Aberrant morphometric networks in Alzheimer's disease have hemispheric asymmetry and age dependence

Alzheimer's disease (AD) is associated with abnormal accumulations of hyperphosphorylated tau and amyloid-β proteins, resulting in unique patterns of atrophy in the brain. We aimed to elucidate some characteristics of the AD's morphometric networks constructed by associating different morphometric features among brain areas and evaluating their relationship to Mini-Mental State Examination total score and age. Three-dimensional T1-weighted (3DT1) image data scanned by the same 1.5T magnetic resonance imaging (MRI) were obtained from 62 AD patients and 41 healthy controls (HCs) and were analysed by using FreeSurfer. The associations of the extracted six morphometric features between regions were estimated by correlation coefficients. The global and local graph theoretical measures for this network were evaluated. Associations between graph theoretical measures and age, sex and cognition were evaluated by multiple regression analysis in each group. Global measures of integration: global efficiency and mean information centrality were significantly higher in AD patients. Local measures of integration: node global efficiency and information centrality were significantly higher in the entorhinal cortex, fusiform gyrus and posterior cingulate cortex of AD patients but only in the left hemisphere. All global measures were correlated with age in AD patients but not in HCs. The information centrality was associated with age in AD's broad brain regions. Our results showed that altered morphometric networks due to AD are left-hemisphere dominant, suggesting that AD pathogenesis has a left-right asymmetry. Ageing has a unique impact on the morphometric networks in AD patients. The information centrality is a sensitive graph theoretical measure to detect this association.

Recurrent Lymphocytic Hypophysitis Presenting as Internal Carotid Artery Stenosis and Oculomotor Nerve Palsy

A 75-year-old woman presented with nausea and vomiting. Magnetic resonance imaging (MRI) revealed that she had a pituitary mass. A biopsy revealed lymphocytic hypophysitis (LYH). Symptoms were improved by hormone replacement therapy. Although she was asymptomatic, follow-up MRI revealed an increase in the size of the mass. Intravenous methylprednisolone (IVMP) reduced the size of the mass; however, right ophthalmalgia and oculomotor nerve palsy developed. MRI showed that the pituitary mass had enlarged to the right oculomotor nerve in the cavernous sinus and to the right internal carotid artery (ICA), causing stenosis of the ICA. After IVMP administration, the symptoms dramatically improved, but ICA stenosis persisted.

Insights from the ganglionic acetylcholine receptor autoantibodies in patients with Sjögren's syndrome

OBJECTIVE

It is not known whether autonomic neuropathy is a feature of Sjögren's syndrome (SS) or whether it is related to circulating antiganglionic acetylcholine receptor (gAChR) antibodies. The goal of the present study was to investigate the autonomic dysfunction in patients with SS and the associations between autonomic dysfunction, anti-gAChR antibodies, and clinical features of SS.

METHODS

(1) The first observational study tested for the presence of gAChR antibodies in the serum samples from 39 patients with SS (absent information regarding autonomic symptoms) and healthy volunteers. (2) In the second study, serological and clinical data from 10 Japanese patients diagnosed with SS were reviewed. These patients showed autonomic dysfunction, and luciferase immunoprecipitation systems (LIPS) test was conducted to detect anti-α3 and anti-β4 gAChR antibodies. (3) In the final analysis, we combined the data of seropositive SS patients with autonomic symptom from the first study with all of the patients from the second study, and analyzed the clinical features.

RESULTS

(1) The LIPS assay revealed that anti-gAChRα3 and anti-gAChRβ4 antibodies were detected in the sera from patients with SS (23.1%, 9/39). Five of nine SS patients had autonomic symptoms. (2) Anti-α3 and anti-β4 gAChR antibodies were also detected in 80.0% (8/10) of patients with SS with autonomic symptoms. Six of the ten patients were diagnosed as having SS after neurological symptoms developed. These seropositive patients had predominant and severe autonomic symptoms and were diagnosed with autonomic neuropathy. (3) Thirteen of fifteen SS patients with autonomic symptoms (86.7%) were seropositive for anti-gAChR antibodies, and we confirmed sicca complex, orthostatic hypotension, upper and lower gastrointestinal (GI) symptoms, and bladder dysfunction at high rates.

CONCLUSION

The present results suggest the possibility of anti-gAChR antibodies aiding the diagnostics of SS with autonomic dysfunction.

