Flow independent black blood imaging with a large FOV from the neck to the aortic arch: A feasibility study at 3 tesla

PURPOSE

To investigate the feasibility of obtaining black-blood imaging with a large FOV from the neck to the aortic arch at 3 T using a newly modified Relaxation-Enhanced Angiography without Contrast and Triggering for Black-Blood Imaging (REACT-BB).

MATERIALS AND METHODS

REACT-BB provides black-blood images by adjusting the inversion time (TI) in REACT to the null point of blood. The optimal TI for REACT-BB was investigated in 10 healthy volunteers with TI varied from 200 ms to 1400 ms. Contrast ratios were calculated between muscle and three branch arteries of the aortic arch. Additionally, a comparison between REACT-BB and MPRAGE involved evaluating the depiction of high-intensity plaques in 222 patients with stroke or transient ischemic attack. Measurements included plaque-to-muscle signal intensity ratios (PMR), plaque volumes, and carotid artery stenosis rates in 60 patients with high-intensity plaques in carotid arteries.

RESULTS

REACT-BB with TI = 850 ms produced the black-blood image with the best contrast between blood and background tissues. REACT-BB outperformed MPRAGE in depicting high-intensity plaques in the aortic arch (55.4% vs 45.5%) and exhibited superior overall image quality in visual assessment (3.31 ± 0.70 vs 2.89 ± 0.73; p < 0.05). Although the PMR of REACT-BB was significantly lower than MPRAGE (2.227 ± 0.601 vs 2.285 ± 0.662; P < 0.05), a strong positive correlation existed between REACT-BB and MPRAGE (ρ = 0.935; P < 0.05), and all high-intensity plaques that MPRAGE detected were clearly detected by REACT-BB.

CONCLUSION

REACT-BB provides black-blood images with uniformly suppressed fat and blood signals over a large FOV from the neck to the aortic arch with comparable or better high-signal plaque depiction than MPRAGE.

Diffusion weighted imaging combining respiratory triggering and navigator echo tracking in the upper abdomen

OBJECTIVES

To evaluate a new motion correction method, named RT + NV Track, for upper abdominal DWI that combines the respiratory triggering (RT) method using a respiration sensor and the Navigator Track (NV Track) method using navigator echoes.

MATERIALS AND METHODS

To evaluate image quality acquired upper abdominal DWI and ADC images with RT, NV, and RT + NV Track in 10 healthy volunteers and 35 patients, signal-to-noise efficiency (SNRefficiency) and the coefficient of variation (CV) of ADC values were measured. Five radiologists independently performed qualitative image-analysis assessments.

RESULTS

RT + NV Track showed significantly higher SNRefficiency than RT and NV (14.01 ± 4.86 vs 12.05 ± 4.65, 10.05 ± 3.18; p < 0.001, p < 0.001). RT + NV Track was superior to RT and equal or better quality than NV in CV and visual evaluation of ADC values (0.033 ± 0.018 vs 0.080 ± 0.042, 0.057 ± 0.034; p < 0.001, p < 0.001). RT + NV Track tends to acquire only expiratory data rather than NV, even in patients with relatively rapid breathing, and can correct for respiratory depth variations, a weakness of RT, thus minimizing image quality degradation.

CONCLUSION

The RT + NV Track method is an efficient imaging method that combines the advantages of both RT and NV methods in upper abdominal DWI, providing stably good images in a short scan time.

Three-dimensional multicontrast blood imaging with a single acquisition: Simultaneous non-contrast-enhanced MRA and vessel wall imaging in the thoracic aorta

PURPOSE

To evaluate MRA and vessel wall imaging (VWI) image quality in the thoracic aorta using a novel method named BRIDGE (bright and dark blood images with multishot gradient-echo EPI).

METHODS

The BRIDGE method consists of 3D multishot gradient-echo EPI acquisition using pulse gating, navigator gating, and magnetization preparation with a T₂ -preparation pulse and a nonselective inversion-recovery pulse. The BRIDGE and conventional methods (noncontrast MRA based on 3D turbo-field-echo [TFE] and VWI based on 3D turbo spin echo with variable refocusing flip angle [VRFA-TSE]) were performed in 10 healthy volunteers and 10 patients. The SNR, contrast-to-noise ratio (CNR), and sharpness in the thoracic aorta were compared for MRA evaluation. The values of SNR_lumen , SNR_wall , CNR_wall-lumen , contrast ratio (CR)_lumen-muscle , coefficient of variation, sharpness, lumen area, and wall area in the thoracic aorta were compared for VWI evaluation. Two radiologists independently performed qualitative image-analysis assessments.

RESULTS

When MRA and VWI were acquired, the acquisition time was 26.6% to 27.8% shorter with BRIDGE than the conventional method. In the MRA evaluation, BRIDGE and TFE methods were comparable. In the VWI evaluation, BRIDGE was superior to the VRFA-TSE method in blood suppression and evaluation of the ascending aorta. Because the blood signal suppression of BRIDGE is based on the T₁ value of blood, the blood signal can be suppressed more uniformly than with the VRFA-TSE method, regardless of age, blood flow velocity, or vascular anatomy.

CONCLUSION

The BRIDGE method can provide both MRA, to assess vascular anatomy and luminal changes, and VWI, to assess the vessel wall and detect vulnerable plaques, in a single scan.

