Physiological and behavioural assessments of stress levels in owls housed at owl cafes

Owl cafes, where customers view and interact with owls, have become popular in Japan. There are multiple aspects of the environment which may be stressful to nocturnal owls, including lighting, tethering and frequent interactions with humans but, to date, welfare has not been investigated. This preliminary study examines the effects of owl cafes and customers on the physiological stress (faecal corticosterone levels [FCL]) and behaviour of the owls. Seven eagle owls (Bubo bubo ) and two African scops owls (Ptilopsis leucotis), in two cafes, were studied over an eight-day period. Cafe A (n = 5) was closed for one day per week, whilst cafe B (n = 4) was open every day. In cafe A there was higher FCL in owls during open days than closed days suggesting that the conditions on open days increase stress in owls. Eight of nine owls showed evidence of some aversion or avoidance of humans, whilst no affiliative behaviours were observed. The number of visitor interactions was not associated with the level of physiological stress; and when comparing owls, there was a tendency for individual owls with a higher percentage of aversive responses to customers to also have higher FCL. Close human interactions of a negative nature, that result in aversion, may be a significant stressor, but further research is required.

Perinatal health services organization for preterm births: a multinational comparison

OBJECTIVE

To explore population characteristics, organization of health services and comparability of available information for very low birth weight or very preterm neonates born before 32 weeks' gestation in 11 high-income countries contributing data to the International Network for Evaluating Outcomes of Neonates (iNeo).

STUDY DESIGN

We obtained population characteristics from public domain sources, conducted a survey of organization of maternal and neonatal health services and evaluated the comparability of data contributed to the iNeo collaboration from Australia, Canada, Finland, Israel, Italy, Japan, New Zealand, Spain, Sweden, Switzerland and UK.

RESULTS

All countries have nationally funded maternal/neonatal health care with >90% of women receiving prenatal care. Preterm birth rate, maternal age, and neonatal and infant mortality rates were relatively similar across countries. Most (50 to >95%) between-hospital transports of neonates born at non-tertiary units were conducted by designated transport teams; 72% (8/11 countries) had designated transfer and 63% (7/11 countries) mandate the presence of a physician. The capacity of 'step-down' units varied between countries, with capacity for respiratory care available in <10% to >75% of units. Heterogeneity in data collection processes for benchmarking and quality improvement activities were identified.

CONCLUSIONS

Comparability of healthcare outcomes for very preterm low birth weight neonates between countries requires an evaluation of differences in population coverage, healthcare services and meta-data.

Outcomes of peripherally inserted double lumen central catheter in very low birth weight infants

OBJECTIVE

In order to evaluate safety and usefulness of peripherally inserted double lumen central catheter (PIDLCC) in very low birth weight (VLBW) infants, outcomes of VLBW infants who had PIDLCC was studied.

SUBJECTIVE

Thirty-nine VLBW infants who were admitted to our NICU in 2013 were retrospectively analyzed.

RESULTS

Mean birth weight and gestational age was 1042.7 gram and 28.5 weeks, respectively. Total duration of indwelling PIDLCC was 1121 days (mean 28.5+18.2 days) with 85 PIDLCCs used. Dressing at the insertion site was done twice weekly with 10% povidone iodine. Four (10.3% with mean of 48 days) infants had catheter-related blood stream infection (CRBSI), with a 3.57 infection per 1000 catheter-day. The mean for days of PIDLCC in 35 infants without CRBSI was 26.5 days. Organisms isolated were Staphylococcus epidermidis, Staphylococcus aureus and Staphylococcus capitis ureolytic. Our study showed significant difference in the duration of indwelling catheter (p = 0.023) and intraventricular hemorrhage (p = 0.043) between the CRBSI group and non-CRBSI group. Five (12.8%) infants had abnormal thyroid function test, in which two infants required thyroxine supplementation upon discharge. However, duration of PIDLCC and abnormal thyroid function test was not statistically significant (p = 0.218). One (2.5%) infant died (death was not related to CRBSI). There was no serious adverse effects secondary to PIDLCC.

CONCLUSION

It is concluded that the use and maintenance of PIDLCC is safe for VLBW infants, but close monitoring should be observed to detect early signs of infection.

Effect of L-thyroxine supplementation on very low birth weight infants with transient hypothyroxinemia of prematurity at 3 years of age

OBJECTIVE

To evaluate the effects of levothyroxine (L-T4) supplementation on growth and neurodevelopmental outcomes at 3 years of age in very low birth weight (VLBW) infants with transient hypothyroxinemia of prematurity (THOP).

STUDY DESIGN

VLBW infants with plasma thyroid-stimulating hormone concentrations <10 mIU l^-1 and free thyroxine concentrations <0.8 ng dl^-1 were defined as having THOP and randomly assigned to the Treated (20 infants) or Untreated (31 infants) group. The Treated group received L-T4 at a dose of 5 μg kg^-1 day^-1. Growth and neurodevelopmental outcomes at 3 years of age were compared between the two groups.

RESULTS

There were no significant differences in body length, body weight or head circumference mean s.d. scores or in neurodevelopmental outcomes between the two groups.

CONCLUSION

L-T4 supplementation in VLBW infants with THOP demonstrated no beneficial effect at 3 years of age.

Hypertensive disorders of pregnancy and outcomes of preterm infants of 24 to 28 weeks' gestation

OBJECTIVE

To examine the relationship between hypertensive disorders of pregnancy (HDPs) and mortality and major morbidities in preterm neonates born at 24 to 28 weeks of gestation.

