Sarcopenia Is Associated with Fecal Incontinence in Patients with Dysphagia: Implication for Anal Sarcopenia

OBJECTIVES

To examine the relationship between sarcopenia and fecal incontinence in patients with dysphagia.

DESIGN

Cross-sectional study using the Japanese sarcopenic dysphagia database.

SETTING

19 hospitals including 9 acute care hospitals, 8 rehabilitation hospitals, 2 long-term care hospitals, and 1 home visit rehabilitation center.

PARTICIPANTS

460 dysphagic patients, aged 20 years and older.

MEASUREMENTS

Sarcopenia was diagnosed by the 2019 criteria of the Asian Working Group for Sarcopenia. Fecal incontinence was assessed by health care professionals at baseline according to the definition of the Japanese Practice Guidelines for Fecal Incontinence. We examined whether there was a significant difference between the rate of fecal incontinence in patients with/without sarcopenia. Age, sex, type of dwelling, Barthel index, Charlson comorbidity index (CCI), calf circumference, handgrip strength, body mass index, malnourishment, C-reactive protein level, serum albumin level, and delivery of enteral nutrition by nasogastric and/or gastrostomy tube were measured. To examine the relationship between sarcopenia and fecal incontinence, logistic regression analysis was performed with adjustments for age, sex, sarcopenia, CCI, enteral nutrition, and dwelling.

RESULTS

The mean age of patients was 81 ± 10 years. Of the 460 study patients, 404 (88%) patients had sarcopenia and 104 had fecal incontinence (23%). The rate of fecal incontinence was higher in the sarcopenia group than the non-sarcopenia group (25% vs. 7%, P = 0.003). Logistic regression analysis showed that sarcopenia was independently associated with fecal incontinence (odds ratio: 3.114, 95% confidence interval: 1.045, 9.282).

CONCLUSION

The prevalence of fecal incontinence was 23% in patients with dysphagia. Sarcopenia was independently associated with fecal incontinence, which suggests the presence of anal sarcopenia. Defecation control should be assessed in patients with sarcopenia.

Construction and Quality Evaluation of the Japanese Sarcopenic Dysphagia Database

OBJECTIVES

To describe the activity and evaluate the quality of the Japanese sarcopenic dysphagia database.

DESIGN

Cohort registry study.

SETTING

19 hospitals including 9 acute care hospitals, 8 rehabilitation hospitals, 2 long-term care hospitals, and 1 home visit rehabilitation team.

PARTICIPANTS

467 dysphagic patients, aged 20 years and older.

MEASUREMENTS

The following indices were assessed at baseline: age, sex, main disease, sarcopenic dysphagia, whole body sarcopenia, Food Intake Level Scale (FILS), malnutrition diagnosed by the Global Leadership Initiative on Malnutrition criteria, oral status assessed by the Revised Oral Assessment Guide or the Oral Health Assessment Tool, activities of daily living assessed by the Functional Independence Measure (FIM) or the Barthel Index (BI), Charlson comorbidity index, C-reactive protein and serum albumin levels, dysarthria, hoarseness, aphasia, pressure ulcers, bladder, bowel, and kidney function, respiratory status, polypharmacy, number of drugs, and involvement of health care professionals and rehabilitation nutrition team. FILS, FIM or BI, and outcome including discharge destination were assessed at follow-up. A simple comparison of cases and evaluation of the quality of data were performed.

RESULTS

The mean age was 80.4 ± 11.4 yr. The variable input error was 0. The number of patients with missing data was high for estimated glomerular filtration rate, C-reactive protein, serum albumin, skeletal mass index, and tongue pressure. The prevalence of either probable, possible, or no sarcopenic dysphagia was 105 (23%), 182 (39%), or 179 (38%), respectively. Doctors including physiatrists, nurses, physical therapists, and registered dietitians were involved with most patients, while the rehabilitation nutrition team was involved in only 16% of patients.

CONCLUSIONS

The quality of the database was relatively high. Sarcopenic dysphagia is common in patients with dysphagia.

Fluctuation of Hepatic Focal Nodular Hyperplasia Size with Oral Contraceptives Use

Patient: Female, 44

Final Diagnosis: Focal nodular hyperplasia

Symptoms: Liver masses

Medication: —

Clinical Procedure: CT • MRI • Pathology

Specialty: General and Internal Medicine

Self-harm and Suicide Attempts in a Japanese Psychiatric Hospital

OBJECTIVE

Self-harm and attempted suicide are risk factors for suicide in psychiatric hospital in-patients. This study aimed to analyse the circumstances of self-harm and suicide attempts in a Japanese psychiatric hospital so as to improve management and care.

METHODS

Incident reports of self-harm and suicide attempts during a 12.4-year period from November 2000 to March 2013 were reviewed. A descriptive analysis was conducted in terms of age, sex, and diagnosis of patients, as well as level, ward, situations, and causes of incidents.

RESULTS

During the study period, 90 cases of self-harm and attempted suicide involving 58 patients were reported. The rate of self-harm and suicide attempts was 0.05 per 1000 patient-days. The types of selfharm and suicide attempts included hanging (n = 25), wrist cutting (n = 19), ingestion of foreign objects (n = 17), and others (n = 29). The single case of completed suicide involved hanging, in a patient with schizophrenia. Among 55 patients with relevant data, the most common clinical diagnosis was mood disorder (41.8%), followed by schizophrenia (36.4%). Mood disorder was 3.5 times as prevalent in females as in males (14 vs. 4). Fourteen patients with mood disorder (n = 8) or schizophrenia (n = 6) were repeatedly involved in 46 of 89 cases of self-harm or attempted suicide; 11 were female. One woman with mood disorder attempted suicide 9 times within the same year. The top 3 management and care factors related to self-harm and suicide attempts were failure to adhere to preventive procedures (28%), insufficient therapeutic communication (28%), and difficulty in predicting suicide (20%).