Lactulose ingestion causes an increase in the abundance of gut-resident bifidobacteria in Japanese women: a randomised, double-blind, placebo-controlled crossover trial

The genus Bifidobacterium comprises various bacterial species, and the complement of species within the human intestinal tract differs from individual to individual. The balance of these bifidobacterial species remains poorly understood, although it is known that the abundance of bifidobacteria increases following the ingestion of prebiotics. We previously conducted a randomised, placebo-controlled, double-blind, crossover study of 2 g/day lactulose ingestion for 2 weeks in 60 Japanese women. To study the effect of lactulose ingestion on each bifidobacterial species, here, we measured the abundance of each of the principal bifidobacterial species. After lactulose ingestion, the log cell counts of the Bifidobacterium adolescentis group (8.97±0.08 vs 9.39±0.08, P=0.0019), Bifidobacterium catenulatum group (9.45±0.10 vs 9.65±0.10, P=0.0032) and Bifidobacterium longum group (9.01±0.07 vs 9.29±0.07, P=0.0012) were significantly higher than in the placebo ingestion control group. However, the log cell counts were similar for Bifidobacterium breve (8.12±0.12 vs 8.33±0.12, P=0.20), Bifidobacterium bifidum (9.08±0.12 vs 9.42±0.14, P=0.095) and Bifidobacterium animalis subspecies lactis (8.65±0.53 vs 8.46±0.46, P=0.77). Cluster analysis of the log cell count data at the bifidobacterial species level revealed three distinct clusters, but the combinations and ratios of the constituent bifidobacteria were not affected by lactulose ingestion. Furthermore, principal coordinate analysis of the intestinal microbiota in the lactulose and placebo ingestion groups using Illumina MiSeq showed no significant differences in the intestinal microbiota as a whole. These results suggest that 2 g/day lactulose ingestion for 2 weeks significantly increases the abundance of intestinal bifidobacteria, but does not affect the intestinal microbiota as a whole.

Improved selective visualization of internal and external carotid artery in 4D-MR angiography based on super-selective pseudo-continuous arterial spin labeling combined with CENTRA-keyhole and view-sharing (4D-S-PACK)

PURPOSE

Four-dimensional magnetic resonance angiography (4D-MRA) based on super-selective pseudo-continuous arterial spin labeling, combined with Keyhole and View-sharing (4D-S-PACK) was introduced for scan-accelerated vessel-selective 4D-MRA. Label selectivity and visualization effectiveness were assessed.

METHODS

Nine healthy volunteers were included in the study. The label selectivity for the imaging of internal carotid artery (ICA) and external carotid artery (ECA) circulation was assessed qualitatively. The contrast-to-noise ratio (CNR) in 4D-S-PACK was measured in four middle cerebral artery (MCA) and superficial temporal artery (STA) segments and compared with that in contrast-inherent inflow-enhanced multi-phase angiography combined with the vessel-selective arterial spin labeling technique (CINEMA-select). Vessel-selective arterial visualization in 4D-S-PACK was assessed qualitatively in a patient with dural arteriovenous fistula and compared with digital subtraction angiography (DSA) and non-vessel selective 4D-PACK.

RESULTS

4D-S-PACK vessel selectivity was judged to be at a clinically acceptable level in all cases except one ECA-targeted label. The CNR was significantly higher using 4D-S-PACK compared with CINEMA-select in MCA and STA peripheral segments (p < 0.001). In patient examination, territorial flow visualization in feeding artery and draining vein circulation on 4D-S-PACK were comparable with that on DSA and the identification of such responsible vessels was easier on 4D-S-PACK than on 4D-PACK.

CONCLUSION

4D-S-PACK showed high vessel-selectivity and higher visualization effectiveness compared with CINEMA-select. One clinical case was performed and ICA and ECA territorial flow was successfully visualized separately, suggesting clinical usefulness.

Search for η^{'} Bound Nuclei in the ^{12}C(γ,p) Reaction with Simultaneous Detection of Decay Products

We measured missing mass spectrum of the ^{12}C(γ,p) reaction for the first time in coincidence with potential decay products from η^{'} bound nuclei. We tagged an (η+p) pair associated with the η^{'}N→ηN process in a nucleus. After applying kinematical selections to reduce backgrounds, no signal events were observed in the bound-state region. An upper limit of the signal cross section in the opening angle cosθ_{lab}^{ηp}<-0.9 was obtained to be 2.2  nb/sr at the 90% confidence level. It is compared with theoretical cross sections, whose normalization ambiguity is suppressed by measuring a quasifree η^{'} production rate. Our results indicate a small branching fraction of the η^{'}N→ηN process and/or a shallow η^{'}-nucleus potential.

Relationship between the administration of nicardipine hydrochloride and the development of delirium in patients on mechanical ventilation

A history of hypertension is a known risk factor for delirium in patients in intensive care units, but the effect of antihypertensive agents on delirium development is unclear. Nicardipine, a calcium channel blocker, is widely used in ICU as a treatment agent for hypertensive emergency. This study investigated the relationship between the administration of nicardipine hydrochloride and delirium development in patients under mechanical ventilation. We conducted a medical chart review of 103 patients, who were divided into two groups according to the use of nicardipine hydrochloride. The prevalence of delirium was compared with respect to factors such as age, sex, laboratory data, and medical history, by multivariate analysis. 21 patients (20.4 %) were treated with nicardipine hydrochloride in 103 patients. The treatment and non-treatment groups differed significantly in age (72 vs. 65 years) and history of high blood pressure (57% vs. 11%). Multivariate analysis revealed that patients in the treatment group developed delirium significantly less often than those in the non-treatment group (19% vs. 48%). These results suggested that treatment of high blood pressure with nicardipine hydrochloride is a possible method for preventing the development of delirium.