STUDY DESIGN

Using an international cohort, we retrospectively studied 27 846 preterm neonates born at 24⁰ to 28⁶ weeks of gestation during 2007 to 2010 from 6 national neonatal databases. The incidence of HDP was compared across countries, and multivariable logistic regression analyses were conducted to examine the association of HDP and neonatal outcomes including mortality to discharge, bronchopulmonary dysplasia, severe brain injury, necrotizing enterocolitis and treated retinopathy of prematurity.

RESULTS

The incidence of HDP in the entire cohort was 13% (range 11 to 16% across countries). HDP was associated with reduced odds of mortality (adjusted odds ratio (aOR) 0.77; 95% confidence interval (CI) 0.67 to 0.88), severe brain injury (aOR 0.74; 95% CI 0.62 to 0.89) and treated retinopathy (aOR 0.82; 95% CI 0.70 to 0.96), but increased odds of bronchopulmonary dysplasia (aOR 1.16; 95% CI 1.05 to 1.27).

CONCLUSIONS

In comparison with neonates born to mothers without HDP, neonates of HDP mothers had lower odds of mortality, severe brain injury and treated retinopathy, but higher odds of bronchopulmonary dysplasia. The impact of maternal HDP on newborn outcomes was inconsistent across outcomes and among countries; therefore, further international collaboration to standardize terminology, case definition and data capture is warranted.

Impact of pulmonary hypertension on neurodevelopmental outcome in preterm infants with bronchopulmonary dysplasia: a cohort study

OBJECTIVES

To evaluate the impact of pulmonary hypertension (PH) on long-term growth and neurodevelopmental outcomes of extremely preterm infants with bronchopulmonary dysplasia (BPD).

STUDY DESIGN

A single-center retrospective cohort of preterm infants born at <28 weeks gestational age from 2000 to 2011 was evaluated at 3 years of age. Growth and neurodevelopmental outcomes were compared among 3 groups: non-BPD, BPD without PH and BPD with PH. BPD was defined according to oxygen demand at 36 weeks postmenstrual age. PH was diagnosed by echocardiography during the neonatal intensive care unit stay.

RESULTS

Sixty-two infants without BPD, 60 with BPD without PH and 20 with BPD with PH were analyzed. Regardless of PH status, somatic growth was smaller in both BPD groups of infants than in non-BPD infants, with further reduction in the group having BPD with PH. Furthermore, a developmental quotient of <70 was more prevalent in the BPD infants with PH than in the BPD infants without PH (odds ratio (OR): 4.37; 95% confidence interval, CI: 1.16 to 16.5). Multivariate analysis demonstrated that BPD with PH was one of the independent perinatal risk factors for developmental quotient <70 at 3 years of age (OR: 4.94, 95% confidence interval: 1.06 to 24.1).

CONCLUSION

PH had an additional negative effect on long-term growth and neurodevelopmental outcomes of extremely preterm infants with BPD.

Rapid normalization of marked dilatation of the cerebral duro-venous system in a newborn infant mimicking a great vein of Galen varix

A newborn infant with a marked dilatation of the cerebral duro-venous system is presented. The patient was diagnosed as having a vein of Galen aneurysmal varix by a cranial ultrasound examination immediately following delivery. Computed tomographic angiography on the following day, however, showed a marked dilatation of the cerebral duro-venous system, including the great vein of Galen, superior sagittal sinus, torcular herophili and transverse sinuses. There were no arteriovenous fistulas at the vein of Galen. Dilatation of the duro-venous system and concomitant heart failure subsided rapidly after intravenous administration of indomethacin for the treatment of the patent ductus arteriosus on the fourth day of life. Dilatation of the duro-venous system in a newborn infant should be differentiated from any form of vein of Galen aneurysm.

Cerebral hemodynamics after exogenous surfactant administration for respiratory distress syndrome in piglet model

OBJECTIVE

The rapid improvement of lung function after exogenous surfactant treatment for respiratory distress syndrome (RDS) can affect the functions of several other systems, which includes cerebral blood flow volume (CBF). To evaluate the change in CBF after treatment with exogenous surfactant, we measured CBF in a newborn piglet model with RDS.

METHOD

After the lung lavage with normal saline, ten animals under mechanical ventilation were administered either 120 mg/kg surfactant-TA (Surfacten) or air placebo. Heart rate, blood pressure, dynamic lung compliance (Cdyn), PaO2, PaCO2, and CBF were recorded before and every 15 min after surfactant treatment up to 120 min.

RESULTS

Cdyn was improved significantly at 45 min and later after treatment; that of the control group remained unchanged. PaO2 increased and PaCO2 decreased significantly after surfactant treatment in both groups. However, the improvement was significantly less in the control group. CBF significantly decreased by about 30% in the control group, and by about 50% in the treated group at 120 min, with a significant difference between groups. Almost 70% of the changes in CBF were attributable to changes in PaCO2 by multivariate regression analysis.

CONCLUSIONS

Treatment with exogenous surfactant improves lung compliance, and has little effect on CBF itself. The drop in levels of PaCO2 after treatment, however, had a strong relationship with decreases in CBF.

A prospective clinical study on inhaled nitric oxide therapy for neonates in Japan

BACKGROUND

This is the first report about a prospective clinical investigation to study the efficacy and safety of nitric oxide (NO) inhalation in infants with persistent pulmonary hypertension of the newborn (PPHN) in Japan.

