An aberrant fused in sarcoma liquid droplet of amyotrophic lateral sclerosis pathological variant, R495X, accelerates liquid-solid phase transition

Intracellular aggregation of fused in sarcoma (FUS) is associated with the pathogenesis of familial amyotrophic lateral sclerosis (ALS). Under stress, FUS forms liquid droplets via liquid-liquid phase separation (LLPS). Two types of wild-type FUS LLPS exist in equilibrium: low-pressure LLPS (LP-LLPS) and high-pressure LLPS (HP-LLPS); the former dominates below 2 kbar and the latter over 2 kbar. Although several disease-type FUS variants have been identified, the molecular mechanism underlying accelerated cytoplasmic granule formation in ALS patients remains poorly understood. Herein, we report the reversible formation of the two LLPS states and the irreversible liquid-solid transition, namely droplet aging, of the ALS patient-type FUS variant R495X using fluorescence microscopy and ultraviolet-visible absorption spectroscopy combined with perturbations in pressure and temperature. Liquid-to-solid phase transition was accelerated in the HP-LLPS of R495X than in the wild-type variant; arginine slowed the aging of droplets at atmospheric conditions by inhibiting the formation of HP-LLPS more selectively compared to that of LP-LLPS. Our findings provide new insight into the mechanism by which R495X readily forms cytoplasmic aggregates. Targeting the aberrantly formed liquid droplets (the HP-LLPS state) of proteins with minimal impact on physiological functions could be a novel therapeutic strategy for LLPS-mediated protein diseases.

Mechanism underlying liquid-to-solid phase transition in fused in sarcoma liquid droplets

The RNA-binding protein fused in sarcoma (FUS) forms ribonucleoprotein granules via liquid-liquid phase separation (LLPS) in the cytoplasm. The phase separation of FUS accelerates aberrant liquid-solid phase separation and leads to the onset of familial amyotrophic lateral sclerosis (ALS). We previously found that FUS forms two types of liquid condensates in equilibrium, specifically LP-LLPS (i.e., normal type) and HP-LLPS (i.e., aberrant type), each with different partial molar volumes. However, it is unclear how liquid condensates are converted to the pathogenic solid phase. Here, we report a mechanism underlying the aberrant liquid-to-solid phase transition of FUS liquid condensates and the inhibition of this transition with small molecules. We found that the liquid condensate formed via HP-LLPS had greatly reduced dynamics, which is a common feature of aged wild-type FUS droplets and the droplet-like assembly of the ALS patient-type FUS variant. The longer FUS remained on the HP-LLPS, the harder it was to transform it into a mixed state (i.e., one-phase). These results indicate that liquid-to-solid phase transition, namely the aging of droplets, is accelerated with HP-LLPS. Interestingly, arginine suppressed the aging of droplets and HP-LLPS formation more strongly than LP-LLPS formation. These data indicate that the formation of HP-LLPS via the one-phase state or LP-LLPS is a pathway leading to irreversible solid aggregates. Dopamine and pyrocatechol also suppressed HP-LLPS formation. Our data highlight the potential of HP-LLPS to be used as a therapeutic target and arginine as a plausible drug candidate for ALS-causing FUS.

Ultrasound-guided gradual reduction using flexion and abduction continuous traction for developmental dysplasia of the hip: a new method of treatment

We describe our experience in the reduction of dislocation of the hip secondary to developmental dysplasia using ultrasound-guided gradual reduction using flexion and abduction continuous traction (FACT-R). During a period of 13 years we treated 208 Suzuki type B or C complete dislocations of the hip in 202 children with a mean age of four months (0 to 11). The mean follow-up was 9.1 years (five to 16). The rate of reduction was 99.0%. There were no recurrent dislocations, and the rate of avascular necrosis of the femoral head was 1.0%. The rate of secondary surgery for residual acetabular dysplasia was 19.2%, and this was significantly higher in those children in whom the initial treatment was delayed or if other previous treatments had failed (p = 0.00045). The duration of FACT-R was significantly longer in severe dislocations (p = 0.001) or if previous treatments had failed (p = 0.018). This new method of treatment is effective and safe in these difficult cases and offers outcomes comparable to or better than those of standard methods.

Development of a loop-mediated isothermal amplification assay for rapid and simple detection of Erysipelothrix rhusiopathiae

Erysipelothrix rhusiopathiae is a causative agent of swine erysipelas. We developed a novel and highly specific loop-mediated isothermal amplification (LAMP) assay for sensitive and rapid detection of E. rhusiopathiae. The LAMP assay correctly detected 39 E. rhusiopathiae strains. No LAMP products were detected from 14 non-rhusiopathiae Erysipelothrix and 16 non-Erysipelothrix strains, including E. tonsillarum serovar 10 strains, which are difficult to be discriminated from E. rhusiopathiae strains. These results were consistent with those obtained by a conventional E. rhusiopathiae-specific PCR assay. Starting with DNA extraction from a single colony, the gel-based PCR assay took 4 h to provide a result, but the LAMP assay was faster, requiring only 37-80 min. The conventional culture test required more than 3-4 days to isolate and identify E. rhusiopathiae in the enrichment cultures. In contrast, the LAMP assay required less than 22 h from the beginning of the enrichment culture to final determination. These results suggest that the LAMP assay is useful as an adjunct to facilitate early diagnosis of swine erysipelas.

SIGNIFICANCE AND IMPACT OF THE STUDY

This is the first report of a loop-mediated isothermal amplification (LAMP) assay for simple and cost-effective detection of E. rhusiopathiae from swine samples. The LAMP assay provided more rapid detection of the bacterium than conventional PCR and biochemical-based assays, and it may potentially facilitate surveillance and early diagnosis of swine erysipelas in the field.