Efficacy and safety of osteoporosis medications in a rat model of late-stage chronic kidney disease accompanied by secondary hyperparathyroidism and hyperphosphatemia

This study showed that bisphosphonate was safe and effective for the treatment of bone disorders in stage 4 chronic kidney disease (CKD) rats. Intermittent teriparatide therapy showed an anabolic action on bone even under secondary hyperparathyroidism conditions without having an adverse effect on mineral metabolism in late-stage CKD.

INTRODUCTION

Patients with late-stage CKD are at high risk for fragility fractures. However, there are no consensus on the efficacy and safety of osteoporosis medications for patients with late-stage CKD. In the present study, we aimed to examine the efficacy and safety of alendronate (ALN) and teriparatide (TPD) for treating bone disorder in late-stage CKD with pre-existing secondary hyperparathyroidism using a rat model of CKD.

METHODS

Male 10-week-old Sprague-Dawley rats were subjected to a 5/6 nephrectomy or sham surgery and randomized into the following four groups: sham, vehicle (saline subcutaneous (sc) daily), ALN (50 μg/kg sc daily), and TPD (40 μg/kg sc daily). Medications commenced at 24 weeks of age and continued for 4 weeks. Micro-computed tomography, histological analysis, infrared spectroscopic imaging, and serum assays were performed.

RESULTS

Nephrectomized rats developed hyperphosphatemia, secondary hyperparathyroidism (SHPT), and high creatinine, equivalent to CKD stage 4 in humans. ALN suppressed the bone turnover and increased the degree of mineralization in cortical bone, resulting in an improvement in the mechanical properties. TPD further increased the bone turnover and significantly increased the degree of mineralization, micro-geometry, and bone volume, resulting in a significant improvement in the mechanical properties. Both ALN and TPD had no adverse effect on renal function and mineral metabolism.

CONCLUSIONS

BP is safe and effective for the treatment of bone disorders in stage 4 CKD rats. Intermittent TPD therapy showed an anabolic action on bone even under SHPT conditions without having an adverse effect on mineral metabolism in late-stage CKD.

Autoimmune arthritis deteriorates bone quantity and quality of periarticular bone in a mouse model of rheumatoid arthritis

This study showed that autoimmune arthritis induces especially severe osteoporosis in the periarticular region adjacent to inflamed joints, suggesting that arthritis increases the fragility fracture risk near inflamed joints, which is frequently observed in patients with RA.

INTRODUCTION

Periarticular osteoporosis near inflamed joints is a hallmark of early rheumatoid arthritis (RA). Here we show that rheumatic inflammation deteriorates the bone quality and bone quantity of periarticular bone, thereby decreasing bone strength and toughness in a mouse model of RA.

METHODS

Female BALB/c mice and SKG mice, a mutant mouse model of autoimmune arthritis on the BALB/c background, were used. At 12 weeks of age, BALB/c mice underwent either Sham surgery or bilateral ovariectomy (OVX), and SKG mice underwent intraperitoneal injection of mannan to induce arthritis. Eight weeks later, the mice were killed and the femurs and tibias were subjected to micro-computed tomography, Fourier transform infrared (FTIR) spectroscopic imaging, X-ray diffraction, histology, and mechanical testing.

RESULTS

SKG mice developed significant trabecular bone loss in both the distal metaphysis of the femur and the lumbar vertebral body, but the extent of the bone loss was more severe in the distal metaphysis. Neither SKG nor OVX mice exhibited changes in the geometry and matrix properties of the diaphysis of the femur, whereas SKG mice, but not OVX mice, did exhibit changes in these properties in the distal metaphysis of the femur. Bone strength and fracture toughness of the distal metaphysis of the tibia adjacent to the inflamed ankle joint were significantly decreased in SKG mice.

CONCLUSIONS

Autoimmune arthritis induces periarticular osteoporosis, characterized by deterioration of cortical bone geometry and quality as well as by trabecular bone loss, leading to severe bone fragility in periarticular bone adjacent to inflamed joints.

The Power of Traditional Design Techniques: The Effects of Viewing a Japanese Garden on Individuals With Cognitive Impairment

PURPOSE

This study is to examine how viewing a Japanese garden affects Japanese patients with dementia.

BACKGROUND

In a previous study, authors explored the effect on individuals with Alzheimer's disease of viewing an indoor Japanese garden at a nursing home in the United States and reported that viewing the garden significantly reduced the heart rate, evoked short-term and long-term memories, and improved behavioral symptoms. However, it was unclear whether these effects were caused by the design of Japanese garden or unfamiliarity of the design to Caucasians.

METHODS

We constructed a Japanese garden on the rooftop of a hospital in Japan and assessed with a total of 25 subjects on the following categories: (1) eye movement, (2) heart rate, and (3) behavior under four different conditions: (a) open view of the site before construction of the Japanese garden (the control space), (b) open view of the Japanese garden, (c) view of the Japanese garden through closed door, and (d) view of Japanese garden through closed door with the chrysanthemum scent. Findings/Results: Viewers' eyes scanned larger area while viewing the Japanese garden, and viewing the Japanese garden significantly reduced heart rate and improved behavioral symptoms than the control space. We also found that the effect of viewing the same Japanese garden differed across three conditions: the view through an open door, a closed door, and a closed door with added scent.

Clinical features of a new disease concept, IgG4-related thyroiditis

OBJECTIVES

Immunoglobulin (Ig)G4-related disease is a recently proposed systemic disorder that includes autoimmune pancreatitis (AIP), Mikulicz's disease, and various other organ lesions. In the present retrospective study, we examined whether thyroid lesions should also be included in IgG4-related disease (Ig4-RD) under the new term IgG4-related thyroiditis.