METHODS

Patients in the present study had to meet the following entry criteria: (i) they had to be younger than 7 days of age; (ii) they had to have evidence of PPHN as defined by echocardiograph; (iii) they had to have severe systemic hypoxemia under mechanical ventilation at 100% oxygen supplementation; and (iv) they had to have a failure to respond to conventional therapies. Patients were excluded from this trial if they had any of the following: hypoplastic lung, structural cardiac lesions or severe multiple anomalies.

RESULTS

Nitric oxide inhalation therapy was performed in 68 infants who had severe PPHN at 18 hospitals between May 1995 and May 1997. At birth, 21 of 68 infants (31%) weighed less than 1,500 g and 39 infants weighed more than 2,500 g. The diagnoses associated with PPHN were as follows: 27 infants had meconium aspiration syndrome, 15 infants had dry lung syndrome, nine infants had congenital diaphragmatic hernia, six infants had respiratory distress syndrome, three infants had pneumonia and eight infants had other diagnoses. The mean oxygenation index (OI) before NO inhalation therapy in 68 infants was 43.2; 55 infants (81%) had good responses.

CONCLUSIONS

These results may be valuable for further randomized controlled and double-blind trials in Japan to evaluate whether NO inhalation therapy is more effective than conventional therapy in infants with severe PPHN.

[Seizures associated with fever in children of congenital adrenal hyperplasia]

We investigated seizures in 22 children with congenital adrenal hyperplasia (CAH), eight of whom had seizures associated with fever. The follow-up period was 5-18 years. The onset of seizures ranged from 1 to 4 years of age, and the total number of seizures was one to three in all cases. Four cases had seizures twice within 24 hours. None had seizures after 5 years of age. In two of the eight cases, the seizures may have caused by hypoglycemia or hyponatremia, in the remaining six they were considered to be febrile seizures. Three of them had first-degree relatives with febrile seizures. Electroencephalogram was recorded in five cases, with normal results in all of them. One case with febrile status developed localization-related epilepsy later. None showed developmental delay during follow-up. Although seizures in CAH have been ascribed to hypoglycemia and/or metabolic disorders (hyponatremia), our findings implicate unknown factors in the pathogenesis such as excess secretion of corticotropin releasing factor (CRF) under stress, prolonged elevation of CRF during fetus life and linkage between CAH and febrile seizures on the chromosome 6.

16-Dehydropregnenolone 3-sulfate, its source and metabolism in the feto-placental unit

We have investigated the serum concentration of 16-dehydropregnenolone (3 beta-hydroxy-5,16-pregnadien-20-one) 3-sulfate (16-DHPS) in the umbilical artery (U.A.), umbilical vein (U.V.) and maternal vein (M.V.) to discover the origin of 16-DHPS. Although there was no significant difference between the levels of 16-DHPS in U.A. (18 +/- 15 ng/ml, mean +/- SD., n = 28) and U.V. (10 +/- 9 ng/ml, n = 28), these values were significantly higher (U.A., p < 0.001; U.V., p < 0.001) than that in M.V. (2 +/- 3 ng/ml, n = 28). These levels in the U.A. and U.V. did not fall in infants (30 +/- 18 ng/ml, n = 7) during the early neonatal period (2-7 d after birth). A significant correlation between the serum levels of 16-DHPS and 16-hydroxypregnenolone (3 beta, 16 alpha-dihydroxy-5-pregnen-20-one) 3-sulfate (16-OH-PregS), which may be the precursor steroid for 16-DHPS, was observed in the U.A. (r = 0.630, n = 28, p < 0.001), but not in the U.V. Moreover, this significant correlation persisted during the early neonatal period (p < 0.05, r = 0.842, n = 7), although the neonate had been separated from the maternal milieu. These results suggest that 16-DHPS originates in the fetus. To confirm the metabolic pathway of 16-DHPS (i.e. pregnenolone (3 beta-hydroxy-5-pregnen-20-one) 3-sulfate (PregS)-->16-OH-PregS-->16-DHPS), we investigated the correlation between the serum concentrations of the precursor steroid and the product in both the U.A. and U.V. A significant correlation was obtained between the serum concentrations of PregS and 16-OH-PregS both in the U.A. (p < 0.001, r = 0.563, n = 28) and U.V. (p < 0.05, r = 0.476, n = 27). As described above, the serum levels of 16-DHPS and 16-OH-PregS only correlated significantly in the U.A. These findings support the existence of the pathway, PregS-->16-OH-PregS-->16-DHPS, in the fetus.

Postnatal change of renal artery blood flow velocity and its relationship with urine volume in very low birth weight infants during the first month of life

Although the renal artery blood flow velocity has been investigated recently using the ultrasound Doppler method, little is known about the longitudinal change of renal artery blood flow velocity and its relationship with urine volume in very low birth weight infant. Thus, we measured renal artery blood flow velocities by means of the pulse Doppler method in 28 very low birth weight infants. Maximum, minimum, and mean blood flow velocities were determined at postnatal days 0, 1, 2, 3, 4, 5, 6, 13, 20, and 27. The resistance index was also calculated. The maximum and mean blood flow velocities increased gradually after birth, and were significantly higher at 13, 20, and 27 days after birth. The minimum blood flow velocity and the resistance index were relatively constant during the study period. The mean blood flow velocities were also analyzed for any correlation with urine volume. There was a poor correlation between urine volume (ml/kg/day) and mean blood flow velocity (cm/s) (Y = 2.38X + 57.4, Y: urine volume, X: mean blood flow velocity, n = 161, r = 0.338, P < 0.01). However, if the mean renal artery blood flow velocity was less than 10 cm/s, oliguria was observed in most cases. The measurement of the renal artery blood flow velocities appears to be useful in understanding the background condition of renal function in very low birth weight infants.

