Response to regarding the case image article entitled "A case of angle-closure glaucoma caused by spontaneous lens dislocation" by Kondo et al

The occurrence of acute angle closure with posterior displacement of the lens is rare compared with that of anterior dislocation; however, several studies have reported its occurrence.

Ulcerative sarcoidosis: An atypical cause of leg ulcers

We present the case of an 83-year-old woman with leg ulcers who was diagnosed with sarcoidosis. This case highlights the importance for clinicians to consider ulcerative sarcoidosis when encountering patients with leg ulcers along with hilar adenopathy, uveitis, elevated serum angiotensin-converting enzyme, and histopathological findings of epithelioid cell granulomas.

A Case Report of Grave's Disease Presenting With an Episode of Restless Legs Syndrome

This case report explores a rare presentation of restless legs syndrome (RLS) in a 59-year-old female with a history of Graves' disease (GD), highlighting the diagnostic challenges and the importance of considering thyroid dysfunctions in RLS. The patient, previously diagnosed and treated for GD, presented with acute nocturnal discomfort in her lower limbs, along with symptoms of fatigue, weight loss, and palpitations. Physical examinations and thyroid function tests indicated a recurrence of GD. Her RLS symptoms notably resolved following the treatment of GD with methimazole, pointing towards secondary RLS induced by GD. This case emphasizes the necessity of a comprehensive diagnostic approach in RLS, particularly in differentiating it from mimicking conditions including leg cramps, arthritis, peripheral neuropathy, and drug-induced akathisia, and identifying underlying etiologies like thyroid dysfunctions. The resolution of RLS symptoms after GD treatment underlines the potential link between thyroid dysfunctions, iron metabolism, and the dopaminergic system in RLS pathophysiology.

Crowned dens syndrome: A case series of 72 patients at eight teaching hospitals in Japan

Background

Crowned dens syndrome (CDS) is characterized by calcification around the odontoid process, accompanied by neck pain. Although CDS is supposedly rare, we regularly diagnose and manage this condition, indicating a perception gap between previous studies and our experience. The purpose of this study was to determine the annual incidence of CDS, time to diagnosis in CDS, as well as the features of CDS.

Methods

The study design was a retrospective case series study conducted at eight teaching hospitals in Japan. We identified CDS cases from April 2013-March 2015. CDS was diagnosed when patients had acute onset of neck pain and CT showed calcification around the dens and when other diagnoses were unlikely.

Results

Seventy-two CDS cases were identified. Mean annual incidence was 4.6 ± 2.3 cases at each hospital. Among those with available data, 57 of 64 had limited rotation (89.1%). The diagnosis of CDS was made in general internal medicine or the emergency medicine department in 61 cases (84.7%). A total of 62 cases (86.1%) were diagnosed within 1 day of presentation, and the median time from initial presentation at the hospital to diagnosis was 0.0 days (25th-75th percentiles, 0.0-1.0). For treatment, NSAIDs were used in 56cases (77.8%) and acetaminophen in 20 cases (27.8%).

Conclusion

CDS might be more common than has been reported to date. Time to diagnosis of CDS was within 1 day of visiting a teaching hospital. Cervical motion restriction is common in CDS and may be useful in establishing the diagnosis.

A Case of Pseudohyperaldosteronism Induced by Yokukansan and Shakuyakukanzoto That Resulted in Severe Hypokalemia

Pseudohyperaldosteronism can be induced by the excessive use of Chinese herbal medicines (Kampo medicines), resulting in serious disorders. We report a case of pseudohyperaldosteronism induced by two Kampo medicines which resulted in severe hypokalemia. A 70-year-old woman was hospitalized for a left calcaneal fracture. She had no subjective symptoms other than trauma. On her admission, blood test results revealed a low serum potassium level of 2.4 mmol/L by chance, as well as low levels of both renin and aldosterone. The patient had been taking 5 g of Yokukansan per day for the past three months. In addition, she was on 5 g Shakuyakukanzoto per day for three months until a month prior to hospitalization. The daily licorice content from the aforementioned herbs was 1.0 g and 4.0 g, respectively. After hospitalization, the administration of the Kampo medicines was discontinued, and 610 mmol of potassium was administered over a period of 13 days, which resulted in the normalization of serum potassium levels. Pre-existing hypertension slowly improved as well. Patients consuming licorice at doses of 2.5 g per day or more, as in our case, are at a high risk of developing pseudohyperaldosteronism. Furthermore, the risk is particularly high with long-term licorice consumption as well as for women and elderly patients. To this end, high-dose potassium supplementation may be necessary for normalizing serum potassium levels. Therefore, awareness regarding the adverse effects of licorice is crucial, even in cases of low dosages of licorice.

A case of superior mesenteric artery syndrome characterized by deep forward bending posture in a cross-legged position on the floor

A 17-year-old healthy male presents with severe epicardial pain and frequent vomiting 1 h after lunch, preferring to sit cross-legged on a stretcher with a deep forward bending posture along with difficulty lying down. SMA syndrome should be considered in the differential diagnosis of patients demonstrating such posture.