METHOD

We enrolled 114 patients with Ig4-RD, including 92 patients with AIP, 15 patients with Mikulicz's disease, and seven patients with IgG4-related cholangitis, and analysed clinical findings, function, serum values of activity markers, computed tomography (CT) images, and histology of the thyroid gland.

RESULTS

Among the 22 patients (19%) in our cohort who were found to have hypothyroidism [thyroid stimulating hormone (TSH) > 4 mIU/L], 11 patients had clinical hypothyroidism [free thyroxine (FT4) < 1 ng/dL] and 11 patients had subclinical hypothyroidism (FT4 ≥ 1 ng/dL). Serum concentrations of IgG, IgG4, circulating immune complex (CIC), and β2-microglobulin (β2-MG) were significantly higher in the hypothyroidism group compared with the remaining 92 euthyroid patients, and serum C3 concentration was significantly lower. After prednisolone treatment, TSH values had decreased significantly (p = 0.005) in this group and FT4 values had increased significantly (p = 0.047). CT images showed that the thyroid glands of patients with clinical hypothyroidism had a significantly greater volume than those of the euthyroid and other groups. Pathological analysis of one resected thyroid gland disclosed a focused lesion with infiltration of lymphocytes and IgG4-bearing plasma cells and loss of thyroid follicles.

CONCLUSIONS

Thyroid lesions associated with hypothyroidism can be considered as a new disease termed IgG4-related thyroiditis. Awareness of this condition should lead to appropriate corticosteroid treatment that may prevent progression to a fibrous state.

Epidemiological survey of the hoof wall cavity ('Gidoh' in Japanese) in racehorses

In October 2001, a survey was conducted about cavities formed within the hoof wall (called GIDOH in Japanese) of racehorses at the Ritto and Miho Training Centres, which are managed by the Japan Racing Association (JRA). Gidoh is defined as a progressive cavity within the deep layers between the stratum medium and stratum internum. A total of 148 out of 5386 surveyed horses (2.75 per cent) were affected. Out of 244 affected feet, fore hooves (84.02 per cent) were more susceptible than hind hooves, and the site most affected was midline dead centre of the toe (59.62 per cent) which tends to place extra stress at the break-over point in a straight-line exercise. Logistic regression analysis revealed that prevalence was significantly related with horse affiliation (OR 0.65, 95 per cent CI 0.46 to 0.91) and age (OR 1.43 per one year, 95 per cent CI 1.27 to 1.61). We hypothesised that the primary cause of Gidoh development in JRA stables was mechanical deformation of the hoof wall during exercise, and secondary exciting causes can subsequently lead to the spread of the lesion over the entire hoof wall.

Structural heterogeneity and unique distorted hydrogen bonding in primary ammonium nitrate ionic liquids studied by high-energy X-ray diffraction experiments and MD simulations

Liquid structure and the closest ion-ion interactions in a series of primary alkylammonium nitrate ionic liquids [C(n)Am(+)][NO(3)(-)] (n = 2, 3, and 4) were studied by means of high-energy X-ray diffraction (HEXRD) experiments with the aid of molecular dynamics (MD) simulations. Experimental density and X-ray structure factors are in good accordance with those evaluated with MD simulations. With regard to liquid structure, characteristic peaks appeared in the low Q (Q: a scattering vector) region of X-ray structure factors S(Q)'s for all ionic liquids studied here, and they increased in intensity with a peak position shift toward the lower Q side by increasing the alkyl chain length. Experimentally evaluated S(Q(peak))(r(max)) functions, which represent the S(Q) intensity at a peak position of maximum intensity Q(peak) as a function of distance (actually a integration range r(max)), revealed that characteristic peaks in the low Q region are related to the intermolecular anion-anion correlation decrease in the r range of 10-12 Å. Appearance of the peak in the low Q region is probably related to the exclusion of the correlations among ions of the same sign in this r range by the alkyl chain aggregation. From MD simulations, we found unique and rather distorted NH···O hydrogen bonding between C(n)Am(+) (n = 2, 3, and 4) and NO(3)(-) in these ionic liquids regardless of the alkyl chain length. Subsequent ab initio calculations for both a molecular complex C(2)H(5)NH(2)···HONO(2) and an ion pair C(2)H(5)NH(3)(+)···ONO(2)(-) revealed that such distorted hydrogen bonding is specific in a liquid state of this family of ionic liquids, though the linear orientation is preferred for both the N···HO hydrogen bonding in a molecular complex and the NH···O one in an ion pair. Finally, we propose our interpretation of structural heterogeneity in PILs and also in APILs.

Standard steroid treatment for autoimmune pancreatitis

OBJECTIVE

To establish an appropriate steroid treatment regimen for autoimmune pancreatitis (AIP).

METHODS

A retrospective survey of AIP treatment was conducted in 17 centres in Japan. The main outcome measures were rate of remission and relapse.

RESULTS

Of 563 patients with AIP, 459 (82%) received steroid treatment. The remission rate of steroid-treated AIP was 98%, which was significantly higher than that of patients without steroid treatment (74%, 77/104; p<0.001). Steroid treatment was given for obstructive jaundice (60%), abdominal pain (11%), associated extrapancreatic lesions except the biliary duct (11%), and diffuse enlargement of the pancreas (10%). There was no relationship between the period necessary to achieve remission and the initial dose (30 mg/day vs 40 mg/day) of prednisolone. Maintenance steroid treatment was given in 377 (82%) of 459 steroid-treated patients, and steroid treatment was stopped in 104 patients. The relapse rate of patients with AIP on maintenance treatment was 23% (63/273), which was significantly lower than that of patients who stopped maintenance treatment (34%, 35/104; p = 0.048). From the start of steroid treatment, 56% (55/99) relapsed within 1 year and 92% (91/99) relapsed within 3 years. Of the 89 relapsed patients, 83 (93%) received steroid re-treatment, and steroid re-treatment was effective in 97% of them.