Visualization and genetic analysis of alternative splicing regulation in vivo using fluorescence reporters in transgenic Caenorhabditis elegans

Transgenic multicolor fluorescence reporters enable the visualization of alternative splicing patterns at a single-cell resolution in living organisms and facilitate further genetic analyses to identify cis-elements and trans-acting factors involved in splicing regulation. In this paper, we describe a method of generating fluorescence alternative splicing reporters for the nematode Caenorhabditis elegans. We describe strategies for designing minigene reporters and methods for constructing them; DNA fragments ('modules', such as promoter/3' cassettes, a genomic fragment of interest and a fluorescent protein cassette) that exist in separate vectors are assembled using site-directed recombination. We also describe strategies and methods for mutant screening and single-nucleotide polymorphism mapping using fluorescence reporters. This is the first detailed description of the design and construction of fluorescence alternative splicing reporters for C. elegans and their use in subsequent genetic analyses. It takes 2-4 months to construct minigenes and generate extrachromosomal lines for visualizing spatiotemporal distribution of alternative splicing events in vivo. Identification of regulators by integration of transgenes, mutant screening and mapping of the responsible genes takes a further 6-12 months. The fluorescence-reporter construction described here can also be applied to the vertebrate cell culture system.

The behavior and effect of isopoly (S-carboxymethyl-L-cysteine) derivatives of nucleic acid bases

Isopoly(S-carboxymethyl-L-cysteine) derivatives of nucleic acid bases were prepared as antisense compounds. These compounds in vitro have been found to form stable complex with oligo-DNA or RNA. This paper deals with effect of antisense compounds in vivo. The target in this paper is the sequence of the PSD-95 protein linked with NMDA receptor. Excess passing of calcium ions through the loss of the signal pathway without PSD-95 proteins caused by antisense compound. The cells detailing with L-cysteine derivatives showed the lowest percentage of 19.1%. The data were compared with that of phosphotioate antisense compound.

Study about the inhibition of L-cysteine derivatives of nucleic acid bases in protein production

Isopoly (S-carboxymethyl-L-cysteine) derivatives of nucleic acids bases were prepared as antisense compounds. In past study, we investigated the properties of these compounds in vitro, and revealed that these compounds in vivo regulated the cell death presumably due to the inhibition of protein production. In this study, western and northern blots were carried out in order to reveal the mechanism of this inhibition for N-methyl-D-aspartate receptor in neuroblastoma x glioma hybrid NG108-15 cell line. In addition, we investigated the resistance of these compounds against cell extract and the metabolism. In conclusion, we proved that these compounds inhibited the protein production by antisense mechanism.

Transfection of fluorescent probed antisense compounds: L-cysteine derivatives of nucleic acid bases

Antisense with L-cysteine derivative (CAS) can recognize DNA and forms the complementary duplex with DNA. So the properties of CAS in vitro and in vivo were examined in this study. CAS was resistant to proteinase K and stabilized RNA against RNase HI. Moreover using fluorescent CAS, the localization was observed by fluorescence microscope and confocal microscope. As a result, CASs were accumulated inside the nucleus in NG108-15.

PQBP-1 increases vulnerability to low potassium stress and represses transcription in primary cerebellar neurons

PQBP-1 is a polyglutamine tract binding protein implicated in transcription. We previously reported that PQBP-1 and mutant ataxin-1, product of the spinocerebellar atrophy type 1 (SCA1) causative gene, cooperatively induce cell death in culture cells. Simultaneously, we showed that mutant ataxin-1 promoted interaction between PQBP-1 and RNA polymerase II and enhanced repression of the basal transcription by PQBP-1. In this study, we have examined the effects of overexpression of PQBP-1 to the primary-cultured cerebellar neurons. Our results indicate that overexpression of PQBP-1 inhibits the basal transcription in cerebellar neurons and increases their vulnerability to low potassium conditions.

Increase of CD5(+) B cells during adolescence in female mice

We examined physiological changes in CD5(+) B lymphocytes in mice associated with aging (from 1 or 5 to 50 weeks of age). The most predominant populations of lymphocytes among these mice were mainly CD5(-) B cells in the spleen and peritoneal cavity, and T cells in the thymus. However, in the spleen, CD5(+) B cells increased from 1 to 15 weeks, and then decreased with aging. In the thymus, CD5(+) B cells increased from 3 to 9 weeks of age, and subsequently became more predominant than CD5(-) B cells. In the peritoneal cavity, CD5(+) B cells increased from 5 to 9 weeks of age, became the most predominant population in lymphocytes at 7 to 9 weeks of age, and decreased with aging. The proportion of CD5(+) B cells in total B cells increased from 5 to 7 or 9 weeks of age, and then decreased with aging, with the highest proportion at 9 weeks of age in the spleen (15%), thymus (94%), and peritoneal cavity (54%). These findings indicate that CD5(+) B cells increase physiologically during mouse adolescence, and subsequently decrease with aging.