Inclusion body myositis in an older patient following a fall

After experiencing a fall, an 82-year-old woman developed progressive loss of lower limb strength and was diagnosed with inclusion body myositis. Although falls and muscle weakness are often regarded as consequences of aging, inclusion body myositis should be considered in a patient with a history of multiple falls.

A case of angle-closure glaucoma caused by spontaneous lens dislocation

Spontaneous lens dislocation without genetic factors is rare. In this case, spontaneous lens dislocation occurred without an apparent trigger and resulted in secondary angle-closure glaucoma. A head computed tomography (CT) scan showed lens dislocation. It is critical to assess for lens dislocation during head CT scan for a sudden headache.

Accessory liver lobe in the right thoracic cavity

A healthy 42‐year‐old man presented to the hospital because of chest radiography performed during a medical checkup revealed a tumor. Contrast‐enhanced computed tomography showed a tumor of 5 cm diameter just above the right diaphragm with blood flow from the portal vein. The patient was diagnosed with accessory liver lobe (ALL). No finding suggested malignancy, and he is being followed up. ALLs are usually found in the abdominal cavity, but they can also be found in the thoracic cavity. Although ALL is rare, it should be considered in patients presenting with intrathoracic tumors.

Cytomegalovirus colitis with a new diagnosis of ulcerative colitis in an elderly woman

Objectives: Cytomegalovirus (CMV) colitis is generally diagnosed in immunocompromised patients. It is rare for patients who are not immunocompromised to develop CMV colitis. Cases of CMV colitis in patients with inflammatory bowel disease have also been reported. We encountered a case of CMV colitis with a new diagnosis of severe ulcerative colitis and demonstrated the importance of suspecting ulcerative colitis in immunocompetent patients with CMV colitis.

Patient: A 78-year-old woman was hospitalized with fever and diarrhea that had lasted for a month. Colonoscopy revealed continuous diffuse edema, mucosal redness, and multiple punched-out ulcers with bleeding, suggesting cytomegalovirus (CMV) colitis, although she was not immunocompromised. Immunohistochemical staining revealed CMV-positive cells, and CMV colitis was diagnosed. One month later, a colonoscopy was conducted owing to persistent symptoms despite initiating the prescribed antiviral drug. A complete loss of vascular pattern, easy bleeding of the crude mucosa, and exacerbation of multiple punched-out ulcers were observed. She was diagnosed with severe ulcerative colitis. The symptoms of ulcerative colitis disappeared with prednisolone and 5-amino salicylic acid treatment.

Conclusion: Ulcerative colitis should be suspected in immunocompetent patients with CMV colitis.

Electrical storm 11 days after acute myocardial infarction: a case report

Background

The definition of electrical storm is still debated. For example, an electrical storm is defined as a clustering of three or more separate episodes of ventricular tachycardia/ventricular fibrillation within 24 hours or one or more episodes occurring within 5 minutes of termination of the previous episode of ventricular tachycardia/ventricular fibrillation. When it is refractory to medications, prompt assessments by coronary angiography, sedation, and overdrive pacing should be performed. An electrical storm may occur anytime, including at night or after the patient leaves an intensive care unit.

Case presentation

A 70-year-old Japanese man with type 2 diabetes mellitus was diagnosed as having ST-elevation myocardial infarction. His clinical course after an urgent percutaneous coronary intervention was uneventful, but he developed electrical storm that was refractory to antiarrhythmic medications on day 11 of hospitalization. We used sedative medications and performed ventricular overdrive pacing and transferred him to a university hospital for further treatment, which included electrical ablation and cardioverter-defibrillator implantation.

Conclusion

An electrical storm is a relatively rare and fatal complication of acute myocardial infarction. It is important that the treatment choices for this condition are known by non-cardiologist physicians who might encounter this rare condition.

A microscopic model for inflation from supersymmetry breaking

We have proposed recently a framework for inflation driven by supersymmetry breaking with the inflaton being a superpartner of the goldstino, that avoids the main problems of supergravity inflation, allowing for: naturally small slow-roll parameters, small field initial conditions, absence of a (pseudo)scalar companion of the inflaton, and a nearby minimum with tuneable cosmological constant. It contains a chiral multiplet charged under a gauged R-symmetry which is restored at the maximum of the scalar potential with a plateau where inflation takes place. The effective field theory relies on two phenomenological parameters corresponding to corrections to the Kähler potential up to second order around the origin. The first guarantees the maximum at the origin and the second allows the tuning of the vacuum energy between the F- and D-term contributions. Here, we provide a microscopic model leading to the required effective theory. It is a Fayet-Iliopoulos model with two charged chiral multiplets under a second U ( 1 ) R-symmetry coupled to supergravity. In the Brout-Englert-Higgs phase of this U ( 1 ) , the gauge field becomes massive and can be integrated out in the limit of small supersymmetry breaking scale. In this work, we perform this integration and we show that there is a region of parameter space where the effective supergravity realises our proposal of small field inflation from supersymmetry breaking consistently with observations and with a minimum of tuneable energy that can describe the present phase of our Universe.