CONCLUSION

Self-harm and suicide attempts at this psychiatric hospital occurred at a rate of 0.05 per 1000 patient-days between late 2000 and early 2013. Efforts are needed to increase compliance with suicide prevention procedures and therapeutic communication, so as to improve management and care of psychiatric in-patients and prevent them from committing suicide.

Bombyx mori E26 transformation-specific 2 (BmEts2), an Ets family protein, represses Bombyx mori Rels (BmRels)-mediated promoter activation of antimicrobial peptide genes in the silkworm Bombyx mori

E26 transformation-specific (Ets) family transcription factors are known to play roles in various biological phenomena, including immunity, in vertebrates. However, the mechanisms by which Ets proteins contribute to immunity in invertebrates remain poorly understood. In this study, we identified a cDNA encoding BmEts2, which is a putative orthologue of Drosophila Yan and human translocation-ets-leukemia/Ets-variant gene 6, from the silkworm Bombyx mori. Expression of the BmEts2 gene was significantly increased in the fat bodies of silkworm larvae in response to injection with Escherichia coli and Staphylococcus aureus. BmEts2 overexpression dramatically repressed B. mori Rels (BmRels)-mediated promoter activation of antimicrobial peptide genes in silkworm cells. Conversely, gene knockdown of BmEts2 significantly enhanced BmRels activity. In addition, two κB sites located on the 5' upstream region of cecropin B1 were found to be involved in the repression of BmRels-mediated promoter activation. Protein-competition analysis further demonstrated that BmEts2 competitively inhibited binding of BmRels to κB sites. Overall, BmEts2 acts as a repressor of BmRels-mediated transactivation of antimicrobial protein genes by inhibiting the binding of BmRels to κB sites.

Porphyromonas gingivalis infection exacerbates the onset of rheumatoid arthritis in SKG mice

Epidemiological studies have linked periodontitis to rheumatoid arthritis (RA). Porphyromonas gingivalis (Pg) was reported recently to produce citrullinated protein (CP) and increase anti-cyclic CP antibody (ACPA), both of which have been identified as causative factors of RA. In the present study, we determined the effects of Pg infection on the exacerbation of RA in a mouse model. RA model mice (SKG mice) were established by an intraperitoneal (i.p.) injection of laminarin (LA). Mice were divided into six groups, Ctrl (PBS injection), LA (LA injection), Pg/LA (Pg + LA injection), Pg (Pg injection), Ec/LA (Escherichia coli and LA injection) and Ec (E. coli injection). In order to evaluate RA, joint swelling by the arthritis score, bone morphology by microcomputed tomography (microCT), haematoxylin and eosin staining, ACPA, matrix metalloproteinase-3 (MMP-3) and cytokine level in serum by enzyme-linked immunosorbent assay were determined. Osteoclast differentiation from bone marrow mononuclear cells (BMCs) was examined to clarify the underlying mechanisms of RA. The presence of Pg and CP in joint tissue was also investigated. The arthritis score was threefold higher in the Pg/LA group than in the LA group. Severe bone destruction was observed in joint tissue of the Pg/LA group. A microCT analysis of the Pg/LA group revealed a decrease in bone density. ACPA, MMP-3, interleukin (IL)-2, IL-6, CXCL1 and macrophage inflammatory protein (MIP)-1α levels from the Pg/LA group were the highest. The osteoclastogenesis of BMCs was enhanced in the Pg/LA group. Furthermore, large amounts of Pg components and CP were detected in the Pg/LA group. In conclusion, Pg infection has the potential to exacerbate RA.

Risk factors for neutropenia with lenalidomide plus dexamethasone therapy for multiple myeloma

Neutropenia may develop as an adverse event in patients with multiple myeloma receiving lenalidomide (LEN) plus dexamethasone (DEX) therapy. In the present study, we examined the risk factors associated with grade 3/4 neutropenia during the first cycle of LEN plus DEX therapy. We observed that hemoglobin level (≤ 8.5 g/dl) was a significant risk factor for grade 3/4 neutropenia during the first cycle of therapy (odds ratio: 19.40; 95% confidence interval: 2.68-141.00; p < 0.01). thus, our findings suggest that determining the hemoglobin level could be useful in the risk management for neutropenia in patients receiving LEN plus DEX therapy.

Decreased bone mineral density in diabetic patients on hemodialysis

Renal osteodystrophy in hemodialyzed patients with DM-HD shows different features from that in non-DM,HD. Two studies were done. One was a comparison of BMD in 30 non-DM,HD patients and 30 DM-HD patients. The second was a comparison of possible factors affecting calcium metabolism in the higher and lower BMD groups (n = 20/21) in the DM-HD patients. BMD was measured by dual-energy X-ray absorptiometry (DEXA; Hologic QDR 1,000/W) in the third lumbar vertebra (L3), head, pelvis, and whole body. The BMDs of the DM-HD group were lower in these areas and whole body than that in the non-DM,HD group. A significant difference was found in the head BMD (p less than 0.05). In the second study, factors which may contribute to the differences in BMD were compared in the DM-HD patients divided into higher and lower BMD of the head. The group with higher head BMD had a value 110% of the mean value or more. Clinical and biochemical test results (age, the time since the first dialysis, body weight, the degree of obesity, height, serum calcium, serum phosphate, serum aluminum, serum c-PTH level and the dose of 1 alpha-OH-D3) were compared. The degree of obesity of the patients with higher BMD was significantly larger than that with lower BMD (p less than 0.005).

