrae were statistically analyzed in ataxic foals to clarify abnormal structural factors in the pathogenesis of this problem. At first, multiple regression analysis and cluster analysis were performed with 28 variables in C3-C7 of 39 control foals without lameness. As a result, there were no sex differences in the growth of all cervical vertebral sites, and the most suitable categorization of the age of the foals was 3 clusters of 8 months old or younger, 9-12 months old and 13 months old or older in any sites in the cervical vertebrae. Twenty-eight ataxic and 19 control foals at the age of 13 months or older were then used for discriminant analysis with 20 variables. As a result, 1-7 variables on C3-C7 were selected for sufficient discrimination, in which the heights of the cranial and caudal orifices of the spinal canal, longitudinal length of the vertebral head and height of the vertebral fossa strongly contributed to the discrimination of all the cervical vertebrae. In addition, the widths and longitudinal diameters of the articular processes on articular surfaces strongly contributed to the discrimination of the caudal region of the neck. In conclusion, it was suggested that the lesion in the cervical spinal cord observed in ataxic foals was caused by morphological abnormalities including osteochondrosis and subsequent degenerative joint disease in the cervical vertebrae.

Efficacy of the new radiographic measurement method for cervical vertebral instability in wobbling foals

Cervical myelography and survey radiography was performed on 12 light breed wobbling foals and a new radiographic measurement method was applied for more accurate diagnosis of cervical vertebral instability. Ratios of stenosis of the spinal canal on survey radiography and myelography using relative values in an individual foal were defined on radiograms of lateral flexed position of mid-cervical region, and coincidence between the ratios and histopathological lesions in the cervical spinal cord was investigated. Five of 6 foals had ratios of stenosis on myelography more than 40% at the intervertebral sites where the most severe histopathological lesions were observed. Four of 6 foals had ratios of stenosis on survey radiography more than 40% at the intervertebral sites where the most severe histopathological lesions were observed. Four of 6 foals had ratios of stenosis on survey radiography more than 40% at the intervertebral sites where the most severe histopathological lesions were observed. False-positive diagnosis of CVI was observed in 1 out of 6 foals without histopathological lesion when both ratios of stenosis on myelography and survey radiography were applied. Although the standard value of 40% should be further investigated, the new radiographic measurement method in this study is very useful in clinical diagnosis of cervical vertebral instability in wobbling foals, and the presence of lesions in the cervical spinal cord and their sites by survey radiography may be estimated more accurately.

Evaluation of a monoclonal antibody-based colony blot test for rapid identification of virulent Rhodococcus equi

We recently generated a monoclonal antibody immunoglobulin G1 (MAb 10G5), which can recognize 15- to 17-kDa antigens, virulence-associated antigens of Rhodococcus equi, and developed a colony blot enzyme-linked immunosorbent assay with MAb 10G5 for the rapid identification of virulent R. equi. In this epidemiologic study, we evaluated the results of the colony blot test in the identification of virulent isolates of R. equi from feces of horses and soil and compared them with those from a conventional procedure (plasmid profiles of isolates by agarose gel electrophoresis). Environmental isolates (778 isolates from feces of foals, 170 isolates from feces of dams, and 1,267 isolates from soil on horse-breeding farms in Hokkaido) were tested by the colony immunoblot test, and 238 of the 778 isolates, 6 of the 170 isolates, and 85 of the 1,267 isolates showed positive signals. Positive isolates were then analyzed for the presence of virulence plasmid DNA, and 235 (98.7%) of the 238 isolates from foals, 6 (100%) of the 6 isolates from dams, and 75 (88.2%) of the 85 isolates from soil showed the presence of virulence plasmids. On the other hand, 50 isolates from each source, which were randomly selected from the isolates that showed negative signals by colony immunoblot, did not contain virulence plasmids. These results demonstrated that the colony blot test that uses a monoclonal antibody specific for virulence-associated antigens is a rapid and reliable test for the identification of virulent R. equi.

Relationships between radiography of cervical vertebrae and histopathology of the cervical cord in wobbling 19 foals

Nineteen wobbling foals (17 males and 2 females) showing lameness of hindlimbs at 6 to 21 months of age were investigated radiographically and histopathologically. Minimum sagittal diameter (MSD), minimum flexion diameter (MFD) and minimum dural sagittal diameter (MDD) were measured on plain radiograms or myelograms taken at neutral and flexed positions as indicators of narrowed vertebral canal. After necropsy, the cervical spines and the spinal cord were examined macroscopically and respectively the relationships between radiographic findings and the corresponding morphological lesions were evaluated. Radiographically, lower values than each minimum reference limits were recorded in 14 foals in MSD, 5 foals in MFD and 6 foals in MDD, respectively. According to the histopathologic examination, the disappearance of axons and myelin sheaths, vacuolated spongy degeneration and appearance of macrophages were recognized symmetrically in the white matter of the cervical cord. These lesions were centrally located at the spinal cord radiographically demonstrated as compressed sites in 12 out of 17 foals examined. Macroscopically, asymmetrical overgrowth of one side of the process, encroachment of articular processes into the intervertebral foramina and proliferation of bone around articular facets were observed in the articular processes of bone specimens in the caudal neck of 6 foals. In conclusion, the equine incoordination might mainly be caused by the cervical stenotic myelopathy resulting from cervical vertebral malformation, and therefore the cervical vertebral radiography, especially myelography, is quite very important and effective for the diagnosis of wobbling foals.

Muscular dystrophy-like disease in a thoroughbred foal

A 1-month-old male thoroughbred foal, which had difficulty in walking, was killed and examined by histological, histochemical and ultrastructural methods. The muscles of the trunk and upper hind limbs were chiefly affected, and changes in the affected muscles resembled those in muscular dystrophy in man. The type of muscular dystrophy present in this foal and the significance of this disease in thoroughbred horses are discussed. The dystrophy in this foal resembled the limb-girdle type or myotonic dystrophy of muscular dystrophy in man.

Selective staining of hepatitis B surface antigen in thick epoxy sections of liver

Hepatitis B surface antigen (HBsAg) in epoxy-embedded liver tissues can be stained by aldehyde-fuchsin stain. Sections are oxidized in KMnO4 acidified with H2SO4, then bleached in NaHSO3, both at 70 C. Heating for oxidation and bleaching are absolutely necessary. Diluted aldehyde-fuchsin stain adjusted to pH 1.5 to 1.8 with NaOH is used for staining. HBsAg is specifically stained purple. Other components such as mitochondria and bile pigments are also strained, but are easily distinguished from HBsAg. This staining method is advantageous for the identification of HBsAg-positive cells for electron microscopic observation.

Urinary putrescine, spermidine, and spermine in human blood and solid cancers and in an experimental gastric tumor of rats

An improved method of assay of urinary polyamines (putrescine, spermidine, and spermine) was applied to the study of cancer patients and an experimental gastric tumor of rats. Although total polyamines (putrescine, spermidine, and spermine) in urine of patients with blood and solid cancers were significantly high, putrescine concentrations also increased significantly and were shown to be of diagnostic aid even in solid cancers. A significant increase in putrescine was also noted in the urine of rats with experimental stomach tumors induced by N-methyl-N-nitro-N'-nitrosoguanidine.