[Video assisted thoracic surgery for the treatment of catamenial pneumothorax]

Video assisted thoracic surgery (VATS) was applied in 3 cases of pneumothorax combined with pathologic changes in the diaphragm (two cases of catamenial pneumothorax and one case of suspected catamenial pneumothorax). Case 1, 39-year-old woman, was preoperatively diagnosed as catamenial pneumothorax in the right lung. Thoracoscope was inserted through the 5th intercostal anterior axillary line and the lesion with the pathologic changes in the central tendon of the diaphragm was incised and sutured with Endo-GIA and Endo-STAPELAR. Case 2, 42-year-old woman, was confirmed to have pathologic changes in the central tendon after insertion of thoracoscope through the 5th intercostal anterior axillary line. Minithoracotomy of 50 mm in size was added close to the center of the diaphragm and direct incision and suture of that part were performed. Case 3, 47-year-old woman, underwent thoracoscopy through the 5th intercostal mid-axillary line and bulla in the S2 interlobar surface was incised with Endo-GIA. In this case, the diaphragm was partially incised through additional minithoracotomy because some lesions were detected on that part. VATS can fully be carried out for pathologic changes in the diaphragm in catamenial pneumothorax. Since catamenial pneumothorax may be complicated with another pathologic changes in the diaphragm (Case 1) or in the visceral pleura (Case 3), the whole thoracic cavity, including diaphragm and visceral pleura, should be carefully observed under thoracoscopy. Application of minithoracotomy-associated thoracoscopic surgery is a useful method in the case to whom catamenial pneumothorax is definite or suspected.

Cytokines production of U5A2-13-positive T cells by stimulation with glycolipid alpha-galactosylceramide

We have previously established and reported a novel monoclonal antibody (mAb), U5A2-13, which recognizes a phenotypically similar population of natural killer (NK)-like T cells. Using U5A2-13 mAb, we now describe the functional properties of U5A2-13(+) T cells in both NK1.1-positive or -negative mouse strains. Similar to NK1.1(+) T cells, hepatic U5A2-13(+) T cells of C57BL/6 (NK1.1(+) strain) mice, but not U5A2-13(-) T cells, could be induced to produce large amounts of IL-4 and IFN-gamma by stimulation with glycolipid alpha-galactosylceramide (alpha-GalCer) present on dendritic cells (DC) in a dose-dependent manner. The abundant production of these cytokines from U5A2-13(+) T cells of BALB/c (NK1.1(-) strain) mice is similar to that noted in C57BL/6 mice. Cytokine production by cultures stimulated with DC of beta2-microglobulin-deficient mice was significantly less than that of cultures stimulated with DC of intact mice. Overall, U5A2-13(+) T cells recognize alpha-GalCer presented by CD1d, indicating that U5A2-13(+) T cells can be used to analyze NK-like T cell function in various strains of mice.

Regression and prevention of autochthonous tumors induced by 3-methylcholanthrene after injection of a T-cell receptor alpha /beta positive and CD4/CD8 double negative T-cells

Both the therapeutic and preventative effects of a murine T-cell line, tMK-2, with T-cell receptor (TCR) alpha/beta positive and CD4-/8- double negative (DN) phenotype against autochthonously tumors induced by subcutaneous (s.c.) injection of 3-methylcholanthrene (MC) were examined. Complete regression of the tumor was observed when administration of tMK-2 cells was begun on tumors 5 mm in diameter. The tumor mass in five out of five mice was reduced in size after the administration of tMK-2 cells regardless of the routes of administration: s.c. injection of tMK-2 cells (5 x 10(7) cells) once a week around tumors, intraperitoneal (i.p.) injection (5 x 10(7) cells), or intravenous (i.v.) injection (1 x 10(7) cells). The tumors regressed to the status of a scar within 1 month of initial injection, and this status was maintained throughout the remainder of the 3 months period of tMK-2 cell injection. One month after discontinuation of tMK-2 cell administration, the diameter of the tumors had not increased regardless of the route of injection. The control groups consisted of either untreated mice, mice with i.v. injection of 1 microg of recombinant murine interleukin (IL)-12 once a week, or mice with s.c. injection of autologous splenocytes (5 x 10(7)) from BALB/c mice once a week. Continuous growth of tumors was observed in each group and all control mice died due to bleeding ulcerations of the tumors. Tumor development was effectively prevented when tMK-2 cells were administrated 1 week after the s.c. injection of MC. In the groups receiving s.c., i.p., and i.v. injection of tMK-2 cells, no MC-induced tumors developed, whereas four out of five of the control mice developed autochthonous tumors. The tMK-2 cells also exerted in vitro NK-like cytotoxic activity, and their killing activity was strongly increased in the presence of both IL-2 and IL-12. These results suggest that the injected T-cells with TCR alpha/beta positive and CD4- /8- DN phenotype and NK-like activity are important in the therapy as well as the prevention of tumor development.