Transumbilical embolization of a congenital dural arteriovenous fistula at the torcular herophili in a neonate. Case report

A neonate, in whom a congenital cerebral vascular anomaly had been diagnosed prenatally, exhibited progressive high-output congestive heart failure soon after birth. Cerebral angiography revealed a congenital dural arteriovenous fistula (AVF) with a huge dural lake located at the torcular herophili. In addition to the meningeal blood supply, an unusual pial blood supply from all cerebellar arteries was observed to feed the fistula. The patient was treated by repeated transarterial and transvenous embolization through the umbilical venous route. To the authors' knowledge, neither the existence of a congenital dural AVF at the torcular herophili presenting with an enormous pial blood supply or the technique of trans-umbilical venous intervention has been reported in the literature.

Cerebral blood flow during treatment for pulmonary hypertension

AIM

To determine if the haemodynamics of systemic and cerebral circulation are changed during treatment for persistent pulmonary hypertension of the newborn (PPHN).

METHODS

Fifteen term newborn piglets with hypoxia induced pulmonary hypertension were randomly assigned either tolazoline infusion (Tz), hyperventilation alkalosis(HAT), and inhaled nitric oxide (iNO). Mean pulmonary arterial pressure (PAP), mean systemic arterial pressure (SAP), and cerebral blood flow volume (CBF) were measured.

RESULTS

During hypoxic breathing, PAP increased significantly in all groups. After treatment PAP decreased significantly in all groups, but no significant difference was observed between groups. SAP decreased significantly only in the Tz group, and CBF reduced significantly only in the HAT group. On the other hand, iNO did not change SAP or CBF.

CONCLUSION

Inhaled NO might be ideal for the resolution of pulmonary hypertension.

Localization of sphingomyelinase in lesional skin of atopic dermatitis patients

Because it has been suggested that the majority of the activity hydrolysing [N-methyl-14C] sphingomyelin is due to sphingomyelin acylase in the lesional skins of atopic dermatitis (AD), in this study we used immunologic techniques to localize and quantitate sphingomyelinase in AD lesional and normal skin. A polyclonal antibody raised against a synthetic polypeptide corresponding to a portion of the amino acid sequence deduced from the cDNA of human acid sphingomyelinase, cross-reacted with a 58 kDa, pI 5.8 human epidermal protein in an immunoblot analysis. The 58 kDa protein-rich fraction, partially purified by immunoprecipitation, converted [N-methyl-14C]-sphingomyelin to 14C-phosphorylcholine and ceramides. The reaction products were immunohistochemically observed in the intercellular domain from the upper spinous cell layer to the upper stratum corneum cell layers in the lesional skin of AD patients. Immunoelectron-microscopically, gold particles appeared to be concentrated in the intercellular domains of the granular-upper stratum corneum cells in the lesional skin of AD patients. The total amount of the 58 kDa protein in a 7 mm2 area of the skin was measured by quantitative immunoblot analysis; and was slightly increased in the lesional skin samples [3.5 +/- 0.3 microg per 7 mm2 (n = 7)], as compared with the nonlesional skin samples of AD patients [2.8 +/- 0.19 microg per 7 mm2 (n = 10)] and with the normal skin samples [2.7 +/- 0.22 microg per 7 mm2 (n = 10)]. This difference (between the lesional skin of AD and the nonlesional skin of AD or the normal control) was significant (nonpaired student's t test, p < 0.05).

[Home mechanical ventilation with nasal intermittent positive pressure ventilation for a boy with congenital central hypoventilation syndrome]

We report a 4-year-old boy with congenital central hypoventilation syndrome (CCHS) successfully treated with home mechanical ventilation with nasal intermittent positive pressure ventilation (NIPPV) during sleep hours. He had had frequent severe apneic attacks from the neonatal period. At 8 months, he was treated with positive pressure ventilation following a tracheostomy. At 4 year and 2 months, NIPPV was attempted because of recurrent respiratory tract infections and cor pulmonale. The tracheostomy was successfully abandoned 6 months later. Adequate ventilation has been maintained for more than 3 years without troubles. NIPPV is an effective and non-invasive treatment of CCHS that it significantly improves the quality of life during daytime.

C16 hydroxylation of 3beta-hydroxy-delta5-steroids during the early neonatal period

Temporal changes of the serum levels of 16-hydroxypregnenolone (3beta,16alpha-dihydroxy-5-pregnen-20-one) 3-sulfate (16-OH-Preg S) and 16-hydroxydehydroepiandrosterone (3beta,16alpha-dihydroxy-5-androsten-17-one) 3-sulfate (16-OH-DHEA S) were investigated by analyzing the levels of their precursor steroids, pregnenolone (3beta-hydroxy-5-pregnen-20-one) 3-sulfate (Preg S) and dehydroepiandrosterone (3beta-hydroxy-5-androsten-17-one) 3-sulfate (DHEA S), respectively, in the early neonatal period. The serum levels of these steroids were measured by GC-MS in full-term (gestational age: 37-41 weeks), pre-term (gestational age: 28-36 weeks) and extremely immature (gestational age: 24-27 weeks) infants. The changes in 16-hydroxysteroid production were also investigated by analyzing the ratios of the serum levels of 16-OH-Preg S and Preg S (16-OH-Preg S/Preg S ratio), and 16-OH-DHEA S and DHEA S (16-OH-DHEA S/DHEA S ratio). It was confirmed that the 16-hydroxylation of DHEA S and Preg S increased after birth, and the 16-OH-Preg S/Preg S ratio in full-term infants was significantly higher than in pre-term and extremely immature infants at days 0, 1-6 and 7-13. On the other hand, there were no significant differences between the 16-OH-DHEA S/DHEA S ratios of the three groups at days 0, 1-6 or 7-13. The mechanism of differences in the 16-hydroxylation of Preg S and DHEA S is also discussed.