CONCLUSIONS

The major indication for steroid treatment in AIP is the presence of symptoms. An initial prednisolone dose of 0.6 mg/kg/day, is recommend, which is then reduced to a maintenance dose over a period of 3-6 months. Maintenance treatment with low-dose steroid reduces but dose not eliminate relapses.

Pulmonary involvement of autoimmune pancreatitis

BACKGROUND

A wide variety of systemic lesions have been seen in patients with autoimmune pancreatitis. The pulmonary involvement of autoimmune pancreatitis was analysed to clarify the clinicopathological features of pulmonary lesions in comparison with pulmonary sarcoidosis.

MATERIALS AND METHODS

Nineteen patients had autoimmune pancreatitis and eight had pulmonary sarcoidosis. The symptoms, laboratory data, chest computed tomography, Gallium-67 scintigraphy, pulmonary function testing and bronchoscopy findings, including the histological IgG4-immunostaining and IgG subclasses in the bronchoalveolar lavage in autoimmune pancreatitis, were collected to compare them with pulmonary sarcoidosis.

RESULTS

The serum total protein, IgG and IgG4 levels were found to be significantly elevated in comparison with pulmonary sarcoidosis. In autoimmune pancreatitis, 17 patients showed bilateral hilar lymphadenopathy, while eight showed pulmonary nodules on chest computed tomography. Eighteen of 19 patients on Gallium-67 scintigraphy showed accumulation spots in either the hilar or mediastinal lymph nodes. Six patients with pulmonary nodules demonstrated accumulation spots in the corresponding lesions on chest computed tomography. All eight patients with pulmonary sarcoidosis showed accumulation spots in either the hilar or mediastinal lymph nodes. Bronchoalveolar lavage IgG4 in autoimmune pancreatitis showed a significant increase in comparison with pulmonary sarcoidosis. The histological findings obtained by a transbronchial lung biopsy showed the infiltration of lymphocytes and plasma cells in the thickened interstitum and alveoli with IgG4-positive plasma cell infiltration in patients with autoimmune pancreatitis.

CONCLUSION

IgG4 in the bronchoalveolar lavage was seen at remarkably increased levels and IgG4-positive plasma cells were identified in the pulmonary lesions of patients with autoimmune pancreatitis.

Pre-clinical evaluation of a new orally-active CCK-2R antagonist, Z-360, in gastrointestinal cancer models

BACKGROUND

Gastrin has a role in gastrointestinal (GI) malignancy. This study provides pre-clinical evaluation of a novel, orally-active gastrin/cholecystokinin-2 receptor (CCK-2R) antagonist, Z-360.

METHODS

(125)I gastrin-17 (G17) displacement and G17-stimulated calcium assays were used in classical CCK-2R-transfected cell lines. Akt phosphorylation was assessed by Western blotting. Z-360 efficacy in vivo was evaluated in three human xenograft models, and microvessel density and apoptosis in these models were investigated by immunohistochemistry.

RESULTS

Z-360 inhibited (125)I G17 binding to cells expressing CCK-2R, and G17-stimulated signalling. Reduced Akt phosphorylation in an oesophageal cell-line treated with Z-360 was reversed by co-treatment with G17. Z-360 increased survival in a gastric ascites model (p=0.011) and decreased tumour growth in a hepatic metastasis model (81%, p=0.02). In an orthotopic pancreatic model, Z-360 combined with gemcitabine decreased final tumour weight compared to single agents (84%, p=0.002) and there was increased apoptosis and decreased microvessel density in ex vivo tumour tissue.

CONCLUSIONS

These results show that the orally-active CCK-2R antagonist, Z-360 has high sub-nM affinity for classical CCK-2R, is well tolerated in vivo and exerts an anti-tumour effect.

Reduction of osteocalcin expression in aged human dental pulp

AIM

To investigate the expression of osteocalcin mRNA in young and in aged human dental pulp tissue to determine the characteristics of osteocalcin expression.

METHODOLOGY

Human dental pulp tissues of the third molars were obtained from healthy young (17-23 years) and aged (>50 years) subjects, and total RNA was extracted. Osteocalcin mRNA expression was determined by RT-PCR and by quantitative real-time RT-PCR (QRT-PCR). The threshold cycle (Ct) value, which reflects the amount of PCR, was calculated and the difference between the value in young and aged pulp was statistically analysed.

RESULTS

Osteocalcin mRNA was detected in all samples of human dental pulp tissue homogenates by RT-PCR analysis. Osteocalcin mRNA was expressed in young adult dental pulp but was decreased in aged human dental pulp. QRT-PCR analysis also showed a reduced expression of osteocalcin mRNA in aged human pulp. Expression of osteocalcin in young human pulp was significantly higher (about sixfold) than in aged pulp (P<0.01, Mann-Whitney U-test).

CONCLUSION

Reduction of osteocalcin expression may be associated with the loss of viability in human dental pulp tissue, and may be a characteristic of aged human dental pulps.

Reduction of connexin 43 expression in aged human dental pulp

AIM

To investigate the expression of connexin 43 (CX43) mRNA in young and old human dental pulp tissues to determine the characteristics of CX43 expression.

METHODOLOGY

Samples were obtained from human dental pulp of healthy young (17-23 years) and aged (>50 years) subjects. CX43 expression was determined by RT-PCR and by quantitative real-time RT-PCR (QRT-PCR). The threshold cycle (Ct) value, which reflects the amount of PCR, was calculated and the difference between value in the young pulp and that in the aged pulp was statistically analysed.