Functional and phenotypical characteristics of hepatic NK-like T cells in NK1.1-positive and -negative mouse strains

We previously reported and partially characterized a unique monoclonal antibody (mAb), U5A2-13, which recognizes a T cell subset similar to NK1.1+ T cells, not only in NK1.1-positive mouse strains but also in NK1.1-negative strains. In NK1.1-positive C57BL/6 mice, U5A2-13+ TCRalphabeta+ cells produced abundant IL-4 as well as extremely high levels of IFN-gamma upon CD3 cross-linking, but this did not occur with U5A2-13- TCRalphabeta+ cells. In NK1.1-negative C3H/He mice, U5A2-13+ TCRalphabeta+ cells produced high levels of IL-4 and IFN-gamma upon CD3 cross-linking, but this was not observed with U5A2-13- TCRalphabeta+ cells. To the best of our knowledge, this is the first direct evidence of the presence of NK-like T cells defined phenotypically by U5A2-13 mAb and functionally by IL-4/IFN-gamma production in NK1.1-negative mouse strains. We also demonstrated that U5A2-13- NK1.1+ T cells and U5A2-13+ NK1.1- T cells in C57BL/6 mice could produce both IL-4 and IFN-gamma. In addition, Vbeta8 or Vbeta7 usage by U5A2-13+ NK1.1- T cells was lower than that by U5A2-13+ NK1.1+ T cells, but remained higher than that by U5A2-13- NK1.1- T cells. Based on the present results, U5A2-13 mAb appears to be a valuable tool in the study of NK-like T cells.

Mouse NK1.1+ cytotoxic T cells can be generated by IL-2 exposure from lymphocytes which express an intermediate level of T cell receptor

NK-like T cells which express the NK1.1 molecule and CD3 (or TCR) of intermediate level (CD3int or TCRint cells) were recently demonstrated to be present in various immune organs, and to have NK-like cytotoxic activity against NK target cells. In this study, we investigated whether NK1.1- T cells could express NK1.1. We found that NK1.1+ TCRint cells were much more abundant in the liver (20%) than in the spleen (2%). When hepatic and splenic mononuclear cells (MNCs) were cultured either in the absence of IL-2 or in the presence of CD3/TCR cross-linking, the original NK1.1+ TCRint cells disappeared. However, when they were cultured in the presence of a high dose of IL-2 for 4 days, a new type of NK1.1+ T cell was formed to the extent of approximately 15-20%, and the liver and spleen contained similar percentages of this new type of NK1.1+ T cells. The phenotypes of the original and the new type of NK1.1+ T cells were clearly distinct. The freshly obtained NK1.1+ TCRint cells consisted of double-negative (DN) CD4-CD8- cells and single-positive (SP) CD4+ cells, whereas the new type of NK1.1+ T cells predominantly consisted of DN CD4-CD8- cells and SP CD8+ cells and expressed a high level of CD3 (CD3high or TCRhigh cells). When NK1.1- cells or IL-2 receptor beta-chain (IL-2Rbeta)- cells were isolated from the liver and spleen, and cultured in the presence of IL-2 for 4 days, NK1.1+ T cells were generated from NK1.1- cells, but not from IL-2Rbeta- cells. Our results suggested that the NK1.1- cells, but not IL-2Rbeta- cells, contained the precursor of IL-2-stimulated NK1.1+ TCRhigh cells. When purified NK1.1- IL-2Rbeta+ TCRint cells were cultured in the presence of IL-2 for 4 days, approximately 10% of the cells became NK1.1+ TCRhigh cells. Approximately 60% of the purified NK1.1+ TCRint cells lost NK1.1 expression. The IL-2-stimulated NK1.1+ TCRhigh cells that had arisen from NK1.1- TCRint cells exerted an NK cell-like cytotoxic activity similar to that of the original NK1.1+ T cells. Thus, NK1.1- TCRint cells could express NK1.1 and exert NK-like cytotoxic activity regardless of their origin. It appears that NK1.1+ TCRhigh cells can only be induced through an IL-2-stimulation pathway but not via CD3/TCR cross-linking.

A novel monoclonal antibody permitting recognition of NKT cells in various mouse strains