Three novel mutations and a de novo deletion mutation of the DAX-1 gene in patients with X-linked adrenal hypoplasia congenita

The DAX-1 [DSS (dosage sensitive sex)-AHC critical region on the X, gene 1] gene is responsible for X-linked adrenal hypoplasia congenita (AHC). However, DAX-1 protein structure-function relationships are not well understood. Identification of missense mutations may help to reveal these relationships. We analyzed the DAX-1 gene from seven patients in six kindreds with X-linked AHC and identified one frameshift mutation, two missense mutations, and three deletion mutations. Case 1 had a 388delAG frameshift mutation, inducing a premature stop codon at position 70. Case 2 had a missense mutation, Lys382Asn, which encodes an asparagine (Asn) for lysine (Lys) at position 382. Sibling cases of 3-1 and 3-2 had a missense mutation of Trp291 Cys, which encodes a substitution of cysteine (Cys) for tryptophan (Try) at position 291. The tryptophan (Trp) at position 291 and lysine (Lys) at position 382 in human DAX-1 protein are highly conserved among other related orphan nuclear receptor superfamily members. Cases 4, 5, and 6 showed deletion mutation. In case 6, a de novo deletion mutation was revealed by both southern hybridization and polymerase chain reaction (PCR) of a GGAA tetranucleotide tandem repeat. These findings suggest that: 1) Trp at position 291 and Lys at position 382, located in the C-terminal presumptive ligand binding domain, are important to the functional role of the DAX-1 protein in adrenal embryogenesis and/or in hypothalamic-pituitary activity; and 2) molecular analysis of the DAX-1 gene may help genetic counseling, even in cases with deletion mutation, because a detection of de novo deletion may exclude another affected or carrier child.

Decreased level of prosaposin in atopic skin

In the skin of atopic dermatitis patients, the amount of ceramides in the stratum corneum is decreased. Although the cause of this decrease may be due to the higher activity of acylase, a decrease in the activity of sphingolipid activator proteins may also be the cause. A polyclonal antibody to saposin D, elicited by immunizing rabbits with the synthetic polypeptide from cDNA of saposin D, cross-reacted with a single 65-kDa epidermal protein of pI 5.6 in a 2-dimensional immunoblot study, suggesting that it was prosaposin, the precursor protein of saposin D, from its molecular weight and demonstrating its immunohistochemical localization in the innermost cell layers of the stratum corneum of the skin. The antigenic material was also observed in the epithelium of the esophagus, pneumocytes of the lungs, hepatocytes, and glandular cells of the stomach. Immunoelectron microscopy showed the antigenic material in the cytoplasm of the granular cells and the intercellular spaces, either between the stratum granulosum and the stratum corneum or on the stratum corneum cell envelope. By ELISA, the amount of the 65-kDa protein in the inner surface skin of the upper arm of atopic dermatitis patients (nonlesional skin) [4.1 +/- 2.0 microg per 7 mm2 (mean +/- SD), n = 10] was found to be significantly decreased (p < 0.05) to 66% of that in the normal control (6.2 +/- 1.5 microg per 7 mm2, n = 10). Therefore, the suppression of prosaposin synthesis may be related to the abnormal stratum corneum formation in atopic skin through lower activation of glucosylcerebrosidase or sphingomyelinase.

Molecular basis of nonclassical steroid 21-hydroxylase deficiency detected by neonatal mass screening in Japan

Since 1989, neonatal mass screening for congenital adrenal hyperplasia (CAH) has been performed in Japan, and the frequency of the classical form of 21-hydroxylase deficiency was found to be nearly identical to that in other countries. However, it has not yet been determined whether our mass screening program can detect the nonclassical (NC) form. From 1991 to 1994, about 4,500,000 infants underwent CAH mass screening in Japan. During this period, we identified by screening 2 siblings and 2 unrelated patients who had mild elevation of serum 17-hydroxyprogesterone levels at 5 days of age, but who revealed no symptoms of CAH. They were diagnosed as having probable NC steroid 21-hydroxylase deficiency. To clarify the molecular basis of NC CAH detectable by neonatal screening in Japan, the steroid 21-hydroxylase (CYP21) genes from these cases were analyzed. The 2 siblings (patients 1 and 2) had I172N and R356W mutations in 1 allele and in the other allele had local gene conversion, including the P30L mutation in exon 1. Patient 3, who was unrelated, had gene conversion encoding the same P30L mutation in 1 allele and in the other allele had an intron 2 mutation (668-12 A-->G), causing aberrant ribonucleic acid splicing, and the R356W mutation. Patient 4, also a compound heterozygote, had the R356W and 707del8 mutations. The estimated rate of detection of the NC form by mass screening (1:1,100,000) seemed low compare to the established detection rate for the classical form (1:18,000). As all of our 4 patients were compound heterozygotes with at least 1 allele bearing 1 or more mutations associated with classic CAH, it may be difficult to detect NC cases carrying only NC-associated alleles using our current neonatal mass screening methods.