Bovine Arboviruses in Culicoides Biting Midges and Sentinel Cattle in Southern Japan from 2003 to 2013

Epizootic congenital abnormalities, encephalomyelitis and febrile illnesses in cattle caused by arthropod-borne viruses (arboviruses) are prevalent in Japan. Causative viruses including orthobunyaviruses, orbiviruses and rhabdovirus are thought to be transmitted by Culicoides biting midges. Recently, the incursions of several arboviruses, potentially Culicoides-borne, were newly confirmed in Japan. However, their spread pattern and exact vector species are currently uncertain. Attempts to isolate arboviruses from Culicoides biting midges and sentinel cattle were conducted in Kagoshima, located at the southernmost end of the main islands of Japan, a potentially high-risk area for incursion of arboviral diseases and outbreak of endemic ones. Seventy-eight isolates comprising Akabane, Peaton and Sathuperi viruses of the genus Orthobunyavirus of the family Bunyaviridae, bluetongue virus serotype 16, D'Aguilar virus, Bunyip Creek virus and epizootic haemorrhagic disease virus serotype 1 of the genus Orbivirus of the family Reoviridae, a potentially novel rhabdovirus of the genus Ephemerovirus and unidentified orbivirus-like viruses were obtained from Culicoides biting midges and sentinel cattle between 2003 and 2013. Akabane, Sathuperi, D'Aguilar and Bunyip Creek viruses were selectively isolated from Culicoides oxystoma, suggesting this vector's responsibility for these arbovirus outbreaks. The results of virus isolation also implied that C. tainanus, C. jacobsoni and C. punctatus are competent for the transmission of bluetongue virus serotype 16, Peaton virus and epizootic haemorrhagic disease virus serotype 1, respectively. Our monitoring in Culicoides biting midges and sentinel cattle detected the circulation of Akabane virus just prior to the accumulations of bovine congenital abnormalities and encephalomyelitis by it around study sites in 2003, 2006, 2008 and 2013. Silent circulations of the other arboviruses, including potentially new viruses, were also detected during the study period.

Irsogladine maleate inhibits Porphyromonas gingivalis-mediated expression of toll-like receptor 2 and interleukin-8 in human gingival epithelial cells

BACKGROUND AND OBJECTIVE

Periodontitis is an infectious disease caused by an interaction between the host and periodontopathogenic bacteria. Regulating the immune response in human gingival epithelial cells (HGEC) may contribute to the prevention of periodontitis. Irsogladine maleate (IM) has previously been shown to regulate inflammation and the cell-cell junctional barrier in HGEC. In addition to these functions, control of bacterial recognition is important for preventing inflammation in periodontal tissue. Innate immunity in gingival epithelium is the first line of defense and plays a crucial role against bacterial challenge. Therefore, the effect of IM on regulating toll-like receptor 2 (TLR2), which is part of the innate immunity, was determined in this study.

MATERIAL AND METHODS

OBA-9, an immortalized human gingival epithelial cell line, and primary cultured HGEC were used in this study. Real-time PCR and western blotting were performed in OBA-9 or HGEC stimulated with whole cells of Porphyromonas gingivalis or with lipopolysaccharide (LPS) derived from P. gingivalis (PgLPS) in the presence or absence of IM to determine expression of TLR2 mRNA and production of TLR2 protein. Small interfering RNA (siRNA) against TLR2 was transfected into OBA-9 to clarify the association between the induction of TLR2 and interleukin-8 (IL-8) production.

RESULTS

The addition of IM into P. gingivalis or PgLPS-induced OBA-9 suppressed IL-8 production (p < 0.01). The addition of IM also abolished the induction of TLR2 by P. gingivalis or PgLPS in OBA-9 and primary cultured HGEC (p < 0.01). The suppressive effect of IM on the induction of TLR2 was also confirmed by immunohistostaining. Stimulation with peptidoglycan, a specific ligand for TLR2, suppressed the expression of toll-like receptor 4 (TLR4) mRNA in the presence of IM (p < 0.01). However, LPS derived from Escherichia coli, a ligand for TLR4, did not induce the expression of TLR2 mRNA. The PgLPS-induced expression of TLR4 mRNA was abolished by IM. Knockdown of TLR2 by siRNA transfection resulted in a weaker response of induction of IL8 mRNA in P. gingivalis or PgLPS-stimulated OBA-9.

CONCLUSION

These results suggest that IM suppresses the induction of IL-8 production by regulating increased levels of TLR2.

Efficacy of long-term 4.0 g/day mesalazine (Pentasa) for maintenance therapy in ulcerative colitis

Background

High-dose (4.0 g/day) mesalazine is typically used for induction therapy, but its efficacy as maintenance therapy remains to be determined. We conducted a multicenter retrospective study to investigate the efficacy of continuous treatment with 4.0 g/day of mesalazine.

Material/Methods

Japanese ulcerative colitis (UC) patients receiving acute induction therapy with 4.0 g/day mesalazine were enrolled and followed. Those who clinically improved or who achieved clinical remission were categorized into 2 sub-groups according to the median duration of treatment with 4.0 g/day of mesalazine. The clinical relapse frequency and the time to relapse were analyzed.

Results

We enrolled 180 patients with active UC, and then 115 patients who clinically improved or who achieved clinical remission after treatment with 4.0 g/day mesalazine were categorized into 2 sub-groups according to the median of treatment duration: a short-term treatment group (≤105 days, n=58) and a long-term treatment group (>105 days, n=57). Overall, 45 (39.1%) patients relapsed: 28 (48.3%) in the short-term treatment group and 17 (29.8%) in the long-term treatment group. This difference was statistically significant (p<0.05). The relapse-free rate in the long-term treatment group was significantly higher than that in the short-term treatment group (p<0.05). The mean time to relapse in the long-term treatment group was significantly longer than that in the short-term treatment group (425.6±243.8 days vs. 277.4±224.5 days; p<0.05).

Conclusions

Long-term continuous treatment with high-dose mesalazine (4.0 g/day) may be more effective than short-term treatment for maintenance of remission in UC patients.