By immunizing mouse lymphoma cell line tMK-2U derived from intermediate TCR cells of BALB/c nude mouse, U5A2-13 monoclonal antibody (mAb, a rat IgG2a) was established. U5A2-13 antigen (Ag) was expressed on around 65% of TCRint cells in the liver of the various mouse strains including both NK1.1- and NK1.1+ mouse strains, while NK1.1 Ag was expressed only in NK1.1+ C57BL/6 mouse strain. Among CD3+ cells, 26.3% cells co-expressed U5A2-13 Ag and NK1.1+ Ag, while small proportions of the CD3+ cells were U5A2-13+NK1.1- (9.2%) or U5A2-13-NK1.1+ (4.4%). Among NK1.1+ cells, 54.9% cells co-expressed CD3 and U5A2-13 Ag, while some proportions of the cells were U5A2-13+CD3- (19.4%) or U5A2-13-CD3+ (9.8%). It was found that approximately 85% of NK1.1+CD3+ cells coexpressed U5A2-13 Ag. U5A2-13 Ag with low fluorescence intensity was also expressed on 55% of NK1.1+CD3-NK cells. U5A2-13 Ag immunoprecipitated from tMK-2U cells consisted of three proteins, which were 65 kDa, 33 kDa and 32 kDa under both reducing and non-reducing conditions and these were apparently different from NK 1.1 Ag. These results indicated that U5A2-13 mAb was able to define a similar population to NK1.1+CD3+T cells and to 55% of NK1.1+CD3-NK cells in various strains, through recognizing a different molecule from NK1.1 Ag.

Amelioration of hemiplegia-associated osteopenia more than 4 years after stroke by 1 alpha-hydroxyvitamin D3 and calcium supplementation

BACKGROUND AND PURPOSE

It has been demonstrated that bone mass was significantly reduced on the hemiplegic side of stroke patients, which might increase their risk of hip fracture. We evaluated the efficacy of 1 alpha-hydroxyvitamin D3 [1 alpha (OH)D3] and supplemental elemental calcium in maintaining bone mass and decreasing the incidence of hip fractures after hemiplegic stroke.

METHODS

In a randomized study, 64 patients with hemiplegia after stroke with a mean duration of illness of 4.8 years received either 1 microgram 1 alpha (OH)D3 daily (treatment group, n = 30) or an inactive placebo (placebo group, n = 34) for 6 months and were observed for this duration. Both groups received 300 mg of elemental calcium daily. The bone mineral density (BMD) and metacarpal index (MCI) in the second metacarpals were determined by computed x-ray densitometry. The incidence of hip fractures in these patients was recorded.

RESULTS

BMD on the hemiplegic side decreased by 2.4% in the treatment group and 8.9% in the placebo group (P = .0021), while BMD on the intact side increased by 3.5% and decreased by 6.3% in the treated and placebo groups, respectively (P = .0177). In the treatment group, the difference in BMD between hemiplegic and nonhemiplegic sides decreased significantly compared with that before randomization. This difference increased in the placebo group. We observed a similar improvement in MCI in the treatment group but not in the placebo group. Four patients in the placebo group suffered a hip fracture compared with none in the treatment group (P = .0362).

CONCLUSIONS

Treatment with 1 alpha (OH)D3 and supplemental elemental calcium can reduce the risk of hip fractures and can prevent further decreases in BMD and MCI on the hemiplegic side of patients with a long-standing stroke. Treatment also may improve these indices on the intact side.

Recurrence of spontaneous intracranial hypotension with subdural hematomas

A 59-year-old man developed postural headache associated with a low CSF pressure. A CT scan revealed no abnormal findings and the orthostatic symptoms resolved without treatment 6 weeks after onset. He was diagnosed as having spontaneous intracranial hypotension (SIH) and remained symptom-free until he experienced recurrence of postural headache 9 months later. A lumbar puncture demonstrated low CSF pressure, and a CT scan revealed slit-like ventricles with narrowing of the sulci, Sylvian fissures, and infratentorial cisterns, in addition to bilateral subdural masses. After draining the hematomas, his symptoms resolved completely, and a follow-up CT scan was normal. We hypothesize that recurrent SIH in this case was due to small recurrent tears of a root sleeve. This case emphasizes the importance of follow-up of SIH for at least 9 months after resolution of symptoms.

[Clinical and pathological study of esophageal mucosa with hypopharyngeal cancer]