Serum levels of 16-dehydropregnenolone sulfate during the early neonatal period

We have established a method for quantifying serum 16-dehydropregnenolone (3beta-hydroxy-5,16-pregnadien-20-one) sulfate (16-DHP S) by GC-MS. The levels of 16-DHP S at birth were compared in infants grouped as extremely immature (gestational age: 22-27 weeks), pre-term (gestational age: 28-36 weeks) and full-term (gestational age: 37-41 weeks). The average of the serum concentration of 16-DHP S in full-term infants was 0.172+/-0.104 micromol/l (n=10, mean+/-S.D.) which was significantly higher than the levels of the extremely immature (0.106+/-0.054 micromol/l, n=14, p<0.05) and pre-term infants (0.088+/-0.066 micromol/l, n=33, p<0.01). However, 16-DHP S in sera from normal adults (age 22-73 years, n=40) was not detected. We investigated chronological changes in serum levels of 16-DHP S during the early neonatal period. In extremely immature and pre-term infants, these levels were significantly higher at 2-7 d than those of 16-DHP S at day 0 (p<0.001). The levels at 8-18 d were still significantly higher than those at day 0 (p<0.05), but in full-term infants, these levels did not change at days 0 and 2-7. These results indicate that 16-DHP S is a steroid specific to fetuses and neonates and the involution of the fetal adrenal gland does not affect its serum levels in the early neonatal period.

Truncation at the C-terminus of the DAX-1 protein impairs its biological actions in patients with X-linked adrenal hypoplasia congenita

The DAX-1 [DSS (dosage-sensitive sex)-AHC critical region in the X, gene 1] gene has been reported to be responsible for X-linked adrenal hypoplasia congenita (AHC) and hypogonadotropic hypogonadism. However, the function and structure of the DAX-1 protein have not been characterized. In this study, molecular analysis of the DAX-1 gene from 6 patients with AHC, including 2 siblings, identified 5 novel mutations with 3 nonsense mutations and 2 frameshift mutations. Case 1 had a nonsense mutation at position 395 (Q395X). Cases 2 and 3, who were siblings, had a nonsense mutation at position 91 (Y91X). Case 4 had a 2-base deletion (AT) at nucleotides 1610 and 1611 and a 1-base insertion (G) resulting in a premature stop codon at position 462 (1610-1611 del AT ins G). Case 5 had a nonsense mutation at position 271 (Y271X). Case 6 had a 1-base deletion (C) at nucleotide 1169, which induced a frame shift and a premature stop codon at position 371 (1169 del C). All mutated DAX-1 proteins had truncated C-terminal domains. In addition, reverse transcription-PCR and direct sequencing characterized the mutant messenger ribonucleic acid in testis from case 1. Our results suggest that these 5 novel mutations are responsible for X-linked AHC and that the C-terminus of the DAX-1 protein, especially the terminal 11 amino acids, is necessary for normal adrenal cortical embryogenesis.

Decreased expression of filaggrin in atopic skin

The amounts of the epidermal proteins filaggrin, involucrin, cystatin A and Ted-H-1 antigen produced during the terminal differentiation of keratinocytes were immunohistochemically measured in lesional and nonlesional skin of atopic dermatitis (AD) patients. In addition, the amount of filaggrin in the skin of the inner surface of the upper arm of AD patients (nonlesional skin) and normal controls, obtained by punch biopsy, was measured by an enzyme-linked immunosorbent assay (ELISA) technique. The immunohistochemical study showed that all four proteins were decreased in lesional skin. By contrast, only filaggrin was decreased in nonlesional skin of AD patients. The ELISA showed that the amount of filaggrin in the skin of the inner surface of the upper arm was 2.48 +/- 0.45 microgram/7 mm2 (n = 8) in AD patients, which was 32% of that in the normal controls (7.7 +/- 0.55 microgram/7 mm2; n = 4). This decrease in filaggrin production in atopic skin may be one of the reasons why atopic skin can easily become dry, because filaggrin is thought to be the precursor protein of the emollient factors in the stratum corneum. The evidence that only the expression of filaggrin was suppressed in AD patients, though the genes of filaggrin and involucrin are localized to a very restricted portion of the same gene 1q21, indicates that the filaggrin gene does not share regulatory elements with the involucrin gene.

[Unusual hepatic fibrosis in three cases of Down syndrome]

We report three infants with Down syndrome who had hepatic fibrosis, which is rare in this syndrome. Liver specimens were obtained by biopsy or autopsy. In one patient, the peripheral blood contained blastoid cells, a typical hematological feature of the transiently abnormal myelopoiesis of Down syndrome. Ascites and hepatosplenomegaly were found in all patients. The intralobular hepatic fibrosis was pericellular and perisinusoidal, and the narrowing of the central veins resembled that in venoocclusive disease of the liver. We found some megakaryocytes in the liver, which were stained for von Willebrand factor and platelet glycoprotein IIb/IIIa. In one specimen, collagen type IV and alpha smooth muscle actin were stained by immunohistochemical methods, so the fibrosis in this case was probably caused by cells such as Ito cells derived from myofibroblasts. Overall, the findings suggest that megakaryocytes in the liver of these three patients produce collagen-stimulating cytokines such as transforming growth factor beta, and that Ito cells were involved in the hepatic fibrosis we observed.