Clinical significance of reversed R wave progression in right precordial leads

Objective: Poor R wave progression in right precordial leads is a relatively common electrocardiogram (ECG) finding that indicates possible prior anterior myocardial infarction (MI); however, it is observed frequently in apparently normal individuals. In contrast, reversed R wave progression (RRWP) may be more specific to cardiac disorders; however, the significance of RRWP in daily clinical practice is unknown. The purpose of this study was to clarify the significance of RRWP in clinical practice.

Materials and Methods: We analyzed consecutive ECGs obtained from 12,139 patients aged ≥20 years at Mito Kyodo General Hospital in Ibaraki between November 2009 and August 2012. Our setting is a secondary emergency hospital in the community, and the study participants were inpatients or patients who visited the general or emergency outpatient departments. RRWP was defined as RV2 < RV1, RV3 < RV2, or RV4 < RV3. Regarding ECGs considered to show RRWP, we confirmed the presence or absence of an abnormal Q wave and whether ultrasound cardiography, contrast-enhanced computed tomography, coronary angiography, and/or left ventriculography were performed to obtain detailed information.

Results: RRWP was identified in 34 patients (0.3%). Among these patients, 29 (85%) had undergone cardiac evaluation. The final diagnosis was previous anterior MI in 12 patients (41%) and ischemic heart disease (IHD) without MI in 5 patients (17%). All 17 patients with IHD had left anterior descending (LAD) artery stenosis. The other patients were diagnosed with dilated (two patients, 7%) and hypertrophic (one patient, 3%) cardiomyopathy, left ventricular hypertrophy (one patient, 3%), or pulmonary embolism (one patient, 3%). Only seven patients (24%) were normal.

Conclusions: RRWP is rare in daily clinical practice; however, it is a highly indicative marker for cardiac disease, particularly IHD with LAD artery stenosis.

Development of polymyalgia rheumatica during hospitalization and diagnosis based on history taking by physical and occupational therapists

Polymyalgia rheumatica (PMR) is frequently reported in the outpatient setting and presents with pain, morning stiffness, mild fever, and fatigue. However, the clinical course of PMR during hospitalization is unknown. We report a case of PMR that developed during hospitalization. PMR diagnosis should begin with an evaluation of core inclusion and exclusion criteria. However, when examining elderly patients, retrieving symptom information from the patient or their family is often difficult, especially during prolonged hospitalization. History taking by physical and occupational therapists or by other health care professionals is paramount in the symptomatic diagnoses of inpatients.

Potential antioxidant bioactive peptides from camel milk proteins

Camel milk is traditionally considered to have medicinal characteristics that it has potential health benefits and could help to treat several illnesses. Particularly, it is closest to human breast milk and has high levels of nutrients and bioactive components. The aim of this study was to explore the antioxidant peptides derived from protein fractions of camel milk. Camel milk proteins (CMP) were fractionated into camel casein protein (CCP) and camel whey protein (CWP), which were hydrolyzed with pepsin to produce peptic digests P-CCP and P-CWP, respectively. RP-HPLC was used for fractionation of the peptides from the P-CCP and P-CWP. The antioxidant activities were evaluated using superoxide anion generating system of xanthine oxidase (XOD) and 2,2-diphenyl-1-picrylhydrazyl (DPPH) scavenging assay. Active peptides were analyzed using matrix-assisted laser desorption ionization time of flight mass spectrometry (MALDI-TOF-MS) whereas a number of antioxidant peptides, with masses ranging from 913 to 2,951 Da, derived mainly from alpha-casein, lactophorin and lactoferrin, were identified. When yeast cells are used as a system for modeling mitochondrial disease, the peptides in caseins and whey fractions significantly enhanced the tolerance of yeast cells against peroxide-induced oxidative stress. The results show that both caseins and whey proteins of camel milk possess bioactive peptides with significant radical-scavenging activities and thus herald a fascinating opportunity for their potential as nutraceuticals or therapeutic peptides for prevention and treatment of oxidative stress-associated diseases.

A typical case of giant cell arteritis with vision loss due to delayed diagnosis

A 75-year-old woman lost vision because of delayed recognition of GCA. Early diagnosis and treatment of GCA are important for preventing visual complications. Physicians must remember to evaluate the entire body, not just a single organ/system.