Clinical application of 3D arterial spin-labeled brain perfusion imaging for Alzheimer disease: comparison with brain perfusion SPECT

BACKGROUND AND PURPOSE

Alzheimer disease is the most common neurodegenerative disorder with dementia, and a practical and economic biomarker for diagnosis of Alzheimer disease is needed. Three-dimensional arterial spin-labeling, with its high signal-to-noise ratio, enables measurement of cerebral blood flow precisely without any extrinsic tracers. We evaluated the performance of 3D arterial spin-labeling compared with SPECT, and demonstrated the 3D arterial spin-labeled imaging characteristics in the diagnosis of Alzheimer disease.

MATERIALS AND METHODS

This study included 68 patients with clinically suspected Alzheimer disease who underwent both 3D arterial spin-labeling and SPECT imaging. Two readers independently assessed both images. Kendall W coefficients of concordance (K) were computed, and receiver operating characteristic analyses were performed for each reader. The differences between the images in regional perfusion distribution were evaluated by means of statistical parametric mapping, and the incidence of hypoperfusion of the cerebral watershed area, referred to as "borderzone sign" in the 3D arterial spin-labeled images, was determined.

RESULTS

Readers showed K = 0.82/0.73 for SPECT/3D arterial spin-labeled imaging, and the respective areas under the receiver operating characteristic curve were 0.82/0.69 for reader 1 and 0.80/0.69 for reader 2. Statistical parametric mapping showed that the perisylvian and medial parieto-occipital perfusion in the arterial spin-labeled images was significantly higher than that in the SPECT images. Borderzone sign was observed on 3D arterial spin-labeling in 70% of patients misdiagnosed with Alzheimer disease.

CONCLUSIONS

The diagnostic performance of 3D arterial spin-labeling and SPECT for Alzheimer disease was almost equivalent. Three-dimensional arterial spin-labeled imaging was more influenced by hemodynamic factors than was SPECT imaging.

MRI findings of mucoepidermoid carcinoma of the parotid gland: correlation with pathological features

OBJECTIVE

The aim of this study was to correlate the MRI appearance and pathological findings in each grade of the mucoepidermoid carcinoma (MEC) of the parotid gland.

METHODS

We reviewed surgically proven MECs of parotid glands in 20 patients. Pathologically, 5 tumours were high-grade, 3 were intermediate and 12 were low-grade. MR images were evaluated with emphasis on signal intensities on T(2) weighted images, margin characteristics and lymph node metastasis, correlating these with pathological features.

RESULTS

Among the high-grade MECs, four out of five tumours showed inhomogeneous low to intermediate signal intensity on T(2) weighted images, reflecting high cellularity. All tumours had an ill-defined margin, reflecting invasive tumour growth. Among the intermediate-grade MECs, all three tumours showed intermediate signal intensity on T(2) weighted images and two tumours had an ill-defined margin. Among the low-grade MECs, 11 of the 12 tumours had a hyperintense area on T(2) weighted images because of the existence of abundant mucin secreting cells. Seven tumours had an ill-defined margin, reflecting peritumoural inflammatory changes rather than invasive tumour growth. Lymph node metastasis was seen in three high-grade MECs.

CONCLUSION

MECs of the parotid gland show variable MRI findings reflecting their histological nature, which seems to have certain tendencies depending on the tumour grade.

Vascular supply with angio-CT for superselective intra-arterial chemotherapy in advanced maxillary sinus cancer

Recently popularised, the combined angiography and CT (angio-CT) system is useful for correctly identifying the feeding arteries and their perfusion in various organs. We applied this system for advanced maxillary cancer to expose its feeding arteries and their supplying territories. In addition to the maxillary artery, extramaxillary feeding arteries were usually observed, including the ophthalmic, accessory meningeal, facial, transverse facial and ascending palatine arteries. These extramaxillary feeding arteries exhibited uniform tendencies, depending on the site of extramaxillary tumour extension.

Salivary duct carcinoma of the parotid gland: clinical and MR features in six patients

This study reports the clinical and MR features of salivary duct carcinoma (SDC) of the parotid gland, which is a rare and highly malignant tumour. We assessed retrospectively the clinical and MR features of six patients with histologically proven SDC of the parotid gland. The five men and one woman, ranging in age from 65-71 years (mean, 67 years), had undergone MRI before surgery. All patients presented with parotid masses and four patients had facial paralysis. Two had been aware of the parotid mass for more than 10 years. On MRI, all of the tumours had an ill-defined margin along either the entire circumference or part of the circumference. Four tumours showed infiltration into the subcutaneous or parapharyngeal space. Two tumours showed a wholly solid internal content, and four tumours had varying proportions of cystic content. The signal intensity of the solid portion was low to intermediate on both T(1) weighted and T(2) weighted images. Three patients showed multiple cervical lymph node swellings. Although SDC can show non-specific MRI findings, the combined findings (e.g. low-to-intermediate signal intensities on T(2) weighted images, ill-defined boundaries, infiltration into the surrounding fat space, facial nerve paralysis and associated cervical lymphoadenopathy, seem to suggest a high-grade malignancy.

Subtraction 3D CT angiography with the orbital synchronized helical scan technique for the evaluation of postoperative cerebral aneurysms treated with cobalt-alloy clips

BACKGROUND AND PURPOSE

CT angiography (CTA) has been used for the evaluation of intracranial aneurysms and recently has been applied to assess postoperative aneurysms treated with titanium-alloy clips. We investigated the clinical usefulness of subtraction CTA by using the orbital synchronized helical scan technique (OSHST) for evaluating intracranial aneurysms surgically treated with cobalt-alloy clips.

MATERIALS AND METHODS

We scanned an agar gel phantom with a cobalt-alloy clip mounted in the center by using subtraction CT with and without OSHST. Eighteen patients (20 aneurysms) who underwent surgery with cobalt-alloy clips were postoperatively evaluated with subtraction CTA with OSHST, and the results were compared with those from digital subtraction angiography. Two neuroradiologists independently evaluated the 3D CTA images and source images with and without subtraction for the presence of residual flow in the aneurysm and stenotic change in parent or neighboring arteries.