Perinatal medical support in the area surrounding the Hanshin-Awaji earthquake

After natural disaster, perinatal medical care must usually be provided from outside the disaster area, because most of the medical efforts inside the area focus on patients without special needs. This study reviews the emergency perinatal medical response after the great Hanshin-Awaji earthquake. In the present study, we summarize records of telephone calls and reports from the Neonatal Mutual Cooperative System (NMCS). The day of the earthquake, very little information was available to or from the disaster area. The day after the earthquake, Osaka City General Hospital (OCGH) and Osaka Medical Center and Research Institute for Maternal and Child Health were established as key facilities, and OCGH served as a center through which information passed to and from the disaster area. Most telephone calls to OCGH were placed on the second day after the earthquake by pregnant women concerned about their deliveries. Many high-risk pregnancies and newborn infants were transferred out of the disaster area over the next month. This analysis shows that although the emergency response was very rapid in this instance, the operation may be significantly improved in disasters of this magnitude: (i) if a communication mechanism able to serve a large volume is established; (ii) if helicopter transport was easily available; and (iii) if key facilities to handle communications were previously established so as to be available immediately.

Screening for PIT1 abnormality by PCR direct sequencing method

PIT1 abnormality is defined as a genetic abnormality in the PIT1 gene, which encodes a pituitary specific transcription factor Pit-1/GHF-1.PIT1 abnormality has been reported in several patients displaying either complete or incomplete deficiency of thyrotropin (TSH), growth hormone (GH), and prolactin (PRL) in either familial or sporadic cases. To see if there are abnormalities in the PIT1 gene in patients with incomplete TSH, GH, and PRL deficiency, we utilized a PCR direct sequencing method to determine the Pit-1/GHF-1 coding sequence. A total of 15 patients, 1 patient from a family with TSH and GH deficiency, 3 patients with TSH, GH, and PRL deficiency, and 11 patients treated with both human GH (hGH) and thyroid hormone were studied. In one patient of combined pituitary hormone deficiency, the Arg-271-Trp mutation was detected. Since both of the parents did not harbor this mutation, it is a de novo germ line mutation. No mutation was detected in the other patients, showing that PIT1 abnormality is not a frequent cause of GH deficiency.

Exanthem subitum (roseola infantum) with vesicular lesions

We report a 7-month-old boy who developed vesicular lesions during the course of exanthem subitum. Human herpesvirus-6 (HHV-6) DNA was detected both in the skin lesions and in the throat, by polymerase chain reaction. IgG and IgM antibodies against HHV-6 were 1:10 and < 1:10, respectively on the tenth day of the illness, and > 1:640 and 1:10 on the twenty-second day, respectively. These results suggest that this was primary HHV-6 infection.

Terminal differentiation of facial epidermis of the aged: immunohistochemical studies

In old age, the epidermis tends to become dry and flaky, especially on the lower legs. However, this does not occur on the face, although long-term ultraviolet light irradiation has important effects on the differentiation of facial keratinocytes. Therefore, the differentiation of the epidermal cells of the facial skin in the young and the aged was immunohistochemically examined using antibodies against four differentiation products: filaggrin, involucrin, cystatin A (CTA) and carbonic anhydrase-like protein. The results showed that there was no difference in the amounts of the above three proteins in facial skin between the young and the aged with the exception of CTA. The amount of CTA was much greater in the facial skin of the aged. However, there was a striking decrease of filaggrin content in the skin of the lower leg in the aged. One of the reasons why no scaly skin is found on the face in the aged may be the fact that especially filaggrin does not decrease with aging.

Measurement of growth promoting activity in human milk using a fetal small intestinal cell line

To evaluate the effect of the growth promoting activity in human milk on intestinal cells, a bioassay method was established using a fetal intestinal cell line (FHS 74 Int, ATCC CCL 241), since the developing intestine is considered to be a target organ for the growth factors present in human milk. Human milk had a growth promoting activity on the cultured human fetal intestinal cells. The activity level was very high in colostrum and decreased gradually during lactation, while formula products had no activity. The epidermal growth factor (EGF) concentration in human milk was significantly correlated with the growth promoting activity measured by bioassay. Thus, EGF may be the main growth factor for the proliferation of intestinal cells. These results suggest that human milk may stimulate the proliferation of intestinal cells in newborn infants, especially in very-low-birth-weight infants, and accelerate the maturation of the intestinal portion of the digestive system.

Characterization of ovarian gonadotropin receptor. Monomer and associated form of the receptor

We have purified luteinizing hormone/human choriogonadotropin (hCG) receptor from rat ovary by sequential affinity column on wheat germ lectin-Sepharose and hCG-Sepharose chromatography. The purified receptor, previously identified as a single protein on sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE) (Kusuda, S., and Dufau, M.L. (1986) J. Biol. Chem. 261, 16161-16168), was further characterized by radioiodination with 1,3,4,6-tetrachloro-3 alpha, 6 alpha-diphenylglycouril, and column chromatography on wheat germ lectin-Sepharose. Autoradiography of SDS-PAGE analysis under reducing conditions showed a single radiolabeled band of Mr = 80,000. The radioiodinated receptors treated with peptide:N-glycosidase F migrated at Mr = 54,000. Treatment with neuraminidase alone caused only a minor reduction in molecular weight, and subsequent treatment with endo-alpha-N-acetyl-D-galactosaminidase had little further effect on the receptor. When the radioiodinated receptor was analyzed by fast protein liquid chromatography, a single broad peak was eluted with Mr of approximately 350,000. The higher Mr of radioiodinated receptors than that of native receptors (Mr = 190,000 dimeric form) could be due to the aggregation of labeled molecules. These complexes dissociated into the monomeric form in the presence of SDS. To determine whether the monomers can bind hormone, the purified unlabeled receptors resolved with SDS were electroblotted to nitrocellulose membranes and incubated with 125I-hCG. Autoradiograms of the blots showed a band of monomer (Mr = 78,000) as well as one of dimer (Mr approximately 150,000). These studies have demonstrated that the luteinizing hormone/hCG receptors are predominantly N-linked glycosylated and suggest that the native receptor is a dimer of identical hormone binding subunits associated by noncovalent interactions. Although the individual subunits can bind hormone, it is conceivable that the dimeric form is necessary for signal transduction.