Reduction in Door-to-Balloon Time with Training for Effective and Efficient Action in Medical Service-Better Process (TEAMS-BP) at a Community Hospital in Japan

ST-elevation myocardial infarction (STEMI) is a fatal condition. Prompt primary percutaneous coronary intervention is associated with lower mortality. However, community hospitals in Japan lack human and medical resources, and implementation of the same strategies as those used in the USA, such as an on-call cardiologist at the hospital, to achieve a door-to-balloon time of ≤ 90 min appears particularly challenging. Therefore, we used Training for Effective and Efficient Action in Medical Service-Better Process (TEAMS-BP) to develop a new process and assessed its effectiveness in reducing door-to-balloon time. TEAMS-BP can optimize the process by making the best use of available materials, machines, facilities and manpower. All processes conducted by physicians, nurses, electrocardiogram technicians, radiological technologists, and clerical staff in the emergency room were reviewed, documented, and standardized using the four steps of TEAMS-BP. The following processes were implemented: setting time goals, calling an electrocardiogram technician beforehand, minimizing tasks before calling a cardiologist, confirming the checklist, and providing data feedback. Forty-four STEMI patients who were treated after TEAMS-BP implementation were compared with 58 who were treated before implementation. Median door-to-balloon, door-to-electrocardiogram and door-to-laboratory times were significantly reduced after TEAMS-BP implementation, decreasing from 106 to 82 min, 14 to 6 min, and 67 to 45 min, respectively. In conclusion, implementation of TEAMS-BP improved the door-to-balloon time of STEMI cases without additional resources or costs incurred by the hospital. TEAMS-BP can be implemented by any hospital wishing to develop a new process that accommodates local working conditions.

Improving the workflow of nursing assistants at a general hospital in Japan

Transferring non-specialised tasks from registered nurses to nursing assistants may help registered nurses focus on specialised tasks. Optimising the workflow of nursing assistants by making their tasks more efficient may improve problems associated with the shortage of registered nurses. The nursing assistants at our hospital were stressed about referring inpatients to outpatient specialty clinics. Therefore, we initiated a project to optimise the referral process and reduce the time spent by nursing assistants on this task, with the collaboration of physicians, registered nurses and administrative assistants. The Training for Effective & Efficient Action in Medical Service–Better Process (TEAMS-BP) method, which was developed by modifying the Japanese Training Within Industry–Job Method, was used for the optimisation process. TEAMS-BP teaches users how to break each task down into its individual components, to scrutinise the details, and then to develop new processes by eliminating, combining, rearranging and simplifying tasks. At baseline, each referral took 10 min and was performed 39 times over 10 days in six wards. The first TEAMS-BP cycle did not yield satisfactory results for the nursing assistants. In the second TEAMS-BP cycle, participants included inpatient and outpatient physicians, registered nurses and administrative assistants. As a result, we changed the referral process from paper to electronic records and streamlined referrals that were ordered by inpatient physicians to outpatient physicians. The use of this method saved the equivalent of 175 hours of nursing assistants’ time per year at no additional cost. If we had been able to define the referral process as an interdisciplinary task and show the merits to each department from the beginning, we may have been able to form the interprofessional team in the first TEAMS-BP. Improving the efficiency of nursing assistants can allow other professionals to focus on their specialised tasks more effectively.

Tetanus in the Elderly: The Management of Intensive Care and Prolonged Hospitalization

Tetanus is a potentially fatal infection. Approximately 100 cases are reported in Japan each year; however, little is known about its clinical course and outcomes in the current era of treatment. We herein report three cases of tetanus in elderly patients who survived after mechanical ventilation and intensive care. These patients, together with six other similar cases, had a median weaning period of 31 days and median length of stay of 77 days. In elderly patients, severe systemic forms of tetanus require prolonged mechanical ventilation and hospitalization. To improve prevention, tetanus vaccination should be promoted more aggressively among those who are susceptible to the disease.

[Screening, Brief Intervention, Referral to Treatment(SBIRT) model for alcohol use disorder in Japan]

The prevalence of alcohol dependence in Japan was 0.9% in 2013, but up to 16% adults drink alcohol at levels of unhealthy use. Primary care physicians play an important role in recognizing alcohol use disorder, helping patients change their behavior, and preventing its medical complications. The Screening, Brief Intervention, Referral to Treatment (SBIRT) model is an evidence-based, cost-effective intervention implemented worldwide to reduce alcohol use disorder.

Nonlinear dielectric response of antiferroelectric liquid crystals in the smectic C alpha* phase

Nonlinear dielectric response of antiferroelectric liquid crystals has been studied in the smectic C(alpha)* (SmC(alpha)*) phase. The linear dielectric spectrum shows a single relaxation of Debye type and its relaxation frequency is as high as one hundred kHz. The profile of the third-order nonlinear dielectric spectrum varies in complex fashion with temperature. In the vicinity of the SmA-SmC(alpha)* phase transition, experimentally obtained nonlinear spectra are well described by those calculated with phenomenological theory of Landau type. The soft mode of the SmC(alpha)* phase shows critical slowing-down near the transition temperature. In the lower-temperature region of the SmC(alpha)* phase, the contribution from the soft mode of the SmC(alpha)* phase reduces and the other relaxation mode with Debye-type spectrum appears at several hundred Hz in the nonlinear spectrum. The appearance of this low-frequency mode suggests that the cooperative fluctuation of directors over long range exists in the SmC(alpha)* phase.