RESULTS

RT-PCR analysis of human dental pulp tissue detected CX43 mRNA in all the samples. CX43 was abundantly expressed in young adult dental pulp, but expression of CX43 mRNA was dramatically decreased in aged human dental pulp. QRT-PCR analysis also showed the reduced expression of CX43 in aged pulp, and expression of CX43 in young pulp was significantly higher (about 10-fold, P < 0.01, Mann-Whitney U-test).

CONCLUSION

Reduction of CX43 expression may be associated with the loss of viability in human dental pulp, and is considered as one characteristic of aged pulp.

High serum IgG4 concentrations in patients with sclerosing pancreatitis

BACKGROUND

Sclerosing pancreatitis is a unique form of pancreatitis that is characterized by irregular narrowing of the main pancreatic duct, lymphoplasmacytic inflammation of the pancreas, and hypergammaglobulinemia and that responds to glucocorticoid treatment. Preliminary studies suggested that serum IgG4 concentrations are elevated in this disease but not in other diseases of the pancreas or biliary tract.

METHODS

We measured serum IgG4 concentrations using single radial immunodiffusion and an enzyme-linked immunosorbent assay in 20 patients with sclerosing pancreatitis, 20 age- and sex-matched normal subjects, and 154 patients with pancreatic cancer, ordinary chronic pancreatitis, primary biliary cirrhosis, primary sclerosing cholangitis, or Sjögren's syndrome. Serum concentrations of immune complexes and the IgG4 subclass of immune complexes were determined by means of an enzyme-linked immunosorbent assay with monoclonal rheumatoid factor.

RESULTS

The median serum IgG4 concentration in the patients with sclerosing pancreatitis was 663 mg per deciliter (5th and 95th percentiles, 136 and 1150), as compared with 51 mg per deciliter (5th and 95th percentiles, 15 and 128) in normal subjects (P<0.001). The serum IgG4 concentrations in the other groups of patients were similar to those in the normal subjects. In patients with sclerosing pancreatitis, serum concentrations of immune complexes and the IgG4 subclass of immune complexes were significantly higher before glucocorticoid therapy than after four weeks of such therapy. Glucocorticoid therapy induced clinical remissions and significantly decreased serum concentrations of IgG4, immune complexes, and the IgG4 subclass of immune complexes.

CONCLUSIONS

Patients with sclerosing pancreatitis have high serum IgG4 concentrations, providing a useful means of distinguishing this disorder from other diseases of the pancreas or biliary tract.

High serum IgG4 concentrations in patients with sclerosing pancreatitis

BACKGROUND

Sclerosing pancreatitis is a unique form of pancreatitis that is characterized by irregular narrowing of the main pancreatic duct, lymphoplasmacytic inflammation of the pancreas, and hypergammaglobulinemia and that responds to glucocorticoid treatment. Preliminary studies suggested that serum IgG4 concentrations are elevated in this disease but not in other diseases of the pancreas or biliary tract.

METHODS

We measured serum IgG4 concentrations using single radial immunodiffusion and an enzyme-linked immunosorbent assay in 20 patients with sclerosing pancreatitis, 20 age- and sex-matched normal subjects, and 154 patients with pancreatic cancer, ordinary chronic pancreatitis, primary biliary cirrhosis, primary sclerosing cholangitis, or Sjögren's syndrome. Serum concentrations of immune complexes and the IgG4 subclass of immune complexes were determined by means of an enzyme-linked immunosorbent assay with monoclonal rheumatoid factor.

RESULTS

The median serum IgG4 concentration in the patients with sclerosing pancreatitis was 663 mg per deciliter (5th and 95th percentiles, 136 and 1150), as compared with 51 mg per deciliter (5th and 95th percentiles, 15 and 128) in normal subjects (P<0.001). The serum IgG4 concentrations in the other groups of patients were similar to those in the normal subjects. In patients with sclerosing pancreatitis, serum concentrations of immune complexes and the IgG4 subclass of immune complexes were significantly higher before glucocorticoid therapy than after four weeks of such therapy. Glucocorticoid therapy induced clinical remissions and significantly decreased serum concentrations of IgG4, immune complexes, and the IgG4 subclass of immune complexes.

CONCLUSIONS

Patients with sclerosing pancreatitis have high serum IgG4 concentrations, providing a useful means of distinguishing this disorder from other diseases of the pancreas or biliary tract.

Estrogen-induced resistance to osteoblast apoptosis is associated with increased hsp27 expression

Estrogen has been shown to protect osteoblastic cells from apoptosis. Similarly, estrogen treatment preceding heat shock elevates heat shock protein 27 (hsp27) expression and increases thermoresistance in the murine estrogen receptor-transformed SMER14 osteoblastic cell line. Forced expression of hsp27 expression in other cell lines limits apoptosis. The purpose of this study was to examine the effects of estrogen on staurosporine-induced apoptosis in the context of hsp27 expression. Cell viability was measured by the MTT assay. Early apoptotic events were examined by fluorescent microscopy by using FITC-conjugated Annexin V staining. TUNEL labeling was used to compare the number of apoptotic nuclei following staurosporine treatment of estrogen pretreated or untreated cells. Estrogen treatment increased SMER14 cell viability, but not ROS17/2.8 cell viability, in the presence of staurosporine. Estrogen treatment also reduced annexin V staining and DNA fragmentation. Similar treatment increased SMER14 cell hsp27 levels. The concurrent reduction in induced apoptosis suggests a possible estrogenic mechanism for increasing and/or maintaining the number of viable osteoblasts in bone.