Purification and characterization of Leydig cell luteinizing hormone receptor

We have purified the testicular luteinizing hormone (LH/human choriogonadotropin (hCG)) receptor by sequential affinity chromatography on hCG-Sepharose. The purified LH/hCG receptor was identified as a single protein of Mr = 90,000 +/- 2,000 on sodium dodecyl sulfate-gel electrophoresis (SDS-PAGE), showed high affinity binding for hCG, and a binding capacity of 3.8 nmol/mg of protein. Electrophoretically blotted receptor retained the ability to bind 125I-hCG on nitrocellulose membrane, and the Mr of radioactive band was consistent with that revealed by silver staining. Autoradiography after SDS-PAGE analysis of cross-linked purified receptor-hCG complex showed Mr = 145,000 and Mr = 105,000 bands. These results are consistent with a Mr value for the receptor of 90,000 after accounting for contribution by the intact hormone or its alpha-subunit. Analysis of the free receptor by fast protein liquid chromatography on Superose 12 revealed a single peak of binding activity for 125I-hCG which eluted in the position of Mr = 200,000-240,000 in the presence of Triton X-100. Since a single protein species is observed under reducing or nonreducing conditions in SDS-PAGE, the receptor could exist in the membrane as a dimeric form composed of subunits Mr = 90,000 associated through noncovalent interactions. The pure receptor can be phosphorylated in vitro by the catalytic subunit of cAMP-dependent protein kinase (approximately 0.3 mol of phosphate/mol of receptor). This phosphorylation does not affect the binding characteristics of the receptor. The method described is simple and allows rapid purification of microgram amounts of biological active Leydig cell LH/hCG receptor for structural, functional, and immunological studies.

Purification and characterization of ovarian LH/hCG and prolactin receptors

We have purified the luteinizing hormone (LH)/human choriogonadotropin (hCG) receptor to homogeneity by sequential affinity column on wheat germ lectin-Sepharose and hCG-Sepharose. The method was designed to allow also the purification of lactogen receptor from the initial starting material. Comparable purification of lactogen receptor can be attained using Con A-Sepharose as initial step. The purified LH/hCG receptor was identified as a single protein of Mr = 75,000 on SDS gel electrophoresis. The lactogen receptor is composed of two dissimilar active subunits of Mr 88,000 and 40,000, the latter probably being an integral part of the larger form. Comparison of Mr's derived from SDS gels with those from fast performance liquid chromatography suggested that the native LH holoreceptor is present in a dimeric form, while the lactogen receptor seems to be composed of aggregates that could represent dimeric or trimeric forms of holoreceptor Mr 80,000. Cross-linking studies performed after binding of hCG (radiolabeled in the individual subunits) to the purified LH/hCG receptor indicated that the hCG alpha-subunit undergoes predominant interaction with the receptor molecule. The influence of the beta-subunit in this interaction seems to occur mainly through its association with the alpha-subunit, presumably by conferring specificity to the alpha-subunit for its interaction with the receptor. The alpha-subunit, which is identical within species, has an important role in the receptor binding interaction and biological activity of glycoprotein hormones.

Purification and characterization of the rat ovarian receptor for luteinizing hormone. Structural studies of subunit interaction

We have purified the luteinizing hormone (LH)/human choriogonadotropin (hCG) receptor by sequential affinity column on wheat germ lectin-Sepharose and hCG-Sepharose. The method was designed to allow also the purification of lactogen receptor from the initial starting material. The purified LH/hCG receptor retained full binding affinity and was identified as a single protein of Mr = 73,000 +/- 3,000 on sodium dodecyl sulfate-gel electrophoresis. Cross-linking studies performed after binding of hCG to the purified LH/hCG receptor indicated that the hCG alpha-subunit undergoes predominant interaction with the receptor molecule. The influence of the beta-subunit in this interaction seems to occur mainly through its association with the alpha-subunit, presumably by conferring specificity to the alpha-subunit for its hormonal interaction with the receptor. The technique described in this study is simple and allows rapid purification of microgram amounts of biologically active receptor suitable for further molecular characterization, microsequencing, and functional reconstitution studies.

Semiautomated enzyme immunoassay of thyrotropin as a mass screening test for neonatal hypothyroidism

A sensitive, simple, and rapid semiautomated sandwich enzyme immunoassay (EIA) was developed for measuring thyrotropin in dried blood samples on filter paper for use in screening for neonatal hypothyroidism. Good correlation was found between values for thyrotropin determined by this method and those determined by radioimmunoassay (RIA) (r=0.94). In pilot tests on 17,160 newborn infants in the general population, five cases of primary hypothyroidism were detected by both EIA and RIA. The recall rate was slightly highter in EIA than in RIA.

Adrenoleukodystrophy: new CT findings

Three cases of adrenoleukodystrophy are presented with sequential findings by computed tomography (CT). In two cases, CT confirmed not only the findings of several previous reports of a caudocranial direction of low-density white matter and contrast enhancement at the periphery of affected regions during the active demyelinating process, but also two other unusual features: (1) calcification in the affected white matter along the trigones of the lateral ventricles and (2) development of a mass effect during the active demyelinating period. Calcification alone without low-density white matter was the initial CT presentation in one case. Periventricular calcification may be specific for adrenoleukodystrophy in the appropriate clinical setting.