Kidney fibrosis is independent of the amount of ascorbic acid in mice with unilateral ureteral obstruction

In response to sustained damage to a kidney, fibrosis that can be characterized as the deposition of a collagenous matrix occurs and consequently causes chronic kidney failure. Because most animals used in experiments synthesize ascorbic acid (AsA) from glucose, the roles of AsA in fibrotic kidney diseases are largely unknown. Unilateral ureteric obstruction (UUO) mimics the complex pathophysiology of chronic obstructive nephropathy and is an ideal model for the investigation of the roles of AsA in kidney failure. We examined the impact of a deficiency of Akr1a, a gene that encodes aldehyde reductase and is responsible for the production of AsA, on fibrotic damage caused by UUO in mice. Oxidatively modified DNA was elevated in wild-type and Akr1a-deficient kidneys as a result of UUO to a similar extent, and was only slightly suppressed by the administration of AsA. Even though Akrla-deficient mice could produce only about 10% of the AsA produced by wild-type mice, no difference was observed in collagen I synthesis under pathological conditions. The data implied either a low demand for AsA or the presence of another electron donor for collagen I production in the mouse kidney. Next, we attempted to elucidate the potential causes for oxidative damage in kidney cells during the fibrotic change. We found decreases in mitochondrial proteins, particularly in electron transport complexes, at the initial stage of the kidney fibrosis. The data imply that a dysfunction of the mitochondria leads to an elevation of ROS, which results in kidney fibrosis by stimulating cellular transformation to myofibroblasts.

Syntheses of Recombinant Yellowtail and Flounder Growth Hormones inEscherichia coli

For syntheses of recombinant yellowtail and flounder growth hormones (r-yGH and r-fGH) in E. coli, expression plasmids were constructed. The expression level of r-yGH and r-fGH in the host cells were very high, reaching 15 and 8% of the total protein, respectively. These product proteins were accumulated in inclusion bodies in the cells. The recombinant hormones were isolated from the pellets ina glutathione reduction/oxidation buffer. The refolded hormones were further purified by DEAE-Toyopearl 650M chromatography to homogeneity. The purified r-yGH and r-fGH were composed of 188 and 174 amino acid residues, respectively, having amino-terminal sequences starting with methionine. The recombinant hormones had potent growth-promoting activities on juvenile rainbow trout Salmo gairdneri in a dose-dependent manner.

Distribution of regulatory T cells and interaction with dendritic cells in the synovium of rheumatoid arthritis

OBJECTIVES

The aim of this study was to investigate the tissue distribution of regulatory T cells (Treg cells) and their interaction with dendritic cells (DCs) in synovium from patients with rheumatoid arthritis (RA) or osteoarthritis (OA).

METHODS

Immunohistochemical staining was used to investigate the distribution of Treg cells and the interaction between Treg cells and DCs in RA (n = 30) and OA synovium (n = 8). mRNA levels were measured by quantitative real-time reverse transcription polymerase chain reaction (RT-PCR).

RESULTS

Large numbers of Treg cells were observed in lymphoid aggregates and perivenular infiltration areas in the RA synovium. Specific cellular markers for Treg cells (Foxp3, CD39, LAG-3, and Nrp-1) were found in lymphoid aggregates, perivenular infiltration, and scattered in lining layer areas. As molecular markers for DCs, DC-LAMP, DEC-205, CD80/86, and CD83 were also detected in the lymphoid aggregates and perivenular infiltration areas in RA. Furthermore, the co-localization of Treg cells and DCs was confined mainly in the lymphoid aggregation areas. The number of DCs increased significantly more than the number of Treg cells with inflammatory progression in RA. mRNA expression of the cellular markers for Treg cells (Foxp3, LAG-3, and Nrp-1) and the molecular markers for DCs (DC-LAMP and DEC-205) was increased in RA compared with OA synovium.

CONCLUSIONS

Our results indicate that DCs play a dominant role in regulating the activation and progression of immune responses in RA, even though the number of Treg cells was upregulated at the same time. This suggests that Treg cells do not function normally to suppress the maturation of DCs in the RA synovium.

Magnified endoscopic observation using narrow-band imaging of periampullary adenoma in a patient with familial adenomatous polyposis

BACKGROUND

Adenoma of the major papilla carries a relatively high risk of malignant transformation to carcinoma, the leading cause of death in patients with familiar adenomatous polyposis (FAP) after colectomy.

CASE REPORT

A 35-year-old man had undergone prophylactic colectomy for FAP 3 years earlier. On the forward-viewing and side-viewing endoscopy done for surveillance, the overlying mucosa of the major papilla showed even granularity. On magnifying duodenoscopy using a narrow-band system (NBI), which uses modified optical filters and yields clear images of fine surface structures on the mucosal layer, a compact formation of round pits was seen in the affected ampulla. The microvascular architecture on NBI magnification showed no abnormalities, such as dilated, tortuous or network-like vessels, suggestive of malignancy. On endoscopic retrograde pancreaticocholangiography there was no intraductal growth, and endoscopic ultrasonography showed confinement to the mucosal layer. The ampullary lesion was completely resected using endoscopic snare papillectomy. Histopathological examination of the removed specimen showed tubular adenoma without malignant foci. The patient's post-treatment course was uneventful and without complications, and no local recurrence was noted on repeat endoscopy.

CONCLUSIONS

Thus, endoscopic surveillance and removal of ampullary adenomas appear to be justified.

Imaging-pathologic correlation in corticobasal degeneration

BACKGROUND AND PURPOSE

The clinical diagnosis of corticobasal degeneration (CBD) is often difficult due to varied clinical manifestations. In 4 patients with neuropathologically confirmed CBD, characteristic imaging findings and correlations with neuropathologic features were evaluated. Furthermore, imaging findings in CBD were compared with neuropathologically confirmed progressive supranuclear palsy (PSP) for a differential diagnosis.