RESULTS

For the phantom study, significantly fewer artifacts from clips were noted on images obtained by using subtraction CT with OSHST than on those obtained without OSHST. For the clinical study, subtraction CTA with OSHST also showed fewer clip artifacts than did conventional CTA. Image quality was poor, and we were unable to diagnose residual neck for 5% (1/20) with subtraction CTA with OSHST and 75% (15/20) with conventional CTA. For evaluation of adjacent vessels, image quality was poor for none (0/20) with subtraction CTA with OSHST and for 55% (11/20) with conventional CTA. For subtraction CTA with OSHST, sensitivity in detecting residual neck was 1.0, and specificity was 0.94. For conventional CTA, sensitivity and specificity were both 0.25.

CONCLUSIONS

OSHST is a useful technique for subtracting cobalt-alloy clips, and subtraction CTA with OSHST is available for evaluating aneurysms after clipping with cobalt-alloy clips.

Adsorptive granulocyte/monocyte apheresis for the treatment of refractory rheumatoid arthritis: an open pilot multicentre trial

OBJECTIVE

To assess the efficacy and safety of adsorptive granulocyte and monocyte apheresis (GCAP) in patients with refractory rheumatoid arthritis (RA).

METHODS

Patients with active and refractory RA were treated with weekly GCAP sessions using a column filled with acetate beads (Adacolumn) over five consecutive weeks. Clinical assessments and response to therapy were analysed at weeks 5, 7, 12 and 20 in an open multicentre trial. The primary outcome measure of clinical response was 20% improvement in the American College of Rheumatology criteria (ACR20) at week 20. EULAR (European League Against Rheumatism) response criteria, based on the disease activity score for 28 joints (DAS28) and disability using the Health Assessment Questionnaire (HAQ), were also assessed.

RESULTS

Of 27 patients, 81.5% were women with mean disease duration of 14.4 yr. The mean number of previous disease-modifying antirheumatic drugs (DMARDs) was 3.7, and 48.1% of patients had previously failed on biologicals. On an intention-to-treat basis, 40.7% of patients achieved an ACR20 and 44.4% a therapeutic EULAR response at week 20. These percentages were 50 and 54.5% in 22 patients who completed the trial. In the 10 completers who had previously failed on biologicals, an ACR response was achieved in four patients (ACR20, two; ACR50, one; ACR70, one). A significant decrease was recorded in different ACR response components, including the tender joint and swollen joint counts, pain score and patient and physician global disease assessments, as well as the DAS28 index; most of them improved after week 5. ESR and CRP, but not the HAQ score, had decreased significantly at week 20. The treatment was well tolerated and only one serious adverse event related to the study procedure was documented (sepsis due to a catheter infection).

CONCLUSIONS

GCAP treatment led to significant clinical improvement in a subset of patients with RA who had failed to respond to DMARDs or biologicals. Further large, placebo-controlled studies are warranted to fully assess the therapeutic value of GCAP for refractory RA.

Bilateral humeral lengthening in achondroplasia

Twenty humeral lengthenings were done on 10 achondroplastic dwarfs using the Ilizarov circular fixator. There were five female and five male patients from 6 years 11 months to 17 years 8 months of age (mean, 12 years 10 months) at the time of the operation. Mean length obtained was 7.8 cm (range, 3.5 cm-10 cm). External fixation time ranged from 105 days to 368 days (mean, 221 days). Healing index averaged 30 days/cm (27 days/cm when two patients with radial nerve palsy were excluded). Two half pins in one patient required replacement. Two humeral fractures occurred, one while in the fixator and the other after removal of the apparatus. Transient radial nerve palsy developed during lengthening in two patients, and lengthening was discontinued. Symptoms of radial nerve palsy resolved completely in both patients, but one patient required an additional surgery to explore the radial nerve for persistent paresthesia of the forearm. Although preexisting loose shoulders deteriorate during lengthening and sometimes cause pain and discomfort, they always resolve spontaneously as lengthening proceeds. Bilateral humeral lengthening was very effective for improving function and overall proportion in patients with achondroplasia.

Sequential magnetic resonance imaging in slipped capital femoral epiphysis: assessment of preslip in the contralateral hip

Thirty-three images using magnetic resonance imaging (MRI) in 10 patients with slipped capital femoral epiphysis were evaluated. The MRI of affected hips delineated typical widening of the physis. Sequential MRI demonstrated the process of premature closure of the physis developing from the posterior portion anteriorly. In 4 of the 10 asymptomatic contralateral hips, physeal widening was clearly observed in the center or posteromedial region of the physis on T1-weighted images. We performed prophylactic pinning for the four cases showing physeal widening on MRI, and none of the other cases developed a slip. MRI accurately documented detailed features of slips, as well as physeal changes, and may provide indicative information on prophylactic pinning for contralateral hips.

Safety and efficacy of granulocyte and monocyte adsorption apheresis in patients with active ulcerative colitis: a multicenter study

Active ulcerative colitis (UC) is characterized by activation and infiltration of granulocytes and monocytes/macrophages into the colonic mucosa. The infiltrated leukocytes can cause mucosal damage by releasing degradative proteases, reactive oxygen derivatives, and proinflammatory cytokines. The aim of this trial (conducted in 14 specialist centers) was to assess safety and efficacy of granulocyte and monocyte adsorption apheresis in patients with active UC most of whom were refractory to conventional drug therapy. We used a new adsorptive type extracorporeal column (G-1 Adacolumn) filled with cellulose acetate beads (carriers) of 2 mm in diameter, which selectively adsorb granulocytes and monocytes/macrophages. Patients (n = 53) received five apheresis sessions, each of 60 minutes duration, flow rate 30 ml per minute for 5 consecutive weeks in combination with 24.4 +/- 3.60 mg prednisolone (mean +/- SE per patient per day, baseline dose). During 60 minutes apheresis, 26% of granulocytes, 19.5% of monocytes and 2% of lymphocytes adsorbed to the carriers. At week 7, 58.5% of patients had remission or improved, the dose of prednisolone was reduced to 14.2 +/- 2.25 mg (n = 37). The apheresis treatment was fairly safe, only eight non-severe side effects (in 5 patients) were reported. Based on our results, we believe that in patients with active severe UC, patients who are refractory to conventional drugs, granulocyte and monocyte adsorption apheresis is a useful adjunct to conventional therapy. This procedure should have the potential to allow tapering the dose of corticosteroids, shorten the time to remission and delay relapse.