Hypopharyngeal cancer has been reported to be frequently associated with cancer of the upper gastrointestinal tract, especially the esophagus. We recently reviewed the records of patients who had undergone closed-chest esophagectomy to assess the value of endoscopy with iodine staining as a means of preoperative diagnosis of double cancers in this area and to investigate the characteristics of the hypopharyngeal and esophageal mucosa as sites for multicentric carcinogenesis. The subjects of this study were 30 patients who had undergone closed chest esophagectomy between January 1992 and December 1995 because of hypopharyngeal cancer. The following results were obtained: 1. Preoperative iodine staining often revealed the presence of cancer, with unstained areas covering more than half the circumference of the esophagus and being more than 3 cm in size. 2. Esophageal cancer and hypopharyngeal cancer were detected concurrently in 15 cases (synchronous double cancer) and at different times in 6 cases (metachronous double cancer). Synchronous esophageal cancer was more common in cases of advanced hypopharyngeal cancer, especially Stage IV. 3. When the number of cancer foci, their distribution along the circumference of the esophagus, and the extent of tumor spread in the esophagus were investigated, multiple and localized foci smaller than 1 cm were found to be more common in synchronous cancer, and solitary foci were more common in metachronous cancer. 4. The second primary esophageal cancer often occupied the Im or Ei area, and in metachronous double cancer, it was often localized in the middle and/or inferior segment of the esophagus. 5. In 60% of cases of synchronous double cancer, the esophageal cancer was confined to the mucosa. The esophageal cancer was early stage in 86.7% of cases of synchronous double cancer. These findings allow us to draw the following conclusions: (i) Because esophageal cancer which occurs synchronously with hypopharyngeal cancer tends to recur, it is suggested that a technique that allows complete extraction of the esophagus be selected. (ii) Local treatment such as endoscopic mucosal resection should be selected in metachronous early double cancer. (iii) Unstained areas extending along more than half the circumference of the esophagus and more than 3 cm in size suggest a high probability of the presence of cancer in this area. Adequate examination is needed in such cases. (iv) Screening of the upper gastrointestinal tract is important to detect head and neck cancer. An adequate examination schedule, tailored to the features of individual cases, seems essential.

Vitamin D deficiency and osteopenia in the hemiplegic limbs of stroke patients

BACKGROUND AND PURPOSE

Little is known about bone changes in hemiplegic stroke patients. We evaluated the vitamin D status and bone changes on the hemiplegic and intact sides of stroke patients.

METHODS

Sera were collected from 87 hemiplegic stroke patients (42 outpatients and 45 inpatients) and from 28 control subjects. The sera were assayed for 25-hydroxyvitamin D (25-OHD). Bone density was measured bilaterally from radiographs of the hands. Diet and sunlight exposure were assessed for all subjects.

RESULTS

Serum 25-OHD concentrations were lower in patients (9.1 +/- 4.9 ng/mL for outpatients, 5.9 +/- 4.1 ng/mL for inpatients) than in control subjects (21.6 +/- 3.1 ng/mL). The difference in serum 25-OHD between the two patient groups also was statistically significant. The patients' microdensitometric scores for osteopenia were higher on the hemiplegic side than on the non-hemiplegic side. The microdensitometric scores and their side-to-side differences in patients correlated negatively with the serum 25-OHD concentration and positively with the degree of paralysis. Dietary intake of vitamin D was below the recommended level in 72% of the patients, and 89% of the patients were considered sunlight-deprived.

CONCLUSIONS

Bone mass was reduced significantly on the hemiplegic side in the stroke patients, which might increase the risk of hip fracture. Vitamin D deficiency and disuse are the probable causes of osteopenia in this population. The hypovitaminosis D might be corrected readily by routine use of vitamin D supplements.

Development of osteopenia in the hemiplegic finger in patients with stroke

Previous studies have demonstrated that hip fractures in stroke patients occurred almost exclusively on the hemiplegic side. We examined the bone changes in the second metacarpal of the hemiplegic side in terms of microdensitometric indices in 93 stroke patients with hemiplegia. All six indices indicated a significant decrease in bone mass on the hemiplegic side compared with the contralateral side. Differences in the indices between the hemiplegic and contralateral sides were correlated well with the duration of the illness and Brunstrom's stage for finger, arm, and leg. The same degree of osteopenia occurred in both small capsular and large hemispheric lesions. The same osteopenia was demonstrated in paralyzed and immobilized patients with myopathy. Thus a combination of weakness and immobilization is thought to be responsible for the osteopenia in the hemiplegic metacarpal bone. The osteopenia noted in the second metacarpal in the affected limb may account for the fact that hip fractures in stroke patients occur almost exclusively on the hemiplegic side.

[Catamenial pneumothorax with diaphragmatic and visceral plural endometriosis]

A 47-year-old woman was admitted to our hospital because of two episodes of right pneumothorax. After continuous suction through a thoracic drain, a computerized tomographic scan showed that air was still trapped between lung lobes. Video-assisted thoracic surgery revealed a bulla on the visceral pleural of the upper lobe (S2) and several dark-red spots and white-coated lesions surrounding a defect of the diaphragm. The involved portions of the diaphragm and of the lung were excised. Microscopic examination of the excised specimens showed endometriosis. Catamenial pneumothorax may be caused by intrathoracic endometriosis, but very few cases in which pulmonary or visceral pleural endometriosis was demonstrated histologically have been reported.