MATERIALS AND METHODS

Four patients with neuropathologically confirmed CBD were studied. We evaluated the area of the tegmentum in the midsagittal plane, subcortical white matter (SCWM) abnormality, asymmetric cerebral atrophy, and signal-intensity abnormality in the subthalamic nuclei on MR imaging and compared them with histopathologic findings. Then, MR imaging findings in CBD were compared with those in 13 patients with PSP.

RESULTS

On MR imaging, 3 patients had asymmetric cerebral atrophy extending to the central sulcus. On midsagittal sections, the mean midbrain tegmentum area was 66 mm(2), being markedly smaller than normal, but there was no significant difference between PSP and CBD. All patients had signal-intensity abnormalities of the SCWM, constituting primary degeneration neuropathologically; however, no diffuse signal-intensity abnormality in the SCWM existed in the 13 patients with PSP. In 3 patients, T1-weighted images showed symmetric high signal intensity in the subthalamic nuclei. Neuropathologically, these areas showed characteristic CBD. MR imaging signal-intensity changes also existed in 4 patients with PSP; however, subthalamic nucleus degeneration was more severe in PSP than in CBD.

CONCLUSIONS

In cases with midbrain tegmentum atrophy and signal-intensity changes in the subthalamic nuclei, the differential diagnosis distinguishing CBD from PSP based on MR imaging alone was difficult. White matter lesions and asymmetric atrophy can be useful for a differential diagnosis.

Lipopolysaccharide elicits expression of immune-related genes in the silkworm, Bombyx mori

Lipopolysaccharide (LPS), a major cell wall component of gram-negative bacteria, was found to be unable to activate immune-related genes in Drosophila melanogaster. In contrast, highly purified LPS elicited immune-related gene expression in the fat body of Bombyx mori. However, the level of activation by highly purified LPS was lower than crude LPS and peptidoglycan. Furthermore, synthetic lipid A also activated these genes, suggesting that B. mori possesses unknown signal pathways to activate immune-related genes by LPS. Up-regulation of antimicrobial peptide genes by highly purified LPS was not confirmed in the immune-responsive cell line, NIAS-Bm-aff3, suggesting that some factors necessary for signal transduction activated by LPS are deficient in this cell line.

Significance of radio-pathological correlations: differentiating severe central nervous system infection from acute embolic infarction

We describe two educational autopsy cases of severe central nervous system (CNS) infection and septic emboli, such cases having been difficult to differentiate from acute infarctions via emergency MR imaging studies. We briefly discuss the pathology and MR findings along with radiopathological correlation.

Climate change impacts and risks for animal health in Asia

The threat of climate change and global warming is now recognised worldwide and some alarming manifestations of change have occurred. The Asian continent, because of its size and diversity, may be affected significantly by the consequences of climate change, and its new status as a 'hub' of livestock production gives it an important role in mitigating possible impacts of climate variability on animal health. Animal health may be affected by climate change in four ways: heat-related diseases and stress, extreme weather events, adaptation of animal production systems to new environments, and emergence or re-emergence of infectious diseases, especially vector-borne diseases critically dependent on environmental and climatic conditions. To face these new menaces, the need for strong and efficient Veterinary Services is irrefutable, combined with good coordination of public health services, as many emerging human diseases are zoonoses. Asian developing countries have acute weaknesses in their Veterinary Services, which jeopardises the global surveillance network essential for early detection of hazards. Indeed, international cooperation within and outside Asia is vital to mitigating the risks of climate change to animal health in Asia.

Asymptomatic self-limiting diffuse white matter lesions in subacute to chronic stage of herpes simplex encephalitis

This study evaluated white matter changes in the subacute and chronic stages of herpes simplex encephalitis (HSE). Subjects comprised 15 patients with HSE. All patients were examined using MRI at onset, and then at seven to ten days, three to five weeks and two to three months after onset. In addition, the six patients who displayed white matter signal abnormalities were examined at six months and <one year after onset. Cell count, protein levels, polymerase chain reaction (PCR) of herpes simplex virus in cerebrospinal fluid (CSF), and exacerbation of neurological symptoms as well as dose of acyclovir were compared between patients with and without white matter abnormalities. Diffuse white matter signal changes were identified at the subacute stage (3-5 weeks after onset) of HSE in six patients (6/15, 40%). No significant relationship was observed between the presence of white matter signal abnormalities and laboratory data, acyclovir dose or clinical symptoms. These signal abnormalities disappeared or improved by two years without any clinical treatment. Diffuse white matter signal abnormalities occur frequently in the subacute stage of HSE. Although the mechanisms underlying these white matter lesions have not been elucidated, subclinical immune-mediated processes may be considered. Repeat MRI studies over a long period are necessary for evaluating the clinical process of patients with HSE.

Effect of glutamine on acute lung injury in rats with endotoxemia

We administered endotoxin to rats to produce an acute lung injury model, and assessed the effect on respiratory function when glutamine was added to the solution for total parenteral nutrition. Rats given total parenteral nutrition with glutamine as 33% of the amino acid content were compared with rats given no glutamine. Endotoxin (500 microg/kg) was administered intravenously after 72 h of total parenteral nutrition. The survival rate and the nitrogen balance were significantly improved (P < 0.05) at 48 h after endotoxin administration as a result of glutamine treatment. In addition, the arterial oxygen partial pressure was significantly increased (P < 0.01) and the wet: dry lung weight ratio was decreased (P < 0.05) by glutamine. These results suggested that glutamine improved endotoxin-induced acute lung injury in rats.

Autoimmune pancreatitis with extreme elevation of DUPAN-2

An 80-year-old woman was admitted to our hospital with complaints of jaundice and liver dysfunction. She was found to have a high titer of serum IgG4, positive rheumatoid factor and marked elevation of DUPAN-2 (11,148 U/ml). Computed tomography showed swelling of the pancreas, and endoscopic retrograde cholangiopancreatography revealed diffuse irregular narrowing of the main pancreatic duct, which are typical findings of autoimmune pancreatitis. There was no evidence of malignancy. Administration of 30 mg/day of prednisolone was started. Computed tomography showed significant regression in the size of the pancreas, and the stenosis of the main pancreatic duct was improved on ERCP. The serum level of DUPAN-2 was also markedly decreased after the treatment.