Preliminary traction and the use of under-thigh pillows to prevent avascular necrosis of the femoral head in Pavlik harness treatment of developmental dysplasia of the hip

One hundred and sixty-one hips of 145 patients were treated with the Pavlik harness for developmental dysplasia of the hip. The patients were divided into two groups. Group A consisted of 65 patients (70 hips) who were treated between 1980 and 1987. The harness was applied immediately after the diagnosis. Group B consisted of 80 patients (91 hips) who were treated between 1988 and 1992. These patients received preliminary traction, and small pillows supported the lower extremities from just above the knee to the foot to prevent extreme abduction when the harness was applied. When the distance from the middle point of the proximal metaphyseal border of the femur to the Y-line (distance "a") was 8 mm or more on the initial X-ray picture, the rate of avascular necrosis in group A was 11% and that in group B was 0%; the difference was significant. However, when distance "a" was less than 8 mm, the rate of avascular necrosis in group A was 13% and that in group B was 12%, and there was no significant difference. Thus, we suggest that the Pavlik harness is indicated for developmental dysplasia of the hip in which distance "a" is 8 mm or more. Traction should precede application of the harness, and pillows placed under the thigh must be used during application.

Arthroscopic treatment for traumatic hip dislocation with avulsion fracture of the ligamentum teres

Traumatic hip dislocation in children is a rare condition. Immediate closed reduction is a treatment of choice, but when incongruent reduction results, it can be due to interposition and requires open arthrotomy. We present a previously unreported technique of arthroscopic treatment that was used successfully for traumatic hip dislocation in a 10-year-old girl with impingement of the avulsed ligamentum teres. Arthroscopy was effective in confirming the exact nature of the interposition material and excising the fragment with minimal invasion.

[Novel extracorporeal granulocyte apheresis column inhibits myocardial reperfusion injury: future clinical applications]

OBJECTIVES

Leukocyte infiltration is very important in myocardial ischemia/reperfusion injury. A new extracorporeal circulation therapy using a granulocyte-apheresis column (G-1) has recently been proved to be effective and safe in patients with rheumatoid arthritis and with ulcerative colitis. This study investigated whether this therapy would reduce myocardial ischemia/reperfusion injury.

METHODS

Rabbits were subjected to 30 min ischemia followed by 180 min reperfusion with no treatment (control group: n = 12); or treated with extracorporeal blood circulation (2 ml/min) passing through the G-1 (G-1 group: n = 12), or sham column (sham group: n = 12). Infarct size was determined by tetrazolium staining and expressed as a percentage of the area at risk.

RESULTS

Infarct size in the G-1 group (15.9 +/- 3.4%) was significantly (p < 0.01) smaller than in the control (34.7 +/- 3.9%) and sham (35.2 +/- 4.1%) groups. Granulocyte emigration into the ischemic myocardium assessed by histopathological score was significantly (p < 0.01) less in the G-1 group (0.58 +/- 0.17) than in the sham group (1.42 +/- 0.26). There was a significant (r = 0.78, p < 0.0001) positive correlation between this score and infarct size. Flow cytometry showed alterations in the adhesion molecule expression on granulocytes during the passage through the G-1, but not sham, columns as a low L-selectin and high Mac-1 form, which is associated with the inability to home to the inflamed site.

CONCLUSIONS

Extracorporeal circulation with the G-1 column, a newly-developed clinically applicable therapy, appears to reduce infarct size at least in part by limiting the emigration capacity of granulocytes into the ischemic myocardium.

Early characteristic findings in bowleg deformities: evaluation using magnetic resonance imaging

We used magnetic resonance imaging (MRI) to evaluate bowleg deformities in infancy. Twenty-five tibiae of 13 infants were examined and divided into two groups based on MRI findings: group A had high intensity area in the medial epiphyseal cartilage on T2-weighted images. Group B had depression of medial physis and abnormal signal in the perichondrial region in addition to the epiphyseal lesion. At the final follow-up, all cases in group A demonstrated normal lower leg alignments, whereas five cases in group B showed characteristic roentogenographic findings of Blount's disease. The improvement rate of metaphyseal-diaphyseal angle was correlated with this classification. These findings suggested that abnormal findings in physis and perichondrial region might be preliminary findings in early stage of Blount's disease. The high intensity areas in the medial epiphyseal cartilage were commonly found among the cases with bowing deformities, which suggested that there might be a common pathomechanism between physiologic bowing and infantile Blount's disease.

Human T-cell receptor BV6 gene polymorphism in relation to expression level and CD4/CD8 skewness

Using 50 samples of umbilical cord blood lymphocytes from Japanese donors, we analysed two human T-cell receptor beta variable (TCRBV) genes, BV6S4 and BV6S5, for their polymorphism, usage frequencies and CD4/CD8 skewness. They showed contrasting CD4/CD8 skewness, BV6S4 to CD8+ T cells and BV6S5 to CD4+ T cells. Genotyping of the BV6S4 alleles (A1, A2 and A3) revealed two of the six possible BV6S4 genotypes, A1/A2 and A2/A2. Among the two BV6S4 genotypes, no significant difference was detected in usage frequency or CD4/CD8 skewness. On the other hand, genotyping of the BV6S5 alleles (A1 and A2) revealed all three possible BV6S5 genotypes, A1/A1, A1/A2 and A2/A2, and the gene usage frequency was high, in the order A1/A1 > A1/A2 > A2/A2. These results indicate that the amino acid substitutions in BV6S5 (S36R and G70E) are in some way associated with the expression level of this gene. In the analysis of CD4/CD8 skewness, the three BV6S5 genotypes had similar skewness, indicating that A1 alleles are expressed more frequently than A2 alleles in both CD4+ and CD8+ T-cell populations. Although BV6S5 exhibits marked skewness to CD4+ T cells, our results indicate that the higher expression of A1 alleles is not associated with the increased ratio of CD4+ T cells.