[Changes of type IV collagen 7S and fibronectine in a patient with isolated ACTH deficiency]

A 60-year-old man presented with waste, muscle weakness and pain of knees and shoulders. Endocrinological investigations revealed low plasma cortisol and ACTH levels, delayed response of plasma cortisol to ACTH, no response of plasma ACTH to CRF and normal response to other pituitary hormone to corresponding stimulate test. He was diagnosed as isolated ACTH deficiency. Then we examined plasma type IV collagen 7S and fibronectin, because experimentally, corticosteroid regulates the extracellular matrix structure composed of type IV collagen, fibronectin and so on. These parameters were elevated and rapidly decreased to the normal range with the replacement of hydrocortisone, simultaneously his arthralgia was improved. These parameters can reflect the biochemistric change in cortisol deficiency state.

[Clinical study of photodynamic therapy for laryngeal cancer]

Photodynamic therapy (PDT) is an innovative treatment involving the use of a photosensitizer and low powered laser to selectively destroy tumor cells. In the head and neck, its application to laryngeal papilloma, metastatic tumor and oral cancer have been reported but our report on PDT for laryngeal cancer is the only clinical report in Japan. At present, we treat laryngeal cancer by PDT using argon and excimer dye lasers such as the HpD. In the present study, we assessed the utility and safety of PDT and investigated long-term prognosis after this therapy. The subjects were 12 patients with laryngeal cancer who underwent PDT between February 1988 and October 1993. Among them, ten with cancer of the vocal cords underwent PDT as the primary treatment and two underwent PDT because of recurrence after radiotherapy. Under local anesthesia, PDT was performed using a video endoscope (Pentax EB2000). The optimal dose from an argon dye laser was set at 200-500 mW/cm2 of continuous waves for 20 minutes and that from the excimer dye laser was set at 200 J/cm2 of pulse waves (3-4 mJ/pulse, 30-40 Hz). The argon dye laser used was the Fujinon PDT developed by Fuji Photo Optical Co., Ltd. The excimer dye laser used was a product of Hamamatsu Photonics Co., Ltd. 1) Effect of PDT The effect of PDT as a primary treatment for ten patients was classified as CR in eight and PR in two cases, the CR rate being 80.0%. When evaluated only for T1 patients, the results were classified as CR in eight and PR in one. The patient whose response was classified as PR had refused repeated PDT. CR was maintained for five and 13 months in the two patients who underwent PDT as a secondary treatment after radiotherapy. CR was obtained in 83.3% of all patients studied. 2) Duration of the effect of PDT and long-term prognosis The patients were followed up for 14 to 71 months. The longest duration of CR achieved by PDT monotherapy was 65 months. Among the patients who underwent PDT as a primary treatment, one developed local recurrence and underwent radiotherapy. However, the prognosis was uneventful in all other patients. CR after PDT monotherapy was maintained for 42 months in one T3 patient. Two patients with a history of previous treatment thereafter relapsed and underwent total laryngectomy. The larynx could be conserved in 83.3% of all patients. However, it could be conserved in 100% of patients who underwent PDT as a primary treatment.(ABSTRACT TRUNCATED AT 400 WORDS)

Plasma concentrations of atrial natriuretic peptide in cardioembolic stroke with atrial fibrillation

The aim of the present study was to determine whether the level of plasma atrial natriuretic peptide (ANP), an indicator of atrial stretching, correlates with the formation of a thrombus in the left atrium during cardioembolic stroke with atrial fibrillation. Plasma concentrations of immunoreactive ANP and thrombin-antithrombin III complex (TAT) were measured in five age-matched groups including: 16 patients with acute cardioembolic stroke and atrial fibrillation (group 1), 26 patients with chronic cardioembolic stroke and atrial fibrillation (group 2), 27 patients with atrial fibrillation without previous stroke (group 3), 21 patients with acute lacunar stroke (group 4), and 27 healthy controls. The plasma ANP levels were higher in group 1, regardless of the stage, than those estimated at chronic stage in group 4 and in healthy controls. There were no stage-related differences between groups 1, 2 and 3. Plasma levels of ANP in group 2, a high risk group of cardioembolic stroke, were higher than in group 3, a low risk group. There was no correlation between plasma levels of ANP and mean blood pressure, pulse rate or plasma levels of TAT in any group. These results indicate that the determination of plasma ANP concentration is useful to distinguish a high risk patient from a low risk patient and also a cardioembolic stroke patient from a lacunar stroke patient. They also underscore the difficulties in recognizing left atrial thrombus formation by determining the plasma ANP concentration in cardioembolic stroke.