Genetic characterization of Batai virus indicates a genomic reassortment between orthobunyaviruses in nature

Two viruses were isolated from bovine blood in the southernmost part of Japan in 1994 and 2001, respectively. Genetic analyses showed that the viruses were Batai virus of the genus Orthobunyavirus of the family Bunyaviridae. The sequencing of three genomic RNA segments of the Japanese and Malaysian Batai virus strains revealed that the M RNA segment of Batai virus had high sequence identity with that of Ngari virus. Our results indicate that Ngari virus is a genetic reassortant with S and L RNA segments from Bunyamwera virus and an M RNA segment from Batai virus.

Localization of human glucocorticoid receptor in rheumatoid synovial tissue of the knee joint

OBJECTIVE

This study was conducted to investigate the localization of human glucocorticoid receptors (GCRs) in the knee synovium of patients with rheumatoid arthritis (RA) and to evaluate the correlation between GCR expression and the clinical profiles.

METHODS

Twenty synovial specimens from RA knees, six from knees with osteoarthritis (OA), and five from knees with traumatic arthritis (TA) were obtained at surgery. The GCRs were stained immunohistochemically. The immunopositive cells were counted at random in the lining (synoviocytes) and sublining layers (fibroblastic and lymphoid cells). The relationship between the GCR-expressing cells and clinical profiles was analysed statistically.

RESULTS

GCRs were expressed in the nuclei of synoviocytes and the fibroblastic and lymphoid cells in the sublining layer. The GCR-positivity rate of synoviocytes was 67.1+/-18.4% in RA, 58.7+/-13.5% in OA, and 49.4+/-19.7% in TA, differences between the three groups being statistically insignificant. There was a significant difference in the GCR-positivity rate of sublining fibroblastic cells (p = 0.029), but not synoviocytes or sublining lymphoid cells, from RA patients treated with and without prednisolone, while there was no correlation between the rate for synoviocytes and that for sublining fibroblastic cells from RA patients treated with prednisolone.

CONCLUSIONS

GCRs are localized not only on inflammatory lymphoid cells but also on synoviocytes, suggesting that glucocorticoids could act directly on these cells. Furthermore, the rate of GCR expression on synoviocytes and sublining lymphoid cells is less suppressed with low-dose prednisolone, regardless of the duration of treatment.

Expression of glucocorticoid receptors in non-neoplastic lymphoid follicles and B cell type malignant lymphomas

OBJECTIVE

To evaluate the expression of human glucocorticoid receptors (hGRs), such as hGR (4H2), hGR-alpha, and hGR-beta, in non-neoplastic lymphoid follicles and B cell type malignant lymphomas.

METHODS

The expression of hGRs in non-neoplastic lymphoid follicles and malignant lymphomas, including diffuse large cell lymphoma, mantle cell lymphoma, and follicular lymphoma, was examined immunohistochemically. HGR (4H2) expression was confirmed by double immunostaining of tissues and in isolated cells from tonsillar germinal centres, and by immunoelectronmicroscopy.

RESULTS

In secondary lymphoid follicles of any non-neoplastic diseases--such as chronic tonsillitis, reactive lymphadenitis, and Kimura's disease--the germinal centre cells often expressed hGR (4H2) and hGR-alpha. Double immunocytochemical staining of isolated germinal centre cells showed that the majority of hGR (4H2) positive cells were CD20 positive B cells, and that follicular dendritic cells also expressed hGR. Immunoelectronmicroscopy revealed the presence of nuclear hGR (4H2) in the binucleated follicular dendritic cells and germinal centre cells. The frequency of hGR (4H2) expression in diffuse large B cell lymphoma was higher, that in mantle cell lymphoma was lower, and that in follicular lymphoma was intermediate among the types of malignant lymphoma. The hGR (4H2) expression was less frequent in cases of grade I follicular lymphoma.

CONCLUSIONS

There are differences in hGR expression between the germinal centre and the mantle zone in non-neoplastic lymphoid follicles, and differences of hGR (4H2) expression among the types of malignant lymphoma and grades of follicular lymphoma, which probably contribute to the different steroid sensitivities.

Flow cytometric analysis of expression of transforming growth factor-beta and glucocorticoid-induced tumor necrosis factor receptor on CD4(+) CD25(+) T cells of patients with inflammatory bowel disease

To determine whether human CD4(+)CD25(+) cells express glucocorticoid-induced tumor necrosis factor receptor (GITR) and transforming growth factor-beta (TGF-beta) and the difference in CD4(+)CD25(+) cells between patients with inflammatory bowel diseases and healthy subjects, peripheral blood lymphocytes were obtained from patients with ulcerative colitis (UC; n = 50), Crohn's disease (CD; n = 49), and healthy volunteers (control; n = 50) and flow cytometric analysis was performed. In control subjects, the expression of GITR on CD4(+)CD25(+) cells (41.8 +/- 10.5%) was significantly higher than on CD4(+)CD25(-) cells (11.1 +/- 7.4%). Similarly, TGF-beta expression on CD4(+)CD25(+) cells (5.3 +/- 4.6%) was higher than on CD4(+)CD25(-) cells (1.2 +/- 1.4%). There were no significant differences among UC, CD, and control in CD4(+)CD25(+)/CD4(+) ratio. However, there was a significant difference in the CD4(+)CD25(+) TGF-beta+/CD4(+)CD25(+) ratio between active UC and inactive UC (2.7 +/- 2.6 and 7.2 +/- 3.9%, respectively). The results suggest that TGF-beta is involved in the induction or sustained remission of UC.