Solitary subependymal giant cell astrocytoma: case report

In this report, we describe a case of subependymal giant cell astrocytoma in a patient lacking clinical symptoms of tuberous sclerosis. The absence of any features of tuberous sclerosis initially dissuaded us from including subependymal giant cell astrocytoma in our differential diagnosis.

Possible mechanisms of immunotherapy for maintaining pregnancy in recurrent spontaneous aborters: analysis of anti-idiotypic antibodies directed against autologous T-cell receptors

We examined whether immunotherapy for recurrent spontaneous abortion (RSA) using paternal lymphocytes induces anti-T-cell receptor (TCR) idiotypic antibodies in RSA patients. The sera of these patients were assessed for inhibitory activity against mixed lymphocyte reactions (MLR) between maternal responder cells and paternal stimulator cells. Sera of four of the five women who maintained pregnancy successfully after immunotherapy showed significant MLR inhibition, whereas none of the five women who had unsuccessful pregnancies showed significant MLR inhibition. These sera inhibited the MLR of autologous responder T-cells, when stimulated with lymphocytes having the same HLA-DR antigens as the patient's husband, but not when stimulated with lymphocytes having unrelated HLA-DR antigens. This MLR inhibitory activity was absorbed by autologous maternal T-lymphoblasts induced by stimulation with lymphocytes having the paternal HLA-DR type but not by those induced by stimulation with lymphocytes having other HLA-DR types. The maternal serum inhibited the proliferation of autologous T-cells, but not of non-autologous T-cells, stimulated with paternal lymphocytes. These results indicate that anti-TCR idiotypic antibodies were induced in RSA patients by immunotherapy. These antibodies may contribute to maintaining pregnancy by negatively regulating maternal T-cells directed against HLA-DR antigens of the fetus.

Location of the femoral head in developmental dysplasia of the hip: three-dimensional evaluation by means of magnetic resonance image

By using magnetic resonance imaging, we analyzed the position of the femoral head in 21 hips of 21 infants with developmental dislocation. The femoral head changed its location according to the hip position. In type A dislocation, the head was anterior to the acetabulum when the hip was extended, and it was posterior when the hip was flexed. There was wide contact area between the femoral head and the acetabulum in any hip position. In type B, the head was on the rim of the acetabulum when the hip was extended. When the hip was flexed, the head was on the posterior rim of the acetabulum, and there was no contact between the femoral head and acetabular cartilage. Some heads slipped into the socket with a click phenomenon when the hip was flexed/abducted. In type C dislocation, the head was on the edge of the acetabulum when the hip was extended. When the hip was flexed, the head moved posteriorly, and it was completely out of the socket.

Granulocyte and monocyte apheresis suppresses symptoms of rheumatoid arthritis: a pilot study

To investigate if granulocyte and monocyte apheresis mitigates the symptoms of rheumatoid arthritis (RA), and influences production of panmyelocytes (CD15+ CD16- cells) at the bone marrow level, 27 RA patients who had elevated granulocyte counts were recruited. The granulocyte and monocyte apheresis column (G-1 column) is an extracorporeal type device packed with 220 g cellulose acetate beads to which granulocytes and monocytes specifically adhere. Patients received apheresis of 1 hr duration twice per week, 8 times over a period of 4 weeks. To prepare CD15+CD16- cells, iliac bone marrow aspirate was obtained at baseline and at 2 weeks after completion of the apheresis course. Ex-vivo proliferation of bone marrow low density cells and production of IgM-RF were also investigated. Following granulocyte and monocyte apheresis, there was a suppressed tendency in the number of CD15+CD16- cells in patients with high bone marrow CD15+CD16- cell counts at baseline. Clinical assessments 2 weeks after the completion of apheresis therapy showed improvements in swollen joint count (P < 0.001), tender joint count (P < 0.001) and duration of morning stiffness (P < 0.005). The results suggest that granulocytes and monocytes/macrophages have a pathological role in RA and apheresis treatment to reduce or suppress these cells should benefit patients with RA.

MR findings in three pituitary abscesses. Case reports

We present MR findings in 3 surgically proved cases of pituitary abscess. All lesions were seen as a sellar cystic mass with a thin rim of enhancement. In addition, the pituitary stalk was thickened in 2 cases in which central diabetes insipidus developed. These findings may be suggestive of pituitary abscess.

A role for granulocyte and monocyte apheresis in the treatment of rheumatoid arthritis

Rheumatoid arthritis (RA) is an inflammatory condition, the etiology of which is not well understood. Recent reports indicate a major role of granulocytes in the pathogenesis of RA; arthritic joints are infiltrated with phagocytic leukocytes, granulocytes, and monocytes/macrophages, and it is believed that these cells, by releasing degradative proteinases, cytokines, and reactive oxygen species, contribute to joint destruction. Hence, the apheresis of granulocytes and monocytes may benefit patients with RA. Granulocyte and monocyte apheresis was carried out in 143 patients with RA using an apheresis column (G-1) packed with 220 g cellulose acetate beads, which selectively adsorb granulocytes and monocytes. Patients received 1 or 2 apheresis sessions, each of 1 h duration per week over a 4 week period at a flow rate of 30 ml/min. Apheresis significantly reduced swollen and tender joint counts and the duration of morning stiffness, and it increased grip strength, together with suppression of tumor necrosis factor-alpha and interleukin-1beta production by peripheral blood monocytes. It is concluded that this alternative treatment induces a kind of immunomodulation.

Transition of the craniocaudal velocity of the spinal cord: from cervical segment to lumbar enlargement

RATIONALE AND OBJECTIVES

The authors investigate the craniocaudal velocity of the spinal cord over its full length by using magnetic resonance imaging.