Critical behavior of nonlinear permittivity in the smectic-A phase of chiral liquid crystals

We study the nonlinear permittivity of chiral liquid crystals in the smectic-A (Sm-A) phase near the ferroelectric smectic-C* (Sm-C*) phase and the smectic-C(*)(alpha) (Sm-C(*)(alpha)) phase theoretically and experimentally. The third-order nonlinear permittivity epsilon(3) shows the critical behavior with the exponent of four near the Sm-C* phase and its sign depends on the order of the phase transition. In the case of the Sm-A-Sm-C(*)(alpha) phase transition, the sign inversion of epsilon(3), presumably due to the large fluctuation of order parameter, is observed near the transition temperature.

Influence of deteriorating ability of emotional comprehension on interpersonal behavior in Alzheimer-type dementia

This study investigated the relationship between the ability to recognize emotion and interpersonal behavior in dementia of the Alzheimer type (DAT). After examining the validity and reliability of the Emotion Recognition Test (ERT), an improved version of the tasks used by Shimokawa et al. (2000), 100 patients with DAT underwent evaluation for general cognition using the Mini-Mental State Examination (MMSE) and emotion recognition using the ERT. Within a week of these tests being administered, ward staff rated the patients using the Interpersonal Behavior Checklist (IBC), composed of two behavior scales: indifference to interpersonal relationships and difficulties with patient treatment/management. After investigating the validity and reliability of the scales, the correlations between the MMSE, the ERT, and the two scales of the IBC were calculated. The results suggested that the MMSE did not correlate with either of the two behavior scales, while the ERT correlated significantly with both of the scales. The study results lead to the conclusion that deteriorating emotion recognition ability, rather than deterioration of general cognition, influences the indifferent and awkward interpersonal behaviors of DAT patients.

Optical filters inhibiting television-induced photosensitive seizures

OBJECTIVE

Televised images are the most common stimulus for provoking photosensitive seizures in photosensitive persons. To inhibit photosensitive seizures in photosensitive persons who do or do not have epilepsy, the authors sought nonpharmacologic methods for reducing the levels of photic stimulation of televised images.

BACKGROUND

The authors found two types of pathophysiologic mechanisms (wavelength-dependent and quantity of light-dependent mechanisms) for photoparoxysmal responses (PPR).

METHODS

The authors tested two different types of optical filters, one reflecting long-wavelength red light selectively, which stimulates a wavelength-dependent mechanism, and the other absorbing light in the visible spectrum evenly (neutral density filters). Inhibiting effects of optical filters were studied by conventional intermittent photic stimulation (IPS) using strobe light and novel photic stimulation using flashing cathode ray tubes (CRT).

RESULTS

Both filters individually inhibited PPR insufficiently (less than 50%). Compound optical filters, composed of both types of filters, can inhibit the PPR, approximately 90% for IPS and 95% for photic stimulation with CRT. These compound optical filters do not destroy chromaticity of emissions from the television's CRT.

CONCLUSIONS

These compound filters may be useful to prevent seizures induced by television in photosensitive persons.

Solid state optical activity of dichalcogenides: isolation by chiral crystallization and determination of absolute configuration

[reaction--see text] Optically active diphenyl dichalcogenides were isolated in bulk for the first time by chiral crystallization. The absolute configuration of the P-helical enantiomer of diphenyl disulfide was determined by X-ray crystallography. On the basis of this determination and considering the similarities of the Cotton effects of diphenyl diselenide and ditelluride, the absolute configuration of optically active diphenyl dichalcogenides could be assigned. Furthermore, stereochemistry of chiral crystallization could be controlled by using an optically active crystal as a seed crystal.

Effects of risperidone on event-related potentials in schizophrenic patients

In order to examine the effects of risperidone on cognitive impairment in schizophrenia, event-related potentials (ERPs) were recorded before and after switching from conventional neuroleptics to risperidone in schizophrenic patients. ERPs were recorded during two auditory discrimination tasks (an oddball task and a distraction task) in 10 medicated schizophrenic patients during conventional neuroleptic and risperidone treatments. The amplitudes and latencies of N 100 and P300 component were measured in ERPs for target stimuli in the oddball task and in ERPs for target and novel stimuli in the distraction task. Although N 100 amplitude and latency and P 300 amplitude did not change significantly after switching the drug compared to that during conventional neuroleptic treatment, P 300 latency for target stimuli shortened significantly during risperidone treatment in both tasks, accompanied by the shortening of the reaction time in the distraction task. The P 300 latency change did not correlate with the change of the severity of psychopathology. These findings suggest that risperidone may speed the information processing in schizophrenic patients, contributing to the improvement of cognitive functions.