Isolation of bovine arboviruses from Culicoides biting midges (Diptera: Ceratopogonidae) in southern Japan: 1985--2002

In 1985--2002, surveillance for bovine arboviruses was conducted in Kagoshima, located in the most southern part of the main islands of Japan and known to be an area where bovine arboviral diseases have frequently been epidemic. Culicoides biting midges were collected in a cowshed by light traps. A total of 456,300 Culicoides biting midges representing 13 species were collected, and a portion of each pool of midges were tested for virus isolation. Overall, 85 isolates of six different viruses were obtained from the collected midges. The isolated viruses included two Orthobunyaviruses, Akabane and Aino viruses; three Orbiviruses, Chuzan, D'Aguliar, and Ibaraki viruses; and one unclassified virus, a bunyavirus-like virus. The viruses were most frequently isolated from Culicoides oxystoma Kieffer (85.9% of 85 isolates). Isolations of all viruses except for the bunyavirus-like virus were made from this species. Our data indicated that C. oxystoma is a potential vector for bovine arboviruses in southern Japan.

Efficacy of argon plasma coagulation in nonvariceal upper gastrointestinal bleeding

BACKGROUND AND STUDY AIMS

Various methods of endoscopic hemostasis have been described. However, few reports have investigated the efficacy of argon plasma coagulation (APC) in the treatment of upper gastrointestinal bleeding. The aim of this study was to evaluate the efficacy of APC in various types of upper gastrointestinal bleeding.

PATIENTS AND METHODS

The present study was designed as a prospective and observational study. A total of 254 consecutive patients with upper gastrointestinal bleeding (excluding variceal bleeding) were primarily treated using APC. If it was difficult to achieve complete hemostasis with APC alone, injection of a hypertonic saline-epinephrine solution and clipping were carried out. The initial hemostasis rate, rate of recurrent bleeding after APC, permanent hemostasis rate, and mean procedure time were evaluated.

RESULTS

Initial hemostasis with APC alone was achieved in 193 of the 254 patients (75.9 %). With the assistance of other methods as well, initial hemostasis was achieved in 253 patients (99.6 %). Among the 193 patients treated with APC alone, recurrent bleeding was observed in 11 cases (11 of 193, 5.7 %). With one exception, these cases of recurrent bleeding were controlled with APC alone again; permanent hemostasis was thus ultimately achieved with APC alone in 192 of the 254 patients (75.5 %). The mean procedure time was 8 min. No complications (such as perforation) were observed with the APC treatment.

CONCLUSIONS

These data indicate that APC is a safe, quick, and effective method of treating various types of nonvariceal upper gastrointestinal bleeding and that it can be a powerful tool for endoscopic hemostasis.

The resurgence of Shamonda virus, an African Simbu group virus of the genus Orthobunyavirus, in Japan

Six virus isolations were made from Culicoides biting midges and blood samples of sentinel cattle in Kagoshima and Miyazaki Prefectures, the southern part of Japan, in 2002. Serological and genetical tests identified these viruses as isolates of Shamonda virus (SHAV), which belongs to the Simbu group of the genus Orthobunyavirus of the family Bunyaviridae. Initially, SHAV was isolated from cattle and Culicoides biting midges in Nigeria in the 1960s, and its presence has not been reported until this study. The present results indicate a wider distribution of SHAV than previously assumed.

The emergence in Japan of Sathuperi virus , a tropical Simbu serogroup virus of the genus Orthobunyavirus

In 1999, two viruses were isolated from blood samples of sentinel cattle in the Western part of Japan. The physiochemical and morphological properties of these viruses indicated that they belonged to the family Bunyaviridae. Sequence analysis of the S segment indicates that the two viruses are closely related to Sathuperi virus (SATV). The N-terminal 168 amino acid of the G2 protein of the M segment was highly homologous with that of SATV (98.2%). Given these results, we conclude that the newly isolated viruses are closest to SATV, which was initially isolated in India and Nigeria over 30 years ago.

High-dose rabeprazole-amoxicillin versus rabeprazole-amoxicillin-metronidazole as second-line treatment after failure of the Japanese standard regimen for Helicobacter pylori infection

BACKGROUND

There is currently no optimal second-line treatment after failure of Helicobacter pylori triple therapy.

AIM

To determine effective salvage therapy after failure of lansoprazole-amoxicillin-clarithromycin.

METHODS

After failure of lansoprazole-amoxicillin-clarithromycin 123 out-patients were randomized to receive either 2-week rabeprazole (20 mg b.d.) + amoxicillin (1000 mg b.d.) (RA group) or 1-week rabeprazole (10 mg b.d.) + amoxicillin (750 mg twice b.d.) + metronidazole (250 mg b.d.) (RAM group). Eradication was assessed by the 13C-urea breath test. We also evaluated cytochrome p450 (CYP) 2C19 genotype status, determined by polymerase chain reaction - restriction fragment length polymorphism, and susceptibility to clarithromycin and metronidazole.

RESULTS

On an intention-to-treat basis, H. pylori infection cure was achieved in 37 of 63 (59%) patients in the RA group and in 49 of 60 (82%) patients in the RAM group. Per protocol-based eradication rates in the RA and RAM groups were 66% (37/56) and 88% (49/56), respectively. In both analytic sets there were significant differences between the treatment groups (P < 0.01 in each). Mild adverse events were observed in eight and five patients from the RA and RAM groups, respectively. Genetic predisposition of CYP2C19 and antibiotic resistance did not influence the treatment outcome either regimen.

CONCLUSIONS

The rabeprazole + amoxicillin + metronidazole therapy yielded satisfactory results. In contrast, the cure rate in high-dose rabeprazole + amoxicillin was below an acceptable level.