Determination of bromate in bread by capillary gas chromatography with a mass detector (GC/MS)

A sensitive method was developed for the determination of bromate in bread by capillary gas chromatography with a mass detector (GC/MS). Bromate was extracted with water from bread samples. After centrifugation, the supernatant was filtered and Cl- was removed by an OnGuard-Ag cartridge column. The mixture was absorbed on a DEA solid phase extraction column and washed with water. Bromate was then eluted with 3 M potassium chloride solution. Two ml of 4 x 10(-3) M styrene monomer solution (washed with 1% sodium hydroxide solution before use), 1 ml 0.01 M potassium bromide solution and 1 ml sulphuric acid were added to the eluent and shaken vigorously. The styrene bromo derivative (alpha-bromomethyl-benzenemethanol[2-bromo-1-phenylethanol]) was extracted with 2 ml n-hexane, and determined by GC/MS. Recoveries of bromate from breads were in the range 91.3-98.1% (0.03-0.50 micrograms/g), and the limit of detection was 0.03 microgram/g. Pullman and open top types of white bread, produced by a sponge and dough method and a short process method respectively, were prepared in our laboratory for measurement of residual bromate. When 30 micrograms/g or less bromate as HBrO3 (pullman type), and 75 micrograms/g bromate or less as KBrO3 (open top type), was added to flour, no residual bromate was detected in either type of bread.

A seroepidemiological study of hepatitis C virus (HCV) in an area with a high prevalence of chronic liver disease in the Kyushu district of Japan

The incidence of hepatitis virus type C (HCV) in an area, Futase, of Iizuka city in Chikuho province in the northeastern part of Fukuoka prefecture in Kyushu, Japan, was estimated by screening sera for anti-HCV antibodies. Titers of anti human T-lymphotropic virus type I (HTLV-I) antibodies and hepatitis virus type B surface antigens (HBs) were also determined. The area of the present study is known to have a particularly high prevalence of chronic liver diseases, because coal mining was the key industry until a few decades ago. Also, in the old days it was rather isolated from the neighboring vicinities by surrounding mountains. The subjects of the present survey were 310 patients (117 males and 193 females) with various chronic diseases who visited Futase Social Insurance Hospital during a two year period from 1991 to 1992. Anti-HCV antibodies were detected in the sera of 55 patients, which is an overall positive rate of 18% (26% in male and 14% in female patients). This is extremely high compared to an estimated nationwide average positive rate of 1.6%. Even in 270 patients with normal liver function, the incidence was as high as 10%. The incidences were particularly high in groups of patients aged 40 through 49, 50 through 59 and 60 through 69, ranging from 20 to 23%, while they were as low as 13 and 17% in those aged 70 through 79 and 80 through 89 years, respectively. A high incidence, 57% was estimated for the patients with impaired liver function due to chronic liver diseases, especially in those concomitantly having diabetes mellitus (DM), 91%. The incidence of anti-HCV antibodies was the highest, 100%, in patients having both liver cirrhosis (LC) and DM. This was followed by those having chronic hepatitis (CH) and DM concomitantly and by those with LC alone, 86% each, and by those with CH alone 44%. Furthermore, the genotypes of the HCV in the sera of nine randomly selected carrier patients who had anti-HCV antibodies, even though they had diseases other than hepatic diseases and their liver functions were normal, were examined by the polymerase chain reaction method employing type-specific primers for DNA amplification. As a result, all the HCV strains were type II. On the other hand, there were no apparent differences in the incidences of HTLV-I in the area of the present study and in neighboring provinces of the same prefecture, Fukuoka.(ABSTRACT TRUNCATED AT 400 WORDS)

Phagocytic ability of polymorphonuclear cells and macrophage is not decreased in aged bed ridden patients

The phagocytic ability of polymorphonuclear cells and macrophages from aged, bed ridden patients was investigated. Phagocytosis of carbon in aged bed ridden patients did not differ from that of young controls, and extent of upregulation of granulocytes phagocytosis in response to elevation of incubation temperature was also similar between the two groups. Morphological changes of macrophages in response to ingestion of colloidal carbon was more prominent in young controls. These data suggest that a depressed phagocytosis is not an important factor in the increased susceptibility to infections of aged bed ridden patients, although the reactivity of macrophages may be more closely related to the infection defence.

[Compression of the graft during the corrective surgery for scoliosis in a patient who has undergone a Rastelli's operation: a case study]

A 14 year-old male who had undergone Rastelli's operation for the tetralogy of Fallot had general anesthesia for the corrective spinal instrumentation and posterior fusion. The patient also suffered from the complication of Klippel-Feil syndrome. During the operation, right ventricular pressure gradually increased from 34 mmHg to 60 mmHg and systolic blood pressure decreased from 110 mg to 80 mmHg when the maneuver to correct spinal deformity was done. The hemodynamics returned to its former level after the maneuver was resumed. This change was presumably attributed to the fact that the external conduit was compressed by the sternum and vertebral bodies. In order to prevent this hazardous incidence, it is crucial to understand both the three-dimensional configuration of the thoracic structure and the influence of spinal correction on it. In the prone positioned patients with scoliosis, especially lordoscoliosis, compression or dysfunction of the artificial valve might occur and we have to be aware of the possibility of the compression during general anesthesia and after corrective surgery.