Comprehension of emotions: comparison between Alzheimer type and vascular type dementias

This study investigated the ability of recognizing emotion in dementia. Twenty-five patients with dementia of the Alzheimer type (DAT), 25 patients with vascular dementia (VD), and 12 normal control subjects were evaluated as to general cognition, visuoperception and emotion recognition. The score on the emotion recognition task significantly correlated with that of the Mini-Mental State Examination for VD patients while this was not the case for DAT patients. Moreover, VD patients performed significantly worse than DAT patients on the emotion recognition task in spite of the fact that there was no difference in the general cognitive and visuoperceptual abilities between them. The result of this study coupled with the past studies led to the hypothesis that the relationship between intellectual deficits and the deterioration in recognizing emotions differs according to type of dementia. Caregivers in nursing homes and hospitals need to take into account their patients' intellectual deficits but also their deteriorating ability of identifying emotions.

A study of the arterial supply of the human acetabulum using a corrosion casting method

This anatomical study concerns the arterial supply of the human acetabulum. The purpose is to contribute to prevention of postoperative necrosis of the acetabular bone fragment after rotational acetabular osteotomy (RAO). The arterial supply of the acetabulum was determined using a corrosion casting method. The acetabular branch of the obturator artery supplies the acetabulum through the acetabular notch. The pubic branches supply the pelvic surface of the acetabulum. Deep branches of the superior gluteal artery supply the superior region and the inferior gluteal artery supplies the postero-inferior region. From these results, we recognized that the important artery for achieving successful RAO is the acetabular branch of the obturator artery that supplies the acetabulum through the acetabular notch.

Event-related potentials and thought disorder in schizophrenia

We examined the relationship between event-related potentials and thought disorder in schizophrenia. The subjects were 29 chronic schizophrenic patients. Thought disorder was assessed using the Comprehensive Index of Positive Thought Disorder developed by Harrow and colleagues (Harrow and Quinlan, 1985; Marengo et al., 1986). Auditory event-related potentials were recorded during a standard oddball task. The P300 amplitude correlated negatively with the severity of the thought disorder. The P300 amplitude in the patients with thought disorder was significantly smaller than in the patients without thought disorder. These results suggest that a reduction in P300 amplitude is associated with a fundamental impairment of information processing in schizophrenic patients.

Effects of hypergravity environment on the parathyroid gland of the norepinephrine-treated golden hamster: a stereological study

Effects of 5-gravity environment on the ultrastructure of the parathyroid glands of norepinephrine-treated golden hamsters were studied. In the centrifuged animals treated with norepinephrine, the volume density occupied by the Golgi complexes associated with numerous prosecretory granules was significantly increased compared with that of the control, centrifuged and norepinephrine-treated animals, as well as the volume density occupied by the cisternae of the granular endoplasmic reticulum compared with that of the control and centrifuged animals. In addition, in the centrifuged animals treated with norepinephrine, numerous secretory granules were situated close to the plasma membrane. It is suggested that the synthesis and release of secretory granules may be markedly stimulated in the parathyroid glands of the norepinephrine-treated golden hamsters subjected to a hypergravity environment.

Induction of terminal differentiation and apoptosis in human colonic carcinoma cells by brefeldin A, a drug affecting ganglioside biosynthesis

An appreciable increase in G(M3) with a concomitant decrease in some neolacto-series gangliosides was observed during differentiation of human colonic carcinoma HCT 116 cells induced by a differentiating agent. When the cells were treated with brefeldin A (BFA), a striking increase in de novo biosynthesis of G(M3) and a decrease in biosynthesis of neolactoseries gangliosides were observed after 6 h. Clear morphological changes to differentiated epithelial cells and an arrest of cells in the G0/G1 phase of the cell cycle were observed after 1 day of treatment. Then the cells were led to apoptosis. This activity was not affected by forskolin, which antagonizes the effects of BFA on protein transport and the Golgi apparatus. These results suggest that the differentiation-inducing activity of BFA might be due to its modulatory effect on ganglioside biosynthesis, and that a specific change in ganglioside pattern is an essential prerequisite for induction of differentiation, providing a novel target for differentiation therapy of cancer.

P3a of event-related potential in chronic methamphetamine dependence

To investigate the psychophysiological features of methamphetamine (MAP) dependence, we recorded auditory event-related potentials (ERPs) in 15 patients with MAP dependence and in 15 age-matched normal controls. ERPs were recorded during a standard oddball task and a read task similar to those employed by Squires et al. (Squires NK, Squires KC, Hillyard SA [1975] Two varieties of long-latency positive waves evoked by unpredictable auditory stimuli in man. Electroenceph Clin Neurophysiol 38:387-401). The patients with MAP dependence showed reduced P3a amplitude and area in the read task and delayed P3b latency with normal P3b amplitude and area in the oddball task. These results suggest that central noradrenergic dysregulation may persist after the remission of acute psychotic symptoms in MAP psychosis and that chronic MAP dependence would produce impairment of the frontal cortex.