METHODS

A spin-echo pulse sequence with velocity encoding gradients was used to examine five normal volunteers. Oblique-axial phase images at nine levels, from cervical spinal cord to lumbar enlargement, were obtained with prospective electrocardiogram gating. Time-velocity curves were then generated for these levels.

RESULTS

Every part of the spinal cord moves first caudally after the R-wave of the electrocardiogram, then cranially. When compared with the cranial levels, peak velocity tend to occur later and their values tend to be smaller at the more caudal levels.

CONCLUSIONS

Craniocaudal velocity is transmitted from cervical segment to lumbar enlargement.

Epidermoid tumor of the cerebellopontine angle: signal loss in the contralateral cistern

We report a case of an epidermoid tumor of the right cerebellopontine angle (CPA) in which the contralateral CPA cistern showed abnormal, low signal intensity on T2-weighted fast spin-echo MR images. Diffusion-weighted images showed the epidermoid tumor of the right CPA extending to the prepontine cistern. The cause of the abnormal signal intensity was proved to be an artifactual signal loss due to cerebrospinal fluid flow by phase-contrast MR imaging.

Enhanced expression of CD14 antigen on myeloid lineage cells derived from the bone marrow of patients with severe rheumatoid arthritis

OBJECTIVE

We previously reported the accumulation of abnormal myeloid cell populations reacting with CD14 (MY4) monoclonal antibody in the iliac and epiphyseal bone marrow of patients with severe rheumatoid arthritis (RA). Therefore, we investigated in vitro production and modulation of CD14+ myeloid cells from iliac bone marrow cells.

METHODS

Mononuclear cells were prepared from iliac bone marrow aspirates from patients with RA. The presence of unusual myeloid cells was assessed by 2 color flow cytometry of cells cultured under various conditions.

RESULTS

Cultured iliac bone marrow cells of patients with severe RA produced 14.7% of CD14+ CD15+ cells on average. Cultures derived from healthy donors and from patients with a milder form of RA produced fewer CD14+ CD15+ cells (< 10%). The production of CD14+ CD15+ cells was enhanced by granulocyte macrophage colony stimulating factor and interleukin 1beta, but inhibited by T lymphocytes.

CONCLUSION

Production and modulation of CD14+ myeloid cells were observed in iliac bone marrow of patients with severe RA.

[Evaluation of the assay technique for detection of anti-chlamydial IgA and IgG antibodies in PID patients]

The purpose of this study is to evaluate the usefulness and limitation of Rapizyme CHLAMYDIA, enzyme-linked immunosorbent assay (ELISA) for qualitative detection of anti-chlamydial IgG and IgA antibodies, in the serum of 92 PID patients and 73 pregnant women, compared with those of Sero IPALISA CHLAMYDIA. The result of Rapizyme analysis was obtained within 10 minutes with no special devices. Overall agreements of Rapizyme and Sero IPALISA were 90.9% (IgG) and 90.3% (IgA) in the total patients, 88.0% (IgG) and 85.9% (IgA) in PID patients, and 94.5% (IgG) and 95.9% (IgA) in pregnant women. The positive rate of Chlamydia in PID was 17.4% (16/92). Positive agreement of Rapizyme in Chlamydia positive PID and pregnant women was 100% in both IgG and IgA, and negative agreement was also 100%. Positive agreement in Chlamydia negative PID was 100% in both IgG and IgA, and negative agreement was 90.0% (IgG) and 83.3% (IgA). The results of Rapizyme were in close agreement with those of Sero IPALISA. COI (cut off index) of Sero IPALISA clearly decreased in 3 of 6 PID patients during a 3 to 6 months period after chemotherapy, but those changes were not observed in Rapizyme. These results suggest that Rapizyme CHLAMYDIA is a useful diagnostic kit for Chlamydial PID of outpatients.

AVASCULAR NECROSIS AND THE PAVLIK HARNESS

We analysed the incidence of avascular necrosis in 101 hips of 90 infants with congenital dislocation treated with the Pavlik harness and followed up for more than one year. Using ultrasonography in the flexed-abducted position the hips were classified as type A when the femoral head was displaced posteriorly, but within the socket and making contact with the posterior inner wall of the acetabulum; type B when it was in contact with the posterior margin of the acetabulum, with its centre at this level or anterior to it; and type C when it was displaced out of the socket, with its centre posterior to the posterior rim of the acetabulum.

Eighty-seven hips were reduced by the harness (86%), and seven of these developed avascular necrosis (8%). All 69 hips with type-A dislocation were reduced, and only one (1.4%) showed slight avascular necrosis. Eighteen (78.3%) of 23 hips with type-B dislocation were reduced, and six developed avascular necrosis (33.3%). In one hip, the femoral head was severely damaged. None of the nine hips with type-C dislocation was reduced in the harness.

We conclude that the Pavlik harness is indicated for type-A, but not for type-B or type-C dislocations.

Avascular necrosis and the Pavlik harness. The incidence of avascular necrosis in three types of congenital dislocation of the hip as classified by ultrasound

We analysed the incidence of avascular necrosis in 101 hips of 90 infants with congenital dislocation treated with Pavlik harness and followed up for more than one year. Using ultrasonography in the flexed-abducted position the hips were classified as type A when the femora head was displaced posteriorly, but within the socket and making contact with the posterior inner wall of the acetabulum; type B when it was in contact with the posterior margin of the acetabulum, with its centre at this level or anterior to it; and type C when it was displaced out of the socket, with its centre posterior to the posterior rim of the acetabulum. Eighty-seven hips were reduced by the harness (86%), and seven of these developed avascular necrosis (8%). All 69 hips with type-A dislocation were reduced and only one (1.4%) showed slight avascular necrosis. Eighteen (78.3%) of 23 hips with type-B dislocation were reduced, and six developed avascular necrosis (33.3%). In one hip, the femoral head was severely damaged. None of the nine hips with type-C dislocation was reduced in the harness. We concluded that the Pavlik harness is indicated for type-A but not for type-B or type-C dislocations.