Mitochondrial neurogastrointestinal encephalomyopathy: an autosomal recessive disorder due to thymidine phosphorylase mutations

Mitochondrial neurogastrointestinal encephalomyopathy (MNGIE) is an autosomal recessive disorder defined clinically by severe gastrointestinal dysmotility; cachexia; ptosis, ophthalmoparesis, or both; peripheral neuropathy; leukoencephalopathy; and mitochondrial abnormalities. The disease is caused by mutations in the thymidine phosphorylase (TP) gene. TP protein catalyzes phosphorolysis of thymidine to thymine and deoxyribose 1-phosphate. We identified 21 probands (35 patients) who fulfilled our clinical criteria for MNGIE. MNGIE has clinically homogeneous features but varies in age at onset and rate of progression. Gastrointestinal dysmotility is the most prominent manifestation, with recurrent diarrhea, borborygmi, and intestinal pseudo-obstruction. Patients usually die in early adulthood (mean, 37.6 years; range, 26-58 years). Cerebral leukodystrophy is characteristic. Mitochondrial DNA (mtDNA) has depletion, multiple deletions, or both. We have identified 16 TP mutations. Homozygous or compound heterozygous mutations were present in all patients tested. Leukocyte TP activity was reduced drastically in all patients tested, 0.009 +/- 0.021 micromol/hr/mg (mean +/- SD; n = 16), compared with controls, 0.67 +/- 0.21 micromol/hr/mg (n = 19). MNGIE is a recognizable clinical syndrome caused by mutations in thymidine phosphorylase. Severe reduction of TP activity in leukocytes is diagnostic. Altered mitochondrial nucleoside and nucleotide pools may impair mtDNA replication, repair, or both.

5-[4-(3,3-Dimethylbutoxycarbonyl)phenyl]-4-pentynoic acid and its derivatives inhibit ionotropic gamma-aminobutyric acid receptors by binding to the 4'-ethynyl-4-n-propylbicycloorthobenzoate site

Acyclic noncompetitive antagonists of ionotropic gamma-aminobutyric acid (GABA) receptors, bearing an ester or ether linkage, were designed, synthesized, and assayed for their inhibition of the specific binding of [3H]4'-ethynyl-4-n-propylbicycloorthobenzoate (EBOB), a radiolabeled noncompetitive antagonist, to rat brain and housefly head membranes. 5-[4-(3,3-Dimethylbutoxycarbonyl)phenyl]-4-pentynoic acid (DBCPP), a butyl benzoate analogue, was found to competitively inhibit the binding of [3H]EBOB in rat brain membranes, with an IC50 of 88 nM. The potency conferred by the p-substituent decreased in the order C(triple bond)C(CH2)2COOH > C(triple bond)C(CH2)2COOCH3 > C(triple bond) CH > Br. Pentyl phenyl ethers were equally potent compared with butyl benzoates, while phenyl pentanoates and benzyl butyl ethers were less pont. These compounds were generally less active in housefly head membranes than in rat brain membranes. The introduction of an isopropyl group into the 1-position of the 3,3-dimethylbutyl group of a butyl benzoate and two benzyl butyl ethers caused an increase in potency in housefly GABA receptors, whereas this modification at the corresponding position of other compounds led to an unchanged or decreased potency. In the case of rat receptors, this modification resulted in a decrease in potency except for a phenyl pentanoate. To confirm that DBCPP interferes with GABA receptor function, we performed whole-cell patch clamp experiments with rat dorsal root ganglion neurons in the primary culture. Repeated co-applications of GABA and DBCPP suppressed GABA-induced whole-cell currents with an IC50 of 0.54 microM and a Hill coefficient of 0.7. These findings indicate that DBCPP and its derivatives inhibit ionotropic GABA receptors by binding to the EBOB site and that there might be structural difference in the noncompetitive antagonist-binding site between rat and housefly GABA receptors.

Corneal thickness measurements with the Topcon SP-2000P specular microscope and an ultrasound pachymeter

OBJECTIVE

To compare the reproducibility of measurements obtained with a new pachymetry instrument, the Topcon specular microscope (Topcon SP-2000P; Topcon America Corp, Paramus, NJ), with those obtained by ultrasound pachymetry.

METHODS

Corneal thickness was measured in 40 eyes of 40 patients 3 times each with the Topcon SP-2000P and an ultrasound pachymeter (DGH 500, DGH Technology Inc, Exton, Pa) by 2 separate investigators. Comparisons included average thickness as measured by each instrument, average thickness for each instrument as measured by each investigator, and differences in thickness due to corneal abnormalities.

RESULTS

Mean corneal thickness measured by the Topcon instrument was significantly less (32 microm; P<.001) than the mean value obtained with the ultrasound pachymeter. Similarly, mean values obtained with the 2 instruments by the 2 investigators were significantly different (P<.001 and .008 for investigators 1 and 2, respectively), with the Topcon value less than the ultrasound value in both cases. Both instruments detected abnormalities in corneal thickness equally well. However, the measurements obtained with the Topcon instrument by the 2 investigators were more consistent (no significant difference [P=.32]) than those obtained with the ultrasound unit (difference was significant [P=.02]).

CONCLUSIONS

The new noncontact Topcon specular microscope provides measurements of corneal thickness that are somewhat less than those of ultrasound pachymetry, but that seem to be more consistent from one operator to another, possibly as a result of the elimination of observer bias induced by probe placement required by the ultrasound unit. This consistency may be important in the comparison of measurements by different operators over time in patients being followed up after refractive surgery or other therapeutic interventions.