High-dose rabeprazole-amoxicillin versus rabeprazole-amoxicillin-metronidazole as second-line treatment after failure of the Japanese standard regimen for Helicobacter pylori infection

BACKGROUND

There is currently no optimal second-line treatment after failure of Helicobacter pylori triple therapy.

AIM

To determine effective salvage therapy after failure of lansoprazole-amoxicillin-clarithromycin.

METHODS

After failure of lansoprazole-amoxicillin-clarithromycin 123 out-patients were randomized to receive either 2-week rabeprazole (20 mg b.d.) + amoxicillin (1000 mg b.d.) (RA group) or 1-week rabeprazole (10 mg b.d.) + amoxicillin (750 mg twice b.d.) + metronidazole (250 mg b.d.) (RAM group). Eradication was assessed by the 13C-urea breath test. We also evaluated cytochrome p450 (CYP) 2C19 genotype status, determined by polymerase chain reaction - restriction fragment length polymorphism, and susceptibility to clarithromycin and metronidazole.

RESULTS

On an intention-to-treat basis, H. pylori infection cure was achieved in 37 of 63 (59%) patients in the RA group and in 49 of 60 (82%) patients in the RAM group. Per protocol-based eradication rates in the RA and RAM groups were 66% (37/56) and 88% (49/56), respectively. In both analytic sets there were significant differences between the treatment groups (P < 0.01 in each). Mild adverse events were observed in eight and five patients from the RA and RAM groups, respectively. Genetic predisposition of CYP2C19 and antibiotic resistance did not influence the treatment outcome either regimen.

CONCLUSIONS

The rabeprazole + amoxicillin + metronidazole therapy yielded satisfactory results. In contrast, the cure rate in high-dose rabeprazole + amoxicillin was below an acceptable level.

Antibacterial peptide defensin is involved in midgut immunity of the soft tick, Ornithodoros moubata

Two defensin genes A and B were previously demonstrated to be up-regulated by blood feeding in the soft tick, Ornithodoros moubata [Nakajima et al. (2001) Two isoforms of a member of the arthropod defensin family from the soft tick, Ornithodoros moubata (Acari: Argasidae). Insect Biochem Mol Biol 31: 747-751]. In this study, two defensin isoforms C and D similar to defensins A and B were newly cloned. A total of four defensins have been identified in O. moubata. All four Ornithodoros defensins are coded as prepro-defensins. Ornithodoros defensin genes consist of four exons and three introns, an organization reported in mussel defensins but not insect defensins. Ornithodoros defensin C and D genes are predominantly expressed in the midgut and up-regulated in response to blood feeding. The mature peptide of the previously cloned Ornithodoros defensin A was purified from the midgut lumen, indicating defensin is secreted into the midgut. These findings confirm the involvement of Ornithodoros defensin in midgut immunity.

cDNA cloning, characterization and gene expression of nitric oxide synthase from the silkworm, Bombyx mori

Molecular cloning and nucleotide sequencing of cDNA encoding Bombyx mori nitric oxide synthase (BmNOS) was conducted to analyse its possible role in insect immunity. The amino acid sequence deduced from the BmNOS cDNA showed 84%, 54% and 53% identity with those of NOSs from Manduca sexta, Drosophila melanogaster and Rhodonius prolixus. Recombinant BmNOS produced in insect cells using baculovirus was found to require NADPH, Ca2+, calmodulin and tetrahydrobiopterin (BH4) for its activity. The BmNOS gene was constitutively expressed at a low level in the larval fat body, haemocyte, Malpighian tubule and midgut, and adult antenna, and induced strongly in the fat body by lipopolysaccharide (LPS), suggesting that the BmNOS gene plays different physiological roles in different tissues. Injection of NO donors that produce NO in vivo induced the gene expression of an antibacterial peptide, cecropin B, strongly suggesting that NO produced by BmNOS following LPS stimulation is involved in signal transduction as a signalling molecule for immune gene expression.

Expression of complement regulating factors in gastric cancer cells

AIMS

To investigate the deposition of complement components, C3d and C5b-9, and the expression of complement regulating factors (S protein, membrane cofactor protein (MCP; CD46), protectin (CD59), decay accelerating factor (DAF; CD55), and type 1 complement receptor (CR1; CD35)) in gastric cancers.

METHODS

Specimens of gastric cancer were examined by immunohistochemistry and immunoelectron microscopy.

RESULTS

Four complement regulating factors (S protein, MCP, protectin, and DAF) were expressed on gastric cancer cells, in ultrastructurally localised areas on the cell membrane. CR1 was not expressed. The staining intensity of DAF in both differentiated and undifferentiated adenocarcinomas was significantly higher than in histologically normal gastric epithelium. Furthermore, the staining intensity of DAF in gastric cancers showing a diffusely infiltrating growth pattern was higher than in gastric cancers showing an expanding growth pattern.

CONCLUSIONS

These data indicate that DAF may play a role in cancer cell infiltration and resistance in tumour cells.

Expression of glucocorticoid receptor and 11beta hydroxysteroid dehydrogenase in a case of pulmonary epithelioid haemangioendothelioma

This report describes a case of pulmonary epithelioid haemangioendothelioma in which the tumour cells expressed the glucocorticoid receptor and 11beta-hydroxysteroid dehydrogenase. The patient, a 15 year old girl, who had no other complaints or past illnesses, was found to have an abnormal shadow on a chest roentgenogram obtained at a school medical examination. Multiple nodular shadows in the bilateral lungs were also confirmed by computerised axial tomography scan. A diagnosis of pulmonary epithelioid haemangioendothelioma was made on the basis of lung biopsy specimens. The tumour cells were immunohistochemically positive for factor VIII related antigen, CD31, and CD34, but not surfactant apoprotein A. In addition, almost all of the tumour cells showed simultaneous expression of the glucocorticoid receptor and 11beta hydroxysteroid dehydrogenase, suggesting that steroid treatment would be effective.