T-cell receptor diversity expressed by CD4+ T cells activated by primary allogeneic HLA-DR stimulation: estimation of the degree of CDR3 diversity

In order to analyse the diversity of T-cell receptors (TCRs) expressed by the T-cell population activated by allogeneic HLA-DR stimulation, TCR beta cDNA was synthesized from mRNA of human CD4+ T cells that had been stimulated in a primary mixed lymphocyte reaction (MLR). The TCR beta cDNA was amplified by the polymerase chain reaction (PCR), subjected to bacterial cloning, and sequenced from V beta through J beta. Twenty-six different V beta and 10 different J beta segments were detected among 56 randomly selected cDNA clones. Occurrences of V beta 17.1 and J beta 1.5 were higher than those found in the CD4+ T-cell population activated with a CD3-specific antibody. A total of 53 different CDR3 sequences, two of them occurring more than once, were detected among the 56 cDNA clones. In order to estimate the degree of CDR3 diversity, amino acid similarity in the CDR3 region of the cDNA was calculated and compared with those of the anti-CD3-activated T-cell sequences as well as those of various published T-cell clone sequences, each directed to either alloantigens or single antigenic peptides. It was found that the similarity score among CDR3 sequences obtained from the MLR (56.4 +/- 10.3) was comparable to those of anti-CD3-activated T cells (55.7 +/- 10.7) and those of T-cell clones directed toward alloantigens (range, 48.4 +/- 12.4-59.4 +/- 13.1), but significantly smaller than those of T-cell clones directed toward single antigenic peptides such as those derived from myelin basic protein (75.6 +/- 17.9) and cytochrome c (76.9 +/- 20.5). These results provide quantitative proof that TCRs of T cells activated by primary allogeneic HLA-DR stimulation have a larger diversity than those recognizing single antigenic peptides.

[Blood flow measurement of portal vein with fast cine phase contrast MR imaging under breath-holding]

Flow measurements of the right portal vein were performed in seven healthy volunteers with the segmented k-space fast gradient-echo phase-contrast (fcard-PC) sequence under breath-holding. The mean velocity and the flow rate of the right portal vein at maximal expiration, 14.3 +/- 4.4cm/sec and 457 +/- 218 ml/min, were significantly greater (p < 0.01) than those at maximal inspiration: 11.8 +/- 3.8cm/sec (mean +/- SD) and 364 +/- 191ml/min, respectively. Fcard-PC enabled flow measurements to be obtained under breath-holding. Using this technique, we demonstrated portal venous flow changes according to respiratory phase.

Prediction of reduction in developmental dysplasia of the hip by magnetic resonance imaging

The acetabular rim of 33 hips in 29 patients with developmental dysplasia of the hip was evaluated using magnetic resonance imaging (MRI). The hips were classified into the following three groups according to the shape of the acetabular rim: 12 hips with sharp acetabular rim (group 1), 13 hips with dysplastic and round acetabular rim (group 2), and eight hips with inverted acetabular rim (group 3). The position of the femoral head with the hip flexed and abducted was also recorded, according to the criteria proposed by Suzuki. They were all treated initially with the Pavlik harness. All group 1 hips were successfully reduced with the Pavlik harness, whereas in group 2 hips, all but three hips were reduced. In all group 3 hips, reduction was not successful. MRI provided useful information regarding the probability of reduction with the Pavlik harness.

Phenotypic characteristics of bone marrow cells in patients with rheumatoid arthritis

OBJECTIVE

Our previous study showed the presence of abnormal myeloid lineage cells in the epiphyseal bone marrow adjacent to joints affected with severe rheumatoid arthritis (RA). Now, we investigated whether there were any changes of other marrow cell populations related to RA, and whether there were any pathologically characteristic changes in the iliac bone marrow, which is one of the major systemic hematopoietic organs.

METHODS

2-Color flow cytometry was carried out to analyze the phenotypes of mononuclear cells (MNC) fractions in bone marrow aspirates and venous blood from 56 patients with RA and 7 non-RA controls.

RESULTS

The absolute number of MNC in the iliac bone marrow was increased by 3-fold in the RA patients compared with the non-RA controls. In contrast, no significant increase of MNC was observed in the tibial epiphyseal bone marrow or peripheral blood. The ratio of each MNC fraction in the iliac bone marrow did not differ significantly between the RA patients and the non-RA controls. In lymphocyte subsets, the percentage of HLA-DR+CD8+ cells to all CD8 cells in the iliac bone marrow increased significantly in the RA patients compared with the non-RA controls. Abnormal myeloid cells (MX-GA+MY4+ cells), specific to severe RA, were found to be more concentrated in the iliac bone marrow than in the tibial epiphyseal bone marrow.

CONCLUSION

Characteristic pathologic changes of the iliac bone marrow suggest an important role of systemic bone marrow in the progression of RA.

Genetic analysis of hydatidiform moles utilizing the oligonucleotide-DNA typing of the HLA-DRB gene

The genetic origin of hydatidiform moles was analysed utilizing HLA-DNA typing. Using HLA-DR type-specific oligonucleotide probes, the DRB types of seven moles were determined and compared with the parental DRB types to determine the paternal and/or maternal origin of the moles. In four cases, the molar tissues showed single DRB types of paternal origin, although in one, the molar DRB type was also possessed by the mother. These four moles were, therefore, considered to be androgenetic in origin. Chromosomal karyotyping was carried out for three of these cases and confirmed the DR-DNA typing results. Two moles demonstrated a DRB-type triplet, which strongly suggested triploidy. Although one mole showed a heterozygous DRB type, karyotyping indicated triploidy (69, XXX) and suggested that this mole was caused by dispermy-fertilization, in which both of the sperms had the same DRB type. Although the majority (about 80%) of partial hydatidiform moles have been reported to be triploid as a result of dispermy, four of the moles analysed in this study (cases 1, 2, 3 and 4), diagnosed as partial macroscopically and/or histopathologically, were found to be androgenetic in origin using karyotyping and DR-DNA typing. Therefore, HLA-DR DNA typing, combined in some cases with karyotyping, provides an accurate method for diagnosing androgenesis and triploidy in complete and partial hydatidiform moles.