Ultrastructure of the parathyroid gland of the young golden hamster after short-term treatment with ethanol

We studied the ultrastructure of the parathyroid gland of young golden hamsters after short-term treatment with ethanol (1.5 g/kg bw or 6.0 g/kg bw). We did not find any ultrastructural changes of the parathyroid gland after administration of 1.5 g/kg ethanol. In the hamsters, 3 hours after administration of 6.0 g/kg ethanol, the mean serum calcium concentration was significantly low as compared to that of the control animals. In the parathyroid gland 1 hour after administration of 6.0 g/kg ethanol, the Golgi complexes associated with a few prosecretory granules and the volume density occupied by the Golgi complexes decreased compared with that of the control animals. In the parathyroid glands 3 hours after administration of 6.0 g/kg ethanol, the Golgi complexes decreased as compared with those of the control animals, while the large vacuolar bodies increased. These findings suggest that the cellular activity of the parathyroid gland is suppressed after short-term treatment with ethanol. Intracellular lumen was found in the parathyroid chief cells 3 hours after administration of 6.0 g/kg ethanol, and the significance of this structure is discussed.

[Reproducibility and wave analysis of multifocal electroretinography]

We studied the reproducibility of multifocal electroretinography by repeated measurements in normal subjects. We also analyzed the amplitude and implicit time of the waves. Nine healthy eyes including myopic cases (-4.1 D on average) of 9 normal males, aged 19 to 42 years, were the objects of study. We used a (Visual Evoked Response Imaging System III (VERIS III), by TOMEY Corp.) for multifocal electroretinography. Each eye was examined 4 times on different days. The stimulus elements consisted of 103 hexagons. The net recording time was 4 minutes. We used the coefficient of variation (standard deviation/average) of 4 measurements of response density as index of reproducibility. Poor fixation and blinking were important factors that affected the reproducibility. In all the 9 eyes, reproducibility of multifocal electroretinography, expressed as average of the coefficient of variation of all regions, was 22% on average. In 6 eyes with good fixation and without blinking, the reproducibility was 15% on average. In 6 eyes with good reproducibility, we analyzed three parameters of the focal response waves: all traces, quadrants and rings, as well as the amplitude and latency of the waves. These data served as controls. Our studies showed that the response density correlated closely with the amplitude and not with the latency in normal subjects.

The parathyroid glands of two species of dolphin--Risso's dolphin, Grampus griseus, and bottlenose dolphin, Tursiops truncatus

Although there have been many reports regarding the structure of the parathyroid glands of various terrestrial mammals, little is known about the parathyroid glands of marine mammals including Cetacea. The morphology of the parathyroid glands of three Risso's dolphins, Grampus griseus (about 3 m in length and 300 kg in weight), and three bottlenose dolphins, Tursiops truncatus (about 3 m in length and 300 kg in weight), was examined macroscopically and microscopically. The dolphins examined in the present study had two or four parathyroid glands that varied in size and location on the thyroid gland. Each parathyroid gland was encapsulated by fibrous tissue on the dorsal surface of the thyroid gland, and was divided into several lobules by interlobular connective tissue which contained numerous capillaries. The parenchymal cells consisted of pale staining chief cells. Each cell was polygonal and about 15 microm in diameter, and had one round or oval nucleus. Oxyphil cells were not found. Considering their greater body size, the parathyroid glands were rather small. By electron microscopic observation, the parathyroid gland of the bottlenose dolphin had sparse granular endoplasmic reticulum, poorly developed Golgi complexes, and abundant secretory granules in the cytoplasm of the chief cells. These results support a possibility that the activity of the parathyroid gland is suppressed to adapt to a sea habitat.

Effect of immobilization on the ultrastructure of the golden hamster parathyroid gland

To investigate the morphological changes of the parathyroid gland of the immobilized hamsters, we studied the ultrastructure of the parathyroid gland of golden hamsters kept in special small cage (Ballman cage II). All hamsters of the control group were kept in one ordinary cage. Each hamster of the isolated group was kept in ordinary cage individually. Each hamster of the immobilized group was kept in Ballman cage II individually. All hamsters were kept for 5 days. On the first and fifth day of the experiment, bone mineral content (BMC) and bone mineral density (BMD) of whole body were measured by dual energy X-ray absorptiometry (DXA). In the control and isolated groups, BMD of the fifth day was significantly increased as compared to that of the first day. In the immobilized group BMC and body weight were significantly decreased. There was no significant difference among 3 groups concerning the mean serum calcium level. Volume density of the cell organelles and inclusions was estimated and compared among 3 groups. Volume density of the lysosomes and large vacuolar bodies of the isolated and immobilized groups was significantly higher than that of the control group. Much more lipid droplets were observed in the immobilized group than the control and isolated groups. No particular differences were observed as to the Golgi complex in the isolated and the immobilized groups compared to the control group. These findings suggest that the cellular activity of the parathyroid gland is suppressed with immobilization.

Event-related potentials during a selective attention task with short interstimulus intervals in patients with schizophrenia

OBJECTIVE

To study selective attention in schizophrenia by examining event-related potentials during a dichotic listening task with short interstimulus intervals (ISIs).

DESIGN

Prospective study.

PARTICIPANTS

Twelve patients with schizophrenia in remission and 12 age-matched controls with no history of psychiatric or neurological illness.

INTERVENTIONS

Participants were asked to push a button in response to target stimuli in either ear.