In vivo evaluation of hsp27 as an inhibitor of actin polymerization: hsp27 limits actin stress fiber and focal adhesion formation after heat shock

The role of hsp27 as an inhibitor of actin polymerization was considered in the context of the actin cytoskeleton and its relationship with focal adhesion formation. The aim of this study was to evaluate the potential effects of hsp27 on focal adhesion formation as a relevant biological consequence of actin stress fiber formation. When hsp27 was overexpressed in stably transfected cells, cell attachment was delayed and recovery of disrupted stress fibers and focal adhesions was limited. In ROS 17/2.8 cells, heat shock caused the reversible disruption of stress fibers and focal adhesions. The loss of stress fibers and focal adhesions was associated with reduced phosphotyrosine on the focal adhesion kinase (FAK). Microinjection of recombinant 6-His hsp27 and phosphorylated 6-His hsp27 was used to demonstrate that nonphosphorylated hsp27 prevented the recovery of stress fibers and focal adhesions. These results provide in vivo evidence that hsp27 acts as an inhibitor of actin polymerization that can alter cellular interactions with extracellular environments by perturbation of stress fibers, and subsequently focal adhesions.

Determination of oxygen tension on rabbit corneas under contact lenses

PURPOSE

To determine oxygen tension (PO2) on rabbit corneas beneath rigid gas permeable (RGP), hydrogel, and silicone elastomer lenses under open- and closed-eye conditions and to demonstrate the relationship between PO2 and overnight corneal swelling response in the rabbit model.

METHODS

An improved PO2 monitoring system (PO-2080) with a platinum-micro-wire-electrode was used to measure PO2. An ultrasonic pachymeter (DGH-2000) was used to measure corneal thickness after overnight wear.

RESULTS

The relationship between PO2 and oxygen transmissibility (Dk/ L) of the contact lens was linear for Dk/L between 0 and 70 x 10(-9) (cm/ sec)(mLO2/mL x mmHg). For Dk/L greater than 70 x 10(-9), PO2 gradually reached a plateau at 120 mmHg for open-eye conditions and 20 mmHg for closed-eye conditions. PO2 was inversely related to the overnight corneal swelling, ranging from 5.1% swelling at PO2 113.5/17.5 mmHg (open/closed-eye) for a hyper Dk/L lens (125 x 10(-9)) to 15.1% swelling at PO2 10.4/5.1 mmHg for a low Dk/L lens (11.5 x 10(-9)).

CONCLUSIONS

Polarographic determination of PO2 provides reliable information about the amount of oxygen available to the cornea under a lens for both open-eye and closed-eye conditions. The data demonstrate that it is not possible to achieve normal oxygen levels with contact lens wear, even when hyper Dk/L lenses are worn.

Active-MMP2 in cancer cell nests of oral cancer patients: correlation with lymph node metastasis

We examined the gelatinolytic activity in human oral squamous-cell carcinoma tissues in order to evaluate the capability of intravasation and extravasation of cancer cells. By a microdissection-zymography, we demonstrated separately the gelatinolytic activities in cancer cell nests and stroma adjacent to the cancer cells. The gelatinolytic activities, such as pro-matrix metalloproteinase (MMP)9 and active-MMP2 in most of cancer cell nests were much higher than those of normal gingival epithelium. Moreover, the activities of active-MMP2 in cancer cell nests of metastatic cancers were significantly higher than those of non-metastatic cancers (p<0.05). These results suggest that active-MMP2 in cancer cells can be a predictive marker for metastasis formation in oral squamous-cell carcinoma patients.

[Long-term gadolinium-enhancement of cauda equina on MRI in a case of spinal cord infarction after epidural anesthesia]

A 49-year-old woman developed paraplegia 26 hours after appendectomy under epidural and general anesthesia. Systolic blood pressure fell to 85 mmHg for 25 minutes after epidural anesthesia, which was performed at the level of the L1/2 intravertebral space. Neurological examination revealed paraplegia and superficial sensory impairment below the level of the L 1 spinal cord. The bladder was atonic by cystometry. MRI showed gadolinium enhancement of the cauda equina extending over a long period (3 months) and spinal cord infarction. The infarction was at the level of 10th thoracic spinal vertebra to conus and was limited to the gray matter of the spinal cord. We consider that the reason for spinal cord infarction was prolonged hypotension of the patient, who was diabetic, hypertensive and hypercoagulopathic. The blood supply to the gray matter is mainly from the central artery which is derived from the anterior spinal artery, and the gray matter is particularly vulnerable to hypotension. Our hypotheses concerning gadolinium enhancement of the cauda equina are the following: 1) enhancement of the cauda equina was seen due to collateral formation after spinal cord infarction, and 2) long-term enhancement of the cauda equina was observed due to an ischemic lesion involving a large area.

[Investigation of metal allergy to constituent elements of intraoral restoration materials]

Allergies caused by metals have been increasing. The number of patients visiting dentists with the chief complaint of metal allergy has also been increasing. From March 1994 to February 1997, 263 patients who complained of various symptoms visited our allergy clinic. Among them, 184 patients were suspected to have allergy caused by metals in dental restoration materials and were referred to the patch test. Among 165 patients', 128 were positives for metal allergy. Constituent elements of intraoral metals were analyzed in 107 of these 128 positive patients. The findings were as follows: 1. The most common five elements acting on the patients were Hg, Co, Ni, Cr, and Pd. 2. The most frequently used elements of dental restoration metal materials were Zn, Ag, Cu, Au, and Pd, and the alloy was Au-Ag-Pd alloy. 3. The highest tendency of coincidence between allergen and intraoral metals were observed among Co-Cr-Ni alloys and Pd, Ni, and Cr elements. 4. In case of palmoplantar pustulosis, allergen metals tended to be the same as intraoral metal elements.