Lymphocyte membrane modifications induced by HIV infection

Novel carbohydrate antigen expressions were observed on T lymphocytes from HIV infected patients using flowcytometric analysis with four mAbs; BM-1, ACFH-18, FH-2 and C-6. These carbohydrate antigens were also expressed on oncogenic transformed cells but were either not expressed or were weakly expressed in lymphocyte populations from healthy subjects. A dramatic change in glycosylation was induced on CD8+T cells from HIV infected patients. The glycosylation change correlated with the progression of the disease. The incidence of Ley antigen expression on CD8+T cells increased as the disease progressed with the ongoing impairment of immune function. The phenotype change that occurred with Ley antigen expression might reflect the abnormal activation of T lymphocytes of some specific, but unknown, population of CD8+T cells. Thus, carbohydrate changes on the cell surface may induce immunological abnormality and accelerate the damage within the CD4+T cell subset, resulting in an impairment of the antigen specific immune system.

Polymerase chain reaction (PCR)/single-strand conformation polymorphism (SSCP) analysis of the human HLA-DQB regions

Genetic diagnosis of 13 alleles of HLA-DQB1 (0501, 0502, 5031, 5032, 0601, 0602, 0604, 0201, 0301, 0302, 3032, 0401 and 0402) from 65 human DNA samples was achieved by applying single-strand conformation polymorphism (SSCP) analysis to DNA fragments amplified by the polymerase chain reaction (PCR) using a convenient primer set for DQB1 (recommendation of the International Histocompatibility Workshop, 1991). Differences between strand images (narrow/distinct or broad/diffuse) from the individual alleles and their electrophoretic mobilities are regarded as criteria for confirming the genetic diagnosis of DQB1 alleles. This primer set amplifies not only DNA fragments belonging to DQB1, but also to DQB2, and classification of 3 phenotypes (1.1, 1.2 and 1.1/1.2) in the presence of two alleles at the latter locus was suggested. Consequently, PCR/SSCP of DNA amplified by this primer enables classification of the phenotypes, at least under our experimental conditions, into 3 x 91 groups. Two advantages of SSCP analysis over VNTR with regard to the use of amplified DNA in forensic practice are described.

Tissue transmigration of CZON (Cosmosin) to middle ear mucosa, maxillary sinus mucosa, and palatine tonsils

The concentration of CZON was determined by HPLC in surgical patients with chronic otitis media, sinusitis, and tonsillitis. One gram of CZON was injected intravenously prior to surgery. The time course of the mean tissue CZON level was as follows: In the middle ear mucosa, 3.7 micrograms/g at 15 min, 7.2 micrograms/g at 30 min, and 2.9 micrograms/g at 1 hr (the half life: 21.3 min). In the maxillary sinus mucosa, 10.5 micrograms/g at 15 min, 11.8 micrograms/g at 30 min, and 2.8 micrograms/g at 1 hr (the half life: 17.5 min). In the tonsils, 14.9 micrograms/g at 15 min, 9.3 micrograms/g at 30 min, and 2.0 micrograms/g at 1 hr (the half life: 13.2 min). The concentration was high in the maxillary sinus mucosa and the tonsils, but was low in the middle ear mucosa. In the formers the transfer ratio reached its peak 15 to 30 min after administration, but in the latter the peak was reached 30 to 60 min after administration. The order of the transfer ratio at each region was above 25%. The tissue concentration exceeded the MIC80s of frequent isolates from these infections. CZON is considered to be a highly useful drug in the treatment of these infections.

Analysis of the HLA-DR gene frequencies in Japanese cases of juveniles rheumatoid arthritis and rheumatoid arthritis by oligonucleotide DNA typing

HLA-DR gene frequencies in 59 Japanese children with juvenile rheumatoid arthritis (JRA) and 62 Japanese adults with rheumatoid arthritis (RA) were analyzed by oligonucleotide DNA typing. As in other studies, the frequency of DRB1*0405 in RA patients was significantly higher than in the Japanese controls. In a comparison of non-classified JRA patients with Japanese controls, no significant differences were observed in the frequency of DR types. However, when the JRA patients were classified into four clinical types, i.e., a rheumatoid factor-positive [RF(+)] polyarticular type, a rheumatoid factor-negative [RF(-)] polyarticular type, a pauciarticular type, and a systemic onset type, DRB1*0405 was found to be significantly higher in the RF(+) polyarticular JRA patients than in the controls (P < 0.05). Thus, the RF(+) polyarticular type of JRA had the same HLA association as RA. This result is consistent with the fact that both RF(+) polyarticular JRA and RA cases have a similar clinical course.

A single universal primer for the T-cell receptor (TCR) variable genes enables enzymatic amplification and direct sequencing of TCR beta cDNA of various T-cell clones

We designed a primer for the PCR directed against a highly conserved sequence of the TCR V beta gene. The V beta-universal primer, in combination with a constant region-specific primer, enabled us to amplify TCR beta cDNA of allo-HLA class-II-reactive T-cell clones by PCR without prior knowledge of their V beta sequences. The amplified TCR cDNA was purified by agarose gel electrophoresis and subjected to direct sequencing. In nine of ten T-cell clones analyzed, direct TCR sequencing gave readable sequence ladders, including two-thirds of V beta, junctional, and J beta regions. One T-cell clone gave an unreadable mixed-profile sequence ladder, indicating that this clone expressed more than one major TCR beta transcript. Even in this case, however, it was possible to determine two different TCR beta sequences separately using sequence primers specific to one of the 13 J beta segments deduced from the mixed ladder. Thus, direct sequencing utilizing the single V beta-universal primer enabled a simple, rapid, and reliable sequence determination of TCR beta cDNA of all T-cell clones analyzed.