OUTCOME MEASURES

Reaction time, correct response rate and results of electroencephalography recorded at 3 regions: mean segmental amplitudes between 0 and 200 ms and between 200 and 400 ms after stimuli and processing negativity (Nd), measured by the negative area during these periods.

RESULTS

Distinct slow-positive potentials for unattended stimuli, which were elicited in a task with long ISIs in a previous report, did not emerge in either group in this study. Although the 2 groups did not differ significantly in terms of Nd area, in the controls the mean segmental amplitude for attended standard stimuli was significantly greater than that in the patients with schizophrenia.

CONCLUSIONS

Impairment of selective attention in patients with schizophrenia is related to a lack of ability to focus attention on attended task-relevant stimuli during a selective attention task with short ISI.

Nuclear bodies of the human lung in psittacosis

Lung piece obtained from a female patient with psittacosis by biopsy. A nuclear bodies of five different types were observed, depending on their degree of ultrastructural development. First type showed fibrillary nuclear bodies surrounded by a clear halo. Type II resembled the nuclear body of type I but showed heterogeneously electron density. Type III comprised nuclear bodies with a fibrillary cortex containing a central granular component. These bodies were separated from the nucleoplasm by a clear halo. Type IV was characterized by a more complex structure and resembled the nuclear body of type III but with dense osmiophilic granules. Nuclear bodies of type V were comprised of numerous osmiophilic granules.

Effect of centrifugation on the ultrastructure of the parathyroid gland of the magnesium-treated golden hamster

The ultrastructure of the parathyroid glands (PTG) of magnesium (Mg)-treated golden hamsters exposed to centrifugation at 1.2 G for 7 days was compared to that of the control, Mg-treated or centrifuged groups. In the PTG of the Mg-treated group exposed to centrifugation, the Golgi apparatus increased compared with that of the Mg-treated group, but was similar to that of the control and centrifuged groups. The cisternae of the rough endoplasmic reticulum (rER) increased compared with that of the Mg-treated group and decreased compared with that of the centrifuged group, but was the same as that of the control group. There were no significant differences among the 4 groups with regard to lysosomes, large vacuolar bodies, lipid droplets and secretory granules. These observations suggest that the rER is sensitive to centrifugation compared with the Golgi apparatus and more importantly the inhibitive effect of Mg on the synthesis of the hamster parathyroid hormone is enfeebled by centrifugation at 1.2 G.

[Analysis of choroidal blood flow by laser speckle flowgraphy]

We applied real-time laser speckle flowgraphy (RLSFG) to quantitate the choroidal circulation. RLSFG was developed utilizing the laser speckle phenomenon. A diode laser, 830 nm in wavelength, serves as the light source. The quantitative index of blood flow velocity is represented as normalized blur (NB), or square blur rate (SBR). This method was applied to the posterior fundus of monkey and human eyes. While one measurement covers a fundus area of 1 mm x 1 mm, it is possible to measure a wider fundus area by montage. The wide color maps showed the architecture of choroidal vessels. It was possible to measure the choroidal blood flow in areas free of major retinal vessels. Application of the method to 3 eyes of retinal artery occlusion and 4 eyes of geographic choroiditis showed that the obtained SBR values in normal fundus is derived 25% from the retinal and 75% from the choroidal circulation. The findings show the potential value of RLSFG in quantitating the choroidal blood flow in situ.

The effect of magnesium on the fine structure of the golden hamster parathyroid gland in vivo and in vitro

We examined the effect of magnesium (Mg) on the fine structure of the golden hamster parathyroid gland in vivo and in vitro. In the in vivo study, the principal changes in the parathyroid glands 10 and 30 min, and 1 hr after Mg injection showed a significant decrease in the area of the Golgi apparatus and cisternae of the rough endoplasmic reticulum compared with those of the control animals. The serum calcium level in the experimental animals 30 min and 1 hr after the injection was significantly low compared with that of the control animals. In the vitro study, the area of the Golgi apparatus in the Mg-treated group significantly decreased as compared with that of the control group. These changes suggest that Mg directly suppresses the synthesis of hamster parathyroid hormone in the short term.

Effects of short-term treatment with CaCl2 or EDTA on the parathyroid glands in pregnant golden hamsters, with special reference to large vacuolar bodies

The large vacuolar bodies in the parathyroid glands of pregnant golden hamsters after administration of CaCl2 or EDTA were investigated. In the parathyroid glands of the pregnant animals 15 min after administration of CaCl2, the mean serum calcium concentration was significantly high when compared to that of the control animals. In the parathyroid glands of the pregnant animals 15, 30 and 60 min after administration of EDTA, the mean serum calcium concentration was significantly low when compared to that of the control animals. In the parathyroid glands of the pregnant animals 15 min after administration of CaCl2, the percentage area occupied by large vacuolar bodies was significantly increased when compared to that of the control animals. In the parathyroid glands of the pregnant animals 15 min after administration of EDTA, the percentage area occupied by large vacuolar bodies was significantly decreased when compared to that of the control animals.